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Conditions + definitions > Cardio > Flashcards

Cardio Flashcards

1
Q

What is the endocardium?

A

Inner most layer of heart
Lines heart chambers
Made of simple squamous epithelium on basement membrane
Forms valves

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2
Q

What is the myocardium?

A 
The middle layer of the heart, thickest
Made of cardiac muscle
Striated with lots of mitocondria
Rich capillary bed
Myocytes connected by intercalated discs
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3
Q

What are intercalated discs?

A 
Complex junctions that connect myocytes
Desmosomes
>Binds myocytes together
Gap junctions
>Electrical communication
>Essential cor o-ordination oc cardiac cycle
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4
Q

What is the epicardium?

A

Outer layer of heart
Made up of connective tissue and BM with simple squamous pithelium
>Epithelium same as visceral layer of serous pericardium
Contains main branches of coronary arteries

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5
Q

What are the features of the heart valves?

A

Control direction of blood
Cusps - thin structures derived from endocardium
Work passively
Chordae tendineae and papillary muscles prevent valve failure

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6
Q

What are the heart valves?

A

Semilunar - Pulmonary /Aortic

Atrio-ventricular - bicupsid (mitral) / tricupsid

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7
Q

What is the cardiac skeleton?

A

Connective tissue that provides structural support to the heart
Provides electrical insulation

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8
Q

What are the coronary arteries?

A

Left and right - have smaller subdivisions
Found in epicardium
During systole aortic sinuses shielded by aortic valve cusps
In diastole blood can then enter

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9
Q

What makes up the cardiovascular system?

A

Heart
arteries, veins, capillaries
Lymphatics

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10
Q

What are the layers of a blood vessel?

A 
Tunica intima
>simple squamous Epithelium + BM + epithelium
Tunica media
>Muscle - smooth or elastic
Tunica adventitia
>Connective tissue
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11
Q

What are the types of arteries?

A

Elastic
Muscular
Arterioles

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12
Q

What are elastic arteries?

A

For large conducting arteries - like Aorta
Work as a pressure reservoir
Stretched during systole, and during dystole they recoil maintianing pressure on blood
Due to elastic fibres in tunica media in laminae

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13
Q

What are muscular arteries?

A

For distribution of blood to regions - like femoral
No elastic laminae, but smooth muscle cells
Do have elastic fibres in internal elastic lamina and external elastic lamina
>Found underneath epithelium and between Tunica media and adventitia

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14
Q

What are arterioles?

A

Terminal branches before capillaries
No internal elastic lamina
Only 1 or 2 layers of smooth muscle in tunica media
And no tunica adventitia
They control blood flow to capillary beds
And control systemic blood pressure

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15
Q

What are capillaries?

A

Main site of echange for nutrients and gases
Thin walled with only tunica intima
Have pericytes that help control bloof flow

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16
Q

What are pericytes

A

an incomplete layer of cells surrounding basment membrane of capillaries
Have contractile properties

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17
Q

What are the three types of capillary?

A

Continuous
Fenestrated
Discontinuous

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18
Q

What are the features of continuous capillaries?

A

Can control what is exchanged in and out
Material must pass through cell of between cell
Selective transport mechanims
Foundin muscle

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19
Q

What are the features of fenestrated capillaries?

A

Have pores in the lining (fenestrations)
Can be with or without protein diaphgrams (which filter moecules by weight or charge)
Found in endocrine glands/renal corpsucle

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20
Q

What are the features of discontinuous capillaries?

A

Have gaps between endothelial cells (and basement membrane)
Allow free passage of fluid and cells
Found in Liver, spleen, bone marrow

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21
Q

What are sinusoids?

A

Large diameter discontinuous capillaries
Found where large amount of exchange takes place
T. intima contains phagocytic cells

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22
Q

What is the structure of a vein?

A 
Thin T intima
IEL/EOL thin or absent
T mediat thin or absent
T adventitia made of collagenous tissue
Have valves to prevent backflow
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23
Q

What is the difference between superficial veins and deep veins?

A

Superficial are thick walled and have no surrounding support

Deep are thin walled and have surrounding support from deep fascia and muscle

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24
Q

What is teh lymphatic system?

A

Drains tissue fluid lost from capillaries
Drains into venous system
Nodes found alongside major veins/artery origins
Valves direct flow

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25
Q

What are lymph capillaries?

A

Blind ended capillaries lined by vey thin epithelium
No fenestations
Absent basal lamia
Lumen contained via negative hydrostatic pressure
>has collagenous filaments linking to surrounding tissue to keep lumen open
No red blood cells enter

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26
Q

Where is the blood/lymphatic cupply of blood vessels?

A

Blood - vasa vasorum in T adventitia

Lymphatics in T adventitia

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27
Q

What is the cardiac cycle?

A

Diastole
Atrial systole
Ventricular contraction
Ventricular ejection

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28
Q

What is the pressure volume loop?

