Medicine 1 > Week 3 CVS > Flashcards

Week 3 CVS Flashcards

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1
Q

The boarders of the aortic root

A

The Sinuses of Valsalva

to

The Sinotubular junction

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2
Q

The boarders of the ascending aorta

A

The sinotubular junction

to

The Brachiocephalic artery

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3
Q

Boarders of the aortic arch

A

Brachiocephalic artery

to

just after the left subclavian artery

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4
Q

The origin of the left coronary artery

A

The left sinus of valsalva

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5
Q
  • Junction between the sinus of Valsalva and the ascending aorta is called the
A

Sinotubular junction

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6
Q

What 3 layers do all arteries have?

A
  1. Tunica Intima (endothelial cells and subendothelial layer of collagen and elastic fibres)
  2. Tunica media (smooth muscle cells which secrete elastin in the form of sheets or lamellae)
  3. Tunica adventitia - tough , loose connective tissue (collagen and elastic fibres) not lamellae
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7
Q

The purpose of the collagen in the adventitia

A

prevents elastic arteries from stretching beyond their physiological limits during systole

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8
Q

definition of true aneurysm

A

localised enlargement (STRETCH and DILATION) of ALL 3 layers of artery wall

caused by weakening of the vessel wall

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9
Q

inherited causes of aneurysm of aorta

A
  • bicuspid aortic valve
  • Marfans
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10
Q

False aneurysm

A
  • does not involve all 3 layers of vessel
  • rupture contained by adventitia or surrounding tissue
  • higher risk of rupture
  • latrogenic - medical intervention (invasive angiogram)
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11
Q

two diagnostic Investigations of thoracic aneurysm

A
  1. CT angiogram of aorta
  2. MRI of aorta (diagnose and follow up)

(non-diagnostic - CXR - show wide mediastinum/Echocardiogram - look at root, valve,)

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12
Q

Two diagnostic tests for thoracic aorta

A
  1. CT angiogram aorta – quick but risk of radiation
  2. MRI aorta (For patients’ who require serial tests)
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13
Q

what is an aortic dissection

A
  • tear in the inner wall (intima)
  • blood enters and splits the media
  • progates along/blood forces walls apart
  • acute emergency or chronic
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14
Q

aneurysm is a high risk factor for a dissection

a. true
b. false

A

a. true

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15
Q

Type A standford classification of aortic dissection

A

all dissections involing the asceniding aorta - no matter the origin

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16
Q

Type B aortic dissections

A

do NOT involve ascending aorta

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17
Q

symptoms of aortic dissection

A
  • severe chest pain - radiating into the back/scapula
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18
Q

What would you find on examination when someone has aortic dissection

A
  • aortic regurgitation
  • pulmonary oedema
  • hypertension* sometimes hypotension
  • reduced or absent peripheral pulses
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19
Q

investigations to diagnose aortic dissection

A
  • CT angiongram

ECG(ST elevation) /CXR (wide mediastinum)

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20
Q

Treatment for Type A dissection

A

involves ascending aorta
- surgery
- blood pressure control (IV nitrate, IV beta blocker, IV sodium nitroprusside, CCB)

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21
Q

Treatment for type B dissesction

A
  • MAINLY CONTROL BLOOD PRESSURE
     IV nitrate
     Calcium channel blocker
     IV sodium nitroprusside

Percutaneous endovascular intervention or surgery if risk of rupture/expanding.

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22
Q

Infection and inflammation causes of aortic aneurysm and dissection

A
  • Infection: syphilis
  • Inflammation: Takayasu’s arteritis
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23
Q
  • A Granulomatous vasculitis: affects the aorta and main branches. That results in stenosis, thrombosis, aneurysms, branches of aorta
A

Takayasu’s arteritis

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24
Q

Congenital aortic aneurysm

A
  • Bicuspid aortic valve
  • Aortic Coarctation
  • Marfans syndrome
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25
cardiac syphilis causes aortic stenosis a. true b. false
b. false aortic regurgitation
26
signs of coarctation of aorta
- cold legs - poor leg pulses - palapate femoral and radial artery (for radial femoral delay)
27
narrowing in descending aorta.
coarctation of aorta
28
- Fibrillin 1 gene mutation causes
Marfans
29
Marfans
connective tissue weakness/disease multisystem cardiac : aortic/mitrial valve prolaspe, regurigation. thoracic , aneurysm and dissection
30
if coarctation is before the subclavian artery there will be a radial-radial delay a. true b. false
a. true and right radial-femoral
31
if coarctation of aorta is afrter the subclavian artery there will be a radial-radial delay a. true b.false
b. false no radial-radial delay but right AND LEFT radial-femoral delay
32
diagnosis of coartation
- CT scan - MRI ttreat - PCI/surgical
33
last normal piece of artery before the aneurysm begins.
the neck
33
last normal piece of artery before the aneurysm begins.
the neck
34
: Wilson and Jungner classic screening criteria
- health problem (aneurysms are common) - accepted treatment (fix > 5.5cm) - diagnosis and treatment - recognisable latent or early symptom phase - suitable test (Ulstrasound) - Acceptable for people - natural history understood - agreed policy on population - cost of case finding, diagnosis and treatment balanced with expenditure on care - case finding continuous (not once for all)
35
If you do have the condition but test negative
false negative
36
if you do have the condition and test and test positive
true positive
37
if you dont have the condition and test positive
false positive
38
how screen for aneurysms and what age /gender
over 65 males ultrasound
39
when to surveil and when to treat?
o If less than <5.5cm - surveillance program o If greater than >5.5cm - surgery that day UK small aneurysm study
40
when not treat aneurysms under < 5.5 cm
– the risk of rupture is less than (< 1% per year)
41
tests to assess fitness for EVAR of aneurysms
- exercise tolerance - cardiopulmonary exercise tolerance (CPEX) - functional capacity - aortic morpholog - no concurrent malignancy
42
when used open AAA repair
- challenging morphology (short neck) - o Unsuitable anatomy (short neck/hostile iliacs) -> if fit -> OPEN REPAIR
43
when used open AAA repair
- challenging morphology (short neck)
44
process of treating AAA
Ultrasound > 5.5 cm CT angiogram o Good anatomy -> endovascular repair o Unsuitable anatomy (short neck/hostile iliacs) -> if fit -> OPEN REPAIR,
45
difference in outcomes of EVAR v Open AAA repair (EVAR 1)
early outomes - EVAR keeping more people alive 5-6 years - no difference 6+ - Open AAA more durable
46
EVAR 2 trial: comparing endovascular stenting versus nothing in OLD/FRAIL PATIENTS'
no change in all cause mortality after 3-4 years unfit patients/old frail - no point fizing -EVAR stenting no benefit in old
47
Measures on Edinburgh ruputred aneurysm score ERAS 1-3
* Hb <9 * BP <90 * GCS <15
48
Measures on Edinburgh ruputred aneurysm score
* Hb <9 * BP <90 * GCS <15
49
Ruptured AAA – Open or EVAR treatment? -IMPROVE
o No difference in 30-day survival between groups o Open surgery – faster
50
surveillence of aneurysm < 5.5cm
regular ultrasound checks
51
There are 2 main types of surgery for an AAA:
* endovascular surgery – the graft is inserted into a blood vessel in your groin and then carefully passed up into the aorta * open surgery – the graft is placed in the aorta through a cut in your tummy
52
pro-artherotic dietry items
- cholesterol - saturated/trans fats - sodium - alchol
53
recommended daily amount of trans fats
5g
54
recommended daily amount of saturated fats
30g men 20g women
55
anti-atherogenic dietry items
- poly unsaturated fats PUFA - mono unsaturated fats MUFA - CHO rich - NSP non starch polysaccharides
56
benefits of n3 PUFA fish oil
reduces TAG anti-inflammatory/anti-thrombotic
57
Coronary arteries are also called?
epicardial arteries because they run along the outer surface of the heart (epicardium)
58
microcirculation
small arteries arterioles capillaries (exchange)
59
dihydropyridine CCBs
* vasolditing * relax smooth muscle (prevent Ca2+ influx into smooth muscle surrounding arteries/arterioles) * Amlodipine, felodipine, nifedipine * REDUCE AFTERLOAD
60
non-dihydropyridine CCBs
* rate limiting * block Ca2+ influx into the heart * reduce HR/strenght of contraction * increases diastolic perfusion time
61
Side effects of CCBs
* peripheral oedema (DHP) * bradycardia/heart block (NDHP) * Flushing/headache * Reduce LV function * Hypotension
62
CT can be used to identify small volume leaks a. true b. false
b. false need to be 2-3ml per min
63
what is usually used as constrast
IV iodine
64
B- mode ultrasound
2D scans anatomical planes gives antomical structure
65
M-mode ultrasound
motion mode fixed plane over time assess Heart valve movement
66
3 types of functional vascular imaging
fMRI ultrasound radionuclide imaging
67
doppler imaging
* flow of blood alter US frequencies * direction and quantity of flow * RED flow -away * blood towards probe * can be used to detect DVT
68
can be used to detect DVT non-invasively
doppler imaging
69
CT scan density high to low
(white - high density , black - low) Bones (white) soft tissue/blood water fat lung air (black)
70
most important modifiable risk factor in lacunar stroke
high blood pressure *hypertension* same for intracranial haemorrage
71
Causes of ischaemic stroke
* disease of large arteries - caroti (stenosis, clots) * cardio-embolic - arial fibrilation * tiny vessels - hypertension/penetrating arterial disease
72
causes of haemorragic stroke
hypertension amyloid - glass like vessels hypocholesteraemia (LOW cholesterol) secondary to ischaemia
73
brocos area
speach production
74
wernicks area
speach comprehension
75
example of gain of function during stroke
* pins/needles * involuntary movement
76
anterior cerebral artery infarct features
* paralysis /sensory loss of conta-lateral leg, foot, toes * gait/stance problems
77
middle cerebral artery infarct features
* paralysis of contralateral face, arm, leg * homoygous heminopia * aphasia * unilateral neglect
78
you need an MRI to see lacunar strokes a. true b. false
a. true
79
features of lacunar stroke
no cortical signs (aphasia, neglect, hemionopia) it is purely motor/sensory e.g. dysarthria - loss of speach due to muscle problem ataxia - no control of movement - hemiparesis - if in brain stem vb
80
aortic root
sinuses of valsava to sinotubular junction
81
ascending aorta
sinotubular junction to brachiocephalic artery
82
Arch of aorta
right brachiocephalic trunk to left subclavian artery
83
descending thoracic aorta ends at?
the diaphragm - leaves at T12
84
What is a true aneurysm ?
localised enlargement of an artery caused by weakend of a wall true aneurysm - involves all 3 layers of vessel wall (intima, media, adventitia) STRETCH + DILATION of ALL 3 layers
Medicine 1
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