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First Year Dundee Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Where does excitation within the heart begin?

A

The pacemaker cells within the Sino-Atrial Node

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2
Q

Each pacemaker cell produces a SPP (__________ _________ __________) which trigger an _______ ________ when they combine and exceed a threshold.

A

Spontaneous Pacemaker Potential

Action Potential

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3
Q

What ions move Before/during and after pacemaker potential depolarizations?

A

Before- Na+ ion influx
During- Ca2+ influx through L-type channels
After- K+ efflux- repolarization

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4
Q

Through what junctions does excitation spread?

A

Gap junctions

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5
Q

What is unique about myocyte action potentials?

A

They exhibit a plateau phase which is maintained by Ca2+ channels.

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6
Q

What effect does vagal tone have on the heart rate?

A

The vagal tone slows the intrinsic heart rate (which is around 100bpm) to the normal resting heart rate (60bpm).

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7
Q

What effect does parasympathetic stimulation have on heart function?

A

negative chronotropic- slows heart rate and increases AV nodal delay

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8
Q

What receptors are involved in vagal stimulation of the heart?

A

Muscarinic M2 acetylcholine receptors

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9
Q

What effect does sympathetic stimulation have on the heart and what receptors do they use?

A 
Positive chronotropic effect and positive inotropic effect- increases heart rate and decreases AV nodal delay
Beta1 adrenoceptors (noradrenaline)
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10
Q

What do cardiac sympathetic nerves supply?

A

SA and AV nodes

myocardium

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11
Q

What drug is used to increase the heart rate during extreme bradycardia?
How does it act?

A

Atropine

Competitive inhibitor of muscarinic M2 receptors

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12
Q

why is Ca2+ necessary for muscle contraction?

A

It removes the troponin and tropomyosin from the myosin heads allowing crossbridge formation

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13
Q

Where is Ca2+ stored in myofibrils?

A

the sarcoplasmic reticulum

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14
Q

What is the purpose of transverse tubules?

A

They carry action potentials to the sarcoplasmic reticulum

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15
Q

What does the Frank-Starling curve show?

A

The greater the end diastolic volume the greater the stroke volume

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16
Q

What does one Cardiac cycle consist of?

A

The period from the beginning of one heart beat to the beginning of the next.

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17
Q

During contraction and relaxation the volume of the ventricles remains constant. What do you call these states?

A

Isovolumetric ventricular contraction and relaxation.

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18
Q

What causes the dicrotic notch?

A

Valve vibration

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19
Q

where would you place your stethoscope bell to listen to each of the four valves?

A

Aortic- 2nd intercostal space on right beside sternum
Pulmonary- 2nd intercostal space on left side of sternum
Tricuspid- 4th intercostal space on left side beside sternum
Mitral- 5th intercostal space mid-clavicular line

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20
Q

Where is most of the blood stored?

A

Peripheral venous pool

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21
Q

What name is given to the sounds heard when investigating the blood pressure?

A

Korotkoff sounds

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22
Q

Which blood vessels contribute most to systemic vascular resistance?

A

Arterioles

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23
Q

how do you investigate postural hypotension?

A

Ask patient to lie flat for 3 minutes then record change in blood pressure
systolic drop by 20mmHg or more
diastolic drop by 10mmHg or more

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24
Q

Where is Angiotensinogen produced?

A

the liver

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25
Q

Where is Angiotensin I converted to Angiotensin II?

what catalyses this reaction?

A

Lung Vascular endothelium

Angiotensin Converting Enzyme

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26
Q

Where is Renin released from?

A

The kidneys

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27
Q

What effect do natriuretic peptides have on the blood vascular system?

A

Vasodilation, sodium and water excretion, reduced renin release

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28
Q

Brain type Natriuretic Peptide is synthesised in the brain and ventricles. When BNP is found in the serum, what does this signify?

A

Heart failure

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29
Q

How many Standard, augmented and precordial leads does an ECG possess?

A

standard- 3
augmented- 3
precordial- 6

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30
Q

How long should the QRS complex last for?

A

less than 0.1 seconds.

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31
Q

how long should the PR interval be?

A

0.08-0.10secs

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32
Q

Name the two layers of the pericardium. Which layer secretes pericardial fluid?

