CARDIOVASCULAR Flashcards

(81 cards)

1
Q

What is the different stages of hypertension

A

Stage 1: 140/90mmHg

Under 80 and 135/85mmHg
with
risk factors:
diabetic/renal disease/CVD/end organ damage

Stage 2: 160/100mmHg

SEVERE

Stage3: 180/110mmHg

Stage 4:
Persistent

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2
Q

What increases the risk of hypertension

A
Smoking 
Diabetes 
Hyperlipidaemia 
Previous MI or stroke 
Family history

Increased age - decreases arteriole compliance

Alcohol

High sodium diet (<6mg)

Obesity (activates SNS)

Low birth weight

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3
Q

What is the aetiology of hypertension

A

Primary - idiopathic

Secondary 
Drug induced: oral contraceptive, NSAIDS, Steriods 
Endocrine disorder: cushions, chronns 
Co-arctation of aorta 
Sleep apnoea 
Renal disease: renal artery stenosis
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4
Q

What is the investigations for hypertension

A

ABPM - Ambulatory Blood pressure Monitoring

HBPM - Home Blood pressure Monitoring

For end organ damage:

ECG + ECHO

Renal ultrasound
asses GFR

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5
Q

What is the treatment plan for hypertension

A

TARGET BP
< 135/80mmHg
Over 80 years
<145/85mmHg

STAGE 1:
-CBB if over 55 or pregnant
or
-ACEI/ARB if under 55

STAGE 2:
-add thiazide diuretic with either CBB or ACEI

STAGE 3
- CBB+ACEI +Thiazide

STAGE 4:
- Further diuretic therapy

low K+ levels

  • low does spironolactone
  • further diuretic therapy

High K+ levels
-higher dose thiazide

PREGNANT 
Before:
- CBB: nifiedipine 
- beta blocker: atenelol
- Centrally acting agent: methydopa

During:

  • add thiazide diuretic
  • CBB: amlodipine
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6
Q

What is the symptoms of angina

A

pain or discomfort radiating from your retrosternal chest into your neck and jaw and down your left arm

Tight band pressure and heaviness on the chest

Stable - aggravates with exercise
Unstable - happens are rest

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7
Q

What is the investigations for stable angina

A
Bloods:
FBC
Lipid profile 
Electrolytes
Liver/thyroid test 

CXR

ECG
QRS- LVH
ST segment depression
Evidence of myocardial ischaemia

Exercise tolerance test/ETT

Myocardial perfusion imaging

Computed tomography (CT) coronary angiography

Cardiac catheterisation/coronary angiography

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8
Q

What is the medical treatment for stable angina

A

FIRST LINE TREATMENT:

Short acting nitrates - GTN
Beta blockers - bisoprolol/atenolol

SECOND LINE TREATMENT:

IK channel blockers (Ranolazin/Ivabradine)

Long-acting nitrates

K channel blockers (Nicorandil)

Fatty acid oxidation inhibitor -Trimetazidine

Angioplasty:
PCI- stenting or CABG

General measures to stop disease progression:
Statins
ACE inhibitors
Aspirin (or clopidogrel if allergic)

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9
Q

What is acute coronary syndrome

A

Spontaneous plaque rupture & local thrombosis, with
degrees of occlusion resulting in unstable angina, NSTEMI, STEMI, and sudden cardiac death

Potentially leading to myocardial necrosis

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10
Q

What is the risk factors of stable angina and ACS

A

Smoking

Lifestyle- exercise & diet

Diabetes mellitus

Hypertension

Hyperlipidaemia

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11
Q

What is the investigations for ACS

A

ECG

  • ST elevation or depression?
  • is Irregular/ Ventricular fibrillation /multiple wavelets?

