Podcast
Questions and Answers
Which of the following best describes the primary focus when initially managing a patient presenting with chest pain?
Which of the following best describes the primary focus when initially managing a patient presenting with chest pain?
- Assessing the patient's long-term cardiovascular risk factors.
- Determining the patient's eligibility for chiropractic treatment.
- Ruling out potentially life-threatening cardiovascular conditions. (correct)
- Identifying any musculoskeletal causes of chest pain.
A patient describes their chest pain as 'crushing' and also reports associated nausea and sweating. Where else should you focus your questioning, based on the images on potentially concerning chest pain?
A patient describes their chest pain as 'crushing' and also reports associated nausea and sweating. Where else should you focus your questioning, based on the images on potentially concerning chest pain?
- History of recent upper respiratory infection or fever.
- Any recent trauma or injury to the chest wall.
- Pain or discomfort in the jaw, neck, arm or upper back. (correct)
- Exposure to allergens or irritants.
If a patient reports chest pain, which of the following body systems should be considered as potential sources of the pain, alongside the cardiovascular system?
If a patient reports chest pain, which of the following body systems should be considered as potential sources of the pain, alongside the cardiovascular system?
- Respiratory and gastrointestinal systems. (correct)
- Reproductive and lymphatic systems.
- Nervous and urinary systems.
- Integumentary and endocrine systems.
When assessing a patient with chest pain, which of the following findings during a general cardiovascular examination would warrant urgent referral?
When assessing a patient with chest pain, which of the following findings during a general cardiovascular examination would warrant urgent referral?
During an additional physical examination of a patient with chest pain, what would you expect to observe in a presentation of musculoskeletal inflammation?
During an additional physical examination of a patient with chest pain, what would you expect to observe in a presentation of musculoskeletal inflammation?
Which of the following cardiac investigations provides real-time functional information about the heart, such as ejection fraction and blood flow?
Which of the following cardiac investigations provides real-time functional information about the heart, such as ejection fraction and blood flow?
What is the primary purpose of performing an angiography in the context of cardiac disease?
What is the primary purpose of performing an angiography in the context of cardiac disease?
Atherosclerosis is characterized by which of the following pathological processes in the arterial wall?
Atherosclerosis is characterized by which of the following pathological processes in the arterial wall?
Which of the following is a characteristic feature of hyaline arteriosclerosis?
Which of the following is a characteristic feature of hyaline arteriosclerosis?
Hyperplastic arteriosclerosis is most directly associated with which of the following conditions?
Hyperplastic arteriosclerosis is most directly associated with which of the following conditions?
What is the primary pathological change associated with Monckeberg arteriosclerosis?
What is the primary pathological change associated with Monckeberg arteriosclerosis?
Which of the following is the initial step in the pathogenesis of atherosclerosis?
Which of the following is the initial step in the pathogenesis of atherosclerosis?
What is the role of LDL cholesterol in the development of atherosclerosis?
What is the role of LDL cholesterol in the development of atherosclerosis?
Which of the following cellular events contributes directly to the formation of the fibrous cap in an atherosclerotic plaque?
Which of the following cellular events contributes directly to the formation of the fibrous cap in an atherosclerotic plaque?
The rupture of an atherosclerotic plaque leads directly to which of the following acute events?
The rupture of an atherosclerotic plaque leads directly to which of the following acute events?
Which of the following is considered the most powerful modifiable risk factor for atherosclerosis?
Which of the following is considered the most powerful modifiable risk factor for atherosclerosis?
How does diabetes mellitus contribute to the development of atherosclerosis?
How does diabetes mellitus contribute to the development of atherosclerosis?
Why is it crucial to understand atherosclerosis in a general medical practice?
Why is it crucial to understand atherosclerosis in a general medical practice?
Which of the following symptoms is typically associated with the initial stages of atherosclerosis?
Which of the following symptoms is typically associated with the initial stages of atherosclerosis?
A patient presents with exertional angina. What is the most likely underlying cause?
A patient presents with exertional angina. What is the most likely underlying cause?
Which of the following best describes the typical chest pain associated with angina pectoris?
Which of the following best describes the typical chest pain associated with angina pectoris?
A patient reports exertional chest pain relieved by rest. What historical details regarding the chest pain best indicates a pain of cardiac origin?
A patient reports exertional chest pain relieved by rest. What historical details regarding the chest pain best indicates a pain of cardiac origin?
A patient with a history of stable angina reports that their usual chest pain is now occurring with less exertion and is not fully relieved by rest. What is the most appropriate next step?
A patient with a history of stable angina reports that their usual chest pain is now occurring with less exertion and is not fully relieved by rest. What is the most appropriate next step?
Which of the blood tests best differentiates unstable angina from myocardial infarction?
Which of the blood tests best differentiates unstable angina from myocardial infarction?
What is the primary goal of initial medical management of angina pectoris relating to lifestyle?
What is the primary goal of initial medical management of angina pectoris relating to lifestyle?
