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Cardio Questions Flashcards

1
Q

Define mediastinum

A

Central compartment in thoracic cavity between pulmonary cavities

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2
Q

What covers the mediastinum?

A

Mediastinal pleura - covers all thoracic viscear bar lungs

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3
Q

How is volume and pressure change permitted in the mediastinum?

A

CT is loose and parietal pleura of lungs flexible

CT stiffens with age - structures less mobile

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4
Q

Parts of the mediastinum

A

Superior

Inferior - Anterior, Middle, Inferior

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5
Q

Limits of the superior mediastinum

A

Superior aperture to the transverse thoracic plane - T4/5

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6
Q

Limits of inferior mediastinum

A

Transverse thoracic plane to the diaphragm

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7
Q

Anterior inferior mediastinum

A

Body of sternum, transverse thoracic plane and pericardium. Continues with superior mediastinum superiorly

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8
Q

Contents of anterior inferior mediastinum

A

Sternopericardial ligaments

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9
Q

What is found in the anterior inferior mediastinum in children?

A

Thymus

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10
Q

Middle inferior mediastinum

A

Pericardium, Heart, ASC aorta, pulmonary trunk, SVC, arch of azygos, main bronchi

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11
Q

Borders of the heart

A

Right, Left, Superior, Inferior

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12
Q

Anterior/sternocostal surface is formed by which part of the heart?

A

Right ventricle

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13
Q

Posterior or base is formed by which part of the heart?

A

Left Atrium

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14
Q

Inferior surface of the heart

A

Left ventricle, partly right

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15
Q

To what structure is the inferior border of the heart related?

A

Central tendon of the diaphragm

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16
Q

What spinal level is the heart anterior to?

A

T5-T8

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17
Q

As the heart is related to the diaphragm, what happens to its position when standing upright?

A

Vertical position

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18
Q

What type of blood is carried by the aorta?

A

Oxygenated

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19
Q

Parts of the aorta

A

Ascending
Arch
Descending - thoracic and abdominal

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20
Q

Wheter does the abdominal aorta bifurcate and into which vessels?

A

L4- right and left common iliac

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21
Q

At what level do the common iliac vessels bifurcate?

A

L5

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22
Q

Name the branches of the ascending aorta

A

Left coronary artery

Right coronary artery

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23
Q

Branches of the left coronary artery

A

Anterior interventricular

Circumflex

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24
Q

Branches of the right coronary artery

A

Posterior interventricular

Right marginal

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25
Position of the right marginal artery
Sinks into right ventricle
26
Where do both coronary arteries originate>
Aortic sinus
27
Describe the anastamosis of the coronary arteries
Anterior interventricular and posterior interventricular | Circumflex and right coronary artery as it continues
28
Branches of the aortic arch
Braciocephalic Left subclavian Left common carotid
29
Describe the veins of the heart
Great - within anterior ventricular groove Middle - posterior ventricular groove Small - next to right marginal
30
Where do the veins of the heart drain?
Into the coronary sinus to the right atrium
31
Branches of the descending thoracic aorta
Oesophageal arteries Bronchial arteries Pericardial arteries Posterior intercostal arteries
32
Terminal branches of abdominal aorta
Common iliac L4 External iliac - L5 Internal iliac
33
Where do the common iliac arteries lie?
Iliac fossa
34
What artery does the external iliac become?
Femoral
35
What does the internal iliac artery supply>
Pelvic viscera
36
Which organs are supplied by branches of the abdominal aorta?
``` Diaphragm Adrenals Kidneys Gut tube Gonads ```
37
What electrolyte abnormality is consitent with prolonged QT interval>
Hypokalaemia
38
What does a long QT interval indicate?
Delayed repolarization of ventricles
39
What are the possbile consequences of long QT syndrome>
Ventricular tachycardia / Torsades de pointes Collapse/Sudden death
40
What is a normal corrected QT interval?
less than 430 ms in males and 450 ms in females.
41
What is the physiological cause of a long QT interval>
defects in the alpha subunit of the slow delayed rectifier potassium channel
42
Name some causes of LQTS
Congenital - Jervell-Lange-Nielsen syndrome, Romano Ward Syndrome ``` Drugs - amiodarone, sotalol class 1a antiarrhythmic drugs tricyclic antidepressants selective serotonin reuptake inhibitors (especially citalopram) methadonechloroquine terfenadine** erythromycin haloperidol ondanestron ``` ``` Electrolyte - hypocalcaemia, hypokalaemia, hypomagnesaemia acute myocardial infarction myocarditis hypothermia subarachnoid haemorrhage ```
43
What is the difference between Jervell Lange Nielsen Syndrome and Romano Ward syndrome?
Both congenital and associated with LQTS Jervell has deafness included due to abnormal postassium channel No deafness in Romano Ward
44
Features of LQTS
may be picked up on routine ECG or following family screening Long QT1 - usually associated with exertional syncope, often swimming Long QT2 - often associated with syncope occurring following emotional stress, exercise or auditory stimuli Long QT3 - events often occur at night or at rest sudden cardiac death
45
Management of LQTS
Avoid drugs exacerbating long QT interval Reduce strenuous exercise Beta blockers - *** sotalol may exacerbate** Implantable cardioverter defib in high risk case
46
What is the gold standard investigation for Pulmonary embolism?
CTPA
47
What must be arranged if CTPA unavailable and patient has suspected PE?
Administer interim therapeutic anticoagulation - DOAC - apixabon, rivaroxaban
48
What ECG changes are seen in patient with PE?
S1Q3T3 Right bundle branck block and right axis deviation Sinusd tachycardia
49
CXR findings in PE
Typically normal | May find wedge shaped opacification
50
Which drugs can cause torsades de pointes?
Macrolides eg clarithromycin
51
Characteristics of torsades de pointes on ECG
rapid, irregular QRS complexes, which appear to be 'twisting' around the baseline
52
What is torsades de pointes?
a form of polymorphic ventricular tachycardia associated with a long QT interval. It may deteriorate into ventricular fibrillation and hence lead to sudden death.
53
Management of torsades de pointes
IV Magnesium sulfate
54
Features of acute pericarditis
Chest pain - may be pleuritic Pericardial rub Tachypnoea Tachycardia
55
Cause of acute pericarditis
``` Uraemia viral infections (Coxsackie) tuberculosis uraemia (causes 'fibrinous' pericarditis) trauma post-myocardial infarction, Dressler's syndrome connective tissue disease hypothyroidism malignancy ```
56
Changes on ECG in acute pericarditis
Saddle shape ST elevation | PR depression
57
What additional investigation should patient with acute pericarditis have with ECG?
Transthoracic echocardiogram
58
Management of acute pericarditis
Treat underlying cause | NSAIDs and colchicine
59
ECG signs of hyperkalaemia
Small or absent P waves, tall tented T waves and broad bizarre QRS complexes Long PR interval Sine wave
60
Symptoms of hypokalaemia
fatigue, muscle weakness, myalgia, muscle cramps, constipation, hyporeflexia and rarely paralysis.
61
ECG signs of hypokalaemia
``` U waves small or absent T waves (occasionally inversion) prolong PR interval ST depression long QT ```

Cardiology (7 decks)

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