week 4

Question 1

inflammatory heart disease mechanism

Answer 1

immune cells attack heart causing inflammation and damage leading to scarring and fibrosis

Question 2

pericarditis 4 characteristics

Answer 2

pleural inflammation
pericardial effusion
ST elevation on ECG
Serious cases leads to pericardial tamponade

Question 3

myocarditis 3 characteristics

Answer 3

myocardium inflammation
elevated troponin and inflammatory markers

Question 4

endocarditis 2 characteristics

Answer 4

endocardium inflammation
often due to vegetations of immune complexes

Question 5

RHD progression 5

Answer 5

Infection
Sore throat and skin sores
Rheumatic fever
Recover and fibrosis or recurrent infection
rheumatic HD

Question 6

immune complex disease definition and cause

Answer 6

antigen antibody complexes which deposit in tissue causing inflammation

occur when there is excessive antigen/antibody present which are not cleared

Question 7

infective endocarditis and immune complexes

Answer 7

immune complexes attack endocardium cause inflammation, seed to structures incl valves

Question 8

RHD key tissue manifestations

Answer 8

brain (chorea), skin (subctuaneous noduels), MSK (arthritis)

Question 9

complications of RHD

Answer 9

emboli - from vegetations
AF
stroke
infective endocarditis

Question 10

common pathogens implicated in endocarditis

Answer 10

staphylococcus aureas
streptococcus viridians

Question 11

infective endocarditis clinical features (4 main tissue manifestations)

Answer 11

Skin: janeway lesions, osler nodes and splinter haemorhages
Joints: Arthritis
Kidneys: Glomerularnephritis
Eyes: conjunctivale haemorhages, ROth spots

Question 12

major features of infective endocarditis 2

Answer 12

1. positive blood culture
2. echocardiogram w vegetation

Question 13

complications infective endocarditus

Answer 13

emboli
HF
sepsis

Question 14

pathology of infective endocarditis 6 steps

Answer 14

infection->bacteraemia->seeding and adhesion->immune response->immune complex formation->chronic inflammation

Question 15

infective endocarditis management 3

Answer 15

antibiotics
HF management
Palliative treatment

Question 16

what calcium channel opens first in pacemaker production and what triggers it

Answer 16

the T type calcium channel opens first allowing rapid depolarisation
triggered by influx of sodium reaching minimum threshold

Question 17

sympathetic influence on HR (not BP) 3

Answer 17

adrenaline and noradrenaline release = chronotropy and inotropy increasing calcium channel currents and sodium channel currents

Question 18

parasympathetic activation of heart

Answer 18

acetylcholine release
binds to muscarinic receptors
increases potassium channel currents
causing hyperpolarisation

Question 19

4 key causes for AF

Answer 19

electrical remodelling
structural remodelling
Ca handling abnormalities
Neural remodelling

Question 20

where do ectopic beats normally come from in AF

Answer 20

pulmonary veins

Question 21

what are the key reasons for AF occuring from the four causes listed prior

Answer 21

reduced refractory period, shorter AP time

Question 22

reason for palpitations, dyspnoea, exercise intoleance, fatigue, chest discomfort, dizziness and syncope in atrial arhythmias

Answer 22

palpitations = irregular heartbeat

dyspnoea+exercise intolerance+fatigue = comprimised CO

chest discomfort = ischaemia

dizziness+ syncope = reduced blood flow to brain

Question 23

4 key drugs in AF management

Answer 23

rate drugs: beta blockers calcium channel anyagonists

rhythm drugs: Amiodarone

anticoagulation

risk factor management

Question 24

scoring system used to link AFib and stroke risk

Answer 24

CHADVAS2 score
1> men = anticoagulation
2> women = anticoagulation

Question 25

4 types of bradyarrhythmia

Answer 25

sinus bradycardia sinus arrhythmia sinus ageing sick sinus syndrome

Question 26

Bradyarrhythmia diagnoses (ECG AV blocks)

Answer 26

type 1 = prolonged PR intervals type 2 mobitz = continually prolonged until one p wave missing type 2 = intermittent type 3 = comple dissociation between atrial and ventricular impulses

Question 27

list management of bradyarrhythmias

Answer 27

cardiac pacemakers

Question 28

types of pacemakers 3

Answer 28

single chamber dual chamber biventricular

Question 29

sudden cardiac arrest

Answer 29

sudden cessation of cardiac activity

Question 30

sudden cardiac death

Answer 30

sudden and unexpected death occuring within an hour of sympotm onsent or within 24hrs of asymptomatic

Question 31

risk factros for sudden cardiac arrest 3

Answer 31

hypertension smoking obesity

Question 32

types of ventricular arrhythmias 5

Answer 32

polymorphic incl torsades des pointes bidirectional monomorphic ventricular flutter ventricular fibrillation

Question 33

list of basic management in ventricular arrhythmias 4

Answer 33

defibrillation CAD management anti-arrhythmic management risk factor management

Question 34

difference between cardiac blues and depressino

Answer 34

cardiac blues: after MI/surgery, will resolve depression: long term, underlying factor, check FHx and SHx

Question 35

presentation of AFIB on ECG signs 2

Answer 35

irregular irregular rate and rhythm

Question 36

invasive management technique in AF

Answer 36

pulmonary vein catherisation and electrical isolation preventing the regeneration and dissemination of ectopic beats

Question 37

what is the rhythm control drug in afib

Answer 37

amiodarone

Question 38

mech of action in amiodarone

Answer 38

blocks potassium channels in myocardial cells resulting in hyperpolarisation whcih decreases rate of contraction and firing

Question 39

criteria of CHADVAS

Answer 39

C = congestive HF H = hypertension A = age<75 D = diabetes V = vascular disease A = age>75 S = sex

Question 40

reasons for sinus bradychardia 5

Answer 40

increased vagal tone SA remodelling/dysfunction decreased sympathetic medication athlete

Question 41

what does sinus arrhythmia look like on an ecg

Answer 41

will always have p waves but the RR intervals are irregular