Cardiac Flashcards
What is left-sided heart failure?
Failure of the left side of heart. Mostly by systolic failure (ineffective pumping). Ischaemic heart disease is most common cause. Another cause is chronic hypertension. The left-side of the heart constantly has to overcome high systemic pressures therefore hypertrophies. This causes increased oxygen demand and also less area and volume of blood pumped out each beat. Dilated cardiomyopathy can also cause LHF
Describe diastolic left sided heart failure?
Diastolic failure refers to problems with filling. Such as with chronic hypertension which leads to hypertrophy- this creates less room for filling. Another cause is aortic stenosis and hypertrophic cardiomyopathy which both cause hypertrophy of the left ventricle. Restricted myopathy also causes diastolic failure as the heart is able to stretch
Symptoms of left-sided heart failure?
Backup of blood into the pulmonary system, this causes pulmonary oedema. This causes delayed oxygen exchange which leads to dyspnoea and orthopnoea
Persistent cough, crackles and wheeze on auscultation
cyanosis
Medications for left-sided heart failure?
ACE inhibitors to dilate blood vessels and increase blood flow
Diuretics- reduce fluid overload
What is right sided heart failure?
Often caused by left-sided heart failure or by congenital heart defect with a left to right shunt. Chronic lung diseases another cause isolated RHF- in response to hypoxia, pulmonary arterioles constrict which increases pulmonary blood pressure which leads to right sided hypertrophy and failure
Symptoms of right-sided heart failure?
Systemic congestion- jugular venous distention, hepatospleenomegaly- can eventually lead to cirrhosis and liver failure.
Ascites
Pitting oedema
Risk factors for MI?
Atherosclerosis, male, age, fam history, ethnicity, smoking, hypertension, dyslipidemia
Difference between STEMI and NSTEMI
NSTEMI- partial occlusion of the coronary artery. Ischaemia occurs proximally to where the vessel supplies. STEMI is complete occlusion of the artery causing myocyte death and ischaemia distally and moving proximally until it is resolved
Clinical presentation of ACS?
Central crushing chest pain- may radiate down left arm, neck/jaw or back
Diaphoresis
Nausea and vomiting
Feeling of impending doom
Differentials of central chest pain?
Tamponade, pericarditis, aortic aneurism, anxiety, PE, pneumothorax, oesophageal rupture
What is troponin?
A protein that is attached to tropomyosin and helps with muscle contraction. Cardiac specific troponin is troponin 1 and T
When are troponin levels first detected, peak, and how long do they stay elevated for?
Troponin is detectable 4-8hours post onset of symptoms, peaks 12-24hours and stay elevated for 10 days
Diagnosis of MI with Troponin?
Initial troponin levels and then repeated at 3-6 hours. normal < 0.03 µg/L
Chest pain clinical pathway?
Vitals and ECG and review by MO within 10 mins 02 Aspirin 300mg, nitrates IV access- troponin, FBC, U&Es pain relief continuous cardiac monitoring chest xray
If chest pain for more than 30mins but less than 12hrs and ST elevation in 2 leads- Primary PCI within 90mins of costact- if not available- thrombolysis
Antithrombolitic therapy- 300mg aspirin, Clopidogrel 600mg with planned PCI and 300mg with thrombolytic intervention
Heparin or enoxaparin
What is MOAN acronym for ACS?
Morphine
Oxygen (if under 93%)
Aspirin and clopidogrel
Nitrates
What is endocarditis and risk factors?
Infection of the endococardium most commonly by staph aureus. Risks: congenital heart defects, surgical devices ie pacemaker, artificial valve, rheumatoid arthritis, IV drug use, certain dental and medical procedures
Presentation endocarditis?
Symptoms of acute infection occur within a week, symptoms of subacute may take weeks or months to develop
Flu-like symptoms
heart murmur
aching muscles or joints
janeway lesions (non-tender, small erythematous or haemorrhagic macular or nodular lesions)
osler nodes (painful, red, raised lesions found on the hands and feet)
Roth spots- retinal hemorrhages with a pale centre
splinter haemorrhages
haematuria- glomerularnephritis
Diagnosis endocarditis?
Modified Duke Criteria (2 major or 1 major and 3 minor)
Clinical presentation
ECG
Positive blood cultures- need at least 2 its drawn 12hours apart
Rule out rheumatoid factor
TTE or TOE showing mass on valve, access or new dehiscence of prosthetic valve
Management for endocarditis?
Complications of endocarditis?
IVABs dependent on bacteria and if community or hospital acquired and if native or prosthetic valve
Community acquired: Benzylpenicillin + Fluclox + Gent for 1-2 weeks
Complications: MI, pericarditis, mycotic aneurysm, CHF
What is pericarditis and cause?
Inflammation of the pericardium which surrounds the heart. Main cause is viral infection, can also be bacterial or fungal. Can also occur following MI, heart surgery, trauma or uraemia. Or due to autoimmune disease: Lupus
What are symptoms of pericarditis?
Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain
Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation
Pain is worse in the supine position or upon inspiration (breathing in)
Pericardial rub on auscultation
Tachypnoea
Tachycardia
Fever
Complications of pericarditis
Pericardial effusion which can lead to tamponade
What is cardiac tamponade and signs?
Abnormal accumulation of pericardial fluid creates pressure and causes impairment in diastolic filling of the heart.
Features include tachypnoea, tachycardia and atrial arrhythmias- eg AF, Kussmaul sign (a paradoxical rise in JVP on inspiration) and pulses paradoxus
What is pulses paradoxus?
A decrease in systolic blood pressure greater than 10mmHg during inspiration. To perform use stethoscope and BP cuff, find systolic, sounds should not be heard on inspiration, slowly lower cuff pressure until kormokoff sounds also heard on inspiration, difference should be less than 10
