Cardio Flashcards
1
Q
What’s type A aortic dissection
A
Ascending aorta
2/3 cases
2
Q
What’s type B aortic dissection
A
Descending aorta
1/3 of cases
3
Q
What’s DeBakey’s type 1 aortic dissection
A
Originates in ascending aorta
Propagates to at least aortic arch
Possibly beyond it
4
Q
What is DeBakey’s type 2 aortic dissection
A
Originates in and is confined to ascending aorta
5
Q
What is DeBakey’s type 3 aortic dissection
A
Originates in descending aorta
Rarely extends proximally
Can extend distally
6
Q
Management of type A dissection
A
Surgical management
Maintain BP over 100mmHg
7
Q
Management of Type B aortic dissection
A
Conservative
Bed rest
Reduce BP with IV labetalol
8
Q
Features of mitral stenosis
A
Dyspnoea
Haemoptysis
Mid-late diastolic murmur (best heard in expiration)
Loud S1
Opening snap
Low volume pulse
Malar flush
AF
9
Q
Management of mitral stenosis
A
With AF as well - warfarin used with moderate/severe
Can use DOAC’s
Asymptomatic - regular echos
Symptomatic - percutaneous mitral balloon valvotomy or surgery
10
Q
What is LBBB
A
Cardiac conduction abnormality due to slow or absent conduction through left bundle. Means left ventricle takes longer to fully depolarise. Wide QRS complexes.
Can be due to MI, HTN, cardiomyopathy
11
Q
What is ventricular tachycardia
A
Broad complex tachy originating from a ventricular ectopic focus. Can go to VF.
12
Q
What are the two types of VT?
A
Monomorphic - from MI
Polymorphic - torsades, long QT
13
Q
Management of VT
A
Adverse signs - low bp, chest pain, heart failure - immediate cardioversion
Meds - amiodarone, lidocaine, procainamide
NEVER VERAPAMIL
14
Q
What creates heart sound S1
A
Closure of mitral and tricuspid valves
15
Q
When is S1 soft?
A
Long PR
Mitral regurg
16
Q
When is S1 loud?
A
Mitral stenosis
17
Q
What causes S2 heart sound?
A
Closure of aortic and pulmonary valves
18
Q
When is S2 soft?
A
Aortic stenosis
19
Q
What causes S3?
A
Diastolic filling of ventricle
Heard in LVF, constrictive pericarditis and mitral regurg
20
Q
What causes S4?
A
Atrial constriction against a stiff ventricle
21
Q
When is S4 heard?
A
Aortic stenosis
HOCM
HTN
22
Q
Drug management of angina pectoris
A
Aspirin and statin if not CI
Sublingual GTN for attacks
Beta blocker or calcium channel blocker
If only ccb then verapamil or diltiazem
If in combination with bb then amlodipine or nifedipine.
Only add 3rd drug if waiting for PCI or CABG
3rd drugs - long acting nitrate, ivabradine, nicorandil, ranolazine
23
Q
How does Flecainide work?
A
Blocks the Nav1.5 sodium channels in the heart
24
Q
How does bisoprolol work
A
Blocks beta one adrenergic receptors in heart muscle
25
How does procainamide work
Induces rapid blocking of batrachotoxin activated sodium channels rapidly
26
What is S3 also known as?
Gallop rhythm
27
Aetiology of acute pericarditis
Viral infections - coxsackie
TB
Uraemia
Post MI - early (1-3d) fibrinous, late (weeks-months) Dressler’s
Radiotherapy
Connective tissue disease - SLE, RA
Hypothyroidism
Malignancy - lung and breast
Trauma
28
Features of acute pericarditis
Chest pain, pleuritic, relieved by sitting forwards
Non productive cough, dyspnoea, flu like symptoms
Pericardial rub
29
Acute pericarditis investigations
ECG changes - global and widespread not territories, saddle shaped ST elevation, PR DEPRESSION
TTE
Bloods - inflammatory markers, trop
30
Management of acute pericarditis
Majority as outpatient unless high risk (fever, raised trop)
Treat underlying cause
Avoid strenuous physical activity
Combination of NSAID’s and colchicine with idiopathic or viral
31
Common bugs of endocarditis
S aureus
S epidermidis if <2 months post valve surgery
32
Pathophysiology of arrhythmogenic right ventricular cardiomyopathy
Autosomal dominant
Right ventricular myocardium is replaced by fatty and fibrofatty tissue
33
Presentation of arrhythmogenic right ventricular cardiomyopathy
Palpitations
Syncope
Sudden cardiac death
34
Investigations of arrhythmogenic right ventricular cardiomyopathy
ECG - V1-3 anomalies, usually TWI,
Echo changes subtle - enlarged hypokinetic right ventricle
MRI to show fibrofatty tissue
35
Management of arrhythmogenic right ventricular cardiomyopathy
Drugs - sotalol
Catheter ablation
ICD
36
What’s Naxos disease
Autosomal recessive form of arrhythmogenic right ventricular cardiomyopathy
Triad of ARVC, palmoplantar keratosis, woolly hair
37
Congenital causes of Long QT syndrome
Jervell-Lange-Nielsen syndrome (included deafness)
Romano-Ward syndrome (no deafness)
38
Drug causes of prolonged QT interval
Amiodrarone, Dora lol
TCA’s, SSRI’s
Methadone
Chloroquine
Terfenadine
Erythromycin
Haloperidol
Ondansetron
39
Other causes of long qt interval
Electrolyte - hypocalcaemia, hypokalaemia, hypomagnasaemia
Acute MI
Myocarditis
Hypothermia
Subarach
40
MI complications
Cardiac arrest.
