Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiac > Cardiac Lectures > Flashcards

Cardiac Lectures Flashcards

1
Q

What is the outermost layer of the heart?

A

Pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two layers of the pericardium?

A

Fibrous pericardium and serous pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the function of the fibrous pericardium?

A
  1. Forms protective outer layer
  2. Anchors heart to diaphragm / mediastinum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the layers of the serous pericardium?

A
  1. Inner visceral layer (epicardium)
  2. Outer parietal layer (fused to fibrous pericardium)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the potential space between serous pericardial layers called?

A

Pericardial cavity (lubricant, NOT air)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the mitral valve?

A

The bicuspid valve between the left ventricle and atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the fibrous skeleton of the heart?

A

The collagenous rings that surround the atrio-ventricular canals and extend to the origins of the aorta and pulmonary trunks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the purpose of the fibrous skeleton of the heart? (3 reasons)

A
  1. Provides an insulating barrier between the atria and
    ventricles
  2. Anchors the valve cusps (leaflets) to prevent dilation
    of valves
  3. Provides attachment for spirals of myocardium that
    extend towards the apex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the purpose of chordae tendineae and papillary muscles?

A

Prevents inversion of the valves into the atria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How many cusps do semi-lunar valves have?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a valve stenosis?

A

Valve not opening fully

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is valve regurgitation?

A

Valves leaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is endocarditis?

A

Infection or vegetation on the valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What valve is seen in the ‘fish eye’ echo view?

A

Mitral valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which coronary arteries can you see from an anterior view of the heart?

A

Left anterior descending and right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe anatomically how the aorta leaves the heart

A

The aorta leaves the base of the heart and loops posteriorly and to the left behind the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which coronary arteries can you see from the posterior view of the heart?

A

The end of the right coronary artery and the circumflex artery (these join)
- you can also see the coronary sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What structures can you see from the posterior view of the heart?

A

Mainly the left ventricle, right and left atrium, pulmonary arteries and veins, vena cava, aorta and coronary sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the coronary sinus?

A

The major coronary veins, on the posterior side of the heart, located just above the circumflex artery

Drains blood directly to the right atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is the pulmonary artery related to the pulmonary veins from posterior view?

A

The pulmonary artery is above the pulmonary veins (between veins and aorta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What proportion of the myocardium do the epicardial arteries supply?

A

The outer 2/3rds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When does most of cardiac perfusion occur?

A

Diastole, as contraction of cardiomyocytes during systole causes extravascular compression of the arteries

Tachycardia can be concerning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What 3 conditions are under the umbrella term Acute Coronary Syndrome (ACS)?

A
  1. Unstable angina
  2. Non st-elevation MI
  3. ST-elevation MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 3 types of angina?

A
  1. Stable
  2. Unstable
  3. Prinzmetal (variant angina)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the difference between stable and unstable angina?

A

Stable has triggers e.g. exercise or stress and usually stops when resting - caused by fixed atherosclerotic build up

Unstable is unpredictable and can occur at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What structures allow cardiocyte contraction?

A

Myofibrils contract to shorten the sarcomere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the name for the site that joins adjacent cardiomyocytes?

A

Intercalated disks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do action potentials transfer from cell to cell in the myocardium?

A

Through gap junctions and intercalated disks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is cardiac amyloidosis? And what can it cause?

A

Amyloid deposits take the place of cardiomyocytes - causes restrictive heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is Frank-Starking law? And what proportion of blood in the ventricles is ejected each contraction?

A

The heart pumps what it recieves (roughly 2/3rds of the blood in each ventricle each contraction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Explain the heart sounds

A

Lub - sound of AV valves closing (start of systole)
Dup - sound of semi-lunar valves closing (end of systole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 4 different stages of the cardiac cycle?

A
  1. Isovolumetric contraction
  2. Ventricular Ejection
  3. Isovolumetric relaxation
  4. Ventricular filling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Explain ventricular filling

A
  1. Rapid passive diastolic filling
  2. Atria contract
  3. Mitral (and tricuspid) valves close

Coincides with P-wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Explain isovolumetric contration

A

Is the QRS of the ECG, LV starts to contract, all valves are closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is ventricular pre-excitation? And what is it caused by?

A

Early excitation and contraction of the ventricles due to accessory pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is long QT syndrome? And what can it predispose?

A

QT > 450 ms (greater than 2.1 large squares)
(start of Q to end of T)
It can predispose to ventricular arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a normal QT interval?

A

350 - 450 ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How many large ECG squares make up 1 second?

A

5 squares (each square is 200ms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is JVP and why is it useful?

A

Jugular venous pressure - provides an indication of central venous pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What does a raised JVP indicate? And what cardiac causes can elevate JVP?

A

Venous hypertension. Cardiac causes of this include:
1. Right sided heart failure (can often result from COPD or restrictive lung diseases)
2. Tricuspid regurgitation (caused by endocarditis)
3. Constrictive pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What can fine bibasilar crackles indicate?

