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Phase 2A revision > cardio to work on > Flashcards

cardio to work on Flashcards

1
Q

What histological layer of the artery may be thinned by an atheromatous plaque?

A

Media

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2
Q

Give 5 possible causes of angina

A
  • atheroma/stenosis of coronary arteries
  • valvular disease
  • aortic stenosis
  • arrhythmia
  • anaemia
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3
Q

Name 3 differential diagnoses for angina

A
  1. Pericarditis/myocarditis
  2. PE
  3. Chest infection
  4. Dissection of aorta
  5. GORD
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4
Q

Describe type 1 MI

A

Spontaneous MI with ischaemia due to a primary coronary event
e.g. plaque erosion/rupture, fissuring or dissection

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5
Q

Describe type 2 MI

A

MI secondary to ischaemia due to increased O2 demand or decreased supply such as in coronary spasm, coronary embolism, anaemia, arrhythmias, hypertension or hypotension

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6
Q

Give 3 signs of MI

A
  1. Hypo/hypertension
  2. 3rd/4th heart sound
  3. Signs of congestive heart failure
  4. Ejection systolic murmur
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7
Q

Name 3 possible differential diagnoses of MI

A
  1. Pericarditis
  2. Stable angina
  3. Aortic dissection
  4. GORD
  5. Pneumothorax
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8
Q

What might the ECG of someone with NSTEMI show?

A

May be normal or might show T wave inversions and ST depression

Might also be R wave regression, ST elevation and biphasic T wave in lead V3

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9
Q

Give 2 potential side effect of P2Y12 inhibitors

A
  1. Bleeding
  2. Rash
  3. GI disturbances - ulceration
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10
Q

Give 5 potential complications of MI

A
  • sudden death
  • arrhythmias
  • persistent pain
  • heart failure
  • mitral incompetence
  • pericarditis
  • cardiac rupture
  • aneurysm
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11
Q

what are the clinical features of PE?

A

SYMPTOMS

  1. Breathlessness
  2. Pleuritic chest pain
  3. signs/symptoms of DVT

SIGNS

  1. Tachycardia
  2. Tachypnoea
  3. pleural rub
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12
Q

What is the treatment for a PE?

A
  • LMW heparin,
  • oral warfarin for 6 months
  • DOAC - for outpatient with a relatively minor PE
  • Treat cause if possible
  • surgery for massive clot - embolectomy
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13
Q

How would you describe an arterial thrombus?

A

Platelet rich (a ‘white thrombosis’)

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14
Q

How would you describe a venous thrombosis?

A

Fibrin rich (a ‘red thrombosis’)

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15
Q

Describe the aetiology of pericarditis

A
  1. Viral (common) - e.g. enteroviruses, adenoviruses
  2. Bacterial - e.g. mycobacterium tuberculosis
  3. Autoimmune - e.g. Sjören syndrome
  4. Neoplastic
  5. Metabolic - e.g. uraemia
  6. Traumatic and iatrogenic
  7. Idiopathic (90%)
  8. dressler’s syndrome
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16
Q

Name 3 differential diagnoses for acute pericarditis

A
  1. MI
  2. Angina
  3. Pneumonia
  4. Pleurisy
  5. PE
  6. GORD
  7. pneumothorax
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17
Q

What investigations might you do on someone who you suspect to have pericarditis?

A
  1. ECG - diagnostic
  2. CXR
  3. Bloods - FBC, ESR and CRP, Troponin
  4. Echocardiogram - usually normal, rule out silent pericardial effusion
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18
Q

What might the ECG look like in someone with acute pericarditis?

A
  1. Saddle shaped ST elevation

2. PR depression

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19
Q

What are the signs of Cardiac tamponade?

A

Beck’s triad:

  1. low BP but high HR
  2. Increased JVP
  3. Quiet S1 and S2
  • Pulsus paradoxus = pulses fade on inspiration
  • Kussmaul’s sign = rise in jugular venous pressure with inspiration
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20
Q

Name 3 major predictive markers for complications for pericarditis

A
  1. Fever >38 degree
  2. Subacute onset
  3. Large pericardial effusion
  4. Cardiac tamponade
  5. Lack of response to aspirin or NSAIDs after at least 1 week of therapy
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21
Q

what are the treatments for peripheral vascular disease?

A 
Control risk factors:
    - Smoking cessation
    - Regular exercise
    - Weight reduction
    - BP control, DM control
    - Statin 
Antiplatelet therapy:
    - Aspirin/clopidogrel
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22
Q

Give 4 signs of critical ischaemia

A
  1. Rest pain
  2. Classically nocturnal
  3. Ulceration
  4. Gangrene
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23
Q

what are the risk factors for heart failure?

A
  1. > 65 y/o
  2. African descent
  3. Men
  4. Obesity
  5. Previous MI
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24
Q

what are the clinical signs of left heart failure?

A
  1. Pulmonary crackles
  2. S3 and S4 and murmurs
  3. Displaced apex beat
  4. Tachycardia
  5. fatigue
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25
Q

what are the clinical features of right HF?

A
  1. Raised JVP
  2. Ascites
  3. peripheral oedema
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26
Q

what are the clinical features of heart failure?

A

SOFA PC

  • shortness of breath
  • orthopnea
  • fatigue
  • ankle swelling
  • pulmonary oedema (due to backflow from decreased CO; produced cough with pink frothy sputum)
  • cold peripheries

Raised JVP
End respiratory crackles

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27
Q

what is the management for chronic HF?

