Section 1
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What is the course of the sensory fibres associated with chest pain and radiation of pain to arms?
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Section 1
(50 cards)
What is the course of the sensory fibres associated with chest pain and radiation of pain to arms?
Sensory fibres travel via sympathetic trunks and tener T1-4 (or T5) spinal cord segments.
Why does the aortic pressure fall much less rapidly than ventricular pressure during isovolumetric ventricular relaxation?
The aortic run-off is much less rapid, and dependent on peripheral resistance
Although the heart maintains CO well in the face of increased afterload, it is at the expense of increasing _______ requirements. Patients with coronary insufficiency tend to develop ________ if _________ develops.
Energy, angina, hypertension
What is the approximate ejection fraction in a normal adult?
65%
1. Arch of aorta 2. Pulmonary trunk 3. Left auricle 4. Left ventricle 5. Inferior vena cava 6. Right atrium 7. Superior vena cava 8. Right brachiocephalic vein
Label the features 1-8.
What is the course of the sensory fibres associated with cardiac reflexes?
Sensory fibres travel within the vagus nerve to enter T1-4 (or T5) spinal cord segments
What is considered a prolonged PR interval?
200 ms
What is the definition of after-load?
The pressure that the ventricles must overcome to eject blood. This is the aortic pressure at the time the aortic valve opens.
What does the QRS complex represent?
Ventricular depolarisation
What duration of the QRS complex indicate supraventricular origins?
Narrow QRS complexes, < 100 ms
Which waveforms indicate LBBB?
'W' shape, deep S wave in lead V1; 'M' shape in lead V6
What duration of the QRS complex indicate ventricular origins?
Broad QRS complexes, > 100 ms
Which waveform indicates left atrial hypertrophy?
Split P wave
What are two ways to increase venous return?
1. Sympathetic innervation of veins --> venoconstriction of peripheral veins. 2. Skeletal muscle pump (especially when exercising)
How would sympathetic stimulation (adrenaline or noradrenaline) affect the heart rate?
Increases the slope of the pacemaker potential (via ion conduction channels), resulting in more rapid achievement of the threshold potential required for depolarisation. This results in a higher heart rate.
What does the serous pericardium contain?
The parietal and visceral percardium.
What is Wilson's central terminal?
The negative pole in the unipolar leads
Criteria for normal axis on ECG?
Leads I, II and III are positive; alternatively Leads I and aVF are positive.
Which structure allows the AV node to conduct signals very slowly (at 0.05 m/s)?
Fibrous ring (insulating connective tissue)
The intercalated discs in cardiac myocytes are comprised of which structures?
Desmosomes and gap junctions.
Which waveforms indicate RBBB?
RSR' in lead V1 Deep S wave in lead V6
What does the PR interval represent?
Time from onset of atrial activation to onset of ventricular activation
How long does the action potential plateau go for in ventricular muscle?
~ 300 ms
What is the function of the fibrous pericardium?
Retains heart in position and limits chamber overdistension. It fuses with the sternum, walls of great vessels, and diaphragm.
The PQRST ECG pattern:
What are the gap junctions in cardiac myocytes made of?
Connexin 43 molecules which form pores between two cell membranes.
What is the definition of pre-load?
The tension in the ventricular wall at the end of diastole (measured as the ventricular-end diastolic pressure)
How would parasympathetic stimulation (acetylcholine) affect the heart rate?
Decreases the slope of the pacemaker potential (via ion conduction channels), resulting in slower achievement of the threshold potential required for depolarisation. This results in a lower heart rate.
Which waveform indicates left ventricular hypertrophy?
(S wave in V1) + (R wave in V5/V6) > 35 mm.
What is the Frank-Starling law?
The greater the filling of the ventricle (i.e. the EDV), the greater the force of contraction and hence stroke volume.
What does the S1 heart sound correspond to?
Closure of the AV valves (mitral and tricuspid)
Which nerve carries sensory fibres associated with the fibrous and parietal pericardia?
Phrenic nerve (C3-5 spinal cord segments).
What do the neurotransmitters adrenalin, noradrenalin/norepineprine do to increase contractility?
Increases peak sarcoplasmic reticulum Ca2+ release, but shortens time-course of systole.
Which nerves give parasympathetic innervation to the heart?
Vagus nerve (X)
What does the S2 heart sound correspond to?
Closure of the aortic and pulmonary valves.
What does the P wave represent?
Atrial depolarisation
Which ion current maintains the long plateau of the cardiac action potential?
Ca2+
What does the ST segment represent?
The ventricles before repolarisation - should be isoelectric
Which spinal cord segments via the sympathetic trunks give sympathetic innervation to the heart?
T1-4 (or T5)
What is the definition of ejection fraction?
Stroke volume / End-diastolic volume
During which phase of the cardiac cycle does the SA node depolarise?
Atrial systole
How do cardiac glycosides increase the amplitude of contraction of the heart?
Act to inhibit the Na+/K+ pump. As a result Na+ builds up inside the cell, and the electrochemical gradient decreases, leading to reduced activity of the Na+/Ca2+ exchanger. This results in increased Ca2+ concentration inside the cell. Extra Ca2+ will result in more Ca2+-induced-Ca2+ release, and the net effect is a rise in [Ca2+] in the cell. Consequently the force increases.
What does the T wave represent?
Ventricular repolarisation
According to the Frank-Starling law, how would increased venous return affect the cardiac output?
Increase in venous return --> increased EDV --> increased force of ventricular contraction --> increased stroke volume --> increased cardiac output.
What is the placement of the frontal ECG leads (V1, V4 and V6)?
V1: 4th intercostal space to the right of the sternum V4: 5th intercostal space in the mid-clavicular line V6: Horizontally even with V4/V5 in the mid-axillary line
Which waveform indicates right atrial hypertrophy?
Peaked P wave (P pulmonale); > 2.5 mm in the inferior leads
According to the Frank-Starling law, how would increase in afterload affect the cardiac output?
Increase in afterload reduces stroke volume. This leaves more blood in the left ventricle. In the next cardiac cycle, the same amount of blood will fill the same ventricle --> increase in EDV. According to the Frank-Starling law, this results in an increased force of contraction, leading to increased SV, resulting in the same amount of cardiac output.
ECG segments and intervals:
What is the function of gap junctions in cardiac myocytes?
Allows rapid conduction of the action potential throughout the heart by channeling water and ions between cells.
Which drug can specifically block the 'funny channel' to slow heart rate?
Ivabradine
Section 2
(50 cards)
What is the mechanism of action of spironolactone?
It is a potassium-sparing diuretic, reduces Na+ reabsorption by antagonising aldosterone (a hormone that contributes to water retention).
