Cardiology Flashcards

Question

What are the risk factors for abdominal aortic aneurysm?

Answer 1

``` SMOKING Family history Increased age Male sex (however rupture more likely in females) Congenital/connective tissue disorders Dyslipidaemia COPD Atherosclerosis Hypetension Centripetal obesity ``` There are NO specific identifiable causes - may be due to atherosclerosis OR altered tissue metalloproteinases diminish the integrity of the arterial wall

Answer 2

Epidemiology varies by region, age and sex Highest prevalence in male smokers Prevalence increases with age 4-6 times more likely in men

Answer 3

If unruptured: ASYMPTOMATIC and an incidental finding If ruptured: Abdominal, back, loin or groin pain which is sudden and severe Syncope Shock

Answer 4

Abdominal and/or back pain Pulsatile abdominal mass Hypotension

Answer 5

Palpable, pulsatile, laterally expansile abdominal mass Hypotension Abdominal bruit Retroperitoneal haemorrhage can cause Grey-Turner's sign

Answer 6

ABDOMINAL USS - abdominal aorta diameter >3cm. Cannot tell if aneurysm is leaking Bloods: ESR/CRP - if elevated, inflammatory AAA FBC - leukocytosis and anaemia suggest inflectious AAA Culture - if positive with leukocytosis and anaemia, suggests infectious AAA CT angiography - shows if ruptured MRI angiography - anatomical mapping to assist with operative planning

Answer 7

A separation occurs in aortic wall intima, usually by a discrete intimal tear, causing blood flow into a new false channel composed of the inner and outer layers of the media.

Answer 8

Results from an intimal tear that expands into the media of the aortic wall which is preceded by degenerative changes in the smooth muscle of the media. - HYPERTENSION - Bleeding from the vasa vasorum - Connective tissue disease: Marfan syndrome and Ehlers-Danlos syndrome (weakening of the media) - Bicuspid aortic valve - Aortic atherosclerosis - Iatrogenic (aortic manipulation with cardiac surgery or interventional procedures.) - Congenital cardiac abnormalities (e.g. coarctation of the aorta) - Aortitis - Trauma

Answer 9

Expansion of the false lumen can lead to obstruction of the subclavian, carotid, coeliac and renal arteries. Hypoperfusion of the target organs of these major arteries can give rise to other symptoms (e.g. carotid artery collapse).

Answer 10

``` Hypertension Atherosclerotic aneurysmal disease Marfan’s syndrome Ehlers-Danlos syndrome Bicuspid aortic valve Smoking Coarctation Crack cocaine use Family history of aortic dissection Increased age Heavy lifting Pregnancy ```

Answer 11

Congenital abnormality whereby the aorta is narrowed

Answer 12

Mostly affects men over 50 years old (40-60 is most common) | 0.5-3 cases per 100,000 people annually

Answer 13

Acute severe central TEARING chest pain which radiates to back (interscapular and lower pain) Other symptoms caused by obstruction of branches of the aorta: Carotid artery - hemiparesis (weakness of half the body), dysphasia, blackout Coronary artery - chest pain (angina or MI) Subclavian artery - ataxia, loss of consciousness Anterior spinal artery - paraplegia Coeliac axis - severe abdominal pain (due to ischaemic bowel) Renal artery - anuria, renal failure

Answer 14

BLOOD PRESSURE DIFFERENCE BETWEEN THE TWO ARMS >20mmHg Pulse deficit (reduced or absent due to aortic arch involvement) Diastolic murmur on back below left scapula descending to abdomen (crescendo murmur common in proximal dissections) Hypertension Wide pulse pressure Hypotension associated with tamponade Signs of Aortic Regurgitation: High volume collapsing pulse Early diastolic murmur over aortic area ``` Pulsus paradoxus - Abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. May indicate: - Tamponade - Pericarditis - Chronic sleep apnoea - Obstructive lung disease ```

Answer 15

CT ANGIOGRAPHY - will show intimal flap ECG - often normal however if MI, ST segment depression CXR - may show widened mediastinum Bloods: Cardiac enzymes - usually negative Renal function tests - elevated creatinine and urea if renal perfusion is compromised LFTs - elevated AST and ALT if liver perfusion is compromised FBC - may show anaemia if haemorrhage Type and cross to prepare for surgery

Answer 16

Obstruction of blood flow across the aortic valve due to pathological narrowing. A progressive disease that presents after a long subclinical period with symptoms of decreased exercise capacity, exertional chest pain (angina), syncope, and heart failure. Narrowing of the left ventricular outflow at the level of the aortic valve

Answer 17

Calcification of aortic valve - most common cause in adults Congenital bicuspid valve Rheumatic heart disease in developing countries

Answer 18

``` Smoking Hypertension Diabetes LDL cholesterol Age >60 years old Congenitally bicuspid valve Rheumatic heart disease Chronic kidney disease ```

Answer 19

Most common valvular disease in US and Europe - 3% of 75 year olds 2nd most frequent cause for cardiac surgery More common in males Patients typically prevent 70s-80s Patients with bicuspid aortic valves present two decades earlier

Answer 20

May be asymptomatic initially Dyspnoea on exertion Exertional chest pain (angina due to increased O2 demand of the hypertrophied left ventricle) Syncope or dizziness on exercise (due to outflow obstruction) Symptoms of heart failure (e.g. dyspnoea, orthopnoea)

Answer 21

Ejection systolic murmur (crescendo-decrescendo) which radiates to carotids and is loudest at right upper sternal border Diminished S2 (softened or absent) Narrow pulse pressure Slow-rising pulse Thrill in the aortic area (only if severe) Forceful sustained thrusting undisplaced apex beat A bicuspid valve may produce an ejection click

Answer 22

Transthoracic echocardiogram with Doppler (visualises structural changes and levels of stenosis) - elevated aortic pressure gradient, measurement of valve and LV ejection fraction Cardiac MRI - shows stenotic aortic valve Cardiac catheterisation - shows elevated aortic pressure gradient ECG - may show left bundle branch block and left ventricular hypertrophy: - Absent Q waves - Deep S in V1/V2 - Tall R in V5/V6 - Inverted T waves in I, aVL and V5/6 - Left axis deviation CXR - Post-stenotic enlargement of ascending aorta, Calcification of aortic valve Cardiac angiography - Allows differentiation from other causes of angina (e.g. MI) and assessment of concomitant coronary artery disease

Answer 23

A localised area of damage and breakdown of skin due to inadequate arterial blood supply - an ischaemic ulcer. Usually seen on the feet of patients with severe atheromatous narrowing of the arteries supplying the legs.

Answer 24

The ulcers are caused by a lack of blood flow to the capillary beds of the lower extremities ``` Risk Factors: Coronary heart disease History of stroke or TIA Diabetes mellitus Peripheral arterial disease (e.g. intermittent claudication) Obesity and immobility ```

Answer 25

22% of leg ulcers are arterial ulcers | Prevalence increases with age and obesity

Answer 26

Often DISTAL - at the dorsum of the foot or between the toes (over bony prominences) Punched-out appearance Often elliptical with clearly defined edges (sharp demarcation) The ulcer base contains grey, granulation tissue NIGHT PAIN - hallmark of arterial ulcers - Painful, especially at night or when the legs are elevated - Pain is worse when supine (arterial blood flow is further reduced when supine) - Pain is relieved by dangling the affected leg off the end of the bed

Answer 27

``` Night pain Punched-out appearance Hairlessness Pale, cold skin Absent pulses Nail dystrophy Wasting of calf muscles ```

Answer 28

Duplex ultrasonography of lower limbs - assess patency of arteries and potential for revascularisation or bypass surgery ABPI - < 0.8 Percutaneous angiography ECG Bloods: Fasting serum lipids, fasting blood glucose and HbA1c (diabetes is a major risk factor) FBC - anaemia can worsen the ischaemia

Answer 29

Highest ankle pressure DIVIDED by highest brachial pressure >1.2 - Abnormally hard vessel (e.g. calcified - often false negative) 1.2-1.0 - normal 0.8-0.9 - mild arterial disease and claudication 0.5-0.79 - moderate arterial disease with severe claudication <0.5 - severe arterial disease with pain at rest, ulceration, gangrene and critical ischaemia

Answer 30

Arterial ulcer - punched out ulcer, night pain, pain when supine, low ABPI, cold skin Venous ulcer - painful, worse on standing, normal ABPI, warm skin Neurotrophic ulcer - painless, abnormal sensation, warm skin

Answer 31

A macro-reentrant atrial tachycardia with atrial rates usually above 250 bpm up to 320 bpm Wave of muscle contraction through atria Re-entrant rhythm in atria - overrides sinus node - atria contract repeatedly at fast rate Between IVC and coronary sinus is CAVOTRICUSPID ISTHMUS which propagates re-entry signal more slowly - allows to get past refractory period

