AS PACES Cardio Flashcards
DDx Cardiac clubbing
Congenital Cyanotic Heart Disease (FoF, TGV)
Atrial Myxoma
Subacute bacterial endocarditis
Takayasu’s arteritis
“Pulseless arteritis”
Heart sounds
S1 - mitral
S2 - aortic
S3 - rapid ventricular filling of dilated LV
S4 - atrial contraction against stiff ventricle
AS - clinical symptoms and prognosis
Angina - 50% at 5 years
Syncope - 50% in 3 years
Dyspnoea - 50% in 2 years
Echo features of severe AS
Valve area <1cm
Pressure gradient >40mmHg
Jet velocity >4m/s
AR - signs (eponymous)
Quincke’s - capillary pulsation
Corrigan’s - vigorous carotic pulsation
De Musset’s - head bobbing
Muller’s - uvula pulsation
Traube’s - pistol shot sound over femora’s
Durozier’s - systolic murmur over femoral artery on proximal compressions
Rosenbach’s - systolic pulsations of the liver
Causes AR
Bicuspid AV Rheumatic HD AI - Ank Spond, RA CTD - Marfan's, Ehler's Danlos (if acute think IE, type A aortic dissection)
Echo features of AR
Jet width (>65% outflow tract = severe)
Regurgitant jet volume
Premature closing of mitral valve
Mitral Stenosis - cause for malar flush
CO –> backpressure + vasoconstriction
Mitral Stenosis - causes and echo features of severe disease
Rheumatic heart disease, prosthetic valve
Valve orifice <1cm; pressure gradient >10mmHg, pulmonary artery systolic pressure >50mmHg
Mitral stenosis - treatment
Medical - optimise RF
Surgical - in mod/sev AS, percutaneous balloon valvuloplasty, valvotomy, replacement if repair not possible
Pathophysiology of rheumatic fever
Ab X reacting following Group A S. pyogenes, molecular mimicry. Myosin, muscle glycogen and SM cells. Path: aschoff bodies and anitschkow myocytes
Rheumatic fever - Jones Criteria
GAS infection + 2 major or 1 major and 2 minor
Major - pancarditis, arthritis, subcut nodules, erythema marginatum, sydenham’s chorea
Minor - fever, ESR/CRP, arthralgia, prolonged PR, Hx rheumatic fever
Rheumatic fever - management
Bed rest until CRP normal BenPen 0.6-1.2mg IM for 10 days Analgesia - NSAIDs ± Oral Prednisolone if CCF, CM, Chorea - diazepam
IE - Dukes criteria
2 major; 1 major + 3 minor; all 5 minor
Major: Positive cultures, endocardial involvement - new murmur, vegetation
Minor: predisposition (IVDU, cardiac lesion), fever >38, emboli (septic infarcts, splinters), immune (GM, roth spots, RF), positive blood culture not meeting criteria
Types of valve replacements
Ball and cage, tilting disc, bileaflet, porcine valves, bovine valves
Biological are less durable (±10years) but do not require long term anti coagulation
Complications of valve replacement
TE: 1-2% per annum even on warfarin Anaemia: warfarin and haemolysis Bleeding IE Failure
Atrial fibrillation - management
Acute <48hrs, if unstable DC cardioversion, if stable: rate, LMWH, cardiovert (DC, fled or amiodarone)
Paroxysmal - pill in pocket (flecainide or amiodarone), prevention (BB)
Persistant - rhythm: treat precipitant, 3wks warfarin then DC/medical. Rate: BB, rate limiting CCD, 2nd line digoxin
AF - scores
CHADVASC - determines necessity of anticoagulation in AF
HASBLED - determines risk of bleeding if anti coagulated
ABCD2 score - after TIA what is the risk of CVA
Pacemaker - indications
HB - Mobitz T2, Complete
Symptomatic bradycardia - sick sinus syndrome
Drug resistant tachyarrythmias
BV pacing in CHF
Pacemaker - letters
1 - chamber paced (AVD)
2 - chamber sensed (AVD)
3 - response (Inhibited, Triggered, Dual)
Medical management of CCF
1st - BB + ACEi + loop diuretic
2nd - Add spironolactone (or epleranone)
3rd - Digoxin
4th - Cardiac resynchronisation therapy
