Cardiovascular - Lecture 2

Question 1

Describe right-sided heart failure

MUST KNOW

Answer 1

Ineffective RV contractility
Failure of RV pumping ability
Decreased CO to lungs
Blood backup into RA & peripheral circulation
Weight gain, peripheral oedema, engorgement of kidneys & other organs

Question 2

Describe left-sided heart failure

MUST KNOW

Answer 2

Ineffective LV contractility
Failure of LV pumping ability
Decreased CO to body
Blood backup into LA & lungs
Pulmonary congestion, dypsnea, activity intolerance
Pulmonary oedema, right-sided heart failure

Question 3

What is angina/how does it occur?

MUST KNOW

Answer 3

When cardiac workload & myocardial O2 demands exceed the ability of coronary arteries to supply adequate amount of oxygenated blood - transient myocardial iscemia

Question 4

Symptoms & Signs of angina

Answer 4

generally not painful, a troublesome ache
discomfort below sternum, may radiate to left shoulder, down inside of left arm, throat, jaw, teeth, upper abdo - never above ears or below umbilicus

Question 5

What is unstable angina?

MUST KNOW

Answer 5

Any change in angina is unstable & should be taken seriously, suddenly occurring with rest etc

Question 6

What is myocardial infarction?

MUST KNOW

Answer 6

Myocardial necrosis resulting from abrupt disruption in coronary blood flow to part of the myocardium. Infarcted tissue is permanently dysfunctional & predominantly affects the LV

Question 7

Valvular Heart Disease - Aortic stenosis-what is it?

MUST KNOW

Answer 7

A narrowing of the aortic valve, obstructing blood flow from the LV to the ascending aorta during systole

Question 8

Aetiology of aortic stenosis

Answer 8

aortic schlerosis, degenerative aortic valve disease, thickening of aortic valve structures by fibrosis & calcification - over years schlerosis turns into stenosis

Question 9

Symptoms & signs of aortic stenosis

Answer 9

exertional syncope because cardiac output can’t increase enough to cope with demands
angina
dyspnoea

Question 10

clinical manifestation of aortic stenosis

Answer 10

aortic regurgitation due to increased pressure load & hypertrophy of LV
carotid & peripheral pulses weaker
systolic BP may be high
hallmark finding is a crescendo-decrescendo ejection murmur, heard at upper L & R sternal borders when a pt. leans forward - murmur becomes louder when stenosis worse

Question 11

Prognosis of aortic stenosis

Answer 11

50% of deaths occur suddenly when severe

valve replacement for pts. who can tolerate surgery

Question 12

What is aortic regurgitation? What is it caused by?

MUST KNOW

Answer 12

incompetancy of the aortic valve causing flow from the aorta into the left ventricle during systole
Caused by infective endocarditis, chronic - rheumatic fever

Question 13

Presentation, symptoms & signs of aortic regurgitation

Answer 13

acute - HF & cardiogenic shock
chronic - asymptomatic for years, progressive exertional dyspnea, palpitations
Signs - as chronic develops - systolic BP goes up, diastolic down, murmur, normal S1, slapping S2, head bobbing,femoral bruit, pulsation of fingernail capilliaries

Question 14

What is mitral stenosis?
What is it caused by?

MUST KNOW

Answer 14

narrowing of the mitral valve that impedes flow from left atrium to left ventricle
caused by Rheumatic fever almost always

Question 15

Presentation/signs & symptoms of mitral stenosis

Answer 15

loud S1, murmur increases after valsalva, large LV & increased pressure to compensate, pulmonary venous pressure increases leading to right ventricular failure/tricuspid regurg. leading to LA enlargement & perhaps atrial fibrillation

15-40 years: generally asymtomatic until atrial fibrillation, initial symptoms similar to heart failure, dyspnea
chronic - pulmonary oedema, fatigue

Question 16

What is pericarditis?
What is it caused by?

MUST KNOW

Answer 16

inflam. of pericardium, often with fluid accumulation

Caused by - infection, MI, trauma, tumours, cancer, metabolic disorders

Question 17

Clinical presentation - signs & symptoms

Answer 17

Inflammation &/or fluid accumulation
acute - chest pain, maybe dyspnea
cardiac filling impaired leading to low CO, friction rub may be heard

chest pain, dull or sharp sub sternal, may radiate to neck, shoulders (mild to severe)
usually aggravated by thoracic motion
tachypnea
fever
chills/weakness

Question 18

List some causes of chest pain - think of heart & outside of that area….

Answer 18

angina - tight, heavy
myocardial infarction - tight, heavy, more severe than ang.
pericarditis - sharp, raw, worse lying down
aortic dissection - severe, tearing interscapular (stroke..)
respiratory - pleuritic pain - sharp, stabbing, inspir. worse
GO reflux - burning discomfort, worse bending
oesophageal spasm - central chest, can mimic angina
musculoskeletal - costochondritis, rib fracture
dermatolgical - shingles, usually unilateral

Question 19

Chest pain red flags

Answer 19

tachycardia
bradycardia
tachypnea
hypotension
Signs of hypoperfusion - confusion, ashen colour, perspiring a lot
shortness of breath
new heart murmurs

Question 20

Common presenting complaint

Answer 20

chest discomfort
breathlessness
palpitation
pre syncope/syncope
peripheral oedema

Question 21

Breathlessness - generally due to 1 of 4 reasons……..

Answer 21

1 - Increased ventilatory demand - exertion, illnes with a fever, hypoxic state, severe anaemia, metabolic acidosis
2 - Decreased ventilatory capacity - pleural effusion, pneumothorax, intrathoracic mass, rib injury or muscle weakness
3 - increased airway resistance - asthma, chronic obstructive pulmonary disease
4 - decreased pulmonary compliance - interstitial fibrosis, pulmonary odema

Could also be left ventricular dysfunction related