Block 2 - Cardiology Flashcards by Mark Brown

Symptoms of left sided heart failure?

Orthopnea - increased venous return from lying down

Paroxysmal nocturnal dyspnea - increased venous return from edema reabsorption

Pulmonary edema

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Symptoms of right sided heart failure?

Hepatomegaly - increased central venous pressure

Jugular venous distension - increased CVP

Peripheral edema

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What are the side effects of ACEi?

Diarrhea

Muscle pain

Rabdomyolysis - break down of muscle

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What virus causes spenomegaly?

EBV

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What are the triad of symptoms of pyelonephritis

Fever

Pain at costo-vertebral junction

nausea or vomiting

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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

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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

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Treatment of acute heart failure?

Patient at 45° and O2

Morphine

ECG

FLurosemide

CXR and ABG

Nitrates if systolic > 100 mmHg

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What is the advantage of morphine apart from pain relief.

Anxiolytic

Vasodilator with quick onset

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How long does it take IV flurosemide to take effect?

20 mins

This is why morphine is given as a vasodilator first.

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Triad of cogestive heart failure?

Ft - Ryan Bartar CT1

Raised JVP

Crepitations at lung bases

Ankle oedema

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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?)

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Symptoms and signs of Mitral regurgitation?

Symptoms include dyspnoea fratigue and palpitations

Signs: AF, displaced apex, pansystolic murmur.

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What is the anion gap?

[Na⁺] - ([Cl^-] + [HCO₃^-])

> 17 confirms there is a metabolic acidosis

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What are the causes for a raised anion gap?

KARMEL

Ketosis

Asprin (also paracetamol and other toxins)

Renal failure

Methanol

Ethylene Glycol

Lactate

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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

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** **A**cute pulmonary oedema **W**eight loss **P**ND **A**bdominal hepatic reflux **N**eck dystension **I**ncreased cardiac shadowing on CXR **C**rackles on lung bases

What are minor symptoms of the Framingham Criteria?

**HEARTVN** **H**epatomegaly **E**ffusion **A**nkle oedema bilaterally exe**R**tional dyspnoea **V**ital capactiy (1/3) **N**octurnal cough

What is the management of Torsades de pointes (haemodynamically stable)?

IV magnesium sulphate