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CV > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Define syncope

A

Total loss of consciousness due to cerebral hypoperfusion characterised by rapid onset short duration and spontaneous complete recovery

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2
Q

What are the 4 types of shock?

A

Hypovolaemic
Cardiogenic
Obstructive
Distributive

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3
Q

What are the types of hypovolaemic shock?

A

Haemorrhagic
Non-haemorrhagic

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4
Q

Up to what % of blood volume loss can the body compensate for?

A

> 30%

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5
Q

When the CO is decreased what response will be elicited by the baroceptor reflex?

A

Increase in HR

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6
Q

What volume of pulse is seen in hypovolaemic shock?

A

Low

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7
Q

What impact will the baroceptor response have on SVR in hypovolaemic shock?

A

Increased SVR (Cool peripheries)

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8
Q

What hormonal responses may be seen in hypovolaemic shock?

A

Increased vasopressin
Increased renin-angiotensin-aldosterone system action

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9
Q

What occurs in cardiogenic shock?

A

Sudden severe impairment of cardiac function leading to sustained hypotension

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10
Q

What occurs in obstructive shock?

A

Physical obstruction to circulation either into or out of the heart

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11
Q

What can cause obstructive shock?

A

Cardiac tamponade
Tension pneumothorax
PE
Severe aortic stenosis

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12
Q

How can a tension pneumothorax lead to shock?

A

Increased intrathoracic pressure, decreasing venous return.

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13
Q

What causes distributive shock?

A

Excessive vasodilation and abnormal distribution of blood flow

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14
Q

What are the 2 types of distributive shock?

A

Neurogenic
Vasoactive e.g. septic, anaphylactic

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15
Q

How could a SCI lead to shock?

A

Loss of sympathetic tone to vessels and heart, causes massive venous and arterial vasodilation.

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16
Q

What type of shock leads to bradycardia?

A

Neurogenic

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17
Q

Describe vasoactive shock.

A

Release of vasoactive mediators, leading to massive venous and arterial vasodilation and increased capillary permeability.

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18
Q

What type of shock doesn’t indicate volume replacement?

A

Cardiogenic

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19
Q

What is the tunica intima composed of?

A

Endothelial cells (simple squamous) supported by a basal lamina and thin layer of connective tissue

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20
Q

What is the tunica media made up of?

A

Mostly smooth muscle

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21
Q

What is the tunica adventitia made up of?

A

Supporting connective tissue

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22
Q

What separate the tunica layers?

A

Internal and external elastic membrane

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23
Q

What can help differentiate elastic arteries?

A

Many sheets of elastic fibre in the tunica media

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24
Q

Describe the histology of arterioles.

A

Only 1 or 2 layers of smooth muscle in the tunica media and almost no adventitia
Narrower lumen than arteries

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25
Q

What replaces smooth muscle in meta arterioles?

A

Pericytes

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26
Q

Where are capillaries absent?

A

Epithelial cells
Epidermis of skin, hair and nails
Cornea
Hyaline cartilage

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27
Q

Where are continuous capillaries found?

A

Muscle, connective tissue, lung, skin and nerves

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28
Q

Where are fenestrated capillaries found?

A

Mucosa of the gut
Endocrine glands
Glomeruli of the kidney

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29
Q

Where are discontinuous capillaries found?

A

Liver
Spleen
Bone marrow

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30
Q

What are precapillary sphincters?

A

Smooth muscle at the beginning of the capillary to help control flow by constricting the lumen

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31
Q

What differentiates postcapillary venules and venules?

A

Intermittent smooth muscle

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32
Q

Describe the histology of veins.

A

Relatively thin but continuous tunica media typically with a few layers of smooth muscle. Large veins have a thick adventitia which incorporates bundles of longitudinally orientated smooth muscle

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33
Q

Order these from innermost to outermost:
Myocardium
Endocardium
Epicardium

A

Endocardium
Myocardium
Epicardium

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34
Q

What is endocardium composed of?

A

Endothelium
Basal lamina
Thin layer of collagen fibres
Layer of denser connective tissue

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35
Q

What is the subendocardium?

A

Found in some areas
Loose connective tissue containing small blood vessels and nerves and Purkinje fibres

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36
Q

Describe the myocardium.

