Medicine Marrow Pg 361-370 (Cardiology)
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Questions and Answers

Which condition is associated with bradycardia?

  • Cardiac tamponade
  • Anxiety
  • High output states
  • Myxedema (correct)

    • Relative bradycardia occurs when there is a rise in heart rate corresponding fairly to a rise in temperature.

    False

    What heart rate increase is expected for every 1º rise in temperature, based on the relative bradycardia definition?

    10 beats/min

    Conditions like _____ and _____ usually do not cause relative bradycardia.

    <p>dengue, malaria</p> Signup and view all the answers

    Match the condition with its associated cause:

    <p>Sinus Tachycardia = Fever Sinus Bradycardia = Athletes Relative Bradycardia = Typhoid Myxedema = Hypothyroidism</p> Signup and view all the answers

    What condition is indicated by a pulsus bisferiens?

    <p>Severe aortic regurgitation</p> Signup and view all the answers

    A hypokinetic pulse is characterized by an increased amplitude.

    <p>False</p> Signup and view all the answers

    What causes a pulsus dicroticus?

    <p>Left ventricular failure</p> Signup and view all the answers

    A hypokinetic pulse may be observed due to decreased stroke volume caused by ________ dysfunction.

    <p>left ventricular</p> Signup and view all the answers

    Match the pulse type with its corresponding characteristic cause:

    <p>Pulsus bisferiens = Severe aortic regurgitation Pulsus dicroticus = Left ventricular failure Hypokinetic pulse = Decreased stroke volume Pulsus Tardus and Parvus = Severe aortic stenosis</p> Signup and view all the answers

    Which of the following pulse types is characterized by one peak in systole and one peak in diastole?

    <p>Pulsus dicroticus</p> Signup and view all the answers

    Hypertrophic cardiomyopathy is associated with a pulsus bisferiens.

    <p>True</p> Signup and view all the answers

    What waveform characteristics are associated with a pulsus tardus and parvus?

    <p>Slow and weak pulse</p> Signup and view all the answers

    What is the primary factor indicated by the arterial pulse waveforms?

    <p>Left ventricular performance</p> Signup and view all the answers

    The velocity of ejection does not affect the shape of the arterial pulse waveform.

    <p>False</p> Signup and view all the answers

    What position should the patient be in to assess the carotid pulse accurately?

    <p>Supine position with neck slightly turned towards the side of palpation</p> Signup and view all the answers

    A pulse apex deficit greater than _____ suggests atrial fibrillation.

    <p>10</p> Signup and view all the answers

    Match the following aspects of arterial pulse to their descriptions:

    <p>Stroke volume (SV) = Affects sharpness of upstroke and height of peak Velocity of ejection = Determines onset of peak in the waveform Pulse apex deficit = Indicates potential atrial fibrillation Carotid arteries = Best site for feeling arterial pulse</p> Signup and view all the answers

    What characterizes a pulsus alternans pulse?

    <p>Alternating high and low volume pulse</p> Signup and view all the answers

    Pulsus bigemini involves normal beats that are followed by late contractions.

    <p>False</p> Signup and view all the answers

    What mechanism is responsible for pulsus alternans?

    <p>Fluctuating calcium uptake and release</p> Signup and view all the answers

    Pulsus paradoxus is defined as a systolic blood pressure fall of >___ mmHg during inspiration.

    <p>10</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Pulsus Alternans = Alternating high and low volume pulse Pulsus Bigemini = Normal beat alternates with premature contractions Pulsus Paradoxus = Systolic blood pressure falls during inspiration Reverse Pulsus Paradoxus = Systolic blood pressure increases with inspiration</p> Signup and view all the answers

    Which of the following conditions can cause pulsus paradoxus?

    <p>Cardiac tamponade</p> Signup and view all the answers

    Pulsus alternans rhythm is irregular.

    <p>False</p> Signup and view all the answers

    What is a clinical feature used to differentiate between MVP and HCM?