ECHO

  • Overall contractility
  • MR
  • abnormality
  • LV ejection: LV dysfunction

Troponin test

Blood test

CXR

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12
Q

What is the medical treatment for ACS

A
IMMEDIATE 
Morphine (or diamorphine) 
Oxygen 
Nitroglycerine (GTN spray or tablet) 
Aspirin 300 mg orally (crush/chew) 
Fibrinolysis /thrombrolysis 
Primary PCI
Defibrillation

LATER TREATMENT
Dual anti-platelet therapy Aspirin + ADP receptor (clopidogrel) for one year following ACS event

SECONDARY PREVENTION: REDUCE RISK 
ADP receptor blocker: clopidogrel
antithromboytic therapy: Heparin + Fondaprinux
Intravenous nitrate 
Statin 
Beta blockers - no other contradictions 
ACE inhibitors - LV dysfunction present 
Coronary revascularisation treatment:  CABG or PCI
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13
Q

Define aneurysm

A

Weakened blood vessel wall, which is pushed outwards due to blood pressure causing excessive localised swelling in the wall of an artery

True: involving all 3 layers

False: thin adventitial layer or by the surrounding soft tissue

Dissecting: An aneurysm in which the inner wall of an artery rips longitudinally, the blood forces the wall apart creating two lumen passages

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14
Q

What is the aetiology of THORASIC AORTIC DISSECTING ANEURYSM

A

Hypertension

Atherosclerosis

Trauma

Smoking

Marfan’s syndrome

co-arctation

Bicuspid valve

Syphilis/mycotic infection

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15
Q

What is the signs and symptoms of an aortic aneurysm

A
SOB 
Heart Failure: pulmonary oedema
Hypotension 
Pulsatile mass, tender 
Back pain 

In the Ascending aorta
Dysphagia (difficult swallowing)
Hoarseness

Sharp chest pain radiating to back and between shoulder blades

Collapse
- due to rupture or dilation

ST elevation

soft early diastolic murmur - AR

Reduced or absent peripheral pulses
(BP mismatch between sides)

Hypotension/ hypertension

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16
Q

What is the treatment of aneurysm

A

TYPE A - ascending aorta : Surgery
Open
Endovascular

TYPE B descending aorta : BP control
(sodium nitroprusside plus beta blocker)

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17
Q

What is the investigations for aneurysm

A

Screening
Ultrasound
- easy, cant plan from

CT /MRA

  • detailed anatomy,
  • bad for contrast + radiation

ECHO

Test for fitness for surgery
Lung function
ECG
Bloods

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18
Q

What is the investigations for chronic/ acutelimb ischaemia

A

Exercise tolerance test
Ankel brachial pressur index
Bruegers test - thombosis

Ascultation of peripheral pulses

CT/MRA

  • First line
  • allows treatment planning

Duplex

Digital subtraction angiogram
- visualise blood vessels

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19
Q

What is the treatment of chronic/ acutelimb ischaemia

A

Anti-coagulation:
Antiplatelte therapy
Statin therapy

Analgesia

Embolectomy/ thromectomy
Thrombolysis

Angioplasty and stent

Surgical bypass
- new route for blood

Non-Salvageable
Amputation

Smoking cessation
Diabetic control
BP control
Exercise

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20
Q

What is the cause of chronic and acute limb ischaemia

A
Chronic
 -Atheosclerotic, Vasculitis 
 Buergers disease - thrombosis 
(linked to smoking)
 Diabetes mellitus 

Acute: thrombosis or embolus

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21
Q

What is the symptoms and staging of chronic limb ischemai

A
Ulceration, Pallor 
Feet slow to regain colour - then dark red appears 
 (Decreases capillary refill time)
Hair loss
decreased peripheral pulses 
Diabetes  

STAGE 1: Asymptomatic

STAGE 2: Mid claudication (cramping) pain in limb
{IIA- walking >200m}
{IIB - walking <200m}

STAGE 3: Rest pain, mostly in the feet

STAGE 4: Necrosis, gangrene of the limb

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22
Q

What is the symptoms for acute limb ischaemia

A
Pain 
Pallor 
Perishingly cold 
Paraesthesia 
Paralysis 
Pulseless 
(compared in both legs)
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23
Q

