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Phase 3B > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

What is acute coronary syndrome?

A
  • STEMI
  • NSTEMI
  • Unstable angina
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2
Q

What is a STEMI?

A

Myocardial infarction resulting in ST elevation

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3
Q

What causes are there for Non ST elevation?

A
  • Unstable angina

- NSTEMI

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4
Q

What are non-modifiable risk factors for ACS?

A
  • increasing age
  • male gender
  • family history of premature coronary heart disease
  • premature menopause
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5
Q

What are modifiable risk factors for atherosclerosis causing ACS?

A
  • Smoking
  • DM and impaired glucose intolerance
  • Hypertension
  • Dyslipidaemia
  • Obesity
  • Physical inactivity
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6
Q

What are some non-atherosclerotic causes of ACS?

A 
-Coronary occlusion secondary to:
>vasculitis
>CHD
>cocaine use
>coronary trauma
>congenital coronary anomalies
>increase oxygen requirement
>decreased oxygen delivery
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7
Q

How does unstable angina and NSTEMIs present?

A 
-Prolonged chest pain at rest
>Sweating
>Nausea
>Vomiting
>Fatigue
>Shortness of breath
>Palpitations
>Little response to GTN spray
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8
Q

Which groups of patients may present atypically with ACS?

A
  • Diabetics

- Women

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9
Q

What are some differential diagnosis of chest pain?

A
  • Acute pericarditis
  • Myocarditis
  • AS
  • PE
  • Pneumonia
  • Pneumothorax
  • GORD
  • Acute gastritis
  • Acute pancreatitis
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10
Q

What investigations should be done for suspected ACS?

A
  • 12 lead ecg
  • Troponin (6hr and 12 hrs post chest pain onset)
  • Blood glucose
  • ECHO
  • CXR
  • Coronary angiography
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11
Q

What is the acute management for ACS?

A
  • MONA
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin (300mg) or 180mg Ticagrelor
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12
Q

What further management is required for ACS?

A
  • coronary angiography - PCI if necessary

- rate limiting medications

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13
Q

What are some lifestyle modifications that a patient can do to prevent a further ACS epsiode?

A
  • Smoking cessation
  • Weight loss
  • Exercise
  • Dietary alterations
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14
Q

What are some potential complications of ACS?

A
  • Cardiogenic shock
  • Ischaemic MR
  • Supraventricular arrhythmias
  • Ventricular arrhythmias
  • Heart block
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15
Q

What is a STEMI?

A
  • An acute myocardial infarction caused by necrosis or myocardial tissue due to ischaemia
  • Usually due to a blockage of a coronary artery by a thrombus
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16
Q

How is STEMI diagnosed?

A
  • Raise in troponin
  • Symptoms of ischaemia
  • ST elevation on ECG
  • Imaging evidence of new loss of myocardium or new regional wall motion abnormality
  • Identification of intracoronary thrombus by angiography or autopsy
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17
Q

What is the epidemiology of STEMI?

A
  • Most common cause of death in the UK
  • Affects 1 in 5 men and 1 in 10 women
  • Incidence increases with age
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18
Q

What are modifiable risk factors for an NSTEMI?

A
  • Smoking
  • DM
  • Metabolic syndromes
  • Hypertension
  • Hyperlipidaemia
  • Obesity
  • Physical inactivity
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19
Q

How does MI present?

A
  • Central/Epigastric chest pain
  • Radiates to arm, shoulders, neck, jaw (usually left side)
  • Substernal pressure, squeezing, aching, burning, sharp pain
  • Associated with sweating, nausae, vomiting, dyspnoea, fatigue, palpitations
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20
Q

What are some atypical presentations of MI?

A
  • Abdominal discomfort
  • Jaw pain
  • Altered mental state in the elderly
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21
Q

What are signs of an MI?

A
  • Low grade fever
  • Pale, cool, clammy skin
  • Dyskinetic cardiac impulse
  • Signs of congestive heart failure
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22
Q

How quickly should GTN work?

A
  • Straight away
  • Side effects: headache
  • ACS more likely if spray taken 3 times within 5 minutes and no relief
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23
Q

What are the investigations that should be done if an MI is suspected?

A
  • ECG
  • Bloods (trop)
  • CXR
  • Pulse oximetry and blood gases
  • CARDIAC CATHETERISATION AND ANGIOGRAPHY
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24
Q

What pre-hospital management is required for an MI?