A

Fibrous and serous

serous secretes pericardial fluid

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33
Q

Into which chamber does the coronary sinus drain?

A

the right atrium

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34
Q

What is cardiogenic shock?

A

Sustained hypotension due to damage to the heart and thus low cardiac contractility.

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35
Q

What is vasoactive shock?

A

Vasoactive mediators cause increased capillary permeability resulting in low serum volume and therefore shock.

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36
Q

Pathogenesis of ischaemic heart disease: begin with initial _________ injury. _____ and __________ accumulate at the site of damage. ______ _______ migrates to the area and eventually a ________ cap forms

A 
endothelial
Lipids
macrophages
Smooth muscle
collagenous
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37
Q

What is stenosis?

A

The narrowing of a blood vessel lumen

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38
Q

What is an aneurysm?

A

Abnormal and permenant dilatation of an artery

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39
Q

What is an aortic dissection?

A

Splitting of the aorta into to channels

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40
Q

What is the difference between somatic and visceral pain? How do they present?

A

Somatic pain- follows somatic dermatomes
Visceral pain- Originates from the organs
somatic- sharp, localised, stabbing pain
visceral- dull, aching, poorly localised

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41
Q

What does TLOC stand for?

A

Transient Loss of Consciousness

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42
Q

What is syncope?

A

transient loss of consciousness because of cerebral hypoperfusion

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43
Q

name the three types of reflex syncope.

A

Vasovagal
situational
Carotid sinus

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44
Q

Where are lipoprotein lipases located?

A

The capillary endothelium of adipose/muscle tissue

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45
Q

Where are LDL receptors expressed?

A

Liver

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46
Q

What Function does HDL have?

A

It is involved in the elimination of excess cholesterol.

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47
Q

Describe the action of Statins.

A

Statins are competitive inhibitors of HMG-CoA. They stop cholesterol formation in the liver. This decrease in synthesis causes an increase in LDL receptor expression in the liver leading to enhanced LDL clearance.

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48
Q

What are fibrates?

A

Agonists to nuclear receptors which enhance the transcription of Lipoprotein lipases

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49
Q

what drug reduces the absorption of cholesterol in the duodenum by inhibiting NPC1L1?

A

Ezetimibe

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50
Q

Name three clinical signs of hyperlipidaemia

A

Xanthoma
Xanthelasma
Corneal Arcus
Milky blood/serum

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51
Q

name two possible side effects of statins

A

Rhabdomyolosis, myalgia

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52
Q

Is familial Hypercholesterolaemia an autosomal dominant or recessive disorder?

A

Autosomal dominant

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53
Q

Which ducts drain into the right and left venous angles?

A

Right- Right lymphatic duct

Left- Thoracic duct

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54
Q

What is the difference between primary and secondary hypertension?

A

Primary- no obvious cause
secondary- Due to a medical condition e.g. aldosteronism, cushings syndrome, phaochromocytoma, renal damage, coarction of the aorta

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55
Q

In what way does hypertension remodel the heart?

A

Left ventricular hypertrophy

this is poorly perfused leading to interstitial fibrosis

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56
Q

What is the best diagnostic test for hypertension?

A

An Ambulatory Blood Pressure Monitor

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57
Q

What may be exhibited in the eyes of hypertensive patients?

A

Hypertensive retinopathy

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58
Q

Outline the four stages of treatment for hypertensive patients who are under 55

A

A to
A+C/A+D
A+C+D
more D + B

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59
Q

How would hypertension treatment for over55s/afro-Carribbean differ than for under 55s?

A

they start on C or D rather than A

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60
Q

What is the best treatment for complicated hypertension?

A

Spironolactone

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61
Q

What drug may worsen peripheral vascular disease?

A

Beta blockers

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62
Q

nitrates cause a decrease in intracellular ________ leading to the __________ of vascular smooth muscle.

A

calcium

relaxation

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63
Q

Which is stronger- loop diuretics or thiazide diuretics? How do they act?

A

Loops stronger

they block Na+ reabsorption in the kidneys

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64
Q

Name two cardioselective beta blockers

A

Atenolol, Bisoprolol

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65
Q

Propranolol and carvedilol are examples of what drug?

A

Non-selective beta blockers

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66
Q

What is amlodipine?