Definition of varicose veins and aetiology

A

Dilated swollen superficial veins in the lower limbs

if the valves become weaked or damaged then blood can back up and pool in the veins; causing them to swell

long saphenous; 80-87%
short sapnhenous; 21-30%

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24
Q

Risk factors of varicose veins

A

Standing occupation

Pregnancy - twins

previous DVT

Previous major trauma

Family history - can be hereditary

Female

Lack of exercise

Obesity

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25
Symptoms and signs of varicose veins
``` localised / generalised discomfort in the leg nocturnal cramps swelling acute haemorrhage pruritis (itching) ``` Superficial thrombophlebitis (inflammation of the wall of a vein associated with thrombosis) Skin changes: spider discolouration
26
What is the investigations and treatment for vaircose veins
Duplex ultrasound MANAGMENT exercising, losing weight elevation, loose clothing compression hosiery (stockings) Superficial venous Surgery: Minimally invasive procedures involving thermal ablation: Endovenous Laser removal Radio frequency ablation Injection - sclerotherapy Compression
27
What is the definition of chronic venous insufficiency | and the aeitiology
a condition where veins cannot pump enough blood back to the heart ``` Venous hypertension Varicose veins Failure of muscle pumps -Superficial /deep venous reflux Venous obstruction Neuromuscular Obesity Inactivity ```
28
What is the signs and symptoms of chronic venous insufficiency
Ankle oedema Telangectasia - spider veins Venous eczema Haemosiderin pigmentation - orangey colour in the lower limbs Hypopigmentation “atrophie blanche” - white patches Lipodermatosclerosis - inflammation of subcutaneous fat in the legs Venous ulceration
29
What is the investigations and management of chronic venous insufficency
Ambulatory venous pressure: Fall in pressure from standing motionless to active movements ABPI (Ankle Brachial Pressure Index) Duplex ultrasound compression therapy; systemic / topical therapy; most ulcers colonised rather than infected exercise; calf muscle pump
30
What is Deep vein thrombosis and its aetiology
Venous thromboembolism in the legs Venous thrombus due to disruption of virchos triad - more due to stasis + hypercoagubility
31
What is the risk factors to DVT
Increasing age - Tissue trauma - Immobility - Obesity - Smoking - Some systemic diseases e.g. cancer - Inheritance Heritable thrombophilia – an inherited predisposition to venous thrombosis - Pregnancy
32
What is the sign and symptoms of DVT
``` Unilateral limb swelling Persisting discomfort Calf tenderness Warmth Redness- erythema Pigmentation pittin oedema May be clinically silent - asymptomatic ``` If not treated Ulceration
33
What is the investigation and management of DVT
Use Wells score in clinical assessment for pre test probability Blood test: D dimer Ultrasound Anticoagulation: Warfarin Heparin Thrombolysis
34
What Mitral stenosis and its aetiology
Narrowing of mitral valve to less than 2cm (from 4-6cm) ``` Rheumatic Heart disease (strep. infections) Congenital MS Infective endocarditis systemic lupus erythematous (autoimmune disease affecting tissue) ```
35
What is the symptoms and signs of mitral stenosis
``` Dyspnoea Heamoptisis Chest pain Hoarsness - due to compression of laryngeal nerve Palpitations (due to AF) ``` ``` Tachycardia Mitral facies (discolouration of nose and cheeks) JVP - prominent a wave Diastolic thrill tapping apex beat RV heave (Normal pulse due to normal systole) Diastolic murmur - s3 ```
36
What is mitral regurgitation and the aetiology
Valves become incompetent and leaky either chronic or acute ``` Rheumatic Heart Disease Mitral valve prolapse - acute Infective endocarditis Degenerative Previous MI causing LV dilation / annulus dilation ```
37
What is the signs and symptoms of MR
