... Flashcards
What shows on an IE ECG and why?
A new conduction disorder due to vegetation on the Bundle of his or purkinje fibres
Appears as Long PR (AV block) or broad QRS
What is non-infective endocarditis and what causes it?
Non-bacterial Thrombotic Endocarditis (NBTEC)
Fibrin-platelet vegetation due to disturbance of the valve endothelium
Electrodes/catherters - Degenerative - Local Inflammation - Rheumatic heart disease
When do you do surgery in endocarditis?
If complicated by:
- Uncontrolled Infection
- HF
- AV block
- Embolism
- PV dysfunction
- Leaflet Perforation
Risk factors for IE?
IVDA Immunocompromised (incl. Aids) Burns Prosthetic Valve Previous IE Old Male Diaebets Heart Disease Recent Surgery
What does a CXR show in IE?
Pulm. Abscesses and HF
What tests are done for IE?
CXR - ECHO ECG Urinalysis FBC - CRP - ESR - U&E Blood Culture
What are the duke criteria?
Major: 2 seperate +ve blood cultures Persistant +ve blood cultures \+ve culture for coxiella burnetti \+ ECHO New Murmur
Minor:
- Immunologic Signs
- Vascular Signs
- Microbiological evidence not worthy of Major score
- Pyrexia
- Predisposition (e.g. IVDA or Immunocompromised)
What tests are there for aortic dissection?
TOE
CXR (Effusion - Tamponade - Tracheal Deviates - Loss of Aortic Knob)
CTA/MRA
How do we treat takayasus arteritis and what consewuences are there of it?
Steroids and surgery
Neuro effects - Renal artery stenosis - Aortic stenosis - Aneurysm - Thrombosis
What are the clinical signs of a false aneurysm?
Thirll - Bruit - Pulsatile Mass
How does Varicose veins progress to CVI?
Gravity
- > Superficial venous reflux
- > Varicose Veins
- > deep veins acting as collateral circ.
That plus gravity again leads to CVI:
- > Deep venous reflux
- > Hypertensive Veins
- > Exudate
- > Inflammation
What re the symptoms of varicose veins?
Discomfort Red discolouration Nocturnal Cramps Oedema Pruritis
What causes constrictive pericarditis?
Post-Pericarditis
TB
Idiopathic
How does constrictive pericarditis present?
With Symptoms of RHF:
Fatigue - Dyspnoea - Malaise/Weakness
Raised JVP - Ascites - Peripheral Oedema - Hepatomegaly
How do we test for constrictive pericarditis?
ECHO
CXR -> CT/MRI
Cardiac Catherterisation
What causes Tamponade?
Aortic Dissection
Surgery
Warfarin
Pericarditis
How does tamponade present?
Low BP - High HR - Muffled Heart Sounds - Raised JVP
Dyspnoea - Cough - Central Chest Pain - Fatigue - Dizziness/syncope
How do we Diagnose tamponade?
Becks TRiad - Low BP/High JVP/Muffled Heart Sounds
ECG - Low Voltages
ECHO - Large pericardium and Collapsing ventricles
CXR - Large globular heart
Pericardiocentesis + PCR
What causes Acute Pericarditis?
Infection Rheumatic Heart Disease SLE Malignancy MI Idiopathic Trauma/Surgery
How does acute pericarditis present?
Central Chest Pain - Pericardial Rub and maybe Fever
How do we treat/investigate acute pericarditis?
Investigate: ECG - Saddle (concave) ST elevation CXR - ECHO Blood Cultures and Serology FBC - U&E - CRP - ESR Cardiac Enzymes e.g. cTn
What causes myocarditis?
Infection Autoimmune (e.g. Sarcoid, Rheumatic fever or SLE) Drugs incl. Chemo Cocaine Idiopathic
How does myocarditis present?
Chest Pain Dyspnoea Tachycardia/Tachypnoea Arthralgia Cyanosis Plus general infection symptoms if infection (Sore Throat - Malaise - Fatigue - Headache - Sweats/Chills)
How do we treat myocarditis?
Anti-biotics/Anti-fungals/IV Immunoglobulins as necessary
Nsaids/CCS
