Cardiovascular conditions Flashcards
(144 cards)
1
Q
What is angina?
A
Mismatch between supply of oxygenated blood to the heart versus myocardial demand causing pain to the chest.
2
Q
What causes angina?
A
Usually a narrowing of the coronary vasculature (reduced blood flow)
May also be caused by reduced perfusion pressure (low blood pressure, low MAP) or poor collateral blood supply
3
Q
What type of chest pain is angina?
A
Ischaemic type chest pain.
Often described as a pressure/tightness but can fluctuate
4
Q
What forms is angina generally split into?
A
Stable (pectoris)
Unstable (type of ACS)
Prizmetal (spasmodic)
5
Q
What is angina pectoris?
A
Stable angina
6
Q
What typically causes angina pectoris?
A
Atherosclerosis of the coronary arteries
7
Q
What is stable angina often a first sign of?
A
Developing ishaemic heart disease/coronary heart disease
8
Q
What is the main difference between stable and unstable angina?
A
Unstable angina presents symptoms at rest versus at exertion as with stable angina
9
Q
Why is unstable angina treated as an emergency?
A
May be a precursor to/symptom of myocardial infarction
10
Q
What is primzmetal angina due to?
A
The etiology is not well understood but due to cornary spasm - potentially from overreaction from vasoconstrictive stimuli with or without stenosis
May be associated with patients with other vasoconstrictive disorders such as raynauds or migraines
11
Q
What external factor is the main cause of prinzmetal angina?
A
Recreational drug use (cocaine, amphetamines, cannabis)
12
Q
What are the similarities and differences between the symptoms of prinzmetal angina and unstable/stable angina?
A
Prinzmetal angina presents with similar ischaemic chest pain.
Rest doesn’t usually relieve symptoms and it similarly is not thought to be caused by exertion
13
Q
What is atherosclerosis?
A
The process of lipid accumulation (plaque formation), scarring and inflammation of the vascular wall resulting in narrowing of vasculature due the vasculature wall thickening, weakening of the vessel walls and a reduction of vessel elasticity. It may also result in thrombosis
14
Q
What can atherosclerosis cause?
A
ACS
CVA
AAA
Peripheral vascular disease
Significant cause of hypertension, which can worsen it.
15
Q
How does atherosclerosis develop?
A
Damaged endothelium
Fatty streaks
Fibrous plaques
Complicated lesions
16
Q
What is the mechanism of atherosclerosis?
A
Damaged endothelium causes lipid accumulation (LDLs build up), platelet attachment, and migration of smooth muscle into the intima.
WBCs activate several positive feeback loops which cause build up of fat.
The build up of fat develops a fibrous cap and absorbs calcium salts and hardens.
17
Q
How do atherosclerosis plaques become fibrous?
A
The lipid pool becomes covered with collagen
18
Q
What are most common causes of endothelial damage that increases risk of atherosclerosis?
A
Hypertension
Smoking
Diabetes mellitus
High cholesterol
19
Q
What do atherosclerosis plaques consist of?
A
A combination of cholesterol, calcium and WBCs
20
Q
What can cause sinus tachycardia?
A
Shock
PE
Pyrexia
Anxiety
Exercise
Drugs
Pain
Dehydration
Hypoxia
Hyperthyroidism
21
Q
What can cause sinus bradycardia?
A
Inferior/posterior MI
Vagal stimulation
Arrhythmia medication
Hypothermia
Hypo/hyperkelaemia
SA node disease
Raised ICP
Post heart transplant
Hypothyroidism
22
Q
What can cause sinus arrhythmias?
A
DISCS HEMP
Drug toxicity
Infection
Scar tissue
Coronary heart disease
Stress
Hormones
Electrolyte imbalance
Medication
Post heart surgery
23
Q
What are the three main types of atrial conduction abnormalities?
A
Atrial fibrillation
Atrial flutter
Premature atrial complexes (PACs)
24
Q
What kind of rhythm does atrial fibrillation follow?
