Cardiology Flashcards
(62 cards)
1
Q
ischemic change on ECG
A
T wave inversion
pathological Q waves
2
Q
atypical presentation of ACS
A
elderly
diabetic
post op
3
Q
what can ECHO detect
A
LV
valve disease
RMWA
EF
4
Q
A.fib causes
A
CARDIAC: - HTN - Valvular disase (MS/MR) – rheumatic fever - HCM - Ischemic heart disease PULMONARY CAUSES - pneumonia - PE - Pul HTN METABOLIC : - hyperthyroidism - Hyperkalemia, Mg and Ca Iatrogenic - aortic valve replacement - lidocaine and cocaine - B-agonst Others: - alcohol - caffeine intake
5
Q
definition for V.T
A
3 or more conservative ventricular complex occurs at a rate of 100 - 250 bpm
6
Q
treat V.T stable
A
electrical cardioversion
amiodarone
Lignocaine
7
Q
primary prevention of VT
A
ICD
8
Q
use of ICD
A
- LV dysfunction due to presence of MI
LVEF 30-40%
NYHA II and III
9
Q
complication of VT
A
death O2 ischemic encephalopathy acute renal insufficiency Aspiration pneumonitis trauma related
10
Q
ECG of hypertrophic Cm
A
LVH - increase pericardial voltage
non specific ST
T wave abnormality
Deep narrow (dagger like) Q waves
11
Q
Hypertrophic CM
A
massive hypertrophy in LEFT ventricle due to genetic mutation in sarcomere protein results in
- decrease CO
- sudden cardiac arrest - VT
- syncope with exercise
12
Q
signs of hypertrophic CM
A
Jerky pulse JVP LARGE A WAVE 4th heart sounds Late systolic murmur - LOUD during valsalva - soft in Squat
13
Q
definition of Dilated Cm
A
AD dilation of 4 chambers of heart resulting in systolic dysfunction and biventricular CHF
14
Q
treatment HCM
A
Sudden cardiac death - ICD
advanced heart failure / non obstructive - TRANSPLANT
AF and stroke - drugs, Anticoagulant, ablation
15
Q
restrictive CM
A
decrease compliance of ventricle endomyocardium resulting restrictive filling during diastole
16
Q
ABRUPT ANGINA LIKE ONSET in post menopausal women with diffuse T wave inversion
A
Takostubo Stress CM - transient regional systolic dysfunction lV apex/ or mid - ventricle w/o obstruction coronary arteries and coronary angiogram
17
Q
Diagnostic test for CM
A
- ECHO
- left and right ventricle dilation
decrease LV EF
MR and TR
LV thrombus - Cardiac MRI
18
Q
Screening for complication test for CM
A
- ECG
- sinus tacky
- left atrial abnormalities
- decrease voltage - CXR
- CM
- interstitial alveolar edema
- transverse endomyocardial
19
Q
therapeutic test for CM
A
Cardiac cauterization and ablation
20
Q
treatment CM in general
A
Avoid (exertion, competitive spots, CCB, NSAIDS )
Family Screen
ICD HF tx biventricular pacing / AICD LVAD (left ventricular atrial device) Cardiac transplant
21
Q
heart failure definition
A
abnormality of the cardiac striation or function leading to failure of the heart to deliver 02 at the rate required for tissues
22
Q
sings of Left heart failure
A
S3
crackles
23
Q
right heart failure
A
raised JVp hepatojugular reflex sacral and lower extremity edema ascots parasternal heave right upper quadrant hepatosplendomegly
24
Q
diagnostic test heart failure
A
CXR T.T.ECHO BNP or NT-proBNP Morphology Cardiac MRI imaging (CMR) - scar burden - EF - infiltrative process Coronary Angiography (Ventriculogram) - b/c 60% HF pts have CAD Heart Catheterisation (Left and right)
25
cause of heart failure test
```
ECHO
ECG
FBC (Anaemia)
TFT’s
Coronary Angiography (CAD)
Urinalysis (looking for proteinuria)
Serology for HIV, Rheumatological Conditions, Viral, Haemochromatosis and Genetic testing.
