week 3

Question 1

how do semilunar valves operate (what is their key differentiation from AV valves)

Answer 1

They close and open according to pressure gradients

They lack papillary muscles and chordae tendinae

Question 2

what are the three layers of valves

Answer 2

fibrosa (innermost)
spongiosum
Ventricularis/atrialis (superficial)

Question 3

what is sound 1

Answer 3

av valves closing

Question 4

what is sound 2

Answer 4

SL valves closing

Question 5

what is sound 3

Answer 5

rapid ventricular filling

Question 6

what is sound 4

Answer 6

atrial contraction and turbulent blood in filled ventricles

Question 7

what are pathological causes for the splitting of second heard sound

Answer 7

bundle branch blocks

Question 8

frank starling mech 7 steps

Answer 8

greater venous return
greater end diastolic volume
greater preload
greater muscle tension
greater force of contraction
greater ejection fraction
greater cardiac ouput

Question 9

what regulates cardiac work

Answer 9

baroreceptor reflex
arterial pressure

Question 10

physiological responses to exercise in terms of circulation 4

Answer 10

1. vasodilation of skeletal muscle BVs
2. vasoconstriction of GIT
3. Increased muscle pumping
4. sympathetic activation: noradrenaline and adrenaline release

Question 11

arterial pressure

Answer 11

cardiac output is inversely proportional to peripheral resistance

Question 12

parasympathetic response in cardiac control

Answer 12

vagal
acts on sa and av node, reduces rate of firing
fast action

Question 13

sympathetic response

Answer 13

causes chronotropy and inotropy through noradrenaline release
also causes vasoconstriction

Question 14

baroreceptor mech

Answer 14

baroreceptors in aortic arch and coronary sinues
signal to cardio centre in medulla
either parasympathetic or sympathetic result

Question 15

key vasoconstricors 3

Answer 15

adrenaline
vasopressin/ADH
angiotensin 2

Question 16

key vasodilators 2

Answer 16

tissue derived vasodilators (metabolically driven) ex. adenosine

endothelium derived vasodilators ex. nitric oxide

Question 17

what is the autoregulatory method for blood flow to the brain

Answer 17

myogenic mechanism: increased intravascular pressure->cerebral arteries constrict to prevent excessive blood flow, decreased intravascular pressure-> dilate to increase blood flow

metabolite concentrations will also influence

Question 18

three broad groups for HF causation and their subgroups

Answer 18

myocyte related: ischaemia, toxins, trauma, CAD, myocarditis
Conduction related: Arrhythmias
Loading related: Hypertension, PAD

Question 19

Pathophysiology mech of HF 6 steps

Answer 19

index event
reduced cardiac output
compensatory mechanisms
secondary organ damage
LV remodelling
further decline

Question 20

the 3 compensatory mechanisms in HF onset

Answer 20

RAAS activation
Sympathetic activation
Natiuretic peptide release

Question 21

what are the physical changes in HF that occur

Answer 21

LV remodelling including dilatation, hypertrophy and fibrosis

Question 22

history symptoms of HF 5

Answer 22

swelling
dyspnoea
orthopnoea
fatigue
exercise intolerance

Question 23

clinical symptoms in HF 3 right sided

Answer 23

raised JVP
added S3 sound
pitting oedema

Question 24

what does an echocardiogram assess in HF 3

Answer 24

LV ejection
dilatation
diastolic function

Question 25

reason for dyspnoea in HF

Answer 25

reduced cardiac ouput backflow increased pulmonary pressure pulmonary congestion and oedema increased blood air barrier impaired gas exchange

Question 26

reason for peripheral oedema in HF

Answer 26

low cardiac output->backflow->increased venous pressure->fluid enters interstitium

Question 27

acute management of HF

Answer 27

furosemide Sublingual GTN supportive care ex. oxygen

Question 28

role of sublingual GTN in acute HF management

Answer 28

vasodilator to reduce preload and afterload

Question 29

long term drug management Hf

Answer 29

ARNI beta blocker Mineralcorticoid receptor antagonist SGLT2 inhibitors

Question 30

what can worsen HF (think in terms of 3 broad categories CVD, health, external)

Answer 30

CVD: Arrhythmias, MI, CAD structural abnormalities Health: Infection, hypertension External: Drugs, chemo, diet

Question 31

drugs which precipitate HF 4

Answer 31

some chemotherapy drugs tricyclic antidepressants NSAIDs calcium channel blockers

Question 32

r sided HF complications 5

Answer 32

L. HF Peripheral oedema hepatic congestion->cirrhosis renal congestion->renal dysfunction abdominal congestion->ascites

Question 33

l. sided complications 5

Answer 33

pulmonary oedema pulmonary congestion pulmonary hypertension fatigue exercise intolerance

Question 34

reasons for valvular regurgitation to occur (physiological) 3

Answer 34

abnormal leaflet closure muscle dissection congenital/structural abnormalities

Question 35

reasons for valvular stenosis to occur (physiological)

Answer 35

calcification stenosis pre/para valvular

Question 36

pathological reasons for valvular disease 7

Answer 36

ageing RHD infective endocarditis Medications trauma Connective tissue disorders congenital abnormalities

Question 37

characteristics of aortic stenosis 4

Answer 37

systolic, radiates to carotids, loudest on phonocardiogram, highest pressure

Question 38

characteristics of aortic regurgitation 3

Answer 38

early diastolic murmur, second loudest on phonocardiogram, greatest volume

Question 39

characteristics of mitral regurgitation 5

Answer 39

pan systolic murmur, low pressure, higher volume, radiates to axilla, third loudest

Question 40

role of clinical geneticist

Answer 40

medical doctor

Question 41

role of genetic counsellor

Answer 41

non directive advise about tests and diagnoses

Question 42

people involved in the multidisciplinary genetics team 3

Answer 42

genetics counsellor clinical geneticist psychologist