Cardio Flashcards
1
Q
Describe the two processes of atherosclerosis
A
- fatty deposits in the artery walls
- the process of hardening or stiffening of the blood vessel walls
2
Q
what are the non-modifiable risk factors of CVD (3)
A
- age
- FHx
- male
3
Q
What are the modifiable risk factors of CVD (7)
A
- smoking
- alcohol consumption
- poor diet
- low exercise
- obesity
- poor sleep
- stress
4
Q
What medical co-morbidities are associated with CVD
A
- DM
- HTN
- CKD
- Inflammatory conditions (RA)
- atypical antipsychotic medication
5
Q
What are the typical complications of CVD
A
- angina
- MI
- TIA/Stroke
- PVD
- chronic mesenteric ischaemia
6
Q
What is chronic mesenteric ischaemia
A
when plaque builds up in the major arteries that supply blood to the small intestine or small bowel
7
Q
define primary prevention
A
intervening before health effects occur
8
Q
define secondary prevention
A
detecting and treating disease or injury as soon as possible to halt or slow the process of disease
9
Q
What does the QRISK score do
A
calculate the pts risk of having a stroke or MI in the next 10 yrs
10
Q
what percentage on the QRISK indicates treatment? and what treatment?
A
> 10% means the pt should be started on statins
11
Q
what is the secondary prevention of CVD
A
4 As
- aspirin (plus 2nd antiplatlet, clopidogrel for 12mths)
- atorvastatin 80mg
- atenolol (or other B-blockers)
- ACEi (ramipril)
12
Q
What are the notable side effects of statins (3)
A
- myopathy
- T2DM
- haemorrhagic strokes (RARE)
13
Q
what is myopathy
A
any disease that affects the muscles that control voluntary movement in the body resulting in muscle weakness
14
Q
what is angina
A
it is a symptom - ‘attacks’ of chest pain
15
Q
what defines stable angina
A
when the symptoms are always relieved by GTN (glyceryl trinitrate)
16
Q
what defines unstable angina
A
when the symptoms come on random at rest and aren’t relieved by GTN
17
Q
what drug class does GTN spray belong to
A
nitrates
18
Q
how does GTN work
A
relax the muscle walls of the blood vessels and reduce the workload of the heart
19
Q
what is the gold standard Ix for angina
A
CT coronary angiography
20
Q
what other baseline Ix are commonly done for angina
A
- physical exam (?heart sounds, HF, BMI)
- ECG
- FBC (?anaemia)
- U&E (prior to starting ACEi)
- LFTs (prior to starting statins)
- lipid profile
- TFT (?hypo/hyperthyroid)
- HbA1C & fasting glucose (?DM)
21
Q
Why are U&Es performed prior to commencing ACEi?
A
ACEi reduce GFR and raise serum potassium
22
Q
Why are LFTs performed prior to commencing statins?
A
statins elevate liver enzymes
23
Q
What is the immediate symptomatic management of angina?
A
GTN spray
24
Q
What is the long term symptomatic management of angina
A
B-blocker (bisoprolol 5mg OD)
Ca channel Blocker (amlodipine 5mg OD)
25
what surgical interventions can be used for angina?
Percutaneous Coronary Intervention (PCI)
Coronary Artery Bypass Graft (CABG)
26
define thrombus
a blood clot formed in situ within the vascular system, impeding blood flow
27
what are thrombus from fast flowing arteries mainly made of
platlets
28
what are the different types of acute coronary syndrome (ACS)?
- unstable angina
- STEMI
- NSTEMI
29
how is a STEMI classified
- ST segment elevation
| - New LBBB
30
how is NSTEMI classified
- ST segment depression
- deep T wave inversion
- prolonged Q wave
31
how is unstable angina classified
- chest pain when at rest
- no ECG changes
- no rise in troponin
32
what is a differential for unstable angina
musculoskeletal chest pain
33
what can cause raised troponins
- MI
- chronic renal failure
- sepsis
- myocarditis
- aortic dissection
- PE
34
what symptoms suggest ACS
- central crushing chest pain
- pain may radiate to L arm and jaw
- N+V
- SOB
- sweaty/clammy
- palpitations
35
how can DM pts experience an ACS
a silent MI
36
Ix for ACS
- - physical exam (?heart sounds, HF, BMI)
- ECG
- FBC (?anaemia)
- U&E (prior to starting ACEi)
- LFTs (prior to starting statins)
- lipid profile
- TFT (?hypo/hyperthyroid)
- HbA1C & fasting glucose (?DM)
- CT coronary angiogram
- CXR
- ECHO (after event to look at function damage)
37
Tx for STEMI
<2hrs - Primary PCI
>2hrs - Thrombolysis
38
Name two drugs that are used in thrombolysis
alteplase
| streptokinase
39
define thrombolysis
the dissolution of a blood clot
40
Tx for NSTEMI
BATMAN!!!
