Cardio 2 Flashcards
which valves close to cause S1
mitral and tricuspid
which valves close to cause s2
aortic and pulmonary
when is the 4th heart sound heart
just before s1
what causes the 4th heart sound
hypertrophic ventricle
the 2 special manoeuvres in cardio exam assess for what valve abnormality
left hand side= mitral stenosis
leaning forward= aortic regurg
how to grade murmurs
grade 2= quiet
grade 3= easy to hear
how to present a murmur
the patient has a
- harsh/soft/blowing
- grade x
- systolic/diastolic
murmur
it is heard loudest in the
4.aortic/pulmonary/mitral/tricuspid area
5. does/doesnt radiate to xyz
this suggests a diagnosis of
stenosis/regurg affects which chamber in relation to the valve
the chamber before
stenosis causes hypertrophy
regurg causes dilatation
aortic stenosis murmur
ejection systolic, crescendo decrescendo
how does aortic stenosis affect pulse
slow rising
narrow pulse pressure
aortic regurg murmur
early diastolic
how does aortic regurg affect the pulse
collapsing pulse- think if it as the blood flowing back because of regurg
wide pulse pressure
mitral stenosis murmur
early diastolic
signs of mitral stenosis
malar flush- due to back pressure into pulmonary system
AF- left atrium struggling to push can disrupt electrical activity
marfans syndrome common murmur
aortic regurg
mitral regurg murmur
pan systolic
causes of murmurs
infective endocarditis
rheumatic heart disease
ischaemic heart disease
connective tissue disorder eg marfans, ehlers danlos
tricuspid regurg murmur
pansystolic
signs of tricuspid regurg
raised JVP
pulsatile liver
peripheral oedema
ascites
pulmonary stenosis murmur
ejection systolic
signs of pulmonary stenosis
raised JVP
oedema
ascites
causes of pulmonary stenosis
congential: ToF and noonan syndrome
what valve pathology most commonly requires replacement
aortic stenosis
what scar indicates valve replacement
midline sternotomy
INR traget AF
2-3
INR target mechanical valve
2.5-3.5
complications of valve replacement
thrombus formation
infective endocarditis
haemolysis
what valve replacements need warfarin
only metallic
what surgeries can be done for valve replacement
TAVI- bioprosthetic replacement
open surgery- bioprosthetic or metallic replacement
most common causative organism for infective endocarditis
staphylococcus aureus
what do janeway lesions and oslers nodes look like
janeway lesions= flat red macules on palms and soles of feet
oslers nodes= red/purple nodules on pads of fingers/toes
how should blood cultures be taken in infective endocarditis
3 times
different sites
6 hrs apart
what is better out of TOE and trans thoracic echo
TOE- more sensitive and specific
how long does abx therapy in infective endocarditis last
4 weeks= native valves
6 weeks= prosthetic valves
criteria for infective endocarditis
dukes
major criteria dukes
- positive culture
- imaging findings eg on echo
HOCM inheritance
autosomal dominant
how is blood flow disrupted in HOCM
left ventricular outflow tract obstruction
what pathologies cause irregularly irregular heart rate
AF
ventricular ectopics
how to differentiate between causes of irregularly irregualr heart rate
if ventricular ectopics they will disappear once heart rate is over a certain threshold
what valve abnormality causes valvular AF
mitral stenosis
first line rate control in AF
beta blocker
flecanide vs amiodarone for rhythmn control in AF
amiodarone for structural heart disease
how long should a patient be anticoagulated for before delayed cardioversion in AF
3 weeks
what drug is used for pill in pocket management of AF
flecanide
what investigation do you need to do for everyone on anticoagulation who has a fall
CT head
reversal agent for apixaban/rivaroxaban
adenexat alpha
reversal agent for dabigatran
idarucizumab
moa warfarin
vitamin K antagonist
prolongs PT
what enzyme metabolises warfarin and where is it found
cytochrome p450 in liver
reversal agent for warfarin
vitamin K
what score is used to assess bleeding risk in those with AF
ORBIT
what is left atrial appendage occlusion
used when someone with AG cant be anticoagulated due to bleeding risk
the left atrial appendage is where clots are most likely to form so it is occluded
SVT pathophysiology
there is a reentry circuit from ventricles to atria so the electrical signal goes back to atria, travels to AVN and causes a loop
narrow QRS complex length
<0.12 secs
<3 small squares
SVT mx
- vagal manoeuvres
- adenosine
- verapamil or beta blocker
- synchronised DC cardioversion
what part of the nervous system do vagal manoeuvres affect
parasympathetic
what should you not give in wolff parkinson white
beta blocker or adenosine (blocks the AV node and encourages use of the accessory pathway)
avoid adenosine in
asthma
COPD
heart failure
heart block
wolff parkinson white
adenosine dosage
6mg
then 12mg
then 18mg
4 main narrow complex tachycardias
SVT
sinus tachycardia
AF
atrial flutter
atrial flutter mx
same as AF- anticoagulation based on chadsvasc
radiofrequency ablation of re-entrant circuit
QT interval prolonged when
> 440 milliseconds in men
460 milliseconds in women
normal PR interval
0.2 secs
5 small squares
first degree heart block on ECG
prolonges PR interval
second degree heart block on ECG
mobitz type 1= increasing PR interval until one p wave is not followed by a QRS complex
mobitz type 2= regularly dropped QRS complex
3rd degree heart block on ECG
no association between p waves and QRS complexes
mx for unstable patients at risk of asystole
- atropine
- inotropes
- transcutaneous pacing
- transvenous pacing
- permanent pacemaker when possible
when is a single chamber pacemaker placed in right atrium vs right ventricle
right atrium if issue with SA node
right ventricle if issue with AV node
risk of what is an indication for implantable cardiac defibrillators
going into v tach or v fib
how do you identify pacemaker on ECG
a single sharp vertical line before p waves/ qrs complexes
