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Heart Lung and Kidney > HLK Week 2 > Flashcards

HLK Week 2 Flashcards

1
Q

What limits the ability of a blood vessel to expand and accommodate blood?

A

The connective tissue layer surrounding it.

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2
Q

What are the 4 layers in a blood vessel (not present in all vessels)?

A
  • Endothelial layer
  • Elastic layer
  • Smooth muscle layer
  • Fibrous tissue layer
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3
Q

How does arterial compliance work to accommodate a pressure pulse?

A

Blood exerts a perpendicular pressure on the walls of the artery, which expand to accommodate it and then further propel it forward as the vessel returns to normal. As compliance decreases with age/pathology, pressure in the artery rises.

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4
Q

Total peripheral resistance is determined in large part by what type of vessel?

A

Arterioles

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5
Q

How is resistance related to viscosity and the length and radius of vessels?

A
  • Proportional to viscosity and length

- Inversely proportional to 4th power of radius

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6
Q

What is responsible for most of the control of vasoconstriction in peripheral vascular beds?

A

Neurally secreted norepinephrine acting on alpha receptors

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7
Q

Give an example of how local control can overrule sympathetic activity:

A

Exercising one arm: sympathetic activity is the same throughout the body, but because of local control blood flow is only increased in the muscle being exercised.

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8
Q

Contrast the actions of norepinephrine and epinephrine in regards to smooth muscle activity:

A
  • Neurally secreted norepinephrine acts on alpha adrenergic receptors in peripheral arteries to cause vasoconstriction
  • Epinephrine secreted into plasma by adrenal medulla acts on beta adrenergic receptors in the heart and lungs to cause vasodilation
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9
Q

What two forces drive capillary exchange?

A
  • Diffusion: concentration gradients across capillary wall

- Bulk flow: hydraulic gradients due to pressure differences across capillary wall

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10
Q

What is oncotic pressure?

A

Osmotic pressure due to the presence of colloids in a solution.

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11
Q

What is Starling’s hypothesis?

A

It says that the flow across a capillary wall is proportional to the difference in pressure across the wall. The pressure on each side is a compound pressure made up of hydrostatic and oncotic pressures.

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12
Q

With pitting edema, explain how pushing on a patient’s tissue causes edema to disappear:

A

By pushing on the tissue, you increase the tissue pressure, which forces fluid back into the veins. This is why compression stockings are recommended for people with edema.

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13
Q

What two things do cardiovascular homeostasis mechanisms preserve blood flow to above all others?

A

Brain and kidneys

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14
Q

In terms of improving cardiac function, which is more important to treat, preload (through diuresis) or afterload (through SBP reduction)?

A

Afterload. LV performance is afterload dependent but relatively preload independent.

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15
Q

In patients with CHF, what category of hemodynamic status is correlated with poor outcomes?

A

Both cold (low perfusion) types: cold and wet (volume overload but still low output) or cold and dry (volume depleted with low output).

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16
Q

True or false: In patients with CHF, both Digoxin and diuretics (with the exception of aldosterone inhibitors) are good for keeping patients out of the hospital but don’t reduce mortality.

A

True

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17
Q

Which classes of HF drugs reduce mortality?

A
  • Beta blockers
  • ACE’s/ARB’s
  • Aldosterone inhibitors
  • Combination Hydralazine and Isordil
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18
Q

Describe the use of beta blockers in CHF:

A
  • Never use in cold & wet patients
  • Only use in warm & dry patients
  • In the long term, improves long term ventricular responsiveness to adrenergic stimulation
  • Shields cardiac muscle from long term effects of norepinephrine
  • Improves LV performance and reduces mortality
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19
Q

What sort of patient would combination Hydralazine and Isordil be good for in reducing mortality?

A

African Americans

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20
Q

Mesenteric ischemia:

A

Should be suspected in elderly, atherosclerotic patients complaining of frequent indigestion.

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21
Q

Amaurosis fugax:

A

Temporary blindness causes by thromboembolism in the carotid artery that ends up in the arterioles feeding the eye.

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22
Q

SSx of chronic arterial insufficiency:

A
  • Intermittent claudication
  • Sparse or absent distal leg hair
  • Dependent rubor
  • Distal ulceration
  • Diminished or absent pulses
  • Delayed capillary refill with thickened nails
  • Cool extremities
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23
Q

Drug tx for arterial insufficiency:

A
  • Aspirin or Clopridogrel as anti-platelet therapy
  • Rheologic modifier such as Pentoxifylline to decrease viscosity and platelet adhesion
  • Phosphodiesterase inhibitor such as Cilostasol to suppress platelet activation and increase vasodilation
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24
Q

SSx of acute arterial insufficiency:

A
  • 50% have severe, unrelenting leg pain
  • 50% have insidious onset of pain over several hours
  • Compartment syndrome (remember the 5 P’s)
25
Q

5 P’s of compartment syndrome:

A
  • Pain
  • Pallor
  • Paresthesias
  • Pulselessness
  • Paralysis
26
Q

Thromboangiitis obliterans:

A
  • AKA Buerger’s Disease
  • Occlusive inflammatory disease of small/medium distal arteries of extremities
  • Prevalence higher in men from southeast Asia, India and Japan who smoke
27
Q

SSx of Buerger’s disease:

A
  • Most of the SSx of chronic arterial insufficiency, occurring in upper as well as lower extremities
28
Q

Biggest non-genetic risk factor for developing varicose veins:

A

Pregnancy

29
Q

How is the Trendelenberg test used in the workup of varicose veins?

