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Cardiovascular > Conditions and Treatment > Flashcards

Conditions and Treatment Flashcards

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1
Q

Mitral Regurgitation

A

= backflow through the mitral valve
Clinical: dyspnoea, fatigue, AF, displaced hyperdynamic apex, RV heave, soft S1, split S2
Ix: ECG, ECHO (assess LV function)
Management: Rate control and anti-coagulate if AF, diuretics and surgery

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2
Q

Treatment: Native Valve endocarditis

A

Amoxicillin

Gentamicin

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3
Q

Type A Dissection

A

Ascending aorta is involved

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4
Q

Treatment of Constrictive Pericarditis

A

Complete pericardial resection

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5
Q

Hypertension Profile

A

Clinical: usually asymptomatic, features of end/organ damage, underlying causes
Ix: fasting glucose, cholesterol, 24-HR ambulatory blood pressure monitoring

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6
Q

Endocarditis Pathophysiology

A

= formation of a microbial vegetation upon the cardiac valves which can be friable - throwing off septic emboli

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7
Q

Aortic Reguritation

A

Clinical: exertional dyspnoea, orthopnoea, PND, syncope
SIGNS - collapsing pulse, wide pulse pressure
Ix: ECG, CXR, ECHO, cardiac catheterisation to assess severity
Management: reduce systolic hypertension and later ECHO

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8
Q

Cardiac Tamponade

A

= accumulation of pericardial fluid increases intrapericardial pressure
> poor ventricular filling > reduced cardiac output
Clinical: increased pulse, pulsus parodoxus, raised JVP, muffled heart sounds
Ix:
CXR - big globular heart
ECG - low voltage QRS, ECHO is diagnostic
Management: Drain

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9
Q

Mitral Stenosis

A

Clinical: symptoms usually when <2cm
Dyspnoea, fatigue, palpitations, chest pain
Ix: ECG, ECHO (diagnostic)
Management: Rate control (AF) and anti-coagulation, may need valve replacement or balloon valvuloplasty

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10
Q

Angina

A

= a result of myocardial ischaemia
Clinical: central chest tightness or heaviness on exertion
Causes: atheroma (from hypertension), hyperlipidaemia, smoking, diabetes
Ix: ECG (ST depression)

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11
Q

Hypertrophic Cardiomyopathy

A

= can result in left ventricular outflow tract obstruction
- Leading cause of sudden cardiac death: autosomal dominant inheritance
Clinical: sudden cardiac death, angina, dyspnoea, palpitation, syncope
Ix: ECG (LVH), ECHO (asymmetrical septal hypertrophy), cardiac catheterisation

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12
Q

Strep viridans (ENDOCARDITIS)

A

Dental treatment

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13
Q

Left Sided Heart Failure

A

Clinical: dyspnoea (on exertion), orthopnoea, PND, oedema, tachycardia, crepitations, pleural effusion, apex displacement
Ix:
CXR - cardiomegaly, interstitial fluid
ECHO (may give a cause) and bloods

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14
Q

Descriptor of Aortic Regurgitation

A

= high pitched early diastolic murmur (heard in expiration with patient sat forward)

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15
Q

Descriptor of Mitral Regurgitation

A

= pansystolic murmur of apex radiating to the axilla

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16
Q

Treatment of Ventricular Tachycardia (Chronic)

A

Revascularisation
ICD
Heart Failure Therapies
NOT anti-arrhythmic drugs

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17
Q

Atrial Septal Defect

A

= hole connects the atria
Clinical: atrial fib, raised JVP, pulmonary ejection systolic murmur, pulmonary hypertension
Ix: ECG (RBBB and prolonged PR interval), CXR, ECHO (diagnostic)
Treatment: closure

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18
Q

Management of Hypertension ( <55 years)

A
  1. ACE inhibitor
  2. ACEi/ARB and calcium channel blocker
  3. ACEi/ARB and calcium channel blocker and thiazide diuretic
  4. Add further diuretic or a-blocker/B-blocker
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19
Q

Management of Dilated Cardiomyopathy

A

Treatment for Heart Failure

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20
Q

Treatment of Atrial Flutter

A
  1. Radiofrequency ablation

- Warfarin to prevent thromboembolism

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21
Q

Treatment of Monomorphic Stable VT

A

IV procainamide
Sotalol
Amiodarone
Beta Blockers

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22
Q

Ostium Secondum

A
  • Hole occurs high in the septum

- Often asymptomatic until adulthood as the L>R shunt depends on ventricular compliance