A

Bundles and layers of contractile cardiac muscle
Individual muscle fibres are surrounded by delicate collagenous connective tissue with a rich network of capillaries

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37
Q

What is the function of intercalated discs?

A

Pass across fibres at irregular intervals to assist in action potential conduction

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38
Q

Describe the epicardium.

A

Single layer of flattened epithelium called mesothelium
Basal lamina
Fibroelastic connective tissue
Some places adipose tissue

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39
Q

What are the two divisions of the pericardium?

A

Fibrous
Serous

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40
Q

What is fibrous pericardium?

A

Sac of tough fibrocollagenous connective tissue

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41
Q

What are the 2 divisions of the serous pericardium and where is each found?

A

Parietal - Lines the inner surface of the fibrous pericardium
Visceral - Covers the surface of the heart

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42
Q

Describe the fibrous skeleton of the heart

A

Thick band of connective tissue
Around the valves , between the atria and between the ventricles
Supports the valves and provides attachment for the cardiac muscle fibres

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43
Q

What are the 3 types of cardiac muscle cell?

A

Contractive
Pacemaker
Conducting

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44
Q

What are the 3 categories of syncope?

A

Reflex syncope
Orthostatic hypotension
Cardiac syncope

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45
Q

What are the 3 types of reflex syncope?

A

Vasovagal reflex syncope
Situational reflex syncope
Carotid sinus reflex syncope

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46
Q

What is reflex syncope?

A

All types where neural reflexes modify HR and/or vascular tone hence predisposing to a fall in MAP sufficient enough to affect cerebral perfusion

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47
Q

What can trigger vasovagal reflex syncope?

A

Emotional distress
Orthostatic stress

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48
Q

What occurs in situational reflex syncope?

A

Faint during or immediately after a specific trigger e.g. cough, swallowing etc

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49
Q

In what types of reflex syncope may cardiac permanent pacing be indicated?

A

May be in situation reflex syncope
Likely in carotid sinus reflex syncope

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50
Q

What can trigger carotid sinus reflex syncope?

A

Mechanical manipulation of the neck, shaving, tight collar etc

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51
Q

What indicates postural hypotension?

A

Drop within 3 minutes of standing from lying in systolic BP of at least 20 diastolic (with or without symptoms) or at least diastolic (with symptoms)

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52
Q

What may cause cardiac syncope?

A

Arrythmias
Acute MI
Structural cardiac disease
Other e.g. PE, aortic dissection

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53
Q

What may be suggestive of cardiac syncope?

A

Syncope during excretion or when supine
Presence of structural cardiac abnormality or coronary heart disease
Family hx of sudden death at a young age
Sudden onset palpitations immediately followed by syncope
ECG findings

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54
Q

Name a vitamin supplement recommended for all adults

A

Vitamin D

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55
Q

What vitamin deficiency are vegans at high risk of?

A

B12

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56
Q

What impact can plant sterols and stanols have?

A

Reduction in cholesterol

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57
Q

Where is the heart found?

A

Middle mediastinum

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58
Q

Where do the phrenic nerves run?

A

Anterior to the root of the lung

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59
Q

What is cardiac tamponade?

A

Pericardial cavity fills with blood placing pressure on the heart

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60
Q

What is the most external layer of the pericardium?

A

Fibrous pericardium

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61
Q

What is the transverse pericardial sinus?

A

Space within the pericardial cavity posterosuperiorly
Lies posterior to the ascending aorta and pulmonary trunk

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62
Q

What are the borders of the heart?

A

Right and left lateral
Inferior
Superior

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63
Q

Where is the apex beat best heard

A

5th intercostal space in the mid clavicular line

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64
Q

What may happen to the apex beat in cardiac enlargement?

A

Can shift towards the left

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65
Q

What are the auricles of the heart?

A

Extensions of the atria that optimise filling and increase capacity

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66
Q

What groove is found between the right and left ventricles?

A

Anterior intraventricular groove

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67
Q

What is the coronary sinus?

A

Short venous channel which all cardiac veins drain to

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68
Q

What groove is found posteriorly between the left and right atria?

A

Interatrial groove

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69
Q

What groove is found posteriorly between the right and left ventricles?

A

Posterior interventricular groove

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70
Q

What are the first branches of the aorta?

A

Right and left coronary arteries

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71
Q

What are the branches of the right coronary artery?

