week 7-L1 cardiovascular disorders

Question 1

define cardiomyopathies and give examples

Answer 1

disorders affecting cardiomyocytes or cardiac muscle function
E.g. heart failure, dilated cardiomyopathy, take stub syndrome and hypertrophic cardiomyopathy

Question 2

define heart failure and which types exist

Answer 2

heart unable to maintain adequate circulation for metabolic requirements
divided into PRESERVED EJECTION FRACTION and REDUCED EJECTION FRACTION

Question 3

describe preserved ejection fraction

Answer 3

EF>50% and reduced diastolic function resulting from concentric muscle growth
inability to relax but still pumping the quantity of blood however less blood fills the ventricles due to valves semi closed.
no particularly good outcome form pharmaceutical

Question 4

describe reduced ejection fraction

Answer 4

EF>40% and reduced systolic function resulting from eccentric muscle development
inability to pump out the blood quantity required due to weakened heart muscles, pharmaceutical outcome good

Question 5

underlying causes of heart failure

Answer 5

secondary to cardiac damage- ischaemia or myopathy
hypertension
valve disease

Question 6

effects of heart failure on cardiac output and life expectancy

Answer 6

decrease cardiac output and venous blood accumulation

poor prognosis-50% mortality rate <5 years

Question 7

heart failure ECG and findings

Answer 7

non-specific multiple potential ECG abnormalities-hypertrophy or atrial fibrillation,
Diagnosis: elevated echocardiography and elevated natriuretic peptides

Question 8

symptoms of heart failure

Answer 8

breathlessness
fatigue
fluid retention caused by cardiac dysfunction

Question 9

types of muscular cardiovascular disorders

Answer 9

dilated
hypertrophic
tako tsubo

Question 10

define Dilated cardiomyopathy
pathophysiology: causes and effects on cardiac output and life expectancy
investigations

Answer 10

cardiomegaly and dilation, systolic dysfunction with hypo-contraction
causes mainly inheritance familial secondary to anterior myocardial infarction leading to reduced Q phase and ejection fraction < 40%, mortality rate 10-50%
symptoms: dysnopnea, fatigue, genetic testing
no ECG findings since abnormalities similar to LVH

Question 11

define hypertrophic cardiomyopathy
pathophysiology: causes and effects on cardiac output and life expectancy
investigations

Answer 11

unexplained left ventricular hypertrophy-primarily affects the inter-ventricular septum
autosomal dominant inheritance, decrease in Q and can cause sudden cardiac death during exercise
dysnopnea, fatigue, genetic testing
no ECG findings since abnormalities similar to LVH

Question 12

define Tako tsubo syndrome
pathophysiology: causes and effects on cardiac output and life expectancy
investigations

Answer 12

left ventricular dysfunction where the apex balloons and symptoms mimic myocardial infarction aka broken heart syndrome
stressful event mainly women
decrease in Q, ejection fraction about 40% with 5% mortality rate
symptoms: chest pain, increase cardiac biomarkers normal blood vessel and ST segment elevation
NB shape left ventricle post contraction is like octopus in pot

Question 13

define conduction abnormalities

Answer 13

disorders affecting bioelectrical transmission along the heart

Question 14

name some conduction abnormalities

Answer 14

atrial arrhythmias-atrial fibrillation and WPW
ventricular arrhythmias-ventricular fibrillation and torsade de pointes
tachycardias-sinus and atrial
conduction block-AV block type 1,2,3 and bundle branch block

Question 15

define ECG in atria

Answer 15

P-wave which shows atrial contraction

Question 16

define ECG conduction

Answer 16

P-R interval showing conduction in the AV node-120-200ms

NB conduction stops at AV node

Question 17

define ECG ventricular

Answer 17

QRS complex-ventricular depolarisation< 120ms
ST segment-plateau phase-isoelectric baseline
QT interval-total duration of ventricular depolarisation and repolarisation-HR incr means QT decr
R-R interval- duration between ventricular depolarisation aka HB

Question 18

define ECG positional

Answer 18

cardiac axis normally between -30 and +90 degree

Question 19

define atrial arrhythmias- atrial fibrillation
pathophysiology
investigations

Answer 19

disorganised electric activity and contraction resulting in blood accumulation and clot in atria
caused by-spontaneously active cells throughout atria leading to small decline in Q and incr heart failure and stroke
checked by- palpitations and chest pain
ECG showing- absent P-waves, irregularly irregular rhythm and fibrillary waves

Question 20

define atrial arrhythmias- Wolff Parkinson white
pathophysiology
investigations

Answer 20

cause of tachycardia and abnormal cardiac electrical conductance-another route beside AVN to ventricles
cause- accessory conduction pathway
Q unchanged and normal life expectancy
investigation-palpitations and chest pain
preexcitation- QRS complex ECG is biphasic/inverted-T wave of ECG

Question 21

Cardiovascular disorders conduction

Answer 21

Ventricular arrhythmias
tachycardias
conduction block

Question 22

ventricular arrhythmias-fibrillation

Answer 22

originate from His-Purkinje system or ventricular myocytes with ventricles contracting at 150-400 bpm
cause- structural heart disease, MI or congenital leading to complete loss of Q and cardiac output from seconds to minutes
investigations- syncope and ECG irregular deflections and difficulties identifying PQRST waves

Question 23

ventricular arrhythmias- Torsade de pointes

Answer 23

polymorphic ventricular tachycardia occurring due to long QT interval
congenital or acquired QT prolongation leading to reduced repolarisation
reduced Q either auto resolves or progress to deadly V fib
investigations- chest pain, syncope with twisting around the point

Question 24

tachycardias- Sinus (STach) and atrial (ATach)

Answer 24

characteristic atrial rate between 100-250 bpm
STach-P waves followed by QRS complexes
physiological with normal ECG
ATach-P waves not always followed by QRS complex
ectopic source of atrial beat with ECG solitary p-waves dependent on level of block
effects for both-unchanged or slightly decreased Q

Question 25

Conduction block- AV block definition
pathophysiology
investigations

Answer 25

definition-impaired electrical conduction through AVN classified as type 1 (Wenckebach or Mobitz 1) type 2 and type 3 AV block
patho- fibrosis or calcification of conduction system
type 1- AVN, type 2 and 3- HIS Purkinje system and decrease in Q
investigations-type 1 incr P-R interval
type 2- increase P-R interval 1 beat loss AV conduction
Type 3-complete or consistent loss of conduction from atria to ventricles

Question 26

conduction block- bundle branch block definition
pathophysiology
investigations

Answer 26

impaired electrical conduction in right/left branches of fascicles of Bundle of His
pathophysiology-: LBBB consequence of ischaemia or heart disease
RBBB- benign and asymptomatic
LBBB- results in decrease in Q
Investigations- widening of QRS complex>120s
fascicles blockage- alteration in cardiac axis-posterior-LAD and anterior-RAD

Question 27

Vascular disorder and examples

Answer 27

disorder that affects the blood vessels
HYPERTENSION- primary and secondary
MYOCARDIAL INFARCTION-NSTEMI and STEMI

Question 28

hypertension definition
pathophysiology
investigations

Answer 28

clinic BP>140/90 mmHg
cause and effect- no particular cause, decrease in Q, increase risks of heart disease and end-organ damage
investigations-monitor BP

Question 29

myocardial infarction and angina definition
pathophysiology
investigations

Answer 29

MI- acute coronary syndrome-cardiac tissue damage to coronary artery blockage
angina-pain in chest brought by physical or emotional stress
cause and effect-myocardial ischaemia due to coronary heart disease causing decrease in Q and high mortality
investigations- ST segment elevation

Question 30

STEMI and NSTEMI

Answer 30

ST-elevation myocardial infarction complete blockage of coronary artery
non-ST-elevation myocardial infarction partial blockage or coronary artery