WEEK 8: ON THE BUSES

Name the coronary arteries

Is this a left-dominant or right-dominant heart?

Name the branches off the aortic arch

A PATIENT PRESENTS WITH EXCESSIVE SWEATING Is this due to (sympathetic or parasympthetic)

(activation or deactivation)? Sympathetic activation What abnormalities of the cardiovascular system

would you expect to be associated with this? Positive chronotropy (inc HR), positive inotropy

(inc contraction force), positive dromotropy (increased AV nodal conduction velocity), positive lusitropy (increased rate of myocyte relaxation)

What neurotransmitter is associated with the post-ganglionic sympathetic synapses?

Noradrenaline

COMPARE AND CONTRAST THESE WITH THE PARASYMPATHETIC SYSTEM

Name the parts of the conducting system of the heartDoes the myocardium depolarise from left-right; right-left; inside-outside or; outside-inside

Where within the heart would you find the following change in membrane potential?Which channels open to cause the various changes in membrane potential?

A PATIENT PRESENTS WITH PALPITATIONS. GIVE A DIFFERENTIAL DIAGNOSIS FOR PALPITATIONS Probability Diagnosis

Anxiety Premature beats (ectopics) Sinus tachycardia Drugs

Serious MI/angina Arrhythmias (VT, bradycardia, sick sinus syndrome, Torsade de pointes) WPW syndrome Electrolyte disturbances (hypokalaemia, hypomagnesaemia, hypoglycaemia)

Pitfalls Fever/infection Pregnancy Menopause Drugs Mitral valve disease Aortic incompetence Hypoxia/hypercapnia Tick bites Phaeochromocytoma

Neuro Cardiac neurosis anxiety

WHAT ARE THE MAIN MECHANISMS OF ARRHYTHMIA Disorders of impulse formation or

automaticity Abnormalities of impulse conduction Re-entry Triggered activity

WHAT ARE THE THREE ABNORMALITIES FOUND ON AN ECG TRACE FOR A PATIENT WITH WPW SYNDROME? Short PR Wide QRS Delta waves

DESCRIBE THE FOLLOWING ECG TRACES

WPW syndrome

Ischaemia – lateral side (shows in I, aVR, aVL, V4, V5 and V6

WHAT IS THE TYPICAL MANAGEMENT FOR BRADYARRHYTHMIAS Pacemaker insertion

WHAT IS THE TYPICAL MANAGEMENT FOR TACHYARRHYTHMIAS Drugs Sinus tachycardia

Metoprolol tartrate verapamil

Paroxysmal SVT Adenosine Verapamil

VT Lignocaine Amiodarone Sotalol Flecainide Atenolol/metoprolol

DURING WHAT ARRHYTHMIAS IS IT SUITABLE TO SHOCK A PATIENT? Sustained VT AF VF

WHAT ARE THE TYPICAL SYMPTOMS OF ANXIETY

Neurological•Dizziness•Headache•Trembling•Twitching•Shaking•parasthesia

Cardiovascular•Palpitations•Tachycardia•Flushing•Chest discomfort

GIT•Nausea•Indigestion•Diarrhoea•Abdominal distress

Respiratory•Hyperventilation•Breathing difficulty•Air hunger

Cognitive•Fear of dying•Difficulty concentrating•‘mind going blank’•hypervigilance