A
  • Used to distinguish superficial venous insufficiency due to saphenofemoral valve incompetence from perforator vein incompetence
  • Compress saphenous vein with leg elevated, then have patient stand while maintaining compression
  • If varicosities return, problem is perforator incompetence
30
Q

Describe Virchow’s triad:

A
  • Stasis, hypercoagulability and vessel damage

- = increased risk of phlebitis

31
Q

What is Trousseau’s sign (of malignancy)?

A

Superficial migratory thrombophlebitis, often occurring in unusual locations, that may be the 1st indication of a cancer, esp. pancreatic and lung cancer

32
Q

What’s the DDx for chest pain in the primary care setting?

A
  • ~1.5 % MI or ACS
  • 20 % chest wall pain
  • 13 % reflux esophagitis
  • 13 % costochondritis
  • Other systems (GI, pulmonary, psych, CV)
33
Q

What is the definition of likelihood ratio?

A

It’s the ratio of true positives to false positives

34
Q

What kinds of surgery do not require interruption of anticoagulant therapy?

A
  • Dental, dermatologic or ophthalmologic surgeries, which are considered minor risks for bleeding
  • All others are considered major risks for bleeding.
35
Q

What is the MOA of vorapaxar?

A

Blocks thrombin receptors on platelets

36
Q

Indication for Aggrenox (ASA + ER dipyrimadole)

A

To prevent recurrent stroke in patients who have had a TIA or ischemic stroke

37
Q

What is the MOA of aspirin?

A

Irreversibly blocks thromboxane A2 production in platelets, decreasing their ability to aggregate.

38
Q

What would you expect to see on exam of a patient with myocarditis?

A
  • Tachycardia
  • Pleural or pericardial chest pain
  • Gallop
  • Signs of HF
  • Conduction defects
  • Cardiomegaly
  • Pulmonary edema/hypertension
39
Q

On exam, pericardial rub, dyspnea, and chest pain that is worse when supine would indicate:

A

Pericarditis

40
Q

How would you treat myocarditis?

A
  • NSAIDS for pain
  • Abx for pathogen, if identifiable
  • ACE/Beta blocker if left ventricular EF is less than 40%
41
Q

What’s the typical patient population for congenital bicuspid-related aortic stenosis?

A

Male, 40’s to 60’s

42
Q

Which type of murmur is typically associated with a “crescendo-decrescendo” sound?

A

Aortic stenosis

43
Q

Murmur due to aortic stenosis:

A
  • Opening click just after S1

- Followed by crescendo decrescendo murmur

44
Q

Murmur due to mitral regurgitation:

A
  • Murmur begins at S1

- Followed by holosystolic murmur

45
Q

Murmur due to mitral valve prolapse:

A
  • Mid systolic click

- Followed by flat murmur

46
Q

Murmur due to aortic regurgitation:

A
  • Murmur begins at S2

- Followed by decrescendo only murmur

47
Q

Murmur due to mitral stenosis:

A
  • Opening snap
  • Followed by decrescendo with pre-systolic accentuation (due to atrial kick)
  • Described in class as mid diastolic rumble with pre-systolic murmur
48
Q

What physiologic condition is associated with S3?

A

Volume overload (sound made by chordae tendinae tensing due to rapid filling, which in the elderly or sick is due to volume overload)

49
Q

What physiologic condition is associated with S4?

A

Pressure overload (sound made by atrial kick pumping blood into a stiff (due to hypertrophy) ventricle)

50
Q

What is the treatment for hypertrophic cardiomyopathy?

A
  • Beta blockers
  • Septal ablation
  • Myectomy or alcohol injection
51
Q

SSx of acute vs. chronic aortic regurgitation:

A

Acute: patients usually present with HF and shock
Chronic: Sx of HF develop slowly over time

52
Q

Describe the pulse pressure in a patient with aortic regurgitation. How does this affect the carotid pulses?

A
  • Very wide

- Carotid pulses are often very visible

53
Q

Patient population for mitral stenosis:

A

Women in their 40’s and 50’s from developing countries with Hx of rheumatic heart disease

54
Q

Treatment for mitral stenosis:

A
  • Manage A-fib with digoxin
  • Anticoagulate for stroke risk
  • Can do surgery to break apart stenotic valve, with regurgitation as a sequela
55
Q

What other electrolyte must be administered prior to administering calcium or potassium?

A

Magnesium if it’s also deficient

56
Q

Normal ranges for BMP:

A
  • Glucose (65 - 100)
  • Sodium (135 - 145)
  • Potassium (3.5 - 5)
  • Calcium (8.5 - 10.5)
  • BUN (8 - 20)
  • Creatinine (0.8 - 1.4)
  • Bicarb (22 - 27)
  • Chloride (95 - 105)
57
Q

What is the importance of chloride and bicarbonate ions in a BMP?

A

Common anions used to regulate acid base balance and osmotic pressure

58
Q

What is the importance of BUN and creatinine in a BMP?

A

Good indicators of renal function

59
Q

What should you think if you see a patient with profound carotid pulses and a wide pulse pressure?

A

Aortic regurgitation

Heart Lung and Kidney (6 decks)

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