cardio clinical Flashcards
(127 cards)
1
Q
aortic stenosis AEx
A
age - calcification
congenital - bicuspid
rheumatic HD
2
Q
aortic stenosis Sx
A
LATE
syncope
angina
SOB
3
Q
aortic stenosis SGx
A
SEM (aortic point)
radiates to carotids
low volume pulse
forceful displaced apex (LVH)
4
Q
aortic stenosis Ix
A
CXR
ECG - LVH
echo (key)
5
Q
aortic stenosis Tx
A
valve replacement (AVR)
(if not tolerated) TAVI -
transcatheter AV implantation (stent)
6
Q
mitral regurg AEx
A
primary =
prolapse
myxomatous (floppy)
chordae / papillary muscle
rupture
infective endocarditis
rheumatic HD
secondary =
LV dys
cardiomyopathy
post MI
7
Q
mitral regurg Sx
A
SOB
peripheral oedema
fatigue
8
Q
mitral regurg SGx
A
pansystolic murmur (apex)
radiates to axilla
displaced apex
HF signs (causes)
AFib
9
Q
mitral regurg Ix
A
CXR - cardiomegaly
ECG - AFib assoc
echo (key)
10
Q
mitral regurg Tx
A
diuretics + ACEi (if HF)
OHS - valve repair / replace
clips if not tolerated (infancy etc)
11
Q
aortic regurg AEx
A
infective endocarditis
rheumatic HD
bicuspid valve
connective tissue disorders (EDs / marfan’s)
aortic root disease (dissection / HTN)
12
Q
aortic regurg Sx
A
LATE
SOB
13
Q
aortic regurg SGx
A
early diastolic murmur (erb’s)
collapsing pulse
austin-flint murmur = diastolic rumble at apex
displaced apex
14
Q
aortic regurg Ix
A
CXR - cardiomegaly
ECG
echo (key)
lean forward + breathe out manoeuvre
15
Q
aortic regurg Tx
A
treat underlying cause =
ACEi
vasodilators (acute)
B blockers (marfan’s)
if symptomatic / LV threat = valve replacement
16
Q
mitral stenosis AEx
A
rheumatic HD
age - calcification
congenital (rare)
17
Q
mitral stenosis Sx
A
SOB
fatigue
palpations (AFib)
18
Q
mitral stenosis SGx
A
mid-diastolic murmur (apex)
malar flush
tapping apex beat
19
Q
mitral stenosis Ix
A
CXR - straight left heart border
ECG - AFib
echo (key)
turn to left manoeuvre
20
Q
mitral stenosis Tx
A
diuretics
treat AFib
valve replacement
(not tolerated) balloon valvuloplasty
21
Q
IC AEx
A
atherosclerosis
22
Q
IC Sx
A
pain in calves on exertion
relieved by rest
23
Q
IC Ix
A
pulses check
ABPI - ankle/brachial
<0.9 = positive
<0.4 = severe
duplex USS
angiography
24
Q
IC Tx
A
LIFESTYLE
(managing Sx - unlikely)
angioplasty + stent
inflow or outflow bypass
amputation!
25
CLTI AEx
atherosclerosis
26
CLTI Sx
pain at rest / night
ulceration + necrosis
diminished / absent pulses
poor tissue nutrition
27
CLTI Ix
pulses check
ABPI - ankle/brachial
<0.9 = positive
<0.4 = severe
duplex USS
angiography
28
CLTI Tx
LIFESTYLE
(limb threat - more likely)
angioplasty + stent
inflow or outflow bypass
amputation!
