Medicine 1 > CVS > Flashcards

CVS Flashcards

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1
Q

A side effect of furosemide (diuretic) on serum potassium

A

Hypokalaemia.

A side effect of furosemide is hypokalaemia as more potassium is lost in the urine, along with sodium, chloride and water.

Hypokalaemia would be seen on ECG as U waves, small or absent T waves, prolonged PR interval, ST depression and/or long QT.

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2
Q

How is hypokalaemia seen on ECG waves

A

* U waves
* Small or absent T waves
* Prolongest PR interval
* ST depression
* and/or long QT

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3
Q

Hypercalcaemia affect on ECG waves

A
  • Shortening of the QT interval.
  • In severe hypercalcaemia, J waves may be seen. It can be caused by hyperparathyroidism or malignancy.
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4
Q

Hyperkalaemia affect on ECG

A
  • tall-tented T waves
  • loss of P waves
  • broad QRS complexes
  • sinusoidal wave pattern and/or ventricular fibrillation
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5
Q

What can cause hyperkalaemia

A
  • acute kidney failure
  • chronic kidney disease
  • diabetic ketoacidosis
  • addisons disease
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6
Q

Beta-blockers should be avoided in peripheral artery disease

a. true
b. false

A

a. true

BB can restrict blood flow to peripheral blood vessels, by blocking beta-adrenergic receptors, hence worsening oxygen delivery.

This can cause ischaemia and pain, worsening the symptoms of peripheral arterial disease, such as intermittent claudication.

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7
Q

propranolol is lipid soluble therefore crosses the blood-brain barrier
a. true
b. false

A

a. true

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8
Q

contradinications of beta blockers

A
  • uncontrolled heart failure
  • asthma
  • sick sinus syndrome
  • concurrent verapamil use: may precipitate severe bradycardia
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9
Q

side effects of beta blockers

A
  • bronchospasm
  • cold peripheries
  • fatigue
  • sleep disturbances, including nightmares
  • erectile dysfunction
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10
Q

beta-blockers have now replaced digoxin as the rate-control drug of choice in atrial fibrillation

a. true
b. false

A

a. true

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11
Q

cardiac output and right artial pressure in heart failure

A
  • Cardiac output decreases (the heart can not pump enough blood to meet the bodys oxygen requirements)
    - Right atrial pressure increases (due to back pressure caused by the hearts ability to pump blood)
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12
Q

Withdrawing beta blockers suddenly can cause

A

rebound tachycardia

If a beta blocker needs to be stopped and has been taken chronically, the medication dose should be tapered down.

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13
Q

aspirin is commonly stopped before surgery to?

A

reduce the risk of bleeding

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14
Q

“sartans” are what drugs

A

ARBs for (hypertension)

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15
Q

Atrial fibrillation puts the patient at risk of a stroke due to the possibility of

A

a blood clot formation in the left atrium which then travels up to the brain causing an ischemic stroke.

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16
Q

Warfarin works by inhibiting

A

inhibiting Vitamin K epoxide reductase and therefore preventing the gamma-carboxylation of vitamin K dependent clotting factors.

It therefore only affects clotting factor II, VII, IX and X, and protein C and S

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17
Q

brain natriuretic peptide actions

A
  • vasodilator: can decrease cardiac afterload
  • diuretic and natriuretic
  • suppresses both sympathetic tone and the renin-angiotensin-aldosterone system
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18
Q

Which of the
medication affects renin directly?

A
  • beta blockers

beta-blockers suppress the release of renin from the juxtaglomerular cells in the kidneys.

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19
Q

angiotensin-converting enzyme (ACE) inhibitors impede the release of renin directly

a. true
b. false

A

b. false

ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II. They do not impede the release of renin directly.

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20
Q

ACE-inhibitors and trimethoprim are known to cause severe life-threatening hyperkalaemia.

what should you monitor ?

A

Urea and electrolytes should be measured regularly to keep an eye on the potassium levels.

