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PACES Y6 > Cardio + resp > Flashcards

Cardio + resp Flashcards

(51 cards)

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1
Q

Non-murmur signs in aortic stenosis

A

Narrow pulse pressure
Slow rising pulse
Thrill

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2
Q

Non-murmur signs in aortic regurgitation

A

Wide pulse pressure
Collapsing pulse
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)

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3
Q

Non-murmur signs in mitral stenosis

A

Malar flush
Dyspnoea
Haemoptysis

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4
Q

Causes of different murmurs

A

Aortic stenosis: rheumatic fever, bicuspid valve, calcification
Aortic regurgitation: rheumatic fever, bicuspid valve, connective tissue disorder
Mitral regurgitation: rheumatic fever, calcification, connective tissue disorder
Mitral stenosis: rheumatic fever

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5
Q

Different cardiothoracic incicions

A

Midline sternotomy
Clamshell incision (for widespread traumatic chest injury)
Sub-clavicular incision

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6
Q

Indication for midline sternotomy

A

Open valve surgery
Coronary artery bypass grafting
Cardiac transplant

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7
Q

Different types of valve replacements procedures and valves

A

Procedures:
Transcatheter aortic/pulmonary valve implantation (usually biological)
Surgical aortic valve replacement

Valves:
Metallic - younger patients (last longer, tolerate anticoagulation therapy)
Biological - older patients (usually porcine/bovine, or homograft more durable but less widely available)

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8
Q

Drugs you need to be on after valve replacement

A

Only needed in metallic heart valve, or biological if there is atrial fibrillation

LMWH for bridging
Warfarin
Not recommended to use DOACs regardless of AF

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9
Q

Murmur investigations

A

Bedside: obs for pulse pressure, ECG for ventricular strain
Bloods: BNP, FBC, CRP and blood cultures for infective endocarditis, risk factors e.g. lipids, HbA1c
Imaging: TTE

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10
Q

Murmur management

A

MDT for regular follow-up
Conservative e.g. cardiovascular lifestyle
QRISK to determine whether statins, etc. are needed
Valve replacement

Regurgitations: reduce afterload with ACEi, BB, diuretics

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11
Q

What is a QRISK score?

A

QRISK3 (the most recent version of QRISK) is a prediction algorithm for cardiovascular disease that uses traditional risk factors

A QRISK over 10 (10% risk of CVD event over the next ten years) indicates that primary prevention with lipid lowering therapy (such as statins) should be considered

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12
Q

Indications for valve replacement

A

Asymptomatic and valve gradient >40mmHg or valve area <1cm2
Symptomatic

Balanced with patients history, overall health, and risk/benefits
Take into account the cause e.g. infective endocartditis

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13
Q

Heart failure signs

A

Left signs:
- dyspnoea
- orthopnoea
- paroxysmal nocturnal dyspnoea

Right signs:
- raised JVP
- peripheral oedema
- hepatomegaly, ascites

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14
Q

Heart failure causes

A

Myocardial (coronary artery disease, HTN)
Valvular
Pericardial (constrictive)
Arrhythmias

Non-cardiac: high output (sepsis), volume overload (CKD, nephrotic syndrome)

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15
Q

New York Heart Association classification for heart failure

A

1 - no limitation
2 - dypnoea on activity
3 - marked limitation on activity
4 - dyspnoea at rest

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16
Q

Ejection fraction classification for heart failure

A

HFpEF: >= 50% (LV unable to relax)
HFrEF: <40% (LV unable to contract properly)

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17
Q

Heart failure investigations

A

Bedside - ECG for LVH
Bloods - BNP: 400-2000 (TTE within 6 weeks), >2000 (TTE within 2 weeks)
CXR - alveolar oedema, Kerley B lines, cardiomegaly, upper lobe diversion, pleural effusion

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18
Q

Heart failure management

A

Conservative
1. ACE inhibitor, ARB, or beta-blocker
2. Spironolactone, SGLT-2 inhibitor (e.g. dapagliflozin) or entresto (sacubitril/valsartan) if HFrEF
3. Hydralazine with nitrate

