Block 2 - Cardiology Flashcards
Symptoms of left sided heart failure?
Orthopnea - increased venous return from lying down
Paroxysmal nocturnal dyspnea - increased venous return from edema reabsorption
Pulmonary edema
Symptoms of right sided heart failure?
Hepatomegaly - increased central venous pressure
Jugular venous distension - increased CVP
Peripheral edema
What are the side effects of ACEi?
Diarrhea
Muscle pain
Rabdomyolysis - break down of muscle
What virus causes spenomegaly?
EBV
What are the triad of symptoms of pyelonephritis
Fever
Pain at costo-vertebral junction
nausea or vomiting
Whats is POTS
Postural Orthostatic Tachycardic Syndrome
ALso known as syautonomia. Main symptom is widely variable blodd pressure and can lead to syncopy, dizziness etc. Is part of a wider ANS dysfunction syndrome.
Treatment: High salt intake of salt, stockings, Low dose ß blockers, avoid standing up for long times
What is cardio-renal syndrome?
Where both the heart and kidneys are dependent on each other. This is through:
Heamodynamic stability
Renal-cardiac connectors e.g: BNP and inflammatory markers
Treatment of acute heart failure?
Patient at 45° and O2
Morphine
ECG
FLurosemide
CXR and ABG
Nitrates if systolic > 100 mmHg
What is the advantage of morphine apart from pain relief.
Anxiolytic
Vasodilator with quick onset
How long does it take IV flurosemide to take effect?
20 mins
This is why morphine is given as a vasodilator first.
Triad of cogestive heart failure?
Ft - Ryan Bartar CT1
Raised JVP
Crepitations at lung bases
Ankle oedema
Symptoms and signs of Arotic stenosis?
Triad of heart failure, angina and sncopy
Patient experiences - Chest pain, exertional dyspnoea and syncopy
Signs - slow rising pulse, displaced apex and systolic ejection mumur ( and ejection click?)
Symptoms and signs of Mitral regurgitation?
Symptoms include dyspnoea fratigue and palpitations
Signs: AF, displaced apex, pansystolic murmur.
What is the anion gap?
[Na+] - ([Cl-] + [HCO3-])
> 17 confirms there is a metabolic acidosis
What are the causes for a raised anion gap?
KARMEL
Ketosis
Asprin (also paracetamol and other toxins)
Renal failure
Methanol
Ethylene Glycol
Lactate
When do you use Flecanide for cardioeversion?
No structural change or ischaemia (usually younger people) who are in AF
What is the treatments for SVT?
Adenosine - slows the heart rate
Has a half life of 8s
What can cause LBBB?
Digitalis intoxication
Hyperkalaemia
Hypertrophy
ischaemia
Aortic stenosis
What causes RBBB?
Hypertrophy/ Cor pulmonale
PE
Ischaemia
Myocarditis
Rheumatic heart disease
Artial septal defect
What is P pulmomale and what are its causes?
Right atrial hypertrophy due to portal hypertension.
Causes:
Chronic lung disease
Tricuspid stenosis
Congenital heart disease
What is P mitrale and what causes it?
Left artial hypertrophy.
Causes:
LV hypertrophy, Mitral stenosis
What features of a ECG indicate p pulmonale?
Peaked T waves in V1/2, II, III, AvF
What features of a ECG indicate p mitrale?
Bifid P waves
T wave > 40 ms
What feature on ECG indicates Hypokaleamia?
Porminant U wave
What feature on ECG can indicate Hyperkalaemia?
Peaked T waves
What types of AF are there?
First degree
Paroxysmal
Persistant
Perminant
What is the difference between paroxysmal and persistant AF?
Both have 2 or more episode however paroxysmal self terminate spontaneously where as persistant has to be cardioverted.
What is Dresslers syndrome?
Usually 2-6 weeks post MI.
Autoimmune attack on myocardium
What does the ECG image indicate
Digitalis toxicity. Usually acompinied by hypekalaemia, GI dystress arrythmias.
Digibindin is used as treatment.
What are SVTs and how are they treated?
Artrial tachycardia, Atrial flutter and Atrialventricular nodal ventrant tachycardias (AVNRT).
Haemodynamically stable use Carotid sinus masage and adenosine.
If haemodynamically unstable then try DC cardioeversion.
What qualifies someone as haemodynamically unstable?
HR
BP
Hypoxic
Heart failure
What criteria is used for heart failure?
Framingham Criteria
How is heart failure diagnosed using the Framingham Criteria?
2 Major symptoms
1 Major and 2 Minor symptoms
What are major symptoms of the Framingham Criteria?
SAW PANIC
S3
Acute pulmonary oedema
Weight loss
PND
Abdominal hepatic reflux
Neck dystension
Increased cardiac shadowing on CXR
Crackles on lung bases
What are minor symptoms of the Framingham Criteria?
HEARTVN
Hepatomegaly
Effusion
Ankle oedema bilaterally
exeRtional dyspnoea
Vital capactiy (1/3)
Nocturnal cough
What is the management of Torsades de pointes (haemodynamically stable)?
IV magnesium sulphate