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21
Q

Infective endocarditis is a risk factor for emboli

a. true
b. false

A

a. true -

the pulmonary valve can become affected, and the vegetation on the valve has embolised and has become lodged in the pulmonary capillary bed.

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22
Q

Indapamide and other thiazide-like diuretics are known to cause sexual dysfunction.

a. true
b. false

A

a. true

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23
Q

Hypertrophic cardiomyopathy can present with sudden death

a. true
b. false

A

a. true.

HCM results in obstruction of the left ventricular outflow tract due to asymmetric septal hypertrophy.

Symptoms and signs: sudden death; angina, dyspnoea, palpitations, syncope.

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24
Q

0-24hr post-MI histology findings:

A
  • early coagulative necrosis,
  • neutrophils,
  • wavy fibres,
  • hypercontraction of myofibrils.
  • High risk of ventricular arrhythmia,
  • HF and cardiogenic shock
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25
1-3 days post-MI histology
*** Extensive coagulative necrosis, * neutrophils (associated with fibrinous pericarditis)**
26
3-14 days post-MI histology
*** macrophages + granulation tissue at margins. *** High risk of free wall rupture, * papillary muscle rupture * LV pseudoaneurysm
27
2 weeks to several months post-MI histology:
*** contracted scar complete. ** * Associated with Dressler syndrome, * HF, arrhythmias, mural thrombus
28
Fluid overload in the lung can increase the pulmonary perfusion pressure and therefore right ventricular strain. A. True B. False
a. true . This will in-turn cause right ventricular hypertrophy (RVH). Right heart failure developing secondary to left heart failure is called
29
Ticagrelor can cause dyspnoea a. true b. false
a. TRUE *** P2Y12 receptor antagonist that prevents ADP-mediated P2Y12 dependent platelet activation and aggregation. ** * The sensation of dyspnoea in ticagrelor-treated patients is triggered by adenosine. * Ticagrelor prevents the clearance of adenosine, which increases its concentration in the circulation. * Adenosine receptors are found in the lungs, where adenosine has been shown to stimulate sensory nerve fibres that can produce dyspnoea.
30
Aspirin works by
* Blocking prostaglandin synthesis. * It is ***non-selective ***for COX-1 and COX-2 enzymes.
31
common side effects of aspirin
gastric irritation heartburn bleeding
32
fondaparinux is what type of drug
* anti-platelet * factor Xa inhibitor. * Other examples of factor Xa inhibitors include rivaroxaban and apixaban.
33
common side effects of fondaparinux, rivaroaban and apixaban (Anti-platelet factor Xa inhibitors)
*** easy bruising and bleeding. ** * Dyspnoea could occur in the event of severe blood loss or pulmonary, but neither of these have been suggested here.
34
What is another cause of increased pulse pressure?
* aorta becomes less compliant due to age-related changes. * increased SV
35
what would decrease pulse pressure
* aortic stenosis * Heart failure -> is characterized by reduced ejection fraction and therefore stroke volume. * Decreased blood volume -> would decrease preload due to reduced venous return. * Impaired ventricular relaxation -> would reduce diastolic filling and therefore preload.
36
why does aortic stenosis decrease SV
End systolic volume would increase because of an ***increase in afterload*** increased afterload because - of an increase in resistance that ***the heart must pump against due to a hard stenotic valve.***
37
Amyloidosis : histoloy
pple green birefringence with polarised light
38
Rheumatic fever develops following an immunological reaction to what bacteria?
Streptococcus pyogenes infection
39
presence of a pansystolic murmur in rheumatic fever likely represents
mitral regurgitation
40
Naftidrofuryl is a 5-HT2 receptor antagonist which can be used for
peripheral vascular disease causes vasodilation and thus increases blood flow to ischaemic tissues.
41
Doxazosin
is an alpha 1 blocker. Alpha 1 blockers cause smooth muscle relaxation
42
ticagrelor mechanism of action
r has a similar mechanism of action to clopidogrel - inhibits ADP binding to platelet receptors
