Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

YQU IDSA DAY KERL ERLN AWIC WIK A C A S E B A S E D A P P R O A C H T O RD ISO UBC CAD Q QB Cardiac A DAY omy CAD RLN QUB IK DSA KAERLYN LINDSAY AND SAMERLRWICKER OSOC RIC ARI CEA QBC DISO BCR QUBCA M t Fred SY ERLI LID WIC CKE EA Fred is a 85M preseAtWng to ED with new sudden onset central ISOC crushing chest pOCn 8/10 that radiates to his left shoulder. AD No associated:Domiting, nausea, cough. QUBC SHx: 40 paBk-years - Nil alcohol "Not good for you" Nil PMHxYQ I NSA CAD ED Rive a dose of GTN spraYQ- no improvment. WIK NDS ER On examination: ERL OSOC HR: RR:1BP:15O2:9WICmp:37.6 ARDI -Cardiac/Respiratory/Abdominal examination normal- UBC ISO Q A MyocCrdial infarct is suspected and a 12lead ECG requested *Fred befoQUBCath lab paged + Asprin prescribed QU YQU What are the e vINroots of the DSA KRL ERLN ARIC WIC SOE renic nerve? EAR RDI ISC UBC CRD Q QUB A:AC3 C4 CAD RLN: C4 C5 QUB IKE C: C2 C3 C4 DSA EAW D: C3 C4 C5 ERL O SC E: C4 C5 C6 WIK ARI CEA QUC DIOS BCAR QBCAR DSY SY What are th ELI erve roots of the LID WIK IKR CER ARW ISO hrenic nerve? SOCE CAD RDI QUB UBCA AQ R ALNC3 C4 UBCA CEB: C4 C5 SAYQ ARI C: C2 C3 C4 LND SCE D: C3 C4 C5 ICKR RDO E: C4 C5 C6EAR BC OSC QU "C3,4,5 keep Ahe di hram alive" QUBC QUB YQU INDA DSA KRL ERLN ARIC WIC SOE EAR RDI ISC UBC Often in MI patCRD experience pain Q radiating toQl t shoulder +/- left Orm DSY CADI What is the natomical basis Qor this? IKE DSA EAW ERL O SC WIK ARI CEA QUC DIOS BCAR QBCAROften in MI patient experi nAe pain UBC radiating to left shouSd r +/- left arm Y LND C(nerves combine and share) What is the anCKomical asis for this?cal vERtebrae ARWI (BrachWICKplexus rotts here) O E C3R Shnerver sensory TheDIeart muscle itself has no sSOCC4y in(Axillary nerve) BCAR RDI QUThe anterior aspect of pariBCalPhrenic nervehas sensory innervation froAYleft Phrenic nerveates diaPHRAM) IND BCA The left Phrenic nErve C3,4,5 and sensory nYrves for left shoulder CW and arms C5 share the sNme roots E ERL The BrainOgets onfused and experinces the phrenic pain as shoulder pain C(ARportanP(Heart sack) UBC IOS Q R OSC QU So you get the CG.D.Y SA ERLI LN W IK You do all the uICal bits: CEARDetails, quality rhytEA, rate etc - All chec s out normal DISO Can you see the pathology? BCR RDI QU UBC SYQ AD LID UBC IKE SAQ AW RLD SCE IKE RIO EAW UCA IOSC Q CAR UCAR YQU IDSA DAY KERL ERLN AWIC WIK SCE CER RDO ISO UBC CAD Q QB DAY CAD RLN QUB IK DSA ERW ERLN OSOC RIC ARI CEA QBC DISO BCR QUBCAAnterior-septal YQU MI IDS DSY KRL ELI ARWI WIK SOCE CEA RDI IOS UBCA CRD Q QUB DSY CARD RLI QUB IKE DSY EAW ELI OSC RWIK ARD CE QUBC DI S BCAR QBCA IDS DSA KEL ERL ARWI WIK SOCE Which artery is Affe ed in an RDI I S UBC Anterior-septCAR EMI? Q QB I A: Left DAterior Descending CAD B: PoRteri r Descending QUB C: Right circumflex DSY ED: Left Circumflex ELI OSC RWIK ARD E: Coronary SinuCE QUC DISO BCA QU YQ QUB DSY SA ELI LD WIhich artery is AffectedIKnR CER EAW DISO Anterior-septal