cardio DPD Flashcards
Acute rheumatic fever (AI disease)
5 major criteria
Arthritis Chorea (st vitus dance) Carditis (endocarditis/myocarditis) Subcutaneous nodules Erythema marginatum
AVRT
Type of SVT
Wolff-parkinson white syndrome
Bundle of Kent accessory pathway
Mitral valve prolapse
Barlow syndrome/click murmur syndrome
Occurs when one or two leaflets of mitral valve are pushed back into L atrium during systole. Causes a mid-systolic click, with late systolic murmur at apex (can radiate to axilla). May develop into MR and complications of bacterial endocarditis may occur
Austin Flint murmur
Occurs in aortic regurgitation
Low-pitched, mid-diastolic rumble at apex
causes a physiological mitral stenosis-like murmur.
Graham Steell murmur
Pulmonary regurg/HTN
High-pitched
Early diastolic murmur
Louder on inspiration
Carey Coombs murmur
Mitral stenosis (in rheu fever) Short, mid-diastolic rumble at apex
Dopamine agonists
used to treat prolactinomas
Bromocriptine
Cabergoline
Dopamine antagonists
anti-emetics
Metoclopramide
ACEi’s effect on plasma creatinine initially
Increases
this is abnormal but continue to administer the drug
Hypoglycaemic collapse causes
T1DM (insulin OD?)
Insulinoma (very rare)
Swollen leg DDx
- DVT (any risk factors?)
- Cellulitis
- Ruptured baker’s cyst
- CCF (usually bilateral leg swelling)
- Liver failure
Dressler’s syndrome
Autoimmune pericarditis
Sodium nitroprusside indications
Rapid BP lowering
Most effective and reliable drug
Secondary hypertension causes
90% are primary
Phaeochromocytoma Cushings Conns Acromegaly Renal artery stenosis Aortic co-arctation
Loud S1 with opening snap
Mid-diastolic murmur
Mitral stenosis
apex beat is tapping, heave: RV hypertrophy and pulmonary HTN, malar flush, AF, orthopnoea, thready pulse
Commonest cause of mitral stenosis (obstructed blood flow from LA to LV)
Rheumatic fever
Water-hammer pulse
Collapsing pulse, wide PP
= aortic regurg
Aortic regurg causes
Abnormalities (bicuspid valve, IE, rheumatic fever)
Dilation (hypertension -> LVH)
Aortic regurg (reflux of blood from aorta to LV in diastole) signs and symptoms
Symptoms of HF (S3, S4, orthopnoea, palpitations) Displaced apex beat Early diastolic murmur Wide PP, collapsing pulse CXR = cardiomegaly ECG = LVH Echocardiogram
Aortic stenosis (obstruction from LV) signs and symptoms
Angina, syncope ESM radiates to carotids Narrow PP, slow rising pulse CXR = calcified aortic valve ECG = LVH
Aortic stenosis causes
Rheumatic heart disease
Calcification of bicuspid aortic valve
Calcification of tricuspid valve in elderly
Cardiac arrest O/E
Unconscious
Not breathing
No carotid pulse
Cardiac arrest Rx
ABCDE
CPR + defibrillator
IV adrenaline
(Amiodarone and atropine)
HTN classification
Normal
Normal high
Normal: <130, <85
Normal high: 130-39, 85-89
HTN classifcation Stage I (mild) Stage II (moderate) Stage III (severe) Stage IV (very severe)
Stage I (mild): 140-159, 90-99 Stage II (moderate): 160-79, 100-109 Stage III (severe): 180-209, 110-120 Stage IV (very severe): ≥210, ≥120
HTN classifcation
Isolated systolic Class I
Isolated sytolic Class II
Isolated systolic Class I: 140-159, <90
Isolated sytolic Class II: ≥160, <90
Hypertensive retinopathy grades
Grade 1 - silver wiring
Grade 2 - AV nipping
Grade 3 - flame haemorrhage, cotton wool spots (ischaemia)
Grade 4 - all features and papilloedema
Chronic HTN other signs
LVH Heave S4 (ventricular hypertrophy) Bruits ECGs: deep S wave V1/2, tall R wave V5/6. Together >7large sqares
High renin and aldosterone levels suggest…
Renal artery stenosis
Low renin and high aldosterone levels suggests..
