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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
Q

What is mixed valve disease?

A

Valves do not open or close properly

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26
Q

What are the three shunts in the foetal heart?

A

Ductus Venosus
Foramen Ovale
Ductus arteriosus

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27
Q

What is aspirin?

A

Thromboxane A2 inhibitor

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28
Q

Name some P2Y12 Inhibitors?

A

Ticagrelor, Prasugrel, Clopidogrel

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29
Q

What can we give patients if they can’t take statins?

A

Ezitimibe

PCSK9 Inhibitors

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30
Q

What is Aminodarone?

A

An anti-arrhythmic drug

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31
Q

Why are anti-platelets given in an MI?

A

The thrombus that occludes the coronary artery is made up of platelets
, therefore anti-platelets can help.

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32
Q

What is in virchows trias?

A

Hypercoaguable state
Endothelial injury
Circulatory stasis

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33
Q

Name some direct oral anticoagulants (DOACs)?

A

Apixaban

Rivaroxaban

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34
Q

Describe a Mitral Regurgitation Murmur…

A

Pan-systolic high pitched murmur

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35
Q

What can be a side effect of a thiazide diuretic?

A

Gout

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36
Q

What is can concomitant use of amiodarone and erythromycin cause?

A

Ventricular arrhythmias

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37
Q

What is the mechanism of nitrates?

A

They cause a decrease in intracellular calcium resulting in smooth muscle relaxation

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38
Q

What type of beta blocker is lipid-soluble?

A

Propanolol

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39
Q

What is the mechanism of heparin?

A

Activates anti-thrombin III

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40
Q

What is the mechanism of clopidogrel?

A

P2Y12 Inhibitor

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41
Q

What is the mechanism of Abciximab?

A

Glycoprotein IIb/IIIa inhibitor

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42
Q

What is the mechanism of dabigatran?

A

Direct thrombin inhibitor

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43
Q

What is the mechanism of Rivaroxaban?

A

Direct factor X inhibitor

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44
Q

What is the mechanism of nicorandil?

A

Potassium channel activator. It can treat hypertension

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45
Q

What is the mechanism of thiazide like diuretics?

A

Inhibit Na+ Cl- cotransporter

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46
Q

What clotting factors are affected by warfarin?

A

1972 mnemonic
10, 9, 7, 2
and protein c

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47
Q

When does atrial repolarisation occur on an ECG?

A

It is masked by the QRS complex

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48
Q

When does the S4 heart sound occur?

A

Just before S1

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49
Q

What is the cause of an S4 heart sound?

A

Ventricular stiffening

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50
Q

What is first degree heart block?

A

Prolongation of the PR interval

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51
Q

What are the types of second degree heart block?

A

Mobitz Type 1

Mobitz type 2

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52
Q

What Mobitz Type 1 heart block?

A

Progressive lengthening of the PR interval followed by a drop of the PR interval

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53
Q

What is Mobitz Type 2 heart block?

A

2:1 P waves.

For each 2 P waves, only one of them are followed by the QRS complex. The PR intervals are normal.

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54
Q

What is third degree, complete heart block?

A

These is no connection between the P wave and the QRS complex, they occur independently of one another.

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55
Q

What are vagal manoeuvres used to slow down?

A

Supraventricular tachycardia

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56
Q

What is adenosine used for?

A

To slow down supraventricular tachycardia

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57
Q

What does a Ventricular Tachycardia ECG show?

A

Broad complex tachycardia

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58
Q

What does a Supraventricular Tachycardia ECG show?

A

Narrow QRS complex

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59
Q

What are some causes of sinus tachycardia?

A 
Exercise
Pain
Anxiety
Hypoxia
Hypercapnia
Acidaemia
Sepsis
PE
Hyperthyroidism 
Drug and Alcohol Withdrawl
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60
Q

What are some pharmacological causes of sinus tachycardia?

A

Beta Agonists e.g. Salbutamol
Amphetamines
Cocaine
Anti-muscarinics

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61
Q

What is a supraventricular tachycardia?

A

Any tachycardia that is originating from above the bundle of his, usually due to a re-enterent circut

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62
Q

How do we manage an SVT?

A

Vagal manoeuvres

Adenosine 6 mg IV rapid bolus, further doses can be given at 12 mg

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63
Q

What conditions do we avoid adenosine in?

