Cardiology Flashcards

(212 cards)

1
Q

Define coronary artery disease

A

Narrowing/blockage of the coronary arteries caused by atheroscleoris leading to angina

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2
Q

What are the modifiable and non-modifiable risk factors for CAD?

A

Modifiable - smoking, alcohol excess, obesity, inactivity, hyperlipidaemia, hypertension, OCP
Non-modifiable - male sex, increasing age, family history, genetics

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3
Q

What features of a history would make you suspect CAD?

A

Central pain/tightness in the chest which may radiate to the jaw/arm and is brought on by exertion (exercise, emotional stress)
PMH/FH of heart disease

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4
Q

What features on examination would make you suspect CAD?

A

Examination may be normal
Xanthelasma/corneal arcus - hyperlipidaemia
High BP - hypertension
Ejection systolic murmur/slow-rising pulse - aortic stenosis

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5
Q

What investigations would you do if you suspected CAD?

A

Bloods - FBC, TFTs, glucose, HbA1c, lipids, U&Es, troponin
ECG
Imaging - CXR, echo

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6
Q

How is CAD managed?

A

First line - lifestyle modifications, GTN, beta blocker, verapamil
Second line - beta blocker and dihydropyridine, isosorbide mononitrate

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7
Q

What further interventions are available for CAD and when would they be used?

A

PCI revascularisation - single vessel disease or multi-vessel disease <65 years with suitable anatomy
CABG - multi-vessel disease >65 years or diabetic

Pain management if patient is not suitable for either

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8
Q

What are the complications of PCI?

A
Bleeding 
MI
Dissection
Haematoma 
Stroke
Death
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9
Q

What are the differential diagnoses to consider for CAD?

A
MI
Aortic dissection 
PE
GORD
Angina
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10
Q

What are the complications of CAD?

A

MI
AV block
Arrhythmia
Sudden cardiac death

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11
Q

What is the prognosis of CAD?

A

Cardiovascular risk can be lowered with lifestyle modifications and treatment

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12
Q

How can CAD be prevented?

A

QRISK score in primary care can identify risk early
Healthy lifestyle
Secondary prevention drugs - ACEi, statin, BB, DAPT

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13
Q

Define myocardial infarction

A

Acute coronary syndrome in which cardiac myocytes die because of myocardial ischaemia, most commonly caused by atherosclerotic embolus

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14
Q

What are the modifiable and non-modifiable risk factors for MI?

A

Modifiable - smoking, alcohol excess, obesity, inactivity, hyperlipidaemia, hypertension, OCP
Non-modifiable - male sex, increasing age, family history, genetics

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15
Q

What features of a history would make you suspect MI?

A

Severe, crushing, central chest pain radiating to the jaw/arm which does not settle with GTN

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16
Q

How might an MI present differently in an elderly or diabetic patient?

A

Fatigue
Syncope
Dyspnoea

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17
Q

What features on examination would make you suspect MI?

A

Pale
Sweaty/clammy
Hypotensive

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18
Q

What investigations would you do if you suspected MI?

A

Bloods - FBC, troponin, glucose, U&Es
ECG - ST depression and T wave inversion or persistent ST elevation
Cardiac monitoring - arrhythmia

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19
Q

When should a troponin be repeated in a patient with suspected MI?

A

4-6 hours after initial sample

12 hours after pain settles

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20
Q

What is the immediate management for a MI?

A
Oxygen 
GTN
Morphine 
Metoclopramide 
Aspirin 
Clopidogrel/ticagrelor
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21
Q

What are the 2 main treatments for MI and when would they be carried out?

A

PCI - presenting within 12 hours of symptom onset, able to transfer within 120 minutes of attending
Thrombolysis - transfer time >120 minutes

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22
Q

What is the process for a patient undergoing thrombolysis?

A

Tenecteplase given and transferred for rescue PCI (if unsuccessful) or angiography (if successful)

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23
Q

What are the contra-indications of thrombolysis?

A
Previous intracranial haemorrhage 
Ischaemic stroke in past 6 months 
Major trauma/surgery in past 3 weeks 
Puncture 
GI bleeding 
Cerebral malignancy 
AVM
Dissection
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24
Q

What additional drug should be given to patients undergoing PCI for myocardial infarction?

