Cardiology E-Book

Tim Betts

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Clinical Cases
• Sprache: Englisch

Seitenzahl: 586

Veröffentlichungsjahr: 2013

Beschreibung

Cardiology: Clinical Cases Uncovered is the ideal integrated text to help you recognize, understand and know how to investigate and manage many heart-related disorders and conditions. Written by three practising cardiologists, it leads students through a clinical approach to managing problems with 26 real-world cardiovascular cases. There is strong emphasis on high-quality figures, particularly 12-lead ECGs, as these play such a major role in the evaluation of the cardiac patient.

Following a question-answer approach throughout the narrative, with self-assessment MCQs, EMQs and SAQs, Cardiology: Clinical Cases Uncovered includes sections on cardiac anatomy, physiology and pathology which provide the essentials required to understand clinical cardiology, and is ideal for medical students and junior doctors on the Foundation Programme, specialist nurses and nurse practitioners, and for those with plans for a career in cardiology.

Leseprobe

Contents

Preface

How to use this book

Disclaimer

List of abbreviations

Part 1: Basics

Basic science

Approach to the patient

History

Presenting complaint

Examination

Investigations

Part 2: Cases

Case 1 A 47-year-old man with chest pain

What advice should the receptionist give?

What action can be taken by the paramedics?

What is the differential diagnosis for a patient presenting in this way and what features may help to establish that the pain is cardiac in origin?

What other features in the history help to assess the probability of coronary artery disease?

What features on examination help to confirm a cardiac cause of his pain?

His ECG is shown in Figure 1.1. What abnormalities are shown? How specific are these abnormalities for coronary artery disease?

What other routine investigations should be arranged on admission?

What is the significance of the troponin result?

After a diagnosis of ACS is made, what treatments would be indicated?

How would you interpret the lipid profile?

What is the pathology that gives rise to this clinical presentation?

How would you describe this ACS?

What factors decide whether this patient should undergo coronary angiography?

What is the role of exercise stress testing in this patient?

What medication should this patient be discharged on and for how long should this be continued?

Case 2 A 60-year-old heavy goods vehicle (HGV) driver with chest pain

What are the abnormal findings on the ECG? What is the diagnosis and which coronary artery is likely to be involved?

What other possible causes are there for ST elevation in the anterior chest leads?

Is this patient a candidate for immediate thrombolysis?

What alternative treatment is available for this condition and what are the potential benefits?

What thrombolytic agent would you use?

What causes would you consider for the hypotension in this patient and what clinical features would you look for on examination?

What action would you take?

What additional treatments would be appropriate?

How would you assess whether the treatment with the thrombolytic drug had been successful?

What other investigations/factors may be helpful in determining the prognosis in this patient?

When would it be appropriate to arrange the exercise test and what factors may make it difficult to interpret?

What is your differential diagnosis for the cause of this man’s sudden deterioration and what investigations would you request?

How would you manage this patient?

What further interventions should be considered for this patient?

What advice should this patient be given regarding driving and returning to work?

Case 3 An 85-year-old man with collapse

What are the possible causes of his collapse and what further questions would you ask to try to confirm the diagnosis in each case?

What abnormalities are shown in his ECG?

What initial management steps should be instituted?

Which coronary artery is likely to be involved in the acute event?

Why has this patient developed complete heart block?

Would this patient be a candidate for thrombolysis?

What action can be taken for the management of his complete heart block?

What are the possible causes of his hypotension, how would you investigate this further?

How would you manage this patient?

What ECG changes might be expected in conjunction with the aneurysm formation? What additional treatment may be required?

Ideally, what medications should this patient have prescribed on discharge?

What advice would you give him concerning his medication?

Case 4 A 71-year-old man with exertion chest tightness

What is the most likely cause of his symptoms and what other medical conditions does this patient have that may predispose to this presentation?

What other aspects of the history would be important in confirming your suspicions?

What is the significance of the family history?

What changes are shown on the ECG and what is the significance of these changes?

What further non-invasive investigations can be performed to help to confirm the diagnosis of angina in this man and what factors determine which investigation is appropriate in the first instance?

Which findings are indicative of a poor prognosis on this exercise test?

What classes of agents may be effective in controlling this patient’s symptoms?

What are the most probable causes of his renal failure and how would you investigate this further?

