Cardiology Flashcards
(139 cards)
1
Q
What clinical feature is associated with mitral stenosis?
A
Malar flush
2
Q
What murmur is associated with mitral stenosis?
A
Rumbling mid-diastolic murmur with opening snap
3
Q
What murmur is associated with mitral regurgitation?
A
Pansystolic murmur radiating to the left axilla
4
Q
What murmur is associated with aortic stenosis?
A
Ejection systolic murmur radiating to the carotids and apex
5
Q
What murmur is associated with aortic regurgitation?
A
End diastolic murmur (Austin Flint murmur)
6
Q
Name the pulse seen in aortic regurgitation.
A
Collapsing pulse
7
Q
Describe how mitral stenosis is most commonly caused.
A
- Group A beta-haemolytic streptococci e.g strep pyogenes cause rheumatic fever
- Rheumatic fever can lead to rheumatic heart disease
- This can result in mitral stenosis
8
Q
How are valvular diseases diagnosed?
A
Echocardiogram
9
Q
What is the most common cause of mitral regurgitation?
A
Mitral valve prolapse
10
Q
What is the most common valvular disease in the UK?
A
Aortic stenosis
11
Q
What is the most common cause of aortic stenosis?
A
Calcification due to ageing
12
Q
What are the main clinical features of aortic stenosis?
A
Triad of:
- Exertional syncope
- Exertional angina
- Exertional dyspnoea
13
Q
Name the pulse seen in aortic stenosis.
A
Carotid parvus et tardus (weak and slow-rising pulse)
14
Q
What is cardiomyopathy?
A
Diseases of the heart muscle which make it harder for the heart to pump blood to the rest of the body
15
Q
Name the 4 main types of cardiomyopathies.
A
- Dilated cardiomyopathy (DCM)
- Hypertrophic cardiomyopathy (HCM)
- Restrictive cardiomyopathy (RCM)
- Arrhythmogenic right ventricular cardiomyopathy (ARVC)
16
Q
In what way can cardiomyopathies be inherited?
A
Autosomal dominant pattern
17
Q
What is the most common cardiomyopathy?
A
Dilated cardiomyopathy
18
Q
Which cardiomyopathy is associated with sudden death in young people?
A
Hypertrophic cardiomyopathy
19
Q
What happens in DCM?
A
Heart chamber has become stretched and weakened so can’t effectively pump blood out of the heart
20
Q
Describe what happens in HCM.
A
Abnormal thickening of the heart muscle:
- Systole is normal
- Diastole is reduced as the heart can’t relax properly due to thickening
21
Q
Describe what happens in RCM.
A
Heart muscle becomes more stiff due to amyloidosis (abnormal amyloid deposits on the heart)
- Systole is normal
- Diastole is reduced as heart can’t relax properly due to stiffness
22
Q
What happens in ARVC?
A
Right ventricular muscle is replaced by fat and fibrous tissue
23
Q
What is infective endocarditis?
A
An infection caused by bacteria entering the bloodstream and reaching the heart
24
Q
Name 6 clinical features of infective endocarditis.
A
- Fever
- New murmur
- Splinter haemorrhages
- Osler nodes
- Janeway lesions
- Roth spots
25
What is the 1st line investigation for infective endocarditis?
Blood cultures - 3 sets from 3 different sites before antibiotics
26
What is the gold standard investigation for infective endocarditis?
Echocardiogram - valvular vegetation
27
Which heart valve is first to be affected in infective endocarditis?
Tricuspid valve
28
What is the most common causative organism of infective endocarditis?
Staphylococcus aureus
29
What is the most common causative organism of infective endocarditis in IVDUs?
Staphylococcus aureus
30
What is the most common causative organism of infective endocarditis in non-IVDUs?
Streptococcus viridans
31
What is the most common causative organism of infective endocarditis following oral surgery?
Streptococcus viridans
32
What is the most common causative organism of infective endocarditis in those with prosthetic heart valves?
Staphylococcus epidermidis
33
How is infective endocarditis treated?
Antibiotics
34
What criteria is used for infective endocarditis?
Modified Dukes criteria
35
What is pericarditis?
Inflammation of the pericardium which surrounds the heart
36
What is the most common cause of pericarditis?
Unknown - idiopathic
37
Name 4 causes of pericarditis.
- Viruses e.g enterovirus
- Bacteria e.g TB
- Autoimmune e.g RA, SLE, SjS
- Metastases from primary cancer e.g lung, breast
38
Describe the presentation of pericarditis (3).
- Fever
- Chest pain
- Pericardial rub
39
Describe the chest pain associated with pericarditis (5).
