cardio Flashcards
What are the 4 classifications of Heart failure in terms of the New York Heart failure Classification?
Class I — no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, breathlessness, or palpitations.
Class II — slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.
Class III — marked limitation of physical activity. Comfortable at rest but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations.
Class IV — unable to carry out any physical activity without discomfort. Symptoms at rest can be present. If any physical activity is undertaken discomfort is increased
What are the common causes of HF?
Damage e.g. MI, valvular issues, HTN, renal artery stenosis or end stage kidney failure. cardiomyopathy, congenital e.g. TOF.
Drugs, alcohol, toxins.
Pericarditis
Cor-pulmonale
Typical symptoms of HF
Cold peripheries Lightheadedness SOB on exertion Ankle swelling - oedema. PND - sleeping on pillows (orthopneia)
what are the symptoms of Cor Pulmonale
Ascites, increased peripheral venous pressure, raised JVP, fluid retention, anorexia, weight gain + symptoms of LS HF.
What are the signs of HF?
Tachycardia laterally displaced apex beat, heart murmurs and third and fourth heart sounds (gallop rhythm) HTN Enlarged liver Raised JVP
Management of HF
Beta blockers: chronic HF. NOT acute.
Severe symptoms: start loop diuretic (in acute) - Furosemide.
CCB: Diltiazem/Verapamil.
Diagnosis - HF in terms of NT-pro BNP
Suspected HF:
ECG, CXR
BNP (brain natriuretic peptide
BNP) gives idea of suspected HF. >2000 be seen within 2weeks.
400-2000: 6 weeks.
>400: not likely HF
GOLD STANDARD: transthoracic ECHO
Management of Chronic HF (reduced EF)
- Offer diuretics to alleviate symptoms of fluid retention.
- HF with reduced EF - ACE and BB. Add MRA if symptoms continue e.g. 2L Spironolactone.
3L nitrate or ivabradine.
Preserved: lifestyle changes, exercise rehabilitation, manage AF.
What are the 3 main types of shock and name examples
Cardiogenic: pump failure e.g. MI, cardiomyopathy, arrythmias.
Hypovolemic - intravascular volume e.g. burns, GI loss, haemorrhage.
Failure of vasoregulation: sepsis, pulmonary embolus (massive), cardiac tamponade, anaphylaxis.
Symptoms/Signs of Shock
Symptoms: cold, unwell, faint, SOB, oliguria.
Signs: pale, sweaty, tachypnoea, cold peripheries, CRT prolonged, tachycardia, postural hypotension, confusion, coma
Sepsis 6
3 in 3 out.
Blood cultures, urine, Lactate
IV access, oxygen, BS antibiotics, IV fluids
Define Aortic Stenosis
Causes
Narrowing of the aortic valve.
Most common cause: calcification of the valve.
Developing worlds: Rheumatic fever.
Symptoms of Aortic Stenosis
SAD
Dyspnoea
Syncope
Angina
Describe the clinical features on auscultation for aortic stenosis
Systolic murmur. Mid to late peaking Crescendo-descrescendo pattern Radiates to carotids. 2nd intercostal space to right of sternum. (right upper sternal border)
ECG/CXR changes in aortic stenosis
Gold standard in diagnosis.
ECG may show LVH or left ventricular strain.
CXR may show cardiac enlargement, calcification of the aortic ring.
ECHO - Key diagnostic tool
Management - Aortic Stenosis
Management: avoid heavy exertion.
Surgical intervention: valve replacement, balloon valvuloplasty.
Aortic Regurgitation:
Definition
Cause
Diastolic leakage of blood from the aorta into the left ventricle.
Caused by disease of the aortic valve (bicuspid aortic valve, rheumatic fever, IE, collagen vascular disease)
Acute caused by endocarditis/aortic dissection.
Chronic - symptoms of HF, asymptomatic many years.
Symptoms - Aortic Regurg
Sudden onset pulmonary oedema and hypotension/cardiogenic shock.
Myocardial ischaemia or aortic root dissection.
Chronic: palpitations, uncomfortable awareness of pounding of heart when lying on left side.
Clinical Features - Aortic Regurg
Wide pulse pressure: increased systolic BP, reduced diastolic BP.
Early diastolic murmur best heard in the aortic area with the patient sitting forward in expiration.
Mitral stenosis - definition and causes.
Narrowing of the mitral valve.
Causes: rheumatic fever, degenerative calcification, IE.
