cardio amk Flashcards
how to assess a patients stroke score risk
CHAD2DS2 - VASc score
what should be offered in first line for reducing stroke risk in AF
DOACs - direct oral anticognualtns - rivaroxaban - patients with AF are at increase risk of stroke due to atrial emboli
anticoagulants slow down clotting reducing fibrin formation and prevent clot formation and growth
anti-platlet drugs like aspirin prevent platelets from clumping together and prevent clot formation and growth
what is atorvastatin
statin
what INR
prothrombin time
The international normalized ratio (INR) is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin
A 61-year-old woman visits her GP to review her anginal medication. She is concerned about her condition and asks about what has caused the narrowing of her coronary arteries.
Which of the following is a change which occurs in the process of atherosclerosis?
Phagocytosis of HDLs by macrophages, forming foam cells
Infiltration of the tunica externa by LDL particles
Fatty infiltration of the subendothelial space
Hypertrophy of the arterial layers
Increased nitric oxide bioavailability
Fatty infiltration occurs at the subendothelial space
Atherosclerosis is a complex process which develops over a number of years. A number of changes can be seen:
initial endothelial dysfunction is triggered by a number of factors such as smoking, hypertension and hyperglycaemia
this results in a number of changes to the endothelium including pro-inflammatory, pro-oxidant, proliferative and reduced nitric oxide bioavailability
fatty infiltration of the subendothelial space by low-density lipoprotein (LDL) particles
monocytes migrate from the blood and differentiate into macrophages. These macrophages then phagocytose oxidized LDL, slowly turning into large ‘foam cells’. As these macrophages die the result can further propagate the inflammatory process.
smooth muscle proliferation and migration from the tunica media into the intima results in formation of a fibrous capsule covering the fatty plaque.
3 arterial blood supplies of the thymus
Superior thyroid artery (1st branch of external carotid) Inferior thyroid artery (from thyrocervical trunk) Thyroidea ima (in 10% of population -from brachiocephalic artery or aorta)
at what level does the right phrenic nerve cross the diaphragm
T8
STEMI in leads II, III, avF
hat infarction and artery
inferior myocardial infarction
right coronary artery
st elevation seen in V1,2
anteroseptal defect
LAD
V3,4
anterior RCA/LAD
I , AVL V5,6
lateral
circumflex artery
bundle branch blocks through what structure
bundle of his
MARROW
WILLIAM - left
if hypertension with typ2 or
under 55 and not black without type 2 what do you prescribe
first line ACEi or ARB
then either or or add thiazide or CCB
if ages 55 or over or black without T2D
CCB first line
then ACEi or ARB or thiazide
enalapril is an ACEi how does it work and side effects
stimulate dilation of BV by inhaibiting production of angiotensin II
dry cough due to increased bradykinin
amplodipine is a CCB and prevents entry for smooth muscle calcium and muscle contractions and slow deep at SA node what are the side effects
headaches and flushing feeling with swollen ankles
losartan is an ARB - angiotensin blocker by backing receptors especially AT1 found in heart and blood vessels
side effects
severe N+ V
confusion
dizziness - side effect strongest on first dose especially if taking a diuretic
hyperkalaemia
coronary arteries arise form the ascending aorta. on the right the subclavian and carotid arise from the brachiocephalic on theft
subclavian and carotid arise from arch of the aorta singularly
atrial blood pressure formula
DBP + 1/3 ( SBP - DBP)
AGT2 is vasoconstrictor of the efferent arterioles what does Ace work
lungs
if someone has acute heart failure and is not responding to treatment what should be considered
CPAP
normally for heart failure give loop diuretics plus oxygen and vasodilators ( hypotension side effect)
respiratory failure give CPAP
in cardiogenic shock give inotropic agents e.g. dobutamine
renin secreted by what cells
juxtaglomerular cells
what factors stimulate renin secretion
erect posture hypotension hyponatrraemia SNS catcholamines
factors that reduce renin secretion are beta blockers(by inhibiting β1-adrenergic receptors located on JG cells.) and NSAIDs (Cyclooxygenase inhibition by NSAIDs results in two results; first, they decrease distal sodium delivery by reducing glomerular filtration and enhancing salt absorption by the nephron; second, by inhibiting macula densa PGs production they reduce renin release.)
origin of IVC
L5
level the aorta bifurcates into the left and right common iliac
L4
Intercristal plane
L4 - level of highest point of iliac crest
Intertubercular plane
level of L5 body
subcostal margin
Lowest margin of 10th costal cartilage
bosentan is used to treat primary pulmonary hypertension what does it do
endothelin - 1 receptor antagonist
ecg finding of hypokalaemia
Small or inverted T waves, ST segment depression and prominent U waves are all ECG signs of hypokalaemia. Other signs include a prolonged PR interval (can also be present in hyperkalaemia) and a long QT interval.
ecg findings of hyperkalaemia
small or absent P waves is an ECG sign of hyperkalaemia.
QRS complexes become wide and unusual.
A patient develops shortness of breath, wheezing and hypotension following head and neck surgery. It is suspected that this could be due to a large air embolism.
Which of the following could have allowed this to happen?
Negative atrial pressures may allow air embolization to occur when neck veins are exposed to air
Important for meLess important
Head and neck surgeries are the most common causes of air embolisms. Depending on the position of the patient negative pressures can develop in the venous circulation and the atria due to thoracic wall movement. If a vein is cut during the surgery then these negative pressures cause air to move into the veins causing an air embolism.
branches of external carotid
‘Some Angry Lady Figured Out PMS’
Superior thyroid (superior laryngeal artery branch) Ascending pharyngeal Lingual Facial (tonsillar and labial artery) Occipital Posterior auricular Maxillary (inferior alveolar artery, middle meningeal artery) Superficial temporal
what nerve supplies the central diaphragm and pericardium
phrenic nerve
what is aortic dissection and symptoms
Aortic dissection is aorta splits
present with symptoms of sudden onset chest pain with radiation to the back, shortness of breath and the patient would be systemically unwell e.g. hypotension
common symptom In heart failure
Paroxysmal nocturnal dyspnoea (suddenly waking up at night short of breath) is a key feature in heart failure; more commonly occurring in left-sided heart failure
MI symptoms
chest pain, clamminess, nausea and ECG changes.
PE symptoms
pleuritic chest pain, shortness of breath and haemoptysis.
right sided heart failure symptoms
raised JVP, ankle oedema and hepatomegaly.