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23
Q

ECG in Ischaemia

A
  • ST depression
  • T wave inversion
  • Hyper acute R waves
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24
Q

Treatment of Acute Pericarditis

A

Bed rest and NSAIDs

Colchine can be useful

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25
STEMI
Total occlusion of the artery
26
Claudication
= insufficient blood reaches the exercising muscle (felt in the legs usually)
27
Stroke
= acute onset of focal neurological symptoms and signs < disruption of blood supply - Can be ischaemic or haemorrhagic Causes: atherosclerosis, cardiac emboli Clinical: sudden vision loss, dizziness, difficulty swallowing, sudden headache, weakness in one arm, slurred speech Ix: CT and MRI
28
A 52-year old man with hypertension wakes up suddenly in the night feeling SOB, on examination he has bilateral basal crackles Treatment?
``` IV Furosemide (loop diuretic) Helps relieve the symptoms of shortness of breath due to acute peripheral oedema ```
29
Myocarditis
= inflammation of the myocardium Causes: idiopathic, viral, bacteria, drugs Clinical: fatigue, dyspnoea, chest pain, fever, palpitations, tachycardia Ix: ECG (ST T wave abnormalities), viral serology and PCR
30
Pulmonary Stenosis
= usually congenital Clinical: dyspnoea, fatigue, oedema, ascites, RV heave, ejection systolic murmur Ix: ECG, CXR, ECHO Management: pulmonary valvuloplasty
31
Treatment of Atrial Fibrillation (Rate Control)
Digoxin (when HF also) Beta Blockers Verapamil/diltiazem Adenosine
32
Tricuspid Regurgitation
Causes: functional, rheumatic fever, infective endocarditis Clinical: fatigue, hepatic pain, ascites, oedema, RV heave, pansystolic murmur Management: treat underlying cause
33
Restrictive Cardiomyopathy
Causes: idiopathic, amyloidosis, sarcoidosis Clinical: presents like constrictive pericarditis, features of RVF Ix: Cardiac catheterisation and treatment
34
Treatment of Ventricular Ectopics
Beta Blockers
35
Right Sided Heart Failure
Causes: LVF, pulmonary stenosis, lung disease Clinical: peripheral oedema, ascites, nausea, anorexia, elevated JVP, hepatomegaly Ix: Bloods, CXR, ECHO
36
Treatment of S.viridans endocarditis
Pencillin (or some form) e.g. benzylpenicillin | Gentamicin IV
37
Treatment of Ventricular Tachycardia (ACUTE)
! DC Cardioversion (defibrillation) | Adenosine
38
Treatment of S.aureus endocarditis
Flucloxacillin IV
39
Ventricular Septal Defect
= hole connects the ventricles Clinical: severe heart failure in infancy SMALLER - louder murmurs LARGER - pulmonary hypertension Ix: ECG, may see LVH, CXR (enlarged if big defect) Management: medical (may close spontaneously)
40
What treatments could you give in acute left sided heart failure?
Sit the patient up High flow oxygen (not in COPD) IV Diamorphine (not/careful in COPD) IV GTN (only if blood pressure not too low)
41
Treatment of terminal Congestive Heart Failure
Aim to use furosemide to reduce swelling - Thiazide and loop diuretic - Spironolactone could be used - B Blocker (if no hypotension) - Could use S-V instead of ACEI
42
If ACEi/ARB intolerant in heart failure
Hydralazine and Isosorbide Dinitrate
43
Ix for PAD
Bloods (exclude diabetes etc) Ankle brachial pressure index (ankle P/brachial P) CT/MRI angiography
44
Management of Chronic Heart Failure
``` Diuretics (loop) ACEi - left ventricular dysfunction B-Blockers - good in long term Spironolactone (decreases mortality) Digoxin ```
45
Management of Acute MI
``` Oxygen Morphine (anti-emetic) GTN sublingual Aspirin 300mg Clopidogrel (Thrombolysis or PCI) ```
46
Treatment of MRSA endocarditis
Vancomycin | Rifampicin
47
Treatment of Atrial Fibrillation (Rhythm Control)
``` Restore NSR - AADs e.g. amiodarone ! DC Cardioversion Maintain NSR - AADs - Catheter ablation of the atrial focus (pulmonary veins) - Surgery ```
48
Signs of Endocarditis
Fever Roth Spots Oslers nodes Murmur Janeway lesions Anaemia Nail Haemorrhages (splinter) Emboli
49
ACS (Conditions and Pathophysiology)
- Includes unstable angina and MI | Plaque rupture > Thrombosis > Inflammation
50
Management of Hypertrophic Cardiomyopathy
B-blockers or Verapamil
51
Pre-disposing factors for Endocarditis
Heart valve abnormality, congenital heart disease, post-rheumatic fever, IV drug users, prosthetic valve
52
Staph aureus (ENDOCARDITIS)
IV drug users (person who injects drugs)
53
Acute Pericarditis
= inflammation of the pericardium Can be idiopathic/2y to virsuses/bacteria Clinical: central chest pain, worse on inspiration, relief on sitting forward, pericardial rub Ix: saddle shaped ST elevation - may be normal, blood tests, cardiomegaly
54
Treatment of Enterococcus species
Amoxicillin/Vancomycin | Gentamicin IV
55
Abdominal Aortic Aneurysm
= artery with dilation >50% original diameter - True aneurysm involves all layers of the arterial wall RF: Fx, gender, age, smoking, vascular disease Clinical: can be asymptomatic RUPTURED - abdominal pain (radiates to back), collapse, exspansile abdominal mass, shocky Management: elective repair RUPTURED - cross clamp aorta, stent placement
56
Treatment of SVT
1. Valsalva manoeuvre (if haemodynamically stable) 2. IV Adenosine 3. DC cardioversion (if unstable)
57
Treatment of SVT (Chronic)
``` Avoid stimulants Radiofrequency ablation Anti-arrhythmic Drugs - Beta Blockers - Calcium Channel Blockers ```
58
Treatment of Sinus Bradycardia (Haemodynamic Compromise)
Pacing
59
A 45-year old woman complains of palpitations and investigation confirms the diagnosis of thyrotoxicosis and atrial fibrillations with ventricular rate of 110 per minute Treatment?
Bisoprolol | Useful for the rapid relief of thyrotixic symptoms e.g. AF
60
Managment of Ischaemic Stroke
Anticoagulant Vasodilator Statin
61
Treatment: Drug User endocarditis
Flucloxacillin IV
62
Aortic Dissection
= blood splits the aortic media Clinical: sudden chest pain, ripping/tearing, radiate to back, hemiplegia, unequal BP Management: Type A = surgery, Type B = medical CXR, ECG, CT/MRI (time permitting)
63
Treatment of PAD
Risk Factor modification | Percutaneous Transluminal Angioplasty (PTA) or surgical reconstruction
64
Enterococcus faecalis
Genito-Urinary Surgery
65
Cardiomegaly
Enlarged heart (compensating by getting bigger as cannot pump properly)
66
Aortic Stenosis
Clinical: elderly patient, chest pain, exertional dyspnoe or syncope SIGNS - slow rising pulse, heaving apex, LV heave Ix: ECG and ECHO (diagnostic) Management: usually surgery (prompt valve replacement)
67
NSTEMI
Non-complete occlusion of the artery
68
Management of Myocarditis
Bed rest and treatment of underlying cause
69
Treatment: Prosthetic Valve endocarditis
Vancomycin Gentamicin Rifampicin (usually also need valve replacement)
70
Classic description of VSD
Harsh pansystolic murmur heard at the left sternal edge with/without left parasternal heave
71
Treatment of Sinus Bradycardia
Isoprenaline
72
1st Line Investigation for AAA
Ultrasound
73
Subacute Presentation of Endocarditis
``` Fever Malaise Weight loss Tiredness Breathlessness ```
74
Dilated Cardiomyopathy
= dilated 'flabby' heart of unknown cause Seen in males more than females Clinical: fatigue, dyspnoea, pulmonary oedema, right ventricular failure Ix: serum BNP is sensitive and specific in diagnosing heart failure, CXR, ECG, ECHO
75
Galloping Rhythm
Third, fast heart sound (both the tachycardia and 3rd heart sound make it appear as 'galloping')
76
ECG findings of STEMI
ST elevation Hyperacute T waves New LBBB
77
Management of Hypertension (>55 years/black)
1. Calcium channel blocker or Thiazide diuretic 2. ACEi/ARB and thaizide diuretic OR ACEi/ARB and calcium channel blocker 3. ACEi/ARB and calcium channel blocker and thiazide diuretic 4. Add further diuretic or a-blocker/B-blocker
78
Descriptor of Mitral Stenosis
= mid-late diastolic murmur with loud S1 - Associated malar flush - Tapping non-displaced apex beat
79
Treatment of Sinus Bradycardia (Acute)
Atropine
80
Coarctation of the Aorta
= congenital narrowing of the descending aorta, just distal to the origin of left subclavian Assoc: bicuspid, Turner's syndrome Clinical: radiofemoral delay, weak femoral pulse, increased BP, systolic murmur Ix: CT or MRI angiogram Treatment: surgery (balloon dilation + stenting)
81
Ventricular Septal Perforation after MI
- Dead wall is necrotic, friable tissue | - Rupture happens due to the pressure created by the heart
82
Treatment of Sinus Tachycardia
Beta Blockers | Treat the underlying cause
83
Peripheral Arterial Disease Physiology and Features
= atherosclerosis causes stenosis of the arteries Clinical: cramping pain after walking, ulceration, paroxysmal foot pain, absent peripheral pulses, cold white legs, increased cap refill
84
Complications of MI
``` Arrhythmias Ventricular Septal Perforation Ischaemic Mitral Regurgitation Systemic Embolism Pericarditis Cardiogenic Shock ```
85
Treatment of SVT (ACUTE)
Vagal Manourvres e.g. carotid massage Adenosine Verapamil
86
Strep milleri (ENDOCARDITIS)
Prosthetic valves
87
Descriptor of Aortic Stenosis
= ejection systolic murmur with S4, radiates to carotids
88
Bicuspid Aortic Valve
- Work well, go unnoticed at birth | - Many eventually develop aortic stenosis/regurgitation
89
Management of Angina
Relief - GTN spray Prophylaxis - aspirin, B-blockers, long acting nitrates Surgery - bypass, PTCA
90
Fallot's Tetralogy
VSD Pulmonary Stenosis Right Ventricular Hypertrophy Overriding aorta
91
Normal person ejection fraction
~60% = blood that moves from the ventricle to the aorta
92
Staphylococcus epidermis endocarditis
Vancomycin and Gentamicin IV | Rifampicin PO
93
Management of Haemorrhagic Stroke
Evacuation of haematoma | Craniotomy
94
Constrictive Pericarditis
``` = heart enclosed in rigid pericardium Clinical: similar to RVF, raised JVP, diffuse apex beat, quiet heart sounds Ix: CXR - small heart ECHO/CT/MRI ```
95
Treatment of Hypertension (WHO?)
- All with BP >160/100 mmHg | - Those with BP >140/90 mmHg (dependent on risk)
96
Type B Dissection
Ascending aorta is not involved
97
Ostium Prium
- Associated with AV valve anomalies | - Present earlier in life
98
Large A waves
Tricuspid Stenosis Pulmonary Stenosis Pulmonary Hypertension
99
Cannon A waves
Ventricular Tachycardia
100
Absent A waves
Atrial Fibrillation
101
Giant V waves
Tricuspid regurgitation
102
The pulse is regular and jerky in character. The cardiac impulse is hyperdynamic and not displaced. There is a mid-systolic murmur with no ejection click, loudest at the left sternal edge
Hypertrophic Cardiomyopathy
103
SLE, verrucous vegetations
Libman-Sacks endocarditis
104
Signs of Tamponade
Hypotension Pulsus Paradoxus Quiet heart sounds High JVP that rises further on inspiration
105
Kussmaul's sign
JVP that rises further on inspiration
106
A 50-year old woman with breast cancer presents with breathlessness and collapse. She has a weak pulse 120/min, BP 90/40 mmHg Heart sounds are faint and QRS complexes are small
Pericardial Effusion with Tamponade
107
Right Ventricular Hypertrophy surface landmark
4th intercostal left parasternal area
108
Treatment of AF NPMH
Flecanide
109
Treatment of VT
Amiodarone
110
Treatment of VT related to Digoxin
Digibind
111
A 19-year old man comes to the clinic for review. His girlfriend is extremely worried about him as he has had a number of syncopal attacks over the past few months and has noticed some violent nightmares and thrashing about in bed. What is this? Treatment?
Brugada syndrome | Implantable cardiac defibrillator
112
Chronic Rheumatic Heart Disease
= result of untreated pharyngitis - subcutaneous nodules - involuntary movements of large joints MITRAL STENOSIS

Cardiovascular (7 decks)

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