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Phase 2a Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

equation for stroke volume (SV)

A

end diastolic vol (EDV) - end systolic vol (ESV) = SV

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2
Q

equation for cardiac output (CO)

A

Heart Rate (HR) x Stroke Volume (SV)

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3
Q

equation for BP

A

CO x Total Peripheral Resistance (TPR)

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4
Q

equation for Pulse Presure (PP)

A

systolic - diastolic

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5
Q

equation for Mean Arterial Pressure (MAP)

A

diastolic + 1/3 PP

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6
Q

equation for ejection fraction

A

SV/EDV

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7
Q

what’s Ohms law?

A

Flow = Pressure Grad/R

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8
Q

whats Poiseuille’s law?

A
  • flow is proportional to radius to power of 4*
  • small change in R = BIG change in flow*

R = 8xLxViscosity /πr4

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9
Q

define preload

A

vol of blood in ventricles immediately before contraction

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10
Q

define afterload

A

force against which ventricles contract in order to expel blood

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11
Q

define contractility

A

strength/vigour of contraction during systole

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12
Q

define elasticity

A

ability of heart to return to normal shape after stretching (by recoiling)

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13
Q

define compliance

A

how easily heart will stretch when filled with blood

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14
Q

define resistance

A

force that must be overcome to push blood in circulatory system

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15
Q

define ATHEROGENESIS

A

formation of fat deposits in arteries

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16
Q

7 risk factors for ATHEROGENESIS

A

1) . age
2) . smoking
3) . increased LDLs
4) . Obesity
5) . diabetes
6) . fam history
7) . high BP

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17
Q

4 components of ATHEROSCLEROSIS plaque

A

1) lipid
2) . necrotic core
3) . connective tissue
4) . fibrous cap

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18
Q

list 7 inflammatory markers found in ATHEROSCLEROSIS plaque

A 
IL-2
IL-6
IL-8
IFN-Gamma
TGF-Beta
MCP-1
C reactive protein
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19
Q

what is C reactive protein

A

non specific inflammatory marker

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20
Q

how does ATHEROSCLEROSIS start

A

1) . endothelial injury
2) . leads to endothelial dysfunction
3) . adhesion molecules sent to lymphocytes
4) . lymphocytes migrate to vessel wall

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21
Q

what are the 4 stages of ATHEROSCLEROSIS

A

1) . fatty streak
2) . intermediate lesion
3) . fibrous plaque
4) . plaque rupture

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22
Q

describe 1st stage of ATHEROSCLEROSIS (fatty streak)

A
  • fatty streak occurs
  • loaded with lipids / T-cells / Macrophages
  • everyone has them
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23
Q

3 features of 2nd stage of ATHEROSCLEROSIS (intermediate lesion)

A

1) . foam cells (lipid filled macrophages)
2) . smooth muscle proliferation
3) . platelet adhesion

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24
Q

2 features of 3rd stage of ATHEROSCLEROSIS (fibrous plaque)

A

1) . fibrous layer of collagen + elastin

2) . are calcified

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25
Q

outline the 4th stage of ATHEROSCLEROSIS (plaque rupture) and how it leads to angina

A

1) . fibrous cap rupture due to increased inflammation
2) . plaque ruptures then heals repeatedly -> increasing occlusion
3) . full occlusion -> angina

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26
Q

what at most basic level causes myocardial ISCHAEMIA

A

imbalance between demand/supply of myocardial oxygen

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27
Q

what is the epidemiology of ISCHAEMIC HEART DISEASE

A

UK DEATHS

  • 70k a year
  • 1/7 men
  • 1/11 women
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28
Q

what’s the pathological basis for ISCHAEMIC HEART DISEASE

A

1) . imbalance in cardiac muscle oxygen supply/demand

2) . atherosclerosis causes narrowed arteries -> ischaemia and pain (angina)

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29
Q

list 7 causes of ISCHAEMIC HEART DISEASE

A

1) . coronary artery atheroma (most common)
2) . LV hypertrophy
3) . anaemia (less O2 carrying capacity)
4) . hypoxia (less O2 available)
5) . coronary artery thrombosis
6) . coronary artery spasm
7) . arteritis

