another CVS review

Question 1

name a K+ channel blocker

Answer 1

amiodarone

Question 2

name an Na+ channel blocker

Answer 2

Lidocaine

Question 3

Which of the following conditions can be treated with β-adrenoreceptor antagonists?

Answer 3

Heart failure, supraventricular tachycardias (slowing AV conduction) and post-MI (reduce oxygen demand of the myocardium and reducing sympathetic activity) are indications for beta blockers. (not unstable angina)

Question 4

An otherwise healthy 20 year old man presents to A&E with episodes of a racing heartbeat, shortness of breath, and sweating that last for minutes at a time. Upon performing an ECG, the doctor diagnoses him with Wolff-Parkinson-White syndrome. Which class of drug will the doctor prescribe to treat the tachycardia?

Answer 4

The doctor would give a potassium channel blocker like amiodarone, because this increases the absolute refractory period of the myocytes - this will help to prevent the re-entry loop.

Question 5

A patient presents to A&E with symptoms of heart failure. An ECG is performed which also shows her to be tachycardic. Which drug should she be prescribed?

Answer 5

Digoxin is an example of a cardiac glycoside, and it causes an increase in vagal activity. This slows AV node conduction to slow the heart rate. It also acts to increase intracellular calcium, to increase the force of contraction of the heart.

Question 6

Which of these diseases could increase the pulmonary capillary pressure?

Answer 6

Mitral stenosis can cause the left atrial pressure to increase, which will increase the capillary pressure in the lungs.

Question 7

What is the PRIMARY mechanism by which Glyceryl trinitrate (GTN) spray alleviates myocardial ischaemia in a patient with stable angina?

Answer 7

By dilating systemic veins NO reduced the preload to the heart (reduces the venous return) and hence reduces the force of contraction. This reduces the workload of the heart.

Question 8

How does adenosine work to terminate a supraventricular tachycardia arising from a re-entry pathway?

Answer 8

Slows / momentarily blocks AV node conduction

Question 9

A 78 year old woman has congestive heart failure (failure of both sides of the heart). She has developed peripheral oedema affecting her ankles. How will changes in the Starling forces at the capillaries have caused oedema at the ankles?

Answer 9

Hydrostatic pressure at the capillaries will have increased due to raised venous pressure

Question 10

ECG A fib findings

Answer 10

absent P waves, irregularly irregular QRS complex

Question 11

Which leads look at the right coronary artery?

Answer 11

The anterior (V3 and V4) and the inferior (II, III, and aVF) leads look at the distribution of the right coronary artery.

Question 12

Which condition gives a sawtooth baseline on an ECG due to P waves?

Answer 12

Atrial flutter presents with a saw tooth baseline on ECGs due to the consecutive P waves. This is caused by a re-entry loop in the atria.

Question 13

What is the most common heart condition that presents with an irregularly irregular rhythm?

Answer 13

Atrial fibrillation is the most common cause of an irregularly irregular rhythm.

Question 14

difference between a fib and flutter ecg

Answer 14

Question 15

What is the first sign of hypokalaemia to appear on an ECG as potassium concentration decreases?

Answer 15

The first sign of hypokalaemia is a low T wave. With increasing severity, it is also assocaited with a high U wave and then a low ST segment.

Question 16

what is Torsades de Pointes

Answer 16

Torsades de Pointes is a polymorphic ventricular tachycardia, meaning that it is a state of ventricular fibrillation but the QRS complexes all look very different. It is associated with a long QT interval.

Question 17

Why does the chest pain in a patient with stable angina come on with exercise?

Answer 17

Blood flow through the left coronary artery is compromised because diastole is shorter and the oxygen demand has increased

Question 18

acute anterolateral NSTEMI?

Answer 18

ST depression in leads I, aVL, V3, V4, V5 and V6 and presence of troponins

Question 19

A 50 year old man had a routine blood pressure measurement at the GP surgery. Three readings were taken and the results were consistently 140/95 mmHg. This was followed up by 24 hour ambulatory blood pressure measurement which gave a value of 137/87 mmHg. How would his blood pressure be classified?

