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Week 0 Flashcards

1
Q

Define claudication

A

How far a patient can walk until onset of symptoms
Official definition: a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

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2
Q

Describe the progression of symptoms of each stage of arterial occlusion:

  1. Asymptomatic arterial narrowing
  2. Symptomatic arterial narrowing
  3. Arterial occlusion
A
  1. None (hence asymptomatic)
  2. Predictable and relieved by rest. [Intermittent claudication]
  3. Increasing severe symptoms, onset of symptoms with less exertion, pain at rest. Critical limb ischaemia –>Acute limb ischaemia
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3
Q

What are the non-modifiable risk factors for CV risk? (5)

A 
Age
Gender
Family history
Low birth weight
Ethnicity
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4
Q

What are the modifiable risk factors for CV risk? (6)

A 
Hypertension
Hyperlipidaemia
Diabetes
Obesity
Smoking
Sedentary lifestyle
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5
Q

What are the points to consider when taking a PMH for CVD? (6)

A 
History of vascular disease
Diabetes
Hyperthyroidism
Renal disease
Hypertension
Hypercholesterolaemia
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6
Q

Age at which experiencing symptoms of CVD is considered young

  1. First degree male relative of less than …….. years
  2. First degree female relatives of less than……. years
A
  1. 55

2. 65

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7
Q

What are the common symptoms of CVD? (6)

A
  1. Chest pain
  2. Breatlessness (inc orthopnoea and paraoxysmal nocturnal dyspnoea)
  3. Palpitations
  4. Syncope/dizziness
  5. Oedema
  6. Peripheral vascular symptoms e.g. Intermittent claudication
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8
Q

What is angina?

A

A clinical syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress which increase myocardial oxygen demand.
At times patients can present for the first times with severe symptoms/arterial occlusion

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9
Q

Name 3 key features of classical, stable angina

A
  1. Predictable in onset
  2. Reproducible
  3. Relieved by rest or GTN (Glyceryl Trinitrate)
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10
Q

Name 2 of the main acute coronary syndromes

A
  1. Unstable angina

2. Acute MI (including NSTEMI and STEMI)

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11
Q

What does STEMI stand for?

A

ST elevation myocardial infarction

[ST referring to damage to blood vessels]

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12
Q

What does NSTEMI stand for?

A

Non-ST elevation myocardial infarction

[ST referring to damage to blood vessels]

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13
Q

What is pericarditis?

A

Inflammation of the pericardium

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14
Q

What are the symptoms for pericarditis and how are they relieved?

A

Sharp/retrosternal pain

Relieved by sitting forwards

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15
Q

Describe the symptoms of aortic dissection?

A

Sudden and severe.

Radiating to left shoulder/back

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16
Q

What is dyspnoea?

A

Shortness of breath

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17
Q

Name 3 different forms of dyspnoea?

A
  1. Acute
  2. Chronic
  3. Acute-on-chronic
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18
Q

What is orthopnoea?

A

The sensation of breathlessness in the recumbent position, relieved by sitting or standing.)

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19
Q

What is paroxysmal nocturnal dyspnoea? (PND)

A

A sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position.

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20
Q

Is the use of diuretics and dyspnoea related?

A

Yes

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21
Q

Associated symptoms of dyspnoea?

A

Cough, sputum, chest pain, palpitations

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22
Q

Name 4 types of arrhythmia and how it feels for patient?

A

Ventricular/atrial extrasystole: Heart misses a beat/heart jumps
Atrial fibrillation: May be unnoticed/ heart racing/associated breathlessness
Supraventricular tachycardia: Heart racing/ associated polyuria
Ventricular tachycardia: Heart racing/associated breathlessness/ Presents as syncope vs palpitations

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23
Q

Potential causes for dizziness and syncope? (5)

A 
Postural hypotension
Neurocardiogenic
Micturiation syncope
Cardiac arrhythmias (either tachy or brady)
Mechanical obstruction to cardiac output
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24
Q

What would unilaterial vs bilateral oedema suggest?

