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cardiovascular Flashcards

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1
Q

What are the typical signs of MI chest pain?

A

crushing/gripping/heavy pain, retrosternal radiating to jaw/shoulder/teeth or rarely back/abdomen, pain/parasthesia in both arms most commonly L, provoked by exercise, relieved by rest/nitrates, dyspnoea/nausea/sweating/palor

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2
Q

What are the typical signs of Aortic Dissection?

A

Severe central chest pain, radiates to back and down arms, shock/neurological symptoms due to secondary loss of blood to spinal cord, renal failure/acute lower limb ischeamia/visceral ischaemia, absent peripheral pulses

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3
Q

Typical signs of pleuritic chest pain

A

Localised, sharp, worse on deep breathing/coughing, tenderness of costochondral junction, pain in shoulder tip

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4
Q

typical signs of chest pain in oesophageal disease

A

central, retrosternal, heartburn, worse bending over/stooping/lying down, relieved by antacids

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5
Q

typical signs of chest pain from musculoskeletal disease

A

local tenderness, worse with certain movements, history of trauma.

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6
Q

what conditions may cause pleuritic pain

A

pneumothorax, PE, Pneumonia

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7
Q

typical signs of chest pain from pericarditis

A

Sharp, constant sternal pain. Relieved by sitting forwards. May radiate to shoulder/arm. Worse lying on left and inspiration, swallowing and coughing. Ass. Symptoms: Acute dyspnoea if effusion, +/- palpitations

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8
Q

what conditions may predispose someone to aortic dissection

A

Genetic conditions (Marfan’s eg), smoking, hypertension, syphilis, hypercholesteroleamia

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9
Q

what is the prognosis for somebody with HF

A

poor, 82% dying within 6 years of diagnosis

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10
Q

what are the histological/morphological changes in acute pulmonary odema?

A

increase of fluid in alveolar walls/interstitium subsequently affecting alveolar spaces, Main cause is increased LV pressure causing increased pressure in alveolar cappilaries. Fluid leaks from capillaries into interstitium, Increased flow of fluid into pulmonary lymphatics leading to increased stiffness of lungs and dyspnoea. Capillary rupture leads to leaking red cells into interstitium and alveoli, Hb phagocytosed by macrophages, accumulate iron pigment and lie in alveoli interstitium (HF cells)

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11
Q

what will be the typical clinical features of somebody with acute pulmonary odema

A

dyspnoea, paroxysmal nocturnal dyspnoea (breathlessness waking pt at night), orthopnoea (SOB lying down), acute SOB and wheezing (cardiac asthma), anxiety and perspiration, productive frothy/blood tinged cough

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12
Q

what might be the examination findings of somebody with Acute pulmonary odema

A

tachypnoic, tachycardia, gallop rhythm, raised JVP, peripheral circulatory shutdown, crackles/wheeze throughout chest

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13
Q

what might be the ABG findings in a patitent with acute pulmonary odema?

A

Initially, P02 and PCO2 fall due to overbreathing, later PCO2 increases beacuse of impaired gas exchange

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14
Q

what might be the chest xray findings in somebody with acute Pulmonary odema

A

diffuse haziness, kerley b lines (prominance of lobular septa), cardiomegaly, upper vessel enlargement, odema/pleural effusion

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15
Q

What may be the ECG findings in somebody with acute pulmonary odema

A

tachycardia/arhythmia/MI/ischaemia

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16
Q

What tests could be performed on a person with acute pulmonary odema?

A

ABG, U and E, FBC, glucose, d-dimer, CRP, CXR, ECG, cardiac enzymes to indicate infarction, Echocardiogram to indicate valvular cause/MI

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17
Q

what conditions may cause Acute pulmonary odema due to increased capillary permeability?

A

pneumonia, ARDS, toxins (chlorine/mustard gas), circulating toxins (histamine/septicaemia), renal failure, radiation

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18
Q

what conditions may cause Acute pulmonary odema due to increased capillary presure?

A

LHF due to atrial causes (mitral stenosis/longstanding regurge), ventricular causes (MI, IHD, Hypertension) or valve disease (aortic/mitral regurge/stenosis)

Aryhthmias, failure of prosthetic heart valve,VSD,Cardiomyopathy,-ve inotropic drugs (B-blockers), acute myocarditis, pericardial disease, pulmonary venous obstruction, IV fluid overload (eg blood transfusion)

Rarely Left atrial myxoma (none-cancerous tumour)

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19
Q

what conditions cause acute pulmonary odema due to reduction in plasma oncotic pressure?

A

Hypoalbuminaemia (nephrotic syndrome, cirrhosis)

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20
Q

what conditions cause acute pulmonary odema because of lymphatic obstruction?

A

Tumour, parasite infection

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21
Q

what other conditions cause acute pulmonary odema

A

pulmonary emboli, raised ICP (due to haemorrhage), pregnancy induced hypertension, high altitude, neurogenic (head injury), heroin OD

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22
Q

what interventions/medication should be given to somebody with acute pulmonary odema?

A

sit up to reduce pulmonary congestion, High flow O2, Nitrates (GTN iv/sublingual) titrated up every 10 mins to reduce preload, Loop diuretic (furosemide IV), morphine 10-20mg IV and metoclopramide 10mg IV (sedation, vasodilation) Aminophylline IV over 10 mins (bronchodilate, vasodilate, increase cardiac contractility. Only usually when bronchospasm present)

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23
Q

what are the most common causes of HF

A

IHD (30-40%), dilated cardiomyopathy (30%), Hypertension (15-20%)

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24
Q

What causes other than IHD dilated cardiomyopathy and Hypertension (15-20%) are there for HF

A

undilated cardiomyopathy, restrictive (amyloidosis/sarcoidosis), valvular heart disease (any), congenital (ASD/VSD), alcohol/drugs, chemo, hyperdynamic circulation (Paget’s, anaemia, thyrotoxicosis, haemocromatosis), pulmonary hypertension/Cor pulmonale (COPD), arrhythmias (AF, bradycardia, heart block), pericardial disease (pericarditis/effusion)

