cardiac Flashcards
palpable pulsatile abdominal mass, abdo/back pain, HTN
AAA
central crushing chest pain that radiates to arms/neck/jaw, pallor + sweating
ACS (unstable angina, STEMI, NSTEMI)
unexplained weight loss, fatigue, oedema that is resistant to diuretic therapy, periorbital purpura, neuropathy, waxy skin, easy bruising
amyloidosis
punched out, elliptical ulcer with defined edges and grey base on feet / legs. night pain relieved by dangling legs off bed
Arterial ulcer
cetral tearing chest pain that may radiate to between shoulder blades. BP difference between arms of >20mmHg
aortic dissection
end-diastolic soft murmur, louder at sternal border or when pt sits forward, louder at end of expiration,
water hammer pulse (rapidly appearing and disappearing pulse at corotid)
visible pulsation on nail bed/in eyes/neck
head nodding in time with pulse
aortic regurgitation
worsening SOB (esp on exertion), high pitched ejection systolic murmur, heaving apex beat, slow rising pulse, narrow pulse pressure, exertion syncope, leg swelling
aortic stenosis
irregularity irregular tachycardia with no p waves
AF
young athletes with no PMH presenting with syncopal episodes
angina, palp, jerky carotid pulse, double apex beat but not displaced, ejection systolic murmur
hypertrophic cardiomyopathy
tricuspid +mitral regurge murmur, apex beat displaced
association with alcohol
dilated cardiomyopathy
painless swollen leg, erythema, skin colour changes. calf pain when forced dorsiflexion of ankle
RF - recent surgery, immobile, obese
DVT
area of oedema/erythema, blisters, extreme out of proportion pain, signs of sepsis/systemic inflam
necrotising fascitis
orthopnoea, exertion dyspnoea, paroxysmal nocturnal dyspnea, fatigue, nocturnal cough (w/ pink frothy sputum), wheeze, displaced apex beat, S3 gallop rhythm
LHF
oedema, weight gain, nocturia, dec exercise tolerance, inc JVP, facial swelling
RHF
fever with sweats and chills, malaise, arthralgia, confusion, signs of anaemia, pyrexia, tachycardia, vasculitis, rheumatoid factor in blood
infective endocarditis
high pitched pan-systolic murmur louder in inspiration, S3, displaced apex beat
Mitral regurg
mid diastolic, low-pitched rumbling murmur at apex, louder when pt lies on left side, loud S1, opening snap
associated with AF and malar flush
mitral stenosis
flu like prodrome, SOB, palp, positional chest pain (worse when lying down)
bloods - raised CK and troponins
myocarditis
sharp, central pleuritic chest pain relieved by sitting forward , pericardial friction rub, tamponade
widespread saddle shaped ST elevation
pericarditis
painfull, pulseless, paralysed, perishingly cold, pale limb with paraesthesia
acute limb ischaemia
progressive SOB, weakness, dizziness, angina, RV heave, tricuspid regurg, raised JVP
pulmo HTN
fever, joint pain, malaise, SOB, chest pain, palp, recent sore throat, chorea, small painless SC nodules seen on joints/tendons, erythematous rash with raised edges
rheumatic fever
regular, narrow complex tachycardia with no p waves,
SVT
slurred upstroke QRS on ECG
WPW syndro
pan systolic murmur heard at lower left sternal border, louder on inspiration, inc JVP, pulsatile liver
tricuspid regurg
large, shallow painless ulcers with an ire margin situated above the medial malleoli, swelling and itching
venous ulcers
irreg, broad complex tachycardia that can cause cardiac arrest and SCD, pulseless
vent fibrilation
regular broad complex tachycardia, symptoms of heart failure
vent tachycardia
Whats the management for STEMI
MONA BASH
morphine, oxygen, nitrates, anti-platelets (aspirin + clopidogrel), BB, ACEi, statins, heparin
Management for NSTEMI/unstable angina
1 - aspirin + clopidogrel
2 - fondapurinux if low bleeding risk
3 - unfractionated heparin if coronary angiogram plannned