STESC BCR A: Left Anterior Descen ing QU BCA B: PosterSAYQDescen ing A C: RighL circumflex UBC D: Ieft Circumflex SYQ E:oronary Sinus RLID SCE IKE RDO ERW UCA ISOC Q CAD UBCAD NDAY SA ERL RLN RICK ICE OEA EAR DIS SC BCR ARDI QU UBC SYQ ADI LID UBC IKE DSAQ EAW RL SC IKE RI EAW UCA IOSC Q CAR QB QU QU DAY SA ERLN LN FreW gets a stent in the LADICucessfully CEAR EAR DISO and heads home SC BCR RDI QU UBC SYQ A LID UBC IKE SAQ AW RLD but returnS 6 months later to GP with severe dyspnea worse RI EAW wUe lying down, palpitIOSons and nkle oedema. Q CAR UBCAR NDSY SA RLI RLD On AuscultaRWIn you hear a Pan-SystolIK murmur, thi combined OCE with the dyspnea:EAW DIS SC BCR What valve is lARIly fail g? QU UBC SAYQ ADI A: TLNc spid valve QUBC ICEitral valve DSY EAR RLI SC C: Aortic valve IKE RDO D: Pulmonary valve UCA ISO Q E: Semi-CAnalve QUB QU QU On Auscultation you hear a an-Systolic murmurS this combi ed ERLN LID WIC with the dyspnea: IKE CEAWhat valve is likely faEling? DIOS SOC BCAR RDI Q A: Tricuspid val e SYQ AR B: MiLI l alve UC C:IKrtic valve SYQ ARW RLID SOCED: Pulmonary valve ICK RDI E: Semi-lunar valve UBCA IOSC Q CARD UCARD INDA DSA KRL ERLN ARIC WIC SOE CEAR RDI IS UBC CRD Q QUB I How has a AnterDSrtal STEMI caused MitCAl Regurgitation? QUB IKE DSA EAW ERL O SC RWIK ARI CEA QUC DIOS BCAR Q YQ BCAR The AnteriorAQeptal TEMI has resultedYin a papillary muscle rupLurithout the papillary mNscles the l aflets CKER ERL do nAW fction to stop backfloWICesulting i backlog of SCE blood to the lungs ADI IOS C CRD Papillary MusAtriuC QUB Ventricle IOS DSY CAR ELI YQB WIK NSA Atrium CER VentriKERL ISO RWIC CRD OCEA QUB DI S CARI QUB Case 1 DSY SA ELI LD WIK IKER A 71F pCEsents to a cardiology cEAnic complaining that she has been haviDI al itations for 6 monthsS The palpitations last a few minutes B d she sometimes feels dizRy when they occur. She has no other QU symptoms and nU relevant MHx. On examination you discover that she has an iAregularly irregular pulse LND UBC aIC Ro suspect AF. SYQ AR RLID SCE IKE RDO ERW UCA ISOC Q CAD UBCAD SYQ A RLID LDS IKE KER The elecEl conduction within the Aeart is controlled by the Icemaker of the heart". What is this and where is it CRD DI QUB locateBCAR YQ DI INDA BCA A) TheKER nod , located in thAYQeft atrium B) ThR AV node, located in LID right atrium C) TOC node located in the Inter-ventricular septum DOD) The SA node, locaEed in the right atrium BCAR E) The SA node, located in the left atrium QU ADO UBC QUB NDSY SA KELI RLD RWI IKE The elOctrical conduction withinEAhtrolled by theDpacemaker of the heart". What is t i and where is it BCR ARI QU locatUB? SAYQ AD LND QUBC A) ThICAV node, located in tDSYleft atrium B) EAe AV node, located inRLIe right atrium C) TSe AV node located in WIe inter-ventricular septum ARD) The SA node, locateE in the right atrium UC E) The SA node, Iocated in t e left atrium Q CAD QUB QU UBCA Conduction System AYQ LIDS Bachmann'sDbundle specialised cells which can LeftERLrium generate