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Medical Studies 1 > Week 1 Cardiovascular > Flashcards

Week 1 Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

the base surface of the heart refers to what position

A

posterior

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2
Q

the diaphragmatic surface of the heart refers to what position

A

inferior

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3
Q

the left and right surfaces of the heart refer to what position

A

left and right lateral

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4
Q

the anterior surface of the heart refers to what position

A

anterior

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5
Q

what chambers are founds on the base surface of the heart

A

left and right atrium

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6
Q

what chambers are found on the diaphragmatic surface of the heart

A

right and left ventricle

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7
Q

what chambers are found on the left pulmonary surface of the heart

A

left ventricle

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8
Q

what chambers are found on the right pulmonary surface of the heart

A

right atrium

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9
Q

what chambers are found on the anterior surface of the heart

A

right ventrcle,left ventricle, right atrium

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10
Q

list the borders of the heart

A

right border
left border
inferior border
superior border

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11
Q

what structure(s)/chamber(s) are found in the right border

A

right atrium

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12
Q

what structure(s)/chamber(s) are found in the left border

A

left ventricle (majority)
left atrium (minority)

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13
Q

what structure(s)/chamber(s) are found in the inferior border

A

right ventricle (majority)
left ventricle (minority)

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14
Q

what structure(s)/chamber(s) are found in the superior border

A

right atrium
left atrium
auricles

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15
Q

Describe the structure of the cardiac skeleton

A

-dense fibrous CT
-forms four rings around each of the cardiac valves
-forms two fibrous CORONETS around the aortic and pulmonary valves
-forms two fibrous RINGS around the bicuspid and tricuspid valve

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16
Q

list the functions of the cardiac skeleton

A

anchorage
insulation
attachment
structure

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17
Q

how does the cardiac skeleton provide anchorage

A

anchors the heart valves and maintains proper alignment

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18
Q

how does the cardiac skeleton provide insulation

A

electrically insulates the atria from ventricles, assits with coordinated contractions

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19
Q

how does the cardiac skeleton provide attachment

A

serves as the myocardial attachment point

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20
Q

how does the cardiac skeleton provide structure

A

maintains structural integrity of the heart during the cardiac cycle

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21
Q

coronary arteries consist of

A

left and right coronary arteries

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22
Q

left coronary artery bifrucates into

A

left anterior descending artery and left circumflex artery

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23
Q

right coronary artery branches into

A

right marginal artery and posterior descending artery

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24
Q

function of left anterior descending artery

A

supplies:
-anterior 2/3 of interventricular septum
-left ventricle
-right ventricle

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25
Q

function of left circumflex artery

A

supplies :
-left atrium
-left ventricle

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26
Q

function of the right marginal artery

A

supplies right ventricle

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27
Q

function of posterior descending artery

A

supplies:
-left ventricle
-right ventricle
-posterior 1/3 of interventricular septum

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28
Q

whats a dominance pattern

A

refers to the coronary artery that supplies the posterior descending artery

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29
Q

describe a left dominant pattern

A

the left cirucmflex artery supplies the posterior descending artery

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30
Q

describe a right dominant pattern

A

the right coronary artery supplies the posterior descending artery

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31
Q

Outline the right dominant pattern

A
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32
Q

function of left marginal artery

A

supplies left ventricle

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33
Q

location of great cardiac vein

A

runs alongside left anterior descending artery

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34
Q

location of middle cardiac vein

A

posterior surface of heart

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35
Q

list the structures of venous drainage of the heart

A

-coronary sinus
-great cardiac vein
-middle cardiac vein
-small cardiac vein
-anterior cardiac vein

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36
Q

function of coronary sinus

A

receives blood from several major cardiac veins (middle cardiac vein, great cardiac vein and small cardiac vein) and empties it into right atrium

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37
Q

function of great cardiac vein

A

drains anterior aspects of heart

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38
Q

function of middle cardiac vein

A

drains posterior regions of ventricles

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39
Q

function of small cardiac vein

A

drains right atrium and right ventricle

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40
Q

function of anterior cardiac vein

A

directly drains the right ventricle into the right atrium (bypasses coronary sinus)

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41
Q

location of small cardiac vein

A

runs along right atrioventricular groove

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42
Q

list the factors that infleunce autonomic regulation of vascular diameter

A

metabolic
autonomic innervation
endothelium
physical forces
hormonal

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43
Q

describe sympathetic innervation of coronary arteries

A

-involves prenganglionic fibres from (T1-5)
-involves post ganglionic fibres from cervical ganglia
-targets the SA/AV node, coronary arteries, cardiomyocytes
-positive inotropic effect

