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CV Midterm/Quiz 1 Flashcards

1
Q

Name 3 symptoms of CV Pt. History

A

Chest Pain, Palpitations, Dyspnea, Edema, Syncope

Orthopnea, Paroxysmal Nocturnal Dyspnea

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2
Q

If a patient presents with severe tearing or ripping chest pain, what may be the cause?

A

Aortic Disection

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3
Q

Very brief, sharp, and stabbing pain that is localized on a superficial chest wall, and may be worse with palpating is indicative of what?

A

Psychogenic or Musculoskeletal Pain

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4
Q

What is the most common cause of Syncope, and what are some of its features?

A

Vasovagal Syncope

Sweating, nausea, dizziness, feeling cold, triggered by prolonged standing, pain, or an unpleasant environment.

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5
Q

What is Myxedema?

A

Edema resulting from hypothyroidism.

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6
Q

What is Anasarca?

A

Edema involving all aspects of the body: upper and lower extremities, and the face.

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7
Q

When would you take a comprehensive vs. a focused history?

A

Comprehensive:

  • New Patient
  • Annual visit
  • Hospital Admission

Focused:

  • Routine Follow-up
  • Acute Care Visit
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8
Q

Why do we take a Pt. History?

3 reasons

A
  1. Characterize Concerns
  2. Evaluate Risk Factors
  3. Develop a differential Diagnosis
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9
Q

What are the 3 types of capillaries? What are their characteristics?

A

Continuous:
- Cells meet, with no holes

Fenestrated:
-Cells meet, but full of fenestrations (holes)

Discontinuous:
-Cells don’t meet. Allow proteins to leave.

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10
Q

Which vessels have the largest impact on BP?

A

Arterioles

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11
Q

Which vessels most easily allow WBC extravatioin?

A

Venues

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12
Q

What is the difference between Angina and Myocardial Infarction?

A

Angina is Cardiac cell pain

Infarction is actual cell death and damage.

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13
Q

What are the differences between Arteries vs. Veins?

A

Arteries have

  • Smaller lumen
  • Largest tunica media
  • higher elastic fibers
  • Vessels maintain cylindrical shape

Veins have

  • larger tunica External
  • Valves.
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14
Q

What are the functional roles of vessel endothelium?

A
  1. Mediates the bidirectional exchange of molecules from blood to tissue
  2. Offers no-thrombogenic surface and controls clot formation
  3. Facilitates local inflammation and immune response.
  4. Promotes proliferation of cells within the vascular wall and WBC.
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15
Q

What are the histological layers of blood vessels?

A

Tunica intima

  • Endothelium
  • Subendothelium: loose CT, may contain scattered smooth muscle

Tunica Media: Middle layer composed of smooth muscle and elastic fiber

Tunica External: loses CT of collagen 1 and elastic fiber. Also contains autonomic nerve fibers and Vasa vasorum (small vessels that feed large vessels)

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16
Q

How do you differentiate the Epicardium from the endocardium?

A

Epicardium has fat and vessels.

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17
Q

What is another name for Visceral Pericardium?

A

Mesothelium

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18
Q

Explain cardiac muscle tissue

A

Short cells with singe (maybe two) central nucleus

Cross-striations

Intercalated discs of desomosomes, fascia adherents, and gap junctions (electrical binding)

Often branched.

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19
Q

What makes up Cardiac Output?

A

Stroke Volume and HR

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20
Q

What is the ejection Fraction?

A

The ratio of the Stroke volume over the End Diastole Volume.

Normal is .55-.7

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21
Q

What type of nervous control is most important for coronary circulation?

A

Local Control.

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22
Q

What is the a, c, and v wave of the Jugular Venous Pulse?

A

A: cause by atrial contraction

C: occurs when ventricles begin to contract

V: occurs toward the end of ventricular contraction.

23
Q

What is the Incisura?

A

Small pressure pulse as the Aortic and Pulmonic valves close.

24
Q

When are the Aortic and left ventricle pressures the same?

A

From the end of the Ventricular systole: isovolumetric contraction to the end of ventricular systole.

Once the valve closes the pressure obviously becomes different.

