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Nick's MD1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

In what form does Hb carries about 15% of its respiratory carbon dioxide?

A

carbaminohaemoglobin

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1
Q

What percentage of respiratory carbon dioxide does Hb carry as carbaminohaemoglobin?

A

15%

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1
Q

Name three factors that can shift the O2 saturation curve to the right

A

Increased DPG Increased temperature Decreased pH

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1
Q

What effect does altitude adaptation have on the O2 saturation curve?

A

Shifts it to the right

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1
Q

What is a typical EDV?

A

110 to 120ml (Guyton and Hall, 1996)

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1
Q

What is a typical cardiac output?

A

5-5.25 L/min

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1
Q

What effects does parasympathetic stimulation of the heart have?

A

Decreased heart rate

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1
Q

What is APTT

A

Activated partial thrombin time

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1
Q

Identify these valve events

A
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1
Q

What are the 3 layers of a blood vessel?

A

Intima

Media

Adventitia

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1
Q

Which vessels contribute most to blood pressure?

A

Arterioles

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1
Q

Define embolus

A

Intravascular mass carried in the blood stream to a remote site. May be solid, liquid or gaseous

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1
Q

Define atherosclerosis

A

Accumulation of lipid and fibrous connective tissue (plaque) in the intima of medium and large arteries

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1
Q

Name 4 ways endothelium is implicated in atherosclerosis

A
  1. Endothelial damage increases permeability to LDL
  2. Damaged endothelium loses its normal anti-coagulant properties
  3. Endothelium recruits macrophages through expression of selectins, ICAM and VCAM
  4. Endothelial cells don’t produce as much prostacyclin or NO → impaired vasodilation
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1
Q

What is the ligamentum arteriosum a remnant of?

A

Ductous arteriosus

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1
Q

What condition is this?

A

Aortic regurgitation

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2
Q

What does concentric hypertrophy compensate for?

A

Increased afterload

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3
Q

What is the order of the cardio exam?

A

General inspection. Palmar creases. Capillary refill. Radial pulse. BP. Conjunctiva. Lips and tongue. JVP. Carotid pulse. Palpate apex beat. Auscultation. Lungs. Shin oedema. Dorsal pedis pulse. Posterior tibial pulse.

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3
Q

Define eccentric hypertrophy

A

Normal relative wall thickness

Increased LV mass

LV enlargement

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4
Q

Define concentric hypertrophy

A

Increased relative wall thickness

Increased LV mass

No LV enlargement

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5
Q

Define compliance

A

ability of any chamber to accept increased volume

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6
Q

What are the constitutive subunits of Hb in adults and foetuses?

A

Adults: 2 alpha and 2 beta Foetuses: 2 alpha and 2 gamma

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6
Q

What type of blood vessels are these?

A

Arterioles

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7
Q

What condition is this?

A

Mitral stenosis

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8
Q

What effects does sympathetic stimulation of the heart have?

A

Increased heart rate and force of contraction

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8
Q

What 2 forms may a true aneurysm take?

A

Sacular (unilateral outpouching) and fusiform (bilateral outpouching)

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8
Q

What is the molecular target of heparin?

A

Heparin enhances activity of antithrombin III, which inhibits factor Xa and thrombin

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9
Q

What percentage of red blood cell dry content does Hb make up?

A

97%

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11
Q

Name 4 outcomes of atherosclerosis that predispose to CV disease

A
  • Stenosis
  • Impaired vasodilation
  • Unstable plaque
  • Local prothrombotic environment
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12
Q

What makes up about 97% of red blood cell dry content?

A

Hb

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14
Q

What does eccentric hypertrophy compensate for?

A

Increased volume (preload)

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15
Q

What are the 4 main classes of drug used to treat hypertension?

A

ACE inhibitors

Angiotensin receptor antagonists

Beta blockers

Calciium channel blockers

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16
Q

What is a typical ejection fraction?

A

60% (Guyton and Hall, 1996)

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16
Q

List 5 acute signs of hypovolaemia

A

Tachycardia

Hypotension

Cold/clammy skin

Poor capillary refill (> 2 secs)

Tachypnea (if severe hypovolaemia)

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16
Q

What are 4 distinguishing features of the phrenic nerve course?

A
  1. Runs along scalenus anterior muscle
  2. Passes between subclavian artery and vein
  3. Passes anterior to lung root
  4. Pierce diaphragm
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17
Q

Why does Hb carry nitric oxide bound to a globin thiol group? And when does Hb release it?

A

It rrelaxes vascular walls and enhance gas diffusion. Hb releases NO at the same time as oxygen.

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17
Q

What type of blood vessel is this?

A

Arteriole

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19
Q

How is bradykinin degraded?

