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178 Cards in this Set

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what is the definition of heart failure?

the inability of a heart to maintain adequate perfusion of the tissues (co) with a normal filling pressure

what is systolic dysfunction?

impaired emptying due to impaired contractility or increased afterload

what is impaired ventricular relaxation or obstruction to filling?

dystolic dysfunction

what can cor pulmonale be caused by?

right sided heart failure

what does renin convert angiotensinogen to?

angiotensin 1

what does ACE convert?

angiotensin 1 to angiotensin 2

what stimulates the production of renin from the kidney?

reduced renal artery pressure caused by decrease in CO and increased renal sympathetic tone due to the baroreceptor reflex

what does angiotensin 2 do?

vasoconstrict, stimulates adrenal glands to produce aldosterone which stimulates kidney to reabsorb NA+

what is BNP (b type naturetic peptide) produced by?

failing myocardium

what does vasopressin do?

increases the retention of water and constricts blood vessels



what does venoconstriction cause?

increased filling pressures

what does vasconstriction cause?

increased afterload

what does increased RV filling pressure lead to?

peripheral oedema

what does increased LV filling pressure lead to?

pulmonary oedema

what does pressure overload lead to?

concentic hypertrophy, sacromeres added in parallel

what does volume overload lead to?

eccentric hypertrophy, sarcomeres added in series

why does heart failure lead to odoema?

increased venous pressure leads to an increase in capillary pressure and salt and water retention leads to a decrease concentration of proteins in the blood so doesnt draw the water from the fluid back in

what is tachyapnea?

increased breathing

what murmur do you get in left sided heart failure?

tricuspid regurgitation

what causes the kidney to release renin?

decreased renal perfusion

what kind of heart failure can anaemia and pagets disease cause?

high output heart failure

what does pericardial constriction cause?

diastolic dysfunction

is digitoxin lipophilic or hydrophilic?

lipophilic

what do cardiac glycosides inhibit?

Na/K ATPase

why does inhibiting the Na/K ATPase lead to increased cardiac function?

increases Na in the cell so increases ca in the cell via the Na/Ca exchanger

what do cardiac glycosides deacrease?

AV conduction and Rate

how are dobutamine and dopamine given?

IV

what do milrinone and Amrinone inhibit?

cAMP phosphodiesterase

what is fursemide?

loop agent

what do amiloride and spirononlactone spare as diuretics?

K+

what do thiazides do on VSM?

vasodilate

what are the side effects of thiazides?

K loss and hypotension

where do loop agents work?

thick asending loop of henle

what do loop agents inhibit?

na/k/2cl transporter

what does spironolactone antagonise?

aldosterone

what do amiloride or triamterene, the k sparing agents block?

na channel in kidney

what do captopril and enalapril inhibit the production of?

angiotensin 2

what does lostartan block?

angiotensin 2 receptor

what can cause a t wave inversion and a depressed ST?

unstable angina

what can cause an elevated ST?

MI

where is the tear in an aortic aneurysm?

through the tunica intima into the tunica media

where does an aortic dissection radiate to?

back between the shoulder blades

where does the air go in a collapsed lung?

pleural space

where are M2 receptors found and what is their action?

cardiac muscle, decrease HR and contractility

where are M3 receptors found and what is their action?

VSM, vasodilate due to production of NO

what is the action of Verapamil?
antagonist of L type calcium channels

why does adrenaline have more effect on cardiac force and contractility than noradrenaline?

noradrenaline agonises alpha receptors more strongly so acts on alpha 1 causing vasoconstriction of the coronary arteries decreasign flow

what is the effect of serotonin on vsm?

vasoconstricts

what does prazosin do?

a1adrenoreceptor antagonist

what does phenylephrine do?

a1 agonist

what is dobutamine?

b 1 agonist, for cadiogenic shock

what does digoxin inhibit?

na/k atpase

which autonmic NS dominates at rest?

parasympathetic

what is the normal stroke volume at rest?

4-8l per min

what is stroke volume and what is the normal amount?

stroke volume is the amount of blood pumped out in 1 beat and the normal amount is 55-100ml

what are the 3 main dterminant of stroke volume?

preload afterload and contractility

what is the intrinsic regulation of SV?

starlings law

what is angiotensin mainly produced by

the liver

what are the actions of prostacyclin and NO?

vasodilators and inhibit platelet aggregation

what is myocardial stunning?

prolonged isheamia, prolonged systolic dysfunction despite the restoration of blood flow only gradually begins to regain contractile force

how is heparin (anticoagulant) administered?