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30
Q

list 6 modifiable risk factors for ISCHAEMIC HEART DISEASE

A

1) . smoking
2) . obesity
3) . exercise
4) . diet (high sat fat)
5) . alcohol intake
6) . sedentary lifestyle

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31
Q

list 4 clinical risk factors for ISCHAEMIC HEART DISEASE

A

1) . hypertension
2) . diabetes
3) . Hyperlipid/cholesterolemia
4) . depression

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32
Q

list 4 non-modifiable risk factors for ISCHAEMIC HEART DISEASE

A

1) . age
2) . fam history/genetics
3) . gender (M>F)
4) . ethnicity

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33
Q

list 3 psychosocial risk factors for ISCHAEMIC HEART DISEASE

A

1) . high stress job
2) . low social interaction
3) . lack of support network

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34
Q

what is the QRISK2 score

A

predicts risk of CVD in the next 10 years

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35
Q

list 9 things the QRISK2 score considers

A

1) . BP
2) . Age
3) . smoking status
4) . cholesterol
5) . rheumatoid arthritis
6) . diabetes mellitus
7) . anti-hypertensives
8) . BMI
9) . ethnicity

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36
Q

define ANGINA (angina pectoris)

A
  • description of chest pain

- result of myocardial ischaemia

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37
Q

list 5 types of angina

A

1) . stable
2) . unstable
3) . variant
4) . decubitus
5) . nocturnal

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38
Q

define stable ANGINA

A
  • induced by effort

- relieved by stress

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39
Q

define unstable ANGINA

A
  • crescendo
  • increases in severity
  • occurs at rest
  • is of recent onset ( <1 month)
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40
Q

define variant ANGINA

A
  • Prinzmetal’s
  • caused by coronary artery spasm
  • unprovoked angina (at rest)
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41
Q

define decubitus ANGINA

A

occurs lying down

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42
Q

define nocturnal ANGINA

A
  • occurs at night

- may wake you from sleep

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43
Q

list 4 symptoms of ANGINA

A

1) . central crushing chest pain radiating to arms/jaw/neck
2) . dyspnoea
3) . palpitations (laboured breathing)
4) . syncope (fainting)

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44
Q

list 3 signs of ANGINA

A

1) . chest pain with exertion
2) . pain fixed with rest/GTN spray
3) . exacerbated with cold weather/anger/excitement

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45
Q

3 scoring factors when determining type of Angina

A

1) . central tight chest pain radiating to arms/neck/jaw
2) . caused by exertion
3) . relieved by Rest/GTN

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46
Q

outline what score out of 3 is needed for determining anginal pain

A 
3/3 = typical
2/3 = atypical
1/3 = non-anginal
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47
Q

list 5 differentials for ANGINA

A

1) pericarditis/myocarditis
2) . pulmonary embolism
3) . chest infection
4) . GORD
5) . aortic dissection

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48
Q

list 5 investigations for ANGINA

A

1) . 12 lead ECG
2) . CT angiogram
3) . stress ECG
4) . FBC
5) . Chest X-Ray

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49
Q

what would you see in ECG for ANGINA

A
  • usually normal
  • may show ST depression
  • may show T wave inversion
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50
Q

what would you see in CT angiogram in ANGINA

A
  • narrowing of a coronary artery

- can then go in and open artery with stent/balloon

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51
Q

what would bloods show for ANGINA

A
  • FBC shows anaemia

- cardiac enzymes present

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52
Q

what do you look for in Chest-X ray for ANGINA

A
  • check heart size

- check pulmonary vessels

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53
Q

list 3 lifestyle treatments for ANGINA

A

1) . weight loss
2) . more exercise
3) . quit smoking

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54
Q

list 7 drugs used to treat ANGINA

A

1) . GTN spray (1st line)
2) . Beta blockers
3) . Calcium channel blocker
4) . anti-platelet
5) . statins
6) . ACE inhibitors
7) . Ivabradine