Iron studies
Fasting lipids
PFT’s
```
Real causes:
- heart: IHD, HTN, valvular, tachyarrythmia
- OTHER: alcohol, hyperthyroisiam, DM, Acromegly, VIRAl infection, heamochrmatosis, illicit drug
26
Prognostic test for heart failure
BNP / NT-proBNP
LFT’s (Hepatic congestion)
ECG
27
if no response LMNPO
1. invasive BP motor
2. GTN IV infusion
3. Vasoactive agents - Dobutamine and Milirone
4. New agent - Serelaxin
28
drugs that improve prognosis is heart failure
AAAB
ACE ARB ALDEROSTERONE INHIBITOR BB
PLUS mechanical intervention
29
murmurs affected with handgrip
decrease - HOCM
| Increase MR. AR. VSD
30
murmurs affected with Squating
increase a. stenosis
| decrease HOCM
31
risk factor for acute pericarditis
```
Acute Pericarditis
Viral infections
Recent myocardial infarction
Prior cardiac surgery
Prior malignancy
Autoimmune disorders and vasculitides
Uraemia
```
32
clinical features of acute pericarditis
```
Chest pain
Sudden onset
Anterior chest
Sharp
Pleuritic
Exacerbated by inspiration / coughing
Relieved by sitting up / leaning forward
```
33
clinical features of chronic pericarditis
Dyspnea on exertion
Fatigability
Reduced exercise capacity
34
clinical features of tamponade
```
Can be of sudden onset post cardiac procedure
Can be insidious as in SLE or malignancy
Vague atypical chest pain
Syncope or presyncope
Dyspnea and tachypnea
Peripheral oedema
```
35
what does a pericardial rub sound like
Pericardial Rub
Scratchy / Squeaking Quality
Intermittent (hours) and Variable Intensity
best heard with the stethoscope diaphragm (firm pressure applied)
loudest over the left sternal border
Loudest with patient leaning forward & holding breath
36
sings of acute pericarditis
- fever
- pericardiac rub
- Suspension of respiration during auscultation permits distinction of a pericardial friction rub from a pleuropericardial or pleural rub (only heard during inspiration)
37
signs of constrictive pericarditis
Cachexia
Elevated jugular venous pressure (JVP)
Pulsus paradoxus
Kussmaul's sign (the lack of an inspiratory decline in JVP)
```
Chest
Pericardial knock (heart sound occurring prior to S3)
pleural effusion (stony dull on percussion)
```
Abdomen
Ascites
Pulsatile hepatomegaly
Lower Limbs
Peripheral edema
38
signs of cardiac tamponade
```
Tachypnea
Sinus tachycardia
Hypotension
Elevated jugular venous pressure
Venous distension in the forehead and scalp
Muted or muffled heart sounds
Pulsus paradoxus
(Exaggerated drop in systolic blood pressure >10 mmHg on inspiration)
```
39
ECG pericardial disease
diffuse ST elevation (concave up)
reciprocal ST depression in aVR & V1
PR segment elevation in lead aVR
PR segment depression in V5 and V6
40
treatment for chronic pericarditis
Pericardiectomy (definitive treatment option)
| Diuretics (temporising measure and for patients who are not candidates for surgery)
41
treatment for cardiac tamponade
```
Percutaneous drainage (catheter pericardiocentesis)
Open surgical drainage with or without pericardiotomy (pericardial "window”)
```
42
NUMBER 1 cause of acute pericarditis
VIRAL
43
Name 2 differentials of pericardial rub
pleuropericardial rub
| pleural rub
44
infective endocarditis definition
inflammation or colonization by infectious agents of heart valve or inner lining of the heart (mural endocardium)
45
pathogenesis of endocarditis