A

Fluid or mucus build-up in the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What does the bundle of His divide into?

A

Left and right bundle branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What does the left bundle branch divide into?

A

Anterior and posterior fascicle
- anterior goes into LV muscle anteriorly
- posterior goes down the wall into the apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Where do the purkinje fibres originate from?

A

The anterior fascicle and the right bundle branch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Define a P wave?

A

The first deflection of the cardiac cycle. Caused by the atrial contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Define Q

A

Q is the first negative deflection below the isoelectric baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Define T waves?

A

The signal from ventricular repolarisation. Can be negative or positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the U wave? And what is a proposed source

A

A second deflection following the T wave, usually in the same direction. Its source is unknown, but could be due to delayed purkinje repolarisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the J point?

A

Is the junction between QRS and T wave. Is found on all ECGs.

There are many causes of J point deviation from baseline (pathological and not)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the J wave (Osbourne wave) indicative of?

A

Hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the ST-segment?

A

The time between the J point and the start of the T wave. i.e. the time between ventricular depolarisation and repolarisation

  • it should be around 0.08 ms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How long is a normal ST segment?

A

80 - 120 ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which leads indicate lateral ischemia?

A

I, aVL, V5, V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which leads indicate septal ischemia?

A

V1-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which leads indicate anterior ischemia?

A

V3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Which leads indicate inferior ischemia?

A

II, III, aVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How is coronary vasospasm detected on ECG?

A

Very similar to acute STEMI, however is transient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the difference between segments and intervals?

A

Segments are usually end-start
Intervals are usually end-end of features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How do you determine heart rate on ECG if regular?

A

300 / number of large spaces between QRS complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How do you calculate HR from ECG if irregular?

A

Number of complexes in 6 seconds (30 large squares) X 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the standard calibration of an ECG?

A

10mm (10 small squares) = 1mV
25mm/second

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the colours of standard 4 electrode ECG?

A

Right arm = red
Left arm = yellow
Left ankle = green
Right ankle = black

These are the same for the 12-lead ECG as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Where are V1 and V2 positioned?

A

4th intercostal space, either side of the sternum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What does right or left arm reversal do to the ECG?

A

It completely inverts it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the maximum value for PR interval?

A

120 - 200 ms (one large square)
PR interval should be constant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the PR interval?

A

From the start of the P wave to the start of the QRS (Q)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is usually the lowest bpm in bradycardia?

A

40 bpm
(If lower, consider heart block)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How does inspiration and expiration impact HR?

A

Inspiration increases HR
Expiration decreases HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is sinus arrhythmia?

A

Regularly irregular heart rate - can be caused by breathing
(uncommon after the age of 40)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the difference between atrial fibrillation and atrial flutter?

A

QRS complexes are usually regular in flutter. Saw-tooth flutter waves are seen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is ventricular tachycardia? And how does it appear on ECG

A

Broad QRS complex, HR > 120 bpm, independent P waves. Usually >3 beats (this would be ventricular ectopics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How long does each of the 12 ECG leads show? And how long does the rhythm strip show?

A

Each lead shows 2.5 seconds and the rhythm strip shows 10s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What is a normal PR interval?

A

3 - 5 small squares (120 - 200ms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Describe first degree heart block?

A

Long PR interval >200ms
(Q comes home late)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Describe 2nd degree Wenkebach (Mobiz 1) heart block?

A

PR interval gets progressively longer, then skips a QRS, then comes early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Describe Mobiz type 2 heart block

A

PR stays the same but the heart irregularly skips beats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is 3rd degree heart block?

A

P and QRS are completely independent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is ventricular pre-excitation?

A

Wide QRS with delta wave, short PR interval, secondary T wave changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What causes ventricular pre-excitation?

A

Accessory pathways (e.g. Wolf-parkinson white syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

How do statins lower cholesterol?

A

Block conversion of acetate to cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are 3 main types of cholesterol lowering drugs?

A

Statins, PCSK9 and Ezetimibe (less common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Name some common blood pressure medications?

A
  • Ca channel blockers
  • ACE inhibitors
  • Angiotensin-2 blockers
  • diuretics
  • beta blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is ‘bad cholesterol’?

A

Low density lipoprotein (LDL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Are pulses present in capillaries?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is systolic pressure?

A

The pressure created by the heart as it pumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is diastolic pressure?

A

The pressure remaining in the vessels during cardiac relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is pulse pressure?

A

The difference in systolic and diastolic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the usual ratio of Sys BP : Diast BP : PP?

A

3 : 2 : 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is mean arterial pressure?

A

Arterial pressure averaged over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Is mean arterial pressure closer to systolic or diastolic pressure?

A

Diastolic pressure - twice as long is spent in diastole than systole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

How much lower are female BPs than male on average?

A

Around 8 - 10 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Where should the stethoscope be placed for taking manual blood pressure?

A

Brachial artery at the Antecubital fossa (inside elbow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What is a K1 Korotkov sound?

A

Faint repetitive tapping, artery is just open = systolic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What is a K5 Korotkov sound?

A

No sound, laminar flow = diastolic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What do you do if K5 goes to zero?

A

Use K4 (muffling of sounds)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What percentage of adults does hypertension affect?

A

1 in 4 (25%). Is 3rd biggest risk of premature death in the UK after smoking and diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is stage 1 hypertension?

A

Clinic BP > 140/90 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is stage 2 hypertension?

A

Clinic BP > 160/100 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is severe hypertension?

A

Clinic systolic BP > 180 or diastolic pressure > 120 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

How often should BP be taken in ambulatory BP measurements?

A

At least twice per hour in the persons usual waking hours

An average of at least 14 measurements should confirm BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

How often should home blood pressure monitoring be measured?

A

–two consecutive seated measurements, at least 1 minute apart
–blood pressure is recorded twice a day for at least 4 days and
preferably for a week
–measurements on the first day are discarded –
average value of all remaining is used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

How should patients be positioned for BP?

A

Cuff at level of heart, arm supported

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is the ischaemic cascade?

A

Hypoperfusion -> cellular metabolic changes -> Diastolic dysfunction -> systolic dysfunction -> ECG changes -> chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is the doppler equation?

A

fo = ((v + vo) / (v + vs)) fo

fo = frequency observed
v = speed of sound (1540m/s)
vs = source velocity
vo = velocity observed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What are the 5 echo windows?

A

Suprasternal, left and right parasternal, apical and subcostal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are the 2 aspects used when naming echo images?

A
  1. Acoustic plane
  2. View (Long axis, short axis, 4 chamber, 2 chamber, 5 chamber)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What orientation is long axis?

A

Slices from base to apex of the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What orientation is short axis?

A

Slices roughly parallel to AV line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is congestive heart failure?

A

Inability of heart to meet metabolic demands.
Characterised by reduced cardiac output.
Usually occurs if the heart becomes too weak or stiff.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What are some clinical symptoms of congestive heart failure?

A

Dypsnoea, oedema, fatigue and poor exercise tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Name the pathophysiological changes following MI that lead to CHF?

A

MI -> reduced heart function -> period of stabilization -> terminal decline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Why does the heart fail several years after MI?

A

Is a cycle.
LV dysfunction causes LV remodelling and neurohormonal stimulation. This increases LV dysfunction directly and secondary to increased peripheral resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Name some of the many aspects of neurohormonal activity that is increased in CHF

A

Plasma renin, plasma neurepinephrine, ANP, endothelin-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What are the acute and chronic effects of neurohormonal stimulation in CHF?

A

Acute: Increases blood pressure, preserves perfusion to organs

Chronic: Increased afterload, reduced stroke volume, myocyte necrosis and apoptosis, sodium retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What electrolyte is retained as result of CHF neurostimulation?

A

Sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is cardiac afterload?

A

The pressure at which the heart must overcome to eject blood during systole
(Is directly proportional to MAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

How is plasma neuradrenaline associated with mortality in CHF?

A

Increased neuradrenaline is associated with increased mortality rates in CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

How does neurohormonal activity impact heart structure in CHF?

A

The heart becomes dilated and larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is ejection fraction equal to?

A

Stroke volume / end-diastolic volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are some of the causes (aetiology) of CHF?

A

MI, hypertension, valvular heart disease, idiopathic dilated cardiomyopathy, secondary cardiomyopathy (alcohol, anthracyclines), myocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is anthracycline cardiomyopathy?

A

Cardiomyopathy as result of free radicals from doxorubicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is myocarditis?

A

Inflammation of myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What symptoms can myocarditis cause?

A

Chest pain, SOB, heart arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is the S1 heart sound?

A

The first sound caused by the closing of the mitral and tricuspid valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What is the S2 heart sound?

A

The second heart sound caused by the closing of the aortic and pulmonary valves

126
Q

How does inspiration change the S2 sound?

A

It splits S2, with the pulmonary valve shutting after the aortic - normally they occur almost at the same time

127
Q

What causes the heart sounds S3 and S4?

A

S3 and S4 are caused by blood striking the LV walls - usually because they are dilated

128
Q

What are some signs and symptoms of left sided heart failure?

A

S3 and S4 heart sounds
Dsypnoea
Orthopnoea (breathlessness lying)
Cough
Chest crackles
S3 and S4 sounds

129
Q

What are some signs and symptoms of right sided heart failure?

A

Abdominal distension and loss of appetite
Elevated JVP
Hepatomegaly
Peripheral oedema

130
Q

What is hepatomegaly?

A

Enlarged liver

131
Q

What are treatments for acute heart failure?

A

Sit patient up (reduces LA pressure)
Give oxygen, morphine, sublingual nitroglycerin
Check cardiac rhythm
IV loop diuretic

132
Q

How does sitting up treat acute heart failure?

A

It decreases LA pressure

133
Q

What are medical treatments of chronic heart failure?

A

Maintain oedema free
Fluid and salt restriction
Inhibition of RAS or neurohormonal stimulation

  • Causes negative chronotropic and ionotropic effects
134
Q

How do beta blockers impact cardiac function?

A

They block the release of renin, neuradrenaline and adrenaline
- improves the heart’s ability to relax
- reduce risk of sudden cardiac death

135
Q

What are some common medications to treat hypertension and CHF?

A

ACE inhibitors, beta blockers, angiotensin receptor blockers (ARBs), aldosterone inhibitors

136
Q

How do ACE inhibitors work?

A

Inhibit angiotensin converting enzyme activity

137
Q

What are some of the difficulties of treating heart failure?

A

Most treatments reduce blood pressure - you can only reduce BP so much
Multiple medications are complex for both patients and doctors
Electrolytes and renal function must be closely monitored

138
Q

What is diastolic heart failure?

A

Heart failure with preserved ejection fraction.
LV systolic function is maintained.
Is problem with LV relaxation.
Is often associated with comorbidities e.g. diabetes, age, renal dysfunction, hypertension

139
Q

What are the main causes of sudden cardiac death?

A

Ventricular tachycardia / fibrillation

140
Q

Which medications reduce risk of sudden cardiac death?

A

Beta blockers -> increase ability of heart to relax
- implantable cardiodefibrillators also reduce death

141
Q

What are mortality rates of heart failure patients?

A

Around 33%

142
Q

What is a typical dose of ionising radiation from a chest X-ray?

A

0.06 mSv (micro Sievert)

143
Q

Which structures can be seen on a chest X-ray?

A

Heart, lungs, aorta, pulmonary vessels, bones, soft tissue, diaphragm, liver, gastric air

144
Q

What are the ABCDEFs of chest X-rays?

A

Airways
Breast shadows
Bones
Cardiac silhouette
Costophrenic angles
Diaphragm
Edges
Extrathoracic tissues
Fields
Failure

145
Q

What is the costophrenic angle?

A

The angle where the diaphragm meets the ribs.
Sharply-pointed downwards angle

146
Q

What are some common reasons for ordering a chest X-ray?

A

Pleural effusion
Pneumothorax
Haemothorax (blood in pleural space)
Pulmonary Embolism
Trauma
TB
Monitoring chest drainage
Lung cancer
Chest pain (MI)
COPD
Asthma

147
Q

What is a pleural effusion?

A

Build up of fluid in the pleural space

148
Q

What are cardiac reasons for ordering a chest X-ray?

A

Cardiomegaly
Wide mediastinum
Heart failure
Pleural effusion

149
Q

What is the mediastinum?

A

The space within the thorax that contains the heart and other structures

150
Q

Why do lung fields appear dark?

A

Due to presence of air in the lungs

151
Q

How can you identify lung disease on CXR?

A

Most disease replace air with liquid - appears white

152
Q

Are chest X-rays usually taken in AP or PA?

A

Usually PA
- anterior structures are closer to detector
- reduces size of cardiac silhouette

153
Q

What is the cardiothoracic ratio?

A

Ratio of transverse diameter of the heart to the internal diameter of the chest at its widest point, just above the dome of the diaphragm

154
Q

What is increased cardiac silhouette usually caused by?

A

Cardiomegaly (but can also be caused by pericardial effusion)

155
Q

What are the 3 stages of CHF seen on X-ray?

A
  1. Redistribution - increased pulmonary markings, cardiomegaly
  2. Interstitial oedema
  3. Alveolar oedema
156
Q

What is aspirin prescribed for?

A

Anti-inflammation drug, also used as an antithrombotic (antiplatelet)

157
Q

What is amlodipine?

A

Calcium channel blocker used to treat hypertension and coronary artery disease

158
Q

What are the reporting guidelines for the ambulatory ECG?

A

There currently are not guidelines

159
Q

What are the two fundamental functions of pacemakers?

A
  1. Pace
  2. Sense
160
Q

What does a pacemaker pulse generator contain?

A

Battery, capacitor, telemetry coil, connector for leads

161
Q

What do pacemaker leads comprise?

A

Electrodes, conductor, insulation, connector, fixation mechanism

162
Q

What is a pacemaker threshold?

A

The minimum amount of electrical energy required for the pacemaker to cause cardiac muscle depolarisation

163
Q

What is capture of the heart?

A

The myocardial response to electrical stimulation

164
Q

What is the 3 letter pacemaker code?

A
  1. Paced - A, V or D (dual)
  2. Sensed - V, A, D or 0 (none)
  3. Mode of response:
    - T = triggered, I = inhibited, D = dual, 0 = none
165
Q

What is CRT?

A

Cardiac resynchronisation therapy

166
Q

What is PBL-STOP in pacemakers?

A

Presenting rhythm
Battery status
Lead status

Sensing
Threshold
Observation, Data and Events
Programme and print

167
Q

How can filters impact ECGs?

A

They can remove pacing spikes

168
Q

Which side of the heart do most of the vessels come out of?

A

Posterior side

169
Q

What is WPW syndrome?

A

Presence of congenital accessory pathways and episodes of tachyarrhythmias

170
Q

What is the RAAS system and how does it impact the heart?

A

Renin angiotensin aldosterone system
- acts to help retain salt and water
- increases PVR and can worsen heart failure

171
Q

What is the first choice medication for treating AF?

A

Beta-blockers or calcium channel blockers (help increase cardiac relaxation)

172
Q

What is the heart rate range for newborns?

A

110 - 150 bpm

173
Q

At what ages does a child’s heart rate become similar to adults?

A

6 +

174
Q

What is the heart rate range for a typical 2 year old?

A

85 - 125 bpm

175
Q

What is the heart rate range for a typical 4 year old?

A

75 - 115 bpm

176
Q

What are the 3 types of narrow complex QRS?

A

Sinus, atrial or junctional

177
Q

What are the two types of wide QRS complex?

A

Ventricular and supraventricular with aberrant conduction

178
Q

What are vagal manoeuvres?

A

An action used to stimulate the parasympathetic nervous system e.g. valsalva manoeuvre, cough etc.

179
Q

What is AVRT?

A

Atrioventricular re-entrant tachycardia. Involves an accessory pathway either orthodromic (anterograde) or antidromic (retrograde)

180
Q

What are the colours and positions of the 3 electrode ECG?

A

White - right shoulder (2nd intercostal space)
Black - left shoulder (2nd intercostal space)
Red - left 9th rib

181
Q

What are the colours and positions of the 5 electrode ECG?

A

White - right shoulder (2nd intercostal space)
Black - left shoulder (2nd intercostal space)
Red - left 9th rib
Green - right 9th rib
Brown - right 4th intercostal (v1)

182
Q

Where is V4 located?

A

5th intercostal space, mid-clavicular line

183
Q

Where is V5 located?

A

5th intercostal space, anterior auxillary line

184
Q

Where are V7 - 9 placed?

A

Posterior chest wall, same level as V6

185
Q

What are the colours and positions of the 4 electrode ECG?

A

Red
Yellow
Green
Black

186
Q

What colours are chest leads V1-6?

A

Red
Yellow
Green
Orange
Black
Purple

187
Q

What are common ECG presentations of V1 - V2 misplacement?

A

P wave changes, Incomplete RBBB
(also false STEMI, Brugada’s syndrome and T-wave inversion)

188
Q

What is Brugada syndrome?

A

An ECG abnormality with a high incidence of sudden death in patients with structurally normal hearts.

A sodium channelopathy

189
Q

What are common ECG features of WPW syndrome?

A

Delta wave
Short PR interval (<120ms)
ST and T wave changes
Long QRS

  • caused by accessory pathways and tachyarrhythmias
190
Q

What is the immediate clinical management of a patient with haemodynamically unstable AF?

A

DCCV if acute AF and anticoagulants (e.g. warfarin, heparin, DOACs)

191
Q

Should AV nodal blocker drugs be used for accessory pathway patients with AF?

A

NO:
Conduction through the AV node actually helps to slow AP conduction - AVN has longer refractory period than APs

192
Q

What 2 forms of tachycardia are present in WPW patients?

A
  1. Atrial fibrillation or flutter that can bypass the AVN via AP
  2. Atrioventricular re-entrant tachycardia
193
Q

what is the most common form of VT?

A

Monomorphic VT
- regular, broad complex tachycardia

194
Q

What is the clinical significance of VT?

A

Impaired cardiac output - consequently hypotension, collapse and acute heart failure

  • caused by extreme heart rates and reduced atrial coordination (‘kick’)
195
Q

What are the 3 factors when classifying VT?

A
  1. Clinical presentation - haemodynamically stable / unstable
  2. Duration - sustained >30s or non-sustained
  3. Morphology - monomorphic, polymorphic, TDP, bidirectional, ventricular flutter
196
Q

What is Toutes De Pointes?

A

A pattern of VT similar to the double helix - twist
QT prolongation

197
Q

What are the 3 mechanisms of VT?

A
  1. Reentrant (commonest)
  2. Triggered activity VT
  3. Abnormal automaticity
198
Q

What are some key ECG features of AF?

A

Irregularly irregular, no P waves, no isoelectric baseline, QRS usually <120ms (unless BBB)
- note fibrillation may mimic P waves

199
Q

What are 2 proposed mechanisms for AF?

A

Focal activation - often pulmonary veins
Multiple wavelet mechanism - fibrillation is formed by re-entrant circuits
- process is potentiated with dilated LA

200
Q

What is AF with slow ventricular response?

A

Ventricular rate <60bpm (is less common than AF with fast response)

201
Q

What is atrial flutter?

A
  1. Narrow complex tachycardia (like AF)
  2. Regular atrial activity at 300bpm
  3. Loss of isoelectric baseline (like AF)
  4. “saw tooth” pattern of inverted flutter waves in leads II, III aVF
  5. Upright flutter waves in V1 that may resemble P waves

May have variable or non-variable AV conduction ratio

202
Q

What causes atrial flutter?

A

Supraventricular tachycardia caused by a re-entry circuit within the right atrium
- length of re-entrant circuit corresponds to the size of the right atrium - predictable rate of ~300bpm

203
Q

What is the most common AV conduction ratio in flutter?

A

2 : 1 - leads to ventricular rate of 150bpm

204
Q

What are the different forms of re-entrant circuits in atrial flutter?

A

Anticlockwise re-entry (90%)
Clockwise re-entry (10%)

205
Q

How can anti-clockwise and clockwise atrial flutter be distinguished on the ECG?

A

Anti-clockwise has inverted flutter waves in leads II, III aVF and upright flutter waves in V1 that may resemble P waves

Clockwise is the opposite

206
Q

What is AVNRT?

A

Atrioventricular Nodal Re-entrant Tachycardia

207
Q

How can you distinguish atrial flutter from AVRT or AVNRT?

A

Flutter nearly always has a rate of around 150 bpm
AVRT and AVNRT are faster (170 - 250 bpm)

208
Q

How can vagal manoeuvres or adenosine impact AVNRT?

A

AVRT or AVNRT can often return back to sinus rhythm
- be careful with AVNRT as AVN acts as a brake on accessory pathway (longer refractory period)

209
Q

How can vagal manoeuvres or adenosine impact sinus tachycardia and atrial flutter?

A

It slows the ventricular rate

210
Q

How can Brugada syndrome be identified on ECG?

A

McDonalds M in >1 of V1 - 3

211
Q

What are common ECG features of WPW syndrome?

A

Delta wave present (curved QRS) and T wave changes - often inverted

212
Q

What direction do most APs travel?

A

Both ways

213
Q

What are some of the causes of low voltage QRS?

A
  1. Obesity
  2. Fluid around heart (pericardial or pleural effusion)
  3. Air - emphysema or pneumothorax
  4. Infiltrative / connective tissue disorders
  5. Loss of viable myocardium (dilation, previous massive MI)
214
Q

What is diaphoresis?

A

Excessive sweating due to underlying health conditions

215
Q

What is pericardial tamponade? And how may it present on ECG

A

Compression of the heart by the pericardial fluid. Can cause low voltage ECG and sinus tachycardia

216
Q

What gives the lungs a ‘lacy’ appearance on chest X-ray?

A

Pulmonary vasculature

217
Q

ST elevation in which ECG leads is indicative of Right coronary artery stenosis/occlusion?

A

II, III, aVF

218
Q

Which coronary arteries are likely to be stenosed / occluded in lateral lead ischemia?

A

LAD and left circumflex artery

219
Q

Which coronary artery is likely occluded if anterolateral ECG leads show STEMI?

A

Left anterior descending

220
Q

What is the clinical impact of using a blood pressure cuff that is too small?

A

It falsely elevates BP measurements

221
Q

What is the clinical impact of using a blood pressure cuff that is too big?

A

It falsely lowers BP measurements

222
Q

Which spinal nerves can increase ionotropy and chronotopy through the sympathetic NS?

A

T1 - 4

223
Q

What are negative chronotropes and some examples?

A

Decrease heart rate
- Beta-blockers and calcium channel blockers

224
Q

What are negative ionotropes and some examples?

A

Decrease heart force of contractility
- beta blockers and calcium channel blockers
(also some anti-arrhythmic drugs e.g. flecainide and disopyramide)

225
Q

What are positive ionotropes and some examples?

A

Increase heart force of contractility
- dopamine and dobutamine

226
Q

What are positive chronotropes and some examples?

A

Increase heart rate
- e.g. dopamine and dobutamine

227
Q

Which part of the ECG represents isovolumetric contraction?

A

The QRS

228
Q

Which part of the ECG represents ejection?

A

QRS to 3/4 of T wave

229
Q

Which part of the ECG represents isovolumetric relaxation?

A

last 1/4 of T wave

230
Q

On which side of the body does lead III point towards?

A

The lower right

231
Q

Which coronary arteries can cause inferior STEMI?

A

Any of the 3 main coronary arteries
- RCA in 80% of cases
- LCx in 18%
- LAD rare

232
Q

What does the ST segment represent and how long should it be?

A

The refractory period and should be 80ms (2 squares)

233
Q

How is dextrocardia identified on ECG?

A

P wave inversion in lead I and poor P wave progression in the chest leads

234
Q

Why is lead II commonly selected as the rhythm strip?

A

It shows P wave activity the clearest

235
Q

What is aberrant conduction?

A

When the impulse cannot properly travel through the His-purkinje fibre system
- shows as a broad QRS complex

236
Q

What determines the dominance of the coronary arteries?
And what is the most common dominance?

A

Which artery feeds the posterior descending artery
- Right dominance occurs in 90% of cases

237
Q

Which coronary arteries supply the SA node?

A

RCA (60%)
LCx (40%)

238
Q

If ST elevation is seen in leads II, III and aVF, which coronary artery is likely occluded?

A

RCA (90%)
LCx (10%)

239
Q

What are the default filter settings for ECGs?

A

0.05 - 150 Hz
- displayed at bottom right of ECG
However all filters should initially be turned off
- this detects from 0.67 - 150Hz

240
Q

What is the maximum filter setting that should be applied?

A

0.67 - 45Hz

241
Q

Describe the layers of the heart from inner to outer

A

Endocardium -> myocardium -> visceral pericardium -> pericardial cavity -> parietal pericardium

242
Q

Is the LV wall thicker at the base or apex?

A

Is thicker at the base

243
Q

What is the bulk of the myocardium composed of?

A

Cardiomyocytes

244
Q

What are the dimensions of cardiomyocytes?

A

Length = 120um
Width = 20 - 30 um

245
Q

What surrounds each cardiomyocyte?

A

The network of interstitial connective tissue

246
Q

What is the perimysium?

A

The thick connective tissue weave between cardiomyocytes that bears shear forces and prevents misalignment

247
Q

What are the 3 layers of the left ventricle wall according to longitudinal alignment of myocardial strand?

A

Superficial (subepicardial)
Middle
Deep (subendocardial)

  • not anatomically separated - just different arrangements of myocardial strands
248
Q

What are the two weaves that provide connective support to myocytes?

A

Endomysial weave (thin) - coordinates force and prevents slippage

Perimysium weave (thick) - bears shear force and prevents misalignment

249
Q

What is the heart crux?

A

The cross shape formed by the intersection of the planes of the atrial and ventricular septa upon the inferior AV junction

250
Q

How are the left and right AV junctions anatomically related?

A

Right AV junction is inferior to the left

251
Q

What does cephalad mean?

A

Towards the head (or anterior extremity of the body)

252
Q

What are the 3 basic components of the ventricles?

A
  1. Inlet
  2. Apical trabecular
  3. Outlet
253
Q

How many groups of papillary muscles support the mitral and tricuspid valves?

A

Only 2 support the mitral.
A variable number support the tricuspid

254
Q

How are the superficial subepicardial fibres and deep myofibres arranged?

A

Deep are longitudinal (apex - base)
Superficial are circumferential

255
Q

What can sometimes limit the views of the RV using echo?

A

The RV is located directly behind the sternum
- RV also has very thin walls

256
Q

What are heart trabeculations?

A

Bundles of muscle that extend into the chamber

257
Q

Describe the structures seen in a parasternal long axis echo view?

A

The LV is seen at the top of the screen with the LV and LVOT below and some of the LA and AO origin

258
Q

Where is the coronary sinus located?

A

In the left atrioventricular groove

259
Q

What are the 3 basic parts of the right atrium?

A
  1. The appendage
  2. The venous part
  3. The vestibule
    (note is also the septum)
260
Q

What is the terminal groove?

A

A fat-filled groove where the SA node is located

261
Q

What is the Eustachian valve?

A

The valve between the Vena Cava and the right atrium

262
Q

How does the coronary sinus drain?

A

Into the right atrium through the Thebesian valve

263
Q

Which cardiac disease is rheumatic fever as a child a risk factor for?

A

Mitral valve stenosis

264
Q

Do patients with heart valve replacements need to take blood thinning drugs?

A

Not if prosthetic valves are used
However they do if they have mechanical replacement valves

265
Q

Stenosis in which coronary artery is most likely for an antero-septal STEMI?

A

LAD

266
Q

How is stable angina detected on ECG?

A

ST depression
- is associated with chest pain on exertion

267
Q

Why is exercise ECG not used for stable angina diagnosis? And what are the specificities and sensitivities of it

A

There are better methods available (e.g. dobutamine stress echo)
- sensitivity = 70%
- specificity = 80%

268
Q

What are the specificities and sensitivities of dobutamine stress echo?

A

Sensitivity = 85%
Specificity = 95%

269
Q

What is treatment of choice for coronary artery stenoses?

A

Percutaneous coronary intervention (PCI)
- or CABG in extreme cases

270
Q

How is NSTEMI detected on ECG?

A

Either ST-depression or T wave inversion

271
Q

What are key features of myocytes?

