Cardio questions

What is shock?• Acute failure of circulation resulting in

impaired or absent perfusion to tissues and subsequent insufficient oxygen provision to cells (hypoxia).

What are the 5 main types of shock?• Hypovolaemic• Cardiogenic• Neurogenic• Septic• Anaphylactic

Hypovolaemic shock• Causes

• Blood loss• Massive vomiting and/or diarrhoea

• Pathophysiology• Loss of circulating volume, reduced venous return, reduced SV, reduced CO, lower BP, reduced O2

delivery, impaired cellular function• S&S

• Cold, clammy peripheries• Tachycardia• Prolonged cap refill time• Empty Veins

• Management• Fluids

Cardiogenic• Causes

• Pump failure – e.g. ischaemia, arrhythmias, electrolyte disturbances

• Pathophysiology• Backlog of blood builds up in the lungs

• S&S• Cold, clammy peripheries• MAY have tachycardia• Prolonged cap refill time• MAY have raised JVP

• Management• Inotropes (venodilators)

Septic/Anaphylactic• Septic shock

• Infection of the blood results in systemic inflammatory response and mass vasodilation – fluids leaks out

• Anaphylactic shock• IgE mediated – type I hypersensitivity• Allergen stimulates IgE to bind mast cells which then degranulate and release histamine.• Vasodilation and increased capillary permeability.

• S&S• Warm, dry peripheries• Tachycardia• Short cap refill time• BOUNDING pulse

Management of sepsis?• FBC & serum lactate• High flow oxygen• IV fluids• Accurate urine output measurement• Blood culture• IV empirical antibiotics

Management of anaphylaxis?• Adrenaline• Oxygen

• Fluids if needed• Steroids and antihistamines for support

Name the three shunts in foetal circulation…• Ductus arteriosus

• collapses after birth, becomes ligamentum arteriosum• Foramen ovale

• closes after birth, becomes fossa ovalis• Ductus venosus

• collapses after birth, becomes ligamentum venosum

Tetralogy of Fallot?1. Pulmonary stenosis

2. RV Hypertrophy

3. Over-riding aorta

4. VSD

What are the 3 layers of blood vessels?• Tunica intima• Tunica media• Tunica adventitia

Murmurs• Systolic?

• MR• Pansystolic

• AS• Ejection systolic

• Diastolic?• MS

• Late diastolic• AR

• Early/mid diastolic

• Continuous?• PDA

Describe where you would auscultate for murmurs…

What is this?

Would you shock it?Ventricular Tachycardia

IF PULSELESS

What is this?

Would you shock it?Ventricular Fibrillation

YES

What are these?

Atrial Fibrillation

Atrial Flutter

Where would you find this action potential?Pacemaker cells

1. Na ‘funny channels’ open and Na moves out

2. Na channels close and t-type Ca channels open

3. T-type Ca channels close and L-type open

4. L-type Ca channels close and K channels open (repol)

Where would you find this action potential?Cardiomyocytes

0. Depol – fast Na channels open1. Early repol – Na channels close

and K channels open2. Plateau – Ca channels open3. Repol – Slow K channels open

and Ca channels close4. Resting

What are the 2 types of hypertrophy in the heart?• Concentric• Wall thickness increases• No increase in volume• Usually caused by high pressure

• Eccentric• Volume increase• Usually caused by mitral/aortic regurg

What is pericarditis? (5 Ps)• Pleuritic positional pain with a preceding pyrexial illness

3 Degrees of heart block?• First Degree• Slowed impulse >PR interval

• Second Degree• Wenckebach = progressively

increasing PR interval until dropped beat

• Mobitz type 2 = P:QRS fixed ratio e.g. 2:1, 3:1 etc.

• Third Degree• Complete heart block = no

relationship between P and QRS rhythms

What would you use to reverse Warfarin?• Vitamin K

• Prothrombin Complex Concentrates• FFP

What would you use to reverse heparin?• Protamine sulphate

Causes of chest pain?• Cardiovascular: Ischaemia, Pericarditis, Aortic dissection• Respiratory: Infection, PE, Pneumothorax• Neuromuscular: intercostal muscle myositis / strain• Arthritic/Orthopaedic: costochondritis, rib fracture, metastasis• GI: Reflux oesophagitis, Oesophageal spasm, Gastritis• Excitement: anxiety attack, hyperventilation

That’s all folks!