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Cardiology Flashcards

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1
Q

Ductus venosus

A

Umbilical vein-> IVC

Bypass liver

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2
Q

Foramen ovale

A

Right atrium-> left atrium

Bypass right ventricle and pulmonary circulation

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3
Q

Ductus arteriosus

A

Pulmonary artery->aorta

Bypass pulmonary circulation

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4
Q

Features of innocent murmurs

5S

A 
Soft
Short
Systolic
Situation dependent
Symptomless
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5
Q

Pan-systolic murmurs DD

A

Mitral stenosis: 5th intercostal space, mid-clavicular line
Tricuspid regurgitation: 5th intercostal space, left sternal border
VSD: left lower sternal border

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6
Q

Ejection-systolic murmurs

DD

A

Aortic stenosis: 2nd intercostal space, right sternal border
Pulmonary stenosis: second intercostal space, left sternal border
Hypertrophy obstructive cardiomyopathy: 4th intercostal space, left sternal border

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7
Q

Conditions associated with infective endocarditis

A 
VSD
PDA
Aortic valve abnormalities 
Bicuspid aortic valve
Tetralogy of fallot
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8
Q

Infective endocarditis triad

Pathophysiology

A

Endothelial damage, sheer stress forces
Platelet adhesion
Microbial adherence

Bacteraemia
Bacteria protected in vegetation

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9
Q

Infective endocarditis causative organisms

A

Organisms have surface receptors to fibronectin
S. Aureus
Strep viridans, after dental procedures
Enterococci, after GU or GI surgery

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10
Q

Clinical features of infective endocarditis

A 
Persistent low grade fever
Heart murmur
Splenomegaly 
Petechiae
Oslers node
Jane way lesions
Splinter haemorrhages
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11
Q

Embolic phenomena in infective endocarditis

A 
Splinter haemorrhages
Glomerular nephritis: haematuria
Pulmonary emboli 
Cerebral emboli: seizures, hemiparesis
Roth spots: retinal haemorrhages
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12
Q

Infective endocarditis investigations

A

Blood cultures, 3 culture over 48-72hours
Echocardiography
Microscopic haematuria
Anaemia, leukocytosis, raised ESR

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13
Q

Modified Dukes criteria for infective endocarditis

Major criteria

A

Positive blood culture:
2 blood cultures >12hrs apart
3 positive cultures >1 hour apart

ECHO:
Mass on valve/ implanted material;
Abscess
Dehiscence of prosthetic valve 
New valvular regurgitation
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14
Q

Modified Dukes criteria for infective endocarditis

Minor criteria

A

Predisposing heart condition or IV drug use
Fever: temperature >38
Vascular phenomena
Immunological phenomena: glomerulonephritis, Roth spots, oslers nodes, rheumatoid factor
Microbiological pneumonia
ECHO

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15
Q

Diagnosis of infective endocarditis

A

Modified dukes criteria
Two major criteria
5 minor
One major three minor

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16
Q

Complications of infective endocarditis

A 
Systemic embolisation
Abscess formation
Pseudoaneurysm 
Valvular perforation
Heart failure
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17
Q

Infective endocarditis

A

IV penicillin or ceftriaxone 4 weeks

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18
Q

Acute rheumatic fever

A

2-4 weeks after pharyngitis

Strep pyogenes

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19
Q

Epidemiology acute rheumatic fever

A

Developing countries
Tropical countries
Females

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20
Q

Pathophysiology rheumatic fever

A

Streptococcus pyogenes
Gram-positive cocci
Cytolytic toxins: streptolysin O and S

M proteins are immunogenic to B cells
Anti-M antibodies affect heart (rheumatic heart disease), brain, joints and skin

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21
Q

Risk factors for rheumatic fever

A 
Children and young people
Poverty
Overcrowded and poor hygiene places
FH of Rh fever
D8/17 B cell antigen positivity
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22
Q