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44
Q

describe parasympathetic innervation of coronary arteries

A

-consists of preganglionic fibres from brainstems vagal nuclei and vagus nerve
-involves post ganglionic fibres from neurons in cardiac plexus
-targets SA/AV node and coronary arteries
-negative inotropic effect

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45
Q

Describe role of endothelium in cardiac physiology

A

-endothelial cells that line coronary arteries play a role in regulating vascular tone and blood flow
-release factors like NO that induce vasodilation
-releases endothelin that causes vasoconstriction

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46
Q

Function of arteries

A

carry oxygenated blood away from the heart to various body tissues

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47
Q

Function of veins

A

return deoxygenated blood from tissues back to the heart

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48
Q

Function of capillaries

A

tiny,thin walled vessels where oxygen and nutrients are exchanged within tissues

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49
Q

List the basic principles of circulatory function

A

-blood is pumped from heart into arteries
-arteries branch into smaller vessels and eventually become capillaries in tissues
-capillaries allow for the exhange of oxygen and nutrients and waste products
-deoxygenated blood returns to heart via veins
-the heart pumps blood to lungs for oxygenation (pulmonary circulation) rest is (systemic)

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50
Q

what is pressure gradient in terms of blood vessels

A

describes the difference in pressure between two ends of a vessel

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51
Q

what is vascular resistance in terms of blood vessels

A

the impediment to flow through a vessel

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52
Q

whats ohms law

A

pressure (gradient)= flow x resistance

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53
Q

identify types of blood flow

A

laminar or turbulent

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54
Q

what is turbulent blood flow

A

disorderly, flowing crosswise in in a vessel

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55
Q

what is laminar blood flow

A

flows in streamlines, with each parallel layer remaining the same distance from the vessel wall

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56
Q

identify the impediments to blood flow

A

physical
directional
velocity

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57
Q

describe physical impediments to blood flow

A

physical obstruction such as the presence of atherosclerotic plaque /ischaemia

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58
Q

describe directional impediments to blood flow

A

change in directions such as the vasculature of the aortic arch

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59
Q

describe velocity as an impediment to blood flow

A

high velocity can derail trails of laminar flood flow, enabling turbulence

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60
Q

list the factors that affect vascular resistance

A

-organisation of vascular network
-characteristics of blood
-extravascular mechanical forces
-vessel diameter
-vessel length

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61
Q

Describe, using an example how organisation of vascular network can impact vascular resistance

A

series circuits result in higher overall resistance and greater pressure drops, while parallel circuits allow for lower resistance, more uniform pressure distribution, and variable flow rates.

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62
Q

describe how characteristics of blood can impact vascular resistance

A

variables in the blood eg, viscosity, protein, cell levels can impact blood flow

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63
Q

describe how extravascular mechanical forces can impact vascular resistance

A

things such as compression via muscle contraction and pump can impact flow

64
Q

describe how vessel diameter can impact vascular resistance

A

vessel diameter is reciprocal to resistance, decreases as resistance increases

65
Q

describe how vessel length can impact vascular resistance

A

vessel length is proportional to resistance, increases as resistance increases

66
Q

what is vascular conductance

A

measure of the blood flow through a vessel for a given pressure gradient
-reciprocal of resistance

67
Q

identify the determinants of coronary blood flow

A

availability to oxygen
blood vessel diameter
CO
SV
BP

68
Q

what are the 3 characteristics of coronary blood flow

A

high oxygen demand
high resting oxygen extraction
limited anaerobic capacity

69
Q

describe high oxygen demand as a feature of coronary blood flow

A

unlike other components of the body, the heart is in constant need of oxygen

70
Q

describe high resting oxygen extraction as a feature of coronary blood flow

A

at rest, the human heart extracts 70-80% of oxygen delivered from coronary blood flow (contrast to 30-40% for normal tissue)

71
Q

describe limited anaerobic capacity as a feature of coronary blood flow

A

the heart fails to work effectively without oxygen supply, this maintains aerobic capacity

72
Q

what is vasomotor tone

A

refers to the intrinsic level of contraction and relaxation of vascular smooth muscle which maintains the baseline diameter of blood vessels

