Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PACES > Cardio > Flashcards

Cardio Flashcards

(92 cards)

Start Studying
1
Q

What are the clinical signs of aortic stenosis?

A
  1. Slow rising pulse
  2. Narrow pulse pressure
  3. Right ventricular failure - v waves, loud P2, basal creps
  4. Soft A2
  5. Loud P2
  6. Late peaking of a long systolic murmur
  7. S4 (Tenesee)
    Gallavardin phenomenon - all over pre-cordium but importantly not radiating to axilla
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you classify AS severity?

A
  1. Character of murmur
  2. Slow rising pulse
  3. Cardiac decompensation
  4. LVH (S1+R6 >35mm (7 large squares), LBBB, AF
  5. Echo - peak gradient >64mmHg, or mean gradient >40mmHg; best measure is ratio of valve velocity vs. LVOT velocity (dimensionless index)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the causes of AS?

A

Bicuspid AV
Calcification
Rheumatic valve disease
Congenital
Rare: IE, Paget’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment of AS?

A

If >75 = TAVI
If <75 = surgical aortic valve replacement unless surgeons dont agree

Main contraindications to TAVI
1. PVD
2. Malignant features of annulus (wont sit correctly)
3. CAD

Main contraindications for surgical aortic valve
1. RT to chest
2. Prev sternotomy
3. CLD
4. PHTN
5. Poor LV

Untreated, severe AS has a 50% 1 year mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the workup for TAVI?

A

Routine bloods
PFTs if smoker
ECG gated CT
Angiogram if CT doesnt show coronary arteries well enough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Complications of TAVI

A

Arrhythmias
Vascular haematomas
Stroke / MI / annular rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for Mitral valve repair/replacement?

A

When indicated and feasible, repair is the preferred treatment

Indications for surgery:
Symptoms + severe MR on echo
Severe MR on echo + AF, LV diastolic or systolic dysfunction (all of these predict worst POST-OP outcomes, and so trigger early surgery in asymptomatic patients)
Acute MR post MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes for MR?

A

Acute:
1. Rupture of chords
2. IE
3. Trauma

Chronic:
1. Structural
MV prolapse
Mitral annular calcification (age related)
LV dilation
Cardiomyopathies

  1. Connective tissue
    Marfan’s
    EDS
    Pseudoxanthoma elasticum
    Osteogenesis imperfecta
  2. Inflammatory
    RA
    Rheumatic fever (typically causes mixed rheumatic valve disease)
  3. Endocarditis
    Sub-acute IE
    SLE
    Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ix for MR?

A

ECG (AF, p mitrale)
Urine dip - haematuria
Fundoscopy (Roth spots)
Temp
FBC (anaemia), WCC, CRP, ESR, renal profile
Echo - MV and extent / severity of regurg, any vegetation or prolapse, PHTN, LVEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of pulmonary hypertension?

A

TR with giant v waves, Loud P2, creps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S3 -

A

Ken T.UCKY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

S4

A

Te.NE SEE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical signs of severe MR?

A

Soft S1
S3/S4
Displaced heaving apex
Precordial thrill
Widely split S2 (earlier emptying of LV as some goes out of aorta, some goes into LA)
PHTN
AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Murmur of MV prolapse?

A

S1 -> mid-systolic ejection click -> S2. Valsalva causes earlier ejection click (reduced pre-load)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the causes for MV prolapse?

A

Primary (Inherited) - myxomatous degeneration
Seconday: Marfan’s, Ehler-Danlos, Pseudoxanthoma elasticum, osteogenesis imperfecta, PKD, SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the prevelance of MV prolapse?

A

5-10% of gen pop, more common in females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Complications of MV prolapse?

A

Can progress to mitral stenosis and them mitral regurgitation
Stroke
Endocarditis
Prolonged QT
Sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the inheritance of MV prolapse?

A

Autosomal dominant inheritance, exhibiting age and sex-dependant penetrance
Elastin, fibrillin, collagen I and II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes reverse splitting of S2?

A

LBBB
HOCM
Severe AS
WPW
PDA
MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is your differential for an ejection systolic murmur?

A
  1. AS
  2. Aortic sclerosis
  3. HOCM
  4. PS

Pan-systolic
1. MR (AS NEVER radiates to axilla)
2. VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What medications must you AVOID in AS?

A

Vasodilators (increase gradient across the valve) - ACEi, nitrates, sildenafil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the mainstay of medical management in AS?

A

Beta-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the causes for pulmonary stenosis?

A
  1. Congenital
  2. Noonans, Turner’s, Down syndrome
  3. Rubella
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the causes of a widely split S2?

