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mrcp paces > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Indications for aortic root replacement in Marfans

A

Aortic root diameter >50mm (or 45mm if FHx of dissection)

Rate of dilatation >3mm/yr

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2
Q

Causes of AF

A

Age related

Cardiac related
IHD and MI
Sick sinus syndrome 
Valvular - MR/MS
Dilated LA
Rheumatic heart disease
Htn
Cardiomyopathy
Driven
Sepsis
Alcohol 
Thyrotoxicosis
Drugs - stimulants
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3
Q

Mx of AF

A

Assess for anticoagulation

Rate vs rhythm control

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4
Q

What does a fourth heart sound indicate

A

Atria contracting against a stiff LV - pressure overload

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5
Q

Follow up ix for coarctation repair

A

MRI, not echo

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6
Q

Complications of mitral prolapse

A

Progression to MR
Infective endocarditis
Arrhythmias

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7
Q

Indications for surgical repair of mitral regurg

A

Valve repair preferred to valve replacement
Repair of valve = valvuloplasty
Repair of ring - annuloplasty

Indications:
Increasing LV dilatation (volume overload) - LVED dimension >45mm -> heart failure
Acute MR post CT rupture or infective endocarditis
Heart unable to tolerate acute MR - decompensates

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8
Q

Mx of aortic stenosis

A

Medical mx

TAVI

Valvotomy if young adult or child (delays need for valve replacement)

Valve replacement - bioprothetic or metallic

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9
Q

Four classic peripheral signs of infective endocarditis

A 
Janeway lesions (non tender macules, blanching, typically on palms)
Osler nodes - raised tender lesions on finger pulps
Splinter haemorrhages
Petechiae
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10
Q

What does a third heart sound indicate

A

Rapid ventricular filling in a dilated ventricle - volume overload

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11
Q

Eisenmengers syndrome
Def
Causes

A

Longstanding L->R shunt causing pul htn and reversal of shunt direction

Large VSD - Fallots tetralogy
Primary pul htn
ASD
PDA (normal splitting of S2, widening on inspiration due to delay in P2; only lower limbs cyanosed)

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12
Q

Indications for mitral valve replacement for mitral stenosis

A

Symptoms limiting normal activity - heart failure
Pulmonary oedema
Recurrent emboli
Pulmonary oedema in pregnancy (emergency transcatheter valvuloplasty)

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13
Q

Main presentation of coarctation

A

Htn

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14
Q

Features of Tetralogy of Fallot

A

Overriding aorta
VSD
Pulmonary stenosis
RVH

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15
Q

Causes of pul stenosis

A

By level:
Supra-valvular - Tetralogy of Fallot
Valvular (commonest)
Sub-valvular - Tetralogy of Fallot, congenital Rubella syndrome

Congenital heart disease - Tetralogy of Fallot (treated with shunt rather than correction or post surgical correction)

Infection - Rubella, infective endocarditis, rheumatic fever

Turners, Downs and Noonan’s syndromes

Carcinoid syndrome

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16
Q

Causes of mitral prolapse

A

Primary myxomatous degeneration (commonest)
Connective tissue disease - Marfans, Ehlers Danlos, Osteogenesis imperfecta
PKD
Cardiomyopathy

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17
Q

Causes of tricuspid regurgitation

A

Commonest - RV dilatation / failure due to:
Left sided heart disease - MV disease
Cor pulmonale (RHF due to lung resistance) - Primary pul htn
RV infarction

Causes of primary TR:
Infective endocarditis (esp IVDU)
Congenital heart disease
Carcinoid syndrome

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18
Q

Causes of mitral incompetence / regurg

A

Primary - Valve degeneration
Functional regurgitation - widening of LA/LV - cardiomyopathy, htn
Progression of mitral valve prolapse
Papillary muscle dysfunction - ischaemia, infarction, degeneration
Infective endocarditis

Iatrogenic Post valvotomy for mitral stenosis

Connective tissue disorders - SLE, RA, ank spond

Congenital - Marfans, ED, pseudoxanthoma elasticum

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19
Q

Causes of a raised JVP

A

CCF - ischaemic, valvular, hypertensive, cardiomyopathy
Cor pulmonale (RHF due to lung resistance)
Pul htn
Constrictive pericarditis
Pericardial effusion

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20
Q

Complications that can arise following coarctation repair

A

Recurrence
Aortic valve degeneration (tends to be bicuspid)
Aneurysm at the site of repair (+/- infection +/- rupture)
Aortic dissection in later life

21
Q

What are the causes of acute MR (3)

A

Trauma, MI, endocarditis

22
Q

Causes of aortic stenosis

A

Degenerative calcification
Rheumatic heart disease
Bicuspid aortic valve

23
Q

Indications for aortic valve replacement

A

Aortic stenosis
Symptomatic (angina, syncope, dyspnoea) in the presence of normal LV function

Aortic regurg - LV dysfunction (EF <50%), widening of LV (LV dimension >50mm in systole, LVED dimension >70mm)

Acutely in infective endocarditis

Both can be combined with coronary artery grafting

24
Q

Causes of aortic incompetence

A

Infection - Rheumatic fever and infective endocarditis
Long standing htn -> aortic dilatation, aneurysm and dissection
Marfans
Ankylosing spondylitis

25
Q

Indications for valvotomy in mitral stenosis (valve widening)

A

Mobile valve

Absence of incompetence (no MR)

26
Q

Cardiac features of Noonan syndrome

A 
Septal defects - Atrial and ventricular
Hypertrophic cardiomyopathy 
Pulmonary stenosis (commonest)
27
Q

