Question 1. What Are The Positional Changes In Pain Noted By Patients With Pericarditis?
Pain due to pericarditis is usually aggravated by thoracic motion, cough, or deep breathing; it may be relieved by sitting up and leaning forward.
Question 2. How Long Does It Take For Total Cpk Levels In The Blood To Return To Normal After A Myocardial Infarction?
For return to normal range is between 36 to 72 hours.
Question 3. What Is The Kussmal Sign?
- Kussmaul’s sign is the observation of a jugular venous pressure (JVP, the filling of the jugular vein) that rises with inspiration. It can be seen in some forms of heart disease. Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity.
- Kussmaul’s sign suggests impaired filling of the right ventricle due to either fluid in the pericardial space or a poorly compliant myocardium or pericardium.
Question 4. What Is The Best Most Specific And Sensitive Indicator For A Re-myocardial Infartion(post Mi)?
CPK-MB’s Coz they return normal after 4-5 days but the Troponins are raised for 4 weeks after 1st MI.
Question 5. Describe The Classical Signs Of Mitral Stenosis?
Question 6. What Is Peripheral Resistance?
It is the resistance ofeered to the flowing of blood by the vesselspresent in the Periphery ie the arteriole whose diameter varies between 100 to 4oo micromillimeter & also by the smooth muscle of the precapillary sphincter.
Question 7. Who Really Performed The First Open Heart Surgery?
Daniel Hale Williams.
Question 8. What Was The Surgical Method For The First Open Heart Surgery?
Question 9. What Are The Most Common Causes Of Cardiovascular Related Syncope?
Arrhythmias and neurocardiogenic syncope.
Question 10. How Often Does Rupture Of The Pulmonary Artery Occur With Right Heart Catheterization?
0.2% of the time.5 times.
Question 11. What Is The Effect Of Inspiration On The Return Of Venous Blood To The Heart?
Due to negative intrathoracic pressure and antigravity direction valvesprevent backward flow of blood.
Question 12. What Are The Electro Cardiogram Findings Of A Mobitz Type Ii Second Degree Av Block?
Non Progressive Prolonged PR interval with absent QRS complex depends on after no of regular P wave.
Question 13. How Often Will The Ekg Be Abnormal In Patients Having An Mi?
85% of PATIENTS having MI show evidence on EKG.
Question 14. Normal Jvd Is 6-8 Cm, What 5 Conditions Are Associated With Increased Jvd?
Congestive cardiac failure due to Ischemic heart disease Cor pulmonale Valvular heart disease like mitral stenosis Congenital heart disease like VSD Pericarditis and pericardial effusion.
Question 15. What Are The Reversible Causes Of Pulseless Electrical Activity?
- hydrogens (acidosis)
- thrombosis (MI)
- thrombosis (PE)
- tension PTX
Question 16. What Exactly Is Cardiovascular Disease, And What Are The Risk Factors?
The term cardiovascular disease covers both heart and blood vessel disorders. To prevent these diseases, you must understand and be willing to modify the risk factors for them. These include:
- Cigarette smoking.
- High blood cholesterol.
- High blood pressure.
- Lack of exercise.
Question 17. What Levels Of Exercise Are Considered Best To Help Prevent Heart Disease?
Aerobic activity, such as swimming, brisk walking, running or biking, strengthens the heart. Cardiovascular disease ranks as number one killer, claiming the lives of more than 40% of those who die each year. So do regular exercise and a balanced diet.
Question 18. What Are The Symptoms?
A number of symptoms are associated with heart failure, but none is specific for the condition. Perhaps the best known symptom is shortness of breath (“Dyspnea”). In heart failure, this may result from excess fluid in the lungs. The breathing difficulties may occur at rest or during exercise. In some cases, congestion may be severe enough to prevent or interrupt sleep.
Fatigue or easy tiring is another common symptom. As the heart’s pumping capacity decreases, muscles and other tissues receive less oxygen and nutrition, which are carried in the blood. Without proper “Fuel”, the body cannot perform as much work, which translates into fatigue.
Fluid accumulation, or edema, may cause swelling of the feet, ankles, legs, and occasionally, the abdomen. Excess fluid retained by the body may result in weight gain, which sometimes occurs fairly quickly.
Persistent coughing is another common sign, especially coughing that regularly produces mucus or pink, blood–tinged sputum. Some people develop raspy breathing or wheezing.
