Cardiology(MED) Flashcards
(45 cards)
Patients culture come back with strep bovis and tricuspid valve is vegetated. How do you work out underlying cause>
Strep bovis infection is associated with colorectal carcinoma so we’d do a colonoscopy. The strep bovis in this. case has infected the tricupsid valves causing the vegetations and therefore infective endocarditis
What is a normal aortic root diameter?
1.7-3.3cm
Ultrasound surveillance time guidelines and aortic root diameter
-Patients with aortic root diameter of <4.5cm is yearly surveillance
-Patients with 4.5-5.4cm dilated is 3 monthly
What is becks triad?
-Hypotension
-Muffled heart sounds
-Raised JVP
What is the most common cause of viral myocarditis and how does the ECG present?
Coxsackie B virus
-Diffused ST elevation and elevated troponin levels
What is pulsus paradoxus and what can it be seen in ? How may the ECG present?
Pulsus paradoxus is the exaggerated drop in blood pressure >10mmHg at the end of inspiration that can be seen in cardiac tamponade
-On an ECG, heart swings like a pendulum
What is first line treatment for bradycardia and how does it work?
-Atropine 500micrograms and can give 6 doses up to 3 mg
-Works by inhibiting vagus nerve, increasing firing to SAN to increase heart rate
What are the characteristics of mitral regurgitation?
-Pan systolic murmur radiating to axilla
-Loudest on expiration
What is dukes criteria and what is included in it
For infective endocarditis:
Major criteria:
-2 positive blood cultures with typical organism
-Positive echocardiogram
Minor criteria:
-Fever>38
-Immunological phenomena
-Vascular phenomena
-predisposing heart disease
What is the mode of inheritance for hypertrophic obstructive cardiomyopathy?
Autosomal dominant
What causes digoxin toxicity in terms of potassium?
Hypokalaemia therefore keep an eye out for diuretics or drugs that may cause it like loop diuretics that aren’t K+ sparing
What is the first line treatment for infective endocarditis for an individual with a prosthetic valve?
1st line: flucloxacillin + rifampicin + gentamicin
-The Rifampicin penetrates biofilms on prosthetic material
What is the first line treatment for infective endocarditis for an individual with native valves?
Flucloxacillin
What is the water bottle sign on an x-ray?
Indicates pericardial effusion
What is the management for pericardial effusion?
pericardiocentesis
What is the most common bacteria that causes infective endocarditis?
Staph aureus
What are the target INR values for patients with metallic aortic and mitral valves?
Aortic-3
Mitral-3.5
What drugs can cause long QT interval and tossardes de points?
-Clarythromycin
-SSRIs
What is the range of K+ that we would either give spiranolactone or bisoprolol in hypertension?
Spiranolactone if <4.5
Bisoprolo if >4.5
How does mitral stenosis present and what is the most common cause?
Diastolic murmur
Loud snap in S1 sound
Most common cause is rheumatic fever
What are indications for surgical valve repair in infective endocarditis?
Indications for surgery:
- S- severe valvular incompetence (obstructed or infected)
- A- Aortic root abscess -PR interval prolongation is an indication for surgery: can be secondary to aortic root abscess
- R - resistant to ABX or fungal - (bacteriaemia or fever over 5 days since therapy)
- C- cardiac congestive HF has been caused (eg pitting oedema, SOB when lying, Ascites)
- E- emboli (recurrent after abx)
What drug does clopidgorel interact with making it less effective?
PPI such as omeprazole
what do thiazides do to glucose tolerance?
Worsen glucose tolerance causing hyperglycaemia
BASHed heart
Heart failure and what improves mortality
-Beta blockers
-Acei/ARB
-spiranolactone
-Hydralazine
Furosemide and digoxin is just symptomatic releief
