Cardio pathology Flashcards
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?
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.
ECG change V1-V4
Which coronary artery?
Left anterior descending
ECG change I, II, aVF
Which coronary artery?
Right coronary
ECG change I, aVL +/- V5-6
Which coronary artery?
Left anterior descending or left circumflex
Tall R waves
V1-2
Which coronary artery
Usually left circumflex, also right coronary
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?
Smooth muscle proliferation and migration from the tunica media into the intima
Cardiovascular effect of BNP
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.
What is the cause of a 4th heart sound?
4th heart sound is indicative of a abnormally stiff ventricle. Therefore the sound is forceful atrial contraction.
When can rubbing of the pericardium be heard?
Pericardial effusion
What can be heart when there is a ventricular septal defect?
systolic murmur
What could cause a diastolic murmur?
mitral regurgitation
First heard sound
Closure of mitral and tricuspid valves
Second heart sound
Closure of aortic and pulmonary valves
Third heart sound
Caused by rapid filling of ventricles with blood during diastole
Abnormalities in first heart sound
Soft if there is a long PR (i.e. long time between atrial depolarisation and ventral depolarisation).
Loud in mitral stenosis
Abnormalities in second heart sound
Soft in aortic stenosis
Abnormalities in third heart sound
It is normal under the age of 30 but after that it is heard in
- left ventricular failure
- constrictive pericarditis
- mitral regurgitation
When may 4th heart sound also be heard?
Aortic stenosis
Hypertrophic cardiomyopathy
Hypertension
Site of auscalation - pulmonary valve
left 2nd intercostal space at upper sternal border
Site of pulmonary auscalation - aortic valve
Right 2nd intercostal space at upper sternal border
Site of pulmonary auscalation - mitral valve
Left fifth intercostal space, medial to midclavicular line
Site of pulmonary auscalation - tricuspid valve
Left 4th intercostal space, at the lower left sternal border
What would be suggestive of heart failure on a chest X-Ray?
Upper zone vessel enlargement
Which coronary vessels supply the anterior septum of the heart?
Left anterior descending
Which complications are associated with ventricular septal defects?
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
Pathological explanation of process occurring in an abdominal aortic aneurysm in an otherwise well 65-year old, hypertensive male?
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.
Increase in this indicates mitral valve stenosis
Left atrial end-systolic pressure
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?
50mls
Stroke volume = 70mls in a normal person
120-70=50
Occlusion of which vessel is most likely to result in a fatal heart attack?
Left main coronary artery
Severe pulmonary hypertension is a cause of …
Right heart failure
SOB, severe peripheral oedema and ascites after a heart attack indicates …
Biventricular failure
Pulmonary oedema in the presence of normal central venous pressure is a sign of …
left heart failure
Increase in this signifies left heart failure
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.
Left sided heart failure symptoms
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
Right sided heart failure symptoms
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
What is responsible for synthesising coagulation factors and fibrinogen
The liver
Released upon cell activation, containing a high concentration of a molecule that acts as an agonist at the platelet P2Y12 receptor
Platelet dense granules
