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Easter revision 2018 > CVS > Flashcards

Flashcards in CVS Deck (79)
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1

How does ANP work?

Released when the atrial myocytes are stretched, and it vasodilates afferent arteriole to kidney to increase kidney blood flow in order to decrease Na reabsorption and lower fluid level (i.e. it causes natriuresis)

2

Which two endocrine glands does angiotensin II act on?

Adrenal gland to release aldosterone (increases Na reabsorption) and hypothalamus to produce ADH (increase water reabsorption)

3

Describe murmurs for mitral stenosis and regurg

Mitral regurg is holosystolic murmur, mitral stenosis is diastolic rumble

4

Describe murmurs for AV stenosis and regurg

AV regurg is early decrescendo diastolic, AV stenosis is crescendo decrescendo

5

Where does aldosterone act?

On principle cells of collecting duct

6

Name three stages of hypertension?

Stage 1 - 140/90, 2 - 160/100, 3- 180 or 110

7

Causes of secondary HTN?

Renal artery stenosis, CKD, Conn's syndrome (aldosterone secreting adenoma) or Cushing's syndrome (excess cortisol stimulates aldosterone Rs)

8

Complications of HTN?

Retinopathy, stroke, MI, LV hypertrophy (from increased afterload), HF, kidney failure

9

How to calculate maBP?

actual formula is maBP = TPR x CO
but can work out with maBP = diastolic P + 1/3 pulse pressure e.g. 60 + 10 = 70

10

What is shock? Give types

Shock is inadequate blood flow, so either due to reduced CO or reduced TPR.
Reduced CO: mechanical shock where it can't fill, cardiogenic shock where it can't pump, hypovolemic shock (haemorrhage, burns, D&V, hyponatremia)
Reduced TPR: toxic shock or anaphylactic shock

11

Examples of mechanical shock?

Can't fill e.g. cardiac tamponade due to fluid in pericardial space (treat with pericardiocentesis) or massive PE occluding large pulmonary artery so RV can't empty

12

At what % of fluid loss will you display signs of shock?

Less than 20% no shock, 20-30% some signs, 30-40% serious shock

13

Signs of shock?

Tachycardic, low BP, sweaty, flushed, pale, weak pulse

14

What is septic shock?

Persisting hypotension despite fluids following sepsis

15

Describe what electrical events each part of an ECG is representing

P wave - atrial depol
Q wave- IV septum depol
R wave - apex of ventricle depol
S wave - base of ventricle depol
T wave - repol of ventricles (double negative so appears +)

16

Which leads show inferior heart problems?

aVF, II, III (RCA)

17

Which leads show lateral heart problems?

aVL, I, V5,6 (LCA)

18

Which leads show anterior heart problems?

v1,V2,V3,V4 (LAD)

19

On ECGs how much are the boxes worth?

5 large squares 1sec, one large square 200ms, one small square 40ms, 25 small squares are 1sec

20

How to calculate HR from ECG?

300/no. of large squares = bpm
Or if irregular count how many in six secs (30 large boxes) and times by 10

21

How long should a PR interval be?

3-5 small boxes (120-200ms)

22

How long should a QRS interval be?

<3 small boxes (<120ms)

23

How long should QT interval be?

11-12 small boxes (<0.45 in M, <0.47 in F)

24

Describe the types of heart block (= problem with conduction between A and V)

1st degree - PR interval >5 small boxes
2nd degree - Mobitz Type 1 (Wenkebach phenomenon) is where PR gets longer and longer until one QRS isn't transmitted
2nd degree - Mobitz Type 2 where PR normal then suddenly drops. High risk of progression to 3rd degree
3rd degree - complete heart block, atrial depol normal but NOT conducted to Vs so ventricular escape rhythm, wide QRS

25

Describe the types of heart block (= problem with conduction between A and V)

1st degree - PR interval >5 small boxes
2nd degree - Mobitz Type 1 (Wenkebach phenomenon) is where PR gets longer and longer until one QRS isn't transmitted
2nd degree - Mobitz Type 2 where PR normal then suddenly drops. High risk of progression to 3rd degree
3rd degree - complete heart block, atrial depol normal but NOT conducted to Vs so ventricular escape rhythm, wide QRS

26

What is ventricular tachycardia?

Consecutive ventricular ectopics. High risk of VF

27

What does VF result from?

Multiple ectopic foci in ventricles, uncoordinated coordinate, ventricles quiver, no CO, shockable

28

Why is endothelial muscle more vulnerable to ischaemia than epithelial?

Because coronary arteries are on epithelial surface

29

What are STEMIs and NSTEMIs occlusions of?

STEMI is major coronary artery, NSTEMI is minor coronary artery or partial occlusion of major

30

Describe ECG STEMI progression

ST elevation, T wave inversion, pathological Q waves persist