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Phase 2a > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Arthrogenesis RF

  • Modifiable
  • Non modifiable
A

Modifiable

  • High cholesterol
  • Smoking
  • Alcohol
  • Obesity
  • Sedentary lifestyle
  • Hyperlipidaemia
  • HTN
  • DM

Non mod

  • Male
  • Family hx
  • Age
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2
Q

Atherosclerosis pathogenesis

A

-Endothelial injury
-endothelial dysfunction
-endothelium releases chemoattractants
-Leukocytes accumulate and migrate into vessel walls releasing inflamm cytokines
IL-6
IL-1
IFN-Gamma
LDL - can pass in and out of arterial wall when in excess
Accumulation leads to glycation and oxidation

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3
Q

Stages of atherogenesis

A
  1. fatty streak
  2. Intermediate lesions
  3. Fibrous plaques
  4. Rupture of fibrous plaque
  5. Erosion
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4
Q

Complonents of Fatty streak

A

Foam cells and T-lymphocytes

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5
Q

Components of Intermediate lesions

A

Foam cells
T lymphocytes
Vascular SM
Aggregated platelets

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6
Q

Fibrous plaque components

A 
Central necrotic tissue 
Foam cells 
T - lymphocytes 
Vascular SM 
Fibrous cap - Fibrin+Elastin
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7
Q

Primary prevention of CVD

A 
- QRISK 3 Score 
If score >10% innitate STATINS
- Stop Smoking 
-Stop drinking Alcohol 
-Tx Co-morbidities 
- Diet 
-Excercise 
-Weight Loss
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8
Q

Secondary prevention of CVD

A 
After CVD development 
A - Asprin + Clopidogrel (12m)
A - Atorvastatin 
A - Atenolol - Bisoprolol (Titrated) 
A - ACEi (Titrated) - Ramipril

Titrated to max tolerable dose

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9
Q

Complications of atherosclerosis

A
  • TIA
  • MI
  • Peripheral vascular disease
  • Strokes
  • Chronic Mesenteric Ischaemia
  • Angina
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10
Q

What is stable angina

A 
Chest pain due to reversible myochardial Ischaemia 
Mismatch in O2 demand and supply
Exacerbated by excercise
Relieved by rest +GTN Spray 
Radiation: Neck,Jaw,Arm 
Exacerbating factors:
- Cold weather 
- Emotion 
- Heavy meal
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11
Q

Types of Angina

A

Stable
Unstable
Prinzmetal - C.A vasospasm
Decubitus - Precipitated by lying flat

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12
Q

Causes of Myochardial Ischaemia

A
  • Decrease B.F –> Atheroma
  • Decrease O2 carrying capacity –> Anaemia
  • Decrease O2 availability –> Hypoxia
  • Increase distal resistance –> L.V hypertrophy
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13
Q

What percentage occlusion does a rapid decline in perfusion occur

A

Diameter stenosis > 70%

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14
Q

Stable angina Investigations

A

ECG

  • ST depression/ T-wave inversion
  • Excercise ECG - ST depression

Bloods
- FBC/U+E/HbA1c/LFT

CT Coronary Angiogram

  • GOLD - Diagnostic
  • Shows narrowing
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15
Q

Stable Angina Management

A

Secondary prevention

  • Weight loss
  • Diet
  • Smoking/Alcohol
  • Hyperlipidaemia –> Statins
  • 75mg Asprin

Short term Sx relief
- GTN Spray
5mins - repeat - pain - 999

Long term sx relief
- Bisoprolol
-CCB –> Amlodopine
Either or used in combo if sx not controlled

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16
Q

What are the methods for revascularisation

A
  • Percutaneous Coronary Intervention

- Coronary Artery Bypass Graft

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17
Q

PCI

  • Procedure
  • Advantages
  • Risks
A
  • Ballon inflated in stented vessel + Stent (Drug eluting)
  • DAPT (Asprin + Clopidogrel) Decrease risk of instent thrombosis

A:
Less invasive
Short recovery

D:
DAPT
Risk of stent thrombosis
Not for compex cases

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18
Q

CABG

  • Procedure
  • Advantages
  • Disadvantages
A

Use ITA to bypass stenosis in LAD/RCA

A:
Good prognosis
Complex cases

D:
Invasive
Risk - Stroke,Bleeding
Long recovery - Hospitalised

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19
Q

What is ACS

A

Umbrella term for Unstable angina and MI
- Result of rupture of a fibrous cap –> Platelet aggregation –>thrombus formation from an atherosclerotic plaque blocking a coronary artery