73
Q

identify the factors effecting vasomotor tone

A

sympathetic innervation
parasympathetic innervation
local gas levels

74
Q

describe how sympathetic innervation impacts vasomotor tone

A

the sympathetic branch of the ANS releases norepinephrine and stimulates alpha-adrenergic receptors on vascular smooth muscle cells causing vasoconstriction

75
Q

describe how parasympathetic innervation impacts vasomotor tone

A

the parasympathetic branch predominantly affects vasodilation in specific areas, such as genitalia and digestive system

76
Q

describe how local gas levels impacts vasomotor tone

A

changes in local tissue oxygen levels (hypoxia) can lead to vasodilation, while high levels of carbon dioxide (hypercapnia) can cause vasoconstriction

77
Q

what is atherosclerosis

A

a chronic vascular disease characterised by the build up of atherosclerotic plaque in the coronary arteries, hardening and narrowing the arteries, restricting blood flow to the heart muscle

78
Q

what is coronary heart disease

A

involves the narrowing or blockage of coronary arteries due to plaque formation, leading to reduced oxygen supply to the heart and potential angina or MI

79
Q

what is myocardial infarction

A

occurs when a coronary artery is completely blocked, usually by blood clot, leading to a loss of blood supply or part of the heart muscle and causing tissue damage or necrosis

80
Q

what is a coronary artery dissection

A

a tear in the coronary artery wall causing blood to flow between the layers if the artery, leading to reduced blood flow to heart and possible ischaemia

81
Q

describe initial stage of atherosclerosis

A

atherosclerosis process is triggered by a certain stimuli, including trauma, HTN, hyperlipidaemia, triggers endothelial injury and inflammation

82
Q

describe mid stage atherosclerosis

A

switch from acute to chronic inflammation, dominated by macrophage activity

83
Q

describe late stage atherosclerosis

A

vascular inflammation become less important, involves the formation and rupture of atherosclerotic plaques

84
Q

Outline mechanism of atherosclerosis

A

-endothelial damage (various causes eg HTN,Smoking,Diabetes)
-dyslipidaemia (high LDL’s/low HDL’s)
-more LDL diffuses across damaged endothelium and accumulates in the intima
-LDL in the intima is oxidised into lipids that trigger chronic inflammation of vessel wall
-inflammation attracts macrophages
-CAM’s allow macrophages to attach to the endothelium
-macrophages enter (via diapedesis) phagocytose the oxidised LDL and become filled with fat (foam cells form)
-foam cells accumulate in intima forming lipid core
-SM cells move towards intima, lay down fibrous CT (collagen) that accumulates around lipid core, forming fibrous cap
-fibrous cap eventually bursts (collagen becomes unstable)
-development of atheroma –>atherosclerosis
-this can attract a thrombus which can lead to an embolus (and block various blood supply to other areas)

85
Q

identify some sources of endothelial damage

A

-hypertension
-hyperglycaemia
-free oxygen radicals (from smoking)
-hyperlipidaemia
-physical injury
-turbulent blood flow

86
Q

what molecules modulate WBC movement during atherosclerosis

A

selectins
integrins
Cell adhesion molecules (CAMS)

87
Q

role of selectins in atherosclerosis

A

monitor monocyte adhesion under flow by capturing monocytes

88
Q

role of integrins in atherosclerosis

A

adhesion of monocytes

89
Q

role of CAM’s in atherosclerosis

A

bring leukocytes to complete arrest

90
Q

list two CAM’s

A

VCAM-1
ICAM-1

91
Q

what is VCAM-1

A

vascular protein; binds to VLA-1 and a4B1 integrin, expressed by endothelial and smooth muscle cells

92
Q

what is ICAM-1

A

intracellular proteins; binds to LFA-1; expressed by endothelial cells and leukocytes

93
Q

what are fatty streaks

A

early precursor lesion of atherosclerosis (lacks fibrosis, thrombosis or calcification)

94
Q

list the histopathological features of atherosclerosis

A

neovessel formation
apoptotic macrophages
plaque crystals

95
Q

describe neovessel formation (atherosclerosis)

A

aims to supply oxygen and nutrients to hypoxic regions of the plaque, the resulting new blood vessels are often fragile and contribute to plaque instability and the risk of rupture

96
Q

describe apoptotic macrophages (atherosclerosis)

A

the failure to efficiently clear apoptotic macrophages within atherosclerotic plaques leads to secondary necrosis, inflammation, and plaque instability.

97
Q

describe plaque crystals (atherosclerosis)

A

crystallisation due to the formation of plaques within blood vessels

98
Q

name some cells involved in atherosclerosis

A

monocytes/macrophages
platelets
T cells
SMC’s
Dc
neutrophils

99
Q

describe interplay between macrophages and SMC’s

A

-as plaques develop, SMC’s migrate towards plaque surface, secrete collagen and form a fibrous cap
-SMC’s also contribute to plaque expansion by releasing inflammatory chemokines
-this causes recruitment of monocytes and macrophages
-SMC apoptosis occurs, exacerbating plaque inflammation and instability

100
Q

what is the prevalence of hypertension in men globally

A

32-37%

101
Q

what is the prevalence of hypertension in women globally

A

30-34%

102
Q

describe the difference between primary and secondary hypertension

A

-primary hypertension describes high BP with no identifiable underlying cause and is thought to be a combination of genetic, environmental and lifestyle factors
-secondary hypertension arises from. an identifiable underlying condition

103
Q

identify the causes of secondary hypertension

A

metabolic syndromes
adrenal (phaechromocytoma)
medication/drugs
renal disease
hyper/hypothyroidism
polycystic ovary syndrome

104
Q

address the treatment of primary vs secondary hypertension

A

primary=requires long term management through lifestyle modifications and pharmacotherapy
secondary=treating the underlying contributing condition

105
Q

outline the pathophysiology of secondary hypertension (RENAL)

A

-damaged kidneys have a lesser capacity to excrete sodium and water, leading to fluid retention and increased BV
-this causes dysregulation of RAAS
-elevated levels of angiotensin II and aldosterone, leading to vasoconstriction

106
Q

outline the pathophysiology of secondary hypertension (thyroid)

A

-in hyperthyroidism, elevated thyroid hormones increase CO and enhance peripheral vascular resistance leading to increased BP
-in hypothyroidism, reduced thyroid hormones can lead to increased peripheral resistance and dyslipidaemia, leading to increased BP

107
Q

signs and symptoms of primary hypertension

A

-generally asymptomatic
-in extreme cases–> headache, epistaxis, arrhythmias, visual disturbances, chest pain, dyspnoea, confusion

108
Q

signs and symptoms of secondary hypertension

A

-can present alongside end organ damage, leading to CAD, stroke, renal disease, retinopathy
-heart palpitations (due to phaechromocytoma) and anxiety

109
Q

list the investigation methods for hypertension

A

EUC, ACR
TFTs
Lipid profiles
Urinanalysis

110
Q

Describe the use of EUC and ACR for hypertension investigation

A

increased creatinine, abnormal albumin-creatinine ratio, or low GFR may indicate hypertension due to renal impairment

111
Q

ACR and EUC stand for

A

albumin creatinine ratio
Electrolytes, urea, creatinine

112
Q

Describe the use TFTs for hypertension investigation

A

thyroid function tests, abnormal thyroid hormone levels may indicate hypertension due to hypo/hyperthyroidism

113
Q

Describe the use lipid profiles for hypertension investigation

A

tests for hyperlipidaemia, when found alongside hypertension, this poses pt at severe cardiovascular risk

114
Q

Describe the use urinalysis for hypertension investigation

A

detects proteinuria or other abnormalities indicating potential kidney involvement in hypertension

115
Q
A
116
Q
A
117
Q

values for different degrees of HTN

A

normal 120-129 and 80-84
elevated normal: 130-139 and 85-89
grade 1: 140-159 and 90-99
grade 2: 160-179 and 100-109
grade 3 180+ and 110+

118
Q

list the stages of severe hypertension

A

-severely elevated hypertension without symptoms
-hypertensive urgency
hypertensive emergency

119
Q

features of severely elevated hypertension without symptoms

A

-180/110 or higher
-no symptoms or end organ damage
-no immediate threat to life
-treatment within 1-2 days

120
Q

features of hypertensive urgency

A

-180/110 or higher
-symptoms present
-no end organ damage
-moderate non acute damage/dysfunction
-treatment within hours

121
Q

features of hypertensive emergency

A

-220/140 or higher
-symptoms present
-significant acute end organ damage
-immediate threat to life
-treatment within minutes

122
Q

effects of hypertension on brain

A

stroke; initiates thrombus formation leading to reduced cerebral perfusion

123
Q

effects of hypertension on heart

A

MI, left ventricular hypertrophy, CHF

124
Q

effects of hypertension on kidneys

A

-exacerbate/cause renal failure due to pressure imbalances in nephron

125
Q

effects of hypertension on eyes

A

hypertensive retinopathy; causing damage to retina and changes such as retinal haemorrhages and exudates that can impair vision

126
Q

effects of hypertension on blood vessels

A

-atherosclerosis, that can form a clot which lodges in areas such as heart, brain or lungs (embolism)
-can cause PVD and infarctions

127
Q

identify the ways we can image the chest

A

chest radiograph
CT chest
MRI chest
ultrasound
digital subtraction angiography

128
Q

benefits of x ray imaging

A

-good for looking at bones
-good for distinguishing between air filled structures and soft tissue

129
Q

limitations of x ray imaging

A

-cant distinguish between adjacent tissues of the same density

130
Q

what view is the standard X-ray

A

PA, posteroanterior

131
Q

what are the lab conditions for a chest x ray

A

-taken at 6 feet
-upright on full inspiration
-patient close to the film

132
Q

features of AP film

A

-used on adult patients (sick) or children
-may be supine or sitting
-taken at shorter distance from film

133
Q

why are lordotic view x rays used

A

to further assess apical pathology that may be obscured on a frontal film

134
Q

why are lateral decubitus view x rays used

A

-look for air trapping in lungs
-check for pleural air (rises) or pleural fluid (layers dependently)

135
Q

why are expiratory films used

A

-pneumothorax (more obvious on expiration)
-detect focal air trapping (the obstructed lung will appear darker)

136
Q

outline the systematic approach to interpret an x ray

A

INSIDE OUT
-heart
-mediastinum
-hilar
-lungs
-pleural reflections
-upper abdomen
-bones
-soft tissues

137
Q

how do CT scans work

A

2D images are acquired in the axial plane but can be reconstructed in multiple 2D planes and in 3D

138
Q

what is the purpose of CT

A

achieve greater contrast resolution (allow for differentiation between different soft tissues)

139
Q

define hounsfield units

A

standardised unit, relative to water, reflecting attenuation or density

140
Q

hounsfield units for air, fat, water, organs, bone and metal

A

air=-1000
fat=-120 to -90
water=0
organs=20 to 60
bone = 2000
metal= 3000

141
Q

list the different types of CT

A

Standard CT chest (post contrast)
High resolution CT (non contrast)
CT aortogram (+/- gating)
CT Pulmonary angiogram
CT Coronary angiogram

142
Q

What conditions are standard CT chest used for

A

pneumonia, malignancy, pleural disease

143
Q

What conditions are high resolution CT used for

A

parenchymal diseases, eg interstitial lung disease

144
Q

What conditions are CT aortogram used for

A

aortic pathologies

145
Q

What conditions are CT pulmonary angiogram used for

A

pulmonary embolism

146
Q

What conditions are CT angiogram used for

A

coronary artery disease

147
Q

features of standard CT chest

A

-post contrast
-triggered at approximately 20seconds when the contrast is in the arterial system

148
Q

features of high resolution CT

A

-non contrast
-thin slices
-post processing
-can be done on expiration
-can be performed prone

149
Q

features of CT aortogram

A

-more rapid injection of contrast
-can be gated (scan is triggered at a particular point of CC -via ECG monitoring)
-usually mid to end diastolic

150
Q

features of CT pulmonary angiogram

A

-contrast injected at a raid rate
-timed for peak contrast enhancement (triggered in region of interest)
-apices to diaphragm only (view)

151
Q

features of CT coronary angiogram

A

-uses high contrast flow rate
-timed for peak opacification of coronary arteries
-medications sometimes used in conjunction (ie to lower HR)
-ECG gated
-post processing (curved reconstructions, MPR, MIP)

152
Q

what do MPR and MIP stand for

A

MIP = maximum intensity projection MPR = multiplanar reconstruction

153
Q

what is a lordotic view

A

the clavicles appear high such that the lung apices are not visible above the clavicles. The ribs appear more horizontal and are more V-shaped than C-shaped

154
Q

what is a lateral decubitus view

A

pleural and peritoneal cavities are visible

155
Q

how does pheochromocytoma cause HTN

A

-excess release of catecholamines
-causing vasoconstriction
-increased CO and paroxysmal HTN

156
Q

how does cushings syndrome cause HTN

A

-excess cortisol release
-increased sodium and potassium retention
-increased BP

Medical Studies 1 (15 decks)

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