43
Troponin I
* is one of three troponin proteins involved in skeletal and cardiac muscle contraction. * It* binds to actin to hold the troponin-tropomyosin complex* in place * . By doing this the myosin-binding site on the actin remains blocked by tropomyosin and no muscle contraction can take place. In this case, doctors are testing for troponin I as its presence in the bloodstream can indicate myocardial muscle injury.
44
Subunits of troponin
* troponin C: binds to calcium ions * troponin T: binds to tropomyosin, forming a troponin-tropomyosin complex * troponin I: binds to actin to hold the troponin-tropomyosin complex in place
45
irregularly irregular heart rhythm is likely to be
atrial fibrilation
46
nearly the only cause of mitrial stenosis
rheumatic fever
47
The Valsalva manoeuvre decreases the intensity of the ejection systolic murmur heard in aortic stenosis a. true b. false
a. true
48
Administering amyl nitrite, raising legs, expiration and squatting increase the intensity of aortic murmurs by increasing the volume of blood flow through the valve. a. true b.false
a.true
49
**Fibrinoid necrosis** is seen in the arterioles of patients with
malignant hypertension.
50
first-line for reducing stroke risk in AF
DOACs e.g. edoxaban'. According to NICE 2021 guidelines on preventing stroke in people with atrial fibrillation, DOACs should be given as first-line anticoagulant therapy.
51
anti-biotic that can cause a prolonged QT interval
Erythromycin
52
The most common ECG finding of hypercalcemia
short QT interval
53
Eisenmenger syndrome can present clinically with
clubbing, cyanosis, and tiring easily (due to underlying VSD) This boy has features of an uncorrected VSD, a common cardiac defect in patients with Down syndrome. This results in an increased pulmonary blood flow and can cause vascular remodeling and pulmonary hypertension. This leads to RV hypertrophy and a reversal of the shunt (originally left to right). Clubbing, cyanosis, polycythaemia, and plethora are signs of late disease, known as Eisenmenger syndrome.
54
Coarctation of the aorta is associated with hypertension and pulse discrepancies. a. truee b. false
a, true
55
absent a waves.
atrial fibriliation
56
Where in the nephron does furosemide act?
is a loop diuretic. It inhibits Na+/K+ 2Cl- channels in the thick **ascending **loop of Henle.
57
stenosis occurs when what percentage of the lumen is occluded?
> 50-70%
58
Main symptom of peripheral arterial disease
claudication/calf pain on walk
59
manefestations of atheroma
*stable angina * Peripheral arterial disease * Renal atrophy - due to renal artery stenosis * acute atherothrombotic occlusion * rupture/fissue/occlusin - acute events * Embolism * Ruptured abdominal aortic anuerysm
60
Causes of thrombus
virchows triad 1. changes in blood vessel wall (endothelial injury) 2. changes in blood constituents (hypercoagubility) 3. changes in blood flow (stasis**turbulance)
61
describe the organisatin of thrombus
overtime the thrombus shrinks and is digested by macrophages new vessels/capillaries will grow into the area granulation tissue is formed
62
what is an embolism
dettached intravascular mass (solid , liquid or gas) most common are disloged thromboembolism
63
most common cause of thrombo-embolism
DVTs travel into heart (IVC) -> pulmonary circulation -> occlude pulmonary artery (PE) -> infarct in pulmonary tissue
64
what a valvular vegetations?
* infective or thrombotic nodules which develop or valve leaflets /impair normal valve mobility
65
ischaemia
lack of blood supply to tissue/organ
66
hypoxia
lack of 02 to the tissue/organ
67
stagnant hypoxia
normal inspired 02 but abnormal delivery a) occlusion of vessel b) systemic shock
68
biochemical abnormalities of atheroma
low 02 supply increased anerobic metabolism increases lactate - decreased cell function/death
69
cells with a high metabolic rate die much quicker a. true b false
a. true neurons, heart muscle, v (fat and connective tissue)
70
1st line treatment for DVT
DOACs apixaban or rivaroxaban (factor Xa inhibitors)
71
the first line radiological investigation for suspected stroke
A non-contrast CT head scan
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