A

Unilateral- DVT, soft tissue infection, trauma, lympathic, obstruction
ateral- CV issue (cardiac failure, chronic venous insufficiency), hepatic/renal pathology, medication side effect, pelvic mass, immobility

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25
Action of pec maj?
Shoulder flexion and adduction
26
Action of pec minor?
Stabilises scapula
27
Action of latissimus dorsi?
Shoulder extensions and adduction
28
Action of serratus anterior?
Scapular protraction and rotation in shoulder abduction
29
What vessels supply breast?
Axillary and internal thoracic arteries
30
What lympathetic nodes drain breast?
Axillary and internal thoraxix nodes
31
What is the main function of a thoracic wall?
Respiratory movements | Structures involved: Ribs, costal cartilages, intercostal muscles, diaphragm)
32
What is the inlet and outlet for the thorax and abdomen?
``` Thorax -Inlet: Neck -Outlet: Diaphragm Abdomen -Inlet: Diaphragm -Outlet: Pelvic diaphragm ```
33
What structures make up the thoracic inlet?
T1 1st Ribs and CCs Manubrium
34
Order structures from ant to post which lie on the first rib: Subclavian artery, inferior trunk of brachial plexus and subclavian vein BETWEEN THE THORAX AND UPPER LIMB
Subclavian vein, subclavian artery, inferior trunk of brachial plexus
35
Name 4 structures that pass between the thorax and the neck?
1. Vessels that supply and drain the head and neck 2. Trachea 3. Oesophagus 4. Nerves (R+L Vagus and R+L Phrenic)
36
Name the 5 structures that surround that close the thoracic outlet
``` Diaphragm T12 12th and 11th ribs Costal cartilages of Ribs 10,9,8,7 Ziphoid cartilage ```
37
What is the ziphoid cartilage
The cartilaginous section at the lower end of the sternum,
38
What are the 3 positions of openings of the diaphragm?
T8, T10 and T12
39
What structures pass through the diaphragm at point T8/caval opening?
Inferior vena cava | Right phrenic nerve
40
What structures pass through the diaphragm at point T10/oesophageal opening?
Oesophagus Vagal trunks Left gastric vessels
41
What structures pass through the diaphragm at point T12/aortic hiatus?
Aorta Azygos vein Thoracic duct
42
What does pleura line?
Thorax, lungs and chest wall
43
What does pericardium line?
The heart
44
What does the peritoneum line?
Abdomen and pelvis
45
What are the 4 sections of pleura?
Diaphragmatic, mediastinal, cervical, costal
46
What is the point where the diaphragmatic and costal pleura meet called?
Costadiaphragmatic recess
47
What are the positions of the four corners of the heart?
2nd Left CC 3rd Rt CC 6th Rt CC Left 5th Interspace (projects heart beat sound)
48
What is the mediastinum?
Structures in the midline of the thorax, between the left and right pleural cavities
49
What is the position of the superior mediastinum?
Lies between the inlet and the plane between the sternal angle and T4/5 Behind manubrium Bifurcation of pulmonary trunk just inferior to sup. mediastinum
50
What is the position of the inferior mediastinum?
Lies inferior to the plane between the sternal angle and T4/5 and the thoracic outlet
51
What is the sternal angle?
2nd CC- T4/5
52
What is the position of the anterior mediastinum?
Lies behind the manubrium and sternum, anterior to the superior mediastinum and the upper part of the inf. mediastinum
53
Which section of the mediastinum contains the thymus?
The anterior Atrophies with age to become a fatty remnant
54
How many subdivisions does the inferior mediastinum have, and what are they called?
3 Anterior mediastinum Middle mediastinum Posterior mediastinum
55
Which section of the mediastinum contains the | contents of the pericardium (ie heart and great vessels)?
Middle mediastinum
56
What are the contents of the posterior mediastinum?
Aorta Oesophagus Thoracic duct Azygos veins
57
The pericardium: What is it made up of? Function?
Made up of serous (inner) and fibrous (outer) layers | Surrounds the heart so that it can move, expand, contract
58
