Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PACES > Cardio > Flashcards

Cardio Flashcards

1
Q

Early diastolic murmur

A

Aortic regurgitation -

Early diastolic murmur (best heard at left sternal edge, with patient sat forward and breath held in expiration).
Look for: pulse large volume and collapsing, de Musset's sign (head nodding), Corrigan's sign (visible carotid pulsations), displaced forceful apex beat.
Also: check BP (wide pulse pressure).
Look for hyperdynamic circulation: Traube's sign 'pistol shot femorals' Quincke's sign of nail bed capillary pulsations, Duroziez's sign of a to-and-fro murmur.
Causes: Rheumatic fever, hypertension, atherosclerosis, endocarditis, bicuspid aortic valve. Also associated with: Marfan's syndrome, ankylosing spondylitis, rheumatoid arthritis, syphilis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Congenital pulmonary valve disease

A

Downs (trisomy 21)
Noonan (short stature, micrognatia, wideey spaces eyes, ears back)
Turner (X chromosome, short stature and reporuductive failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of mitral regurgitation

A 
Degenerative (age related) 
Underlying MVP - note connective Tissue Disorders
IE
Rheumatic Fever
MI (papillary muscle rupture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Investiagations to request: mitral regurgitation

A

ECG, Fundoscopy, Urine dipstick
Bloods - inflammatory markers, FBC (anaemia), U&E
Echo - pulmonary htn, concommitant lesions, ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Complications of aortic stenosis

A

Endocraditis - splinters, ON (finger pulp), JL (palm), Roth spots (retina), temperature, splenomegaly, haematuria
LVD - displaced apex beat, bibasal crackles
Concution problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DDx ESM

A 
HOCM
VSD
PS
Aortic sclerosis
Aortic flow - high output states
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of AS

A 
Biscuspid AV (congenital) 
Aquired (age, rheumatic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Severity of AS

A 
ASD
Angina - 5 
Syncope - 3 
Dyspnoea - 2
50% mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dukes Criteria for IE

A

Major –> Typical organism on 2 blood cultures, Echo evidence of IE
Minor –> Pyrexia, echo suggestive, predisposition (e.e.g prosthetic valve), embolic phenomena, vasculitic phenomena (ESR, CRP), atypical organism on blood culture

2 major
or
1 major and 2 minor
or 
5 minor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of AS

A

Asymptomatic - none, good dental health, regular review of symptoms and echo findings to assess gradient and LVF
Surgical - AVR +/- CABG (operative 3-5% mortality
Percutaneous - baloon aortic valvuloplasty or TAVI
NNT for TAVI 5 at 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigating ESG

A

ECG - LVH, conduction defect (e.g. 1*HB)
CXR - ?valvular calcification, ?cardiomegaly
Echo - mean gradient 40mmHg, valve area <1.0 severe
Angiography - ?extent of co-existing CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

AR eponymous signs

A 
deMussets - head bobbing
Corrigans - visible carotid pulsations
Quicke's - nail bed pulsation
Durosier's - diastolic murmur proximal to femoral artery compression
Traube's - pistol shot femoral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DDx aortic regurg

A

Valve leaflet - endocarditis (acute), rheumatic fever (chroinc)
Aortic root - dissection/trauma (acute), dilatation due to marfans and hypertension, aortitis (ank spond, syphilis, vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of a collapsing pulse

A 
AR
Prednancy
PDA
Pagets
Anaemia
Thyrotoxicosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigating AR

A

ECG - lateral TWi
CXR - cardiomegaly, widened mediastinum
TTE/TOE - severity, LVEF and dimentions, root size, jet width
Cardiac catheterisation - grade severity and check coronary patency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Managing AR

A

1 Medical - ACE-i and ARBs (reduce afterload)
Regular review - symptoms, echo: LVEF, LV dimentions and degree of AR
Surgery (acute) - dissection, aortic root abscess or endocarditis
Surgery (chronic) - wide pulse pressure >100mgHg, ECG changes on ETT, LV enlargement >5.5 cm systolic diameter, or EF <50%
Ideally aim to replace valve prior to LVD and dilatation

Asymptomatic with EF>50% - 1% mortality and 5 years
Symptomatic of all three criteria - 65% mortality at 3 years

17
Q

Mitral stenosis on examination

A

Malar flush, irregular pulse (AF), tapping apex beat, left parasternal heave if PTH ir enlarged left atrium
Loud 1st heart sounds
Opening snap followed by mid diastolic murmur best heart in apex left lateral in expiration with bell.