Diagnosis of acute rheumatic fever

A

Positive throat culture for Group A B-haemolytic streptococci
Or Elevated anti-streptolysin O
Or Anti-deoxyribonuclease B titre

And

2 major criteria
1 major and 2 minor

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23
Q

Major criteria (SPECS)

A 
Sydenham chorea
Polyarthritis 
Erythema marginatum 
Carditis 
Subcutaneous nodules
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24
Q

Minor criteria (CAPE)

A 
CRP/ ESP- raised acute phase reactant
Arthralgia
Pyrexia/ fever
ECG- prolonged PR interval 
Joint (arthritis or arthralgia) and cardiac (carditis or prolonged PR interval)
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25
Acute rheumatic fever investigations
``` Bloods: ESR, CRP, FBC Bloods culture to exclude sepsis Rapid antigen detection test Throat culture Anti-streptococcal serology ECG CXR ECHO ```
26
Management of rheumatic fever
Benzathine benzylpenicillin, phenoxymethylpenicillin, amoxicillin Aspirin or NSAIDs Emergency valve replacement In severe carditis: glucocorticoids and diuretics Secondary prophylaxis with IM benzathine benzylpenicillin every 3-4weeks Oral phenoxymethylpenicillin twice daily Oral sulfadiazine daily Oral azithromycin
27
ASD
Females more likely to have ostium secundum
28
Risk factors PDA
``` Rubella in maternal Prematurity Maternal smoking in 1st trimester Maternal diabetes Maternal drug use ```
29
PDA features
``` Sob Difficulty feeding Poor weight gain LRTI L->r shunt, pulmonary HTN, right heart hypertrohpy, LVH ```
30
PDA murmur
Crecendo- decrecendo Machinery Continues through second heart sound
31
Management PDA
Monitor until 1 year Trans-catheter Surgical closure
32
Types of ASD
``` Patent foramen ovale Ostium secundum defect Ostium primum defect Sinus venosus defect Coronary sinus defect ```
33
Syndromes associated with ostium secundum ASD
Treacher-Collins syndrome | Thrombocytopenia- absent radii syndrome
34
Complications PDA
Stroke, VTE can pass from right heart-> left heart-> brain Pulmonary HTN, RSHF AF, atrial flutter Eisenmenger syndrome
35
ASD presentation
``` SOB Difficulty feeding Poor weight gain LRTI Dyspnoea, weight gain, stroke ```
36
ASD murmur
Mid-systolic ejection murmur Crecendo-decrecendo murmur At upper left sternal border Fixed split second heart sound: pulmonary valve closes after aortic valve Diastolic rumble in lower left sternal edge
37
Management ASD
<5mm spontaneous closure within 12months Transvenous catheter closure Open heart surgery via femoral vein Anticoagulants: aspirin, warfarin, NOACs
38
VSD genetic association
Down’s syndrome | Turner’s syndrome
39
Risk factors VSD
``` Maternal DM Maternal Rubella infection Alcohol maternal Uncontrolled maternal phenylketonuria FH Down’s syndrome Trisomy 18 Trisomy 13 Holt-oram syndrome Teratogens ```
40
Presentation VSD
``` Poor feeding Tachypnoea Failure to thrive Dyspnoea Eisenmenger s cyanosis ```
41
Examination VSD
``` Undernourished Sweat on forehead, LOW CO so increases SNS Increased WoB Cyanosis, blue complexion Clubbing ```
42
Murmur VSD
``` Pan-systolic murmur Left lower sternal border 3rd/4th intercostal space Systolic thrill on palpation S1–>S2 ```
43
VSD management
Transvenous catheter closure via femoral vein Open heart surgery Infective endocarditis prophylaxis
44
Medical management VSD
Adequate weight gain, NG tube feedings Diuretics, reduce pulmonary congestion ACEi Digoxin
45
Complications VSD
``` CHF Growth failure Aortic valve regurgitation Pulmonary vascular disease, Eisenmengers Frequent chest infections Infective endocarditis Arrhythmias Sudden death ```
