Cardiovascular Flashcards
AORTIC STENOSIS causes symptoms ECG features CXR features investigations management
causes - rheumatic, calcified valve
symptoms - SOB, pre/syncope, angina
ECG - LVH/LV strain pattern
CXR - none (LV dilates inwards - PO)
investigations - transthoracic doppler echo + ECG
management - valve replacement if symptomatic or gradient > 40, manage HTN
CCF examination findings differentials investigations management
findings - clubbing, c + p cyanosis, SOB, oedema, AF, crackles, hepatomegaly, cardiomegaly, displaced apex, HS3, pacemaker
investigations - BNP, ECG, echo, renal + liver function, CXR
management - lifestyle, ACEi, b-blocker, spironolactone, furosemide, CRT
ACUTE HF causes examination findings differentials investigations management
causes - decompensation, ACS, arrhythmia, volume overload, infection
findings - SOB, oedema, end-insp crackles, raised JVP
differentials - PE, pneumonia
investigations - obs, BNP, troponin, renal + liver function, ECG, CXR, transthoracic echo
management - treat cause, hi flow oxygen if sats <90, IV furosemide, IV GTN (if BP > 90)
MI causes examination findings differentials investigations management
examination findings - HS3
differentials - GORD, ulcer, costochondritis, aortic dissection, PE, panic attack, pericarditis/myocarditis
investigations - obs, glucose, renal + liver function, TFTs, troponins, ECG, CXR, coronary angiogram, later - echo
management - morphine, oxygen if <94, nitrates, aspirin 300, clopidogrel, beta blocker if NSTEMI or STEMI + haem stable, PCI
AORTIC REGURGITATION causes CXR findings ECG features differentials investigations management
causes - rheumatic, IE, HTN, marfan’s, RA, ank spond
symptoms - SOB, fatigue, palpitations, oft asymptomatic
ECG features - nil
CXR features - cardiomegaly, HF signs
differentials
investigations
management - diuretics, vasodilators, replacement if severe
MITRAL STENOSIS
causes
investigations
management
causes - rheumatic HD
investigations - echo, CXR, ECG
management - anticoagulation, rate control any AF, diuretics, balloon valvuloplasty if indicated
INFECTIVE ENDOCARDITIS causes examination findings investigations management
causes - IVDU, rheumatic, dentist
examination findings - osler + janeway, dentition, splinter haemorrhages, clubbing, splenomegaly, roth spots, microscopic haematuria
investigations - 3 blood cultures from 3 peripheral sites, FBC (anaemia), urinalysis, CXR, echo (vegetations)
management - oral hygiene, benzylpenicillin + gentamicin, valve repair/replacement
MITRAL REGURGITATION
causes
investigations
management
causes - rheumatic, IE, post-MI papillary muscle rupture, marfan’s, SLE, valve prolapse, LV dilatation
investigations - echo, CXR, ECG
management - anticoagulation, manage any AF, diuretics, ACEi (as HTN worsens MR + to reduce afterload), valve repair if severe
what are the causes of AF?
IHD hyperthyroidism pneumonia PE alcohol rheumatic
MITRAL STENOSIS timing position of stethoscope position of patient quality radiation other features systemic features CXR features ECG features
timing - mid-diastolic
position of stethoscope - apex with bell
position of patient - LHS + expiration
quality - rumbling (low pitched)
radiation - nil
other features - opening snap, tapping apex, loud HS1
systemic features - AF, RHF signs, malar flush, (crackles?), SOB, fatigue
CXR features - enlarged LA, pulmonary venous congestion
ECG features - AF common, P mitrale (bifid P waves)
how can you describe a murmur?
timing intensity position of stethoscope position of patient quality radiation systemic features
how can you describe a murmur?
timing intensity position of stethoscope position of patient quality radiation systemic features
MITRAL REGURGITATION timing position of stethoscope position of patient quality radiation
MITRAL REGURGITATION timing - pansystolic - obliterated HS2 - "BURR" position of stethoscope - apex position of patient - normal quality - blowing radiation - axilla
AORTIC STENOSIS timing position of stethoscope position of patient quality radiation
timing - ejection systolic position of stethoscope - aortic position of patient - normal quality - crescendo-decrescendo radiation - carotids
AORTIC REGURGITATION timing position of stethoscope position of patient quality radiation
timing - early diastolic stethoscope - LLSE patient - leaning forward in expiration quality - high pitched radiation - none
what are the indications for a bioprosthetic valve over metallic valve?
elderly - ie if valve will outlast pt
CI to warfarin - childbearing age (F)
patient choice
differentials for crackles
HF pneumonia/LRTI renal failure fibrosis COPD
differentials for raised JVP
RHF - PE (as infarction in pulmonary artery), right sided MI
fluid overload - eg renal failure
cor pulmonale
liver failure - congestive backup + hypoalbuminaemia
JVP goes up cos heart not pumping properly
IE - big 5 signs
2 in hands - clubbing + splinters
1 in heart - changing murmurs
2 in abdo - splenomegaly + microscopic haematuria (assoc GN)
rarities - osler, roth, janeway
commonest causes of splinter haemorrhages
gardening/microtrauma
IE
vasculitis
causes of AF
IHD
RHD
thyrotoxicosis
alcoholic HD
HTN
main 2 reasons for an irreg irreg pulse + how can you differentiate?
AF
multiple ventricular ectopics - diminish w exercise/increased HR
what causes ventricular ectopics?
scar tissue
what happens to the ventricle in AS? how is this on examination?
pressure overload - ventricle enlarges inwards, causing a powerful apex/beat which is not displaced
