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Flashcards in Cardiology Deck (34):
1

What does the first heart sound represent?

Closure of the tricuspid and mitral valves

2

What does the second heart sound represent?

Closure of the aortic and pulmonic valves

3

What causes S3?

Though to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by the inflow of blood from the atria

4

What is S3 associated with?

Heart failure
- May be due to mitral regurgitation, dilated left ventricle, post MI or dilated cardiomyopathy

May also be ventricular septal defect

May be physiological in young children/adult or pregnancy fourth trimester

5

What causes S4?

Contraction of an atrium against a non-compliant ventricle

6

What is S4 associated with?

Often left-ventricular hypertrophy due to hypertension

7

What are the main arteries of the heart?

Right coronary which branches to the marginal and posterior interventriculcar

Left coronary which branches to the circumflex and left anterior descending

8

Which kinds of MI are associated with RCA infarct?

Inferior MI and posterior MI

9

Which kinds of MI are associated with LAD infarct?

Anteroseptal, anterior and anterolateral

10

Which kinds of MI are associated with circumflex artery infarct?

Lateral and isolated posterior

11

ST elevation in leads V3-V4 means?

Small anterior infarct

12

ST elevation in leads V2-V5 means?

Small anterior infarct

13

ST elevation in leads V1-V3 means?

Anteroseptal infarct

14

ST elevation in leads V4-V6, 1 and AVL means?

Anterolateral infarct

15

ST elevation in leads I and AVL means?

Lateral infarct

16

ST elevation in leads II, II and AVF means?

Inferior infarct

17

ST elevation in leads in V1 and V2

Posterior infarct

18

Which leads have ST elevation in an anterior infarct?

V3-4 or 2-5

19

Which leads have ST elevation in an anteroseptal infarct?

V1-V3

20

Which leads have ST elevation in an anterolateral infarct?

V4-6, I and AVL

21

Which leads have ST elevation in a lateral infarct?

I and AVL

22

Which leads have ST elevation in an inferior infarct?

II, III and AVF

23

Which leads have ST elevation in a posterior infarct?

V1 and V2

24

What are the difference that enable the JVP to be distinguished from the carotid?

JVP cannot be palpated
JVP has complex waveform
JVP increases on inspiration and decreases on expiration
JVP can be obliterated by mild pressure
JVP increases with mild pressure over liver

25

What are the main examination findings in aortic regurge?

Pan systolic murmur loudest at the left lower sternal edge when the patient is leaning forward

Water-Hammer Pulse

Low diastolic and increased pulse pressure

26

What are Stokes-Adams attacks?

Sudden transient loss of consciousness induced by a slow or absent pulse and subsequent loss of cardiac output.

The underlying problem is either complete heart block or SAN disease.

Not associated with a change in posture or any other trigger, usually last seconds (If they go on for more than 15–20 seconds twitching may occur due to cerebral anoxia)

Patient becomes flushed after an attack as well oxygenated blood is pumped

27

How can the causes of chest pain be broken down?

Cardiac
- Ischaemic: Angina, unstable angina and MI

- Non-ischaemic: Pericarditis, valvular, aortic dissection

Non-cardiac
- Gastro-oesophageal: Oesophageal spasm, GORD, PUD

- Resp: Pneumonia, PE, pneumothorax

- Other: MSK, herpes zoster

28

What are the causes of heart failure with reduced ejection fraction (HF-REF)?

Myocardial infarction; coronary artery disease

Dilated cardiomyopathy
- Familial/Viral/Peri-partum/AI/Drugs/Alcohol

Acute myocarditis

Valvular heart disease

Arrhythmias

29

What are the causes of heart failure with preserved ejection fraction (HF-PEF)?

LVH; Hypertension

Genetic
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy

Infiltrative
- Amyloidosis
- Sarcoidosis

Valvular disease

30

What is diastolic heart failure?

Symptoms and signs of heart failure with preserved left ventricular ejection fraction above 45-50% and abnormal left ventricular relaxation (assessed by echocardiogram)

There is increased stiffness in the ventricular wall and decreased left ventricular compliance leading to impairment of diastolic ventricular filling and hence decreased cardiac output

More common in elderly hypertensive patients but may occur with primary cardiomyopathies (hypertrophic, restrictive and infiltrative)

31

What are the symptomatic classifications of HF?

Class I - No limitation

Class II - Mild limitation, comfortable at rest but normal physical activity produces fatigue, dyspnoea or palpitations

Class III - Marked limitation, comfortable at rest but gentle physical activity produces marked symptoms of heart failure

Class IV - Symptoms of heart failure occur at rest and are exacerbated by any physical activity

32

What are the three main causes of aortic stenosis?

Bicuspid aortic valve
Calcification
Rheumatic valve disease

33

What are the three main causes of aortic regurgitation?

Aortic root dilatation
Post-endocarditis
Rheumatic fever

34

What is Brugada syndrome?

Signs and symptoms?

A channelopathy, most commonly caused by a mutation in SCNA5 gene

Syncope and cardiac arrest (commonly at night)
Nightmares and thrashing at night
Asymptomatic and found due to ST elevated in V1-V3
[Fever often exacerbates clinical features]