29
DVT AEx
virchow's triad =
hypercoagulable
endothelial injury
stasis
30
DVT Sx
calf Sx
warmth
tenderness
swelling
redness
mild fever
31
DVT Ix
WELLS score gives guidance
D-dimer (rule out test)
doppler USS (diagnostic)
32
DVT Tx
DOAC
LMWH / warfarin 2nd line
treatment length depends on HERDOO2 score
3 month min - 3-6 - life
33
PE AEx
DVT
AFib
34
PE Sx
SOB
pleuritic chest pain
DVT Sx
collapse / death
fever
haemoptysis
35
PE SGx
tachycardia
hypoxia
cyanosis
low BP
36
PE Ix
(WELLS) PE likely = CT pulmonary angiogram
PE unlikely = D-dimer, if positive then CTPA
V/Q scan in renal impairment / contrast allergy
avoiding radiation = above or leg USS
CXR - normal early, wedge infarct late
ECG - sinus tachy, S1Q3T3
37
PE Tx
DOAC
LMWH / warfarin 2nd line
thrombolysis in severe / circ failure
treatment length HERDOO2, 3m min
38
angina AEx
atherosclerosis
39
angina Sx
central / left discomfort
tight / crushing feeling
SOB
exertion - relieved on rest
40
angina Ix
CT coronary angiography
exercise tolerance
myocardial perfusion scan
catheter angiography
41
angina Tx
lifestyle + GTN
long-term -
1. B blocker
(not tolerated) = CCB
2. ^ combo
3. long acting nitrate
4. nicorandil
5. ivabradine
6. ranolazine
2nd prevention -
1. aspirin + statin
2. ACEi
surgery -
PCI
CABG
42
HTN AEx
gen CVD RF
43
HTN Sx
usually asymptomatic
malignant -
headache
blurred vision
N+V
chest pain
altered mental status
44
HTN SGx
pulses bruits
examine fundi (hypertensive retinopathy)
45
HTN Ix
monitoring -
ABPM if clinic >140/90
HBPM if ABPM declined
46
HTN Tx
monitor for end organ damage
lifestyle interventions
<55 -
1. ACEi / ARB (Bb in FF)
2. + CCB
3. + thiazide diuretic
4. + spironolactone
>55 / black -
1. CCB
2. + ACEi / ARB (Bb in FF)
3. + thiazide diuretic
4. + spironolactone
statins if CVD risk >10%
47
shock Tx
ABCDE
high flow O2
volume replacement (HV)
inotropes (CG)
chest drain (TP)
adrenaline (APh)
vasopressors (SpT)
48
AAA AEx
age
men
FHx
smoking
HTN
atherosclerosis
49
AAA Sx
75% asymptomatic
25% central pain
ruptured - sudden onset ab pain (+ ab mass)
50
AAA SGx
'trash feet' - dusky discoloured
collapse (hypotension)
tachycardia
51
AAA Ix
monitoring - USS
program exists ^
ruptured - CT scan
52
AAA Tx
RF control -
anti-hypertensives
lipid lowering
graft - EVAR or open repair
(asymptomatic only if >5.5cm)
53
aortic dissection AEx
FHx
connective tissue disorders
trauma
54
aortic dissection Sx
chest / interscapular pain
chest / back pain
abdominal pain
syncope
55
aortic dissection SGx
renal / visceral / limb ischaemia
pulse deficits
56
aortic dissection Ix
CT angiography
57
aortic dissection Tx
lower BP
TEVAR
open repair
58
unstable angina AEx
atherosclerosis (rupture)
59
unstable angina Sx
crushing central chest pain
prolonged angina
no relief w/ GTN / rest
sweating
N+V
>30 mins
60
unstable angina SGx
xanthelasma
61
unstable angina Ix
ECG - may be normal / non-specific changes (abnormal T / ST depression)
troponin blood test - negative
62
unstable angina Tx
morphine + antiemetic IV
DAPT (aspirin + clop)
GTN (if hypertensive)
O2 (if hypoxic)
LIFESTYLE
DAPT (aspirin + clop)
ACEi
B blocker
Statin
(GTN for angina
spiro for HF signs)
high risk consider PCI
63
NSTEMI AEx
atherosclerosis (ruptured)
64
NSTEMI Sx
crushing central chest pain
radiates to jaw / arms
no relief w/ GTN / rest
sweating
N+V
>30 mins
65
NSTEMI SGx
xanthelasma
66
NSTEMI Ix
ECG - may be normal
ST depression
deep T wave inversion
pathological Q waves (late)
troponin blood - positive
67
NSTEMI Tx
morphine + antiemetic IV
DAPT (aspirin + clop)
GTN (if hypertensive0
O2 (if hypoxic)
LIFESTYLE
DAPT (aspirin + clop)
ACEi
B blocker
Statin
(GTN for angina
spiro for HF signs)
high risk consider PCI
68