- B (b-blocker)
- A (aspirin 300mg stat)
- T (ticragrelor 180mg stat/clopidogrel 300mg stat)
- M (morphine)
- A (anticoags, LMWH eg. enoxaparin)
- N (nitrates eg. GTN)
41
what risk score is used for NSTEMI
GRACE score
42
What does the GRACE score evalute
a pts risk of death in the next 6mths of an NSTEMI
43
what are the different GRACE scores
<5% - LOW risk
5-10% - MEDIUM risk
>10% - HIGH risk
44
When does the GRACE score suggest treatment
>5% (pt is a medium to high risk of mortality) means it is indicated that the pt be considered to early PCI tx (within 4days of admission
45
what are the complications of an MI
DREAD
```
D - death
R - rupture of the cardiac septum or papillary muscles
E - oEdema (heart failure)
A - arrhythmia/aneurysm
D - Dressler's syndrome
```
46
What is Dressler's Syndrome
Pericarditis 2-3wks after an MI
47
What causes Dressler's syndrome
localised immune response
48
How does Dressler's syndrome present
- pleuritic chest pain
- low grade fever
- pericardial rub on auscultation
- PMHx of MI
49
What Ix is used to diagnose Dressler's syndrome & what does it show
ECG
- global ST elevation
- T wave inversion
50
Tx of Dressler's syndrome
NSAIDs (1st)
Steroids
Pericardiocentesis - in severe cases
51
Secondary Prevention for ACS
the 6A's!
- Aspirin 75mg OD
- Another antiplatlet (clopidogrel/ticagrelor) for 12mths
- Atorvastatin 80mg OD
- ACEi (ramipril max 10mg OD)
- Atenolol
- Aldosterone antagonist for pts with clinical HF (eplerenone 50mg OD)
52
what secondary prevention lifestyle advice is given for ACS
- smoking cessation
- reduce alcohol consumption
- healthy diet (Mediterranean)
- cardiac rehabilitation
53
what is Hypertension
high blood pressure >140/90
54
what are the types of HTN
- primary/essential HTN (no underlying cause)
| - secondary
55
What are the causes of secondary HTN
ROPE
- Renal (MOST COMMON)
- Obesity
- Pregnancy induced HTN/pre-eclampsia
- Endocrine (mainly hyperaldosteronism)
56
What are the complications of HTN
- ischaemic heart disease
- CVA
- hypertensive retinopathy
- hypertensive nephropathy
- HF
57
how is HTN classified
- stage 1 >140/90
| - stage 2 > 160/100
58
what is the medical management for HTN for pts under 55yrs and non-black
step 1 : A
step 2: A+C
step 3: A+C+D
step 4: A+C+D+D
59
what is the medical management for HTN for pts over 55yrs and black
step 1 : C
step 2: C + ARB
step 3: C+ARB+D
step 4: C+ARB+D+D
60
What metabolite needs to be considered when administering diuretcis
serum potassium
```
>4.5mmol/L = higher dose thiazide-like diuretic
<4.6mmol/L = potassium sparing diuretic
```
61
name a higher dose thiazide-like diuretic
indapamide
62
name a potassium sparing diuretic
spironolactone
63
how do potassium sparing diuretics work
blocking the action of aldosterone in the kidneys resulting in Na excretion and K retention
= aldosterone antagonist
64
what is monitored when taking ACEi or diuretics
regular U+Es for hyperkalaemia
65
which patients would you prescribe a CCB over an ACEi for HTN
pregnant women
66
define heart failure
a clinical syndrome resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress
67
what are the two types of heart failure (HF)
Acute & Chronic
68
How does NICE define acute HF
New onset HF in a pt with no known cardiac dysfunction
Acute decompensation of Chronic HF
69
Define Left Ventricular Ejection Fracture (LVEF)
the percentage of the blood in the left ventricle which is pumped out with each heartbeat
70
What are the triggers for Acute HF
- Iatrogenic (aggressive IV tx)
- SEPSIS
- MI
- Arrhythmia
71
Symptoms of Acute HF
- rapid onset breathlessness
- SOB
- cough with 'frothy white/pink sputum'
72
Signs of Acute HF
- raised RR
- reduced Sp02
- tachycardia
- 3rd heart sound
- bilateral basal crackles
- hypotension
73
