CVS

Question 1

Coronary arteries=

Answer 1

first branches of the aorta from the aortic sinus’

Question 2

features of coronary arteries

Answer 2

Question 3

ischaemic heart disease; stable angina symptoms

Answer 3

• Central chest pain and tightness
  
  • Brought on by exercise and relieved by stress
  • Radiations to neck, shoulder, elft arm

Question 4

treatment for stable angina

Answer 4

• nitrates (sublingual GTN)
• B- blockers
• calcium channel antagonists

Question 6

B blockers increase the length of diastole

Answer 6

• B- blood flow to the left coronary artery is compromised because diastole (relaxation) is shorter

Question 7

Answer 7

• E - Dilation of systemic veins
  
  • Dilating veins in systemic circulation reduces the return of blood to the right side of the heart which lowers preload, therefore force of contraction is reduced making the heart work less hard
    
    • Constrict left coronary artery going into the myocardium

Question 8

acute coronary syndromes

Answer 8

Unstable angina, NSTEMI, STEMI

Caused by plaque rupture and thrombus formation

• Continuum of increasing severity depending on extent, duration and location on the thrombus/blockage

Question 9

Unstable angina vs NSTEMI vs STEMI

Answer 9

• Unstable angina- partial occlusion  no death to muscle
• NSTEMI- death of cardiomyocytes but not full thickness
  
  • Non- ST elevation myocardial infarction
• STEMI- full thickness death

Question 10

Unstable angina

Answer 10

• Rapid onset pain at rest
  
  • Severe central- may radiate less than MI
  • Cause
    
    • Disruption of atherosclerotic plaque and thrombus formation
    • Limited duration and extent of obstruction
    • May be ST depression and or T wave inversion
    • No detectable necrosis (Troponin not elevated)

Question 11

MI

Answer 11

• Acute severe central chest pain (crushing)
  
  • Radiating to neck, left shoulder and arm
  • Not relieved by reast
• Strong sympathetic reaction
  
  • Sweating
  • Pallor
    
    • STEMI- full thickness necrosis of myocardial wall
    • NSTEMI- more limited necrosis

Question 13

typical ECF changes with STEMI

Answer 13

Question 14

Q wave is a sign

Answer 14

of previous death of electrical tissue –> persists for years

Question 15

Answer 15

E

Question 16

Answer 16

Question 17

lateral leads and which artery

Answer 17

I, aVL, V5-V6

• left circumflex
• LAD

Question 18

inferior leads

Answer 18

II, III, aVF

• RCA and/ore LCx

Question 19

anterior/septal leads

Answer 19

V1-V4

• LAD

Question 20

Answer 20

E

Question 21

time course of eleavtion in cardiac troponins and emzymes

Answer 21

Question 22

troponin

Answer 22

Troponin I and T for cardiac

troponin C for skeletal muscles

Question 23

heart failure can be due to

Answer 23

systolic dysfunction- inability to contract properly

• ejection fraction will be reduced (HFrEF)

diastolic dysfunction- inability to relax or fill properly

• ejection fraction may be preserved (HFpEF)

can be a combination

Question 24

HFpEF

Answer 24

stroke volume will be reduced as well as EDV (a ratio) – so will be unchanged

Question 25

frank starling curve

Answer 25

The higher the stroke volume, the stronger the contraction

Question 26

Answer 26

120- 80/120

• D- 33%
• 120-80/120
• EDV volume- systolic volume = stroke volume
• Stroke volume/ EDV = ejection fractions

Question 27

Left vs right vs congestive heart failure

Answer 27

Commonest cause of right sided heart failure is left sided heart failure

Question 28

causes of left ventricular failure

Answer 28

• previous MI
• volume overload due to mitral or aortic regurgitation
• dilated
• cardiomyopathy
• chronic hypertension
• severe aortic stenosis

Question 29

causes of right ventricular failure

Answer 29

• usually left ventricular heart failure- congestive
• secondary to chronic lung disease - pulmonary hypertension (cor pulonale)
• pulmonary valve stenosis

Question 30

Answer 30

C

Question 31

Answer 31

C

Question 32

oedema is madfe worse by

Answer 32

fluid retention

Question 33

Answer 33

B

Question 34

Answer 34

B

Question 36

Answer 36

C

Question 37

Answer 37

B

Question 38

Answer 38

D

Question 39

Answer 39

D

Question 40

Answer 40

• E
  
  • P wave and QRS are independent of each other
  • Therefore atria and ventricles depolarise separately

Question 41

Answer 41

D

prolonded PR interval

Question 42

ECG interval segment

Answer 42

Question 43

Answer 43

B

Question 44

Question 45

Electrode placement

Answer 45

Ride your green bike

Question 46

Answer 46

Z

Question 47

which lead is used as the rhythm strip

Answer 47

lead II

Question 48

Answer 48

ventricular depolarisation

Question 49

what each part of the ECG relates to

Answer 49

Question 50

Answer 50

• 300/2.5 = 125bpm
• Sinus tachycardia

Question 51

Regular heart rate calc

Answer 51

= 300/ big boxes between Rs

Question 52

Irregular=

Answer 52

Number of r waves in 30 large boxes (6 seconds) x 10

Question 53

Third degree heart block is always

Answer 53

bradycardia

Question 54

Answer 54

prolonged PR interval

Question 55

Answer 55

• Second degree heart block (Mobitz type 1)
  
  • Progressive lengthening of PR interval
  • until drop out of QRS complex

Question 56

Answer 56

• Second degree heart block (Mobitz type 2)
  
  • May need pacemaker

Question 57

first degree AV block

Answer 57

Question 58

Answer 58

• Third degree heart block
• QRS are wide because block is happening at more distal site, therefore broad complexes

Question 59

Answer 59

A