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CVS > Lecture 14 > Flashcards

Lecture 14 Flashcards

1
Q

Name the 2 circulations of the lungs

A

Bronchial - systemic circulation
- supplies metabolic needs

Pulmonary - alveoli
- oxygenates blood

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2
Q

Exercise CO

A

20-25 L/min

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3
Q

Adaptations to lower resistance

A

Short, wide vessels - lower TPR
Lots of parallel capillaries - 1/R + 1/R
Less smooth muscle in arterioles - little contraction

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4
Q

Adaptations to promote gas exchange

A

High density of capillaries - increased surface area

Thin tissue layer - short diffusion pathway

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5
Q

Optimal ventilation perfusion ration

A

0.8

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6
Q

Pulmonary response to hypoxia in the lungs

A

Vasoconstriction of pulmonary vessels to decrease perfusion ventilation equals perfusion

Blood diverted to well ventilated alveoli to optimise gas exchange

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7
Q

Effect of chronic hypoxia pulmonary vasoconstriction

A 
Chronic increase in vascular resistance 
Pulmonary hypertension 
Increased afterload in RV
RV hypertrophy 
Right sided heart failure

At altitude
Lung disease

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8
Q

Which pressures influence the pulmonary circulation

A

Hydrostatic

Oncotic

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9
Q

Pulmonary oedema

A

Mitral valve stenosis
LV failure - increased preload

Hydrostatic pressure in the pulmonary vein increases
Greater than oncotic pressure 
Fluid moves out 
Oedema in base of lungs - orthostasis 
Oedema in all lung - lying down

Treatment: diuretics

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10
Q

Adaptations of cerebral circulation

A

High oxygen extraction rate
High basal flow
High capillary density - reduced diffusion distance

Anastomoses

Myotonic autoregulation - maintains perfusion during hypotension
- low BP = vasodilation

Metabolic regulation - hypercapnia (CO2) - vasodilation (exercise)

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11
Q

Hyperventilation

A

Hypocapnea (dispel too much CO2) - Cerebral vasoconstriction

Causes syncope and dizziness

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12
Q

Metabolites that cause vasodilation

A

Increased CO2
Adenosine
Increased Potassium
Decreased oxygen (except lungs)

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13
Q

Adaptations of coronary circulation

A 
Short fibre diameter 
Lots of capillaries - short diffusion pathway 
All capillaries are opened 
Continuously perfumed 
Produce nitric oxide - vasodilator 
High basal flow
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14
Q

Functional end arteries

A

Coronary arteries have few arterio-arterial anastomoses

Prone to atheromas

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15
Q

Skeletal muscle circulation adaptations

A

High vascular motor tone - allows fro vasodilation to increase flow
Capillary density dependent on type
Half of capillaries opened - other half for recruitment

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16
Q

Adaptations of cutaneous circulation

A

Arteriovenous anastomoses
Arterial to venous shunts
Bradykinin - non apical skin vasodilation

17
Q

Causes of chest pain

A 
Musculoskeletal and skin
Lungs and pleural sac
Heart and pericardial sac
Oesophageal 
Aorta
18
Q

Musculoskeletal and skin

A

Well localised
Painful on palpating
Sharp

Examples:
rib fracture
shingles
Costochondritis

19
Q

Pleural sac and lungs

A

Localised
Painful on inhalation, coughing, positional movements
Sharp pain

Examples:
Pneumonia
Pulmonary embolism

20
Q

Cardiac and pericardial sac

A

Dull crushing pain
Radiating to jawline, arms and shoulders
Central

Examples:
MI
Pericarditis - sharp central pain non radiating
Ischaemia

21
Q

Aorta

A

Sharp tearing pain
Radiates to back

Example

Aortic dissection

22
Q

Oesophageal

A

burning sensation

Examples:
Oesophageal reflux
Peptic ulcer disease

23
Q

Differences between visceral and somatic pain

A 
Visceral is:
Dull and central pain 
Worsened with exertion
Involves the heart
Poorly localised
Somatic:
Localise 
Sharp pain
Involves pleural and pericardial sac 
Worse on inspiration, positional change and coughing
24
Q

Pericarditis

A 
Sharp pain
Localised
Predisposition: Male and infection 
Worse on coughing, inspiration and positional movement 
Better when sitting up 
Widespread ST elevation saddle

Pericardial rub may be heard

25
Q

Atherosclerosis

A

Lipid Laden core with fibrous external cap

Partially occluded coronary arteries causing ischaemia

26
Q

Stable angina

A

Pain on exertion
Relieved at rest

Dull tight pain
Central
No autonomic symptoms
Relieved with GTN spray (nitrates)

27
Q

Unstable angina

A

Pain at rest and made worse on exertion
Lasts longer
ST depression
T wave inverted and flattened

28
Q

Acute coronary artery syndrome

A

Atheromatous plaque rupture
Thrombus formed
Acute increased occlusion (not stable angina) of coronary arteries

E.g coronary dissection or spasm

29
Q

How to distinguish between unstable angina and MI

A

Blood test for Troponin I

Present - MI

30
Q

MI

A

Pain at rest
Worse on exertion

Autonomic symptoms:

  • sweating
  • nausea and vomiting
  • tachycardia

Pathological Q wave
T wave inversion
ST elevation or depression

Regional wall motion abnormal
Loss of viable myocardium

31
Q

Infarct

A

ST segment elevation
Hyperacute T wave
New left bundle branch block

CVS (14 decks)

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