What type of respiratory failure will acute HF present with
T1RF
74
What causes the 3rd heart sound in Acute HF
early-diastolic rapid distention of the L ventricle + rapid ventricular filling +abrupt deceleration of the atrioventricular blood flow
- the force of the blood filling the L ventricle due to the high pressure of the overloaded vasculature system -
75
What are the signs of R-sided HF
- raised JVP
| - peripheral oedema (ankles/legs/scrotum)
76
Ix for Acute HF
- ECG
- ABG
- CXR
- BNP
- ECHO
77
CXR findings of HF
```
A - alveolar oedema
B - Kerley B lines (interstitial oedema)
C - cardiomegaly
D - dilated prominent upper lobe vessels
E - pleural effusion
```
78
in Acute HF what takes priority Ix or Tx
Tx - pts can deteriorate rapidly
79
What does BNP stand for
B-type natriuretic Peptide
80
What is BNP
a hormone released from the ventricles when the myocardium is stretched beyond the normal range
81
What does BNP do
- relaxes the smooth muscle reducing the systemic vascular resistance
- acts as a diuretic on the kidneys promoting more excretion of H20
82
What are the other causes of a raised BNP
- tachycardia
- sepsis
- PE
- renal impairment
- COPD
83
Mx for Acute HF
Pour SOD
- Pour away IV fluids (stop IV fluids)
- Sit up
- O2
- Diuretics (furosemide 40mg stat)
84
what is monitored in Acute HF
- fluid intake
- UO
- U&Es
- daily body weight
85
What are the two types of Chronic HF
- systolic heart failure (impaired contraction)
| - diastolic heart failure (impaired relaxation)
86
Symptoms of Chronic HF
- SOB (worse on exertion)
- cough with frothy white/pink sputum
- orthopnoea
- paroxysmal nocturnal dyspnoea
- peripheral oedema
87
what is Orthopneoa
the sensation of SOB when lying flat - how many pillows do pts have to use to sleep
88
what is paroxysmal nocturnal dyspnoea
sudden waking during the night with a severe attack of SOB and cough
89
what is the first line Ix for HF
BNP blood test
90
what is the diagnostic Ix for HF
ECHO
91
What are the causes of Chronic HF
- Ischaemic Heart disease
- HTN
- Valvular disease (AS)
- Arrhythmias (AF)
92
What lifestyle advice is given for chronic HF
- smoking cessation
- yearly flu and pneumococcal vaccine
- exercise as tolerated
- optimise tx of co-morbidities
93
what is the first line management for Chronic HF
ACEi (ramipril 10mg OD max)
B-blocker (bisoprolol 10mg OD max)
if not controlled
```
Aldosterone antagonists (eplerenone/spironolactone)
Loop diuretics (furosemide 40mg OD)
```
94
What does ARB stand for
angiotensin receptor blocker
95
Name an ARB
candesartan
96
What classification is used to assess the severity of HF
The New York Heart Association's (NYHA) Classification of Heart Failure
97
How does the NYHA define the different levels of HF
Class I: no symptoms on ordinary physical activity.
Class II: slight limitation of physical activity by symptoms.
Class III: less than ordinary activity leads to symptoms.
Class IV: inability to carry out any activity without symptoms.
98
What are the common SE of ACEi
- dry cough
- hyperkalaemia
- hypotension
99
how do ACEi work
inhibits angiotensin-converting enzyme from converting angiotensin 1 to angiotensin 2 stimulating the dilation of blood vessels
- increased Na + Urine excretion
- reduced resistance in kidney blood vessels
- increased venous capacity
- decreased CO + SV
100
contraindications for ACEi
- hyperkalemia (>5.5mmol/L)
- renal artery stenosis
- pregnant
- previous bad reaction
101
how do Beta Blockers work
block the hormone ephinephrine
102
common SE of Beta Blockers
- bradycardia (fatigue/dizzy/lightheaded)
- cold figners/toes
- difficulties sleeping
- nausea
103
contraindications for Beta blockers
- asthma
- uncontrolled HF
- bradycardia
- hypotension
- certain cardiac rhythm issues
104
How do Calcium Channel Blockers work?