Where is angiotensinogen synthesised?
Liver
What is the mechanism of action of nitrates (e.g. isosorbide dinitrate/nitrate) in treating heart failure?
Causes peripheral vasodilation (especially in the veins). Metabolism of drugs release NO2- and converted to NO --> activates guanylyl cyclase --> increase in cGMP in vascular smooth muscle cells --> activates PKG --> relaxation of smooth muscle via several mechanisms.
Studies have shown for beta-blockers that in the long run, ________ can result in a higher mortality than __________.
Metoprolol, carvedilol
What are some adverse effects of spironolactone?
Hyperkalaemia, renal impairment, gynaecomastia
What is the definition of cardiac contractility?
The ability of the heart to contract, at any given end-diastolic ventricular volume.
What is the mechanism of action of methyldopa?
Used in hypertension in pregnancy. It is a competitive antagonist of DOPA-decarboxylase; it is converted to methyl dopamine by DOPA-decarboxylase, then alpha-methylnordrenaline, which activates presynaptic CNS α2 receptors --> inhibits sympathetic outflow.
What is the mechanism of action of thiazides?
Act on early distal tubule to inhibit NaCl reabsorption by inhibiting Na+/Cl- cotransportation. Decrease in body water retention (decrease in blood volume). It also causes vascular smooth muscle to become less responsive to vasoconstrictors.
How does exercise increase venous return in the body?
What does cyclic AMP phosphorylate in response to neural/hormonal stimuli? What effects does this have on cardiac contractility?
1. Slow Ca2+ channels, promoting entry of more Ca2+ from the extracellular space; 2. A SR protein that causes the SR to release more Ca2+, and 3. Myosin, which increases the rate of myosin cross-bridge cycling 4. Phosphorylation of the SR calcium uptake pump removes Ca2+ more rapidly from the cytoplasm, thus promoting relaxation.
How do the excitatory muscarinic receptors (M1, M3 and M5) act to increase intracellular calcium levels?
Selectively couple to the Gq/G11-type G-proteins resulting in the generation of IP3 and DAG through activation of the phospholipase C (PLC) --> increased intracellular [Ca2+]
What are the beta-blocks of choice in Australia for the treatment of heart failure?
Bisoprolol, carvedilol, metoprolol succinate, nebivolol
What is the action of angiotensin II?
Stimulates the production of aldosterone.
What is an organic valve lesion?
An intrinsic structural disorder of the valve cusp or chordae tendineae (c.f. functional valvular disease)
What are the effects of cardiac vagal stimulation on the heart's contractility?
Decrease in myocardial intracellular Ca2+ --> reduced contractility
What are some adverse effects of ACE-inhibitors?
Hypotension, hyperkalaemia, angioneurmtic oedema, dry cough, renal impairment
What are some contraindications for the usage of ACE-inhibitors?
Renal artery stenosis Severe renal impairment Hyperkalaemia Hypotension
How do ACE-inhibitors cause dry cough and angioedema as a side effect?
Inhibit the breakdown of bradykinin, which causes cough and angioedema, for the sake of vasodilation, thrombolytic activity and inhibition of cell growth.
What is the recommended combination of treatments for acutely decompensated heart failure?
Diuretics (to reduce fluid volume); vasodilators (decrease preload and afterload); and inotropes (augment contractility)
______-sided heart failure results in ______ congestion, while right-sided heart failure results in ________ venous congestion (e.g. peripheral oedema). Chronic ____-sided failure can also cause _____-sided failure.
Left, pulmonary, systemic, left, right.
How does adrenaline decrease diastolic BP?
1. Activates ß2-receptors on systemic arteries --> dilation
Describe a noradrenergic plexus.
Sympathetic postganglionic axon terminals form a noradrenergic plexus around the blood vessel. The terminals contain varicosities that are close to smooth muscle cells. These varicosities contain the neurotransmitter. The vesicles cross the neuroeffector junction to activate the smooth muscle receptors.
What is the first-line therapy in Australia for heart failure?
ACE-inhibitors (PBS)
How does acetylcholine lead to decrease in the slope of pacemaker potentials?
ACh released from the vagus nerve fibres acts on muscarinic M2 receptors, leading to increased K+ current and reduced pacemaker current. Thus hyperpolarisation results --> reduction in rate of rise of pacemaker potential.
Coronary blood flow occurs mainly during _______?
Diastole
What is the mechanism of action of loop diuretics?
Inhibit the cotransport of Na+/K+/2Cl- in order to inhibit NaCl reabsorption in the thick ascending loop of Henle.
What is the mechanism of action of ACE-inhibitors?
Lower both arterial and venous resistance by preventing the increase in (vasoconstrictor) angiotensin II that is often present in heart failure. Cardiac output increases.
Forward failure leads to inadequate left _________ _________.
ventricular output
What is the order of potency of neurotransmitter on alpha-adrenoreceptors (excitatory responses)?
Norepinephrine > epinephrine > isoprenaline
What is the order of potency of neurotransmitter on beta-adrenoreceptors (inhibitory responses)?
Isoprenaline > epinephrine > norepinephrine
What is the mechanism of action of dobutamine and dopamine (in treatment of acute heart failure)?
They are sympathomimetic agents. Activate cardiac β-receptors and stimulate adenylyl cyclase (via G-protein coupling) --> increase in cAMP --> activation of cAMP-dependent protein kinase, which leads to phosphrolyation of L-type Ca2+ channels --> increase in probability of their opening --> increase in Ca2+ influx. This increases the force of myocardial contraction.
What are some contraindications for usage of beta-blockers?
Asthma, bradycardia, hypotension, clinical instability, possibly severe renal impairment
What is the main advantage of angiotensin II type 1 receptor blockers (ARBs) over ACE-inhibitors?
Provide a more complete blockade since angiotensin II can be produced by enzymes other than ACE.
How can left ventricular failure lead to pulmonary venous congestion?
Increased load on left atrium, which has a thin wall and cannot compensate adequately --> atrial fibrillation.
How does noradrenaline or adrenaline lead to rise of the slope of pacemaker potential?
They act on β1-receptors, producing increased cAMP, which then increases the pacemaker current. The inward Ca2+ current also increases, leading to a steeper slope of pacemaker potential.
What is the mechanism of action of carbidopa?
Inhibits DOPA decarboxylase, used in Parkinson's disease to prevent peripheral metabolism of L-DOPA into DOPA.
How does adrenaline increase systolic BP?
1. Increase heart rate: activates ß1-receptors on ventricular myocardial cells --> increased force 2. Activation of venous receptors --> venoconstriction increases venous return and stroke output
What is dobutamine used for? Which adrenoceptor does it bind to?
