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Beth PACES 2025 > Cardio > Flashcards

Cardio Flashcards

(70 cards)

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1
Q

NSTEMI Mx

A

Invasive coronary angiography + angioplasty + stent
CABG

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2
Q

Myocardial CP with negative trop Ix

A

Pre test probability (GRACE/TIMI) —> high mortality: invasive coronary angiography
Low: CTCA

Functional tests: exercise stress, MIBI scan, stress echo, MRI

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3
Q

Stable angina Rx

A

10 yr CV event risk >10% - statin
Aspirin
Anti angina (BB, nitrate, CCB, Nicorandil, ranazine, ivabradine)

If symptoms persist on 2x drugs then consider revascularization

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4
Q

Pericarditis with effusion causes

A

Infective: viral, HIV, TB
Uraemia
Cancer
Autoimmune disease: RA, lupus
Prev trauma / cardiac surgery
Post MI (dressers)

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5
Q

Signs that AS is severe

A

Soft/delayed S2 (A2) - immobile leaflets & prolonged LV emptying
Delayed ESM
S4

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6
Q

Complications of AS

A

IE
LV dysfunction
Pulmonary HTN –> RV failure
Conduction problems

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7
Q

DDx ESM

A

HOCM
VSD
AS/Aortic sclerosis
Flow murmur

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8
Q

CC of AS

A

Bicuspid (congenital)
Rheumatic
Calcification/Age

Associations:
- coarctation/bicuspid valve
- angiodysplasia - Heydes syndrome

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9
Q

Ix for AS

A

ECG: ? LVH, conduction issues (long PR)

Bloods: anaemia (Heydes), ESR (IE)

CXR: calcified valve, HF

Echo: mean gradient >40mmHg = severe + reduced LV function

ETT: BP drop + symptomatic

CT: calcification, coronary/peripheral artery patency?

Cardiac catheter: invasive gradients

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10
Q

Mx of AS

A

ASx: regular review of symptoms + echo to assess gradient/LV function

ASx + LVEF <50% ? surgery

Symptomatic:
- Aortic valve replacement +/- CABG
(low operative mortality: EuroScore I or II)
- TAVI (transcutaneous aortic valve implantation) in high surgical risk EuroScore >20%, frail, prev cardiac surgery

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11
Q

Duke’s Criteria for IE

A

Major:
- Typical organism in BC x2
- Echo = abscess/vegetation/dehiscence

Minor:
- Fever >38
- Echo suggestive
- Predisposed eg prosthetic valve
- Embolic phenomena
- Vasculitis phenomena (CRP/ESR)
- Atypical organism on BC

2 major
1 major + 2 minor
5 minor

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12
Q

IE - who gets Abx prophylaxis?

A

Prosthetic valves
Prev IE
Cardiac transplants with valvulopathy
Some congenital heart disease

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13
Q

AR eponymous signs

A

Corrigons: visible vigorous neck pulsation
Quinckes: nail bed capillary pulsation
De Mussets: visible head nod
Taubes: pistol shot sound over femoral arteries

DDx: collapsing pulse - high flow state - pregnancy, anaemia, thyrotoxic

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14
Q

Causes of AR

A

Valvular
Biscuspid aortic valve
Endocarditis
Rheumatic Fever

Dilitation
Aortic root dissection (type A)
Marfans
HTN

Aortitis
Ank spond / Vasculitis/ syphillis

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15
Q

Ix of AR

A

Bloods for IE/vasculitis
CXR: cardiomegaly, pulm oedema
CT: size of aortic root/dissection
Echo: LVEF, LV size, aortic root size, vegetation, jet width
Cardiac catheter pre-op? coronary patency

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16
Q

Mx of AR

A

HF Mx = ACEI/ARB (reduce afterload)
Regular review of Sx/Echo

Acute (dissection/IE/aortic root abscess) - SURGERY
Aortic root dilation of >5cm

Chronic - SURGERY if:
- Symptoms: reduced ET (NYHA >II)
and/or
- 1) Pulse pressure >100mmHg
- 2) ECG changed on ETT
- 3) LVEF <50%, LV ESD >50mm, >65% LVOT width

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17
Q

Complications of mitral stenosis

A

Pulm HTN –> RHF
Pulm oedema.
Endocarditis
Embolic complications (high stroke risk if MS + AF)

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18
Q

CC of mitral stenosis

A

Rheumatic (MCC)
Senile degeneration
IE

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19
Q

Ix of mitral stenosis

A

Bloods: IE
ECG: p mitrale, AF
CXR: enlarged left atrium, pulm oedema
Echo:
- severe = valve<1cm2, gradient >10mmHg
- left atrial thombus, calcified valve?
- RVF + pulm HTN >50mmHg

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20
Q

Mx of mitral stenosis

A

AF - rate control + anticoag
HF - diuretic

Mitral valvuloplasty - if valve pliable + not calcified, no atrial thrombus

Mitral valvotomy surgery (open or closed)

