CVS week 2 Flashcards

Question

when is renin released?

Answer 1

low perfusion pressure (low blood pressure) low blood volume

Answer 2

the kidney converts angiostensinogen (from liver) to angiostenisin 1

Answer 3

angiostensin converting enzyme (ACE) endothelial enzyme found predominantly in the lungs

Answer 4

acts on the adrenals leading to the release of aldosterone

Answer 5

b. false vasconstriction also triggers the release of aldosterone

Answer 6

1. angiostensin 2 (vasoconstrictor) 2. aldosterone

Answer 7

- retention of circulating volume - by retaining Na+ and therefore H20 - at the expense of K+ (in the distal convuluted tubule of the kidney)

Answer 8

1. ACE inhibitors (angiostensin converting enzyme) prevents Ag1-> Ag2 2. Angiostenisin 2 receptor antagonists (ARBs)

Answer 9

ACEi drugs

Answer 10

to prevent abherant remodlling of ventricle after an MI

Answer 11

 Reduce blood pressure.  Reduce afterload on the heart.  Prevent aberrant remodelling after MI.  Reduced proteinuria in kidneys (Risk factor for CV disease) - independent risk factor

Answer 12

- reduced perfusion of the kidneys (glomerulus) can lead to kidney damage/hyperkalaemia via renal failure - cough - breakdown of bradykinin (hormone) - orthostatic (postural) hypotension - first dose hypotension

Answer 13

 Reduce blood pressure.  Reduce afterload on the heart.  Prevent aberrant remodelling after MI.  Reduced proteinuria in kidneys (Risk factor for CV disease) - independent risk factor

Answer 14

- reduces perfusion pressure in the glomerulus leading to renal impairment - hyperkalaemia via aldosterone levels - orthostatic hypertension - NO COUGH

Answer 15

aldosterone antagonist - vasodilation - diuretic - Na+/fluid loss - heart failure (with ACE/ARB) - sometimes hypertension

Answer 16

gynaecomastia (breast pain) alderstone antagonist - used in HF with ACE/ARBs - sometime hypertension

Answer 17

a. true aldosterone antagonist vasodilation /

Answer 18

with NSAIDS + ACEi hyperkalaemia is a risk/seen if AKI occurs close monitoring of renal function

Answer 19

b. false more vascular selective - less effect on myocardial pacemaking tissue blocks Ca2+ entery to smooth muscle - causing vasodilation/reducing TPR (amlodipine) or felodipine

Answer 20

are calcium channel blockers - blocks Ca2+ entry to smooth muscle cells - vasodilation/reduced TPR (dihydropyridine - more vascular selective)

Answer 21

myocardial selective block Ca2+ entry to myocardial pacemaking tissue AND smooth muscle cells verapamil and ditiazem

Answer 22

Sacubitil (increases loss of sodium/and therefore H20) increases vasodilation] - used in symptomatic heart failure with reduced ejection fraction

Answer 23

sacubitil - do not use with ACEi

Answer 24

a/ true cough/angioedema as ACE may increase bradykinins

Answer 25

cholesterol by blocking HMG-CoA enyzme (rate limiting step) reduce LDL cholesterol in blood

Answer 26

10 year risk is greater than 20% >20% risk in 10 years

Answer 27

secondary prevention after CV event

Answer 28

are diuretics used in hypertension - block NaCl reabsorption

Answer 29

diuretic (also cause vasodilation/venodilation)- anti-hypotensive effects /reduce preload

Answer 30

Block NaCl reabsorption in the distal convoluted tubule of the kidney

Answer 31

Block NaCl reabsorption in the distal convoluted tubule of the kidney

Answer 32

loop diuretics block NaCl+ reabsorption in the ascending loop of henley (more pronounced effect) versus thiazide (block NaCl reabroption at the distal convuluted tubule)

Answer 33

- electrolye disturbance (low K, low Na, high Ca2+) - hyperglycaemia - increase in glucose - deydration/renal impairment - orthostatic hypotension ** anti-hypertensive

Answer 34

symptomatic HF furosemide/bumetamide

Answer 35

a. false False – it is the other way round. ARBs can be useful alternatives to ACEIs in patients who develop a troublesome cough from ACEI use.

Answer 36

False – mechanical reopening of the blocked artery by percutaneous coronary angioplasty is the firstline management, with the best evidence base. However for remote and rural patients for whom travel time to the nearest PCI centre is too long, thrombolysis can be used as an alternative.

Answer 37

a. true However for remote and rural patients for whom travel time to the nearest PCI centre is too long, thrombolysis can be used as an alternative.