A

By angiotension converting enzyme

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20
Q

Define thrombus

A

Clotted mass of blood that forms within the cardiovascular system during life

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21
Q

Define afterload

A

Load encountered by ventricle at the beginning of systole.

The amount of work the heart needs to do to eject blood

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22
Q

What effect does beta adrenoceptor stimulation have on the heart?

A

Increased heart rate and cardiac contractility

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23
Q

What is it called when there is an infection of heart valves?

A

Endocarditis

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24
Q

What effect does shifting the O2 saturation curve to the right have on Hb affinity for O2?

A

Decrease

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24
Q

Where does the parasympathetic nervous system innervate the heart?

A

SA node and AV node

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25
Q

What is the function of lipoproteins?

A

liporoteins transport fats such as cholesterol in the blood

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27
Q

When CO increases, what happens to venous pressure?

A

Decreases

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28
Q

Name two mechanisms Hb uses to achieve variable sigmoid binding character for oxygen association

A

Subunit cooperativity and allosteric effectors

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29
Q

What are 4 important things to ask about when taking a syncope history?

A

Before. What were you doing before it happened? Did you noticing anything else just before it happened?

During. How long were you unconscious for? Did anyone see it happen…what did they say?

After. How long did it take you to recover? How did you feel afterwards?

PMHx previous episodes? Heart problems?

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31
Q

What is the main risk factor for aortic disection?

A

Hypertension

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32
Q
A
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32
Q

What is the characteristic histological feature of elastic arteries?

A

Up to 50 layers of elastin in the media

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33
Q

How do beta blockers treat arrythymias?

A

Reduce sympathetic drive to SA node

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36
Q

What are the braches off the arch of the aorta from right to left?

A

Brachiocephalic a (branches into right subclavian a and right common carotid a)

Left common carotid a

Left subclavian a

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37
Q

What type of blood vessel is this?

A

Medium vein

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38
Q

What cardiac phase does S2 correspond to?

A

Isovolumetric relaxation

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40
Q

At the level of which thoracic vertebrae does the heart sit?

A

T5 to T8

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42
Q

The names of angiotensin receptor antagonists end with what?

A

-sartan

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43
Q

Define compliance

A

Ability of a chamber to accept a volume of fluid

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43
Q

Mitral regurgitaiton would typically cause which type of hypertrophy?

A

Eccentric hypertrophy

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45
Q

Where is the sternal angle?

A

Horizontal line between manubriosternal joint and T4/T5

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46
Q

Describe 5 steps in secondary haemostasis

A

1 vessel damage releases tissue factor 2 extrinsic pathway: parathrombin → thrombin, 3 fibrinogen to fibrin, 4 fibrin crosslinks under factor XIIIa control 5 meshwork

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46
Q

What are the contraindications to treatment with ACE inhibitors?

A

Bilateral renal stenosis

Pregnancy

Angioneurotic oedema

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47
Q

What does the vascular funciton curve describe?

A

Describes what happens to venous pressure when CO varies

48
Q

What is cardiac remodeling?

A

Increase of relative wall thickness without increase in left ventricle mass

49
Q

What are the 3 components of Virchow’s triad of thrombosis?

A

Vessel wall Blood composition Blood flow

50
Q

What is the descending order of WBC concentrations in the blood?

51
Q

What are the 3 critical intermediates of cholesterol synthesis?

A

HMG-CoA (hdroxymethyglutaryl-CoA),

isoprene

squalene

54
Q

What do the names of ACE inhibitors end in?

55
Q

What is a typical SV?

A

70ml (Guyton and Hall, 1996)

56
Q

What is the molecular target of warfarin?

A

Vitamin K reductase

Inhibition of this prevents reduced VitK acting as a cofactor for activation of factors 2, 7, 9 and 10

57
Q

What are the 3 main components of the coagulation system?

A

Vasoconstriction, platelet plug and fibrin mesh

58
Q

What type of noradrinergic receptors are found on the heart?

A

Beta 1 (because you have 1 heart)

58
Q

Name 3 vasoactive agents that endothelium releases and describe their effect on vasculature

A

Vasoconstrictor: endothelin
Vasodilator: NO and prostacyclin (PGI2)

58
Q

How do K+ channel blockers affect arrhythmias?

A

Prolong cardiac AP by slowing repolarisation

59
Q

What percentage of the blood is in the arteries?

62
Q

List 5 factors that may affect the effects of warfarin

A

Diet (VitK)

Hepatic disease

Hypermetabolic state

Pregnancy

Drug interactions, eg NSAIDs, EtOH

63
Q

What are the 3 general complications of atherosclerosis?

A

Infarct

Ischaemia

Aneurysm

65
Q

Volume overload would typically cause which type of LV hypertrophy?

