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Aa. Year 1 Questions > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is a D-dimer test used for?

A

An D-dimer test rules out the presence of a serious blood clot. If D-dimer levels are normal, there is unlikely any blood clot so this can be ruled out. Elevated levels cant rule out a blood clot.

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2
Q

What are the inferior ECG leads?

A

Leads II, III, aVF

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3
Q

What are the anterior ECG leads?

A

V2-V6

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4
Q

What does mediastinal widening on a CXR suggest?

A

Aortic Dissection

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5
Q

What is a common side effect of ACE inhibitors?

A

A dry cough

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6
Q

What type of channel restores resting potential in phase 4?

A

Na+/K+ ATPase

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7
Q

What antiplatelet drug is a phosphodiesterase inhibitor?

A

Dipyridamole, this decreases cellular uptake of adenosine

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8
Q

What part of the cardiac conduction system has the fastest velocity?

A

Purkinje Fibres

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9
Q

What wave is electrocardioversion synchronised to?

A

R wave

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10
Q

What does troponin C bind to?

A

Calcium ions

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11
Q

What is the action of endothelin?

A

It is a long-acting vasoconstrictor and bronchoconstrictor.

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12
Q

What is a common chronic cause of RBBB?

A

Cor pulmonale (Right ventricular hypertrophy)

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13
Q

What are the most common valve failures after heart failure diagnosis?

A

Mitral regurgitation and tricuspid regurgitation

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14
Q

What contraindicates the prescription of a beta blocker?

A

Asthma

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15
Q

What part of the heart does ivabridine act on?

A

Sino Atrial Node

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16
Q

What does troponin I bind to?

A

Actin

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17
Q

What are differential diagnoses for inferior ST elevation?

A

Inferior STEMI

Aortic dissection

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18
Q

A murmur radiating to the carotids suggests…

A

Aortic Stenosis

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19
Q

A murmur radiating to the axilla suggests…

A

Mitral Regurgitation

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20
Q

What factor can make right sided murmurs louder?

A

Inspiration

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21
Q

Name some common murmurs…

A 
Innocent murmur
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Mitral stenosis
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22
Q

What type of murmurs are always pathological?

A

Diastolic

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23
Q

What is valve stenosis?

A

Valves dont open properly

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24
Q

What is valve regurgitation?