Influenza and pneumococcal vaccine

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19
Q

Types of pacemakers and indications

A

Single-chamber: lead in right atrium OR ventricle (heart block affecting one chamber)
Dual-chamber: lead in right atrium AND ventricle (heart block affecting both chambers)
Biventricular/cardiac resynchronisation: lead in right atrium and both ventricles
Leadless: small and inside right ventricle, used for bradycardic patients, can’t have traditional surgery or complications with leads

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20
Q

CHADSVASc vs ORBIT

A

CHADSVASc for anticoagulation determination
0 - no treatment
1 - consider anticoagulation in males
2 - offer anticoagluation

Congestive heart failure
Hypertension / treated
Age >= 75 (2)
Age 65-74 (1)
Diabetes
Previous stroke, TIA, thromboembolism
Vascular disease
Sex - female

ORBIT for bleeding risk, to consider whether anticoagulation is in the best interests of the patient, no formal rules, depends on individual patient factors (e.g. alcohol or drug abuse, how bad their bleeding history is)
Low haemoglobin (2)
Age > 74
Bleeding history e.g. GI bleed
Renal impairment
Antiplatelets

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21
Q

Which anticoagulation is recommended for reducing stroke risk in atrial fibrillation?

Study These Flashcards
A
  1. DOAC e.g. apixaban
  2. Warfarin

NOT aspirin

22
Q

Infective endocarditis signs

Study These Flashcards
A

Clubbing
Splinter haemorrhages
Osler’s nodes (tender)
Janeway lesions (non-tender)
Roth spots (fundoscopy)
Splenomegaly

23
Q

Infective endocarditis investigations

Study These Flashcards
A

Bedside: obs, ECG
Bloods: infection including blood cultures, inflammation
Imaging: echo

Cover Duke’s criteria (2 major, 1 major + 3 minor, 5 minor)
Major = positive blood culture, echo findings or new regurgitation

24
Q

Infective endocarditis management

Study These Flashcards
A

Antibiotics
Initial blind - native: amoxicillin, sepsis or allergic: vancomycin + gentamicin, prosthetic: vancomycin + gentamicin + rifampicin
Treat according to culture after

Surgery
- severe incompetence
- aortic abscess (long PR interval)
- cardiac failure
- resistant to abx