Answer 32

Type 1 - TYPICAL ATRIAL FLUTTER - most common Single re-entrant cycle which moves around the tricuspid valve of RIGHT atrium in counter-clockwise direction Type 2 - ATYPICAL ATRIAL FLUTTER Re-entrant cycle in right or left atrium, exact location less clearly defined

Answer 33

Underlying disease such as ischaemia makes heart cells irritable and changes properties such as refractory period, making re-entrant circuit more likely Usually initiated by premature atrial contraction due to unknown cause

Answer 34

ECG - electrical activity not initiated by SA node so NO P WAVES - F-waves produced instead which have sawtoothed shape most prominent in leads II, III, aVF, and V1. See 2:1 atrial:ventricular beats, for example as AV node has a much longer refractory period than SA node, therefore not every atrial contraction can cause a ventricular contraction CXR - may be underlying lung disease Bloods: Thyroid function tests - can be underlying thyroid disease U&Es - may be underlying electrolyte abnormality

Answer 35

``` Atrial = 150ms Ventricular = 330ms ```

Answer 36

``` If supraventricular tachycardia and underlying condition which means cannot tolerate tachy: Shortness of breath Chest pain Dizziness Nausea Palpitations Fatigue Syncope ``` Symptoms of heart failure or pulmonary symptoms

Answer 37

1. Prolonged tachycardia leads to ventricular decompensation which leads to HEART FAILURE 2. Atria not contracting effectively leads to stasis of blood which can cause clots - embolism to brain causing STROKE May degenerate into atrial fibrillation

Answer 38

1. Anticoagulation to prevent clotting of blood to prevent stroke 2. Rate control to prevent ventricular tachycardia - beta blockers, calcium channel blockers - try this first with anticoagulation 3. Electrical cardioversion to stop the episode of flutter by depolarising all atrial tissue at once to allow sinus node to take control IF HAEMODYNAMICALLY UNSTABLE 4. Radiofrequency catheter ablation which destroys cavotricuspid isthmus tissue therefore stopping propagation of signal Treat underlying cause

Answer 39

``` Increasing age Valvular dysfunction Atrial septal defect Recent cardiac or thoracic procedures Surgical or post-ablation scarring of atria Heart failure Hyperthyroidism COPD Asthma Pneumonia Diabetes Male Anti-arrhythmic drugs for atrial fibrillation ```

Answer 40

Prevalence increases with age 2.5 times more common in men Often co-exists with atrial fibrillation

Answer 41

Hypotension | Jugular venous pulsations with rapid flutter waves

Answer 42

THROMBOEMBOLISM - Embolic stroke risk of 4% per year Risk is increased with left atrial enlargement or left ventricular dysfunction Worsening of existing heart failure

Answer 43

Chronic AF in a diseased heart does not usually return to sinus rhythm

Answer 44

Sudden cardiac arrest is a sudden state of circulatory failure due to a loss of cardiac systolic function. Acute cessation of cardiac function. It is the result of 4 specific cardiac rhythm disturbances: 1. Ventricular fibrillation 2. Pulseless ventricular tachycardia 3. Pulseless electrical activity 4. Asystole. Torsades de pointes is a sub-group of polymorphic VT in patients with an underlying prolonged QT interval, sometimes related to hypomagnesaemia.

Answer 45

``` Main underlying causes: Ischaemic heart disease Cardiovascular disease Dysrhythmias Cardiomyopathy ``` Ventricular tachycardia and ventricular fibrillation are the two most common causes Pulseless electrical activity is caused by myocardial ischaemia/infarction, hypovolaemia, hypoxia, and pulmonary embolism ``` The REVERSIBLE causes of cardiac arrest are the 4 Hs and 4 Ts: Hypothermia Hypoxia Hypovolaemia Hypokalaemia/Hyperkalaemia ``` Toxins (and other metabolic disorders (drugs, therapeutic agents, sepsis)) Thromboembolic Tamponade Tension pneumothorax

Answer 46

Survival is estimated at <20% for patients presenting out-of-hospital with Ventricular Fibrillation Survival is <10% overall for patients presenting with out-of-hospital cardiac arrest

Answer 47

Patient unresponsive following syncope Cardiac arrest is usually sudden ``` May be preceded by: Fatigue Fainting Blackouts Dizziness ```

Answer 48

Unconscious and not breathing | Absent carotid pulses (absence of circulation)

