Cardiovascular Flashcards
(492 cards)
1
Q
What might the ECG of someone with unstable angina show?
A
May be normal or might show T wave inversion and ST depression
2
Q
What might ECG of someone with NSTEMI show?
A
May be normal or show T wave inversion and ST depression. May also be R wave regression, ST elevation and biphasic T wave in lead V3
3
Q
What might ECG of someone with STEMI show?
A
ST elevation in anterolateral leads. After a few hours, T waves invert and deep, broad pathological Q waves develop
4
Q
ECG: What is J point?
A
Where QRS complex becomes ST segment
5
Q
ECG: What is normal axis of QRS complex?
A
-30 –> +90
6
Q
ECG: What does P wave represent?
A
Atrial depolarisation
7
Q
ECG: How long should PR interval be?
A
120-200ms
8
Q
ECG: What might a long PR interval indicate?
A
Heart block
9
Q
ECG: How long should QT interval be?
A
0.35-0.45s
10
Q
ECG: What does QRS complex represent?
A
Ventricular depolarisation
11
Q
ECG: What does T wave represent?
A
Ventricular repolarisation
12
Q
ECG: Where would you place lead 1?
A
From right arm to left arm with positive electrode being at left arm. At 0
13
Q
ECG: Where would you place lead 2?
A
From right arm to left leg with positive electrode being at left leg. At 60
14
Q
ECG: Where would you place lead 3?
A
From left arm to left leg with positive electrode being at left leg. At 120
15
Q
ECG: Where would you place lead avF?
A
From halfway between left arm and right arm to left leg with positive electrode being at left leg. At 90
16
Q
ECG: Where would you place lead avL?
A
From halfway between right arm and left leg to left arm with positive electrode being at left arm. At -30
17
Q
ECG: Where would you place lead avR?
A
From halfway between left arm and left leg to right arm with positive electrode being at right arm. At -150
18
Q
What is dominant pacemaker of the heart?
A
SA node. 60-100bpm
19
Q
How many seconds do following represent on ECG paper?
a) small squares
b) large squares
A
a) 0.04s
b) 0.2s
20
Q
How long should QRS complex be?
A
Less than 110ms
21
Q
In which leads would you expect QRS complex to be upright in?
A
Leads 1 and 2
22
Q
In which lead are all waves negative?
A
avR
23
Q
In which leads must R wave grow?
A
From chest leads V1 to V4
24
Q
In which leads must S wave grow?
A
From chest leads V1 to V3. It must also disappear in V6
25
In which leads should T waves and P waves be upright?
Leads 1, 2, V2 --> V6
26
What might tall pointed P waves on an ECG suggest?
Right atrial enlargement
27
What might notched, 'm shaped; P waves on an ECG suggest?
Left atrial enlargement
28
Give 3 signs of abnormal T waves
1. Symmetrical
2. Tall and peaked
3. Biphasic or inverted
29
What happens to QT interval when HR increases?
QT interval decreases
30
What part of ECG does plateau phase of cardiac action potential coincide with?
QT interval
31
Name 3 conditions caused by atherosclerosis
1. Heart attack
2. Stroke
3. Gangrene
32
What is the main problem caused by atherosclerosis?
Plaque ruptures leading to thrombus formation
33
Give 5 risk factors for atherosclerosis
1. Age
2. Smoking
3. High cholesterol
4. Obesity
5. Diabetes
34
Where are atherosclerotic plaques found?
Peripheral and coronary arteries
35
What factor affects the distribution of atherosclerotic plaques?
Changes in flow/turbulence e.g. bifurcations
36
What is a neointima?
A new or thickened layer of arterial intima formed by migration and proliferation of cells from the media
37
What does an atherosclerotic plaque consist of?
1. Lipid
2. Necrotic core
3. Connective tissue
4. Fibrous cap
38
What can an atherosclerotic plaque result in?
1. Occlusion of lumen (angina)
| 2. Rupture
39
What is the response to injury hypothesis?
1. Injury to endothelial cells leads to endothelial dysfunction
2. Signals sent to leukocytes which accumulate in vessel wall
40
What causes inflammation in the arterial wall?
1. LDLs
| 2. Leukocytes
41
What are chemoattractants?
Chemicals that attract leukocytes
42
What are the stages of leukocyte recruitment to vessel walls?
1. Capture
2. Rolling
3. Slow rolling
4. Firm adhesion
5. Transmigration
43
What are the stages of atherosclerosis?
1. Fatty streaks
2. Intermediate lesions
3. Fibrous plaques
4. Plaque rupture
44
What do fatty steaks consist of?
Aggregations of foam cells and T lymphocytes in the intimal layer of vessel wall
45
What is the intermediate layer composed of?
1. Foam cells
2. Vascular smooth muscle cells
3. T lymphocytes
4. Platelets
5. Extracellular lipids
46
What is the fibrous cap?
Layer of collagen and elastin that covers the lipid core and necrotic debris in fibrous plaques
47
What are fibrous plaques composed of?
1. SMC
2. Macrophages
3. Foam cells
4. T lymphocytes
48
What must happen to the fibrous cap to maintain it?
Resorption and redeposition
49
What is used to treat coronary artery disease?
Percutaneous coronary intervention (PCI)
50
What is a major limitation of PCI?
Restenosis
51
What drugs can be used to reduce restenosis?
1. Taxol
| 2. Sirolimus
52
What is cardiac failure?
Failure to transport blood out of heart
53
What happens in severe cardiac failure?
Cardiogenic shock
54
What is a ventricular septal defect?
Hole in septum between 2 ventricles
55
What causes ischaemia?
Sudden reduction to lumen size
56
What is Dressier syndrome?
Inflammatory reaction of pericardium following MI
57
What happens when the stretch capacity of sarcomeres is exceeded?
Cardiac contraction forces decreases
58
What happens in left sided cardiac failure?
Pulmonary congestion and overload of the right side
59
What happens in right sided cardiac heart failure?
Venous hypertension and congestion
60
What happens in diastolic cardiac failure?
Stiff heart
61
What causes congenital heart disease?
Misplaced structures or arrest of the progression of normal structure development
62
Give 3 conditions associated with congenital heart disease
1. Downs syndrome
2. Rubella
3. Thalidomide
63
Give 3 congenital heart disease conditions where there are right shunt problems
1. Ventricular septal defect
2. Patent ductus arteriosus
3. Hypoplastic left heart syndrome
64
Give 2 congenital heart disease conditions where there are left shunt problems
1. Tetralogy of Fallot
| 2. Tricuspid atresia
65
What is left side shunting associated with?
Right side cardiac failure and right side cardiac hypertrophy
66
What is ostium secundum?
Central defect in central septum
67
What are the 4 main features of tetralogy of Fallot?
1. Pulmonary stenosis
2. Ventricular septal defect
3. Over-riding ventricular septal defect
4. Right ventricle hypertrophy
68
What is the result of correction of the aorta?
