Cardiac Diseases Flashcards

1
Q

Investigations to confirm heart failure

A
  1. ECHO
  2. Pro-BNP/NT Pro-BNP
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2
Q

Investigations to look for etiology of heart failure

A
  1. ECHO (Structural abnormality, Valvular disease)
  2. ECG (Arrythmia ; cause / complication)
  3. Thyroid Function Test, FBC (TRO secondary causes)
    - high output heart failure in hyperthyroidism and anemia
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3
Q

Investigations to look for complication of heart failure

A
  1. CXR
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4
Q

Classification of Coronary Artery Disease

A
  1. Stable Angina
  2. Acute Coronary Syndrome
    - Unstable Angina
    - NSTEMI
    - STEMI
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5
Q

Cardiac symptoms & signs of coronary artery disease

A

Symtoms:
1. Chestpain
2. HF symptoms
3. Arrythmia symptoms

Signs:
1. HF signs
2. Irregular pulse

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6
Q

Investigations to confirm CAD

A

To confirm Stable Angina :
1. ECG
2. Risk Stratification (Stress Test/CT Coronary)
3. Coronary Angiography if high risk.

To confirm ACS :
1. ECG
2. Cardiac Enzymes
3. Coronary Angiography

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7
Q

Investigations to look for etiology of CAD

A
  1. Lipid Profile
  2. Diabetic screening (HBA1c, FBS)
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8
Q

Investigations to look for complications of CAD

A
  1. ECHO (Heart failure, Mechanical complication)
  2. CXR (Pulmonary Edema)
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9
Q

Classification of arrythmia

A
  1. Tachyarrythmia
    - Narrow complex tachycardia
    - Broad complex tachycardia
  2. Bradyarrythmia
    - Sinus bradycardia
    - AV block
    - Sinus block
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10
Q

Narrow complex tachycardia definition & types

A

QRS complex ≤ 120 ms

  1. Sinus tachycardia
  2. Junctional tachycardia
  3. Supraventricular tachycardia
  4. Atrial fibrillation
  5. Atrial flutter
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11
Q

Broad complex tachycardia definition & type

A

QRS complex > 120 ms

  1. Ventricular tachycardia
  2. Ventricular fibrillation
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12
Q

Cardiac arrythmia symptoms & signs

A

Symptoms
1. Arrythmia symptoms
2. Heart failure symptoms (low cardiac output d/t poor heart contractility)

Signs
1. Irregular pulse
2. Heart failure signs
3. Valvular heart disease signs
4. Signs of complications (stroke)

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13
Q

Investigation to confirm cardiac arrythmia

A
  1. ECG
  2. Cardiac Electrophysiology Study
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14
Q

Investigations to look for etiology of cardiac arryhtmia

A
  1. Electrolytes
  2. TFT
  3. FBC
  4. Renal Profile (uremia)
  5. ECHO (valvular heart disease)
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15
Q

Investigations to look for complications of cardiac arrythmia

A
  1. CXR
  2. ECHO (Heart failure)
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16
Q

Characteristic of mitral stenosis (MS)

A

Mid Diastolic murmur
Best heard at mitral area
Accentuated by expiration
and left lateral tilt

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17
Q

Symptoms of Mitral stenosis

A

Symptoms
1. Exertional dyspnea
2. Hemoptysis (d/t PO)
3. Palpitations (AF)
4. Chest pain

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18
Q

Signs of mitral stenosis

A

Signs
1. Malar flush
2. Atrial fibrillation
3. Tapping apex beat
4. Low volume pulse
5. Loud S1

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19
Q

Causes of mitral stenosis

A
  1. RHD (most common)
  2. Annular calcification
  3. Congenital
  4. Mucopolysaccharides
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20
Q

Characteristics of mitral regurgitation (MR)

A

Pansystolic murmur
best heard at mitral area
Radiating to left axilla
Accentuated by expiration

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21
Q

Symptoms of mitral regurgitation

A
  1. Palpitations
  2. Exertional dyspnea
  3. Fatigue
  4. Weakness
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22
Q

Signs of mitral regurgitation

A
  1. Atrial fibrillation
  2. Displaced, thrusting apex beat
  3. Soft/ absent S1
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23
Q

Causes of mitral regurgitation

A
  1. Papillary muscle rupture/dysfunction
  2. Mitral valve prolapse
  3. RHD
  4. IE
  5. Connective tissue disorder
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24
Q

Characteristic of aortic stenosis (AS)

A

Ejection systolic murmur
Best heard at aortic area
Radiating to carotid
Accentuated by expiration

