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Year 3 Conditions > Cardio > Flashcards

Cardio Flashcards

1
Q

What is a heave

A

Palpable heart beat- LVH or RVH

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2
Q

Drug prefferred in hypertenisive crises

A

IV labetalol then sodium nitropusside and diltiazem

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3
Q

Symptoms of WPWS

A

SOB
Palpitations
Dizziness

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4
Q

What happens in 2nd degree heart block physiology

A

Some P waves manage to get through

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5
Q

How to treat SVT

A

Adenosine 6mg then if fails 12mg if that fails repeat

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6
Q

Where is mitral stenosis best heard

A

Apex when rolled onto left in expiration

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7
Q

What is given after MI to alleviate nausea

A

IV metoclopramide

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8
Q

Complications post MI

A 
VT
Cardiogenic shock
Heart blocks
Mitral regurg
Dresslers syndrome
Ventricular septal defect
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9
Q

What is bisoprolol used for

A

Beta blocker used in AF rate control

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10
Q

Difference between type a and b aortic dissection

A

type a more proximal in ascending aorta whereas b is more distal in descending aorta

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11
Q

What are the risk factors for rheumatic fever

A

poverty
overcrowded living quarters
family history of rheumatic fever
D8/17 B cell antigen positivity

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12
Q

Types of ablation

A

Cryoablation- freezing affected area

Radio frequency ablation- heat on area

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13
Q

What is CHADS VAS score

A 
Congestive heart failure
Htn
Age 64-74 1 point
Diabetes
Stroke history or any other VTE 2 points 
Vascular disease
Age >74 2 points
Sex- female gets a point
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14
Q

What does a canon a wave suggest

A

Sustained V tach

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15
Q

What can an ICD do

A

Monitor ryhtm and rate, if notices abnormality can do 3 things
Pacing
Cardioversion
Defibrillation

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16
Q

What are common signs of rheumatic fever on examination

A 
Heart murmur
Chorea
erythema marginatum
subcutaneous nodules
Pansystolic murmur
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17
Q

How long does sydenhams chorea last

A

1 year

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18
Q

If patient who is a IV drug user has a pansystolic murmur what do you think

A

Tricuspid regurg

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19
Q

Which veins are varicose veins most commonly found along the distribution of

A

Long and short saphenous
Long- groin to medial part of calf
Short- popliteal fossa to lateral malleolus

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20
Q

When would you do Abdo US IE

A

Splenomegaly

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21
Q

ECG diagnosis of irregular QRS and extended QT

A

Torsades des pointes

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22
Q

What are kerley b lines

A

small horizontal lines in lower lobes of lungs

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23
Q

Difference in pain between arterial, venous and neuropathic ulcers

A

Arterial- very painful
Venous- slightly painful
Neuropathic- no pain

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24
Q

How does aortic dissection appear on CXR

A

Widened mediastinum to right

Blunted aortic notch

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25
Q

Differences between critical limb ischaemia and intermittent claudication

A

Like stable angina vs unstable

Claudication just on exertion but critical limb ischaemia all the time like at night and rest

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26
Q

Immediate actions when somenoe goes into V fib

A

Call for help

Start CPR

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27
Q

Cardiac causes of arrythmias

A 
IHD
Structural heart changes
Cardiomyopathy
Pericarditis
Myocarditis
Aberrant conduction pathways
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28
Q

Causes of sinus tachycardia

A

Caffeine
Alcohol
Dehydration
Anxiety

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29
Q

Main complication of WPWs

A

Can go into deadly V fib if go into A fib or flutter

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30
Q

Mid diastolic murmur

A

Mitral stenosis

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31
Q

Managment of AF BP stable sx started under 48hrs ago

A

Rate- beta blocker
Rythm- DC or chemical
Stroke risk- DOAC post evaluation

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32
Q

Associated features of neuropathic ulcers

A

Can get osteomyelitis

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33
Q

MONA BASH

A 
Morphine
Oxygen is sats below 94
Nitrates
Anti Platelets
Beta blockers
ACE inhibitors
Statin
Heparin
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34
Q

Chronic management of A fib

A

Rate control using rate limiting Ca blocker- if fails digoxin and amiodarone
Rythm control done via cardioversion, flecainide, ablation or IV amiodarone
Anticoagulation with warfarin or heparin- only done if CHADS VAS score above 1

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35
Q

What is treatment for type b aortic dissection

A

blood pressure control and monitoring

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36
Q

how to exclude MI from angina diagnosis

A

Troponin

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37
Q

What does cardiomyopathy mean

A

Heart muscle becoming structurally abnormal in absence of ischaemia etc

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38
Q

What is sydenhams chorea

A

Movement disorder- irregular, abrupt and rapid involuntary movements

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39
Q

Presentation of mitral stenosis

A

Pulnomary hypertension leads to dyspnoea, haemoptysis and chronic bronchitis presentation

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40
Q

What is ECG sign of Q wave infarction

A

Q wave heavily inverted

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41
Q

Criteria for HF

A

New York Heart failure

1-4

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42
Q

Difference between aspirin and warfarin

A

Aspirin affects platelets and warfarin clotting factors

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43
Q

What patients can’t adenosine be used in

A

Asthmatics

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44
Q

What is hypertrophic cardiomyopathy

A

Marked hypertrophy of left ventricel in absence of an identifiable cause such as HTN or valve disease

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45
Q

What causes pansystolic murmur

A

Mitral regurg
Tricuspid regurg
Ventricular septal defect

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46
Q

What does bruits over intercostal spaces suggest

A

Aortic coarctation

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47
Q

Chemical rhythm management of AF

A

Amiodarone or flecainide

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48
Q

What is important to remember when viewing Echo

A

Upside down so ventricles are atria

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49
Q

Once you have checked the rythm after a round of CPR what must you always do

A

Check pulse as could be PEA

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50
Q

How would investigations appear for aortic stenosis
ECG
CXR

A

ECG

  • p mitrale
  • LVH
  • LBBB or AVN block

CXR

  • dilation of aorta
  • LVH
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51
Q

What does pericardial friction rub indicate

A

Pericarditis

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52
Q

Risk factors for emboli

A

AF

Aneurysm

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53
Q

Treatment for haemodynaimcally unstable sustained v tach

A

Immediate cardioversion
Follow with amiodarone
Pacemaker

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54
Q

for pericarditis complications how do you differentiate between congestive heart failure and pericardial effusion

A

In congestive heart failure the pulnomary vasculature will be congested alongside cardiomegaly whereas pulnomary congestion would be absent in pericardial effusion

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55
Q

ECG signs of mitral stenosis

A

P mitrale as enlarged atrium

Can be signs of AF

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56
Q

What are complications of ICD

A

Bleeding and infection during insertion
Leads come off requiring future surgery
Damage to left sublcavian
Collapsed lung

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57
Q

Presentation of critical limb ischaemia

A 
Ulcers 
Gangrene
Rest pain 
Night pain
Like unstable angina
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58
Q

What is cause of sudden death in HCM

A

Arrythmia

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59
Q

What happens to blood pressure in aortic dissection

A

Hypertensive to begin with but immediately can drop due to haemorrhagic shock

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60
Q

What does mid systolic click suggest

A

Mitral valve prolapse

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61
Q

What can cause murmur in HCM

A

Hypertrophy of septum interfering with mitral valve leaflets

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62
Q

What can cause pump failure in relation to HF

A

Beta blockers
Anti-arrythmics
Heart block
Post MI

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63
Q

Management of A fib acute

A

DC cardioversion if severe signs shown such shock and myocardial ischaemia
Drugs such as fleicanide

