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HYMS Block 13 > Ischaemic Heart Disease and Arrythmia > Flashcards

Ischaemic Heart Disease and Arrythmia Flashcards

1
Q

How can stress increase your risk of CVD? (4)

A

Impacts:

  1. diet
  2. level of exercise
  3. alcohol intake
  4. smoking
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2
Q

Name 4 examples of chronic stressors that can increase risk of CHD

A
  1. Socioeconomic status
  2. work stress
  3. marital stress
  4. caregiver strain
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3
Q

What pathological mechanism leads to increased risk of CHD with stress?

A

Increased activation of HPA axis and sympathetic nervous system, which induces various pathophysiological responses that increase risk of CHD

  • hypertension
  • inflammation
  • insulin resistance
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4
Q
  1. What type of response does repeated stress lead to?

2. What can also happen with repeated stress?

A
  1. Anticipatory stress response

2. slower recovery following each stressor

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5
Q
  1. What is Primary Appraisal with respect to stress?

2. What is Secondary Appraisal with respect to stress?

A
  1. appraisal of the life event as a threat/ whether it is a harm/benefit
  2. Appraisal of personal coping abilities to cope with stress (e.g. resources available; coping strategies)
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6
Q

Describe the dual process model of grief:

  1. loss orientated tasks
  2. restoration orientated tasks
A
  1. grief work, breaking bonds, denial

2. doing new things, new relationships etc

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7
Q
  1. What is cardiac neurosis/Da Costa’s Syndrome?
  2. What is it associated with?
  3. How is it pharmacologically managed
  4. How else is it managed?
A
  1. Psychiatric disorder involving chest pain, SOB, rapid pulse, fatigue, palpitations with no underlying cardiac pathology
  2. exhaustion and emotional strain
  3. Antidepressants
  4. psychological support/therapy
    modification of lifestyle factors
    regular visits to same team
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8
Q

What are the 4 cardinal signs of cardiac disease?

A
  1. chest pain
  2. breathlessness
  3. Palpitations
  4. Syncope
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9
Q
  1. What are the three characteristics of typical / definite angina?
  2. Where might angina radiate to?
  3. Name 4 features of chest pain that make a diagnosis of stable angina unlikely
A
  1. acute substernal chest pain
    provoked by exertion or emotional stress
    improves with rest or GTN spray
  2. jaw or left arm
  3. continuous/prolonged
    unrelated to activity
    brought on by breathing
    assocated with other symptoms such as dizziness, palptatations etc
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10
Q

What is the character of pain associated with:

  1. myocarditis
  2. pericarditis
  3. dissecting aortic aneurism
A
  1. vague and mild pain, associated with systemic symptoms
  2. sharp stabbing pain worse on inspiration and lying flat
  3. substernal pain often described as sudden, excrutiating tearing that radiates to the back
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11
Q
  1. What is pulmonary oedema?
  2. What is paroxysmal nocturnal dyspnoea
  3. What cardiac pathology are these associated with?
A
  1. oedema of the lungs. Characterised by orthopnea and pink frothy sputum
  2. waking from sleep with coughing and wheeze, lasting for around 15-30 mins
  3. Heart failure
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12
Q
  1. When does vasodepressor syncope usually occur?
  2. What is it a response to?
  3. What is carotid sinus hypertrophy?
  4. What is it important to listen for?
A
  1. after prolonged standing
  2. response to stress
  3. can induce syncope by rubbing neck (and compressing baroreceptors)
  4. carotid bruit
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13
Q
  1. Name 3 cardiac causes of clubbing
  2. What are osler’s nodes?
  3. What are Janeway’s lesions?
  4. What are these indicative of?
  5. What are splinter haemorrhages indicative of?
  6. What is arcus senilis?
  7. What is xanthalma?
A
  1. congenital cyanotic heart disease
    infective endocarditis
    Atrial myxoma
  2. painful red raised lesions of the finger pulps
  3. erythematous macular lesions on the hypothenar eminence
  4. infective endocarditis
  5. infective endocarditis
  6. peripheral corneal opacity; can appear due to hyperlipidemia
  7. fatty deposits around the eyelids. Sign of familial hypercholesterolaemia
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14
Q

What events happen causing the JVP waveform:

