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Year 3 Buzzwords > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Aortic regurgitation

A

Early diastolic crescendo/decrescendo
Left sternal edge on expiration sitting forwards
Caused by valvular damage (infective endocarditis, senile calcification) or aortic problems (dissection, aortitis, connective tissue disorders)
Associated signs e.g. de Musset (head bobbing), Corrigan’s (pulsating carotids), Traube (pistol shot femorals), waterhammer pulse (collapsing pulse), wide pulse pressure
+/- Austin Flint murmur

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2
Q

Austin Flint murmur

A

Mid diastolic murmur
Apex/mitral area
Associated with severe aortic regurgitation
Displacement of blood striking anterior mitral valve leaflet

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3
Q

Aortic stenosis

A

Ejection systolic murmur
Left sternal edge, radiates to the carotids
Soft S2 sound
Narrow pulse pressure, slow rising pulse
Most common cause is rheumatic heart disease
Bicuspid valve +ve ejection systolic click

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4
Q

Mitral regurgitation

A 
Pansystolic murmur
Loudest at the apex beat radiating to the axilla 
Soft S1 +/- S3
Post-MI
Pulmonary oedema (L sided heart failure)
Barlow syndrome
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5
Q

Barlow syndrome

A

Mitral valve prolapse
Mid-systolic click followed by late systolic murmur
Standing: click moves towards S1
Squatting: click moves away from S1
(similar to hypertrophic cardiomyopathy)
RF: connective tissue disorders, bicuspid valve

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6
Q

Mitral stenosis

A

Rumbling mid-diastolic murmur
Mitral area laying on the left on expiration
Loud S1 with opening snap
Signs: malar flush, AF,, undisplaced tapping apex beat, peripheral cyanosis
Most common cause is rheumatic heart disease
Graham Steell murmur

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7
Q

Graham Steell murmur

A

Early diastolic murmur
Left sternal edge on inspiration
Pulmonary regurgitation secondary to pulmonary hypertension/mitral stenosis

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8
Q

Tricuspid regurgitation

A

Pansystolic murmur
Lower left sternal edge on inspiration (Carvallo sign)
Loud P2 of S2 heart sound (splitting)
Giant V waves in JVP
Signs: headaches, epigastric pain worse with exercise

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9
Q

Pericardial effusion

A

Muffled heart sounds
Beck’s Triad
Lupus/malignancy

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10
Q

Beck’s Triad

A

Muffled heart sounds
Raised JVP
Low BP

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11
Q

HCM

A 
Double apex beat
Jerky carotid pulse
Family hx sudden death
Harsh ejection systolic murmur
Louder with valsalva manouvres
Treated with ß-blockers
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12
Q

Patent Ductus Arteriosus

A

Machine-like murmur
Bounding pulse, wide pulse pressure
Left subclavian thrill

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13
Q

Heart failure

A

Left: dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, Cheyne-Stokes respiration, fine inspiratory crackles (pulmonary oedema)
Right: peripheral oedema, hepatomegaly, raised JVP
↑BNP, ECG changes
G: transoesophageal echo
CXR: Alveolar oedema, kerley B lines, Cardiomegaly, Dilated upper lobe diversion, pleural Effusions

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14
Q

ECG changes in left ventricular hypertrophy

A

Deep S V1/2
Tall R V5/6
Inverted T lead I/aVL/V5-6
Left axis deviation

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15
Q

Infective endocarditis

A

IVDU
Tricuspid murmur/right sided heart failure
Petechiae, microvascular haematuria
FROM JANE C: fever, Roth’s spots, Osler’s nodes (painful), murmur, Janeway lesions (palm), anaemia, nail (splinter haemorrhages), emboli, clubbing
Modified Duke Criteria

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16
Q

Modified Duke Criteria

A

Infective endocarditis (2M/1M3m/5m)
Major:
1) typical cultures x2 separate occasions or continuously positive cultures
2) positive echo or new heart murmur
Minor:
1) Fever >38
2) Predisposing heart condition or IV drug user
3) Vascular phenomenon: emboli, infarcts, signs in hands etc
4) positive cultures not meeting major criteria
5) positive echo not meeting major criteria

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17
Q

Management for infective endocarditis

  • empirical
  • native valve
  • prosthetic valve
  • staph
  • entero
  • culture negative
  • surgical management
A

Empirical (streptococcus): benzylpenicillin + gentamicin
Native valve: benzylpenicillin (beta-lactams) + gentamicin
Prosthetic valve/resistant: vancomycin + gentamicin + rifampicin
Staph: flucloxacillin/vancomycin + gentamicin
Entero: amoxicillin + gentamicin
Culture -ve: vancomycin + gentamicin
Surgical: replace valve

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18
Q

Atrial fibrillation

A

Irregularly irregular pulse
Absent P waves in ECG
Absent A waves in JVP
Old, palpitations, SOB, fatigue, syncope

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19
Q

Atrial flutter

A

Narrow complex tachycardia
150 bpm ventricular rate with 2:1 block (atrial rate = 250-350 bpm)
Saw-toothed appearance on ECG

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20
Q

Ventricular tachycardia

A 
Broad complex (tall waves)
Previous MI
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21
Q

Management of VT

A

Pulseless: non-synchronised DC cardioversion + ALS protocol
Pulse: 1) synchronised cardioversion 2) treat cause/electrolyte imbalances 3) anti-arrhythmics: amiodarone

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22
Q

Torsades de Pointes

A

Polymorphic VT

Management: 1) IV magnesium sulphate 2) treat cause/electrolyte imbalances 3) isoprenaline infusion

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23
Q

Ventricular fibrillation

A

Irregular broad complex tachycardia

Pulseless

24
Q

Management of VF

A

Pulseless: defibrillation
Implantable cardioverter defibrillator (ICD)
Empirical beta-blockers

25
Q

Management of acute/unstable AF

A 
Rhythm:
1) high flow oxygen
2) correct electrolytes
3) DC cardioversion
4) Chemical cardioversion: IV amiodarone or flecainide
*Flecainide contraindicated in ischaemic heart disease
Rate: 
1) verapamil (CCB) or ß-blocker
2) digoxin or amiodarone
26
Q

Management of chronic/stable AF

A

Rate:
1) bisoprolol (ß-blocker) or verapamil (CCB) *combination is contraindicated (2nd line digoxin or amiodarone)
2) anti-coagulate 3/52 with warfarin or NOACs (dabigatran, apixaban, rivaroxaban)
Rhythm:
1) elective chemical cardioversion with flecainide or amiodarone +/- 4/52 sotalol or amiodarone

27
Q

Management of paroxysmal AF

A

Pill-in-pocket

1) sotalol or flecainide PRN
2) anticoagulation with warfarin or NOACs

28
Q

Wolff-Parkinson White syndrome

A

Delta wave on ECG
Predisposition to SVT
Accessory pathway (radiofrequency ablation)

29
Q

First degree heart block

A

Physiological

Prolonged PR interval > 0.2s

30
Q

Second degree heart block

A

Mobitz type I:
Gradually prolonging PR interval and dropped QRS
Mobitz type II: Regular prolonged PR interval with dropped QRS
(may have regular P:QRS ratio e.g. 2:1/3:1)
*requires consideration of ICD

31
Q

Third degree/complete heart block

A 
Broad QRS
Bradycardia
Disassociation between P and QRS waves
Cannon A waves in JVP
Management: ICD
32
Q

Aortic dissection

A 
Collapsed whilst exercising
Radio-radial/femoral delay
Tearing pain radiating to the back
Hx of connective tissue disorder
Type A: ascending aorta
Type B: descending aorta (after subclavian vein)
33
Q

Pericarditis

A

Pericardial friction rub ‘snow crunching sound’
Pain better on leaning forwards
Sudden onset pleuritic chest pain
Male, post-MI (Dressler’s syndrome)

34
Q

Myocardial infarction

A

Central, crushing chest pain
Radiates to jaw/left arm
MONABASH

35
Q

Management of acute heart failure

A

1) sit up
2) IV furosemide
3) high flow oxygen
4) nitrates if in pain (morphine if refractory)

36
Q

Pulmonary embolism

A

Sharp, pleuritic chest pain
Haemoptysis
RF: OCP, long haul travel, recent immobility
Well’s criteria

37
Q

Well’s criteria (7) for PE

A 
Clinical signs and symptoms of PE (3)
PE is most likely diagnosis (3)
HR > 100 bpm (1.5)
\+3/7 immobilisation or surgery within 4/52 (1.5)
Previously PE or DVT (1.5)
Malignancy with treatment in past 6/12 or palliative (1)
Haemoptysis (1)
>4: CTPA (pregnant: V/Q)
<4: D-Dimer (+ve then CTPA)
38
Q

