CVS Flashcards

1
Q

Heart faliure - def, types, Sy, Ix, Mx acute, Mx chronic

A

D - CO inadequate for bodies requirements.

Types - Systolic (EF <40%) vs diastolic (EF >50%). Right, left and CCF.

Sy - Left - SOB, poor ex tolerance, fatigue, orthopnoea, PND, nocturnal cough, pink frothy sputum, wheeze, cold peripheries.
Right - peripheral oedema, ascites, nausea, anorexia, facial engorgement, epistaxis.

Ix - ECG, BNP, CXR, if abnormal echo.

Mx acute - sit upright, O2 if required, diamorphine IV (vasodil), furosemide 40-80mg IV, consider GTN. CPAP.

Mx - chronic - stop smokin, less salt, weightloss. Furosemide, add spironolactone if hypokal. ACEi, b-blocker, digoxin. Palliate.

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2
Q

HTN - Types, Ix, Mx

A

Types - Vast majority essential HTN (isolated systolic), also malignant HTN (rapid rise - headache, retinal haemorrhage, papilloedema - furosemide and labetalol), secondary HTN (renal/endocrine disease).

Ix - If >140/90 offer ABPM, if >180/110 start Mx immediately. If ABPM >135/85 treat.

Mx - If <55 ACEi(ramipril)/ARB(candesartan) if >55/black start CCB (nifedipine). If not controlled combine with other not taking. ADD thiazide-like diuretic (chlortalidone/idapemide). Add spironolactone. If RF or diabetes start on ACEi irrelevant of age.

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3
Q

Mitral stenosis - Sy, IX, Mx

A

Sy - SOB, fatigue, palpitations, chest pain. Malar flush on cheeks. Rumbling mid diastolic murmur. Most common murmur following RheumHD.

Ix - ECF - AF, P-mitrale (biphasic P - LA hypertrophy), RVH. Echo diagnostic.

Mx - Rate control and anticoagulate if AF. Balloon valvuloplasty.

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4
Q

Mitral prolapse/regurg - cause, Sy, Ix, Mx

A

Cause - prolapse=congenital, regurg=calcification in elderly.

Sy - atypical CP, palpitations, SOB. Si regurg pan systolic murmur, prolapse=mid systolic click/murmur.

Ix - ECG - AF, P-mitrale. Echo.

Mx - Rate control AF. Surgery if severe.

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5
Q

Aortic stenosis - Cause, sy, Ix, Mx

A

C - Senile calcification, congenital/rheum fever.

Sy - Triad = angina, syncope, HF. SOB, dizzyness. Slow rising pulse, narrow pulse pressure, heave, ESM rad to carotids.

Ix - ECG - P-mitrale, LV strain, LBBB. Echo diagnostic. DDX HCM.

Mx - Prognosis poor without surgery - TAVI or percutaneous valvuloplasty.

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6
Q

Hyperlipidaemia - Types, Sy, Ix, Mx

A

Types - Common primary (most common, rise in LDL only). Familial primary hyperlipidaemia (multiple subtypes, suspect if FH or chol >7 <30yo and >9 if older). Secondary - cushings, hypothyroidism.

Sy - xanthomata on elbows/knees, palmar/tendons, eyelids (xanthelasma) or cornea (arcus).

Ix - Screen with lipid profile those at risk of hyperlipidaemia (FH, corneal arcus, xanthomata) or risk of CVD.

Mx - statin if QRISK >10%/10yrs, atorvastatin 20mg first line. Familial - add fibrates, ezetimibe (inhibits chol absorption), PCSK9 inhibitor - alirocumab.

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7
Q

Pericarditis - Def, Sy, Ix, Mx, Perocardial effusion

A

D - Imflammation of the pericardium, idiopathic or due to viral/bacterial infection, Dressler’s syndrome (Ab against heart 2wks post MI), autoimmune.

Sy - Central chest pain worse on inspiration or lying flat, releived by sitting forward. May show effusion or tamponade.

Ix - ECG - PR depression, saddle shaped ST elevation, may be everywhere (unlike MI).

Mx - Ibuprofen, treat cause, colchicine/steroids/immunosuppressants.

Pericardial effusion - fluid accumulation due to pericarditis.
Sy - SOB, raised JVP, bronchial breathing at left base.
Ix - echo.
Mx - treat cause, pericardiocentesis.

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8
Q

Cardiac tamponade - Def, Sy, Ix, Mx

A

Def - effusion prevents filling and reduces CO.

Sy - tachy, hypotension, pulsus paradoxus, JVP, Kussmaul’s sign (paradoxical rise in JVP with insp). Becks triad - falling BP, rising JVP, muffled HS.

Ix - Echo. Low QRS on ECG.