It is an beta-1 agonist. Used to increase cardiac contractility.
What ist the mechanism of action of digoxin (in treatment of acute heart failure)?
It is an inotrope. Inhibits membrane Na+/K+-ATPase, which increases intracellular Na+ and produces a secondary increase in intracellular Ca2+. This increases the force of myocardial contraction.
How do the inhibitory muscarinic receptors (M2 - cardiac; and M4 - CNS) act to decrease intracellular calcium levels?
Preferentially activate Gi/Go-type G-proteins, thereby inhibiting adenylate cyclase, reducing intracellular concentration of cAMP, and prolonging K+ channel opening --> decreased Ca2+ conductance
What are some drugs to avoid in heart failure?
NSAIDs, thiazolidinediones Use caution in: anti-arrhythmic agents, metformin (used to treat type II diabetes)
What is the action of renin on angiotensinogen?
Converts it into angiotensin I
What are the effects of cardiac sympathetic stimulation on the heart's contractility?
Increase in circulating adrenaline --> increase in intracellular Ca2+ in myocardial fibres --> increase in contractility
___________ is a non-selective beta-blocker, whereas _________ is a beta1-selective beta-blocker, making it __________ safer to use in patients with COPD.
Carvedilol, metoprolol, safer.
What is the mechanism of action of K-sparing diuretics?
Inhibit reabsorption of Na in the late distal and cortical collecting tubule
How is the ACh signal stopped within the synapse?
Membrane-bound acetylcholinesterase breaks into choline and acetate. Choline is then taken up into the presynaptic terminals.
Backward failure leads to ________ _________ in the lungs and/or systemic viscera.
venous congestion
How is angiotensin I converted to form angiotensin II?
It is cleaved by ACE (an enzyme bound to the membrane of endothelial cells) to form angiotensin II.
What are salbutamol, terbutaline, and salmeterol used for? Which adrenoceptor do they bind to?
They are beta-2 agonists, used as bronchodilators.
What is the mechanism of action of hydralazine?
Acts as a vasodilator by relaxing vascular smooth muscle. Used often in treatment of hypertension.
Section 3
(50 cards)
Statins should not be used in combination with drugs such as __________ or __________. However they can be combined with __________ for better control.
amiodarone, gemfibrozil, ezitimibe.
What is the mechanism of action of abciximab (a monoclonal antibody), tirofiban and eptifibitide?
Inhibits platelet aggregation by binding to the GPIIb-IIIa receptors.
Describe the progression of myocardial infarction (ischaemia, injury, infarction).
What is the treatment regime of acute coronary syndrome?
Percutaneous coronary intervention (PCI), beta-blockers, statin therapy, antiplatelet therapy (e.g. aspirin, clopidogrel, glycoprotein IIb-IIIa inhibitors), antithrombitic therapy (UFH vs. LMWH, fondiparinux, bivalirudin, clean)
What are some clinical features of systemic venous congestion?
Elevation of JVP Pitting oedema Oedema of the sacrum Ascites and effusions
What are some ECG waveforms seen in pericarditis?
ST elevation (flat or concave, seen in all leads except aVR). P wave part of downward slanting of baseline (PR depression)
Which type of lipoproteins are most likely to contribute to atherosclerotic cardiovascular disease?
Apolipoprotein B100 containing lipoproteins (VLDL, IDL, LDL, lipoprotein a)
What are the features of the spleen in chronic venous congestion?
Congested and enlarged spleen, prominent pale fibrous trabeculae, due to back-pressure into the portal venous system.
What is the mechanism of action of statins (lipid-lowering drugs)?
Also known as HMG CoA reductase inhibitors. Block the synthesis of cholesterol in the liver --> release of sterol regulatory element binding proteins (SREBPs) --> up-regulate the LDL receptor gene --> increased number of LDL receptors --> more removal of circulating LDL particles. They limit atheroma progression and reduce the risk of future events.
What is the relationship of the phrenic nerve to the aortic arch?
The phrenic nerve passes anteriorly to the aortic arch.
What are the causes of hepatic ischaemia in forward and backward heart failure?
Forward: lowered CO from left ventricle Backward: venous congestion
What is the action of fibrates in the treatment of hyperlipidaemia?
Act as ligands for the nuclear transcription receptor PPAR-alpha and stimulate lipoprotein lipase activity. First line drugs in patients with very high plasma triglyceride.
What kinds of populations are at risk of developing peripheral vascular disease?
14% of patients > 70 years old. 3x increase in risk with diabetes mellitus.
Confusion is a manifestation of ________ ischaemia due to _________ failure
cerebral, forward
What are some differential diagnoses for ST segment elevation?
Ventricular hypertrophy, ventricular aneurysm, conduction abnormalities, hyperkalaemia, pericarditis, Brigade syndrome, Takotsubo cardiomyopathy
Pathologic waveforms in which leads could indicate left anterior descending artery involvement?
Anterior
What is the mechanism of action of aspirin?
Inhibits platelet TXA2 synthesis, which is a powerful inducer of platelet aggregation, by irreversibly inhibiting COX. Weak on its own, often given with clopidogrel.
Which arteries are usually accessed in cardiac catheterisation?
Femoral or radial arteries
What is the criteria for a 'pathological Q wave'?
Q wave is 1/3rd of subsequent R wave. Indicates presence of infarct, since these areas become electrically silent (fail to depolarise - the lead 'sees' the territory on the other wall)
How does auto-regulation of blood flow to a vascular bed by local factors (metabolites) respond to increased blood pressure?
Increased blood pressure --> increased blood flow --> reduction in metabolites --> vasoconstriction --> reduced blood flow.
What is peripheral vascular disease and what are their manifestations?
Atherosclerosis of the aorta, carotid artery, iliac, femoral lower and upper limb vessels. Can also manifest as a stenosis, occlusion, aneurysms, or as a result of trauma.
Why do plaque fractures occur frequently at the carotid bifurcation?
Mechanical stress at the bifurcation --> plaque fracture and intra-plaque haemorrhage.
Pathologic waveforms in which leads could indicate circumflex branch of left coronary artery involvement?
Lateral (± inferior)
Where could an embolus blocking the intra-cerebral vessels come from originally?
From an unstable plaque at the carotid bifurcation (or anywhere from extra cranial vessels).
What are the symptoms of ACS?
Acute onset, rapidly progressive angina (at rest). Diaphoresis, tachycardia, pulmonary oedema, dyspnoea, syncope (cardiac arrest/ventricular arrhythmia).
There is evidence that _________ confer similar __________ benefit as ACE-inhibitors.
ATII receptor antagonists / ARBs, survival
Revascularisation procedures include: _________ and _________.
