Cardiac conditions Flashcards

Question

IE treatment

Answer 1

ABx in line w/ trust policy Surgery if: Heart failure- urgent surgical valvular replacement valvular obstruction persistent bactaraemia myocardial abscess Regerral to endocarditis MDT

Answer 2

senile calcification bicuspid aortic valve rheumatic heart disease

Answer 3

symptomatic fluid overload (dyspnoea/orthopnea/peripheral oedema) Chest pain Dizziness faints

Answer 4

slow rising pulse w/ narrow pulse pressure. slow rising pulse usually noticeable at carotids. LV heave Heaving and undispalced apex beat Harsh ejection systolic murmur heard at left sternal edge: loudest leaning forward on end expiration. Murmur may radiate to both carotids and is often ehard widely across the chest. Crescendo-decrescdendo. Decreased following Valsalva manouevre

Answer 5

ECG- LV hypertrophy (deep S waves in V1 and V2, tall R waves in V5 and V6) Echocardiohram- diagnostic

Answer 6

if asymptomatic observe diuretics to improve symptoms surgical aortic valve replacement or transcatheter aortic valve insertion

Answer 7

if asymptomatic observe diuretics to improve symptoms surgical aortic valve replacement or transcatheter aortic valve insertion

Answer 8

Rheumatic fever IE connective tissue diseases biscuspid aortic valve aortic dissection

Answer 9

early diastolic murmur- intensity increased by the handgrip manouevre. Heard at lower left sternal edge, sat forward breath held in expiration. Collapsing pulse Wide pulse pressure Quincke's sign (nailbed pulsation) De Musset's sign (head bobbing)

Answer 10

surgery indications include: Symptomatic patients w/ severe AR Asymptomatic patients w/ severe AR who have LV systolic dysfunction

Answer 11

Acute sudden crushing pain radiating to jaw, neck or left arm Exertional pain worsened by stress and exertion Dyspnoea N&V Palpitations Sweatiness and clamminess Symptoms should continue at rest for over 15 mins

Answer 12

ST segment elevation >1mm in adjacent limb leads (I, II, III, aVF, aVL) ST segment elevation >2mm in adjacent chest leads (V1-V6) New LBBB w/ chest pain or suspicion of MI

Answer 13

ST segment depression in a region Deep T wave inversion/flattening present in more than 2 continuous leads that have dominant R waves

Answer 14

Abnormal/normal ECG, normal consistent troponin. Ie no biochemical evidence of ischaemia

Answer 15

PCI always- blocked arteries are opened up using a balloon following which a stent may be deployed to prevent the artery occluding again in the future. This is done via a catheter inserted into either the radial or femoral artery. Consider thrombolysis if > 2hrs, using agents like alteplase/streptokinase if PCI is unavailable Aspirin and second antiplatelet before PCI tho

Answer 16

BATMAN Beta blockers Aspirin Ticagrelor/clopidogren Morphine IV Antithrombotic eg fondaparinux (LMWH alternative) Nitrates- GTN sublingual or buccal Assess need of PCI/thrombolysis using the GRACE score, use CRUSADE score for assesment of risk of bleeding during PCI while being on anti platelet therapies

Answer 17

Stop smoking reduce alcohol cardiac rehabilitation 6 A's: Aspirin 75mg OD another antiplatelet eg clopidogrel or ticagrelor 12 months Atorvastatin 80mg OD ACE inhibitor eg ramipril 10mg OD Atenolol or other B blocker Aldosterone antagonist If PCI is not preferred, or extensive left main stem disease- offer CABG

Answer 18

keep in hospital for a couple days. DARTH VADER Death Arrhythmia Rupture of free wall/papillary muscles Tamponade HF VSD Aneurysm or another MI Dressler's syndrome/pericarditis Embolism or oedema Rupture of papillary muscles or Free Wall Pericarditis also

Answer 19

Constricting chest pain that radiates to neck/shoulders/jaw/arms precipitated by physical exertion, relieved by rest / GTM in about 5 mins

Answer 20

Bloods, ECG, CXR, troponins CT coroanry angiography- site and degree of stenosis within coronary arteries can then be identified Need invasive coroanry angiography if CAD is v likely

Answer 21

immediate- GTN 2-5,2-5, 2 + 999 2 puffs under tongue, wait 5 mins. Baseline symptomatic relief- beta blocker and /or CCB. If CCB used as a monotherapy then use a rate limiting one like verapamil or diltiazen. BETA BLOCKERS SHOULD NOT BE PRESCRIBED W/VERAPAMIL- risk of complete heart block. secondary prevention of CVD- aspirin, ACEi, atorvastatin, already on ebta blocker

Answer 22

PCI w/ coronary angioplasty-put catheter into brachial or femoral artery, feeding that up to the coronary arteries under xray and injceting contrast so the coronary arteries and any areas of stenosis are highlighted on xray CABG- involves opening the chest along the sternum causing a midline sternotomy scar, taking a graft vein from the leg (usually the great saphenous vein) and sewing it on to the affected coronary artery to bypass the stenosis

Answer 23

Hypertension pregnancy trauma cocaine known AA bicuspic aortic valve Connective tissue disorders, eg Marfan's Male Age Atherosclerotic disease

Answer 24

sudden, tearing chest pain radiating to the back dyspnoea abdo pain can be asymptomatic

Answer 25

unequal arm pulses and BP weak or absent carotid, brachial or femoral pulse acute limb iscahemia Horner's syndrome in type A dissections (ascending aorta)- Ptosis, Miosis, Anhidrosis Hypotension New early diastolic murmur- aortic regurgitation murmur can present w/ features of dissection complications eg distended neck veins, signs of heart failure etc

Answer 26

ECG CXR- widened mediastinum CT angiogram of chest, abdo, pelvis- can see double lumen, entry tear, evidence of aortic dilatation MRI angiogram for futher details Classification is Stanford: Type A- involvement of proximal aorta Type B- involvement of distal aorta

Answer 27

open surgery to prevent aortic rupture into the pericardium. Aortic root surgery- removal of ascending aorta w/ or w/o the aortic arch and replacement w/ a synthetic graft

Answer 28

Usually conservatively Usually bed rest and beta blockers- IV beta blockage, pain management w/ IV morphine

Answer 29

age male steroid treatments

Answer 30

idiopathic secondary to bacteria, viruses, fungi, drugs etc. Often follows a viral illness

Answer 31

central chest pain worse on inspiration or lying flat and relief by sitting forward pain can be constant or intermittent sharp pain Unlike iscahemic pain it's often relieved by sitting forwads and aggravated by thoracic movement, coughing and breathing Fever Tachycardia Pericardial friction rub- typically loudest at left lower sternal border

Answer 32

Raised WBC/CRP/ESR ECG- widespread saddle ST elevation, followed later by T wave inversion Echocardiogram can be used to diagnose a pericardial effusion

Answer 33

NSAID w/ PPI for 1-2 weeks Add colchicine 500mcg onde daily or twice daily for 3 months to reduce recurrent risk Recurrent/chronic pericarditis- novel treatment options are immunosuppressants Constrictive pericarditis - final stage of inflammation involving the pericardium definitive treatment is usually surgical pericardiectomy (resection of the pericardium)

Answer 34

chest pain dyspnoea orthopnea

Answer 35

quiet heart sounds pulsus paradoxus (abnormally large drop in BP during inspiration) Hypotension Raised JVP Classical features of cardiac tamponade- Beck's triad- Hypotension, raised JVP, muffled heart sounds

Answer 36

treatment of underlying cause drainage of effusion where requried- needle pericardiocentesis, surgical drainage