passmed Flashcards
A patient has a cardiac output of 6 L/min and a heart rate of 60/min. Her end-diastolic left ventricular volume is 200ml.
What is her left ventricular ejection fraction (LVEF)?
50%
First, calculate the stroke volume:
Cardiac output = heart rate x stroke volume.
Stroke volume = cardiac output / heart rate.
= 6000/60 = 100ml.
Then calculate LVEF:
LVEF = (stroke volume / end diastolic LV volume) x 100.
= (100/200) x 100.
= 50%.
EF equally stroke volume divided LDV
ejection faction equals what
stroke volume divided by LDV
different types of heart failure
Heart failure with preserved ejection fraction (HFpEF) is correct. It is usually caused by ventricular stiffness secondary to long-standing hypertension or ventricular hypertrophy. This would lead to abnormal filling of the ventricles during diastole and a normal ejection fraction on the echocardiogram (>50%).
Heart failure with reduced ejection fraction (HFrEF) is incorrect as this patient has an ejection fraction of 60%, and a normal ejection fraction is >50%.
High output heart failure is incorrect. High output heart failure is usually caused by obesity, hepatic disease and lung disease. It may present concurrently with HFpEF. However, in the absence of such risk factors, this is not the most appropriate answer.
Left ventricular failure is incorrect. This patient presents with signs of pulmonary and peripheral oedema which suggests that both left and right ventricles are affected. This should be termed as ‘congestive cardiac failure’ rather than left ventricular failure.
Right ventricular failure is incorrect. This patient presents with signs of pulmonary and peripheral oedema which suggests that both left and right ventricles are affected. This should be termed as ‘congestive cardiac failure’ rather than right ventricular failure.
what is high output heart failure
High-output heart failure refers to a situation where a ‘normal’ heart is unable to pump enough blood to meet the metabolic needs of the body.
Causes anaemia arteriovenous malformation Paget's disease Pregnancy thyrotoxicosis thiamine deficiency (wet Beri-Beri)
how does amiodarone affect warfarin
decreases its metabolism
what are the two main reasons fro using digoxin
Digoxin can be either used in heart failure with reduced ejection fraction, as it inhibits Na+/K+ ATPase and improves contractility, or as a secondary option in atrial fibrillation because it can also inhibit the AV node.
does hypertension normally cause symptoms
no
‘egg-on-side’.
Transposition of the great arteries has an ‘egg-on-side’ appearance on x-rays
transposition of great arteries due to failure of what
e failure of the aorticopulmonary septum to spiral during septation.
Global ST and PR segment changes:
pericarditis
greatest proportion of musculi pectinati found
right atrium
for stress and dilation
facial artery branch of
external carotid
nkle brachial pressure index (ABPI)
1 Normal
0.6-0.9 Claudication
0.3-0.6 Rest pain
<0.3 Impending
what is intermittent claudication
intermittent claudication: aching or burning in the leg muscles following walking
patients can typically walk for a predictable distance before the symptoms start
usually relieved within minutes of stopping
not present at rest
management of critical limb ischaemia
Risk factor modification e.g. smoking cessation, treat hypertension and high cholesterol, prescribe clopidogrel
Supervised exercise programs to increase blood flow
Percutaneous transluminal angioplasty
Surgical reconstruction i.e. bypass graft using the saphenous vein
Amputation
myocardial necrosis marker
troponin I
is the posterior cerebral artery closely related to the 3rd cranial nerve
yes
if you are treating angina with beta blockers but person has asthma do you need to replace them
yes
An unusually tall 43-year-old lady presents to the surgical clinic with bilateral inguinal hernias. She develops chest pain and collapses. As part of her investigations a chest x-ray shows evidence of mediastinal widening. What is the most likely underlying diagnosis?
aortic dissection
Marfans syndrome may present with a variety of connective tissue disorders such as bilateral inguinal hernia. They are at high risk of aortic dissection, as in this case.
