2. Cardio

Question 1

What receptors control heart rate?

Answer 1

Beta 1- increase heart rate

Muscarinic- Decrease heart rate

Question 2

What causes left sided heart failure?

Answer 2

acute myocardial infarction although dysfunction of the valves, mitral valve regurgitation being the most common, can also result in back flow of blood into the pulmonary circulation

Question 3

How do you work out the rate on an ECG?

Answer 3

Th normal rate of an ECG should be 25mm/sec menaing each small box is 0.04 s and each big box is 0.02 seconds

Therefore 30 big boxes is 6 seconds (30x0.2=6s) and the number of QRS complexes in that time (ventricular contractions) is the heart rate

Question 4

Where do you place the limb leads in an ECG

Answer 4

Right arm- red
Left arm- amber
Left leg- green
Right leg- black

Question 5

What is meant by sinus rhythm?

Answer 5

P wave for every Q

Question 6

What nerves controls heart rate?

Answer 6

Vagus nerve- parasympathetic

Branch of phrenic nerve- sympathetic

Question 7

Describe the pathway of conduction in the heart?

Answer 7

Sinoatrial node
Atrioventricular node
Bundles of hiss
Perkinje fibres

Question 8

What hormones control cardiac output?

Answer 8

Epinephirine is released from adrenal medulla constricting arteries

angiotensin is produced in low blood volumes causing arteriolar constriction

vasopressin is an ADH hormone that constricts arterioles

ANP and BNP is produced in response to high blood volume, dilating arteries

Constriction increases BP

Question 9

What controls short term blood pressure

Answer 9

Carotid and aortic baroreceptors

Question 10

What controls long term blood pressure

Answer 10

The kidney and there three distinct hormone systems:

Renin-angiotensin-aldosterone system releases angiotensin II increasing MAP

ADH increases MAP when it is low

ANP decreases MAP when it senses it has raised

Question 11

A patient has a slow rising plateuing pulse. What is this a sign of?

Answer 11

Aortic stenosis

Question 12

How do you test for endocarditis?

Answer 12

Echocardium and multiple blood cultures

Question 13

How do you treat infective endocariditis

Answer 13

2 antibiotics for at least 2 weeks IV and then oral

Question 14

Describe the fate of the aortic arches?

Answer 14

The first and second arches disappear early, a remnant of the 1st arch forms part of the maxillary artery (a branch of external carotid artery)

The third aortic arch constitutes the commencement of the internal carotid artery, and is therefore named the carotid arch

The fourth right arch forms the right subclavian

The fourth left arch becomes the arch of the aorta

The fifth arch disappears on both sides

The sixth arches form the pulmonary arteries

Question 15

What is the best drug to treat angina?

Answer 15

beta blockers- only one with a negative ionotropic effect. They decrease heart rate, increasing diastole and increasing the time the heart spends in diastole

Question 16

What other treatments should you consider for angina?

Answer 16

CCB

Aspirin

Statin

Cardiology stenting

(GTN acute)

Question 17

When should thrombolysis be used for strokes?

Answer 17

only within 4 and a half hours of onset

Question 18

What are the common types of drug sused in cardio?

Answer 18

Anti hypertensives- CCB, ACE inhibitors, beta blcokers

anti platelets- aspirin and clopidogrel

Anti- coagulants- heparin and warfarin

statins

Question 19

When do you use digoxin?

Answer 19

Heart failure and AF (not in poor renal function)

Question 20

Pregnant woman develops red face, breathlessness and a raised JVP?

Answer 20

Mitral stenosis

Could also be JVP but has mitral faces (red face)

Question 21

What heart valve abnormality is associated with rheumatic heart disease

Answer 21

mitral regurgitation

Question 22

What are some classic symptoms of marfans

Answer 22

Increased aortic root diameter
Apical blebs
Mitral regurgitation
Tall
Ductal ectasia (widening of dural sack)

Question 23

What genetic mutation causes marfans?

Answer 23

Fibrin mutation