geeky medics Flashcards
Which of the following cardiovascular conditions is Marfan’s syndrome associated with?
Arrhythmia
Restrictive cardiomyopathy
Endocarditis
Aortic dissection
aortic dissection
An aortic dissection begins as an intimal tear which then allows for blood to pass through the weakened media of the aortic wall. The most common cause of aortic dissection is hypertension but it can also be caused by connective tissue diseases such as Marfan’s syndrome and Ehlers-Danlos syndrome.
Marfan’s syndrome is caused by a gene mutation in FBN1 on chromosome 15 leading to a defect in fibrillin (a glycoprotein that forms a sheath around elastin). It causes cystic medial necrosis of the media which is due to fragmentation of elastic laminae with an accumulation of myxoid material in aortic media leading to aortic dissection. Other cardiac pathology associations include aortic valve incompetence and mitral valve prolapse. Other findings of the syndrome are tall stature with long extremities, hypermobile joints, pectus excavatum, arachnodactyly and upward/temporal subluxation of lenses.
The ECG shows ST elevation in leads V5 and V6, I and aVL.
Which coronary artery branch was most likely affected in this patient?
Left anterior descending
artLeft circumflex artery
Sinoatrial penetrating arteries
Right posterior descending artery
Right marginal artery
left circumflex
You are asked to a review a 65-year old female in A&E who has presented with chest pain and shortness of breath. Upon taking a history, she informs you that she has been experiencing sharp and piercing central chest pain, which is worse during inspiration. Furthermore, her breathlessness is exacerbated when reclining, and she has been suffering from a mild fever and cough for the past couple of days. Upon auscultation, a pericardial rub can be heard. Clinical examination is otherwise unremarkable. A 12-lead ECG has been requested which shows widespread concave ST elevation across the limb and precordial leads.
What is the most likely diagnosis?
Endocarditis
Pneumothorax
Pulmonary embolism
Myocardial infarction (MI)
Pericarditis
pericarditis
Pericarditis involves the swelling and irritation of the pericardium often following a viral infection. Pericarditis can often initially present with symptoms that mimic myocardial infarction (MI) with the patient reporting chest pain and shortness of breath alongside ST-elevation on a 12-lead ECG.
Typical symptoms of pericarditis include chest pain which is retrosternal, pleuritic (exacerbated on inspiration) and worse when lying flat. The sharp central chest pain associated with pericarditis is caused by the irritated and inflamed layers of the pericardium rubbing against each other, especially on inspiration. There is sometimes an associated pericardial friction rub which can be heard on auscultation.
A 12-lead ECG will often show widespread concave ST elevation through all leads. Pericarditis can be differentiated from an MI on a 12-lead ECG in several ways. Pericarditis often causes widespread ST abnormalities, unlike myocardial infarction which typically causes changes in a subset of leads that relate to the area of infarction. Pericarditis can sometimes cause localised ST elevation similar to an MI, however, there should be no reciprocal ST depression.
Ultimately, more definitive diagnostic techniques are required to diagnose pericarditis and rule out an MI. Cardiac troponin and CRP should be measured and transthoracic echocardiography and a chest X-ray should be performed.
Endocarditis
typically presents with fever and sometimes secondary effects of the disease such as septic emboli causing a stroke. Clinical examination typically reveals splinter haemorrhages, Janeway lesions, a new or changing cardiac murmur and Roth spots on fundoscopy. The chest pain, ECG changes and pericardial rub are not features of endocarditis.
What type of cardiomyopathy is seen in the sudden death of young athletes?
Dilated cardiomyopathy
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Hereditary hypertrophic cardiomyopathy is due to autosomal dominant mutations in the beta-myosin heavy chain. It causes massive hypertrophy of the left ventricle which results in diastolic dysfunction and subaortic stenosis. Thus, there is an increased risk for ventricular arrhythmias which is a common cause of sudden death in young athletes.
Which stage of the cardiac cycle best correlates with the T wave?
Early ventricular systole
Late ventricular systole
Atrial systole
Midventricular systole
Ventricular diastole
ventricular diastole
