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Phase 2A revision > cardio to work on COPY > Flashcards

cardio to work on COPY Flashcards

1
Q

Name 3 differential diagnoses for angina

A
  1. Pericarditis/myocarditis
  2. PE
  3. Chest infection
  4. Dissection of aorta
  5. GORD
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2
Q

Name 3 possible differential diagnoses of MI

A
  1. Pericarditis
  2. Stable angina
  3. Aortic dissection
  4. GORD
  5. Pneumothorax
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3
Q

what are the clinical features of PE?

A

SYMPTOMS

  1. Breathlessness
  2. Pleuritic chest pain
  3. signs/symptoms of DVT

SIGNS

  1. Tachycardia
  2. Tachypnoea
  3. pleural rub
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4
Q

Name 3 differential diagnoses for acute pericarditis

A
  1. MI
  2. Angina
  3. Pneumonia
  4. Pleurisy
  5. PE
  6. GORD
  7. pneumothorax
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5
Q

what are the treatments for peripheral vascular disease?

A 
Control risk factors:
    - Smoking cessation
    - Regular exercise
    - Weight reduction
    - BP control, DM control
    - Statin 
Antiplatelet therapy:
    - Aspirin/clopidogrel
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6
Q

what are the clinical signs of left heart failure?

A
  1. Pulmonary crackles
  2. S3 and S4 and murmurs
  3. Displaced apex beat
  4. Tachycardia
  5. fatigue
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7
Q

what are the clinical features of right HF?

A
  1. Raised JVP
  2. Ascites
  3. peripheral oedema
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8
Q

what is the management for chronic HF?

A

1st line = ACEi, beta blocker
2nd = ARB + nitrate
3rd = cardiac resynchronization or digoxin
4th = diuretics (furosemide)
5th = aldosterone antagonist (spironolactone)

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9
Q

what are the side effects of ACE inhibitors?

A
  1. Hypotension
  2. Hyperkalaemia
  3. Acute renal failure
  4. Teratogenic
  5. cough - from build up of kinin
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10
Q

Give 4 potential side effect of ARBs

A
  1. Hypotension
  2. Hyperkalaemia
  3. Renal dysfunction
  4. Rash
    Contraindicated in pregnancy
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11
Q

Give 3 potential side effects that are due to the vasodilatory ability of CCBs

A
  1. Flushing
  2. Headache
  3. Oedema
  4. Palpitations
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12
Q

Give 2 potential side effects that are due to the negatively chronotropic ability of CCBs

A
  1. Bradycardia
  2. Atrioventricular block
  3. Postural hypotension
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13
Q

Give a potential side effect that is due to the negatively inotropic ability of CCBs

A

Worsening cardiac failure

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14
Q

Give 5 potential side effects of diuretics

A
  1. Hypovolaemia
  2. Hypotension
  3. Reduced serum Na+, K+, Mg+, Ca2+
  4. Increased uric acid –> gout
  5. Erectile dysfunciton
  6. Impaired glucose tolerance
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15
Q

What are the functions of ANP and BNP?

A
  1. Increased renal excretion of Na+ and water
  2. Vasodilators
  3. Inhibit aldosterone release
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16
Q

How does digoxin work?

A

Inhibits the Na+/K+ pump therefore making the action potential more positive and ACh is released from parasympathetic nerves

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17
Q

What are the main effect of digoxin?

A
  1. Bradycardia
  2. Reduced atrioventricular conduction
  3. Increased force of contraction (positive inotrope)
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18
Q

Give 3 potential side effects of digoxin

A
  1. Nausea
  2. Vomiting
  3. Diarrhoea
  4. Confusion
    Also has a narrow therapeutic range
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19
Q

Name 4 potential effects of amiodarone

A
  1. QT prolongation
  2. Interstitial lung disease
  3. Hypothyroidism
  4. Abnormal liver enzymes
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20
Q

Name a disease that might cause tall P waves

A

Right atrial enlargement

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21
Q

Name a disease that might cause broad notched P waves

A

Left atrial enlargement

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22
Q

Give 2 effects of hypokalaemia on an ECG

A
  1. Flat T waves
  2. QT prolongation
  3. ST depression
  4. Prominent U waves
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23
Q