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25
In HF.... are released from the atria in response to atrial stretch. These act as physiological antagonists to the fluid conserving effect of aldosterone
In HF natriuretic peptides are released from the atria in response to atrial stretch. These act as physiological antagonists to the fluid conserving effect of aldosterone
26
In HF natriuretic peptides are released from the atria in response to .... These act as physiological antagonists to the fluid conserving effect of aldosterone
In HF natriuretic peptides are released from the atria in response to atrial stretch. These act as physiological antagonists to the fluid conserving effect of aldosterone
27
In HF natriuretic peptides are released from the atria in response to atrial stretch. These act as ....
In HF natriuretic peptides are released from the atria in response to atrial stretch. These act as physiological antagonists to the fluid conserving effect of aldosterone
28
clinical features LHF
fatigue, exertional dyspnoea, paroxysmal nocturnal dyspnoea (SOB waking up at night), orthopnoea, weight loss, cold peripheries, muscle wasting
29
Clinical features RHF
Fatigue, breathless, anorexia, nausea, symptoms of fluid retention (facial engorgement, pulsation in neck and face, odema up to sacrum and abdo wall, ascites)
30
what might be the clinical findings in a patient with HF
often few until late ventricular 3rd/4th heart sound, tachycardia (combined, gallop rhythm), mitral regurge (dilation of mitral annulus, ring in MV), crackles at lung base (BIbasal, end inspiratory), pulmonary odema if severe, cool peripheries, peripheral cyanosis, wheeze, raised JVP (R sided), RV heave (pulmonary hypertension), murmors of mitral/aortic valve disease, displaced apex beat, hepatomegaly, tender, smooth (pulsatile in tricuspid regurge), pitting odema,
31
what might be heard when auscultating a patient's lungs with heart failure?
crackles at lung base, end inspiratory, bibasal. wheeze
32
how might a patient's liver feel in a patient with HF?
tender, smooth, enlarged, pulsatile if tricuspid regurge
33
heart failure is unlikely if .... findings are normal. If either are abnormal then ..... is required to confirm
BNP and ECG echo
34
what might be the findings on a chest x-ray of somebody with HF?
cardiomegaly (>50% cardiothoracic ration), prominent veins in upper lobe, alveolar shadowing (batwings). pleural effusion, kerley B-lines
35
what would be the treatment of intractable (not responding to treatment) HF?
strict bed rest, metolazone (thiazide diuretic), IV furosemide, IV opiates and nitrates to relieve symptoms, daily weight and freq u and e's (beware hypokalemia), DVT prophylaxis (teds and enox), sometimes IV inotropes if needed, heart transplant as last resort
36
what might be the ECG findings in HF?
evidence of ischaemia/MI/ventricular hypertrophy
37
define the New York classifications of HF
1. disease present but normal exercise tolerance 2. Dyspnoea on ordinary activities 3. Limiting dyspnoea on less than ordinary activities 4. Dyspnoea at rest
38
explain the pathogenesis of infective causes of valve disease?
immune mediated inflammation/damage to valve cusps or damage by infection cause exposing of valve collagen, thrombus deposition, developing as nodules/warty growths called vegetations, collagenous scarring causing physical distortion to valve
39
aortic stenosis is most commonly caused by ....
aortic stenosis is most commonly caused by calcification of congenital bicuspid valve, scarring after rheumatic fever or senile calcification
40
.... is most commonly caused by calcification of congenital bicuspid valve, scarring after rheumatic fever or senile calcification
aortic stenosis is most commonly caused by calcification of congenital bicuspid valve, scarring after rheumatic fever or senile calcification
41
complications of .... might be LVH, angina and sudden death due to arhythmias
complications of aortic stenosis might be LVH, angina and sudden death due to arhythmias
42
complications of aortic stenosis might be....
complications of aortic stenosis might be LVH, angina and sudden death due to arhythmias
43
symptoms of aortic stenosis
often none until late progression, exercise induced syncope, angina, dyspnoea
44
examination findings of pt with aortic stenosis ....
small, slow rising carotid pulse, 4th heart sound, systolic thrill in aortic area, ejection systolic murmur, crescendo decrescendo in nature best heard in aortic area radiating to carotid arteries
45
examination findings in patient with ... small, slow rising carotid pulse, 4th heart sound, systolic thrill in aortic area, ejection systolic murmur, crescendo decrescendo in nature best heard in aortic area radiating to carotid arteries
aortic stenosis
46
main causes of ..... are retraction of cusps due to post-inflammatory scarring, erosion by infective endocarditis, retraction due to age related calcification, dilation of aortic wall ring and valve due to inflammatory diseases (eg syphilis, ankylosing spondylitis)
main causes of aortic regurge are retraction of cusps due to post-inflammatory scarring, erosion by infective endocarditis, retraction due to age related calcification, dilation of aortic wall ring and valve due to inflammatory diseases (eg syphilis, ankylosing spondylitis)
47
main causes of aortic regurge are......ankylosing spondylitis)
main causes of aortic regurge are retraction of cusps due to post-inflammatory scarring, erosion by infective endocarditis, retraction due to age related calcification, dilation of aortic wall ring and valve due to inflammatory diseases (eg syphilis, ankylosing spondylitis)
48
symptoms of aortic regurge are usually ......
symptoms of aortic regurge are usually nothing until LVF occurs, pounding of heart, angina pectoris, dyspnoea, uncommonly arrhythmias
49