- Acute onset
- Pleuritic - sharp chest pain when breathing deeply
- Relief sitting forward
- Worse lying down
- Constant, not related to exertion
40
What is a pericardial rub?
A squeaky/scratchy sound best heard with the diaphragm of the stethoscope over the left sternal border at the end of expiration
41
How is pericarditis diagnosed?
ECG:
- PR depression
- Saddle-shaped ST elevation
42
How is pericarditis treated?
NSAIDs and colchicine (prevents recurrence)
43
What is a pericardial effusion?
Fluid within the pericardial cavity exceeds the physiological amount of 50 ml
44
What are the 2 types of pericardial effusion? How are they caused?
- Transudative effusion - increased venous pressure results in reduced drainage of serous fluid
- Exudative effusion - inflammatory processes affecting the pericardium
45
Name 2 causes of a transudative pericardial effusion.
- Congestive heart failure
- Pulmonary hypertension
46
Name 5 causes of an exudative pericardial effusion.
- Infection e.g TB, HIV
- Autoimmune e.g RA, SLE
- Injury to pericardium e.g after MI or open heart surgery
- Cancer
- Medications e.g methotrexate
47
Describe the presentation of pericardial effusion (4).
- Chest pain
- A feeling of fullness in the chest
- Dyspnoea
- Orthopnoea
48
What may happen if a pericardial effusion compresses the phrenic nerve?
Hiccups
49
What may happen if a pericardial effusion compresses the oesophagus?
Dysphagia
50
What may happen if a pericardial effusion compresses the recurrent laryngeal nerve?
Hoarse voice
51
What is the 1st line investigation for a pericardial effusion? What does it show?
ECG:
- Tachycardia
- Low voltage QRS complexes
- Electrical alternans
52
What is the gold standard investigation for a pericardial effusion?
Echocardiogram - echo free zone around the heart:
- Assess size of effusion
- Assess haemodynamic effect of effusion
53
How is a pericardial effusion treated?
- Treat underlying cause
- Drainage of the fluid e.g needle pericardiocentesis or surgical drainage
54
What can be done if a pericardial effusion keeps recurring?
Pericardial window - a portion of the pericardium is removed to allow fluid to drain from the pericardial cavity into the pleural or peritoneal cavity
55
What happens in a cardiac tamponade?
- Build-up of fluid around the heart which puts pressure on the heart
- The fibrous pericardium is not-stretchy so heart is compressed and is unable to fill with blood properly
56
Describe the presentation of a cardiac tamponade.
Beck's triad:
- Falling blood pressure
- Rising jugular venous pressure
- Muffled heart sounds
57
Describe what can happen to blood pressure in a cardiac tamponade.
Pulsus paradoxus - systolic blood pressure drops by > 10 mmHg on inspiration
58
How is cardiac tamponade treated?
Pericardiocentesis
59
What is the main cause of peripheral vascular disease?
Atherosclerosis
60
Describe the presentation of acute limb ischaemia.
- Pain
- Paralysis
- Pallor
- Parasthesia
- Pulselessness
- Perishingly cold
61
What is the 1st line investigation for peripheral vascular disease?
Ankle-brachial index (ABI)
62
What is the gold standard investigation for peripheral vascular disease?
CT angiography
63
How is peripheral vascular disease treated (4)?
- Viable limb - revascularisation
- Non-viable limb - amputation
- Anti-platelets to prevent clots e.g aspirin, clopidogrel
- Exercise therapy
64
How do anticoagulants work?
Prevent the formation of blood clots by interfering with clotting factors in the coagulation cascade
- Treatment of a venous thrombosis
65
How do antiplatelets work?
Prevent the formation of blood clots by preventing platelets from clumping together
- Treatment of an arterial thrombosis
66
Give 3 examples of anticoagulants.
- Warfarin
- Heparin e.g dalteparin, enoxaparin, tinzaparin
- DOACs e.g apixaban, rivaroxaban
67
How does warfarin work?
Vitamin K antagonist - prevents the formation of vitamin K dependent clotting factors (2, 7, 9 and 10)
68
How does heparin work?
Inhibits factor 10a indirectly via antithrombin 3 and thrombin
69
How do DOACs work?
Inhibits factor 10a directly
70
Give 4 examples of antiplatelets. How do they work?
- Aspirin - COX inhibitor
- Clopidogrel - P2Y12 receptor antagonist
- Tricagrelor - P2Y12 receptor antagonist
- Prasugrel - P2Y12 receptor antagonist
71
Describe the difference between the composition an arterial vs venous thrombosis.
Arterial - platelet rich (white)
Venous - fibrin rich (red)
72
What are risk factors for a DVT (8)?