Acute - dysnopea / pulmonary oedema Chronic - fatigue Palpitations - Afib RV heave Brisk and hyperdynamic apex beat Signs of right heart failure: - prominent JVP - reduced pulse rate Loud systolic murmor between s1-s2 radiates to mid axillary
38
What is aortic stenosis and what is the aetiology
Narrowing of the aorta to less than 1.5-2cm (from 3-4cm) Degenerative (athlersclerosis) Rheumatic heart disease Bicuspid stenosis
39
What is the signs and symptoms of aortic stenosis
Usualy asymptomatic Chest pain On exertion: Syncope + dizzines Breathlessness Pulse - small volume and slow rising RH failure present: JVP prominent Low BP Vigorous and sustained apex beat RV heave Systolic murmur - radiates to carotid S1 = less audible S2 = Harsh ejection sound
40
What is aortic regurgitation and what is the aetiology
Dysfunctional leaflets aortic leaflet or Dilation of aorta ``` Bicuspid aortic vale Rheumatic heart disease Infective endocarditis Connective tissue disorder: marfans Hypertension ```
41
What is the signs and symptoms of aortic regurgitation
Asymptomatic: Exertional Dyspnoea Pulse - large volume - retracting/ collapsing - wide pulse pressure e.g 170/40mmHg Hyper-dynamic and displaced apex beat (due to overloaded heart) Diastoli murmur heard on expiration
42
What is the investigations for valvular diseases
ECG: Bigger P or R wave? ST elevation? CXR -cardiomegaly, calcification ECHO - AV cusp anatomy - LV function/dilation/hypertrophy - annular disease - shows the backflow of blood - Pressure gradient MRI - valves open or shut - pressure gradient Cardiac catherisation - LV angiography - pressure gradient
43
What is the treatment for valvular diseases
Afib present - anticoagulation Improve ventricle contractility/reduce BP: Diuretics Vasodilators - prolong till surgery Valve replacement or repair Mechanical/prosthetic - need warfarin Biologival/ native - will wear out
44
Define endocarditis
Infection of the inner layer of the hearts - endocardium - Heart valves (native/prosthetic) - Inter-ventricular septum, - Chordae tendinae, - Intra cardiac devices Invasive procedures: prothetics, cardiac surgery brushing teeth
45
What is the risk factors for endocarditis
``` CARDIAC Native/ prosthetic valve disease Congenital heart disease Rheumatic heart disease Cardiac surgery Prior native IE Cardiac hypertrophy ``` ``` NON CARDIAC IVDA immunocompromised eg elderly/AIDS diabetes mellitus trauma (burns) indwelling medial devises health care association ```
46
What is the microbiology of endocarditis
- staph.aureas - strep viridans ``` Pseudomonase aerguginosa HACEK organisms Fungi Enterocci ```
47
What is the signs and symptoms
Weight loss Headache ``` F- fever R - roth spots O - oslers nodes m - murmur J - jane way lesions a - anemia n- Nail haemorrhage e - embolism ```
48
What is the tests for endocarditis
Blood tests FBC C -reactive protein (CPR) erythrocyte sedimentation rate (ESR) ``` Blood cultures (if negative can be due to intracellular bacteria/previous antibiotics/fastidious organisms) ``` urea + electrolytes -asses kidney function ECG - shows conducting delay CXR - Heart failure ECHO 1st line = TTE 2nd line = TOE - High clinical suspicion + TTE normal - See complications + asses/measure vegetation -prosthetic/ intra-cardiac device present Intracellular bacteria Serological PCR Cell culture
49
What is the treatment for endocarditis
prolonged antibiotic therapy + removal of prosthetic material Native - Gentamicin + IV amoxycillin vancomycin (sepsis or allergic) Prosthetic - Gentamicin + IV vancomycin + rifampicin Good oral dental care
50
What is the definition of heart failure
A clinical syndrome compromising of dysnopea, fatigue, or fluid retention due to cardiac dysfunction either at rest or on exertion with accompanying neurohormonal activation RAAS + Sympathetic Caused by LV dysfunction or injury
51
What is the signs and symptoms
Breathlessness Fatigue -reduced exercise capacity ``` tachycardia raised JVP hepatomegaly (microscopically see nutmeg appearance) Oedema - pitting -chest creptiations or effusions Displaced or abnormal apex beat Obstructive sleep orthnopea? ``` Auscultation Third systolic heart sound S3
