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Paces > Cardio > Flashcards

Cardio Flashcards

1
Q

Causes of clubbing

A

Cardiac - congenital heart disease, IE
Resp - ILD/ TB/ CF/ Bronchiectasis
Gastro - IBD
Familial

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2
Q

What is a PDA?

A

The ductus arteriousus is a connection between the proximal left pulmonary artery and the descending aorta just distal to the left subclavian artery in the foetus which allows the blood to bypass the lungs which are filled with amniotic fluid. After birth this closes to become the ligamentum arteriosus. Failure to close = PDA

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3
Q

Is PDA associated with congenital heart disease?

A

In adults it is usually an isolated finding but can be associated with congenital heart disease

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4
Q

When are patients with PDA considered for surgery?

A

If they develop either LV volume overload or RV pressure overload will be considered for closure

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5
Q

PDA murmur

A

Continuous machine like murmur ‘rolling thunder’ (quieter flow during diastole)
Heard best 2nd IC left sternal edge but also posteriorly (heard when listening to lung bases)

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6
Q

Eisenmengers syndrome features

A

Clubbing, central cyanosis, loud and widely split 2nd heart sound with associated RV heave (and no murmur = original left to right shunt has now reversed)

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7
Q

What is Eisenmengers syndrome?

A

Longstanding left to right shunt from congenital heart disease
Typically VSD/ ASD or PDA
causing pulmonary hypertension, reversal of the shunt and then cyanosis

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8
Q

Complications of Eisenmengers

A

RVF
Paradoxical embolism
IE
Haemoptysis
Hypoxia

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9
Q

Congenital syndromes associated with VSD

A

Downs
Edwards
Di George

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10
Q

What happens to murmur of VSD in Eisenmengers?

A

Murmur decreases as pulmonary hypertension ensues and subsequent reversal of shunt

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11
Q

Pulmonary hypertension management (3)

A

Endothelial antagonists - bosentan
Phosphodiesterase 5 inhibitors - sildenafil
Prostanoid infusions

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12
Q

Differentials for VSD murmur (4)

A

ASD - wide fixed split 2nd heart sound
MR - Pansystolic murmur loudest on expiration at apex and radiates to axilla
TR - pansystolic murmur heard best on inspiration at lower left sternal edge
PS - ejection systolic murmur loudest on inspiration in pulmonary area

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13
Q

Common causes of constrictive pericarditis

A

Viral or bacterial
Post surgery eg after CABG
After TB
Radiation

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14
Q

Causes of restrictive cardiomyopathy

A

Primary: endomyocardial fibrosis (Loeffler’s syndrome - eosinophils infiltrate the endocardium)

Systemic: sarcoidosis, scleroderma, haemochromatosis, malignancy, amyloidosis

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15
Q

Why do we need to differentiate between constrictive and restrictive cardiomyopathy?

A

Briefly - very diff management plans so constrictive the mainstay is surgery

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16
Q

Restrictive cardiomyopathy signs

A

Minimal unless RVF

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17
Q

What is restrictive cardiomyopathy?

A

Rare disease of myocardium
Diastolic dysfunction with restrictive ventricular physiology but systolic function usually preserved

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18
Q

Rhythm control of AF

A

Flecainide only if no structural heart disease
Or DCCV

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19
Q

Chadvasc

A

Score >1 = anticoagulation
For AF stroke risk
CCCF
HTN
>/= 75
DM
Stroke/ TIA - 2 (the rest are 1 point each)

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20
Q

Risk of stroke with AF if chadvasc = 0

A

1.9%
=1 then 2.8%
=2 then 4%
= 3 then 5.9% etc

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21
Q

2nd most frequent indication for valve surgery

A

MR

22
Q

Most frequent aetiology of mitral regurgitation

A

Degenerative i.e. prolapse or flail leaflet

23
Q

Secondary / functional MR is

A

Where valve leaflets and chordae are structurally normal and MR results from LV abnormality ie dilated or ischaemic cardiomyopathy

24
Q

Management of secondary MR

A

No evidence that valve replacement helps so medical management ie of heart failure

25
Q

HASBLED

A

HTN
Renal disease
Liver disease
Stroke
Prior major bleeding or predisposition to
Labile INR
>65
Medications ie anti platelets nsaids
Alcohol excess

Score of greater than 2 = high risk for major bleeding

26
Q

Indication for anti coagulation in mitral valve disease

A

Presence of AF or previous emboli

27
Q

How to diagnose IE?