IV

what do stretokinase and tPa cause?

conversion of plasminogen to plasmin

what is the main side effect of thrombolytics?

strokes

how do you estimate a patients HR form an ECG?

300/no. of squares between the Rs

what does heparin inhibit?

factor Xa

what does TNKtpa do?

convert plasminogen to plasmin


what does aminodarone and lidocaine do?

1b antiarrhymic, na channel blocker

what is the central processor for the baroreceptor reflex?

vasomotor centre in the brain stem

what is the effector mechanism in the baroreceptor reflex?

TPR

what happens to intrathoracic pressure during inspiration?

gets more negative which fills central veins

what is c wave?

ventricular contraction

what is x wave?

atrial relaxation

what does a chonotrophic agent affect?

HR

what do endothelin and serotonin cause?

vasoconstriction

how does no cause vasodilation?

stimulates g c in VSM which increases cgmp levels

what activates no synthase?

ca2+, calmodulin

what activates e nos without ca just by stress?

pkb

what does sildedenafil inhibit?

phosphodiesterase which converts cgmp back to GMP so promoting vasodilation

what does cgmp activate?

pkg which reduces ca causing relaxation

what does pkg activate?

myosin light chain phosphotase, takes of phosphate from MLCK making it inactive and activates ca pump on SR making more ca go into the SR

what causes inactivation of no syntase in oxidative stress?

becomes oxidised (in hypertension etc)

what causes the plateau phase in the san action potential?

ca2+ channels

where are the valves attached?

endocardium

what does ANP act on?

kidney

what is flow equal to?

change is pressure/resistance in vessles but flow (co) is MAP/TPR in whole circulation

what does pressure overload lead to?

concentric hypertrophy

what does volume overload lead to?

eccentric hypertrophy

what is the structure of the capillaries in the kidney or gut?

large pores and fenestrated

what is the structure of the capillaries like in the spleen or liver?

discontinous, no tight junctions and wide spaces between cells

what is rate of diffussion proportional to?

solute permeability x surface area x concentration gradient/ thickness

what parts of the autonomic NS cause a change in diastolic BP?

only sympathetic

why does the cardiac tissue get less perfusion when we age?

stiffer arteries mean reduced time in diastole

where is vasopressin stored?

posterior pituatory

what does losartan block?

angiotensin 2

what do minoxidil and pinacidil activate?

k+ channels, hyperpolarises cell

what do thiazsides block?

na/cl- symporter, vasodilate

what inhibits aldosterone?

spirolactone

what do guanethidine and guanabedrel inhibit?

ganglion blockers

what is the effect of potassium levels with ace inhibitors?

increases

what kind of blood vessels are the aortic and pulmonary vessels?

elastic arteries

what does adenosine and oestrogen and progesterone cause?

vasodilation

where soes vasopressin not work?

coronary or cerebral vessels

what does isotartan antagonise


?

angiotensin 2 (no cough)

what is the bayliss effect?

stretch of the muscle opens a stretch activated ion channel which results the the cells becvoming depolarised which results in a ca2+ influx causing contraction

From which artery is blood pressure most commonly measured when using the auscultation technique?

brachial

Why was the value of systolic blood pressure obtained by palpation (feeling the pulse) not considered to be sufficiently accurate?
The correct answer is: Because the use of palpation of the pulse leads to an underestimate of systolic blood pressure
What cardiovascular variables are adjusted by the autonomic nervous system in order to increase blood pressure in the short term, for example in the seconds after rising up from a recumbent position?
Decreased arteriolar calibre, Increased heart rate, Venous constriction

what are the first line drugs for heart failure?

ace inhibitors

what effect do non specific b blockers have on vsm?

vasoconstriction

what side effects can a1 antagonists such as prazosin cause?

reflex tachycardia, stimulation of the kidneys

give some examples of potassium channel activators

Minoxidil Pinacidil

what drugs for hypertension can lead to hirtuism and na+ and water retention ?

potassium channel activators

what are Clonindine, Guanabenz Guanfacine?

a2 agonists

where is methyl dopa carboxylated?

liver

Guanethidine Guanedrel are blockers of what?

ganglion (dont cross BBB)

what is Verapamil used for?

arrhymias, l type channel ca blocker

what is Diltazem?

a benzothiazapine, l type channel blocker for angina

what are the dihydropyridines selective for?