Answer 38

a. true Conn’s Syndrome involves overproduction of Aldosterone.

Answer 39

False – monocytes do this, where they transform to foamy macrophages.

Answer 40

False – the cells travel down the centre of the vessel in normal laminar flow, and the plasma is in contact with the vessel walls.

Answer 41

True – these drugs are potent vasodilators, and can cause ankle swelling. This is a common reason for stopping therapy with CCBs.

Answer 42

Beta-blockers improve anginal symptoms by slowing the resting heart rate.

Answer 43

True. Activation of the sympathetic nervous system produces vasoconstriction (increasing vascular resistance), tachycardia (increasing cardiac output) and increased stroke volume (increasing cardiac output) all of which will increase blood pressure. The sympathetic nervous system also stimulates activation of the RAAS, which brings about longer-term blood pressure control.

Answer 44

False – the difference between a hypertensive emergency and a hypertensive “urgency” is the presence of end-organ damage, such as renal failure, confusion or heart failure. If there is NO end-organ damage, this is a hypertensive urgency, and can be managed with oral drugs and a review in 24 hours. A hypertensive emergency requires admission to hospital and usually IV therapy.

Answer 45

False – the difference between a hypertensive emergency and a hypertensive “urgency” is the presence of end-organ damage, such as renal failure, confusion or heart failure. If there is NO end-organ damage, this is a hypertensive urgency, and can be managed with oral drugs and a review in 24 hours. A hypertensive emergency requires admission to hospital and usually IV therapy.

Answer 46

refers to the presence of end organ damage If there is NO end-organ damage, this is a hypertensive urgency, and can be managed with oral drugs and a review in 24 hours. A hypertensive emergency requires admission to hospital and usually IV therapy.

Answer 47

False – pre-eclampsia is a condition that occurs in pregnant patients over 20 weeks gestation, and is diagnosed when new or worsening hypertension occurs alongside proteinuria >300mg/24h.

Answer 48

Pregnant patients over 20 weeks gestation new or worsening hypertension WITH Proteinuria > 300mg/24 hours

Answer 49

Protein is present in the blood; healthy kidneys should only filter tiny (trace) amounts into the urine as most protein molecules are too large for the filters (glomeruli). It is not usual to lose protein in the urine. When this does happen it is known as 'Proteinuria'.

Answer 50

True – the prevalence of hypertension rises with age, and the majority of cases will be essential (i.e. no identifiable underlying cause). Essential hypertension is fairly unusual in young patients (eg under-30s) however, and in these patients it is much more likely that there will be an underlying cause such as renal disease or an endocrine disorder.

Answer 51

False – Rheumatic is associated with infection by Group A beta-haemolytic streptococcal infections (such as strep throat).

Answer 52

Group A beta-haemolytic streptococcal (e.g. strep throat)

Answer 53

True – this causes them to become brittle, and will show up on CTs and X-rays (remember that bone appears white on X-rays and CTs because it is calcified).

Answer 54

b. false False. Blood pressure = Cardiac output x Peripheral Vascular Resistance, so an increase in PVR will increase blood pressure.

Answer 55

True – while they are an important part of the pharmacological management of stable heart failure, beta blockers can severely worsen acute heart failure if the patient is fluid overloaded.

Answer 56

false – while they are an important part of the pharmacological management of stable heart failure, beta blockers can severely worsen acute heart failure if the patient is fluid overloaded. (Add Clarifier) Add Footnote

Answer 57

True – these patients have marked limitations, with symptoms on walking one or two blocks, or climbing a single flight of stairs.

Answer 58

True – this is seen in acute rheumatic fever in the heart. It refers to a focus of chronic inflammatory cells, necrosis and activated macrophages.

Answer 59

seen in acute rheumatic fever in the heart. It refers to a focus of chronic inflammatory cells, necrosis and activated macrophages.

Answer 60

a. true True – this is one of the antihypertensive drugs that is recommended for use during pregnancy.

Answer 61

True – the thrombus will shrink and contract with time, and the fibrin will be broken down, leading to the lumen of the vessel reopening (recanalising) somewhat.

Answer 62

True – this is part of the process that forms the fibrous tissue cap over the atheroma lipid core.

Answer 63

These plaques are termed “complicated” once they rupture or fissure, or haemorrhage occurs, or a thrombus forms. - occlusion of vessel lumen - stroke - MI

Answer 64

True – ACE inhibitors have been shown to benefit morbidity and mortality in heart failure. They prevent conversion of Angiotensin I to Angiotensin II, thus inhibiting the RAAS and reducing preload and afterload.

Answer 65

a. true They prevent conversion of Angiotensin I to Angiotensin II, thus inhibiting the RAAS and reducing preload and afterload.