A

Dukes criteria
2 major and 5 minor
Both major / 1 major and 3 minor / all 5 minor
Major: positive echo (mobile vegetation), specific bacteria on 2 separate blood cultures
Minor: fever >38, other positive BCs, different echo findings, septic embolism, janeway lesions/ osler nodes

28
Q

Bacteria in IE

A

Staph aureus
Strep viridans, strep bovis
HACEK group

29
Q

How does rheumatic disease most commonly affect the mitral valve?

A

Mixed valve disease

30
Q

ECG of mitral valve disease

A

AF
P mitrale due to left atrial enlargement
LVH

31
Q

CV waves in JVP

A

Tricuspid regurgitation

32
Q

How might murmur change with severe mitral disease?

A

If pulmonary hypertension becomes pronounced then can develop tricuspid regurgitation

33
Q

Differential for diastolic murmur

A

Austin flint murmur
Low pitched diastolic rumbling
Severe aortic regurgitation where the regurgitant jet hits the mitral valve
Best heard at apex so can be mistaken for mitral stenosis

34
Q

What’s usually the predominant lesion in mixed aortic valve disease?

A

Usually aortic stenosis with a mild degree of regurgitation- ie when the valve stiffens there’s some leaking

35
Q

Aortic regurgitation caused by (simple pathophys)

A

Either valvular pathology ie stenosis or pathology of the aortic root

36
Q

Acute AR caused by

A

IE
trauma
Aortic dissection

37
Q

Why does collapsing pulse happen?

A

Wide pulse pressure from regurgitant volume in AR

38
Q

Signs attributed to wide pulse pressure in AR

A

De maussets- head bobbing
Quinkes- capillary pulsation in fingertips and lips
Mullers - uvular pulsation

39
Q

Exacerbate AR murmur

A

Sit up hold breath in expiration

40
Q

Why do you roll the patient to left in CV exam?

A

To elicit MS murmur
Mid diastolic murmur, difficult to hear
Use of bell useful for low frequency murmurs

41
Q

Why do we sit patients forwards during the CV exam?

A

Bring heart forwards to help to listen for AR best heard in expiration at lower left sternal edge

42
Q

HOCM murmur

A

Ejection systolic caused by LVOTO

Or

Pan systolic murmur caused by systolic anterior of mitral valve resulting in MR

43
Q

Causes of cardiac hypertrophy

A

Pressure overload is HTN, Aortic stenosis
HOCM
Fabreys
Amyloidosis

44
Q

HOCM treatment

A

Symptoms - beta blocker
Myosin inhibitors
Assess risk of cardiac death ? Need for ICD
Genetics - familial evaluation
Severe disease - septal reduction therapy (myomectomy or alcohol)

45
Q

Congenital heart disease causes

A

TOF
Pulmonary atresia
Tricuspid atresia
Pulmonary stenosis
Eisenmengers syndrome
Ebstein anomaly
TGA

46
Q

TOF surgery

A

Balloon valvuloplasty typically done to relieve pulmonary stenosis
Surgery to improve blood flow to the lungs (plumbing the left subclavian into the pulmonary artery distal to the stenosis) right lateral thoracotomy scar
Repair VSD - midline sternotomy scar

47
Q

TOF features

A

4
VSD
pulmonary stenosis
Over riding aorta
RVH

48
Q

How does apex differ between AR and AS?

A

Pressure overload conditions cause heaving apex ie AS, HTN, LVH
AR is a volume overload problem so this causes a thrusting apex beat

49
Q

Severe AS signs

A

Slow rising low volume pulse
Narrow pulse pressure
Absent 2nd heart sound
Longer murmur
Radiation to carotids
Evidence of LVH ie heaving apex beat and 4th heart sound

50
Q

What is AS gradient mean?

A

The gradient is the pressure difference across the aortic valve so severe AS = >40 mm Hg gradient

51
Q

Criteria for severe AS

A

Peak velocity >4 m/ sec
Gradient >40 mm Hg
Size <1 cm2

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