Cardio Pathology Flashcards
(228 cards)
1
Q
Endocarditis
A
- infection of the inner lining of the heart
- infection in the blood vessels coming out of the heart
Symptoms :
- fever
- chills
- small red/purple spots on the skin
- painful red lumps on fingers and toes
2
Q
what is it?
Malignant hypertension
A
- severely high blood pressure
180/120 - can cause multiple complications and organ damage
- more vasoconstriction
- medical emergency
3
Q
giant cell arteritis
A
- pain and stiffness in the neck
- due to inflammation of the blood vessels
- causes narrowing of arteries and reduced blood flow
4
Q
pericarditis
A
- inflammation of the pericardium
- can be caused by virus and bacteria
symptoms:
- chest pain,
- fever
- ECG changes
5
Q
Aortic Stenosis
A
- valve disease
narrowing of the aortic valve opening - it is followed by three symptoms
- heart failure
- syncope
- angina
- slow rising pulse
- decreased exercise tolerance
6
Q
Cardiac Tamponade
A
- there is accumulation of fluid, blood and air in the pericardial space
- this raises intra pericardial pressure
- diastolic filling is reduced - cardiac output is reduced
Symptoms:
- tachycardia
- confusion
- chest pain
- hypotension, quiet heart sounds and raised JVP
7
Q
What is Pericardiocentesis
A
procedure done to remove fluid that gets built up in the pericardium
8
Q
Aortic Regurgitation
A
- the aortic valve is leaking and causes the blood to flow in the reverse direction
9
Q
Mitral regurgitation
A
- when the mitral valve doesn’t close properly
- the blood flows backwards into the heart
10
Q
Aortic Sclerosis
A
- thickening of the aortic valve
- but doesn’t properly block blood flow
11
Q
Tricuspid Stenosis
A
- narrowing of the tricuspid valve
- disruption in blood flow from right atrium to right ventricle
12
Q
STEMI on ECG
A
- new onset left bundle branch block LBBB
13
Q
De Musset’s Sign
A
bobbing of head along with heartbeat
14
Q
Quincke’s sign
A
pulsation of nail beds
15
Q
Traube’s sign
A
pistol shot sound coming from femoral pulse
16
Q
Muller’s sign
A
bobbing of the uvula
17
Q
Widened pulse pressure
A
low diastolic pressure
18
Q
ACUTE BRADYCARDIA
what is it?
A
-heart rate of less than 60 bpm
19
Q
Causes of Bradycardia
A
- beta blockers
- calcium channel blockers
- hypothyroidism
- electrolyte abnormalities (hypokalaemia)
20
Q
CLINICAL FEATURES OF BRADYCARDIA
A
- dizziness
- fatigue
- syncope
21
Q
MANAGEMENT OF BRADYCARDIA
A
DR ABCDE
IF PATIENT IS HAVING ANY OF THESE 4: shock, myocardial ischaemia, HF or Syncope:
GIVE ATROPINE 500mcg IV
(If doesn’t work then give adrenaline 2-10mcg per minute)
22
Q
how does Atropine work in managing bradycardia
A
blocks vagus activity to the heart so the firing to the SA node is increased
23
Q
which antibiotics are associated with Long QT interval?
A
Macrolides
24
Q
what causes raised JVP?
A
venous hypertension
25
MYOCARDITIS
What is it?
- inflammatory disease of the myocardium
26
CAUSES OF MYOCARDITIS
- viral infection
- auto-immune conditions
- chagus disease
- kawasaki disease: high temperature for over 5 days and swollen neck glands
27
SYMPTOMS OF MYOCARDITIS
- HF
- Palpitations
- Chest Pain
- Fatigue
28
What is heard on auscultation in pericarditis
pericardial rub
29
DIAGNOSING MYOCARDITIS
ST segment and T wave changes on ECG
Elevated troponin levels
ventricular dysfunction
30
MANAGEMENT OF MYOCARDITIS
- treat the underlying cause
- treat HF
31
TACHYCARDIA
what is it
heart rate >100bpm
32
MANAGEMENT OF TACHYCARDIA IN UNSTABLE PATIENT
EMERGENCY SYNCHRONISED DIRECT CURRENT CARDIOVERSION
33
MANAGEMENT OF TACHYCARDIA IN STABLE PATIENTS with REGULAR RHYTHM
Vagal manoeuvres or Valsalva manoeuvre - blow into tube
IF this fails:
GIVE ADENOSINE 6MG (over 2 seconds)
6MG
12MG
34
MANAGEMENT OF TACHYCARDIA IN STABLE PATIENTS with IRREGULAR RHYTHM
IF ONSET IS <48 HOURS: Flecainide
IF ONSET IS > 48 HOURS: Bisoprolol or Verapamil
35
SICK SINUS SYNDROME
36
What is given to manage tachycardia in ASTHMATIC PATIENTS
Verapamil (adenosine CANNOT be given to asthmatic patients)
37
when is digoxin used?
