Cardiology 1 Flashcards by Jack Wildman

What are the common presenting symptoms of aortic stenosis?

Syncope
CP
SOB, orthopnoea, PND, palps, fatigue

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Clinical signs of aortic stenosis?

Narrow pulse pressure, slow rising pulse
Heaving LV apex
Soft or absent HS2 plus ejection systolic murmur

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Complications of aortic stenosis?

LVF
Endocarditis
Damage to AV node -> heart blocks/arrhythmias

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Surgical options for aortic stenosis?

Transcatheter Aortic Valve Implantation TAVI

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5 causes of aortic regurgitation?

Aortic dissection
Congenitally bicuspid
Infection 
Degenerative 
Inflammatory

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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

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What is the most common cause of congenital tricuspid regurgitation?

Ebsteins anomaly

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Clinical signs of tricuspid regurgitation?

Signs of RVF incl Rosenbach pulsatile liver
Parasternal heaves/thrills
Pansystolic murmur at LSF louder on inspiration

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Common causes of mitral regurgitation?

Usuals
Papillary muscle rupture - MI, IE
Ring dilatation secondary to LVF

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Clinical signs of mitral regurgitation?

Signs of LVF
Apical thrill
Pansystolic murmur radiating to axilla

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What arrhythmia is related to mitral stenosis and how?

Mitral stenosis causes increased LA pressure and can cause AF

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3 main causes of aortic stenosis?

Congenitally bicuspid
Degenerative
Infective (rheumatic - though normally mitral)

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3 types of ACS?

Unstable angina
STEMI
NSTEMI

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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

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What combo of investigations/clinical picture is suggestive of unstable angina?

Symptoms occurring at rest

Normal ECG and cardiac markers

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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

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Apart from GTN spray, first line drugs for stable angina?

Beta blockers or calcium channel blockers

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Management of angina after first line?

Long acting nitrate (isosorbide)
Nicorandil
Add either to B blocker or Ca channel blocker

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Secondary prevention drugs in ischaemic heart disease?

Aspirin
Statins
ACEi

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2 operations for revascularisation in IHD?

CABG

PCI

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Drug of choice for symptom management in CCF?

Diuretics (furosemide)

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3 drugs to slow disease process in CCF?

ACEi
B blockers
Digoxin

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2 most common causes of heart failure?

Hypertension

IHD

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Normal PR interval?

120-200ms

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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?

AV node

What does type II second degree heart block suggest malfunction of?

Purkinje fibres/His bundle

Which type of second degree heart block is Wenkebach?

Type I

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?

Lyme disease

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?

LAD

What artery is responsible for an inferior MI?

RCA

Which artery is responsible for a lateral MI?

Left circumflex

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 Shock

Normal paper speed of ECG trace?

25mm/sec

How long is one big square in ECG trace?

0.2 seconds

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?

Pulseless VT | VF

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?

Myocarditis

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?

Hypothyroid (myxoedema)

Becks triad of cardiac tamponade?

Hypotensive 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?

Mitral stenosis

Which murmur is listened for with patient leaning forward in expiration?

Aortic regurgitation

What type of murmurs generally are best listened for with the patient in expiration?

Diastolic murmurs

Which valve disease causes a malar flush?

Mitral stenosis

Which valve disease is characterised by an opening snap followed by a low pitched mid diastolic murmur?

Mitral stenosis

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?

``` CKD Liver cirrhosis Chronic hypoxia (COPD) Sepsis Old age ```

4 features of ToF?

Large VSD Overriding aorta Pulmonary stenosis RVH

Cardiology 1 Flashcards

(66 cards)