Revision Flashcards
How do you calculate pulse pressure?
Systolic-diastolic
How is MAP calculated?
Diastolic + 1/3 pulse pressure
How is MAP calculated?
Diastolic + 1/3 pulse pressure
What are the stages of hypertension?
Stage 1- 140/90 Stage 2- 160/100 Severe- systolic >180
What is the dicrotic notch?
A secondary upstroke in the descending part of arterial pressure corresponding to the transient increase in aortic pressure upon closure of the aortic valve
What is the dicrotic notch?
A secondary upstroke in the descending part of arterial pressure corresponding to the transient increase in aortic pressure upon closure of the aortic valve
Draw the heart with its main arterial blood supply
Draw the heart with its main venous drainage
Label “X”
Right coronary artery
Label “V”
Circumflex artery
Label “W”
LAD
Why does the chest pain in a patient with stable angina come on with exercise?
Blood flow through the left coronary artery is compromised because diastole is shorter
What is the primary mechanism by which Glyceryl trinitrate (GTN) spray alleviates myocardial ischaemia in a patient with stable angina?
Primary: Vasodilation of veins
Reduces the PRELOAD to the heart through the venous system, heart contracts less hard
Secondary: Vasodilation of coronary arteries
List the acute coronary syndromes in order of severity
Unstable angina
NSTEMI
STEMI
What is the difference between NSTEMI and STEMI?
Have infarction in both but a STEMI is a full thickness infarction whereas NSTEMI is not full thiickness
What is the difference between stable and unstable angina?
Stable- comes on during exercise
Unstable- comes on at rest
What changes might you see on an ECG during unstable angina?
Would you have elevated troponin C?
ST depression and or T wave inversion
No- no detectable necrosis
What factors may alter the experience of MI? i.e. with/without pain
Diabetic patients
Women
Elderly
Describe the changes that you would see on ECG following STEMI
Acute (minutes-hours): ST elevation
Hours: ST elevation, Q wave development, R wave dimishes
Day 1-2: Pathological Q wave
Days later: ST normalises, T wave inverted
Weeks: ST & T normal, Q wave persists
What is the definition of a Q wave?
When does the Q wave become pathological?
First deflection in the QRS complex is downwards
Bigger than 2mm in depth
A 64 year old man suffered severe chest pain whilst out shopping and was assessed by paramedics at the scene.
The paramedics performed a 12 lead ECG which showed signs of an inferior STEMI (ST elevated myocardial infarction). In which group of leads would ST elevation suggest an inferior infarct?
Leads II, III, avF
A 64 year old man suffered severe chest pain whilst out shopping and was assessed by paramedics at the scene.
The paramedics performed a 12 lead ECG which showed signs of an inferior STEMI (ST elevated myocardial infarction). In which group of leads would ST elevation suggest a lateral infarct?
Leads I, aVL, V5, V6
Which of the following findings are consistent with an acute inferior non-ST elevated myocardial infarction (NSTEMI)?
ST depression in leads I, II, aVF and raised troponin
What is end diastolic volume?
The full extent to which the ventricle has filled at end of diastole
What is the end systolic volume?
What is the stroke volume?
What is the ejection fraction?
How do we calculate it?
(SV/EDV) X100
Systolic heart failure is heart failure with _______ ejection fraction
Reduced
Diastolic heart failure is heart failure with _______ ejection fraction
Preserved
A patient is having her heart function assessed by echocardiography. If the end diastolic volume of her left ventricle is 120ml and the end systolic volume is 80ml what is her ejection fraction expressed as a percentage?
33%
How does lung disease lead to right ventricular failure?
Chronic hypoxia leads to vasoconstriction increasing vascular resistance
Why does pulmonary oedema get worse when lying down?
Redistrubution of blood
Pulmonary oedema rather than peripheral oedema
Lung capillaries distend more
A patient with heart failure develops pulmonary oedema. The patient is already taking an ACE inhibitor. What type of drug would be most appropriate additional therapy to alleviate the pulmonary oedema and reduce the workload of the heart?
Loop diuretic