Answer 49

``` Bloods: FBC - low haematocrit in haemorrhage U&Es - may show electrolyte abnormalities eg hyper or hypokalaemia as a cause Cardiac biomarkers - normal or elevated ABG ``` Continuous cardiac monitoring - identify cardiac rhythm Echo - assesses cardiac activity and left ventricular function. May show valvular abnormalities, myocardial scarring, cardiomyopathy, pericardial effusion, tamponade ECG: may show QT interval, ST-segment or T-wave changes; conduction abnormalities; ventricular hypertrophy

Answer 50

Shockable: Ventricular fibrillation Pulseless Ventricular tachycardia Non-shockable: Asystole Pulseless electrical activity

Answer 51

Attach cardiac monitor and defibrillator ``` If pulseless VT or VF (shockable rhythms): Defibrillate once (150-360 J biphasic, 360 J monophasic) CPR, reassess rhythm, shock again if still in pulseless VT or VF Administer adrenaline (1 mg IV) after second defibrillation and again ever 3-5 mins If persists after 3rd shock - administer amiodarone 300 mg IV bolus (or lidocaine) ``` If pulseless electrical activity or asystole (non-shockable rhythms): CPR for 2, and then reassess rhythm Administer adrenaline (1 mg IV) every 3-5 mins Atropine (3 mg IV, once only) if asystole or PEA with rate < 60 bpm Treatment of REVERSIBLE causes: Hypothermia - warm slowly Hypokalaemia/Hyperkalaemia - correction of electrolyte levels Hypovolaemia - IV colloids, crystalloids and blood products Tamponade - pericardiocentesis Tension Pneumothorax - aspiration or chest drain Thromboembolism - treat as PE or MI Toxins - use antidote for given toxin

Answer 52

Rate: 100-120 compressions per minute 30 compressions:2 rescue breaths Compression at least 5cm

Answer 53

Death Rib and sternal fractures Irreversible anoxic brain injury Recurrent cardiac arrest

Answer 54

Generally poor Early provision of CPR improves prognosis Worse outcomes: long time to discovery of arrest, short duration of CPR, pre-existing cerebrovascular accident or renal dysfunction

Answer 55

Inability of the cardiac output to meet the body's demands despite normal venous pressures. The impaired ability of the heart to cope with the metabolic needs of the body.

Answer 56

``` LOW OUTPUT Cardiac Failure (reduced cardiac output) 1. Left Heart Failure: IHD Hypertension Cardiomyopathy Aortic valve disease Mitral regurgitation ``` 2. Right Heart Failure: Secondary to left heart failure (congestive cardiac failure) Infarction Cardiomyopathy Pulmonary hypertension/embolus/valve disease Chronic lung disease Tricuspid regurgitation Constrictive pericarditis/pericardial tamponade ``` 3. Biventricular Failure: Arrhythmia Cardiomyopathy (dilated or restrictive) Myocarditis Drug toxicity ``` ``` HIGH OUTPUT Cardiac Failure (increased demand): Anaemia Beri Beri Pregnancy Paget's disease Hyperthyroidism Arteriovenous malformation ```

Answer 57

10% of those over 65 years old have heart failure

Answer 58

Left Heart Failure - symptoms caused by pulmonary congestion causing pulmonary hypertension and oedema - Dyspnoea - Orthopnoea (more venous blood back to heart and into pulmonary circulation) - Paroxysmal nocturnal dyspnoea - Fatigue ``` Acute Left Ventricular Failure: Dyspnoea Wheeze Cough Pink frothy sputum ``` ``` Right Heart Failure: blood backup in body Swollen ankles Fatigue Increased weight (due to oedema) Reduced exercise tolerance Anorexia Nausea ```

Answer 59

Left Heart Failure: Tachycardia Tachypnoea Displaced apex beat Bilateral basal crackles S3 gallop (caused by rapid ventricular filling) Pan-systolic murmur (due to functional mitral regurgitation) ``` Acute Left Ventricular Failure: Tachypnoea Cyanosis Tachycardia Peripheral shutdown Pulsus alternans Gallop rhythm Wheeze (cardiac asthma) Fine crackles throughout lung ``` Right Heart Failure: Raised JVP - > 3cm Hepatomegaly/splenomegaly due to blood back up Ascites Ankle/sacral pitting oedema Signs of functional tricuspid regurgitation

Answer 60

Pulsus alternans = Arterial pulse waveforms showing alternating strong and weak beats. It is a sign of LV systolic impairment. In LV dysfunction, ejection fraction significantly decreases. Causes reduction in stroke volume therefore more blood remains in ventricle. This causes an increase in end-diastolic volume. This means that the left ventricle is stretched more for the next contraction. Due to Starling's Law, the increased stretch of the left ventricle caused by the increased end-diastolic volume leads to an increase in the strength of the myocardial contraction. This results in a stronger systolic pulse.