Angioplasty, CABG (coronary artery bypass grafting)
What is the first line therapy for hypercholesterolaemia?
Statins, e.g. simvastatin. (Other interventions include: diet, alcohol restriction, managing secondary causes).
Pathologic waveforms in which leads could indicate right coronary artery involvement?
Inferior (± lateral)
How can peripheral oedema be exacerbated by forward failure?
Renal hypoperfusion --> activation of renin-angiotensin system --> increased aldosterone production --> Na+ and H2O retention
What is the action of histamine on blood vessels?
Vasodilator and increases capillary permeability (released from mast cells and in allergic reactions).
What is the primary receptor for adrenergic nerves that transmit noradrenaline (norepinephrine) to cause vasoconstriction?
alpha-1 (sympathetic)
What are the inferior leads of an ECG?
II, III, aVF
What are the septal leads of the ECG?
V1-2
What are the lateral leads of an ECG?
I, aVL, V4-6
How is resistance of a vessel related to its radius, length and viscosity of the blood?
Directly proportional to length and viscosity, inversely proportional to fourth power of radius.
What are the features of pulmonary venous congestion?
- Congested capillaries in alveolar walls - Alveolar oedema (transudate) - RBCs in alveoli - RBC degradation by macrophages, which become filled with haemosiderin - Pulmonary fibrosis
How does auto-regulation of blood flow to a vascular bed by local factors (metabolites) respond to decreased blood pressure?
Decreased blood pressure --> decreased blood flow --> accumulation of metabolites --> vasodilation --> increased blood flow
Which muscle separates the subclavian vein and artery?
Scalenus anterior
What is the mechanism of action of clopidogrel?
Reduces platelet aggregation by irreversibly blocking the effect of ADP on platelet activation. It has a synergistic action when given with aspirin.
Which of these statements about aspirin is incorrect? A. It improves outcomes for patients with acute coronary syndromes. B. Aspirin is effective for secondary prevention of adverse events in patients with known cardiovascular disease. C. Aspirin is effective for primary prevention of adverse events in patients at high risk of cardiovascular disease. D. Aspirin is effective for primary prevention of adverse events in patients at low risk of cardiovascular disease.
D is the wrong answer. Aspirin is NOT effective for primary prevention of adverse events in patients at LOW RISK of cardiovascular disease.
Statins are effective for primary and secondary prevention of _________, adverse events and recurrent __________ in patients either at risk or with known cardiovascular disease. Statins are also effective for prevention of _______ in patients with known cardiovascular disease.
death, infarction, stroke
What are some drugs that act as P2Y12 inhibitors?
Clopidogrel, prasugrel, ticarelor
How do Ca2+ channel blockers work?
Bind to L-type Ca2+ channels and, by blocking entry of Ca2+ into the cell, cause relaxation of arteriolar smooth muscle. Examples include nifedipine, amlodipine.
What is the characteristic description of hepatic ischaemia in chronic venous congestion?
Nutmeg liver - liver fills up with blood and becomes enlarged.
What is the action of vasopressin on blood vessels?
In response to low blood volume (e.g. haemorrhage): - potent vasoconstrictor action - antidiuretic effect
What are the anterior leads of the ECG?
V3-V4
What are the biomarkers that might indicate an acute coronary syndrome?
Troponin and creatine kinase (both peak after about ~1 day). ST segment changes may occur, along with pathological Q waves.
What kind of receptors does adrenaline act on to cause vasodilation?
beta
Which structures pass between the first rib and clavicle?
Subclavian artery, subclavian vein and brachial plexus
Section 4
(50 cards)
Through which investigation would a bacterial diagnosis be made to establish endocarditis?
1. Blood cultures (demonstration of bacteraemia, 2-3 sets in 24h) 2. Clinical supportive evidence (risk factors; history and examination) 3. Demonstration of vegetative endocarditis (echocardiography)
What are some clinical features of rheumatic fever?
1) Migratory polyarthritis of the large joints 2) Carditis 3) Subcutaneous nodules 4) Erythema marginatum of the skin 5) Sydenham chorea (neurologic disorder, involuntary purposeless, rapid movements)
Endocarditis is often _________ with a delayed presentation.
subacute
Where do acute rheumatic endocarditis vegetations occur in the heart? What do they consist of?
On the lines of apposition of left heart valves (mitral, aortic). Consist of fibrin and platelets (no micro-organisms!)
The interval between the rheumatic fever attack and the throat infection is _ to _ weeks. This means that the pharyngeal cultures for GAS are ________ at the commencement of the fever.
3 to 4 weeks, negative
What are the differences in indications for surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI)?
SAVR: for patients with low/intermediate surgical risk TAVI: for patients with high surgical risk
When should a transcatheter mitral valve replacement be used?
- Severely symptomatic patients - Favourable anatomy - Reasonable life expectancy - Prohibitive surgical risk due to comorbidities
In which age group does the first attack of rheumatic fever occur most frequently?
5-15 years old, of which 50-75% will develop carditis (the risk is lower if first onset is in adult life)
What is a typical presentation of septicaemia?
1. Non-specific symptoms and signs of inflammation (tachycardia ± tachypnoea, fever, vasodilation, constitutional symptoms) 2. Symptoms and signs of septicaemia focus 3. Symptoms and signs of end-organ sequelae 4. Immunologic dysfunction 5. Septic shock syndrome (multiple organ failure of complex aetiology, diffuse cell injury, inflammatory mediators)
What are some examples of non-specific inflammatory markers?
- (minor) neutrophilic - elevated ESR - Ig - Immune complexes - acute phase proteins e.g. ferritin - anaemia of chronic disease
Since the invention of ________, the incidence of rheumatic fever has ________ dramatically since the late 20th century.
antibiotics, fallen
Epidemiological risk factors for acute rheumatic fever include ________ standards of living, socially and economically ___________ populations
lower, disadvantaged
Recurrent rheumatic endocarditis can lead to cumulative effects that result in valve lesions such as ______?
Aortic stenosis/regurgitation Mitral stenosis/regurgitation (rare tricuspid involvement)
Who should be revascularised by PCI?
STEMI patients (urgent PCI is best treatment)
What are Aschoff nodules in rheumatic myocarditis?
Areas of central necrosis. Foci of swollen eosinophilic collagen surrounded by lymphocytes (mainly T cells), plasma cells and plump macrophages. This results from granulomatous immunological inflammation via the myocardium.
What is optical coherence tomography (OCT) in coronary angiography?
Uses reflection of near-infrared light to assess lumen size and penetrates some distance below the lumen surface.
At which vertebral level is the oesophageal hiatus located?
T10
How do you treat an abdominal aortic aneurysm?
Use an endoluminal graft.
What are some therapies to prevent sudden death?