Cardiogenic shock
Chronic heart failure
Tachyarrhythmia
Bradyarrhythmia
Pericarditis
Left ventricular aneurysm
Ventricular septal defect
Acute mitral regurg
41
Why does cardiac arrest mostly happen after MI
Developing ventricular fibrillation
42
Common tachyarrhythmias after MI
Ventricular fibrillation
Ventricular tachycardia
43
Which bradyarrhythmia follows MI?
AV block follows inferior MI
44
What is Dressler’s syndrome and when does it occur?
2-6 weeks after MI
Pericarditis
Fever, pleuritic pain, pericardial effusion and raised ESR.
Treat with NSAID’s
45
Describe ventricular septal defect after MI
Occurs in first week
1-2% of patients
Acute heart failure and pan systolic murmur
Echo is diagnostic
Urgent surgical correction
46
Describe acute mitral regurgitation
More common with infero-posterior infarction and may be due to ischaemia or rupture of papillary muscle
Acute hypotension & pulmonary oedema
Early to mid systolic murmur
Treat with vasodilator therapy then surgery
47
When do you get a slow rising/plateau pulse?
Aortic stenosis
48
When do you get a collapsing pulse
Aortic regurgitation
Patent ductus arteriorsus
Hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
49
Describe bisferiens pulse and when is it seen
‘Double pulse’ - two systolic peaks
Seen in mixed aortic valve disease
50
When do you get a jerky pulse??
HOCM
51
When do you get pulsus paradoxus
Severe asthma
Cardiac tamponade
52
When do you get pulsus paradoxus?
Severe Asthma
Cardiac Tamponade
53
Describe Eisenmenger’s syndrome
Reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension.
Occurs when an uncorrected left-to-right leads to a remodelling of the pulmonary microvasculature causing obstruction and pulmonary hypertension
54
What is Eisenmenger’s syndrome associated with
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
55
Features of Eisenmenger’s
Original murmur may disappear
Cyanosis
Clubbing
Right ventricular failure
Haemoptysis, embolism
56
Management of Eisenmenger’s
Heart-lung transplantation
57
When are ejection systolic murmurs louder on inspiration?
Pulmonary stenosis
Atrial septal defect
58
When are ejection systolic murmurs louder on expiration?
Aortic stenosis
HoCM
59
When are pansystolic murmurs herd
Mitral/tricuspid regurgitation - tricuspid louder during inspiration
Ventricular septal defect (harsh in character)
60
When do you get late systolic murmurs?
Mitral valve prolapse
Coarctation of aorta
61
When do you get early diastolic murmurs?
Aortic regurgitation (high pitch and blowing)
Graham-Steel murmur - pulmonary regurg
62
When do you get mid-late diastolic murmurs
Mitral stenosis (rumbling)
Austin-Flint murmur (severe aortic regurgitation)
63
When do you get a continuous machine-like murmur
Patent ductus arteriosus
64
Features of cardiac Tamponade
Becks triad -
Hypotension, Raised JVP & Muffled heart sounds
Other -
Dyspnoea & Tachycardia
Absent Y on descent of JVP
Pulsus paradoxus, Kussmaul’s
ECG - electrical alternans
65
Management of cardiac Tamponade
Urgent pericardiocentesis
66
What are the centrally acting antihypertensives?
