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PACES > Cardio > Flashcards

Cardio Flashcards

1
Q

Midline sternotomy scar

A
  • CABG (saphenous vein graft scar present)

- Valvular surgery

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2
Q

Causes of raised JVP

A

Cardiac

  • RHF/Cor Pulmonale
  • PE
  • RV Infarction
  • Constrictive pericarditis

Non-cardiac
- SVCO

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3
Q

Infective Endocarditis signs

A

Fever

Hands

  • Janeway lesions (painless)
  • Oslers nodes (painful)
  • Splinter haemorrhages

Face
- Roth spots (ophthalmoscopy)

Heart

  • Murmur
    - In IVDU, Tricuspid regurgitation
    - Otherwise, Mitral regurgitation

Abdomen
- Splenomegaly

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4
Q

What is S3 + causes

A

Extra heart sound due to rapid ventricular filling in a compliant ventricle

Causes

  • Normal/physiological in young patients <40
  • High output states (thyrotoxicosis, anaemia)
  • LVF
  • Mitral Regurgitation
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5
Q

What is S4 + Causes

A

Extra heart sound due to vigorous atrial contraction to push blood into a non-compliant ventricle

Causes (anything that causes LVH)

  • Hypertension
  • Hypertrophic cardiomyopathy
  • Aortic stenosis
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6
Q

Aortic Stenosis signs

A 
Narrow pulse pressure
Slow rising carotid pulse
Heaving apex beat (LVH)
Ejection systolic murmur loudest in aortic area radiating to carotids
Signs of anaemia
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7
Q

Causes of Aortic stenosis

A

Age related calcification

Bicuspid aortic valve

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8
Q

Causes of mitral stenosis

A

Rheumatic heart disease (occurs around 10y after infection)

Austin-flint murmur: Increased LV load due to severe AR

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9
Q

Signs of mitral stenosis

A

Mitral facies (erythema due to cutaneous vasodilation on the face)

Mid diastolic low rumbling murmur loudest in mitral region with no radiation

Signs of HF (due to LA dilatation)
P Mitrale on ECG (left atrial hypertrophy)

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10
Q

Causes of aortic regurgitation

A
  • Bicuspid aortic valve
  • Rheumatic heart disease
  • Aortic dissection
  • Infective endocarditis
  • Connective tissue diseases eg. Marfan’s
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11
Q

Signs of aortic regurgitation

A
  • Quinke’s sign (nailbed pulsation)
  • Collapsing pulse
  • De Musset’s sign (Head bobbing)
  • Corrigan’s sign (Enhanced carotid pulsation)

Early diastolic murmur loudest at LL sternal edge

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12
Q

What is Pulsus Paradoxus + causes

A

Loss of radial pulse during inspiration due to an inappropriate drop in BP. Occurs in constrictive cardiac diseases:

  • Cardiac tamponade
  • Constrictive pericarditis
  • Restrictive cardiomyopathy
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13
Q

Kussmaul’s sign

A

Paradoxical rise in JVP associated with constrictive heart disease

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14
Q

Causes of tricuspid regurgitation

A

RVF
Valve prolapse
Infective endocarditis
Rheumatic heart disease

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15
Q

Risk factors for Infective endocarditis

A

Valvular disease

  • Prosthetic valve
  • Valve damage e.g. rheumatic heart disease

Heart disease
- Congenital heart disease

Other

  • Poor dentition
  • IVDU
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16
Q

Causes and complication of Mitral regurgitation

A

Rheumatic heart disease
Infective endocarditis
Mitral valve prolapse

Retrograde blood flow across mitral valve increases LV preload, leading to dilatation and HF over time

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17
Q

Presentation of mitral regurgitation

A

Sx of HF

Dyspnoea
Orthopnoea
PND
Peripheral oedema

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18
Q

Valve surgeries

A

Open
- Valve repair (normally done for regurgitation)
- Valve replacement (done in stenosis)
- Mechanical valves are lifelong but require
warfarin anticoagulation
- Tissue valves last 10-15y but don’t require
anticoagulation

Transcatheter (for people not suitable for invasive surgery)
- TAVI (guidewire into femoral artery under XR guidance

19
Q

Indications for CABG

A 
- >50% stenosis PLUS 1 of:
		○ Severe angina unresponsive to medical therapy
		○ Marked ST depression on exercise ECG
		○ Left main stem stenosis
		○ Severe triple vessel disease
		○ Angina w/ LV dysfunction
20
Q

Causes of AF

A

Cardiac

  • Ischaemic heart disease
  • Valvular heart disease
  • Cardiomyopathy
  • hypertension

Non-cardiac

  • Thyrotoxicosis
  • Alcohol
  • PE
  • Sepsis
21
Q

Causes of Dilated Cardiomyopathy

A

Alcohol
Viral infections
Haemochromatosis
Hypertension

22
Q

Causes of restrictive cardiomyopathy

A

Amyloidosis
Sarcoidosis
Haemochromatosis
Fibrosis

23
Q

Heart failure types

A

HFrEF (EF <40%)
Inefficiency of heart pumping, so stroke volume reduced

HFpEF (EF>40%)
Inefficiency of diastolic heart filling, not pumping

LHF
RHF
CHF

High output vs Low output
High output = increased oxygen demand e.g. anaemia, thyrotoxicosis, pregnancy

24
Q

NYHA classification of HF

A

NYHA I: No symptoms with ordinary physical activity
NYHA II: Symptoms with ordinary physical exercise
NYHA III: Symptoms with less than ordinary physical exercise
NYHA IV: Dyspnoea at rest

