Diseases of the Cardiovascular System Flashcards
(207 cards)
1
Q
What is ischaemic heart disease
A
inadequate blood supply to the myocardium
2
Q
Incidence of CHD
A
10% in women, 16% in men
3
Q
Causes of Ischaemic Heart Disease
A
Almost always atheroma +/- thrombosis
Myocardial hypertrophy - usually occurs in conjunction
Vasculitis or amyloid deposition
4
Q
When does auto regulation of coronary blood flow break down
A
Over 70% occlusion
If over 90% occlusion insufficient at rest
5
Q
Which area of the heart has the lowest perfusion levels
A
Sub-endocardial
6
Q
3 types of angina
A
Stable/typical - predicatable
unstable/crescendo - unpredictable - coronary artery spasms treat with calcium channel blockers
Variant/Prizemental - RED FLAG SYMTPOM, getting worse often due to plaque disruption
7
Q
What is acute coronary syndrome
A
Actue MI and crescendo angina
8
Q
What usually causes sudden cardiac death
A
Arrhythmias
9
Q
What does chronic ischaemic heart disease cause
A
Hypertrophied heart
10
Q
What is acute ischaemia
A
atheroma + acute thrombosis/haemorrhage
Get transmural MI
Usually due to atheroma plays rupturing
11
Q
Describe the MI Morphology stages
A
1)
12
Q
When can a subendocardial MI occur
A
Can infarct without any coronary artery occlusion if:
Stable atheromatous occlusion of coronary artery
Acute hypotensive episode
13
Q
5 Markers of cardiac myocyte damage
A
Troponin CKMB LDH1 Aspartate Transaminases Myoglobin
14
Q
Troponin in MI’s
A
Peaks 12/24 hours
Detectable for 7 days
Also raised post PE, heart failure and my carditis
15
Q
CKMB in MIs
A
Peaks 10-24 hours
Detectable for 3 days
3 types of CK, CKMM, CKBB, CKMB
16
Q
LDH1
A
Peaks at 3 days
Detectable for 14 days
17
Q
Myoglobin
A
Peaks at 2 hours
Also detecable in skeletal muscle damage
18
Q
Aspartate transaminases
A
Also present in liver so less useful
19
Q
MI Complications
A
Mural thrombosis/emboli can cause stroke (due to altered flow)
Autoimmune pericarditis (dressler;s syndrome)
LV Failure
Ischaemic pain
Arrythmias
Myocardial rupture –> tamponade
20
Q
How is familial hypercholesterolaemia inherited
A
mutation in LDL receptor gene or apolipoprotein B
Autosomal dominant
21
Q
What do heterozygotes for familiar hypercholesterolaemia get
A
Early atherosclerosis
Tendon Xanthoma
Corneus Arcus
Treat with statinsQ
22
Q
What are statins
A
Hydroxymethylglutamyl Co A Reductase inhibitos
23
Q
What is abnormal bp
A
140/90
24
Q
Secondary hypertension causes
A
Renal, endocrine, CV, neurological
25
All inherited and acquired hypertension share
Increased net salt balance
26
Primary hypertension causes
```
cardiac baroreceptors
RAS
Kenin-kallikrein defeciency
naturetic peptides
adrenergic receptros
ANS
autrocrine factors released by blood vessels
```
27
Where is renin synthesised and stored
in the juxtaglomerular apparatus in the afferent arteriole of the kidney
28
What does angiotensinogen II do
short half life
causes vasoconstriction
Causes renal cortex to secrete aldoesterone
29
What secretes aldosterone
the zone glomerulosa cells of the adrenal cortex
30
What can cause increased aldosterone production
Renal artery stenosis
| Coarctation of the aorta
31
How do we detect coarctation of the aorta
differences in leg/arm bp
| characteristic chest x-ray
32
What is conn's syndrome
Excessive aldosterone production but low renin
33
Causes of conn's syndrome
Mostly due to adrenocortical adenoma
| Some due to nodular hyperplasia
34
Effects of Conns Syndrome
High bp due to aldosterone
| Potassium loss - muscle weakness, cardiac arrythmias, paraesthesis, metabolic alkalosis
35
Diagnosing conns syndrome
CT of adrenas
36
What is phaemochromacytoma
