DARTH VADER - death - arrhythmias - rupture (mitral regurg due to papillary muscle rupture) - tamponade - HF - valve disease - anureysm (ventricular) - Dressler's - embolism - reinfarction

Cardio Flashcards by Falak Naqvi

Atypical angina Ix (3)

CT coronary angiography
Functional imaging
Invasive coronary angiography

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Gold standard Ix for aortic dissection

Cat aortogram

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Pericarditis

Viral causes:

Coxsackie,flu, EBV and mumps

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Pericarditis

Bacterial causes

Strep viridans (native, non IVDU)
Steph aureus - IVDU, RH involvement
Staph epidermidis ( prosthetic valves)

Do 3 blood cultures for IE
DUKEs Criteria
Pneumonia (mycoplasma?), step, straps, TB, rheumatic fever

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Pericarditis O/E

Pericardial rub
Soft S1
S4 gallop

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Complications of pericarditis

Cardiac tamponade

Pericardial effusion

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Complications of MI

DARTH VADER

death
arrhythmias
rupture (mitral regurg due to papillary muscle rupture)
tamponade
HF
valve disease
anureysm (ventricular)
Dressler’s
embolism
reinfarction

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Acute ACS management

MONA BASH

Morphine, oxygen, nitrates, antiplatelets

B blockers, ACEi, statins, (LMWH)

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Immediate unstable angina/NSTEMI management

Aspirin and antithrombin eg fondaprinux

If undergoing angi within next 24hrs give LMWH instead

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High risk NSTEMI/ unstable angina management via GRACE

glycoprotein inhibitors (IIb/IIIa)

- PCI

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Functional cardiac imaging examples

12 lead ECG
Exercise ECG
Cardiac catheterisation
ECHO

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Structural cardiac imaging examples

Echo
CXR
CT or coronary angiogram

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Left ventricular failure can cause

Cardiomegaly 
Displaced apex beat
S3
RV HEAVE
murmurs - aortic valve

Nb right ventricular failures cause mitral murmurs

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Gold standard investigation for HF

BNP and TTE Echo Doppler

Nb BNP is sensitive but not specific, on its own cannot diagnose HF. If negative can rule out HF

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Management of PE if haemodynamically unstable

Thrombolysis or embolectomy

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Immediate unstable angina/NSTEMI management

Aspirin and antithrombin eg fondaprinux

If undergoing angi within next 24hrs give LMWH instead

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High risk NSTEMI/ unstable angina management via GRACE

glycoprotein inhibitors (IIb/IIIa)

- PCI

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Functional cardiac imaging examples

12 lead ECG
Exercise ECG
Cardiac catheterisation
ECHO

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Structural cardiac imaging examples

Echo
CXR
CT or coronary angiogram

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Left ventricular failure can cause

Cardiomegaly 
Displaced apex beat
S3
RV HEAVE
murmurs - aortic valve

Nb right ventricular failures cause mitral murmurs

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Gold standard investigation for HF

BNP and TTE Echo Doppler

Nb BNP is sensitive but not specific, on its own cannot diagnose HF. If negative can rule out HF

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Heart failure on CXR

Alveolar odema (bat wings) 
Kerly B lines
Cardiomegaly
Dilated prominent upper love vessels 
Pleural effusion

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Hypertension management

After ACD

Consider further diuretic, alpha blocker or b blocked

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BP control goals

stage 1 and 2
diabetic
> 80

140/90
130/80
150/90

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Hypertension medication side effects | ACE inhibitors

Cough, increased K, renal failure, Angio odema

Hypertension medication side effects | ARB

Vertigo, urticarial, puritis

Hypertension medication side effects | CCB

Ankle oedema Flushes Headache Gum hyperplasia

Hypertension medication side effects | Thiazides

``` Decreased potassium (ECG changes, arrhythmias) Decreased Na (confusion) ```

Hypertension medication side effects | Spirolocatone

Increased potassium, gynaecomastia

Hypertension medication side effects | B blocker

Bronchospasm, heart failure, lethargy

Gold standard for pericarditis

Echo | NB do cxr is tamponade suspected

Early diastolic murmur

Regurgitation murmurs | Aortic and pulmonary

Late diastolic murmurs

Stenosis | Mitral and tricuspid

Aortic stenosis

``` Worsening SOB PND Collapse Leg swelling Narrow pulse pressure and heaving apex beat ```

Graham steel

Pulmonary regurgitation | Early diastolic murmur

Austin Flint

Aortic incompetence - AR | AR gives wide pulse pressure

Mitral stenosis is associated with..

``` AF Opening snap Loud S1 Red cheeks Rheumatic fever ```

Becks Triad

1. low arterial blood pressure, 2. distended neck veins, and 3. distant, muffled heart sounds. CARDIAC TAMPONADE

Hyperkalaemia ECG signs

tented t waves broad QRS flattened p waves (path deep Q waves) --> lead to sine wave pattern and VF

Imaging to show infarcted myocardium

Nuclear studies of myocardium | single photon emission CT

Causes of AF

Causes of atrial fibrillation can be remembered using ‘Dehydrated PIRATES’: ``` Dehydration Pulmonary disease, e.g. pulmonary embolism Ischaemia (hypertension, ischaemic heart disease, heart failure) Rheumatic heart disease Anaemia, atrial myxoma Thyrotoxicosis Ethanol abuse Sepsis ```

Kussmaul’s sign

Kussmaul’s sign is a raised jugular venous pressure (JVP) upon inspiration that falls in expiration and is seen in constrictive pericarditis.

Investigations for chest pain

1. ECG 2. Troponin +ve= coronary angio -ve= ETT 3. Echo

Non cardio and resp causes of chest pain

Musc: costochondritis, Tietz's Gastro: GORD, oesophageal spasm, esophagitis, gastritis

STEMI/NSTEMI (amir sam management)

STEMI; aspirin, clopidogrel, PCI | NSTEMI: aspirin, clopidogrel and fonduparinx (anti thrombin)

Outflow obstruction (right and left)

Left: AS, HOCUM Right: PE

The t in an ecg should finish before the middle of the R-R interval in what?

Long QT syndrome: 1. Congenital: mutations in K channels 2. Aquired: low K or Mg, drugs

Carvallo's sign is a clinical sign found in patients with tricuspid regurgitation.

The pansystolic murmur found in this condition becomes louder during inspiration; this sign enables it to be distinguished from mitral regurgitation.

Mummurs that increase on inspiration:

PS, PR | TR

Pansystolic mumurs

1. MR 2. TR 3. VSD

DDx of increased JVP

1. RHF 2. TR (giant v waves) 3. Constrictive pericarditis

Cannon A waves

complete heart block VEB VT

elevated and fixed JVP

SVC obstruction

Causes of RHF

- secondary to LHF | - pulmonary HTN (PE, COPD)

TR causes

- valve leaflets | - right ventricle dilation

Causes of sinus tachycardia

- sepsis - hypovolaemia - endocrine (thyrotoxicosis and phaeo)

Causes of SVT

re entery circuit

AF causes

Throtoxicosis, Alcohol Heart: muscle, valve, pericardium Lungs: pneumonia, PE, cancer

VT causes

ischemia, electrolyte abnormality, long QT

short pr | delta wave

AVRT

When is adenosine contra indicated?

asthmatics

LVH differentials

AS or pulmponary HTN

mid systolic click

mitral valve prolapse

split S2

atrial septal defect

mitral; valve

aortic valve

medication which can increase your potassium levels in HF | which lower your potassium

SPIROLACTONE Thiazide diuretics, fusemide