Answer 66

True – thyrotoxicosis is a rare cause of angina. It causes increased metabolic demand due to pathologically elevated thyroid hormone levels.

Answer 67

true It causes increased metabolic demand due to pathologically elevated thyroid hormone levels.

Answer 68

False – highly stenotic (i.e. plaques that occlude a large proportion of the lumen) plaques often have a thick fibrous cap, and are less vulnerable to rupture.

Answer 69

True – remember that cells that are deprived of oxygen will undergo anaerobic respiration. Lactate is a product of anaerobic respiration, and can be detected in a blood test. A clinical application of this is that we routinely check lactate levels in patients who have sepsis, as it gives a good indication of how “sick” a person is. Sepsis raises tissue oxygen demand and also limits oxygen delivery due to vasodilation and hypotension.

Answer 70

lactate is a product of anaerobic respiration, and can be detected in a blood test. A clinical application of this is that we routinely check lactate levels in patients who have sepsis, as it gives a good indication of how “sick” a person is. Sepsis raises tissue oxygen demand and also limits oxygen delivery due to vasodilation and hypotension.

Answer 71

True – ACE inhibitors can have adverse effects on the development of the foetal renal system, and are contraindicated in pregnancy.

Answer 72

False – they are alternating bands of RBCs and platelets.

Answer 73

fully developed atheroma have a lipid core, surrounded by a fibrous tissue cap.

Answer 74

fully developed atheroma have a lipid core, surrounded by a fibrous tissue cap.

Answer 75

True. Type 2 MIs occur when there is a mismatch for whatever reason between myocardial oxygen demand and myocardial oxygen supply (eg tachycardia, anaemia, etc), but the ischaemia is NOT caused by atheromatous coronary artery disease.

Answer 76

occur when there is a mismatch for whatever reason between myocardial oxygen demand and myocardial oxygen supply (eg tachycardia, anaemia, etc), but the ischaemia is NOT caused by atheromatous coronary artery disease. -tachycarida - anaemia

Answer 77

True – chronically elevated blood cholesterol levels can damage the endothelium by increasing local production of oxygen free radicals.

Answer 78

increasing local production of oxygen free radicals n directly cause endothelial damage leading to atheromatous plaque formation.

Answer 79

Glyceryl Trinitrate (GTN, or “the red spray”) which can be administered under the tongue to produce vasodilation and rapid angina relief.

Answer 80

can cause an increases BP

Answer 81

age-related change that involves the thickening of smooth muscle, intimal fibrosis and duplication of internal elastic laminal layer – all of which also cause luminal narrowing.

Answer 82

False – this describes atherosclerosis. Careful, because the words sound very similar! Arteriosclerosis is an age-related change that involves the thickening of smooth muscle, intimal fibrosis and duplication of internal elastic laminal layer – all of which also cause luminal narrowing.

Answer 83

True – anything that increases the coagulability of the blood will increase risk of DVT. Burns or severe trauma will increase the circulating coagulation factors in the blood as the body attempts to heal.

Answer 84

False – total occlusion of an artery often follows plaque rupture, as this exposes the highly thrombogenic plaque contents to the bloodstream and provokes thrombus formation. It causes non-reversible ischaemia, and can lead to tissue infarction.

Answer 85

False – this is usually a combination of a “supply” and a “demand” issue. As the heart rate and stroke volume increases with exercise, the oxygen demand of the tissue increases as it works harder. Supply is unable to increase to meet this demand, often due to narrowing of the coronary arteries by atheromatous disease, and the tissue becomes ischaemic. There may also be a slight reduce in supply, as the coronary arteries fill during diastole (remember that diastole is reduced as heart rate increases), but this does not cause symptoms in a healthy heart.

Answer 86

“supply” and a “demand” issue. - HR and SV increases - oxygen demand of tissue increase - supply is unable to meet demand due to narrowing of coronary arteries (atheromatous disease and tissue becomes ischaemic - There may also be a slight reduce in supply, as the coronary arteries fill during diastole (remember that diastole is reduced as heart rate increases), but this does not cause symptoms in a healthy heart.

Answer 87

False – we tolerate a slightly higher blood pressure in people over 80, as the risks associated with multiple drug treatments including increased risk of falls becomes more of a concern. People over 80 should have a target blood pressure <145/85mmHg.

Answer 88

145/85mmHg

Answer 89

False – this is a clinical finding in coarctation of the aorta.

Answer 90

discrepancy in BP in left and right arm

Answer 91

True – reduced cardiac output is registered by the body as reduced circulating volume, and so the salt and water is retained through RAAS activation in an attempt to raise this.

