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2b deck > cardio important > Flashcards

cardio important Flashcards

1
Q

Diagnosis of DVT

A

Ultrasound

D-Dimer if US negative

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2
Q

Treatment DVT

A

apixaban/rivaroxaban first line

OR LMWH hep followed by dabigatran/edoxaban

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3
Q

Aortic dissection signs/symptoms

A
  • intense TEARING chest pain radiating to back
  • nausea/vomiting
  • ascending aortic dissections can cause aortic regurgitation
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4
Q

diagnosis Aortic dissection

A
  • CT angiography if haemodynamically stable
  • Transesophageal Echo if haemodynamically unstable
  • CXR: WIDENING of mediastinum
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5
Q

Peripheral vascular disease symptoms

A
  • claudication on exertion/elevation of limb
  • ulceration
  • colour changes
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6
Q

peripheral vascular disease diagnosis

A
  • Doppler US = first line
  • bruit makes whoosing sound (listen with stethoscope)
  • Ankle-brachial index- symptoms begin if ABPI is less than 0.9 (rest pain seen if 0.2-0.4, gangrene= up to 0.4)
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7
Q

medical treatment for peripheral vascular disease

A

statin + clopidogrel

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8
Q

hypertension management:

A
  • Patient <55 y/o or DM:
    step 1: ACE-i/ARB
    step 2: add CCB OR Thiazide-like diuretic
    step 3: add Diuretic/CCB (whichever not added already)
  • Patient >55 y/o or afro-Caribbean:
    step 1: CCB
    step 2: add Ace-i/ARB
    step 3: add Diuretic

step 4: if potassium<4.5mmol/L add spironolactone, if potassium >4.5mmol/L add beta blocker

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9
Q

what is wolff-parkinson-white? What would you see on ECG? Treatment?

A
  • cardiac arrhythmia caused by accessory pathway connecting atria and ventricles.
  • Would see short PR interval + delta wave
  • treatment: radiofrequency ablation of accessory pathway, sotalol/amiodarone/flecainide
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10
Q

what electrolyte channel is associated with long-Qt syndrome

A

l-type calcium channels let in more calcium so membrane potential is more positive and harder to repolarise

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11
Q

what can be the consequence of long-Qt syndrome

A

Torsade de pointes- a type of ventricular tachycardia. Can lead to sudden death

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12
Q

S3 (third heart sound) pathological causes

A

left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

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13
Q

Pulmonary valve location

A

Left second intercostal space, at the upper sternal border

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14
Q

Aortic valve location

A

Right second intercostal space, at the upper sternal border

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15
Q

Mitral valve location

A

Left fifth intercostal space, just medial to mid clavicular line

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16
Q

Tricuspid valve location

A

Left fourth intercostal space, at the lower left sternal border

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17
Q

S4 heart sound

A

forced atrial contraction due to stiffened ventricle which may be due to e.g. ventricular hypertrophy

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18
Q

ejection systolic murmur causes

A

aortic stenosis
pulmonary stenosis, hypertrophic obstructive cardiomyopathy
atrial septal defect, tetralogy of Fallot

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19
Q

Holosystolic (pansystolic) murmur causes

A

mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character)
ventricular septal defect (‘harsh’ in character)

20
Q

Late systolic murmur causes

A

mitral valve prolapse

coarctation of aorta

21
Q

Early diastolic murmur causes

A 
aortic regurgitation (high-pitched and 'blowing' in character)
Graham-Steel murmur (pulmonary regurgitation, again high-pitched and 'blowing' in character)
22
Q

Mid-late diastolic murmur causes

A 
mitral stenosis ('rumbling' in character)
Austin-Flint murmur (severe aortic regurgitation, again is 'rumbling' in character)
23
Q

Continuous machine-like murmur cause

A

patent ductus arteriosus (may be accompanied by bounding pulse)

24
Q

aortic regurgitation signs

A
  • collapsing pulse
  • early decrescendo diastolic murmur
  • BOUNDING PULSE - if severe can have head-bobbing and capillary beds of fingernails pulsate
25
Q

aortic stenosis signs

A
  • ejection click
  • crescendo-descendo murmur (ejection systolic murmur)
  • slow rising small-volume pulse (best felt at carotid)
  • can have syncope
  • if blood restricted to coronary arteries, can cause angina. Can also lead to microangiopathic haemolytic anaemia
26
Q

most common cause of mitral valve stenosis

A

rheumatic fever most commo (can also be caused by left heart failure + damage to papillary muscles)