A

1st line = ACEi, beta blocker
2nd = ARB + nitrate
3rd = cardiac resynchronization or digoxin
4th = diuretics (furosemide)
5th = aldosterone antagonist (spironolactone)

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28
Q

What are the blood pressure readings for someone to be diagnosed with Stage 1 hypertension?

A

Clinic BP = 140/90

ABPM = 135/85

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29
Q

What are the blood pressure readings for someone to be diagnosed with Stage 2 hypertension?

A

Clinic BP = 160/100

ABPM = 150/95

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30
Q

What are the blood pressure readings for someone to be diagnosed with severe hypertension?

A

Systolic BP = >180

Diastolic BP = >110

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31
Q

Write an equation for BP

A

BP = CO x TPR

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32
Q

Give 4 functions of angiontensin II

A
  1. Potent vasoconstrictor
  2. Activated sympathetic nervous system - increased NAd
  3. Activates aldosterone - Na+ retention
  4. Vascular growth, hyperplasia and hypertrophy
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33
Q

what are the side effects of ACE inhibitors?

A
  1. Hypotension
  2. Hyperkalaemia
  3. Acute renal failure
  4. Teratogenic
  5. cough - from build up of kinin
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34
Q

Give 4 potential side effect of ARBs

A
  1. Hypotension
  2. Hyperkalaemia
  3. Renal dysfunction
  4. Rash
    Contraindicated in pregnancy
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35
Q

Give 3 potential side effects that are due to the vasodilatory ability of CCBs

A
  1. Flushing
  2. Headache
  3. Oedema
  4. Palpitations
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36
Q

Give 2 potential side effects that are due to the negatively chronotropic ability of CCBs

A
  1. Bradycardia
  2. Atrioventricular block
  3. Postural hypotension
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37
Q

Give a potential side effect that is due to the negatively inotropic ability of CCBs

A

Worsening cardiac failure

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38
Q

Give 4 potential side effects of verapamil

A
  1. Worsening of cardiac failure (-ve inotrope)
  2. Bradycardia (-ve chronotrope)
  3. Atrioventricular block (-ve chronotrope)
  4. Constipation
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39
Q

Give 3 conditions in which Beta blockers can worsen them

A
  1. Asthma or COPD
  2. PVD
  3. Heart failure
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40
Q

Give 5 potential side effects of diuretics

A
  1. Hypovolaemia
  2. Hypotension
  3. Reduced serum Na+, K+, Mg+, Ca2+
  4. Increased uric acid –> gout
  5. Erectile dysfunciton
  6. Impaired glucose tolerance
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41
Q

What are the functions of ANP and BNP?

A
  1. Increased renal excretion of Na+ and water
  2. Vasodilators
  3. Inhibit aldosterone release
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42
Q

Why can Neprilysin (NEP) inhibitors work for heart failure treatment?

A

NEP metabolises ANP and BNP

NEP inhibitors therefore increase levels of ANP and BNP in the serum

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43
Q

Give 2 potential side effects of nitrates

A
  1. Headache
  2. GTN syncope
  3. Tolerance
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44
Q

Name two class 1 drugs of the Vaughan Williams classification

A

Class 1 are Na+ channel blockers
1a = disopyramide, quinidine
1b = lidocaine
1c = flecainide (tachycardias)

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45
Q

Name three class 2 drugs of the Vaughan Williams classification

A

Class 2 are Beta blockers
Propranolol
Atenolol
Bisoprolol

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46
Q

Name a class 3 drug of the Vaughan Williams classification

A

Class 3 rugs prolong the action potential
Amiodarone
Side effects are likely with these

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47
Q

Name two class 4 drugs of the Vaughan Williams classification

A

Class 4 drugs are calcium channel blockers (but NOT dihydropyridines as they don’t effect the heart)
Verapamil
Dilitiazem

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48
Q

How does digoxin work?

A

Inhibits the Na+/K+ pump therefore making the action potential more positive and ACh is released from parasympathetic nerves

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49
Q

What are the main effect of digoxin?

A
  1. Bradycardia
  2. Reduced atrioventricular conduction
  3. Increased force of contraction (positive inotrope)
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50
Q

Give 3 potential side effects of digoxin

A
  1. Nausea
  2. Vomiting
  3. Diarrhoea
  4. Confusion
    Also has a narrow therapeutic range
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51
Q

In what disease is digoxin clinically indicated?

A
  1. Atrial fibrillation

2. Severe heart failure

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52
Q

How does amiodarone work?

A

Prolongs action potential by delaying depolarisation

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53
Q

Name 4 potential effects of amiodarone

A
  1. QT prolongation
  2. Interstitial lung disease
  3. Hypothyroidism
  4. Abnormal liver enzymes
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54
Q

Name a disease that might cause flattening of the P wave

A
  1. Hyperkalaemia

2. Obesity

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55
Q

Name a disease that might cause tall P waves

A

Right atrial enlargement

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56
Q

Name a disease that might cause broad notched P waves

A

Left atrial enlargement

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57
Q

What aspect of the heart is represented by leads II, III and aVF?

A

Inferior aspect

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58
Q

What might ST elevation in leads II, II and aVF suggest?

