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4MB Medicine Aaron > Cardiology 2 > Flashcards

Cardiology 2 Flashcards

1
Q

List aetiology/risk factors for myocarditis

A

Viral infection (Coxsackie, CMV, adenovirus, HIV) Drugs (cyclophosphamide, penicillin, chloramphenicol, phenyotin, radiation) Idiopathic

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2
Q

List clinical features of myocarditis

A

Fatigue Dyspnoea Palpitations Chest pain Fever Tachycardia Soft S1, S4 gallop rhythm

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3
Q

What investigations would you do for myocarditis?

A

ECG (STE/STD, T inversion, arrhythmia, AV block) Tropnonin I or T confirms diagnosis CK

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4
Q

Outline treatment of myocarditis

A

Supportive, rest, treat cause Avoid sports ACEi/B-blocker/spironolactone where heart failure

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5
Q

List aetiology/risk factors for pericarditis

A

Viruses (EBV, Coxsackie, flu, mumps, varicella, HIV) Bacteria (pneumonia, rheumatic fever, TB) Post-MI (Dressler’s syndrome) Drugs Inflammatory/chronic disease

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6
Q

List clinical features of pericarditis

A

Chest pain, worse on inspiration/lying flat, relieved sitting forward Friction rub Evidence of effusion/tamponade

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7
Q

What investigations would you order for pericarditis?

A

ECG shows widespread saddle-shaped STE CXR Echo Cardiac enzymes (troponin may be raised) Blood cultures/serology

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8
Q

Outline treatment of pericarditis

A

Rest, analgesia Treat cause Steroid or immunosuppression

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9
Q

What are cardiomyopathies?

A

Diseases that affect the mechanical/electrical function of the heart

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10
Q

What is hypertrophic cardiomyopathy?

A

LV outflow obstruction from asymmetrical septal hypetrophy

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11
Q

What is the genetic abnormality in hypertrophic cardiomyopathy?

A

Autosomal dominant mutation in sarcomeric genes, resulting in reduced myosin and troponin

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12
Q

List clinical features of hypertrophic cardiomyopathy

A

Asymptomatic or sudden death Syncope Chest pain Dyspnoea Jerky pulse Double apex pulsation Systolic thrill, ejection murmur

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13
Q

What investigations would you order for hypertrophic cardiomyopathy?

A

ECG shows LVH, inferolateral Q waves May be in AF/WPW Echo shoes asymmetrical septal hypertrophy, midsystolic aortic valve closure

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14
Q

Outline treatment of hypertrophic cardiomyopathy

A

B-blocker/verapamil for symptoms Amiodarone control arrhythmia Septal myomectomy if severe Implantable defib

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15
Q

What is dilated cardiomyopathy?

A

Dilated ventricles with systolic dysfunction but preserved wall thickness Essentially a flabby heart

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16
Q

What genetic abnormality causes dilated cardiomyopathy?

A

Mutation in cytoskeletal/myocyte genes causing contractile insufficiency

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17
Q

What risk factors is dilated cardiomyopathy associated with?

A

Alcohol Hypertension Haemochromatosis Viral infections Autoimmunity

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18
Q

List clinical features of dilated cardiomyopathy

A

Fatigue Dyspnoea Po oedema RV failure, emboli Raised JVP Arrhythmia, tachycardia Hypotension Displaced apex Jaundice, ascites, hepatomegaly

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19
Q

What investigations would you do for dilated cardiomyopathy?

A

CXR shows cardiomegaly, po oedema ECG Echo shows dilated chambers, low ejection fraction

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20
Q

Outline treatment of dilated cardiomyopathy

A

Manage heart failure (digoxin, furosemide, ACEi) Pacing Heart transplant

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21
Q

What is restrictive cardiomyopathy?

A

Reduced volume of both ventricles with atrial enlargement and impaired filling

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22
Q

What conditions are associated with restrictive cardiomyopathy?

A

Amyloidosis Haemochromatosis Sarcoidosis Scleroderma

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23
Q

List clinical features of restrictive cardiomyopathy

A

Similar to pericarditis RHF signs Hepatomegaly, ascites

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24
Q

What investigations would you do for restrictive cardiomyopathy?

