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CSB335 > Cardiac diseases > Flashcards

Cardiac diseases Flashcards

1
Q

Cardiac tamponade is classified as either ____ or ____.

A

Traumatic or non-traumatic

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2
Q

How much serous fluid is contained in a normal pericardium?

A

35mL

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3
Q

True or false: the pericardium can readily stretch

A

False

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4
Q

What is the definition of cardiac tamponade?

A

Gradual or sudden accumulations of >100-200mLs of fluid that increases pressure and compresses the heart, preventing diastolic filling of atria and ventricles

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5
Q

What are the S&S of late stage cardiac tamponade?

A 
Shock
Narrowed pulse pressure
Pulsus paradoxus (peripheral pulse becomes weak or disappears on inhalation - can be difficult to detect with hypotensive pts)
Beck's triad (increased jugular venous pressure [JVP], hypotension, and muffled heart sounds)
Usually clear lung fields 
Signs of fever (pericarditis)
Pleural effusions 
Peripheral cyanosis (often upper body)
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6
Q

True or false: increased JVP may not be present in significant hypovolaemia

A

True

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7
Q

Does absence of hypotension rule out cardiac tamponade?

A

No

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8
Q

True or false: early cardiac tamponade is often asymptomatic

A

True

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9
Q

What are the ddx for cardiac tamponade?

A 
Massive pulmonary embolism
Tension pneumothorax
Superior vena cava obstruction
Chronic constrictive pericarditis
Air embolism
Right ventricular infarct
Severe CCF/cardiogenic shock
Extrapericardial compression (haematoma, tumour)
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10
Q

Describe the mx of cardiac tamponade

A

Secure airway
High flow O2
Consider fluids if hypotensive (no tx delay)

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11
Q

What is pericarditis?

A

Inflammation of the pericardium

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12
Q

What are the causes of pericarditis?

A 
Idiopathic (probably viral)
Viral (mumps, influenza, HIV)
Rheumatoid arthritis
Radiation injury
Trauma
AMI
Hypersensitivity to drugs
Renal failure, uraemia, myoxedema
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13
Q

What are the S&S of pericarditis?

A

Hx of recent viral illness
Retrosternal pain oninspiration, movement &
supine posture
Pain improves sitting and leaning forward
Not dyspnoaeic (may have shallow breathing
because of pain)
Sinus tachycardia is common

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14
Q

What are common ECG changes in pericarditis?

A
  • ST elevation in inferior and anterior leads with a concave upwards (saddle shaped) appearance in first stage of acute pericarditis
  • As this resolves widespread T wave inversion is often seen
  • PR segment depression
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15
Q

What is constrictive pericarditis?

A

Thickening, fibrosis and calcification (especially with
tuberculous) of the pericardium, encasing the heart in a solid, non-compliant envelope that impairs diastolic
filling

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16
Q

What may appear the same as constrictive pericarditis?

A

Pleural effusion as a result of pericarditis that leads to cardiac tamponade

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17
Q

What are the causes of constrictive pericarditis?

A

Any pericardial injury or inflammation:

  • Cardiac surgery (radiation therapy & idiopathic causes are most common)
  • Tuberculous constriction (rare in developed countries, but remains significant in underdeveloped countries - consider this in relation to increasing numbers of refugees in Australia from underdeveloped countries and an increase in tuberculosis in developed countries)
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18
Q

True or false: years may elapse between the insult and the clinical manifestation of constrictive pericarditis

A

True

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19
Q

What is the definition of an aneurysm?

A

A sac formed by the localised dilation of the wall of an artery, vein, or the heart.

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20
Q

What is usually the cause of ventricular aneurysm?

A

Poor ventricular remodelling after a large transmural infarction

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21
Q

List the various types and locations of aneurysms

A

Berry aneurysm - Circle of Willis
Micro aneurysm - Intracerebral arteries
Ventricular aneurysm - Myocardial ventricle
Thoracic Aneurysm - Root of aorta (ascending/arch of
aorta)
Pseudoaneurysm - result of ventricular aneurysm (these have narrow necks and are not lined with endocardium)
Abdominal aneurysm (most common) - Usually lower abdomen
Visceral Aneurysm - Splenic, hepatic, superior
mesenteric, renal, popliteal, femoral, upper limb & carotid

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22
Q

What are the risk factors for abdominal aortic aneurysm?

