Cardiovascular System

Question 1

First heart sound

Answer 1

Closing of the AV valves. First mitral than tricuspid.

Question 2

Systole

Answer 2

Events associated with ventricular contraction and ejection, short part of the cardiac cycle.

Question 3

Diastole

Answer 3

Events associated with ventricular relaxation and filling, long part of the cardiac cycle.

Question 4

Chronotropic

Answer 4

That influence the heart rate.

Question 5

Dromotropic

Answer 5

Affect the conduction speed in the AV node, therefore the rate of electrical impulse on of the heart.

Question 6

Inotropic

Answer 6

Affect the force/energy of the contraction of the heart.

Question 7

Vagal / parasympathetic activation of the heart

Answer 7

Decrease chronotropy, decrease dromotropy and decrease inotropy by releasing acetylcholine.

Question 8

Sympathetic activation of the heart

Answer 8

Increase in chronotropy, increase in dromotropy, increase in inotropy by releasing noradrenaline.

Question 9

What controls the heart rate ?

Answer 9

The sinoatrial node is the pacemaker of the heart, it is innervated by the vagal efferent fibres to prevent the heart from having a too high frequency of beat.

Question 10

What happen to the duration of the cardiac cycle when the heart rate increase.

Answer 10

The diastole phase shorten, the cardiac cycle last less than 1s.

Question 11

Third heart sound

Answer 11

Pathological signs after 40 of fatigue of the ventricles that became too stiff. Heard during the filling phase.

Question 12

What method do you use to auscultate the heart ?

Answer 12

All Patient Take Med
Aorta (right up), Pulmonary (left up), Tricuspid (right down), Mitral (left down)

Question 13

Second heart sound

Answer 13

Closing of semilunar valve. First aortic valve then pulmonary valve.

Question 14

How do the AV valves close ?

Answer 14

Pressure in the ventricles exceed pressure in the atrial, then the papillary muscle and their attached chordae tendinae contract preventing the AV valves leaflets from bulging back.

Question 15

What does the Frank-starling law say ?

Answer 15

Preload volume increase ==> EDV increase ==> pressure increase
Preload volume decrease ==> EDV decrease ==> pressure decrease
Afterload volume increase ==> pressure increase ==> stroke volume decrease
Afterload volume decrease ==> pressure decrease ==> stroke volume increase

Question 16

What does the preload affect ?

Answer 16

It influences the interaction between the myosin and actin forming the muscle contraction. The higher it is, the stronger the connection between the two will be.

Question 17

Parasympathetic efferent fibres

Answer 17

Vagus nerve

Question 18

Sympathetic efferent fibres

Answer 18

Cardiac nerve from the lower cervical and the upper thoracic ganglia.

Question 19

Autonomic nervous system

Answer 19

Both the sympathetic and the parasympathetic. Consist of autonomic nerves conducting impulse from the central nervous system to the glands, smooth muscle and cardiac muscles.

Question 20

Cardiac output

Answer 20

Total blood flow pumped per minute

Question 21

Stroke volume

Answer 21

EDV minus ESV

Question 22

Pressure gradient

Answer 22

Difference between the atrial and ventricular pressure.

Question 23

Total energy of blood

Answer 23

Sum of the pressure energy and the kinetic energy (which is the square velocity of the blood flow).

Question 24

What is a physiological shock ? What are the major causes ? What are the main symptoms ?

Answer 24

Life threatening clinical state characterised by deficiency of blood supply.
Caused by allergic reaction, significant blood loss, heart failure, blood infection,dehydration poisoning and burn.
Symptoms : low blood pressure, weak pulse, confusion, thirst, low glucose level, bone fracture, organ rupture,…

Question 25

What is hypovolemic shock ?

Answer 25

A problem in circulatory blood volume. There isn’t enough blood in the vessel to carry the oxygen. Caused by internal or external blood loss.

Question 26

What is angina ?

Answer 26

Chest pain caused by reduced blood flow to the heart muscle.

Question 27

What are the most common symptoms of myocardial infraction ?

Answer 27

Chest pain (burning, squeezing, heaving feeling) and dyspnea.

Question 28

What is the relationship between the levels of troponin and the cardiovascular system ?

Answer 28

One hour after myocardial damage, the level of troponin 1 can be detected.

Question 29

When would crackles be heard ?