(atypical) silent MI Sx
women, elderly, diabetes
mild Sx, no chest pain
SOB
fatigue
aches
overall illness feeling
discomfort in back / chest / neck / jaw
heartburn
N+V
ab pain
may occur up to a month before MI -
SOB
palpitations
fatigue
sleep disturbance
anxiety
indigestion
69
STEMI AEx
atherosclerosis (ruptured)
70
STEMI Sx
crushing central chest pain
radiates to jaw / arms
no relief w/ GTN / rest
sweating
N+V
>30 mins
71
STEMI SGx
xanthelasma
72
STEMI Ix
ECG - ST elevations / LBBB
troponin positive
73
STEMI Tx
morphine + antiemetic IV
DAPT (aspirin + clop)
GTN (if hypertensive0
O2 (if hypoxic)
LIFESTYLE
DAPT (aspirin + clop)
ACEi
B blocker
Statin
(GTN for angina
spiro for HF signs)
PCI if <2 hours onset
thrombolysis >2 hours
74
AFib AEx
HTN
HF
congenital / valve disease
hyperthyroidism
electrolyte disturbance
inflammation (sepsis / rheumatic HD / gen -itis)
post MI
lone AF = idiopathic
75
AFib Sx
30% incidental finding
rapid palpitations
SOB
chest pain
dizziness / syncope
76
AFib SGx
irregularly irregular pulse
77
AFib Ix
ECG - atrial rate >300bpm
irregularly irregular rhythm
no p waves, 'f' waves
narrow QRS
vent rate variable
78
AFib Tx
treat cause if possible
RATE CONTROL -
B blocker
CCB
digoxin
2nd line -
ablation of AV + pacemaker
RHYTHM CONTROL -
reversible - new onset - HF - rate control failed
cardioversion - DCCV or pharmacological (ami)
(after = antiarrhythmic dugs, B blocker 1st line)
2nd line -
LA catheter ablation
maze procedure
long-term -
DOAC in patients w/ valve disease or CHADS2-VASc score of >2
(2nd line = warfarin)
79
atrial flutter AEx
HTN
HF
congenital / valve disease
hyperthyroidism
electrolyte disturbance
inflammation (sepsis / rheumatic HD / gen -itis)
post MI
80
atrial flutter Sx
mostly asymptomatic
mild arrhythmia Sx
(palpations etc)
81
atrial flutter Ix
ECG - atrial rate >300bpm
ventricular rate 150bpm
narrow QRS
regular rhythm (possibly variable)
82
atrial flutter Tx
symptomatic + acute = cardioversion
catheter ablation
(or class 3 / AV nodal blocking)
DOAC to prevent stroke
83
SVT AEx
AVNRT
most common
women love her
AVRT
accessory pathway
common in WPW syn
ectopic (EAT)
84
SVT Sx
palpations
SOB
85
SVT Ix
ECG - fast narrow complex tachy
bpm >150
rarely visibly p waves
86
SVT Tx
EAT -
spontaneous + normal heart = reassure
bad Sx = B blocker
avoid stimulants
acute -
increase vagal tone (valsalva, carotid massage)
IV adenosine
DCCV if ^ fails
long-term -
B blockers, CCB, ami
radiofrequency ablation
avoid stimulants
87
VTACH AEx
most have significant CVD
CAD - past MI - HF
inherited cardiomyopathy / channelopathy
idiopathic
iatrogenic (meds)
monomorphic - increased re-entry (past MI)
polymorphic - abnormal vent repolarisation (long QT / drug tox / electrolytes)
88
VTACH Sx
dizziness
syncope
hypotension
cardiac arrest
can be remarkably well tolerated in some
89
VTACH SGx
pulse rate generally 120-220bpm
90
VTACH Ix
ECG - monomorphic + polymorphic
91
VTACH Tx
unstable w/ pulse = DCCV
stable = pharma CV, DCCV
pulseless = defib
long-term -
correct triggers
anti-arrhythmics generally ineffective (often used + ICD for Sx)
ICD in recurrence risk
catheter ablation
92
AVB AEx
age
acute MI
myocarditis
infiltrative disease (amyloid / sarcoid)
drugs = B blockers, CCB
calcific aortic valve disease
aortic valve surgery
genetic (Lenegre's / myotonic dystrophy)
93
long QT syndrome AEx
congenital
Jervell-Lange-Nielson - autosomal recessive, assoc deafness
Romano-Ward syndrome - autosomal dominant, isolated
acquired = electrolyte im, drugs, diabetes, acute MI
94
long QT syndrome Sx
syncope
SCD (due to TdP)
95
long QT syndrome SGx
polymorphic VTACH (TdP)
lone AF
heart block
96
long QT syndrome Ix
ECG - Torsades de Pointes