cardiac valves become infection by micro emboli from bacteria or fungi in the circulation --> forms thrombi --> vegetation --> micro-organism into body --> systemic findings
Dextran (step mutant ) -> virulence factor that promotes adherence
coagulase negative bacteria - BIOFILM - promotes adherence
Endocardial surface - previously damagesd, previous endocarditis, prior Sx or pacemaker
46
organism that cause endocarditis
```
VIRIDANS (S. mutans)
GI / GU bus : E.fecalis *prostate sx
Staph. aures (IVDU) and epidermidis
Fungi
HACEK
```
47
clinical I.E
Flu like - myalgia , dry cough, fatigue
Low grade fever
WL
Cardinal symptoms
```
Vascular:
New cardiac murmur
Splinter Haemorrhage
Janway lesions (Painless)
Splenomegaly
Hematuria
infracts / emboli/ mycotic aneurysm / Intercranial haemorrhage / conjunctival haemorrhage
```
```
IMMUNE: GROR
GN
Roth (Bulls' eye lesion)
Osler node
Rheumatoid factor
```
48
dx of IE
Clinical
(Blood Culture) -3 sets in 12-14 hour period
ECHO (TTE/TEE)
- first line, repeat 7-8 days
THEN REDO IF - complication, operation, following operation
49
gold standard to test for immunological causes of IE
Pathologic exam of valve or tissue
50
Major criteria IE DUKES
1. at least 2 positive blood cultures at least 12 hour apart
2. typical organism consistent with IE on two separate occasions
3. single positive blood culture for coxeilla burnetii or IgG titre > 1:800
51
Minor criteria
positive Blood cultures that done meet the major criteria
fever > 38
Vascular phenomenon
Immunological phenomena
Predisposition - cardiac condition , IVDU ,
52
surgery indications for IE (ABSOLUTE )
Valvular dysfunction
Uncontrolled infection on antibiotics
Haemodynamic instability
53
Investigation cause of IE
1. MSU
| 2. CXR - sending the tip of any lines for culture
54
surgery indications for IE (Relative)
Onset of AV block – aortic root abscess
Fungal etiology
Relapse s/p appropriate therapy
Recurrent emboli despite appropriate antimicrobial therapy
Persistent fever (≥ 10 days) despite empiric antimicrobial therapy for culture negative endocarditis
Recurrent endocarditis
Prosthetic Valve Endocarditis
55
antibiotic treatment for I.e
Native value subacute infection : B/A + G
Native valve septic infection: V+G OR B/A + F +G
Prostethic Valvue or MRSA: V+G +R
IVDU: B+ F + G OR V+G
56
ECHO findings that require Sx
Vegetation
Persistent vegetation after system. emboli Ant. MV vegetation >10mm
>1 embolic - w.i 1st 2 weeks of ab
Increasesveg size depiste Ab
```
Valvular dysfunction
AR or MR w/ VF
HF unresponsible to medical therapy
Valve perforation or rupture
Perivalvular extension
Valvular dehiscence
New Heart Block
Large abscess or extension of abscess despite appropriate antimicrobial therapy
```
57
complication IE
```
Heart failure
Renal failure
Stroke
Septic Shock
Periannular complication
```
58
Carotid sinus syndrome
> 3 sec asystole
>50 mmHg fall in SBP (vasodepressor )
At carotid sinus
59
postural hypotension definition
Orthostatic hypotension means syndrome ass. w/ being in an upright position (20mmg DROP in SBP and 10mmhg DROP in DBP)
60
positive carotid sinus message
> 3 second or decrease 50mmhg or decrease 30 DBP
| PLUS RESP SYMPTOMS
61
causes of acute pericarditis
```
VIRAL
Recent MI
Cardiac Sx
Malignly
Autoimmune disorder (vasculitis)
Uraemia
```
62
definition of pericardial knock
heart sound occurring before S3
