Cardiology IV Flashcards
(46 cards)
At which stage of pregnancy does peri-partum cardiomyopathy usually occur [1] and go on till? [1]
Which subpopulations of pregnant women usually suffer from peripartum cardiomyopathy? [2]
peri-partum cardiomyopathy:
- last month of pregnancy and 5 months post-partum
- usually older; greater parity and multiple gestations
Name two infective organisms that can cause cardiomyopathy [2]
Coxsackie B virus
Chagas diesease
State an autoimmune disorders that dispose patients to cardiomyopathy [1]
SLE
Explain the clinical consequences of HOCM [5]
Myocardial hypertrophy:
- predominantly in the interventricular septum
- asymmetric septal hypertrophy narrows the left ventricular outflow tract (LVOT).
Diastolic dysfunction:
- Reduced compliance and elevated filling pressures ddue to hypertrophy
LVOT obstruction:
- The interventricular septal hypertrophy, combined with systolic anterior motion (SAM) of the mitral valve, causes dynamic obstruction of the LVOT during systole.
- This increases the pressure gradient across the LVOT, reducing cardiac output and provoking symptoms.
Mitral regurgitation:
- The SAM of the mitral valve contributes to mitral regurgitation by displacing the valve leaflets, exacerbating the hemodynamic abnormalities and worsening heart failure symptoms
Arrhythmogenesis:
- Myocardial disarray, fibrosis, and ischemia increase the risk of ventricular and atrial arrhythmias
- can lead to sudden cardiac death.
Describe the typical signs seen in HOCM patient [7]
Ejection systolic murmur (left ventricular outflow obstruction):
- harsh crescendo-decrescendo shortly after S1 and loudest at the apex and lower left sternal edge
Mid-late systolic murmur (mitral regurgitation):
- occurs at the apex. Depending on the extent of mitral regurgitation and the direction of the jet regurgitating through the mitral valve it may be pansystolic
S4 gallop:
- This can be heard in patients with impaired diastolic function, reflecting atrial contraction against a noncompliant left ventricle.
Heave (visible or palpation pulsation)
Thrill (palpable murmur)
Features of heart failure:
- raised JVP, crackles on lung auscultation, peripheral oedema
Bifid carotid pulse:
- A rapid upstroke followed by a mid-systolic dip may be observed, known as the ‘spike and dome’ pulse.
Increased left ventricular wall thickness ≥[] mm in the absence of any other identifiable cause is consistent with HCM
Increased left ventricular wall thickness ≥15 mm in the absence of any other identifiable cause is consistent with HCM
Describe the medical managment plan for a patient with HOCM used to reduce symptoms and LVOT obstruction [5]
A. Beta blockers
- 1st line: atenolol or propranolol
B. CCBs:
- Verapamil
C. antiarrhythmic agents:
- Disopyramide
D. Diuretics:
- furosemide
- Caution is warranted due to the potential for hypovolemia and exacerbation of LVOT obstruction.
E. Anticoagulation:
- Indicated in patients with atrial fibrillation or a history of thromboembolic events.
Which drug classes should be avoided in HOCM patients? [3]
nitrates
ACE-inhibitors
inotropes
How do you manage arrhythmogenic right ventricular cardiomyopathy? [3]
Management
* drugs: sotalol is the most widely used antiarrhythmic
* catheter ablation to prevent ventricular tachycardia
* implantable cardioverter-defibrillator
Describe the different classifications of Necrotising soft tissue infections (NSTIs) with regards to their infective organisms
Type I:
- polymicrobial: typically mixed anaerobes & aerobes, on average four or more organisms
Type II:
- group A streptococcus (Strep. pyogenes +/- Staph. aureus)
Type III:
- Gram-negative monomicrobial infection.
- Typically associated with Vibrio species infection
Type IV:
- Fungal infection (typically Candida species, zygomycetes).
NSTI:Type 2 is caused by []
PassMed
type 2 is caused by Streptococcus pyogenes
Treatment of gangrene varies depending on location and cause but is centred around radical surgical debridement +/- amputation. Surgical procedures may also include what? [4]
- Removal of embolus or thrombus
- Balloon catheterisation or stent
- Arterial or venous bypass surgery
- Hyperbaric oxygen treatment.
Which of the following is usually caused by trauma, such as a bite?
Type 1
Type 2
Type 3
Type 4
Which of the following is usually caused by trauma, such as a bite?
Type 1
Type 2
Type 3
Type 4
You investigate a patient who is demonstrating signs of CLI.
How do you determine from the vessel affected if this patient needs open surgery or endovascular revascularization? [2]
Open surgery: lesions of common femoral artery and infrapopliteal disease
Endovascular: short segments: aortic iliac disease
What ECG changes would indicate myocarditis [3]
- tachycardia
- Prolonged QRS
- QT prolongation
- Diffuse T wave inversion
Can trigger arrhythmias
What are the potential complications of myocarditis? [2]
Complications
* heart failure
* arrhythmia; frequent premature ventricular complexes, irregular and polymorphic VT, or ventricular fibrillation possibly leading to sudden death
* dilated cardiomyopathy: usually a late complication
What treatment is given to patients with suspected giant cell myocarditis? [1]
In patients with suspected giant cell myocarditis, steroids are recommended and have been shown to improve survival
E.g. methylprednisolone
Define pericardial effusion [1]
Define pericardial tamponade [3]
Pericardial effusion is when the potential space of the pericardial cavity fills with fluid. This creates an inward pressure on the heart, making it more difficult to expand during diastole (filling of the heart).
Pericardial tamponade
* Pericardial effusion is large enough to raise the intra-pericardial pressure.
* This increased pressure squeezes the heart and affects its ability to function: it reduces heart filling during diastole, decreasing cardiac output during systole.
* This is an emergency and requires prompt drainage of the pericardial effusion to relieve the pressure.
What are the triad (Beck’s) assocaited with cardiac tamponade? [3]
Classical features - Beck’s triad:
* Hypotension
* Raised JVP
* Muffled heart sounds
Other features:
* Dyspnoea
* Tachycardia
* An absent Y descent on the JVP - this is due to the limited right ventricular filling
* Pulsus paradoxus - an abnormally large drop in BP during inspiration
* Kussmaul’s sign - much debate about this
* ECG: electrical alternans
What are key differences between constrictive pericarditis and cardiac tamponade with regards to: [4]
- JVP
- Pulsus paradoxus
- Kussmauls sign
- Features on CXR
What sign is thought to be is considered to be specific for pericarditis? [1]
- Pain that has radiation to the trapezius ridge
The main consequence of chronic pericarditis is development of [].
The main consequence of chronic inflammation of the pericardium is development of constrictive pericarditis.
Patients with constrictive pericarditis typically present with symptoms related to what? [1]
Patients characteristically present with features of right heart failure.
Symptoms
* Shortness of breath
* Leg swelling
* Abdominal swelling
* Exercise intolerance
Signs
* Raised jugular venous pressure
* Peripheral oedema
* Ascites
* Hepatomegaly
