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MS1 > Week 2: Cardiology > Flashcards

Week 2: Cardiology Flashcards

1
Q

Features of the Coronary Circulation

A

-High O2 Consumption
-High Resting O2 Extraction
-Limited Anaerobic Capacity

As such, Adjustments to the supply of oxygen to cardiac muscle is governed by coronary vasomotor tone, and thus myocardium is vulnerable to disruptions to the coronary blood flow

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2
Q

What does restricted o2 supply lead to (myocardium)

A

-increased rate of glycolysis
-Hence lactate is produced faster than it can be uptaken
-pH shifts towards acidosis
-Leads to consequences of ischema and potential pain typical of angina

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3
Q

Chronic Stable Angina vs Unstable Angina

A

-Stable = coronary flow impaired under conditions of high O2 demand leading to ischemia
-Unstable = Coronary flow impaired under resting conditions leading to ischemia

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4
Q

Characteristics of Angina

A
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5
Q

Grades of Angina

A
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6
Q

Dermatone

A

Specific areas of the skin that are supplied by individual spinal nerves

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7
Q

Dermatone C3-C4 and C5-T1

A

C3-C4:The neck and upper shoulders
C5-T1: upper chest, shoulders and upper back

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8
Q

Causes of Acute Coronary Syndrome

A

-Atherosclerosis (which results in embolus blocking coronary artery) (MOST COMMON)
-Coronary artery spasm
-Spontaneous Coronary Artery Dissection (SCAD
-Coronary microvascular dysfunction
-MI with non obstructed coronary arteries

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9
Q

How Does SCAD lead to ACS

A

Sudden tearing of layers in coronary artery wall, leading to a blockage

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10
Q

How does a coronary artery spasm lead to ACS

A

Temporary constriction of a coronary artery, restricting blood flow to the heart

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11
Q

How does Coronary microvascular dysfunction lead to ACS

A

Impaired function of the small vessels in the heard affecting blood supply to the heart muscle

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12
Q

Pathophysiology of infarction due to atherosclerosis

A
  1. Plaque formation
  2. Plaque erosion/rupture
  3. Occluded coronary artery
  4. Arterial pressure drop across stenosis
  5. Reduced blood floe
  6. Poor oxygen perfusion
  7. Oxygen supply and demand mismatch
  8. Infarction
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13
Q

Symptoms of MI

A

-Tight Chest pain in substernal area with radiation to the left arm or jaw (2/3 of cases)
-Dyspnea
-Nausea
-Palpitations
-Weakness
-Diaphoresis (excessive sweating)
NB: atypical presentation can be present in women, diabetics, elderly

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14
Q

STEMI

A

ST-Elevated myocardial infarction
-Serve heart attack with ST segment elevation on the ECG
-Indicates a transmural Infarction/full vessel obstruction of coronary artery
-Elevated Troponins
-type of ACS

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15
Q

NSTEMI

A

Non-ST-elevated myocardial infarction
- Partial heart attack with no ST-segment elevation
- Indicating partial coronary artery blockage / subendocardial infarction
- Type of ACS
- Elevated Troponin levels, ECG looks similar to unstable angina

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16
Q

Unstable angina

A

-Chest pain or discomfort caused by reduced blood flow to the heart, often a precursor to a heart attack (MI).
-only partial blockage of artery
-normal Troponins
-ECG looks similar to to NSTEMI

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17
Q

Differentiating between Stable Angina, Unstable Angina, STEMIA and NSTEMI

A

Patient History is used to differentiate stable angina (relieved by rest)
Troponin Levels differentiates Unstable angina (not elevated) from NSTEMI and STEMI (elevated)
ECG differentiates STEMI (ST elevation) from NSTEMI and Unstable Angina (normal, inverted t waves, or st depression) and Stable Angina (Normal)

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18
Q

Angiography

A

Imaging modality that enables visitation of blood vessels, can allow occlusions to be observed

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19
Q

PCI

A

Percutaneous Coronary Intervention AKA angioplasty

a catheter with a deflated balloon at its tip is inserted into the narrowed artery, and the balloon is inflated to compress the plaque and widen the vessel. A stent is often placed to keep the artery open, reducing the risk of re-narrowing.

Helps restore blood flow to heart muscle

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20
Q

Lateral surface of the heart ECG leads

A

I, aVL, V5, V6
Supplied by the Left circumflex artery

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21
Q

Inferior surface of the heart ECG leads

A

II, III, aVF
Supplied by the Right marginal atery

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22
Q

Anterior surface of the heart ECG leads

A

V3, V4
Supplied by the Left anterior descending artery (and RCA)
NB: the LAD is also known as as the widow maker due to high morbidity associated with an LAD infarction

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23
Q

Septal Surface of the Heart ECG leads

A

V1, V2
Supplied by the Left anterior desceding artery

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24
Q

ECG findings and Serum Troponin in Unstable Angina

A

ECG: ST-segment depression; T wave inversion
Serum troponin: Normal

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25
Q

ECG findings and Serum Troponin in NSTEMI

A

ECG: ST-Segment depression; T wave inversion
Serum Troponin: Rise and fall

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26
Q

ECG findings and Serum Troponin in STEMI

A

ECG: ST segment elevation
Serum Troponin: rise and fall

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27
Q
A

NSTEMI ECG

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28
Q
A

STEMI ECG

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29
Q
A

Normal ECG

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30
Q

Coronary Angiography - Why and How

A

Why: helps evaluate the patency and condition of the coronary arteries.
How: involves threading a catheter through a blood vessel (typically the femoral or radial artery) and advancing it to the coronary arteries under X-ray guidance. A contrast dye is injected through the catheter directly into the coronary arteries. This dye makes the blood vessels visible on X-ray images, allowing the cardiologist to assess blood flow and detect any stenosis.

