CVS General Flashcards
What is Beck’s triad?
What is it a sign of?
- Hypotension
- Raised JVP
- Muffled heart sounds
Sign of cardiac tamponade
What would you hear in pericardial effusion?
Pericardial friction rub
Which artery supplies the SA node in most people?
What about in the other 40%?
- 60% - RCA
- 40% - LCA
Which artery (or arteries) supplies the AV node?
AV nodal branch from posterior RCA
Which artery supplies the RA?
RCA
Which arteries supply the RV?
- Right marginal
- LAD
Which artery supplies the LA?
Circumflex branch of LCA
Which arteries supply the LV?
- Left marginal
- LAD
Where is S1 heard best?
What about S2?
- Apex - using bell
- Pulmonary area - diaphragm
What are the 4 defects found in Tetralogy of Fallot?
What is the anatomical anomaly underlying all 4?
1) RV hypertrophy
2) Over-riding aorta
3) Pulmonary stenosis
4) VSD
Due to IV septum being too anterior
What is the difference between aortic stenosis and coarctation of the aorta?
Aortic stenosis = narrowing of the aortic valve
Coarctation of the aorta = narrowing of the aorta in the region of the ligamentum arteriosum
What signs relating to the pulses would you see in coarctation of the aorta? Why?
Radial-radial pulses synchronous, but radial-femoral delay as blood flow to upper limbs/head fine as subclavian/carotid arise before narrowing, but blood flow to rest of body compromised
What are the 3 classic symptoms of aortic stenosis?
- Chest pain
- Dyspnoea
- Syncope
Give two signs of aortic stenosis apart from murmur
Slow-rising pulse
Thrill
What would be the character of the pulse in aortic regurgitation?
Collapsing
Give some clinical features of mitral stenosis
- Dyspnoea
- Palpitations
- Malar flush
- Tapping apex beat
Why might mitral stenosis lead to AF?
Increased LA pressure due to resistance to flow into LV
Therefore LA hypertrophy - can cause AF
What is systolic blood pressure a measure of?
What about diastolic?
- Systolic = max arterial pressure
- Diastolic = min arterial pressure
How is mean arterial pressure calculated?
Diastolic pressure + 1/3rd pulse pressure
What is stroke volume?
How is it calculated?
Volume of blood leaving LV with each contraction
End diastolic volume minus end systolic volume
What influences BP?
TPR and CO as BP = TPR x CO
Describe Starling’s law of the heart
In basic terms, the more blood in, the more blood out
Hence stroke volume increases with end diastolic volume (up to a point)
The greater the stretch, the harder the myocytes can contract - hence greater output
What is contractility?
The extent by which SV increases with venous pressure
What is preload?
What is afterload?
Preload = end diastolic stretch Afterload = resistance against which the LV has to pump
What is a murmur?
Extra/abnormal sound during the heartbeat cycle, caused by turbulent blood flow
What causes S1?
What about S2?
What are their characters?
- AV valves closing at the beginning of ventricular systole - crescendo-decrescendo
- Outflow valves closing at the end of ventricular systole - shorter duration, higher frequency
Which sound does the pulse occur with?
S1
What ECG changes would you see in stable angina?
At rest, none!
How would you determine whether someone was having unstable angina or an NSTEMI?
- Unstable angina - ST depression but no necrosis biomarkers
- NSTEMI - ST depression with necrosis biomarkers
What are the diagnostic criteria for a STEMI?
Rise of necrosis biomarkers, PLUS one or more of:
- Ischaemic symptoms
- Pathological Q waves on ECG
- ECG changes indicative of ischaemia
- Coronary artery intervention
What ECG changes would you expect to see in a STEMI?
- Tall T waves
- ST elevation
- Prolonged PR interval
- T wave inversion after a couple of days
- Long-term - pathological Q waves
What changes on an ECG would be seen in hypokalaemia?
- ST depression
- U waves
What changes would you expect to see on an ECG in hyperkalaemia?
- Tall (tented) T waves
- Prolonged PR interval
- Widened QRS
- Absent P wave
Give some changes you would see in AF on an ECG
- Irregularly irregular rhythm
- Tachycardia
- Absent P waves
- Oscillating baseline
Where would you place the 6 chest leads for a 12 lead ECG?
- V1 - 4th ICS, right sternal edge
- V2 - 4th ICS, left sternal edge
- V3 - Between V2 and V4
- V4 - 5th ICS, MCL
- V5 - Between V4 and V6
- V6 - 5th ICS, MAL
What is the difference between systolic and diastolic heart failures?
Which is more likely to occur alone?
- Systolic - problem with ventricular contraction
- Diastolic - problem with filling
- Diastolic more likely to occur alone
What is congestive heart failure?
HF where both right and left sides are affected
What is the major cause of RHF?
Secondary to lung conditions - cor pulmonale
Give some clinical features of RHF
- Fatigue
- Dyspnoea
- Increased JVP
- Ascites, hepatomegaly
- Peripheral oedema
What is the major cause of LHF?
Ischaemic heart disease - results in hypertension which increases afterload on LV
List some clinical features of LHF
Pulmonary oedema Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Minial peripheral oedema
