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Cardiovascular > Investigations of heart disease > Flashcards

Investigations of heart disease Flashcards

1
Q

What is the S1 heart sound?

A

Mitral and tricuspid valve closure

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2
Q

What is the S2 heart sound?

A

Aortic and pulmonary valve closure

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3
Q

What is the S3 heart sound?

A

In early diastole during rapid ventricular filling, normal in children and pregnant women, associated with mitral regurgitation and heart failure

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4
Q

What is the S4 heart sound?

A

‘Gallop’, in late diastole, produced by blood being forced into a stiff hypertrophic ventricle, associated with LV hypertrophy

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5
Q

Where can the apex beat be palpated?

A

5th left intercostal space and mid-clavicular line

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6
Q

What is responsible for the apex beat?

A

The left ventricle

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7
Q

What is the definition of stroke volume?

A

The volume of blood ejected from each ventricle during systole

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8
Q

What is the definition of cardiac output?

A

The volume of blood each ventricle pumps per minute (L/min)

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9
Q

What is the definition of total peripheral resistance?

A

The total resistance to flow in systemic blood vessels from beginning of aorta to vena cava

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10
Q

What is the definition of preload?

A

How much blood is in the ventricles before it pumps (end-diastolic volume)

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11
Q

What is the definition of afterload?

A

The pressure the left ventricle must overcome to eject blood during contraction

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12
Q

What is the definition of contractility?

A

The force of contraction and the change in fibre length

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13
Q

What is the definition of elasticity?

A

The myocardial ability to recover normal shape after systolic stress

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14
Q

Name 4 types of P wave abnormalities

A
  • Low amplitude
  • High amplitude
  • Broad notched ‘bifid’
  • Alternative pacemaker foci
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15
Q

Name 4 types of P wave abnormalities

A
  • Low amplitude
  • High amplitude
  • Broad notched ‘bifid’
  • Alternative pacemaker foci
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16
Q

What might cause low amplitude P wave abnormalities?

A
  • Atrial fibrosis
  • Obesity
  • Hyperkalaemia
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17
Q

What might cause high amplitude P wave abnormalities?

A

• Right atrial enlargement

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18
Q

What might cause broad notched ‘bifid’ P wave abnormalities?

A

• Left atrial enlargement

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19
Q

What might cause alternative pacemaker foci P wave abnormalities?

A
  • Focal atrial tachycardias

* ‘Wondering pacemaker’

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20
Q

Name 2 types of PR interval abnormalities

A
  • Prolonged

* Shorter

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21
Q

What might cause prolonged PR interval abnormalities?

A

Disorders if the AV node and specialised conducting tissue

22
Q

What might cause shorter PR interval abnormalities?

A
  • Often in younger patients

* In pre-excitation (Wolff-Parkinson-White)

23
Q

Name 3 types of QRS complex abnormalities

A
  • Broad QRS complexes
  • Small QRS complexes
  • Tall QRS complexes
24
Q

What might cause broad QRS complex abnormalities?

A

Ventricular conduction delay, bundle branch block (BBB)

25
Q

What might cause small QRS complex abnormalities?

A
  • Obese patient
  • Pericardial effusion
  • Infiltrative cardiac disease
26
Q

What might cause tall QRS complex abnormalities?

A
  • L ventricular hypertrophy (S wave in V1 and R wave in V5/6 >35mm)
  • Thin patients
27
Q

Name 2 types of QT interval abnormalities

A
  • Long QT

* Short QT

28
Q

What might cause elevated ST segment abnormalities?

A
  • Early repolarisation
  • MI
  • Pericarditis/myocarditis
29
Q

What happens to the T wave defelection in bundle branch block?

A

Deflection is in the opposite direction to the QRS complex

30
Q

What is the range of the normal heart rate?

A

60-100 BPM

31
Q

What controls the normal heart rate?

A

The dominant pacemaker = the sinoatrial node

32
Q

Name 6 common tachycardias

A
  1. Atrial fibrillation (AF)
  2. Atrial flutter (AFl)
  3. Supraventricular tachycardia
  4. Focal atrial tachycardia
  5. Ventricular tachycardia (VT)
  6. Ventricular fibrillation (VF)
33
Q

Give 4 causes of bradycardia

A
  1. Conduction tissue fibrosis
  2. Ischaemia
  3. Inflammation/infiltrative disease
  4. Drugs
34
Q

What is 1st degree AV heart block?

A

A simple prolongation of the PR interval which doesn’t usually cause symptom or need treatment

35
Q

Give 4 potential causes of 1st degree AV heart block

A
  • Hypokalaemia
  • Myocarditis
  • Inferior MI
  • AVN blocking drugs e.g. β-blockers, CCB
36
Q

What is 2nd degree AV heart block?

A

Electrical impulses sometimes fail to reach the lower heart chamber which can cause skipped beats

37
Q

What are the 2 types of 2nd degree AV heart block?

A

Mobitz types 1 and 2

38
Q

Outline characteristics of Mobitz type 1 heart block

A
  • Beats skipped in a regular pattern
  • PR interval gradually increases until AV node fails completely and no QRS waves are seen then it starts over again
  • Symptoms not usually experienced
39
Q

Outline characteristics of Mobitz type 2 heart block

A
  • Beats skipped in an irregular pattern
  • Sudden, unpredictable loss of AV conduction and loss of QRS
  • Due to a loss of conduction in Bundle of His and Purkinje fibres
  • Can cause light headiness, dizziness and syncope
40
Q

What is 3rd degree AV heart block?

A
  • Aka complete heart block
  • Electrical impulses cannot pass from the atria to the ventricles
  • P waves are completely independent of QRS complex
41
Q

Give 5 causes of complete heart block

A
  1. Structural heart disease
  2. IHD
  3. Hypertension
  4. Endocarditis
  5. Lyme’s disease
42
Q

What treatment can you give for complete heart block?

A
  • Depends on aetiology
  • Permanent pacemaker
  • IV atropine
43
Q

What are the characteristic shapes seen in a left bundle branch block ECG?

A
  • ‘w’ shape in V1

* ‘m’ shape in V6

44
Q

What are the characteristic shapes seen in a right bundle branch block ECG?

A
  • ‘m’ shape in V1

* ‘w’ shape in V6

45
Q

Describe the depolarisation that occurs in left bundle branch block

A

Septal depolarisation is reversed as impulse spreads to RV via R bundle branch then to LV via the septum

46
Q

In right bundle branch block, why is the early part of the QRS complex unchanged?

A

The LV is still activated normally

47
Q

What might be seen on an ECG of infarction or ischaemia?

A
  • T wave flattening inversion
  • ST segment depression/elevation
  • Q waves changed in old infarction
48
Q

What might be seen on an ECG in hyperkalaemia?

A
  • Tall T waves
  • Flattening of P waves
  • Broadening of QRS
  • Eventual ‘sine wave pattern’
49
Q

What might be seen on an ECG in hypokalaemia?

A
  • Flattening of T wave

* QT prolongation

50
Q

What might be seen on an ECG in hypercalcaemia?

A

QT shortening

51
Q

What might be seen on an ECG in hypocalcaemia?

A

QT prolongation

Cardiovascular (5 decks)

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