Give an effect go hypocalcaemia on an ECG

A
  1. QT prolongation
  2. T wave flattening
  3. Narrowed QRS
  4. Prominent U waves
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24
Q

Give an effect of hypercalcaemia on an ECG

A
  1. QT shortening
  2. Tall T wave
  3. No P waves
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25
Give 3 potential consequences of arrhythmia
1. Sudden death 2. Syncope 3. Heart failure 4. Chest pain 5. Palpitations May also be asymptomatic
26
Give 2 causes of bradycardia
1. Conduction tissue fibrosis 2. Ischaemia 3. Inflammation/infiltrative disease 4. Drugs
27
what is the clinical presentation of AV node re-entry tachycardia (AVNRT)?
Rapid regular palpitations – abrupt onset, sudden termination Chest pain and breathlessness Neck pulsations Polyuria
28
Describe the acute treatment of AV node re-entry tachycardia (AVNRT)
Vagal manoeuvre, carotid sinus massage catheter ablation and adenosine (block AVN to terminate the SVT)
29
Describe 3 characteristics of an ECG from someone with accessory pathway arrhythmia
1. Delta wave 2. Short PR interval 3. Slurred QRS complex
30
Give 4 causes of sinus tachycardia
1. Physiological response to exercise 2. Fever 3. Anaemia 4. Heart failure 5. Hypovolaemia 6. pain
31
What is the treatment for stable ventricular tachycardia?
IV beta blockers (bisoprolol) and IV amiodarone
32
what is the clinical presentation of atrial fibrillation?
can be asymptomatic 1. SOB 2. Chest pain 3. Palpitations 4. Syncope 5. fatigue 6. apical pulse greater than radial pulse
33
what are the causes of atrial fibrillation?
``` Idiopathic Hypertension Heart failure Coronary artery disease Valvular heart disease Cardiac surgery Cardiomyopathy Rheumatic heart disease ```
34
What does the CHA2DS2 VASc score take into account
``` CHD HTN Age (>75) = 2 points DM Stroke (previous) = 2 points Vascular disease Age 65-74 Sex (female) ``` Score >1 = anticoagulation
35
Describe the treatment for atrial fibrillation
- cardioversion - LMWH (enoxaparin) and DC shock - rate control - 1st line = beta blocker, 2nd line = CCB - rhythm control - BB (bisoprolol), CCB (verapamil), digoxin, anti-arrhythmic (amiodarone) - anti-coagulation
36
What might you give someone to help restore sinus rhythm in atrial fibrillation?
Electrical cardioversion or pharmacological cardioversion using flecainide
37
What is atrial flutter?
Fast but organised waves in the atrium | Atrial rate 250-350 bpm
38
Describe the pathophysiology of atrial flutter
the P wave produces a sawtooth pattern with regular conduction to the ventricles - Wave of contraction around the atria causing the repolarisation of the AV node
39
what are the causes of long QT syndrome?
1. Congenital 2. hypokalaemia, 3. hypocalcaemia 4. Drugs - amiodarone, tricyclic antidepressants 5. bradycardia 6. Acute MI 7. diabetes
40
what are the causes of heart block?
``` Athletes Sick sinus syndrome IHD – esp MI Acute myocarditis Drugs Congenital Aortic valve calcification Cardiac surgery/trauma ```
41
what are the symptoms of aortic stenosis?
Occur when valve area is 1/4 of normal (normal - 3-4 cm2) 1. Exertional syncope 2. Angina 3. Exertional dyspnoea
42
what are the signs of aortic stenosis?
- ejection systolic murmur radiating to carotids and apex - crescendo-decrescendo - sustained, heaving apex - slow rising pulse - narrow pulse pressure - soft S2 if severe
43
what are the symptoms of mitral regurgitation?
palpitations exertional dyspnoea fatigue weakness
44
Give 3 signs of mitral regurgitation
1. Pan-systolic murmur radiating to left axilla 2. Soft/absent S1 3. displaced, thrusting apex 4. atrial fibrillation
45
What is the management of mitral regurgitation?
- Mild is managed by following patient with echoes every 1-5yrs - Beta-blockers - ATENOLOL - Calcium channel blockers - DIGOXIN - Diuretics - FUROSEMIDE - ACEIs - RAMIPRIL or HYDRALAZINE - Surgical intervention if severe and symptomatic or - If ejection fraction <60% - New onset AF
46
What causes aortic regurgitation?
acute - infective endocarditis - rheumatic fever - aortic dissection chronic - rheumatic disease - bicuspid aortic valve - aortic endocarditis
47
Give 3 symptoms of aortic regurgitation
- palpitations - angina - dyspnoea
48
Give 3 signs of aortic regurgitation
- early diastolic murmur - decrescendo - water hammer (collapsing) pulse - wide pulse pressure - displaced apex
49
What investigations might you do in someone who you suspect to have aortic regurgitation?
CXR - cardiomegaly, aortic root enlargement ECHO - assess severity ECG - left ventricular hypertrophy cardiac catheterisation
50
What investigation might you do in someone who you suspect to have aortic stenosis?
- Echocardiography - CXR - cardiomegaly, dilated ascending aorta, pulmonary oedema, LV enlargement - ECG - depressed ST and T wave inversion
51
What investigations might you do in someone who you suspect to have mitral regurgitation?
1. ECG 2. CXR 3. Echo - estimates LA/LV size and function 4. doppler and colour flow doppler to measure severity
52
Describe the management for someone with aortic regurgitation
IE prophylaxis ACEi (ramipril) = vasodilators Regular echos - motion progression Surgery if symptomatic
53
what are the symptoms of mitral stenosis?
1. progressive dyspnoea 2. Haemoptysis (coughing up blood) 3. palpitations (AF) 4. chest pain
54
what are the signs of mitral stenosis?
rumbling mid-diastolic murmur with opening snap - decrescendo-presystolic crescendo 1. malar flush 2. AF 3. tapping apex beat 4. low volume pulse 5. loud snapping S1
55
What investigations might you do in someone who you suspect to have mitral stenosis?
1. ECG - AF, left atrial hypertrophy causes bifid P wave 2. CXR - large L atrium, pulmonary oedema 3. Echo - gold standard for diagnosis
56
Describe the management for mitral stenosis
If mild treatment is not required Beta blockers control HR - ATENOLOL and DIGOXIN Diuretics for fluid overload - FUROSEMIDE Percutaneous balloon valvotomy to increase size of mitral valve opening Mitral valve replacement
57
what are the risk factors for infective endocarditis?
- IV drug use - poor dental hygiene - skin and soft tissue infections - dental treatment - IV cannula - cardiac surgery - pacemaker - immunocompromised
58
What investigations might you do in someone who you suspect to have infective endocarditis?
1. Blood cultures - essential 2. Echo - TTE ot TOE 3. Bloods - raised ESR and CRP, normochromic normocytic anaemia 4. ECG - long PR interval, MI
59
Describe the treatment for infective endocarditis
1. Antibiotics based on cultures 2. Treat any complications 3. Surgery - remove and replace valve
60
What additional property makes propranolol the most useful beta blocker to help control the arrhythmias which occur immediately following a heart attack?
It can also block sodium channels
61
What are the 4 main features of tetralogy of fallot?
1. Ventricular septal defect 2. Over-riding aorta 3. RV hypertrophy 4. Pulmonary stenosis
62
What are the risks associated with Eisenmengers syndrome?
1. Risk of death 2. Endocarditis 3. Stroke
63
How does mild coarctation of the aorta present?
Presents with hypertension Incidental murmur Should be repaired to try to prevent problems in the long term
64
What long term problems can occur due to coarctation of the aorta?
Hypertension - early CAD, early stroke, subarachnoid haemorrhage Re-coarctation requiring repeat intervention Aneurysm formation at the site of repair
65
How does a patient present with pulmonary stenosis?
``` Right ventricular failure Collapse Poor pulmonary blood flow right ventricular hypertrophy Tricuspid regurgitation ```
66
What are 3 problems with a bicuspid aortic valve?
1. Degenerate quicker than normal valves 2. Become regurgitant earlier than normal valves 3. Associated with coarctation and dilation of ascending aorta
67
What is Dressler's syndrome?
