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C Flashcards

1
Q

5 factors determining Stroke Volume

A
  1. Preload (venous return) - defined by intravascular filling status, venomotor tone, RA pressure
  2. Afterload - MAP against which LV volume ejected, increased afterload increases end diastolic stretch & contractility
  3. Contractility - Starling relationship between EDV and force of contraction
  4. Heart Rate - filling proportional to duration of diastole
  5. Rhythm (coordinated cardiac contraction)
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2
Q

3 factors determining Heart Rate

A
  1. Neural Stimulation of SAN by parasympathetic/sympathetic nervous system
  2. Chronotropes
    Positive - adrenaline, isoprenaline
    Negative - beta-blockers, verapimil
  3. Atrial Filling increasing RA stretch increases HR via mechanically-coupled ion channels
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3
Q

Poiseuille-Hagen Equation

A

Flow is proportional to radius^4

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4
Q

3 factors controlling Vasomotor Tone

A
  • Nitric Oxide - released in response to shear stress, results in vasodilation
  • Sympathetic Stimulation - of vascular smooth muscle
  • Circulating Catecholamines - on vascular smooth muscle
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5
Q

Mean Arterial Pressure =

A

CO x TPR

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6
Q

Cardiac Output =

A

SV x HR

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7
Q

Arterial Pressure Waveforms A B C D?

A

A - normal - Ao is opening of aortic valve just after S1. Ac is closure of aortic valve (S2). Dichrotic notch due to elastic recoil of aorta as valve closes.
B - aortic stenosis - slow-rising, late peaking.
C - aortic regurgitation - high volume upstroke, rapid fall in pressure to lower diastolic pressure. This produces collapsing pulse.
D - bisfiriens pulse - co-existing AS/AR. Biphasic ejection, mid-systolic dip.

Note - area under curve reflects stroke volume

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8
Q

Normal JVP waveform - what occurs at each letter?

A

a wave - right atrial contraction
x descent - right atrial relaxation
c wave - tricuspid valve bulges back into right atrium as it closes
x’ descent - blood draws into PA, “sucking” blood towards cardiac apex
v wave - passive right atrial filling
y descent - tricuspid opening

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9
Q

Vaughan-Williams classification of anti-arrhythmic drugs - examples

A
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10
Q

Stages of cardiac action potential and which antiarrhythmics act at each stage

A
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11
Q

3 pathologies at a wave of JVP waveform

A

Giant a wave - obstruction to RV flow eg PHTN, pulmonary/tricuspid stenosis
Cannon a wave - contraction of RA when tricuspid valve closed (eg CHB)
Loss of a waves - afib/flutter

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12
Q

1 pathology at v wave of JVP waveform

A

Giant v waves - severe tricuspid regurgitation

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13
Q

2 pathologies at y descent of JVP waveform

A

Blunted y descent - impaired RV filling
(eg tamponade)
Accentuated y descent - accelerated filling (eg constrictive pericarditis)

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14
Q

ECG - causes of pathological q waves

A

Characteristics - >2mm deep, >1mm wide, >25% depth of QRS, in V1-3

  • Myocardial Infarction
  • Cardiomyopathy - HCM, infiltration
  • Conduction - LBBB, WPW
  • Rotational eg dextrocardia
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15
Q

ECG - causes of LAD

A
  • Structural - LVH, cardiomyopathy, primum ASD, tricuspid atresia
  • Conduction - LBBB, left sided hemi-block
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16
Q

ECG - causes of RAD

A

Structural - RVH - secondary to lung disease, PE, large secundum ASD
Conduction - RBBB
Infancy

17
Q

ECG - causes of LBBB

A

Ischaemic - post-MI
Structural - LVH, myocarditis/cardiomyopathy
Right ventricular pacemaker at apex

18
Q

ECG - causes of RBBB

A

Ischaemia - post-MI
Structural - RV strain (e.g. PE), ASD, myocarditis/cardiomyopathy
Normal in young

19
Q

ECG - causes of dominant/tall R waves in V1

A

Ischaemia - Posterior MI
Structural - RVH, right ventricular strain, septal hypertrophy in HCM, dextrocardia
Conduction - LV pacing, WPW type A

20
Q

ECG - feature of left atrial enlargement

A

Biphasic p wave in V1

21
Q

ECG - feature of right atrial enlargement

A

Tall p wave in II

22
Q

ECG features in athletes

A
  • Sinus bradycardia
  • 1st degree HB
  • 2nd degree HB - Mobitz 1/Wenkeback
  • Voltage criteria for LVH
  • Early repolarisation
23
Q

ECG - causes of transient q waves

A

Coronary vasospasm
Hypoxia
Hypothermia

24
Q

ECG features of hypothermia

A
  • Prolonged PR QRS QTc
  • Osborne/ J waves
  • Ventricular ectopy
  • Shivering artefact
25
Q

ECG features of hypokalaemia

A
  • u waves!
  • flat/inverted t waves, ST depression
  • tall p waves, prolonged PR
  • prolonged QT, broad QRS
26
Q

ECG features of hyperkalaemia

A
  • Tall tented t waves
  • absent p waves
  • broad QRS -> sinusoidal waves
27
Q

ECG features of hypocalcaemia

A

Long QT interval
Can precipitate Torsades de Pointes

28
Q

ECG features of hypercalcaemia

A

Short QT interval

29
Q

4 types of prolonged ECG monitoring and their features

A
  1. Holter monitor - 24h to 7d with patient diary. V ectopics >20% - risk of future cardiomyopathy - beta blocker +/- echo.
  2. External recorders - intermittent monitor on chest at symptom onset
  3. Wearable loop recorders - self-erasing loop continuous monitoring.
  4. Implantable loop recorders - ECG recorded at pre-spec rhythm criteria, 3+ year implantation
30
Q

4 indicators of viable myocardium

A
  • Wall thickness >6mm at end-diastole
  • Improved contractile function with low dose inotropes
  • Scar <50% of wall thickness (late-gadolinium enhancement on CMR)
  • Intact, functioning cell membrane (PET scan)
31
Q

Anatomical imaging for CAD

A

CT Calcium scoring
CT coronary angiogram

32
Q

Functional imaging for myocardial ischaemia

A

Stress Echo
Stress myocardial perfusion screen (nuclear)
Stress cardiac MRI

33
Q

Features of RV infarction (complication of inferior MI)

A

STE/isoelectric ST in lead V1
+/- ST depression in V2
STE in III>II

Relevance? Preload sensitive (poor RV contractility)
Nitrates contraindicated, give fluid if hypotensive

34
Q

Causes/Risk Factors for Aortic Dissection

A

3 Cs
Cardiac
- Chronic Hypertension (with acute precipitant e.g. weights, cocaine)
- Age
- Male
- Hyperlipidaemia / cholesterol
- Poor diet
- Smoking
Connective Tissue Disease
- Ehler’s Danlos, Marfans
Conditions / Surgical
- Bicuspid aortic valve
- Coarctation
- CABG
- AVR

35
Q

SALIM mnemonic

A

Simvastatin, Atorvastatin - Lipophilic statins more likely to cause Myopathy

Pravastatin, Rosuvastatin, Fluvastatin - hydrophilic statins

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