52
What is the two forms of heart failure
Systolic HF - decreased pumping function of the heart - Reduced CO - activates increased in Central venous pressure due to RAAS - increase in pressure result in further dilation Diastolic HF - thickening and stiff heart muscle - same CO due to greater EDV - smaller ejection fraction
53
What is the investigations for Heart failure
Investigate underlying cause ECHO - LV systolic function/thickness/LV ejection fraction (severe = <30%) - Diastolic function - pericardial effusion - valvular disease - pressure pulmonary/aortic valve MRI CXR MUGA (IV-radionucleide) - pumping ability of ventricles - LVEF Screening tests ECG (normal = no LV systolic disfunction) BNP (elevated in HF)
54
What is the treatment for heart failure
Loop Diuretics Diuretic ACE inhibitors ARB Beta blockers aldosterone antagonists Positive ionotropes - digoxin Warfarin ANP/BNP enhancements
55
Define marfan syndrome
Autosomal dominant Multisystem Connective tissue disease due Mutation of Fibriliin 1 gene on chromosome 15q21 mutation
56
What is the presentation of marfans
``` skeletal tall stature arm width longer than height pectus carinatum dural ectasia scoliosis / kyphosis thumb ankle foot wrist issues reduced ankle extension arachnodactyly (long digits) ``` chest pneumothorax protrusio acetabuli - abnormal hip bone pectus carinatum - pigeon chest abnormal facies eye lens subluxation (aka ectopia lentis)
57
How do you diagnose Marfans
Ghent 2010 criteria 2+ findings of: ``` Cardiovascular - aortic dilation/dissection/ MV prolapse Eyes – ectopia lentis Family history Fibrillin 1 mutation Systemic score ≥ 7 - Skeletal - Respiratory - Myopia - dural ectasia - Mitral valve prolapse - Skin ```
58
What is the investigations for Marfans
Echocardiography - MANDATORY -AORTIC ROOT DIAMETER MRI of lumbar spine - dural ectasia Pelvic xray - protrusio acetabuli Chest x ray - look for blebs Genetic testing - Fibrillin 1 mutation - when only a few features are present FAMILTY TESTING - ECHO + BLOOD SAMPLE FOR FIBRLIN GENE MUTATION
59
What is the treatment for Marfans syndrome
ANTIHYPERTENSIVES B blockers Angiotenin 11 Receptor blockers Prophyllactic aortic root surgery (if sinus valsalva exceeds 5.5cm growth) (warfarin needed if mechanical valve inserted)
60
Down syndrome
atrio-ventricular septal defect | Hypotonic
61
Turners syndrome 45X | -single nucleotide
Co- arctation of the aorta Short stature neck webbing Puffy hands gonadal dysgenesis
62
Noonan syndrome PTPN11 | - single nucleotide
Pulmonary stenosis Short stature Neck webbing Cryptochordism Characteristic face
63
22q11 deletion syndrome | -Microdeletion
``` C - cardiac malformation of Outflow tract A - abnormal facies T - thymic hypoplase C - cleft palate H - hypoparathyrodism 22 ```
64
Williams syndrome | - microdeltion of elastin on chromosome 7
Aortic stenosis Hypercalceimia cocktail party manner characteristic face 5th finger clinodactyly
65
Tetarogens
Fetal alcohol syndrome anti epileptic drugs rubella - affects back and lower limbs maternal diabetes mellitus AtrioVentricular septal defect Characteristic face ADHD hearing loss Motor difficulties
66
What is dilated cardiomyopathy
Can be one but more often all chambers dilated and functionally impaired SYSTOLIC DISFUNCTION ejection problem resulting in heart failure
67
What is the aetiology of dilated cardiomyopathy
Ischaemia Valvular disease Endocrine/thyroid problems Genetics and familial DCM muscular dystrophy Inflammatory/infectious ``` toxic exposure (alcohol, drugs, endocrine) ``` Post child birth tropical disease Injury, cell loss, scar replacement (sarcoid)
68
What is the signs and symptoms of dilated cardiomyopathy
``` dyspnoea fatigue orthopnoea, PND, ankle swelling, weight gain of fluid overload, cough ``` ``` Poor superficial perfusion pulse - irreg if in AF, SOB at rest, narrow pulse pressure, JVP elevated+/- TR waves, displaced apex, S3 and S4, MR murmur often, pulmonary oedema, pleural effusions, ankle oedema/ sacral oedema, acites, (the accumulation of fluid in the peritoneal cavity) hepatomegally (liver enlargement) ```