Apart from the heart what else does the fibrous pericardium surround?
The great vessels
59
What are the attachments of the fibrous pericardium?
Superiorly: Roots of the great vessels Inferiorly: Central tendon of the diaphragm
60
Which nerves provide the sensory innervation of the fibrous pericardium?
The phrenic nerve
61
What are the two pericardial folds/reflections?
Oblique sinus: Lies posterior to the left atrium, potential space Transverse sinus: Separates the great arteries and veins
62
What vessels are anterior and posterior to the transverse pericardial sinus?
Ant- Aorta and pulmonary | Post- Sup. vena cava and left auricular appendage of left atrium
63
What is the base of the heart?
The posterior surface
64
What structures make up the anterior, sternocostal surface of the heart?
RIGHT VENTRICLE Right atrium Left ventricle Left auricular appendage
65
What structures make up the inferior/diaphragmatic surface of the heart?
LEFT VENTRICLE Right ventricle Coronary sinus
66
What structures make up the poster/base surface of the heart?
LEFT ATRIUM
67
What structures make up the right and left border of the heart?
Right border: Right atrium | Left border: Left ventricle and left auricle
68
What is the position of the apex of the heart?
5th left intercostal space, mid-clavicular line
69
What structures lay on either side of the heart?
Pleura, LUNGS, phrenic nerves
70
What vessels/structure are found on to the right of the mediastinum? (3)
- SVC - Arch of the azygos - IVC ALL RELATED TO RA AND VEINS
71
What vessels/structure are found on to the left of the mediastinum? (4)
- Left common carotid artery - Left subclavian artery - Arch of aorta - Thoracic aorta ALL RELATED TO LV AND ARTERIES
72
``` Phrenic nerves: Passes between which body cavities? Enters superior mediastinum posterior/anterior to BCV? Right phrenic: Related to veins/arteres? Left phrenic: Related to veins/arteries? ```
Passes between the fibrous pericardium and the parietal pleura Enters the superior mediastinum posterior to the BCVs. Right phrenic= Veins Left phrenic= Arteries
73
What vessel is this: BCV? LCC? LSC?
Brachiocephalic Vein Left Common Carotid Left Subclavian
74
What nervous supply to the right and left phrenic nerves supply? (4)
1. SOLE MOTOR SUPPLY TO THE DIAPHRAGM 2. Sensory from the central tendon of the diaphragm and it's parietal pleura and underlying peritoneum 3. Sensory from the mediastinal parietal pleura 4. Sensory from the pericaridum
75
Which nerve supplies the skin over the shoulder?
Lateral surpraclavicular
76
Phrenic nerves are branches of which plexus?
Cervical
77
In order to produce flow throughout the CVS, what must be maintained?
Pressure
78
Functions of the CVS?
- Bulk flow of materials - Temperature regulation - Homeostasis - Host defense - Reproduction
79
When it comes to the ANS regulation of the blood vessels, which control is more influential?
Sympathetic
80
What is the purpose of the parallel arrangement of the CVS? (2)
1. Allows independent regulation of blood flow to different organs 2. Adapts to the metabolic demands of the tissues
81
What causes valves to passively open?
Pressure differences of either side
82
Are the aortic and pulmonary valves bicuspid or tricuspid?
Tricuspid as they are more heavy duty and undergo more stress
83
What structures connect cardiac muscle cells?
Desmosomes and gap junctions at the intercalated disks. Intercalated disks allow branching of cells into a network
84
Why is it important to have gap junctions between cardiac muscles cells?
As they directly connect the cytoplasm of adjacent cells and permit the easy transfer of ions between cells. This allows synchronized complete contraction of all the cells
85
What is myocardium?
The cardiac muscle that allows myogenic contraction .
86
What is endocardium?
The endothelium that lines the cambers and valves of the heart
87
What is pericardium?