What risks should be quoted to the patient and what precautions should be taken prior to performing his angiogram?

How should this patient be managed?

The patient is referred for coronary artery bypass surgery. What further investigation is appropriate prior to surgery?

What medications should be continued long term following bypass surgery?

Case 5 A 50-year-old man with sudden-onset severe central chest pain

What is the differential diagnosis?

What additional findings on examination may help to determine the cause of his pain?

What further investigations would you consider?

How would you classify this dissection?

What would be your immediate management of this patient?

What complications may have occurred that would account for this deterioration and how would you investigate this further?

What is the definitive treatment of this condition?

What conditions are associated with aortic dissection?

What arrangements should be made for follow-up of this patient?

The patient is booked for yearly follow-up with contrast CT of the aorta. What are the possible complications arising from this form of imaging?

Case 6 A 45-year-old man with chest pain and breathlessness

What abnormalities are present on the ECG?

What are the main differential diagnoses on the basis of the ECG and the history?

What additional aspects of the history and examination would help you to establish diagnosis?

What scoring system may be used to estimate the probability of pulmonary embolism?

How would you interpret the arterial blood gases?

Do the results of the troponin and D-dimer help in establishing the diagnosis?

What CXR findings may be helpful?

What is your immediate management?

What further imaging may be helpful at this point?

What treatment options are available and how would you choose between them?

Should this patient have: (1) A thrombophilia screen? (2) Further investigation to rule out an underlying malignancy?

What may account for this presentation?

Case 7 A 34-year-old man with chest pain following a viral illness

What abnormalities are present on this ECG and what features help to distinguish these abnormalities from those seen in acute myocardial infarction?

What causes are there of this condition?

What other clinical features in the history and examination may be present in this condition?

How would you interpret these findings?

What further investigations may be helpful?

What treatment would you offer and what advice would you give to the patient?

What is the differential diagnosis and what features on clinical examination may be helpful?

What is the definitive investigation in this condition and what does it show?

How should this patient be managed?

Of what potential complications of this procedure should the patient be informed?

How would you interpret these findings?

What important long-term complication may arise from pericarditis and what are the clinical features?

Case 8 An 80-year-old woman with acute severe breathlessness

What is the probable diagnosis?

What are the findings on the arterial blood gases and what is cause for each abnormality?

What abnormalities are seen on the CXR and what is the differential diagnosis of the radiographic findings?

What features on examination would point specifically to a cardiogenic cause for pulmonary oedema in this woman?

What are the possible causes of pulmonary oedema in this woman and how may they be distinguished by further investigation?

What does the ECG demonstrate and what is the underlying pathology?

How would you manage this patient?

What other interventions would you consider?

What factors would influence your decision regarding resuscitation status?

What factors contribute to the perioperative risk for coronary bypass surgery and what alternatives are available?

What are the long-term risks of this procedure?

What medications should the patient be taking?

Case 9 A 50-year-old man with exertional breathlessness

What is the differential diagnosis for the cause of his breathlessness?

What other features in the history may help to establish the diagnosis?

What is the differential diagnosis for the patient’s upper abdominal pain and loss of appetite and what further questions would you ask?

What is the most probable diagnosis?

How would you classify the severity of his symptoms?

How does the measured ejection fraction in this patient compare to that of a normal heart?

What is the clinical significance of the finding of global hypokinesia and right heart dilatation?

What is the significance of the finding of mitral regurgitation?

What further investigations may be required to establish the diagnosis in this patient?

What are the possible causes of the abnormal liver function tests and what further investigations should be considered?

What further investigations would you consider?

What drug therapy would you introduce?

How would you manage the atrial fibrillation in this patient?

What further therapeutic options are available?

Cardiac transplantation and left ventricular assist devices

What advice and what further measures should be taken to reduce the risk of decompensation in this patient?

What is the long-term prognosis in this patient and what is the usual mode of death?

Case 10 A 72-year-old woman with breathlessness on exertion

What are the causes of chronic heart failure in the presence of normal left ventricular function?

What is the significance of the atrial septal defect (ASD) on the echocardiogram in the context of the clinical presentation and how do you explain the absence of any abnormality on auscultation of the heart?

What is meant by diastolic dysfunction on the echocardiogram? What evidence is there for diastolic heart failure in this case?

What further investigations would be appropriate?