What is the investigation of choice for an arterial ulcer
Duplex USS of lower limbs
what CXR changes would you see with an aortic dissection
widened mediastinum
what is an austin-flint murmur`
mid-diastolic rumbling murmur heard at apex. associated with aortic regurg
what is the management plan for AF
If haemodynamically unstable - DC cardioversion
1 rhythm control - DC or chemical cardioversion
2 - rate control - verapamil, BB, digoxin
3 - check stroke risk, high - warfarin
What drugs can be used for a chemical cardioversion
flecainide (contraindicated if prev Hx of IHD) or amialdarone
What ECG changes would you see with atrial flutter
SAW tooth
What would you use to check the risk of stroke in AF
CHAD2 score
CHF (+1), HTN (+1), Age >75 (+2), DM (+1), prev stroke/TIA (+2)
If 0 or 1 - aspirin, if >2 then warfarin
What are the 8 main causes of cardiac arrest
4H - hypothermia, hypoxia, hypovolaemia, hypokalaemia
4T - toxins, thromboembolic, tamponade, tension pneumothorax
what is homan’s sign
forced dorsiflexion of ankle -> calf pain
indicates DVT
what is the most common cause of recurrent DVTs at a young age
inherited disorer
Factor V lieden - mut of factor 5 makes it resistance to degradation by protein C -> inc F5 -> procoagulant state -> DVT
What JVP signs can be seen with complete heart block
Cannon A waves - large volume pulses
What is the first step of management fo acute heart block
IV atropine
what are the steps of management for chronic heart failure
1 - ACEi (enalapril) 2 - BB (bisoprolol) 3 - duretics - if evidence of fluid retention 4 - Digoxin 5 - treat cause
what 5 CXR changes can be seen with chromic heart failure
Alv oedema, B-lines, Cardiomegaly, Dilated upper lobe vessels, pleural Effusion
what is cor pulmonale
enlargement and failure of RV due to inc lung pressure/vasc resistance
What are the management steps for acute HF
Sit Pt up and give high flow O2 furosemide (loop diuretic) GTN infusion CPAP treat cariogenic shock if hypotensive
how would you manage HTN if <55 and not afro-caribbean
1 - ACEi (switch to ARB if develop cough)
2 - ACEi/ARB + CCB
3 - + thiazide diuretic
how would you manage HTN if >55 or AC
1 - CCB
2 - CCB + ACEi/ARB
3 - + thiazide diuretics
what type of drugs end in -pril
ACEi
what type of drugs end in -tan
ARB
what type of drugs end in -dipine
CCB
what type of drugs end in -ide
thiazide diuretic
what type of drugs end in -olol
BB
what type of drugs end in -osin
Alpha B
what are the complications of ACEi
cough, inc potassium/creatinine
what are the complications of CCB
swelling +angiooedema
what level is considered level 3 HTN and a medical emergency
180/120
what’s the target BP for someone <80
140/90
what’s the target BP for someone >80
150/90
what are the most common causes of infective endocarditis
strep (40%)
staph (35%)
enterococci (20%)
what autoantibody is found in the blood with inf endocarditis
rheumatoid factor
what murmur is often associated with AF
mitral stenosis - mid diastolic low pitched murmur
how can you tell the difference between myocarditis and pericarditis
cardiac biomarkers raised in myocarditis but not pericarditis (CK and troponins)
pain in calf on exercise
PVD - intermittent claudation of femoral a.
pain in buttock on exercise
PVD - intermittent laudation of iliac a
what inv would confirm pulmo HTN
R H catheterisation
what causes rheumatic fever
Group A strep throat inf
what is the management of SVT
if haemo unstable - DCC
1 - vagal manœuvres + chemical cardioversion
2 - adenosine
when is adenosine contraindicated
in asthma - use verapamil
what murmur is associated with infective endocarditis
Tricuspid regurg - pan-systolic
what is the management of VF
urgent defib and cardioversion
what ECG change is seen in WPW syndro
delta wave
