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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
ECG findings and Serum Troponin in NSTEMI
ECG: ST-Segment depression; T wave inversion Serum Troponin: Rise and fall
26
ECG findings and Serum Troponin in STEMI
ECG: ST segment elevation Serum Troponin: rise and fall
27
NSTEMI ECG
28
STEMI ECG
29
Normal ECG
30
Coronary Angiography - Why and How
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.
31
Reperfusion in ACS management
Thrombolytics (if <30mins) or PCI/angioplasty (<90mins) Restores blood flow
32
Pharmacological Managment of ACS
**MONA** -Morphine -oxygen -nitrates (GTN) -aspirin/anti-platelet + treat if hypotension or tachycardic
33
Secondary ACS management
-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
34
Label
35
R’ wave (Second positive deflection (aka second sharp up))
36
ECG Leads - V1 (Placement, areas monitored, and arteries that supply)
Placement: Fourth intercostal space; Right Sternal Edge Area: Wall of right ventricle Artery: LAD
37
ECG Leads - I (Placement, areas monitored, and arteries that supply)
Placement: Right arm to left arm Area: High Lateral Wall Artery: LCx
38
ECG Leads - II (Placement, areas monitored, and arteries that supply)
Placement: Right Arm to Left Leg Area: Inferior Surface Artery: RCA
39
ECG Leads - III (Placement, areas monitored, and arteries that supply)
Placement: Left arm to Left leg Area: Inferior surface Artery: RCA
40
ECG Leads - aVR (Placement, areas monitored, and arteries that supply)
Placement: Right Arm Area: NA Artery: NA
41
ECG Leads - aVL (Placement, areas monitored, and arteries that supply)
Placement: Left arm Area: High Lateral wall Artery: LCx
42
ECG Leads - aVF (Placement, areas monitored, and arteries that supply)
Placement: Left Leg Area: Inferior surface Artery: RCA
43
ECG Leads - V2 (Placement, areas monitored, and arteries that supply)
Placement: 4th ICS; Left sternal edge Area: Wall of right ventricle Artery: LAD
44
ECG Leads - V3 (Placement, areas monitored, and arteries that supply)
Placement: Midway between V2 and V4 Area: intraventricular septum Artery: LAD
45
ECG Leads - V4 (Placement, areas monitored, and arteries that supply)
Placement: 5th ICS; Midclaviuclar Area: interventricular septum Artery: LAD
46
ECG Leads - V5 (Placement, areas monitored, and arteries that supply)
Placement: 5th ICS Anterior mid-auxiliary line Area: Left ventricle Artery: LCx
47
ECG Leads - V6 (Placement, areas monitored, and arteries that supply)
Placement: 5th ICS; mid auxilairy Area: Left ventricle Artery: LCx
48
Rate assessment of an ECG
300/(no. of large squares in an R-R intervals)
49
ECG- how long (in seconds) in a small box and a big box
small:0.04s Big:0.2s
50
ECG- how to see if it is sinus rhythm
Sinus rhythm has a p wave before QRS
51
ECG axis - checking if it is normal
Look at aVF and I -Both should be positive
52
ECG axis, different conditions when lead 1 or aVF is negative
53
ECG - Left Ventricular Hypertrophy
LVH = If S wave in V1 + R wave in V5 or V6 >35mm
54
Reading an ECG
**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
Type 1 MI
MI due to plaque disruption; fissure, erosion, rupture, dissection
56
Type 2 MI
MI due to oxygen supply/demand mismatch Causes: Anaemia, Coronary artery spasm, Hypotension, Hypoxia (eg due to lung disease)
57
Type 3 MI
Ischaemia without biomarkers available; sudden cardiac death
58
Type 4 MI
Associated with PCI; during operation (4a) or stent thrombosis (4b)
59
Type 5 MI
Myocardial infarction associated with cardiac surgery
60
How does artery dissection cause an MI
Tear in the coronary artery wall leading to reduced blood flow to the heart.
61
How does a Coronary artery spasm cause an MI
Sudden, temporary constriction of a coronary artery, reducing blood flow.
62
How can myocarditis cause a MI
Inflammation of the heart muscle, which can lead to myocardial infarction (MI).
63
Causes and symptoms of Coronary artery spasm
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
How does fibre intake reduce Coronary heart disease risk
-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
Benefits of food fortification with plant sterols and stanols
-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
DASH diet
-dietary approchaes to stop hypertension -eat fruit/vegtables, whole grains, and lean protein
67
Peripheral Vascular disease
atherosclerotic affection of the peripheral arterial tree
68
Peripheral arterial disease symptoms
• 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
Cerebrovascular Atherosclerosis Symptoms
Unilateral weakness Hemi-negligence Trouble speaking Unilateral vision loss Dizziness/syncope Confusion
70
Mechanism of Intermittent claudation
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
a waveform in JVP
caused by artial contractions - Conditions with a prominent ‘a wave’ include tricuspid stenosis, pulmonary hypertension, and right ventricular hypertrophy.
72
C Wave JVP
c Wave - Tricuspid Valve Closure
73
x Descent JVP
- Atrial Relaxation - accentuated in situations like cardiac tamponade and constrictive pericarditis.
74
v Wave JVP
- Atrial Filling - An elevated or prominent ‘v wave’ can indicate tricuspid regurgitation, where blood leaks back into the right atrium during ventricular systole.
75
Why is describing the case the most important step in ethical decision making?
Because if the description is incorrect then the reasoning will also be incorrect
76
Why is troponin T a better marker of cardiac damage than creatinine kinase-MB?
Troponin T is more specific to myocardium than creatinine kinase MB
77
erbs point
3rd ICS Left sternal edge
78
Acute management of Heart Failure
* Diuretics (IV Furosemide) to manage fluid overload * Vasodilators eg Nitrogylcerin
79
Furosemide mech
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
Rheumatic fever mostly effects what valve
Mitral also aortic but to a lesser extent
81
Efflux of which of the following ions is responsible for the repolarisation of myocardial cells?
K+
82
slowing leaking of which of the following ions into a cardiac pacemaker cell is responsible for this cell reaching its threshold potential
Na+
83
An ABG result showing high pH, high CO2 and high HCO3- is most consistent with which of the following?
vommting induced alkadosis
84
An ABG result showing high pH, low CO2 and normal HCO3- is most consistent with which of the following?
hyperventilation
85
which way does exercise shift Hb O2 curve
right bc exercise is the right thing to do duh
86
which electrolyte/mineral disturbance is most closely associated with MM
Hypercalcemia
87
vitamin B9
Folate
88
Vitamin B12 is absorbed in which part of the GI tract?
ileum
89
Which cells are diagnostic in biopsy of Hodgkin's Lymphoma
Reed-Sternberg cells

MS1 (17 decks)

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