Answer 92

reduced cardiac output is registered by the body as reduced circulating volume, and so the salt and water is retained through RAAS activation in an attempt to raise this. (Add Clarifier) Add Footnote

Answer 93

a. true True. This is called a “stepped” approach and can limit side effects, and some drugs have synergistic effects when used together.

Answer 94

- infarction of tissue causing stroke, gangrene and gut infarction Some tissues have good collateral blood supply and are less vulnerable to infarction.

Answer 95

True – rheumatic fever causes inflammation of the heart, and this includes the endocardium, of which the valves are part. Inflammation of the valves can result in valve stenosis, regurgitation, or vegetations, all of which may be clinically detected as murmurs.

Answer 96

a. true Inflammation of the valves can result in valve stenosis, regurgitation, or vegetations, all of which may be clinically detected as murmurs

Answer 97

False – it is virtually the only cause of mitral stenosis.

Answer 98

True – this is one of the standard investigations performed in suspected acute coronary syndromes. Be aware, however, that any state which places stress on the heart (e.g. sepsis, myocarditis, severe tachycardia) can result in a troponin rise, so this is not sufficient to diagnose ACS in isolation.

Answer 99

b. false any state which places stress on the heart (e.g. sepsis, myocarditis, severe tachycardia)

Answer 100

False – the heart undergoes a process of coagulative necrosis, where the architecture of the dead tissue is largely maintained. Colliquative necrosis involves breakdown of the tissue to a liquid. If this occurred in the heart, we would see ventricular rupture post-MI much more frequently than we do (although it does happen). The brain undergoes colliquative necrosis after an infarction.

Answer 101

where the architecture of the dead tissue is largely maintained - when infarcted

Answer 102

involves breakdown of the tissue to a liquid. If this occurred in the heart, we would see ventricular rupture post-MI much more frequently than we do (although it does happen). The brain undergoes colliquative necrosis after an infarction.

Answer 103

True – three large clinical trials have shown no benefit over medical treatment of secondary hypertension due to renal artery stenosis from atherosclerosis. This is compared to renal artery stenosis due to fibromuscular dysplasia, where hypertension can be reversed by angioplasty and stenting of the renal artery.

Answer 104

a. true but atheroclerotic stenotic renal arteries can not be reversed -

Answer 105

False – most commonly, the long saphenous VEIN is used.

Answer 106

True – damage to endothelial lining is the first stage of atheroma formation. This results in a chronic inflammatory response as the artery heals. These two stages occur in a cycle and result in the development of atheromatous plaques.

Answer 107

damage to endothelial lining (results in chronic inflammatory response) occurs in a cycle

Answer 108

b. false False – normal myocardium will take up tracer. An absence indicates compromised blood supply to the myocardium.

Answer 109

5g/day trans 30g for men and 20g for women saturated

Answer 110

True. This is called the “nocturnal dip”, and the loss of this is an indicator of poor prognosis in hypertension.

Answer 111

True – this may appear after exercise during an exercise tolerance test, indicating cardiac ischaemia. ST segment depression may also indicate fixed or ongoing ischaemia, as in a Non-ST-elevation myocardial infarction (NSTEMI)

Answer 112

False – older people have lower renin levels, therefore using ACE inhibitors (drugs which block the conversion of Angiotensin I to Angiotensin II) is less likely to be effective, and they are not the firstline treatment choice in this age group.

Answer 113

False – a careful approach still needs to be taken, as overly-rapid correction of blood pressure can precipitate ischaemic events. Aim to lower blood pressure by 10-20% within the first hour, and then to 160/100mmHg over the next 6 hours.

Answer 114

careful - 10-20% lowering withiin. the first hour - then to 160/100 over next 6 hours - ischaemic events if lower too fast

Answer 115

False. Rheumatic fever is a disease of disordered immunity, and classically presents with - inflammation of the heart and joints. - This typically affects large joints, such as wrists, elbows, knees and ankles.

Answer 116

b. false Rheumatic fever presents with painful arthritis of the small joints.

Answer 117

True – orthostatic hypotension is commonly seen in association with hypertension, and is common in the elderly. Management is tricky, and will usually involve a combination of non-pharmacological techniques, and changing drug doses and timing.

Answer 118

hyperlipidaemia. corneal arcus refers to a pale ring of lipid deposit visible in the peripheral cornea. This is most significant in young patients. It is considered normal in the elderly.

Answer 119

deep venous system of the legs. This can travel up the vena cava to the right side of the heart, and then into the pulmonary artery, where it becomes a pulmonary embolism.

CVS week 2 Flashcards

(150 cards)