CARDIOVASCULAR Flashcards

Question

Symptoms and signs of varicose veins

Answer 1

``` 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

Answer 2

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

Answer 3

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 ```

Answer 4

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

Answer 5

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

Answer 6

Venous thromboembolism in the legs Venous thrombus due to disruption of virchos triad - more due to stasis + hypercoagubility

Answer 7

Increasing age - Tissue trauma - Immobility - Obesity - Smoking - Some systemic diseases e.g. cancer - Inheritance Heritable thrombophilia – an inherited predisposition to venous thrombosis - Pregnancy

Answer 8

``` Unilateral limb swelling Persisting discomfort Calf tenderness Warmth Redness- erythema Pigmentation pittin oedema May be clinically silent - asymptomatic ``` If not treated Ulceration

Answer 9

Use Wells score in clinical assessment for pre test probability Blood test: D dimer Ultrasound Anticoagulation: Warfarin Heparin Thrombolysis

Answer 10

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) ```

Answer 11

``` 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 ```

Answer 12

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 ```

Answer 13

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

Answer 14

Narrowing of the aorta to less than 1.5-2cm (from 3-4cm) Degenerative (athlersclerosis) Rheumatic heart disease Bicuspid stenosis

Answer 15

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

Answer 16

Dysfunctional leaflets aortic leaflet or Dilation of aorta ``` Bicuspid aortic vale Rheumatic heart disease Infective endocarditis Connective tissue disorder: marfans Hypertension ```

Answer 17

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

Answer 18

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

Answer 19

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

Answer 20

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

Answer 21

``` 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 ```

Answer 22

- staph.aureas - strep viridans ``` Pseudomonase aerguginosa HACEK organisms Fungi Enterocci ```

Answer 23

Weight loss Headache ``` F- fever R - roth spots O - oslers nodes m - murmur J - jane way lesions a - anemia n- Nail haemorrhage e - embolism ```

Answer 24

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

Answer 25

prolonged antibiotic therapy + removal of prosthetic material Native - Gentamicin + IV amoxycillin vancomycin (sepsis or allergic) Prosthetic - Gentamicin + IV vancomycin + rifampicin Good oral dental care

Answer 26

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

Answer 27

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

Answer 28

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

Answer 29

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)

Answer 30

Loop Diuretics Diuretic ACE inhibitors ARB Beta blockers aldosterone antagonists Positive ionotropes - digoxin Warfarin ANP/BNP enhancements

Answer 31

Autosomal dominant Multisystem Connective tissue disease due Mutation of Fibriliin 1 gene on chromosome 15q21 mutation

Answer 32

``` 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)

Answer 33

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 ```

Answer 34

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

Answer 35

ANTIHYPERTENSIVES B blockers Angiotenin 11 Receptor blockers Prophyllactic aortic root surgery (if sinus valsalva exceeds 5.5cm growth) (warfarin needed if mechanical valve inserted)

Answer 36

atrio-ventricular septal defect | Hypotonic

Answer 37

Co- arctation of the aorta Short stature neck webbing Puffy hands gonadal dysgenesis

Answer 38

Pulmonary stenosis Short stature Neck webbing Cryptochordism Characteristic face

Answer 39

``` C - cardiac malformation of Outflow tract A - abnormal facies T - thymic hypoplase C - cleft palate H - hypoparathyrodism 22 ```

Answer 40

Aortic stenosis Hypercalceimia cocktail party manner characteristic face 5th finger clinodactyly

Answer 41

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

Answer 42

Can be one but more often all chambers dilated and functionally impaired SYSTOLIC DISFUNCTION ejection problem resulting in heart failure

Answer 43

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)

Answer 44

``` 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) ```

Answer 45

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)

Answer 46

``` Avoid heavy exercise Avoid dehydration Explore FH and first degree relatives, ECGs and echoes may be required Consider genetic testing ``` avoid NSAID

Answer 47

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

Answer 48

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

Answer 49

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

Answer 50

``` 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

Answer 51

enhance relaxation:, beta blockers, CBB -verapamil, Anti arrhythmic - disopyrimide AF - anticoagulate Obstructive - surgical / alcohol septal ablation High risk - implantable cardioverter defibrillator

Answer 52

Acute or chronic inflammation of the myocardium reducing function and resulting in heart failure ``` Virus bacterial HIV lymes disease drugs Toxic exposure ```

Answer 53

``` Heart failure fatigue SOB Potential fever arrhythmias ```

Answer 54

``` ECHO MRI Viral DNA PCR Biopsy Test for autoantibodies, strep antibodies, HIV, lymes disease Troponin testing ```

Answer 55

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 ```

Answer 56

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

Answer 57

Syncope seizure sudden death arrhythmias precipitated by emotion, exercise and drugs Beta blockers Nicrorandil NA channel openers- Lidocaine

CARDIOVASCULAR Flashcards

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