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Finals PACES > Cardio > Flashcards

Cardio Flashcards

1
Q

Bisferiens pulse

A

Mixed AS/AR

A biphasic pulse on the wrist which is abnormal

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2
Q

Poor dentition

A

Risk factor of IE

Remember to ask for urine dipstick and ophthalmoscopy at end

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3
Q

Cannon A waves (JVP)

A

Arrythmias

Complete heart block, VEBs and VT

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4
Q

Giant V waves (JVP)

A

Tricuspid regurg

look for ear-wiggling, feel for pulsatile hepatomegaly

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5
Q

Carvallo’s sign

A

able to hear tricupsid regurg louder on inspiration at LLSE

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6
Q

Central cyanosis

A

Hypoxic lung disease
Right-to-left cardiac shunt ==> cyanotic congenital heart disease OR eisenmenger’s syndrome
Methaemoglobinaemia ==> drugs OR toxins

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7
Q

Differentiating between AF and VEBs

A

On exercise, VEBs disappears whilst AF doesn’t

Or use ECG

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8
Q

Causes of AF

A 
IHD
Rheumatic HD
Thyrotoxicosis
Pneumonia
PE
Alcohol
Valvular disease
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9
Q

JVP (vs carotid)

A

Double pulsation
Non-palpable
Obliterated when pressure applied to base
Height decreases with inspiration (in restrictive disease opposite occurs = Kussmaul sign)
Rises with hepatojugular reflex

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10
Q

Kussmaul sign causes

A

Restrictive disease

Tamponade, constrictive pericarditis and restrictive cardiomyopathy

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11
Q

Pulsus paradoxus

A

Peripheral pulse disappears with inspiration as BP falls (this is physiological) but this is exaggerated
Causes: restrictive disease = Tamponade, constrictive pericarditis and restrictive cardiomyopathy and severe asthma/COPD
NB cardiac tamponade also have Beck’s triad (hypotension, raised JVP adn muffled heart sounds)

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12
Q

Non-palpable apex beat

A

Remember to check for dextrocardia

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13
Q

LHF on X-Ray ABCDE

A 
alveolar oedema
kerley B lines
cardiomegaly
upper lobe venous diversion
plerual effusion
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14
Q

Causes of pericarditis

A 
Viral (coxsackie)
Bacterial/fungal
immediate post MI
Dressler's (2-10 weeks post)
SLE/RA/scleroderma
Uraemia
Malignancy
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15
Q

Causes of heart failure

A

Can be split into acute and chronic

  1. Pump failure: IHD (acute); cardiomyopathy; constrictive pericarditis; arrhthmia
  2. Excessive preload: regurg valvular disease (MR, AR); fluid overload (e.g. renal failure, IV fluids; acute)
  3. Excessive afterload: AS, HTN
  4. High output failure (all acute): anaemia; pregnancy; metabolic (hyperthyroidism, Paget’s)
  5. Isolated RHF: cor pulmonale, primary pulmonary HTN
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16
Q

Mitral stenosis features

A 
Most common cause = RHD
Mid-diastolic
Opening snap
Tapping apex
Loud 1st heart sound
P mitrale (bifid P wave)
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17
Q

Mitral issues (MS, MR)

A

Lead to AF

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18
Q

Mid-diastolic murmur

A

MS
Austin flint (2ndary to AR)
Carey Coombs (active RHD, disappears with it)
Tricupsid stenosis

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19
Q

Rx of mitral stenosis

A

AF Rx and anticoagulation
Diuretics
Can perform percutaneous balloon valvuloplasty

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20
Q

Causes of MR

A 
RHD
IE
Valve prolapse
Papillary muscle rupture (post MI)
Marfan's
SLE
Secondary to LV dilatation
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21
Q

Mitral Valve prolapse (Barlow syndrome)

A

Audible click heard +/- late systolic murmur;

B-B may relieve chest pain if there are symptoms, if severe can have surgery

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22
Q

Pansystolic murmur

A

Aortic stenosis/sclerosis
Tricupsid regurg
VSD

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23
Q

Tricuspid regurg

A

Pulsatile hepatomegaly
Giant V waves on JVP
Ear wiggling
Carvallo’s sign can help

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24
Q

Rx of MR

A

AF Rx and anti-coagulation
Diuretics
ACEi (as HTN makes MR worse)
Valve repair is preferred to valve replacement

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25
Q

Causes of AS

A

RHD
Calcification of bicuspid valve
Calcified tricuspid valve (sclerosis = doesn’t radiate and no slow rising pulse)

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26
Q

AS

A

Ejection systolic
Slow rising pulse
Narrow pulse pressure

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27
Q

Ejection systolic

A

Sclerosis
HOCM
Pulmonary stenosis
MR

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28
Q

Rx for AS

A

Treat HTN with ACEi / CCB

If severe + LV impairment can undergo CABG or TAVI

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29
Q

Symptoms of AS

A

Increasing order of severity:
SOB
Angina
Syncope/presyncope

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30
Q

Aortic Regurg causes

A 
RHD
IE
HTN
Aortic dissection
Marfan's
RA
Ank spond
Syphilis (luetic heart disease)
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31
Q

Early diastolic murmur

A

AR
Pulmonary regurg
Graham steele (PR 2ndary to pulmonary HTN)

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32
Q

AR features

A 
Early diastolic
Corrigan
Quinke
De Musset
Duroziez
Traube
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33
Q

RX for AR

A

Diurectics and vasodilators

34
Q

Corrigan

A

Exaggerated carotid pulse

35
Q

Quinke

A

Nailbed pulsation

36
Q

De Musset

A

Head nodding

37
Q

Duroziez

A

Diastolic femoral murmur

38
Q

Traube

A

Pistol shot femorals

39
Q

Indications for bioprosthetics

A

Doesn’t last as long, but don’t need to be on warfarin so:
Elderly (valve will outlast them as 15 years life)
Ppl cannot take warfarin (e.g. women of child bearing age)
Patient choice

40
Q

Inferior view

A

RCA

II, III, aVF

41
Q

Anterolateral

A

L circumflex

I, aVL, V5-6

42
Q

Anteroseptal

A

LAD

V2-4

43
Q

Anterior

A

Left main stem

V2-6

44
Q

Posterior

A

RCA

V1, V2, V3 (reflected) would add extra leads in back to visualise

45
Q

Right axis deviation (>90) causes

A 
Anterolateral MI
RVH, PE
Left posterior hemiblock
WPW
ASD secundum
46
Q

Left axis deviation (

A 
Inferior MI
LVH
Left anterior hemiblock
WPW
ASD primum
47
Q

Absent P waves

A

AF, SAN block, nodal block

48
Q

P mitrale

A

bifid P waves = LA hypertrophy

MS, HTN, AS, MR

49
Q

P pulmonale

A

Peaked P waves = RA hypertrophy

Pulmonary HTN, COPD

50
Q

Depressed ST segment

A

Ischaemia (flat ST)

Digoxin (down sloping ST)

51
Q

Long QTc (380-420ms=normal)

A

Derived from QT/SQRT(r-r) = Bazett’s formula
TIIMME:
Toxins - macrolides, amiodarone
Inherited - Romano-ward, Jervell, Brugada
Ischaemia
Myocarditis
Mitral valve prolapse
Electrolytes: hypOmagnesia, kalaemia, calcaemia, thermia

52
Q

U waves

A

Occurs after T waves and seen in hypOkalaemia (flattened T wave usually)

53
Q

J waves

A

Occurs between QRS and ST segment, from hypothermia, hypercalcaemia, SAH

54
Q

Bifascicular block

A

RBBB + left axis deviation, as there is also a left anterior hemiblock

55
Q

Trifascicular block

A

RBBB + 1st degree AV clock

Need pacemaker as unlike 1st degree heart block bundle of His doesn’t create escape rhythm

56
Q

LVH on ECG

A

S in V1 + R in V6 >35mm
LAD
May see T wave inversion in II, aVL, V5 - 6

57
Q

Brugada syndrome

A

RBBB and coved ST elevation in V1-3

see images

58
Q

Hyperkalaemia ECG

A

Tall tented T waves
Wide QRS
Absent P waves
Bradycardia

59
Q

Hypokalaemia ECG

A

Small T waves
ST depression
Prolonged QT interval
Prominent U waves

60
Q

VT causes

A 
I'M QVICK (as tachy)
Infarction
Myocarditis
QT interval prolonged
Valve abnormality
Iatrogenic (digoxin)
Cardiomyopathy (dilated)
K (hypo), magnesium, O2 hypo as well and acidosis
61
Q

CHA2DS2VAS

A 
Congestive cardiac failure
HTN
Age > or equal 75
DM
Stroke or TIA
Vascular disease
Age 65-74
Sex female
Score 0 = aspirin 300mg
1 or greater = warfarin (in AF may also use NOAC (e.g. apixiban/dabigatran) if C/I to warfarin)
62
Q

Pathological Q waves

A

Indicated full thickness STEMI
If not present then subendocardial infarction
NB new onset LBBB also indicates STEMI

63
Q

MI complications

A

Death Passing PRAED St
Death - VF, LVF, CVA
Pump failure
Pericarditis (Rx NSAID and echo to exclude effusion)
Rupture (myocalacia cordis –> cardiac tamponade/mitral regurg/septal rupture
Arrhythmias
Aneurysm (ventricular - shows persistent ST elevation and should anticoagulate and consider excision)
Embolism (LV mural thrombus)
Dressler’s syndrome (NSAID or steroids if severe)

64
Q

Pathophysiology of HF

A 
Reduced CO initially → compensation
 Starling effect dilates heart to enhance contractility
 Remodelling → hypertrophy
 RAS and ANP/BNP release
 Sympathetic activation

Progressive ↓ in CO → decompensation
 Progressive dilatation → impaired contractility +
functional valve regurgitation
 Hypertrophy → relative myocardial ischaemia
 RAS activation → Na+ and fluid retention → ↑ venous
pressure → oedema
 Sympathetic excess → ↑ afterload → ↓ CO

65
Q

HF can be split into low output (reduced CO) and high output (increased needs)

A 
Low output:
Pump failure (MI, arrhythmias)
Excessive preload (AR, MR, fluid overload)
Excessive afterload (AS, HTN, HOCM)

High output: RVF then LVF
Anaemia, AVM
Thyrotoxicosis, Thiamine deficiency (beri beri)
Pregnancy, Paget’s

66
Q

CCF: framingham criteria

2 majors or 1 major and 2 minor

A 
Major:
PND
\+ve abdominojugular reflux
neck vein distenstion
S3
Basal creps
Cardiomegaly
Acute pulmonary oedema
Wt loss >4.5kg in 5 days 2ndary to Rx
Minor:
Bilateral ankle oedema
SOB O/E
HR >120bpm
nocturnal cough
Hepatomegaly
Pleural effusion
30% vital capacity
67
Q

Mx of CCF

A

ACEi, B-B (carvedilol) + loop diurectic (frusemide)

B-B go slow and start low; not to be used in acute HF

68
Q

HTN staging

A

Stage 1: >140/90
Stage 2: >160/100
Stage 3 / severe: >180/110
Malignant: severe + papilloedema and/or retinal haemorrhage

69
Q

HTN eye (Keith-Wagener) Classification

A
  1. Tortuosity and silver wiring
  2. AV nipping
  3. Flame haemorrhages and cotton wool spots
  4. Papilloedema

 Grades 3 and 4 = malignant hypertension

70
Q

Infective endocarditis Dx

A

Dukes criteria: 2 majors OR 1 major + 3 minors OR 5 minors

Major:
2 +ve blood cultures (take 3 >12 hrs apart)
+ve echo or new murmur

Minor:

  1. predisposition (IVDU or prosthetic)
  2. Fever >38
  3. Emboli (signs e.g. janeway etc)
  4. Immune issues (like GN, Roth spots etc)
  5. +ve blood culture not meeting major criteria
71
Q

Causes of IE

A

Culture +ve:
S. viridans; S aureus; S epidermis; pseudomonas

Culture -ve: HACEK
Haemophilus, Actinobacilus, Cardiobacterium,
Eikenella, Kingella

Non-infective:
SLE

72
Q

Rx IE

A 
Empiric:
Acute severe - IV fluclox + gent
Subacute: IV benpen + gent
Staph (IVDU): IV fluclox + rifampicin
Fungi: IV flucytosine + fluconazole PO (amphotericin if flucy resistant or Aspergillus)
73
Q

Rheumatic fever patho

A

Ab cross-reactivity following Group A β-haemolytic strep. (pyogenes) –> T2 hypersensitivity reaction (molecular mimicry of M2 protein)
Aschoff bodies and Anitschkow myocytes seen

On Ix: ASOT or strep Ag test done

74
Q

Rheumatic fever Dx

A 
Jones Criteria: evidence of GAS infxn + 2 major OR 1 major + 2 minor
Major = PASES
 Pancarditis
 Arthritis (most common)
 Subcutaneous nodules
 Erythema marginatum
 Sydenham’s chorea
Minor:
 Fever
 ↑ESR or ↑CRP
 Arthralgia (not if arthritis is major)
 Prolonged PR interval (not if carditis is a major)
 Prev rheumatic fever
75
Q

Rheumatic fever Rx

A

 Bed rest until CRP normal for 2wks
 Benpen 0.6-1.2mg IM for 10 days
 Analgesia for carditis/arthritis: aspirin / NSAIDs
 Add oral pred if: CCF, cardiomegaly, 3rd degree block
 Chorea: Haldol or diazepam

Secondary Prophylaxis to prevent recurrence of Pen V 250mg/12h PO for:
 Carditis + valve disease: until 40yrs old
 Carditis w/o valve disease: 10yrs
 No carditis: 5yrs

76
Q

HOCM signs

A

Jerky pulse
Double apex beat
Harsh ejection systolic murmur at LLSE
S4

77
Q

Atrial myxoma

A

May be familial: e.g. Carney Complex
 Cardiac and cutaneous myxoma, skin
pigmentation, endocrinopathy (e.g. Cushing’s)

90% in left atrium (fossa ovalis)

Features:
 Clubbing, fever, ↓wt., ↑ESR
 Signs similar to MS (MDM, systemic emboli, AF)
Ix: echo
Rx: excision
78
Q

Restrictive cardiomyopathy causes

A 
miSSHAPEN
Sarcoid
Systemic sclerosis
Haemochromatosis
Amyloidosis
Primary: hereditary
Eosinophilia (loffler's eosinophilic endocarditis)
Neoplasia (carcinoid --> TR and PS)
79
Q

Dilated cardiomyopathy causes

A 
DILATE
Dystrophy
Infection (from myocarditis)
Late pregnancy (peri/post partum)
Autoimmune (SLE)
Toxins (EtOH, doxorubicin, cyclophosphamide)
Endocrine (thyrotoxicosis)
80
Q

Dilated cardiomyopathy signs

A 
 JVP ↑↑
 Displaced apex
 S3 gallop
 ↓BP
 MR/TR
81
Q

Marfan’s

A 
Slit-lamp examination: ectopia lentis
Histology: cystic medial necrosis
Cardiac signs:
 Aortic aneurysm and dissection
 Aortic root dilatation → regurgitation
 MV prolapse ± regurgitation
82
Q

Indication for CABG

A

 L main stem disease
 Triple vessel disease
 Refractory angina
 Unsuccessful angioplasty

Finals PACES (12 decks)

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