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EXAM 2021 > Cardio > Flashcards

Cardio Flashcards

1
Q

AS

A

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.
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2
Q

murmur history

A 
does valsalva change it
timing: diastolic/systolic/continous
loudest location: APTM
Radiation
quality/pitchy
intensity
presence of thrill/clicks.
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3
Q

AR

A

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

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4
Q

ASD

A 
Sx: mostly asymptomatic, as older: CCF
Cause - congenital
Murmur  ESM - pulmonary 
ECG: RBB w LAD; or RAD. 
Mx: OT if severe
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5
Q

coarct of aorta

A

associated w turners
narrowing of aorta just past arch
radiofemoral delay, HTN, scapular bruit.

OT

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6
Q

MR

A

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.

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7
Q

MS

A

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

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8
Q

hypertrophic cardiomyopathy

A

harsh mid systolic murmur.

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9
Q

Angina

A

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.

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10
Q

AAA

A

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

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11
Q

STEMI CRITERIA

A 
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.
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12
Q

SECONDARY PREVENTAION CVA/IHD

A
  • 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
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13
Q

Phaeo

A

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)

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14
Q

WPW

A

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

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15
Q

polyarteritis nodosum (vasculitis)

A

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.

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16
Q

wegners granulomatosis

A 
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
17
Q

hyperchol

A

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

18
Q

waist circ

A

< 80 women
< 94 men
< 25BMI

19
Q

coronary calcium score

A

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

20
Q

PVD

A

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

21
Q

compression stockings

A

OK if for chronic venous insuff/varicose veins

  • ABI > 0.6
  • present food pulses palpable.
22
Q

Inf Endocarditis

A

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.

23
Q

L sided CCF

  • HFpEF ( <50% EF)
  • HFrEF (diastolic failure)- inabilty to relax to fill.
A

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)

24
Q

R sided CCF

A

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)

25
Q

CCF Mx (non pharma)

A
  • 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
26
Q

CCF Mx pharma

A

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

27
Q

AF RF

A

RF:

  • DM,
  • obesity
  • thyroid (hypo/hyper)
  • nutritional def
  • smoking
  • metabolic syndromes
  • osa
  • sedentary lifetyle
  • cardiomyopathy/MS/CCF/CHD
  • sepsis
28
Q

AF OE

A 
irregularly irregular pulse, often rapid. 
associated haemodyanmic status
BMI
ethnicity
thyrotoxic
pulmoanry disease
CCF
sepsis
obvious valvular path
29
Q

Mx non pharma AF

A 
weight loss, aim < 25 BMI
reduced etOH
control DM
OSA screening/mx
consider falls risk
30
Q

Mx AF pharma

A

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

EXAM 2021 (10 decks)

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