Symptoms of Mitral Stenosis
Breathlessness, orthopnoea, PND.
Palpitations due to AF.
Clinical features of Mitral Stenosis
Malar flush, raised JVP, lateral placed apex beat, right ventricular heave, loud first heart sound - opening snap.
Mid-late diastolic murmur best heard with patient in left lateral position with the bell of stethoscope.
Management - Mitral Stenosis
diuretics, long acting nitrates, beta blockers.
Percutaneous mitral commissurotomy.
Valve Replacement.
Mitral Regurg - Definition
Causes
Mitral valve not closing properly, causing abnormal leaking from left ventricle through the mitral valve and back into the left atrium with the left ventricle contracts..
Causses: trauamtic, EDS, mechanical, infectious.
Mitral Regurg
Symptoms
Clinnical features
Pansystolic murmur at apex.
Radiates at axilla.
On expiration.
What are innocent heart murmurs?
Common in babies and young children.
Heart is usually working fine.
Sometimes fevers can bring on heart murmurs in children - 1-2 weeks bring back for review.
If symptomatic - refer to paediatrician
What is atrial septal defect?
Communication between the left and right side of the heart.
Asymptomatic in childrens.
Subtle soboe/palpitations in second decade of life.
SOB, fatigue, exercise intolerance, palpitations, syncope, peripheral oedema, thromboembolic manifestations, cyanosis in adults.
SOFT SYSTOLIC EJECTION MURMUR.
Management by specialists: refer to cardio - surgical closure.
What is ventricular septal defect
One or more holes in the septum.
Communication between left and right ventricles of the heart.
Symptoms depend on size of hole.
Not obvious at birth.
Clinical Presentation:
Splitting of second heart sound, heart pansystolic murmur.
What are the 4 anatomical features of TOF
- Large ventricular septal defect.
- Overriding aorta.
- Right ventricular outflow obstruction.
- Right ventricular hypertrophy.
What is Patent Ductus Arteriosus?
PDA should be closed after birth but remains open. When a baby is born, increased o2 levels and prostaglandin from placenta helps close PDA.
Rubella infection/ foetal destress keep it open -
Symptomatic large PDA: LRTI, feeding difficulties, poor growth, failure to thrive.
Pericarditis:
Definition
Causes
Acute vs chronic classification
Inflammation of the pericardium.
90% idiopathic or due to viral infections.
Associated with systemic autoimmune disorders.
Acute: 4-6 weeks.
Chronic >3 months
Pericarditis - Symptoms
Pleuritic chest pain, worse on lying down, better sitting forward.
Intermittent fevers.
Pericarditis -Examination findings
ECG findings
Pericardial friction rub
Tachycardia
ECG: wide spread globally upward ST elevation. (J-point).
PR elevation in leads aVR and V1
Acute Pericarditis - Management
NSAIDS, can add colchicine.
Corticosteroids.
Pericardial Effusion -
Definition and Causes
Collection of fluid in the pericardial space.
Cause: Local e.g. acute/chronic pericarditis/ effusion.
Systemic causes e.g. kidney failure, rise in urea, effusion.
Cardiac Tamponade - Definition
Accumulation of blood, fluid, pus, clots or gas in pericardial space.
Results in reduced ventricular filling and reduced CO and subsequent haemodynamic compromise.
Medical emergency
What is Beck’s triad?
Cardiac tamponade classic findings.
Symptoms:
Dyspnoea, tachycardia/tachypnoea, cold and clammy extremeties.
Triad:
LOW BP, MUFFLED HEART SOUNDS, RAISED JVP
what is the definitive tx for cardiac tamponade?
Pericardiocentesis - Managed in ITU.
Acute rheumatic fever - definition
Rare, common in developing countries.
Autoimmune disease following a group A streptococcal infection.
Can affect joint, heart, brain, skin.
Chronic changes tom heart valves referred to as chronic rheumatic disease.
Acute rheumatic fever - signs/symptoms and diagnosis
1-5 weeks after sore throat: chest pain, fever, palpitations, heart murmur. Erythema nodosum (swollen fat under skin), chorea.
Diagnosis: Jones 2015 criteria.
Throat swabs: ESR, CRP, FBC, ECHO.
Acute Rheumatic Fever - Management
eradicate streptococcal infection, suppress inflammation.
Penicillin, aspirin, HF tx.
Diazepam if chorea present
What is the MONA acronym for ACS.
Morphine
Oxygen
Nitrates
Antiplatelets: Aspirin 300mg.
