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mrcp paces > Cardiac > Flashcards

Cardiac Flashcards

(48 cards)

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1
Q

Indications for aortic root replacement in Marfans

A

Aortic root diameter >50mm (or 45mm if FHx of dissection)

Rate of dilatation >3mm/yr

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2
Q

Causes of AF

A

Age related

Cardiac related
IHD and MI
Sick sinus syndrome 
Valvular - MR/MS
Dilated LA
Rheumatic heart disease
Htn
Cardiomyopathy
Driven
Sepsis
Alcohol 
Thyrotoxicosis
Drugs - stimulants
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3
Q

Mx of AF

A

Assess for anticoagulation

Rate vs rhythm control

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4
Q

What does a fourth heart sound indicate

A

Atria contracting against a stiff LV - pressure overload

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5
Q

Follow up ix for coarctation repair

A

MRI, not echo

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6
Q

Complications of mitral prolapse

A

Progression to MR
Infective endocarditis
Arrhythmias

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7
Q

Indications for surgical repair of mitral regurg

A

Valve repair preferred to valve replacement
Repair of valve = valvuloplasty
Repair of ring - annuloplasty

Indications:
Increasing LV dilatation (volume overload) - LVED dimension >45mm -> heart failure
Acute MR post CT rupture or infective endocarditis
Heart unable to tolerate acute MR - decompensates

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8
Q

Mx of aortic stenosis

A

Medical mx

TAVI

Valvotomy if young adult or child (delays need for valve replacement)

Valve replacement - bioprothetic or metallic

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9
Q

Four classic peripheral signs of infective endocarditis

A 
Janeway lesions (non tender macules, blanching, typically on palms)
Osler nodes - raised tender lesions on finger pulps
Splinter haemorrhages
Petechiae
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10
Q

What does a third heart sound indicate

A

Rapid ventricular filling in a dilated ventricle - volume overload

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11
Q

Eisenmengers syndrome
Def
Causes

A

Longstanding L->R shunt causing pul htn and reversal of shunt direction

Large VSD - Fallots tetralogy
Primary pul htn
ASD
PDA (normal splitting of S2, widening on inspiration due to delay in P2; only lower limbs cyanosed)

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12
Q

Indications for mitral valve replacement for mitral stenosis

A

Symptoms limiting normal activity - heart failure
Pulmonary oedema
Recurrent emboli
Pulmonary oedema in pregnancy (emergency transcatheter valvuloplasty)

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13
Q

Main presentation of coarctation

A

Htn

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14
Q

Features of Tetralogy of Fallot

A

Overriding aorta
VSD
Pulmonary stenosis
RVH

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15
Q

Causes of pul stenosis

A

By level:
Supra-valvular - Tetralogy of Fallot
Valvular (commonest)
Sub-valvular - Tetralogy of Fallot, congenital Rubella syndrome

Congenital heart disease - Tetralogy of Fallot (treated with shunt rather than correction or post surgical correction)

Infection - Rubella, infective endocarditis, rheumatic fever

Turners, Downs and Noonan’s syndromes

Carcinoid syndrome

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16
Q

Causes of mitral prolapse

A

Primary myxomatous degeneration (commonest)
Connective tissue disease - Marfans, Ehlers Danlos, Osteogenesis imperfecta
PKD
Cardiomyopathy

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17
Q

Causes of tricuspid regurgitation

A

Commonest - RV dilatation / failure due to:
Left sided heart disease - MV disease
Cor pulmonale (RHF due to lung resistance) - Primary pul htn
RV infarction

Causes of primary TR:
Infective endocarditis (esp IVDU)
Congenital heart disease
Carcinoid syndrome

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18
Q

Causes of mitral incompetence / regurg

A

Primary - Valve degeneration
Functional regurgitation - widening of LA/LV - cardiomyopathy, htn
Progression of mitral valve prolapse
Papillary muscle dysfunction - ischaemia, infarction, degeneration
Infective endocarditis

Iatrogenic Post valvotomy for mitral stenosis

Connective tissue disorders - SLE, RA, ank spond

Congenital - Marfans, ED, pseudoxanthoma elasticum

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19
Q

Causes of a raised JVP

A

CCF - ischaemic, valvular, hypertensive, cardiomyopathy
Cor pulmonale (RHF due to lung resistance)
Pul htn
Constrictive pericarditis
Pericardial effusion

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20
Q

Complications that can arise following coarctation repair

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A

Recurrence
Aortic valve degeneration (tends to be bicuspid)
Aneurysm at the site of repair (+/- infection +/- rupture)
Aortic dissection in later life

21
Q

What are the causes of acute MR (3)

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A

Trauma, MI, endocarditis

22
Q

Causes of aortic stenosis

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A

Degenerative calcification
Rheumatic heart disease
Bicuspid aortic valve

23
Q

Indications for aortic valve replacement

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A

Aortic stenosis
Symptomatic (angina, syncope, dyspnoea) in the presence of normal LV function

Aortic regurg - LV dysfunction (EF <50%), widening of LV (LV dimension >50mm in systole, LVED dimension >70mm)

Acutely in infective endocarditis

Both can be combined with coronary artery grafting

24
Q

Causes of aortic incompetence

Study These Flashcards
A

Infection - Rheumatic fever and infective endocarditis
Long standing htn -> aortic dilatation, aneurysm and dissection
Marfans
Ankylosing spondylitis

25
Indications for valvotomy in mitral stenosis (valve widening)
Mobile valve | Absence of incompetence (no MR)
26
Cardiac features of Noonan syndrome
``` Septal defects - Atrial and ventricular Hypertrophic cardiomyopathy Pulmonary stenosis (commonest) ```
27
Indications for treatment of pulmonary stenosis
Pressure gradient across valve >64mmHg or >4m/s Valvular area <1cm2 Signs of RHF Balloon valvuloplasty Valve replacement
28
Red flags in the presence of a PDA Ix Indications for intervention
Collapsing pulse RV heave (pressure overload) - pul htn Cyanosis = pul htn Evidence of LV failure - due to Eisenemgers Systolic / continuous murmur loudest in pulmonary region in expiration, radiating to the back Ix: Cardiac MR/CT Echo R heart catheterisation Indications for intervention: Raised pulmonary artery pressure - pul htn LV volume overload PA pressure or vascular resistance >2/3 systemic vascular pressure / resistance Follow up only at 6mths if no adverse features, or regularly if persistent post intervention
29
Causes of aortic regurg
``` Primary myxomatous disease Rheumatic heart disease Htn Ankylosing spondylitis CTD - SLE, Osteogenesis imperfecta, Marfans, Ehlers Danlos ``` Acute AR - infective endocarditis, trauma, dissection
30
Ix for aortic stenosis
Echo Exercise testing Angiography for CAD
31
Causes of secondary htn
Renal - Renal artery stenosis, diabetic nephropathy, GN, PKD Phaeochromocytoma Endo - Hyperthyroidism, Cushings, Conns, Acromegaly Cardiovascular - coarctation Drugs - steroids, OCP
32
Changes seen on hypertensive retinopathy
Gr1 - Silver wiring Gr2 - AV nipping Gr3 - Flame haemorrhages, cotton wool exudates, Microaneurysms Gr4 - Papilloedema
33
Mx of malignant htn
Hypertensive emergency - BP >180/110 and end organ damage Hypertensive urgency - BP >180/110, no end organ damage End organ damage - stroke, encephalopathy, renal impairment, ACS, acute LVF, dissection Hypertensive emergency - IV labetalol / GTN in ITU/HDU setting Hypertensive urgency - oral agents - CCB, ACEi, diuretics Correct BP over 24hrs to <160 systolic
34
Causes of a widely split S2
Delay in P2 - pul stenosis, RBBB, deep inspiration | Early A2 - MR, VSD, causing LV to empty quickly
35
Cause of a split S2 not varying with inspiration (fixed split)
ASD - no pressure differential between the atria, so no change wit respiration pattern
36
Causes of reversed split S2
Early P2 closure - pul htn, Eisenmengers | Late A2 - LBBB, aortic stenosis
37
Causes of Eisenmenger's syndrome
VSD (commonest) ASD PDA
38
Indications for closure of a VSD
Significant L->R shunt Pt undergoing cardiac surgery for another indication Endocarditis Aortic regurgitation with prolapse of valve leaflet through VSD
39
Complications of Eisenmenger's syndrome
``` Significant shunting of blood (R->L) with systemic:pulm ratio >2 Cyanosis and hyperaemia Paradoxical embolus RV failure Infective endocarditis Haemoptysis LV dysfunction Acute septal rupture post MI ```
40
Causes of congenital cyanotic heart disease
``` Tetralogy of Fallot Transposition of the great arteries Pulmonary atresia Pulmonary stenosis Ebsteins anomaly Tricuspid atresia Eisenmengers ```
41
Complications post surgery for correction of Tetralogy of Fallot
Pulmonary regurg Infective endocarditis Coagulopathy Polycythaemia (due to chronic cyanosis)
42
Causes of diastolic heart failure | Ix
Constrictive disease - constrictive pericarditis, restrictive cardiomyopathy Ix: Echo, CXR, cardiac CT, cardiac MR, cardiac catheterisation
43
Causes of a restrictive cardiomyopathy
Amyloidosis (commonest) Sarcoidosis Haemachromatosis Scleroderma Endocardial or pericardial fibrosis Radiotherapy Drugs - hydroxychloroquine Idiopathic
44
Causes of constrictive pericarditis Features Ix
TB Connective tissue disease - RA, scleroderma, SLE Trauma / post-surgery Radiotherapy Evidence of bi-atrial dilatation / right and left heart failures Ix - cardiac catheterisation - left and right atrial diastolic pressures are raised
45
Diagnosis of infective endocarditis
Dukes criteria 2 major and 5 minor criteria Either both major, 1 major and 3 minor, or all 5 minor Major: Blood culture - typical bug in 2 samples Echo - vegetation or abscess Minor: Fever >38 Risk factors / predisposition Vasculitic signs - Osler nodes, haematuria, petechiae, raised ESR/CRP Embolic signs - Roth spots, splinter haemorrhages, Janeway lesions Abnormal echo or blood culture not meeting major criteria
46
Ddx of midline sternotomy
CABG Open valve replacement Open repair of congenital heart disease Heart +/- lung transplant
47
Symptoms of aortic stenosis is worsening order
ASD | Angina, syncope, dyspnoea
48
Complications of aortic valve replacement
Surgical complications - infection, bleeding, pain, scarring, failure, recurrence Specific - valve regurgitation / leak, infective endocarditis, microangiopathic haemolytic anaemia

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