Lifestyle factors, pharmacological agents (beta-blockers), implantable cardioverter-defribillators (ICD)
Subacute bacterial endocarditis usually involves bacteraemia that latch onto endovascular site, such as in ____________ abnormal or _________ heart valve, in ________ (due to eating, tooth brushing, dentistry) or could be introduced via ________.
congenitally, rheumatic, mouth, surgery.
What are some features of septic shock?
1. Hypotension and circulatory failure 2. Oliguria and renal failure 3. Haemostatic failure (DIC) 4. Pulmonary failure (pulmonary oedema) 5. GI failure (direct hepatic damage, gut mucosal ischaemia --> translocation of gut organisms) 6. Nutritional failure, due to GI failure
At which vertebral level is the canal opening located?
T8
What is a fractional flow reserve (FFR) in coronary angiography?
Measures pressure drop across a stenosis at maximal vasodilatation.
Which vessels are commonly subject to peripheral vascular disease in the diabetic population?
Tibial and fibular vessels ("the diabetic foot")
What are some organisms that could contribute to endocarditis?
ACUTE: - Viridans streptococci (e.g. S. mutans) - Enterococcus faecalis SUBACUTE: - Staphylococcus aureus - Pseudomonas aeruginosa
What is the definition of 'septic shock'?
Cardiovascular collapse due to septicaemia
In rheumatic endocarditis, the damage that occurs in the cardiac valves is due to _______ in response to injury.
fibrosis
Acute bacterial endocarditis is usually caused by a particularly virulent organism such as ________________.
Staphylococcus aureus. (There is often no underlying endovascular abnormality; usually disastrous outcome without early / very aggressive management.)
How can aortic/mitral stenosis result from fibrosis of cardiac valves?
Fibrous adhesions extend within valve commissures, resulting in a significant narrowing through the valve --> aortic/mitral stenosis.
What is the definition of 'septicaemia'?
The syndrome of host response to microbial invasion that is clinically apparent (e.g. fever and constitutional symptoms).
What is the prevalence of familial long QT syndrome?
1/3,000
What are some immediate complications of percutaneous coronary intervention?
Myocardial infarction, coronary damage requiring emergency CABG.
What are the consequences of vegetations forming on chordae tendineae of the mitral valve?
Chordae tendineae become thickened/fibrotic. Valve leaflets are held open, leading to regurgitation.
At which vertebral level is the aortic hiatus located?
T12
What is an intravascular ultrasound (IVUS) in coronary angiography?
Measures lumen size at stenosis and vessel wall structure using a small, high frequency ultrasound probe. It is highly invasive.
What is the mortality of an abdominal aortic aneurysm, even if the patient gets to hospital?
Up to 50%
What are the biggest risk factors for sudden death in hypertrophic cardiomyopathy?
- Previous cardiac arrest - LVH ≥ 30 mm on ECG - Family history - Unexplained syncope - Non-sustained ventricular tachycardia
What are the sequelae of endocarditis?
- local destruction of valve/paravalvular tissues - chronic antigenaemia (especially SBE) - embolic phenomena
What is exercise stress testing used for?
Confirmation of absence of symptoms; assessment of haemodynamic response to exercise; assessment of prognosis.
In the diabetic foot, anatomic deformities due to motor neuropathy is caused by _____?
Calluses, corns, pressure ulcers, deep-seated tissue necrosis.
What are some late complications of percutaneous coronary intervention?
In-stent restenosis, stent thrombosis
What kinds of macrophages are found in Aschoff nodules?
Anitschkow cells (prominent nucleoli) Aschoff multi-nucleated giant cells
What is the prophylaxis regime for preventing recurrence of rheumatic fever following GAS infection?
Penicillin, at least 5 years after the most recent attack, until patient reaches early 20s
What are some complications of long QT syndrome?
Syncope and sudden death
What is acute rheumatic fever?
An acute, often recurrent, immunological inflammatory disorder which follows an upper respiratory infection (e.g. infected throat) due to Group A streptococci.
Which pathological features are characteristic of arrhythmogenic right ventricular cardiomyopathy?
Fatty infiltration of the RV ± LV, since myocardium can be replaced with fat. Fibrosis is also involved.
In arrhythmogenic right ventricular cardiomyopathy, which kinds of mutations occur?
Mutations of the desmosomal genes (ARVC8), within the cell-cell junctions.
Unknown cause of sudden death accounts for which percentage of young Australians?
31%
What is the pathophysiology of acute fibrinous pericarditis?
The exudation of fibrin into the pericardial cavity stimulate fibrous adhesions between parietal and visceral pericardium.
Which genetic mutation results in Brugada syndrome?
SCN5A
Section 5
(50 cards)
When does embryonic blood vessel formation occur?
Week 3
Congenital heart defects account for approximately what percentage of perinatal deaths?
20%
By the end of which week does gastrulation take place?
Week 2
Who should be revascularised by CABG?
Diabetic patients with multi vessel disease, patients with complex and extensive disease
Patent ductus arterioles can occur due to __________ transition complicated by __________ delivery.
normal, premature
How do catecholamines contribute to regulation of adaptive processes in the transition to birth of the foetus?
- Stimulate type 2 pneumocytes to produce surfactant - Shift lung fluid from fluid excreting to fluid absorbing (to improve lung compliance) - Increase blood supply to vital organs (heart, brain) - Mobilises fuels: free fatty acids, glycogenolysis and gluconeogenesis
How is persistent foetal circulation treated?
Oxygen, pulmonary vasodilators, catecholamines.
What are some examination findings which put the child at risk of developmental delay?
Abnormal: growth, congenital abnormalities (CHD: 50-60%)W, neurocutaneous lesions, optical findings (60%), ear findings (75%), visceral findings, neurological function, sensory.
What is the functional pathology of pulmonary atresia?
Pulmonary blood flow is dependent on ductal potency (usually right-sided heart lesions). There is cyanosis within the first few hours despite good gas exchange. PGE1 infusion to re-open ductus is life-saving. No improvement with oxygen.
________ of attachment to a consistent _________ can have significant negative effects on brain development and cognitive functioning.
Absence, caregiver
What is the pathology of coarctation of the aorta?
Systemic output to the lower body is dependent on ductal patency. Feel for femoral pulses to check.
What is the prevalence of babies born with a Robertsonian translocation?
1/900. This is the most common kind of chromosome rearrangement known in humans.
What kinds of errors in meiosis occur in trisomy 21?
Meiosis I: failure of homologous chromosomes to separate Meiosis II: failure of sister chromatids to separate
How do we currently classify the severity of an intellectual disability?
