1. DVT (any risk factors?) 2. Cellulitis 3. Ruptured baker's cyst 4. CCF (usually bilateral leg swelling) 5. Liver failure

cardio DPD Flashcards by denise lin

Acute rheumatic fever (AI disease)

5 major criteria

Arthritis 
Chorea (st vitus dance) 
Carditis (endocarditis/myocarditis) 
Subcutaneous nodules 
Erythema marginatum

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AVRT

Type of SVT
Wolff-parkinson white syndrome
Bundle of Kent accessory pathway

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Mitral valve prolapse

Barlow syndrome/click murmur syndrome

Occurs when one or two leaflets of mitral valve are pushed back into L atrium during systole. Causes a mid-systolic click, with late systolic murmur at apex (can radiate to axilla). May develop into MR and complications of bacterial endocarditis may occur

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Austin Flint murmur

Occurs in aortic regurgitation
Low-pitched, mid-diastolic rumble at apex
causes a physiological mitral stenosis-like murmur.

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Graham Steell murmur

Pulmonary regurg/HTN
High-pitched
Early diastolic murmur
Louder on inspiration

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Carey Coombs murmur

Mitral stenosis (in rheu fever)
Short, mid-diastolic rumble at apex

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Dopamine agonists

used to treat prolactinomas

Bromocriptine

Cabergoline

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Dopamine antagonists

anti-emetics

Metoclopramide

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ACEi’s effect on plasma creatinine initially

Increases

this is abnormal but continue to administer the drug

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Hypoglycaemic collapse causes

T1DM (insulin OD?)

Insulinoma (very rare)

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Swollen leg DDx

DVT (any risk factors?)
Cellulitis
Ruptured baker’s cyst
CCF (usually bilateral leg swelling)
Liver failure

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Dressler’s syndrome

Autoimmune pericarditis

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Sodium nitroprusside indications

Rapid BP lowering

Most effective and reliable drug

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Secondary hypertension causes

90% are primary

Phaeochromocytoma
Cushings
Conns
Acromegaly
Renal artery stenosis
Aortic co-arctation

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Loud S1 with opening snap

Mid-diastolic murmur

Mitral stenosis

apex beat is tapping, heave: RV hypertrophy and pulmonary HTN, malar flush, AF, orthopnoea, thready pulse

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Commonest cause of mitral stenosis (obstructed blood flow from LA to LV)

Rheumatic fever

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Water-hammer pulse

Collapsing pulse, wide PP

= aortic regurg

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Aortic regurg causes

Abnormalities (bicuspid valve, IE, rheumatic fever)

Dilation (hypertension -> LVH)

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Aortic regurg (reflux of blood from aorta to LV in diastole) signs and symptoms

Symptoms of HF (S3, S4, orthopnoea, palpitations)
Displaced apex beat
Early diastolic murmur
Wide PP, collapsing pulse
CXR = cardiomegaly
ECG = LVH
Echocardiogram

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Aortic stenosis (obstruction from LV) signs and symptoms

Angina, syncope
ESM radiates to carotids
Narrow PP, slow rising pulse
CXR = calcified aortic valve
ECG = LVH

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Aortic stenosis causes

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Rheumatic heart disease
Calcification of bicuspid aortic valve
Calcification of tricuspid valve in elderly

Cardiac arrest O/E

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Unconscious
Not breathing
No carotid pulse

Cardiac arrest Rx

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ABCDE
CPR + defibrillator
IV adrenaline
(Amiodarone and atropine)

HTN classification
Normal
Normal high

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Normal: <130, <85

Normal high: 130-39, 85-89

``` HTN classifcation Stage I (mild) Stage II (moderate) Stage III (severe) Stage IV (very severe) ```

``` Stage I (mild): 140-159, 90-99 Stage II (moderate): 160-79, 100-109 Stage III (severe): 180-209, 110-120 Stage IV (very severe): ≥210, ≥120 ```

