CVS Overview

Question 1

Dysfunction of cardiac contractile function:

Answer 1

Heart failure

Question 2

Heart failure is

Answer 2

Dysfunction of cardiac contractile function

Question 3

Dysfunction of coronary blood supply is

Answer 3

Ischaemic heart disease

Question 4

Ischaemic heart disease is

Answer 4

Dysfunction of coronary blood supply

Question 5

Dysregulation of vascular tone is

Answer 5

Hypertension

Question 6

The main components of the heart:

Answer 6

Vasculature
Coronary arteries
Myocardium

Question 7

The heart acts as a…

Answer 7

Muscular pump

Question 8

Why is blood pumped

Answer 8

Upped around the body to meet metabolic demands
Blood pumped to the lungs for gas exchange
These 2 pumping circuits connected by the heart

Question 9

Describe the phases of the cardiac cycle

Answer 9

• Diastole (relaxation/filling)
  Isovolumic relaxation, early filling, diastasis, late filling (active)
• Systole (contraction)
  Isovolumic contraction, ventricular ejection

Question 10

What is cardiac output

Answer 10

The volume of blood pumped around the body in 1 minute
CO = strove volume x heart rate

Question 11

What is stroke volume determined by

Answer 11

Cardiac stretch and ionotropic status among other factors

Question 12

What is the calculation of ejection fraction

Answer 12

LVEF = (end diastolic volume - end systolic volume) / end diastolic volume

Question 13

Describe heart failure definitions

Answer 13

A complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation

Clinical syndrome caused by a reduction i the hearts ability to pump blood around the body

Clinical syndrome in which a cardiac abnormality impairs its pump function and ability to support a physiology

Question 14

Heart failure comprises …

Answer 14

A demonstratable abnormality of cardiac function and a resultant set of clinical features
May in Volvo systole, diastole or both
Mainly L ventricular failure, may be R and frequently both occur

LV systolic impairment is the main abnormality discussed

Question 15

Pathophysiology of heart failure

Answer 15

Cardiac contractile impairment
Activation of compensatory mechanisms in dysfunctional way
Imbalance between vasodilator and vasoconstrictor effects on circulation
Haemodynamic consequences on the circulation and fluid balance

Question 16

Describe the detection of heart failure

Answer 16

Clinical assessment - symptoms and signs
Evidence of systolic dysfunction - echocardiogram, electrocardiograph, brain natriuretic peptide

Question 17

What are the symptoms of heart failure

Answer 17

Pathophysiology dominated by ‘back pressure’ changes related to elevated cardiac pressures
Dyspnoea
Exercise intolerance
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue
Oedema/fluid accumulation

Question 18

Describe the myocardial blood supply

Answer 18

Pump function requires energy and oxygen
These are deliverable by the coronary arteries
Oxygen extraction is high at rest
Coronary arteries are essentially end arteries
Heart is therefore relatively susceptible to ischaemia

Question 19

Supply and demand of the blood flow of the heart

Answer 19

Demands:
-Cardiac work, HR, BP
-Cardiac mass
-ionotropic status
Supply:
-oxygen carrying capacity
-Driving pressure
-Coronary tone , vasodilators factors, vasoconstriction factors, metabolic factors

Question 20

Describe Ischaemic heart disease overview

Answer 20

Nearly lays due to coronary atherosclerosis
Obstructive disease of pericardial arteries
Multiple risk factors: age gender, genetic ,hypertension, diabetes, mellitus, hyperlipidaemia, cigarette smoking

Question 21

Describe overview of myocardial infarction

Answer 21

Coronary artery plaque rupture with thrombotic occlusion
Blood flow reduction is complete and sudden
Ischaemia develops into infarction if unrelieved
Permanent cardiac damage ensues. May lead to systolic dysfunction/heart failure

Question 22

What is hypertension

Answer 22

Elevation in systemic blood pressure
Level at which treatment is effective at reducing events
May be systolic, diastolic or both

Question 23

Why treat hypertension?

Answer 23

Reduction in vascular and cardiac events:
Ischaemic heart disease, hypertensive heart damage, stroke/haemorrhage, renal disease

Question 24

Treatment of hypertension

Answer 24

Confirm diagnosis
Consider ABPM
Screen for cause
Assess overall vascular risk
Lifestyle changes
Salt avoidance
Pharmacological therapy

Question 25

Stage 1 hypertension

Answer 25

Clinical 140/90 or higher AND subsequent ambulatory blood pressure is 135/85 or higher

Question 26

Stage 2 hypertension

Answer 26

Clinical blood pressure : 160/100 mmHg or higher but less than 180/120 mmHg and subsequent HBPM average 150/95 mmHg or higher

Question 27

Stage 3 or severe hypertension

Answer 27

Clinical systolic BP of 180 mmHg or higher or clinical diastolic BP of 120mmHg or higher