A

RCA blockage

Leads represent inferior aspect of heart, RCA supplies inferior aspect

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59
Q

Give 3 effects hyperkalaemia on an ECG

A

GO - absent P wave
GO TALL - tall T wave
GO long - prolonged PR
GO wide - wide QRS

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60
Q

Give 2 effects of hypokalaemia on an ECG

A
  1. Flat T waves
  2. QT prolongation
  3. ST depression
  4. Prominent U waves
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61
Q

Give an effect go hypocalcaemia on an ECG

A
  1. QT prolongation
  2. T wave flattening
  3. Narrowed QRS
  4. Prominent U waves
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62
Q

Give an effect of hypercalcaemia on an ECG

A
  1. QT shortening
  2. Tall T wave
  3. No P waves
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63
Q

Give 3 potential consequences of arrhythmia

A
  1. Sudden death
  2. Syncope
  3. Heart failure
  4. Chest pain
  5. Palpitations
    May also be asymptomatic
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64
Q

Give 2 causes of bradycardia

A
  1. Conduction tissue fibrosis
  2. Ischaemia
  3. Inflammation/infiltrative disease
  4. Drugs
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65
Q

Name 3 types of supraventricular tachycardia

A
  1. Atrial fibrillation
  2. Atrial flutter
  3. AV node re-entry tachycardia
  4. AV re-entry tachycardia (accessory pathway)
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66
Q

what is the clinical presentation of AV node re-entry tachycardia (AVNRT)?

A

Rapid regular palpitations – abrupt onset, sudden termination
Chest pain and breathlessness
Neck pulsations
Polyuria

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67
Q

Describe the acute treatment of AV node re-entry tachycardia (AVNRT)

A

Vagal manoeuvre,
carotid sinus massage
catheter ablation and adenosine (block AVN to terminate the SVT)

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68
Q

What drugs might you give someone to suppress further episodes of AV node re-entry tachycardia (AVNRT)?

A

Beta blockers, CCB

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69
Q

Describe 3 characteristics of an ECG from someone with accessory pathway arrhythmia

A
  1. Delta wave
  2. Short PR interval
  3. Slurred QRS complex
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70
Q

Give 4 causes of sinus tachycardia

A
  1. Physiological response to exercise
  2. Fever
  3. Anaemia
  4. Heart failure
  5. Hypovolaemia
  6. pain
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71
Q

What ECG changes might you see with someone with ventricular tachycardia?

A

Crescendo-decrescendo amplitude = torsades de pointes

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72
Q

What is long term treatment for ventricular tachycardia in high risk patients

A

Implantable cardioverter defibrillator (ICD)

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73
Q

What is the treatment for stable ventricular tachycardia?

A

IV beta blockers (bisoprolol) and IV amiodarone

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74
Q

what is the clinical presentation of atrial fibrillation?

A

can be asymptomatic

  1. SOB
  2. Chest pain
  3. Palpitations
  4. Syncope
  5. fatigue
  6. apical pulse greater than radial pulse
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75
Q

what are the causes of atrial fibrillation?

A 
Idiopathic 
Hypertension 
Heart failure 
Coronary artery disease 
Valvular heart disease 
Cardiac surgery 
Cardiomyopathy
Rheumatic heart disease
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76
Q

Describe 2 characterics of an ECG taken from someone with atrial fibrillation

A
  1. Absent P waves
  2. Irregular and rapid QRS complexes
  3. Fine oscillation of the baseline
    ‘Irregularly irregular’
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77
Q

What score can be used to calculate the risk of stroke in someone with atrial fibrillation?

A

CHA2D2 VAS

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78
Q

What does the CHA2DS2 VASc score take into account

A 
CHD
HTN
Age (>75) = 2 points
DM
Stroke (previous) = 2 points
Vascular disease
Age 65-74 
Sex (female)

Score >1 = anticoagulation

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79
Q

Describe the treatment for atrial fibrillation

A
  • cardioversion - LMWH (enoxaparin) and DC shock
  • rate control - 1st line = beta blocker, 2nd line = CCB
  • rhythm control - BB (bisoprolol), CCB (verapamil), digoxin, anti-arrhythmic (amiodarone)
  • anti-coagulation
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80
Q

What might you give someone to help with rate control in atrial fibrillation?

A

BB, CCB, digoxin

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81
Q

What might you give someone to help restore sinus rhythm in atrial fibrillation?

A

Electrical cardioversion or pharmacological cardioversion using flecainide

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82
Q

What is the long term treatment for atrial fibrillation?

A

Catheter ablation

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83
Q

What is atrial flutter?

A

Fast but organised waves in the atrium

Atrial rate 250-350 bpm

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84
Q

Describe the ECG pattern taken from someone with atrial flutter

A
  1. Narrow QRS

2. Saw tooth flutter (F) waves

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85
Q

Describe the pathophysiology of atrial flutter

A

the P wave produces a sawtooth pattern with regular conduction to the ventricles
- Wave of contraction around the atria causing the repolarisation of the AV node

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86
Q

What are ectopic beats?

A

Non sustained beats arising from ectopic regions of atria or ventricles
Very common, generally benign arrhythmias caused by premature discharge

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87
Q

what are the causes of long QT syndrome?

A
  1. Congenital
  2. hypokalaemia,
  3. hypocalcaemia
  4. Drugs - amiodarone, tricyclic antidepressants
  5. bradycardia
  6. Acute MI
  7. diabetes
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88
Q

what is the clinical presentation of long QT syndrome?

A
  1. Palpitations
  2. Syncope
    - may progress to VF
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89
Q

what are the causes of heart block?

A 
Athletes
Sick sinus syndrome
IHD – esp MI
Acute myocarditis
Drugs
Congenital 
Aortic valve calcification
Cardiac surgery/trauma
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90
Q

What kind of heart block is associated with wide QRS complexes with an abnormal pattern?

A

Right bundle branch block (RBBB) and Left bundle branch block (LBBB)

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91
Q

What changes would you see on an ECG from someone with a LBBB?

A

WiLLiaM
slurred S wave in V1 (resembles W)
R wave in V6 (resembles M)

wide QRS with notched top in V6

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92
Q

What changes would you see on an ECG from someone with a RBBB?