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64
Q

Signs on examination of mitral regurg

A

Displaced and hyperdynamic apex

Pansystolic murmur radiating to axilla

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65
Q

What is pink cheeks a sign of

A

Mitral stenosis

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66
Q

What is common auscultation sign for arrythmias

A

Varied first heart sounds intensity

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67
Q

What does syncope during exercise indicate

A

Very concerning- condition predisposing to instant cardiac death such as long QT syndrome

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68
Q

What is most common PE ECG finding

A

Sinus tachycardia

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69
Q

How will chronic stable angina appear on ECG

A

At rest normal but during exercise will see ST depression

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70
Q

Sign of basal ganglia rhem fever involvement

A

Sydenhams chorea

Can also get psychiatric

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71
Q

Chronic causes of aortic regurg

A

Hypertension
Autoimmune- rheumatoid, rheum fever, SLE, seroneg arthrides
Congenital
Connective tissue disorders

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72
Q

What causes fourth heart sound

A

Ventricular hypertrophy- sound is atria contracting

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73
Q

How will a posterior MI present on ECG

A

ST depression in V1-3

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74
Q

Examples of valsava manoeuvres

A

Sticking fingers down throat
Pressing against eyeballs
Dipping face in cold water or swallowing cold drinks/ice
Holding breath and trying to exhale

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75
Q

Investigations for limb ischaemia

A

ECG
Handheld doppler
ABPI
Angio MRI/CT

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76
Q

What happens in reactive hyperaemia

A

Massive build up of metabolic waste products

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77
Q

Whats a tapping apex

A

Palpable apex beat and loud first heart sound

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78
Q

Immediate management of HF

A

Sit the patient up

15L/min oxygen

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79
Q

Treatment for haemodynalically stable sustained v tach

A

IV amiodarone
IV sotalol
Pacemaker

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80
Q

Medical management of HF

A

IV furosemide
GTN
Morphine

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81
Q

What drugs must be avoided in WPWS

A

Digoxin
Verapamil
Bisoprolol
All block AV conduction

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82
Q

Causes of dilated cardiomyopathy

A

Idiopathic
Infection- cocksackie B causes myocarditis
Congenital- duchenne muscular dystrophy, haemochromatosis
Alcohol as toxic to myocardium
Drugs- cocaine, chemo

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83
Q

What is good marker of how severe mitral regurg is

A

Larger the apex

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84
Q

Results of investigations for mitral stenosis

A

ECG- p mitrale, AF
CXR- pulnomary oedema, left atrial enlargement
Echo- LAD, mitral orificie reduced size

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85
Q

What is brown pigmentation around venous ulcers

A

Haemodesrin

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86
Q

Who do you see splenomegaly in cardio

A

Infective endocarditis

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87
Q

What is osteomyelitis

A

Infection of bone under skin

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88
Q

What is first drug that must be given to patient coming in with ACS and why

A

Aspirin- stop platelet action

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89
Q

What does increased JVP on inspiration suggest

A

Constricitve pericarditis

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90
Q

What arrythmia is associated with death in long QT

A

Torsade de pointes

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91
Q

Most common form of pericarditis

A

Fibrinous

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92
Q

Range of warfarin dose

A

2mg-10mg

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93
Q

What are risk factors for aortic dissection

A 
Any connective tissue disorder like Marfans 
Htn
Atherosclerosis
Ehlers Danos syndrome
Coarctation of aorta
Aortic valve defect
Patent ductus arteriosus
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94
Q

What is unsustained v tach

A

Brief and self resolving
Asymptomatic
When present with CAD and LVD is risk factor for sudden death

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95
Q

What system are clotting factors the problem in

A

Venous

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96
Q

What happens at each HYHFA criteria

A

1- heart disease but no SOB from undue exercise
2- SOB fine at rest but bad on exertion
3- less than ordinary activities cause SOB
4- SOB present at rest

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97
Q

Signs on examination of aortic regurg

A 
Collapsing pulse
Bounding pulse
Early diastolic murmur high pitched
Wide pulse pressure
Quinckes sign
De musset
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98
Q

What is DC cardioversion

A

direct current cardioversion- electrodes applied to chest to restore a normal heart rythm from an abnormal one

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99
Q

How does p mitrale appear

A

Bifid p wave

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100
Q

How does p pulmonale appear

A

High p wave

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101
Q

Examples of SVTs

A

AVRT

AVNRT

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102
Q

Older surgical treatment for stable angina

A

Coronary artery bypass graft

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103
Q

Investigations for rheumatic fever

A

Blood cultures
Throat swab
CRP - very heightened
Echo

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104
Q

What are different types of v tach

A

Sustained vs unsustained

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105
Q

Difference in appearance on CXR between hypertrophied vs dilated LV

A

On CXR dilated will appear large whereas LVH appears normal

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106
Q

When do you give aspirin

A

If evidence of atheroma or ischaemia in coronary arteries or carotid

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107
Q

ECG v tach

A

Wide and bizarre QRS’

HR> 100

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108
Q

At what size are elective abdo aortas operations organised

A

When above 5.5cm

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109
Q

Investigations for HF

A

Bloods- BNP
CXR
ECG
Echo

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110
Q

Longer term signs of ischaemia wouldnt see in acute limb ischaemia

A

Hair loss

Ulcers

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111
Q

What HF medication is likely to have side effect of yellow tinged vision

A

Cardiac glycosides such as digoxin

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112
Q

What is quinckes sign

A

Pulsatile nature of aortic regurg means there is bouding pulse so your head almost nods as blood flow reaches it. This can be seen when press nail against surface and the line which is white will move

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113
Q

Causes of mitral stenosis

A

Rheumatic fever
Endocarditis
Prosthetic valves

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114
Q

What symptoms can limb claudication present with other than pain

A

Parasthesia
Cold feet
Hair loss
Ulcers

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115
Q

What is done in carotid sinus massage

A

Rub carotid on side of neck where bifurcation is

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116
Q

How are aortic dissections classified

A

Type A- ascending aorta

Type B- descending aorta

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117
Q

What can cause mitral regurg

A 
LV dilation
Senile calcification
Endocarditis
Rheumatic fever
Cardiomyopathy
Connective tissue disorders
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118
Q

What would you give an old inactive patient in AF

A

Digoxin

Anti-coagulate

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119
Q

Important investigations in WPWS

A

TSH

Echo

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120
Q

Treatment for unsustained v tach

A

If no underlying heart condition no treatment needed however if is one then ICD needed and amiodarone secondary to this

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121
Q

What could cause sudden death in young healthy person during exercise

A

HCM

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122
Q

What is the name of second part of second heart sound

A

Pulmonary

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123
Q

What presents with syncope, SOB on exertion and angina

A

Aortic stenosis

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124
Q

When are left sided valve problems more common

A

In high oressure systems

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125
Q

Symptoms of A fib

A

Palpitations
Stroke
Irregular pulse

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126
Q

Dose of aspirin if carotid artery ischaemia or atheroma evidence

A

300mg

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127
Q

STEMI management is dependant upon what

A

If symptoms started 12 hours ago or less

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128
Q

2 problems that can occur at any time following MI

A

AF

HF or LVD

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129
Q

Symptoms for atrial flutter

A 
Palpitations
Exercise intolerance
Confusion and dizziness
Chest pain 
SOB
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130
Q

