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Cardiovascular Disorders Flashcards

1
Q

What three areas can cardiovascular disorders affect?

A

Muscular
Conduction
Vasculature

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2
Q

What are cardiomyopathies?

A

Disorders that affect cardiomyocytes or cardiac muscle function

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3
Q

Give examples of cardiomyopathies?

A 
Heart failure
- Reduced ejection fraction
- Preserved ejection fraction
Take tsubo syndrome 
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
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4
Q

Define heart failure

A

Heart unable to maintain adequate circulation for metabolic requirements of body

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5
Q

Define preserved ejection fraction

A

Preserved ejection fraction (HFpEF): EF ≥ 50%, ↓ diastolic function

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6
Q

Define reduced ejection fraction

A

Reduced ejection fraction (HFrEF): EF ≥ 40%, ↓ systolic function
Can be treated pharmacologically

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7
Q

What is normal ejection fraction?

A

60-70%

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8
Q

What happens in reduced ejection fraction heart failure

A 
Systolic disfunction
Heart cannot pump as well
Insufficient strength
Dilated left ventricle
Thinning of muscle 
Eccentric development of muscle- myocytes develop alongside each other
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9
Q

What happens in preserved ejection fraction heart failure

A

Increase in muscle mass of left ventricle
Can pump but not relax
Diastolic disfunction
Concentric development of muscle- myocytes develop on top of each other

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10
Q

What are the underlying causes of heart failure?

A 
Obesity
Ischaemia
Myopathy 
Hypertension 
Valve disease
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11
Q

What would tend to cause more preserved EF HF?

A

Hypertension

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12
Q

What would tend to cause more reduced EF HF?

A

Myocardial infarction

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13
Q

What are the effect of HF on cardiac output and life expectancy?

A

↓ cardiac output, venous blood accumulation

Poor prognosis: 50% mortality rate < 5 years

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14
Q

What are the ECG findings for Heart failure?

A 
Non-specific
Multiple potential ECG abnormalities 
Linked to potential cause: e.g. Hypertrophy or Atrial Fibrillation
Enlarged QRS complex
Not diagnostic marker
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15
Q

What is a a diagnostic marker?

A

Elevated natriuretic peptide levels

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16
Q

What are general symptoms of heart failure?

A
  • breathlessness, fatigue & fluid retention caused by cardiac dysfunction
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17
Q

What is tako tsubo syndrome named after?

A

A Japanese octopus pot

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18
Q

What is tako tsubo syndrome?

A 
Left ventricular enlargement 
Apex balloons 
Symptoms mimic MI
Takes on octopus pot shape
Arrises later in life
Caused by stress/trauma "broken-heart syndrome"
80-90% female
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19
Q

What is the effect of tako tsubo on cardiac output and life expectancy?

A

↓Q, ejection fraction ~ 40%.

5% mortality

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20
Q

What are the ECG findings of Tako Tsubo?

A

ST segment elevation
typically associated with MI
But no increase in MI markers

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21
Q

What are the general symptoms of Tako Tsubo?

A

Chest pain
Increased cardiac biomarkers
Normal blood vessels

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22
Q

Define conduction abnormalities

A

disorders that affect bioelectrical transmission along the heart

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23
Q

Give examples of conduction abnormalities?

A 
Atrial Arrhythmias
- Atrial fibrillation
-WPW
Tachycardias
-Sinus
-Atrial
Ventricular arrhythmias
- Ventricular fibrillation
- Torsade de pointes
Conduction block
- AV block (types 1, 2 &amp; 3)
- Bundle branch block
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24
Q

What is a normal ECG? (Atrial)

A

P-wave
Atrial contraction
Normal – followed by a QRS complex

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25
Q

What is a normal EGG? (Conduction)

A

P-R interval
Conduction through AV node
Normal – between 120-200 milliseconds (msec)

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26
Q

What is a normal EGG? (Ventricular- QRS)

A

QRS complex
ventricular depolarisation.
Normal – less than 120 msec

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27
Q

What is a normal EGG? (Ventricular- ST)

A

ST segment – plateau phase.

Normal – at baseline

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28
Q

What is a normal EGG? (Ventricular- QT)

A

QT interval – total duration of ventricular depolarisation & repolarisation

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29
Q

What is a normal EGG? (Ventricular- R-R)

A

R-R interval – duration between ventricular depolarisations (heart beat)

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30
Q

What is a normal EGG? (Cardiac axis)

A

Normal – between -30 to +90 degrees

31
Q

What does a taller QRS complex mean?

A

More muscle mass in the ventricle of the heart

32
Q

What does a wider QRS complex mean?

A

Slower conduction within the muscle

33
Q

What is the most common atrial arrhythmia?

A

Atrial Fibrillation

34
Q

Define AF

A

Disorganised electric activity and contraction
Not all of the blood is released from the atria
Blood accumulates in atria
Clots and embolises and can cause a stroke

35
Q

What is the underlying cause of AF?

A

Spontaneously active cells throughout the atria

can be associated with pulmonary veins

36
Q

What are the effects of AF on cardiac output and life expectancy?

A

Modest decline in output

Increase risk of heat failure and stroke

37
Q

What are the general symptoms of AF?

A

Palpitations

Chest pains

38
Q

What are the ECG findings for AF?