A

Right marginal artery
Posterior interventricular artery

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72
Q

What are the branches of the left coronary artery?

A

Left anterior descending artery
Left marginal artery
Lateral branch
Circumflex artery

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73
Q

What are the 2 parts of the heart’s septum?

A

Interatrial
Interventricular

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74
Q

What 3 openings are found in the right atria?

A

Superior vena cava
Inferior vena cava
Coronary sinus

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75
Q

What is the oval fossa?

A

Thumbprint type depression associated with the interarterial septum

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76
Q

What is the crista terminalis?

A

Division between the smooth area of the right atria and the tribecular carna

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77
Q

What are the cusps of the tricuspid valve?

A

Anterior
Posterior
Septal

78
Q

What are the 2 semilunar valves?

A

Pulmonary
Aortic

79
Q

What arises from the sinuses of the aortic valve?

A

Coronary arteries

80
Q

Where are papillary muscles found?

A

Cardiac wall attaching to tendinous cords extending from the leaflets

81
Q

Where is the area of auscultation for the mitral valve?

A

5th left intercostal space midclavicular line

82
Q

Where is the area of auscultation for the tricuspid valve?

A

4th left intercostal space, sternal edge

83
Q

Where is the area of auscultation for the pulmonary valve?

A

2nd left intercostal space sternal edge

84
Q

Where is the area of auscultation for the aortic valve?

A

2nd right intercostal space sternal edge

85
Q

What is an ECG lead?

A

The imaginary line the between 2 or more electrode

86
Q

What happens on an ECG when depolarisation moves toward the recording electrode?

A

Upward deflection

87
Q

What causes a downward deflection on an ECG?

A

Depolarisation moves away from recording electrode

88
Q

What are the chest leads on an ECG?

A

V1 to V6

89
Q

What are the 6 limb leads on an ECG?

A

I, II, III, aVR, aVL, aVF

90
Q

Where are the limb electrodes placed?

A

Left LL
L UL
R UL
R LL (earthed)

91
Q

What does the P wave represent?

A

Atrial depolarisation

92
Q

What does the QRS complex represent?

A

Ventricular depolarisation

93
Q

What does the T wave represent?

A

Ventricular repolarisation

94
Q

Which segment on an ECG is isoelectric?

A

ST segment

95
Q

Which lead is used for the rhythm strip?

A

Lead II

96
Q

What is the standardised speed of ECG paper?

A

25mm/sec
One large square 0.2 secs
One small block 0.04 secs

97
Q

What is the normal duration of the QRS complex?

A

0.1 secs or less

98
Q

Where is the PR interval and what does is represent?

A

Start of P wave to start of QRS complex
Time for SA node impulse to reach the ventricles

99
Q

What is the normal length of the PR interval?

A

0.12 - 0.2 secs

100
Q

What does the QT interval represent?

A

Primarily time for ventricular depolarisation and repolarisation

101
Q

What is a normal time for QT interval?

A

Needs to be corrected for HR
Normally 0.36 to 0.44 secs at rate of 60bpm

102
Q

Where are lead I, II and III?

A

Lead I between R and L arm
Lead II between R arm and L leg
Lead III between L arm and L leg

103
Q

What leads give a horizontal view of the heart?

A

V1 to V6

104
Q

How does coronary venous blood drain?

A

Via the coronary sinus into the right atrium

105
Q

Is the oxygen extraction higher or lower in the coronary circulation comparted to systemic?

A

Higher ~75% compared to ~25%

106
Q

What is the nervous supply of coronary arterioles?

A

Sympathetic vasoconstrictor

107
Q

What is functional sympatholysis?

A

Sympathetic stimulation of the heart results in coronary vasodilation despite vasoconstrictor affect

108
Q

What receptors are abundant in the coronary arteries?

A

Beta 2

109
Q

What can overcome sympathetic vasoconstrictor tone in skeletal muscle?

A

Metabolic hyperaemia

110
Q

What circulation meets the metabolic needs of airways?

A

Systemic bronchial circulation

111
Q

What is the typical pulmonary artery BP?

A

Systolic - 20 - 25
Diastolic - 6 - 12

112
Q

Is pulmonary capillary pressure lower or higher than systemic?

A

Lower

113
Q

What effect does hypoxia have on pulmonary arterioles?

