Cardiac Pathology 2 Flashcards
(145 cards)
1
Q
Retrosternal sharp chest pain, worse when lying flat is indicative of _________
A
Pericarditis
2
Q
What ECG finding is present in pericarditis
A
Widespread ST (saddle-shaped) elevation
3
Q
Treatment for pericarditis
A
Ibuprofen
4
Q
Acute treatment of ACS (2)
A
Aspirin 300mg and clopidogrel 300mg PO
5
Q
VERY HIGH BP and papilloma with a history of HTN is…
A
Malignant hypertension
6
Q
Severe frontal headaches, visual disturbances, confusion, SOB with a history of HTN is…
A
Hypertensive encephalopathy (raised ICP)
7
Q
Respiratory distress, oedema and _____ suggest heart failure
A
Fluid overload
8
Q
Sudden onset tearing chest/back pain is indicative of ____
A
Aortic dissection
9
Q
Thunderclap headache 10/10 pain is indicative of what?
A
Subarachnoid haemorrhage
10
Q
Optimal management of AF with haemodynamic instability?
A
DC cardioversion
11
Q
These (3) features indicate haemodynamic instability
A
Shock
Syncope
Heart failure
12
Q
What is the gold standard investigation for myocarditis
A
Endomyocardial biopsy
13
Q
What is commonly used to diagnose pericarditis
A
ECG
14
Q
What complication of mitral stenosis increases the risk of thromboembolic events
A
Atrial fibrillation
15
Q
If your echo is inconclusive in AORTIC REGURGE what investigation should you perform?
A
Cardiac MRI
16
Q
What would reduce a heart failure (bradyarrhythmia) mortality risk?
A
Permanent pacemaker
17
Q
What sign on ECG may indicate LEFT ATRIAL enlargement
A
P - mitrale
18
Q
Anterior STEMIs cause ST elevation in which leads?
A
V3-V4
19
Q
What blood tests should be done before commencing an ACE inhibitor?
A
U&E, Creatinine, eGFR
20
Q
What 3 conditions are associated with a pansystolic murmur
A
Mitral regurge
Tricuspid regurge
VSD
21
Q
What murmur in mitral regurge
A
Pansystolic murmur
22
Q
What murmur in tricuspid regurgitation
A
Pansystolic
23
Q
What murmur in VSD?
A
Pansystolic murmur
24
Q
What conditions cause flow murmurs in adults (3): A______, T______, P________
A
Anaemia
Thyrotoxicosis
Pagets disease
25
What valve is most commonly affected by IVDUs
Tricuspid
26
When is a carotid endarterectomy indicated?
Carotid artery stenosis 70-99%
27
What rheumatological conditions can cause **mitral stenosis**? S______, R_______
SLE
Rheumatoid arthritis
28
Acute hypertensive emergency has two key features:
1. systolic BP _______ or diastolic BP _____
2. signs of ______
1. >180mmHg or >120mmHg
2. End organ damage
29
Aortic regurge happens when the aortic valve fails to prevent blood from leaking back across the valve during _______ (systole/diastole?)
**Diastole**
30
Acute aortic regurgitation occurs in what 2 main pathologies?
Infective endocarditis
Aortic dissection
31
Chronic aortic regurgitation occurs in what?
Rheumatic heart disease
32
What connective tissue disorders are associated with Aortic regurgitation?
Marfans
Elhers Danlos
33
What is de **Quinckes** sign ?
Nail bed pulsation
34
When can **de Quinckes** occur?
Aortic regurge
35
What is **De Mussets** sign
Head hobbing
36
What is head hobbing an indication of ?
**De Mussets** sign = aortic regurgitation
37
What is **Corrigans Sign**
Dancing carotids
38
What is **Corrigans sign** indicative of?
Aortic regurgitation
39
What is **Mullers sign** ?
Pulsation of the uvula
40
What is pulsation of the uvula indicative of?
Aortic regurgitation
41
What pathology would you find a Waterhammer pulse be evident
Aortic regurgitation
42
An ____________ murmur would be indicative of **aortic regurgitation**
Early diastolic
43
An early diastolic murmur is heard best at the ________ region, leaning _________ and on ________.
Aortic region
Leaning forward
On expiration
44
With an early diastolic murmur (aortic regurgitation) what other sounds may you hear? (2)
Soft S1
Occasional ejection flow murmurs
45
Mitral regurge is best heard as a _________ murmur
Pansystolic
46
A Pansystolic murmur is best heard at the _________ region and radiates to the _________
Mitral region
Radiates to the axilla
47
Aortic regurge can lead to which 2 complications
1. Cardiovascular collapse
2. De Novo acute HF
48
Aortic stenosis presents as a __________ murmur
Ejection systolic
49
An ejection systolic murmur is best heard in the ______ region and radiates to the ________
Aortic region
Radiates to the carotids
50
Pulmonary regurge presents with _________ murmurs
Diastolic murmurs
51
What murmur has a crescendo-decrescendo sound heard best at the RIGHT upper sternal border
Ejection systolic (aortic stenosis)
52
What does an ejection systolic murmur sound like
Crescendo-decrescendo
53
Tricuspid regurge presents as a _________ murmur
Pansystolic murmur @LEFT LOWER STERNAL BORDER
54
Tricuspid stenosis presents as a _________ murmur
Mid-diastolic murmur
55
Mitral stenosis is heard as a _________?
Mid-diastolic murmur with an opening snap
56
Opening snap sound indicates _________ which is caused by ________
Middiastolic murmur
Mitral stenosis
57
There are two valves problems that cause a EJS murmur - what are they?
Aortic stenosis
Pulmonary stenosis
58
What two valve abnormalities cause early diastolic murmur? (2)
Aortic regurge
Pulmonary regurge
59
Widened pulse pressure is seen in _______ REGURGE
Aortic
60
What would give a **definitive** diagnosis of aortic REGURGR
Transthoracic echo
61
Medical management of aortic REGURGE is _________ +/- _________
Beta blockers
Losartan (ARB)
62
Acute
63
Sawtooth on ECG =
Atrial flutter
64
Atrial flutter is a common S________ Tachycardia
Supraventricular tachycardia
65
Atrial flutter is characterised by _________ rate or ______ rate
Rapid atrial rate
Fixed or variable ventricular rate
66
3 common causes of atrial flutter include P_________, S______ , I______
Pulmonary disease
Sepsis
IHD
67
What are the 3 main symptoms of atrial flutter
Palpitations
SOB
Chest pain
68
Atrial flutter will have an atrial rate of approximately ______bpm
300
69
Atrial flutter is caused by an aberrant re-entrant circuit within the ______ atrium. This activates the ____ node and is not able to conduct impulses down the _______ system
RIGHT ATRIUM
AV NODE
HIS PURKINJE SYSTEM
70
Irregularly irregular pulse is indicative of 2 key cardiac conditions :
Atrial fibrillation
Atrial flutter
71
Atrial flutter management if haemodynamic instability….
DC cardioversion +/- amiodarone
72
What drug do you give in supraventricular tachycardia’s
Amiodarone
73
What drug do you give in bradycardia
Atropine
74
Atrial fibrillation is caused by problems with the _____ node
SA NODE
75
A single waveform on the jugular venous pressure indicates what?
Atrial fibrillation
76
An apical->radial pulse deficit indicates …
Atrial fibrillation
77
What blood tests may be important in atrial fibrillation
WCC/ CRP
TFTS
ALCOHOL USE - MCV anaemia
78
What is the CHADS2VASc score used for
Stroke risk in AF
79
What is the ORBIT score used for
Bleeding risk in AF
80
Anticoagulant first line in AF
DOAC (apixaban/ rivaroxiban)
81
Pill in pocket treatment for AF
Flecainide
82
AF and hypotension - should give
Digoxin
83
How to reverse digoxin
Digibind
84
Normal management of AF in hospital (2)
Rate (beta blocker)
and rhythm control (amiodarone/ cardioversion)
85
_________ is a broad complex tachycardia (can be pulse/pulseless)
Ventricular tachycardia
86
What are two shockable rhythms
Ventricular tachycardia
Ventricular fibrillation
87
ECG features of VT include _______ (>100bpm), ______P waves and _______ QRS
Tachycardia (>100bpm)
Absent p waves
Monomorphix regular QRS complexes (>120ms)
88
Immediate management of pulseless VT
Unsynchronised shock
89
IV adrenaline and IV amiodarone should be administered after the _____ shock in VT
3rd
90
Pulsed VT management
300mg IV amiodarone
91
QRS complexes in VF are ______ and ________
Polymorphic and irregular (>120ms)
92
Management of VF
Shock
IV amiodarone
IV adrenaline
93
There are 3 main **broad complex tachycardias***
VF
VT
TORSADES DE POINTES
94
Cardiac tamponade is an accumulation of _________ that causes a rise in ______ leading to compression of the heart and reduced _________
Pericardial fluid
Intrapericardial pressure
Reduced cardiac output
95
What is Becks triad
1. muffled HS
2. Increased jvp
3. Hypotension
96
What is becks triad indicative of ?
Cardiac tamponade
97
Symptoms of Cardiac tamponade include S______, T______, C_______, C_______, A_________
SOB
TACHYCARDIAC
CHEST PAIN
CONFUSION
ABDOMINAL PAIN
98
Pulsus parodoxus is indicative of….
Cardiac tamponade
99
Immediate management of cardiac tamponade =
Pericardiocentesis
100
CXR findings in cardiac tamponade
Large globular heart
101
Bradycardia is a rare of < _____bpm
<60bpm
102
Presentation of bradycardia (3)
Fatigue
Lightheaded
Syncope
103
The most common cause of bradycardia is _______
Sick Sinus syndrome
104
Further surgical management of bradycardia.
Transcutaneous pacing
105
Aortic dissection arises from a tear in the ____ leading to blood flow between the inner and outer walls of the _______.
Tunica intima
Aorta
106
Common risk factors for **aortic dissection** include H______, connective tissue disorders like M______, V______ heart disease, stimulants like ________ & ________
Hypertension
Marfans
Valvular heart disease
Cocaine and amphetamines
107
Type A Aortic dissection affects the _______ and its arch
Ascending aorta
108
Type B Aortic dissection affects _______
The descending aorta
109
Left heart failure think ______
Lungs
110
Clinical signs on examination for **aortic dissection** are 1. Radio-_______ delay, 2. Radio-__________ delay, 3. Different ______ between arms
Radio-radio delay
Radio-femoral delay
Different BP between arms
111
Echocardiogram of aortic dissection may show _______
Pericardial effusion
112
CXR in aortic dissection may show ______
Widened mediastinum
113
Initial management of aortic dissection ? (3)
Resuscitation
Cardiac monitoring
BP control (IV metoprolol)
114
initial BP control in aortic dissection is managed by:
IV METOPROLOL
115
definitive management of Type A aortic dissection
Surgical management
116
Definitive management of Type B aortic dissection
Managed conservatively with BP control +/- endovascular repair
117
Cardiac catheterisation involves the insertion of a catheter into the heart and/or great vessels for ______ and ________ purposes
Diagnostic
Therapeutics
118
Cardiac catheterisation is commonly used for the treatment of coronary artery disease through _______ & _________
PCI
- Stenting
- Angioplasty
119
Other indications for cardiac catheterisation: IATREB
Imaging
Angioplasty
TAVI
Repair - ie. Septal defects
Electrophysiology (catheter ablation)
Biopsy
120
What’s a TAVI
Transcatheter aortic valve implantation
121
When would catheter ablation be indicated? (3)
AF
atrial flutter
Wolff-Parkinson-White
122
What are the specific ECG changes observed in digoxin toxicity? (4)
‘reverse tick’ sign
T wave inversion
Shortened QT
Slight PR interval
123
What is the ‘reverse tick’ sign on ECG
Downsloping ST depression
124
Ophthalmology findings in digoxin toxicity (3)
Blurred vision
Yellow/ green discolouration
Haloes in vision
125
Non-opthalmological findings in digoxin toxicity include: N_____, D____, C_____, F_______, P______, S______
Nausea/ vomiting
Diarrhoea
Confusion
Fatigue
Palpitations
Syncope
126
How to treat digoxin toxicity
Digifab \ digibind
127
ECG changes in **hypokalaemia** include _______ P waves, _______ PR intervals, _____ depression and ____ waves
Widened P waves
Prolonged PR intervals
ST depression
U waves
128
Management of hypokalaemia
IV K+
129
Ejection systolic murmurs are described as _____-pitched, _____-______ (“_______shaped”), **mid systolic** murmurs
High pitched
Crescendo-decrescendo
Diamond shaped
130
Low output HF occurs when cardiac output is ________ due to a primary problem with the ______ is unable to meet the body’s needs
Reduced cardiac output
Primary problem in the heart
131
High output HF refers to a heart that has a _____ cardiac output but there is an _____ in peripheral metabolic demands that’s the heart is unable to meet.
**Normal** cardiac output
**Increase** in peripheral metabolic demands
132
Common causes of high-output HF include: (6) AAPPTT
ANAEMIA
ARTERIOVENOUS MALFORMATION
PAGETS DISEASE
PREGNANCY
THYROTOXICOSIS
THIAMINE (B1) DEFICIENCY
133
Systolic dysfunction refers to an impairment of _________ contraction. The ______ are able to fill but the heart is unable to pump blood sufficiently out of the ______ due to impaired myocardial contraction during ______
Ventricular contraction
The ventricles
Ventricle
Systole (reduced ejection fraction)
134
Common causes of systolic HF include: I_____, D_____, M_____, or infiltration (H______, S______)
IHD
Dilated cardiomyopathy
Myocarditis
Haemochromotosis
Sarcoidosis
135
Diastolic HF refers to the inability of the ______ to relax and fill normally so there is a _______ ejection fraction
Ventricles
Preserved ejection fraction
136
Clinical symptoms of LHF: S____, O_______, P_______ dyspnoea, N______ cough, pink frothy sputum, F______
SOB
Orthopnoea
Paroxysmal nocturnal Dyspnoea
Nocturnal cough
Fatigue
137
Auscultation of LHF would often show…
Bibasal fine crackles
138
Tachypnoea, cyanosis, prolonged cap refill, hypotension, pulsus alternans, and S3 gallop rhythm are indicative of _______ HF
Left heart failure
139
Right heart failure causes V________ (pressure builds up behind the R heart) & P________ (reduced R output)
Venous congestion
Pulmonary hypoperfusion
140
Symptoms of RHF include: O_______, W______, A_______, A_______, N________
Oedema
Weight gain
Abdominal swelling
Anorexia
Nausea
141
Clinical signs of RHF (think **fluid overload**) : _______ JVP, pitting ______, H_______, A______, transudative ______________
Raised JVP
Pitting peripheral oedema
Hepatomegaly
As cited
Transudative pleural effusions
142
1st line investigation for HF
NT-pro-BNP level
143
CXR findings in heart failure include: ABCDEF
Alveolar oedema
Kerley B lines
Cardiomegaly
Diversion (upper lobe blood)
Effusion (pleural)
Fluid in the horizontal fissure
144
Right heart failure think _____
Body
145