A

A – ventricular diastole + filling sees a gradual increase in volume and pressure.
B – mitral valve closes and the ventricle contracts, pushing pressure up rapidly.
C – Aortic valve opens and the ventricle is still contracting increasing its pressure, decreasing volume.
D – Aortic valve closes and the ventricle relaxes causing a rapid decrease in pressure.

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29
Q

What is the phonocardiogram?

A

Should hear mitral and tricupsid valves closing together
Then a little later tha aortic + pulmonary closing
“lub-dub” extra hear sounds can be heard in pathology

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30
Q

Why is cardiac muscle unable to exhibit tetanus?

A

Has a longer refractory period than skeletal muscle
Means that when last contraction is ending, new one begins
Stops tetanus from occuring

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31
Q

What affects electrical activity of the heart?

A 
Temperature
Calcium plasma levels hyper=tachycardia + increased contraction, vice versa
Potassium serum levels
Drugs
>CCBs, 
>Cardiac glycosides
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32
Q

What is the conducting system of the heart?

A

SAN through atria
AVN
Through bundle of his
Through purkinje fibres

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33
Q

What do the waves on an ECG correspond to?

A

P - atrial depolarisation
QRS - corresponds to ventricular depolarisation
T - ventricular repolarisation

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34
Q

Where are the ECG limb leads placed?

A

Right wrist
left wrist
Left leg
Placed on right leg but used to earth

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35
Q

What is the PR interval?

A

The time ti takes from atrial depolarisation to ventricular depolarisation

36
Q

What do the precordial leads view?

A

Gives same information, however in the transverse plane

37
Q

How large should a square on ECG paper run?

A

5mm - 0.2 seconds

I.e 30 squares to a minute

38
Q

What is a STEMI?

A

ST elevated myocardial infarction (worse than if it didn’t exist)

39
Q

What is the normal range for the PR interval?

A

0.12-0.2 seconds

40
Q

What is the normal range for the QRS interval?

A

no more than 0.12 seconds

41
Q

What is the normal range for the QT interval?

A

0.42 seconds

42
Q

What HR is normal, bradycardic, tachycardic?

A

Less than 60 = bradycardic
60-100 normal
Above 100 = tachycardic

43
Q

What are starling’s forces?

A

Capillary hydrostatic pressure vs ISF hydrostatic pressure
Plasma osmotic pressure vs ISF osmotic pressure
Net filtration pressure = (Pc - Pif) - (piP - piIF)

44
Q

What is darcy’s law?

A

Flow = pressure/resistance

45
Q

What is poseuille’s law?

A

Resistance is proportional to length of tube * the viscosity of the fluid /radius

46
Q

What determines mean arterial pressure?

A

Cardiac output * total peripheral resistance

47
Q

How is MAP controlled extrinsicly?

A

Neural control through sympathetic nerves
Hormonal control through adrenaline
>Both constriction and dilation, dependent on tissue
Angiotensin
Vasopressin

All above are constriction
ANP?BNP - arterial dilation

48
Q

What are the intrinsic mechanisms for controlling MAP?

A

Metabolic driven (to “flush”)
Pressure autoregulation
Reactive (due to occlusion)
Injury response

49
Q

What contributes to venous return?

A 
Gravity 
skeletal muscle pump
respiratory pump
venomotor tone 
systemic filling pressure
50
Q

What is the vasalva maneuvre?

A

Forced expiration against a closed glottis

Activates baroreceptor reflex due to decreasing venous return momentarily

51
Q

What are the signs of hyperlipidaemia?

A 
Corneal arcus
Tendon xanthomata
Xanthelasmata
Family history
Biochemical evidence
52
Q

What is virchow’s triad?

A

Risk factors for thrombosis

Changes in blood vessel wall
Changes in blood constiuents
Changes in pattern of blood flow

53
Q

How do beta blockers help myocardial demand?

A

Decrease heart rate
Decrease contracility
Decrease systolic wall tension

Thus decrease CO/BP

54
Q

What is the rebound phenomena?

A

Sudden cessation of beta blocker therapy may precipitate myocardial infarction

55
Q

What are the contraindications fo beta blockers?

A 
Asthma
Peripheral Vascular Disease
>Relative contraindication
Raynauds Syndrome
Heart failure
>Those patients who are dependent on sympathetic drive
Bradycardia / Heart block
56
Q

How is HR regulated?

A

Sympathetic - increases
Parasympathetic - decreases

Both act on SAN

57
Q

What is afterload?

A

Afterload is the load against which the muscle tries to contract
Set by arterial pressure
In turn determined by TPR (inversely proportional)

58
Q

How is stroke volume affected by calcium + infacrction + barbituates?

A

Hypercalcaemia - increaes
Hypocalcaemia - decreaes
Infacrction - decreaes
Barbituates - decreaes

59
Q

What are the types of CCBs?