Because heart failure usually develops slowly, the symptoms may not appear until the condition has progressed over years. The heart hides the underlying problem by making adjustments that delay–but do not prevent–the eventual loss in pumping capacity. The heart adjusts, or compensates, in three ways to cope with and hide the effects of heart failure:
Enlargement (“Dilatation”), which allows more blood into the heart.
Thickening of muscle fibers (“Hypertrophy”) to strengthen the heart muscle, which allows the heart to contract more forcefully and pump more blood.
More frequent contraction, which increases circulation.
Question 19. What Is Congestive Heart Failure, And What Are The Treatment Options?
Congestive heart failure happens when the heart cannot pump well enough to distribute blood and oxygen to the tissues of the body. It can be caused by a number of factors. The most common is chronic hypertension, or high blood pressure. Other conditions that may lead to heart failure are coronary artery disease, congenital heart disease, valve disease and either very fast or very slow heart rhythms. There are many treatment options for heart failure, including:
- Medical management with drugs such as ACE (Angiotensin Converting Enzyme) inhibitors.
- Repair or replacement of damaged valves.
- Coronary artery bypass graft.
- Cardiomyoplasty, or the use of skeletal muscle to assist the heart.
- Heart transplantation, reserved as a last mode of therapy.
Question 20. Is There Only One Type Of Heart Failure?
The term congestive heart failure is often used to describe all patients with heart failure. In reality, congestion (the build up of fluid) is just one feature of the condition and does not occur in all patients. There are two main categories of heart failure–Systolic and Diastolic. However, within each category, symptoms and effects may differ from patient to patient.
The two categories are.
Systolic heart failure : This occurs when the heart’s ability to contract decreases. The heart cannot pump with enough force to push a sufficient amount of blood into the circulation. Blood coming into the heart from the lungs may back up and cause fluid to leak into the lungs, a condition known as Pulmonary congestion.
Diastolic heart failure : This occurs when the heart has a problem relaxing. The heart cannot properly fill with blood because the muscle has become stiff, losing its ability to relax. This form may lead to fluid accumulation, especially in the feet, ankles, and legs. Some patients may have lung congestion.
Heart Failures are common Between 2 to 3 million Americans have heart failure, and 400,000 new cases are diagnosed each year. The condition is slightly more common among men than women and is twice as common among African Americans as whites.
Question 21. How Does The Normal Heart Work?
The normal heart is composed of four chambers. The two upper chambers (called atriums or atria) are reservoirs which collect blood as it flows back to the heart. From the atriums, blood flows into the lower two chambers (called ventricles) which pump blood, with each heart beat, into the main arteries. From the right side of the heart one of these arteries (the pulmonary artery) carries blood to the lungs for re-oxygenation. The left side of the heart pumps blood into the other main artery (the aorta), which takes blood to the rest of the body.
The two ventricles and the two atriums are separated by partitions called ‘septums’. The partition between the atriums is called the ‘atrial septum’ and the one separating the two ventricles is the ‘ventricular septum’. Dark red deoxygenated blood (shown blue in diagram) returns to the right atrium from the body through the two main veins called the ‘superior vena cava’ and ‘inferior vena cava’. It is pumped by the right ventricle to the lungs for replenishment with oxygen. The dark blood becomes bright red (shown red in diagram) in the lungs when oxygen is taken up. This red blood returns through two veins from each lung, to the left atrium and is pumped by the left ventricle to the body again.
The heart has its own internal pacemaker which controls its rhythmical beating. It creates an electrical impulse which causes firstly the atriums, and secondly the ventricles, to contract in turn. With each contraction the blood is pumped, then the heart muscle relaxes and the chambers refill with blood, ready for the next contraction.
Question 22. Will My Child Be Considered For A Heart And/or Lung Transplant?
In a small number of children with severe heart problems, the doctors may discuss the possibility of a heart and/or lung transplant. There are many important aspects to the doctors’ decision to recommend a transplant.
This procedure cannot be guaranteed as a long-term cure. The family will require extensive counselling before the decision is made. The hospital has a transplant co-ordinator who works with the cardiologist and surgeon.
Together they provide detailed information on the heart and/or lung transplant. The family will be provided with time for full discussion with the transplant team.
Question 23. Can There Be Complications From Heart Surgery?
Complications from surgery may arise, but with improvements in technology, in surgical procedures and with more surgery being performed at a younger age, the risk of complications is continually being reduced.
The possible complications are related to the specific type of surgery being performed and they vary widely depending on the nature of the problem which requires surgery.
Question 24. Will My Child Need A Pacemaker?