vascular tissue

what are Furosemide, Bumetamide, Etacrynic Acid?

loop diuretics, block na+/k+and 2cl- transporter so na gets lost with k

what do thiazides e.g Chlorthalideone block?

the na/cl- transporter in the DCT, used for hypertension

what do AmilorideTriametrineSpironolactone spare?

potassium

what are Cholestryamine and Colestipol?

bile acid sequestrants

how do cardiac glycosides affect the heart?

they have positive iontopism but negative chonotropism (increase heart contractility but decrease rate) inhibit the na/k exchanger so increases calcium inside the cell because less na gets extruded causing depolarisation but negative chonotropism becuase it decreases the AVN conduction rate

what drugs can be used for WPW syndrome?

cardiac glycosides as decrease avn conduction rate

what do you treat an overdose of cardiac glycosides with?

lidocaine (na channel blocker)

how are phosphodiesterase inhibitors administered?

IV

what effects do phosphodiesterase inhibitors have on the heart?

increase contractility because an increase in camp activates PKA which increases ca

what effects does phosphodiesterase inhibitors have on VSM?

relaxation because it causes SR to take up more calcium

what does warfarin inhibit?

carboxylation of glutamate residues

what does heparin activate?

antithrombin 3

what is the action of clopigrel?

p2y12 inhibitor (ADP antagonist)

what do Abcximab and Tirfiban inhibit?

2b/3a inhibitors

what does streptokinase activate?

plasminogen

when do the av valves shut?

ventricular depolarisation

when is the ejection phase?

ST segment

when is atrioventricular conduction?

pr segment

when is ventricular depolarisation?

qrs

when is atrial depolarisation?

p wave

which wave do you get with hypokalaemia?

u wave

what is raised and low is cardiogeneic shock?

cvp raised but CO low

what kind of shock is cardiaac tamponade?

obstructive heart compressed by pericardial effesuion

what is decreased in distributive shock?

cvp, due to decreased peripheral resistance

what is decreased in hypovoleamic shock?

cvp and co

what does ranolazine block?

late na entry

what does NO stimulate?

gc which increases cgmp which activates PKG which activates myosin light chain phosphatase so phosphate is taken of and muscle relaxes

how are b blockers 241 in glaucoma?

reduces aq humour secretion

what does ca bind to contract smooth muscle?

calmodulin

what do fibrates do?

increase oxidation of fats in the liver

what is a side effect of bile acid binding resisins?

malabsorbtion of lipid soluble vitamins and drugs

what is early after depolarisation due to?

not enough potassium current so another AP takes off

what is delayed after depolarisation due to?

spontaneuos calcium release in cell because the sr has been overloaded with calcium which is pumped out by the na/ca exchanger whivh produces inward current causing depolarisation

what does mg block?

calcium

when does quinidine bind to na channels?

when they are inactve

what is amiodarone?

k channel blocker

what is dilitazem?

ca channel BLOCKER

what is syncope?

interuption of conciousness

what causes the carboxyglutamic residues in the liver to get reduced?

oxidation of k

what affect does aspirin have on warfarin?

displaces warfarin from plasma proteins

what do you use anticoagulants for?

veins as mostly fibrin in veins

what do you anti platelet drugs for?

arteries

how do platelets bind to collagen?

VWF

which factor does trauma activate?

7

what do platlets release in response to binding to colagen?

ADP and thromboxane

what allows prothrombinase to bind to activated platelets?

phosphatidyl serine produced by platlets

what does thrombin cleave?

fibrinogen to fibrin

what cleaves prothrombin to thrombin?

xa

what does TFPI compete with?

factor xa and v11a

what do urokinase and TPA activate?

the conversion of plasminogen to plasmin which breaks down fibrin

what charge is phsphidyl serine

negative

what does tissue factor from a complex with?

factor 7

what does the intact endothelium express to discourage thrombosis?

sulphates mucopolysaccaharides, negative charge

what do tje aplpha granules in platlets contain?

pdgf and fibrinogen

what do the dense bodies in platlets contain?

ADP, ca and 5ht

equation linking co and sv?

co=svxhr

what is a thril?

palitatable murmur, indicative of valve incompetence

which antiarrhymic classess of drugs target the myocardium?

1+3

which antiarrhymic class drugs taget the nodes?

2+4

is diastolic pressure higher in the ventricles or aorta?

aorta because no elastcicity