A

Heparin/enoxaparin

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25
How would a patient with a MI be treated if they presented >12 hours after symptom onset?
Fondaparinaux
26
What are the differential diagnoses for MI?
``` Angina PE GORD Costochondritis Aortic dissection ```
27
What are the complications of MI?
``` HF Myocardial rupture Myocardial dilatation VSD Mitral regurgitation Arrhythmia AV block Pericarditis ```
28
What is the prognosis of MI?
Overall mortality 1-2% | Increased risk if unstable angina, >70 years old or co-morbidities
29
What scoring systems can be used to identify risk of MI?
GRACE | TIMI
30
How can MI be prevented?
Healthy lifestyle | Secondary prevention drugs
31
Define hypertension
Abnormally high BP | >140/>90 mmHg (further subdivided into mild, moderate, severe)
32
What are the modifiable and non-modifiable risk factors for HTN?
Modifiable - diet, inactivity, obesity, alcohol, stress | Non-modifiable - increased age, male sex, ethnicity (black African), genetics
33
What are the different types of HTN?
Essential Secondary Malignant
34
What is malignant HTN?
Severe, rapid rise in BP >200/>130 mmHg which causes fibroinoid necrosis of vessel walls, headache, visual disturbance and LOC
35
What features of a history would make you suspect HTN?
Usually asymptomatic, symptoms only manifest when severe (headache, epistaxis, nocturia)
36
What features on examination would make you suspect HTN?
High BP
37
What investigations would you do if you suspected HTN?
``` Ambulatory BP monitoring Bloods - U&ES, glucose, lipids, calcium ECG Urinalysis Renal USS ```
38
How is HTN managed?
Target BP 140/85mmHg or 130/80mmHg if other co-morbidities 1 - ACEi or ARB if <55 years old OR CCB/thiazide if >55/black 2. Combine ACEi and CCB/thiazide 3. Combine all 3 4. Add further diuretic or BB
39
What drugs can be used for rapid control of BP?
IV sodium nitroprusside | Labetalol infusion
40
What drugs are safe to use in pregnancy for HTN? What is the target BP?
Methyldopa Labetalol Nifedipine <150/100 mmHg
41
What are the complications of HTN?
Cerebrovascular - haemorrhage, infarction, seizure, dementia, stroke, TIA CAD - pulmonary oedema, MI, LV hypertrophy, HF Renal - haematuria, proteinuria, uraemia, CKD PVD - atherosclerosis, aneurysm, dissection Retinopathy - haemorrhage, exudate, papilloedema, blindness
42
What is the prognosis of HTN?
Can be controlled | Depends on level of BP, end-organ damage and CVD RFs
43
How can HTN be prevented?
Healthy lifestyle | BP monitoring
44
Define AF
Disorganised firing of impulses in the atria causing an irregular heartbeat
45
What scoring system can be used in AF and what does it assess?
CHADS2VASC | Risk of stroke in atrial fibrillation
46
What are the components of the CHADS2VASC score?
``` Congestive HF Hypertension Diabetes Age >75, age 65-74 Stroke/TIA/embolism Vascular disease Sex (female) ```
47
What can predispose a patient to developing AF?
``` HF HTN Hyperthyroidism CAD Obesity Surgery Alcohol ```
48
What symptoms might AF cause?
``` Asymptomatic Dyspnoea Chest pain Syncope Palpitations LOC ```
49
What would be the examination findings in a patient with AF?
Irregularly irregular pulse
50
What investigations would you do for a patient with suspected AF?
Bloods - TFTs, LFTs ECG - no P waves, fibrillation, irregular QRS, rate 120-180bpm Echo
51
How is AF managed?
Treat underlying cause Rate control - digoxin/verapamil/diltiazem Rhythm control - cardioversion (medical with flecainide/amiodarone; electrical with DC shock); ablation (may need pacing) Anticoagulation - dabigatran/warfarin
52
What are the complications of AF?
Stroke MI HF Cardiac arrest
53
What is the prognosis of AF?
Can be well managed medically
54
Define supraventricular tachycardia
AVNRT - short + slow and long + fast AV node pathways AVRT - accessory tract Atrial tachycardia
55
What are the risk factors for SVT?
Onset usually 12-30 years | AVNRT more common in women, aggravated by stress/alcohol/caffeine
56
What is the aetiology of SVT?
Idiopathic | Structural heart disease
57
What features of a history would make you suspect SVT?
Rapid, irregular palpitations which start and stop abruptly Palpitations are spontaneous or precipitated and terminated by Valsalva manoeuvres Anxiety, dyspnoea, syncope, dizziness, polyuria, chest pain
58
What are vagal manoeuvres?
Right carotid massage Cold water facial immersion Valsalva (abrupt voluntary increase in intra-abdominal and intra-thoracic pressure; breathing into mouthpiece, holding breath and straining)
59
What examination finding would be in-keeping with SVT?
Prominent JVP
60
What investigations would you do for a patient with suspected SVT?
ECG - determine type of SVT although they are treated in the same way
61
Describe the appearance of AVNRT on ECG
Regular, narrow QRS | P waves not visible
62
Describe the appearance of AVRT on ECG
Short PR Wide QRS Slurred delta wave
63
How is SVT managed if the patient is stable?
Vagal manoeuvres | IV adenosine
64
How is SVT managed if the patient is unstable?
Immediate cardioversion
65
What are the complications of SVT?
VT | Sudden death
66
Define ventricular tachycardia
Potentially life-threatening ventricular rhythm faster than 100 bpm
67
What are the risk factors for VT?
Increased age History of heart disease FH
68
What conditions can predispose a patient to VT?
Cardiomyopathy CAD IHD HF
69
What symptoms are caused by VT?
``` Asymptomatic Dizziness Syncope Hypotension Fatigue Chest pain Cardiac arrest ```
70
What would the examination findings be in a patient with VT?
Pulse 120-200bpm Intermittent canon waves in JVP Variable intensity of 1st heart sound
71
How would a patient with suspected VT be investigated?
ECG - rapid rhythm, broad irregular QRS, AV dissociation
72
How would VT be managed if the patient was stable?
IV amiodarone/lidocaine
73
How would VT be managed if the patient was unstable?
DC cardioversion
74
How is VT managed long-term?
Antiarthythmic drugs Ablation ICD
75
What differential diagnosis should be considered for VT?
SVT with BBB
76
What are the complications of VT?
``` Death VF HF Syncope Cardiac arrest ```
77
What is the prognosis of VT?
Normally resolves after short period
78
Define ventricular fibrillation
Life-threatening, very rapid and irregular ventricular activation with no mechanical effect provoked by ectopic beat which rarely resolves spontaneously
79
What conditions can predispose a patient to VF?
MI Severe metabolic disturbance Brugada syndrome
80
What would the examination findings be in a patient with VF?
Pulseless Unconscious Cardiac arrest
81
What investigation would you do in a patient with suspected VF?
ECG - shapeless, rapid oscillations, disorganised
82
How is VF managed?
Electrical defibrillation (ATLS)
83
What are the complications of VF?
Cardiac arrest | Death
84
What is the prognosis of VF?
High risk of sudden death `
85
Define sinus bradycardia
Sinus rate of <60bpm
86
What are the causes of sinus bradycardia?
Extrinsic - hypothermia, hypothyroidism, cholestatic jaundice, increased ICP, beta-blockers, antiarrhythmic drugs Intrinsic - MI, sick sinus syndrome
87
What investigation could be done for a patient with suspected sinus bradycardia?
ECG
88
How is sinus bradycardia managed?
Treat extrinsic cause Temporary pacing Pacemaker
89
Define the 3 types of AV heart block
First degree AV block - prolonged PR Second degree AV block - Mobitz I (progressively prolonged PR until P wave drops), Mobitz II (dropped QRS without prolonged PR) Third degree/complete AV block - narrow QRS reliable, wide QRS unreliable
90
Define the 2 types of bundle branch block
RBBB - deep S wave in leads I and V6, tall late R wave in V1 | LBBB - opposite of above
91
What are the causes of complete heart block?
``` Transposition of great vessels MI Aortic stenosis Sarcoidosis Amyloidosis CABG Digoxin Amiodarone SLE RA ```
92
What are the causes of RBBB?
Congenital anomaly Pulmonary HTN PE MI
93
What are the causes of LBBB?
Aortic stenosis HTN MI
94
How is heart block managed?
Atropine | Pacing
95
Define heart failure
Impaired ability of the heart to function as a pump to support physiological circulation
96
How is HF classified?
Class I - no limitation Class II - mild limitation, symptoms on normal exercise Class III - larked limitation, symptoms on gentle exercise Class IV - symptoms at rest
97
What are the risk factors for HF?
Increased age MI DM Dyslipidaemia
98
What is the aetiology of HF?
``` IHD Cardiomyopathy Idiopathic Toxins (alcohol, chemotherapy) Genetics ```