A

Valves dont close properly

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25
What is mixed valve disease?
Valves do not open or close properly
26
What are the three shunts in the foetal heart?
Ductus Venosus Foramen Ovale Ductus arteriosus
27
What is aspirin?
Thromboxane A2 inhibitor
28
Name some P2Y12 Inhibitors?
Ticagrelor, Prasugrel, Clopidogrel
29
What can we give patients if they can't take statins?
Ezitimibe | PCSK9 Inhibitors
30
What is Aminodarone?
An anti-arrhythmic drug
31
Why are anti-platelets given in an MI?
The thrombus that occludes the coronary artery is made up of platelets , therefore anti-platelets can help.
32
What is in virchows trias?
Hypercoaguable state Endothelial injury Circulatory stasis
33
Name some direct oral anticoagulants (DOACs)?
Apixaban | Rivaroxaban
34
Describe a Mitral Regurgitation Murmur...
Pan-systolic high pitched murmur
35
What can be a side effect of a thiazide diuretic?
Gout
36
What is can concomitant use of amiodarone and erythromycin cause?
Ventricular arrhythmias
37
What is the mechanism of nitrates?
They cause a decrease in intracellular calcium resulting in smooth muscle relaxation
38
What type of beta blocker is lipid-soluble?
Propanolol
39
What is the mechanism of heparin?
Activates anti-thrombin III
40
What is the mechanism of clopidogrel?
P2Y12 Inhibitor
41
What is the mechanism of Abciximab?
Glycoprotein IIb/IIIa inhibitor
42
What is the mechanism of dabigatran?
Direct thrombin inhibitor
43
What is the mechanism of Rivaroxaban?
Direct factor X inhibitor
44
What is the mechanism of nicorandil?
Potassium channel activator. It can treat hypertension
45
What is the mechanism of thiazide like diuretics?
Inhibit Na+ Cl- cotransporter
46
What clotting factors are affected by warfarin?
1972 mnemonic 10, 9, 7, 2 and protein c
47
When does atrial repolarisation occur on an ECG?
It is masked by the QRS complex
48
When does the S4 heart sound occur?
Just before S1
49
What is the cause of an S4 heart sound?
Ventricular stiffening
50
What is first degree heart block?
Prolongation of the PR interval
51
What are the types of second degree heart block?
Mobitz Type 1 | Mobitz type 2
52
What Mobitz Type 1 heart block?
Progressive lengthening of the PR interval followed by a drop of the PR interval
53
What is Mobitz Type 2 heart block?
2:1 P waves. | For each 2 P waves, only one of them are followed by the QRS complex. The PR intervals are normal.
54
What is third degree, complete heart block?
These is no connection between the P wave and the QRS complex, they occur independently of one another.
55
What are vagal manoeuvres used to slow down?
Supraventricular tachycardia
56
What is adenosine used for?
To slow down supraventricular tachycardia
57
What does a Ventricular Tachycardia ECG show?
Broad complex tachycardia
58
What does a Supraventricular Tachycardia ECG show?
Narrow QRS complex
59
What are some causes of sinus tachycardia?
``` Exercise Pain Anxiety Hypoxia Hypercapnia Acidaemia Sepsis PE Hyperthyroidism Drug and Alcohol Withdrawl ```
60
What are some pharmacological causes of sinus tachycardia?
Beta Agonists e.g. Salbutamol Amphetamines Cocaine Anti-muscarinics
61
What is a supraventricular tachycardia?
Any tachycardia that is originating from above the bundle of his, usually due to a re-enterent circut
62
How do we manage an SVT?
Vagal manoeuvres | Adenosine 6 mg IV rapid bolus, further doses can be given at 12 mg
63
What conditions do we avoid adenosine in?
Obstructive respiratory diseases
64
What is the cause of atrial flutter?
Macro-re enterant rhythms within the atria
65
What is atrial fibrillation?
Disorganised atrial electrical activity and contraction resulting in an irregularly irregular ventricular response
66
What are the causes of Atrial Fibrillation?
``` PIRATES Pulmonary Embolism Ischaemia Respiratory Disease Atrial Enlargement or myxoma Thyroid disease Ethanol Sepsis ```
67
What is the method of rate control in AF?
Beta blocker Consider Digoxin if heart failure CCB Check electrolytes for underlying cause
68
What is the method of rhythm control in AF?
Pharmacological Cardioversion - Amiodarone
69
When do we use rate control in AF?
Onset > 48 hours
70
When do we use rhythm control in AF?
New onset < 48 hours
71
What apolipoprotein do macrophages recognise in order to uptake lipids?
ApoB100
72
Which artery supplies most of the lateral aspect of the left ventricle?
Left circumflex artery
73
What type of drug might worsen symptoms in patients with peripheral vascular disease?
Beta blockers
74
What is a symptom of aortic dissection that may be seen on CXR?
Widening of the mediastinum
75
What is the first branch of the arch of the aorta?
Brachiocephalic Artery
76
What is the second branch of the arch of the aorta
Left Common Carotid
77
What is the third branch of the arch of the aorta?
Left Subclavian Artery
78
What does the brachiocephalic artery split into?
Right Common Carotid and Right Subclavian
79
What is the intraatrial septum?
Fossa Ovalis
80
What s the name for the atrial appendiges?
Right and left auricle
81
What are the Background muscles of the ventricles
Trabeculae Carne
82
What are the background muscles of the atria?
Papillae
83
What valve is particularly affected by IVDU?
Endocardidts of the tricuspid valve
84
What are the left branches of the coronary arteries?
Left anterior descending
85
What does the left coronary artery supply?
Left atrium Most of left ventricle Part of right ventricle Anterior 2/3rds of IVS
86
What coromary vessel runs along the interventricular septum on the anterior surface of the heart?
Left Anterior Descending
87
What vessels could be used for a coronary bypass
internal mammary artery | Saphenous vein
88
What veins unite to form the superior vena cave?
Brachiocephalic veins and Azygous veins
89
What are the vertebral levels of the thoracic aorta?
T4 - T12
90
What are the branches of the thoracic aorta
Posterior intercostal arteries Bronchial Arteries Oesophageal Arteries
91
What are the branches of the abdominal aorta?
``` T12 - Coeliac trunk L1- renal artery L2 - testicular/ovarian arteries L3 - inferior mesenteric artery L4- bifurcation of the abdominal aorta ```
92
What artery supplies the upper limbs?
Subclavian Artery
93
What are the arteries of the upper limb?
``` Axillary Brachial Ulnar Radial Superficial and Deep Palmar Arch Digital Artery ```
94
What are the deep veins of the upper limb?
Same as the arteries and track alongside them
95
What are the superficial veins of the upper limb?
Cephalic Basilic Median Cubital Venae Comitantes
96
What arteries supply the lower limbs?
``` Femoral Popliteal Anterior tibial Posterior tibial Common peroneal Dorsalis pedis Plantar ```
97
What are the deep veins of the lower limb?
Same as the artery
98
What are the superficial veins of the lower limb?
Great saphenous vein | Small saphenous vein
99
What are the contents of the femoral triangle?
``` NAVEL N - femoral nerve A - femoral artery V - femoral vein E - empty space L - deep inguinal lymph nodes ```
100
What are the contents of the femoral triangle?
``` NAVEL - from lateral to medial N - femoral nerve A - femoral artery V - femoral vein E - empty space L - deep inguinal lymph nodes ```
101
What is contained within the carotid sheath?
Common Carotid Artery Internal Jugular Vein Vagus Nerve
102
What is the circle of willis?
Anastomosis of the anterior and posterior vessels to get to the brain
103
What is the difference between bacteraemia and septicaemia?
Bacteraemia is simply the presence of bacteria in the blood whereas septicaemia is the presence and multiplication of bacteria in the blood.
104
What are examples of PCSK9 inhibitors?
Alirocumab and Evolocumab
105
What is contained within the tunica media?
Smooth Muscle
106
What is contained within the tunica intima?
Endothelial cells separated by gap junctions
107
What is contained within the tunica adventitia?
Vaso vasorum, fibroblasts and collagen
108
What are the four main pulses of the lower limbs?
Femoal pulse Popliteal Posterior Tibial Dorsal Pedis
109
Where is the femoral pulse?
2-3 cm below the mid-inguinal point
110
Where is the popliteal pulse?
Behind the partially flexed knee
111
Where is the posterior tibial pulse?
Behind and below the medial ankle
112
Where is the dorsal pedis pulse?
On the dorsum of the foot
113
What is a side effect of thiazides?
Hyponatraemia
114
What are side effects of loop diuretics
Hypokalaemia
115
What are the u waves on ECG?
Deflections immediately following the T wave
116
What are the causes of u waves?
Hypokalaemia
117
What are bifid p waves on ECG?
This is when the p wave has 2 peaks
118
What are the causes of bifid p waves?
Left atrial enlargement
119
What are delta waves in ECG?
Slurred upstrokes of the QRS complex
120
What are the causes of delta waves?
Wolff-Parkinson-White Syndrome
121
What are pathological q waves?
Large q waves
122
What are the causes of pathological q waves?
Prior or current MI
123
What are tented T waves?
Tall T waves
124
What are the causes of tented t waves?
Hyperkalaemia
125
What is the management of supraventricular tachycardia?
1. Vagal Manouvres | 2. Adenosine
126
What is the management of atrial fibrillation?
1. Rate control - Beta blockers etc. | 2. Rhythm control - anti arrhythmic drugs e.g. Amiodarone
127
What are delta waves a common sign of?
Wolff-Parkinson White Syndrome
128
What is Maladie de Roger?
A type of haemodynamically insignificant ventricular septal defect
129
What is the action of troponin I?
Binds to actin to hold the troponin-tropomyosin complex in place.
130
What is the action of troponin T?
Binds with tropomyosin to form the troponin-tropomyosin complex
131
What is the action of troponin C?
Binds to calcium ions
132
What forms chylomicrons?
They are formed from trigycerides, cholesterol and lipoproteins
133
How do chylomicrons enter the blood?
They move into the lymphatic vessels and subsequently drain into the subclavian veins where they enter inot the blood
134
What enzynme breaks down chylomicrons to free the triglycerides?
Lipoprotein Lipase
135
Where are VLDLs released from?
Liver
136
What do loop diuretics act on?
Na-K-2Cl symporter in the thick ascending loop of henle
137
What do thiazide diuretics act on?
Na+ Cl- cotransporter in the distal convoluted tubule
138
What are the two mechanisms of potassium-sparing diuretics?
Epithelial sodium channel blockers | Aldosterone antagonists
139
What is the actions of nitrates?
Cause a decrease in intracellular calcium which results in smooth muscle relaxation
140
Name some PCSK9 Inhibitors?
Alirocumab, Evolocumab
141
What are examples of statins?
Atorvastatin, Fluvastatin
142
What are examples of fibrates?
Fenofibrate
143
What are examples of cholesterol absorption inhibitors?
Ezitimibe
144
Which blood vessels are most commonly blocked in ACS?
Left Anterior Descending Right Coronary Artery Left Circumflex Artery
145
What is the cause of an AAA?
Loss of elastic fibres in the tunica media of the aortic wall
146
What is the cause of varicose veins?
Insufficiency of the superficial venous valves
147
What are the chest x ray features of heart failure?
``` ABCDE A - Alveolar Oedema B - B lines C - Cardiomegaly D - Diversion of vessels E - Effusion ```
148
What defines cardiomegaly?
A cardiothoracic ratio > 50%
149
What are common features of right sided heart failure?
Raised JVP Ankle Oedema Hepatomegaly
150
What are common features of left sided heart failure?
Paroxysmal Nocturnal Dyspnoea
151
What is the equation for left ventricular ejection fraction?
LVEF = (Stroke Volume/End Diastolic LV Volume) x 100
152
What is the most common cause of acute pericarditis?
Infection
153
What ECG signs indicated acute pericarditis?
Global saddle shat ST elevation | PR Depression
154
What is the treatment for uraemic pericarditis?
Haemodialysis
155
What is the most common cause of infective endocarditis?
Staphylococcus Aureus
156
How long does the AV node delay the signal for?
0.21 seconds
157
What is the resting membrane potential for cardiac myocytes?
-90 mV
158
What is the refractory period?
The period of time in which a second stimulus will not cause a response
159
What are the three phases of clot formation?
The vascular phase Platelet phase Coagulation phase
160
What is systolic heart failure?
Heart cant pump the blood hard enough
161
What is diastolic heart failure?
The heart can fill enough
162
What does global ST elevation and PR segment changes on ECG suggest?
Pericarditis
163
What is the most common cause of infective endocarditis?
Viridans Streptococci
164
Which organism is most likely to vegetate on prosthetic hear vavles?
Staphylococcus epidermis
165
How does Fick's Law of Diffusion relate to transport across the capillary wall?
Movement of gases and solutes occurs down the concentration gradient
166
How do lipid soluble substances move across the the capillary wall?
They move through the endothelial cells
167
How do water soluble substances move across the capillary wall?
They go through the water filled pores
168
How do large molecules move across the capillary walls?
They generally cannot cross over the capillary wall and will remain in the blood
169
Why is BNP released in heart failure?
It is released in response to ventricular strain
170
What are the 5 regions of the primative heart?
Sinus Venosus
171
What is the expected ejection fraction?
60-65%
172
Where is renin produced?
Juxtaglomerular cells
173
What does a continuous murmur suggest?
Patent ductus arteriosus
174
What is coarctation of the aorta?
This is a narrowing of the aorta normally below that level of the left subclavian artery around the origin of the ductus arteriosus
175
What makes up tetraology of fallot?
Ventricular septal defect Overriding aorta Pulmonary stenosis Right ventricular hypertrophy
176
What is the action of statins?
Inhibit the action of HMG-CoA reductase
177
Which vessel is most often used for a CABG?
Internal mammary artery
178
What is the mechanism by which beta blockers lower blood pressure?
Inhibit renin release from the kidneys
179
What is the mechanism of action of aspirin?
COX-1 enzyme inhibitor
180
What is the mechanism of action of clopidogrel?
ADP receptor antagonist
181
What is the mechanism of action of adenosine?
A1 receptor agonist
182
What does the a wave represent in JVP?
Atrial contraction
183
What does the c wave represent in JVP?
Bulging of tricuspid valve into atrium during ventricular contraction
184
What does the v wave represent in JVP?
Rise in atrial pressure during atrial filling - releases as the AV valves open
185
Which waves are visible on the JVP?
A and C waves
186
What are the extrinsic controls of vascular smooth muscles?
Nerves - Sympathetic System | Hormones - Adrenaline, Angiotensin II, Antidiuretic hormone
187
What is the action of adrenaline on vascular smooth muscle?
Action on alpha adrenoceptors = Vasoconstriction | Action of B2 adrenoceptors = Vasodilation
188
What is the action of Angiotensin II on vascular smooth muscle?
Vasoconstriction
189
What is the action of Antidiuretic hormone on vascular smooth muscle?
Vasoconstriction
190
What are the intrinsic controls of vascular smooth muscle?
Chemical - Local metabolites (PO2 and PCO2, [H+], ECF, Adenosine Release), Local Humoral Agents (Histamine, Bradykinin, NO, Serotonin, Thromboxane A2, Leukotrienes, Endothelin) Physical - Temperature, Myogenic response to strech
191
What is the action of local metabolites on vascular smooth muscle?
``` Vasodilation - Decreased PO2 Increased CO2 Decreased pH Increased extracellular [K+] Increased Osmolality of Extracellular fluid Adenosine Release ```
192
What is the action of local humoral agents on vascular smooth muscle?
Vasodilation - Histamine, Bradykinin, NO | Vasoconstriction - Endothelin, Thromboxane A2, Leukotrienes, Serotonin
193
What is the action of NO within vascular smooth muscle?
1. Diffuses from vascular endothelium into adjacent smooth muscle cells. 2. Activates the formation of cGMP which serves as a secondary messenger for signalling smooth muscle relaxation
194
What is the precursor for NO?
L-arginine
195
What is an inotropic effect?
Change in cardiac contractility
196
What is a chronotropic effect?
Change in heart rate
197
What is a dromotropic effect?
Change in conduction velocity over the AV node
198
What is a lusitropic effect?
Change in the duration of systole
199
Which ion maintains resting potential in myocytes?
Potassium
200
What does the x descent represent of JVP?
Fall in atrial pressure during ventricular systole
201
What does the y descent represent on JVP?
Opening of the tricuspid valve
202
What is starlings law of the heart?
The higher the cardiac preload, the greater the stroke volume up to a point when the stroke volume decreases due to overloading of the cardiac muscle fibres
203
Which disease is associated with torsades de points?
Long QT syndrome
204
What is the cause of a third heart sound?
Diastolic filling of the ventricles
205
What is the cause of a fourth heart sound?
Atrial contraction against a stiff ventricle, coincides with P wave
206
What diseases are associated with an S3 heart sound?
Left ventricular failure, constrictive pericarditis, mitral regurgitation
207
What diseases are associated with an S4 heart sound?
Aortic Stenosis | Hypertrophic obstructive cardiomyopathy
208
Which congenital heart defect is described as eggs on a string?
Transposition of the great vessels
209
Which congenital heart defect shows a boot shaped heart?
Tetralogy of Fallot
210
What are the two ECG patterns associated with Brugada syndrome?
ST elevation | RBBB
211
What four drugs are first line in heart failure?
``` ABAL ACE Inhibitors - Ramipril Beta Blockers - Atenolol Aldosterone Antagonist - Spironolactone Loop Diuretics - Furosemide ```
212
What are causes of endothelial disruption
Increased LDL Turbulent blood flow Infection Low oestrogen Oxygen free radicals
213
What is the action of warfarin?
Vitamin K reduction inhibitor
214
What is the action of heparin?
Activates antithrombin III
215
What is the action of DOACs (rivaroxaban)?
Factor Xa inhibitor
216
Where is angiotensin converting enzyme produced?
Lungs
217
What is not a common symptoms of heart failure?
Chest pain
218
What is the relationship between resistance to blood flow and the radius of the vessel?
Resistance is inversely proportional to the radius of the blood vessel to the power 4.
219
What generates ketone bodies?
Lipolysis
220
What veins form the coronary sinus?
``` Oblique vein Great cardiac vein Posterior vein of the left ventricle Left marginal vein Posterior interventricular vein ```
221
What drug targets staph aureus?
Flucloxacillin
222
What antibiotics are used for native valves?
Amoxicillin and gentamicin
223
What antibiotics are used for prosthetic valves?
Vancomycin, gentamicin and rifampicin
224
What artery most commonly supplies the AV node?
Right coronary artery
225
What vessels form the left venous angle?
Internal jugular vein and subclavian vein

Aa. Year 1 Questions (12 decks)

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