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31
Q

Reperfusion in ACS management

A

Thrombolytics (if <30mins) or PCI/angioplasty (<90mins)
Restores blood flow

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32
Q

Pharmacological Managment of ACS

A

MONA
-Morphine
-oxygen
-nitrates (GTN)
-aspirin/anti-platelet
+ treat if hypotension or tachycardic

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33
Q

Secondary ACS management

A

-Dual Anti-platelet therapy (used for 12 months post MI)
-Statins (balance cholesterol, reducing formation of plaque)
-ACE inhibitors (reduces blood pressure)
-Beta Blockers (have a negative iontropic effect reducing heart workload and lower BP)
-lifestyle changes (smoking, alcohol, diet)
-Cardiologist referral for monitoring

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34
Q

Label

A
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35
Q
A

R’ wave
(Second positive deflection (aka second sharp up))

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36
Q

ECG Leads - V1 (Placement, areas monitored, and arteries that supply)

A

Placement: Fourth intercostal space; Right Sternal Edge
Area: Wall of right ventricle
Artery: LAD

37
Q

ECG Leads - I (Placement, areas monitored, and arteries that supply)

A

Placement: Right arm to left arm
Area: High Lateral Wall
Artery: LCx

38
Q

ECG Leads - II (Placement, areas monitored, and arteries that supply)

A

Placement: Right Arm to Left Leg
Area: Inferior Surface
Artery: RCA

39
Q

ECG Leads - III (Placement, areas monitored, and arteries that supply)

A

Placement: Left arm to Left leg
Area: Inferior surface
Artery: RCA

40
Q

ECG Leads - aVR (Placement, areas monitored, and arteries that supply)

A

Placement: Right Arm
Area: NA
Artery: NA

41
Q

ECG Leads - aVL (Placement, areas monitored, and arteries that supply)

A

Placement: Left arm
Area: High Lateral wall
Artery: LCx

42
Q

ECG Leads - aVF (Placement, areas monitored, and arteries that supply)

A

Placement: Left Leg
Area: Inferior surface
Artery: RCA

43
Q

ECG Leads - V2 (Placement, areas monitored, and arteries that supply)

A

Placement: 4th ICS; Left sternal edge
Area: Wall of right ventricle
Artery: LAD

44
Q

ECG Leads - V3 (Placement, areas monitored, and arteries that supply)

A

Placement: Midway between V2 and V4
Area: intraventricular septum
Artery: LAD

45
Q

ECG Leads - V4 (Placement, areas monitored, and arteries that supply)

A

Placement: 5th ICS; Midclaviuclar
Area: interventricular septum
Artery: LAD

46
Q

ECG Leads - V5 (Placement, areas monitored, and arteries that supply)

A

Placement: 5th ICS Anterior mid-auxiliary line
Area: Left ventricle
Artery: LCx

47
Q

ECG Leads - V6 (Placement, areas monitored, and arteries that supply)

A

Placement: 5th ICS; mid auxilairy
Area: Left ventricle
Artery: LCx

48
Q

Rate assessment of an ECG

A

300/(no. of large squares in an R-R intervals)

49
Q

ECG- how long (in seconds) in a small box and a big box

A

small:0.04s
Big:0.2s

50
Q

ECG- how to see if it is sinus rhythm

A

Sinus rhythm has a p wave before QRS

51
Q

ECG axis - checking if it is normal

A

Look at aVF and I
-Both should be positive

52
Q

ECG axis, different conditions when lead 1 or aVF is negative

A
53
Q

ECG - Left Ventricular Hypertrophy

A

LVH = If S wave in V1 + R wave in V5 or V6 >35mm

54
Q

Reading an ECG

A

Do not be tempted to overcomplicate. Start with:

Rate
Rhythm
Axis
Context of Clinical History
Then proceed to evaluation of waves:

Are there p waves and what are their features
Describe QRS morphology
Consider T waves - are they concordant with QRS, is there T-wave inversion?
Now consider the intervals:

PR interval (0.12-0.20s is normal)
QRS Interval (Narrow, Broad)
ST segment (important for evaluation of ischemia - is there elevation and/or depression)
QT interval (short, normal, long)

55
Q

Type 1 MI

A

MI due to plaque disruption; fissure, erosion, rupture, dissection

56
Q

Type 2 MI

A

MI due to oxygen supply/demand mismatch
Causes: Anaemia, Coronary artery spasm, Hypotension, Hypoxia (eg due to lung disease)

57
Q

Type 3 MI

A

Ischaemia without biomarkers available; sudden cardiac death

58
Q

Type 4 MI

A

Associated with PCI; during operation (4a) or stent thrombosis (4b)

59
Q

Type 5 MI

A

Myocardial infarction associated with cardiac surgery

60
Q

How does artery dissection cause an MI

A

Tear in the coronary artery wall leading to reduced blood flow to the heart.