99
What are the symptoms of HF?
``` Dyspnoea Orthopnoea PND Fatigue Cough ```
100
What signs would be present on examination of a patient with HF?
``` Displaced apex beat 3rd and 4th heart sounds Elevated JVP Tachycardia Hypotension Bibasal crackles (pulmonary oedema) Peripheral oedema Ascites Tender hepatomegaly ```
101
What investigations would you do for a patient with suspected HF?
Bloods - FBC, U&Es, BNP, LFTs, TFTs Imaging - CXR, echo ECG
102
What are the radiological features of HF on a CXR?
``` A - alveolar oedema (batwing) B - Kerley B lines C - cardiomegaly D - dilation of upper lobe vessels E - pleural effusion ```
103
How is chronic HF managed?
Lifestyle modification Monitoring - capacity, fluid status, rhythm, biomarkers Drugs
104
What drug classes can be used to manage HF? Give an example of each
``` Diuretics (e.g. furosemide) ACEi (e.g. enalapril) ARBs (e.g. candesartan) BBs (e.g. bisoprolol) Aldosterone antagonists (e.g. spironolactone) Glycosides (e.g. digoxin) Vasodilators (e.g. hydralazine) ```
105
What interventions are available for HF?
``` Revascularisation Pacemaker ICD CRT Transplant ```
106
What patients are given CRT for HF?
Severe symptoms | Broad QRS
107
What patients are given ICD for HF?
Symptoms | Narrow QRS
108
What HF patients are suitable for a heart transplant?
Young Severe symptoms <6 months life expectancy
109
What are the complications of a heart transplant?
``` Rejection Infection HTN Malignancy Vascular disease Hypercholesterolaemia ```
110
What are the contraindications for a heart transplant for HF?
``` Age >60 years Alcohol/drug abuse Uncontrolled psychiatric illness Severe renal/liver failure Uncontrolled infection Recent thromboembolism Other disease with poor prognosis Multi-organ disease ```
111
How is acute/decompensated HF managed?
``` Oxygen Diuretics (e.f. furosemide) Vasodilators (e.g. GTN infusion) Inotropes (e.g. dobutamine) Noradrenaline Mechanical assist device ```
112
What should always be considered for patients with HF presenting with an acute/decompensated episode?
Identify underlying cause - ACS, HTN emergency, arrhythmia, acute mechanical cause, infection, PE
113
What are the differential diagnoses to consider for HF?
``` COPD PE Pneumothorax Anaphylaxis Asthma Foreign body obstruction ACS ```
114
What are the complications of HF?
Arrhythmia Thromboembolism Hepatic congestion Pulmonary congestion
115
What is the prognosis of HF?
Chronic - 50% survival at 5 years | Acute - 10% 60 day mortality
116
How can HF be prevented?
Healthy lifestyle Optimal treatment of DM, HTN and hypercholesterolaemia Pharmacological secondary preventative therapy following MI
117
Define endocarditis
Infection of the inner lining of the heart valves leading to growth of vegetation
118
What is the most common bacteria to cause IE?
Staphylococcus aureus, followed by streptococcus viridans
119
What are the risk factors for IE?
Male Elderly IVDU Valve abnormality
120
What is the most common bacteria to cause native valve, IVDU and prosthetic valve endocarditis?
NVE - streptococcus viridans IDVU - staphylococcus aureus PVE - coagulase negative staphylococcus
121
What is the aetiology of IE?
``` Poor dental hygiene IVDU Soft tissue infection Dental treatment Cardiac surgery Pacemaker ```
122
What are the bacterial causes of IE?
``` Coagulase negative staphylococci Staphylococcus aureus Streptococcus viridans Enterococci E.coli Pseudomonas aeruginosa HACEK organisms (haemophilus, aggregatibacter, cardiobacterium hominis, eikenella corrodens, kingella) ```
123
What are the fungal causes of IE?
Candida
124
What zoonotic bacterium can cause IE?
Coxiella burnetti
125
What percentage of IE is culture-negative, and why might this be?
5-10% Previous antibiotic therapy Fastidious organisms which fail to grow
126
What features of a history would make you suspect IE?
``` Fever Prosthetic material in heart Predisposition Malaise Arthralgia ```
127
What features would be seen on examination of a patient with IE?
``` Clubbing New murmur Sepsis Embolic events Haematuria Splinter haemorrhages Peripheral abscesses Osler's nodes Janeway lesions Roth spots Conjunctival petechiae ```
128
How is IE diagnosed?
Duke's criteria | IE is defined as 2 major/1 major + 3 minor/5 minor criteria fulfilled