A
Irregularly irregular
25
What secondary treatments are AF patients usually given and why?
Anti-coagulant medication as the inadequate contractions and therefore inadequate emptying of the atria can cause blood pooling and clotting which can create embolisms
26
What is atrial flutter?
A re-entrant arrhythmia where an impulse circles around a large area of tissue (such as the entire right atrium) regularly at a high rate
27
What are premature atrial complexes, are they cause for concern?
An area of the atria (not the SA or AV node) prematurely produces an impulse. They can be asymptomatic or come with a palpitation or 'jolt' feeling and can happen in healthy people and not be cause from concern. Can be concerning if there are several in a row (bigeminy or trigeminy), this can cause a decrease in cardiac output and lead to other arrhythmias
28
What are the main types of ventricular conduction abnormalities?
Bundle branch blocks
Ventricular tachycardia
Ventricular fibrillation
PVCs
29
What are premature ventricular complexes?
An area of the ventricles (not the His or purkinje fibres) prematurely produces an impulse.
30
How is ventricular tachycardia defined?
Defined as an episode of three or more PVCs at a rate of >100bpm. Can occur with or without a pulse
31
What are the most common causes of ventricular tachycardia?
Previous MI
Electrolyte imbalances
Congenital heart diseases
Coronary heart disease
Side effects of medication
Drug use
32
What treatments are given for ventricular tachycardia?
Anti-arrhythmics
Ablation
Cardioversion
Implantable Cardioverter Defibrillator
Overdrive pacing
33
What are bundle branch blocks?
A disruption in impulse conduction from the bundle or His through either the right or left bundle branch to the purkinje fibres.
34
What are the most common causes of bundle blocks?
Myocardial infarction
Hypertension
Pulmonary embolism
Infections
Cardiomyopathy
Congenital heart diseases
Can be idiopathic
35
Why are bundle branch block patients often taken to the cath lab?
MIs can be hidden by BBBs
36
What are the two types of heart failure?
Systolic heart failure - Can't pump hard enough
Diastolic heart failure - Can't fill enough
37
What is congestive heart failure?
When heart failure causes fluid build up (congestion) around the body
Caused by blood backing up, forcing fluid through the capillary walls which builds up around the body (ankles, feet, arms, lungs and/or other organs)
38
What are the main causes of heart failure?
Coronary heart disease
Heart inflammation (myocarditis, rheumatic heart fever)
High blood pressure
Cardiomyopathy
Irregular heartbeat.
39
What are the main risk factors of heart failure?
Poor lifestyle habits e.g. poor diet, smoking, drug use, heavy alcohol use, and lack of physical activity.
Heart or blood vessel conditions
Serious lung disease
Infections e.g. HIV or SARS-CoV-2
Obesity
Hypertension
Diabetes
40
What is ejection fraction?
The fraction of total left ventricle blood volume that is ejected every pump, expressed as a percentage.
41
What do the different ranges for ejection fraction indicate?
50%-70% = Normal
40%-50% = Borderline
<40% = Systolic heart failure
42
What is cardiomyopathy?
An umbrella term for a disorder of the heart muscle. May be stiffening, stretching, enlarging or constricting.
43
What are the 4 main types of cardiomyopathy?
Hypertrophic cardiomyopathy
Arrhythmic Right Ventricle Dysplasia (ARVD)
Restrictive cardiomyopathy
Dilated cardiomyopathy
44
How does atherosclerosis or ischaemic heart disease lead to heart failure, and what kind?
Atherosclerosis or ischaemic heart disease causes a reduction of blood flow and oxygen to the myocardium causing damage or cell death. Damaged, dead or scar tissue cannot contract properly causing systolic heart failure.
45
How does long standing hypertension lead to heart failure, and which kind?
An increase in mean arterial pressure means the ventricles have to pump harder to eject enough blood. This increased workload causes the myocardium to hypertrophy. This in turn increases the demand for oxygen and places pressure on the coronary vessels restricting blood flow. This leads to tissue damage and weaker contractions, systolic heart failure.
