Cardio Flashcards
LAME syndrome/Carney complex
Lentigenes- spotty skin pigmentation
Atrial Myxoma
Endocrine tumours
Schwannomas
Cause of collapsing pulse
Hyperdynamic circualtion
Aortic regurgitation
Thyroitoxcosis
Pregnancy
Anemia
Features of pulmonary HTN
Raised JVP Left parasternal heave Loud p2 and PSM of TR Pulsatile hepatomegaly Ascites and peripheral odema
S3
Rapid ventricular filling of dilated left ventricle
S4
Atrial contraction against stiff ventricle
Clinical indicator of severe AS
Quiet/absent A2
S4
Narrow pulse pressure
Evidence of decompensation: LVF
Echo feature of severe AS
Valve area 40mmHg
Jet velocity >4m/s
Indications for AS valve replacement
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
Quincke sign
Cappillary pulsatation in the nail beds
Corrigans
Visable vigorous carotid pulsation
De-musset sign
Head nodding
Traubes sign
Pistol shot sound over femoral atery with proximal compression
Duroziez’s sign
Systolic murmur over the femoral artery with proximal compression
Diastolic murmur with distal compression
Mueller’ sign
Systolic pulsatation of the uvula
Fallots tetralogy
VSD
PULMONARY stenosis
Right ventricular hypetrophy
Overriding aorta
Clinical signs of severe AR
Collapsing pulse Wide pulse pressure LVF Austin Flint murmur S3 Long murmur
Austin Flint mumur
Rumbling mid-diastyloic mumur at apex regurgitant jet fluttering the anterior mitral valve
Echo indicators of severity of AR
Jet width > 65% of outflow tract
Regurgitant jet volume
Premature closing of the mitral valve
Indication for surgery in AR
Symptomatic: NYHA >2 LV dysfunction - pulse pressure >100mmHg - ECG changes: T inversion in lateral leads - LV enlargement on CXR or EF
Echo features of severe MR
Jet width >0.6cm squared Systolic pulmonary flow reversal Regurgitant volume greater than 60ml Regurgitant orifce area >0.4cm^2 Regurgitant fraction > 50%
Graham steel mumur
Early diastolic mumur secondary to pulmonary regurgitation
Echo features of severe MS
Valve orifce 10mmHg
Pulmonary artery systolic pressure > 50mmHg
Valve oriface
Dukes criteria
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
- Predisposing factor - cardiac lesion, IVDU
- Fever >38
- Emboli: septic infarcts, splinters, Jane way lesions
- GN,RF, Osler nodes, Roth spots
- Blood culture or Echo not meeting major criteria
Revised Jones criteria
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
- Fever
- Raised CRP or ESR
- Athralgia - not if athritis major
- Prolonged PR - not if athritis major
- Previous rheumatic fever
Types of valve prostheses
Mechanical
- ball and cage - Starr Edwards
- tilting disc - Bjork Shelley
- bileaflet- st Jude
Biological
- porcine tricuspid valves- carpentier Edwards
- homografts - cavaderic
Complication of valve replacement
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
Maangement of Acute AF - under 48hrs
Heamodynamicaly unstable - cardioversion
Stable
- rate control - diltiazem or metaprolol
- start LMWH
- cardiovert: DC or medical - flecinide or amiodarone
CHADSVASC score
Congestive cardiac failure HTN Age over 75 - 2 points DM Stroke or TIA - 2 points Vascular disease Age over 65 Sex - female
HAS BLED
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
Indication for permenant pacing
Complete AV block Mobitz type 2 Symptomatic mobitz type 1 Symptomatic bradycardia Drug resistant tachyarrhythmia Heart failure
Clinical signs of severe AR
Collapsing pulse Wide pulse pressure LVF Austin Flint murmur S3 Long murmur
Austin Flint mumur
Rumbling mid-diastyloic mumur at apex regurgitant jet fluttering the anterior mitral valve
Echo indicators of severity of AR
Jet width > 65% of outflow tract
Regurgitant jet volume
Premature closing of the mitral valve
Indication for surgery in AR
Symptomatic: NYHA >2 LV dysfunction - pulse pressure >100mmHg - ECG changes: T inversion in lateral leads - LV enlargement on CXR or EF
Echo features of severe MR
Jet width >0.6cm squared Systolic pulmonary flow reversal Regurgitant volume greater than 60ml Regurgitant orifce area >0.4cm^2 Regurgitant fraction > 50%
Graham steel mumur
Early diastolic mumur secondary to pulmonary regurgitation
Echo features of severe MR
Valve orifce 10mmHg
Pulmonary artery systolic pressure > 50mmHg
Dukes criteria
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
- Predisposing factor - cardiac lesion, IVDU
- Fever >38
- Emboli: septic infarcts, splinters, Jane way lesions
- GN,RF, Osler nodes, Roth spots
- Blood culture or Echo not meeting major criteria
Revised Jones criteria
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
- Fever
- Raised CRP or ESR
- Athralgia - not if athritis major
- Prolonged PR - not if athritis major
- Previous rheumatic fever
Secondary cause of Hypertension
Renal atery stenosis Phaeocytochroma Cushings Co-artication of the aorta Polycystic kidney disease
Indication for CABG
Left main stem disease
Triple vessel disease
Refractory angina
Unsuccessful angioplasty
Complications of a CABG
Death MI Stroke Pericardial tamponade Heamothroax Post perfusion syndrome Post op AF Non Union of the sternum Graft stenosis
Definition of essential hypertension
BP>140/90mmHg with no secondary cause identified
Isolated systolic HTN
systolic >140 and diastolic is less than 90
Stages of HTN
- Clinic BP> 140/90mmHg and ABPM >135/85
- Clinic BP greater or equal to 160/100 + ABPM/HBPM greater or equal to 150/95
- Severe HTN: systolic greater or equal to 180 or diastolic greater or equal to 110
- Malignant HTN: BP > 180/100 and pappilodema and or retinal haemorrhages
End organ damage in HTN
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
Indication for pharamcological treatment of BP
Under 80 + stage 1 + co-morbid or end organ damage
Stage 2
Under 40+ stage 1
Isolated systolic HTN
Grading of murmur intensity
- Very faint - just audible by expert in optimal conditions
- Quiet - just audible by non-expert in optimal conditions
- Moderately loud
- Loud with palpable thrill
- Very loud with thrill audible with stethoscope partly off chest - systolic only
- Very loud with thrill, audible without a stethoscope - systolic only