A

Vasoconstriction, the opposite to that on systemic arterioles

114
Q

What drives the heartbeat in sinus rhythm?

A

The SA node

115
Q

What causes the pacemaker potential?

A

Funny current

116
Q

What are HCN channels?

A

Hyperpolaristation-activated Cyclic Nucleotide gated channels

117
Q

If HCN channels are blocked what would happen to the HR?

A

Slowed

118
Q

What is the neurotransmitter of the sympathetic ANS?

A

Noradrenaline

119
Q

What is the impact of the sympathetic nervous system on the pacemaker potential and AV nodal delay?

A

Increases the slope of pacemaker potential
Decreases AV nodal delay

120
Q

What impact does the sympathetic ANS have on HR?

A

Increases HR

121
Q

How does the sympathetic ANS impact the Frank-Starling curve?

A

Shifts to the left

122
Q

What is the neurotransmitter of the parasympathetic ANS?

A

Acetylcholine

123
Q

What is the impact of the parasympathetic nervous system on the pacemaker potential and AV nodal delay?

A

Decreases slope of pacemaker potential
Increases AV nodal delay

124
Q

What nerve does the parasympathetic ANS act on the heart through?

A

Vagus

125
Q

What impact does the parasympathetic system have on HR?

A

Decreases HR

126
Q

What does atropine do at acetylcholine receptors?

A

Competitive inhibitor increasing HR

127
Q

Give 2 examples of cardioselective beta blockers?

A

Atenolol
Bisoprolol

128
Q

What effect do beta blockers have on cardiac action?

A

Block sympathetic action
Reduce force of contraction
Slow HR
Reduce myocardial oxygen consumption

129
Q

What are the phases of the contractile myocyte action potential?

A

Phase 0: Fast Na influx
Phase 1: Closure of Na channels and transient K efflux
Phase 2: Mainly Ca influx (L-type Ca channels)
Phase 3: Closure of Ca channels and K efflux
Phase 4: Resting membrane potential

130
Q

Why is calcium required for cross bridge formation in cardiac myocytes?

A

To expose the myosin binding site through confirmational change of the tropomyposin complex

131
Q

What is stroke volume?

A

Volume of blood ejected by each ventricle per heart bead
End diastolic volume - End systolic volume

132
Q

What is cardiac output?

A

Volume of blood pumped by each ventricle per minute
SV x HR

133
Q

What is normal resting cardiac output?

A

~5 litres per minute

134
Q

What extrinsic factors control vascular smooth muscle?

A

Nervous
Hormonal

135
Q

What type of nerve fibres supply vascular smooth muscle?

A

Sympathetic

136
Q

What receptors does noradrenaline work on in vascular smooth muscle?

A

Alpha

137
Q

What impact does adrenaline have on beta 2 receptors and alpha receptors?

A

Beta 2 - Vasodilation
Alpha - Vasoconstriction

138
Q

What intrinsic factors can cause relaxation of arteriolar smooth muscles?

A

Decreased local PO2
Increased local PCO2
Increased local H+
Increases extracellular K+
Adenosine release from ATP

139
Q

What effect does nitric oxide have on blood vessels?

A

Vasodilator

140
Q

Give 2 examples of nitrates?

A

GTN
Isosorbide mononitrate

141
Q

What hormonal systems regulate extracellular fluid volume?

A

RAAS
Natriuretic Peptides
Antidiuretic Hormone

142
Q

Where is aldosterone released from?

A

Adrenal cortex

143
Q

What is the rate limiting step in the RAAS?

A

Renin release from the kidneys

144
Q

What is the overall effect of the RAAS?

A

Increase in Na and water reabsorption in the kidneys
Increased plasma volume

145
Q

How do natriuretic peptides decrease BP?

A

Cause excretion of salt and water in the kidneys reducing blood volume
Act as a vasodilator

146
Q

What are the 2 main types of natriuretic peptides released by the heart?

A

Atrial
Brain-Type

147
Q

What conversion do ACEi inhibit?

A

Angiotensin I to angiotensin II

148
Q

What do ARBs block?

A

Action of angiotensin II at ATI receptors

149
Q

What is the cardiac plexus?

A

Intertwining of different nerve types - Sympathetic fibres, parasympathetic fibres (vagus) and visceral afferent fibres

150
Q

When might statins be prescribed?