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21
Q

Rheumatic fever pathophysiology

A

= immunological cross-reactivity between group A b-haemolytic streptococcal infection & valve tissue

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22
Q

Rheumatic fever Duckett-Jones diagnostic criteria

A

proven b-haemolytic streptococcal infection (throat swab, rapid antigen detection, asot)
or
clinical scarlet fever

plus 2 major or 1 major+2minor

major:
- chorea
- erythema marginatum
- subcut nodules
- polyartritus
- carditis

minor:
- raised esr
- raised wcc
- arthragia
- prev `RF
- pyrexia
- prolonged pr interval

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23
Q

Rheumatic fever mx

A

rest, high-dose aspirin, penicillin

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24
Q

MR complications

A

AF (LA enlargement)
Pulm oedema (increased left pressure)
Pulm HTN
IE
Embolic complications

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25
CC of MR
Congenital (association with primum ASD) Acute: - IE - Papillary rupture Chronic: - Prolapse - CTD - Rheumatic fever - Infiltration (amyloid) - Dilated LV (functional MR) - Calcification
26
Ix of MR
Bloods: IE, CTD ECG: p mutrale, AF, prev MI (Q wave) CXR: cardiomegaly, large LA, pulm oedema Echo: - Severity: volume of MR jet, LV dilitation, reduced EF - Cause: vegetation, torn chordae/ ruptured papillae, ASD Cardiac MRI: volume of MR
27
Mx of MR
Anticoag - AF/embolic comp HF: diuretic, BB, ACEI Percutaneous repair - high surgical risk + symptomatic despite optimal medical Mx Surgical (preferred) - annuloplasty ring/valve replacement - ideally before HF
28
CC of TR:
Congenital = Ebsteins anomaly (atrialization of RV + TR) IE (IVDU) Functional (MC, dilated RV 2' to left heart disease) Implantable device leads --> splint tricuspid valve open Rheumatic fever
29
Ix of TR:
ECG: p pulmonale, AF, RV strain CXR: double right heart border (enlarged RA) Echo: TR jet, RV dilatation
30
Mx of TR
HF: Diuretics, b-blocker, ACE I, stockings for oedema Percutaneous Surgical valve repair if medical mx fails
31
Pulmonary Stenosis Assoc
ToF - PS, overiding aorta, VSD, RVH (sternotomy scar) Noonan's syndrome (male turners) Carcinoid syndrome (gut primary with liver mets secreting 5HT into circulation) --> diarrhoea/wheeze/flush + right heart valve fibrosis (TR + PS) - Rx: somatostatin analogue
32
Pulmonary stenosis Ix
ECG: p pulmonale, RVH, RBBB CXR: large RA/RV Echo: severity, RV function, assoc
33
Mx pulmonary stenosis
Pulmonary valvectomy - gradient >70mmHg or RV Failure Percutaneous pulmonary valve implant Surgical repair/replacement
34
Late complications of prosthetic valves
- Thromboembolus (despite warfarin) - Bleeding - Bioprosthetic dysfunction + LV failure - Haemolysis - IE --> stap epidermis (early), strep viridans (late) - AF
35
Implantable devce complications
Acute - Local infection - PTX - Pericardial effusion /tamponande Chronic: - IE - TR
36
Indications for an ICD (can be subcutaneous or transvenous)
Primary prevention: - Familial condition risk of SCD: LQTS, ARVD, Brugada, HCM, congenital - MI >4wks ago with reduced EF + VT/broad qrs Secondary prevention: - Cardiac arrest due to VT/VF - Sustained VT with compromise / HF
37
Indications for a CRT
LVEF <35% NYHA II - IV on optimal medical Mx Sinus rhythm with broad Qs
38
Indications for a pacemaker
3s pause Tachy-brady Sx mobitz type 2 CHB
39
CC of constrictive pericarditis
TB - cervical LN Trauma - sternotomy/post-MI Tumour Therapy (radio) - tattoo, thoracotomy Tissue - CTD: RA, SLE
40
Ix in constrictive pericarditis
CXR: pericardial calcification, old TB, sternotomy wires Echo: high signal pericardium, ventricular interdependence (DDx from restrictive cardiomyopathy) CT/MRI: thickened pericardium, early diastolic flattened septum
41
Mx of constrictive pericarditis
Medical: diuretics, fluid restriction Surgery: pericardectomy
42
ASD signs
Raised JVP Pulmonary thrill Pulmonary ESM Fixed S2 Tricuspid diastolic flow murmur Signs of deterioration: - Pulm HTN (RV heave, loud p2, cyanosis, clubbing = Eisenmengers) - CCF
43
Types of ASD
Primum = assoc AVSD, cleft mitral valve, downs syndrome Secondum = MCC
44
Complications of ASD
Paradoxical embolus Atrial arrythmia RV dilititation Eisenmengers
45
Ix for ASD
ECG: - Primum = RBBB + LAD - Secondum = RBBB + RAD + AF CXR: small aortic knuckle Echo/MRI: site/size/shunt/anatomy
46
Mx for ASD - Indications for closure:
Symptomatic: SOB, paradoxical emboli Significant shunt: Qp : Qs > 1.5 : 1, RV large
47
Mx for ASD - Contraindications for closure:
severe pulmonary HTN Eisenmengers
48
VSD CC
Congenital: - VSD - ToF - PDA - Coarctation Acquired: - Traumatic/post-op - post-MI
49
Ix for VSD
ECG: bundle branch block CXR: pulmonary plethora Echo/MRI: size/site/shunt/anatomy/assoc Cardiac catheter
50
Mx of VSD
- Conservative - MCC small perimebranous VSD close spontaneously - Percutaneous: Amplatzer device - Surgical: pericardial patch Post-infarct VSD: - Mechanical circulatory support - Early closure with large patch to allow for further tissue loss and prevent dehiscence - Heart transplant
51
What is a Blalock-Taussig shunt?
partially corrects ToF in infancy, by anatomosing sublavian artery (or aorta) to pulmonary artery = absent radial pulse + thoracic scars
52
DDx absent radial pulse
Acute: - embolism - aortic dissection - trauma Chronic: - atherosclerosis - coarctarion - takayasus arteritis
53
Signs of coarctation
HTN in UL Prominent UL pulses, weak femoral Radio-femoral delay Heaving apex Systolic murmur to back, loud a2 +/- murmur from assoc lesion
54
Assoc with coarctation
VSD Bicuspid aortic valve PDA Turners Intracranial aneurysms
55
Coarctation Ix
ECG: LVH, RBBB (if VSD) CXR: notched rib, double aortic knuckle Echo/CT/MRI: flow/anatomy
56
Mx coarctation
Percutaneous endovascular aortic repair Surgical: dacron patch aortoplasty. Anti-HTN Longterm surveillance: re-coarctation, aneurysms
57
What is a PDA
continuity between aorta + pulmonary trunk with LTR shunt (acyanotic) RF: rubella
58
signs of PDA
collapsing pulse thrill in pulmonary region thrusting apex continuous machine like murmur loudest below left clavicle
59
mx of pda
closure - surgery or percutaneously
60
Assoc with HOCM + signs
Assoc: - Friedrichs atxia - Myotonic dystrophy Signs: - Jerky pulse - Double apical impulse (atrial + ventricular contraction) - Thrill at lower left sternal edge - ESM +/- assoc mitral valve prolapse
61
Ix for HOCM
ECG: LVH + strain (TWI) Echo: asymptomatic septal hypertrophy, LVOT obstruction Cardiac MRI /Cardiac catheter Genetic tests - sarcomeric protein mutations
62
DDx of LVH
Athlete Hypertensive heart HOCM Cardiac amyloidosis Anderson-Fabry disease
63
HOCM Mx
ASx: Avoid strenuous exercise, dehydration + vasodilators Sx + LVOT gradient >30mmHg: - BB + verapamil --> lower HR (increase filling time) + negative inotrope (reducing force of LVOT compression) - Cardiac myosin-inhibitors: mavacamten (negative inotrope) - Pacemaker - Septl ablation or surgical myomectomy Refractory = heart transplant Genetic counselling
64
HOCM genetics
autosomal dominant
65
HOCM poor prognosis / indications for ICD
young age at dx syncope documented vt / cardiac arrest fhx of scd septal thickness >30mm Burnt out LV (reduced LVEF + fibrosis)
66
Heart failure causes:
MCC = ischaemia Structural heart disease (valves/congenital) Arrythmias HTN Post-partum CM Drugs/Toxins (anticancer) Endocrine/metobolic: - Thyroid disease - Diabetes - Alcohol - DCM - Obesity Infection/infiltration/inflammation
67
Mx of HF
Treat cause Medical: - fluid/salt restrict _ diuretics - 4 pillars: BB, ARB/ARNI, MRA, SGLT2I Device: - ICD/CRT Surgery: - Volume reduction surgery - improves LVEDP - Heart transplant
68
Indications for heart transplant
Severely impaired LV systolic function, HCM, intractable VT or angina NYHA III or IV despite optimal medical CRT/ICD implant Poor prognosis: CPET <14, markedly high bnp, seattle geart failure model >20% mortality Cardiac cachexia Refractory cardiogenic shock despite mechanical support/inotropes
69
Absolute CI for hear transplant UK
- >65yo + serious comorbidity - sespsis/active infection - incurable malignancy - psychosocial factors: (smoking/alcohol/drug abuse), poor meds compliance - irreversible pulmonary HTN
70
Relative CI for hear transplant UK
BMI >32 DM with end organ damage severe peripheral vascular / cerebral vascular / lung / kidney disease BBV

Beth PACES 2025 (5 decks)

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