Cardiovascular system

Question 1

What forms the right border of the heart, the left border of the heart and the inferior border?

Answer 1

• Right border- Right atrium
• Left border- Left ventricle
• Inferior border- Mostly right ventricle

Question 2

Calculate the cardio-thoracic ratio of X-ray below and express it as a percentage. State if the ratio is in the normal range.

Answer 2

• Cardio thoracic ratio is about 40%
• Should occupy less that 50% or less of the maximum width of the thoarx measured between inner marhins of the ribs

Question 3

Express the cardiothoracic ratio of X-ray 2 as a percentage and comment on the degree of enlargement.

Answer 3

The cardiothoaracic ratio is 70% but should be less than 50%

Question 4

Give 2 reasons why the heart shadow may become enlarged.

Answer 4

• Dilated left ventricle
• Ventricular hypertrophy
• Pericardial effusion which has build up over some considerable time

Question 5

Where on the precordium would you feel for the apex beat if the heart is normal?

Answer 5

• The apex beat should normally be felt in the 5th intercostal space at the mid-clavicular line

Question 6

Name the artery indicated by letter A and state which artery this is a branch of

Answer 6

• Left anterior descending artery
• Branch of the left coronary artery

Question 7

What regions of the heart are supplied by the artery labelled A?

Answer 7

• Anterior aspect of the heart including the left venticle and interventricular septum

Question 8

What would happen in LAD becomes occluded?

Answer 8

• The patient would suffer myocardial infarction

Question 9

Describe the sequence of changes in an arterial wall which lead to arterial occlusion.

Answer 9

• An atheromatous placque forms
• The placque ruptures
• This allows a thrombus to form
• The thrombus either occludes artery or a portion of it breaks loose to travel as an embolus to a smaller artery which it occludes

Question 10

What typical symptoms are experienced by a patient with a myocardial infarction?

Answer 10

• Central crushing check pain which may radiate to the arm, neck or jaw

Question 11

Name the artery labelled B and explain why a blockage in this artery is more likely to cause a rhythm distubance

Answer 11

• Right coronary artery
• Supplies the SA Node in most individuals and the AV Node in most individuals

Question 12

On the diagram label the arround to indicate the point where the

a) AV valves close
b) AV valves open
c) aortic valve closes
d) aortic valve opens

Answer 12

Question 13

In the shaded band labelled A what happens to the left venticular volume and pressure?

Answer 13

• Left venticular volume does not change
• Left ventricular pressure increases
• Isovolumetric contraction

Question 14

Mark on the diagram the positions where the aorta is at its narrowest and widest diameter?

Answer 14

Question 15

Mark on the diagram the position of atrial systole

Answer 15

Question 16

Labelled the structures labelled C, D and E

Answer 16

• C= flaps of the mitral valve
• D= Chordae tendinae
• E= wall of the ventricle

Question 17

What is the function of Chordae Tendinae?

Answer 17

• Pulls the valve flaps taught during systole to prevent prolapse of the valve

Question 18

If the mitral valve is imcompetent (fails to close properly) state what will happen to the glow of blood and what would you hear on auscultation of the heart

Answer 18

• Blood will flow back (regurgitation) into the left atrium during systole
• Systolic murmur

Question 19

If the Mitral valve is stenosed (difficult to open) state what would happen to the flow of blood and what would you hear on auscultation of the heart

Answer 19

• The flow of blood across the valve during diastole will be turbulant
• Mid-diastolic murmur

Question 20

In a patient with long standing mitral valve stenosis what would happen to the left atrium

Answer 20

• Left atrium would become dilated
• This is because of the increased pressure and volume because it is harder for blood to flow through the stenosed valve

Question 21

Answer 21

Question 22

Describe the struction of the pericardial sac?

Answer 22

• Outer fibrous layer
• Double serous layer consisting of an inner visceral layer and an outer parietal layer

Question 23

In some patients if a large pericardial effusion develops rapidly it can cause cardiac tamponade. What is meant by the term cardiac tamponade?

Answer 23

• Cardiac tamponade is compression of the heart leading to a fall in arterial blood pressure (haemodynamic compromise)

Question 24

In a patient with cardiac tamponade why would cardiac output fall?

Answer 24

• There is rapid fluid build up and outer fibrous layer cannot expand
• This puts external pressure on the heart preventing it from filling properly in diastole

Question 25

What would you do to improve the clinical stuitation in Cardiac tamponade?

Answer 25

• Insert a needles to remove fluid from the pericardial sac
• Pericardiocentesis

Question 26

There are 4 defects in the picture below, match the flowing defects to the letter in the diagram:

Ventiruclar septal defect

Right ventrciular outflow obstruction- Pulmonary stenosis

Overriding aorta

Right ventricular hypertrophy

What is this congenital heart defect called?

Answer 26

Tetralogy of fallot

Question 27

Would a baby born with this condition by cyanosed? Explain your answer.

Answer 27

Yes because there is mixing of deoxygenated blood with oxygenated blood leaving the heart

Question 28

If a baby is born with venticular septal defect alone would the baby be cyanosed?

Answer 28

No

Question 29

What long term impact would a large venticular septal defect have on the pulmonary circulation if left untreated?

Answer 29

• Extra blood flow through the pulmonary circulation could damage the pulmonary vasculature causing vasculature causing vascular re-modelling (or hypertrophy of smooth muscle cells in the tunica media) and increased pulmonary resistance