A

Obstructive respiratory diseases

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64
Q

What is the cause of atrial flutter?

A

Macro-re enterant rhythms within the atria

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65
Q

What is atrial fibrillation?

A

Disorganised atrial electrical activity and contraction resulting in an irregularly irregular ventricular response

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66
Q

What are the causes of Atrial Fibrillation?

A 
PIRATES
Pulmonary Embolism
Ischaemia
Respiratory Disease
Atrial Enlargement or myxoma
Thyroid disease
Ethanol
Sepsis
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67
Q

What is the method of rate control in AF?

A

Beta blocker
Consider Digoxin if heart failure
CCB
Check electrolytes for underlying cause

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68
Q

What is the method of rhythm control in AF?

A

Pharmacological Cardioversion - Amiodarone

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69
Q

When do we use rate control in AF?

A

Onset > 48 hours

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70
Q

When do we use rhythm control in AF?

A

New onset < 48 hours

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71
Q

What apolipoprotein do macrophages recognise in order to uptake lipids?

A

ApoB100

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72
Q

Which artery supplies most of the lateral aspect of the left ventricle?

A

Left circumflex artery

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73
Q

What type of drug might worsen symptoms in patients with peripheral vascular disease?

A

Beta blockers

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74
Q

What is a symptom of aortic dissection that may be seen on CXR?

A

Widening of the mediastinum

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75
Q

What is the first branch of the arch of the aorta?

A

Brachiocephalic Artery

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76
Q

What is the second branch of the arch of the aorta

A

Left Common Carotid

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77
Q

What is the third branch of the arch of the aorta?

A

Left Subclavian Artery

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78
Q

What does the brachiocephalic artery split into?

A

Right Common Carotid and Right Subclavian

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79
Q

What is the intraatrial septum?

A

Fossa Ovalis

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80
Q

What s the name for the atrial appendiges?

A

Right and left auricle

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81
Q

What are the Background muscles of the ventricles

A

Trabeculae Carne

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82
Q

What are the background muscles of the atria?

A

Papillae

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83
Q

What valve is particularly affected by IVDU?

A

Endocardidts of the tricuspid valve

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84
Q

What are the left branches of the coronary arteries?

A

Left anterior descending

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85
Q

What does the left coronary artery supply?

A

Left atrium
Most of left ventricle
Part of right ventricle
Anterior 2/3rds of IVS

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86
Q

What coromary vessel runs along the interventricular septum on the anterior surface of the heart?

A

Left Anterior Descending

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87
Q

What vessels could be used for a coronary bypass

A

internal mammary artery

Saphenous vein

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88
Q

What veins unite to form the superior vena cave?

A

Brachiocephalic veins and Azygous veins

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89
Q

What are the vertebral levels of the thoracic aorta?

A

T4 - T12

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90
Q

What are the branches of the thoracic aorta

A

Posterior intercostal arteries
Bronchial Arteries
Oesophageal Arteries

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91
Q

What are the branches of the abdominal aorta?

A 
T12 - Coeliac trunk
L1- renal artery
L2 - testicular/ovarian arteries
L3 - inferior mesenteric artery
L4- bifurcation of the abdominal aorta
92
Q

What artery supplies the upper limbs?

A

Subclavian Artery

93
Q

What are the arteries of the upper limb?

A 
Axillary
Brachial
Ulnar
Radial
Superficial and Deep Palmar Arch
Digital Artery
94
Q

What are the deep veins of the upper limb?

A

Same as the arteries and track alongside them

95
Q

What are the superficial veins of the upper limb?

A

Cephalic
Basilic
Median Cubital
Venae Comitantes

96
Q

What arteries supply the lower limbs?

A 
Femoral
Popliteal
Anterior tibial
Posterior tibial
Common peroneal
Dorsalis pedis
Plantar
97
Q

What are the deep veins of the lower limb?

A

Same as the artery

98
Q

What are the superficial veins of the lower limb?

A

Great saphenous vein

Small saphenous vein

99
Q

What are the contents of the femoral triangle?

A 
NAVEL
N - femoral nerve
A - femoral artery
V - femoral vein
E - empty space
L - deep inguinal lymph nodes
100
Q

What are the contents of the femoral triangle?

