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112 Cards in this Set
- Front
- Back
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In what part of the body are baroreceptors present? |
-Aortic arch -Carotid sinus |
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Baroreceptors in the aortic arch transmits information via |
-vagus nerve to solitary nucleus of medulla |
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Baroreceptors in the aortic arch responds only to |
-High BP |
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Baroreceptors in the carotid sinus transmits information via |
-Glossopharyngeal nerve to solitary necleus of medulla |
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Baroreceptors in the carotid sinus responds to |
-High BP and low BP |
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What is the response of baroreceptors when they sense hypotension |
Hypotension produce a decreases in afferent baroreceptor firing that produce a increases in afferent sympathetic firing and decreases in efferent parasympathetic stimulation that produce vasoconstriction, increases in HR, contractility,and BP |
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Triad of hypertension, bradycardia, and respiratory depression |
Contributes to cushing reaction |
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Chemoreceptors that are stimulated by decreases in Po2 |
-Peripheral chemoreceptors (carotic and aortic) |
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Are stimulated by changes in pH and Pco2 of brain interstitial fluid, which in turn are influenced by arterial C02. Do not directly respond to Po2 |
Central chemoreceptors |
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Organ with largest blood flow (100% of cardiac output) |
Lung |
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Organ with Largest share of systemic cardiac output |
Liver
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Organ with highest blood flow per gram of tissue |
Kidney |
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Organ with largest arteriovenous O2 difference because O2 extraction is 80% |
Heart |
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Released from atrial myocytes in response to high blood volume and atrial pressure |
Atrial natriuretic pepide |
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Causes vasodilation and decreased Na+ reabsorption at the renal collecting tube, constricts efferent renal arterioles and dilates efferent arterioles via cGMP |
Atrial natriuretic peptide |
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What is Autoregulation? |
How blood flow to an organ remains constant over a wide range of perfusion pressures |
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What factor determining autoregulation in the heart? |
-Under perfused -Local metabolites (vasodilatory) Co2, adenosine, NO |
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What factor determining autoregulation in the brain? |
Local metabolites (vasodilatory)CO2,(pH) |
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What factor determining autoregulation in the kidney? |
Myogenic and tubuloglomerular feedback |
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What factor determining autoregulation in the lung? |
Hypoxia causes vasoconstriction |
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What factor determining autoregulation in the skeletal muscle? |
Local metabolites - lactate, adenosine, K+, H+, CO2 |
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What factor determining autoregulation in the skin? |
Sympathetic stimulation most important mechanism- temperature control |
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The pulmonary vasculature is unique in that hypoxia causes |
Vasoconstriction so that only well-ventilated areas are perfused |
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Causes systemic venues vasodilation, reduces preload, and decreased myocardial oxygen demand |
Nitroglycerin |
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Defined as a systolic BP>140 and/or diastolic BP>90 mmHg |
Hypertension |
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Defined as a systolic BP>120 and/or diastolic BP>80 mmHg |
Pre-hypertension |
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Defined as a systolic BP<120 and/or diastolic BP< 80 mmHg |
Normal Pressure |
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What are the risk factors of Hypertension? |
-Age -Obesity -Diabetes -Smoking -Genetics -Black people |
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Represent the 90% of cases of Hypertension |
Primary hypertension (essential) |
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10% of hypertension is secondary to |
-Renal disease -Fibromuscular dysplasia in young patients |
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BP>180/120, without evidence of organ damage, EKG changes, headache, vision abnormality, chest pain, Flash pulmonary edema |
Hypertensive urgency |
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Hypertension can predisposes to |
-Atherosclerosis -LVH -Stroke -CHF -Renal failure -Retinopathy -Aortic dissection |
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Increased myocardial oxygen demand, stiffening of the LV, and encroachment upon the LV lumen |
LVH (left ventricular ) |
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Longitudinal intraluminal tear forming a false lumen, associated with hypertension, biscuspid aortic valve, and inherited connective tissue disorders |
Aortic dissection |
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What are the tow type of aortic dissection? |
-Stanford type A -Stanford type B |
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Diseases that can result in pericardial tamponade, aortic rupture, death, and in CXR shows mediastinal widening |
Aortic dessection |
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Aortic dessection that involve the ascending aorta |
