Cardiovascular Conditions

Question 1

Define AR

Answer 1

Backflow of blood from aorta to LV due to insufficient valve in diastole

Question 2

Aetiology AR

Answer 2

Aortic valve dysfunction

• Infective endocarditis
• RHD
• Bicuspid Valve

Aortic dilatation

• Severe HT
• Aortitis

Question 3

Dsypnoea
Orthopnoea
Angina
Syncope

Water hammer pulse
Wide pulse pressure
Early diastolic murmur heard best over left sternal edge with pt sitting forward

Answer 3

Aortic Regurgitation

Question 4

Investigations AR

Answer 4

CXR

• Cardiomegaly
• Ascending aorta dilatation

ECG
- Signs of LVH

ECHO

• Doppler echo for diagnosis
• may show underlying cause

Cardiac catherterisation
- If uncertain about state of ventricle

Question 5

Define AS

Answer 5

Obstruction of blood flow across aortic valve due to pathological narrowing

Question 6

Aetiology AS

Answer 6

Senile calcification due to ageing
Rheumatic heard disease
Bicuspid valve (calcification)

Question 7

Angina
Syncope
HF symptoms

Narrow Pulse pressure
Slow rising pulse
Thrill in aortic area (palpable murmur)
Ejection systolic murmur at aortic area radiating to carotid

Answer 7

AS

Question 8

Investigations AS

Answer 8

ECHO
- Visualises structural changes of valve

ECG
- Signs of LVH

CXR
- Calcification of valve

Cardiac angiography
- allows differentiation from other angina causes

Question 9

Define MR

Answer 9

Backflow of blood from LV to LA due to mitral valve insufficiency

Question 10

Aetiology MR

Answer 10

Valve leaflet abnormality

• Mitral valve prolapse
• Infective endocarditis
• Connective tissue disorders (Ehler’s Danlos, Marfans)

Annulus issue

• LV dilatation
• RHD

Chordae tendinae/papillary muscle
- Damage of papillary muscle due to MI/IHD

Question 11

Exertional Dyspnoea
Maybe palpitations
Fatigue

Apex beat laterally displaces
Pan systolic murmur heard best at apex with radiation to axilla

Could be mid systolic click with late systolic murmur

Answer 11

MR

Question 12

Investigations MR

Answer 12

ECG
- May show AF/broad bifid P wave (LA dilation)

CXR

• LA enlargement
• Cardiomegaly
• Mitral valve calcificaiton

ECHO

Question 13

Define Mitral Stenosis

Answer 13

Obstruction of blood flow from LA to LV due to mitral valve narrowing

Question 14

Aetiology Mitral Stenosis

Answer 14

RHD

Question 15

Fatigue
SOB
Palpitations
Dyspnoea 
Hoarseness, dysphagia, bronchial obstruction

Peripheral cyanosis
Irregularly irregular pulse
Parasternal heave
Mid-diastolic murmur

Answer 15

Mitral Stenosis

Question 16

Investigations Mitral stenosis

Answer 16

ECG

• bifid p wave
• AF

CXR

• LA enlargement
• Cardiomegaly

ECHO

Cardiac catheterisation
- severity of HF

Question 17

Define rheumatic fever

Answer 17

Inflammatory multisystem disorder, following infection with group A beta haemolytic streptococci

Question 18

Aetiology rheumatic fever

Answer 18

Strep pharyngeal infection

Molecular mimicry to initiate tissue injury

Question 19

General

• fever
• malaise
• anorexia

Joints

• painful, swollen
• decreased movement

Cardiac

• breathlessness
• palpitations
• chest pain

Answer 19

Rheumatic fever

Question 20

Duckett Jones criteria

Answer 20

For assessing rheumatic fever

Question 21

Investigations rheumatic fever

Answer 21

Bloods

• inc WCC
• inc ESR/CRP
• inc antistretolysin O titre

Throat swab
- culture for GAS

ECG
- saddle shaped ST elevations

ECHO

• pericardial effusion
• myocardial thickening
• valvular dysfunction

Question 22

Define TR

Answer 22

backflow of blood from RV to RA

Question 23

Aetiology TR

Answer 23

Congenital - ebstein anomaly
Functional - RV dilatation
RHD
Infective endocarditis - common in IV drug users and PICC lines

Question 24

Fatigue 
breathlessness 
Palpitations 
headaches 
Nausea
Anorexia 
Epigastric pain worse with exercise 
Jaundice 
Lower limb swelling 

Irregularly irregualr pulse 
Inc JVP 
Parasternal heave 
Pansystolic murmur heard best at lower left sternal edge 
Pleural effusion 
Palpable liver 
Pitting oedema

