Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
64 Cards in this Set
- Front
- Back
|
What is the baroreceptor reflex?
|
A mechanism which is mediated by receptors in the walls of the aortic arch and carotid sinuses. Signals are sent to the medulla.
|
|
|
Is the baroreceptor reflex involved in long-term or short-term regulation of BP?
|
Short-term. The stretch receptors are constantly resetting themselves.
|
|
|
What % of all HT patients have essential or primary HT?
|
95%.
|
|
|
What are systems that are potentially responsible for HT?
|
1. blood vessels; 2. CNS; 3. adrenal glands; 4. pressure/volume receptors; 5. kidney.
|
|
|
What happens to CO and TPR as age increases?
|
Cardiac output decreases while total peripheral resistance increases.
|
|
|
What are some clues to indicate secondary HT?
|
1. onset before age 20 or after 50; 2. sudden and severe (stage 3) onset; 3. associated signs and symptoms; 4. no family history of EH.
|
|
|
What are 2 renal conditions leading to HT?
|
1. renal parenchymal disease; 2. renal arterial stenosis.
|
|
|
What is a mechanical cause of HT?
|
Coarctation of the aorta.
|
|
|
What are some endocrine causes of HT?
|
1. pheochromocytoma; 2. adrenocortical hormone excess; 3. thyroid hormone abnormalities.
|
|
|
What are the effects of aldosterone?
|
Increases blood volume by stimulating reabsorption of sodium into the circulation in the distal nephron.
|
|
|
Which organs are damaged in HT?
|
1. heart; 2. cerebrovascular system; 3. aorta and peripheral vascular circulation; 4. kidney; 5. retina.
|
|
|
What are the major effects of HT on the heart?
|
Increased afterload and accelerated atherosclerosis.
|
|
|
What is the source of the 4th heart sound?
|
LVH - the blood rushing into the left ventricle following the contraction of the left atrium.
|
|
|
How does HT affect the supply-demand equation in the heart?
|
Accelerated atherosclerosis leads to lower oxygen supply to the heart, while the increase afterload increases the systolic workload for the heart.
|
|
|
What is an abdominal aortic aneuryism (AAA)?
|
A dilatation of the aorta, usually located below the level of the renal arteries, caused by the mechanical stress of the high pressure on an arterial wall already weakened by medial damage and atherosclerosis.
|
|
|
What is hypertensive retinopathy?
|
Abnormalities of the retina caused by hypertension.
|
|
|
What is papilledema?
|
Swelling of the optic disc caused by elevated intracranial pressure due to malignant HT.
|
|
|
What are the 4 classes of antihypertensive drugs?
|
1. diuretics; 2. sympatholytics; 3. vasodilators; 4. renin-angiotensin system antagonists.
|
|
|
What are 2 types of diuretics?
|
1. thiazide; 2. aldosterone antagonists
|
|
|
What are 4 types of sympatholytics?
|
1. beta blockers; 2. combined alpha-beta blockers; 3. central alpha2 agonists; 4. peripheral alpha1 blockers.
|
|
|
What are 2 types of vasodilators?
|
1. Ca++ channel blockers; 2. direct vasodilators (eg. hydralazine, minoxidil)
|
|
|
How do beta-blockers (eg. propranolol) lower BP?
|
They reduce CO by lowering HR and contractility and they decrease the secretion of renin (consequently angiotensin II) to decrease TPR.
|
|
|
What is recommended as a first-line pharm treatment for HT?
|
Diuretics and beta-blockers.
|
|
|
What % of cardiovascular deaths are due to coronary artery disease?
|
50%
|
|
|
What is the principal cause of myocardial ischemia?
|
Mismatch between supply and demand of oxygen.
|
|
|
How do you calculate average maximum heart rate?
|
220 - (age)
|
|
|
How do you identify ischemia on the EKG?
|
ST interval depression.
|
|
|
How do you calculate cardiac output?
|
heart rate * stroke volume
|
|
|
What factor is most responsible for increase in cardiac output?
|
heart rate
|
|
|
What are 2 key things to look for in an EKG?
|
1) ST depression or elevation; 2) arrhythmias
|
|
|
What is the significance of an ST segment elevation?
|
Patient is having a myocardial infarction.
|
|
|
What can be seen in an echocardiogram?
|
The pump (myocardium) and valves can be examined directly.
|
|
|
Can the coronary arteries be seen directly in an echo?
|
No.
|
|
|
What is syncope?
|
(answer)
|
|
|
What is angina pectoris?
|
(answer)
|
|
|
What is presyncope?
|
(answer)
|
|
|
What defines the supply and demand of the heart?
