Cardio Flashcards
AS
Sx:FTT in children. otherwise: angina/CCF/syncope in > 60 = AS.
Cause: age/calcium deposits, RHD, congenital.
Murmur: harsh crescendo, ESM. Heave. radiates to carotids. delayed peripheral pulses.
ECG- P Mitrale, LVH
Mx
- avoid smoking, weight loss, BP control, Chol control, monitor closely, exercise but not severe
- surgical otherwise. watch for CCF/APO.
murmur history
does valsalva change it timing: diastolic/systolic/continous loudest location: APTM Radiation quality/pitchy intensity presence of thrill/clicks.
AR
Sx (fatigue , sob , peripher oedema)
Cause congenital, age/calcium, endocartidis, RF, marfans.
Murmur: soft blowing early diastolic murmur ; collapsing arterial pulse
Mx : BP contol. TTE momnitoring. surgeons if deteriorating
ASD
Sx: mostly asymptomatic, as older: CCF Cause - congenital Murmur ESM - pulmonary ECG: RBB w LAD; or RAD. Mx: OT if severe
coarct of aorta
associated w turners
narrowing of aorta just past arch
radiofemoral delay, HTN, scapular bruit.
OT
MR
Sx - non specific
Cause: often RHD
Murmur -blowing holosytolic murmur; displaced apex, radiation to axillae. S3.
ECG: AF usually also
Mx: control AF.
if RHD: register on RHD register; benzathing penicillin G until 18-20. 21-28 daily.
MS
Sx: soboe, fatigue, systemic emboli, haemoptysis. chronic cough
Cause : RHD, malignant carcnioid, prosthetic.
Murmur: worse w L lateral position. diastolic murmur.
associate: malar flush, AF
ECG: P mitrale with RAD
Mx: Rx complications
hypertrophic cardiomyopathy
harsh mid systolic murmur.
Angina
1) restrosternal CP, radiating L arm
2) predictable pattern, on x amount of activity
3) relieve by rest/nitrates
mx:
- if high risk: ED for any chest pain… for troponin urgently.
- otherwise:
non pharma: modify RF, weight loss, action plan/education
pharma: GTN, metroprolol for rate control; ccb (amlodipine); then finally: long acting GTN patch/ISMN.
AAA
Sx: non specific pain; lower limb ischemia/claudication. rupture: unstable
RF: male, HTN, fhx of aaa, smoker, atherosclerosis, other aneurysm, marfarn/ehler danlos.
OE: assess if stable; palpate abdomen: pulsatile supraumbilical mass? tender?
Ix:
uss: > 30 = anuerysmal; > 50mm = risk rupture.
Mx
non pharma: regular surveillance, mx plan for rupture/education, manage cvasc risk factors. regular activity.
vasc surg refer.
Surveillance: > 35 = 6 monthly scan, < 35 = 12 monthly scan
STEMI CRITERIA
Persistent changes (20 mins) > 2 leads. 1) > 2.5mm ST E in V2/3 in men < 40; >2 in > 40; >1.5 in women. 2) > 1 mm STE in other leads. 3) scarbosa criteria. w new lbbb.
SECONDARY PREVENTAION CVA/IHD
- statin, start at 80mg
- antiplatelet w aspirin 12 months post STEMI; then just one.
- ACEi - max tol. dose
- regular PCV/influenza/PCV.
- bblocker in LVEF pt.
non pharma
- educate, weight loss, cardiac rehab. healthy diet, weight mx, smoking cessation, reduced etOH
- manage mental health
- OSA
Phaeo
Sx: palpitations, flushing,s weating, headaches, tremor, tachycardia;
OE: HTN, weight loss.
Screening: urine 24 hour metadrenalines. (for asymtpoamtic screen = preferred)
Dx: plasma metadrenalines. (can do when Sx present)
WPW
ECG: delta, short PR, wide QRS
Associated: downs.
no Rx required, but when in AF: Rx urgently –> VT/VF. can try vagal while awaiting ambulance, but essentially needs ED ASAP
polyarteritis nodosum (vasculitis)
small/med vessel autoimmune vasculitis
RF: hep B , middle age.
Sx : prominent systemic featuers: myalgia, anorexia, fever.
+/- skin (palpable purpura, livedo reticularis (lace like); nerves (peripheral tingling); GIT (liver sichaemia w abdo pain); kidney (malignant HTN/ischaemic nephrpathy).
Dx: biopsy.
P: pred, specialist.
wegners granulomatosis
small to med vessel vasculitis. RF: m,iddle aged. Sx: necrosis; granuloma formation; vasculitis of ear, nostril, throat, LRTI. pulmonary infiltrates, glomerulonephritis. Dx: anca pos, biospy Mx : ED
hyperchol
Signs: xanthelasma, corenal acrus senilis.
