cardio questions. what is shock? acute failure of circulation resulting in impaired or absent...
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Cardio questions
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What is shock?
• Acute failure of circulation resulting in impaired or absent perfusion to tissues and subsequent insufficient oxygen provision to cells (hypoxia).
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What are the 5 main types of shock?
• Hypovolaemic• Cardiogenic• Neurogenic• Septic• Anaphylactic
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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
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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)
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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
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Management of sepsis?
• FBC & serum lactate• High flow oxygen• IV fluids• Accurate urine output measurement• Blood culture• IV empirical antibiotics
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Management of anaphylaxis?
• Adrenaline• Oxygen
• Fluids if needed• Steroids and antihistamines for support
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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
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Tetralogy of Fallot?
1. Pulmonary stenosis
2. RV Hypertrophy
3. Over-riding aorta
4. VSD
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What are the 3 layers of blood vessels?• Tunica intima• Tunica media• Tunica adventitia
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Murmurs
• Systolic?• MR
• Pansystolic• AS
• Ejection systolic
• Diastolic?• MS
• Late diastolic• AR
• Early/mid diastolic
• Continuous?• PDA
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Describe where you would auscultate for murmurs…
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What is this?
Would you shock it?
Ventricular Tachycardia
IF PULSELESS
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What is this?
Would you shock it?
Ventricular Fibrillation
YES
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What are these?
Atrial Fibrillation
Atrial Flutter
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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)
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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
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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
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What is pericarditis? (5 Ps)
• Pleuritic positional pain with a preceding pyrexial illness
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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
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What would you use to reverse Warfarin?• Vitamin K
• Prothrombin Complex Concentrates• FFP
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What would you use to reverse heparin?• Protamine sulphate
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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
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That’s all folks!
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