used for fast AF in patients with Heart Failure
38
ECG SHOWS DELTA WAVES AND SHORT PR INTERVAL
what condition is this?
Wolff-Parkinson-White syndrome
39
ECG SHOWS SHORT PR INTERVAL
what condition is this
Lown-Ganong-Lenine syndrome
40
ACUTE MYOCARDITIS
what is it
inflammation of the myocardium
41
FEATURES OF MYOCARDITIS
chest pain
fatigue
palpitations
42
TREATMENT OF ACUTE MYOCARDITIS
painkillers
antibiortics
corticosteroids - alemtuzumab
43
AORTIC DISECCTION
what is it
tear in the tunica intima of the aorta
blood flows between the layers making a false lumen
44
TWO TYPES OF AORTIC DISECCTION
type A - aortic arch and ascending aorta
type B - descending aorta
45
CLINICAL FEATURES OF AORTIC DISECCTION
tearing chest pain
radiates to the back
renal failure/bowel ischemia
46
EXAMINATION FEATURE OF AORTIC DISECCTION
| feature of the blood pressure
different BP on each arm
47
INVESTIGATION FOR AORTIC DISECCTION
CT angiography
ECG
bloods will show raised troponin and positive D-Dimer
48
MANAGEMENT OF AORTIC DISECCTION
TYPE A: surgical management
TYPE B: conservative management
49
AORTIC REGURGITATION
what is it
incomplete closure of the AV valves
50
CAUSES OF ACUTE AORTIC REGURGITATION
infective endocarditis
aortic disecction
51
CAUSES OF CHRONIC AORTIC REGURGITATION
rheumatic heart disease
bicuspid aortic valve
Marfan's syndrome
52
PRESENTATION OF ACUTE AORTIC REGURGITATION
pulmonary oedema
pallor
sweating
53
PRESENTATION OF CHRONIC AORTIC REGURGITATION
exertional dyspnoea
nocturnal dyspnoea
54
EXAMINATION FINDINGS OF AORTIC REGURGITATION
waterhammer pulse
De mussets sign
Quincke's sign
Traube's sign
collapsing pulse
early diastolic murmur
55
MAANAGEMENT OF AORTIC REGURGITATION
aortic root dilation
beta blockers
56
AORTIC STENOSIS
what is it
narrowing of the aortic valve
57
CLINICAL FEATURES OF AORTIC STENOSIS
heart failure
syncope
angina
exertional dyspnoea
58
EXAMINATION FINDINGS OF AORTIC STENOSIS
slow rising pulse
heaving apex beat
ejection systolic murmur on 2nd R. intercostal space
59
ECG FINDINGS OF AORTIC STENOSIS
increased QRS voltage
left axis deviation
60
WHO IS GIVEN INTERVENTION FOR AORTIC STENOSIS
1. symptomatic patients
2. asymptomatic patients with LVEF <50%
3. asymptomatic patients with LVEF <50% who have a fall in BP during exercise
61
MANAGEMENT FOR AORTIC STENOSIS
transcatheter aortic valve implantation (for patients at high risk who cannot have surgery)
or
surgical aortic valve replacement
62
AORTIC SCLEROSIS
what is it
narrowing of the aortic valve without having any affects on the function of the valve
63
CLINICAL FEATURE OF AORTIC SCLEROSIS
ejection systolic murmur that doesnt radiate to the carotids
64
ATRIAL FLUTTER
what is it
regular, rapid atrial rate
65
CAUSES OF ATRIAL FLUTTER
COPD
sleep apnoea
PE
sepsis
alcohol
66
CLINCIAL FEATURES OF AORTIC FLUTTER
dizziness
palpitations
chest pain
67
ECG OF ATRIAL FLUTTER
saw tooth baseline at 300 bpm
68
MANAGEMENT OF ATRIAL FLUTTER
HEAMODYNAMICALLY UNSTABLE: DC cardioversion
HEAMODYNAMICALLY STABLE: rate control by beta blockers or CCB
69
ATRIAL FIBRILLATION
what is it
uncoordinated atrial contraction at 300-600bpm
delay at AV node so only some of the atrial contractions get passed onto the ventricles
70
CAUSES OF ATRIAL FIBRILLATION
