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Cardiovascular Disorders Flashcards

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1
Q

What three areas can cardiovascular disorders affect?

A

Muscular
Conduction
Vasculature

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2
Q

What are cardiomyopathies?

A

Disorders that affect cardiomyocytes or cardiac muscle function

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3
Q

Give examples of cardiomyopathies?

A 
Heart failure
- Reduced ejection fraction
- Preserved ejection fraction
Take tsubo syndrome 
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
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4
Q

Define heart failure

A

Heart unable to maintain adequate circulation for metabolic requirements of body

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5
Q

Define preserved ejection fraction

A

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

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6
Q

Define reduced ejection fraction

A

Reduced ejection fraction (HFrEF): EF ≥ 40%, ↓ systolic function
Can be treated pharmacologically

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7
Q

What is normal ejection fraction?

A

60-70%

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8
Q

What happens in reduced ejection fraction heart failure

A 
Systolic disfunction
Heart cannot pump as well
Insufficient strength
Dilated left ventricle
Thinning of muscle 
Eccentric development of muscle- myocytes develop alongside each other
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9
Q

What happens in preserved ejection fraction heart failure

A

Increase in muscle mass of left ventricle
Can pump but not relax
Diastolic disfunction
Concentric development of muscle- myocytes develop on top of each other

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10
Q

What are the underlying causes of heart failure?

A 
Obesity
Ischaemia
Myopathy 
Hypertension 
Valve disease
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11
Q

What would tend to cause more preserved EF HF?

A

Hypertension

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12
Q

What would tend to cause more reduced EF HF?

A

Myocardial infarction

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13
Q

What are the effect of HF on cardiac output and life expectancy?

A

↓ cardiac output, venous blood accumulation

Poor prognosis: 50% mortality rate < 5 years

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14
Q

What are the ECG findings for Heart failure?

A 
Non-specific
Multiple potential ECG abnormalities 
Linked to potential cause: e.g. Hypertrophy or Atrial Fibrillation
Enlarged QRS complex
Not diagnostic marker
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15
Q

What is a a diagnostic marker?

A

Elevated natriuretic peptide levels

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16
Q

What are general symptoms of heart failure?

A
  • breathlessness, fatigue & fluid retention caused by cardiac dysfunction
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17
Q

What is tako tsubo syndrome named after?

A

A Japanese octopus pot

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18
Q

What is tako tsubo syndrome?

A 
Left ventricular enlargement 
Apex balloons 
Symptoms mimic MI
Takes on octopus pot shape
Arrises later in life
Caused by stress/trauma "broken-heart syndrome"
80-90% female
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19
Q

What is the effect of tako tsubo on cardiac output and life expectancy?

A

↓Q, ejection fraction ~ 40%.

5% mortality

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20
Q

What are the ECG findings of Tako Tsubo?

A

ST segment elevation
typically associated with MI
But no increase in MI markers

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21
Q

What are the general symptoms of Tako Tsubo?

A

Chest pain
Increased cardiac biomarkers
Normal blood vessels

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22
Q

Define conduction abnormalities

A

disorders that affect bioelectrical transmission along the heart

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23
Q

Give examples of conduction abnormalities?

A 
Atrial Arrhythmias
- Atrial fibrillation
-WPW
Tachycardias
-Sinus
-Atrial
Ventricular arrhythmias
- Ventricular fibrillation
- Torsade de pointes
Conduction block
- AV block (types 1, 2 &amp; 3)
- Bundle branch block
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24
Q

What is a normal ECG? (Atrial)