A

-Ambulance
-ECG
-Oxygen saturation monitoring
-GTN spray
-Morphine
-Aspirin
MONA

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25
What is the hospital management for an MI?
- PCI | - Coronary bypass surgery
26
What is Atrial fibrillation?
-Irregular heart beat caused by irregular disorganised electrical activity from the SA node in the atria causing irregular depolarisation and therefore ineffective atrial contractions.
27
What are the ECG findings of AF?
- Irregularly irregular heartbeat - No P waves - Chaotic wavy baseline - Fast or slwow
28
What are the 2 causes of an irregular heart beat?
- AF | - Ventricular ectopics
29
Who is commonly affected by AF?
-The elderly
30
What conditions are associated with an increased risk of AF?
``` -Structural heart abnormalities >Valvular disease >Enlarged atria -Hypertension -Acute MI -Hyperthyroidism -Alcohol and caffeine consumption -Sleep apnoea ```
31
What is the treatment for AF?
- Anti-arrhythmic drugs - Cardioversion - Rate control ie Beta blockers - Anticoagulation ie warfarin, rivaroxaban
32
How is AF classified?
- Acute: episode within previous 48 hours - Paroxysmal AF: self limiting AF lasting <7 days - Recurrent AF: 2+ episodes - Persistent AF: >7day duration - Permanent AF: fails to terminate following cardioversion, relapses within 24 hours
33
What are the common causes of AF?
- Ischaemic heart disease - Hypertension - Valvular heart disease - Hyperthyroidism
34
What are some other less common causes of AF?
-Rheumatic fever -Pre-excitation syndromes (WPW syndrome) -Heart failure -Drugs (thyroxine, bronchodilators) -Acute infection -Electrolyte depletion -Lung cancer -PE -Thyrotoxicosis -Dietary/lifestyle factors >excessive caffeine, alcohol obesity
35
What are the clinical symptoms of AF?
- Asymptomatic - Palpitations - Shortness of breath - Syncope/dizziness - Chest discomfort - Stroke/TIA
36
What are the Complications of AF
-Stroke and thromboemobolism -Heart failure -Tachycardia induced cardiomyopathy and critical ischaemia -Reduced quality of life >Reduced exercise tolerance and impaired cognitive function
37
How is AF diagnosed?
``` -ECG >ambulatory ECG if paroxysmal -Bloods >TFT, FBC, U&E, LEF, coagulation -CXR -ECHO -CT/MRI if stroke is suspected ```
38
What are some differential diagnosis of AF?
- Atrial flutter (characterised saw tooth pattern or regular atrial activation on ECG) - Ventricular ectopic beats - Sinus tachycardia - Supraventricular tachycardias
39
What is the management of the first presentation of AF?
- Investigate and manage the cause of AF. - Rate control treatment - Rhythm control - Assess CHADSVASc for stroke risk - Assess HAS-BLED tool for anticoagulant
40
What are the options for rate control for a patient with AF?
>Beta blocker, calcium channel blocker ie bisoprolol or diltiazem >Digoxin (for sedentary pts) >Combination therapy
41
What are the options for rhythm control for patients with AF?
- Cardioversion | - Pharmacological ie amiodarone or flecainide
42
What does CHADSVASc stand for?
- CCF - Hypertension - Age >75 - Diabetes - Stroke/TIA/VTE - Vascular disease - Age: 65-74 - Female
43
What factors form the HAS-BLED scoring system?
- Hypertension - Abnormal liver/renal function - Stroke - Bleeding - Labile INR - Elderly - Drug/alcohol use
44
When should immediate admission be arranged for a patient with AF?
- Rapid pulse >150bpm | - Low bp <90mmHg systolic
45
What is 1st degree heart block?
-Delay in conduction of the electrical impulse through the AV node
46
What is the diagnostic criteria on ECG for heart block?
-Long constant PR interval. (>5 small squares = >200ms)
47
What may be the cause of slowed conduction through the AV node?
- Disease processes ie ischaemia | - Drugs ie beta blockers
48
What condition is associated with 1st degree heart block?
-AF
49
What is the management for 1st degree heart block?
- Watch and wait - Monitor for any progression - Pacemaker is not usually required as the heart rate is unaffected
50
What are the 2 types of 2nd degree heart block?
-Type 1 (Wenkebank) >lengthening prolonged PR interval until a QRS is missed -Type 2 >constantly prolonged PR intervals with occasional missing beats
51
What is the electrophysiology of Type 1 (2nd degree) heart block?
