Cardio misc Flashcards
What murmer does a VSD have
pansystolic murmer.
What is a LEft to right shunt?
Blood takes an extra trip to lungs. may lead to pumonary HTN bc more blood on the rhs
What would you see with a small VSD?
may be asymptomatic. larger holes present problems in infancy
How is VSD treated?
With surgery at infancy but may heal with age
Why is ASD more dangerous with age?
As heart compliance falls with age, the shunt
increases
This can lead to heart failure and SoB by 40
Eisenmenger’s complex
What is the Eisenmenger’s complex?
shunt reversed due to the
development of pulmonary HTN -> cyanosis and
organ damage.
ALl the blood is pumped out through the aorta, organ damagae because less oxugen to the tissues
What can pulmonary HTN cause?
Cyanosis and organ damage
When can ASD be asymptomatic?
Until adulthood?
what can a bicuspid aortic valve cause?
aortic stenosis +/- aortic regurgitation
pre-dispose an individual to IE, aortic
dilation and aortic dissection
How can a bicuspid aortic valve be treated?
valve replacement
What can cause eisenmenger’s be caused by?
A right to left shunt. pulmonary HTN
What does cyanosis present like?
Blueish tinted skin, around eyes and fingertips and lips
What can cause organ damage and cyanoiss?
Eisenmenger’s complex (all blood leaves through aorta)
What is Coarctation of the Aorta?
Aorta is narrowed at the site of the ductus
arteriosus
What can a severe coarction of the aorta lead to?
blocks aorta, collapse with heart failure
What can a mild coarction of the aorta lead to?
raised BP and systolic murmur (best heard over
left scapula, ‘scapula bruit’)
What murmer do you hear with mild coartcion of the aorta?
systolic murmur (best heard over left scapula, ‘scapula bruit’)
What are the signs of COA?
BP in right arm greater than BP in left arm
(Radio-femoral delay,)
systolic murmur (best heard over
left scapula, ‘scapula bruit’)
What can COA lead to a risk of?
increased risk of infective endocarditis?
How can COA be treated?
sugery insert a stent
What can bicuspid aortic valve pre-dispose a patient to?
IE, aortic
dilation and aortic dissection
What are the symptoms of infentile coarctation?
blue cyanosis. Blood from pulmonary vein to aorta, reduced O2 to tissues. neonatal death. associated with Turner’s sundrome
Adult coarctation?
Ligamentus arteriosis. (ductus closes off)
Feature on CXR of tetralogy of fallot?
boot leg shaped heart due to RV hypertrophy
at what percentage of O2 does cyanosis develop?
less than 80%
What are the 4 key features of tetralogy of fallot
VSD
Pulmonary stenosis
RV hypertrophy
Overriding aorta
Why do you get an overriding aorta in TOF?
RV hypertrophy increases the RV pressure so blood flows into LV bc of the VSD. All the blood leaves through the aota, reduced oxygenation and cyanosis in infants
What do infants withTOF present with
cyanosis and toddlers may squat
Which congenital heart conditon has the higher adult survival rate?
TOF
What are the congenital heart conditions?
TOF, Biscuspid aortic valve, VSD, ASD, coarction of aorta
which is the most common cong. heart defect?
TOF
What can cause MI?
reduced blood flow to the heart muscle (clot or
atheroma)
increased distal resistance (LV hypertrophy)
reduced O2 carrying capacity (anaemia) or availability
(hypoxia)
What causes distal resistance in heart oxygen flow?
LV hypertrophy?
what is the QRISK2 score?
predicts risk of CVD in next ten
years.
Characteristic feature of angina?
relief with rest
ANgiogram of angina?
– Gold standard,
shows luminal narrowing
What would u see in bloods for angina?
anaemia
CABG vs. PCI?
PCTA – stenting or ballooning the narrowing, risk
of restenosis or thrombosis. Less invasive.
CABG – good prognosis but longer recovery, not
for the frail.
what cardiac enzymes do you test for?
troponin, CK, myoglobin
What are the ACS
unstable angina
STEMI
NSTEMI
What condition has a rise and fall in troponin?
NSTEMI
Dx if tropinin is normal but ECG changes and chest pain?
Unstable angina
What is unstable angina aggrevated by?
anaemia
When are ‘silent MIs’ seen?
diabetics and elderly
Symptoms of MI
SOB, chest pain, palpatations, sweating, pain radiates to jaw and arm, lasting >20 mins, with nausea,
signs of Mi?
clammy and pale,
4th heart sound
pansystolic murmur,
may later develop peripheral oedema
What would you hear on an MI?
4th heart sound
pansystolic murmur,
Advice for someone suffering MI/
exercise, drugs and no air travel for 2 months. return to work in 2 months after medication
What cardiac enzyme is raised when there is muscle damamge?
CK-MM. creatinine kinase MM. this is elevated in periheral arterial disease
Treatment for PAD
Clopidogrel (1st line) and other anti-coags
Pain of acute pericarditis?
Central chest pain that radiates to the trapezium ridge
SOB, hiccups (irritation of phrenic nerve)
Relieved by sitting forwards
Worse on inspiration and lying down
Causes of A.pericarditis?
Most common = viral infections (coxsackie B, EBV, mumps)
Bacterial – pneumonia, rheumatic fever, TB, staph, strep
Post-MI (Dressler’s syndrome)
Autoimmune (SLE, RA)
HF compensatory mechanisms?
Increased preload Increased afterload - symp stimulation Salt and water retention - RAAS Myocardial remodelling - myoctype hypertrophy
ABCDE Heart failure anacronym?
alveolar oedema kerley b lines cardiomegaly dilated prominent upper lobe vessels pleural effusion
Investigations for HF?
FBC, LFT, TFT, BNP (B tyoe naturetic peptide), CXR, echo, ecg, CK-MM, troponin I and T
LHF signs?
cardiomegaly Heart murmer cool peripherals weight loss tachycardia reduced BP
also: fatgique, pleural effusion, dysponea on exertion,
RHF signs?
perioheral oedema, pitting oedema, increased JVP ascites nausea anorexia hepatomegaly
can be caused by LHF, pulmonary stenosis, lung disease
ECG in atrial fibrilation?
f waves
no clear P waves
Rapid and irregular QRS complex
irregularly irregular beat
Treatment for Atrial fibrilation
CCBs, BB, Digoxin, Anticoags - warfarin,
Amidarone, electrical DC cardioversion (reset beat)
What causes AF?
heart failure, HTN, rheumatic heart disease, thyrotoxicoses
Symptoms of AF?
asymptomatic, over 65, palpatations, fatigure, HF
What is used to calculate the risk of stroke from an AF?
CHA2DS2VASc Score
What does the CHA2DS2VASc score take into account?
HTN, AGe, DM, prev stroke/TIA, vascular disease, female,
what are F waves?
sawtooth flutter waves
Intrinscic causes of bradycardia (less than 60bpm)
Acute ischaemia
Infarction of SAN
Sick sinus syndrome
Extrinsic causes of bradycardia?
Drug therapy - BB, digoxin
Hypothyroidism
Hypothermia
Raised intracranial pressure