Haemodynamic - ?PHT, functional TR, RV heave, loud P2
Embolic complications - stroke risk high if MS + AF

18
Q

Causes and DDx of mitral stenosis

A

Congenital (rare), acuired - rheumatic heart disease, senile degeneration, large mitral leaflet vegetation from endocarditis

DDx - left atrial myxoma, austin flint murmur

19
Q

Investigating mitral stenosis

A

ECG - p mitrale and AF
CXR - enlarged left atirum calcified valve, pulmonary oedema
TTE/TOE - valve area (<1cm severe, cusp mobility, calcification and left atrial thrombus, RVF

20
Q

Rheumatic Fever

A

Group A beta haemolytic streptococcus (e.g. strep pyogenes) + immunological cross reactivity with valve tissues

Duckett-Jones criteria - proven B haemolytic strep by throat swab or ASOT
Major - chorea, erythema marginatum, S/C nodules, polyarthritis, carditis
Minor - raised ESR, raised WCC, arthralgia, previous rheumatic fever, pyrexia, prolonger PR interval

Treatment - rest, high dose aspirin and penicillin
Prophylaxis - primary prevention - penV 10 days

21
Q

Managing mitral stenosis

A

Medical - AF rate control and anticoagulation, diuretics
Mitral valvuloplasty - if pliable, non calcified and minimal regurgitation and no left atrial thrombus
Surgery - closed mitral valvotoomy (without open heart) or open valvotomy (on bypass) or valve replacement

Prognosis - latent asymptomatic phase 15-20 years, NYHA > 2 = 50% mortality at 5 years

22
Q

Causes of mitral regurgitation

A

Acute –> Bacterial endocarditis or chordae/papillae rupture

Chronic –> Degenerative, rheumatic, CTD, fibrosis (pergolide), functional (dilated LV), calcification, infiltration (amyloid), fibrosis

23
Q

Investigating MR

A

ECG - p mitrale, atrial fibrillation, previous infarctions
CXR - cardiomegaly, LA enlargement, pulmonary oedema

Echo
Severity (size/density or MR jet, LV dilation and reduced EF
Cause (prolapse, vegetation, ruptured papillae, fibrotic restriction, infarction

24
Q

Managing mitral regurgitation

A

Medical - anticoagulation for AF, diuretic, B blocker and ACEi
Percutaneous - mitral clip device for palliation
Surgical - valve repair (preferable) with annuloplasty or replacement

Aim to operate when symptomatic, prior to severe LV dilation and dysfunction

Often asymptomatic for >10 years
25% mortality at 5 years if symptomatic

25
Q

Mitral valve prolapse

A

5% in young tall women
Associated with CTD (e.g. marfan’s, HOCM)
Often asymptomatic but may present with chest pain, syncope, palpitations
Small risk emboli and endocarditis

Mid systolic ejection click + pan systolic murmur
Murmur accenuated by standing from squatting position or during valsalva

26
Q

Tricuspid reguargitation

A

Raised JVP with giant CV waves, thrill left sternal edge
PSM loudest on inspiration

Pulsatile liver, ascites, peripheral oedema,
Pulmonary HTN - RV heave, loud P2
Other valve lesions = rheumatic mitral stenosis

27
Q

DDx tricuspid regurgitation

A

Congenital - Ebsteins anomaly (atrialisation of the RV and TR
Acuired - endocarditis, chronic - functions, rheumatic, carcinoid

28
Q

Investigating and managing tricuspid incompetence

A

ECG - p pulmonale and RVH
CXR - double right heart border (enlarged RA)
TTE - TR jet, RV dilation

Management
Medial - diuretics, B blocker, ACEi, support stocking for oedema
Surgical - valve repair (annuloplasty) if medical treatment fails

29
Q

Pulmonary stenosis

A

Raised JVP with giant A waves, left parasternal heave, thrill in pulmonary area, ESM loudest in inspiration, widely split S2
RVF

30
Q

Carcinoid Syndrome

A 
Neuroendocrine tumour - secreting 5HT3
Primary gut, mets in liver
Diarrhoea, wheeze and flushing 
Right sided heart fibrosis and TR +/- PS
Treated with octreotide or surgical resection
31
Q

Managing pulmonary stenosis

A

Valvotomy if gradient >70mmHg or RVF
Percutaneous pulmonary valve implantation
Surgical repair / replacement

32
Q

Prosthetic valves - scars

A

Midline sternotomy - CABG, AVR, MVR
Lateral thoracotomy - MVR, mitral valvotomy, coarctation repair, BT shunt
Subclavicular - PPM
ACF / wrist - angiography

33
Q

Aortic valve replacement

A

Metallic click insead of 2
May be opening click and ESM
Bioprosthetic valve has normal heart sounds

Abnormal findings - AR

34
Q

Mitral valve replacement

A

Mettalic 1st heart sounds. Opening click in early diastole

Abnormal - MR

35
Q

Choice of valve replacement and complications

A

Metal - durable, but needs anticoagulation, young / co-existing AF
Porcine - no warfarin, less durable, elderly / at risk haemorrhage
Operative mortality 3-5%

Thromboembolus - 1-2% VTE despite warfarin
Bleeding - fatal 0.6, major 3% minor 7% annual
Bioprosthetics dysfunctions
Haemolysis
IE
AF

36
Q

ICD guidelines

A

Primary prevention
MI >4/52 ago (NYHA 120 ms
or
Familial condition with high risk - LQTS, Brugada, HCM

Secondary prevention
Cardiac arrest 2* to VT or VF
Haemodynamically compromising VT
VT with LVEF <35%

+ Cardiac resynchronisation therapy

37
Q

Atrial Septal Defect

A

Fixed split S2 which does not change with respiratory. Pulmonary ESM and mid distolid flow murmur with large left to right shunts

Consider PHT - RV heave and loud P2 + cyanosis and clubbing (Eisenmenger’s R–>L shunt)

38
Q

Types of

A

PACES (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions