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Week 8: On the buses

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

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Week 8: On the buses

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  1. Week 8: On the buses

  2. Name the coronary arteries Is this a left-dominant or right-dominant heart? Name the branches off the aortic arch

  3. 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

  4. Compare and contrast these with the parasympathetic system

  5. Name the parts of the conducting system of the heart Does the myocardium depolarise from left-right; right-left; inside-outside or; outside-inside

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

  7. 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

  8. What are the main mechanisms of arrhythmia • Disorders of impulse formation or automaticity • Abnormalities of impulse conduction • Re-entry • Triggered activity

  9. What are the three abnormalities found on an ECG trace for a patient with WPW syndrome? • Short PR • Wide QRS • Delta waves

  10. Describe the following ECG traces

  11. WPW syndrome

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

  13. What is the typical management for bradyarrhythmias • Pacemaker insertion

  14. What is the typical management for tachyarrhythmias • Drugs • Sinus tachycardia • Metoprololtartrate • verapamil • Paroxysmal SVT • Adenosine • Verapamil • VT • Lignocaine • Amiodarone • Sotalol • Flecainide • Atenolol/metoprolol

  15. During what arrhythmias is it suitable to shock a patient? • Sustained VT • AF • VF

  16. What are the typical symptoms of anxiety • Cardiovascular • Palpitations • Tachycardia • Flushing • Chest discomfort • Neurological • Dizziness • Headache • Trembling • Twitching • Shaking • parasthesia • GIT • Nausea • Indigestion • Diarrhoea • Abdominal distress • Respiratory • Hyperventilation • Breathing difficulty • Air hunger • Cognitive • Fear of dying • Difficulty concentrating • ‘mind going blank’ • hypervigilance

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