CARDIOVASCULAR SYSTEM

Question 1

types of coronary artery disease manifestations

Answer 1

Stable angina 
Unstable angina 
Atypical angina (Prinzmenal) 
MI
Atherosclerotic myocardiosclerosis 
Silent ischemia 
Sudden cardiac death

Question 2

markers for heart attack

Answer 2

1. troponin and ck (dont really use as much now)

Question 3

dresslers syndrme

Answer 3

a type of pericarditis believed to occur after a MI- its the bodys immune response to clearing up the debris but soemtimes it goes over board

Question 4

staging of hypertension

Answer 4

LSO
liable - co increases but normal TPR
stable - co normal but TPR increases
organ damage; compenstaed and decompensated

Question 5

compenstaions of the body in hypertension

Answer 5

pee a lot
decrease HR
vasodilation

Question 6

which recepetors in the heart are responsible for tachycardia

Answer 6

b1

Question 7

most important screening tool for heart failure

Answer 7

BNP

Question 8

whats BNP

Answer 8

its released in response to the stretching of the myocardium by ventricles

Question 9

what level of ejection fraction indicates HF

Answer 9

<40%

Question 10

causes of high output HF

Answer 10

AAPPTT
anemia
Arteriovenous malformation
Paget’s disease
Pregnancy
Thyrotoxicosis
Thiamine deficiency (wet Beri-Beri)

Question 11

physical signs of pulmonary congestion

Answer 11

achypnoea
Bibasal fine crackles on auscultation of the lungs

Question 12

symptoms of pulmonary cogestion

Answer 12

Shortness of breath on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Nocturnal cough (± pink frothy sputum)

Question 13

what is high output HF

Answer 13

so this is where CO is normal ( EF) but its the metabolic needs of the individual are increased so essentially still HF

Question 14

what is diasoltic heart failure and examples

Answer 14

reduced ability of the Ventricles to fill so theres somehting restricting it

Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis

Question 15

causes of heart failure

Answer 15

myocarditis
coranary artery disease
valvular problems - I.e
chronic hypertension
infiltration like hemochromatosis /sarcoidosis
dilated cardiomyopathy
chagas disease in south america

Question 16

s3

Answer 16

(produced by large amounts of blood striking a compliant left ventricle)

occurs in diastole as the heart is filling

usually assocatied with systolic hF(picture)

Question 17

s4

Answer 17

picture says its associated with dialstolic HF

Question 18

systolic vs diastolc HF

Answer 18

s; EF is normal

d: EF not normal

s: s3

D: s4

Question 19

signs of RH failure

Answer 19

distened JVP
ASCITES
pleaural effusions (transudative)
heaptomegaly - abdominal pain
pitting edema of legs, sacrum

Question 20

new york HF class 3

Answer 20

marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).

Question 21

invetsigations for hf

Answer 21

BNP levels
ECHO, ECG , X RAY. (pulmondary markings)
BLOODS-
endocrine(hyperthyroidism), LFTS - heaptomgealy , kidneys values

Question 22

kerley b

Answer 22

associated with pulmonary edema

the interlobular septae are thickened

Question 23

x ray findings from HF

Answer 23

Alveolar oedema (with ‘batwing’ perihilar shadowing)
B: Kerley B lines (caused by interstitial oedema)
C: Cardiomegaly (cardiothoracic ratio >0.5)
D: upper lobe blood diversion
E: Pleural effusions (typically bilateral transudates)
F: Fluid in the horizontal fissure

Question 24

lifestyle modifaction for hF

Answer 24

stop smoking
fluid restriction
salt restriction

Question 25

drugs used in HF

Answer 25

ACE Inhibitors BB digoxin diuretics loops spironolactone hydralazine - vasodilator increases blood flow to CO dopamine - increases contractility

Question 26

INITIAL MANAGEMENT OF ACUTE HEART FAILURE (pumonary edema)

Answer 26

Sit the patient up Oxygen therapy (aiming saturations >94% in normal circumstances) IV furosemide 40mg or more (with further doses as necessary) and close fluid balance (aiming for a negative balance) SC morphine - this is contentious with some studies suggesting that it might increase mortality by suppressing respiration

Question 27

side effects of bb

Answer 27

hypotension erectile dysfucntion psyhcological distrubances bradycardia

Question 28

ace :(

Answer 28

dry cough angioedema HYPERKALEMIA kindey damage

Question 29

Name 2 loops

Answer 29

furosemide and bumetanide

Question 30

usual first line in uk for hF

Answer 30

meds so ace inhibitor and BB If doesnt work then move to spirancolactone

Question 31

cor pulmonale

Answer 31

Right sided heart failure secondary to long-standing pulmonary artery hypertension e.g COPD

Question 32

Which medical device can be used to bridge heart failure patients awaiting a heart transplant?

Answer 32

LVAD - so end stage hF

Question 33

normal EF

Answer 33

50 -70

Question 34

Pulsus alternans

Answer 34

it's quite rare and is a sign of left ventricular pathology failure, the pulse alternates between being strong and weak

Question 35

CRT

Answer 35

biventricular pacing) is a procedure for implanting a permanent biventricular pacemaker. This makes your ventricles (lower chambers in your heart) contract together instead of at different times.

Question 36

how to we classify pulmonary edema

Answer 36

cardiogenic non cardiogenic - exo + endo

Question 37

mechanisms of systolic failure

Answer 37

1. not enough force to pump 2. overburden with volume 3.. overburden with pressure - hypertension -pulmonary hypertension - aortic stenosis

Question 38

whats very specific in the defintion of heart failure

Answer 38

you have to say that the metabolic demands are not met! (because co could be reduced but patient is fine)

Question 39

frank starling principle

Answer 39

stroke volume will increases in response to increase volume of blood which will strech out the chamber and cause it to contract more strongly

Question 40

what is one explanation for the extra fluid in heart faulure

Answer 40

the RAAS gets activated due to poor co and more fluid gets conserved but leaky capillaries

Question 41

dukes major

Answer 41

1. postive blood cultures (more than once) 2. postive echo findings (vegetations, regurgitation , abscess)

Question 42

dukes minor

Answer 42

mb evidence but not fulfilling major fever immunological phenomena risk factors for it

Question 42

dukes minorj

Answer 42

mb evidence but not fulfilling major fever immunological phenomena risk factors for it