... Flashcards
What shows on an IE ECG and why?
A new conduction disorder due to vegetation on the Bundle of his or purkinje fibres
Appears as Long PR (AV block) or broad QRS
What is non-infective endocarditis and what causes it?
Non-bacterial Thrombotic Endocarditis (NBTEC)
Fibrin-platelet vegetation due to disturbance of the valve endothelium
Electrodes/catherters - Degenerative - Local Inflammation - Rheumatic heart disease
When do you do surgery in endocarditis?
If complicated by:
- Uncontrolled Infection
- HF
- AV block
- Embolism
- PV dysfunction
- Leaflet Perforation
Risk factors for IE?
IVDA Immunocompromised (incl. Aids) Burns Prosthetic Valve Previous IE Old Male Diaebets Heart Disease Recent Surgery
What does a CXR show in IE?
Pulm. Abscesses and HF
What tests are done for IE?
CXR - ECHO ECG Urinalysis FBC - CRP - ESR - U&E Blood Culture
What are the duke criteria?
Major: 2 seperate +ve blood cultures Persistant +ve blood cultures \+ve culture for coxiella burnetti \+ ECHO New Murmur
Minor:
- Immunologic Signs
- Vascular Signs
- Microbiological evidence not worthy of Major score
- Pyrexia
- Predisposition (e.g. IVDA or Immunocompromised)
What tests are there for aortic dissection?
TOE
CXR (Effusion - Tamponade - Tracheal Deviates - Loss of Aortic Knob)
CTA/MRA
How do we treat takayasus arteritis and what consewuences are there of it?
Steroids and surgery
Neuro effects - Renal artery stenosis - Aortic stenosis - Aneurysm - Thrombosis
What are the clinical signs of a false aneurysm?
Thirll - Bruit - Pulsatile Mass
How does Varicose veins progress to CVI?
Gravity
- > Superficial venous reflux
- > Varicose Veins
- > deep veins acting as collateral circ.
That plus gravity again leads to CVI:
- > Deep venous reflux
- > Hypertensive Veins
- > Exudate
- > Inflammation
What re the symptoms of varicose veins?
Discomfort Red discolouration Nocturnal Cramps Oedema Pruritis
What causes constrictive pericarditis?
Post-Pericarditis
TB
Idiopathic
How does constrictive pericarditis present?
With Symptoms of RHF:
Fatigue - Dyspnoea - Malaise/Weakness
Raised JVP - Ascites - Peripheral Oedema - Hepatomegaly
How do we test for constrictive pericarditis?
ECHO
CXR -> CT/MRI
Cardiac Catherterisation
What causes Tamponade?
Aortic Dissection
Surgery
Warfarin
Pericarditis
How does tamponade present?
Low BP - High HR - Muffled Heart Sounds - Raised JVP
Dyspnoea - Cough - Central Chest Pain - Fatigue - Dizziness/syncope
How do we Diagnose tamponade?
Becks TRiad - Low BP/High JVP/Muffled Heart Sounds
ECG - Low Voltages
ECHO - Large pericardium and Collapsing ventricles
CXR - Large globular heart
Pericardiocentesis + PCR
What causes Acute Pericarditis?
Infection Rheumatic Heart Disease SLE Malignancy MI Idiopathic Trauma/Surgery
How does acute pericarditis present?
Central Chest Pain - Pericardial Rub and maybe Fever
How do we treat/investigate acute pericarditis?
Investigate: ECG - Saddle (concave) ST elevation CXR - ECHO Blood Cultures and Serology FBC - U&E - CRP - ESR Cardiac Enzymes e.g. cTn
What causes myocarditis?
Infection Autoimmune (e.g. Sarcoid, Rheumatic fever or SLE) Drugs incl. Chemo Cocaine Idiopathic
How does myocarditis present?
Chest Pain Dyspnoea Tachycardia/Tachypnoea Arthralgia Cyanosis Plus general infection symptoms if infection (Sore Throat - Malaise - Fatigue - Headache - Sweats/Chills)
How do we treat myocarditis?
Anti-biotics/Anti-fungals/IV Immunoglobulins as necessary
Nsaids/CCS
What investigations do we do for myocarditis?
Cardiac Enzymes (cTn) Echo MRI/Ct/CXR ECG Biopsy + PCR FBC incl. Antibody levels
How does sacubitril work and what do we use it for?
Inhibits Neprilysin allowing naturietic peptides to work
What tests are there for CHF?
Echo CXR ECG CT/MRI Stress Test FBC - BNP - LFT- RFT - TFT Biopsy Radionuclide Angiography
How does williams syndrome present?
Facies - Hypercalcaemia - aortic Stenosis
How does digeorge syndrome present?
PTA/VSD/Tetralogy
Cleft Palate - Hypothyroidism - Thymic Hypo/Aplasia - Abnormal Facies
How does Noonan/Costello syndromes present?
Pulm. stenosis - Cryptorchidism - Short - Face - Neck webbing
Costello (adds Thick skin folds and cardiomyopathy)
How do we treat long QT?
Class 1b anti-arrythmics - Lidocaine
K+ Supplements
What does a CXR show on Marfan’s?
Apical Blebs
How do we treat Marfan’s
Beta blocker + ARB to slow Sinus of valsalva dilation
Prophyllactic Surgery at 5.5cm or 5% a yr
How is Marfan’s Inherited?
Autosomal Dominant
How do we treat Sinus Bradycardia?
B1 agonist (Isoprenaline) Pacemaker
Whats the valsalva maneouver have to do with SVT?
Incrases Vagal Tone so terminates SVT
How do we test for Afib?
ECHO
ECG
Bloods especially TFT
How do we treat A fib?
Rate Control - Class 2,4,5 - Beta blocker, RL CCB & Digoxin
Rhythm Control:
Electrical - Defib
Chemical - Class 1c,3 - Flecainide & Amiodarone
How does HCM present?
Asymptomatic for a long time then:
Fatigue - Pain - Dyspnoea - Palpitations - Tachycardia - Presyncope - Arrythmias OE
Notched Pulse - Raised JVP - Systolic Murmur which is worse on valsalva maneuover
What tests do we do for RCM?
Biopsy - Amyloid and sarcoid
Serum Fe - Haemochromatosis
Echo - Biatrial enlargement and patchy fibrosis
CXR - Pulm Congestion (normal sized ehart)
MRI
ECG
What treatments are there for each Cardiomyopathy?
Heart Transplant
Treat Cause
Warfarin
ICD
Dilated:
= Reduce Strain - Bblocker/Spironolactone/Diuretic/ACEI
= Increase Contractility - Digoxin
Restrictive:
Reduce Strain - ACEI/Bblocker/Diuretic
Hypertrophic:
= Redcue Strain - Bblocker & Lower exercise
= Surgery on outgrowing septum (Myomectomy or Percutaneous Septal Ablation)
What causes RCM?
Amyloidosis Sarcoidosis Haemochromatosis Other firbosis (e.g. MI, Radiation, Idiopathic or Drugs) Diabetes Genetic Factor
Why might we implant an ICD in a cardiomyopathy?
To prevent Vfib
What do we call the PDA murmur?
A “machinery” murmur (also its ocntinuous)
In waht border is the cardiac notch found?
Anterior