The membrane enclosing the heart, consisting of an outer fibrous layer and an inner double layer of serous membrane. The simple squamous epithelium secretes serous fluid
88
What is myogenic contraction?
Contraction originated in the muscles not by nerve impulses
89
What 3 vessels provide the inflow to the right atrium?
IVC SVC Coronary sinus
90
What does trabeculated mean?
Characterized by thick wall and hypertrophied muscle bundles
91
What are musculi pectinate?
The pectinate muscles (musculi pectinati) are parallel ridges of muscle at pass from the crista terminalis into the auricle
92
What are crista terminalis?
The crista terminalis is generally a smooth-surfaced, thick portion of heart muscle in a crescent shape at the opening into the right atrial appendage
93
What is the difference between the anterior and posterior wall of the right atrium in terms of structure?
Anterior wall is trabeculated: with musculi pectinate and crista terminalis. It also has an auricle The posterior wall is smooth, with an interatrial septum dividing the atria. The fossa ovalis and limbus fossa ovalis is found here (where the foramen ovale used to be)
94
Where in the right atrium is the SAN found?
Close to the opening of the SVC
95
Where in the right atrium is the AVN found?
On septum between the opening of coronary sinus and tricuspid valve
96
What is the limbus fossa ovalis?
The limbus of the fossa ovalis is the ridge that surrounds the fossa ovale in the right atrium.
97
What was the purpose of the foramen ovale?
An opening between the right and left atrium that allowed oxygenated blood coming from the mother to by-pass the non-functioning foetal lungs
98
What are trabeculae carnae?
The trabeculae carneae (columnae carneae, or meaty ridges), are rounded or irregular muscular columns which project from the inner surface of the right and left ventricles of the heart. These are different from the pectinate muscles, which are present in the right atrium and the atrial appendages of the heart. They give power of contractions and give risk to papillary muscles
99
What 3 structures are present in the right ventricle that cause it to be trabeculated?
Trabeculae carneae 3 papillary muscles with chordae tendinae Septomarginal trabeculae (moderator band)
100
What structures prevent cusp eversion of the tricuspid valve during systole?
Papillary muscles Chordae tendineae With each papillary muscle sending chordae tenineae to 2 cusps
101
What are names of the 3 cusps of the tricuspid valce? and what are they attached to?
Anterior, posterior and septal Attached to the fibrous ring which is park of the fibrous skeleton
102
What are the names of the 3 cusps of the pulmonary valve? | and what are they attached to?
Right, left and anterior. | Attached to the fibrous ring which is park of the fibrous skeleton
103
How does an MI affect papillary muscles?
Causes them to become ineffective and valve incompetence
104
Why do the walls of each ventricle become smooth near its outflow?
To create laminar flow into the pulmonary trunk and aorta
105
What structure links the the pulmonary trunk and the aorta?
Ligamentum arteriosum
106
What 2 structures are present in the right ventricle that cause it to be trabeculated?
Trabeculae carneae | 2 papillary muscles with chordae tendinae
107
What are the names of the 2 cusps in the mitral valve? Active/passive competence
Anterior and posterior ACTIVE COMPETENCE
108
Is it during diastole/systole at the aortic valve that blood flows to coronary arteries
Diastole
109
What are the functions of the cardiac skeleton?
Supports valces and myocardium | Electrically separates atria and ventricles (AV bundle of Hi should be the only conduction between them)
110
``` What do these Kardex abbreviations mean: IV SL NG PV TOP IM SC PR INH ```
``` IV: Intravenous SL: Sublingual NG: Nasogeastric PV: Per vagina TOP: Topical IM: Intramuscular SC: Subcutaneous PR: Per rectum INH: Inhalation ```

MD3001 (12 decks)

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