How the CVS fails

Question 1

Ischaemic stroke

Answer 1

cerebral blood vessel blockage

Question 2

Haemorrhagic stroke

Answer 2

cerebral blood vessel rupture

Question 3

Give stress causes leading to a blood vessel bursting

Answer 3

• high pressure - turbulent blood flow - large diameter/high wall tension - low compliance

Question 4

Damage causes of blood vessels bursting

Answer 4

• Trauma i.e transluminal procedures - Atherosclerosis - diabetes

Question 5

What is Atherosclerosis ?

Answer 5

a disease process the furring of blood vessel, caused by fat deposits in the lumen of the arteries

Question 6

Define Compliance

Answer 6

change in volume caused by change in pressure

Question 7

What are the causes of turbulent flow?

Answer 7

• high speed - branching - obstacles - low viscosity - branching - mixing

Question 8

What are the actions of the endothelium?

Answer 8

• Blood vessel tone - Vasodilation - Fluid filtration - Haemostasis - White cell recruitment - Angiogenesis - Hormone trafficking

Question 9

What is a Myocardial Infarction (MI)

Answer 9

a region of the heart that is dead or dying

Question 10

Causes of MI

Answer 10

• blocked coronary artery

Question 11

Causes of Atherosclerosis

Answer 11

• Hyperlipidemia - Immune action - unknown aetiology

Question 12

What is Coronary Artery Disease ?

Answer 12

disease process in which the arteries of the heart are obstructures

Question 13

What is a Plaque rupture

Answer 13

when the fibrous cap of a plaque bursts open

Question 14

Describe the sympathetic activity of MI

Answer 14

• release of adrenaline and noradrenaline
• this increases the rate and contractility of the heart
• increases peripheral resistance and increased risk of arrhythmia
• helps to compensate during heart failure

Question 15

List compensatory mechanisms for MI

Answer 15

• increased HR - increased contractility - increased peripheral resistance - increased risk of arrhythmia

Question 16

What is Left Heart Failure

Answer 16

• blood building up leading to increased hydrostatic pressure in the pulmonary circulation,leading to pulmonary oedema

Question 17

Define Compensation

Answer 17

• maintaining homeostasis of a physiological function despite stressors or malfunction

Question 18

What is Decompensated Heart Failure

Answer 18

the failure of the heart to maintain adequate blood circulation after-long standing previously compensated vascular disease

Question 19

Symptoms in decompensated Heart failure

Answer 19

• respiratory distress

Question 20

What is cardiac remodelling, and how can it be reduced?

Answer 20

• growth of cardiac muscle, this can be a compensatory and a pathological process

Reduced by

• ACE inhibitors: enalapril, captopril
• Aldosterone Receptor inhibitor (K+ sparing diuretics): spironolactone
• 3rd gen. Beta lovers: carvedilol

Question 21

Eccentric cardiac remodelling

Answer 21

dilatation due to volume overload

Question 22

Concentric cardiac remodelling

Answer 22

thickening of cardiac muscles due to pressure overload, ineffective systole

Question 23

Antiduretic Hormone

Answer 23

• secreted from the posterior pitutary

Question 24

What is Aldosterone and how is relevant to cardiovascular function?

Answer 24

• hormone produced in the adrenal cortex that
• causes kidney to reabsorb more NaCl (and more water)
• this increases the plasma volume and increases the blood pressure
• it acts at the collecting ducts of the nephron
• blocked by spironalactone, used to treat hypertension
• steroid hormone: mineralocorticoids

Question 25

What is Angiotensin II and what does it do?

Answer 25

- very strong vasoconstrictor - increases fluid retention by increasing Na+ reabsorption - contributes to ventricular hypertrophy and cardiac remodelling - stimulates aldosterone secretion from the adrenal gland

Question 26

Formation of Ang II

Answer 26

Angiotensinogen from the kidney ~ enzyme renin in the kidney --\> angiotensin I ~ enzyme ACE in the lungs--\> Angiotensin II

Question 27

Drug action on the nephrons tubule system

Answer 27

-

Question 28

GIve two types of Heart Failure

Answer 28

- Chronic Low output failure - Decompensated heart failure

Question 29

Chronic low output

Answer 29

- low cardiac output due to damage - poor survival rate - compensation via increased sympathetic processes

Question 30

Left Heart Failure and it's symptoms

Answer 30

- The left atrium is too full as the left ventricle isn't carrying out systole effectively - Respiratory symptoms: dyspnoea, orthopnoea and paroxysmal nocturnal dyspnoea

Question 31

Right Heart Failure

Answer 31

- Systemic/ peripheral symptoms - increased venous pressure leading to oedema or ascites

Question 32

Symptoms of Heart failure

Answer 32

- fatigue, especially during exercise - peripheral oedema - dyspnoea/ orthopnoea

Question 33

Cardiogenic shock

Answer 33

low perfusion due to low cardiac output

Question 34

Definition of Shock

Answer 34

- the Systolic Blood Pressure goes below 90mmHg

Question 35

What is decompensated Heart Failure and what is the treatment goals?

Answer 35

The body deals with heart failure as if it is a haemorrhage - the kidney increases the plasma volume, to compensate for poor perfusion of renal tissue - leads to fluid overload - the heart is unable to pump the extra fluid - fluid damning leads to increased venous hydrostatic pressures, further damaging the heart - positive feedback loop forms, leading to further damage to the heart - capillaries leak fluid into tissues (lung and ankles oedema) Treatment goals - prevent acute decompensated heart failure - counteract cardiac remodelling- ACE inhibitors and Beta blocking - minimize symptoms

Question 36

Give three processes that might damage a blood vessel rather than damaging the tissue around it

Answer 36

- Intravascular trauma such as PCI - Atherosclerosis - Diabetes

Question 37

What is Renin and why is relevant to the cardiovascular function?

Answer 37

- An enzyme in the RAA system - converts angiotensinogen to angiotensin I which is later converted tot he active form angiotensin II - the RAAS activation needs to vasoconstriction and fluid retention which acts to increase blood pressure - the antagonist of renin is antihypertensives

Question 38

What is Ascites?

Answer 38

- abnormal filling of fluid in the abdomen

Question 39

What is paroxysmal nocturnal dyspnoea

Answer 39

- severe attack SOB and coughing that usually wakes up the individual in the night (it can be frightening)

Question 40

What are the symptoms of pulmonary oedema?

Answer 40

- dyspnoea - paleness - excessive sweating - hypoxia

Question 41

What are the treatments for heart failure?

Answer 41

- ACE inhibitors - Loop diuretics - Beta-blockers - Angiotensin receptor blockers Sometimes - Aldosterone receptor antagonists (K+ sparing diuretics) and Digoxin only improves symptoms

Question 42

Name 4 classes of diuretic drugs/

Answer 42

- Thiazide diuretics - Loop diuretics - Thiazide-like diuretics - K+ sparing diuretics