CVS week 2

Question 1

Type 1 myocardial infarction

Answer 1

spontaneous MI associated with ischaemia abd due to primary coronary event, such as a plaque, eorision, rupture, fissuing or dissection

Question 2

Coronary lesion obstructing lumen/plaque rupture with thrombus is an example of a type 1 MI

a. true
b. false

Answer 2

a. True

type 1 MI - spontaneous MI associated with ischaemia and is due to primary coronary event (plaque rupture etc)

Question 3

Type 2 myocardial infarction

Answer 3

JUST due to supply and demand mismatch of oxygen

(not necessarily indicating a primary issue of the coronary artery)

e.g.
- vasospasm or endothelial dysfunction
- medications - causing vasconstriction/spasm

Question 4

what does ST segment elevation look like if a coronary artery is partially occluded

Answer 4

ST depression (Ischaemia)

T wave - inversion (maybe normal)

Question 5

Partial occlusion of coronary artery causes a depression in ST segment

a. true
b. false

Answer 5

a. true

Question 6

ST segment if artery is completely occluded

Answer 6

ST segment elevation

Question 7

Anterior lateral ST elevation would show in what artery

Answer 7

left anterior descending arteries

Question 8

Why might you not see posterior MI

Answer 8

• Posterior wall is supplied by left circumflex (may not see ST elevation anywhere) - even if LC is completely blocked
• need to put leads on the back of the chest

Question 9

no ST elevation or troponin elevation

a. stemi
b. non-stemi
c. unstable angina

Answer 9

c. unstable angina

Question 10

Reperfusion

Answer 10

therapy that opens up a blocked artery

Question 11

Most common cause of secondary hypertension

Answer 11

primary hyperaldosteronism, including Conn’s syndrome

Question 12

The carotid sinus sends action potentials along which nerve to the medulla?

Answer 12

glossopharyngeal nerve

Question 13

The aortic sinus send action potentials along what nerve to the medulla?

Answer 13

vagus nerve

Question 14

What happens when high blood pressure is detected by the carotid and aortic sinuses

Answer 14

• The force stretches the walls of the blood vessels
• activates channels/increases firing of APs
• Na+ ions flow into sensory nerve endings/AP to medulla
• PNS acts on SA node to decrease HR/relax smooth muscle in arteriples
• X inhibits sympathetic drive X

Question 15

angiotensinogen is released by the

Answer 15

Liver

(and converted to Angiotensin 1) by Renin

Question 16

What organ produces renin

Answer 16

The kidneys

(converts Angiotensinogen to Angiotensin 1)

Question 17

Angiotensin converting enzyme is found primarily in the ?

Answer 17

lungs

(converts AG1 -> AG2)

Question 18

What triggers the release of renin from the Juxtaglomerular cells in the kidney?

Answer 18

1. reduced renal perfusion (fall in BP)/circulating blood volume
2. hyponatremia (low Na+) *** sodium depletion
3. SNS stimulation

increases blood volume

Question 19

In individuals with high BP the kidneys are unable to excrete appropriate amounts of Na+ for any given BP

a. true
b. false

Answer 19

a. true

pressure natriuesis (curve moves to right)

it requires increasing BP to excrete the same amount of Na+/sustain Na+ excretion(natriuesis)

Question 20

rheumatic fever develops throug molecular mimicry of the bacterial M protein

a. true
b. false

Answer 20

a. true

the cell wall of streptococcus pyogenes includes M protein (viruelence factor - antibodies against M protein cross react with myosin and the smooth muscle of arteries)

Question 21

bacteria which causes rheumatic fever

Answer 21

Streptococcus pyogenes

(beta haemolytic streptococcal)

Question 22

granulomatous nodules found in rheumatic heart fever

Answer 22

Ashchoff body

focus of inflammatory cells, necrosis and activate macrophages

Question 23

symptoms/presenting features of rheumatic fever

Answer 23

polyarthritis

pan-carditis

Erythema marginatum (skin rash)

Fever

Heart murmurs

Question 24

biggest manifestation of rheumatic heart disease

Answer 24

valvular abnormalities

Question 25

Rhematic HD is virtually the only cause of?