Answer 19

stage 1 hypertension

Question 20

A patient comes to you presenting with claudication in their left buttock, thigh and calf. You check for pulses in the right leg, and find that the femoral, popliteal and pedal pulses are absent. You suspect arterial stenosis. Which of the following arteries is most likely to be affected?

Answer 20

common iliac

Question 21

A patient comes to you presenting with claudication in their right calf. You check for pulses in the right leg, and find that the femoral pulse is present, but the popliteal and pedal pulses are absent. You suspect arterial stenosis. Which of the following arteries is most likely to be affected?

Answer 21

superficial femoral

Question 22

Parkinson’s patients often have a shuffling gait – meaning that they take small steps and their feet don’t move much when walking (festination). Over time, how can this gait lead to venous hypertension?

Answer 22

Patients with Parkinson’s Disease often do not contract their calf muscle when they walk, so the venous return to the heart is reduced. This can lead to venous hypertension.

Question 23

What structures does the transverse pericardial sinus separate?

Answer 23

The aorta and pulmonary trunk from the venous inflow to the heart

Question 24

A 78 year old man has congestive heart failure (failure of both sides of the heart). He has developed pulmonary oedema due to raise hydrostatic pressure in the pulmonary capillaries. What has caused this increased pressure?

Answer 24

Increased left atrial pressure

Both the left and right side of the heart are failing, but it is the left ventricular failure that causes the increase in capillary hydrostatic pressure in the lungs. If the left ventricle cannot pump out properly, the end systolic pressure is increased. |This makes it harder for the blood to flow from left atrium to left ventricle, The left atrial pressure is thus increased. this increased pressure is transmitted back to the capillaries.

Question 25

A 58 year old man is investigated for acute onset chest pain in the Emergency Department. He has had no previous cardiac events. Which of the following findings are consistent with unstable angina?

Answer 25

ST depression in leads II, III and aVF but no troponin present

Question 26

Answer 26

Third degree heart block

The P-waves are firing at a rate which is faster and independent of the QRS complexes. Note: The QRS complexes are of normal duration, indicating that the block is higher up at the AV node or proximal bundle of His allowing a normal spread of conduction through the ventricles.

Question 27

Answer 27

Anterior interventricular artery

Question 28

A patient comes into A&E with sharp, retrosternal chest pain. Their ECG reveals ST elevation in several leads. What is the most likely condition that this patient has?

Answer 28

pericarditis

Question 29

A patient comes into A&E with chest pain at rest. You do an ECG which shows an ST depression and nothing else. You also do a cardiac troponin assay which comes back negative. What diagnosis would you give this patient?

Answer 29

unstable angina

Question 30

What is most common cause of right-sided heart failure?

Answer 30

left sided heart failure

Question 31

normal ejection fraction

Answer 31

An ejection fraction of over 50% is considered normal.

Question 32

Which of the following would be suitable to use in the initial pharmacological therapy of heart failure?

Answer 32

ACEi, ARBs, diuretics

Question 33

cause of Heart Failure with Preserved Ejection Fraction (HFpEF)

Answer 33

Ventricular hypertrophy is the main cause of Heart Failure with Preserved Ejection Fraction (HFpEF) - to have a maintained ejection fraction there must be diastolic dysfunction (meaning filling is reduced), which can only be achieved if the ventricle walls are very thick.

Question 34

A patient is referred to the cardiology clinic. Upon taking a history and examination you note they are experiencing fatigue and breathlessness, and their apex beat is displaced to the left. Which type of heart failure does this indicate?

Answer 34

his patient seems to be presenting with left sided heart failure, due to their apex beat being displaced to the left, and symptoms of breathlessness.

Question 35

Which of the following conditions can cause cardiogenic shock?

Answer 35

Cardiogenic shock is caused by a failure to pump by the heart. This means the correct answers here are MI, heart failure, and severe dilated cardiomyopathy.

Question 36

Which of the following are a type of shock caused by a fall in total peripheral resistance?

Answer 36

septic shock and anaphylactic shock