HTN classifcation Isolated systolic Class I Isolated sytolic Class II

Isolated systolic Class I: 140-159, <90 | Isolated sytolic Class II: ≥160, <90

Hypertensive retinopathy grades

Grade 1 - silver wiring Grade 2 - AV nipping Grade 3 - flame haemorrhage, cotton wool spots (ischaemia) Grade 4 - all features and papilloedema

Chronic HTN other signs

``` LVH Heave S4 (ventricular hypertrophy) Bruits ECGs: deep S wave V1/2, tall R wave V5/6. Together >7large sqares ```

High renin and aldosterone levels suggest...

Renal artery stenosis

Low renin and high aldosterone levels suggests..

Hyperaldosteronism (Conn's)

de Musset's sign seen in aortic regurg, associated with hyperdynamic pulse.

Head nods in time with pulse

Becker's sign Muller's sign Corrigan's sign Quincke's sign seen in aortic regurg, associated with hyperdynamic pulse.

Visible pulsations of: 1. becker's - pupils and retinal arteries 2. muller's - uvula 3. corrigan's - in neck 4. quincke's - on nail bed

Traube's sign seen in aortic regurg, associated with hyperdynamic pulse.

Pistol shot (systolic and diastolic sounds) on auscultation of femoral arteries

Duroziez's sign seen in aortic regurg, associated with hyperdynamic pulse.

Systolic and diastolic bruit on partial compression of femoral artery

Rosenbach's sign Gerhard's sign seen in aortic regurg, associated with hyperdynamic pulse.

Systolic pulsations of: 1. rosenbach's - liver 2. gerhard's - spleen

Hill's sign seen in aortic regurg, associated with hyperdynamic pulse.

Popliteal cuff SBP exceeding brachial pressure by >60mmHg

Acute malignant HTN Rx

IV b-blocker e.g. labetolol ± sodium nitroprusside Avoid very rapid lowering which can cause cerebral infarction

When is CABG indicated in ischaemic heart disease

Left main stem or three-vessel disease involvement

MI complications (DARTH VADER)

``` Death Arrhythmias Rupture (papillary muscles - acute MR) Tamponade Heart failure Valve disease Aneurysm Dressler's syndrome Embolism Re-infarction ```

Causes of mitral regurg

``` Rheumatic heart disease IE Mitral valve proplapse Papillary muscle rupture Floppy mitral valve/CTDs ```

Coxsackie B virus and Chagas disease are infectious causes of

myocarditis

Investigations for hypertension

``` Bloods: FBC (polycythaemia), U+Es (hypoK+ and renal function) Fasting glucose (DM risk) Lipids ECG (LVH) Urinalysis (nephritis or renal disease) ```

Phaeochromocytoma Rx

``` (Rehydrate if dehydrated) Alpha blockade Beta blockade Localise the lesion surgery ```

A 65 year old patient with a previous MI has a BP of 140/80 on atenolol. What is should be the next step in his treatment?

Add a thiazide diuretic

D-dimer is useless in pregnancy because it will be raised anyway. Pregnant women with DVT risk investigation should be...

Doppler USS of the leg

Polymorphic VT Haemodynamically stable patient Treatment?

IV amiodarone/magnesium | then DC cardioversion or if haemodynamically unstable

Left main stem branches

left anterior descending artery | left circumflex artery

HOCM cardiac signs + symptoms

Regular, jerky pulse Hyperdynamic cardiac impulse (not displaced) (Mid-systolic murmur with no ejection fraction) S4

STEMI Rx

MONABASH <12hours: PCI/fibrinolysis in same 120mins >12hours: consider CABG

Unstable angina/NSTEMI Rx

Analgesia: morphine Anti-ischaemia: GTN spray Immediate aspirin + anti-thrombin therapy: fondaparinux or LMWH Long term: DASH diet, stop smoking, ACEi, dual antiplatelet therapy (aspirin + 2nd agent), statins, b-blockers

Patient with NSTEMI diagnosed will be having a coronary angiogram soon. They have been given aspirin, morphine and GTN spray already so far. What other medication should be given?

Anti-thrombin therapy is indicated here i.e. LMWH or fondaparinux However this patient is having a coronary angiogram soon so LWMH is the choice and not fondaparinux.

cardio DPD Flashcards

(51 cards)