A 
NAVEL - from lateral to medial
N - femoral nerve
A - femoral artery
V - femoral vein
E - empty space
L - deep inguinal lymph nodes
101
Q

What is contained within the carotid sheath?

A

Common Carotid Artery
Internal Jugular Vein
Vagus Nerve

102
Q

What is the circle of willis?

A

Anastomosis of the anterior and posterior vessels to get to the brain

103
Q

What is the difference between bacteraemia and septicaemia?

A

Bacteraemia is simply the presence of bacteria in the blood whereas septicaemia is the presence and multiplication of bacteria in the blood.

104
Q

What are examples of PCSK9 inhibitors?

A

Alirocumab and Evolocumab

105
Q

What is contained within the tunica media?

A

Smooth Muscle

106
Q

What is contained within the tunica intima?

A

Endothelial cells separated by gap junctions

107
Q

What is contained within the tunica adventitia?

A

Vaso vasorum, fibroblasts and collagen

108
Q

What are the four main pulses of the lower limbs?

A

Femoal pulse
Popliteal
Posterior Tibial
Dorsal Pedis

109
Q

Where is the femoral pulse?

A

2-3 cm below the mid-inguinal point

110
Q

Where is the popliteal pulse?

A

Behind the partially flexed knee

111
Q

Where is the posterior tibial pulse?

A

Behind and below the medial ankle

112
Q

Where is the dorsal pedis pulse?

A

On the dorsum of the foot

113
Q

What is a side effect of thiazides?

A

Hyponatraemia

114
Q

What are side effects of loop diuretics

A

Hypokalaemia

115
Q

What are the u waves on ECG?

A

Deflections immediately following the T wave

116
Q

What are the causes of u waves?

A

Hypokalaemia

117
Q

What are bifid p waves on ECG?

A

This is when the p wave has 2 peaks

118
Q

What are the causes of bifid p waves?

A

Left atrial enlargement

119
Q

What are delta waves in ECG?

A

Slurred upstrokes of the QRS complex

120
Q

What are the causes of delta waves?

A

Wolff-Parkinson-White Syndrome

121
Q

What are pathological q waves?

A

Large q waves

122
Q

What are the causes of pathological q waves?

A

Prior or current MI

123
Q

What are tented T waves?

A

Tall T waves

124
Q

What are the causes of tented t waves?

A

Hyperkalaemia

125
Q

What is the management of supraventricular tachycardia?

A
  1. Vagal Manouvres

2. Adenosine

126
Q

What is the management of atrial fibrillation?

A
  1. Rate control - Beta blockers etc.

2. Rhythm control - anti arrhythmic drugs e.g. Amiodarone

127
Q

What are delta waves a common sign of?

A

Wolff-Parkinson White Syndrome

128
Q

What is Maladie de Roger?

A

A type of haemodynamically insignificant ventricular septal defect

129
Q

What is the action of troponin I?

A

Binds to actin to hold the troponin-tropomyosin complex in place.

130
Q

What is the action of troponin T?

A

Binds with tropomyosin to form the troponin-tropomyosin complex

131
Q

What is the action of troponin C?

A

Binds to calcium ions

132
Q

What forms chylomicrons?

A

They are formed from trigycerides, cholesterol and lipoproteins

133
Q

How do chylomicrons enter the blood?

A

They move into the lymphatic vessels and subsequently drain into the subclavian veins where they enter inot the blood

134
Q

What enzynme breaks down chylomicrons to free the triglycerides?

A

Lipoprotein Lipase

135
Q

Where are VLDLs released from?

136
Q

What do loop diuretics act on?

A

Na-K-2Cl symporter in the thick ascending loop of henle

137
Q

What do thiazide diuretics act on?

A

Na+ Cl- cotransporter in the distal convoluted tubule

138
Q

What are the two mechanisms of potassium-sparing diuretics?

A

Epithelial sodium channel blockers

Aldosterone antagonists

139
Q

What is the actions of nitrates?

A

Cause a decrease in intracellular calcium which results in smooth muscle relaxation

140
Q

Name some PCSK9 Inhibitors?

A

Alirocumab, Evolocumab

141
Q

What are examples of statins?

A

Atorvastatin, Fluvastatin

142
Q

What are examples of fibrates?