Which of the following best describes the underlying cause of acute coronary syndromes (ACS)?
Which of the following best describes the underlying cause of acute coronary syndromes (ACS)?
A patient is diagnosed with a non-ST-segment elevation myocardial infarction (NSTEMI). What is the primary difference between this condition and unstable angina?
A patient is diagnosed with a non-ST-segment elevation myocardial infarction (NSTEMI). What is the primary difference between this condition and unstable angina?
Which of the following sets of symptoms would be most suggestive of a myocardial infarction in a female patient?
Which of the following sets of symptoms would be most suggestive of a myocardial infarction in a female patient?
During the physical examination of a patient suspected of having a myocardial infarction, you note crepitus in the lungs. What condition is it MOST suggestive of?
During the physical examination of a patient suspected of having a myocardial infarction, you note crepitus in the lungs. What condition is it MOST suggestive of?
A patient presents to the clinic with complaints of chest pain. What is the MOST important factor during a physical examination to determine if a referral is needed?
A patient presents to the clinic with complaints of chest pain. What is the MOST important factor during a physical examination to determine if a referral is needed?
In the initial management of a patient with a suspected myocardial infarction, what is the primary reason for administering oxygen, aspirin, and nitrates in the pre-hospital setting?
In the initial management of a patient with a suspected myocardial infarction, what is the primary reason for administering oxygen, aspirin, and nitrates in the pre-hospital setting?
Which of the following best describes the underlying pathology of heart failure?
Which of the following best describes the underlying pathology of heart failure?
What best describes the primary compensatory mechanism the body uses to maintain cardiac output in the early stages of heart failure?
What best describes the primary compensatory mechanism the body uses to maintain cardiac output in the early stages of heart failure?
What pathological symptoms are related to fluid shifting out of the blood vessels due to increased pressure in left-sided congestive heart failure
What pathological symptoms are related to fluid shifting out of the blood vessels due to increased pressure in left-sided congestive heart failure
A 68-year-old patient reports increasing breathlessness with minimal exertion, fatigue, and lower extremity edema. Which non-invasive diagnostic test would be most useful to confirm potential diagnosis of chronic heart failure?
A 68-year-old patient reports increasing breathlessness with minimal exertion, fatigue, and lower extremity edema. Which non-invasive diagnostic test would be most useful to confirm potential diagnosis of chronic heart failure?
Which class of medications is typically used as a first-line treatment in chronic heart failure to reduce fluid overload and improve symptoms such as dyspnea and edema?
Which class of medications is typically used as a first-line treatment in chronic heart failure to reduce fluid overload and improve symptoms such as dyspnea and edema?
Which statement best defines 'arrhythmia'?
Which statement best defines 'arrhythmia'?
In the context of cardiac arrhythmias, what is meant by the term 'automaticity'?
In the context of cardiac arrhythmias, what is meant by the term 'automaticity'?
A patient's ECG shows a heart rate of 150 beats per minute. How, most accurately, would you classify this heart rate?
A patient's ECG shows a heart rate of 150 beats per minute. How, most accurately, would you classify this heart rate?
Which of the following is a hallmark characteristic of atrial fibrillation (AF)?
Which of the following is a hallmark characteristic of atrial fibrillation (AF)?
Which chamber of the heart is affected by ventricular arrhythmias?
Which chamber of the heart is affected by ventricular arrhythmias?
Which statement best defines the role of catheter ablation in atrial fibrillation management?
Which statement best defines the role of catheter ablation in atrial fibrillation management?
Which of the following best describes the relationship between arteriosclerosis and atherosclerosis?
Which of the following best describes the relationship between arteriosclerosis and atherosclerosis?
In hyaline arteriosclerosis, which organ is particularly susceptible to diffuse ischaemia?
In hyaline arteriosclerosis, which organ is particularly susceptible to diffuse ischaemia?
A 60-year-old patient with long-standing hypertension is diagnosed with hyperplastic arteriosclerosis. What is the primary mechanism by which hypertension contributes to this condition?
A 60-year-old patient with long-standing hypertension is diagnosed with hyperplastic arteriosclerosis. What is the primary mechanism by which hypertension contributes to this condition?
A patient over 50 years presents with an incidental finding of vascular calcification on X-ray. While asymptomatic, his blood pressure readings are elevated. Which arteriosclerosis subtype is MOST likely?
A patient over 50 years presents with an incidental finding of vascular calcification on X-ray. While asymptomatic, his blood pressure readings are elevated. Which arteriosclerosis subtype is MOST likely?
Which of the following processes is most directly responsible for the chronic inflammatory state within the arterial wall during atherogenesis?
Which of the following processes is most directly responsible for the chronic inflammatory state within the arterial wall during atherogenesis?
How do macrophages contribute to the progression of atherosclerosis beyond the initial inflammatory response?
How do macrophages contribute to the progression of atherosclerosis beyond the initial inflammatory response?
What is the role of smooth muscle cells (SMCs) in atherosclerosis?
What is the role of smooth muscle cells (SMCs) in atherosclerosis?