Think of secondary causes
- LDL = hypothyroid, nephrotic, anorexia
- high TIG, low HDL: DM, obesity, smoking, renal impariment
- high TIG: etOH
- high HDL: oestrogen
Rx:
remember > 4 TIG, start fenofibrate as well as statin.
< 4 TIG then use fenofibrate as 2nd line.
high risk: Rx (and also antiHTN)
mod = 3-6 months lifestyle mod then consider,
if starting Rx: monitor 3 monthly ax until well controlled
waist circ
< 80 women
< 94 men
< 25BMI
coronary calcium score
do when:
- intermediate risk: (10-15% ACVR 5 yr)
- asymptoamtic
- no know coronary artery disease
- 45-75
- atsi/maura > 40.
also consider for lower risk patients: FHx prematuer CAD/DM 40-60yo
PVD
If severe: hair loss, muscle wasting, clawed toes, ulcers (punched out), gangrene
Screen if Sx/RF and > 65: ABI, can also do as its in clinic.
ABI < 0.9 + Sx ulcer/angina/claudication.
(< 0.9 abnormal, 1-1.4 normal, > 1.4 = DM/CKD non compressive arteries which can also suggest calcification so need uss too)
if abnormal then USS duplex +/- CT angiogram.
stenosis > 75% is significant.
Rx: RF modification; revasc surgery, regular POD review
compression stockings
OK if for chronic venous insuff/varicose veins
- ABI > 0.6
- present food pulses palpable.
Inf Endocarditis
Dukes
- Major: 2 x BC pos; echo showing IE / new regurg.
- definitive: tissue valve micro
- Minor: fever, injecting drugs, signs, micro evidence: pos BC
vascular signs:
- janeway lesions, splinter haemorrhages, septic pulmonary infarcts, ICH
immuno signs: osler nodes, roth spots, RF positive, GN.
L sided CCF
- HFpEF ( <50% EF)
- HFrEF (diastolic failure)- inabilty to relax to fill.
pulmonary oedema.
so presents as SOBOE/orthopnoea/ PND/fatigue, reduced UOP,
then if severe will back up R heart and R heart failure too.
signs:
- crackles/railes on ascultation, sob, pink frothy sputum. tachcyardia, irregular HR sometimes
ECG: LVH: down sloping ST depression, TWI lateral leads, deeps S waves; tall R waves lateral leads.
CAUSE:
hypothyroid, AF, IHD, obesity, OSA, drugs, infiltrative (sarcoid), infective (HIV), etOH, age, congenital
once diagnosed, go looking for cause (angio/tte etc)
R sided CCF
peripheral oedema
presents as fatigue, weakness, lethargy, nocturia, increased UOP
signs:
- pitting peripheral oedema, JVP elevation, hepatosplenomegaly, ascites, weight gain, rapid irregular HR.
CAUSES: L heart failure; or else VSD/ASD, or cor pulmonale (R heart failure by primary lung disease)
CCF Mx (non pharma)
- low salt diet
- DT review
- fluid restriction
- sick day managment w frusemide/ACEI
- sick recognition: daily weights at home, if > 1.5kg in day –> review
- cardiac rehab MDT team
- smoking cessation
- reduced etOH
- weight management
- regular physical exercise
- fall prevention
CCF Mx pharma
HFpEF:
- loop or thiazide diuretic
- low dose spiro
HFrEF
- ACEi prophylaxis (watch Cr rise, 30%)
- bblocker prophylactically (up titrate this first) (only if euvolemic)
- low dose spiro
- prn spiro
- ongoing: entresto, cardiac Dr
PCV/influenza/covid
AF RF
RF:
- DM,
- obesity
- thyroid (hypo/hyper)
- nutritional def
- smoking
- metabolic syndromes
- osa
- sedentary lifetyle
- cardiomyopathy/MS/CCF/CHD
- sepsis
AF OE
irregularly irregular pulse, often rapid. associated haemodyanmic status BMI ethnicity thyrotoxic pulmoanry disease CCF sepsis obvious valvular path
Mx non pharma AF
weight loss, aim < 25 BMI reduced etOH control DM OSA screening/mx consider falls risk
Mx AF pharma
manage RF
RHYTHM: very symptomatic / active pt.
- acute: cardiovert, flecanide. amiodarone
- chronic: flecanide, amiodarone (OK w CCF), sotalol
RATE: older, comorbidities, less symptomatic
- acute: fluid overloaded: amiodarone vs. euvolemic: BBlocker
- chronic: metoprolol, dig, verapamil.
CHA2DS2VA >2 = NOAC. 1 = consider.
HASBLED also consider