- Prolonged immobility
- Long haul flights
- Recent trauma/surgery
- Oral contraceptive pill (oestrogen)
- Hormone replacement therapy
- Pregnancy
- Obesity
- Smoking
73
What score can be used to assess DVT or PE risk?
Wells score
74
Describe the presentation of a DVT.
1 leg is:
- Red
- Hot
- Swollen
- Painful
75
What can be done 1st for a suspected DVT/PE?
Quantitive D-dimer
76
Is D-dimer sensitive or specific?
Sensitive - can be used to rule out a DVT/PE but can't be used to confirm a diagnosis
77
What is the gold standard investigation for a DVT?
Venous ultrasound with Doppler:
- Reduced blood flow where DVT is
- Unable to compress vein using ultrasound transducer
78
How is a DVT/PE treated (3)?
- Anticoagulation:
--> 1st line - DOAC
--> 2nd line - LMWH for 5 days, then dabigatran
- Compression stockings
- Physical activity
79
How long should treatment last for a provoked vs unprovoked DVT?
Provoked - 3 months
Unprovoked - 6 months
80
What is a possible consequence of a DVT?
PE
81
Describe the presentation of a PE (6).
- Chest pain - unilateral
- Dyspnoea
- Dizziness
- Syncope
- Cough
- Haemoptysis
82
How is a PE diagnosed?
CTPA
83
Describe the ECG changes seen in PE.
S1 Q3 T3
84
What are non-modifiable risk factors for cardiovascular disease (4)?
- Age over 60
- Black
- Male
- Family history
85
What are modifiable risk factors for cardiovascular disease (7)?
- Hypertension
- Hypercholesterolaemia
- Diabetes
- Unhealthy diet
- Overweight
- Physical inactivity
- Smoking
86
What is an aneurysm?
An abnormal bulge in a vessel
87
What are 2 types of aneurysms?
- True - dilation involves all layers of the arterial wall
- False (pseudoaneurysms) - collection of blood in the adventitia
88
Where are aneurysms most commonly found (2)?
- Abdominal aorta - below where renal arteries branch off, just before the aortic bifurcation
- Thoracic aorta
89
Describe the presentation of an abdominal aortic aneurysm (4).
- Often asymptomatic until rupture - pulsatile abdominal mass
- Abdominal pain
- Hypotension
- Tachycardia
90
How are abdominal aortic aneurysms diagnosed?
Aortic ultrasound
91
How are abdominal aortic aneurysms treated (3)?
- Small aneurysms - monitored
- Large/expanding aneurysms - surgical repair
- Risk factor modification
92
Name 3 complications of abdominal aortic aneurysms.
- Rupture
- Thrombosis
- Exert pressure on adjacent structures
93
What are the causes of aortic dissection? What is the most common cause (5)?
- Chronic hypertension
- Aneurysms
- Atherosclerosis
- Inflammation
- Trauma - shearing stresses
94
Where are the 2 most common sites for an aortic dissection to occur?
- Just distal to the aortic valve in the ascending aorta
- Just distal to left subclavian artery in the descending aorta
95
Describe the presentation of an aortic dissection (5).
- Sudden onset of tearing chest pain
- Pain radiates to back and left arm (mimics MI)
- Shock
- Weak lower limb pulses
- Acute lower limb ischaemia
96
What is the 1st line investigation for an aortic dissection?
ECG - rule out MI
97
What is the gold standard investigation for an aortic dissection?
CT scan - tennis ball sign
98
Name the 2 types of classification for aortic dissection.
- DeBakey classification
- Stamford classification
99
Explain the DeBakey classification.
- Type 1 - originates in the ascending aorta and propagates to at least the aortic arch
- Type 2 - confined to the ascending aorta
- Type 3 - originates distal to the left subclavian artery in the descending aorta
100
Explain the Stamford classification.
- Group A - involves ascending aorta (DeBakey type 1 and 2)
- Group B - does not involve the ascending aorta (DeBakey type 3)
101
What is meant by sinus bradycardia?
A normal sinus rhythm that is below 60 bpm
102
What is meant by sinus tachycardia?
A normal sinus rhythm that is above 100 bpm
103
What are arrhythmias?
Abnormalities in the cardiac rhythm
104
Name an arrhythmia which can cause bradycardia.
Heart block
105
Name 2 types of arrhythmias which can can cause tachycardia. Explain.
- Supraventricular tachycardias (SVT) - narrow complex (QRS < 120 ms)
- Ventricular tachycardias (VT) - broad complex (QRS > 120 ms)
106
Give 4 examples of supraventricular tachycardias.
- Atrial fibrillation
- Atrial flutter
- AVNRT
- AVRT (WPW)
107
What is a sinus rhythm?