Answer 24

TR

Question 25

Investigations TR

Answer 25

Bloods - FBC - LFT - Cardiac enzymes - Blood cultures ECG - p pulmonale (RA hypertrophy) CXR - right sided enlargement Echocardiography Right heard catheterisation

Question 26

Define IE

Answer 26

Infection of the intracardiac endocardial structures

Question 27

Aetiology IE

Answer 27

Common organisms - Streptococci - mainly S. viridans and S.bovis - Staphylococci - S. aureus and S.epidermis - Enterococci - E.faecalis - HACEK - Haemophilus - Acinobacter - Cardiobacterium - Ekinella - Kingella RISK FACTORS - Prosthetic heart valves - Abnormal valves - Recent dental work - IV drug use

Question 28

Fever Roth's Spots Oslers Nodes Murmurs ``` Janeway lesions Anaemia Nail - splinter haemorrhages Emboli Clubbing ```

Answer 28

Infective endocarditis

Question 29

Investigations IE

Answer 29

Blood cultures - 3 different sites at 3 different times Bloods - FBC --> inc neutrophils - Inc ESR/CRP - U&Es - Rheumatoid factor +ve Urinalysis - microscopic haematuria, proteinuria CXR - cardiomegaly - septic pulmonary emboli Echo - detection and visualisation of heart valves

Question 30

Management of Infective Endocarditis

Answer 30

Blind therapy of native valve: amox +/- gentamicin Blind therapy of prosthetic valve: vancomycin + gentamycin + rifampicin Streptococci: Benzylpenicillin & gentamicin Staphylococci: Flucloxacillin & Gentamicin Enterococci: Amox & gentamicin Culture -ve: Vancomycin & Gentamicin Surgery - valve replacement AB prophylaxis for anyone going high risk procedure with IE hx

Question 31

Complications of IE

Answer 31

``` Valve incompetence Intracardiac fistulae Aneurysm formation HF Renal failure Glomerulonephritis ```

Question 32

Define myocarditis

Answer 32

Inflammation (& necrosis) of cardiac muscle

Question 33

Aetiology myocarditis

Answer 33

Viruses - Coxsackie B - Echovirus - EBV - CMV - Adenovirus - Influenza Bacteria - Post-strep - TB - Dipthieria - Clostridia Fungal - Cadidiasis Protozoal - Trypanosomiasis Helmiths - Trichinosis Non infective - SLE, sarcoidosis Drugs

Question 34

``` Fever Malaise Fatigue Lethargy Breathlessness Palpitations Sharp chest pain ```

Answer 34

Myocarditis

Question 35

Define pericarditis

Answer 35

Inflammation of the pericardium

Question 36

Aetiology pericarditis

Answer 36

``` Idiopathic Infective - Coxsackie B - Echovirus - Mumps - Streptococci - Staphylococci ``` Connective tissue disease DRESSLER'S syndrome - months following acute MI Malignancy

Question 37

Sharp central chest pain, aggravated by deep inspiration. Pain relieved by sitting forward Fever Friction rub - best heard @ lower L sternal edge with pt leaning forwards Becks triad - inc JVP, dec BP, muffled heart sounds Tachycardia Pulsus paradoxus

Answer 37

Pericarditis

Question 38

``` Inc JVP with inspiration Pulsus paradoxus Hepatomegaly Ascites Oedema Pericardial knock AF ```

Answer 38

Constricitive Pericarditis

Question 39

Investigations Pericarditis

Answer 39

ECG - Widespread ST elevation with saddle shape ECHO - assess pericardial effusion and cardiac tamponade Bloods - FBC --> WCC - CRP/ESR - Cardiac enzymes (usually normal) CXR - GLobular shadowing if effusion - Pericardial calcification seen in constricitve pericarditis

Question 40

Management pericarditis

Answer 40

Acute - pericardiocentesis drainage Medical - treat underlying cause, NSAIDS for pain management Surgical - surgical excision of pericardium

Question 41

Complications pericarditis

Answer 41

Pericardial effusion Cardiac tamponade Cardiac arrhythmia

Question 42

Define arterial ulcer

Answer 42

Localised area of damage and breakdown of skin due to inadequate arterial blood supply

Question 43

Aetiology arterial ulcer

Answer 43

Lack of blood flow to capillary beds of lower extremities RISK FACTORS - CHD - Diabetes - Hx of Stroke - HT

Question 44

Seen at dorsum of foot or between toes Elliptical with clearly defined edges and base contains grey granulation edges NIGHT PAIN IN LEG Hairless skin Cold limb Absent pulse Wasting of calf muscles

Answer 44

Arterial ulcer

Question 45

Investigations for arterial ulcer

Answer 45

``` Duplex USS ABPI - measure difference between BP in arm and leg ECG Lipids, blood glucose and HbA1c FBC - anaemia can worsen ischaemia ```