TCD 3.4 - Acute-on-chronic breathlessness

Question 1

What is orthopnoea?

Answer 1

Breathlessness worse when lying flat

Question 2

Explain each waveform of jugular venous pressure by echocardiology (cannon waves)

Answer 2

A - Pre-systolic (right atrium contacts)
C - Beginning of ventricular systole (tricuspid valve closes and bulges into right atrium)
X - Atrial diastole
V - End of ventricular systole (passive venous filling of right atrium)
Y - Tricuspid opens (passive filling of right ventricle)

Question 3

Name some causes of a raised JVP (6)

Answer 3

Right ventricular failure
Tricuspid regurgitation/stenosis
Pericardial effusion
Constrictive pericarditis
SVC obstruction
Volume overload (congestive heart failure, renal failure, iatrogenic)

Question 4

What is atrial fibrillation?

Answer 4

A common heart arrhythmia which creates and irregular and often tachycardic heart rate.

Question 5

What does the Frank Starling curve show?

Answer 5

The relationship between preload and stroke volume in the heart

Question 6

How does the Frank Starling curve change during heart failure?

Answer 6

Flattened
Higher preload is required to increase contractility and stroke volume.

Question 7

What can decrease myocardial contractility?

Answer 7

Acidosis
Negatively inotropic drugs (some anaesthetic agents)

Question 8

What can increase myocardial contractility?

Answer 8

Catecholamines (adrenaline, noradrenaline, dopamine)

Question 9

What is DC cardioversion?

Answer 9

Direct current cardioversion -> a defibrillator delivers a controlled electric shock to return the heart to a normal rhythm.

Question 10

What is the difference between synchronised and non-synchronised DC cardioversion?

Answer 10

Synchronised - Persistent unstable tachyarrhythmia
Non synchronised (defib) - Pulseless VT/VF