symptoms of ..... are usually nothing until LVF occurs, pounding of heart, angina pectoris, dyspnoea, uncommonly arrhythmias
symptoms of aortic regurge are usually nothing until LVF occurs, pounding of heart, angina pectoris, dyspnoea, uncommonly arrhythmias
50
Examination findings in aortic regurge may be .....
Examination findings in aortic regurge may be bounding/collapsing pulse, quincke's sign (pulsation of capillaries in nail beds), De Mussett's sign (head nodding with each heartbeat), traube's sign (pistol shot sound over femorals), high pitched early diastolic murmor heard best on expiration lent forward
51
Examination findings in .... may be bounding/collapsing pulse, quincke's sign (pulsation of capillaries in nail beds), De Mussett's sign (head nodding with each heartbeat), traube's sign (pistol shot sound over femorals), high pitched early diastolic murmor heard best on expiration lent forward
Examination findings in aortic regurge may be bounding/collapsing pulse, quincke's sign (pulsation of capillaries in nail beds), De Mussett's sign (head nodding with each heartbeat), traube's sign (pistol shot sound over femorals), high pitched decrescendo early diastolic murmor heard best on expiration lent forward
52
Main causes of ....... are Post inflammatory scarring (rhematic), papillary dysfunction following infarct, LV dilation, infection, floppy mitral valve syndrome, congenital eg Marfan's Ehlers-Danlos
Main causes of mitral regurgitation are Post inflammatory scarring (rhematic), papillary dysfunction following infarct, LV dilation, infection, floppy mitral valve syndrome
53
Main causes of mitral regurgitation are........
Main causes of mitral regurgitation are Post inflammatory scarring (rhematic), papillary dysfunction following infarct, LV dilation, infection, floppy mitral valve syndrome, congenital eg Marfan's Ehlers-Danlos
54
symptoms of Mitral regurge are .....
symptoms of Mitral regurge are palpitations due to increased stroke volume, dsypnoea and orthopnoea due to pulmonary venous hypertension and LVF, fatigue/lethargy, symptoms of RHF later, subacute infective endocarditis, thromboembolism
55
symptoms of ...... are palpitations due to increased stroke volume, dsypnoea and orthopnoea due to pulmonary venous hypertension and LVF, fatigue/lethargy, symptoms of RHF later, subacute infective endocarditis, thromboembolism
symptoms of Mitral regurge are palpitations due to increased stroke volume, dsypnoea and orthopnoea due to pulmonary venous hypertension and LVF, fatigue/lethargy, symptoms of RHF later, subacute infective endocarditis, thromboembolism
56
examination findings in patients with mitral regurge may be .......
examination findings in patients with mitral regurge may be laterally displaced diffuse apex beat and systolic thrill, soft 1st heart sound, pansystolic murmor, 3rd heart sound in diastole, signs related to pulmonary hypertension and RHF
57
examination findings in patients with .... may be laterally displaced diffuse apex beat and systolic thrill, soft 1st heart sound, pansystolic murmor, 3rd heart sound in diastole, signs related to pulmonary hypertension and RHF
examination findings in patients with mitral regurge may be laterally displaced diffuse apex beat and systolic thrill, soft 1st heart sound, pansystolic murmor, 3rd heart sound in diastole, signs related to pulmonary hypertension and RHF
58
.... is caused most commonly by rheumatic fever (50%),
Mitral stenosis is caused most commonly by rheumatic fever (50%),
59
Mitral stenosis is caused .....
Mitral stenosis is caused most commonly by rheumatic fever (50%),
60
complications o..... include AF commonly, LA hypertrophy and dilatation, pulmonary hypertension and haemoptysis and development of LHF
complications of mitral stenosis include AF commonly, LA hypertrophy and dilatation, pulmonary hypertension and haemoptysis and development of LHF
61
complications of mitral stenosis include ......
complications of mitral stenosis include AF commonly, LA hypertrophy and dilatation, pulmonary hypertension and haemoptysis and development of LHF
62
symptoms of mitral stenosis include....
symptoms of mitral stenosis include often nothing until severe severe dyspnoea, haemoptysis, fatigue, weakness, signs of RHF, palpitations
63
symptoms of ..... include often nothing until severe severe dyspnoea, haemoptysis, fatigue, weakness, signs of RHF, palpitations
symptoms of mitral stenosis include often nothing until severe severe dyspnoea, haemoptysis, fatigue, weakness, signs of RHF
64
examination findings in pt with ....include small volume regular or later regularly irregular pulse, JVP increased, loud 1st heart sound and rumbling mid-diastolic murmor heard when on left side on expiration, parasternal left heave
examination findings in pt with mitral stenosis include small volume regular or later regularly irregular pulse, JVP increased, loud 1st heart sound and rumbling mid-diastolic murmor heard when on left side on expiration, parasternal left heave
65
examination findings in pt with mitral stenosis include ....
examination findings in pt with mitral stenosis include small volume regular or later regularly irregular pulse, JVP increased, loud 1st heart sound and rumbling mid-diastolic murmor heard when on left side on expiration, parasternal left heave
66
infective endocarditis more commonly affects the
left sided heart valves
67
.... is the most common organism causing infective endocarditis occuring in 30-50% of all cases
streptococcus viridans is the moost common organism causing infective endocarditis occuring in 30-50% of all cases
68
streptococcus viridans is the moost common organism causing infective endocarditis occuring in ..... of all cases
streptococcus viridans is the moost common organism causing infective endocarditis occuring in 30-50% of all cases
69
what might be the clinical findings in a pt with infective endocarditis