Stanford A |
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Aortic dessection that involve the descending aorta distal to the left subclavia artery |
Stanford B |
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What is the treatment for Aortic dissection? |
B-blocks |
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Chest pain due to ischemic myocardium secondary to coronary artery narrowing or spasm, no myocyte necrosis |
Angina |
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Usually secondary to atherosclerosis, exertional chest pain in classic distribution( usually with ST depression on EKG), resolving with rest |
Stable angina |
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Occurs at rest secondary to artery spasm, transient ST elevation on EKG, known triggers include tabacco, cocaine, and triptans |
Variant angina (prinzmetal) |
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What are the treatment of Variant angina (prinzmetal)? |
-Calcium channel blockers, nitrates, and smoking cessation |
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Thrombosis with incomplete coronary artery occlusion; ST depression on EKG (increases in frequency or intensity of chest pain; any chest pain at rest) |
Unstable /crescendo |
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Progressive onset of CHF over many years due to chronic ischemic myocardial damage |
Chronic ischemic heart disease |
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Causes of acute chest pain |
-Aorta dissection -Unstable angina -MI -Tension pneumothorax -PE
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ST segment elevation only during brief episodes of chest pain |
Prinzmtal's angina |
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Patient is able to point to localize the chest pain using one finger |
Musculoskeletal chest pain` |
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Chest wall tenderness on palpation |
musculoskeletal chest pain |
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Rapid onset sharp chest pain that radiates to the scapula |
Aortic dissection |
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Rapid onset sharp chest pain in a 20 years old and associated with dyspnea |
Spontaneous pneumothorax |
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Sharp pain lasting hours or days and is some what relieve y sitting forward |
Pericarditis |
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Pain made worse by deep breathing |
Musculoskeletal pain |
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Chest pain and dermatomal distribution |
Zoster virus |
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Most common non-cardiac chest pain |
Gerd or musculoskeletal |
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drugs that decreased angiotensin II, GFR by preventing constriction of efferent arterioles |
ACE inhibitors |
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What drugs increases levels of renin and prevents inactivation of bradykinin |
ACE inhibitors |
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Drugs that have effects similar to ACE inhibitors but do not increases bradykinin and decreases risk of cough or angioedema |
ARB,s |
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What are the clinical uses of ACE inhibitors ? |
-Hypertension -CHF -Proteinuria -Diabetic -Nephropathy |
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What are the SE of ACE inhibitors? |
Captopril's CATCHH
-Cough -Angioedema -Teratogen -Increased Creatinine levels -Hyperkalemia -Hypotension |
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Increases cGMP that produce smooth muscle relaxation, vasodilates arterioles > venins; afterload reduction |
Hydralazine |
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What are the clinical uses of Hydralalizine ? |
-Severe hypertension -CHF -Hypertension in pregnancy(fist-line) -Reflex tachycardia(coadministered) |
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What are the SE of hydralazine? |
-Compensatory tachycardia -Contraindicated in angina/CAD) -Fluid retention -Nausea -Headache -Lupus-like syndrome |
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What drugs are safe to use in pregnancy? |
Hypertensive Mons Love Nifedipine -Hydralazine -Methildopa -Labetalol -Nifedipina |
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Drug that open K+ channels and hyperpolarizes smooth muscle, resulting in relaxation of vascular smooth muscle |
Minoxidil |
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What are the uses of Minoxidil? |
-Severe hypertension -Topical application for hair loss) |
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What are the SE of minoxidil? |
-Hypertrichosis -Hypotension -Reflex tachycardia -Fluid retention/edema |
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Drug that vasodilate by increased in NO in vascular smooth muscle that produce a increases in cGMP and smooth muscle relaxation , decreases preload |
Nitroglycerin , isosorbide dinitrate |
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What are the clinical uses of nitroglycerin? |
-Angina -Acute coronary syndrom -Pulmonary edema |
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What are the SE of Nitroglycerin? |
-Reflex tachycardia -Hypotension -Monday disease (tachycardia, dizziness, and headache upon reexposure)
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What drug used in anginal therapy decreases End-diastolic volume, blood pressure, ejection time, and MVO2 ? |
Nitrates (affect preload) |
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What drug used in anginal therapy decreases blood pressure, contractility, heart rate, MVO2 ? |
B-blockers (affect afterload) |
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Initial therapy options of hypertension plus CHF |
Diuretics,ACE inhibitors, B-blockers, aldo-antagonist |
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What drugs are contraindicated in hypertension plus CHF? |
