Cardio Flashcards
Features of pulmonary hypertension?
JAPPP2
- Raised JVP
- Ascites and
- Peripheral oedema
- Loud P2
- left Parasternal heave
Clinical signs of aortic stenosis?
Ejection systolic murmur radiating to the carotids
Forceful apex
Slow rising pulse
Thrill in aortic area
Clinical signs of SEVERE aortic stenosis?
Quiet/absent S2
S4 (atrial contraction against stiff ventricle)
Narrow pulse pressure
Decompensation: LVF
Differentials for aortic stenosis?
Aortic sclerosis (no radiation, normal character)
Mitral regurgitation
HOCM
Causes of aortic stenosis?
Congenital:
- Bicuspid aortic valve
Acquired:
- Calcification of valve
- Rheumatic heart disease
Echo features of severe aortic stenosis?
Valve area <1cm
Pressure gradient >40mmHg
Management of aortic stenosis?
Medical:
- Optimise CV risk: Statins, anti-HTN, DM, anti-plat
Surgery:
- Valve replacement +/- CABG
- TAVI
Indications for aortic valve replacement?
Symptomatic AS
Severe asymptomatic AS
Severe AS undergoing CABG or other valve op
Complications of aortic stenosis?
LVF; PND, orthopnoea, frothy sputum
Conduction problems
Endocarditis
Clinical signs of severe mitral regurgitation?
Atrial fibrillation
LVF
Differentials of MR?
AS
VSD
Tricuspid regurgitation
Causes of MR?
Structural, infective, congenital
Structural:
- LV dilatation
- Papillary muscle rupture
- Mitral valve prolapse
- Calcification
Infective:
- RHD
- Infective endocarditis
Congenital:
- Connective tissue diseases
What investigations would you do for MR and why?
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)
Management of MR?
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)
Signs of SEVERE aortic regurgitation?
- Collapsing pulse
- Wide pulse pressure
- LVF
Causes of aortic regurgitation?
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
What investigations would you do for AR and why?
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)
Examination findings of mitral stenosis?
- Mid diastolic murmur with loud first heart sound and opening snap (MDM OS)
- Tapping apex
- +/- AF
- Left parasternal heave
- Malar flush
Signs of SEVERE mitral stenosis?
Malar flush
Longer murmur
LVF
Causes of mitral stenosis
Infective: RHD, IE
Structural: Prosthetic valve, senile degeneration
Congenital
What investigations would you do for mitral stenosis and why?
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)
Management of aortic regurgitation?
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)
Management of mitral stenosis?
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
P mitrale?
Broad, bifid P waves, found in mitral stenosis
Rheumatic fever treatment and prevention?
Primary prevention: Pen V for 10 days
Secondary: Pen V for 5-10 years
Risk factors for infective endocarditis and associated organisms?
IVDU
Skin wounds
Immunosuppression
S. aureus, strep viridans and s. epidermidis
What is acute rheumatic fever?
Immunological response to strep pyogenes
Complications of valve replacements?
“BEHAVE”
- Bleeding
- Embolism
- Haemolysis
- AF
- Valve failure
- Endocarditis
Causes of AF?
Cardiac: IHD, valve disease, heart failure, PE
Metabolic: Thyrotoxicosis, Hypokalaemia
Infective: Pneumonia, RHD
How do you determine necessity of anticoagulation in AF?
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)
Management of acute AF?
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
Indications for pacemaker?
HAM ST Heart failure biventircular pacing AV node dysfunction Mobitz type 2 Sick sinus Tachyarrythmias drug resistant
Pulmonary hypertension symptoms?
SOB
Reduced exercise tolerance
Peripheral oedema
Criteria for IE
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
Criteria for RHD
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
ECG features of Wolff Parkinson White
Short PR interval Slurred upstroke (delta wave)