Methyldopa - pregnancy
Moxonidine - essential HTN when conventional therapy failed
Clonidine - alpha-2 adrenoreceptors in vasomotor centre
67
What is the most common cardiac tumour?
Atrial myxoma
68
Where do you normally find atrial myxoma
Most in left atrium
Commonly attached to fossa ovalis
More common in females
69
Features of atrial myxoma
Systemic - dyspnoea, fatigue, weight loss, pyrexia of unknown origin, clubbing
Emboli
Atrial Fibrillation
Mid diastolic murmur - tumour plop
Echo - pedunculated heterogenous mass
70
Which sign best indicates severe calcified aortic stenosis
Displaced apex beat
71
Which features of a broad complex tachycardia suggests VT rather than SVT
AV dissociation
Fusion or capture beats
Positive QRS concordance in chest leads
Marked left axis deviation
History of IHD
lack of response to adenosine or carotid sinus massage
QRS > 160ms
72
What is the role of dipyridamole?
Antiplatelet used in combination with aspirin after ischaemic stroke or TIA
73
How does dipyridamole work?
Inhibits phosphodiesterase elevating cAMP which reduce intracellular calcium
Reduced cellular uptake of adenosine and inhibition of thromboxane synthase
74
Features of severe MS
Length of murmur increases
Opening snap becomes closer to S2
75
Features of cholesterol embolism
Eosinophilia
Purpura
Renal failure
Livedo reticularis
76
Causes of cholesterol emboli
Secondary to vascular surgery or angiography
Also - severe atherosclerosis
77
Management of torsades de pointes
IV mag sulf
78
What is torsades de pointes
A form of polymorphic ventricular tachycardia associated with long QT interval.
May lead to VF then sudden death
79
Management of HOCM
Amiodarone
Beta blockers or verapamil
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis
80
Drugs to avoid in HOCM
Nitrates
ACEi
Inotropes
81
HOCM inheritance pattern
AD
1 in 500
Defect in genes encoding contractile proteins
82
Anteroseptal region ECG changes and artery involved
V1-V4
Left Anterior Descending
83
Inferior region ecg changes and artery involved
II, III & aVF
Right coronary
84
Anterolateral region ecg changed and artery involved
V1-V6, I & aVL
Proximal left anterior descending
85
Lateral region ecg changes and artery involved
I, aVL +/- V5-6
Left circumflex
86
Posterior region ecg changes and artery involved
V1-3
Left circumflex (also right coronary)
Horizontal ST depression
Upright T waves
Broad R waves
Dominant R wave in V2
87
ECG features of hypokalaemia
U waves
Small or absent T waves (occasionally inversion)
Prolonged PR interval
ST depression
Long QT
88
What is Ebstein’s anomaly
Congenital heart defect with low insertion of tricuspid valve resulting in large atrium and small ventricle
89
What is Ebstein’s anomaly associated with
Patent Foramen Ovale or Atrial Septal Defect
Wolff-Parkinson White syndrome
90
Clinical features of Ebstein’s anomaly
Cyanosis
Prominent ‘a’ wave in distended JVP
Hepatomegaly
Tricuspid regurgitation- pansystolic murmur, worse on inspiration
RBBB - widely split S1 and S2
91
Causes of ST depression on ecg
Secondary to abnormal QRS (LVH, LBBB, RBBB)
Ischaemia
Digoxin
Hypokalaemia
Syndrome X
92
Features of Takayasu’s arteritis
Systemic features of vasculitis - malaise, headache
Unequal blood pressure in upper limbs
Carotid bruit and tenderness
Absent or weak peripheral pulses
Upper and lower limb clarification on exertion
Aortic regurgitation
93
What is Takayasu’s arteritis associated with
Renal artery stenosis
94
Management of Takayasu’s arteritis
Steroids
95
Investigations into Takayasu’s arteritis
Vascular imaging of arterial tree either MRA or CTA
96
Features of aortic stenosis
Chest pain
Dyspnoea
Syncope/pre syncope
Murmur - ESM, radiates to carotids, decreases following valsalva
97
Features of severe aortic stenosis
Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft/absent S2
S4
Thrill
LVH
98
Causes of aortic stenosis
Degenerative calcification
Bicuspid aortic valve
William’s
Post-rheumatic disease
Subvalvular - HOCM
Fabry’s, SLE, Uraemia
99
Management of aortic stenosis
Valve replacement if symptomatic
100
Which anti hypertensive drugs need to be used cautiously in aortic stenosis?
Beta blockers