fever, changing/new heart murmur, microscopic haematuria, splenomegaly, oslers nodes (tender, red nodules), clubbing, janeway's lesions (painless palmar/plantar macules), splinter haemorrhages
70
which ECG leads look at the left lateral surface of the heart?
I, II, VL
71
Which ECG leads look at the inferior surface of the heart
III and VF
72
which ECG leads look at the RA
VR
73
ECG leads..... look at the Right ventricle
VI AND vII
74
ECG leads VI AND VII look at the.....
ECG leads VI AND VII look at the Right ventricle
75
ECG leads .... look at the septum and anterior wall of the L ventricle
ECG leads V3 AND V4 look at the septum and anterior wall of the L ventricle
76
ECG leads V3 AND V4 look at the .....
ECG leads V3 AND V4 look at the septum and anterior wall of the L ventricle
77
ECG leads ..... look at the left ventricle
ECG leads V5 AND V6 look at the left ventricle
78
ECG leads V5 AND V6 look at the ....
ECG leads V5 AND V6 look at the left ventricle
79
define 1st degree heart block. How will it show in an ECG?
each wave from the SA node is conducted to the ventricles but there is a delay. Prolonging of PR interval >0.22s(3-5 small squares), every depolaration is followed by ventricle depolarisation
80
Define 2nd degree heart block. How will it show in an ECG?
excitation fails to pass through the AV node/bundle of His intermittently. 3 variations. 1. Constant PR interval but occasionally atrial contraction without subsequent ventricular contraction (Mobitz type II) 2. Progressive lengthening of PR interval then failure of conduction of an atrial beat and repeating of the cycle (Wenckebach/Mobitz T1) 3. alternating conducted/not conducted beats (2:1 or 3:1)
81
what are the common causes of 1st/2nd degree heart block
coronary artery disease, acute rheumatic carditis, digoxin, electrolyte disturbances
82
Define 3rd degree heart block. How will it show in an ECG?
Normal atrial contraction but none conducted to ventricles, no consistency with PR intervals
83
what may cause 3rd degree heart block
acute consequence of MI or chronic due to fibrosis around bundle of His,blockage of both bundle branches
84
where are the most common veins to thrombolyse?
anterior/post tibial veins, perineal vein, superficial femoral vein, popliteal vein. Majority occur in deep veins in the leg
85
What are the risk factors for VTE
increased age, pregnancy, synthetic oestrogen, surgery (especially pelvic/orthopedic), previous DVT, malignancy, obesity, immobility, thrombophilia
86
Clinical features of DVT
pain in calf, swelling, red and engorged veins, warmer affected calf, ankle odema,
87
What are the differences between thrombophlebitis and a DVT?
Superficial thrombophlebitis causes a painful swelling along the course of the veins close to the surface of the skin. The pain may vary from moderate discomfort to a cramp-like pain. The pain gradually subsides over a period of one to two weeks, leaving hard clots that can be felt along the course of the veins.
88
why is D-Dimer not a brilliant diagnostic tool for DVT
sensitive but not specific, raised in many other conditions eg preganacy, post-op, malignancy
89
what bedside test can be done to investigate DVT? what will be the finding?
compression ultrasound, vein doesn't collapse on compression
90
what tests should be done on a pt with suspected dvt before commencing anticoagulant therapy if no predisposing factors to DVT?
thrombophilia tests
91
Risk factors for heart failure
disorder of the heart muscle (cardiomyopathy) that causes the heart to become weak congenital (present at birth) heart defects heart attack heart valve disease certain types of arrhythmias (irregular heart rhythms) high blood pressure emphysema (a lung disease) diabetes an overactive or underactive thyroid cancer treatments HIV/AIDS drug or alcohol use severe forms of anemia (a deficiency of red blood cells, which leads to a lack of oxygen to your tissues)
92
Causes right heart failure
Most commonly left failure, right ventricle infarction, massive pulmonary embolism, pulmonary hypertension and chronic obstructive pulmonary disease (COPD).
93
Causes cor pulmanae
Chronic obstructive pulmonary disease (COPD) Chronic blood clots in the lungs Cystic fibrosis Scarring of the lung tissue (interstitial lung disease) Severe curving of the upper part of the spine (kyphoscoliosis) Obstructive sleep apnea, in which pauses occur during breathing because of airway inflammation
94
Causes of hf
Systolic v diastolic. Systolic Ventricle not contracting properly causing reduced co, Ef less than 40%. IHD, MI, cardiomyopathy Diastolic inablity if ventricle to relax and fill, Ef>50%. Constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension Often both coexist
95
What are the signs of left sided hf
Dyspnoea, poor exercise tolerance, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough, pink frothy productive cough, wheeze, nocturia, cold peripheries, weight loss, muscle wasting
96
What are the signs of right sided heart failure
Causes lvf, peripheral odema, ascites, nausea, anorexia, epistaxis, pulsation in neck and face
97
What are the Framingham criteria for hf
At least 2 maj or 1 maj and 2 min Major paroxysmal nocturnal dyspnoea, crepitations, s3 gallop, cardiomegally, increased CVP, weight loss in response to treatment >4.5kg, neck vein distension, acute pulmonary odema, hepatojugukar reflux Minor bilateral ankle odema, dyspnoea on ordinary exertion, tachycardia >120, nocturnal cough, hepatomegally, pleural effusion
98
Treatment of hf chronic
``` Treat cause (eg arrythmia, valve disease) Treat exacerbating factors. Anaemia, infection thyroid hypertension Avoid exacerbating factors NSAIDs, verapamil, ``` Lifestyle reduce salt, stop smoking, weight Medical (diuretics, ace I, b blockers, spironolactone, digoxin, vasodilators) Palliative

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