Procedure for any sustained v tach

A

Pacemaker

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131
Q

Common presentation of HCM

A

Normally no symptoms but can be angina dyspnoea or syncopal attacks

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132
Q

What is an ICD

A

Implanted cardiac defibrillator
An ICD is placed under the skin to monitor your heart rate, with thin wires connecting it to the heart. An ICD constantly monitors your heart rhythm through the electrode and try and correct any abnormalities it notices

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133
Q

1 st degree heart block physiology

A

Ischaemia at AV node means slowing of beats getting through

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134
Q

What type of aortic dissection produces unequal pulses

A

Proximal to left subclavian artery

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135
Q

Main risk factors for PAD

A

smoking – the most significant risk factor
type 1 diabetes and type 2 diabetes
high blood pressure
high cholesterol

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136
Q

What is used to rate control a patient in AF

A

Beta blocker

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137
Q

What is buergers test

A

Hold patients leg up in air for 2 minutes and look for pallor. Then when patient hangs legs over the bed will see in positive buergers the affected leg going from pallor to very red back to pinkiness

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138
Q

First investigation for ACS

A

ECG- is ST elevation?

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139
Q

Very notable sign of mitral stenosis murmur

A

Very loud S1

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140
Q

Differences in accessory pathway WPWS

A

Can be antegrade so from atria to ventricles- known as orthodromic.
Or can be exclusively retrograde and go from ventricles to atria- antidromic

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141
Q

Why does inferior STEMI show up on leads II,III and AvF

A

Leads II, III direction of travel is downwards to feet

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142
Q

What is treatment for type a aortic dissection

A

cardiothoracic surgical intervention

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143
Q

What are other changes seen in MI ECG

A

Reciprocal ST depression

T wave inversion

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144
Q

Complications of v tach

A

Asystole
Sudden cardiac death
V fib

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145
Q

Why does ischaemia predispose to V fib

A

Myocardium more excitable

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146
Q

In leg ischaemia what will what will ABPI be

A

Less than .7

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147
Q

What is 4th HS indicative of

A

Atrial contraction against stiffened ventricle normally from HTN

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148
Q

Minor criteria for IE

A

Predisposition such as IV drug user
Fever over 38C
Vascular signs
Immunological signs

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149
Q

Causes of diastolic HF

A

Restrictive ardiomyopathy
Constrictive pericarditis
Tamponade
LVH

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150
Q

What is multifocal sinus tachycardia caused by

A

COPD hypoxia

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151
Q

What is the inheritance of hypertrophic cardiomyopathy

A

Autosomal dominant

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152
Q

What is sustained v tach

A 
Longer than 30s
Symptomatic
Haemodynamically unstable
Life threatening
Can lead to v fib
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153
Q

Why do you get aortic regurg with aortic dissection

A

Any dilation or ripping of aorta immediately to aortic valve will cause regurg

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154
Q

Reference range for uncomplicated DVT warfarin dose

A

2-3

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155
Q

What is a pericardial friction rub

A

Upon auscultation hear a murmur with 1 systolic and 2 diastolic sounds

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156
Q

Signs on examination of aortic stenosis

A

Narrow pulse pressure
Slow rising pulse
Ejection systolic murmur which radiates to carotids

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157
Q

Most common complication of VSD

A

Endocarditis

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158
Q

What is a U wave

A

Small deflect after T wave seen in hypokalaemia

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159
Q

2 different physiological types of v tach

A

Focal and reentry

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160
Q

what condition can deceivingly elevate troponin

A

Myopericarditis

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161
Q

What causes tapping apex beat normally

A

Mitral stenosis

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162
Q

What is atrial flutter

A

Circulatory or oscillatory atrial impulses around the atria which occasionally stimulates the AVN

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163
Q

When is pericardial rub best heard

A

At left sternal border leaning forward on expiration

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164
Q

5 cardinal signs of rheum fever

A 
Pancarditis
Arthrits
Sydenhams chorea
Erythema nodosum
Subcut nodules
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165
Q

When do you see cannon waves at JVP

A

Third degree HB

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166
Q

what is treatment for pericarditis

A

NSAIDS

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167
Q

Drugs preferred in WPWS and why

A

Amiodarone
Flecainide
Have less blockage on AV node

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168
Q

What does history of IV drug user and recent dental surgery indicate in SBAS

A

Infective endocarditis

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169
Q

Largest cause of death post MI

A

Cardiogenic shock

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170
Q

What system are platelets the problem in

A

Arterial

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171
Q

Differences between dry and wet gangrene

A

Dry occurs in arterial obstruction whereas wet is when bacteria the site normally post venous obstruction

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172
Q

Investigations for mitral regurg

A

CXR
ECG
Echo

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173
Q

What drug has no evidence for post MI use

A

Omega 3

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174
Q

Where are venous ulcers normally on leg

A

Lower third of leg between mallelous and lower calf

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175
Q

Important question to ask for patient with murmur

A

Rheumatic fever when a child

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176
Q

features of marfans

A

raised palate
lens dislocation
arachnodactily

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177
Q

How long after does troponin actually become elevated for in MI

A

12 hours therefore not a good acute investigation

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178
Q

How does a flutter appear on ECG

A

Saw tooth baseline

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179
Q

When are cannon waves seen

A

3rd degree HB

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180
Q

What drugs should be given for stable angina

A

Nitrates- GTN or ISMN
Beta blocker- atenolol
Aspirin
Statin- simvastatin

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181
Q

Is CPR always required in V fib

A

Yes as pulseless

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182
Q

What difference in BP between both arms would be significant

A

20mmHg

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183
Q

What is PND

A

Paroxysmal nocturnal dyspnoea- awake every couple of hours short of breath

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184
Q

What is hypertension defined as

A

BP >140/90

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185
Q

Symptoms of aortic regurg

A

Exertional dyspnoea
Orthopnoea
PND
Rarer- palpitations, syncope, angina

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186
Q

What indicates Left bundle branch block other than William

A

Prolonged QRS complexes

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187
Q

Medication given for after MI

A 
Clopidogrel
Bisoprolol
Aspirin 75mg
Atorvastatin
Ramipril
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188
Q

When are mitral murmurs heard best

A

When rolled on side

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189
Q

Characteristics of venous ulcers

A

Shallow
Irregular shape- can be champagne shaped
Fibrinous material at ulcer bed
Flat or steep margin elevation

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190
Q

What happens to EF in systolic and diastolic HF

A

HF preserved in diastolic but less than 40 in systolic

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191
Q

What is main life threatening issue of ACS immediately

A

Ventricular arrythmia

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192
Q

What can be done to diagnose a tachyarrythmia when in tachycardia

A

Carotid sinus massage
Valsava
IV adenosine

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193
Q

What does p mitrale suggest

A

Left atrial enlargement

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194
Q

What is flow chart of progression to limb ischaemia

A 
Pale, cool and hair less
to
Ulcer and gangrene
to
6Ps
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195
Q

What valve causes first heart sound

A

Mitral (slightly tricuspid)