long QT interval
97
long QT syndrome Tx
acute = treat underlying cause
Mg infusion
DCCV of VTACH
long-term -
B blockers
avoid QT prolonging drugs
pacemaker therapies
avoid triggers (breath holding / sudden auditory stim / sleep)
98
brugada syndrome AEx
congenital - autosomal dominant
cardiac Na + K channels
99
brugada syndrome Sx
risk of polymorphic VTACH + VFib
AFib common
100
brugada syndrome Ix
ECG - ST elevation + RBBB in v1-v3
findings may be intermittent / change
ECG changes only diagnostic w/ provocative testing (drugs to block Na channels)
101
brugada syndrome Tx
genetic testing (+ family)
ICD
avoid triggers (rest or sleep / fever / excessive alcohol / large meals / B blockers / psychotropics / analgesics / anaesthetics)
102
hypertrophic cardiomyopathy AEx
genetic - autosomal dominant
103
hypertrophic cardiomyopathy Sx
asymptomatic
SCD
SOB
AFib
syncope
palpitations
angina
104
hypertrophic cardiomyopathy Ix
ECG - LVH
ST+T wave changes
abnormal Q waves
(usually diagnostic)
105
hypertrophic cardiomyopathy Tx
SCD risk = ICD
chest pain / SOB = B blockers / verapamil
106
ARCV AEx
genetic - autosomal dominant + recessive forms
fibro-fatty replacement of cardiomyocytes in RV
107
ARVC Sx
mostly asymptomatic
vent arrhythmia
syncope
SCD
108
ARVC Ix
ECG usually normal
echo
cardiac MI
genetic testing
109
ARVC Tx
B blockers for arrhythmias
ICD in SCD risk
110
infective endocarditis AEx
organisms in bloodstream:
PWID
ICD
intravascular lines
sepsis
abnormal cardiac endo:
rheumatic HD
congenital HD
valvular degeneration (age)
prosthetic heart valve
staph aureus
viridans strep
enterococcus sp
staph epi
111
infective endocarditis Sx
acute -
overwhelming sepsis
failure
(aggressive organisms)
subacute -
fever
malaise
weight loss
tiredness
SOB
112
infective endocarditis SGx
new heart murmur
finger clubbing
splinter haemorrhages
splenomegaly
roth spots
janeway lesions
osler nodes
microscopic haematuria
113
infective endocarditis Ix
blood culture (3 sets)
echo - vegetations
serology - if blood cultures negative look for atypicals
114
infective endocarditis Tx
empirical =
native valve - amoxicillin + gentamycin IV
prosthetic valve - vancomycin + gentamycin IV (+ rifampicin PO 3-5d)
PWID - fluclox IV
specific =
staph aureus - fluclox IV
viridans strep - benzylpenicillin + gentamycin IV
enterococcus sp - amoxicillin / vancomycin + gentamycin IV
staph epi - vancomycin + gentamycin IV (+ rifampicin PO)
115
myocarditis AEx
young people - SCD cause
enteroviruses (+ others)
may also be a hypersensitivity reaction
116
myocarditis Sx
fever
SOB
chest pain
palpitations
117
myocarditis SGx
third heart sound
arrhythmias
tachycardia
cardiac failure
118
myocarditis Ix
viral PCR - diagnostic
ECG, bloods, CXR
119
myocarditis Tx
supportive treatment
120
pericarditis AEx
myocarditis assoc
viral, bacteria less common
dressler's syndrome - 4-6 weeks post MI
121
pericarditis Sx
chest pain - worse on inspiration, relieved by sitting up
low grade fever
122
pericarditis Tx
supportive treatment
123
HF AEx
ischaemic HD
dilated cardiomyopathy
HTN
other cardiomyopathies, valvular disease, arrhythmias, pericardial disease, infection, alcohol, diabetes, congenital HD
124
HF Sx
exertional SOB
orthopnoea
paroxysmal nocturnal dyspnoea
fatigue
125
HF SGx
tachycardia
raised JVP
cardiomegaly
S3 + S4
bi-basal crackles
pleural effusions
peripheral oedema
ascites
tender hepatomegaly
126
HF Ix
ECG - arrhythmias, past MI, LVH
CXR - cardiac silhouette (size + shape), fluid accum on lungs
bloods - BNP (cardiac hormone) rule out test for symptomatic patients
echo - diagnostic
127
HF Tx
LIFESTYLE
ACEi (or ARNi if uncontrolled)
B blocker
spironolactone
loop diuretic (Sx)
ivabradine
digoxin (Sx)