Mx - pericardiocentesis.

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9
Q

Angina - Types, Sy, Ix, Mx

A

Types - Stable - induced by effort. Unstable - increasing frequency or severity, occurring on minimal exertion or rest.

Sy - Central chest tightness/heavyness, brought on by exertion releived by rest. Radiating to arms and neck, with SOB, nausea, sweatiness, also ppt by emotion, cold, heavy meals.

Ix - If unstable - ECG, cardiac enzymes. Stable - angiography, or funtional imaging (stress echo/MRI).

Mx - Lifestyle, all get aspirin, GTN and statin. Start CCB or b-blocker. If no response do both. Then add long acting nitrate and ref for PCI?CABG.

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10
Q

ACS - Def, Sy, Ix, Mx, complications

A

D - Syndrome of unstable angina, NSTEMI, STEMI.

Sy - Acute chest pain lasting 20m, nausea, sweatiness, SOB, palpitations. May present without pain - silent esp in diabetes/elderly.

Ix - ECG - tall T waves, ST elevation, new LBBB. V1-4 is LAD as anterior. V5-5, I AVL circumflex (also supply inferior if left dominant). II, III, AVL are inferior RCA. Also ST depression, T wave inversion. T wave inversion and path Q waves (>1/4 QRS) follow after days. Bloods - cardiac troponin.

Mx - 300mg aspirin and GTN, morphine and metaclopromide.
If STEMI PCI within 2hrs.
NSTEMI/UA - b-blocker, fondaparinux, ticagrelol/clopidogrel(if AF), GRACE score if moderate/high risk angiography/PCI within 72hrs.
CABG if left main stem disease, triple vessel disease.

Comp - Cardiac arrest, cardiogenic shock, bradycardia/heart block, tachyarrhythmias, HF, DVT?PE, pericarditis/tamponade - N.B Dresslers sy (recurrent pericarditis wks post MI).

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11
Q

Bradyarrhythmias - Cause, heart block types, Mx

A

Cause - drugs (b-blocker, digoxin), sick sinus syndrome (tachy and brady), hypothyroidism, heart block (AV node dysfunction).

First degree - long PR >5squares. No Mx/pace.
Second degree - Mobitz 1 (wenckebach) - PR increases at each QRS until there is a skipped P. Mx - pace if Sy.
Second degree - Mobitz 2 - ratio of P to QRS either 2:1 or 3:1. Mx - pace externally then lab.
Third degree - no relation between P and QRS. Mx - pace externally then lab.

Sick sinus syndrome - varying brady/arrest, heart block, SVT, AF. Mx - pace.

Mx - If asy and >40BPM nothing required. If rate <40 or sy give atropine up to 3mg and insert pacing wire. If no response to atropine transcutaneously pace until op.

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12
Q

AF - def, Cause, Sy, Ix, Acute Mx, Chronic Mx, Paroxysmal Mx

A

Def - Irregularly irregular atrial rhythm caused by rapid depolarisation. Flutter is constant depolarisation with sawtooth baseline on ECG, rate often 150BPM.

Cause - HF, MI, HTN, any major illness, hyperthyroid, caffeine, alcohol, post-op, hypokalaemia.

Sy - Asy or CP, palpitations, SOB, syncope. Irreg irreg pulse.

Ix - ECG - absent P waves, irregular QRS.

Acute Mx (if <48hrs onset) - If unstable emergency cardioversion (200J) or flecainide/amiodarone (if VHD), then anticoagulate for 4wks. If not treat cause, rate control with verapamil/bisoprolol, or digoxin/amiodarone. Anticoagulate with LMWH.

Chronic Mx (>48hrs) - Usually rate control and anticoag - b-blocker/verapamil, digoxin if sedentary. Start warfarin/NOAC based on CHADVASC and HASBLED.
Rhythm control - if young, symptomatic/CCF, first presentation. Do echo, pretreat with sotalol/amiodarone, cardiovert with flecainide, anticoagulate for 4wks.

Paroxysmal AF - pill in the pocket flecainide. Consider anticoagulating.

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13
Q

SVT - Def, Sy, Ix, Mx

A

Narrow complex tachy. Due to AF, atrial flutter, paroxysmal and WPW (congenital accessory pathways).

Sy - palpitations, SOB, CP, pre-syncope.

Ix - ECG - paroxysmal - absent P waves or inverted after QRS. WPW - delta wave (slurred upstroke of QRS).

Mx - Vagal manouvres (20ml syringe/carotid massage), IV adenosine 6,12,12. If nil improvement cardiovert. WPW refer to cardio for electrophysiology (invasive catheter do electrophysiology - locates pathways) and ablation.