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20
Q

Dx STEMI

A

ST elevation
New LBBB
Tall T-waves/T-wave inversion
Pathalogical Q-wave

Troponin T+I elevated
Creatnine Kinase elevated

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21
Q

Dx NSTEMI

A

Normal ECG
ST depression
T-wave inversion
Pathalogical q-wave

Troponin T+I elevated

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22
Q

Dx Unstable Angina

A

ST - depression
T- wave inversion
NO PATHOLOGICAL WAVES

NORMAL TROPONIN LEVELS

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23
Q

RF for ACS

A 
Male 
Obese 
HTN 
Smoking 
Family Hx
Age 
High cholesterol 
DM
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24
Q

Describe the cardiac enzymes

A

Troponin T+I

  • Myocardial necrosis
  • > 30ng/l –> MI
  • Rises 3-12hrs after chest pain onset

Creatnine Kinase MB

  • Low accuracy present in normal individuals
  • Determines re-infarction as levels fall slower than troponin
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25
ACS Sx + signs
Acute central chest pain >20mins - Nausea - Sweating - Vomitting - S.O.B - Feeling of impending doom - Pain radiating to arms/neck/jaw Signs: - HR - BP - Reduced 4th Heart sound
26
Signs of silent MI + who experiences them
- Elderley and DM pts Syncope Pulmonary oedema Vomitting
27
Alternative causes of raised troponins
Sepsis Myocarditis Aortic dissection PE
28
NSTEMI and UA initial Tx
``` M- Morphine (5-10mg) O- 02 (SaO2<90%/S.O.B) A- Asprin (300mg) +Clopidogrel N - Nitrates - GTN spray ``` Additional: Beta blockers Anticoagulant - LMWH (Enoxaparin)
29
Risk stratification NSTEMI
GRACE - 6m risk of death or repeat MI after NSTEMI - High risk if score>10% - Consider PCI to tx CAD TIMI - Thrombolysis In MI Risk of dying from a heart event for pts with NSTEMI/UA
30
STEMI Patho
``` Plaque rupture thrombus occlusion Infammation Myocardial cell necrosis ```
31
STEMI Sx + signs
Sx - Central chest pain - Radiates to arm/neck... - Sweating - S.O.B - Palpitations Signs - Clammy - Pale - 4th heart sound - Pansystolic murmur
32
Acute STEMI managment
Morphine Oxygen Asprin + Ticagrelor (180mg) Nitrates - GTN B- Blocker - Ensure no: HF/HB/COPD/Shock STEMI ECG + PCI availabel in 2hrs? Yes --> PCI NO --> Fibrinolysis
33
Fibrinolysis
STREPTOKINASE Plasminogen activation factors given Plasmin cleaves fibrin to its degradation products breaking up the thrombus
34
STEMI Secondary management
``` Asprin Antiplatelets - Clopidogrel Atorovostatin - (80mg) ACEi - Titrated slowly Atenolol - CI --> CCB ``` Lifestyle - Stop smoking + alcohol - Cardiac rehabilitation - Optomise tx for other conditions - DM/HTN - Mediterranian diet
35
Advice following STEMI
Quit job if: - Airline pilots - Drivers Can return to work in 2 months
36
Differential Dx STEMI
``` Cardio: ACS Aortic dissection Pericarditis Myocarditis ``` Lungs: PE Pneumonia Pneumothorax GI: Oesophageal spasm
37
STEMI Complications
- AV block - Cardiogenic shock - LV failure - PE - Pericarditis - Cardiac tamopnade - Mitral regugitation - Ventricular septal defect - Dresslers syndrome
38
ECG Leads visualisation
1 - Lateral --> Circumflex 2 - Inferior --> RCA 3 - Inferior --> RCA aVR - Neutral aVL - Circulflex aVF - RCA
39
ECG chest leads - Heart area - Vessel
``` SEE ALL LEADS V1 - Septal --> LAD V2 - Septal --> LAD V3 - Anterior --> RCA V4 - Anterior --> RCA V5 - Lateral --> Circumflex V6 - Lateral --> Circumflex ```
40
Rules for ECG
- All waves -ve in aVR - PR interval = 120-200ms - QRS <110ms
41
Heart failure defenition
CO inadequate to meet body's requirements
42
Types of HF + Causes
Systolic - Failure to contract - EF <40% - IHD/MI/Cardiomyopathy ``` Diastolic - Inability to relax and fill - Normal EF as total volume decreased - Reduced pre-load - Tamponade Restrictive cardiomyopathy Constrictive pericarditis Obesity HTN ```