129
What are the minor Duke's criteria?
Predisposition (e.g. heart condition or IVDU) Fever >38˚C Vascular phenomena (e.g. septic emboli) Immunological phenomena (e.g. Osler’s nodes) Positive blood cultures which don’t meet major criteria
130
What are the major Duke's criteria?
Typical organism in 2 separate blood cultures Positive echocardiogram New valve regurgitatio
131
What investigations would you do for a patient with suspected IE?
Bloods - cultures, FBC, U&Es, LFTs, CRP ECG Imaging - CXR, echo
132
How is IE managed?
Prolonged antibiotic therapy for 4-6 weeks
133
What antibiotic is most suitable to treat IE caused by streptococcus?
Benzylpenicillin (+/- gentamicin)
134
What organism causing IE is targeted by treatment with amoxicillin/vancomycin?
Enterococcus
135
What antibiotic is most suitable to treat IE caused by staphylococcus aureus?
Flucloxacillin (+/- gentamicin) Vancomycin used for MRSA
136
What organism causing IE is targeted by treatment with vancomycin/rifampicin?
Coagulase negative staphylococcus
137
What are the indications for surgical management of IE?
HF Uncontrollable infection Prevention of embolism
138
What is the prognosis of IE?
Significant morbidity and mortality even with treatment
139
How can IE be prevented?
Good dental hygiene Avoid skin infection (piercings, tattoos, IVDU) Prophylactic antibiotics before cardiac surgery
140
Define postural hypotension
Low BP (decrease of 20 mmHg systolic or 10 mmHg diastolic) when going from lying/sitting to standing (after 3 minutes)
141
What are the risk factors for PH?
``` Older age Medications Pregnancy Alcohol Bed rest ```
142
What is the aetiology of PH?
Autonomic failure - DM, amyloidosis, PD, ageing Drugs - TCAs, nitrates, CCBs, alpha blockers Prolonged bed rest Volume depletion - dehydration, blood loss
143
What are the symptoms of PH?
``` Feeling dizzy Blurred vision weakness Syncope Headache Confusion Nausea ```
144
What features would be seen on examination of a patient with PH?
``` Depends on cause Murmur - HF/MI Cogwheeling - PD Dry mucous membranes - dehydration Impotence/incontinence - autonomic failure Peripheral oedema - venous insufficiency ```
145
What investigations should be done in a patient with suspected PH?
Bloods - FBC, U&Es, glucose, cortisol Imaging - CXR, echo, CT/MRI Sitting and standing BP Tilt-table testing
146
What are the differential diagnoses for PH?
``` Anaemia Arrhythmia HF MI Valvular heart disease Anxiety ```
147
Define dyslipidaemia
Broad term encompassing hypercholesterolaemia, hyperlipidaemia and mixed dyslipidaemia in which disturbance of fat metabolism leads to changes in lipid concentration in the blood
148
What are the risk factors for dyslipidaemia?
``` Older age Obesity Diabetes Smoking Diet Male sex ```
149
What is the aetiology of dyslipidaemia?
Primary - familial hypercholesterolaemia, familial combined hyperlipidaemia, familial hyperlipoproteinaemia Secondary - hypothyroidism, CKD, nephrotic syndrome, obesity, alcohol, drugs (diuretics, BBs, OCP, HRT, steroids, ciclosporin, phenytoin)
150
What features of a history would suggest dyslipidaemia?
Asymptomatic Symptoms of CVD - chest pain, palpitations, dizziness, oedema FH of premature CVD
151
What signs would be seen on examination of a patient with dyslipidaemia?
Corneal arcus Tendon xanthoma Xanthelasma
152
What investigations should be done for a patient with suspected dyslipidaemia?
Bloods - lipid profile (total cholesterol, LDL, HDL, triglycerides(
153
What are the differential diagnoses for dyslipidaemia?
Primary and secondary causes Alcohol abuse Diabetes mellitus Pancreatitis
154
What are the risk factors for mitral stenosis?
Rheumatic fever Female sex Developing country
155
What are the risk factors for mitral regurgitation?
``` MI IHD Endocarditis Rheumatic fever Congenital disease Older age ```
156
What are the risk factors for aortic stenosis?
Smoking Older age Male sex
157
What are the risk factors for aortic regurgitation?
Older age Congenital disease Infections
158
What is the most common aetiology of mitral stenosis?
Rheumatic fever
159
What is the most common aetiology of mitral regurgitation?
Degeneration
160
What is the most common aetiology of aortic stenosis?