Tumour of the adrenal medulla -> causes an increased secretion of catecholamines (adrenaline/noradrenaline)
37
Presentation of phaemochromacytoma
Pallor, headaches, nervous, hypertension
38
Diagnosis of phaemochromacytoma
24 hours urine collection
| Surgery to treat
39
What is cushing disease
Overproduction of cortisol
40
What produces cortisol
The zone fasiculata cells of the adrenal cortex
41
Causes of cushing's disease
```
Pituitary adenoma (80%)
Paraeoplastic effects of other cancers --> particularly small cell lung cancer as it secretes adrenocorticotrophic horome
```
42
Effects of Cushings
Aldosterone like effect on kidney
| Increased sympathetic nervous system activation
43
Hypertension effects
Hypertensive heart disease
Renal
Cerebrovascular
44
What is hypertensive heart disease
Systemic heart disease causes LV hypertrophy --> Initially without dilation
Later get dilation and LV failure
Cause of Sudden cardiac death
45
Renal effects of hypertension
Vascular changes:
Hyaline arteriosclerosis
Arterial intimal fibroelastosis
Gradual decline in renal function causing chronic renal failure
46
Cerebrovascular effects of hypertension
Hypertensive encephalopathy
| Increased risk of rupture: Atheromatous (intracranial haemorrhage), circle of willis (SAH)
47
What is a hypertensive crisis
bp 180/120
Hypertensive encephalopathy
Retinal haemorrhage
Renal failure
48
What is hypertensive encephalopathy
Confusion, vomiting, convulsions, coma and death
Diffuse cerebral dysfunction
Rapidly treat to reduce raised ICP
49
Risk assessment of CVD
Framinghams, SCORE and QRISK
50
Cardiac disease in low risk individuals
Coronary atheromas due to familial hypercholesterolaemias
Cardiomyopathyies e.g. hypertrophic heart
Channel-opathies causing cardiac arryhytmias e.g. Long-QT and Brugada syndrome
51
Causes of pulmonary hypertension
Loss of pulmonary vasculature
Secondary to LVF
Systemic to pulm. artery shunting
Primary/idiopathic
52
What does RV failure cause
systemic oedema
53
what is heart failure
an insufficiency of cardiac output to meet metabolic demand
54
What are the main causes of heart failure
1) MI
2) Hypertension
3) Valvular
55
Describe what happens in heart failure
Increased cardiac work, increased wall stretch, increased cell stretch, hypertrophy, dilation, cardiac failure
56
Is preload proportional to contractile power?
Yes - but if volume overload causes disruption in blood flow patterns --> regurgitation and decreased contraction etc.
57
Causes of Left sided heart failure? (congestion)
Pre-renal azotemia
58
What is pre-renal azotemia?
Poor perfusion to kidneys causes high urea in blood
Kidneys secrete renin - activates RAS
Naturietc peptides secreted
Causes salt and water retention
59
Where are naturetic peptides produced?
Produced by the atrium when its dilated to cause salt and water retention
60
Features of pulmonary congestion
```
Oedema and heart failure
Blood tingled sputum
Dyspnoae, paraoxysmal nocturnal dyspnoea
Cyanosis
Elevated WEDGE pressure
```
61
Main cause of RH Failure
Pulmonary hypertension - usually secondary to left sided heart failure
62
Signs of Rh Failure
Liver/Spleen Enlargement: Due to passive congestion and NUTMEG LIVER
Kidneys effected
Pericardial and pleural effusion
Systemic Oedema
63
Autopsy of findings in congestive heart failure
Box Car Nuclei
Cardiomegaly
Dilated chambers
Hypertrophy of myocardial fibres
64
What causes valvular heart disease
Due to opening problems (stenosis) or regurgitation (closing problems)
65
Causes of aortic stenosis
Rheumatic fever
| Calcification of valve
66
Cause of mitral valve stenosis
Rheumatic Fever
67
Why does rheumatic fever cause valve problems?