Answer 61

Bloods: FBC, U&E, LFTs, CRP, Glucose, Lipids, TFTs ACUTE Left Ventricular Failure: ABG Troponin - rule out MI BNP - Raised plasma BNP (>400pg/ml) suggests diagnosis of cardiac failure whereas low plasma BNP rules out cardiac failure (<100pg/ml - 90% sensitivity) ``` CXR: Alveolar shadowing Kerley B lines (interstitial oedema) Cardiomegaly Upper Lobe Diversion Pleural Effusion Fluid in the fissures Perihilar shadowing ``` ECG: May be normal, may show ischaemic changes (pathological q waves, t wave inversion), may show arrhythmia or left ventricular hypertrophy Echocardiogram - Assess ventricular contraction, systolic dysfunction = LV ejection fraction < 40%, diastolic dysfunction = decreased compliance of myocardium causing restrictive filling Swan-Ganz Catheter - Allows measurement of right atrial, right ventricular, pulmonary artery, pulmonary wedge and left ventricular end-diastolic pressures

Answer 62

The inability of the cardiac output to meet the demands of the body without increasing diastolic pressure which results in breathlessness and abnormal sodium and water retention leading to oedema.

Answer 63

Acute Left Ventricular Failure: 1. Treating Cardiogenic Shock (severe cardiac failure with low blood pressure): - Use of inotropes (e.g. dobutamine - cardiac stimulant which acts on beta-1 and increases contractility) - Managed in ITU 2. Treating Pulmonary Oedema: - Sit the patient up - 60-100% Oxygen (and consider CPAP) - Diamorphine (venodilator + anxiolytic) - GTN infusion to reduce preload - IV furosemide if fluid overloaded (venodilator and later diuretic effect) 3. Monitor: BP, Respiratory rate, Oxygen saturation, Urine output, ECG 4. TREAT THE CAUSE! (e.g. MI, arrhythmia) Chronic Left Ventricular Failure: TREAT THE CAUSE (e.g. hypertension) AND TREAT EXACERBATING FACTORS (e.g. anaemia). - ACE Inhibitors: Inhibits renin-angiotensin system and inhibits adverse cardiac remodelling - Beta-Blockers: Blocks the effects of a chronically activated sympathetic system!!! - Loop Diuretics: Alongside dietary salt restriction, can correct fluid overload - Aldosterone Antagonists (must monitor K+ as these drugs may cause hyperkalaemia) - Angiotensin Receptor Blockers (must monitor K+ as these drugs may cause hyperkalaemia) - Digoxin: Positive inotrope, reduces hospitalisation but does NOT improve survival. Increases strength of heart muscle contraction. Cardiac resynchronization therapy (CRT): Biventricular pacing improves symptoms and survival in patients with LVEF < 35% - stimulates ventricles to contract at same time Management of underlying associated conditions eg hypertension, IHD, valvular disease, diabetes, rheumatic fever Lifestyle modifications - smoking and alcohol cessation, decrease sodium intake to <2g/day, maintain healthy weight, decrease fluid intake to <2L/day

Answer 64

Respiratory failure Cardiogenic shock Death

Answer 65

50% of those with severe cardiac failure die within 2 years

Answer 66

The portion of blood pumped out of the left ventricle Ejection fraction = stroke volume divided by total left ventricular volume ``` 50-70% = normal 40-50% = borderline <40% = systolic heart failure ```

Answer 67

Systolic heart failure - ventricles cannot pump enough during systole Diastolic heart failure - not enough blood fills into the ventricles during diastole. Thick ventricular walls means the chamber doesn't get an adequate load of blood - Low stroke volume - Normal ejection fraction

Answer 68

A variety of issues resulting from primary disease of the myocardium (heart muscle)

Answer 69

1. Dilated cardiomyopathy - all 4 chambers of the heart dilate, causing thin walls which produce less contraction force 2. Hypertrophic cardiomyopathy - heart walls become thick, heavy and hypercontractile 3. Restrictive cardiomyopathy - the heart muscle is stiff and less compliant, meaning the heart cannot fill properly. The muscles and ventricles all stay the same size

