Cardio Flashcards
26 y/o
pc: 48 hr hx intermittent sharp central chest pain
worse on exertion, and on lying supine
ECG: widespread ST elevation
indicative of:
pericarditis
- often relieved by sitting forwards
important sign on auscultation of a patient with pericarditis:
pericardial rub
immediate management of thoracic aortic dissection:
- IV labetalol (BP reduction)
- IV morphine (sympathetic tone reduction)
definitive management
- EVAR
what is anti-phospholipid syndrome?
- antiphospholipid antibodies
- blood more prone to clotting
- thrombosis!
this is a type of non-bacterial endocarditis where there are growths on the valves of the heart:
Libmann-Sacks endocarditis
- mitral valve commonly associated
what is Tietze syndrome?
rare inflammatory disorder
characterised by chest pain
and swelling of cartilage of one or more upper ribs.
in a patient with tachycardia without any adverse features i.e. uncompromised, what is the first line treatment:
amiodarone 300mg loading dose IV
then infusion 900mg over 24 hrs.
slurred upstroke to QRS complex known as
delta wave
reflects ventricular pre-excitation
ECG of what condition would most likely show
- RBBB
- tall, broad P waves
tall, broad P waves –> atrial enlargement
Ebstein’s anomaly
- young adults with fatigue, palpitations, cyanosis and breathlessness on exertion
this condition typically presents in young patients with episodes of syncope and palpitations :
ECG –> delta waves
wolf-parkinson white syndrome
re-entry circuit –> tachyarrhythmias
left ventricular dilatation often results in what:
mitral regurgitation
what murmur does mitral regurgitation produce:
pan-systolic
best heard over apex, radiating to axilla
causes of mitral regurgitation:
notes
IF CREEP
I - infective endocarditis
F - functional (left ventricular dilation)
C - cardiomyopathy/congenital
R - rheumatic fever / ruptured chordae tendinae
E - elderly calcification
E - ehlers danlos syndrome
P - papillary muscle dysfunction / rupture
causes of aortic regurgitation:
notes
IM DR CRASH
I Infective endocarditis M Marfan syndrome D Dissection (aortic) R Rheumatic fever C Congenital R Rheumatoid arthritis A Ankylosing spondylitis S Systemic lupus erythematosus (SLE) H Hypertension
visible capillary pulsations on nail bed is known as
Quincke’s sign
58 y/o
pc: malaise, fever, night sweats, exertional dysponea
oe: splinter haemorrhages + quinckes sign
indicative of:
aortic regurgitation secondary to infective endocarditis
what type of murmur is heard in aortic regurgitation:
early diastolic murmur
accentuated by patient sitting forward
pericarditis treatment
analgesia NSAIDs (ibuprofen)
for 1-2 weeks until pain resolves
example of a drug used for anti-coagulation in acute coronary syndrome without ST segment elevation
fondaparinux
- factor Xa inhibitor
which sign would be consistent with pulmonary oedema?
perihilar shadowing
‘bat wing’ distribution
suggestive of alveolar oedema
describe mobitz type 1 heart block
progressive lengthening of the PR interval over several complexes
ECG shows dissociated P waves and QRS complexes indicative of:
third degree heart block
collapsing pulse and early diastolic murmur is suggestive of:
aortic regurgitation
in a patient under 70, aortic stenosis most commonly caused by:
bicuspid valve
the following triad is indicative of what:
- hypotension
- tachycardia
- muffled heart sounds
becks triad
indicates pericardial effusion
which artery supplies the left atrium?
circumflex artery
give an example of a drug shown to reduce mortality in severe heart failure:
spironolactone
patient presents with AF, 48hrs.
haemodynamically stable.
most appropriate management:
investigate for reversible causes of AF
- hyperthyroidism and alcohol
bloods
cxr
if no reversible causes found
- medical cardioversion!
- —-> IV FLECANIDE
ECG changes in hyperkalaemia:
- peaked T waves
- widening of QRS complex
- decreased amplitude of P wave
Retinal haemorrhages with pale centres are known as :
Roth spots
- seen in infective endocarditis
high pitched diastolic decrescendo murmur, accentuated on inspiration.
moderate peripheral oedema
cxr normal
indicative of:
pulmonary regurgitation
pulmonary hypertension
- SOB, weakness, oedema –> may lead to right heart failure
management of pulmonary hypertension
diuretics
oxygen therapy
bosentan
- endothelin receptor antagonist
endothelin is an example of a
vasoconstrictor
pericarditis with fever and pleuropericardial chest pain several weeks following MI is known as :
Dressler syndrome
- autoimmune
murmur:
pmh rheumatic fever, loud first heart sound and rumbling mid-diastolic murmur
mitral stenosis
first heart sounds occurs due to :
- closure of the AV valves
- as ventricles contract
- coincides with QRS complex
which valve is auscultated at the left sternal border in the fourth intercostal space:
tricuspid
which valve is best heard over left sternal border at second intercostal space:
pulmonary
what is kartagener’s syndrome:
congenital syndrome of ciliary dysfunction
cilia do not beat properly
what is the correct statin dose for secondary prevention in patients with previous MI:
Atorvastatin 80mg OD
which layer of the pericardium adheres to the heart muscle
visceral layer
known as epicardium
patient with hypertrophic cardiomyopathy will have what type of murmur:
ejection systolic
DECREASED BY SQUATTING
- increases afterload and preload making murmurs louder
large amount of fluid in the pericardial sac is known as :
cardiac tamponade
immediate management
- prepare for pericardiocentesis
normal cardiac axis is from:
-30 to 90 degrees
25 y/o
pc: headache, dizziness and claudication
oe: hypertension in upper limbs, hypotension in lower
characteristic of:
aortic coarctation
- notching of inferior margins of ribs
atrial flutter is what type of tachycardia:
supraventricular
- narrow complex
- sawtooth appearance
this leads to an elevated JVP with large V waves + pan-systolic murmur at left sternal edge
tricuspid regurgitation
- pulsatile hepatomegaly
- left parasternal heave
marfans syndrome associated with what cardiac abnormality:
aortic root dilatation
Tricuspid regurgitation presents with:
loud pansystolic murmur