CARDIAC: ischaemic heart disease, hypertension, rheumatic heart disease
NON CARDIAC: dehydration, hyperthyroidism, sepsis and PE
71
CLASSIFICATION OF ATRIAL FIBRILLATION
| (different names for the duration)
acute <48h
paroxysmal: <7 days
persistent >7 days
permanent >7 days and doesn't go away with cardio version
72
CLINICAL FEATURES OF ATRIAL FIBRIALLTION
palpitations
chest pain
shortness of breath
dizziness
73
MANAGEMENT OF ATRIAL FIBRILLATION
Rate control - given to those who have AF with reversible cause
eg. bisoprolol (BB)
diltiazem (CCB) and Verapamil
BB cannot be given to hypotensive patients so give DIGOXIN
74
MANAGEMENT OF ATRIAL FIBRILLATION BASED ON ONSET
<48 hours - DC cardioversion
>48 hours - 3 weeks on anticoagulation and then DC cardioversion
75
IMPORTANT DRUGS IN AF
flecainide - for younger patients
amiodarone - rate and rhythm control
sotalol - BB
76
CHADS2-VASC SCORE
C- congestive heart failure 1
H- hypertension 1
A- >75 2
D- diabetes 1
S-stroke 2
V- vascular disease 1
A- age <75 1
S-sex Female 1 male 0
males with score 1 and females with score 2 = anticoagulation needed
77
ANTICOAGULATIONS IN AF
direct oral anticoagulation - apixaban and rivaroxaban
warfarin
low molecular weight heparin
78
CARDIAC TAMPONADE
what is it
fluid, blood and air accumulates in the pericardial space
causes raised intra pericardial pressure and reduced cardiac output
79
CLINCIAL FEATURES OF CARDIAC TAMPONADE
shortness of breath
tachycardia
confusion
chest pain
abdo pain
80
BECKS TRIAD FOR CARDIAC TAMPONADE
hypotension
quiet heart sounds
raised JVP
81
RISK FACTORS OF CARDIAC TAMPONADE
pericarditis
serious injury
82
INVESTIGATION FOR CARDIAC TAMPONADE
ECG: low voltage on QRS complex
Chest xray: large, globular heart
ECHO: more fluid around heart
83
MANAGEMENT OF CARDIAC TAMPONADE
unstable patients: pericardiocentesis
stable: surgical drainage
84
CARDIAC MYXOMA
what is it
benign tumour in heart
85
CLINICAL FEATURES CARDIAC MYXOMA
fever
weight loss
nail clubbing
'plop' sound on auscultation
86
ECG FEATURES FOR COPD
right ventricular heave
87
HEART FAILURE MANAGEMENT
cardiac resynchronisation
88
MANAGEMENT OF BRADYCARDIA AFTER MI
transcutaneous pacing
89
MANAGEMENT OF PERICARDITIS IN POST MI PATIENTS
high dose aspirin
90
LEFT VENTRICULAR HYPERTROPHY IS SEEN WHEN
stable angina
91
CONGESTIVE HEART FAILURE: pt is already on ramipril and furosemide and bisoprolol,
what should be given now
spironolactone
92
PATIENT HAS CHEST PAIN FOR 12 HOURS
angiography and PCI
93
NORMAL QT INTERVAL
<350-450ms
94
SYNCOPE after exertion with short QT interval - what is it
cardiac arrythmia
95
COMMON CAUSE OF INFECTIVE ENDOCARDITIS IN IV DRUG USERS
staphyl. aureus
96
WHAT MEDICATIONS SHOULD BE GIVEN TO PATIENTS AFTER AN MI
ACE inhibitor,
beta-blocker
statin
97
Patient with severe hypomagnesaemia collapses - what is the most likely cause of the collapse
Ventricular tachycardia
98
Pernicious anaemia - what is it
Deficiency of red blood cells due to lack of vitamin B12
Mainly due to autoimmune conditions like diabetes
99
Disseminated intravascular coagulation - what is it
small blood clots develop throughout the bloodstream
this blocks small blood vessels
this reduces the platelets and clotting factors needed to control bleeding
causes excessive bleeding.
