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CV Midterm/Quiz 1 Flashcards

1
Q

Name 3 symptoms of CV Pt. History

A

Chest Pain, Palpitations, Dyspnea, Edema, Syncope

Orthopnea, Paroxysmal Nocturnal Dyspnea

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2
Q

If a patient presents with severe tearing or ripping chest pain, what may be the cause?

A

Aortic Disection

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3
Q

Very brief, sharp, and stabbing pain that is localized on a superficial chest wall, and may be worse with palpating is indicative of what?

A

Psychogenic or Musculoskeletal Pain

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4
Q

What is the most common cause of Syncope, and what are some of its features?

A

Vasovagal Syncope

Sweating, nausea, dizziness, feeling cold, triggered by prolonged standing, pain, or an unpleasant environment.

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5
Q

What is Myxedema?

A

Edema resulting from hypothyroidism.

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6
Q

What is Anasarca?

A

Edema involving all aspects of the body: upper and lower extremities, and the face.

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7
Q

When would you take a comprehensive vs. a focused history?

A

Comprehensive:

  • New Patient
  • Annual visit
  • Hospital Admission

Focused:

  • Routine Follow-up
  • Acute Care Visit
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8
Q

Why do we take a Pt. History?

3 reasons

A
  1. Characterize Concerns
  2. Evaluate Risk Factors
  3. Develop a differential Diagnosis
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9
Q

What are the 3 types of capillaries? What are their characteristics?

A

Continuous:
- Cells meet, with no holes

Fenestrated:
-Cells meet, but full of fenestrations (holes)

Discontinuous:
-Cells don’t meet. Allow proteins to leave.

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10
Q

Which vessels have the largest impact on BP?

A

Arterioles

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11
Q

Which vessels most easily allow WBC extravatioin?

A

Venues

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12
Q

What is the difference between Angina and Myocardial Infarction?

A

Angina is Cardiac cell pain

Infarction is actual cell death and damage.

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13
Q

What are the differences between Arteries vs. Veins?

A

Arteries have

  • Smaller lumen
  • Largest tunica media
  • higher elastic fibers
  • Vessels maintain cylindrical shape

Veins have

  • larger tunica External
  • Valves.
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14
Q

What are the functional roles of vessel endothelium?

A
  1. Mediates the bidirectional exchange of molecules from blood to tissue
  2. Offers no-thrombogenic surface and controls clot formation
  3. Facilitates local inflammation and immune response.
  4. Promotes proliferation of cells within the vascular wall and WBC.
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15
Q

What are the histological layers of blood vessels?

A

Tunica intima

  • Endothelium
  • Subendothelium: loose CT, may contain scattered smooth muscle

Tunica Media: Middle layer composed of smooth muscle and elastic fiber

Tunica External: loses CT of collagen 1 and elastic fiber. Also contains autonomic nerve fibers and Vasa vasorum (small vessels that feed large vessels)

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16
Q

How do you differentiate the Epicardium from the endocardium?

A

Epicardium has fat and vessels.

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17
Q

What is another name for Visceral Pericardium?

A

Mesothelium

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18
Q

Explain cardiac muscle tissue

A

Short cells with singe (maybe two) central nucleus

Cross-striations

Intercalated discs of desomosomes, fascia adherents, and gap junctions (electrical binding)

Often branched.

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19
Q

What makes up Cardiac Output?

A

Stroke Volume and HR

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20
Q

What is the ejection Fraction?

A

The ratio of the Stroke volume over the End Diastole Volume.

Normal is .55-.7

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21
Q

What type of nervous control is most important for coronary circulation?

A

Local Control.

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22
Q

What is the a, c, and v wave of the Jugular Venous Pulse?

A

A: cause by atrial contraction

C: occurs when ventricles begin to contract

V: occurs toward the end of ventricular contraction.

23
Q

What is the Incisura?

A

Small pressure pulse as the Aortic and Pulmonic valves close.

24
Q

When are the Aortic and left ventricle pressures the same?

A

From the end of the Ventricular systole: isovolumetric contraction to the end of ventricular systole.

Once the valve closes the pressure obviously becomes different.

25
Q

What are the 5 stages of ventricular heart contraction, and what are the moving parts in each stage?

A

Atrial Systole: AV valves are open and ventricles are filling

Ventricular systole Isovolumetric phase: AV valves shut, and ventricular contraction begins.

Ventricular systole, ejection phase: Aortic and Pulmonary valves open, and the atria fill

Ventricular diastole, isovolumetric phase: all valves are shut

Ventricular diastole, rapid filling: AV valves open, and ventricles fill.

26
Q

What percentage of blood flows to each system?

A 
15% cerebral
5% Coronary
5% Skin
25% renal
25% GI
25% Skeletal Muscle
27
Q

Which vessels have the largest cross sectional area, and which hold the largest blood volume?

A

Capillaries have the largest cross sectional area

Veins hold the largest blood volume.