B-blockers (in acute descompensated), CCB |
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Initial therapy options of hypertension plus Diabetes |
Ace inhibitors, Thiazide |
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Initial therapy options of hypertension plus post MI |
Thiazide, B-blokers, Ace inhibitors, CCB, Nitrates |
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Initial therapy options of hypertension plus atrial fibrillation |
B-blockers, diltiazem/verapamil |
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Initial therapy options of hypertension plus renal insufficiency |
ACE inhibitors |
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Initial therapy options of hypertension plus BPH |
Alfa-blockers |
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Initial therapy options of hypertension plus hyperthyroidism |
Propranolol |
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Initial therapy options of hypertension plus hyperparathyroidism |
Loop diuretic |
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Initial therapy options of hypertension plus osteoporosis |
Thiazide |
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Initial therapy options of hypertension plus migraines |
CCB, B-blocker
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Initial therapy options of hypertension plus essential tremor |
Propranolol |
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What drugs are contraindicated in hypertension plus DM? |
B-blockers |
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What drugs are contraindicated in hypertension plus bradycardia |
Diltiazen/verapamil, B-blockers |
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What drugs are contraindicated in hypertension plus renal insufficiency? |
Ace inhibitors, K+ sparing |
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What drugs are contraindicated in hypertension plus hyperparathyroidism? |
Thiazide |
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What drugs are contraindicated in hypertension plus Gout? |
Thiazide |
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Uncommon, calcification in the media of the arteries, especially radial or ulnar, usually benign |
Monckerberg (medial calcific sclerosis) |
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"Pipestem" arteries on x-ray , does not obstruct blood fluw; intima not involverd |
Monckerberg (medial calcific sclerosis) |
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Common, two types: hyaline and hyperplastic |
Arteriolosclerosis |
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Thickening of small arteries in essential hypertension or diabetes mellitus |
Hyaline arteriolosclerosis |
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''onion skinning'' as seen in severe hypertension |
Hyperplastic arteriolosclerosis |
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Diseases of elastic arteries and large -and medium-sized muscular arteries |
Atherosclerosis |
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What are the risk factors of atherosclerosis ? |
-Smoking -Hypertension -hyperlipidemia -Diabetes -Age -Sex -Family history |
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What are the complications of atherosclerosis ? |
-Aneurysms -Ischemia -Infarcts -Peripheral vascular disease -Thrombus -Emboli |
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What are the locations of atherosclerosis? |
Abdominal aorta>coronary artery>popliteal artery>carotid artery |
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Progressive onset of CHF over many years due to chronic ischemic myocardial damage |
Chronic ischemic heart disease |
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What is the progression of atherosclerosis disease ? |
Endothelial cell dysfunction-->macrophage and LDL accumulation-->foam cell formation-->fatty streaks---> smooth muscle cell migration, proligeration, and extracellular matrix deposition--->fibrous plaque-->complex atheromas |
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Localized pathologic dilation of the aorta, may cause pain, which is a sing of leaking, dissection or imminent rupture |
Aortic aneurysms |
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Associated with atherosclerosis, present as pulsating mas in the abdomen, occurs mor frequently in hypertensive males smokers >50yr |
Abdominal aortic aneurysm |
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Associated with cystic medial degeneration due to hypertension or marfan syndrome, also historically associated with 3rd syphilis |
Thoracic aortic aneurysm |
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SA and AV nodes are usually supplied by |
Right coronary artery |
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Right dominat circulation is due to |
Posterior descending /interventricular artery aries from right coronary artery |
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Codominant circulation is due to |
Posterior descending /interventricular artery aries from both Left circumflex and right coronary artery |
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Coronary artery occlusion most commonly occurs in the |
Left anterior descending artery |
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Coronary blood flow peaks in |
Early diastole |
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Supplies posterior 1/3 of interventricular septum and posterior walls of ventricles |
Posterior descending /interventriucular artery |
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supplies right ventricle |
acute marginal artery |
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Supplies anterior 2/3 of interventricular septum, anterior papillary muscle, and anterior surface of left ventricle |
Left anterior descending artery |
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Supplies lateral and posterior walls of left ventricle |
Left circumflex coronary artery |
