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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
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
26
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
27
Maangement of Acute AF - under 48hrs
Heamodynamicaly unstable - cardioversion Stable - rate control - diltiazem or metaprolol - start LMWH - cardiovert: DC or medical - flecinide or amiodarone
28
CHADSVASC score
``` Congestive cardiac failure HTN Age over 75 - 2 points DM Stroke or TIA - 2 points Vascular disease Age over 65 Sex - female ```
29
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
30
Indication for permenant pacing
``` Complete AV block Mobitz type 2 Symptomatic mobitz type 1 Symptomatic bradycardia Drug resistant tachyarrhythmia Heart failure ```
31
Clinical signs of severe AR
``` Collapsing pulse Wide pulse pressure LVF Austin Flint murmur S3 Long murmur ```
32
Austin Flint mumur
Rumbling mid-diastyloic mumur at apex regurgitant jet fluttering the anterior mitral valve
33
Echo indicators of severity of AR
Jet width > 65% of outflow tract Regurgitant jet volume Premature closing of the mitral valve
34
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 ```
35
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% ```
36
Graham steel mumur
Early diastolic mumur secondary to pulmonary regurgitation
37
Echo features of severe MR
Valve orifce 10mmHg | Pulmonary artery systolic pressure > 50mmHg
38
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 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
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 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
Secondary cause of Hypertension
``` Renal atery stenosis Phaeocytochroma Cushings Co-artication of the aorta Polycystic kidney disease ```
41
Indication for CABG
Left main stem disease Triple vessel disease Refractory angina Unsuccessful angioplasty
42
Complications of a CABG
``` Death MI Stroke Pericardial tamponade Heamothroax Post perfusion syndrome Post op AF Non Union of the sternum Graft stenosis ```
43
Definition of essential hypertension
BP>140/90mmHg with no secondary cause identified
44
Isolated systolic HTN
systolic >140 and diastolic is less than 90
45
Stages of HTN
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
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
47
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
48
Grading of murmur intensity
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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