Cardiology Flashcards

Question

Patient presents with ankle swelling and fatigue. She has a past history of panic attacks and has hot flushes with alcohol, recent Abdo discomfort and diarrhoea. Her JVP is elevated with a pulsation in her earlobes. What is the diagnosis?

Answer 1

Carcinoid Syndrome Rarel neuroendo tumour Mostly GI origin Arise from Enterochromaffin cells Suspect if any FLUSHING and DIARRHOEA

Answer 2

Mitral stenosis

Answer 3

Reduces Heart rate by acting on the "If" channel in the SA node. Primary mode of action is to increase the duration of diastole. No negative effect on LV function. Used for stable angina in sinus rhythm, in patients who are unable to tolerate beta blockers.

Answer 4

Modifies myocardial substrate from fatty acids to carbohydrates, which is energetically more efficient --> reduces myocardial oxygen consumption. No mortality benefit, but reduces symptoms. ``` S/E: Hepatotoxicity (metabolised by Cyp 2D6 --> ** 7-10 % of patients are SLOW METABOLISERS / have Cyp 2D6 mutations ** --> careful drug monitoring!!) ``` Hypoglycaemia Peripheral neuropathy

Answer 5

Sore throat, fevers, coryzal Sx, arthralgias, Sydenham chorea (self limiting), Indigenous population. Must confirm diagnosis with TWO Streptococcal antibody titres: 1. Plasma anti-streptolysin O test - -> picks up 75-80% of Group A strep throat PLUS 2. Anti-DNAse B titres - -> increases the sensitivity of testing (Only less than 5% is picked up on throat swab in Aboriginals, less than 10% picked up in white population - hence need BOTH ASOT and anti-DNAse B) DRUG OF CHOICE For Streptococcal pharyngitis is ORAL PENICILLIN V BD DOSING . ** START TREATMENT WITHIN 9 DAYS of symptom onset! ** to prevent Rheumatic fever. Treatment for arthralgias = ASPIRIN first line Treatment for Sydenham chorea = None, because self-limiting & benign, and anti-chorea meds are toxic. Screening of asymptomatic family members is NOT NECESSARY as Group A Strep is only responsible for 5% of pharyngitis in adults.

Answer 6

Generally presents within 1 year of finishing chemotherapy, with the peak time for the appearance of symptoms about 3 months after last dose. RISK FACTORS: - cumulative dose (strongest risk factor) - IV administration - concurrent Cardiotoxic agents particularly PACLITAXEL, CTX And TRASTUZUMAB - concurrent or prior chest radiation - preexisting CV disease (debatable) ** DEXRAZONANE significantly reduces risk of chronic Cardiotoxicity when given with anthracyclines ** It is an EDTA Chelator. Used in patients who are receiving high cumulative chemo doses.

Answer 7

``` CTCA Highly sensitive (98%) and moderately specific (88%) for CAD ``` Excellent for ruling out significant disease in patients with LOW TO INTERMEDIATE pre-test probability of CAD. Current data does NOT support the use in asymptomatic patients. Not used in patients with previous stents because stents are likely to cause artefact. Need to rule out any allergy to CONTRAST. Need to rule out renal impairment. Patients need to: - be in sinus rhythm with no tachycardia - be able to hold breath for 10sec - be able to tolerate beta blockers and nitrates (nitrates given to dilate coronary vessels during procedure) - able to hold arms above head

Answer 8

1. LAHB - LAD + tall R waves in left sided leads I and aVL + deep S waves in inferior leads II III aVF 2. Bifascicular block - RBBB plus LAHB (eg RBBB plus LAD) usually 3. Trifascicular block - 1st deg HB + LAD + RBBB (usually - this is incomplete Trifascicular block) Or - 3rd deg HB + LAD + RBBB (complete Trifascicular block)

Answer 9

CLINICAL: (Always suspect in patient who has recently undergone a vascular procedure eg. Angiogram) - renal failure - bowel ischaemia - skin: blue toe syndrome ("Trash foot"), livedo reticularis - FEVER, Weight loss, Myalgias, Fatigue (CONSTITUTIONAL Sx as cholesterol crystals trigger an Inflammatory response when they lodge in the small arteries of target organ) ``` LAB FINDINGS: High inflam markers - WCC, CRP Low/consumed C3/4 HIGH EOSINOPHILS for first few days (in 80%!) (mechanism unknown) May have anaemia / thrombocytopaenia ```

Answer 10

B. Coronary Angiography for diagnosis and monitoring of TCAD. Transplant coronary artery disease (TCAD): - the most significant cause of mortality / morbidity post transplant - largely an IMMUNOLOGICAL process --> inflammation --> fibromuscular and smooth cell proliferation --> coronary artery obstruction

Answer 11

Suggests either restrictive or constrictive cardiomyopathy.

Answer 12

Difficult clinically! Differentiate using an Echo. If Echo shows STIFF VENTRICLES and NO pericardial effusion - most likely Restrictive CM rather than Constrictive. Restrictive cardiomyopathy: - increased STIFFNESS OF VENTRICLES leading to POOR DIASTOLIC FILLING with PRESERVED LV FUNCTION - occurs with infiltrative (sarcoid, amyloid, myeloma, lymphoma, irradiation, CT disease) or storage diseases (Haemochromatosis, Fabry), or inflammation (endomyocardial fibrosis, Loffler CM) Echo findings in restrictive CM - no effusion - stiff ventricles - increased early diastolic filling to atrial filling ratio (E:R ratio) - decreased E-deceleration time - decreased isovolumetric relaxation time (40 ms)

Answer 13

FIXED SPLITTING OF 2nd heart sound, PLUS ESM in PULMONIC AREA. Most common ASD is "Ostium Secundum ASD" (75%) and occurs in the region of the Fossa Ovalis ECG may show RAD and RBBB. Patients typically present with NO symptoms, but may have SVTs, right heart failure, paradoxical emboli or recurrent chest infections.

Cardiology Flashcards

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