Flashcards in Cardiology Deck (34):
What does the first heart sound represent?
Closure of the tricuspid and mitral valves
What does the second heart sound represent?
Closure of the aortic and pulmonic valves
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
What is S3 associated with?
- 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
What causes S4?
Contraction of an atrium against a non-compliant ventricle
What is S4 associated with?
Often left-ventricular hypertrophy due to hypertension
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
Which kinds of MI are associated with RCA infarct?
Inferior MI and posterior MI
Which kinds of MI are associated with LAD infarct?
Anteroseptal, anterior and anterolateral
Which kinds of MI are associated with circumflex artery infarct?
Lateral and isolated posterior
ST elevation in leads V3-V4 means?
Small anterior infarct
ST elevation in leads V2-V5 means?
Small anterior infarct
ST elevation in leads V1-V3 means?
ST elevation in leads V4-V6, 1 and AVL means?
ST elevation in leads I and AVL means?
ST elevation in leads II, II and AVF means?
ST elevation in leads in V1 and V2
Which leads have ST elevation in an anterior infarct?
V3-4 or 2-5
Which leads have ST elevation in an anteroseptal infarct?
Which leads have ST elevation in an anterolateral infarct?
V4-6, I and AVL
Which leads have ST elevation in a lateral infarct?
I and AVL
Which leads have ST elevation in an inferior infarct?
II, III and AVF
Which leads have ST elevation in a posterior infarct?
V1 and V2
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
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
Low diastolic and increased pulse pressure
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
How can the causes of chest pain be broken down?
- Ischaemic: Angina, unstable angina and MI
- Non-ischaemic: Pericarditis, valvular, aortic dissection
- Gastro-oesophageal: Oesophageal spasm, GORD, PUD
- Resp: Pneumonia, PE, pneumothorax
- Other: MSK, herpes zoster
What are the causes of heart failure with reduced ejection fraction (HF-REF)?
Myocardial infarction; coronary artery disease
Valvular heart disease
What are the causes of heart failure with preserved ejection fraction (HF-PEF)?
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
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)
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
What are the three main causes of aortic stenosis?
Bicuspid aortic valve
Rheumatic valve disease
What are the three main causes of aortic regurgitation?
Aortic root dilatation