CVS med chi

Question 1

Mr Smith is a 60-year-old man, who when out walking his dog has sudden onset chest pain radiating to his left arm. He is brought into hospital by ambulance where A diagnostic ECG shows a suspected blockage to his left coronary artery.
He is taken for a coronary angiogram and coronary intervention.

The cardiologist gains access to his arterial system via. the right radial artery, where a wire is inserted.

Through which arteries does the wire pass through to reach the coronary circulation?

Answer 1

Right Radial, Brachial, Axillary, Subclavian, Brachiocephalic, Aorta (Arch —> Ascending), Coronary Artery

Question 2

Left Ventricle - Coronary Artery(ies) which supply area

Answer 2

Left Ant Desc

Question 3

branch of Left Ant Desc

Answer 3

left

Question 4

Left Atrium Coronary Artery(ies) which supply area

Answer 4

Circumflex

Question 5

Circumflex branch of

Answer 5

left

Question 6

Right Ventricle Coronary Artery(ies) which supply area

Answer 6

Right Coronary

Question 7

Right Coronary branch of

Answer 7

Right

Question 8

Inferior Coronary Artery(ies) which supply area

Answer 8

Acute Marginal, Diagonal

Question 9

Acute Marginal, Diagonal branch of

Answer 9

Right and Left

Question 10

Posterior Coronary Artery(ies) which supply area

Answer 10

Circumflex, Right Posterior Descending

Question 11

A nurse on your ward has approached you very concerned about a patient on the ward. Mrs Brown is a 60-year-old lady, who was admitted with a chest infection a few days ago; this has improved with a course of antibiotics. However, the nurse has noticed her getting progressively short of breath in the past few hours.
You perform a cardiovascular exam, and on auscultation of her chest you notice a new murmur at her left 5th intercostal space, radiating to her mid-axillary line, with associated crackles in her chest.

Is it normal? What do you notice about this?

Answer 11

Opacities throughout all CXR areas, suggestive of fluid in lung (oedema)

Question 12

What happens to blood flow through the heart if the mitral valve isn’t working – where does blood back up to?

Answer 12

If mitral valve is incompetent, then back flow into the left atrium and pulmonary circulation (there is no other valve to stop back flow – think a continuous column of water), therefore pulmonary artery pressures in lung increase and push plasma out into the airspaces (alveoli)

Question 13

What do you think has happened to Mrs Brown?

Answer 13

Rupture of one of the papillary muscles attached to the cusp of the mitral valve

Question 14

Answer 14

Question 15

Sam, a 30-year-old man, has presented to the hospital with a swollen, red left leg after a long-haul flight. A suspected deep vein thrombosis in his left popliteal vein is diagnosed, and he is started on anti-coagulation therapy.
A few days he returns to the hospital, claiming to be short of breath and unable to climb a flight of stairs without stopping.
A suspected pulmonary embolism is diagnosed.

Through which veins has Sam’s deep vein thrombosis transmitted to become lodged in the lungs as a pulmonary embolism?

Answer 15

Left popliteal —> Left Femoral —> Left External Iliac —> Left Common Iliac —> IVC —> RA —> RV —> Pulmonary Artery

Question 16

The consultant has asked for a set of bloods to be taken from Sam. You notice that he has a ‘good vein’ across the anterior aspect of his elbow.

Answer 16

Question 17

What is an atrial septal defect – how does this occur?

Answer 17

Passage between the LA and RA caused by the failure of the embryological primum ostium and ostium secundum to completely close.

Question 18

Where could a potential clot travel to from the deep veins in his legs?

Answer 18

If this opening persists and then the clot could potentially pass into the arterial system, where it could cause a blockage to one of the arteries in the limbs; or cause a stroke.