    <p>Post-extra systole pulse volume</p> Signup and view all the answers

    Which of the following conditions is characterized by a high amplitude and high volume pulse?

    <p>Ventricular tachycardia</p> Signup and view all the answers

    Irregularly irregular pulses are a feature of atrial fibrillation.

    <p>True</p> Signup and view all the answers

    What is the effect of rigid atherosclerotic vessels on stroke volume in the elderly?

    <p>Stroke volume does not increase.</p> Signup and view all the answers

    Which virus is the most common cause of post-viral acute pericarditis?

    <p>Coxsackie virus</p> Signup and view all the answers

    A dicrotic wave becomes less prominent in a condition with __________.

    <p>complete heart block</p> Signup and view all the answers

    Match the pulse characteristic with its cause:

    <p>Corrigan's / Water Hammer Pulse = Aortic regurgitation Pseudocollapsing Pulse = Mitral regurgitation</p> Signup and view all the answers

    Chest pain associated with acute pericarditis is usually dull and non-pleuritic.

    <p>False</p> Signup and view all the answers

    What clinical feature is described as a high-pitched, leathery sound heard in acute pericarditis?

    <p>Pericardial friction rub</p> Signup and view all the answers

    Treatment for acute pericarditis commonly includes __________ and colchicine.

    <p>NSAIDs</p> Signup and view all the answers

    Match the cause of acute pericarditis with its corresponding category:

    <p>Coxsackie virus = Infections Procainamide = Drugs Breast Cancer = Tumors Systemic lupus erythematosus (SLE) = Autoimmune</p> Signup and view all the answers

    What is the primary purpose of assessing the Jugular Venous Pulse (JVP)?

    <p>To evaluate right heart hemodynamics</p> Signup and view all the answers

    The Internal Jugular Vein (IJV) is less likely to be affected by extrinsic compression compared to the External Jugular Vein (EJV).

    <p>True</p> Signup and view all the answers

    Name the preferred vessel for assessing the Jugular Venous Pulse (JVP).

    <p>Internal Jugular Vein (IJV)</p> Signup and view all the answers

    The IJV is located in the _____ triangle, between the sternal and clavicular head of the sternocleidomastoid muscle.

    <p>carotid</p> Signup and view all the answers

    Match the characteristics of jugular veins with their relevance in assessing JVP:

    <p>EJV = May be affected by external compression IJV = Less visible in hypotensive states</p> Signup and view all the answers

    What is the normal delay for the carotid pulse?

    <p>30 ms</p> Signup and view all the answers

    An exaggerated delay in pulse assessment is a feature of coarctation of the aorta.

    <p>True</p> Signup and view all the answers

    Name one feature of pulse assessment.

    <p>Rate</p> Signup and view all the answers

    The smooth dicrotic notch is associated with a decrease in __________.

    <p>Peripheral Resistance</p> Signup and view all the answers

    Match the imaging technique with its findings regarding coarctation of the aorta:

    <p>CXR = 3 Sign Cardiac MRI = Image of coarctation ECG = Left ventricular hypertrophy Continuous Wave Doppler = Serrated flow pattern</p> Signup and view all the answers

    What is a common hemodynamic change observed in cardiac tamponade?

    <p>Elevation and equalization of diastolic pressure in all chambers</p> Signup and view all the answers

    Pulsus paradoxus is only present in some patients with cardiac tamponade.

    <p>False</p> Signup and view all the answers

    What is the primary treatment for cardiac tamponade?

    <p>Immediate pericardiocentesis</p> Signup and view all the answers

    During the subxiphoid approach for pericardiocentesis, the needle is aimed toward the left ______.

    <p>mid-clavicle</p> Signup and view all the answers

    Match the components of Beck's triad with their descriptions:

    <p>Hypotension = Low blood pressure Prominent JVP = Elevated jugular venous pressure Muffled heart sounds = Distant heart sounds detected on auscultation</p> Signup and view all the answers

    What characterizes the chest pain experienced during myocardial ischemia or infarction?

