Cardio Flashcards
(82 cards)
1
Q
Bisferiens pulse
A
Mixed AS/AR
A biphasic pulse on the wrist which is abnormal
2
Q
Poor dentition
A
Risk factor of IE
Remember to ask for urine dipstick and ophthalmoscopy at end
3
Q
Cannon A waves (JVP)
A
Arrythmias
Complete heart block, VEBs and VT
4
Q
Giant V waves (JVP)
A
Tricuspid regurg
look for ear-wiggling, feel for pulsatile hepatomegaly
5
Q
Carvallo’s sign
A
able to hear tricupsid regurg louder on inspiration at LLSE
6
Q
Central cyanosis
A
Hypoxic lung disease
Right-to-left cardiac shunt ==> cyanotic congenital heart disease OR eisenmenger’s syndrome
Methaemoglobinaemia ==> drugs OR toxins
7
Q
Differentiating between AF and VEBs
A
On exercise, VEBs disappears whilst AF doesn’t
Or use ECG
8
Q
Causes of AF
A
IHD Rheumatic HD Thyrotoxicosis Pneumonia PE Alcohol Valvular disease
9
Q
JVP (vs carotid)
A
Double pulsation
Non-palpable
Obliterated when pressure applied to base
Height decreases with inspiration (in restrictive disease opposite occurs = Kussmaul sign)
Rises with hepatojugular reflex
10
Q
Kussmaul sign causes
A
Restrictive disease
Tamponade, constrictive pericarditis and restrictive cardiomyopathy
11
Q
Pulsus paradoxus
A
Peripheral pulse disappears with inspiration as BP falls (this is physiological) but this is exaggerated
Causes: restrictive disease = Tamponade, constrictive pericarditis and restrictive cardiomyopathy and severe asthma/COPD
NB cardiac tamponade also have Beck’s triad (hypotension, raised JVP adn muffled heart sounds)
12
Q
Non-palpable apex beat
A
Remember to check for dextrocardia
13
Q
LHF on X-Ray ABCDE
A
alveolar oedema kerley B lines cardiomegaly upper lobe venous diversion plerual effusion
14
Q
Causes of pericarditis
A
Viral (coxsackie) Bacterial/fungal immediate post MI Dressler's (2-10 weeks post) SLE/RA/scleroderma Uraemia Malignancy
15
Q
Causes of heart failure
A
Can be split into acute and chronic
- Pump failure: IHD (acute); cardiomyopathy; constrictive pericarditis; arrhthmia
- Excessive preload: regurg valvular disease (MR, AR); fluid overload (e.g. renal failure, IV fluids; acute)
- Excessive afterload: AS, HTN
- High output failure (all acute): anaemia; pregnancy; metabolic (hyperthyroidism, Paget’s)
- Isolated RHF: cor pulmonale, primary pulmonary HTN
16
Q
Mitral stenosis features
A
Most common cause = RHD Mid-diastolic Opening snap Tapping apex Loud 1st heart sound P mitrale (bifid P wave)
17
Q
Mitral issues (MS, MR)
A
Lead to AF
18
Q
Mid-diastolic murmur
A
MS
Austin flint (2ndary to AR)
Carey Coombs (active RHD, disappears with it)
Tricupsid stenosis
19
Q
Rx of mitral stenosis
A
AF Rx and anticoagulation
Diuretics
Can perform percutaneous balloon valvuloplasty
20
Q
Causes of MR
A
RHD IE Valve prolapse Papillary muscle rupture (post MI) Marfan's SLE Secondary to LV dilatation
21
Q
Mitral Valve prolapse (Barlow syndrome)
A
Audible click heard +/- late systolic murmur;
B-B may relieve chest pain if there are symptoms, if severe can have surgery
22
Q
Pansystolic murmur
A
Aortic stenosis/sclerosis
Tricupsid regurg
VSD
23
Q
Tricuspid regurg
A
Pulsatile hepatomegaly
Giant V waves on JVP
Ear wiggling
Carvallo’s sign can help
24
Q
Rx of MR
A
AF Rx and anti-coagulation
Diuretics
ACEi (as HTN makes MR worse)
Valve repair is preferred to valve replacement
25
Causes of AS
RHD
Calcification of bicuspid valve
Calcified tricuspid valve (sclerosis = doesn't radiate and no slow rising pulse)
26
AS
Ejection systolic
Slow rising pulse
Narrow pulse pressure
27
Ejection systolic
Sclerosis
HOCM
Pulmonary stenosis
MR
28
Rx for AS
Treat HTN with ACEi / CCB
| If severe + LV impairment can undergo CABG or TAVI
29
Symptoms of AS
Increasing order of severity:
SOB
Angina
Syncope/presyncope
30
Aortic Regurg causes
```
RHD
IE
HTN
Aortic dissection
Marfan's
RA
Ank spond
Syphilis (luetic heart disease)
```
31
Early diastolic murmur