Answer 25

mitrial stenosis (can also cause aortic regurgitation) tricuspid and pulomnary vavle rarely invovled

Question 26

treatment for rheumatic fever

Answer 26

antibiotics - oral penicillin V NSAIDS - anti-inflammatory treat complications

Question 27

Recommended daily limits of trans fat intake is 30g for men and 20g for women. a. true b. false

Answer 27

False – these are the recommendations for saturated fat intake. It is recommended that all adults limit trans fat intake to 5g/day.

Question 28

Recommended daily intake for saturated fat intake

Answer 28

30g for men and 20g for women.

Question 29

Nifedipine MR (a calcium-channel blocker) is safe for use during pregnancy. a. true b. false

Answer 29

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

Question 30

New blood vessel formation and collagen deposition begins 1-3 days after a myocardial infarction. a. true b. false

Answer 30

False – this occurs 7-10 days post infarction.

Question 31

The end result of myocardial infarction resolution is healed tissue with full restoration of function. a. true b. false

Answer 31

False – mature myocardial infarctions form dense collagenous scars. Depending on the size and site, these may severely impact cardiac function or may be well-compensated, but the muscular contractility will never be regained.

Question 32

Elderly people have high levels of renin, which often is the main driver of hypertension in this age group. a. true b. false

Answer 32

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.

Question 33

Patients with a recent stroke cannot have thrombolysis for a STEMI. a. true b. false

Answer 33

True – the risk of intracranial bleeding is too high.

Question 34

The renin-angiotensin-aldosterone system adjusts blood pressure through sodium and water retention. a. true b. false

Answer 34

True, this is one of the ways that the RAAS controls blood pressure. Activation of the RAAS also produces Angiotensin II, which is a vasoconstrictor.

Question 35

In a pregnant woman, a blood pressure of 160/90mmHg alone would be sufficient to diagnose pre-eclampsia. a. true b. false

Answer 35

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.

Question 36

Pre-eclampsia

Answer 36

* over 20 weeks gestation * new or worsening hypertension * proteinuria > 300mg/24h

Question 37

ST segment elevation on an ECG results from complete occlusion of a coronary artery. a. true b. false

Answer 37

True. These acute coronary syndromes have a high mortality (especially untreated!) and are associated with transmural infarction.

Question 38

Late-stage atheromatous plaques can become calcified. a. true b. false

Answer 38

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).

Question 39

Ruptured atheromatous abdominal aortic aneurysm is common in the elderly and often asymptomatic. a. true b. false

Answer 39

False – an abdominal aortic aneurysm (AAA) is a relatively common finding in the elderly, but rupture is usually fatal.

Question 40

Furosemide is an aldosterone receptor antagonist. a. true b. false

Answer 40

False – furosemide is a loop diuretic. Examples of aldosterone receptor antagonists (mineralocorticoid receptor antagonists) are spironolactone and eplerenone.

Question 41

furosemide is what type of drug?

Answer 41

loop diuretic

Question 42

spironolactone and eplerenone are what type of drug

Answer 42

aldosterone receptor antagonists

Question 43

Statins can be used to help reduce symptoms in stable angina. a. True b. False

Answer 43

False – statins lower cholesterol levels and may slow disease progression in angina and other atheromatous cardiovascular disease, but will not affect symptoms.

Question 44

Stage 1 hypertension is defined as a clinic blood pressure of 135/85mmHg or higher. a. true b. false

Answer 44

False – we know that people tend to have higher blood pressure in the doctor’s office (doctor’s appointments are stressful!) than they do at home, and it is the average blood pressure that we are interested in. For that reason, a home ambulatory average blood pressure of 135/85mmHg or higher is termed stage 1 hypertension, while in the clinic it’s an average BP (over several measurements on separate occasions) of 140/90mmHg.

Question 45

Rheumatic fever is strongly associated with staphylococcal infection. a. true b. false

Answer 45

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

Question 46

Rheumatic is associated with infection by

Answer 46

Group A beta-haemolytic streptococcal infections

Question 47

Percutaneous coronary stenting improves mortality rates in stable angina. a. true b. false

Answer 47

False – it improves symptoms, but there is no evidence it improves prognosis in stable disease. However, PCI (percutaneous coronary intervention) has a big impact on mortality in acute coronary syndrome.

Question 48

PCI (percutaneous coronary intervention) has a big impact on mortality in acute coronary syndrome. a. true b. false

Answer 48

a. true (remember not in stable angina)

Question 49

Acute myocardial infarcts are classified depending on whether there is elevation of the PR segment on the ECG. a. true b. false

Answer 49

False – MIs are classified based on the presence or absence of elevation of the ST segment.

Question 50

Treatment for hypertension should be started if a patient has an overall risk of cardiovascular disease of 5% in 10 years. a. true b,. false

Answer 50

False – treatment should be started if overall risk exceeds 10% in 10 years. Remember that commencing any drug therapy will come with its own risks and side effects, and potential benefit must outweigh this risk. This is why we don’t just start antihypertensive medication on absolutely everyone!

Question 51

Many ischaemic strokes are caused by atherosclerosis of the carotid artery. a. true b. false

Answer 51

True – commonly, atheromatous debris from carotid artery plaques can embolise and travel to the brain, where it becomes lodged in arterial beds and causes ischaemia.

Question 52

The term embolisation specifically refers to movement of detached intravascular thrombus to a distant site. a. true b. false

Answer 52

False – emboli can be solid, liquid or gas. The most common embolus in humans is thrombus, however.

Question 53

ACE inhibitors are less likely to cause a cough as a side effect than Angiotensin Receptor Blockers (ARBs) a. true b. false

Answer 53

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

Question 54

Thrombolysis is the first-line treatment for a STEMI. a. true b. false

Answer 54

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.

Question 55

First line treatment for a STEMI

Answer 55

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.

Question 56

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

Answer 56

True. This is one of the more common causes of secondary hypertension.

Question 57

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

Answer 57

True. This is one of the more common causes of secondary hypertension.

Question 58

Regarding atheromatous plaque formation: neutrophils migrate into the arterial intima in response to endothelial damage. a. true b. false

Answer 58

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

Question 59

In normal laminar blood flow, the cellular component of blood travels at the periphery of the vessel. a. true b. false

Answer 59

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

Question 60

Calcium channel blockers can cause ankle swelling. a. True b. False

Answer 60

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

Question 61

Beta-blockers improve anginal symptoms by slowing the resting heart rate. a. True b. false

Answer 61

True – this reduces myocardial workload and beta-blockers also have some anti-arrhythmic effect.

Question 62

How do beta-blockers improve angina symptoms?

Answer 62

slow the resting HR thus reduces the myocardial workload

Question 63

The sympathetic nervous system is responsible for rapid adjustments to blood pressure. a. true b. false

Answer 63

a. 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.

Question 64

How does the SNS increased blood pressure

Answer 64

* vasoconstriction (increasing vascular resistance), * tachycardia (increasing cardiac output) * increased stroke volume (increasing cardiac output) all of which will increase blood pressure. * stimulates activation of the RAAS, which brings about longer-term blood pressure control.

Question 65

Hypertensive emergencies can be managed on oral drugs and reviewed in 24 hours. a. true b. false

Answer 65

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.

Question 66

the difference between a hypertensive emergency and a hypertensive “urgency”?

Answer 66

urgency - there is no end organ damage - can be managed on oral drugs emergency - end organ damage (Renal failure, confusion , heart failure) - requires hopsital admission + IV therapy

Question 67

In young patients with hypertension, it is more likely that an underlying cause will be found than it is in older patients. a. true b, false

Answer 67

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.

Question 68

Increase in peripheral vascular resistance will lead to a decrease in blood pressure. a. true

Answer 68

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

Question 69

Increase in peripheral vascular resistance will lead to a decrease in blood pressure. a. true

Answer 69

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

Question 70

Beta blockers should not be used in acute heart failure. a. True b. false

Answer 70

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.

Question 71

A patient who has anginal symptoms on climbing one flight of stairs would be classed as having a score of III on the Canadian classification of angina severity. a. true b. false

Answer 71

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

Question 72

A histological feature of rheumatic fever is the Aschoff body. a. true b. false

Answer 72

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

Question 73

Arterial lumina can spontaneously reopen after occlusion by thrombus. a. true b. false

Answer 73

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.