25
Symptoms of aortic stenosis
Triad of 1. Syncope 2. Angina 3. Dyspnea
26
Signs of aortic stenosis
1. Sustained, heaving apex 2. Slow rising pulse 3. Narrow pulse pressure 4. Soft S2 if severe
27
Causes of aortic stenosis
1. Senile calcification of valve 2. Congenital bicuspid valve 3. RHD
28
Characteristics of aortic regurgitation (AR)
Early diastolic murmur Best heard at LLSE Accentuated by expiration and forward lean
29
Symptoms of aortic regurgitation
1. Palpitations 2. Angina 3. Dyspnea
30
Signs of aortic regurgitation
1. Water hammer pulse (Collapsing pulse) 2. Wide pulse pressure 3. Peripheral signs - Corrigan's - De Musset's - Quincke's
31
Acute and chronic causes of aortic regurgitation
Acute 1. Aortic dissection 2. IE Chronic 1. Connective tissue disorder 2. RHD 3. RA, Takayasu's
32
Investigations to confirm VHD
1. ECHO (confirm & assess severity)
33
Investigations to look for etiology of VHD
1. Blood C&S (IE)
34
Investigations to look for complications of VHD
1. ECG (Arrythmia) 2. ECHO (APO) 3. CXR (APO)
35
Symptoms & Signs of IE
Symptoms 1. Fever 2. HF 3. Arrythmia Signs 1. IE stigmata 2. HF signs 3. Murmur 4. Signs of complications (Strke, peripheral emboli)
36
Investigations to confirm IE
1. ECHO (to look for vegetation & assess valvular function)
37
Investigations to look for etiology of IE
1. 3 site blood C&S
38
Investigations to look for complications of IE
1. ECG (Arrythmia) 2. CXR(Heart failure) 3. ECHO (Aortic root abscess)
39
Diseases of myocardium
1. Myocarditis 2. Cardiomyopathy 3. Infiltrative cardiac disease - Cardiac amyloidosis, Cardiac sarcoidosis 4. Myocardial ischemia - CAD
40
Causes of myocarditis
1. Viral infection (Coxsackievirus, Adenovirus) 2. Bacterial infection : Staph/ Strep 3. Autoimmune : SLE 4. Drugs : Chemotherapy 5. Toxins: Alcohol, Heavy metal
41
Symptoms & signs of myocarditis
Symptoms 1. Chestpain (sharp in nature) 2. Heart Failure symptoms 3. Arrythmia symptoms Signs 1. Signs of causative disease 2. Heart failure symptoms 3. Irregular pulse
42
Investigations to confirm myocarditis
1. ECG - Concave ST elevation at multiple leads 2. Cardiac enzymes
43
Investigations to look for etiology of myocarditis
1. Infective markers (CRP/ESR) 2. Connective tissue disease (CTD) screening (ANA, C3C4)
44
Investigations to look for complications of myocarditis
1. CXR 2. ECHO
45
Phenotypes of cardiomyopathy
1. Hypertrophic CM 2. Dilated CM 3. Restrictive CM 4. Non Dilated Left Ventricle CM 5. Arrythmogenic Right Ventricular CM
46
Symptoms & Signs of infiltrative cardiac disease
Symptoms 1. HF symptoms Signs 1. HF signs
47
Investigations to confirm infiltrative cardiac disease
1. ECG (low voltage complex) 2. ECHO (LV wall thickened) 3. MRI (myocardial tissue assessment)
48
Investigations to look for etiology of infiltrative cardiac disease
1. Serum ATTR (Amyloidosis) 2. Serum ACE & Calcium (Sarcoidosis)
49
Investigations to look for complications of infiltrative cardiac disease
1. ECHO (HF) 2. CXR (HF) 3. ECG (Heart block)
50
Causes of pericarditis & pericardial effusion
1. Infection: TB 2. Autoimmune : SLE 3. Neoplasia : Malignancy 4. Uremic Pericarditis 5. Cardiac trauma
51
Symptoms & signs of pericarditis & pericardial effusion
Symptoms 1. Chest pain 2. HF symptoms 3. Symptoms of u/l causes Signs 1. Muffled Heart Sound 2. Heart Failure signs 3. Tachycardia 4. Signs of underlying disease
52
Investigations to confirm pericarditis & pericardial effusion
1. ECHO (Pericardial effusion) 2. ECG - widespread saddleshape ST elevation in pericarditis - low voltage ecg in pericardial effusion
53
Investigations to look for etiology of pericarditis & pericardial effusion
1. Pericardocentesis ( Exudative vs Transudative) 2. RP, TB screening (underlying systemic diseases)
54
Investigations to look for complications of pericarditis & pericardial effusion
1. ECHO (Cardiac Tamponade, Heart Failure) 2. CXR (Heart Failure)
55
Definition of cardiac tamponade
- An emergency situation - Large amount of pericardial effusion compressing the heart - Leading to reduced cardiac output and shock
56
Signs of cardiac tamponade
1. Becks triad - Hypotension - Distended JVP - Muffled Heart sound 2. Pulsus alternans
57
Investigations & expected findings in cardiac tamponade
1. ECG : Electrical alternans, low voltage 2. ECHO: RA/RV Collapse
58
Management of cardiac tamponade
Urgent pericardiocentesis