T3 L3: How the CVS fails

Question 1

What is the opposite of turbulent flow?

Answer 1

Laminar flow. Flow is slower at the edges because of friction

Question 2

Where is NO secreted?

Answer 2

Endothelial cells

Question 3

What is an AMI?

Answer 3

An acute myocardial infarction. Onset is within minutes. Large or multiple infarcts like this can cause heart failure

Question 4

What is the immune action response that causes atherosclerosis?

Answer 4

When there is a tear in the endothelium leading to an accumulation of white blood cells and fatty deposits

Question 5

What is the main symptoms of coronary heart disease?

Answer 5

Angina

Question 6

When do atheroma’s become dangerous?

Answer 6

When the fibrous cap bursts and can lead to formations of emboli

Question 7

What are haemodynamic abnormalities?

Answer 7

BP inconsistencies

Question 8

Name 3 systemic activities that help compensate during heart failure

Answer 8

Increased heart rate, increased contractility, and increased peripheral resistance

Question 9

What is meant by osmotic and hydrostatic pressure in vessels?

Answer 9

High hydrostatic pressure causes water to leave the vessels, high osmotic pressure causes water to enter the vessels. Veins should have a higher osmotic pressure than arteries

Question 10

What type of heart failure causes pulmonary oedema?

Answer 10

Let heart failure because water is backing up from the left side

Question 11

What is orthopoea?

Answer 11

Can only breathe when sitting or standing

Question 12

What is dyspnoea?

Answer 12

Difficulty breathing

Question 13

What is ascites?

Answer 13

Accumulation of fluid in the peritoneal cavity. Can be caused by heart failure

Question 14

What is decompensated heart failure?

Answer 14

The failure of the heart to maintain adequate blood flow after long term CVD

Question 15

What are the 2 types of cardiac remodelling?

Answer 15

Hypertrophy and dilation

Question 16

What 2 drugs can be used to inhibit cardiac remodelling?

Answer 16

ACE inhibitors and spironolactone

Question 17

When is ventricular hypertrophy normal?

Answer 17

In athletes

Question 18

What is the eccentric cause for ventricular hypertrophy?

Answer 18

Dilation because of volume overload

Question 19

What is the concentric cause for ventricular hypertrophy?

Answer 19

Thickening because of pressure overload

Question 20

What is another name for Vasopressin?

Answer 20

Antidiuretic hormone (ADH)

Question 21

What is ADH and what is it’s effect on the body?

Answer 21

It’s a peptide secreted by the posterior pituitary gland that causes the kidneys to absorb more water.

Question 22

What is Aldosterone and what is its effect on the body?

Answer 22

It’s a steroid secreted by the adrenal cortex that causes the kidneys to absorb more NaCl and therefore more H2O. It directly decreases natriuresis

Question 23

What is natriuresis?

Answer 23

Excretion of sodium in the urine

Question 24

What effect does decreased diuresis have on BP?

Answer 24

Increased BP

Question 25

What do diuretic drugs do to diuretic hormones?

Answer 25

They antagonise them leading to fluid loss

Question 26

What effect does increased fluid retention have on aldosterone and ADH?

Answer 26

Increased aldosterone and ADH secretion

Question 27

Where is Renin secreted?

Answer 27

Kidneys

Question 28

Where is ACE secreted?

Answer 28

Lungs and kidneys

Question 29

Describe the formation of aldosterone including precursor molecules

Answer 29

Angiotensinogen (precursor molecule) is converted to angiotensin I by renin. Then ACE converts it into angiotensin II which is active and can develop into aldosterone

Question 30

What type of drug is indapamide?

Answer 30

A thiazide-like drug that blocks the reabsorption at the DCT of the nephron

Question 31

What type of drug is furosemide?

Answer 31

A loop diuretic that blocks reabsorption in the thick loop of the nephron

Question 32

What type of drug is spironolactone?

Answer 32

A K+ sparing diuretic that inhibits aldosterone receptors in the cortical collecting duct

Question 33

What is the difference between chronic low output heart failure and decompensated heart failure?

Answer 33

Decompensated heart failure is a medical emergency but people can live with it chronically. Chronic form is a disease of the elderly

Question 34

What are the symptoms of left heart failure and why do they happen?

Answer 34

Respiratory symptoms. The right heart pumps into the lungs but the left atrium is full so hydrostatic pressure increases in pulmonary circulation. Also known as congestive heart failure because the pulmonary vasculature is congested. In extreme cases, fluid can leak out of vessels and into the lungs

Question 35

What are the symptoms of right heart failure and why do they happen?

Answer 35

Systemic symptoms. The blood can't return to the right heart because its full. This causes an increase in central venous pressure and therefore peripheral oedema or acites

Question 36

What is paroxysmal nocturnal dyspnoea?

Answer 36

Waking up in the middle of the night and not being able to breathe

Question 37

What are the 3 main symptoms of heart failure?

Answer 37

Fatigue, peripheral oedema and dyspnoea

Question 38

What is cardiogenic shock?

Answer 38

Critically low perfusion due to low cardiac output. Defined as <90 mmHg systolic

Question 39

How is positive feedback involved in cardiogenic shock progression?

Answer 39

The heart doesn't have enough blood so it beats slower

Question 40

How is cardiogenic shock treated?

Answer 40

Aggressive IV fluid and oxygen and airway maintained

Question 41

What 3 types of drugs are used for chronic heart failure?

Answer 41

ACE inhibitors to prevent heart remodelling, Diuretics to increase the amount of fluid loss, and beta blockers to lower sympathetic activity

Question 42

What is the sympathetic activity for homeostasis for low cardiac output (fast response)?

Answer 42

Happens to increase BP. Heart rate and contractility increase and there is vasocontriction

Question 43

What is the slow response of the kidneys for homeostasis for low cardiac outpu?

Answer 43

Decreased glomerular filtration rate. Increased central venous pressure, venous return and preload

Question 44

How do the kidneys make decompensated heart failure worse?

Answer 44

The kidneys increase plasma volume to compensate for poor perfusion of renal tissue because the kidneys can't tell the difference between heart failure and haemorrhage. This process leads to fluid overload. The heart can't pump this extra fluid and this leads to rapid deterioration