Determined according to functioning in conceptual (language, time, numbers), social (interpersonal, social responsibility, self-esteem, gullibility, social problem solving, ability to follow rules) and practical domains (ADLs, occupational skills, healthcare, travel/transportation, schedules, money, telephone).
What is the overall prevalence of infant speech disorders in Australia?
1.7%
Congenital heart disease causes symptoms because of structural ________ of the cardiovascular system despite a _______ transition.
abnormality, normal
What are some aetiologies of intellectual disability?
- Single/multiple gene abnormalities - Chromosome disorders (e.g. trisomies) - Teratogens (e.g. foetal alcohol syndrome) - Congenital infections (e.g. CMV)
What is meant by 'intellectual disability'?
Deficits in both intellectual and adaptive functioning.
What is the presentation of persistent foetal circulation?
At birth with respiratory distress, hyperaemia. There is delay in normal pulmonary vascular resistance decrease, and a pulmonary to systemic (right to left) shunt through the foramen ovale ± ductus arterioles.
What is the presentation of an infant with congenital heart disease?
1. Cyanosis (<4 hours) 2. Shock with congestive heart failure (4-24 hours) 3. Shock without congestive heart failure (1-14 days)
What is the pathology of aortic atresia?
The entire systemic output is dependent on ductal potency (usually left-sided heart lesions). Presentation is usually with shock and congestive cardiac failure between 4-24 hours.
A ___________ Robertson translocation results in no excess or deficit of genetic material and causes ______________. An ____________ Robertsonian translocation causes chromosomal _________ or _________ and result in _________ or multiple malformations, such as trisomy 13, and trisomy 21.
balanced, no health difficulties. unbalanced, deletions, additions, syndromes
What are some risk factors of developmental delay?
1) Malnutrition 2) Inadequate stimulation or learning opportunities 3) Iodine deficiency 4) Iron deficiency anaemia These affect at least 20-25% of infants and young children in developing countries.
What is 'mosaicism'?
When the cells within one person have different genetic makeup. Genetic mosaicism (which is well-reported for Down syndrome) is to be distinguished from somatic mosaicism (common in cancer).
How is patent ductus arteriosus (PDA) treated?
Prostaglandin synthetase inhibitors: indomethacin, ibuprofen.
Percutaneous aortic valve replacement may be done via the ________ artery
femoral
What are some common phenotypic features of trisomy 21 (Down syndrome)?
Craniofacial characteristics, hypotonia, joint laxity (particularly atlanto-axial abnormality). Also: wide-spaced toes, single transverse palmar crease, incurving of little finger (clinodactyly)
What are some methods to detect Trisomy 21?
Karyotyping, metaphase / interphase FISH, chromosomal microarray (CMA).
About what percentage of children can be correctly identified for disability or mental health problems via screening processes?
70-90%
How is the patency of the foetal ductus arterioles maintained?
Circulating prostaglandins (PGE2), and prostacyclins
There is no __________ to suggest that ___________ people are more predisposed to congenital heart disease conditions more than others.
evidence, Indigenous
What is 'aneusomy'?
Deletions or duplications of sub-chromosomal regions, or submicroscopic copy number variations (CNVs) associated with psychiatric and developmental disorders.
In __% of trisomic individuals, the supernumerary chromosome 21 is a result of an error in _________.
5%, mitosis
When does haematopoiesis in the foetus begin?
Week 5
What is the Tetralogy of Fallot?
1) Right ventricular outflow obstruction 2) Right ventricular hypertrophy 3) Ventricular septal defect 4) Aortic override (over the RV)
Trisomies are observed in a ___________ proportion of spontaneous ___________.
significant, abortions
What are the clinical features associated with autosomal Trisomy 13?
This is Patau syndrome. It is associated with: - Severe mental retardation - Small eyes, may exhibit a split in the iris (coloboma) - Cleft lip and/or palate - Weak muscle tone (hypotonia) - Increased risk of heart defects - Skeletal abnormalities, and other problems
On which day of gestation does the heart of the foetus start beating?
Day 22
What is 'aneuploidy'?
Refers to the presence of trisomy or monosomy. Definition can be extended to include aneusomy (an abnormal number of copies of a genomic region)
What are the clinical features associated with autosomal Trisomy 18?
This is Edwards syndrome. It is associated with: - Low birth weight - Small, narrow head - Small jaw/mouth - Clenched fists with overlapping fingers - Mental retardation - Heart defects, other organ malformations such that most systems of the body are affected
What are the possible types of combinations of zygotes for one parent with a Robertsonian translocation and another without?
What is a micro-trisomy?
Segmental duplication that is not visible microscopically.
Which specific chromosome arrangement is most common in humans? Which is most important?
Most common: 13q14q. Most important: 14q21q.
Persistent foetal circulation (PFC) or pulmonary hypertension of the newborn (PHN) can be due to ________ transition in infants with a structurally _________ cardiovascular system.
delayed, normal
What are single-gene duplications?
Duplications of only one gene or one functional genomic element (not necessarily a gene). Can be pathogenic.
What is the pathology of transposition of great arteries?
Mixing of systemic and pulmonary systems dependent on ductal patency. There is cyanosis in the first few hours. PGE1 infusion to re-open ductus is life-saving.
How often do chromosome translocations occur in live births?
1/500
What is a Robertsonian translocation?
Chromosome rearrangement formed by fusion of the whole long arms of two acrocentric chromosomes. Susceptible chromosomes are: 13, 14, 15, 21, 22.
Errors in meiosis that lead to trisomy 21 are usually of ________ origin. Most errors of this origin occur in meiosis __, with associations of __________ maternal age.
maternal, I, advanced
How often does trisomy 21 occur in live births?
1/750
Section 6
(50 cards)
As vascular resistance increases, right ventricular (RV) stroke volume __________.
decreases
What could a radio-femoral delay suggest?
Coarctation
Some causes of secondary hypertension are ________?
Medications: OCP, NSAIDs, glucocorticoids, vasoconstrictors, calcineurin inhibitors, erythropoietin, amphetamines Drugs: methamphetmines, cocaine Other: liquorice Other: obesity, diabetes, alcohol intake, hypo-/hyperthyroidism, coarctation, primary renal disease, renal artery disease, primary hyperaldosteronism, OSA, phaeochromocytoma (catecholamine excess), Cushing's syndrome (cortisol excess)
What are the differential diagnoses of the clinical signs exhibited by Alzheimer's disease?
Depression, hypothyroidism, sensory impairments, B12 deficiency
What is 'diagnostic overshadowing'?
When health professionals see someone with and intellectual disability and blame the presenting complaint on it. This occurs particularly when the symptom is behavioural.
Which heart sound is classically associated with hypertension?
S4, which occurs in late diastole.
What is the current life expectancy of patients with Down syndrome?
