Cardio pathology

Question 1

A 53-year-old man presents to the emergency department with central chest pain which began 20 minutes ago. An ECG is ordered which shows ST elevation in leads I, aVL, and V6. Which of the coronary arteries is most likely to be obstructed?

Answer 1

Left circumflex artery

Leads I, aVL, V5 and V6 correspond to the lateral area of the heart. This is supplied by the left circumflex artery.

Question 2

ECG change V1-V4

Which coronary artery?

Answer 2

Left anterior descending

Question 3

ECG change I, II, aVF

Which coronary artery?

Answer 3

Right coronary

Question 4

ECG change I, aVL +/- V5-6

Which coronary artery?

Answer 4

Left anterior descending or left circumflex

Question 5

Tall R waves
V1-2
Which coronary artery

Answer 5

Usually left circumflex, also right coronary

Question 6

A post-mortem examination is carried out to determine the cause of death, which demonstrates 90% stenosis of the left anterior descending artery.

What is the final step in development of this stenosis?

Answer 6

Smooth muscle proliferation and migration from the tunica media into the intima

Question 7

Cardiovascular effect of BNP

Answer 7

Decreased preload and decreases after load

BNP is a vasodilator, diuretic and natriuretic, and decreases sympathetic tone and RAAS.
Its diuretic feature means venous return decreases so preload decreases.
Its decreases of systemic vascular resistance decreases the afterload.

Question 8

What is the cause of a 4th heart sound?

Answer 8

4th heart sound is indicative of a abnormally stiff ventricle. Therefore the sound is forceful atrial contraction.

Question 9

When can rubbing of the pericardium be heard?

Answer 9

Pericardial effusion

Question 10

What can be heart when there is a ventricular septal defect?

Answer 10

systolic murmur

Question 11

What could cause a diastolic murmur?

Answer 11

mitral regurgitation

Question 12

First heard sound

Answer 12

Closure of mitral and tricuspid valves

Question 13

Second heart sound

Answer 13

Closure of aortic and pulmonary valves

Question 14

Third heart sound

Answer 14

Caused by rapid filling of ventricles with blood during diastole

Question 15

Abnormalities in first heart sound

Answer 15

Soft if there is a long PR (i.e. long time between atrial depolarisation and ventral depolarisation).

Loud in mitral stenosis

Question 16

Abnormalities in second heart sound

Answer 16

Soft in aortic stenosis

Question 17

Abnormalities in third heart sound

Answer 17

It is normal under the age of 30 but after that it is heard in

• left ventricular failure
• constrictive pericarditis
• mitral regurgitation

Question 18

When may 4th heart sound also be heard?

Answer 18

Aortic stenosis
Hypertrophic cardiomyopathy
Hypertension

Question 19

Site of auscalation - pulmonary valve

Answer 19

left 2nd intercostal space at upper sternal border

Question 20

Site of pulmonary auscalation - aortic valve

Answer 20

Right 2nd intercostal space at upper sternal border

Question 21

Site of pulmonary auscalation - mitral valve

Answer 21

Left fifth intercostal space, medial to midclavicular line

Question 22

Site of pulmonary auscalation - tricuspid valve

Answer 22

Left 4th intercostal space, at the lower left sternal border

Question 23

What would be suggestive of heart failure on a chest X-Ray?

Answer 23

Upper zone vessel enlargement

Question 24

Which coronary vessels supply the anterior septum of the heart?

Answer 24

Left anterior descending

Question 25

Which complications are associated with ventricular septal defects?

Answer 25

Aortic regurgitation (poorly supported right coronary cusp resulting in cusp relapse)

Eisenmenger’s complex (prolonged pulmonary hypertension from the left-to right shunt results in right ventricular hypertrophy and eventually exceeds the left centricular pressure resulting in reversal of blood flow)

Right heart failure

Pulmonary hypertension

Question 26

Pathological explanation of process occurring in an abdominal aortic aneurysm in an otherwise well 65-year old, hypertensive male?

Answer 26

In established aneurysmal disease there is dilation of all layers of the arterial wall and loss of both elastin and collagen. The primary event is loss of elastic fibres with subsequent degradation of collagen fibres.

Question 27

Increase in this indicates mitral valve stenosis

Answer 27

Left atrial end-systolic pressure

Question 28

If the end diastolic volume (EDV) in the average healthy person’s left ventricle is 120mls, what would you expect the end systolic volume (ESV) to be?

Answer 28

50mls

Stroke volume = 70mls in a normal person
120-70=50

Question 29

Occlusion of which vessel is most likely to result in a fatal heart attack?

Answer 29

Left main coronary artery

Question 30

Severe pulmonary hypertension is a cause of …

Answer 30

Right heart failure

Question 31

SOB, severe peripheral oedema and ascites after a heart attack indicates …

Answer 31

Biventricular failure

Question 32

Pulmonary oedema in the presence of normal central venous pressure is a sign of …

Answer 32

left heart failure

Question 33

Increase in this signifies left heart failure

Answer 33

left ventricular end-diastolic pressure

In heart failure there is reduced contractility therefore there will be a reduction in stroke volume so EDV and ED pressure will be increased.

Question 34

Left sided heart failure symptoms

Answer 34

Paroxysmal nocturnal dyspnoea
Elevated pulmonary capillary wedge pressure
Pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnoea) 
Restlessness, confusion
Orthopnoea
Tachycardia
Dyspnoea on exertion 
Fatigue
Cyanosis

Question 35

Right sided heart failure symptoms

Answer 35

Fatigue
Increased peripheral venous pressure
Ascites 
Enlarged liver and spleen
May be secondary to chronic pulmonary problems
Distended jugular veins
Anorexia + GI distress
Weight gain 
Dependent oedema

Question 36

What is responsible for synthesising coagulation factors and fibrinogen

Answer 36

The liver

Question 37

Released upon cell activation, containing a high concentration of a molecule that acts as an agonist at the platelet P2Y12 receptor

Answer 37

Platelet dense granules