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Year 3 Buzzwords > Cardiovascular > Flashcards

Cardiovascular Flashcards

(56 cards)

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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

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A

Irregular broad complex tachycardia

Pulseless

24
Q

Management of VF

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A

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

25
Management of acute/unstable AF
``` 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
Management of chronic/stable AF
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
Management of paroxysmal AF
Pill-in-pocket 1) sotalol or flecainide PRN 2) anticoagulation with warfarin or NOACs
28
Wolff-Parkinson White syndrome
Delta wave on ECG Predisposition to SVT Accessory pathway (radiofrequency ablation)
29
First degree heart block
Physiological | Prolonged PR interval > 0.2s
30
Second degree heart block
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
Third degree/complete heart block
``` Broad QRS Bradycardia Disassociation between P and QRS waves Cannon A waves in JVP Management: ICD ```
32
Aortic dissection
``` 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
Pericarditis
Pericardial friction rub 'snow crunching sound' Pain better on leaning forwards Sudden onset pleuritic chest pain Male, post-MI (Dressler's syndrome)
34
Myocardial infarction
Central, crushing chest pain Radiates to jaw/left arm MONABASH
35
Management of acute heart failure
1) sit up 2) IV furosemide 3) high flow oxygen 4) nitrates if in pain (morphine if refractory)
36
Pulmonary embolism
Sharp, pleuritic chest pain Haemoptysis RF: OCP, long haul travel, recent immobility Well's criteria
37
Well's criteria (7) for PE
``` 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
Aortic coarctation
Interscapular murmur Decreased femoral pulses Turner's syndrome
39
Stable angina
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
Unstable angina
Episodic but progressing from stable angina | Chest pain at rest lasting longer
41
Prinzmetal/Variant angina
Cyclic ST elevation at rest Female, 50yrs old Vasospasmic (give CCB)
42
Syndrome X
ECG: ST depression Normal angiogram Hypertension, diabetes mellitus, obesity, hypercholesteraemia Give nifedipine
43
Decubitus angina
Angina when lying down (at night before sleeping etc)
44
Dressler's syndrome
Pleuritic chest pain Low-grade fever Pericarditis 2-10/52 post-MI
45
Cor pulmonale
Right heart failure Pulmonary hypertension Large A waves in JVP
46
Ventricular septal defect
Pulmonary hypertension + heart failure = shunt reversal Harsh pansystolic murmur at left sternal edge Left parasternal heave Increased endocarditis risk
47
Atrial septal defect
Wide fixed split second heart sound | Ejection systolic murmur in 2nd/3rd ICS
48
ECG changes in STEMI - anterior - lateral - inferior - posterior
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
JVP waveform changes - SVC obstruction - cardiac tamponade/constrictive pericarditis - tricuspid regurgitation - atrial fibrillation - heart block/AV dissociation/ventricular arrhythmia
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
ECG changes - left atrial hypertrophy - right atrial hypertrophy - pericarditis - PE - hyperkalaemia - hypokalaemia - hypocalcaemia
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
Management of pericarditis
Acute: analgesia and NSAIDs +/- antibiotics, antifungal Chronic: colchicine or NSAIDS Surgical: pericardiectomy (constrictive pericarditis)
52
Supraventricular tachycardia
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
Management for SVT
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
High output heart failure
``` NAP MEALS Nutritional (Beri-Beri) Anaemia Pregnancy Malignancy Endocrine AV malformations Liver cirrhosis Sepsis ```
55
Low output heart failure
``` Left: - valve dysfunction - cardiac (myositis, pericarditis) - drugs (alcohol/cocaine) - systemic (hypertension) Right: - valve dysfunction (tricuspid regurgitation) - pulmonary - cardiac ```
56
Myocarditis
Troponin-TIT

Year 3 Buzzwords (6 decks)

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