Term
| What provides a smooth surface for blood to flow against? |
|
Definition
|
|
Term
| What is the BV endothelium called? |
|
Definition
|
|
Term
| What is in the adventitia around the arteries? |
|
Definition
| CT, Nerves, small arterioles |
|
|
Term
| Do BV get all of their nutrients from the blood they carry? |
|
Definition
| No, they need additional capillaries to provide their own blood supply |
|
|
Term
| What are the elastic arteries often called? |
|
Definition
|
|
Term
| What are two examples of medium BV? |
|
Definition
| Coronary and renal arteries |
|
|
Term
| Can different types of arteries be susceptible to different types of dx? |
|
Definition
|
|
Term
| Compare arteries to veins |
|
Definition
| Veins have greater diameter, larger lumens, thinner walls. Only some veins have smooth muscle |
|
|
Term
| If the CV system is in a hypertensive state, what will present first? |
|
Definition
| enlarged veins before enlarged arteries |
|
|
Term
| What does the weaker nature of veins leave them prone to? |
|
Definition
| irregular dilation compression and inflammation |
|
|
Term
| What do venous valves do? |
|
Definition
| Fxn as check valves to prevent backflow of blood |
|
|
Term
| What is the diameter of a normal capillary? |
|
Definition
|
|
Term
| How thick are capillaries? |
|
Definition
|
|
Term
| How much capillary surface area is there in 1 cubic inch of tissue? |
|
Definition
|
|
Term
| Are capillaries how pressure or low? Fast or slow blood flow? |
|
Definition
| low pressure; slow blood flow |
|
|
Term
| What are fxn's of the endothelium? |
|
Definition
| permeability, vessel repair, coagulation/clotting, regulates inflammation/cell growth, oxidizes LDL, modulates blood flow |
|
|
Term
| Where is the BV endothelium found? |
|
Definition
| Throughout the entire vascular system |
|
|
Term
| What role do cytokines play with BV endothelium? |
|
Definition
|
|
Term
| What role do growth factors play with BV endothelium? |
|
Definition
|
|
Term
| What is the only vein that has oxygenated blood? |
|
Definition
|
|
Term
| Where is the tricuspid valve? |
|
Definition
| Right atrium --> Right ventricle |
|
|
Term
| Where is the mitral valve? |
|
Definition
| Left atrium --> Left ventricle |
|
|
Term
| What is the sinus rhythm? |
|
Definition
| the rhythm of a normal heart |
|
|
Term
|
Definition
|
|
Term
|
Definition
| <100 BPM, rare compared to tachycardia |
|
|
Term
| What is the coronary artery most commonly affected in MI? |
|
Definition
| left anterior descending artery |
|
|
Term
| What does the SA node control? |
|
Definition
| electrical impulse that coordinates contraction of the heart |
|
|
Term
| What can cause tachycardia? |
|
Definition
| fever, sickness, weakness |
|
|
Term
| What is the cutoff for reduced risk of MI with regards to resting heart rate? |
|
Definition
|
|
Term
|
Definition
| contraction/emptying blood form the heart |
|
|
Term
| Do the left and right sides of the heart contract simultaneously? |
|
Definition
|
|
Term
| What two structures receive blood from the heart? |
|
Definition
|
|
Term
| What is the first heart sound? |
|
Definition
| when the tricuspid and mitral valves close at the beginning of heart contraction cycle |
|
|
Term
| What valves are closed as blood is exiting the heart? |
|
Definition
| mitral and tricuspid valve "MT" |
|
|
Term
| What is the first heart sounds also called? |
|
Definition
|
|
Term
|
Definition
| relaxation/filling of heart with blood |
|
|
Term
| What valves are closed during diastole? |
|
Definition
| pulmonary and aortic valves |
|
|
Term
| What causes the second heart sound? |
|
Definition
| Closing of pulmonary and aortic valves |
|
|
Term
| What is the second heart sound also called? |
|
Definition
|
|
Term
|
Definition
| How much blood is present in the ventricle at the end of diastole (how 'full' the heart is) |
|
|
Term
| What is the Frank-Starling relationship? |