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55
Q

GTN SPRAY (glyceryl trinitrate) - method of action

A
  • dilate coronary arteries
  • preload reduced
  • nitrate is vasodilator*
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56
Q

GTN SPRAY (glyceryl trinitrate) - - common side effect

A

headache

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57
Q

BETA BLOCKERS - 3 examples

A

1) . bisoprolol
2) . atenolol
3) . propranolol

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58
Q

BETA BLOCKERS - method of action

A
  • reduce HR (neg chronotropic)

- reduce contraction (neg inotropic)

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59
Q

BETA BLOCKERS - 2 times when are they contraindicated

A

1) . asthma

2) . people with heart block

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60
Q

BETA BLOCKERS - what’s the alternative if contraindicated

A

Calcium channel blockers

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61
Q

CALCIUM CHANNEL BLOCKERS - example?

A

Amlodipine

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62
Q

CALCIUM CHANNEL BLOCKERS - method of action

A
  • block calcium influx into cell
  • utilise calcium within cell
  • relax coronary arteries
  • reduce force of LV contraction (neg inotropic)
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63
Q

ANTI-PLATELETS - give 2 examples

A

1) . aspirin 75mg

2) . clopidogrel (if aspirin contraindicated)

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64
Q

method of action of ASPIRIN?

A
  • inhibits COX-1
  • reduced production of thromboxane A2
  • so platelet aggregation reduced
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65
Q

what do you give if aspirin is contraindicated

A

clopidogrel

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66
Q

STATINS - give 2 examples

A

1) . atorvastatin

2) . simvastatin

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67
Q

STATINS - method of action

A
  • reduce cholesterol

- HMG-CoA reductase inhibitor

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68
Q

ACE INHIBITORS - give 2 examples

A

1) . ramipril

2) . lisinopril

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69
Q

ACE INHIBITORS method of action

A
  • reduce BP

- stop Angiotensin 1 -> 2 conversion

70
Q

list 2 ANGIOTENSIN RECEPTOR BLOCKERS

A

1) . candesartan

2) . losartan

71
Q

method of action of IVABRADINE

A
  • inhibits pacemaker current in SAN

- HR reduced (neg chronotropic)

72
Q

2 other managements if Angina not controlled with drugs

A

1) . Percutaneous Coronary Intervention (PCI) (stenting/balloon)
2) . Coronary Artery Bypass Graft (CABG)

73
Q

2 principles of Angina management

A

1) . manage modifiable risk factors

2) . symptom control

74
Q

define ACUTE CORONARY SYNDROMES (ACS)

A
  • unstable coronary artery diseases

- acute (3 types)

75
Q

list the 3 types of ACS

A

1) . unstable angina
2) . STEMI
3) . NSTEMI

76
Q

(ACS) define UNSTABLE ANGINA

A

1) . cardiac chest pain in crescendo pattern
2) . deterioration from stable angina
3) . symptoms at rest

77
Q

(ACS) define STEMI

A

1) . develops after full occlusion of major coronary artery which was affected by atherosclerosis
2) . full thickness cardiac muscle damage
3) . be diagnosed with ECG

78
Q

(ACS) define NSTEMI

A

1) . full occlusion of minor coronary artery OR partial occlusion of major coronary artery
2) . distal infarction / proximal ischaemia
3) . diagnosed after troponin / other tests

79
Q

Pathology of all ACS

A
  • rupture of athersclerotic plaque

- leads to arterial thrombosis

80
Q

list 4 investigations for ACS

A

1) ECG
2) . Bloods (FBC/U&E/Glucose/Lipids)
3) . Cardiac enzymes
4) . CT angiogram