  1. A
  2. X descent
  3. C wave
  4. V wave
  5. Y descent
A
  1. atrial systole
  2. end of atrial contraction
  3. tricuspid valve closure
  4. venous return against closed tricuspid valve
  5. opening of the tricuspid valve
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15
Q
  1. What event causes S1?
  2. What event causes S2?
  3. What is the cause of a third heart sound?
  4. What us the cause of a fourth heart sound?
A
  1. closure of mitral and tricuspid valves
  2. closure of the aortic and pulmonary valves
  3. beginning of diastole, after S2. low pitch. Indicative of LV FAIURE
  4. before S1 at end of diastole. blood forced into stiff ventricle. failing LV
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16
Q
  1. What does a fatty streak consist of?
  2. In which blood vessel layer does it develop?
  3. What forms over the top of a fatty streak?
  4. What happens to the core of an atheromatic lesion?
  5. What happens when the structure (3) becomes thin and ruptures?
A
  1. aggregates of foam cells (macrophages that have ingested LDLs)
  2. tunica intima
  3. fibrous cap
  4. becomes necrotic
  5. necrotic core is exposed - leads to thrombus formation and further vessel occlusion
17
Q
  1. What is the presentation of angina in diabetics?

2. What two tests are used to confirm a diagnosis of angina?

A
  1. worsening of breathlessness
  2. stress echocardiogram - area of heart supplied by occluded vessel is less dynamic
  3. myocardial perfusion scan
18
Q

What conditions are included in the term Acute Coronary Syndrome? (3)

A
  1. UNSTABLE ANGINA
  2. NON-ST ELEVATION MI - partial occlusion, therefore only small section of heart is damaged
  3. ST ELEVATION MI - total occlusion of artery, causing extensive damage to a large area
19
Q

What do the following coronary vessels supply?

  1. Left main stem
  2. Left Anterior Descending
  3. Right Coronary Artery
  4. Which infarcts tend to have worse outcomes?
A
  1. left side of heart
  2. most of LV, RV, and IV septum
  3. Right side of heart, including SA node and AV node
  4. anterior - RCA, LAD
20
Q

Which ECG leads produce the following views of the heart?:

  1. Inferior
  2. Anterior
  3. Lateral

Which arterial occlusions can be viewed with the following views?

  1. Inferior
  2. Anterior
  3. Septal
A
  1. II, III, aVF
  2. V1-V6
  3. V5, V6, aVL
  4. RCA
  5. LAD
  6. LCx
21
Q
  1. What ECG changes may be seen in NSTEMI? (2)

2. What is the prognosis if ECG changes are seen?

A
  1. ST depression
    T wave changes/Inversion
  2. poor
22
Q
  1. What 4 pharmacological agents are used for NSTEMI treatment?
  2. What is the treatment for STEMI? (2)
A
  1. antiplatelets - ticagrelor or presurgel
    low molecular weight heparin
    statins
    anti-ischamic - beta blocker, nitrates
  2. primary percutaneous coronary intervention
    thrombolysis
23
Q

Name 4 consequences of Coronary Occlusion/MI

A
  1. Myocardial Rupture
  2. Left Ventricular Dysfunction
  3. left ventricular aneuriusm
  4. Sudden Cardiac Death
24
Q
  1. What is a marker for left ventricular dysfunction?

2. How can sudden cardiac death be prevented?

A
  1. NTproBNP

2. implanted defibrilator

25
Q

On an ECG, how many squares make up a normal:

  1. QRS complex?
  2. PR interval
  3. What is the QTc?
  4. How can normal sinus rhythm be calculated?
A
  1. <3 small squares
  2. <5 small squares
  3. QT interval divided by the square root of RR interval
  4. divide 300 by the number of large squares in an R R interval
26
Q

BRADYCARDIA
What does it mean if the QRS complexes are:
1. regular
2. irregular

  1. What does it mean if there are irregular QRS complexes and absent P waves
A
  1. sinus bradycardia
  2. heart block
  3. slow AF
27
Q

What is the ECG trace of:

  1. first degree heart block
  2. second degree heart block type I
  3. second degree heart block type II
  4. third degree heart block
A
  1. Regular QRS complexes; Prolonged PR interval
  2. PR interval gets longer until it skips a QRS
  3. Regular QRS complexes but not always a P wave present before
  4. Regular QRS complexes but wide and slow (indicating they originate from the ventricles); no P wave in front of each QRS
28
Q
  1. What is bundle branch block
  2. Do the R and L sides of the heart conduct synchronously or asynchronously?