A patient with a known atherosclerotic plaque experiences a sudden increase in chest pain at rest. Which event is MOST likely the immediate cause of this change?
A patient with a known atherosclerotic plaque experiences a sudden increase in chest pain at rest. Which event is MOST likely the immediate cause of this change?
A patient with a long history of smoking is counselled on reducing their cardiovascular risk. Why is smoking cessation considered the MOST powerful modifiable risk factor for atherosclerosis?
A patient with a long history of smoking is counselled on reducing their cardiovascular risk. Why is smoking cessation considered the MOST powerful modifiable risk factor for atherosclerosis?
What is the combined impact of elevated glucose levels and increased free radical production in individuals with diabetes mellitus on the development of atherosclerosis?
What is the combined impact of elevated glucose levels and increased free radical production in individuals with diabetes mellitus on the development of atherosclerosis?
A patient reports chest pain that radiates down their left arm and is associated with shortness of breath. What key aspects of their medical history would suggest atherosclerosis as a likely underlying cause?
A patient reports chest pain that radiates down their left arm and is associated with shortness of breath. What key aspects of their medical history would suggest atherosclerosis as a likely underlying cause?
A patient describes experiencing transient ischaemic attacks (TIAs). How does this relate to the typical progression of atherosclerosis?
A patient describes experiencing transient ischaemic attacks (TIAs). How does this relate to the typical progression of atherosclerosis?
During an ECG stress test for a patient suspected of having angina pectoris, what finding would MOST strongly suggest a diagnosis of stable angina?
During an ECG stress test for a patient suspected of having angina pectoris, what finding would MOST strongly suggest a diagnosis of stable angina?
A patient taking medication for hypertension and hyperlipidemia reports experiencing new episodes of exertional chest discomfort. What is the MOST important aspect of this change to assess in determining the next clinical steps?
A patient taking medication for hypertension and hyperlipidemia reports experiencing new episodes of exertional chest discomfort. What is the MOST important aspect of this change to assess in determining the next clinical steps?
During the physical examination of a patient experiencing chest pain, which assessment would be MOST important to perform to exclude possible MI?
During the physical examination of a patient experiencing chest pain, which assessment would be MOST important to perform to exclude possible MI?
A patient with suspected stable angina has a normal resting ECG. Which cardiac test is MOST appropriate to perform NEXT?
A patient with suspected stable angina has a normal resting ECG. Which cardiac test is MOST appropriate to perform NEXT?
Which ECG finding would MOST strongly suggest the presence of myocardial ischaemia? (without infarction)
Which ECG finding would MOST strongly suggest the presence of myocardial ischaemia? (without infarction)
A patient presents with chest pain and is suspected of having acute coronary syndrome (ACS). Why is it critical to differentiate between unstable angina, NSTEMI, and STEMI?
A patient presents with chest pain and is suspected of having acute coronary syndrome (ACS). Why is it critical to differentiate between unstable angina, NSTEMI, and STEMI?
A female patient presents with atypical symptoms suggestive of myocardial infarction. Which symptom would you MOST likely attribute to myocardial infarction?
A female patient presents with atypical symptoms suggestive of myocardial infarction. Which symptom would you MOST likely attribute to myocardial infarction?
During the physical examination of a patient suspected of having a myocardial infarction, you auscultate soft 1st heart sound and 3rd heart sound. What condition are the MOST suggestive of?
During the physical examination of a patient suspected of having a myocardial infarction, you auscultate soft 1st heart sound and 3rd heart sound. What condition are the MOST suggestive of?
What is the MOST appropriate rationale for administering oxygen, aspirin, and nitrates to a patient with a suspected myocardial infarction in the pre-hospital setting?
What is the MOST appropriate rationale for administering oxygen, aspirin, and nitrates to a patient with a suspected myocardial infarction in the pre-hospital setting?
What is the MOST important factor during a physical examination to determine if a referral is needed?
What is the MOST important factor during a physical examination to determine if a referral is needed?
In the context of heart failure, how does increased sympathetic stimulation act as a compensatory mechanism, and what are its potential long-term consequences?
In the context of heart failure, how does increased sympathetic stimulation act as a compensatory mechanism, and what are its potential long-term consequences?
Which of the following best describes the effect elevated levels of brain natriuretic peptide (BNP) have on the body?
Which of the following best describes the effect elevated levels of brain natriuretic peptide (BNP) have on the body?
What is the significance of pulmonary congestion, caused by fluid accumulation in the lungs, in the context of left-sided heart failure?
What is the significance of pulmonary congestion, caused by fluid accumulation in the lungs, in the context of left-sided heart failure?
A patient diagnosed with chronic heart failure reports increasing dyspnea, even with mild exertion. What potential change in their condition does this suggest?
A patient diagnosed with chronic heart failure reports increasing dyspnea, even with mild exertion. What potential change in their condition does this suggest?
What is the MOST likely reason the patient mentioned was prescribed Furosemide when treating heart failure?
