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PACES week > Cardio > Flashcards

Cardio Flashcards

1
Q

Mx of unstable angina

A

Aspirin + Clopidogrel
LMWH
GTN Spray

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2
Q

Standard treatment of STEMI/STEMI

A

MONAC

Morphine
Oxygen
Nitrates
Aspirin
Clopidogrel

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3
Q

Occlusion of which vessel can lead to heart block

A

RCA

(located by SA and AV nodes)

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4
Q

What is negative in RAD

A

Lead I

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5
Q

What is negative in LAD

A

Lead II (& Lead III)

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6
Q

Causes of syncope?

A

Vasovagal (fainting)
Orthostatic

Cardiovascular: arrhythmia, aortic dissection, ACS

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7
Q

Slow rising pulse

A

Aortic stenosis

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8
Q

Most common causes of aortic stenosis

A

Calcific degeneration
Congenital bicuspid valve

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9
Q

Signs of mitral stenosis

A

Palmar erythema
Malar Flush
Left parasternal heave
Stigmata of endocarditis

Loud S1 – closing snap of stenosed mitral valve.
Loud P2- secondary to pulmonary HTN

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10
Q

Most common cause of Mitral stenosis

A

Rheumatic fever (90%)

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11
Q

Mx of mitral stenosis

A

Observation
Percutaneous balloon mitral valvuloplasty
Surgical repair/replacement

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12
Q

Scar present if valvular replacement

A

Median sternotomy scar

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13
Q

How to differentiate the sound of an aortic or mitral valve replacement

A

Remember that the 1st heart sound is closure of the mitral valve and 2nd heart sound closure of the aortic valve.

So a metallic click just before the carotid pulse is a mitral valve replacement and just after the carotid pulse is an aortic valve replacement.

(Listen over both areas for intensity of the click)

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14
Q

Sx of HOCM

A

Jerky pulse
Large A waves in JVP
Ejection systolic murmur radiating to the apex

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15
Q

Differentials for Ejection systolic murmur

A

Aortic stenosis
Pulmonary Stenosis
Aortic sclerosis
HOCM
ASD

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16
Q

Differentials for pansystolic murmur

A

Mitral regurgitation & Tricuspid regurgitation.
VSD ASD

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17
Q

Differentials for diastolic murmur

A

Aortic regurg
Pulmonary regurg
Mitral stenosis
Tricuspid stenosis

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18
Q

Causes of aortic stenosis

A

Calcific degeneration (commonest)

Congenital bicuspid valve, post rheumatic fever & IE

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19
Q

Causes of aortic regurg

A

IE, aortic dissection, rheumatic fever, bicuspid aortic valve, Marfan’s

20
Q

Causes of mitral regurg

A

IE, rupture of chordae tendinae (post-MI), Marfan’s

21
Q

Valve problem associated with carcinoid syndrome

A

Tricuspid stenosis

22
Q

Indications for a median sternotomy

A

Aortic aneurysm/dissection
Mechanical valves
Heart transplant
Coronary artery bypass graft
Thymectomy

23
Q

Signs of LVF

A

Fatigue
Exertional dyspnoea
Orthopnoea + PND
Nocturnal cough (± pink, frothy sputum)

24
Q

Signs of RVF

A

↑JVP + jugular venous distension
Tender smooth hepatomegaly
Pitting oedema
Ascites

25
Q

Chronic heart failure classification

A

*New York Classification**
1. No breathlessness
2. Breathless on moderate exertion
3. Breathless on mild exertion
4. Breathless at rest

26
Q

Heart failure Ix

A

Bloods: FBC, U+E, NT-proBNP, lipids, glucose

CXR
ECG
ECHO: the key Ix

27
Q

Heart failure Ix

A

Bloods: FBC, U+E, NT-proBNP, lipids, glucose

CXR
ECG
ECHO: the key Ix

28
Q

Chronic Heart Failure Mx

A

Beta Blocker + ACEi + Loop diuretic

2nd add spironolactone
3rd consider ivabradine

29
Q

Narrow pulse pressure

A

Aortic stenosis

30
Q

Causes of aortic stenosis

A

Age-related senile calcification
Bicuspid aortic valve
Rheumatic heart disease

31
Q

Clinical Symptoms of Severe AS

A

Angina: 50% dead in 5yrs
Syncope: 50% dead in 3yrs
Dyspnoea: 50% dead in 2yrs

32
Q

AS Ix

A

ECG
Echo

33
Q

AS Mx

A

MDT approach
Optimise CV risk: statins, anti-HTN, DM, anti-plat
Sx: valve replacement ± CABG

34
Q

Causes of AF

A

IHD
Rheumatic heart disease
Thyrotoxicosis
Hypertension
RA

35
Q

Ix of AF

A

ECG

Bloods:
FBC: pneumonia, sepsis
U+E: ↓K
TFTs: ↓TSH, ↑fT4
Troponin
D-dimer: PE

CXR

Echo

36
Q

dDx for irregulary irregular pulse

A

AF
Multiple ventricular ectopics

Clinical Distinction: Exercise pt.
AF: pulse stays irregularly irregular
VE: ↑ HR → regular pulse
↓ diastole time closes window for ectopics

37
Q

IE diagnostic criteria

A

Duke criteria:

2 major
1 major + 3 minor
All 5 minor

MAJOR:
+ve blood cultures (2 separate cultures)

Endocardial involvement: +ve echo: vegetation, abscess, dehiscence or new valvular regurgitation

MINOR:

Predisposition: cardiac lesion, IVDU
Fever >38
Emboli: septic infarcts, splinters, janeway lesions
Immune: GN, Osler nodes, roth spots, RF
blood cultures not meeting major criteria

38
Q

Causes of impalpable apex breat (4)

A

COPD
Obesity
Pericardial effusion
D​extrocardia

39
Q

Fx of Pulmonary HTN

A

^JVP
Left parasternal heave
Loud P2
Pulsatile hepatomegaly
Peripheral oedema

40
Q

Heart sounds (S1-4)

A

S1: mitral valve closure
S2: aortic valve closure
S3: rapid ventricular filling of dilated left ventricle
S4 atrial contraction against a stiff ventricle

41
Q

Causes of aortic regurgitation

A

Bicuspid aortic valve
Rheumatic heart disease
Autoimmune: Ank spondylitis, RA
Connective tissue: Marfan’s, Ehler’s Danlos

Acute:
Infective endocarditis
Type A aortic dissection

42
Q

Murmur standard Ix and Mx

A

Ix: ECG, CXR, Echo + Doppler
Bloods: FBC, U&E, Lipids, glucose, BNP

Mx: MDT approach: GP, cardiologist, dietician
Optimise CV risk: statins, anti-HTN, DM, anti-plat
Regular monitoring

43
Q

Diagnosis of Rheumatic fever

A

Jones Criteria

2 major, 1 major + 2 minor

Major Criteria (CASES)

Pancarditis
Arthritis
Subcut nodules
Erythema marginatum
Sydenham’s chorea

Minor criteria

Prolonged PR interval (not if carditis is a major)
Arthralgia (not if arthritis is a major)
Fever
↑ESR or ↑CRP
Prev rheumatic fever

44
Q

Ix of Rheumatic fever

A

Bloods: FBC, ESR, ASOT
ECG
Echo

45
Q

Rheumatic fever Tx

A

Bed rest until CRP normal for 2 wks
Benzylpenicillin 0.6-1.2 IM for 10 days
Analgesia; carditis/arthritis: aspirin/NSAIDs
Add oral pred if CCF, cardiomegaly, 3rd degree block

46
Q

What pulse sign would you see in pt with HOCM?

A

Pulsus bisferiens - biphasic pulse, is a cardiac cycle with two peaks, a small one followed by a strong and broad one

47
Q

Complications of valve replacement

A

Acute failure of valve e.g. breakage

Chronic failure of valve e.g. stenosis, incompetence

Infective endocarditis
Anaemia
AF
Thromboembolism

PACES week (8 decks)

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