Similarly, long standing hypertension can cause concentric hypertrophy where the extra myocardium crowds into the ventricles reducing the space for blood, this causes diastolic heart failure as the ventricles cannot fill adequately
46
How does dilated cardiomyopathy cause heart failure, and what kind?
Dilated cardiomyopathy is an attempt to increase preload to help with ejection and increase the stretch on the ventricular walls to help with contractions (frank-starling effect). However overtime the muscles get thinner and weaker causing ineffective contractions and systolic heart failure
47
What are common causes of concentric ventricular hypertrophy?
Long term hypertension
Aortic stenosis (narrowing)
Hypertrophic cardiomyopathy (genetic)
48
How does restrictive cardiomyopathy lead to heart failure, and what kind?
Restrictive cardiomyopathy means stiffer and less compliant myocardium. The ventricles can't stretch and fill leading to diastolic heart failure
49
How does decreased blood flow to the kidneys affect patients with heart failure?
Reduced blood flow to the kidneys caused by heart failure actives the RAAS system increasing fluid retention. This increases preload and thereby contraction strength (frank-starling effect). This can compensate in the short term but in the long term the increased fluid can cause the heart failure to become congestive.
50
How does heart failure lead to pulmonary oedema?
Decrease cardiac output from heart failure can cause blood to back up into the lungs. Increasing the pressure in the pulmonary veins and pulmonary artery. Fluid moves from the blood to the interstitial spaces in the lungs causing pulmonary oedema.
51
How does pulmonary oedema lead to its signs and symptoms?
The build up of fluid in the alveoli make diffusion of oxygen and carbon dioxide (and thereby gas exchange) a lot harder. This causes difficulty breathing (**dyspnoea**) especially when lying down (**orthopnea**) and **crackles**. A substantial increase in pulmonary capillary wedge pressure can cause ruptures in the pulmonary capillaries, blood leaks into the alveoli, causing **pink frothy sputum**. Alveolar macrophages digest these blood cells and turn brown from the iron, they are then referred to as **"heart failure cells"**.
52
What is the most common cause of right sided heart failure?
Left sided heart failure
53
What can cause isolated right sided heart failure?
Cardiac shunt caused by atrial or ventricular septal defects
Chronic lung disease
54
How can cardiac shunt cause right sided heart failure?
Septal defects cause shunts where blood moves from the left side of the heart to the right. This increase in blood volume can cause right ventricular hypertrophy which can lead to:
-ischaemia causing systolic dysfunction
-myocardium crowding, reduced volume and reduced compliance causing diastolic dysfunction
55
How do chronic lung diseases cause isolated right sided heart failure?
Chronic lung diseases make gas exchange difficult causing hypoxia. In response to this hypoxia the pulmonary arterioles constrict increasing the pulmonary artery pressure increasing the workload on the right side of the heart. This leads to hypertrophy and heart failure. This whole process is referred to as cor pulmonale.
56
What is cor pulmonale?
When chronic lung disease leads to right sided ventricular hypertrophy and heart failure
57
Explain the congestion that occurs with right sided heart failure
With right sided heart failure blood backs up to the body and the systemic vasculature becomes congested and fluid leaks out the blood vessels into interstitial spaces of the body. Pitting oedema occurs in the legs and sacrum as gravity naturally pulls fluid here when patients are stood and laying down respectively. The jugular vein will also become distended and enlarged. Fluid leaking into the interstitial spaces within organs such as the liver and spleen (hepato spleno megaly) which can cause pain. Long term congestion can cause cirrhosis (called cardiac cirrhosis in this instance) which can lead to organ failure. Long term congestion can also cause fluid to leak through the surface of these organs into the peritoneal space causing ascites, the peritoneal space is large therefore a large amount of fluid can leak into this space before there is a significant change in pressure.
58
How can heart failure lead to arrhythmias?
Heart failure can cause the myocardium to become stretched and thin or thickened and ischaemic. In either case the myocytes are irritated affecting their conductivity leading to arrhythmias
59
What non medication treatments can be given to heart failure patients?
