Cardiac Flashcards
Boot shaped heart (peads)
Tetralogy of fallot
Egg shaped heart (paeds)
Transposition of the great arteries
3rd heart sound
LV failure, mitral regurg, L->R shunt
4th heart sound
Pulmonary stenosis, pulmonary HTN
New onset RBBB with R axis deviation
PE
Split, fixed S2 (paeds)
ASD
Split, widened S2 (paeds)
Pulmonary stenosis
Caput medusae
Portal HTN
Chronic fatigue and palpitations
Torsades de Pointes
“Flutter in chest” that make you “catch your breath”
Paroxysmal atrial tachycardia
Beta blocker used with heart failure
Atenolol
Endocarditis in IVDU
Tricuspid regurg
2nd heart sound
Diaphragm at the mid-left sternal edge
SA node supplied by
Right coronary artery (in most people)
Post-MI heart muscle is weakest on…
Day 10
Digoxin S/E
Slowing of AV conduction Disturbance in colour vision
Bornholm disease
Chest pain caused by Coxsackie B
Continuous murmur in acyanotic heart disease (paeds)
PDA
Symptomatic, acyanotic heart disease with loud pancystolic murmur (paeds)
VSD
Asymptomatic acyanotic heart disease (paeds)
ASD
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Dihydropyridines
-pine
Peripheral
Non-dihydropyridines
-amil
Central
Sick Sinus Syndrome
Due to sinus node dysfunction
Pace if symptomatic
1st Degree Heart Block - ECG
Impulse is conveyed slowly through the AV node
Bradycardic, lengthened PR interval (>0.20 seconds)
1st Degree Heart Block - Causes
AV nodal disease
Enhanced vagal tone (athletes)
AMI
Electrolyte imbalance
Drugs
2nd Degree Heart Block - Mobitz Type 1
ECG
Bradycardic, progressive prolongation of the PR interval followed by a dropped QRS
2nd Degree Heart Block - Mobitz Type 2
ECG
Progressive prolongation of the PR interval with occasional dropped QRS beats
Ratio block, e.g. 2:1, 3:1, etc.
3rd Degree Heart Block - ECG
Ventricular rate is slower than the atrial
No relationship between the P wave and QRS
3rd Degree Heart Block
Blockage in the conduction system
Causes include AMI, congenital, progressive degradation of the conduction system and endocarditis
Pacing is required
ACEi
-prilHTN, heart failureS/E: cough, headache, kyperkalaemiaC/I: renal artery stenosis, pregnancy
ARB
-sartanSame as ACEi but no cough
Beta-blockers
-ololAngina, post-MI, arrhythmias, clinically stable heart failureS/E: bronchoconstriction, AV block, claudication, impotence, depression, sedation, masks hypoglycaemiaC/I: uncontrolled heart failure, diabetes, asthma
Calcium-channel blockers
Dihydropyridines (-pine) - peripheralNon-dihydropyridines (-amil) - cardiacAngina, tachyarrhythmiasS/E: cardiac depression, bradycardia, flushing, oedema, dizziness, headache, constipation, nauseaC/I: heart failure
Thiazides
Mild-moderate HTN, oedema, heart failureS/E: hypokalaemia, hyperuricaemia, hypercholesterolaemia, hyperglycaemiaC/I: diabetes, gout
Spironolactone
Potassium sparing diureticCCF
Amiodarone
Arrhythmias - rhythm controlIncreases QT interval and prolongs action potentialS/E: interstitial lung disease, thyroid dysfunction, abnormal liver enzymes
Warfarin
Blocks factors II, VII, IX, X, protein C and protein S
Heparin
Binds to and activates antithrombin III, which inactivates factor Xa
ASCauses
CalcificationBicuspid valveRheumatic fever
AS Murmur
Ejection systolic radiating to the carotids
AS Pulse
Small volumeSlow rising
ASHeart sounds
Soft S2Prominent S4
ASApex beat
“Pressure-loaded”Non-displacedHyperdynamic
AS Heaves/thrills
Aortic thrill
ASSymptoms
DyspnoeaSyncopeAngina
MR Causes
Mitral valve prolapseRheumatic feverIHDLV hypertrophyIE
MR Murmur
Pan-systolic murmur radiating to the axilla
MRHeart sounds
Soft S1S3
MRApex beat
“Volume-loaded”Displaced, diffuse
AR Murmur
Early diastolic murmur
ARPulse
Water-hammer pulseWide pulse pressure
MSCauses
Rheumatic feverCongenital deformitySLE
MS Murmur
Mid diastolic
Truncus Arteriosus
Presents at birthMild cyanosisEjection systolic murmur at left sternal edgeCan cause heart failureNeed surgery
Transposition of the Great Vessels
Presents on day 1/2Severe cyanosisNo murmurLoud single S2CXR - egg on its sidePG infusion to maintain patency of duct, emergency cardiac catheterisation, switch procedure
Tricuspid atresia
Presents day 1/2 (closure of duct)Severe cyanosisEjection systolic murmur at left sternal edgeCan cause heart failureCXR - boot shaped heartPG and surgery
Tetralogy of Fallot
VSD, Pulmonary stenosis, RVH, overriding aortaPresents at 6-12 monthsIntermittent hypoxic spellsEjection systolic murmur at left sternal edge, radiating to the back, single heart sound, clubbingCXR - boot shaped heart, uptilted vertexGet them to squat with hypoxic spells, sodium bicarb, propanolol, surgery
VSD
Present at 2-3 months with failure to thrive, sweaty during feedsLoud pansystolic murmur at left sternal border. Quiet or loud P2Complicated by CCF75% resolve spontaneously
ASD
AsymptomaticSoft mid-systolic murmur and splitting of S2Complicated by mitral incompetence and endocarditis75% resolve spontaneously
AVSD
Trisomy 21
PDA
Occurs in premature babiesPresents at birth with increased ventilation requirementsContinuous murmur heart beneath the left clavicle NSAIDs to promote duct closure. May need coil at 1yr
Coarctation of the aorta
Turner’s syndromeOften asymptomaticHypertension in upper limbs with hypotension in lower limbsPG and surgery
Kawasaki DiseaseDiagnosis
WARM CREAMWarm - temp >38.5 for 5 daysCervical lymphadenopathyRash - polymorphousErythema and oedema ± peelingAdenopathyMucous membranes (strawberry tongue)
Kawasaki DiseaseManagement
Admit to hospitalIV fluidsIV IG and aspirinCRP and plateletsEchocardiogramRegular paeds review
Atrial Fibrillation - Causes
Electrolyte imbalanceSepsisPEHyperthyroidismCardiomyopathy
Atrial Fibrillation - ECG
Absent P wavesIrregularly irregular ventricular rate
Atrial Fibrillation - Management
Rate control - beta-blockers or digoxin in patients with CCFRhythm control (cardioversion) - amiodaroneProphylaxis against thromboembolic complications depends on CHADSVASc score
Atrial Flutter - Clinical Presentation
Exercise intolerancePalpitationsFatigueLightheadedness
Atrial Flutter - ECG
Too many P wavesSaw-tooth atrial defectionsPossible 2:1 AV block
Atrial Flutter - Management
Rate control - beta-blockers or digoxin in patients with CCFRhythm control (cardioversion) - amiodarone
Ventricular Tachycardia - Management
Amiodarone or sodium channel blockers (lignocaine)
Ventricular Fibrillation - ECG
Rapid, shapeless oscillations