25
CABG indication and procedure
Severe coronary artery disease, failed PCI, very high risk Put on heart-lung bypass machine, healthy vessel taken from leg, chest or arm, and attach to heart to bypass blockage
26
Atrial fibrillation management
Haemodynamically stable < 48 hours Rate control 1. BB (bisoprolol) or rl-CCB (verapamil) 2. Digoxin OR Rhythm control 1. Electrical cardioversion 2. Pharmacological cardioversion (flecainide, amiodarone) Haemodynamically stable > 48 hours Rate control 1. BB (bisoprolol) or rl-CCB (verapamil) 2. Digoxin ORBIT score Start anticoagulation for 3 weeks (DOAC - apixaban, or warfarin) Electrical cardioversion If you can’t wait: LMWH + echo to rule out left atrial thrombus Haemodynamically unstable Electrical cardioversion
27
DVLA for ACS, CABG, pacemaker and ICD insertion
ACS: 4 weeks off (or 1 week if angioplasty) CABG: 4 weeks off Pacemaker: 1 week off ICD: 6 months if ventricular arrhytmia, 1 month if prophylactic
28
What is an ICD?
Implantable cardioverter-defibrillator Treat tachyarrhytmias and life-threatening rhythms (pacemaker is for slow or irregular rhythms) e.g. VT and VF Delivers shocks in addition to pacing the heart
29
Causes of clubbing
Cardiovascular - infective endocarditis - congenital cyanotic heart disease - brachial arteriovenous fistula Respiratory - pulmonary fibrosis - bronchiectasis - bronchial carcinoma - mesothelioma - TB Gastrointestinal - IBD - Coeliac disease - Liver/bowel cancer - Cirrhosis
30
Investigations for pulmonary fibrosis
Bedside: ECG for right ventricular strain, spirometry (FVC decreased, so FEV1/FVC increased) Bloods: ABG, ANA, infection, inflammation Imaging: CXR and HrCT
31
Management of pulmonary fibrosis
Acutely: supportive and high-dose corticosteroids Long-term: Pulmonary rehabilitation (exercise, breathing techniques, education, psychosocial support, nutritional counseling for overall health, stop smoking) Antifibrotics: pirfenidone Supplemental oxygen if hypoxic
32
Investigations of bronchiectasis
Bedside: sputum culture (pseudomonas aerigunosa most common) Bloods: superimposed infection, inflammation Imaging: CXR, HrCT
33
Causes of bronchiectasis
Post-infective e.g. TB, pneumonia Cystic fibrosis Obstruction e.g. lung cancer
34
Management of bronchiectasis
Exercise - airway clearance Inhaled bronchodilator e.g. salbutamol Mucoactive agent e.g. nebulised saline or mucolytic like acetylcysteine Antibiotics for exacerbation
35
Investigations of COPD
Bedside - sputum culture, post-bronchodilator spirometry FEV1/FVC ratio <0.7 Bloods - FBC (secondary polycythaemia from hypoxia) Imaging - CXR
36
Management of COPD
Exacerbation: A-E 24% venturi mask Nebulised salbutamol + ipratropium IV hydrocortisone IV abx Long-term: 1. SABA or SAMA (ipratropium) 2. No asthmatic features: add LABA (salmeterol) and LAMA (tiotropium). Asthmatic features: LABA + ICS Switch SAMA to SABA if taking. 3. LABA + (LAMA + ICS)
37
Additional management of CREST (that has pulmonary HTN/RHF)
For CREST Exercise, stop smoking, physiotherapy Immunosuppression: methotrexate ACE inhibitor if renal involvement
38
More specific investigations of lung cancer
CXR CT chest Bronchoscopy PET scanning
39
Management of lung cancer
Small-cell - Surgery if small - Most are metastasised: radio and chemo (or just palliative chemo) Non-small cell - Surgery if small - radiotherapy - poor response to chemo
40
Types of lung scars and their indications
Posterolateral thoracotomy Anterolateral thoracotomy (goes under pec) May be done for: Lobectomy: malignancy, recurrent localised infection (CF, bronchiectasis) Pneumonectomy Single lung transplant (double is through clamshell) Bullectomy in COPD (bulla space >1cm)
41
Causes of pulmonary fibrosis
Occupational - Asbestosis - Silicosis Infection - Aspergillosis - TB Drugs - Methotrexate - Amiodarone Radiation fibrosis Idiopathic
42
CXR/CT changes of pulmonary fibrosis
bilateral interstitial shadowing (typically small, irregular, peripheral opacities - 'ground-glass' - later progressing to 'honeycombing')
43
Differentiation between asthma and COPD in investigations
Asthma has post-bronchodilator reversibility COPD has post-bronchodilator FEV1/FVC <0.7
44
Peak flow results in different lung conditions
Asthma: usually 20-30% lower Bronchiectasis: usually 20-30% lower COPD: lower than asthma due to airway obstruction Pulmonary fibrosis: lowest due to restrictive lung disease
45
Investigations for pleural effusion
PA x-ray USS CXR CT for underlying disease USS guided pleural aspiration >30g/L = exudate <30g/L = transudate
46
Management of pleural effusion
Treat underlying cause Recurrent aspiration Indwelling catheter Opioids for dyspnoea
47
Signs of CO2 retention
Flap Bounding pulse Narcosis (drowsiness)
48
Signs of cor pulmonale
Lung disease -> right ventricular hypertrophy Peripheral oedema Raised JVP Systolic parasternal heave
49
Upper and lower lobe causes of pulmonary fibrosis
Upper: COPD, silicosis, tuberculosis Lower: idiopathic, systemic sclerosis, hypersensitivity
50
What FiO2 is 1L and other L
1L = 24% 2L = 28% (increases by 4%) 15L = 80%
51
Which vessels are used for CABG?
Saphenous vein Internal mammary artery (best) Radial artery Gastroepiploic artery

PACES Y6 (6 decks)

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