Answer 29

Heard in the lungs of patient when they have a left sided heart failure.

Question 30

What is cardiac tamponade ?

Answer 30

A pathology where the pericardium is filled with fluid, more often blood.

Question 31

What is a cardiac catheterisation ?

Answer 31

A test to determine if there’s coronary heart disease and to determine its location.

Question 32

What are the secondary symptoms of right sided heart failure ?

Answer 32

Oliguria, nausea and weight gain.

Question 33

What is acute heart failure ?

Answer 33

Rapid or gradual symptoms of heart failure leading to unplanned hospital admission. Leading cause of hospitalisation over 65 years old.

Question 34

What instruments/methods do you use to diagnose acute heart failure ?

Answer 34

Electrocardiogram, pulse oximetry, echocardiography, labs, chest x-ray, lung ultrasound. Natriuretic peptide testing

Question 35

With what result of a natriuretic peptide testing is acute heart failure confirmed ?

Answer 35

BNP ≥ 100 pg/mL NT proBNP ≥ 300 pg/mL MR proANP ≥ 120 pg/mL - mid regional pro atrial natriuretic peptide

Question 36

What is the role of natriuretic peptide in HF?

Answer 36

They play important cardioprotective roles. During HF, due to strains caused by high ventricular filling pressure and increased exposure of neurohormones, the ventricles will be stimulated to secrete ANP and BNP.

Question 37

What are the types of natriuretic peptides ?

Answer 37

Atrial natriuretic peptide (ANP) secreted in the atrium and brain natriuretic peptide (BNP secreted in the ventricles : - antagonist effect to angiotensin => diuretics actions, vasodilatation and inhibition of aldosterone C-type natriuretic peptide (CNP) is expressed in the vasculature, CNS and bone. - regulate vascular tone and BP

Question 38

What is the most common form of acute HF?

Answer 38

Acute decompensated heart failure : sudden or gradual onset of signs of HF requiring medical attention. Findings : pulmonary and systemic congestion due to increased left and right heart filling pressure

Question 39

What is physiologic shock ?

Answer 39

Life threatening clinical state characterised by body wide deficiency of blood supply causing oxygen depreciations, buildup of waste products and eventual organ failure.

Question 40

What are the first signs of shock ?

Answer 40

Low BP, weak pulse, rapid heartbeat.

Question 41

What are the different kinds of shock ?

Answer 41

Hypovolemic shock : severe reduction of the circulating volume of blood, leads to oxygen being unable to be transported. Cardiogenic shock : severe heart dysfunction, where damage to the heart leads to hypoperfusion. Obstructive shock : obstruction of blood flow in a major circulatory vessel Distributive shock : loss of the blood vessel tone leading to decrease in BP

Question 42

What are the causes and symptoms of hypovolemic shock ?

Answer 42

Caused by : - External or internal blood loss = hypovolemic hemorrhagic shock - Ectopic pregnancy - fluid loss : excessive vomiting, urination or burns - serious dehydratation Symptoms : high HR, vasoconstriction, cyanosis, dizziness, confusion, fainting.

Question 43

What are the causes of Cardiogenic shock ?

Answer 43

Most common : left ventricular failure Acute ischemia, papillary muscle rupture ventricular septal rupture, cardiomyopathy, acute myocarditis, cardiac tamponade, myocardial infarction, arrhythmia, valvular disease.

Question 44

What are the symptoms of Cardiogenic shock?

Answer 44

Wet and cold skin, dyspnea. Low BP, low CO, high HR ( in most case but because the heart is the problem bradycardia is also possible)

Question 45

What are the causes of obstructive shock?

Answer 45

Pneumothorax, hemothorax, cardiac tamponade, pulmonary embolism.

Question 46

What are the type of distributive shock ?

Answer 46

Sepsis : blood poisoning caused by infections. The pathogens lead to serious damage to the tissues and organs while the immune system results in vasodilatation and fluid leakage. Anaphylactic shock : body mistakes a harmless substance as harmful Neurogenic shock : damage to CNS due mostly to spinal cord injury. The sympathetic tone is lost and blood vessels dilates.

Question 47

What are symptoms of distributive shock ?

Answer 47

Low BP, varying CO, high blood lactate. Brain damage Lack of blood flow to the kidney. Cold, sweaty or bluish warm skin.