What is the significance of the raised BNP in this patient?

What are the possible causes of the anaemia in this patient, which is most likely and what further investigations would you perform?

What is the significance of the Kappa paraprotein band in this patient?

How would you interpret the CXR findings and what further investigations would you perform?

What is the most likely diagnosis?

What changes would you make to the patients medication and why?

Should any action be taken regarding the ASD?

Case 11 A 50-year-old man with a murmur

What is the differential diagnosis of the systolic murmur?

What examination findings may be used to characterise the murmur and identify its cause?

What other features on clinical examination may help to identify the cause?

Why is this unlikely to be an innocent murmur?

What is the most likely diagnosis and why?

What further investigations should be performed and what would you expect them to show?

What is the mechanism of mitral valve prolapse and how should this patient be managed?

What features on clinical examination would you look for that might indicate an increase in the severity of MR?

Why is the patient in heart failure despite a near normal ejection fraction and what is the significance of the elevated pulmonary artery pressure?

How would you manage this patient?

What outcome can be expected?

Case 12 A 30-year-old man with high blood pressure and a heart murmur

What is the differential diagnosis for the auscultatory findings?

What is the differential diagnosis based on these findings and what other clinical signs may help to confirm the diagnosis?

How would you assess clinically the severity of AR in this patient?

What findings on echocardiography would support the diagnosis of severe AR?

What are the possible aetiologies for the aortic valve disease in this patient and what other clinical features would you ask for in the history and look for on examination?

What further investigations would you perform?

What is the usual site of a coarctation and what treatment should be considered?

What is the purpose of the ACE inhibitor?

What complications related to his aortic coarctation may account for his breathlessness?

What further questions would you ask him?

What is the cause of the mid- to late-diastolic murmur at the apex?

What further investigations would you perform?

What are the indications for surgical intervention in this patient and what operation should be performed?

Case 13 A 64-year-old man with collapse and a murmur

What key questions should be asked about the collapse?

What are the main differential diagnoses?

What other questions should be asked?

Can you narrow down your differential diagnosis?

What features in the physical examination are important?

What is the likely diagnosis (or diagnoses) and the mechanism of his syncope?

Based on the history and physical examination, is he likely to have mild, moderate or severe AS?

What simple tests should be requested in A&E?

How should these results be interpreted?

What is the likely cause of his anaemia?

What specialist non-invasive test should be performed next?

How would you interpret this report?

What treatment should be considered?

Should any additional investigations be performed?

Should the patient be allowed home for outpatient referral to cardiology or should this be undertaken on this admission?

Case 14 A 34-year-old man with malaise, chest pains and breathlessness

What are the key questions in the initial history?

What are the most likely differential diagnoses?

Considering the likely diagnosis, what specific questions need to be asked? What features on physical examination should be looked for?

What immediate investigations would you request?

What has caused the symptoms of chest pain and breathlessness that led to his presentation? How could this be confirmed?

What is the immediate management? What are the likely organisms?

In this situation, what are the particular challenges that may need to be overcome during treatment? How should treatment be monitored?

What are the potential complications of infective endocarditis? When should surgery be considered?

What is his prognosis?

What measures are employed to prevent bacterial endocarditis and who should receive them?

Case 15 A 22-year-old woman with faints

What are the most important questions to ask when taking a history for blackouts?

What are the important findings? What are the differential diagnoses?

What initial investigations should be performed?

What does the ECG show?

Does this narrow down the differential diagnoses?

Does the seizure-like activity make epilepsy the most likely diagnosis?

What tests should be done next?

Should she be referred to a neurologist?

What do these results mean? What is the diagnosis?

What are the initial treatment options?

She asks if this condition is life threatening and should she avoid any activities such as driving. What should you tell her?

Is there anything else that can be offered?

Case 16 A 76-year-old woman with blackouts

What are the key questions in the initial history?

What are the differential diagnoses?

What are the appropriate immediate investigations?

What does her ECG show?

How do these tests impact on the differential diagnoses? Do further tests need to be performed or can appropriate therapy be given?

What tests should be performed next?

How urgently should further testing be performed?

What additional advice should be given?

What is the most appropriate treatment and is there any additional adjunctive treatment that could be offered?

What lifestyle issues need to be addressed in ICD recipients?

Reference

Case 17 A 35-year-old woman with palpitations

What key questions should be asked?

What are the key characteristics of the main differential diagnoses?

What is the best way to ask a patient to describe the nature of their palpitations?

What other questions should be asked?

Are any immediate investigations required?

What additional investigation is the most appropriate?

What does the Holter monitor recording show? (Figure 17.1)

What should you tell the patient regarding the diagnosis, prognosis and treatment?

Case 18 A 42-year-old man with palpitations

What are the key questions in the initial history?

What are the differential diagnoses?

What does the 12-lead ECG show?

What treatment options are there and which would you choose and why?

How should this be interpreted and what should be done?

What are the drug treatment options? What are the advantages and disadvantages of each?

What does his 12-lead ECG show?

What is the likely cause of his collapse?

What remaining treatment options are there? What are the advantages and disadvantages of each?

Case 19 A 64-year-old man with fatigue and palpitations

What initial questions should be asked?

What further questions should be asked?

What is the most likely diagnosis?

What are the possible causes of his symptoms?

What investigations need to be performed next?

What does his 12-lead ECG show?

What is the most important abnormality to address?

What treatment is required?

What are the different treatments available?

What other investigation and treatment is required?

Should outpatient DC cardioversion be performed in 4–6 weeks time? What additional preparation should be considered? What are the arguments for and against cardioversion?

What should he do regarding his medications (digoxin, beta blocker, ACE inhibitor and warfarin)? What are the relevant concerns?

Case 20 A 24-year-old man with palpitations

What is your initial approach?

What investigation should be performed next?

What does the 12-lead ECG show?

What is the likely ECG diagnosis?

What is the most appropriate treatment?

How should adenosine be administered? Are there any contraindications and what should the patient be told to expect?

The ECG is then recorded. What does it show?

What should be done next? Does he require hospital admission?

What additional cardiac investigations are required?

Is his condition dangerous or life threatening? What discussions should take place?

What treatments options are available?

He asks if it is OK to continue playing sports. What should you tell him?

Case 21 A 77-year-old woman with fatigue and bradycardia

What are the most likely differential diagnoses?

A 12-lead ECG is performed in the surgery. What does it show?

What are the potential causes? What questions should be asked and what additional tests need to be done?

What action needs to be taken? How soon should it be done?

Should temporary pacing be performed?

What immediate action could be taken if an asystolic arrest occurred while awaiting permanent pacemaker implant?

How does a pacemaker work? What complications need to be consented for?

As part of the check a 12-lead ECG is performed. What does it show?

What are the two diagnoses? What procedure will correct both of them?

How often will she require outpatient follow-up?

Case 22 A 57-year-old man with collapse

What should be done on arrival?

What is the likely cause of his condition? What is the next step?

What does his 12-lead ECG show?

What are the differential diagnoses of broad-complex tachycardia?

What are the immediate treatment options?

How should urgent cardioversion be performed?

What should be done next? What are the potential causes of his arrhythmia?

Would you administer any other immediate treatment? What is the next step? Which investigations will you request?

How should this be treated? Is there anything different you would do from the previous episode? Which drugs would you consider?

How should the amiodarone be administered?

What further action needs to be considered? What additional preventative and therapeutic treatments can be offered?

What should be done before hospital discharge?

Case 23 A 36-year-old woman with a family history of sudden death

What are the important questions to ask in the initial history?

What are the important points in her history and how should they be interpreted?

On the assumption that this may be an inherited cardiac condition, what are the differential diagnoses?

If one of these familial conditions is present in the family, what is the likelihood that she has the abnormal gene?

What investigations and enquires need to be made?

What does her 12-lead ECG show?

What is the diagnosis and how sure can you be?

What should be done next? What treatment can be offered?

What would you advise about beta blockers in pregnancy?

What is the next step in her management?

Case 24 A 60-year-old man with high blood pressure

How do you interpret this blood pressure reading?

What additional questions need to be asked as part of the basic assessment?

What is your advice and management plan?

What would you recommend?

He asks you why he has high blood pressure. What do you tell him and would you perform any additional tests or examinations?

What is your answer?

What are the potential consequences of hypertension?

What would you prescribe him?

What potential side-effects are there from his medication?

What should you do?

What action should be taken?

Once under control, how often should he have medical follow-up?

When should patients diagnosed with hypertension in primary care be referred to secondary care for specialist opinions?

Case 25 A 24-year-old woman with visual loss and dysphasia

What additional questions need to be asked?

What are your differential diagnoses?

What additional examinations need to be performed? What tests will you do?

What are the differential diagnoses?

What test is required? How soon should it be done?

How should these findings be interpreted? What other test is required?

What is the appropriate treatment?

Case 26 A 59-year-old woman with low blood pressure and breathlessness

What is your immediate impression and differential diagnoses?

What questions and aspects of the physical examination are important to achieve a diagnosis?

Based on the above, what is the most likely mechanism of her shock? Within that mechanism, what are the potential causes and what are the key features of each?

What simple investigations would you request immediately?

Her 12 -lead ECG is shown in Figure 26.1. What does it show and how does this help the diagnosis and management?

What is your management plan? Would you give her thrombolysis or other reperfusion therapy?

Is there anything else that can be done?

What does the monitor show?

How should this be treated?

What is the rhythm and what treatment is required?

Part 3: Self-assessment

MCQs

EMQs

SAQs

Answers

EMQ answers

SAQ answers

Index of cases by diagnosis

Index

To my wife, Mags, for her patience. TB

To my parents for their lifelong support. JD

To my father, for his constant love and support. SB

This edition first published 2010, © 2010 by T. Betts, J. Dwight and S. Bull

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell.

Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

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Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Betts, Tim (Tim Rider)Cardiology / Tim Betts, Jeremy Dwight, Sacha Bull.p. ; cm. – (Clinical cases uncovered)Includes indexes.ISBN 978-1-4051-7800-61. Heart–Diseases–Case studies. I. Dwight, Jeremy. II. Bull, Sacha. III. Title. IV. Series: Clinical cases uncovered.[DNLM: 1. Cardiovascular Diseases–diagnosis–Case Reports. 2. Cardiovascular Diseases–diagnosis–Problems and Exercises. 3. Cardiovascular Diseases–therapy–Case Reports. 4. Cardiovascular Diseases–therapy–Problems and Exercises. WG 18.2 B565c 2010]RC682.B48 2010616.1′2–dc222009035144

ISBN: 978-1-4051-7800-6

A catalogue record for this book is available from the British Library

Preface

Although there are many books already published on the subject of cardiovascular medicine, we felt that there was nothing that offered medical students and junior doctors a practical, patient-based approach. This book has been written to fill that gap. It is suitable for students, trainees in general internal medicine, general practice and budding cardiologists.

It provides a concise resume of the key features of anatomy and physiology that have direct clinical applications when investigating and treating patients with cardiac disease. By presenting ‘real world’ examples in 26 case scenarios, all the common (and some uncommon) cardiac diagnoses are revealed. Particular emphasis is placed on history taking, the interpretation of physical signs and the appropriate use of non-invasive and invasive investigations. Arguments for and against differential diagnoses are discussed. Treatment options are explained in detail and the impact of cardiovascular disease on prognosis, lifestyle and genetic screening is explored. Throughout the text, key points and red flags are highlighted and learning points are summarized at the end of each case. High-quality reproductions of electrocardiograms, echocardiograms and other imaging modalities have been included to simulate the real patient encounter.

Three self-assessment sections have been written in the format of commonly-used examination methods. The questions stem from the clinical cases, yet add an additional layer of education and information for the reader.

We hope this book acts as a stepping stone from traditional cardiology texts to the application of knowledge in the clinical world. As well as being a reference and assessment tool, it should above all be an enjoyable read that can be dipped in and out of or read from cover to cover in one go. We hope it inspires the next generation of cardiologists!

Tim BettsJeremy DwightSacha BullOxford

How to use this book

Clinical Cases Uncovered (CCU) books are carefully designed to help supplement your clinical experience and assist with refreshing your memory when revising. Each book is divided into three sections: Part 1, Basics; Part 2, Cases; and Part 3, Self-assessment.

Part 1 gives you a quick reminder of the basic science, history and examination, and key diagnoses in the area. Part 2 contains many of the clinical presentations you would expect to see on the wards or crop up in exams, with questions and answers leading you through each case. New information, such as test results, is revealed as events unfold and each case concludes with a handy case summary explaining the key points. Part 3 allows you to test your learning with several question styles (MCQs, EMQs and SAQs), each with a strong clinical focus.