Pace making
Ventricular assistance devices (VADs)
Heart transplants **(for end stage)**
60
What are the most common treatments for heart failure?
BAD LAMPS
Beta blockers
ACE inhibitors
Diuretics
Lifestyle changes
ARBs
Mineralocorticoid receptor antagonists
Pacemaking and internal defibrillator devices
Surgery (heart valve, bypass, coronary angioplasty etc.)
61
What are LVADs?
Left ventricular assist devices (LVADs) are mechanical pumps fitted to support or take over the pumping function of the heart. They are given to patients waiting for heart transplants who are at risk of dying until a suitable donor is found. Called a bridge to transplant (BTT)
62
Which patients are given LVADs?
Patients with advanced heart failure at <25% ejection fraction who have progressed through optimal medical therapy, cardiac resynchronisation therapy, and non-transplant cardiac surgery. It is given if indicated while they wait for a transplant.
63
How many people each year are fitted with LVADs?
Approximately 80 per year
64
What is the average battery life of an LVAD?
6-8hours
65
How do LVADs work and how are they fitted?
They are palm sized mechanical impeller driven pumps fitted to the left ventricle. They give constant blood flow and therefore LVAD patients have no palpable pulse or readable blood pressure. They have leads that exit via the abdomen and connect to the controller and power supply.
66
Why is LVAD failure a time critical emergency?
If the LVAD fails the dysfunctional left ventricle may not be able to generate adequate cardiac output
LVAD failure can lead to retrograde blood flow as LVADs do not contain any valves to prevent regurgitation
67
What complications are LVAD patients especially susceptible to?
Stroke
Bleeding
Systemic infections
Thrombosis
68
How many LVAD centres are there in the UK, and how many in London?
5 adult only, 1 paediatric only and 1 for both.
In london:
Great Ormond Street (Paediatric only)
Harefield (Adult)
69
What must ambulance staff do with patients with LVAD complications?
If clinically compromised follow the algorithm in ABC format.
If not clinically compromised contact patient's LVAD centre
70
Why may GCS be misleading for LVAD patients?
LVAD patients in VF or VT arrhythmias can still present as GCS 15
71
What are common causes of acute pericarditis?
Open heart surgery
Myocardial infarction
Rheumatic fever
Viral infection
Cancer
Trauma
72
What are the two most common causes of chronic pericarditis?
Tuberculosis
Infection from adjacent tissues
73
What complications can pericarditis cause?
Tamponade
Chronic constrictive pericarditis
Heartfailure
74
What is chronic constrictive pericarditis?
Constrictive pericarditis is a condition in which granulation tissue formation and adhesions between the layers in the pericardium result in loss of pericardial elasticity leading to restriction in the ventricular filling.
75
What are common symptoms of pericarditis?
Chest pain (exacerbated lying down, alleviated sitting forward, also exacerbated by erratic motion e.g. cough, breathing, swallowing)
Tachycardia
Dyspnoea
Cough
Pyrexia
Friction rub
ECG changes
Signs of effusion/tamponade
76
What can cause myocarditis?
Many causes such as pathogens (recent viral infection etc.) or toxins but can be idiopathic
77
What are the symptoms of myocarditis?
Chest pain
Fatigue
Swelling of the legs, ankles and feet
Arrhythmias - can be fatal
ECG changes - can mimic STEMIs
Shortness of breath, at rest or during activity
Light-headedness or feeling like you might faint
Flu-like symptoms such as headache, body aches, joint pain, fever or sore throat
78
What can cause myocarditis?
Usually pathogens or toxins but can be idiopathic
79
What is infective endocarditis?
Infection of the inner lining of the heart, microorganisms attach to the endocardium and heart valves creating inflammation and the formation of vegetations.
Usually occurs in people with other underlying cardiac conditions
80
What are endocarditis vegetations?
Large fragile masses made up of fibrin, platelets, blood cells and microorganisms
81
How is endocarditis dangerous?