|
Definition
| the elastic stretching of the ventricle due to blood filling it |
|
|
Term
|
Definition
| The force that resists blood flow through the body |
|
|
Term
| What is the main cause of afterload? |
|
Definition
|
|
Term
| What is a high afterload? |
|
Definition
| A less elastic arterial system, greater resistance to blood flow |
|
|
Term
| What is contractility also called? |
|
Definition
|
|
Term
|
Definition
| The ability of the heart muscle to change shape independent of preload/afterload |
|
|
Term
| What can decrease contractility? |
|
Definition
|
|
Term
| What controls contractility? |
|
Definition
| calcium levels and Beta-1 sympathetic system |
|
|
Term
| How much blood per minute can a normal heart move? |
|
Definition
|
|
Term
| What do calcium channel blockers do in the heart? |
|
Definition
| Works on the inner walls of cells, decreases contractility by keeping Ca++ in the cell |
|
|
Term
|
Definition
| cardiac output divided by body surface area |
|
|
Term
| What is a normal cardiac index? |
|
Definition
|
|
Term
| What is a sinus (general definition) |
|
Definition
| Any opening/hollowing/cavity |
|
|
Term
| Can the sinoatrial (SA) node regulate the heart beat? |
|
Definition
|
|
Term
| Can the AV node regulate heart beat? |
|
Definition
| Yes, it tends to only 40-60 bpm, tends to be overruled by faster beating SA node |
|
|
Term
|
Definition
| irregular contraction of heart muscle |
|
|
Term
| Where does the contraction impulse go from the AV node? |
|
Definition
| into the bundle of His --> divides into R and L branches --> purkinje fibers in ventricle wall |
|
|
Term
| What does the sympathetic system innervate in the heart? |
|
Definition
|
|
Term
| How does the sympathetic system affect cardiac output? |
|
Definition
| increases calcium, which increases contractility --> greater output |
|
|
Term
| What does the parasympathetic system innervate? |
|
Definition
| atria via the vagus nerve, little effect on ventricles |
|
|
Term
| What does parasympathetic system do to cardiac output? |
|
Definition
|
|
Term
| What maintains the resting membrane potential of nerve fibers? |
|
Definition
| Na/K ATP pump maintains depolarized (more negative) intracellular state |
|
|
Term
| What leaks faster, Na or K? |
|
Definition
| K leaks out faster than Na leaks in, so it will always be negative inside of cell |
|
|
Term
| What is open when a cell is depolarizing? |
|
Definition
|
|
Term
| What is open when a cell is repolarizing? |
|
Definition
|
|
Term
| What is faster, cardiac or regular neural AP's? |
|
Definition
|
|
Term
| Does the SA node spontaneously depolarize? |
|
Definition
|
|
Term
| What causes the SA node to spontaneously depolarize? |
|
Definition
| natural leakiness to Na+ and Ca++ |
|
|
Term
| What are the types of Ca++ channels in the heart? |
|
Definition
|
|
Term
| What Ca++ channel type is affected stronger by cardiac drugs? |
|
Definition
|
|
Term
| What stays depolarized longer, SA node or cardiac muscle? |
|
Definition
|
|
Term
| What causes slow repolarization of cardiac muscle? |
|
Definition
| Ca++ channels that are slow to close |
|
|
Term
| When can cardiac muscle repolarize? |
|
Definition
| once K+ and Ca++ channels are closed |
|
|
Term
| What opens first in cardiac muscle depolarization? |
|
Definition
| Na+ gates first, Ca++ second |
|
|
Term
| Compare cardiac and skeletal muscle |
|
Definition
| cardiac cells are smaller than skeletal, cardiac cells are connected via gap jxn's, all cardiac muscle cells share neural stimulation --> firing at the same time |
|
|
Term
| How many syncytia are found in the heart? |
|
Definition
|
|
Term
| Where are the syncytia found in the heart? |
|
Definition
|
|
Term
| What is the term for blocks of cardiac cells that fire together due to gap jxn's? |
|
Definition
|
|
Term
| Do ions move easier in cardiac or skeletal muscle? |
|
Definition