A

RBBB
Pulmonary stenosis
VSD
ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the causes of a reverse split S2?
LBBB AS HOCM WPW Type B (right sided pathway)
26
What are the cardiac manifestations of Marfan's syndrome?
Aortic root dilation Aortic dissection Aortic regurgitaiton Mitral valve prolapse
27
What are the non-cardiac manifestations of Marfan's syndrome
Arachnodactyly Hypermobile joints Kertoconus and upward lens dislocation Blue sclera Heterochromia of irides Iridodonesis (asymetric iris) - prev lens dislocation + repair High arched palate Pneumothorax Spontaneous intracranial hypotension Dural ectasia Pes planus
28
What is Steinberg and Walker sign?
Steinberg: Marfan syndrome. When patient makes a fist enclosing thumb - thumb sticks out Walker: 1st and 5th digit of one hand overlap over wrist of the other hand
29
What is the gene in Marfan?
AD fibrillin-1 - extracellular matrix protein
30
How do you manage aortic regurg in patients with Marfan's syndrome?
Lifelong beta-blockade Monitoring of aorta with echocardiography Replace aortic root before diameter >45mm if FHx, 50 otherwise, or if rate of expansion is >3mm/year
31
What are the signs of a failing aortic valve?
1. Blurred S2 2. Absence of silence in diastole
32
What are the causes for clubbing?
Thought to be mediated by vasodilation of the clubbed portions due to vasodilators, hypoxia, platelet precursors Cardiac 1. Cyanotic heart disease 2. Atrial myxoma 3. Infective Endocarditis Resp 1. Suppurative lung disease 2. Lung fibrosis 3. Lung cancer 4. Asbestos 5. Mesothelioma 6. Lung abscess GI 1. IBD 2. Liver cirrhosis 3. HCC 4. Coeliac Endocrine 1. Thyroid acropachy Congenital POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein plasmacytoma, Skin changes If unilateral 1. Stroke 2. Aneurysm 3. Brachial plexus injury 4. AV fistula Pseudoclubbing -Lovibond angle maintained, but nailbed has increased curvature
33
What are the stages of clubbing?
1. Normal but fluctuant nailbed 2. Loss of angle of Lovibond 3. Increased pulp 4. Increased breadth
34
What is Noonan syndrome?
Autosomal Dominant with multiple implicated genes including SHP2 Short stature Webbed neck Cubitus Valgus Widely spaced nipples Mild facial changes Proptosis Ptosis Strabismus Pectus excavatum Learning difficulties Impaired coagulation Congenital heart disease - PS (most common), VSD, ASD, HOCM.
35
What are the cardiac manifestations of Noonan's syndrome?
PS is most common Also VSD, ASD, HOCOM
36
What are the cardiac manifestations of Turner syndrome?
Bicuspid aortic valve Dilation and dissection of aortic root
37
Williams Syndrome
38
What are the causes for PS?
Valvular Congenital Rheumatic Noonan's Supra-valvular Wiliams Syndrome Subvalvular Fallot's
39
What do you know about Turner syndrome?
45XO Phenotype Short stature Webbed neck Wide spaced nipples Primary amenorrhoea Cardiac defects including bicuspid aortic valve, aortic root dilation, and dissection Multiple pigmented naevi Short 4th metacarpal Horseshoe kidney
40
What are causes of VSD's?
Congenital Maternal alcohol Aneuploidy syndromes (Down, Edward, Patau) Acquired Ischaemic, iatrogenic (septal puncture)
41
What is the most common type of VSD?
Peri-membranous
42
What are the complications of a VSD?
IE PHTN Aortic regurg if peri-membranous Arrythmias Shunt reversal
43
What is Holt-Oram syndrome?
AD ASD + tri-phalangeal thumbs
44
What are the clinical signs of an ASD?
Fixed split S2 Ejection systolic murmur (increased flow across pulmonic valve) PHTN
45
What are the causes for ASD's?
Ostium secondum (PFO, Holt-Oram) Ostium primum (present earlier and involve mitral and tricuspids) Sinus venosus (SVC junction) associated with anomalous pulmonary venous drainage
46
What are the complications of an ASD?
1. Arrythmias 2. PHTN 3. Eisenmenger's 4. Paradoxical embolism 5. IE 6. Recurrent pneumonias
47
What are the clinical signs of adult co-arctation of the aorta?
Harsh ejection systolic heard in subclavian area (posterior thoracic spine) Typically distal to left subclavian If one radial pulse is weak this may be due to subclavian harvest to repair the coarctation AS/AR (bicuspid valve) Radio-femoral delay Forceful heaving apex beat due to internal thoracic artery collaterals
48
