1. W EEK 8: O N 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. C OMPARE AND CONTRAST THESE WITH THE PARASYMPATHETIC SYSTEM

5. Name the parts of the conducting system of the heartDoes 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. G IVE 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. W HAT ARE THE MAIN MECHANISMS OF ARRHYTHMIA Disorders of impulse formation or automaticity Abnormalities of impulse conduction Re-entry Triggered activity

9. W HAT ARE THE THREE ABNORMALITIES FOUND ON AN ECG TRACE FOR A PATIENT WITH WPW SYNDROME ? Short PR Wide QRS Delta waves

10. D ESCRIBE THE FOLLOWING ECG TRACES

11. WPW syndrome

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

13. W HAT IS THE TYPICAL MANAGEMENT FOR BRADYARRHYTHMIAS Pacemaker insertion

14. W HAT IS THE TYPICAL MANAGEMENT FOR TACHYARRHYTHMIAS Drugs Sinus tachycardia Metoprolol tartrate verapamil Paroxysmal SVT Adenosine Verapamil VT Lignocaine Amiodarone Sotalol Flecainide Atenolol/metoprolol

15. D URING WHAT ARRHYTHMIAS IS IT SUITABLE TO SHOCK A PATIENT ? Sustained VT AF VF

16. W HAT ARE THE TYPICAL SYMPTOMS OF ANXIETY Neurological Dizziness Headache Trembling Twitching Shaking parasthesia Cardiovascular Palpitations Tachycardia Flushing Chest discomfort GIT Nausea Indigestion Diarrhoea Abdominal distress Respiratory Hyperventilation Breathing difficulty Air hunger Cognitive Fear of dying Difficulty concentrating ‘mind going blank’ hypervigilance