Cardiology Flashcards
(36 cards)
Causes of aortic stenosis
CRABS (increasing age)
Congenital (congenital ring, HOCM, Williams syndrome)
Rheumatic fever (esp females and rheumatoid arthritis)
Atherosclerosis
Bicuspid AV calcification (40-60)
Senile calcific degeneration (60+)
Aortic stenosis - PC
Angina Arrhythmias LVH Exertional syncope Emboli - TIA/ stroke
Aortic stenosis - Ix
ECG, CXR, Echo, Catheter
Aortic stenosis - Rx and contraindicated drugs
Medical - statins, antiplatelet
Contraindicated meds - nitrates, ACE inhib., Ca antagonists
SBE prophylaxis
Surgical - Valvuplasty, valve replacement, myomectomy
Causes of aortic regurgitation
- Ring dilation -
a) pressure: hypertension, aortic dissection, trauma
b) Weak connective tissue eg ehlos danlos or marfans, syphilis, cor bovium - Cusp contraction -
a) infection: Rheum fever, infective endocarditis
b) autoimmune: seronegative arthropathies eg. ank spondylitis, Reiter’s
c) toxins: cabergoline, pergolide - Poor fitting
a) biscupid aortic valve disease
b) supracrital VSD
Aortic Regurgitation - PC
- Arrhythmias
- Emboli (from vegetation), TIA: amaurosis fugax, CVA
- Eccentric LVH, LVF, RVF
Aortic Regurgitation - Ix
ECG, CXR, Echo, Catheter
Aortic Regurgitation - Tx
Medical: Nifedipine (avoid in HF), ACE inhibitors
SBE prophylaxis
Surgical: valve replacement
Presentation of mitral stenosis
- Left atrial enlargement – AF, hoarseness, dysphasia, bronchiectasis
- emboli
- pulmonary oedema/recurrent respiratory tract infection
- pulmonary hypertension/RSH failure; ischaemia/cachexia
Mitral stenosis – investigations
ECG CXR echo catheter
Mitral stenosis – treatment
- Anticoagulate
- SBE prophylaxis
- surgical – closed valvotomy, open valvotomy, valve replacement
Causes of mitral regurgitation
a) Ring dilatation 1. LV dilatation (volume overload; AR, pressure overload; AS, HT)
2. Cardiomyopathy: HOCM, dilated, restrictive
3. Trauma/mechanical valve leak
b) Cusp contraction 1. infection e.g. rheumatic fever, SBE
2. Autoimmune e.g. RA, SLE, ankylosing spondylitis
3. ASD, primum
4. Senile calcification degeneration
c) subvalvular apparatus dysfunction e.g. MI, mitral valve prolapse (Marfan’s, VSD, polycystic kidney disease, straight back, ischaemic heart disease, neuroses/women)
Mitral regurgitation – PC
- AF
- pulmonary oedema/recurrent RTI
- pulmonary hypertension/RSH failure
- MVP PC – chest pain, palpitations, syncope, SOB, fatigue
Mitral regurgitation – Ix
ECG CXR echo catheter
Mitral regurgitation - Rx
Anticoagulate in AF, SBE prophylaxis, surgical valve replacement
Causes of atrial fibrillation
A.T.R.I.A.L S.W.I.T.C.H
Acute: PE, MRI, infection, post surgery Thyrotoxicosis Rheumatic heart disease Ischaemic heart disease ABP increased/alcohol/ASD/aortic regurgitation Lung: bronchial carcinoma, PE
Sick sinus syndrome Wolff Parkinson White syndrome Inflammation: pericarditis, myocarditis, endocarditis Toxin: digoxin toxicity Cardiomyopathy e.g. sarcoid Cancer: atrial myxoma Hypokalaemia
Pathophysiology of AF
Parts of the atria lose their refractoriness before the end of atrial systole enabling recurrent but unco-ordinated atrial contraction.
This may be due to atrial enlargement, conduction velocity decreased e.g. information, fibrosis, decreased refractory period e.g. ischaemia, T4, sympathetic tone increase
Management of AF
- Underlying cause
- Rate control – beta-blocker, diltiazem, digoxin
- Rhythm control – amiodarone, flecainide if no ischaemic or structural heart disease, cardioversion
- Anticoagulation – CHADSVASC
Causes of ventricular tachycardia
I.M. Q.V.I.C.K
Infarction
Myocarditis
QT interval increased
Valve abnormality: mitral valve prolapse, aortic stenosis.
Iatrogenic – Digoxin, antiarrhythmics, catheterisation, surgery.
Cardiomyopathy, especially dilated.
K+ low, Mg2+ low, O2 low, acidosis
Causes of bradycardia
D.I.V.I.S.I.O.N.S.
Drugs - (ABCD) antiarrhythmic’s, beta-blockers.calcium antagonists, digoxin
Ischaemia/infarction – inferior or anteroseptal MI
Vagus hypotonia – athletes, vasovagal syncope, hypersensitive carotid sinus syndrome.
Infection
Sick sinus syndrome
Infiltration – restrictive or dilated cardiomyopathy e.g. sarcoid, haemochromatosis, amyloid, muscular dystrophy.
O – hypOthyroidism, hypOkalaemia, hypOthermia, obstructive jaundice
Neuro: raised intracranial pressure
Septal defect: ASD; Surgery or catheterisation
MI – Complications
S - Sudden death P - Pump failure / Pericarditis R - Rupture papillary muscles or septum E - Embolism A - Aneurysm / Arrhythmias D - Dressler’s syndrome
Causes of shock
S.H.O.C.K.I.N.G.
Septic
Hypovolaemia
Organ failure
Cardiogenic
K anaphylaxis
Iatrogenic – blood transfusion: haemolytic reaction, anaesthesia, drugs
Neurogenic – pain, stroke, seizure, autonomic neuropathy
Glands – diabetes mellitus, diabetes insipidus, Addison’s disease, hypothyroidism
Causes of hypertension
P.R.E.D.I.C.T.I.O.N
Primary – essential or isolated systolic
Renal – vascular, glomerulonephritis or tubular nephritis, structural (APKD, tumour)
Endocrine - stress hormones (epinephrine, cortisol, GH, T4); hypermineralocorticoidism (hyper/hypo aldosteronism), other (somatostatinoma, hyperPTHism, ACP)
Drugs
Intracranial pressure
Co-optation of aorta
Toxaemia of pregnancy
Increased viscosity
Overloaded with fluid
Neurogenic
End organ damage of hypertension
C.A.R.N.A.G.E
Cardiac – IHD, LVH, CCF, AR, MR
Aortic – aneurism comedy section
Renal – proteinuria, chronic renal failure
Neurological – CVA, headache, dizzy, syncope
Anaemia
GIT – N and V
Eyes – retinopathy