    <p>Pressure-like heavy and squeezing</p> Signup and view all the answers

    Chest pain in pericarditis improves when the patient leans forward.

    <p>True</p> Signup and view all the answers

    What autoimmune syndrome occurs more than 2-6 weeks after a myocardial infarction?

    <p>Dressler's Syndrome</p> Signup and view all the answers

    In myocardial ischemia, the duration of chest pain is typically _____ minutes, while in infarction it lasts for _____ hours.

    <p>minutes, hours</p> Signup and view all the answers

    Match the following conditions with their characteristic features:

    <p>Pericarditis = Widespread concave ST segment elevation Myocardial Ischemia = Improves with nitroglycerin Dressler's Syndrome = Fever + pleuritic pain + polyserositis Pericardial rub = Present in most pericarditis patients</p> Signup and view all the answers

    Study Notes

    Characterization of Pulse Types

    • Pulsus bisferiens: a pulse with two peaks, one in systole and one in diastole
      • Causes: severe aortic regurgitation, aortic regurgitation with mild aortic stenosis, hypertrophic cardiomyopathy.
      • Mechanism: elevated stroke volume leads to a large amplitude pressure pulse wave.
    • Pulsus dicroticus: a pulse with one peak in systole and one peak in diastole
      • Cause: left ventricular failure.
    • Hypokinetic Pulse: a pulse with a reduced amplitude, often observed in cases of decreased stroke volume due to left ventricular dysfunction.
    • Pulsus Tardus and Parvus: a slow and weak pulse, often seen in cases of severe aortic stenosis.
    • Palpation: Radial (wrist) arterial pulse palpation is often used to assess pulse types.

    Sinus Tachycardia

    • Causes: fever, anxiety, exercise, high output states, hypovolemia, myocarditis, anterior wall MI, cardiac tamponade, cardiogenic shock.

    Sinus Bradycardia

    • Causes: athletes, drugs (beta blockers and calcium channel blockers), increased intracranial tension, hypothermia, inferior wall MI, myxedema (hypothyroidism).

    Relative Bradycardia

    • Characterized by a rise in heart rate that is not proportional to a rise in temperature.
    • For every 1°F rise in temperature, the heart rate should increase by 10 beats/min.
    • Other causes: typhoid, Q fever, Legionella, drug fever, lymphoma, CNS lesions, factitious fever.

    Pulsus Alternans

    • Character: Alternating high and low volume pulse.
    • Mechanism: Calcium (Ca²⁺) uptake and release fluctuate, alternating.
    • Rhythm: Regular.

    Pulsus Bigemini

    • Character: Normal beat alternates with premature contractions.
    • Mechanism: Stroke volume of the premature beat (PMB) decreases, followed by post-PMB pause.
    • Rhythm: Regular.

    Pulsus Paradoxus

    • Definition: Systolic blood pressure falls by >10 mmHg during inspiration.
    • Causes: cardiac tamponade, chronic constrictive pericarditis, COPD, pulmonary embolism, superior vena cava (SVC) obstruction.

    Reverse Pulsus Paradoxus

    • Definition: Systolic blood pressure increases with inspiration.
    • Causes: increased intrathoracic pressure in left ventricular failure, isorhythmic AV dissociation, hypertrophic cardiomyopathy.

    Arterial Pulse

    • A pressure wave originating in the aorta during left ventricular (LV) systole, traveling along the arterial wall.
    • Rate: 5 m/s (faster than the blood column - 50 cm/s).
    • Indicator of LV performance status and how the vascular system reacts to it.
    • Best felt at the carotid arteries.

    Pulse Apex Deficits

    • Patient position: Patient in supine position with neck slightly turned towards the side of palpation.
    • Assessment: Palpate carotid pulse and simultaneously auscultate for heart sounds.
    • Significance: A pulse apex deficit greater than 10 suggests atrial fibrillation.