67
Q

During which cardiac phase is ventricular volume greatest?

A

Isovolumetirc contraction

68
Q

Define preload

A

The amount of stretch on cardiac myocyte fibres at the end of diastole.

69
Q

Name 3 substances that have cholesterol as a precursor in their synthesis

A

Bile acids

VitD

Steroid hormones

70
Q

The names of beta blockers end in what?

71
Q

Define diaphoresis

A

Profuse sweating

72
Q

Where are cholinergic receptors on the heart found?

A

SA node and AV node

73
Q

What is the upper limit for recommended cholesterol levels?

A

5.5 mmol/L

74
Q

A new drug called dozatapril is on the market. What class of drug is this likely to be?

A

ACE inhibitor

75
Q

Aortic stenosis would typically cause what kind of LV hypertrophy?

A

Concentric

76
Q

Where does ligamentum arteriosum attach?

A

Bifurcation of pulmonary trunk to inferior aspect of aortic arch

77
Q

What is the most common cause of LV hypertrophy?

A

Myocardial infarction

79
Q

What is the mechanism of action of statins?

A

All statins are competitive inhibitors of HMG-CoA reductase

80
Q

What effect do Na+ channel blockers have on the cardiac action potential?

A

Reduce phase 0 (up phase) slope and peak of ventricular AP as well as shorten repolarisation

82
Q

What is the average heart mass of a healthy young adult?

83
Q

Name three factors that can shift the O2 saturation curve to the left

A

Decreased DPG Decreased temperature Increased pH

84
Q

How do Ca2+ channel blockers improve arrhythmias?

A

Reduce heart rate and conduction through SA and AV node

85
Q

Name 7 modifiable risk factors for atherosclerosis

A
  • Hypertension
  • Smoking
  • Diabetes mellitus
  • Obesity
  • High LDL:HDL ratio
  • Physical inactivity
  • Proteinuria
86
Q

What are the ‘big 5’ risk factors for atherosclerosis?

A

Hypertension

Diabetes

Hypercholesterolaemia

Smoking

Family history

87
Q

How is ejection fraction calculated?

A

EF = (SV/EDV) * 100

88
Q

Where does the sympathetic nervous system innervate the heart?

A

SA node, AV node and ventricles

89
Q

Which factors does warfarin inhibit?

A

2, 7, 9, 10

90
Q

Which 3 things will affect SV?

A

Preload

Cardiac contractility

Afterload

91
Q

Describe 4 steps in primary haemostasis

A

1 Vessel damage exposes von Willibrand factor on basement membrane and collagen 2 vWF binds to Gp1b on platelets 3 Platelet: adhere, flatten, recruit, degranulate (ADP and thromboxin A2) 4 platelet plug

92
Q

Hypertension would typically cause which type of LV hypertrophy?

A

Concentric

94
Q

Which ventricle is less compliant?

A

Left (because has thicker wall)

95
Q

What percentage of the blood is in the heart?

96
Q

What percentage of the blood is in the capillaries?

97
Q

During which cardiac phase is ventricular volume least?

A

Isovolumetric relaxation

99
Q

A new drug called buprolol is on the market. What class of drug is this likely to be?

A

Beta blocker

100
Q

How is hypertension Dx?

A

Chronic BP greater than 140/90 mmHg

101
Q

Branches of the descending aorta supply which 4 structures?

A

Intercostal aas

Pericardium

Esophagus

Bronchial aas

102
Q

What cardiac phase does S1 correspond to?

A

Isovolumetirc contraction

103
Q

What are the 4 major classes of drugs used for arrhythmias?

A

Beta blockers

Calcium channel blockers

Sodium channel blockers

Potassium channel blockers

106
Q

Fluid in the pericardial cavity is called what?

A

Pericardial effusion

107
Q

What are these areas?

109
Q

What is INR and how is it calculated?

A

International normalised ratio INR = (patient PT/normal PT)^ISI INR = (Patient prothrombin time/mean normal prothrombin time)^international sensitivity index

111
Q

What effect does shifting the O2 saturation curve to the left have on Hb affinity for O2?

112
Q

What condition is this?

A

Aortic stenosis

113
Q

Which substance mediates endothelial vasoconstriction in coagulation?

A

Endothelin

115
Q

Describe 5 steps in the feedback loop of short term regulation of low blood pressure

A
  1. Low blood pressure sensed by stretch receptors in carotid sinus in internal carotid artery
  2. Less stretch causes less firing of glossopharyngeal nerve to nucleus of solitary tract in medulla
  3. Sympathetic nervous system stimulated
  4. Sympathetic nervous system:
    - Increases heart rate (chronotropic)
    - Decreases AV conduction time
    - Increases cardiac contractility (inotropic) (more Ca2+ released per contraction)
    - Increases TPR (alpha adrenocetpors)
    - Increase venous tone (don't want blood hanging around uselessly in the veins)
  5. Blood pressure increased
116
Q

Define left ventriuclar hypertrophy

A

Increase in lefr ventricle mass relative to body size

117
Q

How do beta blockers lower blood pressure?

A

Reduce cardiac output and renin release through antagonism of beta 1 +/- beta 2 adrenocetpors

118
Q

How is left ventrilce relative wall thickness calculated?

A

T/D

Thickness of wall / Diametre of chamber

119
Q

What percentage of the blood is in the lungs?

120
Q

What are 3 important qualities to establish when taking a history of palpitations?

A

1 Rhythm. Regular or irregular? Can you tap out the rhythm?

  1. Rate. Faster or slower than normal?
  2. Strength. Stronger or more forceful than normal?
121
Q

What percentage of the blood is in the veins?

122
Q

List 8 actions of thrombin

A

Fibrinogen → fibrin V -> Va VIII -> VIIIa IX -> IXa XI -> XIa XIII -> XIIIa Binds to thrombomodulin (inhibits Va and VIIIa) Platelet activation

123
Q

Which factors is vitamin K a co-factor for?

A

2, 7, 9, 10

ie the same cofactors that warfarin affects

124
Q

A raised INR indicates which 2 possible things?

A

There is a problem with Factor VII or the patient is on warfarin

125
Q

Define anaemia and which two blood tests are used most often in diagnosis

A

A reduction of the total circulating red cell mass below normal limits.

Haematocrit and haemoglobin concentration

126
Q

Dietary deficiences of which 3 substances may cause anaemia?

A

Iron, VitB12, folate

128
Q

What is the molecular action of calcium channel blockers?

A

Inhibit voltage-gated L-type Ca2+ channels

129
Q

What effect does adrenaline have on TPR and how?

What receptors are involved?

A

Increases TPR due to vasoconstriction.

Stimulation of alpha adrenoceptors.

130
Q

A new drug called stortosartan is on the market. What class of drug is this likely to be?

A

Angiotensin receptor antagonist

132
Q

Name 2 substances that may be elevated in blood after death of cardiac myocytes

A

Troponin I and T

Creatine kinase MB

133
Q

What type of aneurysm is classically seen on the circle of Willis and what is this called?

A

Sacular aneurysm

Called a berry aneurysm

134
Q

What is the most lateral structure in the mediastinum?

A

Phrenic nerves

135
Q

At what vertebral level does the aorta pass behind the diaphragm?

136
Q

Identify these stages of the cardiac cycle

137
Q

What is a typical ESV?

A

40-50ml (Guyton and Hall, 1996)

138
Q

What type of blood vessel is this?

A

Small vein.

The wall of the vein consists of two to three layers of smooth muscle fibres. Note the wide diameter of the lumen relative to the thickness of the wall.

139
Q

What type of blood vessel is this?

140
Q

At what vertebral level does the inferior vena cava pass through the diaphragm?

141
Q

Name these volumes or pressures

142
Q

What is the molecular target of ACE inhibitors?

A

Block conversion of Angiotensin I to Angiotensin II by inhibiting angiotensin converting enzyme

143
Q

Where does left anterior descending artery supply?

A

LAD supplies anterior surface and anterior 2/3 of interventricular septum

144
Q

Where does circumflex artery supply?

A

lateral wall of LV

145
Q

Where does posterior interventricular artery supply?

A

Inferior part of LV and posterior 1/3 of interventricular artery

146
Q

How soon after an AMI will cardiac enzymes begin to possibly be elevated?

147
Q

How long after the event will cardiac enzymes be a sensitive measure of AMI?

148
Q

How soon after an AMI must repurfusion be to be effective?

149
Q

Which artery most commonly supplies the atrio-
ventricular node?

A

Right coronary artery

150
Q

What is the most common inherited genetic disease of hypercoagulability of blood?

A

Factor V Leiden mutation

151
Q

Which bacteria classically causes subacute bacterial endocarditis?

A

Viridans strep

152
Q

Why is aspirin given in low doses as a blood thinner?

A

Low dose maintains selectivity for platelets because it will be at a low concentration by the time it reaches endothelium

153
Q

Why do some NSAIDs increase bleeding time?

A

They impair thromboxane A2, thus impairing platelet aggregation

154
Q

Where is the SA node?

A

In the right atrium, at the top of the crista terminalis and sweeps across in front of the SVC

155
Q

Where is the AV node

A

In the right atrium, between tricuspid valve and coronary sinus

Nick's MD1 (28 decks)

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