- Some but not all P waves are conducted to the ventricles - Increasing PR intervals until a QRS is dropped or missing - Blockage is commonly within the AV node/bundle of His
52
When might a pacemaker be required for someone with Type 1 (2nd degree) Heart block?
-If the atrial contraction rate is low
53
What are some medications that can cause/worsen heart block?
- Calcium channel blockers | - Beta blockers
54
Is Type 1 or type 2 (2nd degree) heart block more likely to progress to 3rd degree heart block?
-Type 2
55
What are the causes of Type 1 (2nd degree) Heart blockl?
- Ischaemia (AV node branch of RCA) - High vagal tone in athletes - Heart surgery - Medications that suppress the AV node
56
What are the findings of type 2 2nd degree heart block on ECG?
-Regular prolonged PR intervals with occasional missing beats
57
What is the clinical significance of type 2 2nd degree heart block?
- May require a pacemaker if the atrial contraction rate is low - Can progress to 3rd degree heart block
58
What are the causes of type 2 2nd degree heart block?
- Ischaemia - Fiboriss within the conducting system - Heart surgery
59
What is 3rd degree heart block?
-There is no communication of electrical conduction between the atria and ventricles
60
What are the findings on ECG of 3rd degree heart block?
- Slow ventricular rate - Irregular or regular rhythm - P waves>QRS - No PR interval
61
What is the electrophysiology behind 3rd degree heart block?
-None of the P waves are conducted to the ventricles -2 individual pacemakers produce individual impulses >One of the pacemakers is below of the heart block
62
What is the clinical significance of 3rd degree heart block
``` -Symptomatic bradycardia >Low cardiac output (hypotensive) -Weak -Dizziness -Decreased exercise tolerance -SOB -Angina ```
63
What are the causes of 3rd degree heart block?
- Ischaemia or infarction - Fibrosis or sclerosis of the conducting fibres - Heart surgery - Cardiomyopathy
64
What is heart failure?
-A clinical syndrome resulting in reduced cardiac output and/or elevated intracardiac pressures at rest of during stress characterised by typical signs and symptoms
65
What are the typical symptoms of heart failure?
- Breathlessness - Fatigue - Ankle swelling
66
What are the typical signs of heart failure?
- Tachycardia - Tachypnoea - Pulmonary rales - Pleural effusion - Raised JVP - Peripheral oedema - Hepatomegaly
67
What are the ways in which heart failure can be classified?
-Acute: >new-onset heart failure (in pts without known cardiac dysfunction) >acute decompensation of heart failure -Chronic: >long standing heart failure -Ejection fraction: >Heart failure with reduced or preserved ejection fraction
68
What groups of people are affected by heart failure?
- Older people | - Older females
69
What are the most common causes of heart failure?
- Coronary heart disease | - Hypertension
70
What are the valvular causes of heart failure?
- Aortic stenosis ->left ventricular hypertrophy - Aortic/mitral regurgitation - ASD, VSD
71
What drugs cause HF?
- Beta blockers - Calcium channel blockers - Anti-arrhythmics
72
What toxins cause HF?
- Alcohol - Cocaine - Mercury
73
What endocrine diseases cause HF?
- DM - Hyperthyroidism - Hypothyroidism - Cushing's syndrome - Phaeochromoctyoma
74
What nutritional deficiencies can cause heart failure?
- Obesity - Cachexia - Thiamine deficiency
75
What infiltrative causes can cause HF?
- Sarcoidosis - Amyloidosis - Connective tissue disease
76
What conditions that increase peripheral demand cause HF?
- Anaemia - Pregnancy - Sepsis - Hyperthyroidism - Paget's disease of the bone - AV malformation - Beriberi
77
How does heart failure present?
- Dyspnoea on exertion and fatigue - Orthopnoea - Paroxysmal nocturnal dyspnoea - Fluid retention - Nocturnal cough (+/- pink frothy sputum) - Syncope
78
What are the signs on examination of HF?
- Tachycardia at rest - Hypotension - Displaced apex beat (with LV dilatation) - Raised JVP - Gallop rhythm - Murmurs - Bilateral basal crackles - Tachypnoea - Pleural effusions - Tender hepatomegaly
79
What investigations should be done to investigate HF?
- BNP elevation (>2000ng/L) - ECG - ECHO - Cardiac MRI
80
What is the New York Association of HF?