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196
Q

Where is DVT normally managed

A

In the community

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197
Q

What 4 rythm abnormalities can cause cardiac arrest

A

V fib
Asystole
Pulseless ventricular tachycardia
Pulseless electrical activity (electrical activity and no cardiac output)

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198
Q

What causes BBBs normally

A

IHD

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199
Q

Differences in auscultation for chronic and acute rheumatic fever

A

Acute- pansystolic mitral regurg

Chronic- diastolic mitral stenosis

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200
Q

Investigations for aortic stenosis

A

CXR
ECG
Echo

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201
Q

What is problem with warfarin in MI treatment

A

Is long acting and produces a pro thrombotic state initially

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202
Q

What can be trauma cause of limb ischaemia

A

Compartment syndrome

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203
Q

Associated findings of venous ulcers

A 
Lipodermofibrosis
Lipodermatosclerosis
Brown pigment 
Telengiectasia
Normal cap refill
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204
Q

Treatment rheumatic fever

A

Bed rest

Antibiotics

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205
Q

What is rheumatic fever

A

Acute rheumatic fever is an autoimmune disease that may occur following group A streptococcal throat infection. It affects the heart and joints mainly

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206
Q

Risk factors for SVT

A

Underlying cardiac issues such as IHD, cardiomyopathy
Hyperthyroidism
Excessive alcohol and caffeine consumption

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207
Q

What decides whether you cardiovert a patient or just slow their ventricular rythm

A

If they are fit and healthy then you will want to cardiovert as slowing ventricular rythm still leaves you with a reduced CO

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208
Q

How many blood cultures needed for IE

A

3

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209
Q

What tachycardia is caused by WPWS

A

Atrioventricular re-entry tachycardia

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210
Q

Where are neuropathic ulcers generally found

A

Under any calluses or pressure points on foot such as plantar aspect of first or fifth MTP joint

211
Q

ECG abnormality infective endocarditis

A

Heart block

212
Q

Mangement of AF BP stable Sx started over 48 hours ago

A

Rate control and anti-coagulate for 3 weeks then come back

213
Q

Signs on examination of mitral stenosis

A

Malar flush
Tapping apex beat
Mid diastolic murmur
Thrill

214
Q

ECG finding for WPW syndrome

A

Delta wave- depolarisation occurs early so R wave starts early missing out Q wave so is upstroke from p wave immediately.
PR interval also shorter

215
Q

What does a mid systolic click followed by a late systolic murmur heard at apex indicative of

A

Barlow syndrome

216
Q

Signs of RHF as opposed to LHF

A

LHF lung related so orthopnoea, SOB, PND, pinky sputum

RHF pre lung related so ascites, oedema, anorexia and epistaxis

217
Q

Test used to determine sats pressure of heart chambers

A

Left and right heart catherterisation

218
Q

Pain character in intermittent claudication

A

Cramping

219
Q

What is a thrill

A

Vibration felt over a valve- indicates turbulent flow

220
Q

How does abdominal aortic aneurysm present

A

With back pain once the aneurysm gets so big it begins to press on the lumbar spine- acute onset think ruptured

221
Q

Why does patients leg go very red in buergers test after hanging them off table

A

Reactive hyperaemia

222
Q

What must be considered when deciding what drug to give for chemical cardioversion in

A

If structural damage give amiodarone

223
Q

How to evaulate whether patient should be started on a DOAC to reduce stroke risk

A

Combine both CHAD-VASC and HAS-BLED and determine whether risk of clot outweighs that of bleeding

224
Q

What are varicose veins caused by

A

Incompetent venous valves

225
Q

What condition are roth spots seen in

A

IE

226
Q

What is main cause of hospital deaths following MI

A

Cardiogenic shock- especially if present long after

227
Q

What is wolff-parkinson white syndrome

A

Congenital heart defect where have an accessory pathway joining atria and ventricles which bypasses AVN resulting in early ventricular depolarisation before purkinjie fibre pathway.

228
Q

Echo findings IE

A

Vegetations
Abcess
Abcess prosthetic valve

229
Q

Vascular signs IE

A

Mycotic emboli

Janeway lesions

230
Q

Observation signs of aortic regurg

A

Quinckes sign

Nodding head

231
Q

What are causes of RHF

A

Lung disease leading to cor pulmonale

Pulmonary stenosis

232
Q

How can lower limb purpura suggest AAA

A

Aneurysms have turbulent flow so leads to embolic formation

233
Q

What pain can ruptured abdominal aorta present with

A

Any abdominal pain anywhere even loin to groin pain

234
Q

what do kerley b lines suggest

A

pulnomary oedema

235
Q

What is management of NSTEMI

A

Give fondaparinaux and GRACE score risk stratification. If low risk then medical management however if high risk do angiography

236
Q

What is used to monitor warfarin dose

A

INR

237
Q

Modern day surgical treatment for stable angina

A

Angioplasty- out a wire in and blow up a balloon and put a stent in sometimes
ALOT LESS invasive

238
Q

At what level does aorta bifurcate

A

L4- same as umbilical therefore have to always have to palpate above umbilicus

239
Q

What is A fib

A

Chaotic and irregular atrial rythm

240
Q

How does tourniquet test work for varciose veins

A

Hold patients leg above level of bed and “milk” blood out of the veins
Place tourniquet over saphofemoral junction(2/3cm lateral and inferior to pubic tubercle)
Get patient to stand up and view if varicose veins fill or not
If veins dont fill then veins collapse so problem is at level of SFJ
If do fill then must move down leg to find level of problem

241
Q

Overall management guidance for arrythmias

A

Conservational- treat immediate cause like less caffeine or pill in pocket
Medication- rythm and rate control or medical cardioversion
Interventional- DC cardioversion, pacemaker, ablation

242
Q

5 major criteria for rheumatic fever

A 
Carditis
Arthritis
Erythema marginatum
Sub cut nodules
Chorea
243
Q

Rare presentation of mitral stenosis

A

Hoarse voice
Dysphagia
All from enlarged LA putting pressure on left recurrent laryngeal nerve

244
Q

What are indicated in immobility

A

Clotting factors

245
Q

What to use if adenosine contraindicated in SVT

A

Verapamil

246
Q

What causes venous ulcers

A

Venous HTN leads to capillary leakage

247
Q

What is kussmauls sign

A

Increased jugular distension on inspiration

248
Q

Treatment paroxysmal A fib

A

Pill in pocket of sotalol or flecainide

249
Q

Associated findings with arterial ulcers

A

Consistent with chronic ischaemia- hair loss, pale, pulseless and extended cap refill

250
Q

What artery is normally affected when get mitral regurg

A

RCA

251
Q

Risk factors for clot forming in situ

A

Cancer
Coagulopathy
Pregnancy

252
Q

Dose of aspirin for coronary artery ischaemia evidence

A

75mg

253
Q

Define SVT

A

A regular narrow complex tachycardia with no p waves and a sv origin

254
Q

What is epistaxis

A

Nose bleed spontaneously

255
Q

What are risk factors for WPWS

A

Ebsteins anomaly
Cardiomyopathy
Septal defects
Valve defects

256
Q

What is major RF for acute limb ischaemia

A

AF

257
Q

Pathway to ACS

A 
Risk factors
Coronary artery inflammation
Atherosclerosis
Plaque rupture
Atherothrombosis
ACS
258
Q