28
Q

What is the lifetime risk of developing HTN for a 55 yr old without HTN?

29
Q

Why don’t the AAFP ACP and European Union accept the new guidelines of HTN as 130/80?

A

Most of the patients being used in the studies were high risk of CVD.

30
Q

How many deaths/day does HTN contribute to?

31
Q

How many people have HTN in the new categories?

A

46% of adults

32
Q

For every increase of 20 in SBP or 10 DBP does what to the risk of heart problems?

33
Q

What is the equation for BP?

A

CO x SVR

CO= stroke volume x HR

34
Q

What is the difference between primary and secondary HTN?

A

Primary is idiopathic. Multiple factors like genetics, age, lifestyle, inactivity, obesity

Secondary has identifiable cause: certain drugs, kidney disease, endocrine cause, sleep apnea.

35
Q

What are the causes of 2nd HTN

A,B,C,D,E

A

A:

  • Accuracy of measurement
  • Aldosteronism (Conn’s syndrome. Adrenal hyperplasia, adrenal tumor)
  • Apnea (VERY common for resistant hypertension)

B:

  • Bruits (renal artery stenosis, or fibromuscular dysphasia)
  • Bad kidneys (renal parenchyma disease)

C:

  • Cathecholamines
  • Coarction of aorta
  • Endogenous Cushing’s Syndrome
  • Cushing’s (excess cortisol production)

D:

  • Drugs (anti-Inflammatory, alcohol increase BP)
  • Diet (salt, obesity)

E:

  • Erthropoietin (blood doping, testosterone)
  • Endocrine (thyroid, acromegaly)
36
Q

What is the DASH diet?

A

Dietary Approaches to Stop Hypertension

2-3 c. Dairy
2-2 1/2 c. Fruit and Veggies
6-8 oz. Whole grains
6 oz or less Lean meat
4-5 times/wk nuts and legumes
Use sparingly oil

Limit salt to less than 1500 mg/day with K+ rich foods.

37
Q

How do you calculate the Mean Arterial Pressure?

A

(SBP+2DBP)/3

38
Q

What is the Nocturnal dip?

A

BP will dip 10-20% when you sleep.

39
Q

What is white coat HTN vs masked HTN

A

Masked are those with habits like smoking that will higher BP at home vs in the office

Some may feel stress and increased BP in the office.

40
Q

What is one of the biggest reasons why treated HTN doesn’t improve?

A

Compliance with medications.

41
Q

What are pharmacological Tx of HTN?

A

ACE/ARB/CCB/Diuretcis are first choices

Chlorthalidone when starting diuretics

Hydorchlorothiazide more commonly used because it is cheaper.

42
Q

Which labs should be used upon diagnosis of HTN?

A 
Chem panel (glucose, Na, K, Ca)
CBC
Lipids
TSH
UA
Maybe an EKG (yes for Dr. Bennett

Pending suspicion:
BNP (brain natuiuretic peptide)
Aldosterone
Urinary catecholamines
Sleep study
AM cortisol
43
Q

What are Pericytes?

A

Contractile cells on capillaries

44
Q

What is Isoprotenol used for?

A

To treat brachycardia, heart block, and sometimes asthma.

45
Q

What is Laplace’s Law?

A

Tension= change in P x radius

46
Q

Why do larger arteries need thicker walls and fibrin

A

The larger radius creates more tension on the walls, plus they are usually under more pressure change as well.

47
Q

What are the 4 mechanisms for material exchange in capillaries?

A

Pinocytosis: Through cells for proteins

Bulk Flow: Driven by pressure through cell junctions

Diffusion across cells: O2 and CO2

Diffusion through Fenestrations: Concentration gradients.

48
Q

Which force drives Bulk Flow?

A

Starling forces

Hydrostatic and Oncotic

49
Q

What are the 2 Starling forces?

What does each force promote in capillaries?

A

Hydrostatic and Oncotic Pressure

Hydrostatic leads to filtration

Oncotic leads to absorption

50
Q

What are the causes of Intracellular and Extracellular edema?

A

Intracellular

  1. Hyponatremia
  2. Depression of metabolic systems of tissue
  3. Lack of adequate cell nutrition

Extracellular:

  1. Abnormal leakage from plasma (most common)
  2. Failure of lymphatic return
51
Q

What are drugs that may cause edema?

A

Steroids, Estrogens, Ca channel blockers, Thiazolidinediones (TZD), and NSAIDS

52
Q

What is Kussmaul Sign?

A

Visible Jugular Vein Distention

Shows right heart dysfunction.

53
Q

What would cause an increase in capillary hydrostatic pressure?

Hydraulic conductance?

Colloid osmotic pressure?

And decrease in Capillary Oncotic Pressure?

A

All causes of Edema

  1. Heart failure
  2. Burn, infection, histamine
  3. Lymphatic blockage
  4. Not enough protein in capillaries. Liver failure, or Protein malnutrition

CV (3 decks)

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