AR
Pulmonary regurg
Graham steele (PR 2ndary to pulmonary HTN)
32
AR features
```
Early diastolic
Corrigan
Quinke
De Musset
Duroziez
Traube
```
33
RX for AR
Diurectics and vasodilators
34
Corrigan
Exaggerated carotid pulse
35
Quinke
Nailbed pulsation
36
De Musset
Head nodding
37
Duroziez
Diastolic femoral murmur
38
Traube
Pistol shot femorals
39
Indications for bioprosthetics
Doesn't last as long, but don't need to be on warfarin so:
Elderly (valve will outlast them as 15 years life)
Ppl cannot take warfarin (e.g. women of child bearing age)
Patient choice
40
Inferior view
RCA
| II, III, aVF
41
Anterolateral
L circumflex
| I, aVL, V5-6
42
Anteroseptal
LAD
| V2-4
43
Anterior
Left main stem
| V2-6
44
Posterior
RCA
| V1, V2, V3 (reflected) would add extra leads in back to visualise
45
Right axis deviation (>90) causes
```
Anterolateral MI
RVH, PE
Left posterior hemiblock
WPW
ASD secundum
```
46
Left axis deviation (
```
Inferior MI
LVH
Left anterior hemiblock
WPW
ASD primum
```
47
Absent P waves
AF, SAN block, nodal block
48
P mitrale
bifid P waves = LA hypertrophy
| MS, HTN, AS, MR
49
P pulmonale
Peaked P waves = RA hypertrophy
| Pulmonary HTN, COPD
50
Depressed ST segment
Ischaemia (flat ST)
| Digoxin (down sloping ST)
51
Long QTc (380-420ms=normal)
Derived from QT/SQRT(r-r) = Bazett's formula
TIIMME:
Toxins - macrolides, amiodarone
Inherited - Romano-ward, Jervell, Brugada
Ischaemia
Myocarditis
Mitral valve prolapse
Electrolytes: hypOmagnesia, kalaemia, calcaemia, thermia
52
U waves
Occurs after T waves and seen in hypOkalaemia (flattened T wave usually)
53
J waves
Occurs between QRS and ST segment, from hypothermia, hypercalcaemia, SAH
54
Bifascicular block
RBBB + left axis deviation, as there is also a left anterior hemiblock
55
Trifascicular block
RBBB + 1st degree AV clock
| Need pacemaker as unlike 1st degree heart block bundle of His doesn't create escape rhythm
56
LVH on ECG
S in V1 + R in V6 >35mm
LAD
May see T wave inversion in II, aVL, V5 - 6
57
Brugada syndrome
RBBB and coved ST elevation in V1-3
| see images
58
Hyperkalaemia ECG
Tall tented T waves
Wide QRS
Absent P waves
Bradycardia
59
Hypokalaemia ECG
Small T waves
ST depression
Prolonged QT interval
Prominent U waves
60
VT causes
```
I'M QVICK (as tachy)
Infarction
Myocarditis
QT interval prolonged
Valve abnormality
Iatrogenic (digoxin)
Cardiomyopathy (dilated)
K (hypo), magnesium, O2 hypo as well and acidosis
```
61
CHA2DS2VAS
```
Congestive cardiac failure
HTN
Age > or equal 75
DM
Stroke or TIA
Vascular disease
Age 65-74
Sex female
Score 0 = aspirin 300mg
1 or greater = warfarin (in AF may also use NOAC (e.g. apixiban/dabigatran) if C/I to warfarin)
```
62
Pathological Q waves
Indicated full thickness STEMI
If not present then subendocardial infarction
NB new onset LBBB also indicates STEMI
63
MI complications
Death Passing PRAED St
Death - VF, LVF, CVA
Pump failure
Pericarditis (Rx NSAID and echo to exclude effusion)
Rupture (myocalacia cordis --> cardiac tamponade/mitral regurg/septal rupture
Arrhythmias
Aneurysm (ventricular - shows persistent ST elevation and should anticoagulate and consider excision)
Embolism (LV mural thrombus)
Dressler's syndrome (NSAID or steroids if severe)
64
Pathophysiology of HF
```
Reduced CO initially → compensation
Starling effect dilates heart to enhance contractility
Remodelling → hypertrophy
RAS and ANP/BNP release
Sympathetic activation
```
Progressive ↓ in CO → decompensation
Progressive dilatation → impaired contractility +
functional valve regurgitation
Hypertrophy → relative myocardial ischaemia
RAS activation → Na+ and fluid retention → ↑ venous
pressure → oedema
Sympathetic excess → ↑ afterload → ↓ CO
65
HF can be split into low output (reduced CO) and high output (increased needs)
```
Low output:
Pump failure (MI, arrhythmias)
Excessive preload (AR, MR, fluid overload)