A
  1. Lots of Myoglobin
  2. Branching structure
  3. Mostly single, central nucleus
  4. Many mitochondria
  5. Myofibrils to contract
  6. Cell-cell contact at intercalated disks
272
Q

What are common thrombolytic drugs?

A

Streptokinase and urokinase

273
Q

Which vertebrae is the superior mediastinum at the level of?

A

T1 - T4

274
Q

What does the superior mediastinum contain?

A

The great vessels

275
Q

What is the inferior mediastinum divided into?

A

Anterior, middle and posterior mediastinum

276
Q

How are the left and right pulmonary veins related to each other as they enter the right atrium?

A

Left are above the right

277
Q

How is the base of the heart anatomically located?

A

Posteriorly compared to the apex and at the level of T6-9

278
Q

What is the level of the aortic arch?

A

T4

279
Q

What is the PR interval?

A

From the start of the P wave to the start of the QRS complex (not until R)
- should be 0.12 - 0.2 seconds

280
Q

What is sinus bradycardia?

A

Less than 60 bpm

281
Q

How do atherosclerotic plaques form?

A
  1. Monocytes enter the vessel wall through the endothelial layer
  2. Monocytes transform into macrophages
  3. Macrophages combine with OxLDL to form foam cells
  4. Smooth muscle cells and foam cells migrate and proliferate
  5. This forms the plaque
282
Q

What are the 3 classes of drugs that help to lower cholesterol?

A
  1. Statins - stop conversion of acetate to cholesterol
  2. PCSK5 inhibitors - stop LDL transport into cell
  3. Ezetimibe - Reduces GI absorption
283
Q

What is orthopnoea?

A

Breathlessness when lying down, relieved by sitting

284
Q

How do ARBs and ACE inhibitors treat heart failure?

A

They decrease salt retention

285
Q

How can heart conditions make echo imaging difficult?

A

They can move the apex of the heart

286
Q

What is the most likely heart condition if the patient has a raised BNP?

A

Congenstive heart failure

287
Q

What is a normal ejection fraction?

A

50% to 70%

288
Q

What is a low EF?

A

40 - 50%

289
Q

What EF is suggestive of CHF?

A

Less than 40%

290
Q

Increases in which ion concentration cause actin and myosin contraction in myocytes?

A

Calcium

291
Q

What is the resting membrane potential and what ions cause this in myocytes?

A

RMP is around -80mV
This is caused by high intracellular k+ concentrations at rest

292
Q

What causes the sharp initial upstroke (depolarisation) in the cardiac cycle?

A

Rapid influx of Na into the cell

293
Q

What causes the initial small decrease in the cardiac cycle?

A

K+ channels open slowly, so K+ starts to leave the cell
(Cl- also leaves cell)

294
Q

What causes the plateau in voltage in the cardiac action potential?

A

Ca2+ channels open and Ca influx balances the K+ outflow

295
Q

What causes the sharper decrease in voltage in the cardiac action potential?

A

All K+ channels open and Ca2+ channels shut so main movement of ions is K+ outflow

296
Q

What maintains the resting membrane potential of myocytes?

A

Sodium potassium ATPase
- 3 Na+ out, 2 K+ in

297
Q

What are the 5 stages of the cardiac action potential cycle?

A
  1. Overshoot (depolarisation) - Na+ in
  2. Partial repolarisation - Slow K+ channels open
  3. Plateau - Ca2+ channels open (influx)
  4. Repolarisation - All K+ channels open
  5. Resting potential
298
Q

What are the 3 bipolar limb leads?

A

I, II, III

299
Q

What are the 3 unipolar limb leads?

A

aVR, aVF, aVL

300
Q

Which ECG leads are likely to have negative traces?

A

aVR, V1-3

301
Q

How do you identify LBBB on ECG?

A

W in V1 and M in V6

302
Q

How do you identify RBBB on ECG?

A

M in V1 and W in V6

303
Q

Why is RMP closest to K+ potential?

A

The membrane is most permeable to K+

304
Q

What are the 3 pressure traces on the cardiac cycle graph?

A

Aortic pressure (Top)
LV pressure (steep middle)
Atrial pressure

305
Q

What is the 3 letter code for pacemakers?

A
  1. Chambers paced = A, V, D, O
  2. Chambers sensed = A, V, D, O
  3. Response to sensing = T, I, D
306
Q

What is the purpose of the telemetry coil of a pacemaker?

A

It allows programming of the pacemaker

307
Q

Is the right or left ventricle wall more smooth?

A

Left is smoother - can result in different lead fixation methods

308
Q

What is threshold?

A

Minimum energy needed to result in a cardiac contraction

309
Q

What is capture?

A

The deoplarisation of the myocardium causing QRS caused by pacemaker

310
Q

How does a pacemaker lead reach the left ventricle?

A

Through the coronary sinus

Cardiac (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions