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CVS Flashcards

1
Q

Which murmurs would you expect to hear during systole?

A
  1. aortic stenosis
  2. mitral regurgitation
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2
Q

Which murmurs would you expect to hear during diastole?

A
  1. Aortic regurgitation
  2. mitral stenosis
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3
Q

How would you know if a murmur was systolic or diastolic?

A

Systolic -> occurs simultaneously with carotid pulse
Diastolic -> murmur occurs between carotid pulses

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4
Q

What are the symptoms of aortic stenosis?

A

SAD!
Syncope (exertional)
Angina
Dyspnoea

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5
Q

What are 3 causes of aortic stenosis?

A
  1. Congenital bicuspid valve
  2. degenerative calcification
  3. atherosclerosis
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6
Q

What would you hear on auscultation of someone with AS?

A

Ejection systolic murmur radiating to carotids
Louder on expiration
Silent S2

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7
Q

What is the management for aortic stenosis?

A

If asymptomatic -> manage conservatively with outpatient TTE every 1/2 years and safety netting r.e. dental hygiene and increased risk of IE

If symtpomatic -> aortic valve replacement/ TAVI

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8
Q

What would you expect to find on auscultation of someone with mitral regurgitation?

A

pansystolic murmur heard loudest over mitral area - radiating to axilla

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9
Q

What are 3 causes of mitral regurgitation?

A
  1. Infective endocarditis
  2. Acute MI
  3. Cardiomyopathy
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10
Q

What would you expect to find on auscultation of someone with aortic regurgitation?

A

Decrescendo early diastolic murmur heard loudest of left sternal edge

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11
Q

What would you expect to find on auscultation of someone with mitral stenosis?

A

low pitched, rumbling, mid-diastolic murmur heard loudest over apex

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12
Q

What would you expect to find on auscultation of someone with mitral stenosis?

A

low pitched, rumbling, mid-diastolic murmur heard loudest over apex

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13
Q

What signs might you expect to find in someone with aortic regurg? (2)

A
  1. waterhammer pulse
  2. wide pulse pressure
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14
Q

What ECG changes would you expect to see in someone with hypokalaemia?

A

U have no Pot and no T
but a long PR and a long QT
(u waves, small/absent T waves)

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15
Q

What ECG changes would you expect to see in someone with hyperkalaemia?

A
  • tall, tented T waves
  • broad QRS complexes
  • loss of P waves
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16
Q

Give 5 causes of RBBB

A
  1. normal variant (old peeps)
  2. RVH
  3. PE
  4. MI
  5. cor pulmonale
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17
Q

What is the main feature of bundle branch blocks on ECG?

A

Broad QRS (>120ms)

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18
Q

Which leads should you look at to identify bundle branch clock?

A

V1 and V6

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19
Q

How would you identify atrioventricular delay on an ECG?

A

PR interval >0.2 secs/ 5 small squares

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20
Q

You are handed an ECG which shows progressive prolongation of PR interval until eventually QRS complex is dropped. What does this suggest?

A

Second degree AV block (type 1)
- i.e. Mobitz type 1/Wenckebach

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21
Q

What is the difference between 1st and 3rd degree heart block?

A

1st = fixed PR interval
3rd = no relationship between A&V

22
Q

What would you see in an ECG of someone with Wolff Parkinson White syndrome? (3)

A
  • Short PR interval (<3 squares)
  • delta wave
  • tachycardia
23
Q

What medications should someone be started on post-MI?

A
  • ACE inhibitor (or ARB)
  • Dual antiplatelet therapy (aspirin + clopidogrel)
  • beta-blocker.
  • statin.
24
Q

What is the first line pharmacological treatment for angina?