Women: ~57.8 years Men: ~61.1 years
What are the clinical signs of Alzheimer's disease?
Deterioration of skills, memory loss, confusion, disorientation, behavioural changes, seizures
The triplication of the ____ gene may be the cause of development of neuropathological hallmarks of _________ disease in those with Down syndrome.
APP, Alzheimer
What is the Foetal or Developmental Origins of Disease Hypothesis?
Organisms make predictive, adaptive responses in anticipation of perceived impending environmental situations. The hypothesis predicts that this starts in utero.
What are some potential dosage-sensitive genes in trisomy 21?
DSCAM, COL6A1, SLC19A1
Children with Down syndrome have a ________ elevated risk of developing leukaemia, particularly acute ______________ leukaemia. These are due to mutations in the ________ gene on the _ chromosome, which plays a pivotal role in myeloid lineage commitment.
10-20x, megakaryoblastic. GATA I, X
What are some therapies aimed at reducing the symptoms of pulmonary hypertension?
Endothelin receptor antagonists, prostanoid therapy, nitric oxide and phosphodiesterase inhibitors
What ECG patterns are supportive for the diagnosis of pulmonary hypertension?
P pulmonale Right axis deviation RV hypertrophy RBBB QTC prolongation SVT, AF
What is the definition of hypertension (as classified in the Western world)?
Systolic BP > 140 mmHg Diastolic BP > 90 mmHg Isolated systolic hypertension: Diastolic BP < 80 mmHg
Gestational diabetes (GDM) affects _____% of pregnant women in Australia, and is __________ in prevalence. This reflects an older, ethnically diverse and more _______ population of pregnant women.
5-10%, increasing, obese
In which gender does pulmonary hypertension occur more frequently?
Female
When minor treatment is required for those with Down syndrome, and the patient is not available / not objecting, which action should be taken?
Treat the patient and record in the notes.
In chronic hypertension, the ___________ _______ is reset so that the operating point for mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA) is chronically increased. (This can occur with several mechanisms that are capable of acting on the sympathetic nervous system).
baroreceptor reflex
Mechanisms of pulmonary hypertension
__________ of cytosine leads to the silencing of the gene in the local area of the chromosome. This process is called __________.
Methylation, repression
What is a bruit?
An abnormal sound generated by the turbulent flow of blood
TMD may be a precursor to _____, with an estimated __% of TMD patients developing ______ within 3 years.
AMKL, 30%
What are some features of Cushing's syndrome?
Red complexion, moon face, obese. A result of excess cortisol.
What contributes to the susceptibility of an individual to pulmonary hypertension?
Abnormal BMPR2 gene
Excessive ___________ binding to ETA and ETB receptors, which are highly concentrated in pulmonary and coronary vasculature. This causes acute and chronic effects including _____________, inflammation, fibrosis, hypertrophy and hyper
endothelin, vasoconstriction
Methylation and ___________ ___________ both turn off transcription of RNA (used for making protein)
chromatin condensation
What are the risk factors and associated conditions for pulmonary hypertension?
- Collagen vascular disease - Congenital heart disease - Portal hypertension - HIV infection - Drugs and toxins - Pregnancy
Higher aortic intimal-medial thickness is a biomarker for later _____________ disease.
cardiovascular
Which risk factors in children with Down syndrome contribute to the prevalence of obstructive sleep apnoea (50-75%)?
Large tongue, narrow oropharynx, obesity, hypotonia
What CXR findings are supportive of pulmonary hypertension?
Central pulmonary artery dilation Pruning (loss of peripheral blood vessels) RA/RV enlargement
What are some associated features of essential hypertension (where all other causes are excluded)?
Family history, high salt intake, race, age, reduced nephron number, inactivity, women with a previous history of pre-eclampsia or eclampsia
What are some clinical signs of hypothyroidism?
Dry hair/skin, constipation, bradycardia, delayed reflexes, slowing of motor/mental activities, growth/cognitive delay in young children.
How do diuretics act to relieve symptoms in right ventricular failure?
Reduces right ventricular preload, and lead to improvement in symptoms of right ventricular overload.
What is meant by 'epigenetics'?
"The study of heritable changes that are not caused by changes in the DNA sequence."
What is the treatment regime for pulmonary hypertension?
Anticoagulants, oxygen, diuretics, rehabilitation. Use calcium-channel blockers (nifedipine, diltiazem, amlodipine) in high dose in vasoreactive patients. Surgical intervention may be required.
Maternal diabetes in pregnancy increases the risk of ________ in offspring. This is not true for type _ diabetes.
obesity, I
What is coeliac disease?
Prevalence: 7-11% Symptoms/signs: chronic diarrhoea, abdominal distension, failure to thrive, anaemia, irritability Screening: antibodies to gluten Diagnosis: jejunal biopsy with villous atrophy Treatment: gluten-free diet
Transient myeloproliferative disorder (TMD) occur in up to __% of infants with Down syndrome. It is characterised by an abundance of _______ within the peripheral ______ and _______. It undergoes spontaneous remission in a majority of cases.
10%, blasts, blood, liver.
What is the pathophysiology of the vascular injury in the development of pulmonary hypertension?
Endothelial dysfunction occurs as a product of risk factors and susceptibility genes, resulting in decreased NO and prostacyclin production, and increased thromboxane and endothelin 1 production. Vascular smooth muscle dysfunction also occurs, with impaired voltage-gated K+ channel. Smooth muscle hypertrophy of the vessel and early intimal proliferation occurs --> vasoconstriction
What is the 'gold standard' investigation for diagnosis of pulmonary hypertension?
Right heart catheterisation for vasoreactivity testing, response to oxygen, fluid load and exercise; assess CHD, shunts.
When major treatment is required for those with Down syndrome, and the patient is not in a capacity to give consent, the only party which can give consent is _______________?
The Guardianship Division of NSW Civil and Administrative Tribunal
Which organs does angiotensin II act on?
Blood vessels (vasoconstriction) Kidney (reabsorption of H2O and NaCl) Adrenal cortex (release of aldosterone, which acts on kidney) Brain (release of vasopressin, which acts on kidney)
Studies suggest that dietary or ___________ intake of ________ ______ may at least partially prevent the association of impaired foetal growth with adult CVD.
supplementary, omega-3 PUFA
Which blood tests should be carried out to ascertain the aetiology of pulmonary hypertension?
Thyroid function, FBC, UEC, LFT. Serology for hepatitis, HIV.
What is the hierarchy of those who can give consent on behalf of a patient who cannot do so themselves:
1. Guardian 2. Spouse or de facto 3. Unpaid carer 4. Friend or family member who has close personal relationship
If born large for gestational age (LGA), adverse health outcomes may include:
- early cardiovascular disease - diabetes - obesity - increased risk of some forms of cancer
How would hypothyroidism be treated?