What is the MOST likely reason the patient mentioned was prescribed Furosemide when treating heart failure?
In a healthy heart, what structure normally initiates the electrical impulses that trigger each heartbeat?
In a healthy heart, what structure normally initiates the electrical impulses that trigger each heartbeat?
Which of the following mechanisms can lead to tachycardic arrhythmias?
Which of the following mechanisms can lead to tachycardic arrhythmias?
How does atrial remodeling contribute to the perpetuation of atrial fibrillation (AF)?
How does atrial remodeling contribute to the perpetuation of atrial fibrillation (AF)?
Which of the following ECG findings is MOST characteristic of atrial fibrillation (AF)?
Which of the following ECG findings is MOST characteristic of atrial fibrillation (AF)?
A patient's ECG shows a consistent pattern of rapid, wide QRS complexes, indicating that the arrhythmia originates from the ventricles. What potential consequence is MOST concerning with ventricular arrhythmias?
A patient's ECG shows a consistent pattern of rapid, wide QRS complexes, indicating that the arrhythmia originates from the ventricles. What potential consequence is MOST concerning with ventricular arrhythmias?
A patient with atrial fibrillation is being considered for catheter ablation. What is the PRIMARY goal of this treatment?
A patient with atrial fibrillation is being considered for catheter ablation. What is the PRIMARY goal of this treatment?
What symptoms are seen in mitral valve stenosis?
What symptoms are seen in mitral valve stenosis?
What occurs in aortic regurgitation?
What occurs in aortic regurgitation?
What would be seen in a patient who has Sub-Acute endocarditis investigations?
What would be seen in a patient who has Sub-Acute endocarditis investigations?
In cardiac diastole, what is happening?
In cardiac diastole, what is happening?
How would one describe someone who has Rheumatoid Fever?
How would one describe someone who has Rheumatoid Fever?
What is the recommended treatment or action if someone is showing Pericarditis?
What is the recommended treatment or action if someone is showing Pericarditis?
What clinical presentation would show a patient with Hypertrophic Obstructive Cardiomyopathy?
What clinical presentation would show a patient with Hypertrophic Obstructive Cardiomyopathy?
A patient's history reveals they have a genetic predisposition to autoimmune responses. Which cardiovascular condition are they MOST susceptible to developing following a streptococcal infection?
A patient's history reveals they have a genetic predisposition to autoimmune responses. Which cardiovascular condition are they MOST susceptible to developing following a streptococcal infection?
Which of the following most accurately describes blood flow during the diastole phase of the cardiac cycle?
Which of the following most accurately describes blood flow during the diastole phase of the cardiac cycle?
A clinician auscultating a patient identifies a heart murmur characterized as a 'stenotic snap'. Which valve condition is MOST likely associated with this finding?
A clinician auscultating a patient identifies a heart murmur characterized as a 'stenotic snap'. Which valve condition is MOST likely associated with this finding?
During an examination, it is noted that the patient has increased central venous pressure and ascites along with peripheral edema, what condition are these symptoms MOST consistent with?
During an examination, it is noted that the patient has increased central venous pressure and ascites along with peripheral edema, what condition are these symptoms MOST consistent with?
Why is it important to sit a patient forward during auscultation when they are suspected of pericarditis?
Why is it important to sit a patient forward during auscultation when they are suspected of pericarditis?
A patient presents with sharp, retrosternal pain that radiates to the neck and shoulders, and they report the pain is relieved by sitting forward and leaning over. Which condition do their symptoms indicate:
A patient presents with sharp, retrosternal pain that radiates to the neck and shoulders, and they report the pain is relieved by sitting forward and leaning over. Which condition do their symptoms indicate:
A patient with suspected sub-acute endocarditis has a list of symptoms. Which of the following list of symptoms is the MOST likely?
A patient with suspected sub-acute endocarditis has a list of symptoms. Which of the following list of symptoms is the MOST likely?
An echocardiogram of a patient with mitral valve stenosis would directly reveal which of the following?
An echocardiogram of a patient with mitral valve stenosis would directly reveal which of the following?
In a patient experiencing aortic regurgitation, what is the MOST likely compensatory change that will occur in the cardiac structure or function?
In a patient experiencing aortic regurgitation, what is the MOST likely compensatory change that will occur in the cardiac structure or function?
Which of the auscultation findings is MOST indicative of aortic regurgitation?
Which of the auscultation findings is MOST indicative of aortic regurgitation?
Genetic testing in a family identifies a novel mutation associated with hypertrophic cardiomyopathy. What is the PRIMARY concern for individuals carrying this mutation?
Genetic testing in a family identifies a novel mutation associated with hypertrophic cardiomyopathy. What is the PRIMARY concern for individuals carrying this mutation?
During a physical examination of a young athlete, a murmur is auscultated, and further evaluation reveals hypertrophic obstructive cardiomyopathy (HOCM). What advice should be given?
During a physical examination of a young athlete, a murmur is auscultated, and further evaluation reveals hypertrophic obstructive cardiomyopathy (HOCM). What advice should be given?
Patient diagnosed with hypertrophic obstructive cardiomyopathy (HOCM), would auscultation likely show?
Patient diagnosed with hypertrophic obstructive cardiomyopathy (HOCM), would auscultation likely show?
Which of the following components is essential to identify in the description of a patient's symptoms, to differentiate a cardiovascular from non-cardiovascular cause of chest pain?
Which of the following components is essential to identify in the description of a patient's symptoms, to differentiate a cardiovascular from non-cardiovascular cause of chest pain?
A previously healthy patient comes and reports breathlessness as a chief complaint, after some mild exertion. What cardiac condition needs to be considered?
A previously healthy patient comes and reports breathlessness as a chief complaint, after some mild exertion. What cardiac condition needs to be considered?
Which investigative method would MOST likely be requested when a patient has a suspected lesion on a heart chamber lining?
Which investigative method would MOST likely be requested when a patient has a suspected lesion on a heart chamber lining?
Why would a patient with suspected abnormal electrical activity have a heart checked for a murmur?
Why would a patient with suspected abnormal electrical activity have a heart checked for a murmur?
In what circumstances would a patient likely receive Fibrinolytic prescriptions, such as those seen in Myocardial Infarction treatments?
In what circumstances would a patient likely receive Fibrinolytic prescriptions, such as those seen in Myocardial Infarction treatments?
A patient's test reports contain signs consistent with low effort tolerance as well as cold peripheries. What is most likely to have caused these symptoms?
A patient's test reports contain signs consistent with low effort tolerance as well as cold peripheries. What is most likely to have caused these symptoms?
A patient is prescribed vasodilators, what is the MOST LIKELY rationale for this prescription, relating to an improvement of current symptoms?
A patient is prescribed vasodilators, what is the MOST LIKELY rationale for this prescription, relating to an improvement of current symptoms?
Flashcards
What is Chest Pain?
What is Chest Pain?
A subjective sensation, often described as crushing, squeezing, or burning in the chest area.
What is Arteriosclerosis?
What is Arteriosclerosis?
A broad term encompassing various conditions that cause the arteries to thicken and lose elasticity.
What is Atherosclerosis?
What is Atherosclerosis?
A specific type of arteriosclerosis caused by the buildup of plaque inside the arteries.
What is Hyaline Arteriosclerosis?
What is Hyaline Arteriosclerosis?
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What is Hyperplastic Arteriosclerosis?
What is Hyperplastic Arteriosclerosis?
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What is Monckeberg Arteriosclerosis?
What is Monckeberg Arteriosclerosis?
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What does ECG monitor?
What does ECG monitor?
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What is Echocardiography?
What is Echocardiography?
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What is Angiography?
What is Angiography?
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Arteries..away/towards heart?
Arteries..away/towards heart?
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Veins..away/towards heart?
Veins..away/towards heart?
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What are the key steps in Hemostasis?
What are the key steps in Hemostasis?
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What processes are key in Fibrinolysis?
What processes are key in Fibrinolysis?
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What are the initial signs of Atherosclerosis?
What are the initial signs of Atherosclerosis?
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What is the initial screening for Atherosclerosis?
What is the initial screening for Atherosclerosis?
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What are the initial tests for Atherosclerosis?
What are the initial tests for Atherosclerosis?
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What is PCI/CABG
What is PCI/CABG
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What is CAD?
What is CAD?
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Give examples of Blood Supply arteries, that supply the ❤️ .
Give examples of Blood Supply arteries, that supply the ❤️ .
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What is Angina Pectoris?
What is Angina Pectoris?
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What is the cause of Angina Pectoris?
What is the cause of Angina Pectoris?
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What will alleviate symptoms of Angina Pectoris?.
What will alleviate symptoms of Angina Pectoris?.
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What is a trigger for Angina Pectoris?
What is a trigger for Angina Pectoris?
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What are some of investigations for Angina Pectoris?
What are some of investigations for Angina Pectoris?
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What is Conservative Management?
What is Conservative Management?
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Etiology of Acute Coronary Syndromes.
Etiology of Acute Coronary Syndromes.
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How is MI diagnosis?
How is MI diagnosis?
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What may cause Myocardial Infarction?
What may cause Myocardial Infarction?
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What can cause Heart Failure?
What can cause Heart Failure?
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What system is at use in Heart Failure?
What system is at use in Heart Failure?
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What is Preload?
What is Preload?
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What can increase Preload?
What can increase Preload?
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What can cause CHF?
What can cause CHF?
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What triggers CHF?
What triggers CHF?
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What is a medical investigation for Congestive Heart Disease.
What is a medical investigation for Congestive Heart Disease.
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What some medical investigations for CHF?
What some medical investigations for CHF?
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What is Aryyhythmias.
What is Aryyhythmias.
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Name a cause of Arrythrnias?.
Name a cause of Arrythrnias?.
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What is Arrehythima?
What is Arrehythima?
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Name some causes of Atrial Fibrillation.