A

Hypercholesterolemia
Diabetes
Angina/MI
CVA/TIA
High risk of MI and CVA

151
Q

What are the possible side effects of statins?

A

Myalgia/ myopathy
Rhabdomyolysis, renal failure

152
Q

Other than statins what medication groups can be prescribed for lowering cholesterol?

A

Fibrates
PCSK 9 inhibitors

153
Q

Name 2 PCSK 9 inhibitors

A

Alirocumab
Evolocumab

154
Q

How do PCSK9 inhibitors work?

A

Inhibit the binding of PCSK9 to LDL receptor increasing the number of LDL receptors available to clear LDL

155
Q

What is inclisiran?

A

Gene silencing drug, silencing the PCSK9 gene

156
Q

What do thiazide diuretics do?

A

Block Na reabsorption in the kidneys

157
Q

Give an example of a thiazide diuretic and an example of a loop diuretic.

A

Thiazide - Bendrofluazide
Loop diuretic - Furosemide

158
Q

Give some side effects of diuretics?

A

Hypokalemia - Fatigue and arrythmias
Hyperglycemia in diabetics
Increased uric acid - May lead to gout

159
Q

Give some examples of cardioselective beta blockers.

A

Atenolol
Bisoprolol

160
Q

Give some examples of non-selective beta blockers.

A

Propanolol
Carvedilol

161
Q

What are the 2 types of calcium antagonist?

A

Dihydropyridines and rate limiting

162
Q

Give an example of a dihyropyridine.

A

Amlodipine

163
Q

What side effect can be caused by calcium channel blockers?

A

Oedema

164
Q

Give 2 examples of rate limiting calcium antagonists.

A

Verapamil
Diltiazem

165
Q

What other medication should be avoided with rate limiting calcium antagonists?

A

Beta blockers

166
Q

What do ACEi block?

A

Angiotensin I being converted to angiotensin II

167
Q

Give an example of an ACEi.

A

Lisinopril

168
Q

Give some potential side effects of ACEi.

A

Cough
Renal dysfunction
Andioneurotic oedema

169
Q

What should be prescribed for HTN in pregnant women?

A

Beta blockers

170
Q

What do ARBs block?

A

Angiotensin II receptors

171
Q

Give an example of an ARB

A

Losartan

172
Q

Give an example of an alpha blocker

A

Doxazosin

173
Q

What do mineralocorticoid antagonists block?

A

Aldosterone receptors

174
Q

When might spironolactone be prescribed?

A

Resistant HTN

175
Q

Name a mineralocorticoid antagonist.

A

Spironolactone

176
Q

What drugs may be prescribed for vasodilation in angina?

A

Nitrates
Calcium antagonists

177
Q

What drugs may be used to reduce HR in angina?

A

Beta blockers
Calcium antagonists
Ivabradine

178
Q

What are some side effects of nitrates?

A

Headache
Hypotension

179
Q

To avoid tolerance what should be advised when prescribing nitrates?

A

8 hours a day nitrate free

180
Q

When can ivabradine act on HR?

A

Only in sinus rhythm

181
Q

What are the categories of anti thrombotic drugs?

A

Antiplatelet
Anticoagulants
Fibrinolytics

182
Q

Give some examples of antiplatelets.

A

Aspirin
Clopidogrel
Prasugrel
Ticagrelor

183
Q

Give some examples of anticoagulants.

A

Heparin
Fonaparinux
Warfarin
Rivaroxaban
Dabigatran
Edoxaban

184
Q

How is a warfarin overdose reversed?

A

Vitamin K

185
Q

Give an example of a fibrinolytic.

A

Streptokinase

186
Q

What can be used to chemically cardiovert in AF?

A

Amiodarone
Flecainide

187
Q

What are the 4 pillars of HF therapy?

A

ARNI/ACEi
Beta blocker
MRA
SGKT2i

188
Q

What effect do neprilysin inhibitors have?

A

ARB and prevent breakdown of naturitic peptides increasing vasodilatory naturitic peptides

189
Q

What is nicorandil?

A

K ATP channel opener

190
Q

What are some side effects of digoxin?

A

Nausea
Yellow vision
Bradycardia
Heart block Ventricular arrythmias

191
Q

What effect does digoxin have?

A

Blocks AV conduction producing a degree of AV conduction delay

192
Q
A

CV (5 decks)

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