Calcification
161
What is the aetiology of aortic regurgitation?
``` Rheumatic fever Arthritides HTN Endocarditis Marfan syndrome ```
162
What features of a history would suggest mitral stenosis?
``` Asymptomatic Dyspnoea Cough Blood-tinged/frothy sputum Palpitations Weakness/fatigue ```
163
What features of a history would suggest mitral regurgitation?
``` Asymptomatic Palpitations Dyspnoea Orthopnoea Fatigue Cardiac cachexia Subacute IE ```
164
What features of a history would suggest aortic stenosis?
Asymptomatic Exercise-induced syncope Angina Dyspnoea
165
What features of a history would suggest aortic regurgitation?
``` Asymptomatic Palpitations Angina Dyspnoea Arrhythmia ```
166
What features would be seen on examination of a patient with mitral stenosis?
``` Malar flush Small volume pulse Increased JVP Loud snap followed by low pitched rumbling Mid-diastolic murmur ```
167
What features would be seen on examination of a patient with mitral regurgitation?
Forceful, displaced apex beat Soft first heart sound Pansystolic murmur
168
What features would be seen on examination of a patient with aortic stenosis?
Small volume carotid pulse Ejection systolic murmur (crescendo-decrescendo) Radiation to carotids
169
What features would be seen on examination of a patient with aortic regurgitation?
Bounding/collapsing pulse Displaced apex beat High-pitched early diastolic murmur
170
What is the best way to hear a mitral stenosis murmur?
Bell at apex | Patient lying on left side in expiration
171
What is the best way to hear a aortic regurgitation murmur?
Left sternal edge | Patient leaning forward and holding breath in expiration
172
How should a patient with a murmur be further investigated?
ECG CXR Echo, Doppler
173
What are the differential diagnoses for valvular heart disease?
``` Thyrotoxicosis Anaemia Pregnancy AV fistula ACS IE Pulmonary/tricuspid disease ```
174
Define cardiomyopathy
Group of diseases of the myocardium which affect the mechanical/electrical function of the heart
175
What is the aetiology of CM?
Primary - HCM, AC, DCM | Secondary - amyloidosis, haemochromatosis, alcohol, sarcoidosis, Friedreich's ataxia, beriberi, SLE, doxorubicin
176
What are the symptoms of CM?
``` Asymptomatic Chest pain Dyspnoea Syncope Dizziness Arrhythmia Sudden death ```
177
What are the examination findings in CM?
4th heart sound due to forceful atrial contraction Jerky carotid pulse Ejection systolic/pansystolic murmur
178
What are the differential diagnoses for CM?
ACS Pericarditis Cardiac tamponade Hyperthyroidism
179
What congenital heart diseases are cyanotic?
Tetralogy of Fallot Transposition of great vessels Severe pulmonary stenosis Tricuspid/pulmonary atresia
180
What congenital heart diseases are acyanotic?
ASD VSD Patent DA
181
What are the main features of VSD?
Most common | Left-to-right shunt
182
What are the main features of ASD?
``` Often diagnosed in adulthood Most common in women Left-to-right shunt Dilation of pulmonary artery Right heart overload ```
183
What are the main features of patent DA?
Persisting communication between proximal left pulmonary artery and descending aorta Left-to-right shunt Indometacin can be used to stimulate closure Bounding pulse, machinery murmur
184
What are the main features of coarctation of the aorta?
Narrowing of the aorta distal to the origin of the left subclavian vein Most common in men Associated with Turner syndrome and bicuspid aortic valve Radiofemoral delay, asynchronous radial pulse
185
What are the main features of tetralogy of Fallot?
VSD, overriding aorta, RV outflow tract obstruction, RV hypertrophy Progressive pulmonary stenosis leads to cyanosis Right-to-left shunt
186
What are the main features of transposition of the great arteries?
RV -> aorta LV -> pulmonary artery Incompatible with life Severe cyanosis
187
What are the risk factors for congenital heart disease?
``` Sex (depending on type) Rubella Diabetes Alcohol Smoking Family history ```
188
What is the aetiology of congenital heart disease?
Unknown Maternal rubella/alcohol misuse/drugs/radiation Genetic/chromosome abnormality
189
How do adolescents/adults with congenital heart disease present?
``` Endocarditis Valvular lesions Arrhythmia Sudden cardiac death Right HF End stage HF ```