43
Calculation for EF
= SV/Total volume
44
HF Causes
``` IHD HTN Cardiomyopathy Arrhythmias --> Atrial fibrillation Aortic stenosis Mitral regrug Chronic lung disease ```
45
Types of output in HF and causes
HIGH - Anaemia - Pregnancy - HTN ``` LOW - Decreased CO that fails to increase with exertion - Pump failure Systolic failure due to decreased HR - Anti - arrhthmic drugs - Excessive pre-load FLuid overload Mitral regurg -Chronic increased afterload Aortic stenosis HTN ```
46
How does HF occur
As heart begins to fail compensatory changes occur | Overtime these compensatory changes get overwhelmed causing pathological development
47
Compensatory changes in HF
- Sympathetic stimulation Increased afterload through peripheral vasoconstriction and Increasing HR/contractility - RAAS Salt and water retention Increases afterload and preload through increased volume and vasoconstriciton ``` -Cardiac Ventricualr dilatation Ventricular remodelling - Myocyte hypertrophy - Interstitial fibrosis ```
48
Why is increased preload beneficial in HF
Failure of heart muscle means blood remain after systole resulting in increased preload This stretches the myocardium Frank starling Maintains CO for a short period
49
Left sided HF Sx
``` Exertional dyspnoea Fatigue Paroxusmal noctural dyspnoea Cough - Frothy sputum Breathlessness Orthopnea ```
50
Left sided HF sings
- Crepitations in lung bases - Tachycardia - Heart murmur - Pulmonary oedema - Cardiomegaly (Displaced apex beat) - 3rd/4th Heart sound - Reduced BP
51
Rght sided HF causes
- Pre-existing LVF - Pulmonary stenosis - Cor pulmonale - Atrial/ventricular septal defect
52
Right sided HF Sx
- Nausea | - Anorexia
53
Right sided HF Signs
- Raised JVP - Hepatosplenomegaly - Ascites - Weigth gain (fluid) - Pitting oedema
54
Cause of paroxysmal noctural dyspnoea
- Decreased adrenaline at night - Resp centres less responsive - Fluid settles over large S.A
55
What is used to classify severuty of Sx in HF
``` New york Heart classification 1. Asymptomatic 2. Slight limitation Comfortable at rest 3. Marked limitations Limiting dyspnoea 4. Dyspnoea present at rest Activtiy leads to discomfort ```
56
HF investigations
Bloods: - Brain natriuretic peptide Levels correlate with severity - FBC/LFT/U+E/TFTs ECG - Shows underlying causes - Ischaemia - LV hypertrophy - Arrhythmias If BNP + ECG abnormal --> Echo Echo - TTE - Assess cardiac chamber dimensions - Valvular disease - Wall abnormalities CXR
57
Changes in CXR for HF
``` A - Alveolar oedema B - Kerley B- lines C - Cardiomegaly D - Dilated upper lobe vessels E - Pleural effusion ```
58
HF management | - Lifestyle
``` Education Loose weight Stop smoking Decrease Alcohol Diet ```
59
HF Management Notes
Avoid exacerbating factors eg: Verapamil/ NSAIDs Tx exacerbating factors eg: Infection/ Anaemia Annual flu and one off Pneumococcal vax
60
Acute HF tx
- 100% O2 - Nitrates - GTN - IV opiates - Diamorphine - IV furosemide (fluid overload) - Consider inotropic drugs
61
Chronic HF tx
``` A - ACEi/ARB B- Betal blocker A - Aldosterone antagonist (Spirinolactone) If A + B don't control sx L - Lood diuretics Digoxin ``` Consider CCB - Amlodopine fro vasodialtion
62
HF RF
- Age>65 - African desecent - Previous MI - Obesity - Men of Lack of protective effect from oestrogen resulting in early onset IHD
63
Why does HTN lead to HF
- Increase arterial pressure - harder to pump in to HTN system - L.V hypertrophy - Increase O2 demand and decreased supply from C.A - Weaker contractions - Systolic failure
64
Why does dilated cardiomyopathy lead to HF
- Chmaber grows to increase increase preload - Increase contraction and strength via FSM - Overtime muscles get thin and weak - Systolic failure
65
How do: | - Aortic stenosis, HTN and hypertrophic cariomyopathy lead to HF