A

CXR shoes po venous congestion ECG low-voltage QRS Echo shows impaired filling Cardiac catheterisation

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25
Q

What is arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A

Fibro-fatty replacement of myocytes, causing RV dilation

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26
Q

What is the genetic abnormality that causes ARVC?

A

Mutation in desmosomal genes affecting the ryanodine receptor

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27
Q

What is atrial myxoma?

A

Rare benign cardiac tumour, usually found in right atrium

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28
Q

List clinical features of atrial myxoma

A

May mimic endocarditis Mitral stenosis Tumour plop on auscultation

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29
Q

What is the difference between ostium secundum and primum atrial septal defect?

A

Secundum: high in septum, presents in adulthood Primum: opposite endocardial cushions, presents early

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30
Q

List clinical features of atrial septal defect

A

Cyanosis Po hypertension Arrhythmia Haemoptysis Chest pain Raised JVP Wide split S2 heart sound Ejection systolic murmur Migraines

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31
Q

What investigations would you do for atrial septal defect?

A

Echo shows left-right shunt ECG shows RBBB with LAD and prolonged PR interval CXR shows small aortic knuckle, po plethora

32
Q

Outline treatment of atrial septal defect

A

Usually closes before age of 10 Transcatheter closure

33
Q

What is the most common congenital cardiac anomaly?

A

Ventricular septal defect

34
Q

List clinical features of ventricular septal defect

A

Severe heart failure Loud murmur, thrill Harsh pansystolic murmur at left sternal edge

35
Q

What investigations would you do for ventricular septal defect?

A

Echo shows left-right shunt Eisenmenger complex (right-left shunt) ECG shows LAD and LVH or PVH CXR shows normal or cardiomegaly

36
Q

Outline treatment of ventricular septal defect

A

May close spontaneously Endovascular or medical closure Treat heart failure

37
Q

What is patent ductus arteriosus?

A

Persistent communication between po. artery and desc. aorta

38
Q

List clinical features of patent ductus arteriosus

A

Bounding pulse Machine-gun murmur

39
Q

What is coarctation of aorta?

A

Narrowing of desc. aorta just distal to insertion of ductus arteriosus

40
Q

List risk factors/aetiology of coarctation of aorta

A

Boys Bicuspid aortic valve Ventricular septal defect Mitral valve disease CTD’s

41
Q

List clinical features of coarctation of aorta

A

Headaches Nosebleeds Radio-femoral delay Scapular bruit

42
Q

What would a CXR of coarctation of aorta show?

A

Rib-notching

43
Q

Outline treatment of coarctation of aorta

A

Surgery Balloon dilation +/- stent

44
Q

What makes up tetralogy of Fallot?

A

Ventricular septal defect Pulmonary stenosis RV hypertrophy Overriding aorta

45
Q

List clinical features of tetralogy of Fallot

A

Cyanosis (right-left shunt) Restless, agitated Toddler squat to increase peripheral resistance Difficulty feeding Failure to thrive Clubbing Exertional dyspnoea Palpitations RV failure Syncope

46
Q

What investigations would you do for tetralogy of Fallot?

A

CXR boot-shaped heart Echo assesses degree of stenosis

47
Q

Outline treatment of tetralogy of Fallot

A

Oxygen Positioning Morphine if irritated Long-term B-blocker Endocarditis prophylaxis Surgery to close VSD, correct po stenosis

48
Q

What is intermittent claudication?

A

Chronic lower limb ischaemia relieved by rest

49
Q

List aetiology/risk factors for intermitted claudication

A

Smoking Diabetes High cholesterol Hypertension

50
Q

List clinical features of intermittent claudication

A

Exertional/cramping pain usually in calves relieved by rest Ulceration Dry skin Hair loss Diminished/absent pulses Cold legs Atrophy Cap refill less than 2s

51
Q

What investigations would you do for intermittent claudication?

