Cardiology

Question 1

Draw simple cardiac anatomy (circulation and valves)

Answer 1

Question 2

Describe blood flow of coronary arteries

Answer 2

2 coronary arteries branch off from the aorta.
Left coronary artery which divides into:

• Left anterior descending artery (LAD) - which supplies the front and bottom of the left ventricle and the front of the septum
• Circumflex artery - blood to the left atrium, side and back of the left ventricle

Right Coronary artery which branches into right marginal and posterior descending artery

• RCA supplies blood to RA, RV and bottom portion of both ventricles

Question 3

Describe the conduction the Heart

Answer 3

Question 4

Anatomy of Valves of the heart

Answer 4

Question 5

Answer 5

1. Midline Sternotomy: used for valve replacements, CABG or cardiac transplant
2. Pacemaker scar: left infraclavicular division. Pacemaker sits in a subcutaneous pocket
3. Posterolateral thoracotomy: gold standard used for pneumonectomy or lobe resection
4. Anterolateral Thoracotomy
5. Axillary thoracotomy

Question 11

Difference between open and closed heart surgery

Answer 11

Open: large incision and heart is exposed. Patient is connected to a heart-lung bypass machine.

Procedures include: CABG, valve replacement, heart transplants, and place ventricular assist device

Closed: Means not placed on Heart - Lung bypass machine. Tend to deal with major blood vessels around the heart

Procedures include: ligation ductus arteriosus, repair coarctation aorta

Question 12

What are the two main type of heart valve prostheses?

Answer 12

Mechanical heart valves and tissue heart valves

Question 13

Pros and Cons of Mechanical Heart valves

Answer 13

Pros

Can last indefinitely

Cons

Require lifelong treatment with warfarin

Question 14

Pros and Cons of Tissue heart valves

Answer 14

Pros

Do not require the use of anticoagulant drugs

Cons

Limited lifespan (last on average 15 years)

Question 15

Difference between Penetrating and non-penetrating trauma

Answer 15

Penetrating trauma: when an object pierces the skin and enters a tissue of the body, creating an open wound.

In blunt, or non-penetrating trauma, there may be an impact, but the skin is not necessarily broken.

NB if the object passes all the way through tissue = perforating injury

Question 16

What can penetrating trauma do to the heart?

Answer 16

In chest:
If pericardium is torn can bleed into chest cavity

If pericardium is not disrupted can cause pericardial tamponade

Question 17

Clinical presentation of myxoma

Answer 17

Asymptomatic (20%) - incidental finding

TRIAD:

1. Valvular Obstruction:

Left sided: dyspnoea, orthopnoe, pulmonary oedema

Right sided: symptoms of right heart failure

1. Embolic Event:

NB distribution depends on location of tumour. LHS = systemic

1. Constitutional symptoms

Weight loss, fatigue, weakness

Can resemble infective endocarditits (fever, arthralgia, lethargy)

Question 18

What is a myxoma

Answer 18

Primary heart tumour. Occurs from primitive connective tissue
Most commonly found in the left atrium (75%)

Question 19

Treatment of myxoma

Answer 19

Complete resection (recurrence rate 1-3%)

Question 20

What is constrictive pericarditis

Answer 20

Chronic inflammation of the pericardium –> thickned, fibrotic pericardium, meaning that the heart cannot function properly

Question 21

Symptoms of Constrictive pericarditis

Answer 21

fatigue, swollen abdomen, difficulty breathing, swelling of the legs and general weakness

Question 22

Treatment of constrictive pericarditis

Answer 22

Pericardial stripping - where the entire pericardium is peeled away from the heart

6% mortality