Whether reading individually or working as part of a group, we hope you will enjoy using your CCU book. If you have any recommendations on how we could improve the series, please do let us know by contacting us at: [email protected].

Disclaimer

CCU patients are designed to reflect real life, with their own reports of symptoms and concerns. Please note that all names used are entirely fictitious and any similarity to patients, alive or dead, is coincidental.

List of abbreviations

AICD

automated implantable cardioverter-defibrillator

ACE

angiotensin-converting enzyme

ACS

acute coronary syndrome

A&E

Accident & Emergency

AHA

American Heart Association

ALT

alanine aminotransferase

AR

aortic regurgitation

AS

aortic stenosis

ASD

atrial septal defect

AV

atrioventricular

AVA

aortic valve area

AVNRT

atrioventricular nodal re-entrant tachycardias

AVRT

atrioventricular re-entrant

BMI

body mass index

BNP

brain natriuretic peptide

bpm

beats per minute

CCU

Coronary Care Unit

COPD

chronic obstructive airways disease

CPAP

continuous positive airways pressure

CPR

cardiopulmonary resuscitation

CT

computer tomography

CTR

cardiothoracic ratio

CVP

central venous pressure

Cx

circumflex

CXR

chest X-ray

DC

direct current

DVLA

Driver and Vehicle Licensing Agency

DVT

deep vein thrombosis

ESR

erythrocyte sedimentation rate

FBC

full blood count

FEV

1

forced expiratory volume in 1 s

FVC

forced vital capacity

GFR

glomerular filtration rate

GGT

gamma-glutamyl transpeptidase

GI

gastrointestinal

GP

general practitioner

GTN

glyceryl trinitrate

Hb

haemoglobin

HDL

high-density lipoprotein

HFNEF

heart failure normal ejection fraction

HGV

heavy goods vehicle

HIV

human immunodeficiency virus

HOCM

hypertrophic obstructive cardiomyopathy

ICD

implantable cardioverter defibrillator

ICU

Intensive Care Unit

INR

international normalised ratio

IVAB

intravenous antibiotics

JVP

jugular venous pressure

LAD

left anterior descending

LBBB

left branch bundle block

LCA

left coronary artery

LCx

left circumflex

LDH

lactate dehydrogenase

LDL

low-density lipoprotein

LMS

left main stem

LQTS

long-QT syndrome

LVEF

left ventricular ejection fraction

LVH

left ventricular hypertrophy

MCV

mean corpuscle volume

MEN

multiple endocrine neoplasia

MIBG

metaiodobenzylguanidine

MR

mitral regurgitation

MRI

magnetic resonance imaging

MS

mitral stenosis

MUGA

multi-gated acquisition

MCV

mean corpuscle volume

NICE

National Institute for Health and Clinical Excellence

NYHA

New York Heart Association

PCI

percutaneous coronary intervention

PDA

patent ductus arteriosus

PEA

pulseless electrical activity

PFO

patent foramen ovale

PV

pulmonary valve

RBBB

right branch bundle block

RCA

right coronary artery

rtPA

recombinant tissue plasminogen activator

rPA

reteplase

SA

sinoatrial

SCD

sudden cardiac death

STEMI

ST-elevation myocardial infarction (also non-STEMI)

SVT

supraventricular tachycardia

TB

tuberculosis

TC

total cholesterol

TIA

transient ischaemic attack

TIMI

thrombolysis in myocardial infarction

TNK

tenecteplase

TS

tricuspid stenosis

TR

tricuspid regurgitation

tPA

tissue plasminogen activator

TR

tricuspid regurgitation

VPC

ventricular premature contraction

VSD

ventricular septal defect

VVIR

ventricular inhibited rate responsive

WCC

white cell count

Part 1

Basics

Basic science

Anatomy

The primary function of the heart is to pump deoxygenated blood to the lungs and to return oxygenated blood to the rest of the body. The basic anatomy consists of:

Pericardium (visceral and parietal): the fibrous sac containing the heart.

Four cardiac chambers: the right and left atria and ventricles.

Heart valves:

Two outflow valves: the aortic and pulmonary valves consist of three semi-lunar cusps.

Two atrioventricular (AV) valves: the mitral and tricuspid valves, which are attached by chordae tendinae to papillary muscles.