Name some causes of Atrial Fibrillation.
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How to manage Fibrillation? .
How to manage Fibrillation? .
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How to manage Heart Valve Disease?
How to manage Heart Valve Disease?
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Heart Valve Disease.
Heart Valve Disease.
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What is Pericarditis
What is Pericarditis
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What can cause ❤️
What can cause ❤️
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Obstructive Cardiomyopathy.
Obstructive Cardiomyopathy.
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Study Notes
- The lecture objectives include identifying and analyzing the clinical presentation and causes of common cardiovascular conditions.
- It aims to evaluate common investigative methods facilitating differential and diagnostic decision-making with reference to the cardiovascular system.
- Another objective is the examination and differentiation between similarly presenting cardiovascular conditions.
- The study includes the assessment of relevant medical & chiropractic treatment and patient management options with reference to the cardiovascular system.
Conditions Overview
- Common cardiovascular conditions covered are arteriosclerosis, angina pectoris, and myocarditis.
- Other conditions are pericarditis, heart failure, hypertrophic obstructive cardiomyopathy, endocarditis, arrhythmias, acute coronary syndrome (unstable angina & MI), rheumatic fever, and heart valve disease.
Chest Pain
- Chest pain can present with various sensations such as crushing, sharp, achy, full, tightness, heaviness, squeezing, dull, burning, discomfort, and pressure.
- Potentially concerning chest pain symptoms can manifest in the brain (lightheadedness, dizziness), upper body(pain in jaw, neck, arm, upper back), and chest (discomfort, pressure, and pain).
- Other symptoms are in the lungs(shortness of breath), stomach(nausea or vomit), skin(cold sweat) and whole body(fatigue).
- Chest pain is also commonly seen in lung disease and GI Disorders.
Chest Pain Overview
- Central chest pain may originate from cardiac or non-cardiac causes.
- Cardiac causes include: acute coronary syndrome, coronary artery spasm, pericarditis/myocarditis, mitral valve prolapse, and acute chest syndrome.
- Non-cardiac causes include PE or oesophageal disease + mediastinitis, trauma, aortic dissection/aneurysm and Boerhaave's syndrome.
- Lateral/peripheral chest pain may stem from pulmonary or non-pulmonary issues.
- Pulmonary causes are tension pneumothorax, pneumonia, pleurisy, and bronchogenic neoplasia.
- Non-pulmonary causes are Bornholm disease (epidemic myalgia), herpes zoster, trauma, MSK pain, GORD, biliary colic, costochondritis, and anxiety.
General Cardiovascular Examination
- Observation includes assessing for cyanosis, digital clubbing, pallor, sweating, and trophic or positional changes.
- Palpation of the apical impulse involves noting diffusion, rebound, and lateralisation.
- Percussion helps determine heart size for cardiomegaly.
- Auscultation & BP checks for 3rd/4th heart sounds, friction rub, snap, murmurs (stenotic).
Additional Physical Examination
- Observation includes assessing for inflammation, rashes, bruising, and symmetry of chest movement.
- Palpation involves checking costal cartilage, muscles, and pecs for intercostal tenderness.
- ROM, temperature (fever), and respiratory (pulmonary cause) examination is also performed.
Common Medical Cardiac Investigations:
- Electrocardiography (ECG) monitors electrical conduction through the heart
- Echocardiography uses ultrasound to provide a functional view of the heart with blood flow etc.
- Gated MRI, contrast ventriculography/positron emission tomography (PET).
- Angiography with/without MRI or CT scans.
- Blood tests assess ESR, CRP, and cardiac biomarkers (cardiac troponin and creatine kinase).
Angiography
- Contrast is injected to visualize blood flow, identification of blockages, and possible angioplasty/stent placement.
Cardiovascular System Refresher
- Key areas of focus are the function of arteries and veins, heart chambers, blood flow through the heart and major vessels.
- Other elements are heart valves, cardiovascular system inputs/outputs, hemostasis, and fibrinolysis.
- Hemostasis includes vascular spasm, platelet plug formation and coagulation = formation of a stable fibrin clot.
- Fibrinolysis includes includes activation of plasminogen, activation of prostacyclin and natural anti-coagulants= healed wound.
Arteriosclerosis:
- This is an overarching term for a group of disorders causing thickening and loss of elasticity in arterial walls
- Non-atheromatous types are hyaline, hyperplastic, and Monckeberg arteriosclerosis vs. atheromatous (atherosclerosis)
Hyaline Arteriosclerosis:
- Involves hyaline thickening in small arterials & arterioles and vessel wall degeneration
- This results of vessel lumen narrowing causing diffuse ischaemia (kidneys) and increased risk of aortic aneurysm/dissection
- Diabetics are at higher risk
- Dx is usually incidental finding on plain X-ray until Sx of complications develop
- Tx includes reductions in cardiovascular risk factors
Hyperplastic Arteriosclerosis:
- A laminated concentric thickening of vessel wall results with a narrowed lumen.