|
Supply = myocardial perfusion; demand = increase in work of heart
|
|
|
What does stress testing achieve?
|
Evaluates hemodynamic response to stress and the adequacy of myocardial perfusion during stress.
|
|
|
How can imaging studies improve diagnostics?
|
The sensitivity and specificity of the diagnosis is improved.
|
|
|
What is a MET?
|
It is a metabolic equivalent, representing the output of the heart at rest.
|
|
|
What are 3 types of echocardiography?
|
Transthoracic, transesophageal and stress echo.
|
|
|
What can be uncovered with stress testing?
|
1) diagnose myocardial ischemia (usually CAD); 2) prognosis of patients with cardiac disease; 3) exercise capacity (cardiac or pulmonary disease); 4) assess treatment efficacy.
|
|
|
What are 3 variables associated with heart oxygen demand?
|
HR, contractility, systolic wall tension
|
|
|
What are 3 variables associated with heart oxygen supply?
|
vascular resistance, coronary blood flow, oxygen carrying capacity
|
|
|
What is the normal cardiac response to exercise?
|
1) increased HR; 2) increased stroke volume (+EDV, -ESV); 3) increased systolic BP and pulse pressure.
|
|
|
What data is obtained from exercise stress testing?
|
1. exercise time; 2. protocol used; 3. baseline HR, BP, EKG; 4. maximal work capacity; 5. EKG change with exercise; 6. exercise induced symptoms.
|
|
|
What are some abnormal EKG readings that can be found through exercise stress testing?
|
1. ST segment elevation or depression; 2. arrhythmias; 3. conduction disturbances, including bundle-branch blocks, AV conduction blocks, inappropriate HR response.
|
|
|
What is some important non-EKG data from stress testing?
|
1. symptoms; 2. overall exercise capacity; 3. inability to raise BP.
|
|
|
What are some short-comings of basic EKG stress study?
|
1. no specificity; 2. lack of sensitivity; 3. inability to quantify extent or location of disease.
|
|
|
What can myocardial perfusion imaging uncover?
|
1. extent of CAD diagnosis; 2. prognosis; 3. left ventricular systolic function; 4. myocardial viability.
|
|
|
What drugs can be used in pharmacological stress testing?
|
adenosine or dipyridamole (vasodilator) and dobutamine (beta agonist)
|
|
|
What are the 4 main variables in cardiology?
|
1. myocardium = pump; 2. valves; 3. coronary arteries = plumbing; 4. electricity (nodes and bundle branches).
|
|
|
What can be seen in a transthoracic echo?
|
1. see ventricular function; 2. examine chamber sizes; 3. examine valve structure and function; 4. see the pericardial space.
|
|
|
What are indications for a transthoracic echo?
|
1. CHF (new SOB or known cardiomyopathy); 2. murmur or known valvular disease; 3. endocarditis; 4. congenital heart disease.
|
|
|
When is transesophageal echocardiography used?
|
1. stroke (find source of embolus); 2. atrial fibrillation; 3. work-up of infective endocarditis; 4. evaluation of valvular structure and function; 5. diagnosis of aortic diseases; 6. patients with poor transthoracic windows.
|
|
|
What are the 4 key concepts in the hypertension lecture?
|
1. HT is a polygenic disorder; 2. the pathogenesis of HT includes early endothelial cell dysfunction and later pathological remodeling of the vessel media; 3. the tissue renin-angiotensin system is the primary mediator connecting the events; 4. HT has serious but preventable sequelae.
|
|
|
How is the mean arterial pressure calculated (MAP)?
|
MAP = total peripheral resistance * cardiac output
|
|
|
What happens to an intact arterial ring when Ach is released?
|
Vasodilation - Ach causes endothelial cells to release EDRF
|
|
|
What are some endothelial dysfunctions?
|
1. failure to regulate vascular tone; 2. failure to keep fluid in vessel lumen; 3. failure to keep the blood liquid.
|
|
|
What are the main sequelae of hypertension?
|
1. arterial disease (atherosclerosis, dissection); 2. heart disease (strain, LVH); 3. kidney disease (arteriolar nephrosclerosis); 4. retinal disease (arteriolar hemorrhage); 5. CNS (hemorrhagic stroke).
|
|
|
What is essential or primary hypertension?
|
HT of unknown origin.
|
|
|
What is secondary HT?
|
HT of known origin.
|
|
|
What determines stroke volume (SV)?
|
Cardiac contractility and preload.
|
|
|
What 3 systems are responsible for blood pressure regulation?
|
1. heart; 2. blood vessel tone; 3. kidney
|