81
Q

list 3 ECG changes in Acute STEMI

A

1) . Tall T waves
2) . ST elevation
3) . new LBB

82
Q

list 3 ECG changes in NSTEMI

A

1) . ST depression
2) . T wave inversion
3) . Q waves

83
Q

what is troponin

A
  • protein which regulates actin/myosin interaction
84
Q

why is troponin used in MI investigation

A

-its a highly sensitive marker for cardiac muscle injury

85
Q

3 cardiac enzymes you would see in ACS

A

1) . Troponin T/I
2) . Creatinine Kinase
3) . myoglobin

86
Q

what is creatinine kinase

A
  • catalyses conversion of creatinine

- utilises ATP to make ADP and PCr (phosphocreatinine)

87
Q

list 5 cardiac causes of raised troponin

A

1) . congestive heart failure
2) . coronary artery disease
3) . myo/endo/pericarditis
4) tachy/bradycardia
5) heart block

88
Q

list 7 non-cardiac causes of raised troponin

A

1) . PE
2) . gram neg sepsis
3) pulmonary HTN
4) renal failure
5) . COPD
6) . diabetes
7) . drugs

89
Q

6 diagnostic tools for UNSTABLE ANGINA

A

1) . take history
2) . FBC = anaemia
3) . cardiac enzymes (troponin normal so NOT MI)
4) . ECG = ST depression when pt in pain
5) . CT coronary angiogram
6) QRISK 2

90
Q

4 risk factor modifications for UNSTABLE ANGINA

A

1) . stop smoking
2) . lose weight
3) . healthy diet
4) . exercise

91
Q

next steps after QRISK2 for high or low risk?

A

low risk
- do elective stress test

high risk

  • PCI
  • CABG
92
Q

7 drugs used to manage UNSTABLE ANGINA

A

1) . antiplatelet therapy
2) . anti-coagulants
3) Nitrates
4) . Beta Blockers
5) . Statins
6) . ACE Inhibitors
7) . Ca Channel blockers

93
Q

list 3 drug types used in anti-platelet therapy of UNSTABLE ANGINA

A

1) . Aspirin
2) . P2Y12 inhibitor (dual therapy with aspirin)
3) . Glycoprotein IIb/IIIa inhibitor

94
Q

P2Y12 INHIBITOR - give 3 examples

A

1) . Clopidogrel
2) . Ticagrelor
3) . Prasugrel

95
Q

P2Y12 INHIBITOR - method of action

A
  • inhibitor the P2Y12 receptors on platelets

- decreases platelet activation and aggregation.

96
Q

IIb/IIIa INHIBITOR - give example

A

abciximab

97
Q

IIb/IIIa INHIBITOR - method of action

A
  • Inhibits ADP-dependant activation of IIb/IIIa glycoproteins
  • stops amplification of platelet aggregations
98
Q

list 3 drugs used in anticoagulant therapy of UNSTABLE ANGINA

A

1) . Heparin
2) . Low Molecular Weight Heparin (LMWH)
3) . Fondaparinux

99
Q

HEPARIN - method of action?

A
  • inhibits factors II/VII/IX/X

- stops thrombus formation

100
Q

what is factor II

A

prothrombin

101
Q

Give an example of a LMWH

A

enoxaparin

102
Q

benefit of using LMWHs

A

-better efficacy than unfractionated heparin

103
Q

method of action of FONDAPARINUX

A
  • inhibits factor Xa
104
Q

benefit of using FONDAPARINUX

A
  • lower risk of bleeding than heparin
105
Q

define MYOCARDIAL INFARCTION

A
  • necrosis of cardiac tissue
  • due to prolonged myocardial ischaemia
  • due to COMPLETE artery occlusion
  • by a thrombus
106
Q

epidemiology of MYOCARDIAL INFARCTION

A
  • most common cause of death in developed countries

- 1/3 cases occur at night

107
Q

pathology of MYOCARDIAL INFARCTION (4 steps)

A

1) . plaque rupture
2) . development of thrombosis
3) . total occlusion of coronary artery
4) . myocardial cell death

108
Q

list 7 risk factors for MYOCARDIAL INFARCTION

A

1) . old age
2) . male
3) . Hx of premature coronary artery disease
4) . Diabetes Mellitus
5) . Hypertension
6) . Hyperlipidaemia
7) . Family History

109
Q

list 6 symptoms of MYOCARDIAL INFARCTION

A

1) . central rushing chest pain
2) . sweating
3) . SOB/Dyspnoea
4) . fatigue
5) . nausea
6) . vomiting

110
Q

list 7 signs of MYOCARDIAL INFARCTION

A

1) . occur at night
2) . lasts > 20 mins
3) . NOT relieved by GTN
4) . pain radiate to left arm/neck/jaw
5) . Pt is pale/sweaty/grey
6) . 4th heart sound
7) . pansystolic murmur

111
Q

why might you hear a 4th heart sound in MYOCARDIAL INFARCTION

A
  • ventricles are stiff/dysfunctional

- atria must contract forcefull to overcome this

112
Q

why might you heart a pansystolic murmur in MYOCARDIAL INFARCTION

A
  • due to papillary muscle dysfunction / rupture
113
Q

list 6 differentials for MYOCARDIAL INFARCTION

A

1) . stable/unstable angina
2) . pericarditis
3) . aortic aneurysm
4) . endocarditis
5) . pulmonary embolism
6) . pneumothorax

114
Q

list 8 investigations you’d do with a suspected MYOCARDIAL INFARCTION

A

1) . clinical History
2) . ECG
3) . Cardiac enzymes
4) . CT angiography
5) . CXR
6) . FBC
7) . U&E
8) . Blood glucose / lipids

115
Q

ECG results for STEMI

A

1) . ST elevation
2) . Tall T waves
3) . LBBB
4) . pathological Q waves

116
Q

ECG results for NSTEMI

A

1) . ST depression (OR)

2) . T wave inversion

117
Q

4 steps for acute (initial) management of MYOCARDIAL INFARCTION

A

1) . MONA
2) . 12 lead ECG / Cardiac Monitor
3) . Beta Blocker IV
4) . Refer for PCI/CABG/thrombolysis

118
Q

what does MONA stand for

A

Morphine
Oxygen (if sats <94%)
Nitrates
Aspirin

119
Q

give an example of a thrombolytic drug

A

Alteplase

120
Q

7 treatments for subsequent MYOCARDIAL INFARCTION (secondary prevention)

A

1) . modify risk factors
2) . aspirin
3) . Dual antiplatelet therapy
4) . statins
5) . Beta blocker
6) . ACE inhibitor
7) . Advice

121
Q

list 6 modifiable risk factors for secondary prevention of MYOCARDIAL INFARCTION

A

1) . Diabetes
2) . Smoking
3) . hypertension
4) . hypercholesterolemia
5) . Exercise
6) . Diet

122
Q

list 2 antiplatelets used in dual therapy for MYOCARDIAL INFARCTION

A

1) . clopidogrel

2) . ticagrelor

123
Q

what do you use if patient is intolerant to ACE inhibitors

A

angiotensin receptor blocker

124
Q

give an example of an angiotensin receptor blocker

A

valsartan

125
Q

list 3 pieces of advice for secondary prevention of MYOCARDIAL INFARCTION

A

1) . return to work after 2 months
2) . no air travel for 2 months
3) . no sex for 1 month

126
Q

list 5 complications following a MYOCARDIAL INFARCTION

A

1) . Myocardial rupture
2) . arrhythmias
3) . pericarditis
4) . Dressler’s sydrome
5) . Death