- This leads to ischaemia in kidneys and increased risk of aneurysm/dissection
- HTN (increased vessel rigidity & subsequent increased peripheral resistance) sustains the HTN
- Diagnosis comes via incidental finding on plain X-ray
Monckeberg Arteriosclerosis:
- This is inflammatory degenerative calcification of the tunica media with potential bone formation within the media.
- Results in artery wall rigidity without luminal narrowing & false + / high BP and diffuse ischaemia (kidneys).
- It causes an increased risk of aortic aneurysm/dissection, thrombosis and arterial occlusion
- Individuals >50yrs can be at risk
- Diagnosis and treatment are similar to hyaline arteriosclerosis.
Atherosclerosis
- Progressive inflammatory disorder of arterial wall characterized by intimal atheromas (plaques) in medium and large arteries.
- Endothelial damage is caused by endothelial dysfunction in areas with non-laminar blood flow.
- No inhibition= NO production is inhibited and vasodilation is reduced.
- Adhesion molecules result from non-laminar blood flow stimulating endothelium and recruiting inflammatory cells.
- LDL and VLDL in blood undergo uptake by macrophages in sub-endothelium, transforming into lipid-laden foam cells.
- Foam cell production attracts smooth muscle cells from the tunica media, enhancing foam cell growth.
- Plaque formation is subendothelial with fibrous cap & extracellular matrix and may also be calcified.
- LDL cholesterol enters the arterial wall, oxidizes to oxLDL, and activates endothelial cells expressing adhesion molecules.
- Monocytes roll over the endothelium, adhere(platelets help) to the ECs, and enter the intima, transforming into macrophages.
- Macrophages ingest oxLDL, forming foam cells, which produce pro-inflammatory cytokines and accelerate inflammation.
- Cell detritus, lipids, and extracellular matrix form a necrotic core with a fibrous cap resulting in calcification
- During plaque rupture Matrix metalloproteinases degrade specific proteases and cause it become an thrombus.
- Atherosclerosis is a leading cause of morbidity/mortality
Atherosclerosis Risk Factors
- Non-modifiable risks are age, family history, and male sex.
- Modifiable risk factors are dyslipidaemia, diabetes, hypertension, smoking, vascular disease and obesity/metabolic syndrome.
- Potential risk factors include alcohol intake, heart transplant, elevated C-reactive protein, and cystine levels. Other risks are reduced fruit/veg intake, prothrombotic conditions, psychological illnesses and lifestyle.
- Age is the most powerful independent risk factor for atherosclerosis as most adults in the UK will have it.
- Age is the most powerful independent risk factor and Smoking is the most powerful modifiable version
- Dietary supplements can be helpful/harmful, Inequalities in education and healthcare (poverty)
- Elevated blood pressure increases Angiotensin II. Low to moderate alcohol use can be used
Atherosclerosis Hallmark
- This condition has an insidious disease progression, patients are generally asymptomatic (decades).
- Symptoms occur when the blood flow is too impeded from impaired tissue perfusion
- Initial signs occur with increased vessel lumen reduction and tend to be transient ischaemic involving stable exertional angina.
- Advanced disease, symptomatic indicates greater stenosis and can have an effect on pain level, rest and CVA & myocardial
Atherosclerosis Investigations
- Symptomatic patients have lipid profile testing alongside physical examinations.
- Other tests are for glucose, and inflammatory markers
- Non-invasive imaging methods are 3D USG, CT or MRI angiography.
- Invasive imaging includes intravascular USG or angioscopy
Atherosclerosis Common Treatments:
- Lifestyle changes: Less saturated fate, no trans fats, Fewer refined carbs, increased Fruit + Veg, reduced Intake
- Pharmacological involves antiplatelets (aspirin/clopidogrel), statins (simvastatin/atorvastatin), beta blockers (atenolol / propranolol), ACE inhibitors and Angiotensin II receptor blockers.
- Surgical interventions consist of percutaneous coronary intervention, coronary artery bypass graft and carotid endarterectomy.
Coronary Artery Disease
- Coronary artery disease (CAD) is a leading cause of death in developed countries
- CAD is blood supply to the heart that includes the right coronary artery (RA, RV, bottom of the LV and back of the septum).
- The left coronary artery splits into the circumflex artery (LA and the side & back of the LV) and left anterior descending artery (front and bottom of LV; the front of the septum).
- Coronary veins return deoxygenated blood to the RA
Blood Supply to the Heart Refresher
- The heart is working 24/7
- It goes through contraction as it is intermittently perfused
- Because of workload its relativey small amount of arteries to do aerobic respiration
- It generates lactic acid which is results in the pain
Angina
- Angina is a type of heart/chest pain that has two main types: angina pectoris and unstable angina.