Excessive afterload (AS, HTN, HOCM)
```
High output: RVF then LVF
Anaemia, AVM
Thyrotoxicosis, Thiamine deficiency (beri beri)
Pregnancy, Paget's
66
CCF: framingham criteria
| 2 majors or 1 major and 2 minor
```
Major:
PND
+ve abdominojugular reflux
neck vein distenstion
S3
Basal creps
Cardiomegaly
Acute pulmonary oedema
Wt loss >4.5kg in 5 days 2ndary to Rx
```
```
Minor:
Bilateral ankle oedema
SOB O/E
HR >120bpm
nocturnal cough
Hepatomegaly
Pleural effusion
30% vital capacity
```
67
Mx of CCF
ACEi, B-B (carvedilol) + loop diurectic (frusemide)
| B-B go slow and start low; not to be used in acute HF
68
HTN staging
Stage 1: >140/90
Stage 2: >160/100
Stage 3 / severe: >180/110
Malignant: severe + papilloedema and/or retinal haemorrhage
69
HTN eye (Keith-Wagener) Classification
1. Tortuosity and silver wiring
2. AV nipping
3. Flame haemorrhages and cotton wool spots
4. Papilloedema
Grades 3 and 4 = malignant hypertension
70
Infective endocarditis Dx
Dukes criteria: 2 majors OR 1 major + 3 minors OR 5 minors
Major:
2 +ve blood cultures (take 3 >12 hrs apart)
+ve echo or new murmur
Minor:
1. predisposition (IVDU or prosthetic)
2. Fever >38
3. Emboli (signs e.g. janeway etc)
4. Immune issues (like GN, Roth spots etc)
5. +ve blood culture not meeting major criteria
71
Causes of IE
Culture +ve:
S. viridans; S aureus; S epidermis; pseudomonas
Culture -ve: HACEK
Haemophilus, Actinobacilus, Cardiobacterium,
Eikenella, Kingella
Non-infective:
SLE
72
Rx IE
```
Empiric:
Acute severe - IV fluclox + gent
Subacute: IV benpen + gent
Staph (IVDU): IV fluclox + rifampicin
Fungi: IV flucytosine + fluconazole PO (amphotericin if flucy resistant or Aspergillus)
```
73
Rheumatic fever patho
Ab cross-reactivity following Group A β-haemolytic strep. (pyogenes) --> T2 hypersensitivity reaction (molecular mimicry of M2 protein)
Aschoff bodies and Anitschkow myocytes seen
On Ix: ASOT or strep Ag test done
74
Rheumatic fever Dx
```
Jones Criteria: evidence of GAS infxn + 2 major OR 1 major + 2 minor
Major = PASES
Pancarditis
Arthritis (most common)
Subcutaneous nodules
Erythema marginatum
Sydenham’s chorea
```
```
Minor:
Fever
↑ESR or ↑CRP
Arthralgia (not if arthritis is major)
Prolonged PR interval (not if carditis is a major)
Prev rheumatic fever
```
75
Rheumatic fever Rx
Bed rest until CRP normal for 2wks
Benpen 0.6-1.2mg IM for 10 days
Analgesia for carditis/arthritis: aspirin / NSAIDs
Add oral pred if: CCF, cardiomegaly, 3rd degree block
Chorea: Haldol or diazepam
Secondary Prophylaxis to prevent recurrence of Pen V 250mg/12h PO for:
Carditis + valve disease: until 40yrs old
Carditis w/o valve disease: 10yrs
No carditis: 5yrs
76
HOCM signs
Jerky pulse
Double apex beat
Harsh ejection systolic murmur at LLSE
S4
77
Atrial myxoma
May be familial: e.g. Carney Complex
Cardiac and cutaneous myxoma, skin
pigmentation, endocrinopathy (e.g. Cushing’s)
90% in left atrium (fossa ovalis)
```
Features:
Clubbing, fever, ↓wt., ↑ESR
Signs similar to MS (MDM, systemic emboli, AF)
Ix: echo
Rx: excision
```
78
Restrictive cardiomyopathy causes
```
miSSHAPEN
Sarcoid
Systemic sclerosis
Haemochromatosis
Amyloidosis
Primary: hereditary
Eosinophilia (loffler's eosinophilic endocarditis)
Neoplasia (carcinoid --> TR and PS)
```
79
Dilated cardiomyopathy causes
```
DILATE
Dystrophy
Infection (from myocarditis)
Late pregnancy (peri/post partum)
Autoimmune (SLE)
Toxins (EtOH, doxorubicin, cyclophosphamide)
Endocrine (thyrotoxicosis)
```
80
Dilated cardiomyopathy signs
```
JVP ↑↑
Displaced apex
S3 gallop
↓BP
MR/TR
```
81
Marfan's
```
Slit-lamp examination: ectopia lentis
Histology: cystic medial necrosis
Cardiac signs:
Aortic aneurysm and dissection
Aortic root dilatation → regurgitation
MV prolapse ± regurgitation
```
82
Indication for CABG
L main stem disease
Triple vessel disease
Refractory angina
Unsuccessful angioplasty