100
Which corticosteriod can be used to increase blood pressure (useful in postural hypotension)
Fludrocortisone
101
ECG side effects of ramipril
hyperkalaemia,
tall t waves,
flat p waves
broad QRS
102
# most common
side effect of PCI
heart can swell and cause compartment syndrome
103
what are the heart related enzymes and what are raised after MI
CKMB and Troponin T and I and Myoglobin - all are there for 3 days
104
how long does troponin stay in the blood for post MI
10 days
105
what does an A wave show
atrial contraction
106
when is absent a wave seen
in uncoordinated atrial activity
107
when is prominent a wave seen
forced atrial contraction
108
when is cannon a wave seen
when the atria contracts against a closed tricuspid valve
109
what is a v wave
ventral contraction
110
what is apixaban
an anticoagulant that is used to prevent stroke
works by blocking 10a - clotting factor
111
what is clopidogrel
anti platelet
112
how does warfarin work
works on the liver and stops the clotting factors from being produced
113
dexathasone uses
steroid
used in severe asthma
used to reduce brain tumour size
114
What does Thrombosis do
Dilutes the clot
115
What does aspirin do and how does it work
Thins blood and prevents a clot from forming
116
What does frobronlysis doe
Dissolves fibronogen
117
What is broad complex tachycardia
No output
Give unsynchronised dC cardio version
118
Shockable Rhythm
VF and pulseless VT
119
Non shockable rhythm
Pulseless electrical activity and a systole
120
Help for pulseless rhythm
CPR for 2 mins and adrenaline
After 3 adrenalines give amiodarone
121
MI
Shortness of breath and malaise
Parasternal thrill and pansystolic murmur along with L sternal angle radiating towards apex
JVP raised
What is it
Ventricular septal defect
Complication of MI
It can cause a pansystolic murmur and acute heart failure
Troponin rises 3 hours MI
Causes pedal oedema
122
VEF = 55%
Bilateral pitting oedema
Asthma and type 2 diabetes
Smoker
What medication should you give
Furosemide and ramipril
123
SOB on exertion
SOB at rest
Smoker and hypertension
Displaced apex beat and crepitations and crackles
Pulmonary oedema due to heart failure
124
IV drug user
6 weeks of fever and malaise
Double p wave
Infective endocarditis
Common in drug users and fever is common symptom
125
SOB
bilateral crackles
Raised JVP
high HR
Pansystolic murmur at apex
Acute mitral regurgitation
126
Where is the SA node
Junction of superior vena cava and right atrium
127
The cardiac electrical cycle
1. Blood goes to atria then goes to ventricles
2. AV slows down the electrical conduction
3. Cardiac muscle depolarises releasing ca
This slows down the repolarisariom phase - causes plateau
4. Then K+ is released - depolarisation
128
What is stroke volume equation
Cardiac output = stroke volume x HR
129
What is reactive hyperaemia
Tissue ischaemia causes an increase in blood flow
130
Functional hyperaemia
Increase in blood flow due to increased metabolic activity
131
Anterior STEMI
Legs swollen for 6 months
Hyperlipidaemia
Due to nephrotic syndrome
132
Pedal oedema and raised JVP
Right sided HF
Raised pressure in right atrium
133
78year old man
Central chest pain radiating to jaw
What treatment
Dusk Antiplatelet therapy and morphine (if o2 is <94%)
134
What is atrial flutter
Regular and rapid contraction of atria
More frequent than ventricle contraction
2:1 ratio
Saw tooth pattern
135
ECG
Leads ii, iii, avF
Which location
RCA
136
ECG
Leads V1-2
Which location
LAD
137
ECG
Leads V3-4
Which location
LAD
138
ECG
Leads V5-6
Which location
Distal LAD and RCA
139
ECG
Leads I and avL
Which location
Lcx
140
ECG
Leads v7-v9
Which location
RCA and lcx
141
Palpitations
Drinks alcohol everyday
Absent p waves
Irregular QRS complex
What do you give
Give Abixaban
142
What is the most common side effect of ramipril
Dry cough
143
Which medication is given instead of ramipril if patient is having dry cough?
Angiotensin II receptor blocker
144
what is a complication of infective endocarditis
perialvular aortic abscess - prolonged PR interval on ECG
- this can then go onto causing heart blocks
145
what features are seen in right sided heart failure
peripheral oedema
raised JVP
hepatomegaly
bloating
146
what features are seen in left sided heart failure
pulmonary oedema
pink frothy sputum
paraoxymsl nocturnsl dyspnoea
cardiac wheeze
147
which medication can cause leg swelling
amlodipine
148
when should PCI be given to patients after MI1/
should be given within 12 hours
best if given in 2 hours
149
dose of atorvastatin for secondary prevention
80mg
150
dose of atorvastatin for primary prevention
20mg
151
what is the scoring system used to assess risk of bleeding in patients taking anticoagulation
ORBIT score
152
what is the underlying pathology of an NSTEMI
incomplete blockage of the coronary artery
153
what condition causes radio-femoral delay
coarctation of the aorta
154
in what condition is coarctation of the aorta common in
Turners syndrome
155
what type of delay does aortic dissection cause
radio-radial delay
156
which antibiotic can cause polymorphic ventricular tachycardia
chest pain and prolonged QT
clarithromycin
157
globular shape of heart on chest x ray
what is it
cardiac tamponade
158
what is seen on ECG of complete heart block
cannon wave
159
new left bundle branch block and chest pain
what is the cause
acute coronary syndrome
160
no clear QRS on ECG
VF
161
rheumatic fever and mid diastolic murmur heard loudest at the apex
what is it
mitral stenosis
162
clinical presentations of hypertension
very high BP
light headed
fatigue
palpitations
SOB
epistaxis - nose bleeds
163
essential hypertension
due to no underlying cause
164
secondary hypertension
if the person always has some condition and as a result of that get hypertension
eg. renal artery stenosis
165
stage 1 hypertension
>135/85
166
stage 2 hypertension classification
>150/95
167
stage 3 hypertension classification
>180/120
168
diagnosing hypertension
ABPM - ambulatory blood pressure monitoring - cuff that the patients wears to home
takes out an average
169
which patients with hypertension do you manage?
stage 2 hypt patients or under 80 stage 1 hypt with diabetes or renal disease
170
step 1 treatment for hypertension
<55 years or diabetic - ACE inhibitor/Angiotensin receptor blocker
>55 years or African - CCB
171
step 2 treatment for hypertension
<55 years or diabetic - ACE inhibitor and ARB AND CCB or thiazide like diuretic
> 55 years or African - CCB AND ACE INHIB AND THIAZIDE LIKE DIURETIC
172
step 3 treatment for hypertension
ACE inhibitor/ARB and CCB and thiazide like diuretic
173
step 4 treatment for hypertension
spironolactone if K<4.5 or alpha blocker
if K>4.5 then beta blocker
174
what is pitting oedema
oedema that responds to pressure
175
what is seen in x ray in heart failure
pleural effusion
cephalisation of the vessels
Kerley B lines
176
why does the heart get bigger in heart failure
because fluid fills in it and it gets bigger
177
what is non-pitting oedema
doesn't respond to pressure
178
what is BNP blood test
when ventricles get stretched to fluid due to heart failure - BNP is released from the ventricles
this can be detected and used to diagnose heart failure
179
what is seen on echo for heart failure
ejection fraction can be detected
can see valve abnormailits
myocarditis
these can be seen
180
heart failure can cause which heart complication
afibrillation
181
management for heart failure
ace inhibitor
beta blocker
spironolactone
furosemide
182
stenosis and regurgitation - what are they
stenosis - doesnt open properly
regurgitation - doesnt close properly
183
where do you hear the LUB DUB sounds of the heart
s1 - lub
s2 dub
184
what do you hear if there is a stenosis
you will hear murmur when blood flows through it in the right direction
185
what do you hear in regurgitation
murmur when blood flows through the valve in the wrong direction
186
S1 is which valve
atrioventricular valve
187
s2 is which valve
pulmonary and aortic
188
