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2 CVS > CVS 3,4,8,9,10,12,14 > Flashcards

CVS 3,4,8,9,10,12,14 Flashcards

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1
Q

What are the 7 phases of the cardiac cycle?

A
  1. Atrial contraction
  2. Isovolumetric contraction
  3. Rapid ejection
  4. Reduced ejection
  5. Isovolumetric relaxation
  6. Rapid filling
  7. Reduced filling
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2
Q

In which side of the heart are valve pathologies most common and why?

A

Left side

Higher pressure

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3
Q

Give 3 causes of Aortic valve stenosis.

A
  1. Degeneration (old age-senile calcification/fibrosis)
  2. Congenital eg bicuspid aortic valve
  3. Chronic rheumatic fever- inflammation
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4
Q

What happens as a result of aortic valve stenosis?

A
  • Less blood getting through
    • Increased left ventricular pressure
      • LV hypertrophy
    • Left sided heart failure
      • Syncope (fainting)
      • Angina (not enough blood to coronary arteries)
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5
Q

Give 2 causes of aortic valve regurgitation.

A
  • Valve damage- endocarditis
  • Aortic root dilation
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6
Q

What happens as a result of aortic valve regurgitation?

A

Blood flows back into LV during diastole- RBCs lyse (Microangiopathic haemolytic anaemia)

Increase Stroke Volume

Increased systolic pressure

  • Bounding pulse
  • Heading bobbing
  • Quinke’s sign- nail beds flush w./ heart beat

LV hypertrophy

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7
Q

Name some causes of mitral valve regurgitation.

A
  • Myxomatous degeneration (CT disorder)
    • Weak chordae tendinae
    • Weak papillary muscle
      • Causing prolapse
  • Damge to papillary muscles after heart attack
  • Left sided heart failure- LV dilation
  • Rheumatic fever
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8
Q

What causes mitral valve stenosis in 99.9% of cases?

A

Rheumatic fever

Commissural fusion of valve leaflets

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9
Q

What happens as a result of mitral valve stenosis?

A
  • Increase LA pressure
    • Pulmonary oedema
      • Difficulty breathing
      • Pulmonary hypertension
        • RV hypertrophy
    • LA dilation
      • Artial fibrillation
        • Thrombus
      • Oesaophagus compression
        • Dysphagia (difficulty swallowing)
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10
Q

Complete the equations:

CO= SV x …..

…..= EDV - ESV

A

CO= SV x HR

SV = EDV - ESV

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11
Q

What is the typical stroke volume of a 70kg man?

A

70ml (=about 67% of normal EDV)

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12
Q

What does the ventricular compliance curve show?

A

Relationship between how much ventricles fill and LV pressure

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13
Q

What is the Frank-Starling law of the heart?

A

More the heart fills, harder it contracts

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14
Q

What are cardiac muscle cells increasingly sensitive to as the muscles are stretched?

A

Ca2+ ions

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15
Q

What type of stimulation affects the contractility of the heart?

A

Sympathetic/adrenaline

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16
Q

What is aortic impedence?

A

LV afterload

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17
Q

Why is the jugular venous pulse used clinically?

A

Direct colum of blood into right atrium

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18
Q

What conditions will increase the Jugular venous pulse?

A
  • Right side of heart- not pumping blood out properly
  • Vol overload with IV infusion
  • Something impairing heart filling eg stap wound
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19
Q

Label the follwing waves and describe what produces them:

  • A
  • C
  • X-descent
  • V
  • Dicrotic notch
  • Y-descent
A
  • A: Atrial systole
  • C: Closing mitral valve
  • X-descent: Atrial pressure initially decreases
  • V: Atrial pressure rising- venous return from lungs
  • Dicrotic notch: Aortic valve closing
  • Y-descent: Opening of mitral valve- ventricular filling
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20
Q

In what unit is BP measured?

A

mmHg (milimetres of mercury)

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21
Q

What is the normal/ideal BP?

A

90/60 mmHg and 120/80mmHg

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22
Q

What are the values of Blood pressure for:

  • Stage 1 hypertension
  • Stage 2 hypertension
  • Severe hypertension
A
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23
Q

What’s the difference between primary and secondary hypertension?

