Week 5 Cardio Flashcards

Question

Endocarditis

Answer 1

Infection of endocardial surface of valves Causes: damaged valve due to previous endocarditis, rheumtic valve disease, degeneration, prosthetic valve Pathophysiology: Platelets and fibrin attached to surface of damaged heart valves producing a sterile thrombotc endocarditis. Bacteria adhere to lesions and start an inflammtory response leading to more fibrin depsotion and **vegetations**. Leads to **valve damage** Vegetations can embolise to spleen, kidney, brain

Answer 2

Native valve endocarditis (NVE) - strep. **viridans** IVDU - staph. **aureus**, gram -ve, fungi Prosthetic valve endocarditis (PVE) - Staph **Epidermis** (**CoNS**), gram -ve, fungi Strep. viridans: **indolent** Staph. aureus, gram -ve, fungal: **acute**

Answer 3

Most pts have valve abnormalities (55-75%): Aortic stenosis, Mitral valve prolapse (MVP) IVDU 30% no identifiable risk

Answer 4

Calification due to age Calcification due to congenital abnormality Rheumatic fever - Strep. Pyogenes infection. - Releases streptolysin O exotoxin - Anti-Streptolysin O antibodies produces to fight streptolysin - Cardiac valves have simiar structure to toxin, so antibodies attack cardiac valves - Stenosis and regurgitation

Answer 5

**Acute:** Toxic presentation Progressive valve damage, metastatic infection Staph. aureus **Subacute:** Mild toxicity Presentation indolent Metastatic infection rare S. viridans, enterococcus

Answer 6

Split into Early, Embolic, Late **Early:** Incubation period 2 weeks Faitgue, malaise Fever+ mumur = IE until proven otherwise **Embolic** Small: splinter haemorrhages, petichiae Large: stroke Righ sided Endocarditis (triscuspid - more common in IVDU) - septic emboli **Late** Immunological: Osler's nodes, finger clubbing, splenomegaly Valve damage, absccess FROMJANE **F**ever, **R**oth spots, **O**sler's nodes, **M**urmur, **J**aneway lesions, **A**naemia, **N**ail bed (splinter haemorrhages), septic **E**mboli

Answer 7

Bacteria: - Coxiella Burnetti **Gram +ve** - Staphylococci: CoNS (epidermis), staph. aureus - Streptococci: strep. viridans, enterococci **Gram -ve** Coliforms e.g. E.coli Psuedomonas Aeruginosa HACEK **Fungal** Candida

Answer 8

FBC, UEs, LFTs, urinalysis (haematuria, proteinuria), CXR, blood cultures **Transthoracic echocardiogram** Non-invasive Transducer in front of chest Sensitivity 50% **Transoesopheageal echocardiogram** Invasive Transducer in oesophagus, requires sedation Sensitivity 80-100%

Answer 9

Major: 2 positive blood cultures, typical organisms Positive echo Minor: Fever \>38 Vascular phenomenon e.g. septic emboli Immunological phenomenon e.g. Osler's nodes Risk factor e.g. heart disease, IVDU Positive blood cultures

Answer 10

Native: IV Amox, Flucox, Gent Prosthetic: IV Vanc + Gent Streptococcus: IV Benzyl + Gent Enterococcus: IV Amox + Gent Staph aureus MSSA: IV Flucox + Gent MRSA: IV Vanc + Gent CoNS: IV Vanc + Gent +/- Rifampicin

Answer 11

Angioedema

Answer 12

Re-entry of circuit using extra electrical pathway, either in AV node or between atrium and ventricle. Electrical activity passes through normal conduction pathway, can conduct back from ventricle to atrium. Initiates circus movement.

Answer 13

Decreased blood flow to heart leading to cardiac necrosis Symptoms: Central crushing chest pain, radiates to jaw/back, SOB, sweatiness, "impending sense of doom" Signs: Tachycardia, Raised JVP, arrythmia, shock Diagnosis: History of ischaemic type chest pain ECG changes Rise in troponin I or T

Answer 14

Type 1: due to primary coronary event e.g. coronary plaque rupture Type 2: increaed O2 demand e.g. HF, sepsis Type 3: sudden cardiac death Difference between type 1 and 2: Type 1: narrowing due to athersclerotic plaque and rupture Type 2: narrowing not due to blood clot, or no narrowing

Answer 15

Aortic aneursym Pericarditis Anxiety PE Oesophageal rupture

Answer 16

ECG CXR Troponin I or T (arises 6-12 hours after chest pain)

Answer 17

ST elevation T wave inversion Q wave (if there is transmural infarction) - marker of ongoing or old MI

Answer 18

STEMI: Acute, total thrombotic occlusion of coronary artery leading to transmural infarction, unless artery opened. ECG shows ST elevation, troponin increased NSTEMI: Acute partial thrombotic occlusion of coronary artery. ECG may show ST depression. Troponin increased. Thrombolytic therapy not beneficial. Unstable angina: Acute coronary event (clinical presentation MI + ECG changes or narrowing on cardio angiography), but no increase in troponin. Investigated with exercise testing, coronary angiography.