190
What are the symptoms of congenital heart disease?
Sycope Dyspnoea Tiredness/fatigue
191
What are the examination findings in a patient with congenital heart disease?
``` Central cyanosis Pulmonary HTN Finger clubbing Polycythaemia Growth retardation Squatting posture ```
192
What are the differential diagnoses for congenital heart disease?
Cardiomyopathy Metabolic disorder Anaemia
193
Outline the anatomy of the pericardium
Protective covering of the heart | Outer fibrous pericardial sac and inner serous pericardium (inner visceral, outer parietal) containing pericardial fluid
194
Define pericarditis
Inflammation of the membrane covering the heart in which fibrinous material is deposited into the pericardial space and a pericardial effusion often occurs
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What is a pericardial effusion?
Collection of fluid in the potential space of the serous pericardial sac
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What is cardiac tamponade?
Large volume pericardial effusion which compromises ventricular filling
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What is constrictive pericarditis?
Chronic condition causing thick, fibrous, calcified pericardium
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What are the risk factors for pericarditis?
``` Male Age 20-50 MI Autoimmune disease Trauma Infection ```
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What is the aetiology of pericarditis?
``` Idiopathic Viral - coxsackie B, echovirus Bacterial - staph, strep TB Fungal - candida MI Malignant Uraemic Autoimmune Post-radiation/surgery/traumatic Familial ```
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What are the symptoms of pericarditis?
Sharp central chest pain exacerbated by movement/respiration/lying down and relieved by sitting forwards Fever Dyspnoea
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What are the examination findings of pericarditis?
Pericardial friction rub Raised WCC Pericardial effusion
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What are the examination findings of pericardial effusion?
Soft/distant heart sounds Obscured apex beat Ewart's sign - compression of left lung base causing dull percussion
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What are the examination findings of cardiac tamponade?
``` Raised JVP Kussmaul's sign Friedreich's sign Pulsus paradoxus Reduced CO ```
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What are the examination findings of constrictive pericarditis?
Raised JVP, Kussmaul's sign, Friedreich's sign, pulsus paradoxus Ascites, oedema, hepatomegaly Dyspnoea, cough, orthopnoea, PND Pericardial knock
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What are the differential diagnoses for pericarditis?
``` Angina Pleurisy PE Aortic dissection GORD ```
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Define aortic dissection
Injury to the intima of the aorta allowing blood to penetrate the diseased medial layer, leading to cleavage of the layers
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What are the 2 types of aortic dissection?
Type A - proximal | Type B - distal
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What are the risk factors for aortic dissection?
``` Smoking Autoimmune rheumatic disorders HTN Marfan and Ehler-Danlos syndrome Atherosclerosis Cardiac surgery Coarctation of the aorta Pregnancy ```
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What is the aetiology of aortic dissection?
Unknown | HTN contributing factor
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What are the symptoms of aortic dissection?
``` Sudden severe central chest pain radiating to back/arms which is tearing in nature Dyspnoea Syncope Dizziness Weakness ```
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What are the examination findings of a patient with aortic dissection?
Neurological symptoms related to loss of blood supply to spinal cord Aortic regurgitation Coronary ischaemia Cardiac tamponade Acute kidney failure/lower limb ischaemia Shock
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What are the differential diagnoses for aortic dissection?
MI PE Mechanical back pain Cardiogenic shock