- Concentric myocyte hypertophy - Muscle crowds in to chamber doom - Diastolic failure
66
How does restrictive cariomyopathy lead to HF
- Muscle stiffer and less compliant - Cant't fill and stretch - Diastolic failure
67
How does IHD lead to HF
C.A atherosclerosis | MI
68
What is Cor pulmonale
Right sided HF caused by rep disease
69
Cor pulmonale causes
- COPD - PE - CF - Interstitial lung disease
70
Cor pulmonale patho
Diseased lung leads to hypoxia - Hypoxic pulmonary vasoconstriciton - Increase pulmonary B.P - Harder for R.V to pump in against - Hypertrophy and failure
71
Acute HF
New onset/ Decompensated chronic HF | Charecterised by pulmonary and/or peripheral oedema without signs of peripheral hypoperfusion
72
Chronic HF
Devlops slowly Venous congestion is common Arterial pressure maintained until late
73
HTN diagnostic BP
Clinic = 140/90 | Ambulatory BP = 135/85
74
HTN - Primary
``` Essential HTN - Unknown cause - Multifactoral genetic susceptibility obesity sedentary lifestyle old age ```
75
HTN - Secondary
R - Renal disease CKD - DM nephropathy Renal artery stenosis Glomerulonephritis O - Obesity P - Pregnancy induced HTN E - Endocrine * Conn's syndome * Cushings syndrome - Hypersecretion of corticosteroids enhances vasoconstrictive effects of adrenaline * Phaemochromocytoma Aorta coarctation
76
Drugs assosciated with HTN
``` Coricosteroids - Prednisolone EPO Alcohol Ecstacy Cocaine Contraceptive pill (Oestrogen) NSAIDs Vasopressin ```
77
HTN RF
``` Age Male DM Afro-carribean Obeaity Alcohol High salt diet Fam hx ```
78
HTN Complications
IHD HF Stroke Haemorrhage
79
HTN CP
Headache Visual disturbances Usually asymptomatic apart from malignant HTN Signs: Bilaterral retinal haemorrhages and exudates Papilloedema
80
HF main causes (3)
IHD Dilated CM HTN
81
HTN Histological changes and untreated results
Fibrinoid necrosis of the vessel wall in untreated results in end organ damage Renal - Haematuria/Proteinuria/Progressive Kidney disease Brain - Cerebral oedema/Haamorrhage Retina - Cotton wool spots/ hard exudates/papilloedema CV HF/Aortic dissection
82
Diagnosing HTN
*Pt has BP >140/90 *Offer ABPM Calculate Qrisk2 and look for end organ damage - Fundoscopy - haemorrhage - Urinalysis - Protein/blood - Blood tests - eGFR *ABPM <135/85 NO tx * ABPM >135/85 tx if Qrisk2>20% or EOD *ABPM >150/95 TX
83
When should you always treat HTN
If there is end organ damage
84
Tests for EOD
``` Urine analysis *A:C - Proteinuria *Dipstick - Haematuria ECG/Echo - LV hypertophy Fundoscopy Bloods - HbA1c/eGFR/Lipids ```
85
Stage 1 HTN
Clinic = >140/90 Ambulatory = >135/85
86
Stage 2 HTN
Clinic > 160/100 Ambulatory >150/95
87
Stage 3 HTN
BP > 180/110 | Immediate ant-HTN tx
88
BP equation
CO X TPR
89
HTN Tx | - Lifestyle
``` Reduce alcohol reduce salt intake Excercise Loose weight Smoking cessation - CVD risk ```
90
HTN tx | - Additional pharamacological tx
Statins - Reduce CVD risk | Optomise glycaemic control in pts with DM HbA1c<53mmol/mol
91
HTN Tx pathway
<55y/o --> HIGH renin >55y/o or Black --> LOW renin A - ACEi B-ARB C - CCB D - Diuretics Add: Spirinolacone Alpha-blocker - hydralazine Beta-blocker
92
HTN treatment targets
Under 80 BP<140/90 | Over 80 BP <150/90
93
Common causes of chest pain
Angina ACS Pericarditis - Sharp pain aggrevated by movement, respiration and changes in posture Aortic dissection - Severe chest pain radiating to back GORD - Exacerbated by lying down MSK - tender to palpate over affected areas PE - dyspnoea/ Tachycardia/ Hypotension
94
What is Bradycardia
Slow HR <60bpm
95
What is tachycardia
Fast HR>100bpm
96
Sinus arrhythmia
- Results from fluctuations in autonomic tone Inspiration --> fall in PNS tone and HR quickens Expiration --> HR falls Children and YA Predictable changes in HR
97