Answer 70

Usually idiopathic ``` Dilated: Post-viral myocarditis infection Alcohol Drugs - cocaine, chemotherapy agents Thyrotoxicosis Genetic Peripartum ``` Hypertrophic: Genetic - autosomal dominant ``` Restrictive: Sarcoidosis Amyloidosis Haemochromatosis Radiation of heart tissue Endocardial fibroelastosis - children ```

Answer 71

Dilated cardiomyopathy is the most common type Hypertrophic cardiomyopathy is the main cause of sudden death in young athletes Prevalence of dilated and hypertrophic cardiomyopathy is 0.05-0.20% Restrictive is even rarer

Answer 72

``` Dilated: Heart failure symptoms - fatigue, dyspnoea, ankle oedema Arrhythmias Thromboembolism Family history of sudden death ``` ``` Hypertrophic: Syncope Usually NO SYMPTOMS Angina Arrhythmias Family history of sudden death ``` ``` Restrictive: Dyspnoea Fatigue Arrhythmias Ankle or abdominal swelling Family history of sudden death ```

Answer 73

Dilated: Pan-systolic murmur due to mitral regurgitation S3 heart sound after S2 S4 heart sounds before S1 Raised JVP Displaced apex beat Functional mitral and tricuspid regurgitations Hypertrophic: Crescendo-decrescendo (ejection systolic) murmur Jerky carotid pulse Double apex beat ``` Restrictive: Raised JVP Kussmaul Sign - paradoxical rise in JVP on inspiration due to restricted filling of the ventricles Palpable apex beat Third heart sound Ascites Ankle oedema Hepatomegaly ```

Answer 74

CXR: May show cardiomegaly, may show signs of heart failure ECG: All Types - Non-specific ST changes, conduction defects, arrhythmias Hypertrophic - Left-axis deviation, signs of left ventricular hypertrophy, Q waves in inferior and lateral leads Restrictive - Low voltage complexes ``` Echocardiography: Dilated: Left ventricular dilation Normal or decreased wall thickness Ejection fraction <45% ``` Hypertrophic: Ventricular hypertrophy (asymmetrical septal hypertrophy) Left ventricular volume normal or low Restrictive: Non-dilated non-hypertrophied ventricles Atrial enlargement Preserved systolic function and diastolic dysfunction (normal ejection fraction) Cardiac Catheterisation - may be necessary to measure pressures Endomyocardial Biopsy - find deposits in myocardium in restrictive Pedigree or Genetic Analysis Chest MRI/CT - see fat, iron or amyloid deposits in restrictive

Answer 75

Chronic inflammation of the pericardium with thickening and scarring. It limits the ability of the heart to function normally.

Answer 76

Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis.

Answer 77

``` Can occur after any pericardial disease process Idiopathic Virus (Coxsackie, mumps, EBV, CMV) TB Mediastinal irradiation Post-surgical Connective tissue disease Underlying systemic condition ```

Answer 78

``` Male Age 20-50 years Transmural MI Cardiac surgery Neoplasm Viral and bacterial infections Systemic autoimmune disorders Mediastinal radiation Pericardial injury ```

Answer 79

More common in adults (20-50y/o) but documented in all ages More common in males Most common disease of the pericardium RARE 9% of patients with acute pericarditis will develop constrictive pericarditis TB has the HIGHEST TOTAL INCIDENCE out of all causes

Answer 80

Chest pain - sharp, stabbing, pleuritic (worse on inspiration) Pain is relieved when sitting up or leaning forward. GTN does not relieve pain and pain is constant, not related to exertion. Pericardial rub (high-pitched/squeaky) Fever Myalgia Heart failure symptoms - fatigue, dyspnoea, peripheral oedema

Answer 81

``` Signs of right sided heart failure: Raised JVP Peripheral oedema Kussmaul's sign (paradoxical rise in JVP on inspiration) Pulsatile hepatomegaly ``` ADVANCED: jaundice, cachexia, muscle wasting

Answer 82

``` Bloods: Serum troponin - mildly elevated ESR/CRP - may be elevated Serum urea - elevated if renal failure FBC - elevated WBC ``` ECG - upwards concave ST-segment elevation globally with PR depressions (SADDLE SHAPED ST-ELEVATION) Pericardial fluid/blood culture - positive if infectious cause CXR - normal or cardiomegaly with water-bottle-shaped enlarged cardiac silhouette if large pericardial effusion. May show calcification of the pericardium. Echocardiogram - helps distinguish from restrictive cardiomyopathy MRI/CT - allows assessment of thickness of pericardium Pericardial biopsy - may be indicated (especially if suspected infective cause)

Cardiology Flashcards

(106 cards)