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Medecine - As PACES > Cardio > Flashcards

Cardio Flashcards

1
Q

LAME syndrome/Carney complex

A

Lentigenes- spotty skin pigmentation
Atrial Myxoma
Endocrine tumours
Schwannomas

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2
Q

Cause of collapsing pulse

A

Hyperdynamic circualtion

Aortic regurgitation
Thyroitoxcosis
Pregnancy
Anemia

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3
Q

Features of pulmonary HTN

A 
Raised JVP 
Left parasternal heave 
Loud p2 and PSM of TR 
Pulsatile hepatomegaly 
Ascites and peripheral odema
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4
Q

S3

A

Rapid ventricular filling of dilated left ventricle

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5
Q

S4

A

Atrial contraction against stiff ventricle

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6
Q

Clinical indicator of severe AS

A

Quiet/absent A2
S4
Narrow pulse pressure
Evidence of decompensation: LVF

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7
Q

Echo feature of severe AS

A

Valve area 40mmHg

Jet velocity >4m/s

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8
Q

Indications for AS valve replacement

A

Symptomatic AS
Severe asymptomatic AS with an ejection fraction less than 50% or valve gradient greater then 50mmHg
Severe AS undergoing CABG or other valve op

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9
Q

Quincke sign

A

Cappillary pulsatation in the nail beds

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10
Q

Corrigans

A

Visable vigorous carotid pulsation

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11
Q

De-musset sign

A

Head nodding

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12
Q

Traubes sign

A

Pistol shot sound over femoral atery with proximal compression

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13
Q

Duroziez’s sign

A

Systolic murmur over the femoral artery with proximal compression
Diastolic murmur with distal compression

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14
Q

Mueller’ sign

A

Systolic pulsatation of the uvula

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15
Q

Fallots tetralogy

A

VSD
PULMONARY stenosis
Right ventricular hypetrophy
Overriding aorta

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16
Q

Clinical signs of severe AR

A 
Collapsing pulse 
Wide pulse pressure 
LVF
Austin Flint murmur 
S3 
Long murmur
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17
Q

Austin Flint mumur

A

Rumbling mid-diastyloic mumur at apex regurgitant jet fluttering the anterior mitral valve

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18
Q

Echo indicators of severity of AR

A

Jet width > 65% of outflow tract
Regurgitant jet volume
Premature closing of the mitral valve

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19
Q

Indication for surgery in AR

A 
Symptomatic: NYHA >2 
LV dysfunction 
- pulse pressure >100mmHg
- ECG changes: T inversion in lateral leads 
- LV enlargement on CXR or EF
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20
Q

Echo features of severe MR

A 
Jet width >0.6cm squared
Systolic pulmonary flow reversal 
Regurgitant volume greater than 60ml 
Regurgitant orifce area >0.4cm^2 
Regurgitant fraction > 50%
21
Q

Graham steel mumur

A

Early diastolic mumur secondary to pulmonary regurgitation

22
Q

Echo features of severe MS

A

Valve orifce 10mmHg
Pulmonary artery systolic pressure > 50mmHg
Valve oriface

23
Q

Dukes criteria

A

Options: 2 major, 1 major + 3 minor, 5 minor

Major
1. Positive blood culture - typical organism in 2 seperate cultures or persistently positive culture

2 endocardial involvement- echo shows vegetation, abscess, dehiscence or there’s is new valvular regurgitation

Minor

  1. Predisposing factor - cardiac lesion, IVDU
  2. Fever >38
  3. Emboli: septic infarcts, splinters, Jane way lesions
  4. GN,RF, Osler nodes, Roth spots
  5. Blood culture or Echo not meeting major criteria
24
Q

Revised Jones criteria

A

Evidence of group A Strep infection plus either 2 major criteria or 1 major 2 minor

Evidence of GAS Infection: +ve throat culture, rapid strep Ag test, raised ASOT or DNA b titre, recent scarlet fever 
Major criteria 
1.pancarditis 
2. Arthritis 
3. Subcutaneous nodules 
4. Erythema marginatum 
5. Sydenham chorea

Minor criteria

  1. Fever
  2. Raised CRP or ESR
  3. Athralgia - not if athritis major
  4. Prolonged PR - not if athritis major
  5. Previous rheumatic fever
25
Q

Types of valve prostheses

A

Mechanical

  • ball and cage - Starr Edwards
  • tilting disc - Bjork Shelley
  • bileaflet- st Jude

Biological

  • porcine tricuspid valves- carpentier Edwards
  • homografts - cavaderic
26
Q

Complication of valve replacement

A

Early

  • surgical complication - 5% operative mortality
  • acute failure: dehiscence, breakage, thrombus
  • infection - staph aureus infective endocarditis

Longterm

  • thromboembolism - 1-2% p/a despite warfarin
  • Anemia - warfarin and heamolysis
  • bleeding
  • infective endocarditis
  • failure- stenosis or regurgitation
27
Q

Maangement of Acute AF - under 48hrs

A

Heamodynamicaly unstable - cardioversion

Stable

  • rate control - diltiazem or metaprolol
  • start LMWH
  • cardiovert: DC or medical - flecinide or amiodarone
28
Q

CHADSVASC score

A 
Congestive cardiac failure 
HTN 
Age over 75 - 2 points 
DM 
Stroke or TIA - 2 points 
Vascular disease 
Age over 65 
Sex - female
29
Q

HAS BLED

A

HTN - 160mmhg
Abnormal renal or liver function
Stroke
Bleeding diathesisis or previous major bleed
Labile INR
Elderly - over 65
Drugs - past history of drugs or alcohol or medication currently which increase bleeding risk

30
Q

Indication for permenant pacing

A 
Complete AV block 
Mobitz type 2 
Symptomatic mobitz type 1 
Symptomatic bradycardia 
Drug resistant tachyarrhythmia 
Heart failure
31
Q

Clinical signs of severe AR

A 
Collapsing pulse 
Wide pulse pressure 
LVF
Austin Flint murmur 
S3 
Long murmur
32
Q

Austin Flint mumur

A

Rumbling mid-diastyloic mumur at apex regurgitant jet fluttering the anterior mitral valve

33
Q

Echo indicators of severity of AR

A

Jet width > 65% of outflow tract
Regurgitant jet volume
Premature closing of the mitral valve

34
Q

Indication for surgery in AR

A 
Symptomatic: NYHA >2 
LV dysfunction 
- pulse pressure >100mmHg
- ECG changes: T inversion in lateral leads 
- LV enlargement on CXR or EF
35
Q

Echo features of severe MR

A 
Jet width >0.6cm squared
Systolic pulmonary flow reversal 
Regurgitant volume greater than 60ml 
Regurgitant orifce area >0.4cm^2 
Regurgitant fraction > 50%
36
Q

Graham steel mumur

A

Early diastolic mumur secondary to pulmonary regurgitation

37
Q

Echo features of severe MR

A

Valve orifce 10mmHg

Pulmonary artery systolic pressure > 50mmHg

38
Q

Dukes criteria

A

Options: 2 major, 1 major + 3 minor, 5 minor

Major
1. Positive blood culture - typical organism in 2 seperate cultures or persistently positive culture

2 endocardial involvement- echo shows vegetation, abscess, dehiscence or there’s is new valvular regurgitation

Minor

  1. Predisposing factor - cardiac lesion, IVDU
  2. Fever >38
  3. Emboli: septic infarcts, splinters, Jane way lesions
  4. GN,RF, Osler nodes, Roth spots
  5. Blood culture or Echo not meeting major criteria
39
Q

Revised Jones criteria

A

Evidence of group A Strep infection plus either 2 major criteria or 1 major 2 minor

Evidence of GAS Infection: +ve throat culture, rapid strep Ag test, raised ASOT or DNA b titre, recent scarlet fever 
Major criteria 
1.pancarditis 
2. Arthritis 
3. Subcutaneous nodules 
4. Erythema marginatum 
5. Sydenham chorea

Minor criteria

  1. Fever
  2. Raised CRP or ESR
  3. Athralgia - not if athritis major
  4. Prolonged PR - not if athritis major
  5. Previous rheumatic fever
40
Q

Secondary cause of Hypertension

A 
Renal atery stenosis 
Phaeocytochroma 
Cushings 
Co-artication of the aorta 
Polycystic kidney disease
41
Q

Indication for CABG

A

Left main stem disease
Triple vessel disease
Refractory angina
Unsuccessful angioplasty

42
Q

Complications of a CABG

A 
Death 
MI 
Stroke 
Pericardial tamponade 
Heamothroax 
Post perfusion syndrome 
Post op AF 
Non Union of the sternum 
Graft stenosis
43
Q

Definition of essential hypertension

A

BP>140/90mmHg with no secondary cause identified

44
Q

Isolated systolic HTN

A

systolic >140 and diastolic is less than 90

45
Q

Stages of HTN

A
  1. Clinic BP> 140/90mmHg and ABPM >135/85
  2. Clinic BP greater or equal to 160/100 + ABPM/HBPM greater or equal to 150/95
  3. Severe HTN: systolic greater or equal to 180 or diastolic greater or equal to 110
  4. Malignant HTN: BP > 180/100 and pappilodema and or retinal haemorrhages
46
Q

End organ damage in HTN

A

Vascular: aneurysm, peripheral aterial disease, dissection
Neuro: CVA( lacunar infarcts, haemorrhages), vascular dementia, encephalopathy with a malignant HTN
Renal - chronic kidney disease
Cardiac: coronary atery disease/IHD, LVH leading to HF,
Eyes - Hypertensive retinopathy

47
Q

Indication for pharamcological treatment of BP

A

Under 80 + stage 1 + co-morbid or end organ damage
Stage 2
Under 40+ stage 1
Isolated systolic HTN

48
Q

Grading of murmur intensity

A
  1. Very faint - just audible by expert in optimal conditions
  2. Quiet - just audible by non-expert in optimal conditions
  3. Moderately loud
  4. Loud with palpable thrill
  5. Very loud with thrill audible with stethoscope partly off chest - systolic only
  6. Very loud with thrill, audible without a stethoscope - systolic only

Medecine - As PACES (6 decks)

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