|
|
Term
| What can induce Ca++ release in a cardiac muscle cell? |
|
Definition
| Initial Ca++ entering cell causes sarcoplasmic reticulum and mitochondria to release Ca++ |
|
|
Term
| If Ca++ cannot leave cardiac muscle, what happens? |
|
Definition
|
|
Term
| What is seen in the unbound [Ca++] when contractility is increased? |
|
Definition
|
|
Term
| Do Ca++ channel blockers completely stop Ca++ flow? |
|
Definition
|
|
Term
| How is Ca++ removed from the cell? |
|
Definition
| Sodium/Calcium exchange, calcium is taken up by the sarcoplasmic reticulum and mitochondria |
|
|
Term
| What is the prevalence of CVD death in the US? |
|
Definition
|
|
Term
| How much does CVD depress life expectancy? |
|
Definition
|
|
Term
| At what ages does cancer overtake CVD for #1 cause of death? |
|
Definition
|
|
Term
| What ratio of pt's wil present with some form of CVD? |
|
Definition
|
|
Term
| Are males or females more likely to die from CVD? |
|
Definition
| Both are equally likely, CVD is the # killer of both sexes |
|
|
Term
| Where do women present with heart dx s/sx? |
|
Definition
|
|
Term
| Which arm is more likely to present pain during a cardiac event? |
|
Definition
| left arm, but both can present it |
|
|
Term
|
Definition
| a short term loss of consciousness |
|
|
Term
| What are the most important s/sx of heart dx? |
|
Definition
| jaw, back, dyspnea, nausea and vomiting (n&V) |
|
|
Term
| What ocular findings increase risk of CVD? |
|
Definition
| ARMD, retinopathy (diabetic or non) |
|
|
Term
| What is the increased prevalence of CVD in ARMD? |
|
Definition
| 2x higher death rate from CVD |
|
|
Term
| What is the increased prevalence of CVD in retinopathy? |
|
Definition
| 2-6x higher chance of heart dx |
|
|
Term
| What can CVD cause in the eye? |
|
Definition
| TIA, central retinal vein occlusion (CRVO), ocular ischemic syndrome (carotid blockage) |
|
|
Term
| Name two CV meds than can cause adverse ocular rxns |
|
Definition
|
|
Term
| What ocular med can cause stroke? |
|
Definition
|
|
Term
| What can require AB prophylaxis? |
|
Definition
| some optometric procedures if the pt also has CVD |
|
|
Term
| What is a typical biochemical sign of MI |
|
Definition
| serum enzyme levels increase |
|
|
Term
| What three enzymes can indicated MI? |
|
Definition
creatine phosphokinase
Lactate dehydrogenase
troponin I |
|
|
Term
|
Definition
| creatine phosphokinase - myocardial band |
|
|
Term
| What is the onset of increased CK-MB? |
|
Definition
|
|
Term
| What can cause LDH-1 serum levels to increase? |
|
Definition
|
|
Term
| What is the peak of CK-MB serum levels |
|
Definition
|
|
Term
| When is CK-MB back to normal after MI |
|
Definition
|
|
Term
| What is the onset of increased LDH-1 after MI? |
|
Definition
|
|
Term
| When I the peak of LDH-1 levels after MI? |
|
Definition
|
|
Term
| When does LDH-1 drop back to normal after a MI? |
|
Definition
|
|
Term
| When does troponin I increase after MI? |
|
Definition
|
|
Term
| What is the peak of troponin I levels after MI? |
|
Definition
|
|
Term
| When does troponin I levels return to normal after a MI? |
|
Definition
|
|
Term
| How many waves are in a normal ECG |
|
Definition
|
|
Term
| What is the 'P' wave in an ECG? |
|
Definition
| atrial cell depolarization |
|
|
Term
| What is the 'QRS' wave in an ECG? |
|
Definition
|
|
Term
| What is the 'T' wave in an ECG? |
|
Definition
| ventricular repolarization |
|
|
Term
|
Definition
| measure of AV conduction time |
|
|
Term
| What is cardiac catheterization? |
|
Definition
| insertion of a thin flexible tube into a vein (often femoral) or artery, which is guided into the heart |
|
|
Term
| What can cardiac catheterization detect? |
|
Definition
| BP and patterns of blood flow; cardiac output in general |
|
|
Term
| How is angiography contrast introduced? |
|
Definition
|
|
Term
| What image is taken in contrast angiography? |