Aetiology of Angina Pectoris:
- A result of a fixed stenosis of 1 or more coronary arteries
- This results myocardium O2 demand exceeding the coronary arteries
- It mimics clinically Sx to MI
- Commonly Caused by coronary atheroma(s) but Can be caused by coronary A. Spasm or Coronary Embolus
- Reversible – NO necrosis or tissue damage
Angina Hallmarks
- It contains Central Diffusive & Contristive pain
- Alleviated with 5MINS upon Resting
- Involves Stable Trigger patters that contain : Physical, Extreme emotions, exposure or heavy meal
Angina Pectoris Investigations
- Physical exams can be unremarkable since these cases can be hard to tell
- Auscultation sounds for heart rhythms on 3rd and 4th
- Ensure following things such as: BP , Pulse Rate and APICAL Impulse Palpatio to exclude
- ECG results should be reversed
- Stress tests and reproductions provide diagnostic results.
Angina Pectoris Common Treatments
- conservative Management such as
- Onward Referral for Further Access
- Understanding Patient Awareness only will Reduce RISK so it's important to provide advice!
- Prescription drugs that use: BETA Blockers, ACE ,++ channels are all vital !
- SURGICAL Intervention such as: Revasculairsation
- PCI
- CABG
Acute Coronary Syndromes:
- They result from an acute obstruction of a coronary artery
- Outcomes depend on the degree and location of obstruction
- Initial medical interventions treat all of them as the same condition
- Excludes in the Conditions of :
- Unstable Angina
- NON — ST-Segment elevation M1
- ST-Segment Elevation M1
ACS Clinical Presentations can be difficult to differentiate
- Unstable Angina: New onset, Minimal exertions during activity (12 mins) this is often
- Myocardia & Infarction: Can occur in body but evidence are revealed which indicate for the resting position
Myocardial Infarction Symptoms- Continue
- Symptoms Typically Develop BUT MAY develop a number of hours in the week.
- Men Are more likely to have but women tend to be the atypical presentation for it
- Indigestion Nauses or Vomiting can have different effects or reactions.
Heart Failure
-
This is what develops when the heart cannot maintain adequate cardiac output resulting in inadequate systemic tissue perfusion.
-
This is mostly from ventricular dysfucntion and preserved Co
-
Systolic happens by Blood ejecting itself, and myocyte ejects which causes the hearts to pump Efficacy
-
What occurs is SYMPATHETIC, HUMOROL Stimulations which eventually lead to "lose a circle"!
-
It is worth noting that there are many causes, here the most common are IHD . HTN cardiomeagaly, HEART BEATS Effevtivley
There are two main heart failure types.
- ACUTE: Failure of the heart as a pump as the most common effect
- CHRONIC: Cardiomyopathy-* This what we focus!
Acute Heart Failure
- Aetiology is a failure of the heart as a pump which causes downstream hypoperfusion & congestion
- This can affect right & left ventricles
- Common causes are IHD, HTN AND cardiomegaly
Chronic Heart Failure
-
- 1st Presentations occurs on some exertive moments/running that is what starts the causes!
Chonic Heart Failure is a Hallmark
- This involves dysponea or paroysmal from certain sides
- CO will determine how poor the effort tolerances are at which there will be weight issues or anorexia
- Because heart are less exertive It becomes a atrophy problem in a immobile state
What occurs for Blood vessels is the following on sides
- Left* — Fluid Builds up! Pulmonary congestions and cause fatigue, this can happen in lung failure!
- Right* — Fluids can collect feet, this will cause adomential congestions and a high case for Pitting
How to treat a failure
- Testing for Bnp-Brain that determines for how are
- Inorder to assist need to Reduce the alcohol usage and go to the exercise.
- You will need to reduce pressure (beta) reduce (Inhibitors), And get a a transplant
- Vasolidation and arterial
Arrhythmais:
- Anything wrong with Electrical System
- It contains SUPRAVENTRICULAT, VENTICULAR, FIBRILLATION . Tachyrdhymi, and slow Conductions
Atrial Fibrilation Hallmarks
- Abnormal firing or looping can
- Palpitations, dyspnea, Co signs or poor effort
- Classifying this involves :Self-Terminating, Long episodes, PERMENENT
Investigations for fibrillation
- Perform pulses since it's abnormal, perform auscultation & murmurs
- Imaging with ECG or ATRIAL FIBRILLATIONS Echo pharmaceuticals, Ca+channels ANTI-ArrYthmic
General Notes on Cardiac Pain
- Name these conditions and the layers for them Myocarditis is from 3 layers Name everything on System Name everything on System
Some Cardiac Heart Sounds To Note:
- PERICARDIDTIS is to prevent the pericardicum rubbing vs the VISCERAL
- Endocarditis as poor that effect the heart valve is
- Hypertrophic genetic but may result in the patient's DEATH
- Cardiac key is key for for Ddx is (heart or no) (jaw / shoulders) or no) (tight or
- Name these conditions and the layers for them
- Myocarditis* is from 3 layers
Home Notes :
- Inorder to diagnosis and to exclude any
- Inclusion or to the is to give central chest or in the of
Differential Diagnosis of Pectoralis
- Perform movements against against of and see where pain occurs The patient needs to give the pain the best to determine and treat the condition
- These notes for review.*
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