Normal rhythm of the heart - all 3 waveforms present:
- P wave
- QRS complex
- T wave
108
What is the most common type of arrhythmia?
Atrial fibrillation
109
What is atrial fibrillation?
An irregularly irregular atrial rhythm:
- This is due to disorganised electrical activity that overrides the normal, organised activity from SAN
110
Give 4 possible complications of atrial fibrillation.
- Irregularly irregular ventricular contractions
- Tachycardia
- Heart failure - due to poor filling of the ventricles during diastole
- Stroke - due to blood pooling in the atria so increased risk of blood clots forming
111
Describe the presentation of atrial fibrillation and atrial flutter (3).
- Palpitations
- Shortness of breath
- Syncope
112
How can atrial fibrillation be diagnosed?
ECG:
- Fibrillatory waves
- Absent P waves
- Narrow QRS complexes
- Irregularly irregular ventricular rhythm
113
What are the causes of atrial fibrillation?
SMITH:
- Sepsis
- Mitral valve pathology
- Ischaemic heart disease
- Thyrotoxicosis
- Hypertension
- Others e.g idiopathic, heart surgery, heart failure, cardiomyopathy
114
What are the 2 methods which can be used to treat atrial fibrillation?
- Rate control - first line generally
- Rhythm control
115
When should rhythm control for atrial fibrillation be used instead (4)?
- Cause of AF is reversible
- New onset AF - less than 48 hours
- AF is causing heart failure
- Still symptomatic despite rate being controlled
116
Describe the treatment for rate control in atrial fibrillation.
- 1st line - beta blockers e.g atenolol
- Calcium-channel blockers e.g diltiazem (not in heart failure)
- Digoxin (only in sedentary people)
117
How can rhythm control be achieved?
Cardioversion:
- Pharmacological cardioversion
- Electrical cardioversion
118
What can be used for pharmacological cardioversion?
- Flecanide
- Amiodarone - for patients with structural heart diseases
119
What is the CHA2DS2-VASc score used for?
To assess whether a patient with atrial fibrillation should be started on anticoagulation due to stroke and TIA risk
120
Explain the CHA2DS2-VASc score.
C - congestive heart failure (1)
H - hypertension (1)
A - age > 75 (2)
D - diabetes (1)
S - stroke or TIA previously (2)
V - vascular disease (1)
A - age 65 - 74 (1)
S - sex female (1)
0 = no anticoagulation
1 = consider anticoagulation
> 1 = offer anticoagulation
121
Name 2 scoring systems which can be used to assess risk of bleeding whilst on anticoagulation.
- ORBIT tool (new)
- HAS-BLED
122
What is atrial flutter?
Fast and regular atrial rhythm, the AVN usually conducts every 2nd flutter so ventricular rate is usually half the atrial rate
123
How is atrial flutter diagnosed?
ECG:
- Sawtooth waves
124
How is atrial flutter treated?
1st line - electrical cardioversion
Other - catheter ablation
125
What is heart block?
When electrical signals from the top chambers of the heart don't conduct properly to the bottom chambers of the heart
126
What are the 2 types of heart block?
- Atrioventricular (AV) block
- Bundle branch block
127
What are the different types of AV block?
- First degree
- Second degree (I and II)
- Third degree
128
What are the different types of bundle branch block?
- Right bundle branch block (RBBB)
- Left bundle branch block (LBBB)
129
What is a 1st degree heart block?
Simple prolongation of the PR interval to greater than 120 ms
130
How is 1st degree heart block treated?
Usually no treatment needed
131
What is a 2nd degree heart block?
Occurs when some P waves conduct and others do not, so there are more P waves than QRS complexes as some impulses fail to reach the ventricles
132
What are the 2 types of 2nd degree heart block?
- Mobitz I block (Wenckebach phenomenon)
- Mobitz II block
133
Describe a Mobitz I block.
PR intervals gradually elongate until a P wave fails to conduct, resulting in an absent QRS complex
134
Describe a Mobitz II block.
PR intervals are constant but some P waves don't conduct, resulting in an absent QRS complex
135
How is a 2nd degree heart block usually treated?
Mobitz I - pacemaker unlikely
Mobitz II - pacemaker likely
136
What is a 3rd degree heart block?
A complete heart block where all atrial activity fails to conduct to the ventricles, so P waves and QRS complexes are completely independent of each other
137
How is a 3rd degree heart block treated?
Pacemaker
138
Describe the ECG changes seen in a right bundle branch block.
maRRow:
- M - QRS looks like an M in V1
- w - QRS looks like a W in V6
139
Describe the ECG changes seen in a left bundle branch block.
wiLLiam:
- W - QRS looks like a W in V1
- M - QRS looks like a M in V6