Sinus bradycardia - When is it normal - Extrinsic causes - Intrinsic causes
- Sleep and athletes - Extrinsic Beta- blockers Anti- arrhythmic drugs Hypothyroidism - Intrinsic MI --> Acute ischaemia of SAN
98
Sever symptomatic bradycardia tx
Atropine
99
Heart Block common causes
CAD Cardiomyopathy Fibrosis of conducting tissue
100
Heart Block - AVN | - First degree
- Delayed AV conduction - Every atrial impulse leads to ventricular contraction - Long PR interval (>0.2secs)
101
Hear block - AVN | - Second degree
Some atrial impulses do not make it through AVN to ventricles - Mobitz type 1 - Mobitz type 2
102
HB - Mobitz type 1 - Defenition - Causes
Wenckebach phenomenon - Longer-longer- longer- drop - Progressive PR interval elongation until beat is dropped and impulse fails to move through to ventriles - Absent QRS complexes Causes: - AVN Blocking drugs - Inferior MI
103
Mobitz type 2 - defenition - causes - risks - Tx
- QRS compexes dropped without PR interval prolongation - Specified ratio (Pwaves:QRS) Causes: - Inferior infarction Risk: Asystole tx- Pacemaker
104
3rd degree HB - defenition - risks
- P waves completely independent of QRS complexes - Ventricular contractions maintaind by escape rhythms - Risk of asystole Causes: HTN Endocarditis IHD --> MI
105
Aropine - MOA - Indications - S/E
- Inhibits PNS - Mobitx type 2 - Complete HB S/E - Pupil dilatation - Urinary retention - Dry eyes - Constipation
106
RBBB - Causes - ECG findings - Oscultation
RBB no longer conducts Late activation of R.V Causes: - healthy individuals - PE - R.V Hypertrophy - IHD - Congenital HD (Fallot's) MaRRoW - M - QRS - V1 - W - QRS - V6 Splitting of S2
107
LBBB - causes - ECG findings
Late activation of L.V Abnormal Q waves Causes: - Aortic stenosis - HTN - Cardiac surgery WiLLiaM W - QRS - V1 M - QRS - V6
108
Sinus tachycardia
- Excercise - Excitement - Fever - Pain - Anaemia - HF
109
Narrow comlex tachy
QRS <120ms - A.Fibrillation - A.Flutter - SVT
110
Broad complex tachy
QRS >120ms | - VT
111
What is AVNRT | - ECG
AV nodal re-entrant tachycardia - Fast HR caused by electrical signals that loop back on themselves - Narrow complex tachycardia - Self perpetuating electrical loop where the re-entry point is back through the SAN ECG: - QRS --> T-wave-->QRS - No Pwave visible as Atria and ventricles recieve impulses at the same time
112
What is AVRT
AV re-entrant tachycardia - Re-entrant loop via accessory pathway Wolff - parkinson white syndrome - Incomplete atria and ventrical separation during development
113
Wolff - Parkinson white syndrome - defenition - bundle name - ECG chnages - CP - Tx
- Accessory electrical pathway connecting atria and venticles - Bundle of Kent ECG - Short PR interval - Wide QRS complex - Delta wave ``` -CP Palpitations dizziness syncope dyspnoea ```
114
SVT Tx
1. Vagal manoevers - carotis massage - Valsalva manoevere - Breath hold 2. Adenosine complete HB for 1/4sec 3. Direct current cardioversion
115
WPWS Tx
Radiofrequency catheter ablation of accessory pathway
116
Adeosine | - CI
Slows cardiac conduction through AVN Resets sinus rhythm - brief asystole CI - HB - COPD - HF
117
Shockable heart rhythms
VT | VF
118
Ventricular fibrillation - Defenition - ECG - Tx
- Rapid and irregular ventricular activation with no mechanical effect --> NO CO - Pt is pulseless, unconscious and resp stops --> C.A - Usually caused by ventricular ectopic beats ECG: - Shapeless rapid oscillations - No organised complexes Tx: - Electrical defib - Cardioverter - defibrillators
119
AF - Defenition - Causes
Chaotic irregular atrial rhythm - 300-600bpm Intermitent response from AVN so irregular ventricular rate ``` Sepsis Mitral stenosis IHD Thyrotoxicosis HTN ```
120
Risk of AF
Embolic stroke
121
AF CP
Sx - chest pain - palpitations - dyspnoea - faintness Signs - irregular pulse - No p waves on ECG - Rapid irregular QRS rhythm
122
AF DD
Atrial flutter | Ventricualr ectopics
123
AF Dx
ECG - No p waves - rapid irregular QRS complexes
124
AF TX
Acute - alcohol toxivity/chest infection tx provoking cause - Cardioversion - LMWH - Enoxaparin - thromboembolism - Cadioversion fails --> Anti-arrhthmic - Amioderone
125
What are most patients with AF usually on
warfarin
126
What is used to calculate the risk of stroke therfore the need for anti-coag
``` CHA2-DS2-VASc Score C - CCF H - A2 - Age >75 D - DM S2 - Stroke V - Vascular disease A - Age (65-74) Sc - - Female ``` ``` 1 = consider asprin or anticoag 2 = oral anti-coag required ```
127
Atrial flutter - Definition - causes
Abnormal but organised atrial rhythm 250-350bpm ``` Idiopathic HTN HF Pericarditis COPD Obesity CHD ```
128
Atrial flutter CP
``` Palpitations chest pain dizziness syncope fatigure breathlessness ```
129
Atrial flutter Dx
saw-tooth like atrial flutter waves - F waves | - if not visiable --> carotid sinus massage
130
Atrial flutter
- radiofrequency catheter ablation - IV Amioderone - sinus rhythm - B-blocker - suppresses arrhthmias
131
Aneurysm defenition
permanent dilation of artery 2x normal diameter
132
Aneurysm Symmetrical Asymetrical
- Fusiform | - Saccular
133
True aneurysm
``` - dilations involving all 3 layers of arterial wall Aorta - A + T Iliac popliteal femoral ```
134
False aneurysm
hole in B.V allows leakage blood collects in adventitia surrounding tissue acts as wall
135
Where do most aneurysms occur specifically
40% - T 60% - A * below branching of renal artery but above aortic birfucation - less elastine so weaker
136
AAA RF
``` HTN Familh hx smoking male trauma hyperlipidaemia Male atherosclerotic damage ```
137
AAA CP
unruptured - no sx - pain: abdo/back/loin - pulsatile abdo swelling ruptured - abdo pain - pulsatile abdomen - collapse - tachy - hypotension
138
AAA DD
GI bleed ischaemic bowel perforated ulcer appendicits
139
AAA Dx
- US | - CT/MRI
140
AAA Tx
RF- smoking cessation BP control Statind small <5.5cm - monitered open surgical repair Endovascular stenting
141
TAA - Ascending - descending
- Marfans/ HTN | - secondary to atherosclerosis
142
TAA CP
asymptomatic - chest pain - aortic regurgitation - compression of local structures --> IVC - Cardiac tamponade
143
TAA Dx
- Transoesophageal echocariography - US - CT/MRI
144
Aortic dissection defenition
- Tear of tunica intima - blood flows between layers of aorta wall increasing diameter of vessel - collects in false lumen
145
AD causes + RF
``` HTN Stress Pregnancy - increase B.V coarctation of aorta Aneuryrsm Trauma - shearing forces ``` RF: Ehlers danlos Marfans
146
AD CP
- Tearing chest pain - pain radiates to back and arms - HTN - Hypotension - shock - absent peripheral pulses
147
AD DD
``` MI ACS Aortic regurgitation MSK pain Pericarditis ```
148
AD Diagnosis
CXR - widened mediastinum CT scan Transoesophageal echo MRI
149
What law is applied to aortic dissections
Laplaces law - increase diameter - increase tension
150
Aortic aneurysm complications
- Aortic insufficiency pulls on valve as it dilates blood flows back to ventricles during diastole - high pitched cough LRL nerve stretched - Blood clots blood polls in extra lumen space - Headache + can't flex neck fowards bleeding into SA space increases pressure irritates meninges
151
Aortic Dissection tx
- analgesia - morphine - resuscitation - surgery replace arch surgical stenting - control HTN - B-blockers - GTN
152
What is peripheral vascular disease
Partial blockage of peripheral vessels by an atherosclerotic plaque resulting in insuffecient perfusion of lower limb
153
Peripheral vascular disease RF
``` Smoking obesity HTN DM Sedentary lifestyle High cholesterol ```
154
Peripheral vascular disease symptoms
``` Pain Pallour Perishingly cold Pulseless Paralysis Parasthesia ```
155
Pericardium function
Promotes cardiac efficiancy - limited dilation Aids atrial filling - creates a closed chamber - Decrease external friction Anatomically fixes heart to sternum and diaphragm
156
Acute pericarditis aetiology - Infectious - non infectious
* Infectious Viral - coxsackie viruses - EBV / HIV/ Mumps bacterial - Mycobacterium TB Fungal - Histoplasa spp --> immunocompromised * Non infectious - Rhemuatoid arthiritis - Uraemia
157
Acute pericarditis clinical presentation
``` Fever chest pain - worse with deep breathing - relieved by sitting and leaning foward Hiccups pericardial friction rub - auscalltation tachycardia pain radiates to arm - trapezius ridge ```
158
Acute pericarditis DD
``` Pneumonia angina MI Aortic dissection Pneumothorax ```
159
Acute pericarditis diagnosis
- ECG saddle shaped ST elevation --> ALL leads PR segment depression -CXR rule out effucion (>300ml to be detectable)
160
Acute pericarditis tx
- NSAIDs - Colchicine --> 3m course S/E - Nausea and diarrhoea
161
How does pericardial effusion lead to tamponade
large volume of fluid collects in pericardial sac ventricullar filling compramised so decrease in CO Cardiac tamponade
162
Pericardial effusion presentation
``` chest pain dyspnoea muffled heart sounds compression of local structures - Hiccough - phrenic nerve - spasm of diaphragm - nausea - diaphragm ```
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cardiac tamponade presentation
``` increase pulse decrease BP Increase JVP Kussmauls sign Pulsus paradoxus - large decreases S.V and Systolic BP during inspiration ```
164
Pericardial effusion diagnosis
CXR - large globular heart ECG - low voltage QRS complex Electrical alternans - Diff heights QRS complexes Echo - echo free zone
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Cardiac tamponade diagnosis
``` CXR - Big globular heart ECG - Low voltage QRS Electrical altercans Echo - Echo free zone Diastolic collapse - R.A/R.V Bck's triad - Falling BP Rising JVP Muffled heart sounds ```
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Pericardial effusion tx
analgesia pericardiocentisis --> Send fluid for culture - ZN stain/ TB culture / Cytology
167
constrictive pericarditis presentation
``` Kussmauls sign right HF signs Ascites Oedema Diffuse apex beat ```
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Constrictive pericarditis diangosis
CXR - small heart + calcification ECG - low voltage QRS Echo - small ventricular cavaties with normal wall thickness CT/MRI - distinguish from restrictive CM
169
Where does infective endocarditis occur (3)
- valves with congenital/aquired defects RS endocarditis more common in IVDU - Normal valves with virulent organisms - Prosthetic valves/ pacemakers
170
Which organism most commonly causes infective endocarditis and descibe it
``` Viridans streptococci Gram +ve alpha haemolytic optochin resistant low virulence ```
171
Where is viridans step found and what type of valves are at risk
found in mouth | attacks previously damaged valves
172
Where is S.aureus found and which groups of people are at risk from infective endocarditis caused by it
Skin IVDU diabetic surgery Attacks healthy or previously damaged valves (Tricuspid)
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S. epidermidis - valves - route of entry
- Prosthetic | - Valve surgery/ IV catheter - HOSPITAL
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RF for infective endocarditis
``` IVDU Poor dental hygeine Dental treatement Prosthetic valve Pacemaker Cardiac surgery congenital heart defects ```
175
Infective endocarditis presentation
systemic features of infection - malaise - fever - night sweats - weight loss Signs: - Spliter haemorrhage (Septic emboli deposit) - Janeway lesions - Oslers nodes - fingers and toes - Roth spots - eyes - Glomerulonephritis - Arrhythmias - HF - PE/Stroke/MI - Murmur - turbulent flow past damged valve
