John Palmer's Chest Pain Flashcards
(243 cards)
1
Q
What must FXa be bound to to contribute to coagulation?
A
FVa
2
Q
What are the symptoms of heart failure mostly attributable to?
A
Decreased venous drainage
3
Q
What did the CAST trial show?
A
Class I anti arrhythmics will not improve survival when used prophylactically
4
Q
What does increased preload do to cardiac contractility?
A
Increased contractility
5
Q
What does 2 P waves per QRS on an ECG reflect?
A
2nd degree heart block e.g. 2:1 type, Mobitz 2
6
Q
Why does exercise increase cardiac contractility?
A
Increased sympathetic stimulation
7
Q
How can cardiovascular risk factors be described?
A
Synergistic
8
Q
Which ligand binds to the P2Y12 receptor?
A
ADP
9
Q
Which vector does aVR correspond to?
A
Right arm
10
Q
At what speed does endocardium to epicardium conduct at?
A
0.3 m/s
11
Q
What does the PR interval reflect the function of?
A
AV node
12
Q
What pumps most of the calcium out of the cell in relaxation?
A
the NCX (Ca2+:3Na+) antiporter
13
Q
Which vector does lead II correspond to?
A
Right arm to left leg
14
Q
Which cell mediates plaque rupture in atherosclerotic plaque?
A
Macrophages
15
Q
What do class III anti-arrhythmic drugs do?
A
Prolongs AP and refractory period
16
Q
During isovolumetric relaxation which valves are open and which are shut?
A
All valves are shut
17
Q
How does fondaparinux work?
A
Inhibits FXa via activation of antithrombin
18
Q
Name a clot buster
A
Streptokinase
19
Q
What is atrial fibrillation a risk factor for?
A
Thromboembolism
20
Q
Why may people not adhere to post-MI treatment?
A
Anexity and depression
21
Q
Which thrombi should be treated with anti-platlet drugs?
A
Arterial
22
Q
What does prothrombinase consist of?
A
FXa and FVa
23
Q
Give two class II anti-arrhythmic drugs.
A
Atenolol and B blockers
24
Q
What is abciximab?
A
A GPIIb-IIIa inhibitor
25
What does the law tell us?
What we must do and not do
26
What does article 2 of the Human Right's Act 1998 give everyone the right to?
Life
27
Give two class I anti-arrhythmic drugs.
Fast Na+ channel blockers and flecainamide
28
Where do eosinophils often migrate to?
The GI tract
29
What does ventricular tachycardia result in?
Fulminant heart failure
30
What is congestive heart failure?
When left heart failure leads to right heart failure
31
What is orthopenoea?
Pulmonary oedema on lying down
32
Why might someone who is having a heart attack be breathless?
Cardiac output is low
33
What percentage of artery must be occluded for it to be significant occlusion?
70%
34
How many people over 70 have heart failure?
10%
35
What do basophils contain?
Pro-inflammatory granules
36
At what speed does the AV node conduct at?
0.05 m/s
37
How much fluid flows through capillaries per day?
4000L
38
Which leads are the chest leads?
V1, V2, V3, V4, V5, V6
39
What direction is lead I in if left is 0 degrees and we are moving clockwise?
0 degrees
40
Which of ticagrelor and clopidogrel prevents cardiovascular events better?
Ticagrelor
41
What do type 2 atheromatous lesions contain?
Smooth muscle cells
42
Which way will increasing contractility move the cyclic graph of volume against pressure of the cardiac cycle?
Upwards because the pressure in the heart is increasing
43
What is a first line drug for heart failure treatment?
ACE inhibitor
44
How do B1 receptors increase contractility?
By increasing the slow inward current
45
How many wires and leads are there in a standard ECG?
10 wires and 12 leads
46
How do platlets bind to Von Willebrand factor?
Via GP1B
47
Which cardiac murmer can be caused by incompetence of the semi lunar valves?
Heard after the second heart sound
48
When is an inverted T wave normal?
In V1
49
Which ligand binds to the GPIIb/IIIa receptor?
Fibrinogen
50
What do inotropic agents do?
Increase contractility
51
What is the typical hydrostatic pressure gradient along a capillary?
25 mmHg, higher at arterial end
52
What is the magnitude of a voltage on an ECG a reflection of?
The vector of depolarisation in the direction of the lead
53
How do neutrophils produce energy?
Anaerobic glycolysis
54
What does a type 4 atheromatous lesion have?
A fibrous cap
55
What do anti-coagulants do?
Prevent growth of a thrombosis
56
What are If channels?
Funny current channels
57
What causes the depolarisation upstroke in the cardiac action potential?
Voltage gated sodium channels
58
Where do haemopoietic stem cells derive from originally?
Mesenchyme
59
What do class I anti-arrhythmic drugs do?