Block Ca2+ from entering the myocardium and smooth muscle of the arteries. Preventing contraction = reduced BP
105
what is R sided heart failure called
Cor Pulmonale
106
what causes Cor Pulmonale
respiratory disease
107
what is the pathophysiology of Cor Pulmonale
raised pressure and resistance in the pulmonary arteries causes pulmonary HTN, resulting in back pressure throughout the systemic venous system
108
what are the respiratory causes of Cor Pulmonale
- COPD
- PE
- Interstitial lung disease
- CF
- Primary pulmonary hypertension
109
how do pts with Cor Pulmonale usually present
SOB
- peripheral oedema
- increased breathlessness on exertion
- syncope
- chest pain
110
what are the signs of Cor Pulmonale
- hypoxia
- cyanosis
- raised JVP
- peripheral oedema
- 3rd heart sound
- murmurs (pan-systolic/tricuspid regurgitation)
- hepatomegaly
111
Mx of Cor Pulmonale
- tx underlying symptoms
| - long term oxygen therapy
112
what causes the first heart sound
closing of the atrioventricular valve
113
what causes the second heart sound
closing of the semilunar valves
114
what can cause a third heart sound
rapid ventricular filing causing the chordae tendineae to pull to their full length and twang like a guitar string
115
what can cause a fourth heart sound
indicates a stiff or hypertrophic ventricle and therefore caused by turbulent bloodflow
116
when is the fourth heart sound heard
heard directly before S1
117
what does a large square on the ECG represent
0.2secs (5mm)
118
what does a small square on the ECG represent
0.04sec (1mm)
119
what is the normal width of a QRS complex
2-3 small squares (0.08/0.12sec)
120
what does a narrow QRS complex typically suggest
an arrhythmia arising in the atria or junctional region
121
what does a broad QRS complex typically suggest
an arrhythmia arising from below the AV node (eg. ventricules) OR a co-existing bundle branch block
122
what are the common types of atrial arrhythmia
- sinus tachycardia
- atrial flutter
- AF
123
what is the main cause of irregular QRS complexes
AF
124
what are the different types of Ventricular Tachycardia (VT)
- monomorphic VT
- fascicular VT
- polymorphic VT
- torsades de pointes tachycardia
125
what is monomorphic VT
- broad QRS (>0.12s)
| - regular rhythm
126
what is fascicular VT
- narrow QRS (0.11-0.14)
127
what is polymorphic VT
- repeated progressive changes in the QRS axis.
128
what is torsades de pointes
subgroup of polymorphic
- prolongation of QT interval
129
what is AF
when the contraction of the atria is uncoordinated, rapid and irregular
130
what causes AF
disorganised electrical activity of the SA node
131
Presenting symptoms in AF
- palpitations
- SOB
- syncope
- symptoms of associated conditions (eg.stroke, sepsis, thyrotoxicosis)
132
what are the two causes of irregularly irregular pulse
- AF
| - ventricular ectopic
133
what ECG changes are seen with AF
- absent P waves
- narrow QRS complex tachycardia
- irregularly irregular ventricle rhythm
134
what is valvular AF
AF in pts with mitral stenosis or a mechanical heart valve
135
what are the most common causes of AF
mrs SMITH
```
Sepsis
Mitral valve pathology (stenosis/regurg)
Ischaemic heart disease
Thyrotoxicosis
Hypertension
```
136
what are the two main principles of treating AF
- rate & rhythm control
| - anticoagulation
137
what should be the first line Mx for AF pts
rate control
138
which different medications can be used for rate control
- beta blocker (eg.atenolol) = FIRST LINE
- CCB (eg. diltiazem)
- digoxin
139
what is the purpose of rate control
reduce HR to extend the time during diastole when the ventricles can be filled with blood
140
what is the alternative to rate control
rhythm control
141
when can rhythm control be used
- reversible causes of AF
- new onset AF
- AF thats causing heart failure
- remain symptomatic despite effective rate control
142
what is the purpose of rhythm control
return the pt to normal sinus rhythm
143
how is rhythm control done
cardioversion
144
what is cardioversion
puts the pt back into sinus rhythm
145
what are the two types of cardioversion
- pharmacological