Study These Flashcards
A
  1. Primary= cause unknown (95% cases)
  2. Secondary= cause defined
24
Q

Give some examples of secondary causes of hypertension

Study These Flashcards
A
  • Renovascular disease
  • Chronic renal disease
  • Hyperaldosteronism
  • Cushing’s syndrome
25
What can hypertension lead to? (5)
1. Heart failure 2. MI 3. Stroke 4. Renal failure 5. Retinopathy
26
What are the 4 neurohumoral pathways controlling circulating volume and BP?
1. RAAS 2. Sympathetic nervous system 3. ADH 4. ANP (Atrial natriuretic peptide)
27
What are the actions of angiotensin II?
28
Give an example of an ACE inhibitor.
Captopril
29
Is bradykinin a vasodilator or vasoconstrictor?
Vasodilator Bradykinin= inflammatory mediator *Releases nitric oxide + others to cause vasodilation*
30
What effects does hyperkalaemia have on myocytes and their ability to fire APs?
1. Slows upstroke 2. Inactivates some Na+ channels as Ek is now more negative
31
What can happen to the heart as a result of hyperkalaemia?
Asystole (heart stops) ## Footnote *may initially get some increased excitiability*
32
What is the normal plasma concentration of K+?
3.5-5.5 mmol/L
33
How is hyperkalaemia treated?
* Calcium gluconate * Insulin and glucose- enhance potassium uptake (won't work if heart already stopped)
34
How can hypokalaemia cause ventricular fibrillation?
1. Longer action potential 2. Delays repolarisation 3. Causes early after depolarisations 4. Oscillations in membrane potential 5. Ventricular fibrillation
35
How does an action potential in the cardiac myocyte result in contraction?
* L-type Ca2+ channels= open * Ca2+ opens CICRs * Ca2+ binds to troponin C * Tropomyosin reveals myosin binding site for actin filament
36
What is MLCK?
Myosin light chain kinase Phosphorylates myosin light chains Phosphorylated to allow binding to actin
37
What enzyme inhibits contraction by inhibiting MLCK
PKA (protein kinase A) Phosphorylates myosin itself
38
How does vascular smooth muscle contract?
* **alpha-adrenoceptors** depolarised/activated * Increased intracellular **Ca2+** * **Ca2+** binding to **calmodulin** * Activation of **MLCK** * Phosphorylates *myosin light chain*
39
What is the affect of **sympathetic** stimulation of β1 receptor in the heart?
Increase rate and force of contraction
40
What is the effect of parasympathetic stimulation of the M2 muscarinic receptors in the heart?
Decreased rate | (Released ACh)
41
The parasympthetic nervous system influences the heart via which nerve?
Vagus nerve (10th cranial nerve) Innervates **SA node** and **AV node**
42
How does the sympathetic nervous system influence the heart?
* Post ganglionic fibres from sympathetic trunk * Innervates SA node, AV node, myocardium * Releases noradrenaline--\> β1 receptors
43
What is the If funny current?
Slow Na+ conductance- slow depolarisation of pacemaker potential
44
Arteries and veins can receive sympathetic stimulation via α1 adrenoreceptors. Coronary and skeletal muscle blood vessels also have what other type of receptor?
β2 adrenoreceptors
45
If sympathetic output to α1 adrenoreceptors is increased- what will occur in the blood vessels?
Increased output= vasoconstriction
46
What is caused by the activation of β2 adrenoreceptors?
Vasodilation
47
What effect do local metabolites have on vasodilation in active tissue?
Active tissue- increases metabolites Increase vasodilation
48
How do baroreceptors work?
In carotid sinus and aortic arch 1. Increase in arterial pressure- stretches receptors 2. Vagus nerve- to medulla 3. Parasympathetic stimulation 4. Bradycardia and vasoldilation to counteract increased mean arterial pressure
49
What drug may be given for cardiogenic shock? (pump failure)
Dobutamine β1 agonist
50
How does Salbutamol work?
β2 agonist
51
What is the muscarinic agonist Pilocarpine used to treat?
Gluacoma (Optic nerve damaged- due to pressure of fluid inside eye)
52
How does sympathetic stimualtion cause renin release?
Renal blood flow decreases Sympathetic stimulation of cells in afferent arteriole to release renin (Renin release increase Angiotensin II levels)
53
What effect do **prostaglandins** have on BP?
Lower BP = vasodilators = enhance glomerular filtration rate = reduce Na+ reabsorption Locally acting
54
What effect does dopamine have of blood pressure?
Lower BP Formed locally in kidney Dopamine receptors in renal blood vessels Reduce reabsorption of NaCl
55
Explain how renovascualr disease can cause high BP.
1. Occlusion of renal artery 2. Fall in perfusion pressure- kidney 3. Activation of RAAS 4. Vasoconstriction and Na+ retention in other kidney
56
Explain how renal parenchymal disease causes high BP? (Chronic kidney disease)
Initially less vasodilator substances Later Na+ retention
57
What is Conn's syndrome?
Aldosterone secreting adenoma Hypertension and hypokalaemia

2 CVS (16 decks)

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