Group A Streptcoccci haemolytic infection
Antibodies produced against
Cross reacts with tissue glycoproteins
Can occur in heart --> causes vegetations
68
acute features of rheumatic fever
Inflammation
Aschoff Bodies
Atischkow bodies - macrophages in the cell
Pancarditis
Vegetations --> on the chordae tendinae and leaflet junctions
69
chronic features of rheumatic fever
Thickened valves
Commissural fusion
Thick, short chordae tendinae
70
Aortic stenosis
Left ventricular hypertrophy but no hypertension
Get ischaemia, cardiac decompression, angina and CHF
71
What is mitral annular calcification
Calcification of the mitral skeleton
| Usually get regurgitation but stenosis possible
72
Who is mitral annular calcification more common in
women
73
Causes of aortic regurgitation
Rheumatic Fever
Infection
Aortic dilation - syphilis, rheumatoid arthritis and Marfans
74
Causes of mitral regurgitations
Mitral valve prolapse
75
Causes of mitral valve prolapse - degeneration of the mitral valve
Infection
Fen-Phen (reaction to anti-obesity drug)
Chrodae tendinae and papillary muscle problems
Calcification of the mitral ring (annulus)
76
What is mitral valve prolapse associated with?
Connective tissue disorders
77
Consequences of mitral valve prolapse
Usually asymptomatic
But get floppy valve - prone to infective endocarditis
Get a mid-systolic 'click' - holosystolic murmur if regurgitation present
Can get occasional chest pain and dyspnoea
78
What causes congenital heart diseases
Problems in embryogenesis in weeks 3-8
79
what % of congenital heart diseases are due to gene abnormalities?
10%
80
What genes are usually involved in congenital heart disease
12, 15, 18, 21 and XO
81
Mutations in which gene cause congenital heart problems?
TBX5 - ASD, VSD
NKX2.5 - VSD
These genes code for transcription factors
82
Which chromosome is important for heart development?
Chromosome 22
| Deletions cause conotrucus!
83
Is rubella a teratogen for heart disease?
Yes
84
What is patent foramen ovale
where the septum primum and secundum don't fuse
| occurs in 1 in 4
85
Symptoms of PFO
Usually asymptomatic
| UNLESS increased pressure on the R side such as pulmonary hypertension
86
Describe the developmet of the aorticopulmonary septum
Septum divides the bulbis cords and truncus and aorta and pulmonary artery
Spirals
87
When does the ductus arteriosus close
Usually at birth due to increase in oxygen and decrease in prostaglandins
88
What happens in patent ductus arteriosus
Oxygenated blood flows back to the heart
Pulmonary hypertension
Ventricular hypertrophy
Heart failure
89
How to treat PDA
Prostaglandin inhibitors
90
3 types of Congential heart Disease2
R->L shunts
L-->R Shunts
Obstructions - of aorta or pulmonary artery
91
What causes L-->R Shunts
1) Atrial Septal Defects
2) Ventricular Septal Defects
3) Patent Ductus Arteriosus
4) Atrioventricular Septal Defect
92
What causes R-->L Shunts
1) Tetralogy of Fallots
2) Transposition of the great vessels
3) Truncus Arteriosus
4) Total anomalous pulmonary venous connection
5) Tricuspid atresia
93
What causes ASD's
90% due to problem in septum secundum
5% due to problem in septum primum
5% due to sinus venosus --> abnormal pulmonary veins draining into the SVC or RA
94
Problems with ASD
Usually asymptomatic until adulthood
95
What causes VSD
90% involve problems in the membranous septum
| If muscular septum involved often get multiple holes --> small ones can fix themselves larger ones need surgery
96
Most common congenital heart defect
VSD - 30% occur alone but lots occur with tetralogy of ballots
Can cause pulmonary hypertension
97
What causes atrioventricular septal defects (AVSD)
Defection AV vavles
| Can be partial or complete with all 4 chambers freely communicating
98
What do a 1/3 of people AVSD also have
Downs Syndrome
99
Direction of shunt in PDA
Initially L-->R
| Then R--> L when it reaches systemic pressure
100
Symptoms of PDA
No cyanosis
Pulmonary hypertension
Significant pulmonary hypertension --> irreversible
101
What is tetralogy of fallots
VSD
Overriding aorta
Pulmonary Stenosis
RV Hypertrophy
102
What causes PINK tetralogy of fallots
if the pulmonic obstruction is small
103
What causes transposition of the great vessels
Abnormal formation of the conotruncal septum --> does not spiral
104
What do you need to survive in the transposition of the great vessels
PDA or PFO
| VSD can occur
105
Which ventricle is thicker in transposition of the great vessels
Right Ventricle
| Fatal in first few months without surgical switching
106
What causes truncus arteriosus
Developmental failure of seperation of the truncus arteriosus CONOTRUNCAL SEPTUM DOESNT FORM --> pulmonary artery and aorta are not separated
107
What problems are associated with truncus arteriosus
VSD - as the conotruncal septum doesn't form it can't fuse with inter ventricular septum so you get a VSD
108
What does truncus arterioles causes
Systemic cyanosis with increased pulmonary blood flow
109
What is total anomalous venous connection
Pulmonary veins drain into the left innominate vein or the coronary sinus
110
What happens if you get a total anomalous venous connection
Get a hypo plastic left atrium
| Need a PFO or an ASD otherwise a fatal condition due to lack of perfusion to the organs!