Complications of IE

A 
Heart block
TIA
AKI
HF
Vertebral osteomyelitis
259
Q

What presents with ST elevation, unraised troponin and chest pain in am or in night

A

Variant angina

260
Q

Management of AF BP stable 3 main aims of treatment

A

Rate
Rhythm
Stroke risk

261
Q

Why does left sides STEMI show up on lead l

A

Direction of its travel is to left

262
Q

when to consider marfans

A

unusually tall with very long limbs

263
Q

What changes can be seen in NSTEMI

A

T wave inversion

ST depression

264
Q

Why are complexes narrow in SVT

A

It starts at level below atria so start at same time

265
Q

Ebsteins anomaly on ECG

A

Tall and broad p waves
Prolonged PR intervals
Right bundle branch patterns
Tachyarrythmias

266
Q

What must be taken into account when prescribing LMWH

A

Weight of patient

Renal function

267
Q

What is the name of first part of second heart sound

A

Aortic

268
Q

Management of Stable angina

A

Beta blockers
GTN
Rf modification

269
Q

Most common cause angina

A

Atherosclerosis

270
Q

Management path of SVT

A

If haemodynamically unstable then DC

If stable do vagal manoeuvres and then course of adenosine

271
Q

Longer term management of HF

A

Beta blocker
ACE inhibitor
RF management

272
Q

Common risk factors for A flutter

A

Heart failure very common
surgical or post-ablation scarring of atria, increasing age, valvular dysfunction, chronic ventricular failure, atrial septal defects, atrial dilation, recent cardiac or thoracic procedures, hyperthyroidism, COPD, asthma, or pneumonia.

273
Q

problem with viral serology test

A

takes 2 weeks for test to come back so useless in acute diagnoses

274
Q

How does congestive heart failure appear on CXR

A

Cardiomegaley
Pleural effusion- can’t see costophrenic angle
Kerley B lines

275
Q

Which drugs commonly affect heart valves

A

Appetite suppressants

276
Q

Differentiate between unstable and stable angina

A

stable only feels pain on exertion whereas unstable can be at rest and sporadic

277
Q

What causes low output HF by category

A

Excessive preload- fluid overload from IV fluid xs, mitral regurg
Pump failure- diastolic and systolic causes
Chronic excessive afterload- aortic stenosis and HTN

278
Q

What to do if STEMI Sx started less than 12 hours ago

A

PCI- if going to be 2 hours until PCI due to site of hospital then give thrombolysis

279
Q

Treatment for complete heart block

A

Pacemaker

280
Q

How does treatment vary between AF and a flutter

A

DC cardioversion preffered over medication. Recurrence rates common so radio frequency ablation

281
Q

What is buergers angle

A

The angle at which the leg is positive for burgers

282
Q

What can make a MI very hard to diagnose

A

ST segments are interpretable in BBBs

283
Q

Typical presentation of rheumatic fever

A

History of recent throat infection
Fever and joint pain
Apical heart murmur
Ring like rash on abdomen and thighs

284
Q

What causes third heart sound

A

HF- ventricular filling

285
Q

Results of investigations for mitral regurg

A

CXR- pulnomary oedema, large LA and LV

ECG- pulnomale mitrale, LVH

286
Q

What are indications for DC cardioversion

A

Any arrythmia most commonly A fib or A flutter

287
Q

What can cause bradycardia after an MI

A

Heart block- side dependant on side of artery damaged

Most cases normally resolve within a few days

288
Q

Long term management of STEMI

A

Bisoprolol
ACE inhibitor
Atorvastatin

289
Q

What happens to BNP in HF

A

Goes up

290
Q

What drugs must be avoided after a MI

A

NSAIDS as CVS side effects

291
Q

Rarer types of angina

A

Decubitus angina
Prinzmetal angina
Chest syndrome x

292
Q

What can make a MI very hard to diagnose

A

ST segments are uninterpretable in BBBs

293
Q

Treatment for suspected aortic dissections

A

Have to control pain and maintain BP around a stable level with anti-hypertensives

294
Q

Investigations for infective endocarditis

A

Echo

Three sets of blood cultures

295
Q

What causes radiofemoral delay

A

Aortic coarctation

Aortic dissection

296
Q

What does treatment for AF depdend on

A

If Sx started within or after 48hrs

297
Q

T2 second degree HB ECG

A

All p waves aren’t followed by a QRS so is disparity. Could be in a 2:1 or 3:1 ratio

298
Q

Tests to be carried out for arrythmias

A 
U and Es
FBC
Glucose
TSH
ECG
potential tape
Echo
Provocation ECG
Stress test
299
Q

Common abdo finding IE

A

Splenomegaly

300
Q

What arrythmia is associated with death in WPWS

A

A flutter or fib leading to V fib

301
Q

What is drug used to convert fast af to slow af

A

Digoxin

302
Q

What is used to monitor LMWH dose

A

APTT

303
Q

What is done in valsava manoeuvre

A

Manouevres that strain against a close glottis

304
Q

What are 5 main causes of pleuritic pain

A 
Pneumothorax
Pericarditis
PE
Pneumonia
Pleuracy
305
Q

Acute causes of aortic regurg

A

Trauma
Infective endocarditis
Type A aortic dissection

306
Q

What is difference between WPW pattern and syndrome

A

Pattern asymptomatic and without arrythmias

307
Q

Typical presentation of aortic coarctation

A

Congenital young person
Atherosclerotic elderly RFx
Radiofemoral delay
Bruits over intercostal spaces

308
Q

Investigations for DVT

A

Doppler US
Venometry
D-dimer

309
Q

What murmur associated with aortic dissection

A

Early diastolic

310
Q

What is given when adenosine contraindicated in asthmatics for SVT

A

Flecainide

311
Q

What is asystole

A

When no cardiac electrical activity

312
Q

What tends to precipitate arterial ulcers

A

Trauma to that area

313
Q

Clinical symptoms of v tach

A

Light headedness
Chest pain
Palpitations
SOB

314
Q

Why do patients stay in hospital after angioplasty

A

Strong chance of going into V fib as very reactive fibres

315
Q

Problem of warfarin

A

Have to have INR checked regularly as warfarin has narrow therapeutic window

316
Q

What do you see quinckes sign in

A

Aortic regurg

317
Q

What is cardiac arrest

A

sudden state of circulatory failure due to a loss of cardiac systolic function

318
Q

What are indications for an ICD

A 
Arrythmias
Conditon that could predispose you to issue in future- cardiomyopathy and long QT syndrome
Structural heart conditions
Previous cardiac arrest 
V tach and v fib in particular
319
Q

