Cardio 3 Flashcards
What should you suspect if you heart a mid-systolic click and a late systolic murmur (longer if the patient is standing)
mitral valve prolapse
Dilated Cardiomyopathy
- most common cardiomyopathy accounting for 90% of cases
- lots of causes but most commonly idiopathic
- What is the pathophysiology behind the symptoms?
- What clinical features are seen?
- dilated heart leading to predominantly systolic dysfunction
- all 4 chambers dilated but LV most of all
- eccentric hypertrophy is seen (sarcomeres are added in series)
- symptoms of heart failure
- S3
- AV valve regurgitation due to dilated heart
- balloon appearance of heart on CXR
DVLA for cardio
What is the advice for
- hypertension
- angioplasty
- CABG
- ACS
- pacemaker insertion
- implantable cardioverter-defibrillator
a) for sustained VT
b) prophylactically
c) for group 2 drivers - successful catheter ablation
- aortic aneurysm
- heart transplant
10 angina
- can drive unless unacceptable side effects and no need to notify DVLA
if group 2 (lorry/bus drivers) cannot drive if BP consistently >180 sys. or >100 dia. - 1 week off
- 4 weeks off
- 4 weeks off (unless successful angioplasty then 1 week as above)
- 1 week off
- a) 6 months off
b) 1 month off
c) permanent bar - 2 days
- > 6cm = notify DVLA, annual observation
6.5cm = cannot drive - 6 weeks (don’t need to notify DVLA)
- pull over if get angina symptoms
Eisenmenger’s Syndrome
- What is it?
- What can cause it?
- What clinical features can be seen?
- How is it managed?
- the reversal of a congenital heart defect left to right shunt
uncorrected shunt -> remodelling of pulmonary microvasculature -> obstruction to pulmonary blood -> pulmonary hypertension -> reverse of shunt
- ASD
- VSD
- patent ductus arteriosus
- original murmur disappears
- right ventricular failure
- cyanosis
- clubbing
- embolism
- haemoptysis
- heart + lung transplant (cry)
S3
- What causes the sound heard?
- What diseases can it be seen in?
- over-compliant ventricle causing you to hear blood bouncing off the ventricle walls
- LV failure (e.g. dilated cardiomyopathy)
- mitral regurgitation
- constrictive pericarditis (known as pericardial knock)
S4
- What causes the sound heard?
- What diseases can it be seen in?
- atrial contraction causing to hear blood hitting off stiff ventricle wall
2. LVH - aortic stenosis - hypertension - hypertrophic obstructive cardiomyopathy
S2
What can cause:
- a widely split S2
- a reverse (paradoxical) split S2
(I.e. P2 closes before A2) - a loud S2
- deep inspiration
- RBBB
- pulmonary stenosis
- LBBB
- severe aortic stenosis
- PDA
- hypertension
- hyper dynamic states
(hyper person = loud person)
What clinical features can be seen in hypercalcaemia?
- bone pain
- renal stones
- abdominal pain
- lethargy / depression
“bones, stones, groans + psychic moans”
exam: corneal calcification + short QT
Hyperlipidaemia
- a) What is eruptive xanthoma?
b) What can cause it? - What can cause tendon, tuberous and palmar xanthoma and xanthelasma?
- a) multiple red/yellow vesicles on extensor surfaces caused by high triglycerides
b)
- hypertryglyceridaemia
- lipoprotein lipase deficiency
Hypertrophic Obstructive Cardiomyopathy
- T/F: it is mostly diastolic dysfunction
- What clinical features are seen?
- What is seen on investigation?
- What diseases is it associated with?
- true - LVH = decreased compliance = decreased CO
- sudden death
- syncope (usually exercise-induced - due to sub aortic hypertrophy resulting in AS symptoms)
- exertion: dyspnoea + angina
mnemonic: death think collapse, syncope also collapse, which is exercise-induced, the other symptoms seen on exercise
exam:
- double apex beat
- ejection systolic murmur
+ increases with valsalva
+ decreases on squatting
3. echo Mr Sam Ash - mitral regurgitation - systolic anterior motion (ASH) of anterior mitral valve leaflet - asymmetric hypertrophy (AsH)
ECG
- LVH
- ST changes and T wave inversion
- Q waves
How is hypertrophic obstructive cardiomyopathy managed?
ABCDE
- amiodarone
- beta blockers or verapamil
- cardioverter-defibrillator
- dual chamber pacemaker
- endocarditis prophylaxis
NOTE
must avoid ACEs, nitrates + inotropes
Where is an inhaled foreign body most likely to be found?
right main bronchus
-> this is because it is more wide and more vertical than the left
Investigating Palpitations
- What investigations should be done in someone who has palpitations?
- What should be done if all these are normal?
- ECG - looking for arrhythmia
TFTs - thyrotoxicosis can precipitate AF and other arrhythmias
U+Es - looking for electrolyte disturbance e.g. hyperkalemia - Holter monitoring: 2-3 lead ECG for 24hrs (or longer if patients doesn’t get daily symptoms) and patient also records when they get symptoms to see if this matches to ECG
Other than acute pericarditis, what should you suspect in a young patient with ST/T wave changes with chest pain / arrhythmia following infection / autoimmune condition
myocarditis
Orthostatic Hypertension
- When is it most common?
- What clinical features are seen?
- neurogenerative disease (e.g. parkinson’s)
- diabetes
- hypertension
- alpha blockers
- drop in BP of >20/10 within 3 mins of standing