127
Q

list 3 types of myocardial rupture and their result

A

1) . Ventricular septum
- right Heart Failure

2) . left ventricular wall
- cardiac tamponade

3) . papillary muscle
- mitral regurgitation/prolapse

128
Q

list 2 arrhythmias that occur following MYOCARDIAL INFARCTION

A

1) Tachycardia

2) brachycardia

129
Q

what is dressler’s syndrome

A

pericarditis following cardiac intervention/surgery

130
Q

list 4 CARDIAC differential diagnosis of chest pain

A

1) . ACS
2) . Aortic dissection
3) . pericarditis
4) . myocarditis

131
Q

list 3 PULMONARY differential diagnosis of chest pain

A

1) . pulmonary embolism
2) . pneumonia
3) . lung cancer

132
Q

list 3 MSK differential diagnosis of chest pain

A

1) . rib fracture
2) . chest trauma
3) . costochondritis

133
Q

list 2 GI differential diagnosis of chest pain

A

1) . esophageal spasm

2) . GORD

134
Q

list 2 PSYCH differential diagnosis of chest pain

A

1) . anxiety

2) . panic attacks

135
Q

define costochondritis

A

inflammation of cartilage btwn ribs/sternum

136
Q

define HEART FAILURE

A
  • state where heart is unable to pump enough blood/O2

- to satisfy needs of metabolising tissues

137
Q

epidemiology of HEART FAILURE

A
  • annual incidence of 10% in pts over 65

- 50% of pts die within 5 yrs

138
Q

list 7 causes of HEART FAILURE

A

1) . ischaemic heart disease!
2) . Hypertension
3) . cardiomyopathy
4) . valvular heart disease
5) . congenital heart disease
6) . alcohol/chemotherapy
7) . factors that increase myocardial work (anaemia/pregnancy/obesity etc)

139
Q

list 4 risk factors for HEART FAILURE

A

1) . age >65 yrs
2) . obesity
3) . Male
4) . people who’ve had previous MI

140
Q

what is SYSTOLIC HEART FAILURE

A
  • failure to contract

- ejection fraction <40% (SV/EDV)

141
Q

list 4 causes of SYSTOLIC HEART FAILURE

A

1) . IHD
2) . MI
3) . Hypertension
4) . Cardiomyopathy

142
Q

what is DIASTOLIC HEART FAILURE

A
  • inability to fill/relax
  • reduced preload
  • ejection fraction >50%
143
Q

list 3 causes of DIASTOLIC HEART FAILURE

A

1) . constrictive pericarditis
2) . cardiac tamponade
3) . hypertension

144
Q

what is LOW OUTPUT HEART FAILURE

A
  • the heart is not functioning efficiently
  • Decreased CO
  • CO doesn’t increase with exertion
145
Q

list 3 causes of LOW OUTPUT HEART FAILURE

A

1) . pump failure
- systolic HF

2) . Excessive Preload
- mitral regurg
- fluid overload

3) . increased afterload
- heart can’t push against it
- hypertension

146
Q

what is HIGH OUTPUT HEART FAILURE

A
  • the requirements of the body are too high
147
Q

list 3 causes of HIGH OUTPUT HEART FAILURE

A

1) . pregnancy
2) . anaemia
3) . hyperthyroidism

148
Q

outline the 2 steps in pathology of HEART FAILURE

A

1) . heart fails -> compensation starts

2) . HF progresses -> compensatory changes overwhelmed -> changes become pathological

149
Q

list 3 compensatory mechanisms for HEART FAILURE

A

1) . sympathetic stimulation
2) . RAAS
3) . cardiac changes

150
Q

list 3 ways sympathetic changes compensate for HEART FAILURE

A

1) . activate SNS -> HR/contractility increased
2) . contract veins -> increased preload (frank starling)
3) . arterial constriction -> increased afterload

151
Q

list 4 ways in which RAAS compensates for HEART FAILURE

A

1) . CO falls / increased sympathetic tone -> RAAS activated -> increased salt / water retention
2) . increases venous pressure / maintains stroke vol (frank starling)
3) . Angiotensin II causes arterial constriction -> increased afterload
4) . salt / water retention -> peripheral + pulmonary oedema -> dyspnoea

152
Q

list 2 cardiac changes seen in compensation for HEART FAILURE

A

1) . ventricular dilation

2) . Myocyte hypertrophy (ventricular remodelling)

153
Q

outline the cardiac compensatory method of ventricular dilation in HEART FAILURE

A

1) . Myocardial failure -> stroke vol decreased -> more blood in heart after systole
2) . increased vol stretches myocardium for stronger contraction (frank starling)
3) . stretching becomes detrimental -> bigger ventricles need more O2