The vegetations formed may disturb the function of the valves and/or pieces of vegetation may break away forming emboli - these are especially dangerous as they may cause infarction or infection in other tissues
82
What is non-infective endocarditis and what can cause it?
When vegetations still form but they are sterile.
May be caused by trauma, autoimmune reactions (such as SLE), vasculitis or hypercoaguable state
83
What are symptoms of non-infective endocarditis?
Symptoms can be similar to infective endocarditis but often present more like those typical to an arterial embolism
84
What are general treatments for heart infections?
Antibiotics
Heart failure/anti arrhythmia drugs
Corticosteroids
Anti-inflammatories
Occasionally surgery e.g. fluid drain
85
Why are aneurysms less common in veins?
The pressure within veins is much lower than arteries
86
What are the two forms of aneurysm and how do they differ?
Saccular (berry) - bulges in only one direction
Fusiform - bulges in all directions
87
Which form of aneurysm is most common in the aorta and cranium respectively?
Fusiform in the aorta
Saccular (berry) intracranially
88
What is the difference between true, dissecting and false(psuedo) aneurysms?
True aneurysm - all 3 layers of vessel wall stretched but intact
Dissecting aneurysm - media of vessel wall is torn in more than one place and layers are split transversely with blood filling the space between them
False aneurysm - media of vessel wall is torn in one place with externa stretched and filled with blood
89
What is the difference between an aneurysm and a haemorrhage?
Haemorrhage is when blood spills out of vessels into surrounding tissues
Aneurysms keep blood contained within the vessel
90
Where do most arterial aneurysms happen?
The aorta
91
What increase in vessel size defines an aneurysm?
Dilation of more than 3cm in diameter or 1.5x the original vessel size
92
What segment of the aorta is more susceptible to aneurysms, why?
The abdominal aorta due to less elastin within the vessel walls and less vasa vasorum
93
Where are abdominal aneurysms normally found?
Below the renal arteries
94
What are the most common causes of aneurysms?
Atherosclerosis
Hypertension
Infection such as syphilis
Connective tissue disorders e.g. Ehlos Danlos, Marfans
Age degeneration
95
What are the main risk factors for aneurysms?
Sex - males more at risk
Smoking
Age - degeneration of collagen and fibrin over time
Family history
Existing cardiovascular disease
96
Why are body aneurysms difficult to diagnose and what are the signs and symptoms?
They are normally asymptomatic
They can come with:
Pain
Pulsating masses (only for vessels that lie more externally)
Associated symptoms from pressure on other organs/tissues
Changes/weakening of pulses of downstream arteries
Difference in BPs in left and right arms
97
What are the signs and symptoms of aneurysm rupture?
Rapid tearing pain
Signs of hypovolaemic shock
98
What are the mortality rates for AAA and TAA?
AAA - 80%
TAA - over 90%
99
What is aortic dissection?
A tearing of the tunica intima of a blood vessel
100
Where do most aortic dissections occur, where else can they occur?
In the first 10cm of the aorta (Type A)
They can also occur anywhere else in the aorta (Type B)
101
What is the link between aortic aneurysms and aortic dissection?
Aortic dissection can lead to false (psuedo) aneurysms or be caused by true aneurysms
102
What complications can aortic dissections cause?
Aneurysms
Rupture
Compression of other vessels
Tamponade due to back flow of fluid into the pericardium
Shock
103
Which valves of the heart more commonly have disorders, why?
Mitral and aortic valves because the left side of the heart is under more pressure
104
What are the three main types of valvular dysfunction?
Prolapse
Regurgitation
Stenosis
105
What is valvular stenosis?
Narrowing, stiffening or thickening of the heart valves
106
What is valvular incompetence?
Valves not closing completely leading to regurgitation
107
Can valves have multiple disorders?
Yes but this is uncommon
108
What can cause enlarged atria?
Heart/valvular failure/dysfuntion (The extra volume of preload is backed up into the atrium which is more flexible and so it stretches and enlarges)
Ventricular hypertrophy
Mass or tumor in your left atrium.