A

Fenofibrate

143
Q

What are examples of cholesterol absorption inhibitors?

144
Q

Which blood vessels are most commonly blocked in ACS?

A

Left Anterior Descending
Right Coronary Artery
Left Circumflex Artery

145
Q

What is the cause of an AAA?

A

Loss of elastic fibres in the tunica media of the aortic wall

146
Q

What is the cause of varicose veins?

A

Insufficiency of the superficial venous valves

147
Q

What are the chest x ray features of heart failure?

A 
ABCDE
A - Alveolar Oedema
B - B lines
C - Cardiomegaly
D - Diversion of vessels
E - Effusion
148
Q

What defines cardiomegaly?

A

A cardiothoracic ratio > 50%

149
Q

What are common features of right sided heart failure?

A

Raised JVP
Ankle Oedema
Hepatomegaly

150
Q

What are common features of left sided heart failure?

A

Paroxysmal Nocturnal Dyspnoea

151
Q

What is the equation for left ventricular ejection fraction?

A

LVEF = (Stroke Volume/End Diastolic LV Volume) x 100

152
Q

What is the most common cause of acute pericarditis?

153
Q

What ECG signs indicated acute pericarditis?

A

Global saddle shat ST elevation

PR Depression

154
Q

What is the treatment for uraemic pericarditis?

A

Haemodialysis

155
Q

What is the most common cause of infective endocarditis?

A

Staphylococcus Aureus

156
Q

How long does the AV node delay the signal for?

A

0.21 seconds

157
Q

What is the resting membrane potential for cardiac myocytes?

158
Q

What is the refractory period?

A

The period of time in which a second stimulus will not cause a response

159
Q

What are the three phases of clot formation?

A

The vascular phase
Platelet phase
Coagulation phase

160
Q

What is systolic heart failure?

A

Heart cant pump the blood hard enough

161
Q

What is diastolic heart failure?

A

The heart can fill enough

162
Q

What does global ST elevation and PR segment changes on ECG suggest?

A

Pericarditis

163
Q

What is the most common cause of infective endocarditis?

A

Viridans Streptococci

164
Q

Which organism is most likely to vegetate on prosthetic hear vavles?

A

Staphylococcus epidermis

165
Q

How does Fick’s Law of Diffusion relate to transport across the capillary wall?

A

Movement of gases and solutes occurs down the concentration gradient

166
Q

How do lipid soluble substances move across the the capillary wall?

A

They move through the endothelial cells

167
Q

How do water soluble substances move across the capillary wall?

A

They go through the water filled pores

168
Q

How do large molecules move across the capillary walls?

A

They generally cannot cross over the capillary wall and will remain in the blood

169
Q

Why is BNP released in heart failure?

A

It is released in response to ventricular strain

170
Q

What are the 5 regions of the primative heart?

A

Sinus Venosus

171
Q

What is the expected ejection fraction?

172
Q

Where is renin produced?

A

Juxtaglomerular cells

173
Q

What does a continuous murmur suggest?

A

Patent ductus arteriosus

174
Q

What is coarctation of the aorta?

A

This is a narrowing of the aorta normally below that level of the left subclavian artery around the origin of the ductus arteriosus

175
Q

What makes up tetraology of fallot?

A

Ventricular septal defect
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

176
Q

What is the action of statins?

A

Inhibit the action of HMG-CoA reductase

177
Q

Which vessel is most often used for a CABG?

A

Internal mammary artery

178
Q

What is the mechanism by which beta blockers lower blood pressure?

A

Inhibit renin release from the kidneys

179
Q

What is the mechanism of action of aspirin?

A

COX-1 enzyme inhibitor

180
Q

What is the mechanism of action of clopidogrel?

A

ADP receptor antagonist

181
Q

What is the mechanism of action of adenosine?

A

A1 receptor agonist

182
Q

What does the a wave represent in JVP?

A

Atrial contraction

183
Q

What does the c wave represent in JVP?

A

Bulging of tricuspid valve into atrium during ventricular contraction

184
Q

What does the v wave represent in JVP?

A

Rise in atrial pressure during atrial filling - releases as the AV valves open

185
Q

Which waves are visible on the JVP?

A

A and C waves

186
Q

What are the extrinsic controls of vascular smooth muscles?