A

Absent p-waves, ‘irregularly irregular’ rhythm, fibrillatory waves

39
Q

What is WPW?

A

Wolff Parkinson White

Atrial Arrythmia

40
Q

Define WPW?

A

Syndrome causing tachycardia & abnormal cardiac electrical conductance

41
Q

What is the underlying cause of WPW?

A

Due to an accessory conduction pathway (the bundle of Kent) between the atria and ventricles

42
Q

What are the effect of WPW on cardiac output and life expectancy?

A

Unchanges

Normal life expectancy

43
Q

What are the general symptoms of WPW?

A

Palpitations

Chest pain

44
Q

What are the ECG findings for WPW?

A

Pre-excitation - QRS complex of ECG & biphasic/ inverted - T-wave of ECG

45
Q

Define conduction block (AV)

A 
Impaired electrical conduction through AV node
Type I (Wenckebach or Mobitz I); type II (Mobitz II) &amp; third-degree (complete) AV block
46
Q

What is the underlying cause of an AV conduction block?

A

Fibrosis or calcification of conduction system

Type I - AV node; types II & III - His Purkinje system

47
Q

What happens in II and III blocks?

A

Other contractions begin by the spontaneously active cells

48
Q

What is the effect on cardiac output?

A

Usually decreases

49
Q

What are the ECG findings for an AV conduction block?

A

Type I: ↑ P-R interval
Type II: ↑ P-R interval  1 beat loss of AV conduction
Type III: Complete/persistent loss of conduction from the atria to the ventricles

50
Q

Define a bundle branch conduction block

A

Impaired electrical conduction in the right or left branches or fascicles of the bundles of His
Right bundle branch block (RBBB)

51
Q

What are the underlying causes of bundle branch blocks?

A

LBBB – consequence of ischaemia or heart disease

RBBB – benign & asymptomatic

52
Q

How does LBBB effect cardiac output?

A

Usually decreases

53
Q

What are the ECG findings for bundle branch blocks?

A 
RBBB &amp; LBBB – Widening QRS complex > 120 msec
Fascicle blockage (hemi-block) – Alterations in cardiac axis: posterior --> LAD &amp; anterior --> RAD
54
Q

Give examples of vascular disorders

A 
Hypertension 
- Primary
- Secondary 
Myocardial Infarction 
- NSTEMI
-STEMI
55
Q

Define hypertension

A

Clinic BP ≥ 140/90 mmHg & ambulatory BP daytime average ≥ 135/85 mmHg

56
Q

What is the underlying cause of hypertension?

A

Primary cause unknown. Various secondary causes

e.g. kidney disease

57
Q

What are the effects of hypertension on cardiac output and life expectancy?

A

Will potentially ↓Q

Increases likelihood of heart disease or end-organ damage

58
Q

What at the symptoms of hypertension?

A

Asymptomatic

Requires BP monitoring

59
Q

What is STEMI?

A

ST elevated myocardial infarction

60
Q

Define MI

A

Acute coronary syndrome resulting in cardiac tissue damage to coronary artery blockage

61
Q

Define Angina

A

Angina - Pain or discomfort that typically radiating from the chest at rest (unstable) or brought on by physical exertion or emotional stress (stable

62
Q

What is the underlying cause of the MI?

A

Myocardial ischaemia/cell death due to coronary artery disease

63
Q

What are the effects of an MI on cardiac output and life expectancy/

A

Dependent on site but most likely ↓Q

High mortality if untreated

64
Q

What are the ECG findings for a MI?

A

ST segment elevation (STEMI) or normal (NSTEMI)
Not in all leads
In specific leads depending on where the blockage has formed

65
Q

An increased afterload resulting from the impaired ventricular function in heart failure is most likely caused which hormone?

A

Angiotensin II

66
Q

Which one of the following cardiac ECG parameters is known to change with heart rate?

A

R-R interval

67
Q

Which one of the following ECG changes would you expect to see in hypertrophy or dilatation of the left ventricle?

A

Larger QRS complex

68
Q

Which one of the following ECG changes would you expect to see in Takotsubo syndrome?

A

S-T Elevation

69
Q

An electrocardiogram from a healthy individual was found to have a cardiac axis of 0 (zero) degrees. Which one of the limb leads would you expect to be isoelectric?

70
Q

Patients suffering from atrial fibrillation (AF) are quite often treated with ‘blood thinning’ drugs such as warfarin. What effect do these drugs have in AF?

A

They reduce the likelihood of clot formation in the atria

71
Q

A number of drugs are licensed to treat hypertension. Which one of these drug classes is most likely to directly reduce afterload?

A

Calcium channel blockers

72
Q

Patient case – Investigations show that a patient has sympatho-excitation due to an adrenal tumour. This is causing myocardial ischaemia. What is the mechanism?

A

Decreased diastolic time
Cardiac arterioles primarily fill during diastole
Less ability for arterioles to fill
Less oxygen supply

73
Q

One of the components of a lethal injection solution involves adjustments of one of the key ions involved in cardiac myocyte depolarisation/repolaristion. Which ion would you change and how?

A

Increase K+
High potassium is used because it stops the hear from contracting
Due to increase in RMP of the cardiac membrane
Na+ channels activate but remain inactivated
Cannot overcome block

Cardiology (16 decks)

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