111
What happens if you get tricuspid atresia
Hypoplastic RV
112
What do you need to survive if you have a tricuspid atresia
PDA or ASD defect needed to fill the Left atrium with blood
VSD needed to pump blood into the pulmonary arteries
Left ventricle supplies both the aorta and pulmonary artery! Heart unable to pump oxygenated blood properly
113
Who is coarctation of the aorta more common in
Males and XO's
114
Which form of aorta coarctation happens in infants that is serious
Proximal to the PDA
115
What occurs with coarctation of the aorta 50% of the time
Bicuspid aortic valve
116
What happens with 100% artretic pulmonary stenosis
Hypoplastic RV with ASD
117
What happens if you get severe aortic stenosis/vavlular
If severe can cause hypo plastic LV which is fatal
118
3 types of aortic stenosis
Valvular
Sub-valvular
Supra-valvular
119
What is endocarditis
inflammation of the endocardium of the heart
120
What are the 2 main forms of endocarditis?
1) Infective
| 2) Non-infective: e.g. NonBacterial Thrombotic Endocarditis (NBTE) or endocarditis of SLE (Libman Sacks)
121
What is the main cause of infective endocarditis
Bacteria, then fungi then virus
122
What are the vegetations in infective endocarditis
Mixture of thrombotic debris and organism --> destroyed the underlying cardiac tissue
123
Describe acute infective endocarditis
Infects normal heart valves
Highly virulent organisms
Necrotizing, ulcerative, destructive lesions
Difficult to cure with antibiotics and usually require surgery
Death frequent
124
Describe sub-acute infective endocarditis
Less virulent organisms
Usually infects formed valves
Wax and wane of flu like symptoms
Cured by antibiotics
125
Risk factors for endocarditis
Cardiac/valvular abnormalities i.e. rheumatic fever
Dental wrok
Structural abnormalities of the heart
126
Bacteria causing endocarditis from mouth
Strep viridans
127
Bacteria causing endocarditis from skin
Staph aureus, especially in IVDU
128
Bacteria causing endocarditis that indicates bowel cancer
Strep. bovis
129
What bacteria commonly infects prosthetic heart valves
Coagulase negative staphylococci e.g. S. Epidermidis
130
What are the vegetation of acute infective endocarditis like
Bulky, friable, potentially destructive
Can cause abscesses
Emboli contain large numbers of virulent organsisms
Usually affects AV, MV and right hear (especially in IVDU)
131
Clinical features of infective endocarditis
Fever, flu-like symptoms, weight loss, murmurs (in 90% of those with left sided infective endocarditis)
132
Clinical Signs of Infective Endocarditis
```
F-fever
R-Roth spots (retinal haemorrhages)
O-Oslers Nodes (subcutaneous lesions in the pulp of digits)
M-Murmur
J-Janeway lesion
A-Anaemia
N-Nail (splinter) haemorrhages
E-Emboli (septic)
```
133
Complication of infective endocarditis
Immunological mediated conditions e.g. glomerulonephritis
134
Who does NBTE infect
Often debilitated patients often with hypercoaguble state
e.g. DVT, PE, Cancer, pro-coagulant effect of tumour-derived mucin or tissue factor
Can occur part of trousseau syndrome of migratory thrombophlebitis
135
What predisposes you to NBTE
endocardial trauma and indwelling catheter
136
What is NBTE (Libman Sacks) associated with
SLE
| usually asymptomatic apart from the SLE symptoms
137
What are the vegetations in Libamn Sacks like
AV vealves affects
| Small, pink, sterile, and warty
138
What are aschoff bodies
Distinctive in cardiac lesions i.e. rheumatic fever
| Foci of T cell, plasma cell and macrophages
139
What does rheumatic fever cause
Pancarditis
| Vegetations are called verucae
140
what are antibodies directed against in Rheumatic fever
