Lecture 21 - Disorders Of The Cardiovascular System

Question 1

When does heart failure occur

Answer 1

When the cardiac output is insufficient to perfuse the body tissues despite normal filling of the heart

Question 2

What does heart failure normal result from

Answer 2

Coronary artery diseases, but also hypertension, vascular disease and cardiacmyopathy

Question 3

What are the symptoms of heart failure

Answer 3

Breathlessness, reduced exercise tolerance, pulmonary oedema and fatigue

Question 4

How is heart failure treated

Answer 4

Through drug therapy

Question 5

What does drug therapy aim to do in heart failure

Answer 5

Reverse maladaptive changes and improve the cardiac output by the use of positive conotropic drugs

Question 6

What is an oedema

Answer 6

An abnormal accumulation of fluid in the interstitium

Question 7

What does an oedema result from

Answer 7

An imbalance between the rate of formation and absorption of interstitial fluid

Question 8

What diseases can cause an oedema

Answer 8

Nephrotic syndrome, congestive heart failure and hepatic cirrhosis with ascites

Question 9

What does nephrotic syndrome involve

Answer 9

A disorder of glomerular filtration, allowing albumin to appear in the filtrate

Question 10

What is albumin in the filtrate known as

Answer 10

Proteinurea

Question 11

What does congestive heart failure arise from

Answer 11

Reduced cardiac output

Question 12

What are the aims of clinical management of heart failure

Answer 12

Reduce preload, reduce after load and to enhance contractility

Question 13

What are used to reduce preload

Answer 13

Diuretics, aldosterone receptor antagonists, aquanetics, ACE inhibitors and venodilators

Question 14

What are used in the reduction of afterload

Answer 14

ACE inhibitors

Question 15

What is used to enhance contractility

Answer 15

Cardiac glycosides and calcium-sensitisers

Question 16

What increases venous and capillary pressures

Answer 16

Expansion of blood vessels

Question 17

What is hepatic cirrhosis with ascites

Answer 17

An increased in the pressure in the hepatic portal vein, combined with decreased production of albumin

Question 18

What does hepatic cirrhosis with ascites cause

Answer 18

A loss of fluid into the peritoneal cavity and oedema

Question 19

Along with Na+ and K+ was else is lost in the use of loop agents

Answer 19

Ca2+ and Mg2+

Question 20

What is the indirect vasodilatory action of loop diuretics possibly caused by

Answer 20

An increased formation of vasodilating prostaglandins, decreased responsiveness to angiotensin II and noradrenaline or through the opening of K+ channels in resistance vessels

Question 21

What are the adverse effects of loop diuretics

Answer 21

Potassium loss which causes the production of low serum potassium levels, a shift in the acid-base towards the alkaline side, a decreased volume of circulating fluid, hypotension, a depletion of calcium and magnesium and in increase in plasma uric acid

Question 22

What is the production of low serum potassium levels known as

Answer 22

Hypokalaemia

Question 23

What is a shift in the acid-base towards the alkaline side known as

Answer 23

Metabolic alkalosis

Question 24

What is a decreased volume of circulating fluid known as

Answer 24

Hypovolaemia

Question 25

What is an increase in plasma uric acid

Answer 25

Hyperuricaemia

Question 26

What causes metabolic alkalosis

Answer 26

An increased H+ secretion from intercalated cells in the collecting tubule

Question 27

How is hypokalaemia corrected

Answer 27

The concomitant us of potassium sparing diuretics or potassium supplements

Question 28

What is spironolactone

Answer 28

An aldosterone receptor antagonist

Question 29

What is spironolactone modulated by

Answer 29

Aldosterone levels

Question 30

What does spironolactone competitively antagonise

Answer 30

The action of aldosterone at cytoplasmic aldosterone receptors

Question 31

How does spironolactone gain access to the cytoplasm

Answer 31

Through the basolateral membrane

Question 32

What is the function of spironolactone

Answer 32

It increases the excretion of Na+ and decreases the excretion of K+

Question 33

Where is spironolactone well absorbed

Answer 33

In the G.I tract

Question 34

What is the major use of potassium sparing diuretics

Answer 34

In conjunction with other agents that cause potassium loss

Question 35

If potassium sparing diuretics are given alone what happens

Answer 35

They cause hypokalaemia

Question 36

What are aldosterone antagonist used in the treatment of

Answer 36

Heart failure, primary hyperaldosteronism, resistant essential hypertension and secondary hyperaldosteronism

Question 37

What is the syndrome name of primary hyperaldosteronism

Answer 37

Conn’s syndrome

Question 38

What does secondary hyperaldosteronism result from

Answer 38

Hepatic cirrhosis with ascites

Question 39

What is an example of a calcium-sensitiser

Answer 39

Levosimendan

Question 40

What do calcium-sensitisers do

Answer 40

They bind to troponin C in cardiac muscle, sensitising it to the action of calcium

Question 41

What effect do calcium-sensitisers have on vascular smooth muscle

Answer 41

It opens KATP channels causing vasodilation

Question 42

What are calcium-sensiters used in the treatment of

Answer 42

Heart failure