A

ANTI-ANGINALS
- GTN spray
- Beta blocker OR calcium channel blocker

2 PREVENTION
- aspirin
- statin

25
What is the second line pharmacological treatment for angina?
1 - Increase dose of first line therapy 2 - Switch to either BB or CCB 3 - prescribe both CCB AND BB 4 - Long acting nitrate e.g. isosorbide mononitrate/nicorandil (max 2 drugs before referral to cardiology)
26
What is the first/second/third line drug therapy for chronic heart failure?
1 - ACE-i + Beta blocker (one at a time) 2 - Add aldosterone-antagonist e.g. spironolactone 3- Add SGLT-2 inhibitor e.g. canagliflozin 4 - specialist input (+loop diuretic for symptomatic relief! furosemide)
27
Other then main drug therapy, what additional care do chronic heart failure patients need?
- one off pneumococcal vaccine - annual flu vaccine - statin + aspirin - cardiac rehab - depression screen
28
What is the management for someone having a STEMI?
1 - oxygen ONLY if <94% 2 - 300mg aspirin 3 - Ticagrelor 4 - <12hrs + PCI in 120mins 5 - fibrinolysis if <12hrs and >120mins to PCI (+nitrates/morphine for pain)
29
What is the management for someone having an NSTEMI or unstable angina?
1 - aspirin 300mg 2 - fondaparinux 3 - calculate GRACE score (6m mortality) Low risk (<3%) = ticagrelor High risk = PCI + ticagrelor
30
A couple of hours post MI and pt is suddenly breathless and coughing up frothy pink sputum - cause?
Acute heart failure
31
How would Dressler's syndrome present?
2-4 weeks post MI with mild fever and pleuritic chest pain
32
Give 5 causes of acute pericarditis
- viral infections - post MI - connective tissue disease - malignancy - trauma
33
What symptoms/signs would you see in someone with acute pericarditis? (5)
- pleuritic chest pain, relieved on sitting forwards - non-productive cough - SOB - flu like symptoms - pericardial rub
34
What is Beck's triad and what does it indicate?
Cardiac tamponade - hypotension - muffled heart sounds - raised JVP
35
What would you find on ECG of someone with acute pericarditis?
WIDESPREAD saddle-shaped ST elevation AND PR depression
36
How would you investigate someone with suspected acute pericarditis?
transthoracic echo ! bloods - inflamm markers raised - troponin may be raised
37
How would you treat a pt with acute pericarditis?
can be managed as outpatients if T<38 and no raised trops - treat underlying cause - no strenuous activity until its resolved - NSAIDs and COLCHICINE
38
What are the typical features of acute limb ischaemia?
ACUTE ONSET Pain — constantly present and persistent. Pulseless — ankle pulses are always absent. Pallor (or cyanosis or mottling). Power loss or paralysis. Paraesthesia or reduced sensation or numbness. Perishing with cold.
39
What are features of intermittent claudication?
- intermittent, progressive cramp-like pain in the calf, thigh or buttock on walking which is RELIEVED BY RESTING
40
What are features of critical/chronic limb ischaemia?
1 or more of: - rest pain in foot for more than 2 weeks - ulceration - gangrene (patients hang leg out of bed to ease pain)
41
What is acute limb ischaemia?
rapid onset of ischaemia in a limb, typically due to a thrombus/embolism
42
What is critical limb ischaemia?
End-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest.
43
Describe a typical arterial ulcer (7)
Small Deep Well defined borders Have a “punched-out” appearance Occur peripherally (e.g., on the toes) Have reduced bleeding Are painful
44
Describe a typical venous ulcer (7)
-Occur after a minor injury to the leg -Large -Superficial -Have irregular, gently sloping borders -Affect the gaiter area of the leg (from the mid-calf down to the ankle) -Are less painful than arterial ulcers -Occur with other signs of chronic venous insufficiency (e.g., haemosiderin staining and venous eczema)
45
How would you investigate someone with peripheral arterial disease?
- handheld doppler - ABPI
46
How would you manage someone with acute limb ischaemia? (6)
1. A-E 2. NBM 3. 15L oxygen, morphine, fluids, ECG, ABG 4. HEPARIN bolus + infusion 5. tissue viability/doppler USS 6. angioplasty/embolectomy
47
Who gets a DOAC?
People with non-valvular AF for prevention of stroke and systemic embolism in adults CHADSVASC score of 2+ or men with score of 1+
48
Give 6 potential causes of new onset AF
PIRATES PE Ischaemia Resp disease Atrial enlargement Thyroid disease Ethanol Sepsis
49
How do you manage AF in someone with SOB/chest pain/tachy/hypotensive ?
ADMIT TO HOSPITAL - electro cardioversion - flecainide
50
How could you modify risk factors for bleeding in someone about to start a DOAC?
- Treat uncontrolled hypertension. - Get better control of INR in people taking a vitamin K antagonist. - Address harmful alcohol consumption. - Treat reversible causes of anaemia.
51
How would you manage new onset AF in a stable patient?
1 - Prescribe beta blocker OR rate limiting CCB 2- Calculate CHADSVASC and ORBIT score and discuss results with patient 2 - If CHADSVASC score >1 in men or >2 in women then prescribe DOAC 3 - if DOAC not suitable prescribe warfarin
52
What risk factors are involved in CHADSVASC scoring system?
CCF HTN Age>75 (2) Diabetes Stroke (prev or TIA) (2) Vascular disease Age>65 Sex = F

MEDICINE FINALS (19 decks)

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