Against the M proteins of the streptococci infection
141
How does rheumatic fever damage heart tissue
CD4+ T cells specific for streptococcal peptides react with streptococcal peptides that read with self-proteins in heart, produce cytokines that activate macrophages
Diagnose with Jones Criteria
142
Causes of Pericarditis
Infection - viruses, Coxsackie B
Immunological processes: RHeumatic Fever, SLE, Dresslers etc
Post MI, surgery, neoplasia, trauma etc
143
Describe types acute pericarditis
Serous/serofibrinous/fibrinous
Purulent/supparative
Haemorrhagic
Caseous
144
Describe chronic pericarditis
ADHESIVE, can cause constrictive peridcarditis
145
Causes of serous pericarditis
Generally non-infective --> usually due to inflammation of adjacent structure or sometimes viral (coxsackie or echovirus)
146
Type of inflammation in serous pericarditis
clear, serous fluid accumulation
147
Most common form of pericarditis
Serofibrinous/fibrinous
148
Cause of fibrinous/serofibrinous pericarditis
```
Post MI
Dresslers
Uraemia
Radiation
Rheumatic fever, SLE,
Trauma and surgery
```
149
Type of inflammation in fibrinous/serofibrinous
Fibrous --> without fluid, dry and granular surface with more intense inflammatory response
Serious fluid and or fibrinous exudate in the pericardial sac
150
Purulent/supurative pericarditis cause
Infection
151
Type of inflammation in purulent/supparative pericaditis
Red, granular exudate upto 500ml
Can cause restrictive pericarditis
Inflammation can extend causing media-stino pericarditis
152
Haemorrhagic pericarditis inflammation type
Caseous (Cheesy) pericarditis e.g. TB or fungal
153
Causes of hemorrhagic pericarditis
Neoplasic
Infection e.g. TB
Following surgery
154
Clinical features of pericarditis
Sharp central chest pain: worse on inhalation and movement, better on sitting forward
Pericardial friction rub - loudest over diaphragm in left sternal edge
Fever, leucocytosis, lymphocytosis
Can get pericardial effusion/tamponade
155
Types of chronic pericarditis
Adhesive - obliterates pericardial cavity
Adhesive mediastinopericarditis --> follow infections, surgery or radiation. Obliterated pericardial cavity extending to surrounding structures. Causes hypertrophy/dilation
Constrictive pericarditis
156
How to treat constrictive pericarditis
Surgery
157
what is cardiomyopathy
Disorder of the myocardium
158
What are the 4 main of types of cardiomyopathy
1) Dilated
2) Hypertrophic
3) Restrictive
4) Arrythmogenic Right Ventricular
159
What is dilated cardiomyopathy
Progressive dilation
Causes contractile dysfunction and systolic failures
Heart gets enlarged, flabby and heavy
160
Causes of dilated cardiomyopathy
20-50% Genetic - AD Mutations in cytoskeleton Proteins
| Rest due to alcohol and toxins e.g. chemo
161
Signs of dilated cardiomyopathy
Congestive heart failure, SOB, dyspnoea, poor exertional acapcity
162
Treatment of dilated cardiomyopathy
Transplant or long-term ventricular assist
163
What is hypertrophic cardiomyopathy
Hypertrophy and poorly compliant left ventricular myocardium
Diastole dysfunction but systolic function preserved --> can't dilate in diastole due to poorly compliant/stiff walls
Main cause of Left Ventricular Hypertrophy
164
Causes of hypertrophic cardiomyopathy
100% genetic - problems in the sarcomeric proteins
165
Signs of hypertrophic cardiomyopathy
Reduced stroke volume and obstruction to LV outflow --> this causes a systolic ejection murmur
Exertional dyspnoea
The anterior mitral leaflet moves towards the inter ventricular septum in systole
166
Main cause of sudden death in young athletes
hypertrophic cardiomyopathy
167
What can hypertrophic cardiomyopathy lead to?