elRctrical IK impulsesC E ERW The SAOnode cSA node SC There is a delay betweenum RIO Qthe signal reaching the BCA Bundle of His AV node YQU InterventriDular septum bundle of His and into the CR left and right bundEeL Left Yundle branch branches IK DSA It then reacheE thee ERLI ventricular walls and theseptum WICK Purkinje fibres causes vRntricular EA Sub-endocardium contrBction Right bundOe branch Q ARDI BC RDI DSAY SA ERLN LID Layers of WI heart wall CKE CER Pericardium ISO Outer lining of the heart CAD 2 layers - fibrous and serous QUB BCpericardium YQU Fibrous pericardiumDis a layer of NDS connective tissue which protects the ELI heart YQ B WIK The serous pericardium is made up of EAR the parietal and visceral layers and the OSO periRardial cavity lies between these. ARDI CEA UBC SIO-endocardium Q CAR QB Q DAY SA Case 2 ERLN LN RICK ICER CEA EAR ISO SC BCpatient with a known diARDIsis of COPD pr sents to the GP as their QU symptoms have gotten wUBse. They state that they are experiencing increased SOB on exSrtion as well as some Ahest pain. On examination you discover theLpatient also as periphUral oedema and a raised JVP. You suspect a diagnosi of Cor Pulmonale as a result of their C PD. EAW RL SC IKE RI EAW UCA IOSC Q CAR QB QU YQU IDS DSY KEL ELI ARWI WIK SOCE many vessels drain diEectly into the RDI right atriImOC BCA CAD QUB OS DSA CARI RLN A) 2 QU ICE B) 3 DAY EAR C) 1 ERLN OSC WICK ARD D) 4 CEAR QUBC DIS BCR QUBCR DAY SA ERLN LN WICK ICER CEAR EAR HoDISO any vessels drain dirSctly i t the BCR RDI QU right atriUBC SYQ LID UBC IKEA) 2 SAQ AW B) 3 RLD SCE C) 1 IKE RI EAW UCA D) 4 OSC Q CARI QB QU YQU I DS DAY Venous dKERL age RLN RWIC ICE SVC 3 vessels drain into the right atrium: DIcoronary sinus, SVC and IVC. CAR CRronary sinus UBC SC Deoxygenated blood Yhen moves into RIO the right ventriIle via the tricuspid AVBCA valveKEL AQU RWI LIDS Blood then travels through the pulmonary semilunar valve into the pulAonary trunk to CA the lungs OCE QUB DIS IVC BCR QUBC SAYQ Y LND INSA ICKR KERL Which oEAR following statements Rs cor ct OSOabout the pulmonary valveA ARDI DIS QUBC BCR YQU A) It has 2 cuspIDSanterior and osterioBCA B) It is the KEigin of the right andAQeft coronary arteries C) The cusRW are at ached to chorLae tendinae D) It has 3 cusps (anterior, Ceft and right) I S AWI E)CAt c nnects the rightSatrium to the pulm nary artery QU RIO UBCA QU SYQ Y LID IDSA CKE KERL WhichERf the following statemeRWI irrect SOC about the pulmonary v lve? ARDI DI S QUBC CAR YQB DI A) It has 2 cuNDA d posterior) BCA B) It is thERorigin of the right aYQ left coronary arteries C) The cRsps a e attached to chIrdae tendinae D) It as 3 cusps (anterior, left and right IOS RWI CAR It connects the riSOC atrium to the p lmonary artery QU RDI UBCA QUBC YQUB Semilu NDr valves DSAY ERL RLN Aortic valveIC Pulmonary valve CEA EAW I S SOC 3 cCADs RDI 3 cusps QUBterior, left and BCA Anterior, left and right AQU right Connects left IDS Connects riBCt ventricle and aortKEL