154
Q

Define Frank-Starling law

A
  • stroke volume of left ventricle will increase as left ventricular volume increases
  • due to the myocyte stretch, causing a more forceful systolic contraction.
155
Q

list the 3 cardinal symptoms for diagnosing HEART FAILURE

A

1) . SOB
2) . Fatigue
3) . Ankle swelling

156
Q

define LEFT SIDED HEART FAILURE

A
  • heart failure with reduced ejection fraction

- caused by systolic dysfunction

157
Q

list 4 causes of LEFT SIDED HEART FAILURE

A

1) . IHD
2) . Hypertension
3) . Cardiomyopathy
4) . Aortic stenosis (narrow aortic valve)

158
Q

outline the pathology of hypertension in LEFT SIDED HEART FAILURE

A

1) . arterial pressure increases -> harder for LV to pump blood out -> LV hypertrophy -> O2 demand increased
2) . coronary arteries squeezed by extra muscle -> less blood delivered to tissue

159
Q

outline the pathology of 2 cardiomyopathies in LEFT SIDED HEART FAILURE

A

DILATED
- heart chamber grows in size to fill ventricle with more blood (increase preload) -> muscle wall gets thin/weak -> systolic HF

RESTRICTIVE
heart wall becomes stiff-> less compliant -> can’t stretch

160
Q

list 6 symptoms of LEFT SIDED HEART FAILURE

A

1) . SOB on exertion
2) . fatigue
3) . weight loss
4) . nocturnal SOB
5) . nocturnal cough w/ pink/frothy sputum
6) . orthopnoea (SOB when lying down)

161
Q

list 6 signs of LEFT SIDED HEART FAILURE

A

1) . Cardiomegaly
2) . pulmonary oedema
3) 3rd/4th heart sounds
4) . pleural effusion
5) . crackle sound in lung bases
6) . tachycardia

162
Q

what is cardiomegaly

A

displaced apex beat

163
Q

list 5 causes of RIGHT SIDED HEART FAILURE

A

1) . left ventricular failure
2) . hypertension
3) . pulmonary stenosis
4) . lung disease
5) . atrial/ventricular shunt

164
Q

outline the pathology of LV failure in RIGHT SIDED HEART FAILURE

A

fluid build up -> increased pressure in pulmonary artery -> harder for right side to pump blood

165
Q

outline the pathology of lung disease in RIGHT SIDED HEART FAILURE

A

COR PULMONALE

pulmonary artery constricts -> increased pulmonary BP -> harder for RV to pump against -> hypertrophy / failure -> harder to exchange O2

166
Q

outline the pathology of an AV shunt in RIGHT SIDED HEART FAILURE

A
  • blood moves from L -> R
  • increased vol on R-side -> RV hypertrophy
  • more prone to ischaemia
  • small filling volume
167
Q

list 5 symptoms of RIGHT SIDED HEART FAILURE

A

1) . SOB
2) . Peripheral oedema
3) . ascites
4) . nausea
5) . anorexia

168
Q

list 5 signs of RIGHT SIDED HEART FAILURE

A

1) . Raised JVP (distention)
2) . hepato/splenomegaly
3) . pitting oedema
4) . ascites
5) . weight gain (from fluid)

169
Q

what are the 4 classes of HEART FAILURE

A

I = no dyspnoea at rest

II = comfortable at rest, dyspnoea with normal activities

III = minor activity produces dyspnoea

IV = dyspnoea at rest

170
Q

list 9 investigations for suspected HEART FAILURE

A

1) . CXR
2) . ECG
3) . Bloods
4) . FBC (anaemia)
5) . LFTs
6) . TFTs
7) . U&Es
8) . Cardiac enzymes
9) . Echocardiogram

171
Q

list 5 things CXR would show in HEART FAILURE (ABCDE)

A
  • Alveolar oedema (bats wings)
  • kerley B lines (intersitial oedema)
  • Cardiomegaly
  • Dilated upper lobe vessel
  • Effusion (plural)
172
Q

what are you looking for when you do LFTs in HEART FAILURE

A

hepatomegaly

Phase 2a Medicine (2 decks)

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