61
Q

How does a Coronary artery spasm cause an MI

A

Sudden, temporary constriction of a coronary artery, reducing blood flow.

62
Q

How can myocarditis cause a MI

A

Inflammation of the heart muscle, which can lead to myocardial infarction (MI).

63
Q

Causes and symptoms of Coronary artery spasm

A

Causes
-Smoking: Nicotine can induce coronary artery spasm
-Drugs: Drugs such as stimulants (e.g., cocaine) can induce coronary artery spasm
-Endothelial Dysfunction: Endothelial damage or dysfunction can cause random vasoconstriction
Symptoms:
Chest pain, Dyspnoea, Tachycardia, Palpitations, Syncope, Jaw/shoulder pain

64
Q

How does fibre intake reduce Coronary heart disease risk

A

-binds to cholesterol in digestive track, nd helps eliminate it from the body
-slows sugar absorption, promoting stable sugar levels, reducing risk of diabetes

65
Q

Benefits of food fortification with plant sterols and stanols

A

-Have a similar structure to cholesterol and compete with dietary t cholesterol (via competitive inhibition) for absorption
-Leads to less cholesterol absorption, lowering LDL levels
-it has no side effects (unlike medications) and is convenient

66
Q

DASH diet

A

-dietary approchaes to stop hypertension
-eat fruit/vegtables, whole grains, and lean protein

67
Q

Peripheral Vascular disease

A

atherosclerotic affection of the peripheral arterial tree

68
Q

Peripheral arterial disease symptoms

A

• PAD is often asymptomatic; the most common symptomatic presentation is intermittent claudication.
• Other symptoms can also occur such as Hypertension, arcus cornelais and star staining

69
Q

Cerebrovascular Atherosclerosis Symptoms

A

Unilateral weakness
Hemi-negligence
Trouble speaking
Unilateral vision loss
Dizziness/syncope
Confusion

70
Q

Mechanism of Intermittent claudation

A
  1. Atherosclerotic plaque formation leading to arterial stenosis
  2. Reduced peripheral perfusion
  3. During exercise/exertion there is a greater oxygen demand, and because of the stenosis there is insufficient perfusion
  4. This leads to ischemia, and anabolic respiration of the muscle
  5. This leads to the build of of metabolites such as lactic acid, causing the pain
71
Q

a waveform in JVP

A

caused by artial contractions
- Conditions with a prominent ‘a wave’ include tricuspid stenosis, pulmonary hypertension, and right ventricular hypertrophy.

72
Q

C Wave JVP

A

c Wave - Tricuspid Valve Closure

73
Q

x Descent JVP

A
  • Atrial Relaxation
  • accentuated in situations like cardiac tamponade and constrictive pericarditis.
74
Q

v Wave JVP

A
  • Atrial Filling
  • An elevated or prominent ‘v wave’ can indicate tricuspid regurgitation, where blood leaks back into the right atrium during ventricular systole.
75
Q

Why is describing the case the most important step in ethical decision making?

A

Because if the description is incorrect then the reasoning will also be incorrect

76
Q

Why is troponin T a better marker of cardiac damage than creatinine kinase-MB?

A

Troponin T is more specific to myocardium than creatinine kinase MB

77
Q

erbs point

A

3rd ICS Left sternal edge

78
Q

Acute management of Heart Failure

A
  • Diuretics (IV Furosemide) to manage fluid overload
  • Vasodilators eg Nitrogylcerin
79
Q

Furosemide mech

A

inhibiting the sodium-potassium-chloride cotransporter in the loop of Henle, leading to increased excretion of sodium, chloride, and water, which reduces fluid overload.

80
Q

Rheumatic fever mostly effects what valve

A

Mitral
also aortic but to a lesser extent

81
Q

Efflux of which of the following ions is responsible for the repolarisation of myocardial cells?

A

K+

82
Q

slowing leaking of which of the following ions into a cardiac pacemaker cell is responsible for this cell reaching its threshold potential

A

Na+

83
Q

An ABG result showing high pH, high CO2 and high HCO3- is most consistent with which of the following?

A

vommting induced alkadosis

84
Q

An ABG result showing high pH, low CO2 and normal HCO3- is most consistent with which of the following?

A

hyperventilation

85
Q

which way does exercise shift Hb O2 curve

A

right
bc exercise is the right thing to do duh

86
Q

which electrolyte/mineral disturbance is most closely associated with MM

A

Hypercalcemia

87
Q

vitamin B9

A

Folate

88
Q

Vitamin B12 is absorbed in which part of the GI tract?

A

ileum

89
Q

Which cells are diagnostic in biopsy of Hodgkin’s Lymphoma

A

Reed-Sternberg cells

MS1 (16 decks)

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