    Hyperkinetic Pulse

    • High amplitude / high volume pulse: ↑ SV → ↑ CO.
    • In elderly:
      • Have rigid atherosclerotic vessels → SV does not increase.
      • Volume high (D/t non-distensibility).
      • ↓ PVR (To maintain BP)
    • Condition with ↓ CO but ↑ amplitude: Complete heart block (CO = SV × HR ↓).

    Acute Pericarditis

    • Inflammation of the pericardium.
    • Causes: infections (post viral, tuberculosis), drugs (procainamide, hydralazine, anthracyclines, minoxidil), tumors, autoimmune conditions (IgG4, SLE, HIV), post-traumatic, post-myocardial infarction (MI), uremia.
    • Clinical Features: sharp, pleuritic chest pain relieved by sitting up and leaning forward, paradoxical pericardial friction rub, high-pitched leathery/scratchy heart sounds best heard in a sitting position at the lower left sternal border.
    • Investigations: ECG (global ST elevation, followed by Spodick's sign: TP segment depression), CXR (possible pericardial effusion), Echo (to rule out cardiac tamponade).
    • Management: aspirin, NSAIDs, colchicine, bed rest, steroids.

    Jugular Venous Pulse (JVP)

    • A window to the right heart, allowing for a non-invasive assessment of right atrial pressure.
    • Indicator of right heart hemodynamics, volume of blood in the venous system, venous tone.
    • Right Internal Jugular Vein (IJV) is the preferred vessel used to visualize JVP.
    • IJV is located in the carotid triangle, between the sternal and clavicular head of the sternocleidomastoid muscle.
    • IJV is lateral to the carotid artery and deep to the sternocleidomastoid muscle.
    • IJV is in a straight line with the right atrium (RA) and is less likely to be affected by extrinsic compression.

    Brachiofemoral Delay

    • Normal Delay:
      • Carotid: 30 ms
      • Brachial: 60 ms
      • Radial: 80 ms
      • Femoral: 75 ms
    • Exaggerated Delay: Coarctation of aorta.

    Pathophysiology of Cardiac Tamponade

    • Characterized by rapid accumulation of fluid, leading to:
      • Increased pericardial pressure.
      • Exaggerated interventricular dependence (Pulsus paradoxus).
      • Hemodynamic changes: Holodiastolic elevation & equalization of diastolic pressure in all 4 chambers.
      • LV Compression: ↓ BP, Obstructive shock, Dyspnoea, Tachycardia.
    • JVP: Sharp, rapid, prominent x descent and absent y descent.
    • Beck's triad: Hypotension, prominent JVP, muffled heart sounds.
    • ECG: Alternating high & low volume complexes (Electrical alternans).
    • Treatment: Immediate pericardiocentesis.

    Complications: Repeated attacks Lead to MI vs Pericarditis

    • Pericarditis: sharp, stabbing chest pain, worsened with inspiration, worse when supine, improved when sitting up or leaning forward, lasts for hours to days, no change with nitroglycerin, friction rub present in most patients, ECG shows widespread concave ST segment elevation and frequent PR segment depression.
    • Myocardial Ischemia or Infarction: pressure-like heavy, squeezing chest pain, no change with respiration or position, lasts for minutes (ischemia), hours (infarction), improved with nitroglycerin, friction rub absent, ECG shows localized convex ST segment elevation and rare PR segment depression.

    Dressler's Syndrome

    • Etiology: >2-6 wks post MI, autoimmune.
    • Clinical Features: Fever + pleuritic pain + polyserositis, pericardial rub (+).
    • ECG: (N) or features of acute pericarditis.
    • Rx: NSAIDS.

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    Description

    Explore the characteristics of various pulse types including pulsus bisferiens, dicroticus, and others related to cardiovascular health. Understand the mechanisms and causes that lead to sinus tachycardia and bradycardia. This quiz will test your knowledge on important cardiovascular concepts.

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