176
what presentation of a pt requires infective endocarditis ruling out
Heart murmur and fever
177
Infective endocarditis diagnosis
Blood cultures - 3 from 3 different sites - take before Abx Blood test - High ESR and CRP Neutrophilia Echo - Transoesophageal ECG - Long PR intervals
178
Infective endocarditis initial tx
Presuming not staph | - Benzylpenicillin + Gentamycin
179
Criteria for infective endocarditis diagnosis
Duke's classification
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Tx for suspected staphylococcus infective endocarditis
Vancomycin swapped for penicillin
181
Infective endocarditis preventions
- Abx prophylaxis to high risk groups before procedure Prosthetic valves Hx of transpalnt Hx of IE - Good oral health - Inform pts of IE sx
182
Aortic valve ausculltation
2nd intercostal space - Right sternal edge
183
Aortic stenosis aetiology
1. Ageing - Degeneration and calcification of normal valve 2. Congenital - Clacification of congenital bicuspid valve 3. Rheumatic heart disease - scar tissue formation
184
Aortic stenosis patho
narrowing of valve = obstructed L.V emptying Increase pressure gradient between aorta and L.V resulting in increased afterload Increase L.V pressure Compensatory L.V hypertrophy - Increased myocardial demand - relative ischaemia --> Angina / Arrhythmia
185
Aortic stenosis presentation
Angina Syncope - exertional HF Signs: - Dizziness - Decrease carotid pulse - SLOW RISING - Decrease intensity of 2nd heart sound - Murmur
186
Aortic stenosis diagnosis
1. Echo - diagnostic L.V hypertorphy 2. CXR - Calcified aortic valve - L.V hypertrophy 3. ECG - L.V hypertrophy - Depressed ST Segments
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Aortic stenosis tx
1. Trancutaneous aortic valve implantation - cracks calcification 2. Aortic valve replacement Infective endocarditis prophylaxis
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Aortic regurg aetiology
Rheumatic fever IE Bicuspid aortic valve
189
Aortic regug presentation
exertional dyspnoea palpitations angina ``` Signs: collapsing pulse wide pulse pressure Ascites displacement of apex beat ```
190
Aortic regurg diagnosis
CXR - enlarged cardiac silouhette Aortic root enlargement ECG - L.V hypertrophy - tall R waves Inverted t waves Echo
191
Mitral regurg aetiology
1. mitral valve prolapse 2. papillary muscle damage - post MI 3. IE 4. LSHF 5. Rheumatic fever
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Mitral regurg presentation
Exerional dyspnoea fatigue palpitations signs: AF Apex beat displaced laterally Soft S1
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Mitral regug diagnosis
- ECG - Severe MR AF LV hypetrophy + LA enlargement - CXR - LA enlargement - Transoesophageal echo
194
Mitral regurg tx
Mild - serial echos Meds: ACEi B- blockers - HR control for AF Diuretics for overload
195
Mitral valve stenosis aetiology
1. rheumatic fever - commisural fission 2. IE 3. Mitral annular calcification - elderly - end stage renal disease
196
Mitral stenosis presentation
Progressive dyspnoea - pulmonary HTN + Congestion - worse with excercise/pregnancy Dysphagia and hoarse voice - pressure on local structures Fatigue chest pain palpitations
197
Mitral stenosis signs
Malar flush Low volume pulse S1 - loud snap RSHF - Increae JVP - Ascites - Peipheral oedema
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Mitral stenosis diagnosis
ECG: - LA enlargement - Bifid P wave - AF CXR - LA enlargement - Pulmonary congestion ECHO - GOLD
199
why is lidocaine effective in VT tx
Blocks inactivation gate of the sodium channel

Phase 2a (11 decks)

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