Aortic coarctation

A

Interscapular murmur
Decreased femoral pulses
Turner’s syndrome

39
Q

Stable angina

A

Exertional chest pain, radiating to jaw
CVD RF: smoking, hyperlipidaemia, obesity
Relieved by rest
Resting ECG: normal
Exercise ECG: ST depression and T wave inversion

40
Q

Unstable angina

A

Episodic but progressing from stable angina

Chest pain at rest lasting longer

41
Q

Prinzmetal/Variant angina

A

Cyclic ST elevation at rest
Female, 50yrs old
Vasospasmic (give CCB)

42
Q

Syndrome X

A

ECG: ST depression
Normal angiogram
Hypertension, diabetes mellitus, obesity, hypercholesteraemia
Give nifedipine

43
Q

Decubitus angina

A

Angina when lying down (at night before sleeping etc)

44
Q

Dressler’s syndrome

A

Pleuritic chest pain
Low-grade fever
Pericarditis
2-10/52 post-MI

45
Q

Cor pulmonale

A

Right heart failure
Pulmonary hypertension
Large A waves in JVP

46
Q

Ventricular septal defect

A

Pulmonary hypertension + heart failure = shunt reversal
Harsh pansystolic murmur at left sternal edge
Left parasternal heave
Increased endocarditis risk

47
Q

Atrial septal defect

A

Wide fixed split second heart sound

Ejection systolic murmur in 2nd/3rd ICS

48
Q

ECG changes in STEMI

  • anterior
  • lateral
  • inferior
  • posterior
A

Anterior: V1-V4 (left anterior descending)
Lateral: lead I, aVL, V5-V6 (circumflex artery)
Inferior: lead II, III and aVF (right coronary artery)
Posterior: ST depression V1-V3, tall broad R waves, R dominance V2

49
Q

JVP waveform changes

  • SVC obstruction
  • cardiac tamponade/constrictive pericarditis
  • tricuspid regurgitation
  • atrial fibrillation
  • heart block/AV dissociation/ventricular arrhythmia
A

SVC obstruction: raised and fixed JVP
Cardiac tamponade/constrictive pericarditis: increased JVP on inspiration/Kussmaul’s sign (pulsus paradoxus)
Tricuspid regurgitation: large V waves
Atrial fibrillation: absent A waves
Heart block/AV dissociation/ventricular arrhythmia: cannon A waves

50
Q

ECG changes

  • left atrial hypertrophy
  • right atrial hypertrophy
  • pericarditis
  • PE
  • hyperkalaemia
  • hypokalaemia
  • hypocalcaemia
A

LAH: p mitrale (bifid p wave)
RAH: cor pulmonale (large a wave)
Pericarditis: widespread saddle-shaped ST elevation
PE: RBBB, right heart strain, S1Q3T3, sinus tachycardia
Hyperkalaemia: tall tented T waves, wide QRS, flat p waves
Hypokalaemia: inverted T waves, U waves, prolonged PR interval, tall p waves, ST depression
Hypocalcaemia: long QT interval

51
Q

Management of pericarditis

A

Acute: analgesia and NSAIDs +/- antibiotics, antifungal
Chronic: colchicine or NSAIDS
Surgical: pericardiectomy (constrictive pericarditis)

52
Q

Supraventricular tachycardia

A

AVNRT: SAN re-entry circuit
Narrow complex tachycardia (no delta wave) + absent p
AVRT: accessory pathway in ventricules
Short PR pathway, delta wave after termination, narrow complex QRS
Paroxysmal heart palpitations
Secondary cardiomyopathy: S3 gallop, RV heave, displaced apex

53
Q

Management for SVT

A

Unstable: DC cardioversion
Stable:
1) vasovagal manoeuvres
2) adenosine 6mg then 12mg x2 every 2 mins *contraindicated in asthmatic patients (give verapamil 2.5mg/5mg)
3) step up (IV amiodarone, verapamil, DC cardioversion)

54
Q

High output heart failure

A 
NAP MEALS
Nutritional (Beri-Beri)
Anaemia
Pregnancy
Malignancy
Endocrine
AV malformations
Liver cirrhosis
Sepsis
55
Q

Low output heart failure

A 
Left:
- valve dysfunction
- cardiac (myositis, pericarditis)
- drugs (alcohol/cocaine)
- systemic (hypertension)
Right:
- valve dysfunction (tricuspid regurgitation)
- pulmonary
- cardiac
56
Q

Myocarditis

A

Troponin-TIT

Year 3 Buzzwords (6 decks)

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