| - electrical
146
which medication are first line for cardioversion
- flecanide
| - amiodarone
147
what medication can be used for long term medical rhythm control
- beta blockers
- dronedarone
- amiodarone
148
what is paroxysmal AF
when AF comes and goes
149
what score is used to assess a pts risk of a stroke with AF
CHADSVASc
150
what score is used to assess a pts risk of bleeding whilst on anticoags
HAS-BLED
151
what is warfarin
vitamin K antagonist
152
what does NOACs stand for
novel anticoagulants
153
what does DOACs stand for
Direct acting Oral Anticoagulants
154
what is the target INR for AF
2-3
155
give examples of a NOAC/DOACs
- apixaban
- dabigatran
- rivaroxaban
156
how are CHADVASc scores used
```
0 = no anticoag
1 = consider anticoag
2 = offer anticoag
```
157
what does CHA2DS2-VASc stand for
```
Congestive heart failure
Hypertension
Age>75 (scores 2)
Diabetes
Stroke/TIA (scores2)
Vascular disease
Age (65-74)
Sex (female)
```
158
what does HAS-BLED stand for
```
Hypertension
Abnormal liver/renal function
Stroke
Bleeding
Labile INR
Elderly
Drugs/alcohol
```
159
what is an arrhythmia
abnormal heart rhythm
160
how many cardiac arrest rhythms are there
4
161
what are the 4 cardiac arrest rhythms
- Ventricular tachycardia
- ventricular fibrillation
- pulseless electrical activity (all normal activity including sinus rhythm without a pulse)
- asystole
162
what are the two shockable rhythms in a cardiac arrest
- VT
| - VF
163
what are the tx options in unstable tachycardia
- consider up to 3 synchronised shocks
| - amiodarone infusion
164
what are the 3 types of narrow complex tachycardia
- AF
- atrial flutter
- SVT
165
what are the 3 types of broad complex tachycardia
- VT
- SVT with bundle branch block
- ?variation of AF if irregular
166
what is the cause of atrial flutter
re-entrant rhythm in the atria where the electircal signal recirculates in a self-perpetuating loop due to an extra electrical pathway
167
what conditions are associated with atrial flutter
- HTN
- IHD
- cardiomyopathy
- thyrotoxicosis
168
tx for atrial flutter
- rate/rhythm control with beta blockers/cardioversion
- tx underlying condition
- radiofrequency ablation
- anticoagulaiton
169
what is the cause of SVT
electrical signal re-entering the atria
170
what is paroxysmal SVT
where SVT reoccurs and remits
171
what are the 3 types of SVT
- atrioventricular nodal re-entrant tachycardia
- atrioventricular re-entrant tachycardia (WOLF-PARKINSON-WHITE syndrome)
- atrial tachycardia
172
what is atrioventricular nodal re-entrant tachycardia
when the re-entry point is back through the AV node
173
what is atrioventricular re-entrant tachycardia
re-entry point is an accessory pathway
174
what is atrial tachycardia
where the electrical signal originates somewhere other than the SA node
175
acute Mx of stable SVT
- continuous ECG monitoring
- valsalva manoeurve
- carotid sinus massage
- adenosine
- verapamil
- direct current cardioversion
176
how does adenosine work
slowing cardiac conversion primarily through the AV node
177
what conditions mean that adenosine should be avoided
- asthma
- COPD
- HF
- heart block
- severe HTN
178
long-term mx of paroxysmal SVT
- beta blockers
- CCB
- amiodarone
- radiofrequency ablation
179
what causes Wolff-Parkinson-White syndrome
an extra electrical pathway connecting the atria and ventricles
180
what is the extra pathway in Wolff-Parkinson-White syndrome called
bundle of kent
181
what is the definitive tx in Wolff-Parkinson-White syndrome
radio-frequency ablation of the accessory pathway
182
what ECG changes are seen in Wolff-Parkinson-White syndrome
- short PR interval
- wide QRS complex
- "delta wave" - slurred upstroke on the QRS complex
183
what is Torsades de Pointes
a type of polymorphic VT - translates as twisting of the tips
184
how does look Torsades de Pointes
height of the QRS complexes progressively get smaller, then larger then smaller and so on
185
what are the two possible outcomes of Torsades de Pointes
- spontaneously revert back to normal sinus rhythm
| - progress to VT
186
what are the ECG changes of Torsades de Pointes
- prolonged QT interval
187
what are the causes of prolonged QT
- inherited (Long QT syndrome)
- medication
- electrolyte disturbance
188
what medications can cause prolonged QT
- antipsychotics
- citalopram
- flecainide
- sotalol
- amiodarone
- macrolide abx
189
what electrolyte disturbances can cause a prolonged QT
- hypokalaemia
- hypomagnesaemia
- hypocalcaemia
190
acute Mx of Torsades de Pointes
- correct cause
- Mg infusion
- defibrillation if VT occurs
191
long term Mx of Torsades de Pointes
- avoid certain medication
- correct electrolyte disturbance
- beta blockers (not sotalol)
- pacemaker/implantable defib
192
what are ventricular ectopics
premature ventricular beats
193
what is bigeminy
when a ventricular ectopic occurs after every sinus beat
194
what is first degree heart block
delayed atrioventricular conduction through the AV node
195
how does first degree heart block present on an ECG
prolonged PR interval > 0.20s (1 big square)
196
what is second degree heart block
when some of the atrial impulses do not make it through the AV node
197
how many types of second degree heart block are there
3
198
what are the different types of second degree heart block
- Mobitz Type 1
- Mobitz Type 2
- 2:1 Block
199
what is Mobitz type 1
where the atrial imputes gradually become weaker until they do not pass through the AV node, then the cycle restarts
200
how does Mobitz type 1 present on an ECG
an increasing PR interval until there is an absent QRS then the cycle repeats
201
what is Mobitz type 2
intermitted failure or interruption of AV conduction
202
how does Mobitz type 2 present
missing QRS complexes
203
what is 2:1 Block
where every other atrial impulse is not strong enough to pass through the AV node
204
how does 2:1 Block present on an ECG
2 p waves for every QRS omplex
205
what is third degree heart block
complete heart block
206
how does third degree heart block present on an ECG
no relationship between p waves and QRS complexes
207
what are pts with thrid degree heart block at significant risk of
asystole
208
what is the mx for stable AV node blocks
observation
209
what is the first line mx for unstable AV node blocks
Atropine 500mcg UV
210
what is the second line mx for unstable AV node blocks
- Atropine 500mcg IV (repeated up to 6 doses - max 3mg)
- other inotropes (eg. noradrenaline)
- transcutaneous cardiac pacing
211
how does atropine work
inhibiting the parasympathetic nervous system
212
what is atropine
antimuscarinic
213
what are alpha blockers used for
- BPH
| - add-on tx in resistant HTN
214
example of an alpha blocker
- doxazosin
- tamsulosin
- alfuzosin
215
how do alpha blockers work
- selective to the a1-adrenoceptor
| - causes smooth muscle relaxation = vasodilation = BP fall and reduced resistance to bladder outflow
216
adverse affects of alpha blockers
- postural hypotension
- dizziness
- syncope
217
Which alpha blocker is licenced for both HTN and BPH
Doxazosin
218
Which alpha blocker is only licenced for BPH
Tamsulosin
219
what is adenosine
a first-line diagnostic and therapeutic agent in SVT
220
how does adenosine work
agonist of adenosine receptors which when activated in the heart
- reduce the frequency of spontaneous depolarisations
- increasing resistance to depolarisation
221
how long does adenosine last
plasma half life < 10seconds
222
Adverse effects of adenosine
bradycardia
| asystole
223
which pts should not be given adenosine
- hypotension
- coronary ischaemia
- decompensated heart failure
- asthma (can cause bronchospasm)
- COPD
224
how is adenosine given
6mg IV
225
when is adrenaline used
- cardiac arrest
- anaphylaxis
- surgical setting (local vasoconstriction)
226
what is adrenaline
potent agonist of the a1-, a2-, b1- and b2- adrenoceptors
227
how does adrenaline work
agonist of adrenoceptors = sympathetic (fight/flight) response
- vasoconstriction
- increased HR
- increase force of contraction and myocardial excitability
- vasodilation of vessels supplying heart and muscle
- bronchodilation
- suppression of inflammatory mediator release from mast cells