Hyperaldosteronism (Conn’s)
de Musset’s sign
seen in aortic regurg, associated with hyperdynamic pulse.
Head nods in time with pulse
Becker’s sign
Muller’s sign
Corrigan’s sign
Quincke’s sign
seen in aortic regurg, associated with hyperdynamic pulse.
Visible pulsations of:
- becker’s - pupils and retinal arteries
- muller’s - uvula
- corrigan’s - in neck
- quincke’s - on nail bed
Traube’s sign
seen in aortic regurg, associated with hyperdynamic pulse.
Pistol shot (systolic and diastolic sounds) on auscultation of femoral arteries
Duroziez’s sign
seen in aortic regurg, associated with hyperdynamic pulse.
Systolic and diastolic bruit on partial compression of femoral artery
Rosenbach’s sign
Gerhard’s sign
seen in aortic regurg, associated with hyperdynamic pulse.
Systolic pulsations of:
- rosenbach’s - liver
- gerhard’s - spleen
Hill’s sign
seen in aortic regurg, associated with hyperdynamic pulse.
Popliteal cuff SBP exceeding brachial pressure by >60mmHg
Acute malignant HTN Rx
IV b-blocker e.g. labetolol
± sodium nitroprusside
Avoid very rapid lowering which can cause cerebral infarction
When is CABG indicated in ischaemic heart disease
Left main stem or three-vessel disease involvement
MI complications (DARTH VADER)
Death Arrhythmias Rupture (papillary muscles - acute MR) Tamponade Heart failure Valve disease Aneurysm Dressler's syndrome Embolism Re-infarction
Causes of mitral regurg
Rheumatic heart disease IE Mitral valve proplapse Papillary muscle rupture Floppy mitral valve/CTDs
Coxsackie B virus and Chagas disease are infectious causes of
myocarditis
Investigations for hypertension
Bloods: FBC (polycythaemia), U+Es (hypoK+ and renal function) Fasting glucose (DM risk) Lipids ECG (LVH) Urinalysis (nephritis or renal disease)
Phaeochromocytoma Rx
(Rehydrate if dehydrated) Alpha blockade Beta blockade Localise the lesion surgery
A 65 year old patient with a previous MI has a BP of 140/80 on atenolol. What is should be the next step in his treatment?
Add a thiazide diuretic
D-dimer is useless in pregnancy because it will be raised anyway. Pregnant women with DVT risk investigation should be…
Doppler USS of the leg
Polymorphic VT
Haemodynamically stable patient
Treatment?
IV amiodarone/magnesium
then DC cardioversion or if haemodynamically unstable
Left main stem branches
left anterior descending artery
left circumflex artery
HOCM cardiac signs + symptoms
Regular, jerky pulse
Hyperdynamic cardiac impulse (not displaced)
(Mid-systolic murmur with no ejection fraction)
S4
STEMI Rx
MONABASH
<12hours: PCI/fibrinolysis in same 120mins
>12hours: consider CABG
Unstable angina/NSTEMI Rx
Analgesia: morphine
Anti-ischaemia: GTN spray
Immediate aspirin + anti-thrombin therapy:
fondaparinux or LMWH
Long term: DASH diet, stop smoking, ACEi, dual antiplatelet therapy (aspirin + 2nd agent), statins, b-blockers
Patient with NSTEMI diagnosed will be having a coronary angiogram soon. They have been given aspirin, morphine and GTN spray already so far. What other medication should be given?
Anti-thrombin therapy is indicated here
i.e. LMWH or fondaparinux
However this patient is having a coronary angiogram soon so LWMH is the choice and not fondaparinux.
