Cardio Flashcards
NSTEMI vs STEMI
NSTEMI indicates ischaemia and STEMI indicates infarction.
STEMI requires urgent PCR, whereas NSTEMI is PCR within 48 hrs
Anterior Heart
V1-2
LAD
Septal Heart
V3-4
LAD
Lateral Heart
V5-6
Left circumflex artery
Anterolateral heart
V1-6
Left main stem disease
Inferior heart
II, III, aVF
Posterior descending branch of RCA
First sign of pulmonary oedema
Bibasal crepitation, as more fluid accumulates pleural effusion is seen on chest x-ray
Key signs of Right Heart Failure
Raised JVP
Bilateral pedal oedema
Murmur heard loudest on inspiration
Right-sided valve lesion
Anatomical landmark for aortic valve
Right 2nd intercostal space midclavicular line
Best way to hear mitral valve pathology
Patient to be in left lateral position
Corrigans signs indications
Hyperdynamic circulation associated with AR
Narrow Pulse pressure indications
Aortic stenosis
Indiciations for CHAD2 score
Predicting risk of subsequent stroke as a result of AF
Signs of ischaemia on ECG
Inverted T waves and ST depression
Signs of infarction on ECG
ST elevation, Q waves and raised troponin
Pulmonary embolism primary Sxs
SoB
Pleuretic chest pain
Hemoptysis
Clinical signs of PE
Pleural rub
Coarse Crackles
AF
Geneva scoring system
Used for predicting AF risk
Hyper-resonance with lung auscultation
Pneumothorax
Mitral Valve Prolapse
Barlow syndrome, click murmur syndrome.
Mid systolic click, followed by late systolic murmur is heard at apex as thickened mitral valve leaflet is displaced into LA during systole
Austin Flint Murmur
low pitched, mid-diastolic rumble at the apex
mitral valve displacement as well as aortic turbulence due to regurgitation qualifies as an Austin Flint murmur
Patent ductus arteriosus sound
Constant machinery murmur
Graham Steel murmur
Hear best at left sternal edge, 2nd intercostal space during inspiration
High pitched early diastolic murmur associated with pulmonary HTN
Carey Coombs murmur
Short, mid distolic rumble heard best at apex, due to turbulent blood flow over thickened mitral valve, often due to rheumatic fever
Aortic dissection pain
severe, tearing pain that radiates toward the back though this can be to the jaw depending on the location of the dissection.
MI pain description
severe, crushing chest pain with an acute onset
Sustained VT
Cannon a waves on JVP and broad QRS complexes
JVP wave forms
a wave – representing atrial systole;
c wave – representing closure of the tricuspid valve (this wave is not
usually visible);
x descent – representing a fall in atrial pressure during ventricular systole;
v wave – representing atrial filling against a closed tricuspid valve;
y descent – representing the opening of the tricuspid valve
Raised JVP seen means…
Fluid overload and RHF
Features seen in CXR with congestive cardiac failure
Cardiomegaly
Bilateral pleural effusions
Alveolar oedema
Kerley B lines (represent interstitial oedema)
First degree heart block on ECG
PR > 0.2s
Shortened PR interval
Fast AV conduction ie Wolff-Parikinson-White Syndrome
Mid-diastolic murmur (±opening snap, representing a mobile valve)
Mitral stenosis
Pan-systolic murmur
Mitral Regurgitation, tricuspid regurgitaiton and ventricular septal defects
Cough seen in HTN patients
ACEi cause dry cough
If this happens, start pts on ARB
Increasing SoB in previous 6 months
Bried periods of central chest pain
O/E BP 115/85
Few rales at both bases
ECG - borderline criteria for left ventricular hypertrophy.
Aortic stenosis
Aortic stenosis murmur
Crescendo systolic murmur heard best at R sternal edge
Mitral stenosis murmur
Mid-diastolic murmur best heard at the apex with opening snap and loud P2
Aortic regurg murmur
Decrescendo Diastolic murmur best heard at the left sternal edge
Mitral regurg murmur
Pan-systolic murmur best heard at the apex
Tricuspid regurg murmur
Pan-systolic murmur best heard at the left sternal edge
Dressler’s syndrome
Autoimmune pericarditis
Rapid BP lowering needed, what drug to give
Sodium nitroprusside
Large vs Small ventricular septal defects
Large ventricular septal defects (VSDs) may indeed be associated with pulmonary hypertension , heart failure and shunt reversal, but a small defect is unlikely to lead to these problems.
VSDs not associated with dysrhythmias
ENDOCARDITIS is persistent hazards
A 61-year-old man presents with a 2-hour history of moderately severe retrosternal
chest pain, which does not radiate and is not affected by respiration or posture. He
complains of general malaise and nausea, but has not vomited. His ECG shows ST
segment depression and T wave inversion in the inferior leads.
Acute Coronary Syndrome - unstable angina as no evident of tissue damage
A 46-year-old man develops sudden severe central chest pain after lifting heavy
cases while moving house. The pain radiates to the back and both shoulders but not
to either arm. His BP is 155/90 mmHg, pulse rate is 92 beats per minute and the ECG
is normal. He is distressed and sweaty, but not nauseated.
Aortic dissection
Aortic dissection management plan
If confirmed, BP reduction and dampening of the aortic systolic wave by beta-blockade is indicated and urgent surgical intervention should be considered.
Aortic regurg signs
Wide Pulse pressure
Decrescendo diastolic murmur
Collapsing pulse
Treatment of SVT
DC cardioversion and IV adenosine
What is SVT associated with
SVT is common in young people and may be associated with excessive nicotine, caffeine and alcohol
Variant angina
Variant angina, sometimes called Prinzmetal’s angina (E), of which this is a typical presentation. Its mechanism is controversial and even its existence has been questioned. The general view is that it is due to vasospasm in small coronary arteries and this is likely to respond to the effects of nitrates and calcium channel blockers such as verapamil. Beta-blockers are not effective and in theory could make it worse by aggravating vasoconstriction, but whether this actually happens is also controversial.
A previously fit 19-year-old man presents with unusual shortness of breath on
exertion. At times, this is also associated with central chest pain. On examination
there is a loud mid-systolic murmur at the left sternal edge. Heart rate and blood
pressure are normal and there is no oedema. The ECG shows left axis deviation and
the voltage criteria for left ventricular hypertrophy and the echocardiogram reveals
a significant thickened interventricular septum, with delayed ventricular filling
during diastole. There is a family history of sudden death below the age of 50.
Hypertrophic obstructive cardiomyopathy
Treatment for hypertrophic obstructive cardiomyopathy
Beta blockers first
Then rate limiting Ca2+ blockers
These 2 slow heart and improve disastolic relaxation
What are 3rd heart sounds and 4th heart sounds associated with?
Heart failure
Sign with constrictive pericarditis
Kussmaul’s sign - increased JVP upon inspiration
Digoxin toxicity
Yellow-tinged vision (xanthopsia)
Slow pulse, with probably ectopics
Most common cause of AF in young person
Thyrotoxicosis