A 21-year-old woman was admitted earlier in the day with a fractured tibia following a footballing injury. She was managed with surgical repair but has suddenly developed a tachycardia on the recovery ward. Her observations show a heart rate of 169 beats/minute, respiratory rate of 18 breaths/minute, and blood pressure of 75/52 mmHg. Her ECG shows ventricular tachycardia. The doctor opts for synchronised DC cardioversion.
Which of the following would be the most appropriate management?
DC cardioversion shock synchronised to the ECG R wave
An electrocardiogram (ECG) was done and showed rapid, irregular QRS complexes, which appear to be ‘twisting’ around the baseline.
tosardes de pointes
A 72-year-old man attends the emergency department following a syncopal episode. He has an ECG which shows a prolonged PR interval, with every second QRS complex dropped. The width of the QRS complexes are normal.
In which part of the heart is the conduction delay likely to be coming from?
AVN
The PR interval represents the time between atrial depolarisation and ventricular depolarisation
2nd degree heart block
pale ulcer which has a ‘punched out’ appearance
arterial ulcer - painful at night and sitting in chair
During surgery on his neck, a man suffers a vagus nerve injury where the nerve is cut near the exit from the skull. He wakes up with a high heart rate and high blood pressure due to loss of parasympathetic tone.
Which of the following other features would be expected with a vagus nerve injury?
Hoarse voice
A fourth-year medical student is asked to examine the abdomen of a 59-year-old man who presented to hospital with generalised abdominal pain. He has a past medical history of chronic obstructive pulmonary disease. The student reported generalised abdominal tenderness but with no peritonism, masses or organomegaly. The student described the liver as ‘bouncing up and down periodically’ on the tips of her fingers.
What is the likely cause for this?
Tricuspid regurgitation presents with pulsatile hepatomegaly due to backflow of blood into the liver during the cardiac cycle
The student is describing pulsatile hepatomegaly, where the liver pulsates with the cardiac cycle. This results from retrograde flow of blood from the heart to the peripheral circulation due to an incompetent valve - hence tricuspid regurgitation.
Hepatitis, mitral stenosis or mitral regurgitation do not cause pulsatile hepatomegaly.
what should all patients with angina be given ob hospital admission
Medication
all patients should receive aspirin and a statin in the absence of any contraindication
sublingual glyceryl trinitrate to abort angina attacks
what does warfarin do to PT and INR
increases both
In mitral stenosis, left atrial pressure is increased which equates to increased pulmonary capillary wedge pressure (PCWP)
true
what is orthopnea
Orthopnea means you find it harder to breathe when you lie down because of fluid in your lungs
what can differentiate heart failure from COPD
Orthopnoea can differentiate heart failure from COPD
patients with recurrent DVT and PE what should you offer r
inferior vena cava (IVC) filters
first line for PE
Thrombolysis
thrombolysis is now recommended as the first-line treatment for massive PE where there is circulatory failure (e.g. hypotension)
The bladder’s detrusor tone is maintained by both the sympathetic and parasympathetic nervous system. The sympathetic nervous system is responsible for relaxing the detrusor, while the parasympathetic nervous system mediates the contraction of the muscle, via M3 muscarinic receptors. As such, antimuscarinics, such as oxybutynin, are typically prescribed to patients with urinary incontinence.
Mirabegron is also used to treat urinary incontinence. However, it is a β3 adrenergic receptor agonist.
Meropenem
antibiotic that is used for organisms that are resistant to most beta-lactams. However, it is usually used as last-line therapy due to its adverse effects.
what is Alfuzosin
alpha blocker treatment for BPH
what is valsalva manoeuvre
The Valsalva maneuver is a breathing method that may slow your heart when it’s beating too fast. To do it, you breathe out strongly through your mouth while holding your nose tightly closed. This creates a forceful strain that can trigger your heart to react and go back into normal rhythm
aortic stenosis