A 
Family history 
Male
Age > 55
Hypertension
Atherosclerosis
Peripheral vascular disease
Hyperlipidaemia
Smoking 
Diabetes
Connective tissue disorders
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23
Q

The risk factors for abdominal aortic aneurysm are almost identical to those for what two major disease groups?

A

Ichaemic heart disease and cerebrovascular disease

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24
Q

What is the pathophysiology behind aneurysms?

A

It is now thought that a defect in connective
tissue metabolism may be the primary cause of
aneurysms. Dilation occurs with loss of elasticity, especially in the setting of hypertension, and there is less ability to withstand additional wall pressure.

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25
Q

What principle is important to remember with regards to aneurysms and the Laplace law?

A

The larger the aneurysm becomes the more rapidly it expands and the weaker the vessel becomes

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26
Q

What is the Laplace law?

Note: slide note claims don’t need to know

A

Wall tension = (Pressure x radius) / tensile force

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27
Q

What are some S&S of a ruptured AAA?

A

Abdominal, flank, back or leg pain
Syncope
Hypovolaemic shock
PEA
Occasional neurological defect (due to spinal cord ischaemia)
Classical presentation: pulsatile mass, hypotension, and flank pain (though this is found in <50% pts)

Other presentations: 
Pain 
Absent or unequal distal pulses
Periumbilical ecchymosis (Cullen's sign) or flank ecchymosis (Grey Turner's sign)
Scrotal haematoma
Abdominal tenderness
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28
Q

In what way are AAA are likely to dissect, and how does this complicate dx?

A

Likely to dissect across vessel sinuses feeding other organs, producing signs of ischaemia in these organs and confounding the clinical picture

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29
Q

What is the most common site for aortic aneurysm?

A

Between the renal and iliac arteries

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30
Q

True or false: deep palpation is useful and recommended when suspecting AAA

A

False

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31
Q

What are the mx goals for all types of anerysms?

A
  • Maintain cerebral perfusion at all times
  • Contain the propagating haematoma by limiting arterial pressure
  • Arrange for potential rapid surgical repair (feasible in many patients)
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32
Q

Is a ruptured aneurysm controlled or uncontrolled haemorrhage?

A

Uncontrolled

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33
Q

Does the minimal fluid resuscitation principle apply to ruptured aneurysms?

A

Yes

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34
Q

What would indicate fluid therapy for a pt with a ruptured aneurysm?

A

Inadequate cerebral perfusion

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35
Q

What are the goals of fluid therapy (if initiated) in AAA?

A

Systolic BP ~80mmHg

HR ~60-80bpm

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36
Q

Describe the mx points for AAA

A

Bilateral large bore IV access
12 lead monitoring
High flow O2
Rapid tx

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37
Q

Should pain relief be withheld in AAA?

A

No

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38
Q

Mortality for AAA is over ____.

A

90%

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39
Q

For which pts is high suspicion of AAA warranted?

A

Patients over 65 who present with abdominal or back

pain and/or unexplained hypotension

40
Q

What is the range of high but normal hypertension?

A

120-139/80-89

41
Q

What is the range for grade 1 hypertension?

A

140-159/90-99

42
Q

What is the range for grade 2 hypertension?

A

160-179/100-109

43
Q

What is the range for grade 3 hypertension?

A

> 180/>110

44
Q

Hypertension is also listed as what values?

A

SBP >140-150mmHg

DBP >90mmHg

45
Q

What are the predisposing factors for hypertension?

A 
Age >60 
Sex (men and postmenopausal women)
Family history of cardiovascular disease
Smoking
High cholesterol diet
Co-existing disorders such as diabetes, 
obesity and hyperlipidaemia
High intake of alcohol
Sedentary lifestyle
46
Q

What is hypertensive encephalopathy?

A

Cerebral dysfunction with diffuse/transient disease or damage of the brain

47
Q

What is characteristic of hypertensive encephalopathy?

A

Disorientatiation, excitability, and abnormal behaviour reversible if BP can be reduced

48
Q

What is the definition of a hypertensive emergency?

A

Severe increase in BP that is complicated by evidence of end-organ dysfunction and requiring immediate BP reduction

49
Q

What are some examples of hypertensive emergencies?

A 
Hypertensive encephalopathy
Intracranial hemorrhage
Unstable angina pectoris
AMI
Acute LVF
Dissecting aneurysm
Eclampsia
Autonomic dysreflexia
50
Q

What is autonomic dysreflexia?

A

A hypertensive emergency - triggering sensory stimulus (bladder/bowel/skin/#) causes excessive reflex activity in the ANS (increased sympathetic activity)

51
Q

What are the S&S of autonomic dysreflexia?

A 
Hypertension
Headache
Bradycardia 
Flushing 
Blotching
Sweating of the skin above level of injury 
Goose bumps 
Chills without fever 
SOB 
Anxiety
52
Q

Describe the mx of autonomic dysreflexia

A

Remove the cause
GTN
Morphine (if unresponsive to GTN)

53
Q

What is a hypertensive crisis?

A

Severe increase in BP without evidence of progressive target organ dysfunction

54
Q

What are some S&S

of hypertensive crisis?

A 
Upper levels of stage 3 hypertension
Papilloedema (inflammation of the optic disk)
Headache
SOB
Pedal oedema
55
Q

What are some S&S of hypertensive emergencies?

A 
BP usually >220/140mmHg
Headache
Confusion
Somnolence
Stupor
Visual loss
Seizures
Focal deficits
Coma
CHF
Oliguria
N + V
56
Q

Describe the mx points for hypertensive crisis

A

Rx target organ dysfunction

Progressive BP reduction (cannot be done in prehospital setting)

57
Q

What is the exception for progressive BP reduction rx for hypertensive crisis?

A

Ischaemic stroke

58
Q

What is the definition of pre-eclampsia?

Note: not the QAS definition

A

Hypertension in pregnancy beyond 20 weeks gestation and proteinuria

59
Q

What are the risk factors for pre-eclampsia?

A 
Gestational hypertension
Family hx of pre-eclampsia
Increased BMI
Renal disease
Diabetes mellitus
No prenatal care
Hypercoaguable states
60
Q

What is the mx for pre-eclampsia?

A 
IV fluid therapy
Magnesium sulphate (CCP - works as a muscle relaxant without affecting the baby - if magnesium sulphate is unavailable use midazolam as second line treatment)
Maintain quiet environment
Minimise body movement
Position comfortably
61
Q

What is the QAS definition of pre-eclampsia?

A 
Systolic equal to or above 140 and/or diastolic equal to or above 90 PLUS one or more of:
Neurological problems
Proteinuria
Renal insufficiency
Haematological disturbances
Foetal growth restriction
62
Q

What two things are encompassed by venous thromboembolism (VTE)?

A

Pulmonary embolism (PE) and deep venous thrombosis (DVT)

63
Q

Explain the pathophysiology behind VTE encompassing two concepts

A

A DVT is a thrombus that forms (usually) in the leg -> a piece breaks off and becomes an embolus -> if it lodges in the lung it is a PE

64
Q

PE survivors are susceptible to the development of what two conditions?

A

Chronic pulmonary hypertension and chronic venous insufficiency

65
Q

What may cause PE to reoccur?

A

Anticoagulation therapy

66
Q

Describe the aetiology (risk factors) of PE

A

Underlying hypercoaguable state (specific condition may not be identifiable; these patients have a clinically silent tendency towards thrombosis)
Prolonged immobilisation
Oral contraceptives
Pregnancy
Hormone replacement therapy (HRT)
Medicial illnesses (cancer, CHF, COPD)
Pts undergoing hip/knee/gynaecological cancer/major trauma/craniotomy surgery are at high risk of secondary PE

67
Q

True or false: PE cannot occur in absence of trauma or surgery

A

False

68
Q

True or false: PE may occur up to a month post surgery

A

True

69
Q

True or false: risk of PE in pregnancy is highest in the third trimester

A

True

70
Q

Why is pregnancy a significant risk factor for PE?

A

Pregnancy causes hypercoagulability

71
Q

What are the S&S for PE?

A

Non specific dysponea, tachypnoea, chest pain
or tachycardia
May present as pain free with dysponea, syncope or cyanosis

72
Q

PE should be expected in pts presenting with…

A

Hypotension with evidence of predisposing factors and

clinical findings of acute RVF

73
Q

What is the mx goal for PE?

A

Prevent thrombus propagation and embolisation

74
Q

Describe the mx for PE

A 
High flow O2
Pain relief 
Haemodynamic support
Emotional support
Positioning 
IV access
Monitor 12 lead ECG and SPO2
Rapid tx
75
Q

Sudden obstruction in the pulmonary circulation puts

an extra load what part of the heart?

A

RV

76
Q

True or false: a small emboli may not produce any ECG changes

A

True

77
Q

What are some typical ECG changes in PE?

Note: “this is a guide, don’t memorise it

A

Peaked P waves leads II, III, aVF
S wave in lead I
Q wave & T wave inversion in lead III
T wave inversion/flattened in R chest leads
S wave in L chest leads

78
Q

What is the definition of stenosis?

A

Heart valve does not open properly, obstructing the flow of blood

79
Q

What is the definition of valve regurgitation?

A

The valve does not close properly, allowing blood to leak backwards

80
Q

What are some S&S of mild heart disease?

A

Exercise causes palpitations/breathlessness/tiredness/SOB/lower limb oedema

81
Q

What are some generalised findings consistent with heart valve disease?

A 
Respiratory distress/CHF/APO
Tachycardia &amp; palpitations
Peripheral vasoconstriction
Peripheral and facial cyanosis
Murmur
JVD
Signs of RHF
82
Q

True or false: aortic stenosis can be congenital

A

True

83
Q

What is the aetiology of aortic stenosis?

A

Congenital
Calcification of valve
Rheumatic disease when pt is 30-70
Degenerative calcification in pts >70

84
Q

What pt hx findings are consistent with aortic stenosis?

A 
Palpitations
Fatigue
Visual disturbances 
Decreased physical activity with increased dyspnoea
Angina 
GTN-induced syncope is higher than normal
Syncope during exertion
LVF symptoms
85
Q

What are the causes of acute aortic regurgitation?

A 
Rheumatic disease
Infective carditis
Trauma
Valve surgery
Aortic dissection/laceration
86
Q

What are the causes of chronic aortic regurgitation?

A 
Rheumatic disease
Syphilis
Aortitis
Marfan syndrome 
Interventricular defect
Arthritis
Hypertension
Infective endocarditis
87
Q

What are the causes of mitral stenosis?

A 
Rheumatic fever
Congenital mitral stenosis
Systemic lupus erythematosus (SLE)
Rheumatiod arthritis
Bacterial endocarditis
Congenital causes (rare)
88
Q

What are the causes of mitral regurgitation?

A 
Acute rheumatic heart disease
Chordae tendinae rupture and papillary muscle 
degeneration
Myocardial ischemia
Mitral calcification
Left ventricular dilatation
Systemic lupus erythematosus (SLE)
Marfan syndrome
89
Q

What are the differential dx for mitral regurgitation?

A 
Aortic stenosis
CHF
APO
Mitral valve prolapse
MI
Myocarditis
90
Q

What generally causes infective endocarditis?

A

Non-bacterial thrombotic endocarditis resulting from turbulence or trauma to the endothelial surface of the heart. Transient bacteremia leads to seeding of lesions with adherant bacteria, and infective endocarditis develops

91
Q

What hx is consistent with infective endocarditis?

A 
Infective endocarditis is an often missed diagnosis - hx is often vague, highly variable, and may focus on 
primary cardiac effects or secondary embolic 
phenomena.
Fever &amp; chills (most common)
Anorexia 
Weight loss 
Malaise
Headache
Myalgias
Night sweats
SOB
Cough
Joint pain 
Focal neurologic complaints and stroke syndromes (20%)
92
Q

Which valve is commonly involved in IV drug use-related endocarditis?

A

Tricuspid, followed by aortic

93
Q

What is the most common infective organism in IV drug-use related endocarditis?

A

Staphylococcus aureus

94
Q

True or false: prosthetic valve endocarditis usually presents shortly after surgery

A

True

95
Q

True or false: endocarditis does not occur in associated with intravascular devices

A

False

96
Q

Fungal endocarditis is commonly found in what two types of pts?

A

IV drug users and ICU pts who receive broad spectrum antibiotics

CSB335 (12 decks)

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