Revision Flashcards
what causes a parasternal heave
right ventricular hypertrophy
what causes a thrill
turbulent blood flow
is stenosis an opening or closing problem
opening
is regurgitation an opening or closing problem
closing
what valves could cause a stenosis murmur during systole
aortic or pulmonary
what valves could cause a regurgitation murmur during systole
mitral or tricuspid
what valves could cause a stenosis murmur during diastole
mitral or tricuspid
what valves could cause a regurgitation murmur during diastole
aortic or pulmonary
what is the normal range for BMI
18-25
where do you measure waist circumference
halfway in between lower rib and iliac spine
what are the normal ranges for waist circumference
102 cm men 82 cm women
what are the normal ranges for cholesterol
low 5 LDL, above 1 HDL
what are the normal ranges for blood pressure
120/80-140/90
what is the cut of age for suspicion of hereditary disease
60 men 65 women
what is the most commonly occluded coronary artery
LAD (left anterior descending)
why do veins have a wider lumen
as they carry most of the blood- capacitance vessels
what is atherosclerosis
a pogressive disease characterised by the build up of plaques within the arteries
describe the pathogenesis of atherosclerotic plaques
endothelial damage
Protective response results in production of
cellular adhesion molecules
Monocytes and T lymphocytes attach to
‘sticky’ surface of endothelial cells
Migrate through arterial wall to subendothelial space
Macrophages take up oxidised LDL-C
Lipid-rich foam cells
Fatty streak and plaque
what is the largest class of lipoproteins
chylomicrons
are triglycerides good or bad
associated with increased risk of CHD events but not as bad as LDL
what does VLDL do in the endogenous pathway
transports triglycerides from the liver to the rest of the body
what do chylomicrons do in the endogenous pathway
transport triglycerides from the gut to the liver
what is xanthelasma
xanthomas of eyelids (may/may not be associated with hyperlipidemia)
what are tendon xanthomas
extensor tendons (of Achilles tendon, fingers, patella. elbows) are infiltrated by lipids
what are tuberous xanthomas
lipid deposits in the dermis and subcutis
what is eruptive xanthomas
small reddish-yellow papules (buttocks, posterior thighs, body folds)
what does hypertension treatment reduce the risk of
ischaemic heart disease, stroke, mortality
what is the assign score
risk of developing CVD
what is essential/primary hypertension
no underlying cause (90%)
what is secondary hypertension
underlying cause (caused by another medical conditions)
what is an example of an intrinsic control mechanism of the heart
the frank starling curve- EDV and stroke volume
what is ventricular preload
degree of stretch cardiac muscle cells before they contract (at the end of diastolic filling)
what is cardiac contractility
degree of shortening of cardiac muscle cells from a fixed fibre length
how does pre load affect CO
greater the stretch, greater the contractility (up to optimum fibre length)
what affect does SA node stretch have on HR
increases HR as caused by increased venous return
what is pressure diuresis
increased urine output due to high blood pressure
what is pressure natriuresis
increased sodium excretion due to high arterial pressure
what leads to the secretion of the enzyme renin by the juxtaglomerular apparatus
in response to reduced blood pressure
what does renin do
converts angiotensinogen into angiotensin I
what cornverts angiotensin I to angiotensin II
ACE
what is angiotension II
potent vasoconstrictor of aterioles and veins and stimulates the adrenal cortex’s release of aldosterone
what does aldosterone do
increases sodium reabsorption into the kidneys
what does the reabsorption of sodium by kidneys do
increases blood volume as water follows sodium, increasing blood pressure
what does ADH do
acts directly on on blood vessels causing vasoconstriction, and increases the permeability of the kidney tubules to water- increasing water reabsorbtion
what stimulates the secretion of ADH
increased solute concentration in plasma detected by hypothalamus
decreases in blood pressure and volume detected by baroreceptors
what is atrial natriuretic peptide released from and in response to what
released from atrial muscle of heart in response to increased stretch
what is the role of atrial natriuretic peptide (BNP)
acts on the kidneys to increase water and sodium secretion. also has vasodilator effect on the arteries and veins
what is masked hypertension (black coat)
true normotension with high clinical pressure
what should be offered to all patients who have hypertension
test urine for presence of protein
take blood to measure glucose, electrolytes, creatinine, estimated glomerular filtration rate and cholesterol
examine fundi for hypertensive retinopathy
arrange a 12-lead ECG.