Thyroxine
_____% of Down syndrome patients have congenital heart disease. Of these, _______ is the most common defect and is the hallmark of Down syndrome.
40-60%, atrioventricular septal defect (AVSD)
Decreased birthweight is associated with increased _____ _________ and __________.
blood pressure, diabetes
Section 7
(50 cards)
What are some intravenous drugs available in the treatment of ventricular tachycardia?
Lignocaine, stall, amiodarone
Why do calcium channel blockers sometimes worsen cardiac ischaemia?
What are the side effects in angiotensin II antagonists?
- Increase in serum K+ (due to less aldosterone) - Worsen renal function - Contraindicated in pregnancy - No dry cough (since bradykinin is still metabolised by ACE)
Why do you treat phaeochromocytoma (catecholamine secreting tumours) with non-competitive alpha-1 antagonists?
What are some oral drugs available in the treatment of ventricular tachycardia?
Sotalol, amiodarone
What is the sympathetic response at alpha-2 membrane receptor proteins?
Negative feedback
Why do beta-blockers improve angina?
Why do beta-blockers sometimes worsen peripheral vascular disease?
When there is hypertrophy, myocytes that are situated furthest from blood vessels become ____________.
necrotic
Why do beta-blockers interact with calcium channel blockers? Are they all equally likely to do this?
What is the sympathetic response at alpha-1 membrane receptor proteins?
Vasoconstriction
Why do ACE-inhibitors sometimes cause a marked first dose hypotension? what should you do about it?
What are some primary renal causes that can lead to hypertension?
Reno-vascular hypertension Renal parenchymal disease Renal tumours
What is the mechanism of selective beta-blockers (beta-1 blockage)?
Decrease heart rate and force of contraction, resulting in decreased cardiac output --> decreased blood pressure. It also inhibits renin release --> decreased blood pressure.
What are some changes in urinary electrolyte patterns in response to K-sparing diuretics?
Increase in Na Decrease in K, Mg
What are some changes in urinary electrolyte patterns in response to loop diuretics?
Increase in Na, K, Ca, Mg
What is the sympathetic response at beta-2 membrane receptor proteins?
Relaxes bronchial and vascular smooth muscle
What is are common drug combinations for the treatment of hypertension?
1. ACE-inhibitors + thiazide (quinapril and hydrochlothiazide) 2. ATII antagonist + thiazide (candesartan + hydrochlothiazide) 3. ATII antagonist + Ca2+ antagonist (olmesartan + amlodipine)
What is 'adrenal phaeochromocytoma'?
An adrenalin-secreting tumour which can cause both paroxysmal and chronic hypertension.
What are the effects of hypertension on the kidney?
Hyaline degeneration, atherosclerosis, hypertensive nephrosclerosis. All these effects exacerbate hypertension via renin-angiotensin.
Which drugs should be used to maintain sinus rhythm in AF?
Anti-arrhythmic drugs: - Flecainide (if no structural heart disease) - Sotalol (if structural heart disease) - Amiodarone (if previous CHF)
What are the effect of hypertension on the right ventricle?
RV hypertrophy, cor pulmonale (due to pulmonary or pulmonary vessel disease)
Which beta-blockers are preferred for treatment in hypertension?
Cardio-selective ones, atenolol or metoprolol
What are some examples of calcium channel blockers that are non-dihydropyridines?
Diltiazem and verapamil
Why do beta-blockers make the hypertension of phaeochromocytoma worse?
What are the effects of hypertension on the left ventricle?
- Concentric LV hypertrophy - Reduced diastolic ventricular volume - Myocytes are hypertrophied with large irregular, hyperchromatic nuclei
Why do ACE inhibitors cause a rise in creatinine? And what should you do about it?
Why do ACE-inhibitors interact with diuretics (favourably and unfavourably)?
Why do beta-blockers worsen asthma?
What are some examples of thiazide diuretics?
Chlorothiazide, hydrochlorothiazide
Why are overdoses of some vasodilators (ACE inhibitors, ATII antagonist, nitrates) generally benign, while calcium-channel blockers are highly lethal?
What is are examples of angiotensin II antagonists?
Losartan, candesartan, irbesartan (blocks subtype AT1 receptors)
Which medications can be used to treat hypertension?
Diuretics, beta-blocker, Ca-channel blockers, ACE inhibitors, angiotensin II receptor inhibitors, alpha-blockers, central acting agents, phaeochromocytoma-specific agents.
What are some changes in urinary electrolyte patterns in response to thiazides?
Increase in Na, K, Mg Decrease in Ca
What are some of the effects of hypertension on arteries?
Loss of elastin and smooth muscle in the media, with replacement by fibrous tissue (hypertensive arteriosclerosis).
What are some examples of calcium channel blockers that are dihydropyridines?
Amlopidine, nifedipine, felodipine, nimodipine
What are some side effects of calcium-channel blockers?
- Vasodilation (peripheral oedema, tachycardia, headache, flushing) - Constipation - Decreased cardiac output --> heart failure (verapamil/diltiazem) - Heart block, brachycardia (verapamil/diltiazem)
Why do some diuretics increase the risk of digoxin toxicity?
What are the risks to the brain in benign hypertension?
Increased risk of: - Cerebral infarction - Intracerebral haemorrhage - Rupture of berry aneurysms in Circle of Willis, resulting in subarachnoid haemorrhage
What are the side effects of beta-blockers?
Bradycardia, muscle fatigue/tiredness, cold hands and feet, weight gain/diabetes mellitus, bronchospasm.
What are the relative efficacies of types of diuretics?
Loop >> thiazides > K sparing
__________ artery fibromuscular __________ is a cause of secondary hypertension, more frequently occurring in young __________.
Renal, dysplasia, women.
Why do diuretics and vasodilators improve symptoms of heart failure?
What is the physiological formula for blood pressure?
CO x PVR
Why are ACE-inhibitors contraindicated in bilateral renal artery stenosis and aortic stenosis?
Which endocrine causes of hypertension can be a result of adrenal cortical adenoma?
Hyperaldosteronism, Cushing Syndrome
Which medications should be used to prevent stroke in AF?
Aspirin, warfarin, new oral anticoagulants (NOACs).
Which procedure is the only potential cure for atrial fibrillation?
Catheter ablation
What is the sympathetic response at beta-1 membrane receptor proteins?
Increases heart rate and force of contraction
What are the pharmacological options to treat atrial fibrillation?
Beta-blockers (slow heart rate) (± Verapamil or diltiazem) Digoxin
Section 8
(31 cards)