A narrowing of the aorta just after the arch, with excessive blood flow being diverted through the carotid and subclavian vessels into systemic vascular shunts to supply the rest of the body
69
What is a common complication of congenital aortic stenosis and coarctation?
Secondary endocardial fibroelastosis
70
What is dextrocardia?
Rightward orientation of the heart
71
What are 5 risk factors for ischaemic heart disease?
1. Hypertension
2. Smoking
3. DM
4. Male
5. Sedentary lifestyle
72
Give 4 conditions that limit coronary flow
1. Atherosclerosis
2. Anaemia
3. Dissecting aneurysm of aorta
4. Fever
73
What can be the result of reperfusion of completely infarcted tissue?
Haemorrhage
74
What are the patterns of infarction?
1. Subendocardial/patchy
| 2. Transmural
75
Give 3 complications of ischaemia damage
1. Arrhythmia
2. Left ventricular
failure
3. Rupture of myocardium
76
What is an aneurysm?
A dilation of part of the myocardial wall, usually associated with fibrosis and atrophy of myocytes
77
What is pericarditis?
A delayed pericarditic reaction following infarction
78
What is cor pulmonale?
Right ventricular hypertrophy and dilatation due to pulmonary hypertension
79
What causes acute rheumatic fever?
Group A β-haemolytic streptococcus infection
80
What are 5 clinical features of rheumatic fever?
1. Carditis
2. Polyarthritis
3. Chorea
4. Erythema marginatum
5. Subcutaneous nodules
81
Give 3 diagnostic criteria for rheumatic fever
1. Hx of rheumatic fever
2. Arthralgia
3. Raised CRP, ESR, WCC
82
What is the commonest cause for infective endocarditis?
Congenital heart disease
83
What organisms are commonly associated with infective endocarditis?
Streptococci, staphylococci
84
Give 5 symptoms of infective endocarditis
1. Fever
2. Anorexia
3. Clubbing
4. Sudden cardiac failure
5. Renal impairment
85
What is the usual age of onset in calcific aortic stenosis?
65-80
86
What is the pathophysiology of calcific aortic stenosis?
Nodular calcific deposits in cusps with progressive distortion of valves opening/closure
87
What does mitral valve prolapse describe?
Degeneration of the mitral valves such that the inner fibrosa layer becomes more loose and fragmentary with accumulation of mucopolysaccharide material
88
What is myocarditis?
Inflammation of the myocardium usually associated with muscle cell necrosis and degeneration
89
What is the commonest form of myocarditis?
Viral myocarditis
90
Give 6 causes of myocarditis
1. Influenza
2. Typhus
3. Staphylococcus
4. Drug reaction
5. SLE
6. Radiation
91
Give 3 symptoms of myocarditis
1. Palpitations
2. Latitude
3. Upper respiratory tract infection
92
What is cardiomyopathy?
Primary cardiac disease with contractile dysfunction and atypical morphology
93
Name 3 types of cardiomyopathy
1. Dilated
2. Hypertrophic (HCM)
3. Arrythmogenic right ventricular (ARVC)
94
What is the pathophysiology of primary dilated cardiomyopathy?
Poorly generated contractile force leads to progressive dilation of heart with some diffuse interstitial fibrosis
95
What is the heart pathology in primary dilated cardiomyopathy?
Enlarged, heavy and dilated heart
96
What does the clinical progression of primary dilated cardiomyopathy involve?
1. Cardiac failure
2. Dysrhythmias
3. Death
97
What are 3 causes of secondary dilated cardiomyopathy?
1. Alcohol
2. Pregnancy
3. Male
98
What is the mechanism for HCM?
Defects in force degeneration allow progressive sarcomeric dysfunction
99
What are the investigations for HCM?
1. High ejection fraction
2. Echo
3. FHx
100
What is ARVC?
A degenerative condition with progressive dilatation of the right ventricle with fibrosis, lymphoid infiltrate and fatty tissue replacement
101
What are the symptoms of endomyocardial disease?
1. High grade eosinophilia
2. Rash
3. Progressive endocarditis
102
What is a cardiac tamponade?
Compression of the heart leading to acute cardiac failure following bleeding in to the pericardial space
103
What conditions is hypertensive vascular disease a risk for?
1. Aortic aneurysm
2. Stroke
3. MI
104
What is the effect of hypertension?
Alters blood vessel walls by decreasing lumen size as wall thickness increases. This causes a progressive increase in vascular resistance in hypertensives
105
Name 5 conditions that cause hypertension
1. Diabetes
2. High aldosterone
3. Cushing's syndrome
4. Hyperthyroidism
5. Renin secreting tumours
106
What is Raynaud's phenomenon?
Intermittent bilateral ischaemia of digits/extremities precipitated by motional cold temperature
107
What is vasculitis?
An inflammatory and variably necrotic process centred on the blood vessels
108
What is the commonest vasculitis?
Giant cell arteritis
109
What is the pathology of giant cell arteritis?
Focal, chronic and granulomatous inflammation of temporal arteries
110
What can giant cell arteritis cause when affecting large vessels?
Aortic aneurysm/ dissection
111
What age does giant cell arteritis usually affect?
>70
112
Give 4 clinical features of giant cell arteritis
1. Palpable blood vessel
2. Granulomatous inflammation
3. Necrosis
4. Focal scarring
113
What is the vasculitis of the respiratory tract and kidney called?
Wegener's granulomatosis
114
Give 5 symptoms of Wegener's granulomatosis
1. Rash
2. Joint pain
3. Neurological changes
4. Haematuria
5. Sinusitis
115
What is Buerger disease?
An inflammatory disease of medium and small arteries affecting the distal limbs
116
What may lead to remission of Buerger disease?
Smoking cessation
117
What are aneurysms?
Dilated areas of vasculature suggesting either congenital or required weakness of the wall of the vessels
118
What dilatation occurs in AAA?
>50% of aortic diameter
119
Where do most AAA occur?
Below renal arteries
120
What is the Tx for AAA?
Prophylactic replacement with Dacron graft or endolumenal prosthesis
121
What is a dissecting aneurysm?
This is a haematoma within the arterial wall with blood entering under pressure from the lumenal surface and dissecting along the length of the media
122
Where do most dissecting aneurysms occur?
Just above aortic ring
123
What are 4 risk factors for varicose veins?
1. Age
2. Female
3. FHx
4. Posture
124
Give 5 risk factors for DVT
1. Bed rest
2. Trauma
3. OCP
4. Age
5. Sickle cell disease
125
What sign is associated with DVT?
Homan sign
126
What is Homan sign?
Painful/tender calves
127
What is the Tx for DVT?
Anticoagulants
128
What is embolism?
Passage of material through the venous or arterial circulations
129
What is angina?
Mismatch of oxygen demand and supply – mostly a lack of supply
130
What is the commonest cause of angina?
