Cardio Flashcards
What is angina?
constricting chest pain caused by reduced blood flow (and hence oxygen supply) to the myocardium due to atherosclerosis narrowing the lumen of coronary arteries
What is stable angina?
symptoms only come on with exertion
relieved by rest or glyceryl trinitrate (GTN)
What is unstable angina?
symptoms appear randomly whilst at rest
type of acute coronary syndrome (ACS)
requires immediate management
What are the main signs and symptoms of aortic stenosis?
chest pain
SoB
syncope
exertional dizziness
ejection systolic murmur radiating to the carotids
What kind of murmur is associated with aortic stenosis?
ejection systolic murmur
radiating to the carotids
decreased during Valsalva maneuvre
What features are associated with severe aortic stenosis?
narrow pulse pressure
thrill
LV hypertrophy
What are the main causes of aortic stenosis?
degenerative calcification - most common cause in >65y.o.
bicuspid aortic valve - most common cause in < 65y.o.
William’s syndrome - supravalvular
post-rheumatic disease
subvalvular - hypertrophic cardiomyopathy
What is the management of aortic stenosis in asymptomatic patients?
conservative - observation
What is the management of aortic stenosis in symptomatic patients?
valve replacement
When do you consider surgery in asymptomatic patients with aortic stenosis?
if the valvular gradient is > 40mmHg and has features of left ventricular systolic dysfunction
What are the options for aortic valve replacement (AVR) in aortic stenosis?
surgical AVR
transcatheter AVR
What patients are suitable for surgical AVR?
young
low-medium operative risk
may have cardiovascular disease (combined surgery)
When should mechanical vs bioprosthetic valve be used?
mechanical
- younger patients (< 65 in aortic, <70 in mitral)
bioprosthetic
- older patients
- tend to last shorter
What patients are suitable for transcatheter AVR?
high operative risk
What patients are suitable for aortic balloon valvuloplasty?
children with aortic stenosis with no calcification
adults with critical aortic stenosis who are not fit for valve replacement
What is aortic regurgitation?
leaking of the aortic valve
What are the main causes of aortic regurgitation?
valve disease
aortic root disease
What are some causes of aortic regurgitation due to valve disease with chronic presentation?
rheumatic fever - most common cause in the developing world
calcific valve disease
connective tissue disease - SLE, rheumatoid arthritis
bicuspid aortic valve
What is the most common cause of aortic regurgitation in the developing world?
rheumatic fever
What are some causes of aortic regurgitation due to aortic root disease with chronic presentation?
bicuspid aortic valve
spondyloarthropathies - e.g. ankylosing spondylitis
HTN
syphilis
Marfan’s
EDS
What are some causes of aortic regurgitation due to valve disease with acute presentation?
infective endocarditis
What are some causes of aortic regurgitation due to aortic root disease with chronic presentation?
aortic dissection
What are some features of aortic regurgitation?
early diastolic murmur - loudest at left sternal edge
wide pulse pressure
collapsing pulse
Quincke’s sign - nailbed pulsation
Austin flint murmur - low pitched rumbling mid-diastolic murmur heard best at the apex (in severe AR)
How is aortic regurgitation assessed?
echocardiography