ventriclAQand Right and left RWI pulmoIDry artery coronary arteCEes KEL originate Iere RWI CRD O E QUB DIS BCAR QUCA YQU Case 3 IDSA DSA KEL ERLN ARWI WIC S CE EA RDI 57yo male presents to IOS ED with severe chest pain which UBCAbegan 30 minutes ago. CAR patient des ribes the pain as "tearing", with a score of 8/10.QThey mentio that the pIin radiated into their back. On examination you otice that the patient is very pale and RLN QU their radiaICpulse on t e left sidDSAs weak. The patient has 20 year pack hEstor and has a historyEortension.olled h OSC WIK ARD CER QUBC DISO BCA QUBCA INDA DSA KRL ERLN ARIC WIC GivSO t e presentation, what iA likely RDI diagnosis for thisIpatie t? UBC CR Q QUB DSY CA RA) STEMI QUB B) Unstable Angina DSA EAW ERL O SC C) AAA rupture WIK ARI D) Cardiac tamConade QUC E) Aortic dissection BCA Q YQ YQU INSA DAY Given t e presentation, what isEtlikely AWI WIC SCE diagnosis for thiE patient? RDI IOSC CA CRD UB OSC DSA) STEMI CARI RLI) Unstable Angina QB IKE C) AAA rupture DSAY ERW ERLN OSOC D) Cardiac taWICnade ARDI E) Aortic dEssectio QUBC DI S BCAR QUBCAR IDS DSA CKEL ERL Which ofARh following statements iWIcorre t SOCE CEA RDI about an aortic dissIcSion? UBC CAR Q A) It is due tQ a tear in t e intima B) It is due to a tear in the adventitia ERLN QUB C) Blood cWICects bet een the medNDSand adventitia D) TE aortic arch is alwaysEinvolved E) The left lateral layer of tRe ascending aorta is the area most ARD OCE QUC common site DI injury BCA QU YQ YQU IDSA DAY Which oKERLe following statementERLs co ect AWI about an aortic dissection? SOCE EAR RDI IOSC BCA A) It is dueCAo a tear i the intima B) It is due to a tear in the adveOtitia DSY CARI C) Blood RLIlects etween the medQUBand adventitia D) Ihe aortic arch is alwDSs involved E) The left lateral layer of Ehe ascending aorta is the area most OSO WI ARDI common siteCEA inj r QUBC DI S BCAR QUBCA DSAY SA Aortic disse tEon LID WIK CKE EAR Due to aWtIar in th innermost IOSC (intOma) layer of the aortic wall CAR AdventitiaBDIOd collects between the QUB Media BCAntima and media and creates a YQU false lumen D InDima Can lead to an aorCAc rupture if ERLI not treated raYQdly W IK Can occur inDany part of the ArAh aorta ERL Ascending O SC Right lateral side of the ARI Descending ascending aorta is the most RooUBC Icommon site for intima Q CARD rupture QU QU SAQ Y LD INDA ICER KRL EAW RWI SC CE ARDO DISO QUBC CA YQB DI Tha NDA you! BCA ERL YQU RWIK INSA CE KERL ISO ARIC CAR SOE QB RDI UBC QUBC YQ INSA DSA KERe erences RLI RWI IKE CE https://my.clevelAndclinic.org/health/diseases/16743-aortic- ISO dissection SO CAD https://www.mayoclinic.org/diseases-conditions/mitral- QUB valve-reguCgitation/symptoms-causes/syc-20350178 https://emergencymedicinecaseRDcom/ecg-cases-25-late- https://healthandwillness.org/stemi-nurses-guide/ Kttps://en.wikipedia.orA/wiki/Coronary_arteries RWIhttps://teachmeanatomN.info/thorax/organs/heart/conducting CEA -system/ KRL ISO R I CRD OCEA QUB DIOS BCAR QBCA