Cardio Flashcards
A 22 yr old man presents for a check up and you hear a left scapula bruit
Dx?
scapula bruit = coarctation of the aorta
What is coarctation of the aorta associated with?
Bicuspid aortic valve and turners syndrome
+ increased risk of IE
Once repaired they have a risk of ao aneurysm
What also causes raised troponin other than MI?
CCF, myocarditis, endocarditis, pericarditis, HB, tachy/brady arrhythmias
Non-Cardiac causes: PE severe pulmonary HTN, renal failure, COPD
In PAD you can do a bestride test to show the limb ischaemia.
Describe this test and what is its name
In PAD you can do a bestride test to show the limb ischaemia.
= Buerger’s test
= with the patient supine, bring their legs up 45 degrees for 2 mins. Then hang their legs off the bed. If +ve the legs go blue –> red due to reactive hyperaemia from post-hypoxic vasodilatation.
What does an ABPI <0.9 mean?
That they have PAD
AMBP should be 1
How should you investigate intermittent claudiation?
Duplex USS + CT angioplasty - these should be used to assess the revascularisation options
What are the treatment options for intermittent claudication?
Supervised exercise program
Angioplasty or stenting
Bypass surgery or graft (only when angioplasty has failed)
Vaso-dilator therapy - naftidrofuyl oxalate
How do you treat critical limb ischaemia?
Revascularisation (angioplasty or bypass surgery)
Analgesics - paracetamol + weak/strong opioids
Give 3 organisms that cause infective endocarditis and RF associated with them
Staph Aureus - IVDU/invasive procedures
Strep Viridans - dental work
Enterococcus - pelvic surgery or infections
What are the management options for SVT?
Valsalva manoeuvre
Adenosine 6mg–>12mg–>12mg
Electrical cardioversion
What are the management options for atrial flutter?
- Convert back to SR - pharmaceutically or electrically
- Rate control - CCB/BB/Digoxin
- Anti-coag
What are the key features of AF on ECG?
No P waves,
Narrow QRS,
Irregularly irregular
No isoelectric baseline
What are the ECG changes of WPW?
Short PR
Delta wave
Long QRS
ST segment and T wave discordant changes (T wave the opposite direction to the QRS)
How does AS present?
Murmur = ESM SAD Syncope Angina Dyspnoea
How can you define heart failure?
A state where the heart is unable to pump enough blood to satisfy the needs of metabolising tissues
A symptomatic condition where breathlessness, fluid retention and fatigue are associated with a cardiac abnormality that reduces cardiac output
How do you treat heart failure?
ABS
ACE-I
BB
Spironolactone (aldosterone antagonist)
What are the 3 main causes of HF?
Ischaemia HD
Cardiomyopathy
HTN
Give the stepwise treatment ladder for HTN
<45 >45/BAC
1 = ACEI CCB
2= ACE-I + CCB
3 = ACE-I + CCB + Diuretic (thiazide like)
4 = ? spironolactone//more diuretic or ab/bb
Give an example of a thiazide-like diuretic?
Indapamide
Chlortalidone
Give some secondary causes of HTN
1) Renal = CKD, renal vascular disease
2) Endocrine = Cushings, Conns, hyperthyroid, hyperparathyroid, aromegaly, pheochromocytoma
A 55yr old man presents to A&E with syncope, dizziness, breathlessness and he is experiencing palpitations. His HR is 38. How would you treat this bradycardia?
Atropine IV
Anti-cholinergic = muscarinic antagonists which reduces the vagal tone
What is a 3rd degree block usually caused by?
Myocardial fibrosis
What are the causes of atrial flutter?
CAD, HTN, hyperthyroidism, obesity, alcohol and COPD
What are the ECG changes seen in atrial flutter?
Saw-toothed waves
Narrow T waves
Atrial rate around 300 and VR around 150 - usually 2:1 block
Give causes of sinus tachycardia: Physiological Pathological Endocrine Pharmacological
Physiological - exertion, anxiety, pain
Pathological - fever, anaemia, hypovolaemia
Endocrine - thyrotoxicosis, phaeochromocytoma
Pharmacological - adrenaline, alcohol, caffeine
Define Torsades de Point
Broad QRS ventricular tachycardia
Its a type of polymorphic ventricular tachycardia in which the cardiac axis rotates over a sequence of 5-20 points. The QRS amplitude varies giving a twisting appearance
Describe the ECG changes seen in ventricular fibrillation?
Chaotic QRS complexes with varied amplitude
No obvious P, QRS, T waves
Rate 150-500bpm
Amplitude decreases with duration: coarse –> fine
What are the SE of Statins?
Myalgia
Stiffness
Weakness
Cramping
How would you repair a thoracic aortic aneurism?
TEVAR = thoracic endovascular aneurysm repair
In someone with Mitral Stenosis, what signs would you see?
Malar flush (CO2 retention)
Raised JVP
RVH - laterally displaced apex and RV heave
Signs of RHF
- Mid-late diastolic murmur heard best at the left lateral sternal edge
What might you see on an ECG with MS?
P mitrale - bifid P wave
often in lead II
How can you treat MS?
M/symptomatic
- AF: anticoagulant
- Dysponoea: diuretics/nitrates
- SOBOE: BB/NDHPCCB
S = valve balloon
Which is the most common and 2nd most common valve disease?
AS
MR
Give some causes of MR
- Degenerative
- IE
- Post MI/ischaemic damage of the chordae tendinae or papillary muscles
- Rheumatic fever
How does rheumatic fever cause valvular disease?
Group A beta haemolytic strep (Pyogenes)
- Antigen mimicry - abs reacts to the glycoproteins and cardiac myocytes causing inflammation and scarring
What is Frank-Starlings law?
As larger volumes of blood flow into the ventricles, the blood stretches the myocytes leading to an increased force of contraction
Increased stroke volume of the heart in response to increased blood volume in the ventricles
What is starlings law in relation to fluid shifts
Fluid movement due to filtration across a capillary wall is dependant on a balance of:
- Hydrostatic pressure gradient (fluid density)
- Oncotic pressure gradient (a form of osmotic pressure that is exerted by proteins that pulls water into the circulatory system)
What ECG changes would you see in a PE?
Sinus tachycardia
S1Q3T3
* Deep S wave in 1
* Deep Q wave and Deep/inverted T wave in 3
Associated RBBBOther then MI, give other causes of a raised troponin
CCF Trauma Myocarditis/pericarditis Aortic dissection Aortic valve disease PE Arrhythmias Stroke
What is the universal definition of a STEMI?
New ST segment elevation at the J point (the point between the S wave and the ST segment) in 2 continuous leads with the cut off points V2 and V3 >0.3mV men and >0.15mV women and over >0.1 in other leads
If the lateral wall of the left ventricle is affected by STE where is the occlusion and in which leads would the STE be?
Leads I, VL and V6 (lateral leads)
Left circumflex coronary artery
What ECG changes would you see in a posterior MI?
- Dominant R wave in V1
- Ischaemic ST depression in V2-V4
- Q waves and ST segment elevation in leads V7-V9
Give some causes of LBBB
Ischaemia
HTN
Cardiomyopathy
Myocarditis
What do you see on a ECG with Left ventricular hypertrophy?
Sinus rhythm
Tall R wave in V5-V6
Inverted T waves in lateral leads
Give some other causes of raised BNP other than HF
LVH, ischaemia
COPD
DM
Cirrhosis of the liver