What is the ECG trace of:

  1. Left BBB
  2. Right BBB
A
  1. conduction delay in the bundle branches
  2. asynchronously
  3. W shape in V1; M shape in V6
  4. M shape in V1; W shape in V 6
29
Q
  1. What is the treatment of sinus bradycardia?
  2. What pharmacological treatments can be given for heart block?
  3. What is the treatment of second or third degree heart block
A
  1. investigate and remove cause
  2. ATROPINE - muscarinic antagonist that stimulates the AV node
  3. pacemaker
30
Q

TACHYCARDIA

  1. What does it mean if QRS <3 small squares?
  2. What does it mean if QRS >3 small squares
  3. What does it mean if QRS complexes are irregular?
  4. What pharmacological agent can be given to determine whether tachycardia is supra-ventricular or ventricular?
A
  1. supraventricular tachycardia
  2. ventricular tachycardia
  3. Atrial fibrilation
  4. Adenosine
    - blocks the AV node
    - will have no effect on ventricular tachycardia
31
Q

What is the mechanism of:

  1. Atrial tachycardia?
  2. Atrioventticular re-entrant tachycardia
  3. AV nodal re-entrant tachycardia
A
  1. drive of electrical activity comes from ectopic pacemaker in the atria rather than the SA node
  2. commonly associated with Wolff Parkinson White Syndrome - an accessoty pathway between atria and ventricles creates re-entrant circuit
  3. re-entrant circuit forms within or just next to AV node
32
Q

What is the ECG trace of:

  1. atrial flutter?
  2. Atrial Fibrilation
  3. Ventricular Tachycardia
  4. Ventricular Fibrilation
A 
1. one P wave for every large square
   saw tooth appearance
2. absent P waves; irregular QRS complexes
3. wide, regular, rapid QRS complexes
4. chaotic
33
Q
  1. What is torsades de pointes?
  2. Which class of anti-arrythmic drugs can cause TDP?
  3. What two electrolyte balances can cause TDP?
A
  1. polymorphic ventricular tachycardia
  2. class 1
  3. low potassium and magnesium
34
Q

How do you treat:

  1. stable supraventricular tachycardia?
  2. stable ventricular tachycardia?
  3. Atrial fibrilation?
A
  1. vagotonic manoeuvres, adenosine
  2. amiodarone, cardioversion
  3. rhythm control, ventricular rate control and anti-thrombotic medication
35
Q

Describe the following phases of the cardiac action potential:

  1. Phase 4
  2. Phase 0
  3. Phase 1
  4. Phase 2
  5. Phase 3
A
  1. resting Vm = -9omV
  2. depolarisation. Opening of fast gated sodium channels
  3. rapid inactivation of Nav
    brief opening and closing of potassium channels makes Vm slightly less positive
  4. Plataeu caused by opening of slow voltage gated Ca channels
  5. repolarisation - potassium channels
36
Q
  1. What is the absolute refractory period?
  2. What is the relative refractory period?
  3. What is the clinical relevance of the relative refractory period?
A
  1. during phases 0-2 and half of phase 3, where myocytes can’t be excited again
  2. last half of phase 3, where stimulation may result in contraction
  3. relevance for DC cardioversion; stimulation during the RRP may result in R on T phenomenon, which may cause VF.
37
Q
  1. What is the treatment of bradycardia?
  2. What can be given if the cause of bradycardia is beta blocker or Ca channel blocker overdose?
  3. What can be given if the cause of bradycardia is digoxin toxicity?
A
  1. Atropine - muscarinic antagonist (blocks parasympathetic innervation which slows the heart rate) Also stimulates the AV node
  2. glucagon
  3. digoxin specific antibody fragments
38
Q

What is the site of action of the following classes of anti-arrythmic drugs:

  1. class I
  2. Class II
  3. Class III
  4. Class IV
A
  1. sodium channel blockers - reduce rate of depolarisation
  2. beta blockers - reduce background sympathetic tone and decrease SA node conduction
  3. Potassium channel blockers - prolong repolarisation (refractory period)
  4. Calcium Channel Blockers - prolong plateau
39
Q

Name Examples of:

  1. Class I antiarrythmics
  2. Class II antiarrythmics
  3. Class III antiarrythmics
  4. Class IV antiarrythmics
A
  1. Lidocaine
  2. Atenolol
  3. Amiodarone, solatol
  4. Verapamil, amlodipine

HYMS Block 13 (4 decks)

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