27
Q

mitral valve stenosis can cause

A
  • pulmonary oedema- caused by blood backing up into pulmonary circulation (symptoms like dyspnoea)
  • right heart failure
  • dysphagia (left atrium gets too big and compresses oesophagus)
28
Q

aortic regurgitation signs

A
  • collapsing pulse
  • visible carotid pulsation
  • head nodding with each pulse
  • loud femoral bruit
29
Q

acute rheumatic fever causative organanism

A

Streptococci

30
Q

acute rheumatic fever symptoms

A
  • sort throat (1-5 weeks prior)
  • fever, abdominal pain, epistaxis (nosebleed)
  • polyarthritis starting in lower limbs (Due to joint swelling)
  • chorea (jerky involuntary movements)- difficulty writing and speaking, hyperextension of joints and diminished tendon reflexes, tongue fasciculation and relapsing grip
  • erythema marginatum- rash with outlines on trunk and limbs
  • subcutaneous nodules
31
Q

aschoff bodies

A

nodules found in the heart in patients with RHEUMATIC FEVER

32
Q

treatment acute rheumatic fever

A

IV benzylpenicillin 600mg iv stat, then penicillin 250mg/6h PO

33
Q

what is eisenmenger syndrome?

A

when the blood flow through original left-right cardiac shunt becomes reversed or bidirectional. It is a result of reactive pulmonary hypertension causing pulmonary pressure to exceed systemic pressure.

34
Q

Tetralogy of fallot- 4 components

A

1- pulmonary stenosis
2 - VSD
3 -overriding aorta
4- Right ventricular hypertrophy

35
Q

Drugs to be avoided in heart failure

A
  • NSAIDs (ibuprofen, diclofenac, aspirin (not low dose), naproxen)
  • ## CCBs - diltiazem or verapamil
36
Q

Heart failure- acute management

A
  • oxygen
  • IV loop diuretics (e.g. furosemide)
  • opiates
  • vasodilators (hydralazine combined with nitrates)
  • ACEi/ARB, beta blockers, spironolactone (PRIMARY TREATMENT)
  • mechanical circulatory assistance
  • continuous positive airway pressure
  • inotropes (digoxin)
37
Q

NYHA classification of heart failure

A

Class I: no limitation of physical activity
Class II: slight limitation of physical activity- symptoms with ordinary levels of exertion e.g. walking up stairs
Class III: marked limitations on physical activity- symptoms with minimal levels of exertion (e.g. dressing)
Class IV: symptoms at rest

38
Q

diagnosis heart failure

A
  • CXR- pulmonary venous congestion, interstitial oedema, cardiomegaly
  • Echo- identifies any pericardial effusion/cardiac tamponade
  • BNP raised >100ml/litre
39
Q

typical symptoms and signs of heart failure

A

1- triad symptoms: SOB on exertion and rest, fatigue
2- signs: tachycardia, tachypnoea, raised jugular venous pressure,
peripheral oedema & pulmonary congestion

40
Q

clinical features of chronic constrictive pericarditis

A
  • Kussmauls sign (paradoxical rise in JVP on inspiration)
  • Freidrich’s sign- raised JVP with sharp rise and y descent
  • pulsus paradoxus- abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration.
  • Systemic venous congestion (ascites, oedema, hepatomegaly, raised JVP
  • Pulmonary venous congestion (dyspnoea, cough, orthopnoea, PND)
  • Reduced cardiac output (fatigue, hypotension, reflex tachycardia)
  • Rapid ventricular filling (pericardial knock)
  • Atrial dilation
41
Q

treatment for pericarditis

A

Bed rest + oral NSAIDs
Aspirin for patents with recent MI
Corticosteriods only for those with known immune cause because their use is linked to pericarditis
recurrence

42
Q

angina pectoris management

A
  • aspirin + statin
  • GTN to abort angina attacks
  • FIRST LINE beta blocker or calcium channel blocker (if both used then use nifedipine, if only CCB then use verapamil or diltiazem- NEVER GIVE VERAPAMIL WITH BETA BLOCKER AS RISK COMPLETE HERT BLOCK)
  • if monotherapy of BB or CCB not working, give both
43
Q

AF treatment

A
  • patient not haemodynamically stable: DC cardioversion
  • patient haemodynamically stable:
    no history of ischaemic heart disease and patient under 65, fleccanide and second line amiodarone
    if history of ischaemic heart disease or over 65, then give beta blockers and second line digoxin
44
Q

management of torsades de pointes

A

IV magnesium sulfate

45
Q

ECG changes in leads

A
  • V1-V4= left anterior descending (anterior MI)
  • I, V5-V6= left circumflex (lateral MI)
  • II, III, aVF= right coronary (inferior MI)

2b deck (18 decks)

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