Answer 19

Anterior STEMI ST elevation in V1-V4 Reciprocal depression in inferior leads (II, III, avF)

Answer 20

High lateral STEMI ST elevation in I, avL Reciprocal depression in inferior leads (II, III, avF) Lateral: i, avL, V5, V6 pics of different morphology of ST elevations

Answer 21

Inferior STEMI ST elevation in inferior leads (II, III, avF) ST depression in high lateral (I, avL)

Answer 22

Left circumflex (mostly) or RCA Reciprocal depression in anterior leads (V1-4) Subtle elevation in inferior and lateral leads

Answer 23

New onset LBBB - infarction Old LBBB - can cover ST elevation Broad QRS (more than 3 squares (120ms)) in Lead I WiLLiaM W in V1 M in V6

Answer 24

ABCD (MOHACT) **M**orphine, Metoclopramide (anti-emetic) **O2** if \<94% sats Unfractionated **h**eparin **A**nti-platelets: aspirin, Clopidogrel (in ambulance) Tricegalor (hospital)

Answer 25

PCI (primary cutaneous intervention) - Improves survival, reduces strokes, speeds up recovery than thromobolytics Risks: vascular damage, stroke If takes more than 90 mins from call to balloon/journey time 40 mins: Thrombolytics Tenecteplase (tissue plasminogen activator) Risks: haemorrhagic stroke, bleeding Contra-indications: previous stroke, GI bleeding, bleeding disorders Diabetic retinopathy not a contra-indication Heparin

Answer 26

BASAT(E) **B**-blockers (Bisoprol) **A**CEi (Ramipril) **S**tatins **A**spirin **T**icagrelor (reversibly blocks ADP receptors of P2Y12(protein involved in platelet aggregration) **E**plerenone - for diabetics, LVSD (left ventricular systolic dysfunction), HF

Answer 27

VT Bradycardia (treat with atropine) AF HF Cardiogenic shock Pericarditis

Answer 28

Smoking cessation Diet Exercise Driving - should not drive for a week Work - aim back 1-2 months Rehabilitation classes

Answer 29

LMW**H** **A**spirin **C**lopidogrel Secondary prevention: ACEi BBlockers Statins Eplerenone (only for diabetics, LVSD, HF) Risk assessment: GRACE score: \>140 - urgent inpatient angiogram

Answer 30

Flu-like symptoms, chest pain worse on inspiration ECG changes: Non specific ST elevation No reciprocal change PR depression Concave ST elevation "saddle back)

Answer 31

Aortic valve: Opens when systolic pressure in LV exceeds end-diastolic pressure in aorta, and closes when pressure falls Narrowing of aortic valve orifice Causes: Calcification (due to wear and tear), thickening, rheumatic valve diesease, congenital e.g. bicuspid Symptoms: Chest pain, SOB, syncope, LV hypertrophy (due to pressure overload) Complications: heart failure, sudden death

Answer 32

Blood flows back to LV from aorta during diastole Symptoms: SOB, reduced capacity for exercise, LV dilatation (due to volume overload) - LV dimesion main indicator of severity Signs: collpasing pulse, displaced apex beat, pulsatile nail bed circulation, head nodding Causes: Degeneration, rheumatic valve disease, Marfan's syndrome, endocarditis

Answer 33

Stenosis: pressure overload Regurgitation: volume overload

Answer 34

Mitral valve: 2 leaflets Opens when pressure in LA exceeds LV pressure during diastole Closes when pressure in LV exceeds LA, during ventricular systole. Stenosis: Narrowing of mitral valve orifice Causes: Rheumatic valve disease (affects mitral valves more), pressure overload Can lead to pulmonary hypertension, AF (as LA dilates) Symptoms: SOB, palpitations, right sided heart failure symptoms

Answer 35

Blood flows from LV to LA during systole Causes: Rheumatic valve disease, LV dilation (pulls leaflets apart), endocarditis Can lead to: Pulmonary hypertension (due to volume overload in LA), and AF (as LA is dilated - affects SA node conduction) Symptoms: SOB, palpitations, right sided heart failure symptoms

Answer 36

History, exam BP ECG Exericise tolerance test Echo Doppler echo Cardioangiography (for surgeon to know if they need to do a coronary artery bypass as well as replacement)

Answer 37

Surgical: Repair - Valvuloplasty Replacement - mechanical or tissue (porcine) - mechanical lasts longer but reuiqres anti-coagulation for life Procedural: TAVI (transcatheter aortic valve implantation/replacement) Mitral clip

