Flashcards in Cardiology 1 Deck (66):
What are the common presenting symptoms of aortic stenosis?
SOB, orthopnoea, PND, palps, fatigue
Clinical signs of aortic stenosis?
Narrow pulse pressure, slow rising pulse
Heaving LV apex
Soft or absent HS2 plus ejection systolic murmur
Complications of aortic stenosis?
Damage to AV node -> heart blocks/arrhythmias
Surgical options for aortic stenosis?
Transcatheter Aortic Valve Implantation TAVI
5 causes of aortic regurgitation?
Clinical signs of aortic regurgitation?
End diastolic murmur (Austin Flint), 3HS if lean forward
Apex beat moves due to LVH
Wide pulse pressure, bounding pulse effects in various places
What is the most common cause of congenital tricuspid regurgitation?
Clinical signs of tricuspid regurgitation?
Signs of RVF incl Rosenbach pulsatile liver
Pansystolic murmur at LSF louder on inspiration
Common causes of mitral regurgitation?
Papillary muscle rupture - MI, IE
Ring dilatation secondary to LVF
Clinical signs of mitral regurgitation?
Signs of LVF
Pansystolic murmur radiating to axilla
What arrhythmia is related to mitral stenosis and how?
Mitral stenosis causes increased LA pressure and can cause AF
3 main causes of aortic stenosis?
Infective (rheumatic - though normally mitral)
3 types of ACS?
What is the difference between stable and unstable angina?
Stable is atheromatous plaque formation in coronary arteries leading to chest pain, SOB, tachy, palps etc. on exertion
Unstable is rupture of plaque causing resting symptoms
What combo of investigations/clinical picture is suggestive of unstable angina?
Symptoms occurring at rest
Normal ECG and cardiac markers
First line management and advice of stable angina?
Short acting nitrate PRN (GTN spray)
Advise of SEs, tell to use twice 5 mins apart and if not better after 10 call ambulance
Apart from GTN spray, first line drugs for stable angina?
Beta blockers or calcium channel blockers
Management of angina after first line?
Long acting nitrate (isosorbide)
Add either to B blocker or Ca channel blocker
Secondary prevention drugs in ischaemic heart disease?
2 operations for revascularisation in IHD?
Drug of choice for symptom management in CCF?
3 drugs to slow disease process in CCF?
2 most common causes of heart failure?
Normal PR interval?
What is first degree heart block?
A long PR interval >200ms
What is Mobitz type I second degree heart block?
Wenkebach - progressive PR elongation until dropped QRS
E.g. 4:3 Mobitz I
What is Mobitz type II second degree heart block?
Intermittent non-conduction of P->QRS complexes with no change in PR interval
What helps to differentiate type I from type II second degree heart block?
Progressive PR elongation in I
No change in II
What does type I second degree heart block suggest malfunction of?
What does type II second degree heart block suggest malfunction of?
Purkinje fibres/His bundle
Which type of second degree heart block is Wenkebach?
Which type of second degree heart block is worse and why?
Type II because it can progress to complete heart block
What is third degree heart block?
Complete lack of atrial-> ventricular conduction, leading to separate atrial and ventricular rhythms
What infectious disease can cause complete heart block?
Management of third degree heart block?
Needs dual chamber pacemaker
What does a LAD artery blockage result in?
An anterior MI with ST elevation in V1-6
What artery is responsible for an anterior MI?
What artery is responsible for an inferior MI?
Which artery is responsible for a lateral MI?
Progression of acute STEMI on ECG?
Ischaemia - ST depression, T wave elevation and inversion
Injury - ST elevation
Infarct and tissue necrosis - Q wave depth (pathological)
What are pathological Q waves due to?
Scar tissue formation
What normally constitutes sinus arrhythmia?
HR increasingly slightly on inspiration due to inhibition of vagal tone and increased sympathetic activity
What is pulsus paradoxus?
BP fall of over 10mmHg on inspiration due to pressure equalisation in the heart chambers
Major causes of pulsus paradoxus?
Cardiac tamponade, constrictive pericarditis
Massive PE, pneumothorax, COPD
Normal paper speed of ECG trace?
How long is one big square in ECG trace?
How to work out rate from rhythm strip?
300/no. of big squares between QRS
OR 6x no. of QRS in the rhythm strip in 10s
Normal QRS interval on ECG?
Less than 200ms
2 shockable heart rhythms?
What is the QRS hallmark of VT?
Broad complex tachycardia
What might you suspect in an otherwise CV-healthy patient who presents with mild CP, SOB, fever following a viral illness?
Describe pericarditic chest pain?
Sharp pain at left precordium radiating through to back, better sitting forward
Differentiating angina vs pericarditic pain?
Pericarditic is affected by posture (better sitting forward) not activity
Angina often activity-dependant and doesn't radiate through to back
What disease can cause a cardiac tamponade over a long period of time which can accumulate large volumes of fluid?
Becks triad of cardiac tamponade?
Distended jugular veins
Distant heart sounds
2 differentials for AF? (Irregularly irregular pulse)
Multifocal ventricular ectopics
SVT with variable AV block
Is a fourth heart sound ever normal?
Which murmur is listened for with the patient rolled onto their left in expiration?
Which murmur is listened for with patient leaning forward in expiration?
What type of murmurs generally are best listened for with the patient in expiration?
Which valve disease causes a malar flush?
Which valve disease is characterised by an opening snap followed by a low pitched mid diastolic murmur?
First line investigation of heart failure if previous MI?
Echo within 2 weeks
First line investigation if heart failure suspected but no previous MI?
Measure serum BNP
5 causes of a falsely elevated BNP?
Chronic hypoxia (COPD)