Arteriovenous fistulas (a connected vein and artery that exchange blood without using capillaries between them).
Athlete’s heart (consistent training increases your heart size).
Ventricular septal defect.
Patent ductus arteriosus.
109
What is rheumatic fever and how does it affect the heart?
An autoimmune disease associated with inflammation of bones, joints, ligaments and tendons, commonly follows group A streptococcal throat infection.
It can affect multiple systems leading to permanent damage to valves, when this damage causes prolonged changes to the heart valves it is known as chronic rheumatic heart disease (RHD)
This damage mostly manifests as mitral stenosis, the cordae tendonae become scarred and inflexible affecting valve movement
110
What is valvular prolapse?
When valve flaps invert
111
How does valvular prolapse occur?
It occurs when one valve flap is larger than the other or if the cordonae tendonae stretch abnormally
This may be idiopathic or due to an underlying condition, damage to the heart valve itself or anything causing strenuous pressure changes either side of a valve
112
What is Ehlers-Danlos syndrome?
Ehlers-Danlos syndromes (EDS) are a group of rare inherited conditions that affect connective tissue. The different types of EDS are caused by faults in certain genes that make connective tissue weaker. There are several types of EDS that may share some symptoms, including:
An increased range of joint movement (joint hypermobility)
Stretchy skin
Fragile skin that breaks or bruises easily
113
What is Marfan syndrome and its signs and symptoms?
A genetic disorder affecting the proteins that help develop healthy connective tissue.
Features may include:
- Tall and slender build.
- Disproportionately long arms, legs and fingers.
- A breastbone that protrudes outward or dips inward.
- A high, arched palate and crowded teeth.
- Heart murmurs.
- Extreme nearsightedness.
- An abnormally curved spine.
- Flat feet.
114
What can cause valvular incompetence and regurgitation?
Cardiomyopathy
Endocarditis
Congenital heart diseases
Age related degradation
Untreated/poorly treated hypertension
115
What is the most common cause of mitral valve stenosis?
Rheumatic heart disease and associated left ventricular hypertrophy
116
What causes valve stenosis?
Congenital problems
OR
Underlying pathology such as infection or calcification
117
What causes infective endocarditis?
Pre-existing damage to the endothelium of the heart leads to infection/inflammation, for example:
Turbulent blood flow
Mechanical damage/trauma
Particles
Toxins
Chronic inflammation
118
What is Non Bacterial Thrombotic Endocarditis?
When the endothelium of the heart is damaged and the healing process causes deposits of fibrin and platelets to build up creating openings which allow for bacteria to enter and grow, usually around the heart valves. Can be a precursor to infective endocarditis.
119
What are the most common causes of heart damage that lead to infective endocarditis?
Turbulent blood flow
Mechanical damage
Particles
Chronic inflammation
120
What is the mortality rate for infective endocarditis?
40%
121
What is valvular lesion?
When any heart valve is damaged or diseased
122
Why is valvular lesion difficult to spot?
Patients are commonly asymptomatic
123
What treatment is given for valvular lesion and when is it given?
Treatment is usually valve replacement with subsequent prophylactic anti-coagulant therapy for life (mechanical valve replacement) or a few months (bioprosthetic valve replacement)
Treatment is undertaken when valvular lesion progresses to symptomatic and/or causes cardiac dysfunction, many patients require only periodic observation with no treatment given
124
What are the two types of replacement valves and which age rage patients are they most often given to?
Bioprosthetic (Pts over 70)
Mechanical (Pts under 50)
125
What are the main risk factors of AF?
Most incidence:
Hypertension
Obesity
Genetic factors
Others include:
Ischaemic heart disease
Valvular heart disease (esp. mitral stenosis / regurgitation)
Acute infections
Electrolyte disturbance/acid base disturbances
Hyperthyroidism
Drugs (e.g. sympathomimetics)
Alcohol
Pulmonary embolus
Pericarditis
Pre-excitation syndromes
Cardiomyopathies: dilated, hypertrophic.