69
What is the investigations for cariomyopathies
Mandatory: Repeated ECG noting left bundle branch block if present Cardiovascular magnetic resonance imaging MRI ECHO Further: CXR N termial pro Brain Natriuetic Peptide - secreted due to excessive stretching Basic bloods Full; Blood Count, urea and electrolytes Coronary angiogram For restrictive cariomyopathy specifically: Biopsy (amyloid non cardiac) antibodies testing (for sclerotic CT diseases) Test for Fabry (low plasma alpha galactosidase A activity)
70
What is the management for cardiomyopathies
``` Avoid heavy exercise Avoid dehydration Explore FH and first degree relatives, ECGs and echoes may be required Consider genetic testing ``` avoid NSAID
71
What is the management and treatment for dilated cardiomyopathy
Correct any endocrine disturbance advice on fluid and salt intake advise on managing wight to identify fluid overload Correct anemia Lower BP: ACEI Angiotensin II blockers, diuretics Lower HR: Beta blockers Spironolactone - steroid drug promotes sodium excretion Anticoagulants as required Cardiac transplant
72
What is restrictive cardiomyopathy and what is its aeitiology
Ventricle walls are rigid, and the heart is restricted from stretching and filling with blood properly. there is a reduced compliance DIATOLIC DISFUNCITON ACTIVE PROCESS due to relaxation of ventricle wall Clinical disorders; Scleroderma - hardening and contraction of skin Diabetic Sarcoid/amyloid ``` Endomyocardial; Fibrosis Radiation Drug effects Carcinoid - tumour in glands ``` Diseases; Haemochromatosis Fabry
73
What is hypertrophic cardiomyopathy and what is its aetiology
a disease in which a portion of the myocardium (heart muscle) is hypertrophic (enlarged) without any obvious cause = Impaired relaxation Inherited Autosomal dominant sarcomere gene defect - Changes the genes in the heart muscle protein Thyroid problems Diabetes
74
What is the symptoms and signs of hypertrophic cardiomyopathy
``` Asymptomatic for many, fatigue, dyspnoea, anginal like chest pain, exertional pre syncope, syncope related to arrhythmias or LV ``` Notched pulse pattern Irreg pulse if in AF or ectopy Double impulse over apex, thrills and murmurs, often dynamic LVOT murmur will increase with valsalve and decrease with squatting JVP can be raised in very restrictive filling
75
What is the treatment for hypertrophic cardiomyopathy
enhance relaxation:, beta blockers, CBB -verapamil, Anti arrhythmic - disopyrimide AF - anticoagulate Obstructive - surgical / alcohol septal ablation High risk - implantable cardioverter defibrillator
76
Define myocarditis and whats it aetiology
Acute or chronic inflammation of the myocardium reducing function and resulting in heart failure ``` Virus bacterial HIV lymes disease drugs Toxic exposure ```
77
What is the signs and symptoms of myocarditis
``` Heart failure fatigue SOB Potential fever arrhythmias ```
78
What is the investigations for myocarditis
``` ECHO MRI Viral DNA PCR Biopsy Test for autoantibodies, strep antibodies, HIV, lymes disease Troponin testing ```
79
Define Pericarditis and its aetiology
Inflammation of the pericardial layers with or without myocardial involvement that can result in pericardial effusion causing cardiac tamponade ``` diopathic viral bacterial, post MI, perforation, dissection of proximal aorta, neoplasia ```
80
What is the sign and symptoms of pericarditis
chest pain with pleuritic features lying back makes it worse - Orthnopea Fever If effusion present: fatigue, SOB, chest pain, low BP/dizzyHigh fever (with no effusion = bacterial) pericardial rub LSE, Raised JVP - Effusion present low BP, muffled Heart Sounds
81
Signs and treatment to Long QT syndrome
Syncope seizure sudden death arrhythmias precipitated by emotion, exercise and drugs Beta blockers Nicrorandil NA channel openers- Lidocaine