Indications for treatment of pulmonary stenosis

A

Pressure gradient across valve >64mmHg or >4m/s
Valvular area <1cm2
Signs of RHF

Balloon valvuloplasty
Valve replacement

28
Q

Red flags in the presence of a PDA

Ix

Indications for intervention

A

Collapsing pulse
RV heave (pressure overload) - pul htn
Cyanosis = pul htn
Evidence of LV failure - due to Eisenemgers

Systolic / continuous murmur loudest in pulmonary region in expiration, radiating to the back

Ix:
Cardiac MR/CT
Echo
R heart catheterisation

Indications for intervention:
Raised pulmonary artery pressure - pul htn
LV volume overload

PA pressure or vascular resistance >2/3 systemic vascular pressure / resistance

Follow up only at 6mths if no adverse features, or regularly if persistent post intervention

29
Q

Causes of aortic regurg

A 
Primary myxomatous disease
Rheumatic heart disease
Htn
Ankylosing spondylitis 
CTD - SLE, Osteogenesis imperfecta, Marfans, Ehlers Danlos

Acute AR - infective endocarditis, trauma, dissection

30
Q

Ix for aortic stenosis

A

Echo
Exercise testing
Angiography for CAD

31
Q

Causes of secondary htn

A

Renal - Renal artery stenosis, diabetic nephropathy, GN, PKD
Phaeochromocytoma
Endo - Hyperthyroidism, Cushings, Conns, Acromegaly
Cardiovascular - coarctation
Drugs - steroids, OCP

32
Q

Changes seen on hypertensive retinopathy

A

Gr1 - Silver wiring
Gr2 - AV nipping
Gr3 - Flame haemorrhages, cotton wool exudates, Microaneurysms
Gr4 - Papilloedema

33
Q

Mx of malignant htn

A

Hypertensive emergency - BP >180/110 and end organ damage

Hypertensive urgency - BP >180/110, no end organ damage

End organ damage - stroke, encephalopathy, renal impairment, ACS, acute LVF, dissection

Hypertensive emergency - IV labetalol / GTN in ITU/HDU setting
Hypertensive urgency - oral agents - CCB, ACEi, diuretics

Correct BP over 24hrs to <160 systolic

34
Q

Causes of a widely split S2

A

Delay in P2 - pul stenosis, RBBB, deep inspiration

Early A2 - MR, VSD, causing LV to empty quickly

35
Q

Cause of a split S2 not varying with inspiration (fixed split)

A

ASD - no pressure differential between the atria, so no change wit respiration pattern

36
Q

Causes of reversed split S2

A

Early P2 closure - pul htn, Eisenmengers

Late A2 - LBBB, aortic stenosis

37
Q

Causes of Eisenmenger’s syndrome

A

VSD (commonest)
ASD
PDA

38
Q

Indications for closure of a VSD

A

Significant L->R shunt
Pt undergoing cardiac surgery for another indication
Endocarditis
Aortic regurgitation with prolapse of valve leaflet through VSD

39
Q

Complications of Eisenmenger’s syndrome

A 
Significant shunting of blood (R->L) with systemic:pulm ratio >2
Cyanosis and hyperaemia
Paradoxical embolus
RV failure 
Infective endocarditis 
Haemoptysis
LV dysfunction 
Acute septal rupture post MI
40
Q

Causes of congenital cyanotic heart disease

A 
Tetralogy of Fallot
Transposition of the great arteries
Pulmonary atresia
Pulmonary stenosis
Ebsteins anomaly
Tricuspid atresia
Eisenmengers
41
Q

Complications post surgery for correction of Tetralogy of Fallot

A

Pulmonary regurg
Infective endocarditis
Coagulopathy
Polycythaemia (due to chronic cyanosis)

42
Q

Causes of diastolic heart failure

Ix

A

Constrictive disease - constrictive pericarditis, restrictive cardiomyopathy

Ix: Echo, CXR, cardiac CT, cardiac MR, cardiac catheterisation

43
Q

Causes of a restrictive cardiomyopathy

A

Amyloidosis (commonest)
Sarcoidosis
Haemachromatosis
Scleroderma

Endocardial or pericardial fibrosis
Radiotherapy
Drugs - hydroxychloroquine
Idiopathic

44
Q

Causes of constrictive pericarditis

Features

Ix

A

TB
Connective tissue disease - RA, scleroderma, SLE
Trauma / post-surgery
Radiotherapy

Evidence of bi-atrial dilatation / right and left heart failures

Ix - cardiac catheterisation - left and right atrial diastolic pressures are raised

45
Q

Diagnosis of infective endocarditis

A

Dukes criteria
2 major and 5 minor criteria
Either both major, 1 major and 3 minor, or all 5 minor

Major:
Blood culture - typical bug in 2 samples
Echo - vegetation or abscess

Minor:
Fever >38
Risk factors / predisposition
Vasculitic signs - Osler nodes, haematuria, petechiae, raised ESR/CRP
Embolic signs - Roth spots, splinter haemorrhages, Janeway lesions
Abnormal echo or blood culture not meeting major criteria

46
Q

Ddx of midline sternotomy

A

CABG
Open valve replacement
Open repair of congenital heart disease
Heart +/- lung transplant

47
Q

Symptoms of aortic stenosis is worsening order

A

ASD

Angina, syncope, dyspnoea

48
Q

Complications of aortic valve replacement

A

Surgical complications - infection, bleeding, pain, scarring, failure, recurrence

Specific - valve regurgitation / leak, infective endocarditis, microangiopathic haemolytic anaemia

mrcp paces (7 decks)

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