25
Q

Signs of HF

A 
Peripheral oedema
Raised JVP
Displaced apex beat
S3 + S4 (gallop rhythm)
Hepatomegaly
26
Q

XR findings in HF

A 
Alveolar oedema
Kerley B lines
Cardiomegaly
Upper lobe diversion
Effusions
27
Q

Mx of chronic heart failure

A

Conservative

  • Exercise programmes
  • Smoking cessation
  • Low Salt diet
  • Fluid restriction

Medical

Drugs to improve symptoms:

  • Diuretics
  • Long acting nitrates

Drugs to improve prognosis:

  • ACEi
  • Beta blocker
  • Spironolactone

One of SHIC:
Sacubitril-valsartan (if LVEF <35%, replaces ACEi)
Hydralazine + isosorbide (esp. in afrocaribbeans, if ACEI/ARB not tolerated)
Ivabradine
CRT

28
Q

Reversible causes of cardiac arrest

A
  • Tension
    • Trauma
    • Thrombin
      • Tamponade
    • Hypoxia
    • Hypokalaemia
    • Hypovolaemia
    • Hypothermia
29
Q

MI complications

A

Dressler’s syndrome (autoimmune pericarditis 6w post-MI)
Arrhythmia (Heart block)
Rupture (Papillary muscle, ventricular septal defect)
Thrombus
Haemorrhage/HF
Valve disease (acute mitral regurgitation)
Aneurysm
Emboli
Re-infarction (use CK-MB instead of troponin)

30
Q

Pericarditis Ix

A

Bedside
- Serial ECGs

Bloods

  • FBC U&E CRP
  • Troponin

Imaging
- Echo (rule out pericardial effusion)

Viral serology

31
Q

3 types of Post-MI rupture

A

Papillary muscle rupture = Acute Mitral Regurgitation
Px: Pulmonary oedema, hypotension, new soft PSM

Interventricular septal rupture = VSD
Px = Chest pain, shock, new harsh PSM

LV free wall rupture
Px: HF, cardiac tamponade

32
Q

Mx of post-MI arrhythmia

A

Inferior MI = Atropine

Anterior MI = Transcutaneous Pacing then permanent pacemaker

33
Q

What are the 3 main consequences of an MI? Explain how this then leads to the DARTHVADER complications

A
  • Reduced contractility
    ○ This means that the heart is not able to pump blood as effectively, possibly leading to cardiogenic shock
    ○ As you get stasis of blood that is not being moved, this predisposed to clot formation (thrombus) which may embolise to other parts of the body, or cause reinfarction within the coronary vessels
    • Electrical instability (disorganised ion movements, disrupted electrical conduction)
      ○ Leads to heart block due to disruption of the SAN and AVN
      ○ Also leads to arrhythmias such as VF
    • Tissue necrosis
      ○ Leads to an inflammatory reaction, which can irritate the pericardium leading to pericarditis
      ○ Necrosed tissue is more prone to rupture, which may lead to rupture in many areas
      § Papillary muscle rupture: Acute Mitral Regurgitation
      § Ventricular septal rupture: VSD
      § LV free wall rupture: Cardiac tamponade (as blood then accumulates within the pericardium
34
Q

Hypothermia ECG findings

A

Bradycardia
J waves
QT prolongation
Arrhythmias

35
Q

Austin flint murmur

A

Early diastolic Murmur + Mid-diastolic murmur

In severe AR, you get so much backflow of blood that you get a regurgitant jet of high velocity bloodflow through the mitral valve, causing a MDM of Mitral stenosis

36
Q

Types of pulmonary hypertension

A

Pulmonary Arterial hypertension
Pulmonary artery obstruction
Chronic lung disease
Left Heart disease

37
Q

Signs of pulmonary hypertension

A

Signs of RHF
Peripheral oedema
Raised JVP

Loud S2
Graham Steel Murmur (EDM along L sternal border essentially representing pulmonary regurgitation due to severe pulmonary hypertension)

38
Q

What is rheumatic fever

A

Autoimmune condition post Group A strep sore throat

39
Q

Rheumatic fever features

A

Major JONES Criteria

Carditis
Arthritis
Sydenham's Chorea (2-6 months after infection)
Erythema Marginatum
Subcutaneous nodules
Minor JONES Criteria
Fever
Raised ESR/CRP
Arthralgia
Prolonged PR interval
Previous RF
40
Q

Rheumatic fever diagnosis

A 
Evidence of GAS infection, AND:
•	Throat culture test +ve 
•	Rapid streptococcal antigen test +ve
•	↑ ISO titre 
•	Recent scarlet fever

 [2a] 2 majors; OR MAJOR: CASES
 [2b] 1 major + 2 minors MINOR: FRAPP

41
Q

Rheumatic fever diagnosis

A 
Evidence of GAS infection, AND:
•	Throat culture test +ve 
•	Rapid streptococcal antigen test +ve
•	↑ ISO titre 
•	Recent scarlet fever

 [2a] 2 majors; OR MAJOR: CASES
 [2b] 1 major + 2 minors MINOR: FRAPP

42
Q

Rheumatic Fever Mx

A

Bed rest
Analgesia
Phenoxymethylpenicillin

Prophylaxis of rheumatic heart disease
Once monthly IM benzathine penicillin OR BD oral phenoxymethylpenicillin

5y if no carditis, 10y if carditis

43
Q

Indications for aortic valve replacement in AS

A

Symptomatic

Aortic valve gradient >40mmHg

PACES (13 decks)

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