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21 Cards in this Set
- Front
- Back
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A male in his late 50’s presents with pain in the chest which radiates to his epigastric region, his left arm, and the middle of his back.What are the two most likely diagnoses? |
Angina Pectoris Acute Myocardiac Infarction |
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Whatsignificant difference in the clinical manifestations helps differentiatebetween these two diagnoses? |
If the symptoms are relieved by rest and sublingual nitroglycerin it is more likely to be classic angina than Acute Myocardial Infarction |
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Describe the underlying pathology of coronary artery disease |
the pathology lies in the fact that there is an acute or chronic “cut off” supply of oxygenated blood to the heart muscle. |
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Describe the anatomy of the chambers, valves and wall of the right side of the heart |
Right atria • SVC • IVC •Coronary sinus • Fossa ovalis • Auricle •Pectinate muscle • Thin walled Right Ventricle • Tricuspid valve • Cordae tendinae •Papillary muscles • Trabeculae carnae • Myocardium thinner than left ventricle • Interventricular septum deviates to the right• Pulmonary semi lunar valve |
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Describe how the heartbeat is intrinsically initiated and coordinated by the conduction system. Include the responses of the heart chambers to depolarisation. |
The sinoatrial node initiates heart beat depolarisation over both atria which go into systole. The impulse reaches the atrioventricular node which pauses, then sends impulses down the atrioventricular bundle into the right and left branches. Then into purkinje fibres. Ventricle go into systole. |
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On further questioning his history indicates he has had previous episodes of chest pain, unrelated to exercise, but often at the same time at night. Name this variant of his condition? |
Varient angina |
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Symptoms are not diminishing, even though the patient is recumbent and on oxygen. Which of the two differentials is more likely to be the cause of his symptoms? |
Acute Myocardiac Infarction |
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State the electrical, Mechanical, Valves and heart sound for a P wave |
Electrical = atrial depolarisation Mechanical = Atrial systole Valves = Bicuspid & tricuspid open Heart sound = none |
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State the electrical, Mechanical, Valves and heart sound for a QRS wave |
Electrical = ventricular depolarisation atrial repolisation Mechanical = Ventricular systole, atrial diastole Valves = Bicuspid & tricuspid closed, aortic & pulmonary semilunar open Heart sound = Lubb |
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State the electrical, Mechanical, Valves and heart sound for a T wave |
Electrical = Ventricular repolarisation Mechanical = Ventricular diastole Valves = Aortic & pulmonary semilunar closed Heart sound = Dupp |
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Describe some of the other clinical manifestations expected in this person. |
• Pain – severe, crushing pain (someone sitting on your chest), substernal pain that radiates to left arm, neck and jaw and not pain is unable to be relieved by rest or medication
• GI complaints – including epigastric distress, nausea and vomiting • Fatigue and weakness • Tachycardia, anxiety, and restlessness • Pale moist skin • Hypotension and shock |
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The clinical presentation and ECG findings are highly suspicious an acute myocardial infarction Outline the pathophysiology of this condition |
Endothelial damage → thrombosis → acute blockage of vessel lumen → ↓↓↓ O2 → acute ischaemia → myocardial infarction. |
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Name the arteries most commonly involved, |
– Left anterior descending interventricular artery – Left circumflex artery – Right coronary artery |
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Describe the R arterial blood supply to the heart tissue. |
- R CORONARY - R CORONARY SUPPLIES - R MARGINAL Branch - POSTERIOR INTERVENTRICULAR Branch - TRANSVERSE Branch |
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Describe the L arterial blood supply to the heart tissue. |
- L CORONARY - L CORONARY SUPPLIES - ANTERIOR INTERVENTRICULAR Branch -CIRCUMFLEX - L MARGINAL Branch |
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Describe the detection of low blood pressure and its correction by nervous reflexes. Do not include the role of adrenaline. |
- Blood pressure is constantly monitored by baroreceptors which transmit data to cardio regulatory centre of the medulla oblongata
- when low blood pressure is detected the body will increase sympathetic nerve activity to increase HR - Heart begins to pump with more force, increasing stroke, volume and cardiac output bringing blood pressure back to normal |
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Describe the aetiology of rheumatic fever. |
Occurs after a throat infection caused by group A steptococcus - usually 1-4 weeks later |
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Describe pancarditis, a clinical manifestation of rheumatic fever. |
an abnormal condition characterized by inflammation of the entire heart, including the endocardium, myocardium, and pericardium.
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One of the serious complications associated with this condition is rupture of the chordae tendonae of the papillary muscles in the left ventricle leading to a regurgitant mitral valve. Explain the pathophysiology of mitral valve incompetence. |
• Incompetence → ↑ blood from left ventricle moves back into left atrium during systole →↑ left atrial pressure → pulmonary oedema. |
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Another, potentially more devastating complication results from weakened scar tissue in the heart resulting in aneurysm which may rupture. This would lead to a heamorrhagic exudate in the pericardium causing cardiac tamponade. Explain the pathophysiology of cardiac tamponade as a result of a large effusion accumulating rapidly? |
- blood or fluid builds up in the space between the myocardium and the pericardium
- ↑ pressure - ventricles unable to fill properly - heart is then unable to perform full functions - rest of the body does not recieve enough blood as a result of this |
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Describe the radiographic appearance of this condition resulting from pericardial perfusion |
enlargement of the cardiac silhouette on CxR |