- Stage 1: no symptoms on ordinary physical activity - Stage 2: slight limitation of physical activity by symptoms - Stage 3: less than ordinary activity leads to symptoms - Stage 4: inability to carry out any activity without symptoms
81
What reasons may heart failure decompensate?
- Further/worsening ischaemia - MI - Additional valvular/diastolic dysfunction - Infections - Arrhythmias (AF) - Electrolyte imbalance - New medications - Worsening comorbidities
82
What is the non-drug management for HF?
-Patient education -Lifestyle modification >smoking cessation, diet and fluid intake/restriction, exercise, limit alcohol -Mental health support -Immunisations
83
What medications should be used to control heart failure?
-Diuretics -ACEi and Beta blockers -Pain relief -Prevention of cardiovascular morbidity >statins >anticoagulants if appropriate
84
What is hypertension?
-Elevated blood pressure in the arteries
85
What is stage 1 hypertension?
>140/90mmHg or >ambulatory bp >135/85
86
What is stage 2 hypertension?
>160/100 or >150/95
87
What is severe hypertension?
>180/110mm Hg
88
What is the leading risk factor for premature death, stroke and heart disease?
-Hypertension`
89
What causes essential hypertension?
- Primary (often the cause is unknown). Most common cause in the elderly - Secondary hypertension (commonly caused by renal disease, endocrine conditions and pregnancy)
90
What renal diseases cause hypertension?
- Intrinsic renal disease ie glomerulonephritis, PCKD, systemic sclerosis - Renovascular disease ie atheromatous, fibromuscular dysplasia
91
What endocrine conditions cause hypertension?
- Cushing's syndrome - Conn's syndrome - Thyroid dysfunction - Acromegaly - Hyperparathyroidism
92
What phamacological substances cause hypertension?
- Alcohol - Cocaine - Amphetamines - Antidepressant - OCP - Ciclosporin
93
What are some modifiable risk factors which can cause hypertension?
- Excess weight - Excess salt - Lack of physical activity - Excess alcohol intake - Stress
94
What are some non-modifiable risk factors?
- Older age - Ethnicity - Family history - Gender (male)
95
How does hypertension usually present?
- Asymptomatic and picked up incidentally - GP should measure adult's bp every 5 years - If bp >140/90 in surgery, then home blood pressure monitoring should be done
96
What investigations can be done to investigate hypertension?
``` -Bloods: >serum electrolytes and creatinine, eGFR, fasting glucose and lipids -Urinalysis -Renal USS -ECHO -MRI of renal arteries -Plasma calcium ```
97
What is a malignant hypertension?
->200/130 with end organ damage >ie encephalopathy, dissection, pulmonary oedema, nephropathy, eclampsia, papilloedema -Immediate treatment required
98
What is a hypertensive urgency?
- >180/120 without end organ damage
99
What lifestyle interventions should be advised to a patient with hypertension?
- Healthy diet = weight loss - Smoking cessation - Physical exercise
100
What medications should be initiated first line for a pt who is under 55 for hypertension?
-ACEi (or ARB if intolerable)
101
What medication should be prescribed to a patient under 55 who's already on an ACEi for hypertension?
-Calcium channel blocker or a diuretic =ACEi + (CBB or diuretic)
102
What medication should a patient be on 3rd line?
-ACEi + CBB + diuretic
103
What is 4th line treatment for hypertension?
++ further diuretic therapy | or alpha blocker or beta blocker and seek specialist advice
104
What medication should be started for a hypertensive patient who is black or >55?
-Calcium channel blocker or -Diuretic
105
What is renal artery stenosis?
-Impairment of renal perfusion caused by disease affecting teh arterial supply of the kidneys >Renal hypoperfusion leads to hyperactivation of teh renin-angiotensin-aldosterone axis
106
What is the most common cuase of renal artery stenosis?
-Atherosclerosis
107
What are risk factors for renal artery stenosis?
- Hypertenion - Advanced age - Evidence of renal impairment - Evidence of peripheral arterial or CVA disease - DM - Smoking - Family history of CVD - Hyperlipidaemia - White racial background
108
How does renal artery stenosis present?
-Usually asymptomatic. Hypertension is detected incidentally.
109