What is pain like in aortic dissection

A

Sudden shearing pain that radiates to back

320
Q

Characteristics of neuropathic ulcers

A

Punched out with deep sinus

Variable depth- can involve down to bone

321
Q

What does ST depression suggest

A

NSTEMI and ischaemia long term

322
Q

Cardinal symptoms of mitral stenosis

A

SOB

Fatigue

323
Q

What are 6 Ps for limb ischemia

A 
Pallor
Pain
Parasthesia
Pulseless
Paralysis
Perishingly cold
324
Q

Antibodies made in rheum fever

A

Anti-streptolysin

325
Q

What can rheumatic fever be caused by

A

Type A strep throat infection

Scarlet fever

326
Q

What is catheter ablation

A

Process used to destroy or scar area of heart giving you the problems

327
Q

What part of virchows triad are anti-platelets aimed at

A

Vessel wall damage as leads to platelet activation

328
Q

What HS is associated with HF

A

3rd- ventricular filling

329
Q

What to do if STEMI Sx started more than 12 hours ago

A

Angiography followed by PCI if needed

330
Q

Where are arterial ulcers normally on leg

A

Distal- on dorsum of toes or feet

331
Q

What is target BP for people

A

Over 80 aim for below 145/85

Under 80 aim for below 135/85

332
Q

What tests do you need to do after stable angina history

A

Exercise test and monitor ECG

333
Q

What happens to pulse pressure as get older

A

Widens

334
Q

How best to visualise if an aortic aneursym is leaking

A

CT aorta

335
Q

Main investigations post MI

A

ECG
CXR
Enzymes

336
Q

Third degree heart block physiologically

A

Atria contracting completely independant of ventricles

337
Q

Pills that can lead to coagulopathy

A

Warfarin

OCP

338
Q

If recurrent PEs without RFx what would be thing to check

A

Thrombophilic screen

339
Q

What does QRS look like in heart blocks

A

Narrow in bilateral blocks

340
Q

Tests for varicose veins

A

Tourniquet/Tredelenburg test

Doppler

341
Q

What is word normally used to describe hyperkalaemia on ECG

A

Tented

342
Q

Management of HCM

A

CCB and B blockers which reduce load on LV and then amiodarone to reduce chance of arrythmias
ICD
Surgery when aortic outflow becomes impaired

343
Q

What part of virchows triad are anticoagulants aimed at

A

Stasis as leads to activation of coagulation factors

344
Q

Presentation of mitral regurg

A

SOB
Fatigue
Palpitations

345
Q

How does hypokalaemia appear on ECG

A

U wave

346
Q

What exclusively normally causes mitral stenosis

A

Rheumatic fever

347
Q

3 types of limb ischaemia

A

Intermittent claudication- stable angina
Critical limb ischaemia-unstable angina
Acute limb ischaemia- STEMI

348
Q

What are 5 wave forms of JVP

A

ACXVY

349
Q

What else would present with ST elevation

A

Ventricular aneurysms

350
Q

How best to listen to aortic regurg murmur

A

In expiration sat forward

351
Q

Difference in heart muscle diastolic vs systolic HF

A

Weak heart muscle in systolic from dilatation whereas in diastolic heart muscle stiff so doesnt fill

352
Q

Investigations for heart failure bedside, bloods, imaging

A

Bedside- ECG
Bloods- ABG, troponin, BNP
Imaging- CXR, Echo

353
Q

Management options if adenosine doesnt work on SVT

A

IV beta blocker
IV digoxin
IV amiodarone
DC cardiovert

354
Q

What could be cause of red swollen leg after an operation

A

DVT

Post operative leg oedema

355
Q

Typical presentation of aortic stenosis

A

Chest pain, syncope and exertional dyspnoea
Very commonly seen in heart failure
Other symptoms include dizziness and dyspnoea at rest

356
Q

What test is used to visualise where blockage in coronary artery is

A

Angiogram

357
Q

Causes of cardiac murmurs

A 
Senile calcification
Rheumatic fever ever
Cardiomyopathy
IHD
Infective endocarditis
Physiological
358
Q

How would leaking abdominal aorta present on examination

A

Tender
Palpable
Pulsatile
Expansile AA

Lower limb purpura

359
Q

What does pain relieved by GTN suggest

A

Unstable angina

360
Q

How to take palpitations history

A 
Nature- fast/slow? regular/irregular?
What precipitates it
Duration
Any accompanying symptoms
Drug history
Medical history of cardiac problems
Does it happen during exercise?
361
Q

Causes of aortic stenosis

A

SEEN IN OLD AGE due to senile calcification and fibrosis
Bicuspid aortic valve
Rheumatic fever

362
Q

What does shortened PR interval show

A

WPWS

363
Q

Urgent reatment for any septal defect

A

Intra aortic balloon pump

364
Q

Appropriate investigations for mitral stenosis

A

ECG
CXR
Echo

365
Q

What is stable angina

A

Partly blocked coronary artery that when HR increases iscahemia becomes significant. Lactate accumulates as aerobic exercise impossible due to lavk of oxygen leading to ST depression

366
Q

Complications of DC cardioversion

A

Clot dislodgement
burns
bradycardia
can develop further arrythmias

367
Q

How is pleuritic pain normally described

A

sharp

368
Q

What would shallow t wave inversion in pericarditis suggest

A

Myopericarditis

369
Q

How does AAA appear on AXR

A

Curved and calcified

370
Q

Most definitive test for HF

A

Echo

371
Q

What causes tachypnoea post MI

A

Pain

372
Q

What is acronym for treating MI

A

MONA BASH

373
Q

What are main symptoms of rheumatic fever

A

Joint pain
Fever
Malaise

374
Q

What if is no ST elevation

A

Is troponin elevated?
Yes is NSTEMI
No is UAP

375
Q

Immediate generic management of ACS

A

Morphine
O2 if required
GTN spray
Dual Antiplatelet therapy

376
Q

Lifestyle suggestions post MI

A 
Reduce fat intake 
Increase intake of whole grains, nuts and veg
Graded exercise programme
Stop smoking
Alcohol in regulation
Avoid NSAIDS
377
Q

How can pneumonia cause AF

A

In middle lobe irritates atrium

378
Q

What could be seen on ECG limb ischaemia

A

AF

Signs of ichaemia

379
Q

What is ebsteins anomaly

A

Ebstein anomaly is a rare heart defect in which the tricuspid valve — the valve between the upper right chamber (right atrium) and the lower right chamber (right ventricle) of the heart — isn’t formed properly. As a result, blood leaks back through the valve and into the right atrium. Very common for accessory pathways to form around the TV

380
Q

Signs examination of mitral regurg

A

AF
PSM
Displaced hyperdynamic apex

381
Q

If patient has previous MI what must consider when looking at their obs

A

Might be on Beta blockers so will mask signs of shock

382
Q

How would investigations appear for aortic regurg
ECG
CXR

A

ECG- LVH
CXR- pulnomary oedema, cardiomegaly, dilated ascending aorta
Echo

383
Q

How do you exclude a pericardial effusion

A

Echo

384
Q

For rheumatic fever does infection have to have affected pharynx

A

Yes- always type a beta haemolytic strep infections

385
Q

Dual antiplatelet therapy used in ACS management

A

Aspirin and Clopidogrel

386
Q

What is management of SVT

A

Adenosine 6mg-> if fails another 6mg then if fails again -> 12mg

387
Q

1st degree heart block ECG

A

Long PR interval

388
Q

T1 second degree HB ECG

A

PR interval increasing until missed P wave then reverts to normal

389
Q

Definition of AF

A

Irregulalrly irregular narrow complex tachycardia with no p waves

390
Q

Immunological signs IE

A

Osler nodes
Positive RhF
Glomerulonephritis
Swollen fingers or toes

391
Q

What does pulsatile liver suggest

A

Tricuspid regurg

392
Q

What does ABPI do

A

Checks pressure difference between brachial and ankle to give index. Ankle/brachial systolic

393
Q

How to diagnose a ventricular spetal defect

A

Check sats of blood in each chamber- if defect will be massive disparity between atria and ventricle

