Cardio Flashcards
Familial lipid disorders of triglycerides
1/ Familial hypertriglyceridaemia - assoc. pancreatitis and retinal vein thrombosis
2/ Lipoprotein lipase deficiency - childhood with eruptive xanthomas and lipiamia retinalis
3/ Apoprotein C deficiency - TG improves w FFP
Rx Fibrates
Familial lipid disorders of LDL
1/ Heterozygous familial hypercholesteremia - early CVD, tendon xanthomas. Genetic defect of LDL-R
2/ Homozygous familial hypercholesteremia
3/ Apoprotein B100 gene mutation
4/ Polygenic hypercholesterolemia
Rx Statins +/- Ezetimibe
Familial lipid disorders of HDL
Tangier disease - ABC1 gene mutation
Rx fibrates
ECG features of arrhythmogenic RV dysplasia
Post excitation epsilon wave in V1-3 with QRS >110ms, TWi +/- LBBB or RBBB
Autosomal dominant
Fibrofatty infiltration of RV leading to poor R function. Angio gold standard dx
Indications for PPM/ICD (3):
NYHA class 3-4 HF
EF <35%
QRS >120ms
Sx benefit and reduced mortality
Features of Congenital Long QT syndrome LQTS?
Recurrent syncope triggered by activity
QTc >500
FHx early sudden death
Rx treat with beta blockers even if ASx
ICD if syncope/arrest on beta blockers
Genetics of LQTS?
LQTS1 - most common. KCNQ1 delayed K ch subunit. Beta blockers most protective. Occurs while swimming
LQTS2 - KCNH2/HERG gene, rapid K ch. Ppt by exercise, loud noises, emotional arousal
LQTS3 - SCN5A gain function mutation in Na ch. Events during sleep
Features of Brugada??
Autosomal dominant
Peak SCD 4th decade
Pseudo RBBB with ST elevation - can be elicited with flecainide challenge
- Loss of function SCN5A gene mutation in 30%
Short QT syndrome
Autosomal dominant.
Short QT - AF young.
WPW features?
Short PR interval, delta wave
Prone to AF -> VF
ECG features of Lown Ganong Levin syndrome?
Short PR <120ms, normal QRS and sinus
HOCM features?
Autosomal dominant
Mutation cardiac beta-myosin heavy chain
SCD risk high if LV thickness >30mm
Rx beta blocker improves diastolic filling. Avoid digoxin and diuretics
ECG flecainide toxicity
PR prolongation, widening of QRS. Possible heart failure. Can cause Torsades.
No QT prolong.
Symptoms of mitral stenosis
SOB - LA pressure, reduced lung compliance
Haemoptysis - increased pulm pressure
PE - LA thrombus
Chest pain - RV hypertrophy, pulm HTN
Hoarseness - compression of laryngeal nerve from LA
Coronary angio - radial access :
- Lowers vascular complications
- Non inferior to death, MI, stroke, bleeding
venous pulse - what do “a x c x v y” represent
a - atrial contraction - absent in AF, large ‘cannon’ in pulm HTN, TS, RV hypertrophy, complete heart block
c - closure of tricuspid valve
v - volume filling into atrium - large in TR
x - fall in atrial pressure during vent systole
y - opening of tricuspid valve
Contraindications to percutaneous mitral balloon valvotomy
1/ Mitral area >1.5cm
2/ LA thrombus
3/ Moderate-severe MR
4/ Severe/bicommissural calcification
5/ Absence of commissural fusion
6/ Severe aortic valve disease or severe TS/TR
Contraindications to percutaneous mitral balloon valvotomy
1/ Mitral area >1.5cm
2/ LA thrombus
3/ Moderate-severe MR
4/ Severe/bicommissural calcification
5/ Absence of commissural fusion
6/ Severe aortic valve disease or severe TS/TR
7/ CAD requiring bypass -> mitral valve repair
Types of MI?
Type 1- atherothrombosis
Type 2 - hypoperfusion
Type 3 - Sudden death without trop/ECG confirmed
Type 4a - due to PCI
Type 4b - due to thrombosis of stent
Type 5 - CABG
Timing of systolic murmurs
Early systolic - MR, TR, VSD
Midsystolic - AS, aortic sclerosis
Holo/pansystolic - MR, TR, VSD
Late systolic - MVP, TVP
R murmurs louder on Inspiration
L murmurs louder on expiration
Timing of diastolic murmurs
Early - AR, PR
Mid - MS (earlier in severe), TS, Atrial myxoma
Late - MS (mild, TS, Atrial myxoma, complete heart block
Factors of GRACE score used to estimate mortality at 0, 6m, 3y mortality
Age
HR
BP
Renal
CHF
ST
cardiac arrest
High trops
Features of complete heart block
Syncope
HF
Brady 30-50bpm
Wide pulse pressure
JVP cannon waves
Variable intensity of S1
Factors for mitral stenosis management
Moderate - area 1.0-1.5, mean gradient 5-10mmHg
PASP - 30-50
Severe - area <1.0, mean gradient >10, PASP >50
Percutaneous mitral balloon valvotomy for sx severe MS without mod/severe MR
If Asx, still do it if there is pulm HTN
