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Finals Revision Progress > Cardio > Flashcards

Cardio Flashcards

1
Q

Features of pulmonary hypertension?

A

JAPPP2

  • Raised JVP
  • Ascites and
  • Peripheral oedema
  • Loud P2
  • left Parasternal heave
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2
Q

Clinical signs of aortic stenosis?

A

Ejection systolic murmur radiating to the carotids
Forceful apex
Slow rising pulse
Thrill in aortic area

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3
Q

Clinical signs of SEVERE aortic stenosis?

A

Quiet/absent S2
S4 (atrial contraction against stiff ventricle)
Narrow pulse pressure
Decompensation: LVF

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4
Q

Differentials for aortic stenosis?

A

Aortic sclerosis (no radiation, normal character)
Mitral regurgitation
HOCM

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5
Q

Causes of aortic stenosis?

A

Congenital:
- Bicuspid aortic valve

Acquired:

  • Calcification of valve
  • Rheumatic heart disease
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6
Q

Echo features of severe aortic stenosis?

A

Valve area <1cm

Pressure gradient >40mmHg

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7
Q

Management of aortic stenosis?

A

Medical:
- Optimise CV risk: Statins, anti-HTN, DM, anti-plat

Surgery:

  • Valve replacement +/- CABG
  • TAVI
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8
Q

Indications for aortic valve replacement?

A

Symptomatic AS
Severe asymptomatic AS
Severe AS undergoing CABG or other valve op

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9
Q

Complications of aortic stenosis?

A

LVF; PND, orthopnoea, frothy sputum
Conduction problems
Endocarditis

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10
Q

Clinical signs of severe mitral regurgitation?

A

Atrial fibrillation

LVF

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11
Q

Differentials of MR?

A

AS
VSD
Tricuspid regurgitation

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12
Q

Causes of MR?

A

Structural, infective, congenital

Structural:

  • LV dilatation
  • Papillary muscle rupture
  • Mitral valve prolapse
  • Calcification

Infective:

  • RHD
  • Infective endocarditis

Congenital:
- Connective tissue diseases

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13
Q

What investigations would you do for MR and why?

A

Bedside:
- ECG (look for LVH, AF, P-mitrale)

Bloods:
- FBC, U+E, glucose, lipids

Imaging:

  • CXR (calcified MV, LVH, pulmonary oedema)
  • Echo (to assess severity)
  • Cardiac catheterisation (assess coronaries)
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14
Q

Management of MR?

A

Medical:

  • Optimise CV risk: Statins, anti-HTN, DM, anti-plat
  • Rate control and anticoagulation for AF
  • Reduce afterload with beta blockers/ ACEis and diuretics

Surgery:
- Valve replacement (ind: symptomatic)

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15
Q

Signs of SEVERE aortic regurgitation?

A
  • Collapsing pulse
  • Wide pulse pressure
  • LVF
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16
Q

Causes of aortic regurgitation?

A

Can be ACUTE or CHRONIC

Chronic:
Structural: Bicuspid aortic valve, aortic dissection type A (acute)
Infective: infective endocarditis (acute), RHD (chronic)
Connective tissue: Marfan’s
AI: Ank spond, RA

17
Q

What investigations would you do for AR and why?

A

Bedside:
- ECG (look for LVH)

Bloods:

  • FBC, U+E, glucose, lipids
  • AI screen: ESR, HLA-B27

Imaging:

  • CXR (cardiomegaly, dilated ascending aorta, pulmonary oedema)
  • Echo (to assess severity and cause)
  • Cardiac catheterisation (assess coronaries)
18
Q

Examination findings of mitral stenosis?

A
  • Mid diastolic murmur with loud first heart sound and opening snap (MDM OS)
  • Tapping apex
  • +/- AF
  • Left parasternal heave
  • Malar flush
19
Q

Signs of SEVERE mitral stenosis?