A pacemaker is a device used to keep control of heart rhythm and rate, if the heart cannot control its own rate or rhythm adequately. Many infants and children experience temporary problems with their heart rate or rhythm in the early period after surgery. Therefore a temporary pacemaker is usually attached for a few days.
The pacemaker wires (which connect the device to the heart) are sewn to the outside of the heart at the time of an operation and emerge through the skin to be attached to the pacemaker, which remains outside the body. These wires will be removed after a few days, when the heart rhythm is normal and the child is recovering. The wires can be pulled out without reopening the wound and this does not damage the heart.
In a few children there may be a need to fit a permanent pacemaker. This is connected to the heart with one or two wires (a much longer lasting equivalent of the pacemaker wires referred to above).
The wires may be introduced either through a vein (and then attached to the inside of the heart), or at an operation (if they need to be connected to the outside of the heart). The pacemaker itself varies in size from a very tiny unit (the size of a twenty cent coin), which can be used for small babies, up to something more like a small pocket watch. The device may be placed under the skin in the upper abdomen or in front of an armpit.
The batteries in these pacemakers last for many years. The pacemaker, its wires and battery all need to be checked regularly (normally every six months) at an outpatient appointment. They will need to be surgically replaced if faulty.
Question 25. Will Subsequent Children Have Heart Problems?
In most families, abnormalities of the heart do not occur in siblings. In a few families, however, subsequent children may be affected. While it is inevitable that parents will be anxious about the health of their next baby, the risks are usually low. When one child has a congenital heart problem, the risk for the next pregnancy is usually between 2% and 4% (i.e. 1 in 50 to 1 in 25).
It is often possible to diagnose a major heart abnormality on an ultrasound scan carried out at around four months or later in the pregnancy. Mothers who have had a previous child with a heart problem will naturally hope that any new baby will be healthy. If they wish to have a scan in subsequent pregnancies, they will need to be referred to one of the experts in this specialised field. Such scans will usually be carried out at one of the major obstetric units in Melbourne or at the Royal Children’s Hospital.
Question 26. What Is Cardiology?
Cardiology is the study and treatment of disorders of the heart; it is a medical specialty which is involved in the care of all things associated with the heart and the arteries. A cardiologist is not the same as a cardiac surgeon – the cardiac surgeon opens the chest and performs heart surgery, a cardiologist, on the other hand, carries out tests and procedures, such as angioplasty.
Question 27. What Is Cardiac Electro Physiology?
Cardiac electrophysiology – the study of the mechanism, spread, and interpretation of the electric currents which occur inside heart muscle tissue – the system that generates the heart beat.
Question 28. What Is Echocardiography?
Echocardiography – the use of ultrasound waves to create images of the heart chambers, valves and surrounding structures. Echocardiography can measure how well the heart is pumping blood (cardiac output), as well as determining levels of inflammation around the heart (pericarditis). Echocardiography can also be used to identify structural abnormalities or infections of the heart valves.
Question 29. What Is Interventional Cardiology?
Interventional Cardiology – involves the use of intravascular catheter-based techniques with fluoroscopy to treat congenital cardiac, valvular and coronary artery diseases.
Question 30. Is Blood Transfusion Necessary?
Blood transfusion is required for many children who have heart surgery and sometimes for other reasons. Blood contains a variety of components, including the red blood cells which carry oxygen, proteins in the plasma and a number of special factors which are necessary for blood clotting to take place (e.g. platelets, fibrinogen, factor 8, etc.).
These components are sometimes given separately, e.g. platelets or plasma, where there is a problem needing treatment with specific blood products. It used to be thought that every child having heart surgery (especially open heart surgery) would need a blood transfusion. Nowadays, with much improved heart-lung bypass equipment, this is not always the case.
In young children (up to two or three years old) it is usually desirable to use blood products, as they may become severely or dangerously anaemic without them. In older children, depending on the complexity of the procedure and the amount of blood which they are likely to lose during the operation, it is often possible to manage without transfusion and when feasible, this is now the preferred option. All children will have their blood cross matched before surgery so that it is available if required.
The blood is provided by the Red Cross Blood Bank and is carefully screened. The provision of blood by families of children undergoing heart operations (for use in their individual child) is not usually possible. Donor screening procedures prevent the transfusion of blood from new donors until several months after their initial screening tests.
This ensures that the tests can be repeated twice, at a time interval of several months, before blood (taken after the second round of testing) is actually transfused into a patient. However, recruitment of new donors from families of patients is helpful, and facilitates greatly the valuable work of the Red Cross Blood Bank throughout the community. Those wishing to become blood donors should contact the nearest Red Cross Blood Bank.
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