Pheochromocytoma
126
What are the different frequencies and durations of periods of AF defined as?
First episode – initial detection of AF regardless of symptoms or duration
Recurrent AF – More than 2 episodes of AF
Paroxysmal AF – Self terminating episode < 7 days
Persistent AF – Not self terminating, duration > 7 days
Long-standing persistent AF – > 1 year
Permanent (Accepted) AF – Duration > 1 yr in which rhythm control interventions are not pursued or are unsuccessful
127
What are the main significant and accessorary complications of AF?
**Thromboembolism/stroke**
Peripheral thromboembolism
Heart failure (cardiac output may reduce by 10-20%)
Tachycardia induced cardiomyopathy
Cardiac ischaemia
128
What percentage of AF patients present as asymptomatic?
30%
129
What are the main symptoms of AF?
Palpatations
Chest pain
Shortness of breath
Dizziness
Fatigue
Malaise
Anxiety
130
What are usual treatments for AF?
**Cardioversion** (Electrical/chemical)
and
**Cardiac medication:**
Anti-coagulants (e.g. DOACs, vitamin K antagonist)
Anti-platelets (e.g. Aspirin and Clopidogrel)
Rate control medications (e.g. beta-blockers, CCB)
Cardiac glycosides (e.g. Digoxin)
131
Do PVC's come with any symptoms?
They can be asymptomatic or come with a palpitation or 'jolt' feeling
132
Are PVC's cause for concern?
They can happen in healthy people and not be cause from concern. Can be concerning if there are several in a row (bigeminy or trigeminy), this can cause a decrease in cardiac output and lead to other arrhythmias/cardiomyopathy
133
What are the difference classifications of bundle branch blocks?
Left/Right
Complete/incomplete
Intermittent/permanent.
134
What complications can bundle branch blocks cause?
Can cause other arrhythmias such as bradycardia.
135
What symptoms accompany bundle branch blocks?
Can be asymptomatic or come with syncope.
136
What kind of heart failure is ejection fraction most relevant for, why?
Systolic heart failure.
Diastolic heart failure can give a normal ejection fraction.
137
Which of pericarditis and myocarditis are more serious and more common?
Myocarditis is generally associated with higher mortality and long term sequale, although both can be serious or self limiting.
Pericarditis is slightly more common
138
What ECG abnormalitites can arise from hyperkalaemia?
Peaked T waves
Prolonged PR
P wave abnormal/absent
Bradyarrhythmias
139
What are the symptoms of hypocalcaemia?
Neuromuscular excitability
Carpopedal spasm
Tetany
Chvostek sign
Trousseau sign
Seizures
140
What ECG abnormalities can hypocalcaemia cause?
Hypocalcaemia causes QTc prolongation primarily by prolonging the ST segment
The T wave is typically left unchanged
Dysrhythmias are uncommon, although atrial fibrillation has been reported
Torsades de pointes may occur, but is much less common than with hypokalaemia or hypomagnesaemia
141
What causes valve calcification?
Usually age related but can be caused and/or accelerated by poor lifestyle (smoking drinking etc.) and other existing medical conditions (diabetes, high cholesterol, high triglycerides, CKD etc.)
142
What is the general difference between atrial fibrilation and atrial flutter?
In atrial fibrillation, the atria beat irregularly. In atrial flutter, the atria beat regularly, but faster than usual and more often than the ventricles, so you may have four atrial beats to every one ventricular beat.
143
What are the symptoms of heart failure?
SoB (esp. on exertion)
Orthopnoea
Pitting oedema
Persistent cough (productive w/ white , frothy pink, or bloody mucus)
Rapid or irregular heartbeat.
Fatigue and weakness.
Wheezing.
Chest pain
Rapid weight gain +/- belly swelling
Reduced ability to exercise.
Nausea and lack of appetite.
Difficulty concentrating or decreased alertness.
144
What is the difference between chronotropy and inotropy?
Chronotropy is the rate of heart contraction.
Inotropy is the strength of contraction.
