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YEAR 1 > cardio theory > Flashcards

cardio theory Flashcards

1
Q

depolarisation + repolarisation electrolyte movement (SA node)

A
  1. Ca2+ influx (de-)
  2. K+ efflux (re-)
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2
Q

depolarisation + repolarisation electrolyte movement (myocytes)

A
  1. Na+ influx (up)
  2. Ca2+ influx (flat)
  3. K+ efflux (down)
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3
Q

stroke volume (SV)

A

volume of blood ejected by each vent per beat

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4
Q

SV =

A

EDV (end diastolic volume) - ESV (end systolic volume)

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5
Q

cardiac output (CO)

A

volume of blood pumped by each vent per minute

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6
Q

CO =

A

SV x HR

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7
Q

systemic vascular resistance (SVR)

A

sum of resistance in all vasculature (sys circ)

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8
Q

mean arterial pressure

A

CO x SVR

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9
Q

MAP =

A

systolic + (diastolic x2)
/3

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10
Q

most resistance in MAP

A

arterioles

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11
Q

S1 cause

A

beginning of systole - mitral + tricuspid

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12
Q

S2 cause

A

start of diastole - pulmonary + aortic

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13
Q

blood vessel layers

A
  1. tunica intima (endo)
    - internal elastic -
  2. tunica media (SM)
    - external elastic -
  3. tunica adventitia (CT)
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14
Q

elastic arteries

A

largest / aorta - sheets of elastic fibres in TM

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15
Q

vasa vasorum

A

blood supply to outer parts of large blood vessels (far from lumen)

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16
Q

arterioles his changes

A

very thin SM, almost no TA

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17
Q

metarteriole his changes

A

SM replaced by pericytes (dis-continuous contractile cells)

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18
Q

capillaries are absent

A

epithelial cells on BM
epidermis (skin / hair / nails)
cornea of eye
hyaline cartilage

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19
Q

capillary types

A
  1. continuous (muscle / CT / lung / skin / nerve)
  2. fenestrated (gut mucosa / endocrine glands / kidney glomeruli)
  3. discontinuous (liver / spleen / bone marrow)
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20
Q

thoroughfare channels

A

direct link between arterioles + venules - bypasses caps

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21
Q

precapillary sphincters

A

SM, control flow into caps

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22
Q

heart layers

A
  1. endocardium (endo + fibrous tissue)
  2. myocardium (SM)
  3. epicardium (meso + fibrous tissue)
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23
Q

pericardium layers

A
  1. fibrous (fibrous + CT)
  2. serous (meso + CT)
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24
Q

valve structure

A

lamina fibrosa -> continuous to fibrous skel

anchored to papilllary muscles by chordae tendineae

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25
Q

shock definition

A

inadequate tissue perfusion / oxygenation (circ sys abnormality)

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26
Q

shock types

A
  1. hypovolaemic
  2. cardiogenic
  3. obstructive
  4. distributive
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27
Q

hypovolaemic shock

A

physical lack of blood -> decreased CO / BP

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28
Q

cardiogenic shock

A

decreased cardiac contractility -> decreased CO / BP

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29
Q

obstructive shock (tension pneumothorax)

A

increased pressure -> decreased venous return
-> decreased CO / BP

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30
Q

distributive shock (neurogenic)

A

loss of sym tone -> decreased venous return + HR -> decreased CO / BP

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31
Q

distributive shock (vasoactive)

A

vasoactive mediators -> vasodilation / decreased venous return -> decreased CO / BP

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32
Q

baroreceptor resp to hypovolaemic shock

A

can comp til >30% loss

increase sympathetic activity (vasoconstriction + increase HR)

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33
Q

ECG physics

A

movement towards recording (+) electrode = UP

movement away = DOWN

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34
Q

limb leads

A

l - RA to LA
ll - RA to LL
lll - LA to LL

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35
Q

normal ECG intervals

A

P wave - 0.08 - 0.1
QRS - 0.1
PR - 0.12 - 0.2
QT - 0.36 - 0.44 (60bpm)

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36
Q

PR interval

A

start of P - start of QRS

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37
Q

ST segment

A

end of QRS - start of T

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38
Q

QT interval

A

start of QRS - end of T

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39
Q

augmented limb leads

A

aVR - RA records
aVL - LA records
aVF - LL (foot) records

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40
Q

chest leads dir

A

v1-v2 - septum
v3-v4 - anterior
v5-v6 - lateral

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41
Q

limb / augmented dir

A

l + aVL - lateral
ll + lll + aVF - inferior

42
Q

syncope definition

A

TLOC due to cerebral hypoperfusion (rapid onset / short duration / spontaneous recovery)

43
Q

syncope types

A
  1. reflex (neural reflexes)
  2. orthostatic hypo
  3. cardiac (cardiac event)
44
Q

reflex syncope

A

neural reflexes -> cardioinhibition or vasodepression -> drop in MAP

45
Q

reflex syncope types

A
  1. vasovagal (stress)
  2. situational (trigger)
  3. carotid sinus (mech manipulation of neck)
46
Q

coronary venous drainage

A

coronary sinus

47
Q

coronary blood flow - intrinsic mechs

A

PO2 decrease = vasodilation
metabolic hyperaemia
adenosine (ATP) = vasodilator

48
Q

coronary blood flow - extrinsic mechs

A

sym stim overridden by metabolic hyperaemia = still vasodilation

49
Q

SkM blood flow in exercise

A

sym tone overridden by metabolic hyperaemia = vasodilation regardless
(+ CO helps)

50
Q

S3

A

early diastolic filling
AFTER S2
rapid blood flow into compliant ventricle - APEX

only pathological in older / cardiac disease

51
Q

S4

A

late diastolic filling
BEFORE S1
rapid blood flow into stiff ventricle - APEX

ALWAYS pathological

52
Q

murmur grades

A

1 - heard by expert
2 / 3 - non-expert, no thrill
4 / 5 - thrill
6 - you dont even need a stethoscope

53
Q

innocent murmur

A

turbulence through normal valve - hyperdynamic sys

pulmonary area
localised
no radiation
no other cardiac abnormalities

54
Q

cardio RF

A

smoking
sedentary life
obesity
alcohol
age
gender
ethnic bg
FHx

55
Q

cardio RF (comorbid)

A

HTN
high cholesterol
irregular heartbeat
high blood glucose
diabetes
chronic kidney disease
inflamm conditions
atypical antipsychotics

56
Q

sites to asses CVD risk

A

QRISK
ASSIGN

57
Q

HTN definition

A

BP level where treatment does more good than harm

58
Q

HTN stages

A

1 - ≥140/90 clinic
≥135/85 ABPM/HBPM

2 - ≥160/100 clinic
≥150/95 ABPM/HBPM

severe (3) - ≥180 sys clinic
OR ≥110 dias clinic

59
Q

HTN monitoring

A

urine - haematuria, Alb:Cr
bloods - FBC, U+E, eGFR, glucose, fasting lipids, electrolytes
fundoscopy
ECG - LVH, past MI

60
Q

HTN targets

A

ABPM / HBPM
<80 - <135/85
80+ - <145/85
diabetes - <130/80 (clinic)

61
Q

secondary HTN causes

A

renal disease
sleep apnoea
endocrine (aldosteronism / cushing’s / adrenal malig)
aortic coarctation
pregnancy HTN assoc

62
Q

virchow’s - hypercoagulable state

A

malignancy
pregnancy
oestrogen therapy
IBD
sepsis
thrombophilia
combined pill

63
Q

virchow’s - endothelial injury

A

venous disorders
venous valvular damage
trauma / surgery
indwelling catheters

64
Q

virchow’s - circ stasis

A

LV dys
immobility / paralysis
venous insufficiency
venous obstruction (tumour / obesity / pregnancy)

65
Q

HERDOO2 scale

A

Hyperpigmentation
Edema
Redness
D-dimer high
Obesity
Older age

women 0-1 no, ≥2 yes
men yes

66
Q

post thrombotic syndrome

A

1/3 of patients w/ idiopathic DVT (5ys)

pain
oedema
hyperpigmentation
eczema
varicose collateral veins
venous ulceration

67
Q

chronic thromboembolic pulmonary hypertension

A

PE complication - 5%

initially asymptomatic
progressive SOB + hypoxaemia
RHF frequently occurs

68
Q

true aneurysm

A

all 3 artery layers involved

69
Q

false aneurysm

A

defect in wall of artery - restrained by surrounding structures

70
Q

types of aneurysm

A
  1. saccular
  2. fusiform
71
Q

EVAR pro/con

A

safer
faster recovery

only possible in 75%
needs follow ups / further interventions

72
Q

open AAA repair pro/con

A

possible in (alm) everyone
effective for life

greater morality risk
slower recovery

73
Q

aortic dissection classes

A

class A - starts before branches (cardiothoracic)
class B - starts after branches (vascular)

