6.15: Cardiovascular Disorders - (Part 1 of 3, GOL)

Question 1

3 definitions of heart failure

Answer 1

Heart unable to maintain adequate circulation for metabolic requirements of body

Preserved ejection fraction (HFpEF): EF ≥ 50%, ↓ diastolic function

Reduced ejection fraction (HFrEF): EF ≥ 40%, ↓ systolic function

Question 2

Underlying cause of heart failure

Answer 2

Secondary to cardiac damage - ischaemia, myopathy
Hypertension, valve disease

Question 3

Signs and symptoms of heart failure

Answer 3

Exertional dyspnoea - breathlessness during exertion

Question 4

Two test to diagnose heart failure

Answer 4

Blood test: elevated brain natriuretic peptide (BNP)
Chest X ray: cardiomegaly

Question 5

Treatment options for heart failure

Answer 5

Drugs that reduce the exertional pressure on heart

Question 6

Two types of heart failure

Answer 6

Systolic
Diastolic

Question 7

Characteristics of systolic heart failure

Answer 7

Weakened heart muscle
Greater valve diameter
Reduced ejection fraction

Question 8

Characteristics of diastolic heart failure

Answer 8

Thicker heart muscle
Smaller valve diameter
Preserved ejection fraction

Question 9

Which feature can be seen on the ECG of person with heart failure?

Answer 9

Larger QRS complex

Question 10

Name a cardiac muscle disorder

Answer 10

Heart failure

Question 11

Name an electrical transmission disorder

Answer 11

Atrial arrhythmias

Question 12

Definitions of atrial arrhythmias

Answer 12

Atrial fibrillation- disorganised electric activity and contraction
Wolff-Parkinson-white (WPW)- syndrome causing tachycardia and abnormal cardiac electrical conductance

Question 13

Underlying cause of AF

Answer 13

Spontaneously active cells throughout atria

Question 14

Underlying cause of WPW

Answer 14

Additional accessory conduction pathway (bundle of Kent) between the atria and ventricles

Question 15

Signs and symptoms of AF and WPW

Answer 15

Palpitations and chest pain

Question 16

ECG findings in a patient with AF

Answer 16

Absent p-waves and irregularly irregular rhythm

Question 17

ECG findings in a patient with WPW

Answer 17

QRS pre-excitation and biphasic/inverted T-wave of ECG

Question 18

Treatment options for AF

Answer 18

Strategies to maintain sinus rhythm (e.g. cardioversion, anti-arrhythmics, catheter ablation)

Question 19

Treatment options for WPW

Answer 19

Benign, no treatments required

Question 20

3 types of conduction block

Answer 20

First degree block
Second degree block
Third degree block

Question 21

What happens during a first-degree block

Answer 21

Slowing down of conduction through AV node

Question 22

What happens during a second-degree block

Answer 22

Reduced transmission of signal from atria to ventricles

Question 23

What happens during a third-degree block

Answer 23

Complete block of current from atria to ventricles

Question 24

Underlying cause of conduction blocks

Answer 24

Damage - (fibrosis, calcification, necrosis) to the conduction system (AV node or His Purkinje system)

Question 25

ECG findings in a patient with a First-degree block

Answer 25

Increased P-R interval

Question 26

ECG findings in a patient with a second-degree block

Answer 26

Increased P-R interval or missing QRS complexes, depending on type of block

Question 27

ECG findings in a patient with a third-degree block

Answer 27

P-waves not followed by QRS complexes

Question 28

Treatment options for Conduction blocks

Answer 28

Discontinuation of AV-blocking drugs (e.g beta blockers, calcium channel blockers) pacemaker implantation in severe cases

Question 29

Definition of hypertension

Answer 29

Clinical BP ≥ 140/90 mmHg & ambulatory BP daytime average ≥ 135/85 mmHg for prolonged period

Question 30

Underlying cause of primary and secondary hypertension

Answer 30

Primary - unknown Secondary - resulting from another medical condition (e.g. kidney disease, adrenal disease)

Question 31

Investigations used to diagnose hypertension

Answer 31

Blood pressure measurement: readings ≥ 135/85 mmHg

Question 32

Treatment options for hypertension

Answer 32

Lifestyle changes followed by anti-hypertensive medication

Question 33

Two vasculature disorders

Answer 33

Hypertension A true coronary syndromes

Question 34

3 steps of progression of acute coronary syndromes

Answer 34

Angina Non-ST-elevated myocardial infarction (NSTEMI) ST-elevated myocardial infarction (STEMI)

Question 35

What is angina

Answer 35

Chest pain due to myocardial ischaemia caused by atherosclerosis

Question 36

What is Non-ST-elevated myocardial infarction (NSTEMI)

Answer 36

Myocardial tissue damage due to prolonged ischaemia caused by atherosclerosis and artery blockage

Question 37

What is ST-elevated myocardial infarction

Answer 37

Serious myocardial tissue damage due to prolonged ischaemia caused by severe atherosclerosis and complete artery blockage

Question 38

Underlying cause of acute coronary syndromes

Answer 38

Atherosclerotic lesions of the coronary artery causing ischaemia (angina), artery blockage (NSTEMI) and then complete artery blockage STEMI

Question 39

Symptoms experienced with angina

Answer 39

Chest pain on exertion or at rest

Question 40

Symptoms experienced with NSTEMI

Answer 40

Chest pain Sweating Nausea and vomiting

Question 41

Symptoms experienced with STEMI

Answer 41

Radiating chest pain Sweating Nausea and vomiting

Question 42

ECG and Blood test results for NSTEMI

Answer 42

ST-depression High troponin levels

Question 43

ECG and blood test results for STEMI

Answer 43

ST- elevation reciprocal ST-depression High troponin levels

Question 44

Treatment for angina

Answer 44

Vasodilators

Question 45

Treatment for NSTEMI

Answer 45

Coronary stents, antiplatelets, vasodilators, anti-emetics, oxygen and pain relief

Question 46

Treatments for STEMI

Answer 46

Coronary stents, anti-platelets, vasodilators, anti-emetics, oxygen and pain relief