Ischaemic heart disease
131
Give 5 predisposing factors for IHD
1. Age
2. Smoking
3. DM
4. FHx
5. Hyperlipidaemia
132
Give 3 supply exacerbating factors for angina
1. Anaemia
2. Hypoxaemia
3. Hypothermia
133
Give 3 demand exacerbating factors for angina
1. Hypertension
2. Hyperthyroidism
3. Valvular heart disease
134
Give 3 environmental exacerbating factors for angina
1. Cold weather
2. Heavy meals
3. Emotional stress
135
Name 3 cell types that contribute to coronary disease
1. SMC
2. Fibrocytes
3. Cholesterol crystals
136
When does myocardial ischaemia occur?
When there is an imbalance between the heart's oxygen demand and supply, usually from an increase in demand accompanied by limitation of supply
137
What can limit blood supply?
1. Impaired blood flow by proximal arterial stenosis
2. Increased distal resistance
3. Reduced oxygen-carrying capacity of blood
138
When is there a rapid decline in coronary flow?
When diameter stenosis reaches 70%
139
Name 4 anginas other than stable
1. Prinzmetal's
2. Microvascular
3. Crescendo
4. Unstable
140
What is the prevalence of angina?
4-5%
141
When do most angina causes occur?
65-74
142
What are the cardiac symptoms of angina?
1. Chest pain
2. Breathlessness
3. Fluid retention
4. Palpitation
5. Syncope or pre-syncope
143
What is the Hx for pain in angina?
```
OPQRST
Onset
Position
Quality
Relationship
Radiation
Relieving or aggravating factors
Severity
Timing
Treatment
```
144
What factors point to ischaemic cardiac pain?
1. Heavy
2. Central
3. Cold weather provokes
4. GTN relieves
5. Breathlessness
6. Smoking
145
Name 4 things in a chest pain DDx
1. Myocardial ischaemia
2. Pericarditis
3. PE
4. Chest infection
146
What is the investigation for chest pain?
1. Routine bloods
2. Lipids
3. ECG
147
What diagnostic tests can be done for chronic chest pain?
1. Exercise testing
2. Myoview scan
3. CT coronary angiography
4. Stress echo
5. Perfusion MRI
6. Coronary angiography
148
What drug types can be used to treat angina?
1. BB
2. Nitrates
3. Aspirin
4. CCB
5. Statin
6. ACEI
149
How do BB effect the heart?
1. Reduce HR
2. Reduce LV contractility
3. Reduce CO
4. Reduce O2 demand
150
Name 3 side effects of beta blockers
1. Tiredness
2. Bradycardia
3. Erectile dysfunction
151
Why are BB contraindicated in asthma?
Can cause severe bronchospasm
152
What is the effect of nitrates
1. Venodilation
2. Arteriodilation
3. Reduce preload on heart
153
What is a side effect of nitrates?
Headache
154
What is the effect of CCB?
Arterial vasodilation so reduce afterload
155
What are 3 side effects of CCB?
1. Flushing
2. Hypotension
3. Oedema
156
What is the effect of aspirin?
1. COX inhibitor
2. Reduce prostaglandin synthesis
3. Reduce platelet aggregation
157
What is a side effect of aspirin?
Gastric ulceration
158
What is the mechanism of statins?
HMG CoA reductase inhibitors
159
What are the pros of PCI?
1. Less invasive
2. Convenient
3. Repeatable
160
What are the pros of CABG?
1. Prognosis
| 2. Deals with complex disease
161
What are the cons of PCI?
1. Risk stent thrombosis
2. Risk restenosis
3. No complex disease
162
What are the cons of CABG?
1. Invasive
2. Risk of stroke/bleedings
3. One time treatmetn
163
What are the symptoms of unstable angina?
1. Cardiac chest pain at rest
2. Cardiac chest pain with crescendo pattern
3. New onset angina
164
How is unstable angina diagnosed?
1. Hx
2. ECG
3. Troponin (no rise)
165
How is STEMI diagnosed?
ECG
166
How is NSTEMI diagnosed?
After troponin results and other investigations
167
What is an MI?
Non-Q wave or Q-wave MI on the basis of whether new pathological Q waves develop on the ECG as a result of it
168
Which MI types are associated with larger infarcts?
1. STEMI
| 2. MI associated with LBBB
169
Describe the cardiac chest pain in MI
1. Unremitting
2. Usually severe but may be mild/absent
3. Occurs at rest
4. Associated with sweating, SOB, nausea
5. 1/3 occur in bed at night
170
Give 3 conditions associated with higher risk MI
1. DM
2. Higher age
3. Renal failure
171
What is the initial management for MI?
300mg aspirin
172
What is the hospital management for MI?
1. Bed rest
2. Pain relief
3. Aspirin +- P2Y12 inhibitor
173
What causes the majority of ACS?
Rupture of an atherosclerotic plaque and consequent arterial thrombosis
174
Give 3 uncommon causes of ACS
1. Plaque rupture
2. Drug abuse
3. Aortic dissection
175
What is troponin?
Protein complex that regulates actin: myosin contraction
176
Name 3 P2Y12 antagonists
1. Clopidogrel
2. Prasugrel
3. Ticagrelor
177
What is the risk of P2Y12 antagonists?
Bleeding
178
Name 2 GPIIb/IIIa antagonists
1. Abeiximab
| 2. Tirofiban
179
When are GPIIb/IIIa antagonists used?
When pt. are undergoing PCI
180
How do anticoagulants work?
Inhibit both fibrin formation and platelet activation
181
What anticoagulant is often used in ACS?
Fondaparinux or heparin
182
What is the treatment of choice for STEMI?
Primary PCI
183
When is coronary angiography performed?
For pt. wit troponin elevation or unstable angina refractory to medical therapy
184
Where is clopidogrel converted to its active form?
Liver
185
Name 4 factors that affect response to clopidogrel
1. Dose
2. Age
3. DM
4. Drug-drug interactions
186
What are the mechanisms of action off ticagrelor?
1. Reversibly-binding P2Y12 antagonist
| 2. Inhibition of adenosine uptake via ENT-1 pathway
187
Give 5 adverse affects of ticagrelor
1. Bleeding
2. Rash
3. GI disturbance
4. Dyspnoea
5. Ventricular pauses
188
What are the signs and symptoms of DVT?
1. Pain
2. Swelling
3. Tenderness
4. Warmth
5. Discolouration
189
What are the investigations for DVT?
1. D-dimer (raised)
2. US compression test proximal veins
3. Venogram
190
What is the Tx for DVT?
1. LMW Heparin
2. Oral warfarin
3. DOAC
4. Compression stockings
191
What are the risk factors for DVT?
1. Surgery
2. OCP
3. Immobility
4. Inherited thrombophilia
5. Pregnancy
192
What are the preventions for DVT?
1. Hydration
2. Early hydration
3. Compression stockings
4. LMW Heparin
193
What is the DDx for PE?
1. MSK pain
2. Infection
3. Malignancy
4. Pneumothorax
5. Cardiac causes
6. Gastro causes
194
What are the symptoms of PE?
