cardiac Flashcards
perdiarditis what is it, what causes it.
sharp constant sternal pain, relieved by leaning foreward.
L arm pain, worsened by lying on left side. - radiation to trap ridge is specific sign.
inflammatory pericardial condition +/- peridardial effusion
80-90% idiopathic- probably viral
bacterial- extension of pneumonia- pneumacoccus/ TB.
post MI- early- transmural necrosis- late- dresslers syndrome.
trauma
SLE is common- 40% of sle pts will get it at some point.
drug -isonizaid
signs and symptoms- ix, mx of acute pericarditis
pericardial friction rub 1/3 of cases
need 2 of the 4
characteristic chest pain
friction rub
suggestive ecg changes— diffuse ST elevation with some T inversion
new or worsening pericardial effusion.— Echo
fever is a prognostic indicator
associations with HIV
Ix:
ECG, echo
bloods- gen inflam + tropnin
mild lyphocitosis common- sig raised WCC is poor prognostic sign.
Rx: majority are mild self limiting - activity restriction (nothing too exerting) 3/12
1st line- NSAIDS for symptom relief+ colchicine (0.5-1.2mg OD) - 3/12
Aspirin if a result of MI
steriods of autoimmune.
complication: cardiac tamponade
recurrency.
risk stratification- fever, trauma, elev trop, subacute, large effusion.
cardiac tamponade definitino + signs + Ix + Mx.
accumulation of fluid in the pericardial space
Tacy pnea, cardia
becks triad- muffled heart sounds, hypotension, raised JVP
pulsus parodoxius, kussmal sign, pericardial rub
causes: malignancy, trauma, cardiovasc surg, coronary intervention(seth)
Ix: clinical diagnosis- urgent echo should be done
ecg- sinus tacy/ non specific
pulseless electrical activity
Rx: pericardiocentesis- echo guided. - subxhiphoid- aim for left shoulder- drain fluid.
discuss dilated cardiomyopathy
dilation and systolic dysfunction of left and right vents
low output heart faliure
vent walls become thin.
50% idiopathic- sporadic gene mutations.
chronic alcohol consumption, hypothyroid, ahaemo, haemochromatosis.
S+S: heart faliure symptoms. - dilated does not cause sudden death.
Ix: echo
Rx: ACEi + B Blocker.
add aldosterone
consider add sglt-2
antocoagulate.
discuss hypertrophic cardiomyopathy
most common genetic cardiac disorder
AD inheritance
Left vent hypertrophy
assoc with Wold parkinson white.
hypertrophy narrows outflow tract (thicker septum)mitral valve pulled- causing systolic anterior motion. —> mitral regurg. + diastolic dysfunction.
S+S: ejection systolic murmer OR Pan systolic (septal defect)
can be asymptomatic- can get angina, syncope, S4, thrills, displaced apex,
sudden cardiac death.
Ix:
valsalva- increaces murmur intensity
squat- decreaces murmur
echo
ecg- left vent hypertrophy- tall r waves, deep ST depression, T wave invesion.
Rx: avoid vol depletion.
rate limiting drugs (b block, CCB)
surgical myectomy/ alcohol septal ablation
cardiodefibrillator
heart transplant
screen 1st degree relatives.
restrictive cardiomyopathy - tell everything
contraction of atria against stiff non dilated ventricles. - diastolic dysfunction. systolic is ok
least common cardiomyopathy
no sudden death
amyloidosis common cause- see sparkle on echo
patho- fibrosis or accumulation of substance in myocardium. - stiffens vents- means they cant fill.
Ix: ECHO
BIOPSY- gold standard.
diagnositc angiography
Rx:
treat underlying cause.
anticoag
Mx heart faliure
arrhythmogenic right ventricular cardiomyopathy
ginetic mutations–> impaired desmosone function –> fibrofatty infiltration –> impaired RV function.
can cause suddden cardiac death via arrythmia
Ix:
ECG- notching of QRS complexes- epsilon wave.
T wave inversion.
Mx:
implantable defibs. - prevention of sudden death.
takostubo cardiomyopathy
broken heart syndrome
severe stress events- catecholamine release
signs and symptoms mimic MI- but NO obstruction of arteries.
apical balooning of left ventricle is pathognomonic
usually self limiting- but there is a risk of death– arythmia or free wall rupture.
B blockers/ ACEi
discuss constrictive pericarditis
formation of granulation tissue in pericardium–> loss 0f elasticity –> incomplete filling.
chronic condition.
cause: TB
viral infection
cardiac surgery
radiation therapy to mediasteinum.
RA, SLE
9% of acute pericarditis ppl get restrictive.
3:1 male:female.
intrathorasic pressure changes are not transferred to heart in this, key differential from tamponade.
S+S: heart faliure symptoms.
ascites, hepatomegaly- increaced venous pressure.
Ix: echo
ecg- nonspecific st changes
Mx: pericardectomy- quite high mortality- so only for late stage disease.
symptom management
infective endocarditis overview, S+S, common bacteria + patho
infection of the endocardium (usually a valve) - commonly right side IVDU, left side others
very rare
bacterial- streptococcal- S viridians- teeth
IVDU- S aureus- tricuspid valve
staph epidermis in central line/ heart prosthetic valve (recently)
S+S= splinter hemm
janeway + osler
fever
mitral regurg (pan systolic)
roth spots (retinal hemm)
patho= bacteria form vegitations after bring trapped by layers of platelets.
diagnosis criteria for infective endocarditis.
major: +ve blood cultures (need 2 if common organism- more if not)
endocardial vegitation on echo
minnor: risk factors (IVDU, cardiac abnormality)
fever >38
rigors
vasculitic phenonema
embolitis phenonema
diagnosis =2 maj
or 1 maj 3 min
or 5 min.
Rx:
benzylpenicillin if strep
fluclox if staph
surgery for valve repair- (abcess, persistence)
complications- abcess- will elongate pr interval- daily ecg monitoring
embolism
glomerulonephritis
myocarditis
acute inflammation of myocardium–> infection, toxins or autoimmune
viral most common- coxsackie + influenza
coke, lime, lead toxicity all other options.
generally self limitng and good prog
Ix: bloods- large rise in troponin
ecg- non specific changes
CT angio gold standard to rule out vascular occlusion.
dull heart sounds heard, non specific S+S
Rx: supposrtive - treat heart faliure, arrythmia etc.
pericardial effusion
fluid in the pericardial sack- caused by anything that causes pericarditis.
becomes tamponade when heart is compressed.
S+S: dyspnoea, inc jvp, bronchial breathing at left base.
Ix: CXR, ecg- electrical alternans, low valt qrs
echo- echo free zone around heart
Rx:
treat cause
pericardiocentesis- can be rx or ix