A

MaRRoW
R wave in V1 (resembles M)
slurred S wave in V6 (resembles W)

wide QRS
RSR pattern in V1

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93
Q

what are the symptoms of aortic stenosis?

A

Occur when valve area is 1/4 of normal (normal - 3-4 cm2)

  1. Exertional syncope
  2. Angina
  3. Exertional dyspnoea
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94
Q

what are the signs of aortic stenosis?

A
  • ejection systolic murmur radiating to carotids and apex - crescendo-decrescendo
  • sustained, heaving apex
  • slow rising pulse
  • narrow pulse pressure
  • soft S2 if severe
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95
Q

What can cause mitral regurgitation?

A
  1. Myxomatous degeneration (mitral valve prolapse) - most common cause
  2. Ischaemic mitral valve
  3. Rheumatic heart disease
  4. IE
  5. dilating left ventricle
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96
Q

what are the symptoms of mitral regurgitation?

A

palpitations
exertional dyspnoea
fatigue
weakness

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97
Q

Give 3 signs of mitral regurgitation

A
  1. Pan-systolic murmur radiating to left axilla
  2. Soft/absent S1
  3. displaced, thrusting apex
  4. atrial fibrillation
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98
Q

What is the management of mitral regurgitation?

A
  • Mild is managed by following patient with echoes every 1-5yrs
  • Beta-blockers - ATENOLOL
  • Calcium channel blockers
  • DIGOXIN
  • Diuretics - FUROSEMIDE
  • ACEIs - RAMIPRIL or HYDRALAZINE
  • Surgical intervention if severe and symptomatic or
    - If ejection fraction <60%
    - New onset AF
99
Q

What causes aortic regurgitation?

A

acute

  • infective endocarditis
  • rheumatic fever
  • aortic dissection

chronic

  • rheumatic disease
  • bicuspid aortic valve
  • aortic endocarditis
100
Q

Give 3 symptoms of aortic regurgitation

A
  • palpitations
  • angina
  • dyspnoea
101
Q

Give 3 signs of aortic regurgitation

A
  • early diastolic murmur - decrescendo
  • water hammer (collapsing) pulse
  • wide pulse pressure
  • displaced apex
102
Q

What investigations might you do in someone who you suspect to have aortic regurgitation?

A

CXR - cardiomegaly, aortic root enlargement
ECHO - assess severity
ECG - left ventricular hypertrophy
cardiac catheterisation

103
Q

What investigation might you do in someone who you suspect to have aortic stenosis?

A
  • Echocardiography
    High gradient = severe stenosis
  • CXR - prominence of ascending aorta
  • ECG - depressed ST and T wave inversion
104
Q

What investigations might you do in someone who you suspect to have mitral regurgitation?

A
  1. ECG
  2. CXR
  3. Echo - estimates LA/LV size and function
  4. doppler and colour flow doppler to measure severity
105
Q

Describe the management for someone with aortic regurgitation

A

IE prophylaxis
ACEi (ramipril) = vasodilators
Regular echos - motion progression
Surgery if symptomatic

106
Q

Name 3 causes of mitral stenosis

A
  1. Rheumatic heart disease
  2. IE
  3. Mitral annular calcification - rarer
107
Q

what are the symptoms of mitral stenosis?

A
  1. progressive dyspnoea
  2. Haemoptysis (coughing up blood)
  3. palpitations (AF)
  4. chest pain
108
Q

what are the signs of mitral stenosis?

A

rumbling mid-diastolic murmur with opening snap - decrescendo-presystolic crescendo

  1. malar flush
  2. AF
  3. tapping apex beat
  4. low volume pulse
  5. loud snapping S1
109
Q

What investigations might you do in someone who you suspect to have mitral stenosis?

A
  1. ECG - AF, left atrial hypertrophy causes bifid P wave
  2. CXR - large L atrium, pulmonary oedema
  3. Echo - gold standard for diagnosis
110
Q

Describe the management for mitral stenosis

A

If mild treatment is not required
Beta blockers control HR - ATENOLOL and DIGOXIN
Diuretics for fluid overload - FUROSEMIDE
Percutaneous balloon valvotomy to increase size of mitral valve opening
Mitral valve replacement

111
Q

In what type of valvular heart disease would you hear a mid-diastolic murmur and a 1st heart sound snap

A

Mitral stenosis

112
Q

In what type of valvular heart disease would you hear a pan systolic murmur?

A

Mitral regurgitation

113
Q

In what type of valvular heart disease would you hear an ejection systolic murmur?

A

Aortic stenosis

114
Q

In what type of valvular heart disease would you see a wide pulse pressure and hear an early diastolic blowing murmur and systolic ejection murmur?

A

Aortic regurgitation

115
Q

Name 4 types of infective endocarditis

A
  1. Left sided native IE
  2. Left sided prosthetic IE
  3. Right sided IE
  4. Device related IE (pacemaker, defibrillators)
116
Q

what are the risk factors for infective endocarditis?

A
  • IV drug use
  • poor dental hygiene
  • skin and soft tissue infections
  • dental treatment
  • IV cannula
  • cardiac surgery
  • pacemaker
  • immunocompromised
117
Q

Which bacteria are most likely to cause infective endocarditis?

A
  1. Staphylococcus aureus
  2. Staphlococcus epidermidi (coagulase negative staph)
  3. Streptococcus viridian’s (alpha haemolytic)
118
Q

Give 3 groups of people who are at risk of infective endocarditis

A 
more common in developing countries
males > females
1. Elderly 
2. IV drug users
3. Those would prosthetic valves 
4. Those with rheumatic fever 
5. Young with congenital heart disease
119
Q

Name 2 sites where vegetation is likely in infective endocarditis

A
  1. Atrial surface of AV valves

2. Ventricular surface of SL valves

120
Q

Give 4 signs of infective endocarditis

A
  1. Splinter haemorrhages - on nails
  2. Osler’s nodes - on hands
  3. Janeway lesions - on hands
  4. Roth spots - in eyes
  5. embolic skin lesions - skin
  6. petechiae - skin
  7. Heart murmurs

anaemia
splenomegaly
clubbing
valve disease

121
Q

Name the criteria that is used in the diagnosis of infective endocarditis

A

Duke’s criteria

122
Q

What investigations might you do in someone who you suspect to have infective endocarditis?

A
  1. Blood cultures - essential
  2. Echo - TTE ot TOE
  3. Bloods - raised ESR and CRP, normochromic normocytic anaemia
  4. ECG - long PR interval, MI
123
Q

Describe the treatment for infective endocarditis

A
  1. Antibiotics based on cultures
  2. Treat any complications
  3. Surgery - remove and replace valve
124
Q

Give 4 indications for surgery in IE

A
  1. Antibiotics not working
  2. Complications
  3. To remove infected devices
  4. To replace valve after infection cured
  5. To remove large vegetations before they embolism
125
Q

Name 2 drugs that can prolong the QT interval

A
  1. Sotalol

2 Amiodarone

126
Q

What additional property makes propranolol the most useful beta blocker to help control the arrhythmias which occur immediately following a heart attack?

A

It can also block sodium channels

127
Q

What are the 4 main features of tetralogy of fallot?

A
  1. Ventricular septal defect
  2. Over-riding aorta
  3. RV hypertrophy
  4. Pulmonary stenosis
128
Q

Would a baby born with tetralogy of fallot be cyanotic?

A

YES
RV pressure higher than LV
Blood passes from RV to LV so patients are blue = cyanosis

129
Q

Briefly decscribe the pathophysiology if Eisenmengers syndrome

A

High pressure pulmonary blood flow damages pulmonary vasculature –> increase in resistance to blood flow (pulmonary hypertension) –> RV pressure increase –> shunt direction reverses (RV to LV) = cynanosis

130
Q

What are the risks associated with Eisenmengers syndrome?

A
  1. Risk of death
  2. Endocarditis
  3. Stroke
131
Q

Describe the pathophysiology behind coarctation of the aorta

A

Excessive sclerosing that normally closes the ductus arteriosus extends into the aortic wall leading to narrowing
stronger perfusion to upper body than lower body causes decreased renal perfusion - leads to systemic hypertension

132
Q

How does mild coarctation of the aorta present?

A

Presents with hypertension
Incidental murmur
Should be repaired to try to prevent problems in the long term

133
Q

What long term problems can occur due to coarctation of the aorta?

A

Hypertension - early CAD, early stroke, subarachnoid haemorrhage
Re-coarctation requiring repeat intervention
Aneurysm formation at the site of repair

134
Q

How does a patient present with pulmonary stenosis?

A 
Right ventricular failure 
Collapse 
Poor pulmonary blood flow 
right ventricular hypertrophy
Tricuspid regurgitation
135
Q

How is pulmonary stenosis treated?

A

Ballon valvuloplasty
Open valvotomy
Open trans-annular patch
Shunt (to bypass blockage)

136
Q

What are 3 problems with a bicuspid aortic valve?

A
  1. Degenerate quicker than normal valves
  2. Become regurgitant earlier than normal valves
  3. Associated with coarctation and dilation of ascending aorta
137
Q

Name 3 congenital heart defect that are not cyanotic

A
  1. VSD
  2. ASD
  3. PDA
    Left to right shunt
138
Q

Name a congenital heart defect that is cyanotic

A
  1. Tetralogy of Fallot

Right to left shunt

139
Q

Why does mitral stenosis cause AF?

A

Increased LA pressure

Stretches myocytes in the atria and irritates pacemaker cells –> AF

140
Q

What is Dressler’s syndrome?

A

Myocardial injury stimulates formation of autoantibodies against the heart
Cardiac tamponade may occur
Dressler’s is a secondary form of pericarditis

141
Q

Give 3 symptoms of Dressler’s syndrome

A
  1. Fever
  2. Chest pain
  3. Pericardial rub
    Occurs 2-10 weeks after MI
142
Q

Write an equation for mAP

A

mAP = DP + 1/3PP

143
Q

Give the equation for stroke volume

A

SV = EDV - ESV

144
Q

Give 2 diseases that result from stress induced ischaemia

A
  1. Exercise induced angina

2. Intermittent claudication

145
Q

Give 2 disease that result from ischaemia due to structural/functional breakdown

A
  1. Critical limb ischaemia

2. Vascular dementia

146
Q

Name 2 diseases that are due to moderate ischaemia

A
  1. Angina

2. Intermittent claudication

147
Q

Name 3 causes of an aneurysm

A
  1. Atherosclerotic (most common)
  2. Ateriomegaly
  3. Collagen disease - Marfans, vascular Ehlers Danlos
  4. tobacco smoking
148
Q

Describe the pathophysiology of an aortic dissection

A

Tear in intimal lining of aorta –> column of blood under pressure enters aortic wall forming haematoma –> separates intima from adventitia –> false lumen
False lumen extends –> intimal tears

149
Q

Mitral regurgitation, what murmur do you hear?
a. Early diastolic murmur
b. Early systolic click murmur
c. Ejection systolic crescendo-decrescendo murmur
d. End diastolic murmur
e. Pansystolic murmur
What are the others murmurs of?

A

e. Pansystolic murmur = occurs throughout duration of systole = Mitral regurgitation

a. Early diastolic murmur = Mitral stenosis
b. Early systolic click murmur = Mitral valve replacement (click = replacement as metal)
c. Ejection systolic crescendo-decrescendo murmur = Aortic stenosis
d. End diastolic murmur
e. Pansystolic murmur = occurs throughout duration of systole = Mitral regurgitation

150
Q

what are the risk factors for acute coronary syndromes?

A 
age
male
family history
smoking
hypertension
diabetes mellitus
obesity and sedentary lifestyle
151
Q

what is the management for an NSTEMI?

A
  • use grace score to predict 6 month mortality and risk of further cardiac events
  • fondaparinux
  • low risk = ticagrel and aspirin
  • high risk = angiography and PCI
  • prasugrel and aspirin
152
Q

what is the role of preload in heart failure?

A
  • heart failure causes decreased volume of blood ejected with each heart beat
  • the myocardial fibres stretch and don’t contract as much
153
Q

what is the role of afterload in heart failure?

A
  • increased afterload causes increased EDV
  • this causes decreased SV and decreased CO
  • this is a vicious circle and continues to exacerbates the problem
154
Q

what additional investigations should be undertaken for acute heart failure?

A
  • BNP
  • serum troponin
  • D-dimer
155
Q

what are the causes of cor pulmonale?

A
  • chronic lung disease
  • pulmonary vascular disorders
  • neuromuscular and skeletal diseases
156
Q

what are the signs of cor pulmonale?

A
  • cyanosis
  • tachycardia
  • raised JVP
  • RV heave
  • pan-systolic murmur due to tricuspid regurgitation
  • hepatomegaly
  • oedema
157
Q

what are the symptoms of cor pulmonale?

A
  • dyspnoea
  • fatigue
  • syncope
158
Q

what investigations should be undertaken for cor pulmonale?

A

arterial blood gas

  • hypoxia
  • sometimes shows hypercapnia
159
Q

what is the management for cor pulmonale?

A
  • treat the underlying cause
  • oxygen
  • diuretics
  • venesection if haematocrit >55
  • heart-lung transplant in young patients
160
Q

what are the causes of atrial flutter?

A
  • idiopathic
  • CHD
  • hypertension
  • heart failure
  • COPD
  • pericarditis
  • obesity
161
Q

what are the risk factors for atrial flutter?

A
  • atrial fibrillation
162
Q

what is the management for atrial flutter?

A
  • Cardioversion
    - Give a LMWH
    - Shock with defibrillator
  • Catheter ablation = definitive treatment – creates a conduction block
  • IV Amiodarone – restore sinus rhythm
163
Q

what are the risk factors for AVNRT?

A 
exertion
emotional stress
coffee
tea
alcohol
164
Q

what is malignant hypertension?

A

markedly raised diastolic BP usually over 120mmHg and progressive renal disease

usually evidence of acute haemorrhage and papilledema

165
Q

what are the consequences of malignant hypertension?

A
  • cardiac failure (LVH)
  • blurred vision (papilledema)
  • haematuria - due to fibrinoid necrosis of glomeruli
  • severe headache and cerebral haemorrhage
166
Q

what is the treatment for recurrent pericarditis?

A
  • The first line treatment is oral NSAIDs e.g. Ibuprofen
  • Colchicine has been proven to be more effective than Aspirin alone
  • In resistant cases, oral corticosteroids e.g. -Prednisolone may be effective, and in some patients, pericardiectomy (removal of part/most of the pericardium) may be appropriate
167
Q

what is the clinical presentation of pericardial effusion?

A
  • Symptoms of a pericardial effusion commonly reflect the underlying pericarditis
  • Soft & distant heart sounds
  • Apex beat obscured
  • Raised jugular venous pressure
  • Dysponea
168
Q

what are the risk factors of MI?

A

Age, male, history of CVD, FHx
Premature menopause
DM, smoking, hypertension, hyperlipidaemia, obesity, sedentary lifestyle

169
Q

what is an aortic dissection?

A

Aortic Dissection is a tear in the intimal layer of the aorta which leads to a collection of blood between the intima and medial layers.

170
Q

what are the risk factors of aortic dissection?

A 
Hypertension- most common risk factor
Trauma
Vasculitis 
Cocaine use
Connective tissue disorders- cause Aortic Dissection in younger adults
171
Q

what are the clinical features of aortic dissection?

A
  • Sudden and severe tearing pain in chest radiating to back
  • Hypotension
  • Asymmetrical blood pressure
  • Syncope
  • Aortic regurgitation, coronary ischaemia, cardiac tamponade
  • Peripheral pulses may be absent
172
Q

what are the investigations of aortic dissection?

A
  • ECG/cardiac enzymes - rule out MI
  • Chest x-ray - widening mediastinum
  • CT scanning- definitive imaging
  • echo - TTE/TOE
  • gold standard = CT angiography
173
Q

what is the management of aortic dissection?

A

-Maintain hemodynamic stability- fluid resuscitation, inotropes, noradrenaline
-Opioid analgesia for pain control - MORPHINE
-Surgical intervention:
Endovascular stent-graft repair
-Put patient on antihypertensives following surgery and recovery - IV METAPROLOL (beta-blockers) or IV GTN (vasodilators)

174
Q

what is the treatment for critical limb ischaemia?

A

Revascularisation (e.g. stenting, angioplasty, bypassing)

Amputation if unsuitable

175
Q

what are the risk factors of mitral stenosis?

A
  • history of rheumatic fever

- untreated strep infections

176
Q

what are the risk factors for mitral regurgitation?

A 
female
lower BMI
advancing age
renal dysfunction
prior MI
177
Q

what is the clinical presentation of atrial flutter?

A 
Palpitations
Breathlessness
chest pain 
Dizziness
Syncope
fatigue
178
Q

what are the risk factors for atrial fibrillation?

A 
Over 60 
Diabetes, 
Hypertension
coronary artery disease 
previous MI
structural heart disease
179
Q

what are the causes of RBBB?

A

Pulmonary embolism
IHD
Atrial ventricular septal defect

180
Q

what is the pathophysiology of RBBB?

A

Right bundle doesn’t conduct
Impulse spreads from left ventricle to right
Late activation of RV

181
Q

what is the clinical presentation of RBBB?

A

Asymptomatic

syncope/presyncope

182
Q

what is the treatment for RBBB?

A

Pacemaker
CRT – cardiac resynchronisation therapy
Reduce blood pressure

183
Q

what is the clinical presentation of LBBB?

A

Asymptomatic

syncope/presyncope

184
Q

what is the pathophysiology of LBBB?

A

Left bundle doesn’t conduct
Impulse spreads from right ventricle to left
Late activation of LV

185
Q

what is the treatment for LBBB?

A

Pacemaker
CRT – cardiac resynchronisation therapy
Reduce blood pressure

186
Q

what are the causes of LBBB?

A

IHD

Aortic valve disease

187
Q

what is the clinical presentation of Mobitz type 1 second degree heart block?

A

light-headedness
dizziness
syncope

188
Q

what is the clinical presentation of Mobitz type 2 second degree heart block?

A

SOB
postural hypotension
chest pain

189
Q

what is the clinical presentation of third degree heart block?

A

dizziness

blackouts

190
Q

what is the presentation of first degree heart block?

A

asymptomatic

191
Q

what are the risk factors for abdominal aortic aneurysm?

A
  • Smoking- MAJOR
  • Family history
  • Connective tissue disorders- Marfan’s, Ehlers-Danlos
  • Age
  • Atherosclerosis
  • Male
192
Q

what is the clinical presentation of an unruptured abdominal aortic aneurysm?

A
  • often asymptomatic
  • causes symptoms if expanding rapidly
  • pain in abdomen, loin or groin
  • pulsatile abdominal swelling
  • bruit on ascultation
193
Q

what is the clinical presentation of a ruptured abdominal aortic aneurysm?

A
  • intermittent/continuous abdominal pain - radiates to back, iliac fossa or groin
  • painful pulsatile mass
  • hypovolaemic shock
  • syncope
  • nausea, vomiting
  • profound anaemia
  • sudden death
194
Q

what are the investigations for abdominal aortic aneurysm?

A
  • Abdominal ultrasound – can assess aorta to degree of 3mm

- CT or MRI angiography

195
Q

what antibiotics are used for endocarditis?

A

staph = vancomycin
if MRSA add rifampicin

other bacteria = benzylpenicillin and gentamycin

196
Q

what is the clinical presentation of tetralogy of fallot?

A 
central cyanosis
low birthweight and growth
dyspnoea on exertion
delayed puberty
systolic ejection murmur
197
Q

what are the investigations of tetralogy of fallot?

A

CXR shows boot shaped heart

Echocardiogram

198
Q

what is the management of tetralogy of fallot?

A
  • Full surgical treatment during first 2 years of life due to the progressive cardiac debility and cerebral thrombosis risk
  • Often get pulmonary valve regurgitation in adulthood and require another surgery
199
Q

what are the signs of pericardial effusion?

A
  • Muffled heart sounds - effusion obscures apex beat, and heart sounds are soft
  • Kussmaul’s sign – elevated jugular pressure that rises with inspiration
  • Fall in BP of more that 10mmHg on inspiration (result of increased venous return to right side of heart)
  • Bronchial breathing at left base
200
Q

what are the investigations for pericardial effusion?

A
  • Chest x ray shows large globular heart
  • ECG - low voltage QRS complexes with sinus tachycardia
  • Echocardiography is diagnostic - echo-free space around heart
201
Q

what is the management for pericardial effusion?

A
  • Most effusions resolve naturally
  • Underlying cause should be sought and treated
  • If effusion recurs despite treatment of underlying cause, excision of pericardial segment allows fluid to be absorbed
  • Pericardiocentesis - Diagnostic or therapeutic
202
Q

what are the investigations for cardiac tamponade?

A
  • CXR – large globular heart
  • Beck’s triad – falling BP, rising jugular venous pressure, muffled heart sounds
  • ECG – low voltage QRS complexes with sinus tachycardia
  • Echocardiography is diagnostic – echo-free space around heart
203
Q

what are the causes of AVRT?

A 
Congenital
Hypokalaemia 
Hypocalcaemia 
Drugs: amiodarone, tricyclic antidepressants
Bradycardia
Acute MI
Diabetes
204
Q

what is the clinical presentation of AVRT?

A

Palpitations
Severe dizziness
Dyspnoea
Syncope

205
Q

what are the investigations for AVRT?

A

ECG - pre excitation

  • short PR interval
  • delta waves (wide QRS complex that begins slurred)
206
Q

what is the treatment for AVRT?

A 
Vagal manoeuvre
     Breath holding 
     Carotid massage
     Valsalva manoeuvre
IV adenosine
Surgery – catheter ablation of pathway
207
Q

what is the pathophysiology of AVNRT?

A
  • 2 pathways in AVN in this pathway
    • 1 has short refractory period and slow conduction
    • 1 has longer effective refractory period and fast conduction
  • In sinus rhythm the atrial impulse usually conducts through fast pathways
  • If impulse occurs early when the fast pathway is still refractory the slow pathway takes over
  • Once the fast pathway is out of refractory the same impulse can travel back up the fast pathway
  • By this time the slow pathway is out of refractory and the signal can go back down the slow pathway
    This sets up a re-entry loop – heart rate of 100-250bpm
    Atria contract quickly in one cycle then slow in the next
208
Q

what are the investigations for AVNRT?

A

Sometimes ECG QRS complexes will show BBB
P wave not visible or seen immediately before (normal) or after QRS complex due to simultaneous atrial and ventricular activation

209
Q

what is the clinical presentation of coarctation of the aorta?

A
  • right arm hypertension
  • bruits over scapulae and back
  • Murmur
  • headaches and
  • nosebleeds
  • hypertension in upper limbs
  • discrepancy in bp in upper and lower body
210
Q

what are the investigations for coarctation of the aorta?

A

CXR - dilated aorta indented at the site of the coarctation
ECG - left ventricular hypertrophy
CT - can accurately demonstrate coarctation and quantify flow

211
Q

what is the epidemiology of coarctation of the aorta?

A

men > women

associated with turner’s syndrome, patent ductus arteriosus

212
Q

what are the causes of left sided heart failure?

A 
Coronary artery disease
Myocardial infection
Cardiomyopathy
Congenital heart defects
Valvular heart disease
Arrhythmias
213
Q

what are the causes of right sided heart failure?

A 
Right ventricular infarct 
Pulmonary hypertension
Pulmonary embolism 
COPD
Progression of left sided heart failure
Cor Pulmonale
214
Q

what are the causes of systolic heart failure?

A

Ischaemic heart disease
Myocardial infection
Cardiomyopathy

215
Q

what are the causes of diastolic heart failure?

A

aortic stenosis

chronic hypertension

216
Q

what murmur is heard with mitral stenosis?

A

rumbling mid-diastolic murmur with opening snap

217
Q

what murmur is heard with mitral regurgitation?

A

pan systolic murmur radiating to the left axilla

218
Q

what murmur is heard with aortic stenosis?

A

ejection systolic murmur radiating to carotids and apex

219
Q

what murmur is heard with aortic regurgitation?

A

early diastolic murmur (best heard on expiration with patient sat forwards)
heard loudest at left sternal edge

220
Q

ECG changes in which regions indicates a lateral MI?

A

lead I
aVL
V5
V6

221
Q

ECG changes in which regions indicates an inferior MI?

A

lead II
lead III
aVF

222
Q

ECG changes in which regions indicates a septal MI?

A

V1

V2

223
Q

ECG changes in which regions indicates an anterior MI?

A

V3

V4

224
Q

ECG changes in lateral regions are caused by which artery in an MI?

A

lateral = circumflex

225
Q

ECG changes in inferior regions are caused by which artery in an MI?

A

inferior = RCA

226
Q

ECG changes in anterior regions are caused by which artery in an MI?

A

anterior = LAD

227
Q

A blockage in the LAD will cause ECG changes in which regions?

A

anterior - V3, V4

septal - V1, V2

228
Q

A blockage in the RCA will cause ECG changes in which regions?

A

inferior - leads II, III, aVF

229
Q

A blockage in the circumflex artery will cause ECG changes in which regions?

A

lateral - lead I, aVL, V5, V6

230
Q

what pharmacological treatments can be used for mitral stenosis?

A
  • beta blockers - atenolol
  • digoxin
  • diuretics - furosemide
231
Q

what pharmacological treatments can be used for mitral regurgitation?

A

Vasodilation

  • ACEi - ramipril
  • hydralazine - smooth muscle relaxer

HR control

  • B blockers - atenolol
  • CCB
  • digoxin

fluid overload
- loop diuretic - furosemide

AF/atrial flutter
- anticoagulation

232
Q

which tool is used to estimate the risk of bleeding in patients on anticoagulation?

A

HAS-BLED

233
Q

which tool is used to estimate the risk of developing a heart attack or stroke in the next 10 years?

A

QRISK3

234
Q

what is the management for SVT?

A

1st line = valsalva manoeuvre
2nd = carotid sinus massage
3rd = cardioversion with adenosine
4th = DC cardioversion with defibrillator

235
Q

what is the mechanism of action for adenosine?

A
  • causes transient AV node heart block
  • very short half life of 8-10 seconds
  • feeling of impending doom
236
Q

which abnormal heart rhythm are people with long QT syndrome at risk of developing?

A

torsades de pointes

237
Q

which congenital heart defects are common in people with trisomy 21 (downs syndrome)?

A

VSD - 30% (heard as a pansystolic murmur)
ASD - 10%
tetralogy of fallot - 5%
PDA - 5%

238
Q

what type of murmur is heard in a ventricular septal defect?

A

pansystolic

239
Q

which microorganism causes rheumatic fever?

A

group A streptococcus - s.pyogenes

240
Q

what is the mechanism of action for apixaban?

A

DOAC - inhibits factor Xa

241
Q

what is hypertrophic cardiomyopathy?

A

genetic disorder characterised by left ventricular hypertrophy -> causes diastolic ventricular malfunction

242
Q

what is the pathophysiology of hypertrophic cardiomyopathy?

A

thickened septum below aortic valve causes outflow tract obstruction -> causes left ventricular hypertrophy

243
Q

what is the most common cause of secondary hypertension?

A

primary hyperaldosteronism - Conn’s syndrome

244
Q

What are the side effects of colchicine?

A

Diarrhoea and nausea

Phase 2A revision (38 decks)

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