25
What are the 5 stages of ventricular heart contraction, and what are the moving parts in each stage?
Atrial Systole: AV valves are open and ventricles are filling Ventricular systole Isovolumetric phase: AV valves shut, and ventricular contraction begins. Ventricular systole, ejection phase: Aortic and Pulmonary valves open, and the atria fill Ventricular diastole, isovolumetric phase: all valves are shut Ventricular diastole, rapid filling: AV valves open, and ventricles fill.
26
What percentage of blood flows to each system?
``` 15% cerebral 5% Coronary 5% Skin 25% renal 25% GI 25% Skeletal Muscle ```
27
Which vessels have the largest cross sectional area, and which hold the largest blood volume?
Capillaries have the largest cross sectional area Veins hold the largest blood volume.
28
What is the lifetime risk of developing HTN for a 55 yr old without HTN?
70-90%
29
Why don’t the AAFP ACP and European Union accept the new guidelines of HTN as 130/80?
Most of the patients being used in the studies were high risk of CVD.
30
How many deaths/day does HTN contribute to?
Over 1000
31
How many people have HTN in the new categories?
46% of adults
32
For every increase of 20 in SBP or 10 DBP does what to the risk of heart problems?
Doubles
33
What is the equation for BP?
CO x SVR CO= stroke volume x HR
34
What is the difference between primary and secondary HTN?
Primary is idiopathic. Multiple factors like genetics, age, lifestyle, inactivity, obesity Secondary has identifiable cause: certain drugs, kidney disease, endocrine cause, sleep apnea.
35
What are the causes of 2nd HTN A,B,C,D,E
A: - Accuracy of measurement - Aldosteronism (Conn’s syndrome. Adrenal hyperplasia, adrenal tumor) - Apnea (VERY common for resistant hypertension) B: - Bruits (renal artery stenosis, or fibromuscular dysphasia) - Bad kidneys (renal parenchyma disease) C: - Cathecholamines - Coarction of aorta - Endogenous Cushing’s Syndrome - Cushing’s (excess cortisol production) D: - Drugs (anti-Inflammatory, alcohol increase BP) - Diet (salt, obesity) E: - Erthropoietin (blood doping, testosterone) - Endocrine (thyroid, acromegaly)
36
What is the DASH diet?
Dietary Approaches to Stop Hypertension ``` 2-3 c. Dairy 2-2 1/2 c. Fruit and Veggies 6-8 oz. Whole grains 6 oz or less Lean meat 4-5 times/wk nuts and legumes Use sparingly oil ``` Limit salt to less than 1500 mg/day with K+ rich foods.
37
How do you calculate the Mean Arterial Pressure?
(SBP+2DBP)/3
38
What is the Nocturnal dip?
BP will dip 10-20% when you sleep.
39
What is white coat HTN vs masked HTN
Masked are those with habits like smoking that will higher BP at home vs in the office Some may feel stress and increased BP in the office.
40
What is one of the biggest reasons why treated HTN doesn’t improve?
Compliance with medications.
41
What are pharmacological Tx of HTN?
ACE/ARB/CCB/Diuretcis are first choices Chlorthalidone when starting diuretics Hydorchlorothiazide more commonly used because it is cheaper.
42
Which labs should be used upon diagnosis of HTN?
``` Chem panel (glucose, Na, K, Ca) CBC Lipids TSH UA Maybe an EKG (yes for Dr. Bennett ``` ``` Pending suspicion: BNP (brain natuiuretic peptide) Aldosterone Urinary catecholamines Sleep study AM cortisol ```
43
What are Pericytes?
Contractile cells on capillaries
44
What is Isoprotenol used for?
To treat brachycardia, heart block, and sometimes asthma.
45
What is Laplace’s Law?
Tension= change in P x radius
46
Why do larger arteries need thicker walls and fibrin
The larger radius creates more tension on the walls, plus they are usually under more pressure change as well.
47
What are the 4 mechanisms for material exchange in capillaries?
Pinocytosis: Through cells for proteins Bulk Flow: Driven by pressure through cell junctions Diffusion across cells: O2 and CO2 Diffusion through Fenestrations: Concentration gradients.
48
Which force drives Bulk Flow?
Starling forces Hydrostatic and Oncotic
49
What are the 2 Starling forces? What does each force promote in capillaries?
Hydrostatic and Oncotic Pressure Hydrostatic leads to filtration Oncotic leads to absorption
50
What are the causes of Intracellular and Extracellular edema?
Intracellular 1. Hyponatremia 2. Depression of metabolic systems of tissue 3. Lack of adequate cell nutrition Extracellular: 1. Abnormal leakage from plasma (most common) 2. Failure of lymphatic return
51
What are drugs that may cause edema?
Steroids, Estrogens, Ca channel blockers, Thiazolidinediones (TZD), and NSAIDS
52
What is Kussmaul Sign?
Visible Jugular Vein Distention Shows right heart dysfunction.
53
What would cause an increase in capillary hydrostatic pressure? Hydraulic conductance? Colloid osmotic pressure? And decrease in Capillary Oncotic Pressure?
All causes of Edema 1. Heart failure 2. Burn, infection, histamine 3. Lymphatic blockage 4. Not enough protein in capillaries. Liver failure, or Protein malnutrition

CV (3 decks)

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