What conditions are associated with CoA?
PDA VSD Bicuspid aortic valve Berry aneurysms Turner Syndrome
49
What are the clinical signs of a PDA?
Severe - collapsing pulse Can lead to cyanotic heart disease Precordial thrill under left clavicle Continuous machine like murmur with systolic accentuation To differentiate it from PS, listen at the back - the murmur will be present here - PS will not
50
What are the causes for a persistent PDA?
Prematurity Low birth weight Maternal use of NSAID's (prostaglandins keep the PDA open; NSAIDs are prostaglandin antagonists) Rubella High altitude Fetal alcohol syndrome Maternal amphetamine
51
How do you treat MV prolapse
If mod-sev, need to consider surgery. This would be mitral valve repair instead of replacement. Might be suitable for minimally invasive surgery.
52
Clinical signs of mitral stenosis?
1. Malar Flush 2. AF 3. Tapping apex (palpable S1) Left parasternal heave if PHTN 4. Opening snap in diastole folllowed by mid-diastolic murmur heard best at apex. The more severe the stenosis, the closer the opening snap is to S2, and the longer the murmur
53
What are the causes of mitral stenosis?
1. Congenital (rare) 2. Rheumatic heart disease 3. Valvular endocarditis 4. Senile degeneration
54
What is the treatment for mitral stenosis?
1. If AF, anticoagulate and rate control 2. Mitral valvuloplasty 3. Surgery - valvotomy
55
What do you know about Ehler Danlos?
AD mutation affeting collagen III Hypermobility and elasticity Fragile skin Joint hypermobility Easy bruising AR, aortic dissection, MV prolapse Subarachnoid haemorrhage Angioid retinal streaks
56
In a case of PHTN and suspected Eisenmenger's, what shunts do you know of, and how would you identify them?
PDA - reverse splitting VSD - Single S2 ASD - fixed split S2
57
What are the indications for closure of a VSD?
Significant right to left shunt Significant PHTN Significant LV dilation
58
What are the possible indications for a posterolateral thoracotomy incision?
1. Pneumonectomy/lobectomy 2. Aortic surgery (Coarctation/dissection) 3. Blalock Tausig shunt (connects subclavian to pulmonary arteries and is associated with a weak ipsilateral radial pulse)
59
What are causes of cyanotic heart disease?
ToF Transposition of great vessels Pulmonary atresia/stenosis Tricuspid atrexia Ebstein's (atrialisation of the right ventricle due to low inserting TV leaflets) Eisenmengers (reversal of left to right shunt)
60
What are causes of acyanotic heart disease?
AS Coarctation ASD VSD PDA
61
Complications of ToF surgery?
PR in adolescence following surgery of ToF - needs valve replacement
62
What is ToF?
1.VSD 2. Over-riding aorta 3. RVOT obstruction 4. RVH
63
What is restrictive cardiomyopathy?
Stiff and non-compliant myocardium that is of relatively normal size Fails to stretch with blood = diastolic failure = bi-atrial enlargement
64
What are causes of restrictive cardiomyopathy?
Primary: Loflers Endomyocardial fibrosis Secondary (infiltrative): Amyloidosis Sarcoidosis Haemachromatosis Radiation
65
What is constrictive pericarditis?
Chronic pericarditis leads to calcification of the pericardium leading to diastolic failure
66
What are common causes of constrictive pericarditis?
Any cause of acute pericarditis. 1. Viral infection (eg. Cocksackie) 2. Uraemia 3. Autoimmune 4. Hypothyroid 5. SLE 6. TB (common cause) 7. Post-MI
67
How do you manage AF?
Emergency: DC Elective Rate control (preferred) Bisoprolol CCB's Digoxin (if in heart failure) Medical rhythm Control Amiodarone (esp in heart failure) Flecainide DC If <48 hours = heparinise and DC If >48 hours = anticoagulate for 4 weeks +/- amiodarone if high risk of failure
68
When is rhythm control preferred over rate control in AF?
If onset is <48 hours If cause is reversible If there is cardiac failure primarily due to AF Atrial flutter amenable to ablation
69
What is the CHA2DS2VASC score?
Risk of stroke in AF Congestive heart failure Hypertension Age (2) Diabetes Sex Stroke Vascular Disease If Chadsvasc comes out negative (0 in M, 1 in F) = need an echo to rule out valvular disease which is an absolute indication for anticoagulation in the presence of AF
70
What is the ORBIT score?
Assess bleeding risk (CRAB!) Clopidogrel or Aspirin (antiplatelet) Renal impairment Age >74 Bleeding history, Hb <130
71
What are the principle management of chronic heart failure?
1. ACEi and BB 2. Aldosterone antagonist 3. SGLT-2 inhibitor 4. AF?: Digoxin; EF <35% despite optimising ACEi/ARB?: Sabucatril/valsrtan; African American?: Hydralazine; broad QRS? CRT 5. One off pneumococcal and annual influenza vaccines
72
How does sacubatril valsartan work?
Valsartan is an AR II blocker Sabucatril is a neprillysin antagonist that normally breaks down natriuritic peptides. By blocking this breakdown, it promotes natriuresis
73
What are the medical treatments available for angina?
Aspirin, Statin, GTN Rate control: 1. BB or CCB (rate limiting non-dihydropiridine eg verapamil or diltiazem) 2. BB + CCB (longer acting dihydropiridine eg amlodipine nifedipine) 3. Add third drug only if referred for PCI/CABG. These include nitrates (vasodilator and reduces pre-load), nicorandil (vasodilator), ivabradine (blocks funny channel at SAN), ranolazine (relaxes tension in muscle walls reducing oxygen demand)
74
What are the indications for cardiac pacing?
1. Symptomatic sinus node disease 2. Mobitz II (asymptomatic) 3. Mobitz I (symptomatic) 4. Complete heart block 5. Persistent AV block post-MI
75
This is a DDDR pacemaker. What does that mean?
1. What is paced? V, A, Dual 2. What is sensed? V, A, Dual 3. What is the response to sensing? [I]nhibit, [T]rigger, [D]ual - can T+I 4. Rate response (enables HR increase with excercise) Most are DDDR unless Permanent AF - these patients need the atria blocked - so have VVIR
76
What is CRT, and what are the indications?
Goal is to re-coordinate biventricular contraction (Leads in LV, RV, and sometimes RA). Can be connected to an AICD and pacemaker.
77
What are the indications for an ICD?
Post MI: LVEF <30% + broad QRS LVEF + NSVT + EP positive Familial: LQTS, Brugada, HCM Cardiac arrest due to VT/VF
78
What are the benefits of CRT?
1. Improves LVEF + haemodynamics 2. Improved ET 3. Improved QoL
79
What are the indications for CRT?
1. Heart failure with ventricular dysynchrony
80
What are the diagnostic criteria for IE?
Duke's. x2maj, x1maj+3min, 5min Maj 1. Echo 2. Pathognomic bac x2 Min 1. RF 2. Temp 3. BC's x1 4. Echo 5. Vasc immune complex
81
What are the risk factors for IE?
IVDU/Haemodialysis Prosthesis Structural heart/valvular disease Rheumatic heart disease Diabetes/CKD
82
What are the signs of SUBACUTE IE?
Fingers, feet, eyes, kidneys Clubbing Petechia and splinter haemorrhages Janeway lesions (palmar/plantar) Osler nodes (distal finger painful) Roth spots Glomerulonephritis
83
What are the causes of aortic regurgitaiton?
Acute -Dissection -Infective endocarditis Chronic valve problem -Bicuspid aortic valve -Rheumatic heart disease -Calcified valves -CTD's -Paget's Chronic root problem -Bicuspid aortic valve -HTN -Marfan -EDL -Ank Spond
84
What are the renal complications of infective endocarditis?
Glomerulonephritis Haematuria Acute interstitial nephritis Eosinophiluria
85
What are the criteria for valve replacement in aortic regurgitation
Symptomatic dyspnoea and reduced excercise tolerance AND/OR -Wide pulse pressure -ECG changes (on ETT) -LV enlargement >5.5cm in systole or EF <50%
86
What is the prognosis in AR?
Asymptomatic with EF>50% - 1% mortality at 5 years Symptomatic and (wide pulse pressure+ECG exertional changes+LV enlargement) = 65% mortality at 3 years
87
What is an Austin Flint murmur?
Mid-late diastolic murmur caused by aortic regurgitant jet hitting mitral valve leaflet.
88
What eponymous signs of Aortic Regurgitation do you know?
Corrigans (Neck) De Musset (Head) Mullers (Uvula) Quincke's (nailbed) Traube's (femoral)
89
How do you manage AR?
Medically Rate control Diuresis ACEi Symptomatic Intervention: -TAVI -Valve replacement
90
What are the clinical signs of constrictive pericarditis?
1. Rapid a and y descents due to collapsing RA against stiff pericardium 2. Kussmaul's sign - increase in JVP on inspiration 3. Pulsus paradoxus 4. Pericardial knock 5. Signs of RHF
91
What are the causes of constrictive pericarditis?
TB Trauma Tumour Radiotherapy Connective tissue disease
92
What are the clinical features of HOCM?

PACES (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions