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PACES PACES PACES VIVA > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the signs of AS?

A
  • Hard to feel pulse AKA low volume (usually slow rising)
  • Narrow pulse pressure
  • “Obvious” - hyperdynamic apex beat - signally LVH
  • Loss of S2 - a sign of severity in AS
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1
Q

What are the signs of AS?

A
  • Hard to feel pulse AKA low volume (usually slow rising)
  • Narrow pulse pressure
  • “Obvious” - hyperdynamic apex beat - signally LVH
  • Loss of S2 - a sign of severity in AS
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2
Q

What examination sign should get you ready for an AS murmur?

A

Hard to feel / low volume pulse!!!

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2
Q

What examination sign should get you ready for an AS murmur?

A

Hard to feel / low volume pulse!!!

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3
Q

Ejection systolic murmur + ECG thats crazy could mean what?

A

HOCM - due to obstruction due to septum

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4
Q

Features of HOCM?

A
  • Jerky pulse
  • FHx of sudden death AD inheritance
  • Associated w/ WPW
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5
Q

Dx of ESM?

A
  • HOCM - quieter on squatting
  • Aortic sclerosis - elderly, w/ no radiation, normal apex and pulse
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6
Q

Signs of AR?

A
  • BIG Pulse + Collapsing
  • Wide pulse pressure
  • Big apex
  • EDM murmur - slurring of the second heart sound
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6
Q

Signs of AR?

A
  • BIG Pulse + Collapsing
  • Wide pulse pressure
  • Big apex
  • EDM murmur - slurring of the second heart sound
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7
Q

Signs of MS? - Unlikely to come up

A
  • Usually Female
  • Low BP
  • Red mitral facies
  • Rumbling Mid-Diastolic Murmur (Burr before S1 (lub))
  • Loud S1 ‘lub’ + tapping apex beat
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8
Q

What does an opening snap in MS suggest?

A

The valve isnt very calcified and may be suitable for mitral valvuloplasty however this needs to be confirmed with echo

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9
Q

Why is S1 loud in MS?

A

LA pressure is raised hence needs greater pressure before it closes hence snaps shut loudly

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10
Q

DDx for Mid-Diastolic murmur?

A
  • MS
  • TS - different location
  • ASD
  • Atrial myxoma - would also have LA mass, fever, clubbing and may embolise
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11
Q

Cyanotic pt w/ scar under breast - what signs should you look for? what could cause this?

A
  • Clubbing
  • AF
  • Signs of right heart strain - TR, raised JVP, parasternal heave, loud P2
  • Possible scars from congenital heart surgery

Shunt - mixing of blood or pulmonary HTN (primary or accquired due to old shunt eg Eisenmengers)

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12
Q

VSD - important info?

A
  • Most common congenital heart leison
  • PSM murmur @ TV site
  • LV dilatation
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13
Q

Compications from AS?

A

Valvular complications:
- Infective endocarditis
- Embolic disease eg stroke
- Haemolytic anaemia

Complications due to impaired outflow:
- Left ventricular failure -> syncope, MI and limb ischaemia

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14
Q

Classical Ix for a pt w aortic stenosis?

A

Bedside:
- Basic obs - check for haemodynamic stability
- Urine dip - proteinuria for infective endocarditis and glycosuria for diabetes
- ECG - LV strain

Bloods:
- FBC - haemolytic anaemia
- Inflammatory markers - CRP and ESR for infective endocarditis

Imaging:
- CXR (signs of pulmonary oedema - cardiomegaly and possibly calcified valve)
- ECHO = Gold standard (<1cm2 valve size or gradient >40mmHg)
- Coronary angio - measure gradient across valve and assess for coronary artery disease

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15
Q

Ix of pt?

A

Imaging:

16
Q

Aortic Stenosis mx?

A

Conservative:
- Pt education = diabetic control, bp control, dental hygiene and modifying other RFs

Medical:
- BP control

Surgical:
- Aortic valve replacement - Open repair or TAVI (high risk) depending on pt risk which is stratified using EUROSCORE

17
Q

What grade is the murmur?

A
18
Q

What are the indicationsof aortic valve replacement?

A

Severe aortic stenosis (symptomatic, EF <50%)
Acute aortic regurg (secondary to aortic dissection)
Infective endo carditis (non-responsive to medical therapy)

19
Q

What factors to consider when deciding on valve replacement?

A

Severity of valve dysfunction - ECHO to measure this
Any recommendation eg HF
Patient choice

20
Q

What are the complications of valve replacement

A
21
Q

Different types of prosthetic valves and +ves and -ves?

A
22
Q

RFs for coronary artery disease?

A
23
Q

What is a coronary artery bypass?

A

Healthy artery / vein from elsewhere (eg saphenous vein) is grafted

The grafted vessel bypasses blocked portion of coronary artery -> creating a new path for oxygenated blood flow to heart muscle

24
Q

What are the indications for CABG?

A

Left main stem disease
Triple vessel disease
Angina not responsive to medical therapy
Unsuccessful PCI

25
Q

Ix for coronary artery disease / CABG?

A
26
Q

What are some causes of pulmonary fibrosis?

A

Methotrexate
Ank Spond
RA
Silicosis

27
Q

What are the causes of Upper and Lower zone pulmonary fibrosis?

A
28
Q

Ddx for fibrosis?

A
29
Q

ix for pulmonary fibrosis?

A
30
Q

What are some indications for a lobectomy?

A

Malignancy
COPD
Chronic lung abscess
TB

31
Q

What are the possible complications of a lung ca?

A
32
Q

What is p-mitrale?

A

Broad notched p-waves that suggests left atrial enlargement

33
Q

What is a pan-systolic murmur?

A

Lasts entire duration between S1 and S2 and doesn’t change in intensity

34
Q

Why does mitral regurg cause an irregularly irregular pulse?

A

MR = MV doesnt close properly -> When LV starts to contract, blood is regurgitated from LV to LA -> LA dilation -> LA remodelling + fibrosis -> Impaired electrical conduction -> AF

Summary

35
Q

What are some differentials for MR?

A
36
Q

Compications of MR?

A

Valvular:
- Infective endocarditis

Reduced outflow:
- LVF
- AF

37
Q

Ix for MR?

A

Bedside:
- basic obs
- urine dip
- ECG - AF? P-mitrale? (sign of dilated LA)

Bloods:
- Inflammatory markers for infective endocardiits
- BNP - if there is associated HF

Imaging:
- CXR - signs of LA enlargement and signs of HF
- Echo - gold standard to assess severity + diagnosis

Special:
- Coronary angio - measure gradient across valve and assess for coronary artery disease

38
Q

NYHA HF classification?

A

Grade 1 - No SOB
Grade 2 - SOB upon moderate activity but none at rest
Grade 3 - SOB upon mild activity but none at rest
Grade 4 - SOB at rest

39
Q

What is HF and what are the causes of LHF and RHF

A
40
Q

Ix of HF patients?

A

Bedside:
- Basic obs
- ECG - signs of LV strain (LBBB + large amplitude QRS) or RV strain (RBBB and RAD)

Bloods:
- FBC - Anaemia which can cause or exacerbate HF
- BNP / NT-pro BNP
- U+Es - renal function which can be deranged in HF due to cardio renal syndrome
- Screen for RFs such as diabetes and hyperlipidemia

Imaging:
- CXR - signs of HF
- ECHO - diagnosis and severity, measuring LVEF

41
Q

Mx of CCF?

A

PACES PACES PACES VIVA (10 decks)

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