394
Q

Pathogenesis of rheum fever

A

Antibodies produced against strep infection that then attacks proteins mimicked in body such as in heart, joints and brain

395
Q

How to define SVT

A

Abnormally fast heart rate (100bpm

396
Q

Symptoms of mitral regurg

A

Dyspnoea- pulnomary hypertension
Palpitations
Fatigue
Fever depending on cause

397
Q

What is most common cause of aortic stenosis in under 60s

A

Bicuspid aortic valve

398
Q

Major criteria for IE diagnosis

A

Positive echo finding

Positive blood culture

399
Q

Investigations A fib

A

ECG
Bloods for normal arrythmia investigations
Echo

400
Q

Managment of acute limb ischaemia

A

IV heparin immediately

Refer to vascular surgery where could emolectomy, bypass or amputation

401
Q

Common valvular dysfunction post MI

A

Mitral regurg due to papillary muscle necrosis

402
Q

Do you use vagal maoeuvres in AF

A

No only in SVT

403
Q

What is aspirin dose post MI

A

300mg stat

404
Q

What is done immediately post MI low BP with fluid in lungs

A

CPAP to force fluid back into vasculature and improve BP

DONT give fluids

405
Q

Differentials for broad complex tachycardia

A

V fib
V tachycardia
Torsades de pointes tachycardia
Antidromic AVRT

406
Q

What happens to valves in cardiomyopathy

A

As walls extend the valves get pulled apart meaning cant shut properly- get regurg disease

407
Q

What causes A fib

A 
HF
PE
Mitral valve disease
Caffeine
Alcohol
Thyroid issues
Electrolyte issues
408
Q

What does p pulmonale suggest

A

Right atrial enlargement

409
Q

Treatment options for acute limb ischaemia

A 
Moving in severity
IV heparin
Emolectomy
Intra arterial thrombolysis
Amputation
410
Q

What is name given to area where venous ulcers are found on leg

A

Gaiter area

411
Q

Management of AF haemodynamically unstable

A

DC cardioversion

412
Q

When do you hear a bruit

A

Anywhere with turbulent flow such as aneurysm or narrowing in vessel

413
Q

Complications of Acs

A 
Pump failure
Rupture of Paillard muscle or septum 
Aneurysm
Embolism
Dressler syndrome 
PRAED
414
Q

what is sign on examination of pericardial tamponade

A

raised jvp

415
Q

What is ABPI

A

Ankle brachial pressure index

416
Q

Causes of bradycardia

A 
Hypothermia
Hypothyroidism
Aerobic training
Legionnaires disease
MI
417
Q

What is the mitral stenosis murmur

A

Low rumbling diastolic

418
Q

difference in history between pericarditis and PE

A

PE very acute onset

419
Q

how can heart failure be excluded from a heart problem diagnosis

A

CXR

420
Q

When best to hear mitral stenosis murmur

A

On expiration with patient rolled over to left

421
Q

Presentations of arrythmias

A 
Palpitations
Syncope
Chest pain
Hypotension
Can be asymptomatic and finding is incidental
422
Q

What drugs cant be given if patient hypotensive

A

Nitrates

423
Q

What does pericardial rub sound like

A

Scratching

424
Q

Appropriate investigations for aortic regurg

A

ECG
CXR
Echo

425
Q

Problem with beta blockers for angina patients

A

Reduce exercise tolerance

426
Q

What is pulse pressure

A

Difference between systolic and diastolic pressure

427
Q

What to think in broad complex QRS

A

VT

BBB

428
Q

What is dressler syndrome

A

Chronic pericarditis

429
Q

What electrolyte disorder is associated with long QT changes

A

Hypocalcaemia

430
Q

Causes of AF

A 
Idiopathic
Pneumonia
PE
Alcohol
IHD
Valvular disease
Hyperthyroidism
431
Q

Characteristics of arterial ulcers

A

Irregular edge
Poor granulation
Dry
Punched out with sharp demarcation

432
Q

When can feel apex thrill what is this most likely

A

Mitral stenosis

433
Q

Complications of VSD

A

Pulmonary HTN
Endocarditis
HF
Shunt reversal

434
Q

Non cardiac causes of arrythmias

A 
Caffeine
Smoking
Pneumonia
Alcohol
Electrolyte imbalances (K,Ca,Mg)
Hypoxia and hypercapnia
Thyroid
435
Q

What is barlow syndrome

A

Most common murmur

A mitral valve prolapase where doesnt close properly

436
Q

Important thing check as cause of hypotension in severely ill patients

A

Renal function

437
Q

Differences between antidromic and orthodromic accessory pathways on ECG

A

Orthodromic appears with delta wave and is narrow complex

Antidromic conceals the accessory pathway and appears wihtout delta wave but has broad complex

438
Q

What is focal atrial tachycardia often caused by

A

Digoxin toxicity

439
Q

What layer is affected in aortic dissection

A

Tunica intima- this shears and blood falls goes into layers

440
Q

Complications of aortic dissection

A 
Rupture into mediastinum
Aneurysm
Cardiac tamponade
Aortic regurg
Blockage of branch of coronary artery or aortic arch
441
Q

Gold standard investigation for aortic dissection

A

CT aorta showing false lumen

442
Q

What can cause pericarditis

A 
URTI recently
TB
Lupus, RA etc
Cancer diagnosis
Uraemia
Post MI
443
Q

What are key defining features of pericarditis ECG

A

Widespread concave ST elevation

AvF often spared and has PR elevation + ST depression

444
Q

How do pericarditis and MI differ on serial ECGs

A

Pericarditis often stays the same whereas MI will change dynamically

445
Q

Complications of pericarditis

A

HF
Tamponade
Recurrent pericarditis
Restrictive pericarditis

446
Q

What is pulsus alternans seen in

A

Pericardial effusion

HF

447
Q

What investigation can help determine cause of pericarditis

A

Pericardiocentesis- high protein may suggest infective cause or cytology may show cancer as cause

448
Q

What are biphasic T waves

A

Where initially T wave elevates and then is inversed

449
Q

What is difference physiologically between NSTEMI and STEMI

A

STEMI affects whole myocardium whereas NSTEMI affects only subendocardium

450
Q

Progression to ACS flow chart

A 
Risk factors
Coronary artery inflammation
Atherosclerosis
Plaque rupture
Atherothrombosis
ACS
451
Q

What causes mitral regurg post MIs

A

Papillary muscle necrosis

452
Q

What causes pulmonary oedema

A

Mitral valve conditions
Dysrrythmias
Renal failure
Acute MI

453
Q

What is the NYHA HF classification used for

A

Chronic HF

454
Q

What do wires over sternum suggest on CXR

A

Previous sternotomy

455
Q

Bloods ordered for HF

A 
FBC
Renal profile
BNP
Troponin
ABG
456
Q

Long term management of HF

A

ACEi or ARB
B blockers
Spironolactone
Cardiac resynchronisation therapy- dual chambered ICD

457
Q

Causes of aortic dissection

A 
Marfans
Ehlers danlos
HTN
Previous cardiac surgery
Vasculitis
458
Q

What is difference in pain between Type A and B dissection

A

Type A to retrosternal

Type B to interscapular

459
Q

O/E aortic dissection

A 
HTN
Aortic regurg
BP difference in arms
HF
Tampondade
Neuro sx- limb weakness, horners syndrome, SVC syndrome
Asymmetrical pulses
460
Q