mitral stenosis makes which murmur
mid diastolic murmur - best heard on expiration
189
mitral regurgitation makes which murmur
pan systolic murmur radiating to left axilla
190
aortic stenosis makes which murmur
ejection systolic murmur radiating to carotids
191
aortic regurgitations makes which murmur
early diastolic murmur best heard on expiration with patient sat forward
192
what is infective endocarditis
inflammation of the inner lining of the heart
193
which bacteria causes infective endocarditis
staphylococcus aureus
194
why is infective endocarditis common in iv drug users
the bacteria staph aureus is on the skin
195
what valve abnormality does infective endocarditis cause
mitral regurgitation
196
presentation of infective endocartitis
myalgia
fever
joint pain
anorexia
night sweats
197
examination findings of infective endocartitis
splinter haemorrhage
Roths spots in the eyes - white heamorrgaes in the eyes
198
what is rheumatic fever
immune mediated inflammatory disease
happens after group A stepto throat infection
199
presentation of rheumatic fever
poly arthritis - red swollen and painful
carditis
sydenhams chorea - rapid and irregular involuntary movements
200
management of rheumatic fever
oral penicillin
NSAIDS
201
what is commonly found in patients with rheumatic fever
it is found in patients who used to live in developing countries
202
what is pericarditis
chest pain
non productive cough
pericardial rub
tachycardia
chest pain worse on lying flat - gets better when leaning forward
203
most common cause of pericarditis
coxsackie virus
post MI
dressers syndrome
204
ECG findings of pericarditis
saddle shaped ST elevation
- seen everywhere on the ECG - due to ischameia of the pericardium
205
why does everyone with pericarditis need to have a trans echo
to rule out effusion
206
how does AF look on ECG
irregular pattern
207
why do strokes happen with AF
static blood - can cause blood clots
go to brain - stroke
208
atrial flutter on ecg
saw tooth pattern
209
IV amiodarone are used for which kind of tachycardia
monomorphic VT
210
Iv magnesium sulphate is used for which kind of tachycardia
polymorphic VT - due to torsades pointes
211
features that show end organ damage in malignant hypertension
headaches
nausea
vomiting
visual disturbances
chest pain
212
symptoms of heart failure
exertion dysponea
proximal nocturnal dysponea
fatigue
213
signs of heart failure
cardiomegaly
heart sounds - S3 and S4
214
what is Kawasaki disease associated with - what disease ?
coronary aneurysms
- so need to do a echocardiogram
215
what is given in secondary prevention of STEMI
atrovatatin high dose 80mg
216
post MI management
aspirin 75mg
beta blockers
ACE inhibitor
high dose statin 80mg
217
how long after MI are troponin levels raised for
2 weeks
218
how long after MI are creatinine kinase levels raised fir
72 hours
219
STEMI first line management
aspirin 300mg and GTN spray
220
what is marfan's disease
connective tissue disorder which causes long toes and fingers
makes it more likely to get spontaneous pneumothorax and also aortic disecction
221
what is a side effect of abruptly stopping bisoprolol or any other beta blockers
high bp and heart rate
known as rebound tachycardia
222
management cascade for chronic heart failure
1. ACE inhibitor and beta blocker
2. Aldosterone antagonist
223
patient has infective endocarditis with MRSA and stent in heart - what antibiotic to give?
IV vancomycin and rifampicin
224
which bacterial cause on infective endocarditis is associated with colorectal cancer?
s______ g_____
Streptococcus gallolyticus
225
which bacterial cause on infective endocarditis is associated with IV drugs users?
s____ a___
staphylococcus aureus
226
which bacterial cause of infective endocarditis is MOST COMMON
s------ v------
Streptococcus viridans
227
which bacterial cause on infective endocarditis is associated with patients with recent cardiac surgery
s------ ep---
Staphylococcus epidermidis
228
what is the pathophysiology of malignant hypertension?
RAAS gets activated and causes vasoconstriction, causing hypo-perfusion and ischaemia