Answer 38

Aortic stenosis: low pitched ejection systolic (crescendo-decrescendo) murmur - Best heard in aortic area (2nd intercostal space right) radiates into neck Aortic regurgitation: high pitched (blowing) early diastolic (as when pressure in LV is below aorta) - Best heard at left sternal edge, with pt sitting forward Mitral stenosis: Low pitched (rumbling) mid diastolic - Best heard at apex, with pt lying on left side Mitral regurgitation: High pitched pan-systolic - Best heard at apex, radiates to axilla Pulm stenosis: soft ejection systolic mumur in pulmonary area Pulm regurg: soft early diastolic murmur in pulmonary area Tricuspid stenosis: diastolic murmur at left sternal edge Tricuspid regurg: soft high pitched pan-systolic at left sternal edge, increased during insp

Answer 39

Thrombus (can occur at site of pre-exsisting atheromatous plaque, in pt with PVD) Embolism (from another source. More likely in pt with no history PVD)

Answer 40

FBC Fasting blood glucose Lipid profile ECG Aortograms

Answer 41

Immediate: Analgeisa, IV heparin Long-term: Aspirin, antihypertensives (not BBlockers) Lifestyle Statins

Answer 42

Cornoary artery - MI Carotid artery - stroke Renal arteries - hypertension, if bilateral - renal failure

Answer 43

Six Ps: Pale Painful Pulseless Paresis (weak) Perishingly cold Parasthesia (tingling sensation)

Answer 44

Pain in leg from brought on from walking, and stops on rest Commonly in calf Benign symptom but indicator of widspread vascular disease

Answer 45

Imaging (although no point if not going to treat e.g. thrombolysis, angioplasty - balloon to stretch artery) - MRI, CT angiography, arteriography Medical: Treat HTN, avoid BBlockers, weight loss

Answer 46

Loss of sensation Muscle tenderness

Answer 47

**First degree heart block:** PR interval \>200ms **Second degree:** Mobitz type 1: PR interval progressivly longer, with dropped beats. Regularly, irregular. Mobitz type 2: dropped beats with no change in length of PR interval. Often needs pacemaker. Can lead to 3rd degree heart block. Third degree: Atria and ventricular depol indenpdent of each other, so p and QRS not assoc. with each other. Requires pacemaker. Can be caused by Lyme disease.

Answer 48

Before antibiotics Asetptic technique 3 bottles 10ml, 1st and last at elast 1 hour apart Taken from peripheral veins

Answer 49

Pts with Staph. aureus bacteraemia IVDU with positve blood cultures Prosthetic valve with postive blood cultures

Answer 50

Normal: -30 to +90 Right axis deviation (+90 - +180) Causes: Right ventriuclar hypertrophy, COPD Left axis deviation (- 30 to -90) Causes: Left ventricular hypertrophy, LBBB Look at leads **I** and **aVF** **Normal**: Lead I: **positive**, avF: **positive** **RAD**: Lead I: **negative**, avF: **positive** **LAD**: Lead I: **postive**, avF: **negative** **Extreme LAD**: Lead I: **negative**, avF: **negative**

Answer 51

RA: broad LA: narrow, long RV: trabeculated endocardium, insertion of chordae tendinae to intraventricular septum LV: smooth endocardium, ellipsoid cavity

Answer 52

Types: Secundum (common), primum Secundum ASD: Septa between right and left atria, causing left to right shunt Examination: Pulmonary flow murmur, split S2 ascultation (as more volume in right side of heart, will delay pulmonary valve closure) Lead to: RV failure, pulmonary hypertension, Eisenmenger syndrome (left to right shunt causes pulmonary hypertension)

Answer 53

Narrowing of aorta, usually where ductus arteriosus inserts Pre-ductal: lower limb cyanosis Post-ductal:upper body hypertension, berry aneurysms, rib notching in adults Different BP in arms and legs

Answer 54

1. Ventricular septal defect 2. Overiding aorta 3. RVOT (riht ventricular outflow tract) obstruction 4. Right ventricular hypertrophy Boot shaped heart on XR

Answer 55

Aorta and pulmonary artery swaps So pulm a. comes off LV goes back to LA Aorta comes off RV goes back to RA Treatment: Arterial swtich Atrial switch

Answer 56

Only one functioning ventricle Causes: tricuspid atresia Treatment: Fontan circulation - Pulmonary valve and artery disconnected with ventricle - IVC and SVC connected to pulmonary arteries, bypassing heart As pulmonary circ relies on high systemic venous pressure, low pulm vascular resistance, anything that causes an imbalance can cause haemodynamic compromise e.g. PE, bleeding

Answer 57

Formen ovale: RA to LA - allows bypass of RV and pulm artery (as lungs aren't formed properly so resistance in pulm a. is high) Of blood pumped into RV and pulm a., most passes to aorta via ductus arteriosus Patent ductus arteriosus: PA to aorta

Answer 58

CHF Stroke Systemic emboli

Answer 59

PR interval: less than 1 big box, \<200ms QTS \< 3 small squares, \<120 ms

Week 5 Cardio Flashcards

(87 cards)