A

Malar flush
Longer murmur
LVF

20
Q

Causes of mitral stenosis

A

Infective: RHD, IE
Structural: Prosthetic valve, senile degeneration
Congenital

21
Q

What investigations would you do for mitral stenosis and why?

A

Bedside:
- ECG (look for LVH and AF, p mitrale)

Bloods:
- FBC, U+E, glucose, lipids

Imaging:

  • CXR (calcified MV, dilated left atrium, pulmonary oedema, pulmonary haemosiderosis)
  • Echo (to assess severity and LV function)
  • Cardiac catheterisation (assess coronaries)
22
Q

Management of aortic regurgitation?

A

Medical:

  • Optimise CV risk: Statins, anti-HTN, DM, anti-plat
  • Rate control and anticoagulation for AF
  • Reduce afterload with beta blockers/ ACEis and diuretics

Surgery:
- Valve replacement (ind: symptomatic NYHA >2)

23
Q

Management of mitral stenosis?

A

Medical:

  • Optimise CV risk (statin, anti-HTN, anti-plat, DM)
  • Consider RF prophylaxis (Pen V)
  • Rate control and anticoagulation for AF
  • Diuretics for Sx relief
Surgical: 
Indicated for moderate to severe MS
- Ballon valvuloplasty
- Valve repair
- Valve replacement if repair not possible
24
Q

P mitrale?

A

Broad, bifid P waves, found in mitral stenosis

25
Q

Rheumatic fever treatment and prevention?

A

Primary prevention: Pen V for 10 days

Secondary: Pen V for 5-10 years

26
Q

Risk factors for infective endocarditis and associated organisms?

A

IVDU
Skin wounds
Immunosuppression

S. aureus, strep viridans and s. epidermidis

27
Q

What is acute rheumatic fever?

A

Immunological response to strep pyogenes

28
Q

Complications of valve replacements?

A

“BEHAVE”

  • Bleeding
  • Embolism
  • Haemolysis
  • AF
  • Valve failure
  • Endocarditis
29
Q

Causes of AF?

A

Cardiac: IHD, valve disease, heart failure, PE
Metabolic: Thyrotoxicosis, Hypokalaemia
Infective: Pneumonia, RHD

30
Q

How do you determine necessity of anticoagulation in AF?

A

CHA(2)DS(2)VAS Score

CCF
Hypertension
Age >75y
DM
Stroke/TIA
Vascular disease
Age 65-74
Sex female

If 0: aspirin
If >1: Warfarin (INR 2-3)

31
Q

Management of acute AF?

A

Acute
If haemodynamically unstable - cardioversion
Otherwise:
- Rate control with beta-blocker or rate-limiting calcium-channel blocker (diltiazem or metoprolol)
- Start LMWH
- DC cardioversion or medical w amiodarone

32
Q

Indications for pacemaker?

A 
HAM ST
Heart failure biventircular pacing
AV node dysfunction
Mobitz type 2
Sick sinus
Tachyarrythmias drug resistant
33
Q

Pulmonary hypertension symptoms?

A

SOB
Reduced exercise tolerance
Peripheral oedema

34
Q

Criteria for IE

A

Duke

2 major or 1 major 3 minor

“BE FIRE”

Major:
Blood cultures confirmed 2 seperate cultures
Echo findings e.g. vegetation

Minor:
Fever
Immune; roth spots /oslers nodes, RF
Risk factors (IVDU/cardiac lesions)
Emboli; splinter haemorrhages, janeway lesions
35
Q

Criteria for RHD

A

Jones

2 major or 1 major 2 minor

PACES FACER

MINOR:
Pancarditis
Arthritis
Chorea
Erythema marginatum
Subcut nodules
MAJOR:
Fever
Arthralgia
CRP/ESR
ECG showing prolonged PR
RF previously
36
Q

ECG features of Wolff Parkinson White

A 
Short PR interval
Slurred upstroke (delta wave)

Finals Revision Progress (16 decks)

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