what blood pressure should be aimed for in people over 80
under 150/90
what is Phaeochromocytoma
a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure
what is Fibromuscular Dysplasia
a non-atherosclerotic, non-inflammatory disease of the blood vessels that causes abnormal growth within the wall of an artery. common in young woman, curable
in treating blood pressure id combination or monotherapy better
Initial combination much more effective than optimized initial monotherapy
what are the three main treatments used for hypertension
A – ACE inhibitor or low-cost angiotensinII receptor blocker (ARB)1
C – Calcium-channel blocker (CCB)
D – Thiazide-like diuretic
what can cause resistant hypertension
Non-concordance ‘White Coat’ Effect Pseudo-Hypertension Lifestyle Factors Drug Interactions Secondary Hypertension True Resistance
what is the most effective treatment for resistant hypertension
Spironolactone (start low go slow)
what hypertension treatment should be used in young women
BCD (B=beta blockers)
fill out the following
younger (<55 years) and non-Black
Step 1
Step 2
Step 3
1= A 2= A + C 3= A + C + D
fill out the following
older (>= 55 years) or black
Step 1
Step 2
Step 3
1= C 2= C + A 3= A + C + D
fill out the following
step 4 (resistant hypertension);
A + C + D + consider further diuretic (b), (c) or alpha- or beta-blocker (d)
Consider seeking specialist advice
what is the new technology developed to treat hypertension
Renal denervation (doesnt work)
Baro-receptor stimulation
Rox Coupler
describe the anatomy of the aortic valve
usually tricuspid, semi luminar (can be bicuspid congenitally)
what are the symptoms of IE
fever, clubbing, splinter haemorrhages, janeway lesions, osler nodes and roth spots
what can septic emboli cause when infecting tissue
micro anuersyms, abscesses
what is haemopericardium
blood in the pericardial sac, causes tamponade
where is pressure acting in the heart felt the most
in the RA, as thin walled
what can cause a haemopericardium
dissecting aneurysm, trauma
after an MI when does scar tissue replace dead tissue
within a few months
what are the two types of inflammation
acute and chronic
what is the cardinal cell of acute inflammation
neutrophils, have granules that have enzymes which break down dead cells
when and why does rupture of myocardium after an MI happen
5-7 after MI, as dead tissue being broken down before it is replaced by scar tissue
what causes co-arctation of the aorta
congenital
how can hypertrophy lead to arrhythmias
as muscle deficient of blood and oxygen so is unstable
what can cause hypertrophy
hypertension, aortic stenosis (working against resistance)
what makes an atherosclerotic plaque bigger
cholesterol accumulating within it
what is the most common site for coronary artery occlusion
proximal third of LAD
how can nuclei shoe necrosis
when cells die their nucleus breaks down, dead cells have no nucleus
when do neutrophils arrive at site of necrosis
build up after 48 hrs
what is pus
dead tissue and dead or dying neutrophils
when does a CXR show cardiomegaly
when width more than 50% of thoracic width
what is the cardiothoracic ratio
ratio of maximum diameter of the heart divided by the maximum diameter of the thorax
what are the pros and cons of angiography
p - excellent coronary arterial depiction, assess anomalies/ plaques/ stenosis/ stents/ CABGs
c - radiation, invasive, complications, may need admission, contrast allergy, kidney damage
what plane of CXR can the cardiothoracic ratio be measured
PA
what are the pros and cos of echocardiography
p - immediate, functional/ valvular/ chamber assesment, no radiation
c - operator (inexperienced) and patient (obese, chest deformity) dependant, incomplete cardiac assessment
cardiac CT can be done with or without contrast. what is a cardiac CT good and bad at showing
non contrast can show presence of calcium in CA but not good at showing vascular lumen to see stenosis
