Clinical Conditions Flashcards
1
Q
What heart murmur is heard in aortic stenosis
A
Systolic
2
Q
What heart murmur is heard in aortic Regurgitation
A
Diastolic
3
Q
What heart murmur is heard in mitral stenosis
A
Diastolic
4
Q
What heart murmur is heard in mitral Regurgitation
A
Systolic
5
Q
What causes aortic stenosis
A
Fibrosis, calcification, congenital (bicuspid), rheumatic fever
6
Q
What causes mitral stenosis
A
Rheumatic fever or valve fusion
7
Q
What causes aortic Regurgitation
A
Aortic root dilation, rheumatic fever
8
Q
What causes mitral valve be Regurgitation
A
Weakening of the tissue, MI damaging papillary muscles, rheumatic fever, fibrosis, LV dilation
9
Q
What can be seen due to a bounding pulse
A
Quinke’s sign and head bobbing
10
Q
What happens to the blood viscosity in multiple myeloma and what does this result in
A
It increases giving slugging in the peripheries as its harder for the heart to pump the blood
11
Q
Give some examples of acute phase proteins
A
CRP, complement factors, fibrinogen, ferritin
12
Q
What are the acyanotic heart defects
A
PDA, atrial septum defect, ventricular septum defect, coarctation of the aorta
13
Q
What is coarctation of the aorta
A
Narrowing of the aorta
14
Q
What is PDA
A
Patent ductus arteriosus - hen the ductus arteriosus doesn’t close so blood flows from the aorta to the pulmonary artery
15
Q
What does atrial septum defect result in
A
An increase in blood flow to the RA giving right heart failure due to pulmonary hypertension
16
Q
What is the most common heart defect
A
Ventricular septum defect
17
Q
What are the cyanotic heart defects
A
Hypoplastic left heart syndrome, transposition of the great arteries, tetralogy of fallot, tricuspid atresia and pulmonary atresia
18
Q
What is hypoplastic left heart syndrome
A
Underdevelopment of the left side of the heart
19
Q
Why is transposition of the great arteries not fatal during pregnancy
A
As the shunts mean that oxygenated blood is still circulated around the body
20
Q
What are the 4 features of tetralogy of fallot
A
Overriding aorta, pulmonary artery stenosis, ventricular septum defect and RV hypertrophy
21
Q
What is tricuspid atresia
A
When there no passage between RA and RV so the RV is underdeveloped
22
Q
What is pulmonary atresia
A
No RV outlet so blood flow back through the RA to LA
23
Q
How does the electrical activity of ventricular myocytes change in hyperkalaemia
A
The membrane potential is more positive, this inactivates more sodium Channels so there is also a slower upstroke
24
Q
What is used to treat hyperkalaemia
A
Calcium gluconate with glucose
25
How does the electrical activity of ventricular myocytes change with hypokalaemia
The action potential lengthens giving delayed depolarisations
26
What type of drug is propranolol
Beta blocker
27
What drugs are used in hypertension
ACE inhibitors, calcium blockers, beta blockers, alpha blockers, diuretics
28
What blood pressure is classed as hypertension
140/90
29
What is essential hypertension
An unknown causes for the rise in bp
30
What is secondary hypertension
When there is a known cause for hypertension e.g. Renovascular disease, conn's syndrome, Cushing's syndrome, phaechromocytoma
31
What causes cardiogenic shock
MI, arrthymias, heart failure
32
What is cardiogenic shock
When the ventricles cant empty properly
33
What is mechanical shock
Where the ventricles cant fill properly
34
What causes mechanical shock
PE, cardiac tamponande
35
What is distributive shock
Excessive vasodilation causing a fall in TPR
36
What causes distributive shock
Anaphylactic shock or septic shock
37
What is hypovoleamic shock
Where there is reduced blood volume so a lower CO
38
What causes hypovoleamic shoc k
Haemorrhage, burns, vomiting, diarrhoea
39
How long should the PR interval be
0.12 - 0.2 seconds
40
How long should the QRS complex be
0.12 seconds
41
What does a long QT interval mean
The ventricles are taking longer to repolarise
42
What does a longer QRS complex mean
The ventricles are taking longer to depolarise - so the normal depolarisation route (His - Purkinjie system) may not being used
43
What is sinus rhythm
Where every p wave is followed by a QRS complex, with a normal heart rate
44
How is first degree heart block seen
Prolonged PR interval
45
How is second degree heart block (Mobitz type 1) seen
Increasing prolonged PR interval until a QRS complex is suddenly dropped
46
How does second degree heart block (Mobitz type 2) present on an ECG
Normal PR interval with a QRS complex suddenly dropped
47
How is third degree heart block seen on an ECG
No coordinated contractions of the atria and ventricles. Usually shows a wider QRS complex as the ventricular escape rhythm takes
48
What is heart block
Slower/failure of conduction between the atria and ventricles via the AVN
49
What is a superventricular rhythm
Where the heart rhythm results from the SAN, AVN or ectopic atrial sites
50
What is a STEMI
Where there is complete occlusion of a coronary artery resulting in an MI giving ST elevation on an ECG
51
What is an NSTEMI
Where there is a large occlusion of a coronary artery resulting in ST depression on an ECG
52
How does angina show on an ECG
ST depression
53
How can you tell the difference between an NSTEMI and angina
An NSTEMI with show troponin on a blood test but angina wont as there's no cell death
54
How does high potassium affect an ECG trace
Gives a high T wave which leads to ventricular fibrillation
55
What doe slow potassium look like on an ECG
Low T wave
56
Weeks after an MI what is seen on an ECG
Pathological Q wave
57
Describe the appearance of a pathological Q wave
1/4 the height of the R wave and 2 small squares tall
58
What are the cardiac causes of chest pain
Ischaemia, pericarditis
59
describe ischaemic chest pain
dull, retrosternal which may radiate to the neck, jaw and shoulders
60
is ischaemic pain visceral or somatic pain
visceral
61
describe chest pain caused by pericarditis
sharp, retrosternal which is worse coughing/inhaling but better sitting up
62
what is heard on auscultation in pericarditis
coarse noise called the pericardial rub
63
what is seen on an ECG in pericarditis
elevated, saddle shaped ST
64
what are the respiratory causes of chest pain
pneumonia and PE
65
describe chest pain caused by pneumonia
pain is to the sides of the chest
66
is chest pain caused by pneumonia somatic or visceral pain
somatic as the irregular surfaces of the infection rub on the pleural sacs
67
describe chest pain caused by PE
sharp, well localised pain
| worse on inspiration
68
describe chest pain caused by acid reflux
the acid from the stomach running up the oesophagus gives a centralised burning pain which is made worse lying down or eating certain foods
69
what are musculoskeletal causes of chest pain
rib fracture or costochondritis
70
what is costochondritis
inflammation of the costal cartilages giving a sharp, localised pain which hurts on palpating and breathing in
71
what is radiating pain
pain that starts in one place and moves around
72
what is referred pain
when pain is experienced somewhere away from the site of origin. the afferent pain signals are sent to the brain but these get mixed with the signals from the dermatomes T1-4 and so the efferent signals are sent down these pathways
73
what is percutaneous coronary intervention
when a balloon is inserted into the coronary artery via the femoral or radial artery. the balloon is then inflated and this crushes the plaque into the artery walls. a metal stent then keeps the artery dilated
74
what is acute coronary syndrome
when there is a sudden reduction of blood flow to the heart
75
why cant stable angina be a cause of acute coronary syndrome
as stable angina occurs over time and cant suddenly cut off the blood supply
76
what is the difference between a STEMI and NSTEMI
STEMI is when the artery is fully occluded causing infarction whereas an NSTEMI is where the plaque occludes most of the artery
77
how can you tell the difference between an NSTEMI and unstable angina
troponin is released during an NSTEMI as there is infarction
78
what is stable angina
ischaemia occurring during exercise as the blood demand of the heart increases however the occlusion of the artery doesn't allow enough blood to reach the heart
79
what will help relieve symptoms of stable angina
GTN spray
80
what is used to treat stable angina
aspirin, beta blockers, statins, ACE inhibitors, CABG
81
what is heart failure
a state in which the heart fails to maintain an adequate circulation for the needs of the body
82
give some causes of heart failure
ischaemic heart disease, hypertension, valve disease, alcohol, amyloidosis
83
what are the clinical features of left heart failure
dyspnoea, orthopnoea, pulmonary oedema, tachycardia
84
why do you get pulmonary oedema in left heart failure
the left side of the heart cant pump blood out so it bacs up into the lungs increasing the pressure in the vessels in the lungs so more fluid passes out
85
why can you cough up blood in left heart failure
the increase pressure in the lungs damages the capillaries
86
what are the systolic causes of left heart failure
ischaemia, hypertension (hypertrophy results in ischaemia due to lack of blood supply), dilated cardiomyopathy (dilation of the muscle as it was hypertrophic but this couldn't be sustained)