A

Rate limiting

Vasodilation

60
Q

How do you treat an ischaemic stroke?

A

Ateplase within 4.5 hours

After confirmed on CT head

61
Q

What is secondary prevention for a stroke?

A

Clopidogrel
Or aspirin + diprydamole

Statins

62
Q

What are the common sites for varicose veins?

A

Long and short saphenous veins

63
Q

What are the S&S of varicose veins?

A 
Cosmesis
Localised or generalised discomfort in the leg
Nocturnal cramps
Swelling
Acute haemorrhage
Superficial thrombophlebitis
Pruritus - itching
Skin changes
64
Q

When should you treat varicose veins?

A

Superficial thrombophlebitis
Signs of chronic venous insufficiency
Bleeding

65
Q

How do you treat varicose veins?

A 
Surgery
High tie, stripping, multiple stab avulsions
Injection (sclerotherapy)
Minimally invasive procedures
Compression
Conservative (may include compression)
66
Q

What is the presentation of chronic venous insufficency?

A 
Ankle oedema
Telangectasia
Venous eczema
Haemosiderin pigmentation
Hypopigmentation “atrophie blanche”
Lipodermatosclerosis
Venous ulceration
67
Q

What is the pathogensis of CVI?

A

Venous hypertension
Venous engorgement and stasis
Imbalance of Starling forces and fluid exudate

Often due to standing still
Or high AVP

68
Q

What is a leg ulcer?

A

breach in the skin between knee and ankle joint, present for over 4 weeks

69
Q

How do you treat CVI?

A

compression therapy
EXCLUDE ARTERIAL DISEASE

Dressings- non-adherent dressings
if painful- hydrocolloid/ foam dressing
Exercise – calf muscle pump

70
Q

What are the causes of lymphodema?

A 
Primary:	
>Congenital
>Praecox
>Tarda
Secondary
>Malignancy
>Surgery (Radical mastectomy; groin/axillary dissection)
>Radiotherapy
>Infection (Filariasis/tuberculosis/pyogenic)
71
Q

What abnormalities is downs associated with?

A

Atrioventircal septal defects

Duodenal atresia

72
Q

What abnormalities is turner syndrome associated with?

A

coarctation of aorta
short stature
gonadal dysgenesis

puffy hands

73
Q

What abnormalities is nooan syndrome associated with?

A

Pulmonary stenosis
Short stature
neck webbing
cryptorchidism

74
Q

What abnormalities is 22q11 deletion syndrome associated with?

A 
C ardiac malformation
A bnormal facies
T hymic hypoplasia
C left palate
H ypoparathyroidism
75
Q

What abnormalities is williams syndrome associated with?

A 
Aortic stenosis (supravalvar)
Hypercalcemia
5th finger clinodactyly
characteristic face
cocktail party manner
76
Q

What abnormalities is marfansyndrome associated with?

A

Connective tissue disorder
Mitral valve prolapse
Pneumothorax!

77
Q

What is a true aneurysm?

A 
Weakness and dilation of vessel wall - include all layers
Associated with:
Hypertension
Atherosclerosis
Smoking
Collagen abnormalities 	(Marfan’s)
Trauma
Infection 	(mycotic/syphillis)
78
Q

What is a false aneurysm?

A

Rupture of aortic wall

Haematoma contained by adventitial layer or surrounding soft tissue

79
Q

How does a false aneurysm present?

A

Thrill
Bruit
Pulsatile mass

Ischaemia
Rupture

80
Q

How does a thoracic aneurysm present?

A

shortness of breath or even heart failure (AR)
dysphagia and hoarseness (ascending aorta, chronic)
Sharp chest pain radiating to back –between shoulder blades –Possible dissection!
Pulsatile mass
Hypotension

81
Q

What are the risk factors for aortic dissection?

A

Hypertension
Atherosclerosis
Trauma
Marfan’s syndrome

82
Q

What is takayasu’s artertitis?

A 
Granulomatous vasculitis
Affects women more than men
Presents with stenosis,
Thrombosis
Aneurysms
Renal artery stenosis
Neurological symptoms
83
Q

What is a bicupsid aortic valave?

A 
Most common congenital abnormality
Prone to stenosis +/- regurgitation
Associated with:
 coarctation
Abnormal aorta (reduced tensile strength)
Prone to aneurysm/ dissection
Monitor with echo/ MRI
84
Q

What are the signs of coarctation?

A

Cold legs
Poor leg pulses
If before left subclavian artery:
>Radial – radial and RIGHT radial-femoral delay

If after left subclavian artery:
>No radial- radial delay
>Right and left radio-femoral delay

85
Q

What are the symptoms of chronic limb ischaemia?

A

Intermittent claudication
“Critical limb ischaemia”
Rest pain
ulceration & gangrene (wet/dry)

Conditions + definitions (68 decks)

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