what are the pros and cons of cardiac CT with contrast
p - excellent depiction, non invasive (as only IV), functional/chamber assesment, looks at vessels and lungs aswell
c- radiation, not as good as catheter angiography, contrast allergy and nephropathy, need specialist equipment and expertise
what are the pros and cons of MRI
p - no radiation, functional and anatomical assesment- good at soft tissue reolution, GOLD
STANDARD
c - takes long, claustrophobia, MRI contraindications (e.g. pacemaker), not good at coronary arteries
what can cardiac MRI calculate
cardiac function
what is a cine cardiac investigation and what does it show
dynamic MRI, shows functionality and any abnormalities
what does nuclear cardiology assess
myocardial perfusion
what may precipitate pulmonary oedema in patients with poor cardiac function
atrial fibrillation
what can echocardiography and MRI show in patients who have previously had an MI
ventricular wall dysnfunction
can interventions be done in the same procedure as CT angiography
yes
what can cause a delay in radial and femoral pulses
coarctation of the aorta which classically happen in proximal part of descending aorta, distal to the left subclavian artery (blood struggles to get through narrowing)
do MRI or echo investigations have associated radiation
no
what valve problem is associated with aortic coarctation IMPORTANT
congential bicuspid aortic valve which is prone to becoming stenosed
what valve problem can cause anginal symptoms
aortic stenosis
when does atrial septal defect often present and with what symptoms
in adulthood- cardiac murmur, exertional dsypnoea
what are clinical features of dilated cardiomyopathy
pleural effusion, LV chamber dilatation, mid-myocardial enhancement
what can delayed enhacement foci be substrates
sudden onset arrhythmias
when should CTPA be used for PE
in patients with ABNORMAL CXR or pre existing lung disease
when should a V/Q scan be used for PE
when patient has NORMAL CXR or no existing lung disease (no perfusion but normal ventilation)
when should CT angiogram be used in in head injury
good at finding blood in brain, e,g malformation of vasculature after a bleed from a haemorrhage
how long approximately does systole and diastole
s 0.3, d 0.5
what is masked by the QRS complex
atrial repolarisation
when do the ventricles contract in an ECG
after QRS in ST segment- mechanical activity follows electrical
where is the ectopic focus that causes A fib
in pulmonary veins
does A fib require permanent pacing
sometimes
when do the ventricles relax in an ECG
in the TP interval
what does the PR interval represent
AV nodal delay
is the heart rate in complete heart block irregular or regular
regular- ventricles excited by alternative pacemaker which usually has slower rate. Despite ventricles going at slower rate, and slow heart rate, rhythm is still regular just slower. Atrial rate different from ventricle rate (rate of P waves different from rate of QRS, but P waves not getting through so doesn’t affect rhythm)
what can slow the heart rate in SVT
adenosine
what do vagal manoeuvres cause
vagal stimulation
what is the treatment of complete heart block, bradycardia and haemodynamic instability
pacemaker
what does the vagus nerve supply in the heart
both AV and SA node
what does vagal stimulation do to heart
increase AV delay by slowing down the firing
what does a tachycardia that doesn’t respond to adenosine mean
below AV node, ventricular
when will vagal manoeuvres not help
if below AV node
why is the QRS in A fib wide
as heart getting excited from within ventricles, not normal pathway
can ventricular tachycardia be treated with ICD
yes
what type of drugs are not effective in VT
anti-arrhythmic drugs
how does atropine speed up HR
as blocks para sympathetic stimulation
what is the anagram for heart murmurs
MRS DARMS