87
what are the diastolic causes of left heart failure
hypertrophy leads to a smaller volume in the ventricles, or the walls are less compliant
88
what are the features of right heart failure
jugular venous distension, systemic oedema, fatigue, dyspnoea, ascites and hepatosplenomegaly
89
why is ascites and hepatosplenomegaly seen in right heart failure
the oedema surrounds the organs and enlarges them as well as fluid entering the peritoneal cavity
90
what causes right heart failure
secondary to left heart failure
| chronic lung disease
91
what is cor pulmonale
chronic lung disease causing right heart failure due to an increased vascular resistance due to vasoconstriction to prevent perfusion of the alveoli which are no longer ventilated
92
what is left ventricular systolic dysfunction
this is systolic left heart failure where there is reduced LV output despite less LV capacity
93
what is heart failure with preserved ejection fraction
left sided diastolic heart failure
| this is where there is reduced cardiac output but normal ejection fraction
94
what is a palpitation
noticeably rapid, strong or irregular heartbeat
95
what neuro-humoral activation is activated by heart failure
- sympathetic nervous system
- RAAS
- natriuretic hormones
- ADH
- bradykinin
96
what is given to patients with angina
- beta blockers
- calcium blockers
- organic nitrates (GTN spray)
97
how do organic nitrates work?
they produce organic nitrates which are venodilators lowering the preload as the heart fills less reducing the force of contraction needed
98
name 3 anti-thrombic drugs
heparin, warfarin, aspirin
99
what conditions increase the risk of thrombus formation
atrial fibrillation, MI, prosthetic heart valves
100
what is adenosine used to treat
supraventricular tachycardias
101
how does adenosine work
acts on alpha 1 to enhance potassium conductance
102
what is used to treat heart failure
cardiac glycosides, beta agonists, ACE inhibitors
103
how do cardiac glycosides work and name one
digoxin. they block Na/K/ATPases causing an increase in intracellular sodium causing the NCX to slow down. this means less calcium is pumped out of the cell so more is stored in the SER increasing the force of contraction.
104
what drug is used in heart failure with AF
cardiac glycosides
105
what are the 4 classes of anti-arrhythmic drugs
- sodium channel blockers
- beta blockers
- potassium channel blockers
- calcium channel blockers
106
give an example of a beta agonist
dobutamine
107
give an example of a potassium channel blocker
amiodrane
108
give an example of a beta blocker
propranolol
109
give an example of a sodium channel blocker nd describe how it works
lidocaine. they blocker sodium channels during depolarisation to prevent the channels being activated again too soon and then dissociate in time for repolarisation
110
what types of arrhythmias are there
bradycardia, tachycardia, atrial flutter, atrial fibrillation, ventricular fibrillation
111
what are the causes of tachycardia
ectopic pacemaker activity, after depolarisations, re-enter loops
112
what are the causes of bradycardia
sinus bradycardia and conduction block
113
what is acute peripheral atrial disease
sudden blockage of an artery causing ischaemia
114
amputation will need to occur how long after acute peripheral arterial disease if the ischemia is not reversed
6 hours
115
what are the symptoms of acute peripheral arterial disease
6 P's (pain, paralysis, perishing cold, paraesthesia, pulseless, pallor)
116
what is chronic peripheral arterial disease
slow narrowing of an artery giving rise to collateral circulation over time
117
what are the symptoms of chronic peripheral arterial disease
- possibly non if the collateral circulation Is sufficient
- intermittent claudication
- rest pain
- ulceration
118
when is rest pain worsened and how is this relieved
lying in bed its worsened as gravity can no longer help bring blood to the foot and heat increases the metabolic rate so hanging the foot out of bed helps
119
true or false: ischemia can result from thyrotoxicosis
true - there is an increased metabolic rate so the person become tachycardic but as the coronary arteries fill in diastole it means the heart receives less oxygen
120
what are the pulses you can feel in the leg
- dorsalis pedis
- femoral
- popliteal
- posterior tibial artery
121
what are varicose veins
veins with incompentant valves as the walls of the veins are weak and become dilated separating the valves
122
what are the complications of varicose veins
haemorrhage, thrombophlebitis (inflammatory response), oedema, skin pigmentation, lipodermatosclerosis, ulceration