Bloods ordered for aortic dissection

A

FBC-leukocytosis
Cross match
D-dimer
Troponin

461
Q

Aortic dissection indications for surgery

A

Type A

Rupture

462
Q

How do systolic murmurs sx tend to differ from diastolic ones

A

Systolic tend to present with exertional dyspnoea whereas diastolic tends to present with fatigue palpitations as well as HF signs

463
Q

What congenital syndrome can cause aortic stenosis

A

Williams- due to high levels of calcification

464
Q

What presents with outgoing personality, mild learning difficulties, large forehead and a short nose

A

Williams syndrome

465
Q

O/E aortic stenosis

A 
ESM
Slow rising pulse
Left ventricular heave
Narrow pulse presssure
Silent S2 in severe AS
466
Q

Causes of aortic stenosis

A

Calcification with age
LV dilation
Rupture of chordae tendinane and papillary muscle post MI

467
Q

O/E mitral regurg

A

Irregularly irregular as AF common
LV heave
PSM

468
Q

What is pulsus tardus and parvus felt in

A

Aortic stenosis

469
Q

Causes of tricuspid regurg

A

Infective endocarditis
Carcinoid syndrome
RV dilation
Ebstein anomaly

470
Q

O/E tricuspid regurg

A

Raised JVP
PSM
Pulsating hepatomegaly
Parasternal heave

471
Q

O/E aortic regurg

A 
Wide pulse pressure
Displaced apex
Corrigans
Quinkes
De musset
Waterhammer pulse
Early diastolic murmur
472
Q

What is austin flint murmur caused by

A

Severe aortic regurg as blood even regurgitates into the LA

473
Q

Where is austin flint murmur heard best

A

Apex- mid diastolic

474
Q

Where is aortic regurg murmur heard best

A

Left sternal edge 3rd/4th ICS

475
Q

What is parasternal heave indicative of

A

Tricuspid regurg

Mitral stenosis

476
Q

O/E mitral stenosis

A 
Malar flush
Tapping apex
Low rumbling murmur mid diastolic- doesnt radiate
Opening snap
AF common
Parasternal heave
477
Q

What presents with chest pain when lying down

A

Decubitus angina

478
Q

Other than troponin and CKMB what other cardiac enzymes can get elevated plus how long they take to be elevated

A

AST- 24 hrs

LDH- 48 hrs

479
Q

How to class HF

A

Pump failure

Increased demands

480
Q

How to classify causes of LHF

A

Valvular
Myocardium
Systemic

481
Q

Valvular causes of HF

A

Mitral regurg
Aortic stenosis
Aortic regurg

482
Q

Myocardial causes of HF

A

IHD
Cardiomyopathy
Myopericarditis
Arrythmias

483
Q

Systemic causes of HF

A

Amyloidosis
HTN
Drugs- cocaine, chemo

484
Q

Increased demands causes of HF

A

Anaemia
Hyperthyroidism
Pregnancy

485
Q

Signs on examination of HF

A 
Arryhtmia could be cause
Murmur could be cause
3rd/4th HS
Displaced apex
Pulsus alternans
Increase BP and HR
Fine end inspiratory crackles
Cardiac asthma
486
Q

What is high output HF

A

When demands of body overwhelm the heart

487
Q

Diagnositc method for HF

A

TTE coupled with doppler colour

488
Q

What is cut off for reduced ejection fraction HF

A

Less than 40

489
Q

Why is echo so useful in HF

A

Visualise the heart and any potential causes

Can work out EF

490
Q

To diagnose preserved ejection fraction HF what must EF be

A

Over 50

491
Q

What diagnositic criteria is used to diagnose HF clinically

A

Framingham
2 major with 1 minor
1 major with 2 minor

492
Q

Long term management of HF principles

A

Treat the cause
Lifestyle management
Drugs- ABD

493
Q

Way to remember drugs used in chronic HF

A

ABD devilliers
ACEi
Beta blockers
Diuretics- spironolactone, loop

494
Q

What drugs are considered in HF as further management

A

Digoxin
Hydralazine
nitrates like ivabradine

495
Q

What further drugs are considered in HF patients who are black

A

Hydralazine

Nitrates like ivabradine

496
Q

What is last considered option for chronic HF

A

Cardiac resynchronisation therapy

497
Q

Complications of HF

A

Death
Resp failure
Kidney failure
Acute exacerbations

498
Q

Generally how does cardiomyopathy present

A

SOB on exertion
Fatigue
Fainting

499
Q

Generally how would investigate cardiomyopathy

A

ECG
Bloods- BNP, tropinin etc
Echo
Cardiac catheterisation

500
Q

O/E cardiomyopathy

A

HF signs

501
Q

Key finding on examination of dilated cardiomyopathy

A

Displaced apex

502
Q

What causes dilated cardiomyopathy

A

Alcohol
Idiopathic
Post viral- from myocarditis

503
Q

What is main problem of dilated cardiomyopathy

A

Leads to poor elecetrical conduction and arrythmias

Only in HOCM does prevent by obstruction

504
Q

What causes hypertrophic cardiomyopathy 50% of time

A

Familial

505
Q

What is inheritance of HOCM

A

A Dominant

506
Q

Typical presentation of hypertrophic cardiomyopathy

A 
Can just be death
SOBOE
Angina
Syncope
Arrythmias
507
Q

What is jerky carotid pulse seen in

A

HCM

508
Q

Examination findings HCM

A

S4
ESM
Double apex beat with heave
Jerky carotid pulse

509
Q

Investigations for HCM

A

ECG- Left axis deviation, Q waves, LVH

Echo- LVH

510
Q

Causes of restrictive cardiomyopathy

A

Sarcoidosis
Haemochromatosis
Amyloidosis
Familial

511
Q

Presentation of restrictive cardiomopathy

A

Asymptomatic or HF signs

512
Q

O/E restrictive cardiomyopathy

A 
S3
Ascites
Hepatomegaly
Oedema
Kussmals sign
513
Q

What can be seen on CXR of myocarditis

A

Pericardial calcification

514
Q

How can echo differentiate constrictive pericarditis from restrictive cardiomyopathy

A

Pericarditis has pericardial thickening whereas restrictive cardiomyopathy will be normal heart muscle

515
Q

How can you cure chronic pericarditis

A

Remove pericardium

516
Q

What is resultant cardiomyopathy myocarditis can lead to

A

Dilated

517
Q

Presentation of myocarditis

A

Pleuritic chest pain worse on lying down
SOB
Palpitations
Flu like prodrome

518
Q

Most common cause of myocarditis

A

Post cocksackie B virus

519
Q

Causes of myocarditis

A

Post cocksackie B virus
Cocaine
Metals
Radiation

520
Q

How can CK and troponin differentiate myocarditis from pericarditis

A

Myocarditis theyre much more elevated

521
Q

ECG changes seen in myocarditis

A

Random ST elevation and T wave changes

522
Q

Test ordered for myocarditis

A

ECG
CK and troponin
Endomyocardial biopsy

523
Q

Diagnostic test for myocarditis

A

Endomyocardial biopsy

524
Q

If has angina as PC what are some causes

A

Hypertrophic cardiomyopathy

Aortic stenosis

Year 3 Conditions (33 decks)

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