|
Definition
|
|
Term
| What is monitored in a cardiac stress test? |
|
Definition
|
|
Term
| What changes during cardiac ischemia during a stress test? |
|
Definition
|
|
Term
| What is echocardiography? |
|
Definition
| ultrasound scan of the heart, measures structure and movement of heart |
|
|
Term
|
Definition
| Multiple gated acquisition scan |
|
|
Term
| What is measured in a MUGA scan? |
|
Definition
| left ventricular wall motion and ventricle ability to eject blood |
|
|
Term
| What is the stress thallium test commonly known as? |
|
Definition
|
|
Term
| What is administered in the DIP-thal test |
|
Definition
| Thallium 201 is injected into the vein |
|
|
Term
| What does the DIP-thal test measure? |
|
Definition
| How much thallium is taken up by myocardial tissues, dead tissues absorbs it poorly |
|
|
Term
|
Definition
| a region of dead or scarred heart tissue of compromised fxn |
|
|
Term
| What does Na/K pump inhibition cause? |
|
Definition
slower conduction through AV node
increased contractility due to increased intracellular [Ca++] |
|
|
Term
| What are the visual side effects of Na/K pump inhibition? |
|
Definition
| blurred vision, altered color perception (blue tinged), haloes on dark objects |
|
|
Term
| When are visual side effects of Na/K pump inhibition most common? |
|
Definition
| overdose of related drugs |
|
|
Term
|
Definition
Decreases contractility through decreased influx of Ca++ into cardiac muscle
Delays removal of Ca++ from pacemaker cells |
|
|
Term
| What is the mechanism of Verapamil? |
|
Definition
| slows heart rate by interfering with SA and AV repolarization |
|
|
Term
| What cardiac meds interfere with the ANS? |
|
Definition
|
|
Term
| What do Beta blockers inhibit? |
|
Definition
|
|
Term
| What drug can slow conduction time and should not be used in severe heart block pt's? |
|
Definition
|
|
Term
| What do beta blockers do to heart activity? |
|
Definition
| decrease heart rate, decrease contractility |
|
|
Term
| What is a retinal macro aneurysm? |
|
Definition
| HTN causes outpouching of BV in the eye |
|
|
Term
| What can cause retinal emboli? |
|
Definition
|
|
Term
| what can increase the risk for diabetic retinopathy? |
|
Definition
|
|
Term
| What can incrase the risk for ARMD? |
|
Definition
|
|
Term
| What % of US population with HTN, is unaware they have HTN? |
|
Definition
|
|
Term
| What % of US population with HTN is controlling it well? |
|
Definition
|
|
Term
| What % of HTN cases are in 3-18 yo? |
|
Definition
|
|
Term
| What % of caucasians have HTN? |
|
Definition
|
|
Term
| What % of african americans have HTN? |
|
Definition
|
|
Term
| What are major risk due to HTN? |
|
Definition
| stroke, heart failure, kidney failure |
|
|
Term
| What is the second most common cause of preventable death in the US? |
|
Definition
| HTN (smoking is #1, but falling; obesity is rising as well) |
|
|
Term
|
Definition
| Joint Council: A group that creates guidelines for care and have highlighted HTN as a focal point of medicine across disciplines |
|
|
Term
| What are HTN risk factors that are not pt controllable?? |
|
Definition
| Family history, gender, age, menopause |
|
|
Term
| What are HTN risk factors that are pt controllable? |
|
Definition
| obesity, dyslipidemia, alcohol abuse, sedentary lifestyle, smoking, lack of sleep, low Vit D may be involved, medication, DM |
|
|
Term
| What can cause BP to change through the course of a day? |
|
Definition
| Morning/Evening, level of anxiety, recent activity, caffeine intake |
|
|
Term
| What is the minimum standard before diagnosing HTN? |
|
Definition
| must average 2 or more properly performed BP reading |
|
|
Term
| Describe a properly performed BP reading |
|
Definition
| pt must be seated, must average 2 different readings on EACH of TWO different office visits |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| When should BP be rechecked in 2 years? |