When should renal artery stenosis be suspected in a patient with hypertension?
- Abrupt onset of hypertension (especially in middle aged pts) - Resistant hypertension (to medical therapy) - Hypertension in a pt with known peripheral vascular/cerebrovascular/cardiovascular disease - In pts with no family history of HTN - Hypertension with hypokalaemia
110
What are the differential diagnosis of renal artery stenosis?
- Essential hypertension - Other causes of renal impairment (glomerulonephritis) - Iatrogenic renal impairment - Malignant primary hypertension
111
What investigations should be done to investigate renal artery stenosis?
``` -Urine and blood tests >eGFR, U&E, blood glucose >24hr urinary protein excretion -urinalysis -Renal USS -CT angiography -MRI ```
112
What is the management for renal artery stenosis?
``` -Lifestyle advice >smoking cessation >DM control >Statins >Adequate hypertensive theray >Avoid ACE/ARB/NSAIDs -Angiography + stenting ```
113
What is a pulmonary obstruction?
-An obstruction within the pulmonary arterial tree -Emboli caused by: >thrombosis (usually arisen from a distant vein and travelled to the lungs via a venous system) >fat >amniotic fluid >air
114
What are major risk factors for a PE?
- Surgery - Obstetrics - Lowe limb problems (fractures, varicose veins) - Malignancy - Reduced mobility - Previous VTE - Major trauma - Central venous lines
115
How do PE's present?
- Dyspnoea - Pleuritic chest pain, retrosternal chest pain - Cough and haemoptysis - Chest symptoms with symptoms of DVT - Tachypnoea - Tachycardia - Hypoxia - Pyrexia - Elevated JVP - Pleural rub - Systemic hypotension
116
What is Well's score?
- Clinically suspected DVT (leg swelling, pain on palpation of deep veins) - Tachycardia - Alternative diagnosis less likely in PE - Immobilisation for >3 days, surgery in last 4 weeks - History of DVT/PE - Haemoptysis - Malignancy
117
What investigations should be done for suspected PE?
- ECG - Baseline investigations (o2 sats, trop and bnp) - ABG - CXR - ECHO - D dimers - Leg ultrasound - CTPA
118
What are the ECG findings of a PE?
-Tachycardia -S1Q3T3 >deep s waves in lead 1, Q waves in lead 3, inverted t waves in lead 3
119
How should a PE be managed?
``` -Initial resuscitation >Oxygen, IV access, analgesia, circulation monitoring -Anticoagulation therapy >LMWH or fondaparinux >rivaroxaban ```
120
What is mitral regurgitation?
-The mitral valve does not close properly causing abnormal leaking of blood from the left ventricle through the mitral valve into the left atrium during contraction
121
What causes primary MR?
- Degenerative changes - Papillary muscle rupture - Infective endocarditis - Trauma
122
What is secondary MR?
-When the valve is structurally normal, but the structures around the valve causes the valve to not work properly. ie cardiomyopathy
123
What are the causes of MR?
- Degenerative - Coronary artery disease - Infective endocarditis - SLE - Acute rheumatic fever - Acute LV dysfunction - Congenital heart disease
124
How does MR present?
- Acute MR: rapid pulmonary odoedma - Chronic MR: heart failure (breathlessness) from dilatation of the LV - Auscultation = pansystolic murmur at the apex
125
What investigations should be done for MR?
- CXR (enlarged LA + LV) - ECG (broad P wave - LA enlargement) - ECHO - Cardiac MRI - Coronary angiography
126
What is the management of MR?
- Surgery - Medical therapies ie nitrates, diuretics - Percutaneous intervention
127
What is aortic stenosis?
-Tight aortic valve usually cause by a calcified degenerative aortic valve
128
What is a risk factor for AS?
-Congenital bicuspid valve
129
How does AS present?
- Shortness of breath - Angina - Dizziness - Syncope - Ejection systolic murmur (radiates to the carotids) - Slow rising, flat character pulse - Narrow pulse pressure
130
What investigations should be done for AS?
- ECG: LVH - CXR: cardiac enlargement, calcification of aortic ring - ECHO - Exercise testing - Cardiac MRI - Coronary angiography
131
What is the management for AS?
- Aortic valve replacement - Baloon valvuloplasty - Transcatheter aortic valve implantation - Medical therapy: digoxin, diuretics, ACEi, control of HTN
132
What is syncope?