Terminate re-entry arrhythmias and slow conduction through conducting system
60
What is happening in ventricular filling?
AV valves are open and blood is forced into ventricle but cannot leave as the aortic and pulmonary valves are shut
61
What does warfarin do?
Inhibits Vit K dependent epoxide reductase activity,
| which modifies FVII, FIX, FX, and prothrombin (FII) during synthesis in liver
62
How does anti-thrombin work as an anti-coagulant?
Inactivates factors IIa, IXa, XIa, XIIa when not in clot
63
Which factors are activated in amplification of coagulation?
V and VIII
64
What is the most common form of myocardial infarction?
Transmural
65
How many patients with newly identified heart failure survive at least 3 months?
75%
66
What does article 8 of the Human Right's Act 1998 give everyone the right to?
Self determination
67
Which heart sound can indicate raised EDP?
S3-S4 gallop rhythm
68
What does increased mean arterial pressure cause?
Increased afterload
69
How many people in UK have heart failure?
650,000
70
What combo of drugs should be used in heart failure?
ACE i and B blocker
71
What do platelets release when activated?
ADP, TXA2, serotonin
72
Which way will increasing afterload move the cyclic graph of volume against pressure of the cardiac cycle?
To the right as there is high EDP therefore high filling
73
Which vector does aVF correspond to?
Left leg
74
What percentage of UK women over 75 have CHD?
25%
75
Which drug induces early after depolarisations?
Procainamide
76
How do platelets stick together?
By fibrinogen binding
77
When do neutrophils die?
After phagocytosing a single pathogen
78
How does GTN work?
Metabolised to NO which relaxes veins and venules to decrease CVP and LVEDP so therefore decreases CO and O2 demand by Starling's law
79
What is the ejection fraction usually in systolic heart failure?
Less than 45%
80
What kind of nucleus does a basophil have?
Bilobed nucleus
81
Which is the rhythm lead?
Lead II
82
How does Warfarin work?
Antagonises vitamin K
83
Which ligand binds to the intergrin A2 B1 receptor?
Collagen
84
Which adrenergic receptors does carvedilol antagonise?
A1, B1, B2
85
What is the plane of detection for the leads of Einthoven's triangle?
Oblique
86
According to Starling's law what must be equal on the left and right sides of the heart?
Stroke volume
87
What is the shape of a platelet?
A biconvex disc
88
How do NO and prostaglandin work as anti-coagulants?
Inhibit platelet aggregation and activation
89
By how much does chronic stress increase risk of CHD?
100%
90
What coagulation factor is thrombin?
FII
91
What kind of nucleus does a erythrocyte have?
No nucelus
92
What is the PR interval?
The time from beginning of P wave to the beginning of the Q wave
93
What does no P waves on an ECG reflect?
Atrial fibrillation
94
What is the length of the QRS complex?
80 ms
95
Which are the anti-platelet drugs?
Aspirin, clopidogrel, ticagrelor, abciximab
96
Which ligand binds to the GP1B receptor?
vWF
97
What is happening in the ejection phases?
The aortic and pulmonary valves open and blood is ejected into aorta and pulmonary valve
98
What initiates amplification of coagulation?
Thrombin
99
What is the plane of detection for the chest leads?
Transverse
100
What kind of nucleus does a lymphocyte have?
Large circular nucleus that fills the cell
101
Which drug induces delayed after depolarisations?
Digitoxin
102
What direction is lead III in if left is 0 degrees and we are moving clockwise?
120 degrees
103
How fast do atria beat in atrial flutter?
300 bpm
104
During isovolumetric contraction which valves are open and which are shut?
All valves are shut
105
What are megokaryocytes precursors of?
Platelets
106
What type of cell is a neutrophil?
Granulocyte
107
What does cholesterol in atheromatous plaques form?
Crystals
108
During atrial systole which valves are open and which are shut?
The atrio-ventricular valves are open and the aortic and pulmonary valves are shut
109
What is the daily net movement of fluid from microvasculature to interstitium?
8L
110
What regulates capillary pressure gradients?
Changes in arteriole resistance
111
Which ligand binds to the GPV1 receptor?
Collagen
112
How do chronotropic agents increase heart rate?
Increasing If current
113
What are the most common risk factors for heart failure?
MI and HT
114
Which cells release tissue plasminogen activator?
Damaged endothelial cells
115
Is cardiac muscle more or less sensitive to stretch than skeletal muscle?
More sensitive to stretch
116
At what heart rate will a ventricular cell take over as cardiac pacemaker?
30 bpm
117
Do B blockers improve symptoms or mortality in heart failure?
Both
118
What direction is lead II in if left is 0 degrees and we are moving clockwise?
60 degrees
119
What will be lower than normal in a failing heart?
Stroke volume
120
What percentages of WBCs are lymphocytes?
40-70%
121
Which are the anti-coagulation drugs?
Heparin, warfarin
122
What does chronic stress cause the release of?
Catecholamines
123
What is a normal haemocrit?
40%
124
In initiation of coagulation what does tissue factor bind to?
FVII
125
Where would a thrombus which is mainly a product of coagulation be found?
In a vein
126
Which channels bring SA nodes to threshold?
If channels only
127
What can't cardiac muscle produce regarding action potentials?
A summation of action potentials
128
How do the action potentials of the epicardium and endocardium compare?
It is shorter in the epicardium
129
What percentages of patients only show partial response to clopidogrel?
33%
130
Which leads are bipolar?
I, II, III
131
What is happening in isovolumetric contraction?
Ventricles are in systole but valves are yet to open so no volume changes, preparing to push blood forcefully out into aorta and pulmonary artery
132
What does tenase consist of?
FVIIIa and FIXa
133
What do cardiac glycosides cause?
Decreased removal of Ca2+ from the cell
134
What direction is aVL in if left is 0 degrees and we are moving clockwise?
-30 degrees (+300)
135
What type of cell is a NK cells?
Lympocyte
136
What is the infarct caused by diffuse stenosis without thrombus or embolism known as?
Subendocardial
137
How does tissue factor pathway inhibitor work as an anti-coagulant?
Combines with and inactivates FXa
138
What direction is aVR in if left is 0 degrees and we are moving clockwise?
-180 degrees (+210)
139
How does ivabradine decrease the work of the heart?
Inhibits If (current of pacemaker potential in SAN) to decrease O2 demand and increase supply
140
What do P2Y12 antagonists prevent?
Platelet aggregation
141
What proportion of the UK population has CHD?
4%
142
What does PR intervals that progressively increases until a QRS complex is missed on an ECG reflect?
Wenckebach-type 2nd degree heart block
143
What causes the plateau phase of the cardiac action potential?
The open state of L-type calcium channels
144
What do verapamil and amlodipine do?
Block Ca2+ entry into smooth and cardiac muscle so decrease force, relax arterial vessels so decrease TPR and O2 demand
145
What is an issue with GTN?
Tolerance builds up due to formation of reactive oxygen species inhibiting ALDH-2
146
How long do neutrophils survive in the circulation?
5 days
147
What does PR upstroke, delta wave, on an ECG reflect?
Accessory pathway from atria to ventricles
148
Which pathogen are eosinophils important in destroying?
Parasites
149
How does rivaroxaban work?
Directly inhibits FXa
150
What does nicorandil do?
K+ channel agonist, opens K+ channels in vascular smooth muscle cells to cause cell hyperpolarisation, vasodilation so decrease TPR and decrease O2 demand
151
What happens to ventricles during heart failure?
Ventricles dilate
152
During rapid and reduced ejection phase which valves are open and which are shut?
AV valves are shut and the aortic and pulmonary open to allow blood to be pushed out
153
What should the ejection fraction of a healthy person be?
55-75%
154
How does heart failure cause oedema?
Venous pressure is increased
155
What type of cell is a monocyte?
Agranulocyte/ mononuclear cell
156
Which leads are augmented and unipolar?
aVL, aVR, aVF
157
What metabolises glyceryl trinitrate (GTN)?
ALDH-2
158
What do eosinophil granules contain?
Basic, cytotoxic proteins
159
By how much will a cardiac rehabilitation programme reduce CHD mortality?
25%
160
How does heart failure ultimately cause death?
Cardiac arrhythmia
161
Name an irreversible P2Y12 antagonist.
Clopidogrel
162
What is happening in isovolumetric relaxation?
Full diastole of the heart, atria fill with blood slowly to prepare for next cardiac cycle
163
What does heparin inhibit?
Factors XIIa, XIa, Xa, IXa and IIa (thrombin)
164
What is the extracellular matrix of blood made of?
Plasma
165
What does streptokinase activate?
Plasminogen
166
Where does the bundle of Kent run in WPW?
Right ventricle to right atrium
167
What is the length of the QT interval?
300-450 ms
168
What do class IV anti-arrhythmic drugs do?
Slows conduction in AV node, slows ectopic pacemakers and reduces AV node excitability
169
In stenotic valvular disease what causes heart failure?
Increased afterload
170
What type of cell is a T cell?
Lympocyte
171
How much air in the blood stream would kill someone?
300 ml
172
How does unfractioned heparin work?
Inhibits FXa and thrombin via activation of antithrombin
173
What differentiates reticulocytes from mature erthrocyte in regards to staining?
RNA stains differently
174
How does aspirin work?
Irreversibility binds COX and inhibits platelet aggregation
175
What is the hydrostatic pressure in the interstitum?
0 mmHg
176
What is the length of the PR interval?
120-200 ms
177
What is the diameter of a lymphocyte?
6-9 micro metres
178
What do statins inhibit?
HMG-CoA reductase
179
According to Starling's law what does the energy released in contraction depend on?
The cardiac fibre length
180
When do latent pacemakers increase in automaticity?
In ischaemia
181
Which act informs the treatment of people ages 16 and over that lack capacity to consent for treatment?
The Mental Capacity Act 2005
182
Which anti-arrhythmic drugs slows heart rate in atrial fibrillation without affecting contractility?
Digitoxin
183
How does dabigatran work?
Directly inhibits thrombin
184
What percentage of heart failure is systolic?
70%
185
What are delayed rectifier channels?
K+ channels
186
What causes heart failure after myocardial infarction?
Ventricular dilation
187
Which vector does lead III correspond to?
Left arm to left leg
188
What determines cardiac output?
Central venous pressure
189
What is the preferred immediate treatment for myocardial thrombus?
Cardiac cathertisation
190
How do B blockers help angina symptoms?
By blocking sympathetic stimulation of heart to decrease force and HR so decrease O2 demand, increase coronary blood supply so increase O2 supply
191
What kind of nucleus does a monocyte have?
Horseshoe shaped nucleus
192
Name an ARB (angiotension receptor blocker)
Valsartan
193
What activates prothrombin?
FXa
194
How does digitoxin increase intracellular Ca2+ in myocytes?
Increases intracellular Na+
195
Where are erythroid precursor cells found?
Bone marrow
196
What kind of nucleus does a megakaryocyte have?
Multi nucleated
197
At what speed do Purkinje fibres conduct at?
4 m/s
198
What direction is aVF in if left is 0 degrees and we are moving clockwise?
90 degrees
199
Which heart sound would indicate delayed conduction?
Split S1 as that is conduction from atria to ventricles
200
What is a normoblast the precursor of?
Erthrocyte
201
What forms the blood brain barrier?
Capillary endothelium
202
What is pitting oedema a sign of?
Elevated venous pressure
203
Which fibrillation results in sudden death?
Ventricular fibrillation
204
Where does haemopoiesis take place in the early embryo?
Liver
205
Give two class IV anti-arrhythmic drugs.
Diltiazem and slow-inward L-type Ca+ channel blockers
206
Which vector does lead I correspond to?
Right arm to left arm
207
What does no correspondence between P waves and QRS complexes on an ECG reflect?
Complete heart block
208
Do loop diuretics improve symptoms or mortality in heart failure?
Symptoms
209
Name a direct FXa inhibitor
Rivaroxaban
210
How is GTN administered?
Patches
211
What does erythropoietin promote?
Growth and division of normoblasts
212
How long after an infarct does ventricular rupture usually occur?
10 days
213
What do platelet dense granules contain?
Serotonin
214
What do class II anti-arrhythmic drugs do?
Inhibits effect of adrenaline
215
When are fibrinolytics used?
To lyse a clot
216
After reaching threshold which channels control the upstroke of the SA node action potential?
L-type calcium channels
217
Give two class III anti-arrhythmic drugs.
Amiodarone and delayed-rectifier K+ channel blockers
218
What is the main pharmacological strategy to deal with angina of effort?
Decrease blood O2 demand
219
Which vector does aVL correspond to?
Left arm
220
What kind of nucleus does a neutrophil have?
Multi lobed nucleus
221
What is the normal percentage of circulating red blood cells that are reticulocytes?
1%
222
What type of cell is a basophil?
Granulocyte
223
What is an arterial infarct without bacterial contamination called?
White, bland infarct
224
At what speed do the atria conduct at?
1 m/s
225
What is the diameter of a normal platlet?
3 micro metres
226
What is claudication?
Muscle pain on exercise
227
What is the current model of coagulation known as?
The cell-based model
228
During rapid and reduced ventricular filling which valves are open and which are shut?
AV open, pulmonary and aortic shut
229
What is preload determined by?
Central venous pressure
230
Which thrombi are platelet rich?
Pale thrombi
231
How is heparin activity tested?
Measure partial thromboplastin time
232
What does long PR interval on an ECG reflect?
1st degree heart block
233
What is the diameter of a normal erythrocyte?
7 micro metres
234
Which factor causes cross-linking of fibrin?
XIIIa
235
What does an M pattern for the QRS complex likely to indicate?
Bundle branch block
236
What initiates cardiac contraction in atrial fibrillation?
The AV node
237
Which of clopidogrel and aspirin reduces mortality more?
Clopidogrel
238
Which channels determinate heart rate?
Potassium channels and If channels
239
Where do newly produced blood cells first enter?
Through a sinusoid
240
How does heparin work as an anti-coagulant?
Activates anti-thrombin
241
Where do symptoms of weakness in heart failure come from?
Increased arterial vasoconstriction
242
Is splitting of the second heart sound always pathological?
No
243
What is the INR?
Prothrombin time