```
Arrythmias
Mural thrombosis
Cardiac Failures
AF
Sudde Death
```
168
What is restrictive cardiomyopathy
Primary decrease in ventricular compliance --> reduces ventricular filling during diastole
169
Causes of restrictive cardiomyopathy
```
Fibrosis
Amyloidosis
Sarcoidosis
Metastatic tumours
Deposition of metabolites
```
170
Size of ventricles in restrictive cardiomyopathy
Normal/slightly enlarged.
| Myocardium is stiff and non-compliant
171
What is arrythmogenic right ventricular cardiomyopathy
Right ventricular dilation and myocardial thinning
172
Cause of arrythmogenic right ventricular cardiomyopathy
Genetic Disease - autosomal dominant
Problem with desmosomes (for cell-cell adhesion)
cells fall off and die during exercise
Replacement of RV with fibrofatty cells
173
Signs of arrythmogenic right ventricular cardiomyopathy
Can be silent, syncope, cardiac death in the young
174
Causes of myocarditis
Mostly infective: Cocsackie A/B Virus
| Chaga's Disease (Trypanosome cruzi protozoa) --> endemic in S. AMerica
175
Symptoms of Myocarditis
Asyomptomatic/heart failures/arrythmias/sudden death
Non-specific symptoms: fatigue, palpitation, precordial deiscomfort, fever
Can mimic an acute MI
176
What can develop from myocarrditis
Dilated cardiomyopathy
177
What do we use to name vasculitis
Chapel Hill Nomenclature
178
What is the most common form of vasculitis
Giant Cell Arteritis (GCA)
179
What arteries does GCA affect?
Large/medium sized
Arteries in head i.e. temporal
Also ophthalmic and vertebral
180
Consequence of GCA in the ophthalmic artery
Can cause permanent blindness --> medical emergency
181
Morphology of GCA
Intimal thickening --> narrows the lumen
Chronic granulomatous inflammaton --> elastic lamina configuration
Multinucleated cells
182
Clinical features of GCA
Facial pain or headache --> particularly superficial temporal artery and jaw claudication
Vague symptoms e.g. fever/weight loss
Rare in under 50s
183
Treatment of GCA
corticosteroids and anti-TNF
184
Diagnosis of GCA
biopsy - take 2-3cm of artery as it is a segmental disease
185
What are aneurysms
localised, permanent dilations of a blood vessel
186
Types of aneursyms
```
atherosclerotic
dissecting
berry
micro
syphilitic
Mycocytic
False
```
187
Most common aneurysm
Atherosclerotic aneurysm --> commonly affects AAA
188
Risk of AAA rupture
less than 4cm no risk
4-5cm = 1%
5-6cm = 11%
over 6 cm = 25%
189
How to detect AAA
Ultrasound and then have endovascular repair
190
What is dissecting aneursym
Tear in the vessel wall and blood goes between the intimal and medial layers
191
Where do dissecting aneurysms usually occur
Usually in the thoracic artery secondary to systemic hypertension
192
Signs of thoracic aorta
Tearing pain in chest radiating upper left shoulder
Progressive vascular occlusion and haemopericardium
High mortality if not treated
193
What are berry aneurysms
Secular lesions in the circle of willis --> commonly at medial weakness of arterial bifurcaions
194
Who berry aneurysms usually occur in
Young hypertensive patients
195
Cause of micro aneursyms
Charcot-Bouchard syndrome --> aneurysms in small cerebral capillaries in hypertensive disease --> causes intracerebral haemorrhages
Also retinal aneurysms in diabetes can causes diabetic retinopathy
196
Cause of syphilitc aneurusms
Tertiary syphilis can cause aneurysms in the ascending aorta
197
What is a mycotic aneurysms
Weakening of the arterial wall secondary to bacterial/fungal infections
198
How to organisms enter in mycotic aneurysms
Enter the media via the vasa vasorum
199
Most common underlying infection in mycotic aneursysms
Sub-acute endocarditis
200
Where do mycotic aneurysms commonly occur
The cerebral arteries
| If it infects the AAA there is a risk of rupture
201
What are false aneurysms
Blood filled spaces around a vessel following traumatic rupture of perforating injury
Adventitial fibrous tissue contains the haematoma
202
When are false aneurysms classically seen
Femoral artery puncture during angioplasty/angiography
203
What do we give to treat acute coronary artery occlusion
Oxygen, ACEi, GTN, Beta blcokers, Pain relief, Statins
204
Why might you collapse and die after an MI
Likely an arrhythmia
205
What could a systolic murmur indicate
Aortic stenosis
206
How can COPD affect the heart
Causes pulmonary hypertension can cause RH failure
207
When is BNP raised
Raised in myocardial stress