-Transient loss of consciousness caused by a transient global cerebral hypoperfusion characterised by rapid onset, short duration and spontaneous complete recovery
133
What are the different causes of neurally mediated syncope?
- Vasovagal syncope - Situational syncope - Carotid sinus hypersensitivity - Glossopharyngeal neuralgia
134
What are the different causes of orthostatic hypotension (causing syncope)
``` -Autonomic failure: >multiple system atrophy, parkinsons, >medications >post-exercise >post prandial -Hypovolaemia >haemorrhage >D+V >Addisons ```
135
What cardiac arrhythmias can cause syncope?
- Paroxysmal supraventricular tachycardia, ventricular tachycardia - Inherited syndromes ie long QT - Drug induced
136
What structural cardiac disease/cardiopulomary disease causes syncope?
- Obstructive valvular disease - Acute coronary syndrome - Hypertrophic obstructive cardiomyopathy - -Aortic dissection
137
What are some cerebrovascular and psychogenic causes of syncope?
- Vascular steal syndromes - Factitious - Anxiety - Panic attaches - Hyperventilation
138
What is the most common cause of syncope?
-Neurally mediated syncope
139
What is the most common cause of syncope in the elderly?
- Cardiac causes - Orthostatic - Postprandial - Polypharmacy
140
What are the differentials of syncope?
- Falls/trauma - Epilepsy - Narcolepsy/catoplexy - Drop attacks - Dizziness - Alcohol/drug abuse - TIA/Stroke - Psychogenic pseudosyncope
141
What is psychogenic pseudosyncope?
- Lasts longer than syncope - Attacks are involuntary and usually related to stress - Commonly affects young people and teenagers - Symptoms are vague, sweatiness and pallor are absent
142
What investigations are there for syncope?
- Orthostatic blood pressure monitoring - ECG - FBC - Fasting blood glucose - Secondary care iX: carotid sinus massage, exercise testing, cardiac bloods, tilt testing
143
What is the management for neurally mediated syncope?
- Medication review and stop offending drugs - Avoid alcohol - Encourage oral fluids - Raise head of the bed - Leg crossing and arm tensince - Treat the underlying cause of the syncope
144
What are the rules about driving in a patient suffering with syncope?
- If the episode is triggered and due to strong Provocation, associated with prodromal symptoms and posture - ie an episode is unlikely to occur if the person is sitting or lying
145
What is infective endocarditis?
-An infection of the endocardium within the heart
146
What are the intracardiac effects of infective endocarditis?
-Valvular insufficiency
147
What are the systemic effects of infective endocarditis?
- Emboli | - Immunological response
148
What is the epidemiology of infective endocarditis?
- Increased age - Increased prevalence with indwelling cardiac devices - Commonly caused by staph (from invasive procedures)
149
What are the risk factors for infective endocarditis?
- Valvular heart disease with stenosis or regurgitation - Valve replacement - Structural congenital heart disease - Previous IE - Hypertrophic cardiomyopathy - IVDU - Invasive vascular procedures
150
What is the pathogenesis causing infective endocarditis?
-All starts with a non-bacterial thrombotic endocarditis as the prerequisite for adhesion and invasion
151
What is the pathogenesis of acute IE?
-Thrombus may be produced by invading organism or by valvular trauma ie placing wires
152
What is the pathogenesis of subacute IE?
Sufficient inoculum of bacteria required to allow invasion of thrombus, bacterial clumping with production of aggutinating antibodies
153
What is the non-bacterial thrombotic endocarditis?
-Results from CKD, neoplasia, SLE, nutrition
154
Which valves are most commonly affected (and in what frequency) in infective endocarditis?
- Mitral valve - Aortic valve - Combined mitral and aortic - Tricuspid
155
What organisms cause infective endocarditis?
``` -Staph. aureus >most common organisms in prosthetic valves, acute IE, IE in IVDU -Strep -Pseudomonas -HACEK organisms >Haemophillus, aggreatibacter, cardiobacterium, eikenella, kingella -Fungi -Enterococci ```
156
How does IE present?
``` -Acute >rapidly progressive infection >poor appetite >weight loss -Chronic >fatigue >low grade fever >flu like illness >polymyalgia >loss of appetite >back pain >pleuritic pain >abdo symptoms ```
157
What are the signs of IE?
-Heart murmurs -Immunological phenomena >Splinter haemorrhages >Roth's spots >Glomerulonephritis >Osler nodes >Janeway lesions
158
What are the investigations required for IE?
``` -Blood investigations >FBC, inflammatory markers, blood cultures -CXR -ECG -ECHO -MRI, CT angiography ```
159
What is Duke's criteria?
- 2 major or - 1 major and 3 minor or - 5 minor criteria to diagnose IE
160
What are the major criteria of Duke's criteria for IE?
- Positive blood culture x2 seperate occasions | - Evidence of endocardial involvement on ECHO
161
What are the minor criteria of Duke's criteria for IE?
- Predisposition (ie heart condition, IVDU) - Fever: >38 - Vascular phenomena - Immunological phenomena - Microbiological phenomena - PCR confirmation - ECHO
162
What are the vascular phenomena associated with IE?
- Major arterial emboli - Septic pulmonary infarcts - Mycotic aneurysms - Intracranial haemorrhage - Conjunctival haemorrhages - Janeway lesions
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What are the immunological henomena associated with IE?
- Glomerulonephritis - Osler's nodes - Roth's spots - Rheumatoid factor
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What are the microbiological phenomena associated with IE?
-Positive blood culture
165
What is the management of infective endocarditis?
``` -Empirical antibiotics >amoxicillin and gentamycin -Consult with micro -Surgery >for heart failure, uncontrolled infection, prevention of embolism ```
166
What is myocarditis?
- Inflammation of the myocardium (acute or chronic) - Can present similarly to MI - Myocardial dysfunction may lead to dilated cardiomyopathy
167
What is the aetiology of myocarditis?
- Infection - Immune mediated - Drugs causing hypersensitivty reaction - Toxic myocarditis - Physical agents
168
What infectious causes are there of myocarditis?
- Viral (most common) | - Diphtheria (most commo bacterial worldwide)
169
What are the immune mediated causes of myocarditis?
- Sarcoidosis - SLE - Scleroderma - Churg-strauss - IBD - T1DM - Kawasaki - Myasthenia Gravis - Thyrotoxicosis
170
What drugs can cause myocarditis via a hypersensitivity reaction?
- Clozapine - Amitriptyline - Colchicine - Furesomide - Methyldopa - Penicillin
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What are toxic causes of myocarditis?
-Drugs >ethanol, cocaine, amphetamines, lithium -Heavy metal poisoning >lead, copper iron
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What physical agents can cause myocarditis?
- Electric shocks - Hyperpyrexia - Radiation
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How does myocarditis present?
``` -Variable >can be asymptomatic, >heart failure >arrhythmias >sudden cardiac death ```
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What are the symptoms of myocarditis?
- Fatigue - Chest pain - Fever - Dyspnoea - Palpitations - Tachycardia - Heart sounds: soft s1/s4 rhythm - Signs of heart failure
175
What investigations are done to investigate myocarditis?
-ECG: >St elevation/depression, t wave inversion, transient AV block -Bloods: FBC, U+E (^creatinine), inflammatory markers -CXR -Viral serology -Endomyocarial biopsy -Cardiac MRI
176
How is myocarditis treated?
- Treat the underlying cause | - Acute myocarditis --> ITU treatment
177
What is chronic pericarditis?
- Long lasting gradual inflammation of the pericardium causing accumulation of fluid in the pericardial space - Precedned by acute pericarditis - Can be effusive or constrictive
178
What is the aetiology of pericarditis?
- Idiopathic - Infective - Inflammatory - Metabolic - CVD - Neoplastic - Drugs, Irradiation, trauma
179
How does pericarditis present?
- Dyspnoea on exertrion - Chest pain, pressure, discomfort - Syncope - Dizziness - Can be asymptomatic - Fatigue, anexiety, confusion
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Investigations for pericarditis?
ECG - saddle shaped ST segment - CXR: calcification - ECHO: diagnostic - MRI: measures thickness of the pericardium
181
How should pericarditis be managed?
- Pericardiectomy - Surgical drainage - Catheter pericardiocentesis

Phase 3B (14 decks)

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