A

Nerves - Sympathetic System

Hormones - Adrenaline, Angiotensin II, Antidiuretic hormone

187
Q

What is the action of adrenaline on vascular smooth muscle?

A

Action on alpha adrenoceptors = Vasoconstriction

Action of B2 adrenoceptors = Vasodilation

188
Q

What is the action of Angiotensin II on vascular smooth muscle?

A

Vasoconstriction

189
Q

What is the action of Antidiuretic hormone on vascular smooth muscle?

A

Vasoconstriction

190
Q

What are the intrinsic controls of vascular smooth muscle?

A

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
Q

What is the action of local metabolites on vascular smooth muscle?

A 
Vasodilation - 
Decreased PO2
Increased CO2
Decreased pH
Increased extracellular [K+]
Increased Osmolality of Extracellular fluid
Adenosine Release
192
Q

What is the action of local humoral agents on vascular smooth muscle?

A

Vasodilation - Histamine, Bradykinin, NO

Vasoconstriction - Endothelin, Thromboxane A2, Leukotrienes, Serotonin

193
Q

What is the action of NO within vascular smooth muscle?

A
  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
Q

What is the precursor for NO?

A

L-arginine

195
Q

What is an inotropic effect?

A

Change in cardiac contractility

196
Q

What is a chronotropic effect?

A

Change in heart rate

197
Q

What is a dromotropic effect?

A

Change in conduction velocity over the AV node

198
Q

What is a lusitropic effect?

A

Change in the duration of systole

199
Q

Which ion maintains resting potential in myocytes?

200
Q

What does the x descent represent of JVP?

A

Fall in atrial pressure during ventricular systole

201
Q

What does the y descent represent on JVP?

A

Opening of the tricuspid valve

202
Q

What is starlings law of the heart?

A

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
Q

Which disease is associated with torsades de points?

A

Long QT syndrome

204
Q

What is the cause of a third heart sound?

A

Diastolic filling of the ventricles

205
Q

What is the cause of a fourth heart sound?

A

Atrial contraction against a stiff ventricle, coincides with P wave

206
Q

What diseases are associated with an S3 heart sound?

A

Left ventricular failure, constrictive pericarditis, mitral regurgitation

207
Q

What diseases are associated with an S4 heart sound?

A

Aortic Stenosis

Hypertrophic obstructive cardiomyopathy

208
Q

Which congenital heart defect is described as eggs on a string?

A

Transposition of the great vessels

209
Q

Which congenital heart defect shows a boot shaped heart?

A

Tetralogy of Fallot

210
Q

What are the two ECG patterns associated with Brugada syndrome?

A

ST elevation

RBBB

211
Q

What four drugs are first line in heart failure?

A 
ABAL
ACE Inhibitors - Ramipril
Beta Blockers - Atenolol
Aldosterone Antagonist - Spironolactone
Loop Diuretics - Furosemide
212
Q

What are causes of endothelial disruption

A

Increased LDL
Turbulent blood flow
Infection Low oestrogen
Oxygen free radicals

213
Q

What is the action of warfarin?

A

Vitamin K reduction inhibitor

214
Q

What is the action of heparin?

A

Activates antithrombin III

215
Q

What is the action of DOACs (rivaroxaban)?

A

Factor Xa inhibitor

216
Q

Where is angiotensin converting enzyme produced?

217
Q

What is not a common symptoms of heart failure?

A

Chest pain

218
Q

What is the relationship between resistance to blood flow and the radius of the vessel?

A

Resistance is inversely proportional to the radius of the blood vessel to the power 4.

219
Q

What generates ketone bodies?

220
Q

What veins form the coronary sinus?

A 
Oblique vein
Great cardiac vein
Posterior vein of the left ventricle
Left marginal vein
Posterior interventricular vein
221
Q

What drug targets staph aureus?

A

Flucloxacillin

222
Q

What antibiotics are used for native valves?

A

Amoxicillin and gentamicin

223
Q

What antibiotics are used for prosthetic valves?

A

Vancomycin, gentamicin and rifampicin

224
Q

What artery most commonly supplies the AV node?

A

Right coronary artery

225
Q

What vessels form the left venous angle?

A

Internal jugular vein and subclavian vein

Aa. Year 1 Questions (12 decks)

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