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Phase 2a > Cardio > Flashcards

Cardio Flashcards

1
Q

Give 4 Risk factors for atheroma formation:

A

Any 4 of:

Age
Tobacco smoking
High Serum Cholesterol
Obesity
Diabetes
Hypertension
Family History

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2
Q

What are the components of an atherosclerotic plaque?

A

Lipid
Necrotic core
Fibrous cap
Connective tissue

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3
Q

Define atherosclerosis

A

injury to ENDOTHELIAL cells leading to

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4
Q

What are the key components of Tetralogy of Fallot

A

Ventricular septal defect
Pulmonary stenosis
Hypertrophy of right ventricle
Overriding aorta - the aorta is positioned above VSD

think (Very Poor Heart Output)

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5
Q

What is one of the common appearances of a patient with Tetralogy of Fallot and why?

A

Cyanosis - Stenosis of pulmonary artery leads to RV pressure > LV pressure so Deoxygenated blood is passed from the right side of the heart to the left along the VSD leading to deoxygenated blood being pumped round the body and hence cyanosis.

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6
Q

What is the treatment for Tetralogy of fallot?

A

Complete surgical repair

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7
Q

What is a VSD?

A

VSD = Ventral Septal Defect = abnormal connection between the two ventricles

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8
Q

Are patients with a VSD cyanosed and why?

A

Not initially - LV pressure > RV pressure so there is increased blood flow to the lungs

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9
Q

What are the symptoms of a large VSD?

A

Breathlessness
Poor feeding
Failure to thrive

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10
Q

What are the symptoms of a large VSD?

A

Breathlessness
Poor feeding
Failure to thrive

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11
Q

What syndrome can a VSD lead to?

A

Eisenmengers syndrome

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12
Q

What does a small VSD increase the risk of?

A

Endocarditis

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13
Q

What is the treatment for a small VSD?

A

No treatment - closes naturally

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14
Q

What is the treatment for a large VSD?

A

Surgery - PA band, complete repair

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15
Q

What are the signs of a large VSD?

A

Small and breathless at birth
Increased Resp Rate
Tachycardia
Cardiomegaly on X-ray
Murmur that varies in intensity

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16
Q

What are the signs of a small VSD?

A

Loud systolic murmur
Thrill
Well grown with normal HR and Resp Rate

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17
Q

How does a VSD lead to Eisenmengers syndrome?

A

Continuous high pressure in pulmonary circulation damages pulmonary vessels over time increasing resistance to blood flow through the lungs until eventually the RV Pressure increases and gradient reverses leading deoxygentated blood to get pumped around the body.

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18
Q

What is an ASD?

A

Atrial Septal Defect = Abnormal connection between two Atria

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19
Q

Are patients with an ASD cyanosed and why?

A

No - Slightly higher pressure in LA than RA so increased blood flow to lungs

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20
Q

What are the symptoms of a large ASD?

A

Right heart dilation
SOBOE (Shortness of Breath on Exertion)
Increased chest infections

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21
Q

What are the symptoms of a small ASD?

A

Generally asymptomatic

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22
Q

What are the clinical signs of an ASD?

A

Pulmonary flow murmur
Fixed split second heart sound
Big pulmonary arteries
Big heart on CXR

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23
Q

What is the treatment for an ASD?

A

Large = Surgical, pericutaneous - key hole technique
Small = no treatment

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24
Q

What is an AVSD?

A

Atrio-Ventricular Septal Defect = essentially complete/partial hole in middle of heart

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25
Q

What are the AV valves like in an AVSD?

A

Instead of two separate valves there is one big malformed one

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26
Q

What is a patent ductus arteriosus?

A
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27
Q

What are the common signs + symptoms of a complete and of a partial AVSD?

A

Complete - Breathless as neonate, Poor weight gain, poor feeding, Torrential pulmonary blood flow

Partial - Presents like small asd/vsd

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28
Q

Whats the treatment for a AVSD?

A

Complete - needs repair/ AV band in infancy
Partial - may be left alone if no right heart dilation

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29
Q

What is a Patent ductus arteriosus?

A

Ductus arteriosus remains after birth - connection between Aorta and Pulmonary arteries

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30
Q

What are the signs of a PDA?

A

Continuous murmur, Large heart

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31
Q

What is a key differential for PDA?

A

Eisenmengers syndrome

32
Q

What are the symptoms of a large/ small PDA?

A

Large - Breathless, Poor feeding, Failure to thrive
Small - usually asymptomatic, increased endocarditis risk

33
Q

What’s the treatment for a PDA?

A

Closure - surgical or pericutaneous

34
Q

What is coarctation of the aorta?

A

Narrowing of aorta at site of insertion of ductus arteriosus

35
Q

What are the clinical signs of coarctation of the aorta?

A

Bruits over scapulae and back from collateral vessels
Right arm HTN (think where narrowing is)
Murmur

36
Q

What are the presentations of severe and mild coarctation of the aorta?

A

Severe - Collapse with heart failure

Mild - HTN + incidental murmur

37
Q

What is the treatment for coarctation of the aorta?

A

Surgical or percutaneous repair

38
Q

What is first degree heart block?

A

Blockage at AV node leading to delay in time taken to get through node

39
Q

How would first degree heart block show on an ECG?

A

Elongated PR interval

40
Q

What is second degree heart block?

A

A delay in conduction between the bundles of HIS and Purkinje fibres

41
Q

How would Mobitz type 1 heart block present on an ECG?

A

The PR intervals gradually elongate until a P wave is completely blocked

42
Q

How would Mobitz type 2 heart block present on an ECG

A

Consistent PR intervals but non conductive P-Waves

43
Q

What is aortic stenosis?

A

Obstruction of blood flow across aortic valve due to aortic valve fibrosis and obstruction

44
Q

Give 3 symptoms of aortic stenosis:

A

Angina
Syncope on exertion
Dysopnea on exertion

45
Q

Why does aortic stenosis lead to a decline in LV function?

A

Pressure gradient develops between LA and LV
LV compensates by undergoing hypertrophy
Eventually cannot hypertrophy anymore and LV function declines as a result

46
Q

Give 2 examples of causes of aortic stenosis:

A

Congenital bicuspid valve
Congenital aortic stenosis
Degenerative calcification
Rheumatic heart disease
Any rare cause known

46
Q

Give 2 examples of causes of aortic stenosis:

A

Congenital bicuspid valve
Congenital aortic stenosis
Degenerative calcification
Rheumatic heart disease
Any rare cause known

47
Q

Give 3 signs of aortic stenosis:

A

Slow rising carotid pulse + decreased pulse amplitude
Soft/absent second heart sound
S4 gallop due to LVH
EJECTION SYSTOLIC MURMUR - CRESCENDO-DECRESCENDO CHARACTER

48
Q

What is the gold standard Ix for Aortic Stenosis and what are you looking for?

A

Echocardiogram - LVH, Dilation and EF, doppler derived gradient + valve areaI

49
Q

What is the treatment for a symptomatic patient with Aortic Stenosis?

A

Aortic valve replacement surgery
Transcatheter Aortic Valve Implantation (TAVI)

50
Q

Give a differential for Aortic stenosis:

A

Aortic sclerosis
IHD
Hypertrophic cardiomyopathy

51
Q

Give 3 RF for Aortic Stenosis:

A
  • Age
    • Congenital bicuspid valve
    • Rheumatic fever
    • CKD
52
Q

What happens in the heart of a patient with mitral regurgitation?

A

Progressive left ventricular volume overload leads to dilation and progressive heart failure

Progressive left atrial dilation and right ventricular dysfunction due to pulmonary hypertension

53
Q

Give 2 investigations for mitral regurgitation and what you would expect to see:

A
  • ECG - may show:
    ○ LA enlargement
    ○ AF
    ○ LV hypertrophy
    • CXR - showing:
      ○ LA enlargement
      ○ Central pulmonary artery
      enlargement
    • Echo - showing:
      ○ LV size + function
      ○ An estimation of the LA
      ○ Valve structure + function
54
Q

What are the common symptoms of Mitral regurgitation?

A
  • Dyspnoea on exertion
    • Heart failure
55
Q

Give a common sign of Mitral regurgitation:

A

Pansystolic murmur at apex radiating to axilla on ascultation

56
Q

Give 3 causes of chronic mitral regurgitation:

A
  • Myxomatous Degeneration
    • Ischemic MR
    • Rheumatic Heart disease
    • Infective endocarditis
57
Q

What is Mitral Regurgitation?

A

Backflow of blood from LV to LA during systole

58
Q

Give a differential for Mitral regurgitation:

A
  • ACS
    • IE
    • Mitral Stenosis
    • Aortic stenosis
    • Aortic or Pulmonic Valve disease
      And Atrial Myxoma
59
Q

Give examples of medications used to treat complications of Mitral regurgitation and the complication they would be used for:

A
  • B blockers, ccb + Digoxin - to
    control AF
    • Anticoags to control AF + flutter
    • Nitrates + diuretics if acute MR
      Heart failure treatment
60
Q

What is Aortic Regurgitation?

A

Leakage of blood into the LV during diastole due to ineffective coaptation of the aortic cusps

61
Q

What causes Aortic Regurgitation

A

Rheumatic Heart disease
Bicuspid aortic valve
Infective endocarditis

62
Q

What causes Aortic Regurgitation

A

Rheumatic Heart disease
Bicuspid aortic valve
Infective endocarditis

63
Q

What pathophysiological compensatory mechanisms occur in Aortic Regurgitation

A

LV Dilation - Progressively leads to heart failure
LVH

64
Q

What are the signs of aortic regurgitation?

A
  • Wide pulse pressure
    • Hyperdynamic and displaced
      apical impulse
    • Diastolic blowing murmur at left
      sternal border
    • Austin flint murmur (apex)
      * Systolic ejection murmur - due to
      increased cross valvular flow
65
Q

What are the symptoms of Aortic Regurgitation?

A

Asymptomatic until 40/50
Progressive symptoms are:
Dyspnoea
Palpitations

66
Q

What are the investigations you would carry out in a patient with suspected Aortic Regurgitation and what would you see?

A

Chest X-ray - Enlarged cardiac silhouette and aortic root enlargement

Echocardiogram - Evaluation of AV + aortic root with measurements of LV dimensions + function

67
Q

How would you manage Aortic Regurgitation with medication?

A

Consider IE prophylaxis

Give vasodilators (+ ACEI’S if in CCF or HTN to improve stroke volume and reduce regurgitation)

68
Q

How would you manage aortic regurgitation if the patient has any symptoms?

A

Serial Echocardiograms

Surgery - SAVR or TAVI if not suitable for SAVR

69
Q

When would you surgically treat an asymptomatic patient with Aortic Regurgitation?

A

If their ejection fraction <50% or their LV is dilated >50mm at the end of systole

70
Q

Give 3 differentials for Aortic Regurgitation:

A
  • Mitral regurgitation
    • Mitral stenosis
    • Aortic stenosis
    • Pulmonary regurgitation
71
Q

What is Mitral Stenosis?

A

Obstruction of LV inflow that prevents proper filling during diastole

72
Q

Give 3 symptoms of Mitral Stenosis:

A
  • Right heart symptoms
    • Haemoptysis
      Progressive dyspnoea
73
Q

Explain the symptoms of Mitral Stenosis Pathophysiologically:

A
  • Progressive dyspnoea due to:
    ○ LA dilation causing pulmonary congestion
    • Increased transmitral pressures lead to left atrial enlargement and AF
    • Right heart symptoms - due to pulmonary venous HTN
      Haemoptysis - due to rupture of bronchial vessels due to elevated pulmonary pressure
74
Q

Give 3 physical signs of Mitral stenosis:

A
  • Prominent ‘a’ wave in jugular venous pulsations
    • Signs of Right sided heart failure

Mitral Facies - pinkish-purple patches on cheeks due to diminished cardiac output in severe MS

DIASTOLIC MURMUR

75
Q

What investigations would you carry out for Mitral Stenosis?

A
  • ECHO - Gold standard
    • Cxr - LA enlargement + pulmonary congestion

ECG - AF + LA enlargement

76
Q

Outline management for a patient with Mitral Stenosis:

A
  • Serial echocardiography - mild 3-5 years, moderate 1-2 years, severe - yearly
    • Medications - B blockers, CCBS + digoxin, Diuretics
    • Percutaneous mitral balloon valvotomy if patient would benefit - i.e. asymptomatic with moderate/ sever MS and a pliable valve
    • IE prophylaxis
      Mitral valve replacement if symptomatic with NYHA class 3 or 4 symptoms

Phase 2a (13 decks)

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