Question 74

Regarding atheromatous plaque formation: Platelet-derived growth factor brings about proliferation of intimal smooth muscle cells. a. true b. false

Answer 74

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

Question 75

Artherocleoris happens to small arteries a/ true b/false

Answer 75

b/false aterio-sceloris - takes place in small arteries/is age-related change atheroscleoris - medium and large arteries

Question 76

how can atheroscelorotic plaques cause anuerysms

Answer 76

increases the diffusion distance from intima to media - weakens the vessel wall

Question 77

The ophthalmic artery arises from

Answer 77

internal carotid

Question 78

Increased stroke volume increases pulse pressure a. true b. false

Answer 78

a. true Pulse pressure is calculated by subtracting the diastolic pressure from the systolic pressure. Therefore anything that increases systolic pressure or decreases diastolic pressure will have the net effect of increasing the pulse pressure. Stroke volume increases the systolic pressure, and therefore overall pulse pressure. Exercise increases stroke volume to meet the demands of the body, therefore exercise increases the pulse pressure.

Question 79

a hormone produced by the kidneys and stimulates the production of red blood cells.

Answer 79

Erythropoietin

Question 80

The parasympathetic nervous system, nitric oxide and prostacyclin are all mediators of arteriolar dilation a. true b. false

Answer 80

a. true

Question 81

dysphagia

Answer 81

difficulty swalloing

Question 82

The coeliac trunk branches off the aorta at T12 a. true b. false

Answer 82

a. true

Question 83

heart failure with reduced ejection fraction (HFrEF) leads to increased afterload - how?

Answer 83

, the left ventricle often becomes dilated, and its contractility is impaired. This dilation increases the wall stress and raises the afterload.

Question 84

Stroke volume = cardiac output / heart rate. a. true b. false

Answer 84

a. true

Question 85

Stroke volume = cardiac output / heart rate. a. true b. false

Answer 85

a. true

Question 86

LVEF = (stroke volume / end diastolic LV volume) x 100. a. true b. false

Answer 86

a. true

Question 87

how to work out LVEF

Answer 87

(stroke volume / end diastolic LV volume) x 100.

Question 88

Troponin I binds to

Answer 88

actin to hold the troponin-tropomyosin complex in place

Question 89

troponin T binds to

Answer 89

tropomyosin, forming a troponin-tropomyosin complex

Question 90

troponin C binds to

Answer 90

calcium ions

Question 91

Where in the body are baroreceptors that detect blood pressure located?

Answer 91

carotid sinus

Question 92

what layers are affected by aortic dissection? where does blood flow?

Answer 92

between tunica intima and tuncia media

Question 93

The tunica intima is the innermost layer of a blood vessel and in an aortic dissection blood flows through a tear in the tunica intima, splitting the tunica intima from the tunica a. true b. false

Answer 93

a. true

Question 94

The PR interval represents

Answer 94

time between atrial depolarisation and ventricular depolarisation

Question 95

what is Wolff-Parkinson-White syndrome

Answer 95

a cardiac condition arising due to the presence of an accessory pathway between the atrium and ventricle. This is often referred to as the Bundle of Kent. Due to this extra connection between the two chambers of the heart, electrical signals can sometimes bypass the usual conduction pathway, allowing for tachyarrhythmias to develop. The reasoning behind this is that this aberrant pathway does not involve the atrioventricular node; the function of which is usually to delay the conduction of electrical impulses, allowing time for the atria to contract fully.

Question 96

Digoxin mechanism of action

Answer 96

Yes, your understanding is correct. Digoxin, a cardiac glycoside, works by inhibiting the Na+/K+-ATPase pump located on the myocardial cell membrane. This inhibition leads to an increase in intracellular sodium concentration. The elevated sodium level inside the cell inhibits the function of the sodium-calcium exchanger (NCX), which usually expels calcium from the cell in exchange for sodium. As a result, there is an increase in intracellular calcium concentration. This surplus of calcium is taken up into the sarcoplasmic reticulum and then released during systole to enhance myocardial contractility - thus exerting a positive inotropic effect. However, it's important to note that while digoxin improves symptoms and exercise tolerance in heart failure, according to NICE guidelines (CG108), it does not have an effect on mortality and should not be used as a first-line treatment due to its narrow therapeutic window and potential for toxicity. It may be considered as an option when symptoms persist despite optimal therapy with ACE inhibitors, beta-blockers and aldosterone antagonists or if these medications are not tolerated.

Question 97

why might ejection fraction be presevered in HF

Answer 97

diastolic dysfunction - reduced compliance of the heart ecause the heart is not able to completely fill with blood during diastole, hence the diastolic dysfunction. But the ejection fraction is preserved because despite the decrease in volume, the same FRACTION of blood is being ejected during each beat .