|
Definition
|
|
Term
| When should BP be rechecked in 1 year w/ lifestyle modification discussion? |
|
Definition
|
|
Term
| When should BP be referred to PCP within 1 mo? |
|
Definition
|
|
Term
| When should BP be referred to PCP within 1 week? |
|
Definition
|
|
Term
| When should BP be referred to PCP within a few hours to 1-2 days? |
|
Definition
>220/>120; 1-2 days if no end organ effects
Refer within a few hours if end organ effects are present |
|
|
Term
| What are end organ effects for the heart? |
|
Definition
| Risk of CVD doubles for EACH increment of 20/10 mmHg above 115/75 mmHg |
|
|
Term
| What CV risk increase with HTN? |
|
Definition
| atherosclerosis, coronary artery dx, heart failure, left ventricular hypertrophy, MI |
|
|
Term
| What is more important for diagnosing HTN, systolic or diastolic BP? |
|
Definition
| systolic > 140 mmHg in individuals over 50 is the most important benchmark |
|
|
Term
| What ethnicity has a greater risk for HTN related mortality? |
|
Definition
|
|
Term
| If BP is >160 mmHg, what is the risk of stroke? |
|
Definition
| 4x greater than with normal BP |
|
|
Term
| What neurological disorder increases in prevalence with HTN? |
|
Definition
|
|
Term
| What % of HTn related deaths are from CVA's? |
|
Definition
|
|
Term
| Having high BP in their 50's increases the chance of what dx later in life? |
|
Definition
|
|
Term
| What is an end organ effect of the kidney? |
|
Definition
atherosclerosis, of renal arteries --> ischemia
nephrosclerosis |
|
|
Term
| What is an end organ effect of the eye? |
|
Definition
retinopathy
swelling of ONH |
|
|
Term
| How many s/sx of end organ effects must a pt present to be diagnosed with an end organ effect? |
|
Definition
|
|
Term
| What is an end organ effect of the CV system? |
|
Definition
|
|
Term
| For a pt under 18, to what increment should their age be defined? |
|
Definition
|
|
Term
| Is a child's height taken into account for BP measurement? |
|
Definition
|
|
Term
| What is a child's height used to calculate for BP readings? |
|
Definition
| height percentile for their age |
|
|
Term
| What percentile is Pre-HTN in a minor? |
|
Definition
| <90th percentile, >95th percentile OR BP >120/>80 mmHg |
|
|
Term
| What percentile is HTN Stg 1 in a minor? |
|
Definition
| >95th percentile --> 5 mm above the 99th percentil |
|
|
Term
| What percentile is HTN stg 2 in a minor? |
|
Definition
| >5mmHg above the 99th percentile |
|
|
Term
| What influences peripheral CV resistance? |
|
Definition
tunic media in arterioles --> vessel size, elasticity Alpha-1 increases vasocontriction in sympathetic stimulation
Blood viscosity |
|
|
Term
| What factors affect cardiac output related to HTN? |
|
Definition
blood volume: renin increases from Beta-1 symp. Stimulation --> higher BP
Beta-1 increases heart rate |
|
|
Term
| When are medications prescribed for minors with HTN? |
|
Definition
| only when compelling indications are present, OR they are HTN Stg 2 |
|
|
Term
| How often should a minor's BP be rechecked if pre-HTN? |
|
Definition
|
|
Term
| How often should a minor's BP b rechecked if HTN Stg 1? |
|
Definition
| 1-2 weeks, if shows up high in 2 subsequent visits, refert within 1 mo to PCP |
|
|
Term
| How often should a minor's BP be rechecked if HTN Stg 2? |
|
Definition
| Refer within 1 week or immediately if symptoms |
|
|
Term
| When should weight-management counseling be discussed with a minor? |
|
Definition
| If at Pre-HTN stage or higher |
|
|
Term
| What CV parameters are use in feedback regulation? |
|
Definition
baroreceptors in carotid sinus (these are fast almost immediate); juxtaglomelular cells in kidney are slower acting (20 min)
Serum osmolarity, if [Na+] is high body retains water to lower it
Increased CO2 and H+ --> body assumes inadequate tissue perfusion --> increases sympathetic brain STEM activity |
|
|