1. SOB
2. Pleuritic chest pain
3. Signs of DVT
195
What are the signs of PE?
1. Tachycardia
2. Tachypnoea
3. Pleural rub
196
What are the investigations for PE?
1. CXR
2. ECG sinus tachy
3. Blood gases: type 1 respiratory failure, decreased O2/CO2
4. D-dimer - raised
5. Ventilation/perfusion scan: mismatch
6. CTPA spiral CT
197
What patients need ventilation/perfusion scans?
Pregnant as cannot have CTPA spiral CT
198
What is the Tx for PE?
1. LMW heparin
2. DOAC
3. IVC filter
199
What is the mechanism of warfarin?
Prevents synthesis of active factors II, VII, IX and X
200
What is the prevention of PE?
1. Early mobilisation
2. Hydration
3. LMW heparin
201
What is thrombosis?
Blood coagulation inside a vessel
202
Describe the arterial circulation
High pressure, platelet rich
203
Describe the venous circulation
Low pressure, fibrin rich
204
What happens when there is thrombosis in coronary circulation?
MI
205
What happens when there is thrombosis in cerebral circulation?
CVA/stroke
206
What happens when there is thrombosis in peripheral circulation?
Peripheral vascular disease: claudication, rest pain, gangrene
207
What are 5 risk factors for arterial thrombosis?
1. Smoking
2. Hypertension
3. DM
4. Hyperlipidaemia
5. Obesity
208
What is the diagnosis for MI?
1. Hx
2. ECG
3. Cardiac enzymes
209
What is the diagnosis for CVA?
1. Hx
2. Examination
3. CT scan
4. MRI scan
210
What is the diagnosis for peripheral vascular disease?
1. Hx
2. Examination
3. USS
4. Angiogram
211
What is the Tx for MI?
1. Aspirin
2. LMW heparin or fondaparinux
3. Thrombolytic therapy: streptokinase tissue plasminogen activator
212
What is the mechanism of aspirin?
Inhibits cyclo-oxygenase irreversible to inhibit thromboxane formation and platelet aggregation
213
What is the Tx for stroke?
1. Aspirin or clopidogrel, prasugrel, ticagrelor
2. TPA
3. Treat risk factors
214
What is the mechanism for TPA?
TPA generates plasmin, degrades fibrin
215
What are the genetic causes for venous thrombosis?
1. Factor V Leiden
2. PT20210A
3. Antithrombin deficiency
4. Protein C deficiency
5. Protein S deficiency
216
What are the acquired causes for venous thrombosis?
1. Anti-phospholipid syndrome
2. Lupus anticoagulant
3. Hyperhomocysteinaemia
217
What is the mechanism for heparin?
Binds to antithrombin and increases its activity
218
How is heparin monitored?
With APTT
219
What is the mechanism for clopidogrel?
Inhibits ADP induced platelet aggregation
220
What is the mechanism of warfarin?
Prevents synthesis of active factors II, VII, IX and X
221
What is the mechanism for DOAC?
Directly act on factor II or X
222
How many ml of serous fluid are in the pericardial sac?
50ml
223
What is the function of the pericardium?
Restrains filling volume of heart
224
Why do chronic effusions rarely cause tamponade?
Allows adaptation of parietal pericardium which reduces effect on diastolic filling of chambers
225
What is acute pericarditis?
An inflammatory pericardial syndrome with or without pericardial effusion
226
2 of which 4 clinical features would diagnose acute pericarditis?
1. Chest pain
2. Friction rub
3. ECG changes
4. Pericardial effusion
227
What causes most cases of acute pericarditis in the UK?
Viral infections
228
Name 4 viruses that can cause acute pericarditis
1. Enteroviruses
2. Herpes viruses
3. Adenoviruses
4. Parvovirus B19
229
What are the neoplastic causes of acute pericarditis?
Secondary metastatic tumours (lungs, breast, lymphoma)
230
What can cause delayed onset acute pericarditis?
1. Pericardial injury syndromes
| 2. Iatrogenic trauma e.g. pacemaker insertion
231
How many pericarditis cases are idiopathic?
80-90%
232
Give 5 symptoms of pericarditis
1. Chest pain
2. Dyspnoea
3. Cough
4. Hiccoughs
5. Rash
233
Describe the chest pain in pericarditis
1. Severe
2. Sharp and pleuritic
3. Rapid onset
4. Left anterior chest or epigastrium
5. Radiates to arm
234
What is important to differentiate against in pericarditis?
Myocardial ischaemia/infarction
235
What are the examinations for pericarditis?
1. Pericardial rub
2. Sinus tachycardia
3. Fever
4. Signs of effusion
236
What are the investigations for pericarditis?
1. ECG
2. Bloods
3. CXR
4. Echocardiogram
237
Describe pericarditis ECG
1. Diffuse ST elevation
2. Concave ST segment
3. Saddle shaped
4. PR depression
238
What are the investigations for pericarditis?
1. FBC (high WCC)
2. ESR & CRP (high)
3. Troponin (high)
4. CXR
239
What is the management for pericarditis?
1. Sedentary activity
2. NSAID or aspirin
3. Colchicine
240
What is the recurrence rate for acute pericarditis?
15-30%
241
What is the commonest cause of pericarditis in the developed world?
Viral pericarditis
242
What bacteria are most commonly involved in pericarditis?
Staph, strep and pneumococci
243
What non-infective conditions can cause pericarditis?
1. Tuberculosis
| 2. Dressler's syndrome
244
What is the sign of tamponade?
Pulsus paradoxus (fall in systolic BP >10mmHg on inspiration)
245
What heart condition causes sudden death in apparently healthy young people?
Sudden arrhythmia death syndrome
246
What are the 3 groups of cardiomyopathy?
1. Hypertrophic
2. Dilated
3. Arrythmogenic
247
What causes hypertrophic cardiomyopathy?
Sarcomeric protein gene mutations
248
Name 4 symptoms of hypertrophic cardiomyopathy
1. Angina
2. Dyspnoea
3. Palpitations
4. Syncope
249
What causes dilated cardiomyopathy (DCM)?
Cytoskeletal gene mutations
250
What is the heart presentation in DCM?
1. Ejects 50-60% of blood
| 2. Struggle to see parts of heart contracting
251
What causes arrythmogenic cardiomyopathy?
Desmosome gene mutations
252
Describe the the cardiac muscle in arrythmogenic cardiomyopathy
Muscle disappears in ventricles and is replaced by fat and fibrosis
253
What wave is seen on ECG in cardiomyopathy?
Epsilon wave
254
What is the presentation of Naxos disease?
1. Woolly hair
2. Palmar and plantar skin thickening
3. Fibro-fatty infiltration of heart
4. Arrhythmia
5. Abnormal ECG
255
What is the primary problem in Naxos disease?
Cell separation
256
Describe Brugada ECG (look up) after ajmaline test
1. Incomplete RBBB
| 2. ST-segment elevation
257
Name 3 aortovascular conditions
1. Ehler Danlos Syndrome
2. Loeys-Dietz
3. Marfan
258
Give 4 clinical features of aortovascular conditions
1. Lanky
2. Arm span > height
3. Protruding sternum
4. Changes in palate and face
259
Name 4 conditions hypertension is a major risk factor for
1. Stroke
2. MI
3. HF
4. Chronic renal disease
260
What is the BP for stage 1 hypertension?
140/90mmHg
261
What is used to confirm HT diagnosis?
Ambulatory blood pressure monitoring
262
What is the BP for stage 2 HT?
160/100
263
What are the treatments for primary HT?
1. Lifestyle modification
| 2. Antihypertensive drug therapy
264
When would secondary hypertension be considered?
1. Young patient
2. Resistant BP
3. Signs of underlying cause
265
Which stage 1 HT patients is drug Tx offered to?
Aged under 80 with 1 or more of
1. Target organ damage
2. Established CVD
3. Renal disease
4. Diabetes
5. 10 year CV risk of 20%+
266
What are the targets for HT Tx?
1. CO and peripheral resistance
2. RAAS and SNS
3. Local vascular vasoconstrictor and vasodilator mediators
267
Build in BP is an interplay between what 2 mechanisms?
1. Hypertrophy
| 2. Salt retention
268
Name 3 ACEI
1. Ramipril
2. Perindopril
3. Enalapril
269
What is the mechanism for ACEI
1. Increase kinin production by inhibiting bradykinin breakdown
2. Reduced angiotensin II formation
270
What are 4 adverse effects to ACEI?
1. Hypotension
2. Acute renal failure
3. Cough
4. Hyperkalaemia
271
Name 3 ARBs
1. Candesartan
2. Valsartan
3. Losartan
272
Name 4 adverse effects to ARBs
1. Symptomatic hypotension
2. Hyperkalaemia
3. Renal dysfunction
4. Rash
273
What group of people are ARBs and ACEIs contra-indicated in?
Pregnant people
274
When are CCB indicated?
1. Hypertension
2. Angina
3. Tachycardia
275
Name 3 CCBs
1. Amlodipine
2. Felodipine
3. Diltiazem
276
What is the mechanism of action of CCB?
L-type calcium channel blockers
277
What is the mechanism of action of amlodipine?
1. Preferentially affect vascular smooth muscle
| 2. Peripheral arterial vasodilators
278
Give 4 adverse effects of amlodipine
1. Flushing
2. Headache
3. Oedema
4. Palpitations
279
Give 4 adverse effects of other CCBs
1. Bradycardia
2. Atrioventricular block
3. Worsening of HF
4. Constipation
280
Name 3 beta blockers
1. Bisoprolol
2. Propranolol
3. Atenolol
281
What does a cardioselective BB indicate?
Beta 1 selective
282
Name 4 adverse effects of BB
1. Fatigue
2. Headache
3. Bradycardia
4. Erectile dysfunction
283
What are the classes of diuretic?
1. Thiazides
2. Loop diuretics
3. Potassium sparing diuretics
4. Aldosterone antagonists
284
Name 4 diuretics
1. Bendoflumethiazide
2. Furosemide
3. Bumetanide
4. Eplerenone
285
Name 4 side effects of diuretics
1. Hypovolaemia
2. Hypokalaemia
3. Hypotension
4. Gout
286
Which anti-hypertensive is used in pregnancy?
Methyldopa
287
What is the main benefit of HF drugs from?
Vasodilator therapy via neurohumoral blockade
288
What drugs are used in HF treatment?
1. Diuretics
2. ACEI and BB
3. Aldosterone antagonists
4. ARBs
5. Hydralazine/nitrate
6. Digoxin
289
What is the mechanism of nitrates?
1. Arterial and venous dilators
2. Reduction of preload and afterload
3. Lower BP
290
Name 3 nitrates
1. Isosorbide mononitrate
2. GTN spray
3. GTN infusion
291
What are 2 common side effects of GTN?
1. Headache
| 2. Syncope
292
Describe chronic stable angina
1. Anginal chest pain
2. Predictable
3. Exertional
4. Infrequent
5. Stable
293
Describe unstable angina
1. Unpredictable
2. May be at rest
3. Frequent
4. Unstable
294
Describe STEMI
1. Unpredictable
2. Rest pain
3. Persistent
4. Unstable
295
What is the Tx for stable angina?
1. Aspirin/clopidogrel
2. Statins
3. GTN spray
296
What is the Tx for NSTEMI or STEMI?
1. GTN spray, opiates
2. Aspirin plus ticagrelor, prasugrel or clopidogrel
3. Antithrombin therapy
4. Angioplasty or CABG
297
What are the classes of antiarrhythmic drugs?
1. Sodium channel blockers
2. Beta adrenoceptor antagonists
3. Prolong AP
4. CCBs
298
Name a drug which prolongs AP
Amiodarone
299
What is the mechanism of digoxin?
Inhibits Na/K pump
300
Name 3 side effects of digoxin
1. Nausea
2. Vomiting
3. Diarrhoea
301
Name 4 side effects of amiodarone
1. Nausea
2. Vomiting
3. Fatigue
4. Tremor
302
What is heart failure?
An inability of heart to deliver blood (and O2) at a rate commensurate with requirements of metabolising tissues, despite normal or increased cardiac filling pressures
303
What is the incidence of HF?
2-20%
304
Give 3 causes of HF
1. Myocardial dysfunciton
2. Hypertension
3. Alcohol excess
305
What are the symptoms of HF?
1. Breathlessness
2. Tiredness
3. Cold peripheries
4. Leg swelling
5. Increased weight
306
What are 4 signs of HF?
1. Tachycardia
2. Displaced apex beat
3. Raised JVP
4. Added heart sounds
307
Describe patients with acute decompensated HF
1. <70yo
2. Male dominance
3. LVEF <40%
308
Describe patients with acute HF
1. 71-76yo
2. 50% female
3. 50% LVEF >40%
309
What is the diagnosis for HF?
1. CXR
2. Blood tests incl. proBNP
3. ECG
4. Echocardiography
5. Myocardial perfusion imaging
310
What NT-proBNP gets referred to a cardiologist?
>400
311
Name 4 things which can raise NT-proBNP
1. HF
2. ACS
3. Advanced age
4. PE
312
Which systems are involved in HF?
1. Sympathetic NS
2. RAAS
3. Inflammation
313
What are the cardinal symptoms of HF?
1. SOB
2. Fatigue
3. Ankle swelling
314
What is Class I HF?
No limitation
315
What is Class II HF?
Slight limitation
316
What is Class III HF?
Marked limitation
317
What is Class IV HF?
Inability to carry out any physical activity without discomfort
318
What are the stages of HF?
1. High risk for developing HF
2. Asymptomatic HF
3. Symptomatic HF
4. End-stage HF
319
Give 3 complications of HF
1. Renal dysfunction
2. Rhythm disturbance
3. Systemic thromboembolism
320
Why are ACEI used to treat HF?