74
Q

CABG vs PCI

A

PCI generally safer, time constraint

75
Q

angina vs ACS

A

fixed stenosis
demand led ischaemia

dynamic stenosis
supply led ischaemia

76
Q

ACS distinction

A

STEMI - total occlusion
NSTEMI - subtotal occlusion
UA - subtotal occlusion, only, ischaemia no infarction

77
Q

MI types

A

inferior - ll, lll, aVF
anteroseptal - v1-v4
anterolateral - l, aVL, v1-v6

78
Q

old MI ECG

A
  1. Q waves
  2. inverted T waves
79
Q

ACS complications

A

death
arrhythmic comp
structural comp - rupture, VSD, valve regurg
functional - acute vent failure, HF, cardiogenic shock

80
Q

troponin complexes

A

TnC - cardiac + SkM
TnI + TnT - cardiac specific

81
Q

MI classifications

A

class 1 - spontaneous + ischaemia due to primary coronary event

class 2 - secondary to ischaemia due to O2 supply / demand imbalance

class 3 - SCD
class 4 - iatrogenic

82
Q

movement through capillary walls

A

fluid - pressure gradient
lipid soluble - endothelial cells
water soluble - water-filled pores

(large molecules do Not)

83
Q

starling forces

A

favouring filtration -
cap hydrostatic pressure
ISF osmotic pressure

opposing filtration -
cap osmotic pressure
ISF hydrostatic pressure

84
Q

starling force favouring

A

arteriolar end - filtration
venular end - reabsorption

85
Q

oedema definition

A

accumulation of fluid in interstitial spaces

86
Q

pulmonary oedema consequences

A

diffusion distance increases -> gas exchange compromised

lung compliance decreases

87
Q

causes of oedema

A

raised cap hydrostatic pressure -
arteriolar dilation
raised venous pressure (RHF - per / LHF - pulm)
((RAAS upregulation in HF))

reduced plasma osmotic pressure -
malnutrition
protein malabsorption
excessive renal secretion
hepatic failure

lymphatic insufficiency -
lymph node damage
filariasis

changes in cap perm -
inflammation

88
Q

NYHA classification of HF

A

1 - no limitation of physical activity
2 - slight limitation of ordinary activity
3 - marked limitation of physical activity, less than ordinary causes Sx
4 - unable to carry out physical activity without Sx, Sx at rest

89
Q

ejection fraction (EF)

A

percentage of blood pumped out of heart in each beat

normal ≥50%

90
Q

HFrEF

A

reduced ejection fraction
≤40% EF

LV unable to eject adequate blood

91
Q

HFpEF

A

preserved ejection fraction

LV unable to properly fill (myocardial stiffness), less blood to pump

92
Q

types of AVRT

A

orthodromic - clockwise
antidromic - anticlockwise

93
Q

cardiorespiratory arrest causes

A

hypoxia
hypovolaemia
hypothermia
hypo / hyperkalaemia

tension pneumothorax
tamponade
toxins
thrombus

94
Q

ECG axis determination

A

aVF = 6, l = 2/3

normal - aVF ^, l ^
left - aVF \/, l ^
right - aVF ^, l \/
extreme right - aVF \/, l \/

95
Q

right sided murmurs

A

louder with inspiration

96
Q

ductus venosus

A

umbilical vein -> IVC
bypasses liver

97
Q

foramen ovale

A

opening in atrial septum
closed by change in pressure

98
Q

ductus arteriosus

A

connects pulmonary bifurcation to descending aorta
maintained by prostaglandin E2
closed by lack of ^ + increase O2

99
Q

infective endocarditis mech

A

1/ heart valve damaged
2. turbulent blood flow over roughened endothelium
3. platelets / fibrin deposited
4. bacteraemia
5. organisms settle in thrombi + become microbial vegetation

100
Q

amyloid

A

abnormal deposition of any protein
waxy pink histology

101
Q

myxoma

A

most common heart tumour
carney’s syndrome - multiple ^

YEAR 1 (11 decks)

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