46
Lesions that result in Eisenmenger
ASD VSD PDA
47
Examination findings Eisenmenger syndrome
Right ventricular heave Loud P2 Raised JVP Peripheral oedema
48
Features of Eiesenmenger syndrome
``` Polycythaemia Plethoric complexion Cyanosis Clubbing Dyspnoea ```
49
Csues of death in Eisenmenger syndrome
Heart failure Infection Thromboembolism Haemorrhage
50
Management
``` Heart-lung transplant Oxygen Sildenafil for pulmonary HTN Treat arrhythmias Treat polycythaemia with venesection Treat thrombosis with anticoagulants Prevention of infective endocarditis with prophylactic antibiotics ```
51
What genetic condition is associated with coarctation of the aorta?
Turners syndrome
52
Presentation of coarctation of aorta
``` Weak femoral pulses Tachypnoea Poor feeding Grey and floppy baby Left ventricular heave: LVH Underdeveloped left arm Underdevelopment of legs ```
53
Coarctation of aorta
Systolic murmur Left infraclavicular area | Below left scapula
54
Management of coarctation of aorta
Prostaglandins to keep ductus arteriosus open | Surgery then ligates ductus arteriosus, correct coarctation
55
Aortic valve stenosis
``` Fatigue SOB Dizziness Fainting Symptoms worse on exertion ```
56
Aortic valve stenosis auscultation
``` Ejection systolic murmur Second intercostal space, right sternal border Crecendo-decrecendo murmur Radiates to carotid Ejection click before murmur Palpable thrill during systole Slow rising pulse, narrow pulse pressure ```
57
Management of aortic valve stenosis
Percutaneous balloon aortic valvoplasty Surgical aortic valvotomy Valve replacement
58
Complications of aortic valve stenosis
``` Left ventricular outflow tract obstruction Heart failure Ventricular arrhythmia Bacterial endocarditis Sudden death, often on exertion ```
59
Conditions associated with pulmonary valve stenosis
Tetralogy of fallot William syndrome Noonan syndrome Congenital rubella syndrome
60
Presentation of pulmonary valve stenosis
``` Fatigue on exertion SoB Dizziness Fainting Usually asymptomatic Palpable thrill in pulmonary area Right ventricular heave(RVH) Raised JVP with giant a waves ```
61
Pulmonary valve stenosis murmur
Ejection systolic murmur Left sternal edge Second intercostal space
62
Management of pulmonary valve st3nosis
Balloon valvuloplasty
63
Tetralogy of Fallot
Pulmonary valve stenosis Overriding aorta VSD RVH
64
Risk factors for ToF
Rubella Increased maternal age Alcohol consumption in pregnancy Diabetic mother
65
Investigations ToF
Echo, doppler flow study | Boot shaped heart
66
Signs and symptoms
Tet spells Cyanosis Clubbing Poor feeding and weight gain
67
Mx of Tet spells
Squat or knees to chest if younger Oxygen Beta blockers,relax right ventricle IV fluids, increase pre-load Morphine, decrease resp driv,e more efficient breathing Sodium bicarbonate, buffer metabolic acidosis Phenylephrine infusion, increase systemic vascular resistance
68
Management and prognosis of ToF
Prostaglandins infusion in neonates to keep ductus arteriosus open Total surgical repair by open heart surgery
69
Epstein’s anomaly
Tricuspid valve lower, poor flow from RA->LUNG ASD R->L WPW
70
Presentation of Epstein’s anomaly
``` Evidence of heart failure Gallop rhythm Cyanosis SoB and tachypnoea Poor feeding Collaps or cardiac arrest ```
71
ECG EBSTEINS ANOMALY
Arrhythmias Right atrial enlargement Right bundle branch block Left axis deviation
72
CXR ebsteins
Cardiomegaly | Right atrial enlargement

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