Q61

What is heart failure?

  • When cardiac function is impaired and/or the heart is unable to maintain a cardiac output sufficient for the body’s metabolic needs

Pass Criteria:

  • Bold to pass

Please classify the types of heart failure.
Prompt: Examples?

  • Pump failure:

    • Systolic dysfunction (contractile dysfunction)
      • Ie:
        • Myocardial contractile dysfunction secondary to ischaemia
        • AMI
        • Pressure or Volume overload
        • Dilated cardiomyopathy
    • Diastolic dysfunction (inadequate filling)
      • Ie:
        • LV hypertrophy
        • Myocardial fibrosis
        • Amyloidosis
        • Pericarditis
    • Others:
      • Arrhythmias
      • Regurgitant flow
        • Ie: MR
      • Outflow obstruction
        • Ie: AS, HOCM
  • Left Heart Failure
    • IHD
    • HT
    • Valvular disease
      • Ie: AS
    • Rheumatic heart disease
    • Myocardial disease
  • Right Heart Failure
    • Ie: secondary to left heart failure
    • PE
    • Pulmonary HT

Pass Criteria:

  • One of the classifications with examples

What are the clinical features of heart failure?
Prompt: What symptoms or signs from other organ systems might occur with heart failure?

  • Lung
    • Breathlessness
    • Orthopnea
    • PND
    • APO
    • Pleural effusions
  • Cardiac
    • 3rd HS
    • Gallop
    • Displaced apex beat
    • AF
    • Murmur
    • JVP elevation
  • Renal
    • RAA activation
      • Fluid retention
      • Pedal oedema
      • AKI
  • Brain
    • Confusion secondary to hypoxia
  • Hepatic
    • Engorgement
    • Ascites
    • Cirrhosis (late)

Pass Criteria:

  • 3/5 organ system symptoms to pass

Q62

What are the systemic and local factors that lead to atherosclerosis?

  • Hypertension
  • Hyperlipidemia
  • Toxins from cigarette smoke
  • Homocysteine
  • Infectious agents
  • Inflammatory cytokines (ie: TNF) can also stimulate pro-atherogenic patterns of endothelial cell gene expression
  • The two most important causes fo endothelial dysfunction are:
    • Haemodynamic disturbances
    • Hypercholesterolaemia
  • Local flow disturbances (ie: turbulence at branch points) leads to increased susceptibility of certain portions of a vessel wall to plaque formation

Pass Criteria:

  • Bold to pass

Which arteries are most often affected by atherosclerosis?

  • Lower abdominal aorta
  • Coronary arteries
  • Popliteal arteries
  • Internal carotid arteries
  • Vessels of the circle of Willis

Pass Criteria:

  • 3 of 5 to pass

How does an atherosclerotic plaque suddenly cause symptoms?

  • Rupture, ulceration, or erosion of the intimal surface of atheromatous plaques exposes the blood to highly thrombogenic substances and induces thrombosis
  • Such thrombosis can partially or completely occlude the lumen and lead to downstream ischemia
  • Haemorrhage into a plaque:
    • Rupture of the overlying fibrous cap, or of the thin-walled vessels in the areas of neovascularization, can cause intra-plaque haemorrhage
  • Atheroembolism:
    • Plaque rupture can discharge atherosclerotic debris into the blodstream, producing microemboli
  • Anuerysm formation:
    • Atherosclerosis-induced pressure or ischemic atrophy of the underlying media, with loss of elastic tissue, causes weakness resulting in aneurysmal dilation and potential vessel rupture

Pass Criteria:

  • 2 of 4 bold to pass

Q63

ECG VT

What rhythm does this ECG show?

  • Broad complex regular tachycardia consistent with VT
  • Rate approximately 180 bpm

Pass Criteria:

  • Must identify that broad complex, regular tachycardia or VT

Q64

A 60 year old alcoholic man is brought into the Emergency Department after being found slumped in a chair. He is found to be in heart failure, and on bedside echocardiogram is found to have a grossly dilated heart with poor contractility in all chambers.

What pathological process is likely to be causing his heart failure?

  • Alcohol related Dilated Cardiomyopathy

Pass Criteria:

  • Bold to pass.

Name some causes of dilated cardiomyopathy.

  • Myocarditis (viral causes)
  • Toxins (alcohol, chemotherapy, cobalt)
  • Congenital
  • Pregnancy

Pass Criteria:

  • Any 2 bolded to pass.

What are potential pathologic consequences of dilated cardiomyopathy?

  • Valve dysfunction (incompetent mitral/tricuspid valves)
  • Mural thrombi
  • Embolisation
  • Arrhythmia (lethal, atrial fibrillation)
  • Death from progressive failure

Pass Criteria:

  • Any 2 bolded to pass.

Q65

What are the pathological consequences of aortic stenosis?
Prompt: What type of ventricular hypertrophy?
Prompt: Which ventricle is hypertrophied?

  • Concentric left ventricular hypertrophy
  • Left ventricular outflow obstruction
  • Myocardial ischaemia (without CAD needing to be present)
  • Sncope
  • Aortic dissection
  • Heart failure (diastolic or systolic)
  • Endocarditis (uncommen)

Pass Criteria:

  • Bold and 3 others to pass.

What are themost likely causes of aortic stenosis in an elderly man?

  • Calcific/degenerative
  • Bicuspid valve
  • Rheumatic heart disease

Pass Criteria:

  • 2 to pass (will not accept congenital as an answer).

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