A

Bloods ECG Catheterisation Duplex US scan ABPI of 0.4-0.9

52
Q

Outline treatment of intermittent claudication

A

Lifestyle improvement (smoking, exercise, weight) Antiplatelets (aspirin) Surgery (angioplasty +/- stent, bypass graft) Amputation

53
Q

Acute limb ischaemia is a surgical emergency. True/False?

A

True Requires revascularisation within 4-6 hours

54
Q

List aetiology/risk factors for acute limb ischaemia

A

Thrombosis in situ Emboli Graft, angioplasty occlusion Trauma

55
Q

List clinical features of acute limb ischaemia

A

Pale Pulseless Painful Paralysis Paraesthesiae Perishing cold

56
Q

Outline treatment of acute limb ischaemia

A

Urgent arteriography Surgical embolectomy Local thrombolysis (tPA) Anticoagulate (heparin) Angioplasty

57
Q

What are varicose veins?

A

Incompetent valves prevent blood progressing from deep to superficial veins, causing long tortuous dilated veins

58
Q

List aetiology/risk factors for varicose veins

A

Obstruction DVT Ovarian tumour Valve disease AV malformation Prolonged standing Pregnancy OCP use

59
Q

List clinical features of varicose veins

A

Pain Crampy legs Tingling Ugly legs Oedema Varicose eczema Ulcers Haemosiderin staining Atrophie blanche Lipidodermatosclerosis Phlebitis

60
Q

What investigations would you do for varicose veins?

A

Doppler USS Trendelenberg test Buerger test

61
Q

Outline treatment for varicose veins

A

Treat cause, education Elevation, stock, lose weight Injection sclerotherapy Laser coagulation Endovenous ablation

62
Q

List aetiology/risk factors for DVT

A

Post-surgery Immobility Increasing age Pregnancy Oestrogen therapy Trauma Malignancy Thrombophilia Previous DVT

63
Q

List clinical features of DVT

A

Calf warmth Tenderness Swelling Erythema Mild fever Pitting oedema PE-like features

64
Q

What investigations would you do for DVT?

A

Bloods: d-dimers, thrombophilia tests Compression Doppler USS PTP score Well’s score

65
Q

Outline treatment of DVT

A

Stop OCP Mobilisation TED stockings Anticoagulate (LMWH, warfarin) IVC filters if active bleeding

66
Q

What is an aneurysm?

A

Greater than 50% dilation of an artery’s original diameter involving all layers of the vessel

67
Q

What are the common sites for an aneurysm?

A

Aorta Iliac artery Femoral artery Popliteal artery

68
Q

List aetiology/risk factors abdominal aortic aneurysm

A

Defect in collagen-elastase regulation Atherosclerosis Trauma Infection CTD’s Vasculitis Genetics

69
Q

List clinical features of abdominal aortic aneurysm

A

May be asymptomatic until rupture Intermittent/continuous abdo pain radiating to back Collapse Hypotension Expansile abdo mass Discoloured peripheries Tachycardia Pallor

70
Q

What investigations would you do for abdominal aortic aneurysm?

A

Regular USS monitoring for men over 65

71
Q

Outline treatment of abdominal aortic aneurysm

A

Less than 5.5 cm - monitoring Reserve surgery unless expanding more than 1cm a year Lifestyle advice, exercise tests Surgery (EVAR, open)

72
Q

Outline acute treatment of rupture of abdominal aortic aneurysm?

A

Blood amylase, ECG, crossmatch blood Catheterise Large IV access, give O Rh blood Prompt surgery and antibiotic

73
Q

What is aortic dissection?

A

Splitting of aortic tunica media Either type A (involving ascending aorta) and type B (not involving ascending aorta)

74
Q

List clinical features of aortic dissection

A

Sudden tearing chest pain radiating to back Hemiplegia Radio-radio delay Hypotension

75
Q

What investigations would you do for aortic dissection?

A

Crossmatch blood ECG CXR CT/MRI Trans-oesophageal echo

76
Q

Outline treatment of aortic dissection

A

Hypotensives (keep systolic 100-110) (labetolol) Urgent surgery

4MB Medicine Aaron (4 decks)

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