Cardiovascular Stuff (PASSMED) Flashcards
Why do ACEi cause chronic dry cough?
ACEi prevent the breakdown of inflammatory peptides (bradykinin and angiotensin II) which causes chronic dry cough
What is the primary dysfunction in heart failure with reduced ejection fraction (HFrEF) and what common symptom can arise from it?
HFrEF is primarily caused by systolic dysfunction (impaired myocardial contraction during systole) which leads to reduced ejection fraction.
A common symptom is dizziness on standing (orthostatic hypotension)
What causes hyperpigmentation seen in patients with varicose eczema/venous ulcers?
Haemosiderin deposition
Where in the nephron does furosemide act?
Ascending limb of the loop of Henle
Patient presents with shortness of breath and sharp, pleuritic right-sided chest pain. CXR shows wedge-shaped opacification. What is most likely diagnosis?
Pulmonary Embolism
- Classically associated with pleuritic chest pain and wedge shaped opacity on CXR
Young patient has a ECG showing sinus rhythm, generalised deep Q waves, widespread T wave inversion and evidence of left ventricular hypertrophy.
What is the most likely diagnosis?
Hypertrophic obstructive cardiomyopathy (HOCM).
What are key features of Brugada Syndrome, and why is it clinically significant?
- Autosomal domiant condition associated with sudden cardiac death in young adults
- May present with unexplained syncope or falls
- Characterised by ST elevation in leads V1-V3
What is the mechanism of action of bendroflumethiazide?
Blocks the Na+/Cl- transporter in the distal convoluted tubule, reducing plasma volume and peripheral resistance
What are the common side effects of thiazide diuretics
- Hypokalaemia
- Hyponatraemia
- Hypercalcaemia
- Gout
- Hyperglycaemia
- Erectile dysfunction
What is the mechanism of action of clopidogrel
ADP receptor antagonist that inhibits platelet activation and clot formation
(Ticagrelor is similar)
What condition is suggested by a liver the ‘bounces’ with the cardiac cycle on palpation?
Tricuspid Regurgitation
- Causes pulsatile hepatomegaly due to retrograde blood flow into the liver during systole
What causes a fourth heart sound (S4) and when is it heard?
S4 ocurs in late diastole and is caused by atrial contraction against a stiff, non-compliant ventricle.
It is associated with conditions like ventricular hypertrophy, HF or ischaemia
What is the function of cardiac troponin I?
Binds to actin to hold to troponin-tropomyosin complex in place
What is Starling’s Law of the Heart?
The force of the hearts contraction is directly related to the intitial length (preload) of the cardiac muscle fibres, the greater the stretch (preload) the greater the force of contraction (up to a point)
What is the mechanism of ambrisentan in the treatment of pulmonary arterial hypertension (PAH)?
Endothelin-1 receptor A (ETA) antagonist, blocking vasoconstriction mediated by endothelin-1 in PAH
What are the features of aortic stenosis?
- Narrowed aortic valve
- Systolic ejection murmur
- Radiates to carotids
- Decreased systolic pressure
- Chest pain, syncope and HF
What are the features of aortic regurgitation?
- Aortic valve fails to close properly
- Diastolic decresendo murmur
- Collapsing pulse
- Displaced apex (lat and inf)
- LV dilation, heart failure
What are the features of mitral stenosis?
- Narrowed mitral valve
- Mid-diastolic murmur
- Opening snap, Malar flush
- Tapping apex beat
- SOB, AF
What are the features of mitral regurgitation?
- Mitral valve doesn’t close properly
- Pansystolic murmur best heard at apex
- Radiates to axilla
- Displaced apex
What are the 4 factors that affect stroke volume?
- Cardiac size
- Contractility
- Preload
- Afterload
What is the mechanism of action of dipyridamole?
Non-specific phosphodiesterase inhibitor (P2Y12 Inhibitor)
Decreases cellular uptake of adenosine
How to ACEi exert their renoprotective effects?
ACEi dilate the glomerular efferent arteriole, reducing glomerular pressure and protecting the kidneys from damage
What are Aschoff bodies?
Granulomatous nodules found in rheumatic heart fever
What is the effect of noradrenaline binding to beta-1 receptors in the SA node?
It increases depolarisation in the SA node = increased heart rate
