CV disorders

Question 1

What defines heart failure?

Answer 1

Heart unable to maintain adequate circulation for metabolic requirements of body

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

Reduced ejection fraction (HFrEF): EF ≤ 40%, ↓ systolic function

Question 2

What are the underlying causes of heart failure?

Answer 2

Secondary to cardiac damage (ischaemia, myopathy), hypertension, valve disease

Question 3

What are the signs+symptoms of heart failure and what tests are used to diagnose it?

Answer 3

Exertional dyspnoea

Blood test: elevated brain natriuretic peptide (BNP)
Chest X-ray: cardiomegaly

Question 4

What does the ECG of someone with heart failure look like?

Answer 4

Enlarged QRS

Question 5

What treatment options are there for heart failure?

Answer 5

Drugs that reduce exertional pressure on the heart

Question 6

Give the definitions of atrial fibrillation and wolff-parkinson-white syndrome

Answer 6

AF:Disorganised electrical activity and contraction

WPW:Additional accessory conduction pathway (the bundle of Kent) between the atria and ventricles

Question 7

Give the underlying cause of AF

Answer 7

Spontaneously active cells throughout the atria

Question 8

Give the underlying cause of WPW syndrome

Answer 8

Presence of additional accessory conduction pathway (the bundle of Kent) between the atria and ventricles

Question 9

What are the signs and symptoms of AF and WPW

Answer 9

Palpitations & chest pain

Question 10

What does an AF ECG look like?

Answer 10

Absent p waves and an irregularly irregular rhythm

Question 11

What does a WPW syndrome ECG look like?

Answer 11

QRS pre-excitation & biphasic/ inverted T-wave of ECG

Question 12

What is the treatment for AF

Answer 12

Strategies to maintain sinus rhythm (e.g. cardioversion, anti-arrhythmics, catheter ablation)

Question 13

What is the treatment for WPW syndrome?

Answer 13

Benign-No treatment needed/given

Question 14

What occurs in first degree heart block?

Answer 14

Slowing down of conduction through AV node

Question 15

What occurs in second degree heart block

Answer 15

Reduced transmission from atria to ventricles

Question 16

What occurs in third degree heart block

Answer 16

Complete block of current from atria to ventricles

Question 17

What is the underlying cause of heart block

Answer 17

Damage (fibrosis, calcification, necrosis) to the conduction system (AV node or His Purkinje system)

Question 18

What does a 1st degree heart block ECG look like

Answer 18

Increased PR interval

Question 19

What does a 2nd degree heart block ECG look like

Answer 19

Increased P-R interval or ‘missing’ QRS complexes, depending on type of block

Question 20

What does a 3rd degree heart block ECG look like?

Answer 20

p-waves not followed by QRS complexes

Question 21

How do you treat heart block?

Answer 21

Discontinuation of AV-blocking drugs (e.g. beta-blockers, calcium channel blockers) or pacemaker implantation in severe cases

Question 22

Define hypertension

Answer 22

-Clinical BP ≥ 140/90 mmHg & ambulatory
-BP daytime average ≥ 135/85 mmHg for prolonged period

Question 23

What is the underlying cause of hypertension?

Answer 23

Primary (essential): unknown
Secondary: resulting from another medical condition (e.g. kidney disease, adrenal disease)

Question 24

What investigations can you undertake to diagnose hypertension?

Answer 24

Blood pressure measurement: readings ≥ 135/85 mmHg

Question 25

Define angina

Answer 25

Chest pain due to myocardial ischaemia caused by atherosclerosis

Question 26

Define NSTEMI(Non-ST-elevated myocardial infarction)

Answer 26

Myocardial tissue damage due to prolonged ischaemia caused by atherosclerosis and artery blockage

Question 27

Define STEMI(ST-elevated myocardial infarction)

Answer 27

Serious myocardial tissue damage due to prolonged ischaemia caused by severe atherosclerosis and complete artery blockage

Question 28

What is the underlying cause of acute coronary syndromes (Angina, NSTEMI, STEMI)

Answer 28

Atherosclerotic lesions of the coronary artery causing ischaemia (angina), artery blockage (NSTEMI) and then complete artery blockage (STEMI)

Question 29

What are the signs and symptoms of angina, NSTEMI and STEMI

Answer 29

Angina: chest pain on exertion (stable) or at rest (unstable) NSTEMI: chest pain, sweating, nausea & vomiting STEMI: radiating chest pain, sweating, nausea & vomiting

Question 30

What would you find in the blood and on the ECG for an NSTEMI patient?

Answer 30

NSTEMI: ST-depression/no changes & high troponin levels

Question 31

What would you find in the blood and on the ECG for a patient with STEMI?

Answer 31

STEMI: ST-elevation with reciprocal ST-depression & high troponin levels

Question 32

How do you treat angina, STEMI and NSTEMI

Answer 32

Angina: Vasodilators STEMI/NSTEMI: coronary stents, antiplatelets, vasodilators, anti-emetics, oxygen & pain-relief