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14
Q

Broad complex tachycardia - VF, VT, Torsade de pointes, Capture beats, Fusion beats

A

VT - broad complex tachy, no P waves. If pulseless or unstable defib. If stable emergency Mx - amiodarone and if fails defib. To diagnose you need to see:

  • Capture beats - normal beat gets through.
  • Fusion beats - VT and normal beat at the same time.

VF - Broad complex tachy with random squigles. DC cardiovert (360J).

Torsade de pointes - looks like VF but is a VF with a varying axis, if stable give magnesium sulphate, if not cardiovert

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15
Q

Hypertensive crisis - Def, Sy, Mx

A

Def - BP >180/110 with acute damage to target organs.

Sy - papilloedema or retinal haemorrhage, stroke, aortic dissection, pulmonary oedema, hypertensive encephalopathy, stroke, intracerebral or subarachnoid haemorrhage, eclampsia, RF.

Mx - promptly reduce BP e.g. labetalol/GTN. Severe HTN urgency (without end organ damage) should be managed more slowly with reduction over 1-2dys with labetalol/amlodipine.

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16
Q

Infective endocarditis - Path, sy, Ix, Mx

A

P - Strep viridians, staph aureus.

Sy - Fever (>1wk) and new murmur, esp if abnormal valves. Fever, rigors, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing, HF. Roth spots (retina), splinter haemorrhages, Janeway lesions, Osler nodes, emboli.

Ix - 3x cultures at different sites/times at peak of fever, echo. Duke criteria - major - cultures, vegetation on echo/new regurg, and minor - RF, fever, vascular Si, positive cultures not meeting criteria, positive echo not meeting criteria. Need 2 maj/1maj 3 min/all 5 min.

Mx - involve micro and cardio - e.g. IV amox and gent 4wks.

17
Q

Congenital heart diseasein adults - Bicuspid aortic valve, ASD, coarctation

A

Bicuspid - most eventually develop AS and are at higher risk of IE.

ASD - Ostium secundum defects most common and usually asy until adulthood with LR shunting causing SOB and HF with pul HTN. May also cause Eisenmenger’s sy (shunt reverses due to pul HTN) and paradoxical emboli (DVT causes stroke). Ix - RBBB and axis deviation. Mx - closure via catheter.

Coarctation - assoc with bicuspid AV and Turners. Si - radiofemoral delay, scapular bruit, HF, IE. Mx - surgery or balloon dilitation.

18
Q

Acute myocarditis - Cause, Sy, Ix, Mx

A

C - idiopathic, viral (flu, hep, mumps), bacterial - Lyme disease, drugs (herceptin, cyclophophamide, penicillin), toxins, vasculitis. Most common cause of sudden death in young.

Sy - Fatigue, SOB, pul oedema, fever palpitations, S4 gallop. HF.

Ix - ECG - ST elevation/depression, T wave inversion, SVT, block. Bloods - troponin without MI. Antimyosin scintigraphy (gamma scan) can confirm.

Mx - supportive, treat cause.

19
Q

Dilated cardiomyopathy - def, sy, Ix, Mx

A

D - dilated flabby heart associated with alcohol, HTN, viral infection, autoimmune, post-partum, X-linked.

Sy - fatigue, SOB, pul oedema, RVF, AF, VT.

Ix - BNP, echo - dilated hypokinetic heart with poor EF.

Mx - HF meds, pacing, ICD, transplant.

20
Q

Hypertrophic cardiomyopathy (HCM) - def, Sy, Ix, Mx

A

D - AD/sporadic outflow tract obstruction from asymmetrical septal hypertrophy. Leading cause of sudden cardiac death in young.

Sy - Sudden death, angina, SOB, palpitation, syncope, CCF.

Ix - echo.

Mx - b-blockers/verapamil, amiodarone for arrhythmias, anticoagulate for paroxysmal AF. Septal myotomy if severe Sy.

21
Q

Thoracic aortic dissection - Sy, Ix, Mx

A

Sy - Sudden tearing chest pain radiating to back. +- hemiplegia, unequal arm pulses/BP, limb ischaemia as occludes aortic vessels.

Ix - CTA - type A=includes ascending, type B=not including ascending.

Mx - Type A requires surgery, B may be dealt with medically. If ruptured and unstable - crossmatch, keep systolic 100-10- with labetolol, summon surgeon and warn theatre, give cefuroxime/metronidazole.

22
Q

Enoxaparin, fondaparinux - def

A

LMWH - activate antithrombin

23
Q

Dabigatran, rivaroxaban, apixaban - def

A

NOAC - direct Xa inhibitor. Dabigatran - direct thrombin inhib.

24
Q

Boerhaave’s syndrome

A

Perf oesophagus - recurrent vomiting followed by chest pain.