A

P-wave
Atrial contraction
Normal – followed by a QRS complex

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25
What is a normal EGG? (Conduction)
P-R interval Conduction through AV node Normal – between 120-200 milliseconds (msec)
26
What is a normal EGG? (Ventricular- QRS)
QRS complex ventricular depolarisation. Normal – less than 120 msec
27
What is a normal EGG? (Ventricular- ST)
ST segment – plateau phase. | Normal – at baseline
28
What is a normal EGG? (Ventricular- QT)
QT interval – total duration of ventricular depolarisation & repolarisation
29
What is a normal EGG? (Ventricular- R-R)
R-R interval – duration between ventricular depolarisations (heart beat)
30
What is a normal EGG? (Cardiac axis)
Normal – between -30 to +90 degrees
31
What does a taller QRS complex mean?
More muscle mass in the ventricle of the heart
32
What does a wider QRS complex mean?
Slower conduction within the muscle
33
What is the most common atrial arrhythmia?
Atrial Fibrillation
34
Define AF
Disorganised electric activity and contraction Not all of the blood is released from the atria Blood accumulates in atria Clots and embolises and can cause a stroke
35
What is the underlying cause of AF?
Spontaneously active cells throughout the atria | can be associated with pulmonary veins
36
What are the effects of AF on cardiac output and life expectancy?
Modest decline in output | Increase risk of heat failure and stroke
37
What are the general symptoms of AF?
Palpitations | Chest pains
38
What are the ECG findings for AF?
Absent p-waves, ‘irregularly irregular’ rhythm, fibrillatory waves
39
What is WPW?
Wolff Parkinson White | Atrial Arrythmia
40
Define WPW?
Syndrome causing tachycardia & abnormal cardiac electrical conductance
41
What is the underlying cause of WPW?
Due to an accessory conduction pathway (the bundle of Kent) between the atria and ventricles
42
What are the effect of WPW on cardiac output and life expectancy?
Unchanges | Normal life expectancy
43
What are the general symptoms of WPW?
Palpitations | Chest pain
44
What are the ECG findings for WPW?
Pre-excitation - QRS complex of ECG & biphasic/ inverted - T-wave of ECG
45
Define conduction block (AV)
``` Impaired electrical conduction through AV node Type I (Wenckebach or Mobitz I); type II (Mobitz II) & third-degree (complete) AV block ```
46
What is the underlying cause of an AV conduction block?
Fibrosis or calcification of conduction system | Type I - AV node; types II & III - His Purkinje system
47
What happens in II and III blocks?
Other contractions begin by the spontaneously active cells
48
What is the effect on cardiac output?
Usually decreases
49
What are the ECG findings for an AV conduction block?
Type I: ↑ P-R interval Type II: ↑ P-R interval  1 beat loss of AV conduction Type III: Complete/persistent loss of conduction from the atria to the ventricles
50
Define a bundle branch conduction block
Impaired electrical conduction in the right or left branches or fascicles of the bundles of His Right bundle branch block (RBBB)
51
What are the underlying causes of bundle branch blocks?
LBBB – consequence of ischaemia or heart disease | RBBB – benign & asymptomatic
52
How does LBBB effect cardiac output?
Usually decreases
53
What are the ECG findings for bundle branch blocks?
``` RBBB & LBBB – Widening QRS complex > 120 msec Fascicle blockage (hemi-block) – Alterations in cardiac axis: posterior --> LAD & anterior --> RAD ```
54
Give examples of vascular disorders
``` Hypertension - Primary - Secondary Myocardial Infarction - NSTEMI -STEMI ```
55
Define hypertension
Clinic BP ≥ 140/90 mmHg & ambulatory BP daytime average ≥ 135/85 mmHg
56
What is the underlying cause of hypertension?
Primary cause unknown. Various secondary causes | e.g. kidney disease
57
What are the effects of hypertension on cardiac output and life expectancy?
Will potentially ↓Q | Increases likelihood of heart disease or end-organ damage
58
What at the symptoms of hypertension?
Asymptomatic | Requires BP monitoring
59
What is STEMI?
ST elevated myocardial infarction
60
Define MI
Acute coronary syndrome resulting in cardiac tissue damage to coronary artery blockage
61
Define Angina
Angina - Pain or discomfort that typically radiating from the chest at rest (unstable) or brought on by physical exertion or emotional stress (stable
62
What is the underlying cause of the MI?
Myocardial ischaemia/cell death due to coronary artery disease
63
What are the effects of an MI on cardiac output and life expectancy/
Dependent on site but most likely ↓Q | High mortality if untreated
64
What are the ECG findings for a MI?
ST segment elevation (STEMI) or normal (NSTEMI) Not in all leads In specific leads depending on where the blockage has formed
65
An increased afterload resulting from the impaired ventricular function in heart failure is most likely caused which hormone?
Angiotensin II
66
Which one of the following cardiac ECG parameters is known to change with heart rate?
R-R interval
67
Which one of the following ECG changes would you expect to see in hypertrophy or dilatation of the left ventricle?
Larger QRS complex
68
Which one of the following ECG changes would you expect to see in Takotsubo syndrome?
S-T Elevation
69
An electrocardiogram from a healthy individual was found to have a cardiac axis of 0 (zero) degrees. Which one of the limb leads would you expect to be isoelectric?
aVF
70
Patients suffering from atrial fibrillation (AF) are quite often treated with ‘blood thinning’ drugs such as warfarin. What effect do these drugs have in AF?
They reduce the likelihood of clot formation in the atria
71
A number of drugs are licensed to treat hypertension. Which one of these drug classes is most likely to directly reduce afterload?
Calcium channel blockers
72
Patient case – Investigations show that a patient has sympatho-excitation due to an adrenal tumour. This is causing myocardial ischaemia. What is the mechanism?
Decreased diastolic time Cardiac arterioles primarily fill during diastole Less ability for arterioles to fill Less oxygen supply
73
One of the components of a lethal injection solution involves adjustments of one of the key ions involved in cardiac myocyte depolarisation/repolaristion. Which ion would you change and how?
Increase K+ High potassium is used because it stops the hear from contracting Due to increase in RMP of the cardiac membrane Na+ channels activate but remain inactivated Cannot overcome block

Cardiology (16 decks)

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