Cardio misc Flashcards by L P

What murmer does a VSD have

pansystolic murmer.

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What is a LEft to right shunt?

Blood takes an extra trip to lungs. may lead to pumonary HTN bc more blood on the rhs

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What would you see with a small VSD?

may be asymptomatic. larger holes present problems in infancy

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How is VSD treated?

With surgery at infancy but may heal with age

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Why is ASD more dangerous with age?

As heart compliance falls with age, the shunt
increases
This can lead to heart failure and SoB by 40
Eisenmenger’s complex

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What is the Eisenmenger’s complex?

shunt reversed due to the
development of pulmonary HTN -> cyanosis and
organ damage.
ALl the blood is pumped out through the aorta, organ damagae because less oxugen to the tissues

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What can pulmonary HTN cause?

Cyanosis and organ damage

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When can ASD be asymptomatic?

Until adulthood?

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what can a bicuspid aortic valve cause?

aortic stenosis +/- aortic regurgitation
pre-dispose an individual to IE, aortic
dilation and aortic dissection

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How can a bicuspid aortic valve be treated?

valve replacement

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What can cause eisenmenger’s be caused by?

A right to left shunt. pulmonary HTN

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What does cyanosis present like?

Blueish tinted skin, around eyes and fingertips and lips

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What can cause organ damage and cyanoiss?

Eisenmenger’s complex (all blood leaves through aorta)

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What is Coarctation of the Aorta?

Aorta is narrowed at the site of the ductus

arteriosus

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What can a severe coarction of the aorta lead to?

blocks aorta, collapse with heart failure

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What can a mild coarction of the aorta lead to?

raised BP and systolic murmur (best heard over

left scapula, ‘scapula bruit’)

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What murmer do you hear with mild coartcion of the aorta?

systolic murmur (best heard over
left scapula, ‘scapula bruit’)

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What are the signs of COA?

BP in right arm greater than BP in left arm
(Radio-femoral delay,)
systolic murmur (best heard over
left scapula, ‘scapula bruit’)

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What can COA lead to a risk of?

increased risk of infective endocarditis?

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How can COA be treated?

sugery insert a stent

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What can bicuspid aortic valve pre-dispose a patient to?

IE, aortic

dilation and aortic dissection

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What are the symptoms of infentile coarctation?

blue cyanosis. Blood from pulmonary vein to aorta, reduced O2 to tissues. neonatal death. associated with Turner’s sundrome

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Adult coarctation?

Ligamentus arteriosis. (ductus closes off)

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Feature on CXR of tetralogy of fallot?

boot leg shaped heart due to RV hypertrophy

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at what percentage of O2 does cyanosis develop?

less than 80%

What are the 4 key features of tetralogy of fallot

VSD Pulmonary stenosis RV hypertrophy Overriding aorta

Why do you get an overriding aorta in TOF?

RV hypertrophy increases the RV pressure so blood flows into LV bc of the VSD. All the blood leaves through the aota, reduced oxygenation and cyanosis in infants

What do infants withTOF present with

cyanosis and toddlers may squat

Which congenital heart conditon has the higher adult survival rate?

TOF

What are the congenital heart conditions?

TOF, Biscuspid aortic valve, VSD, ASD, coarction of aorta

which is the most common cong. heart defect?

TOF

What can cause MI?

reduced blood flow to the heart muscle (clot or atheroma) increased distal resistance (LV hypertrophy) reduced O2 carrying capacity (anaemia) or availability (hypoxia)

What causes distal resistance in heart oxygen flow?

LV hypertrophy?

what is the QRISK2 score?

predicts risk of CVD in next ten | years.

Characteristic feature of angina?

relief with rest

ANgiogram of angina?

– Gold standard, | shows luminal narrowing

What would u see in bloods for angina?

anaemia

CABG vs. PCI?

PCTA – stenting or ballooning the narrowing, risk of restenosis or thrombosis. Less invasive. CABG – good prognosis but longer recovery, not for the frail.

what cardiac enzymes do you test for?

troponin, CK, myoglobin

What are the ACS

unstable angina STEMI NSTEMI

What condition has a rise and fall in troponin?

NSTEMI

Dx if tropinin is normal but ECG changes and chest pain?

Unstable angina

What is unstable angina aggrevated by?

anaemia

When are 'silent MIs' seen?

diabetics and elderly

Symptoms of MI

SOB, chest pain, palpatations, sweating, pain radiates to jaw and arm, lasting >20 mins, with nausea,

signs of Mi?

clammy and pale, 4th heart sound pansystolic murmur, may later develop peripheral oedema

What would you hear on an MI?

4th heart sound | pansystolic murmur,

Advice for someone suffering MI/

exercise, drugs and no air travel for 2 months. return to work in 2 months after medication

What cardiac enzyme is raised when there is muscle damamge?

CK-MM. creatinine kinase MM. this is elevated in periheral arterial disease

Treatment for PAD

Clopidogrel (1st line) and other anti-coags

Pain of acute pericarditis?

Central chest pain that radiates to the trapezium ridge SOB, hiccups (irritation of phrenic nerve) Relieved by sitting forwards Worse on inspiration and lying down

Causes of A.pericarditis?

Most common = viral infections (coxsackie B, EBV, mumps) Bacterial – pneumonia, rheumatic fever, TB, staph, strep Post-MI (Dressler’s syndrome) Autoimmune (SLE, RA)

HF compensatory mechanisms?

``` Increased preload Increased afterload - symp stimulation Salt and water retention - RAAS Myocardial remodelling - myoctype hypertrophy ```

ABCDE Heart failure anacronym?

``` alveolar oedema kerley b lines cardiomegaly dilated prominent upper lobe vessels pleural effusion ```

Investigations for HF?

FBC, LFT, TFT, BNP (B tyoe naturetic peptide), CXR, echo, ecg, CK-MM, troponin I and T

LHF signs?

``` cardiomegaly Heart murmer cool peripherals weight loss tachycardia reduced BP ``` also: fatgique, pleural effusion, dysponea on exertion,

RHF signs?

``` perioheral oedema, pitting oedema, increased JVP ascites nausea anorexia hepatomegaly ``` can be caused by LHF, pulmonary stenosis, lung disease

ECG in atrial fibrilation?

f waves no clear P waves Rapid and irregular QRS complex irregularly irregular beat

Treatment for Atrial fibrilation

CCBs, BB, Digoxin, Anticoags - warfarin, | Amidarone, electrical DC cardioversion (reset beat)

What causes AF?

heart failure, HTN, rheumatic heart disease, thyrotoxicoses

Symptoms of AF?

asymptomatic, over 65, palpatations, fatigure, HF

What is used to calculate the risk of stroke from an AF?

CHA2DS2VASc Score

What does the CHA2DS2VASc score take into account?

HTN, AGe, DM, prev stroke/TIA, vascular disease, female,

what are F waves?

sawtooth flutter waves

Intrinscic causes of bradycardia (less than 60bpm)

Acute ischaemia Infarction of SAN Sick sinus syndrome

Extrinsic causes of bradycardia?

Drug therapy - BB, digoxin Hypothyroidism Hypothermia Raised intracranial pressure

Cardio misc Flashcards

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