A

A calcium channel blocker

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67
Q

What is lisonopril? Give a common side effect of such drugs

A

An ACE inhibitor. Cough

68
Q

What receptors do ARBs block? give an example of an ARB

A

Angiotensin II receptors

losartan

69
Q

Arterial thrombi are treated with __________ whereas venous thrombi are treated with __________.

A

Antiplatelets

anticoagulants

70
Q

Give two examples of parenteral anticoagulants

A

Heparin and fondaparinux

71
Q

In traditional VTE treatment __________ anticoagulants are given first and _______ is given which is a ________ __ antagonist. The __________ coagulants are withdrawn once the _________ has a therapeutic effect (5 days) and has been at such a level for two days.

A 
Parenteral
warfarin
Vitamin K antagonist
Parenteral
warfarin
72
Q

Enoxiparin and dalteparin are examples of what?

A

Low Molecular Weight Heparin (LMWH)

73
Q

Name four DOACs

A

edoxaban
apixaban
rivaroxiban
dabigatran

74
Q

How does dabigatran differ from the other oral anticoagulants?

A

It is a thrombin inhibitor whereas the others are factor Xa inhibitors

75
Q

How is the anticoagulant effect of Vitamin K antagonists measured? What system is used to standardise this assessment?

A

Measured using Prothrombin time

International Normalised Ratio

76
Q

Name two possible side effects of vasodilators

A

headaches and flushing

77
Q

Describe the action of the antiplatelet Aspirin

A

Reversible inhibition of platelet COX-1 and thromboxane production.

78
Q

Ivabradine, nicorandil and ranolazine are examples of what type of drug?

A

Anti-anginals

79
Q

what is GTN spray used for?

A

prophylactic and rapid onset angina treatment.

80
Q

Is the peak flow in the coronary arteries during systole or diastole?

A

Diastole

81
Q

When the cerebral MAP rises vessels ___________ to restrict blood flow.

A

Vasoconstrict

82
Q

Increased C02 in the brain causes blood vessel __________ while decreased C02 causes __________.

A

Vasodilation

Vasoconstriction

83
Q

How do you calculate the cerebral perfusion pressure?

A

CPP= MAP- intracranial pressure

84
Q

Name two alternatives of aspirin

A

ticagrelor

clopidogril

85
Q

What are the main investigations for angina and MI?

A

Echocardiogram, Electrocardiogram, blood tests

86
Q

Name two types of coronary revascularisation

A

CABG- Coronary Artery Bypass Graft

PCI- Percutaneous Coronary Intervention

87
Q

D-Dimer is released into the blood when ______ from a clot is broken down. It has a high ________ predictive value

A

Fibrin

Negative

88
Q

Name three side effects of diuretics

A

hyponatraemia
hypokalaemia
gout

89
Q

Define a stroke

A

Acute onset of focal neurological symptoms due to disruption of blood supply

90
Q

Identify the two types of stroke

A

Ischaemic and haemorrhagic

91
Q

What are the two main investigations for strokes?

A

CT and MRI of the brain

92
Q

How do you manage an ischaemic stroke?

A

Thrombolysis/thrombectomy

93
Q

What is the main investigation for intermittent claudication?

A

Ankle/Brachial blood pressure index

94
Q

What are the two main risk factors of critical limb ischaemia?

A

Smoking and Diabetes

95
Q

the AV node and Purkinje fibres are known as _______ pacemakers. Meanwhile the SA node is dominant- this domination is called ________ __________.

A

latent

overdrive suppression

96
Q

If the SA frequency is pathologically low, the latent pacemakers may become the dominant pacemakers. they would be said to produce ______ beats and a ______ rhythm.

A

escape beats

escape rhythm

97
Q

When the latent pacemaker frequency is pathologically high they are said to be producing _______ beats and a _______ rhythm.

A

ectopic beats

ectopic rhythm

98
Q

Early Afterdepolarizations occur during phase _ and __and delayed afterdepolarizations occur during phase __

A

EADs-2+3

DADs- 4

99
Q

name some causes of triggered activity.

A

Digoxin, catecholamines, hypoxia, acidosis

100
Q

name the two types of second degree heart block

A

Mobitz type I and II

101
Q

What is the difference between ventricular and supraventricular arrhythmias?

A

ventricular- ventricle myocardium

supraventricular- SA, AV, atria

102
Q

Name three possible symptoms of an arrhythmia.

A

Palpitations, syncope, dizziness

103
Q

name three arrhythmia investigations

A

Exercise ECG, echocardiogram, electrophysiological study

104
Q

How do you treat an acute supraventricular tachycardia?

A

Carotid baroreceptor massage, IV adenosine

105
Q

Ventricular tachycardia is a life threatening condition that can appear with either a __________ pattern or a ___________ pattern.

A

monomorphic

polymorphic

106
Q

How do you treat ventricular tachycardia?

A

defibrillation/CPR

107
Q

What are the three signs of a MI on a ECG?

A

ST elevation- wihtin hours
T wave inversion- within days
Q wave formation- old MI

108
Q

What protein may appear in the serum signifying an MI?

A

Troponin

109
Q

Describe the pressure difference that means that filtration is favoured over absorption in the arterioles

A

the capillary hydrostatic pressure is greater than the capillary osmotic pressure

110
Q

What is oedema?

A

When fluid accumulates in the interstitial space

111
Q

Name one cause of pulmonary oedema

A

Left ventricular failure- puts back pressure on the blood vessels of the lungs- capillary hydrostatic pressure then exceeds osmotic pressure

112
Q

How would pulmonary oedema present on a chest X-ray?

A

Bat wing pattern of consolidation (perihilar consolidation)

113
Q

Name two clinical signs of pulmonary oedema

A

SOB

basal crepitations

114
Q

Peripheral and pulmonary oedema are signs of what condition?

A

Heart failure

115
Q

What is the difference between HFrEF and HFpEF?

A

HFrEF- heart failure with reduced ejection fraction- reduced ejection force due to ventricular damage

HFpEF- heart failure with preserved ejection fraction- reduced ventricular filling due to myocardial stiffness

116
Q

Heart failure is associated with the presence of what hormone in the blood?

A

BNP

117
Q

Name four investigations of heart failure

A

Echocardiogram
blood tests
ECG
Chest X-ray

118
Q

Identify Three ways in which heart failure could be managed

A

Exercise therapy
cardiac rehabilitaion
Salt intake restriction

119
Q

What is Ivabradine? Where is this treatment used?

A

It is a funny channel blocker

heart failure

120
Q

What is Digoxin?

A

A cardiac glycoside used for patients in atrial fibrillation with heart failure. it increases heart rate and force of contraction

121
Q

What is the treatment for ventricular fibrillation and ventricular tachycardia?

A

Defibrillation

122
Q

What causes Atrial fibrillation?

A

Ectopic foci in the pulmonary vein ostia

123
Q

Name the four classifications of Atrial fibrillation.

A

Paroxysmal
persistent
longstanding persistent
Permanent

124
Q

What would the ECG of a atrial fibrillation patient show?

A

Chaotic atrial activity- f waves
irregular rhythm
no clear p waves
often ventricular tachycardia

125
Q

Treatment of AF is induced to control the rate and rhythm of the heart. what is usually used to control the rate?

A

A combo of Digoxin and either a beta blocker or a calcium channel blocker ( diltiazem or verapamil)

126
Q

What drugs are used to treat the altered rhythm of the heart in AF? what other cardioversion therapy may be used?

A

Amiodarone and/or sotalol

Direct current cardioversion

127
Q

The CHADSVAS score is used for what purpose?

A

To determine the likelihood of stroke in an individual with AF

128
Q

What characterises the ECG of atrial flutter?

A

sawtooth pattern F waves

flutter frequency 300/min

129
Q

What is a heart murmur?

A

Audible turbulence of blood flow in the heart

130
Q

How does a pansystolic murmur compare to an ejection systolic murmur?

A

Pan-systolic- constant pitch throughout

ejection systolic- pitch increases approaching ejection

131
Q

What type of murmur is Aortic stenosis? Where does it radiate to?

A

Ejection systolic murmur

Radiates to the carotids

132
Q

What type of murmur is Mitral regurgitation?

A

Pan-systolic murmur

radiates to the axilla

133
Q

What type of murmur is mitral stenosis? name an associated sign

A

Mid-diastolic

malar flush

134
Q

What type of murmur is aortic regurgitation? Identify an associated symptom

A

Early diastolic

Collapsing pulse

135
Q

Name two common congenital heart defects

A

Ventricular septal defect

Patent ductus arteriosis

136
Q

What is an ICED?

A

Implantable Cardiac Electronic Device

137
Q

Which valves are most likely to be affected by Infective endocarditis?

A

Mitral and aortic

138
Q

Pathogenesis of endocarditis: valvular damage leads to turbulent blood flow and the aggregation of _______ and _______. Bacterial infection of the blood (__________) leads to infection of the wound. Areas of the wound could break off and cause an abscess or a __________.

A

Platelets
fibrin
bacteraemia
haemorrhage

139
Q

What pathogens are the three main causes of Endocarditis?

A

Staph aureus
Strep viridans
Coxiella burnetti

140
Q

Strep. viridans along with strep. pneumoniae are a part of which haemolytic group?

A

Alpha haemolytic

141
Q

Which antibiotic is the first line treatment for Staph aureus infection?

A

Flucloxacillin

142
Q

How does acute endocarditis present?

A

Overwhelming sepsis

cardiac failure

143
Q

How does subacute endocarditis present? name three signs associated with it

A

Fever, malaise, SOB, weight loss, fatigue

Oster nodes, Janeway lesions, Roth spots

144
Q

Myocarditis and pericarditis are caused by what type of infection normally?

A

Viral infection

145
Q

Identify the three types of cardiomyopathy

A

Dilated
hypertrophic
restricted

146
Q

ST elevation on leads II III and AVF are a sign of what?

A

Inferior myocardial infarction

147
Q

what is losartan?

A

An angiotensin receptor blocker

148
Q

What causes ST elevation on all leads?

A

Acute pericarditis

149
Q

What aspect of the heart has the highest conduction velocities?

A

Purkinje fibres

150
Q

Abdominal Aortic aneurysms begin with degradation of the ________ ________ of the media then subsequent collagen loss of the adventitia

A

Elastic fibres

151
Q

What type of necrosis does the heart exhibit after an MI?

A

Coagulative necrosis

152
Q

Identify the clotting factors warfarin acts upon.

A

10, 9, 7, 2—-(1972)

153
Q

Name a thrombolytic drug used to treat a large PE

A

Streptokinase

154
Q

The first heart sound (S1) marks the beginning of __________ while the second (S2) marks the beginning of _________. S2 can exhibit physiological splitting because there is a delay between the ______ and _________ valve closure.

A

systole
diastole
aortic
pulmonary

155
Q

The third heart sound (S3) is an ____ diastolic low frequency ________ sound. In a young patient it is likely to be __________ but in an old patient it is likely to be _________ and caused by Left ventricular systolic dysfunction.

A

early
filling
physiological
pathological

156
Q

The fourth diastolic heart sound (S4) is a _____ diastolic low frequency filling sound. It occurs when forceful ______ contraction occurs. It is caused by hypertension and _______ __________.

A

Late
Atrial
aortic stenosis

157
Q

An inferior STEMI shows ST elevation in which leads?

A

II, III and AVF

158
Q

An anteroseptal STEMI shows ST elevation in which leads?

A

V1-V3

159
Q

An anterolateral STEMI shows ST elevation in which leads?

A

V4-V6, AVL and I

160
Q

A lateral STEMI shows ST elevation in which leads?

A

AVL and I

161
Q

Identify the normal range of stroke volumes in a healthy individual

A

55-100ml

162
Q

Identify a paediatric condition that causes projectile vomiting in children of 2-6 weeks of age

A

Pyloric stenosis

163
Q

Respiratory inspiration increases stroke volume. Why is this?

A

The thoracic pressure decreases on inspiration. The decreased pressure causes more blood to flow into the atrium.

164
Q

Occlusion of the left circumflex artery would cause what type of MI?

A

Anterolateral

165
Q

What causes a machine like heart murmur? What does this structure normally become?

A

Patent ductus arteriosus

ligamentum arteriosum

166
Q

Chest pain as a result of pericarditis is relieved by doing what?

A

Sitting/leaning forward

First Year Dundee Medicine (4 decks)

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