1. Controls BP
| 2. Inhibits aldosterone which usually retains NA and water
321
What is the effect of diuretics?
Symptomatic relief of oedema and dyspnea
322
What is the Tx for HF with preserved left ventricular ejection fraction?
Diuretics
323
What surgeries can be done in HF?
1. Mitral valve repair
2. Aortic valve replacement
3. Mitral valve replacement
4. Left ventricular re-modelling
324
What are the symptoms of malignant HT in the eye?
1. Haemorrhage
| 2. Papilloedema
325
What is the prevalence of HT in younger people?
10%
326
What is the risk of CV events per 100mmHg increase in BP?
30-40%
327
What are 3 lifestyle changes for lowering BP?
1. Reduce salt intake
2. Weight loss
3. Reduce alcohol intake
328
When should BP lowering medications be withheld?
1. Pregnancy
2. BP drops for another reason e.g. weight loss
3. Surgery (ACEI)
329
What are the basic principles of ECG?
1. Amplitude of deflection is related to mass of myocardium
2. Width of deflection reflects speed of conduction
3. Positive deflection is towards lead/vector
330
What is the normal QRS axis?
-30 to +90 degrees
331
What conditions are associated with left axis deviation (-30 to -90)?
1. Left anterior fascicular block
2. Left bundle branch block
3. Left ventricular hypertrophy
332
What conditions are associated with right axis deviation (90 to 180)?
1. Left posterior fascicular block
| 2. Right heart hypertrophy/strain
333
What conditions is PR interval prolonged in?
1. Disorders of AVN
| 2. Disorders of specialised conducting tissue
334
When is PR interval shorter?
1. Younger patients
| 2. Wolf-Parkinson-White
335
What is the pathophysiology of Wolf-Parkinson-White syndrome?
Extra electrical pathway between atria and ventricles causes a rapid heartbeat
336
What are the symptoms of WPW?
1. Heart palpitations
2. Dizziness
3. SOB
4. Chest pain
5. Sweating
337
What is the treatment for WPW?
1. Lifestyle changes
2. Catheter ablation
3. Amiodarone
338
What can cause long or short QT syndromes?
1. Congenital
2. Drugs
3. Electrolyte disturbances
339
When might ST segment be elevated?
1. Early repolarisation
2. MI
3. Pericarditis/myocarditis
340
When is T wave direction opposite to QRS direction?
Bundle branch block
341
What can T wave inversion indicate?
1. Ischaemia/infarction
2. Myocardial hypertrophy
3. Cardiomyopathy
342
What are 6 common tachycardias?
1. AF
2. Atrial flutter
3. Supraventricular tachycardia
4. Focal atrial tachycardia
5. Ventricular tachycardia
6. Ventricular fibrillation
343
What are supraventricular arrhythmias?
Arrhythmias arising from the top part of the heart
344
What is the ECG pattern of AF?
QRS is irregularly irregular
345
What is the ECG pattern in atrial flutter?
Organised but rapid fluttering in atria (saw tooth pattern in baseline)
346
What is the ECG in sinus tachycardia?
Relatively fast but regular rhythm
347
Describe a patient with ventricular tachycardia
Fast HR, pt. may be conscious, still some BP
348
Describe a patient with ventricular fibrillation
Pt. is unconscious and in cardiac arrest
349
What are the causes of bradycardia?
1. Conduction tissue fibrosis
2. Ischaemia
3. Inflammation/infiltrative disease
4. Drugs
350
What happens in first degree heart block?
1:1 conduction, PR interval is one
351
What happens in second degree heart block?
No longer 1:1, some relationship between atria and ventricles
352
What happens in third degree heart block?
No interaction between atria and ventricles, slower QRS
353
What happens in Mobitz type I heart block?
PR interval increases until AVN fails and no QRS is seen
354
What happens in Mobitz type II heart block?
Sudden unpredictable loss of AV conduction and QRS
355
Describe the LBBB ECG
Looks like W (WiLLiam), broad QRS
356
Describe the RBBB ECG
Looks like M (MaRRow)
357
What does a deep Q wave indicate?
Previous infarction
358
What are ectopic beats?
Non sustained beats arising from ectopic regions of atria or ventricles
359
High burden ventricular ectopic beats can cause what?
Heart failure
360
High burden atrial ectopic beats can cause what?
Atrial fibrillation
361
What is the Tx for ectopic beats?
Reassurance/BB
362
What is the mechanism for ectopic beats?
If area of heart has higher automaticity than SAN
363
Why is AF a risk for stroke?
When atria don't contract regularly can get stasis
364
What are the 2 types of AF?
Proxysmal and persistent
365
What is the Tx for AF?
1. Treat underlying cause
2. BB/CCB
3. Electrical/pharma cardioversion
4. BP control e.g. Sotatol, amiodarone
366
What are the symptoms in diabetic MI?
Sweating and SOB
367
What is the ECG trace for LAD occlusion?
1. ST elevation
| 2. Tombstones
368
What is the ECG trace for pericarditis?
1. ST elevation - saddle shaped
369
What is the ECG trace in AVNRT?
No P waves as these are hidden in QRS
370
What is the Tx for supraventricular tachycardia?
1. CCB/BB
| 2. Adenosine injection
371
What is the Tx for AVNRT?
Catheter ablation
372
What is the pathophysiology for AVNRT?
Ventricles simultaneously contract
373
What is an electrical storm?
3+ sustained episodes of VT or VF, or appropriate ICD shocks during a 24hr period
374
What is the Tx for electrical storm?
1. Correct underlying cause
2. BB, sedation
3. Amiodarone
4. GA/neuraxial blockade
5. Catheter ablation
375
What are the uses of catheter ablation?
1. Reduce episodes of VT or frequency of ICD shocks
| 2. Can be curative for normal heart VT
376
When do symptoms arise in aortic stenosis?
When valve is 1/4 of normal size (3-4cm)
377
What are the types of aortic stenosis?
1. Supravalvular
2. Subvalvular
3. Valvular
378
What are 4 causes of aortic stenosis?
1. Congenital aortic stenosis
2. Congenital bicuspid valve
3. Degenerative calcification
4. Rheumatic heart disease
379
What is the pathophysiology of bicuspid aortic valve?
1. Fusion of 2 valves
| 2. Dilation of aortic wall
380
What is the pathophysiology of aortic stenosis?
1. Pressure gradient develops between left ventricle and aorta as exit of blood is restricted by narrow valve
2. LV function initially maintained by compensatory pressure hypertrophy
3. When compensatory mechanisms exhausted, LV function declines
381
What are the symptoms of aortic stenosis?
1. Syncope
2. Angina
3. Dyspnoea
4. Sudden death
382
What are the signs of aortic stenosis?
1. Pulsus tardus and pulsus parvus
2. Heart sounds
3. Ejection systolic murmur
383
What is the investigation for aortic stenosis?
Echocardiography
1. Left ventricular size and function
2. Doppler derived gradient and valve area
384
What is the grading for aortic stenosis?
Mild: >1.5cm, 2.6-3.0m/s
Moderate: 1-1.5cm, 3-4m/s
Severe: <1cm, >4m/s
385
What is the management for aortic stenosis?
1. Dental hygiene
2. Surgical replacement
3. Transcatheter aortic valve implantation
386
What are the indications for intervention in aortic stenosis?
1. Any symptomatic pt. with severe AS
2. Any pt. with decreasing EF
3. Any pt. undergoing CABG with moderate or severe AS
387
What is mitral regurgitation?
Backflow of blood from the LV to the LA during systole
388
What are the causes of chronic mitral regurgitation (MR)?
1. Myxomatous degeneration
2. Ischaemic MR
3. Rheumatic heart disease
4. Infective endocarditis
389
What is the pathophysiology of MR?
1. Volume overload
| 2. Compensatory: Left atrial enlargement, LVH and increased contractility
390
What is the presentation of MR?
1. Pansystolic murmur at apex
2. Exertion dyspnoea
3. Heart failure
391
How long is the compensatory phase in MR?
10-15yr
392
What are the investigations in MR?
1. ECG
2. CXR
3. Echo
393
What is the management for MR?
1. Medication
2. Serial echocardiography
3. IE prophylaxis
4. Surgery
394
What are the medications for MR?
1. Vasodilator e.g. ACEI
2. BB/CCB/digoxin
3. Anticoagulant
4. Diuretics
395
What is aortic regurgitation (AR)?
Leakage of blood into LV during diastole due to ineffective coaptation of aortic cusps
396
What is the aetiology of chronic AR?
1. Bicuspid aortic valve
2. Rheumatic
3. Infective endocarditis
397
What is the pathophysiology of AR?
1. Combined pressure and volume overload
| 2. Compensatory: LV dilation, LVH
398
What are the signs of AR?
1. Wide pulse pressure
2. Diastolic blowing murmur
3. Austin flint murmur
4. Systolic ejection murmur
399
When does AR typically present?
4th or 5th decade
400
What are the symptoms of AR?
1. Dyspnoea
| 2. Palpitations
401
What are the investigations for AR?
1. CXR (enlarged heart and aortic root)
| 2. Echo
402
What is the management for AR?
1. IE prophylaxis
2. Vasodilators e.g. ACEI
3. Serial echo
4. Surgical replacement
403
What is mitral stenosis?
Obstruction of LV inflow that prevents proper filling during diastole
404
What is the aetiology for mitral stenosis?
1. Rheumatic heart disease
2. Infective endocarditis
3. Mitral annular calcification
405
What is the pathophysiology for mitral stenosis?
1. Progressive dyspnoea
2. Increased transmittal pressures
3. Right HF symptoms
4. Haemoptysis
406
What are the signs of mitral stenosis?
1. Prominent a wave in jugular venous pulsations
2. Signs of right-side HF
3. Mitral facies
4. Diastolic murmur
5. Loud opening S1 snap
407
What is the investigation for mitral stenosis?
1. ECG (AF, LA enlarged)
2. CXR (LA enlarged, pulmonary congestion)
3. Echo
408
What is the Tx for mitral stenosis?
1. Serial echo
2. BB/CCB/digoxin
3. Diuretics
4. Percutaneous mitral balloon valvotomy
5. IE prophylaxis
6. Mitral valve replacement
409
What is infective endocarditis?
Infection of heart valve(s) or other endocardial lined structures within heart
410
What are the types of IE?
1. Left sided native IE
2. Left sided prosthetic IE
3. Right sided IE
4. Device related IE
5. Prosthetic
411
What is the aetiology of IE?
1. Abnormal valve
2. Surgical infection
3. Teeth
4. Previous IE
412
Who does IE typically effect?
1. Elderly with degenerative heart valves
2. PWID
3. Young with congenital heart disease
4. Prosthetic heart valves
413
What is the presentation of IE?
1. Systemic infection signs
2. Embolisation
3. Valve dysfunction
4. HF
5. Arrhythmia
414
What are the major criteria for IE?
1. Bugs grown from blood cultures
| 2. Evidence of endocarditis on echo, or new valve leak
415
What are the minor criteria for IE?
1. Predisposing factors
2. Fever
3. Vascular phenomena
4. Immune phenomena
5. Equivocal blood cultures
416
How is definite IE diagnosed?
2 major, 1 major + 3 minor, 5 minor
417
How is possible IE diagnosed?
1 major, 1 major + 1 minor, 3 minor
418
What is the investigation for IE?
1. Transthoracic echo
| 2. Transoesophageal echo
419
What are the peripheral stigmata in IE?
1. Petechiae rash
2. Splinter haemorrhages
3. Osler's nodes
4. Janeway lesions
5. Roth spots
420
What is the diagnosis for IE?
1. Raised CRP
2. ECG
3. TTE/TOE
421
What is the Tx for IE?
1. Antimicrobials IV 6wk
2. Treat complications
3. Surgery
422
When is surgery indicated in IE?
1. Abx can't cure infection
2. Complications
3. Remove infected devices
4. Replaced valve after infection cured
5. Remove large vegetations before they embolise
423
What are the symptoms in long QT syndrome?
1. Syncope
2. Seizures
3. Sudden death
4. Heart palpitations
424
What is the investigation in long QT syndrome?
ECG - QT interval >460-470ms (M:F)
425
What is the Tx in long QT syndrome?
1. BB e.g. propranolol
| 2. Pacemaker or ICD
426
What test is required following acute anaphylaxis?
Serum tryptase levels (rise)
427
What is septic shock?
When sepsis causes low BP and abnormalities in cellular metabolism
428
What are the symptoms for septic shock?
1. Confusion/slurred speech
2. Blue, pale or blotchy skin
3. Rash that doesn't fade with a glass
4. SOB, breathing fast
429
What are the investigations for sepsis?
1. Microbiology bloods
2. USS/CT/x-ray
3. WCC
4. Platelet count (low)
5. Acidosis in bloods
6. LFT, U&E
430
What is the Tx for sepsis?
IV Abx
431
What is cardiogenic shock?
When your heart sudden can't pump enough blood to meet body's needs
432
What are the cardiogenic shock symptoms?
1. Rapid breathing
2. SOB
3. Tachycardia
4. Loss of consciousness
433
What is the cardiogenic shock investigation?
1. BP (low)
2. Angiogram
3. ECG
4. Echo
5. CXR
434
What is the cardiogenic shock Tx?
1. Aspirin
2. Adrenaline
3. Thrombolytic e.g. alteplase
4. Antiplatelet e.g. clopidogrel
435
What are the symptoms of haemorrhagic shock?
1. Anxiety
2. Blue lips and fingers
3. Low urine output
4. Sweating
5. SOB
436
What is the investigation for haemorrhagic shock?
1. CT/USS
2. Bloods
3. Echo/ECG
437
What is the Tx for haemorrhagic shock?
1. Transfusion
2. Dopamine
3. Adrenaline
438
What are the symptoms for neurogenic shock?
1. Difficulty breathing
2. Chest pain
3. Weakness
4. Bradycardia
439
What is the investigation for neurogenic shock?
1. CT
2. MRI
3. Angiogram
440
What is the Tx for neurogenic shock?
1. Vasopressor e.g. adrenaline
| 2. Atropine
441
How many live births have a cardiac defect?
1%
442
What is scan is done at 18-22 weeks if a parent has cardiac defects?
Foetal ECG
443
What is the maternal mortality in pt. with cardiac defects?
50% - advice against
444
Which cardiac defects cause high risk in pregnancy?
1. Pulmonary HT
2. Severe left heart obstruction
3. Systemic ventricular impairment
4. Marfans syndrome
445
What is the tetralogy of fallot pathophysiology?
1. Ventricular septal defect
2. Pulmonary stenosis
3. Hypertrophy of RV
4. Overriding aorta
446
What is the result of stenosis of RV outflow?
1. RV is higher pressure than LV
2. Deoxygenated blood passes from RV to LV
3. Blue baby
447
What gene mutation is associated with tetralogy of fallot?
22q11 deletion
448
What is the Rx for tetralogy of fallot?
Surgical repair
449
What is a ventricular sept defect (VSD)?
Abnormal connection between the two ventricles
450
What is the pathophysiology of VSD?
1. High pressure LV
2. Low pressure RV
3. Blood flows to RV from LV
4. Increased blood flow to lungs
451
What are the symptoms are large VSD?
1. Breathless
2. Poor feeding
3. Failure to thrive
452
How is large VSD treated in infancy?
1. PA band
| 2. Complete repair
453
What may VSD result in?
Eisenmenger's syndrome
454
What are the clinical signs for large VSD?
1. Small breathless skinny baby
2. Increased RR
3. Tachycardia
4. Big heart CXR
5. Murmur
455
What are the clinical signs for small VSD?
1. Loud systolic murmur
2. Thrill
3. Well grown
4. Normal HR
5. Normal heart size
456
What is the pathophysiology of Eisenmenger's syndrome?
1. High pressure pulmonary blood flow
2. Damage to pulmonary vasculature
3. Resistance to blood flow through lungs increases
4. RV pressure increases
5. Shunt direction reverses
457
What are the types of atrial septal defect (ASD)?
1. Primum
2. Secundum
3. Sinus venosus
458
What is the pathophysiology of ASD?
1. High pressure in LA than RA
2. Shunt left to right
3. Increase blood flow to right heart and lungs
459
What are the signs of ASD?
1. Pulmonary flow murmur
2. Fixed split second heart sound
3. Big pulmonary arteries on CXR
4. Big heart on CXR
460
How are ASDs closed?
1. Surgical
| 2. Percutaneous
461
What condition are atrioventricular septal defects (AVSD) associated with?
Down syndrome
462
What is involved in AVSD?
1. Ventricular septum
2. Atrial septum
3. Mitral valves
4. Tricuspid valves
463
What are the signs of complete AVSD?
1. Breathlessness as neonate
2. Failure to thrive
3. Torrential pulmonary blood flow
464
What are the signs of patent ductus arteriosus?
1. Continuous machinery murmur
2. Large heart
3. SOB
4. Eisenmenger's syndrome
465
What are the signs of Eisenmenger's syndrome?
Clubbed and blue toes
466
What is coarctation of the aorta?
Narrowing of aorta at the site of insertion of ductus arteriosus
467
What is the pathophysiology of coarctation of the aorta?
Complete or almost complete obstruction to aortic flow
468
What are the signs of coarctation of aorta?
1. Right arm HTN
2. Bruits over scapulae and back
3. Murmur
469
What are the long term problems of coarctation?
1. HTN
2. Re-coarctation
3. Aneurysm at site of repair
470
How is coarctation repaired?
1. Subclavian flap repair
2. End to end repair
3. Coarctation angioplasty
471
What are bicuspid AV valves associated with?
1. Coarctation
| 2. Dilatation of ascending aorta
472
What is pulmonary stenosis?
Narrowing of outflow of RV
473
What are the types of pulmonary stenosis?
1. Valvar
2. Sub valvar
3. Supra valvar
4. Branch
474
What are the signs of severe pulmonary stenosis?
1. RV failure as neonate
2. Collapse
3. Poor pulmonary blood flow
4. RV hypertrophy
5. Tricuspid regurgitation
475
What is the Rx for pulmonary stenosis?
1. Balloon valvuloplasty
2. Open valvotomy
3. Open trans-annular patch
4. Shunt
476
What is fontan procedure?
Plumb SVC into pulmonary artery to allow baby to grow and have passive circulation to lungs
477
What is the 5yr mortality in mild peripheral arterial disease (PAD)?
25%
478
What is the most common place for atherosclerosis?
Femoropopliteal bifurcation
479
What are the complications of atherosclerotic plaque?
1. Progression
2. Haemorrhage
3. Plaque rupture
4. Overlying thrombosis
5. Dissection
6. Aneurysm
480
What causes atherosclerotic aneurysms?
Medial thinning beneath plaque
481
What is the commonest aneurysm site?
Infrarenal abdominal artery
482
What are the investigations for aneurysm?
1. BGL
2. Lipids
3. Vasculitic screen
4. BP
5. Duplex
6. CT/MRA
483
What is the Rx for aneurysm?
1. Open aneurysm repair (Dacron graft)
| 2. Endovascular aneurysm repair (stent graft)
484
What are the organ-specific symptoms for ischaemia?
1. Exercise induced angina
2. Gangrene
3. Ischaemic cardiac failure
4. Intermittent claudication
5. Vascular dementia
485
What are the common clinical presentations of peripheral vascular disease (PVD)?
1. Intermittent claudication
2. Critical leg ischaemia
3. Acute limb ischaemia
4. Carotid artery disease
5. Abdominal aortic aneurysm
486
What are the symptoms of acute limb ischaemia?
6 Ps
1. Pain
2. Pale
3. Paralysis
4. Paraesthesia
5. Perishing cold
6. Pulseless
487
What is the pathophysiology of intermittent claudication?
1. Anaerobic metabolism occurs when O2 demand exceeds supply
| 2. Lactic acid formed - pain
488
Describe the pain in intermittent claudication
1. Pain on exertion
2. Classically affects calves
3. Resolves on resting
489
What is the pathophysiology for critical ischaemia?
1. Blood supply barely adequate for basal metabolism
| 2. No reserve for increased demand
490
Describe the pain for critical ischaemia
1. Rest pain
2. Nocturnal
3. Dependency rubor
491
What is the Rx for acute limb ischaemia?
1. Revascularisation
2. Amputation
3. Aspirin
492
How can revascularisation be done in critical leg ischaemia?
1. Vein bypass
2. Percutaneous balloon
3. Stent