Myocardial injury stimulates formation of autoantibodies against the heart Cardiac tamponade may occur Dressler's is a secondary form of pericarditis
68
Give 3 symptoms of Dressler's syndrome
1. Fever 2. Chest pain 3. Pericardial rub Occurs 2-10 weeks after MI
69
Write an equation for mAP
mAP = DP + 1/3PP
70
Give the equation for stroke volume
SV = EDV - ESV
71
Give 2 diseases that result from stress induced ischaemia
1. Exercise induced angina | 2. Intermittent claudication
72
Give 2 disease that result from ischaemia due to structural/functional breakdown
1. Critical limb ischaemia | 2. Vascular dementia
73
Name 2 diseases that are due to moderate ischaemia
1. Angina | 2. Intermittent claudication
74
Name 3 causes of an aneurysm
1. Atherosclerotic (most common) 2. Ateriomegaly 3. Collagen disease - Marfans, vascular Ehlers Danlos 4. tobacco smoking
75
Describe the pathophysiology of an aortic dissection
Tear in intimal lining of aorta --> column of blood under pressure enters aortic wall forming haematoma --> separates intima from adventitia --> false lumen False lumen extends --> intimal tears
76
what is the management for an NSTEMI?
- use grace score to predict 6 month mortality and risk of further cardiac events - antiplatelet therapy = aspirin + clopidogrel antithrombin = LMWH BB + nitrate statins
77
what is the role of preload in heart failure?
- heart failure causes decreased volume of blood ejected with each heart beat - the myocardial fibres stretch and don't contract as much
78
what is the role of afterload in heart failure?
- increased afterload causes increased EDV - this causes decreased SV and decreased CO - this is a vicious circle and continues to exacerbates the problem
79
what are the causes of cor pulmonale?
- chronic lung disease - pulmonary vascular disorders - neuromuscular and skeletal diseases
80
what are the signs of cor pulmonale?
- cyanosis - tachycardia - raised JVP - RV heave - pan-systolic murmur due to tricuspid regurgitation - hepatomegaly - oedema
81
what investigations should be undertaken for cor pulmonale?
arterial blood gas - hypoxia - sometimes shows hypercapnia
82
what is the management for cor pulmonale?
- treat the underlying cause - oxygen - diuretics - venesection if haematocrit >55 - heart-lung transplant in young patients
83
what are the causes of atrial flutter?
- idiopathic - CHD - hypertension - heart failure - COPD - pericarditis - obesity
84
what is the management for atrial flutter?
- Cardioversion - Give a LMWH - Shock with defibrillator - Catheter ablation = definitive treatment – creates a conduction block - IV Amiodarone – restore sinus rhythm
85
what are the risk factors for AVNRT?
``` exertion emotional stress coffee tea alcohol ```
86
what are the consequences of malignant hypertension?
- cardiac failure (LVH) - blurred vision (papilledema) - haematuria - due to fibrinoid necrosis of glomeruli - severe headache and cerebral haemorrhage
87
what is the treatment for recurrent pericarditis?
- The first line treatment is oral NSAIDs e.g. Ibuprofen - Colchicine has been proven to be more effective than Aspirin alone - In resistant cases, oral corticosteroids e.g. -Prednisolone may be effective, and in some patients, pericardiectomy (removal of part/most of the pericardium) may be appropriate
88
what is the clinical presentation of pericardial effusion?
- Symptoms of a pericardial effusion commonly reflect the underlying pericarditis - Soft & distant heart sounds - Apex beat obscured - Raised jugular venous pressure - Dysponea
89
what are the risk factors of aortic dissection?
``` Hypertension- most common risk factor Trauma Vasculitis Cocaine use Connective tissue disorders- cause Aortic Dissection in younger adults ```
90
what are the clinical features of aortic dissection?
- Sudden and severe tearing pain in chest radiating to back - Hypotension - Asymmetrical blood pressure - Syncope - Aortic regurgitation, coronary ischaemia, cardiac tamponade - Peripheral pulses may be absent
91
what are the investigations of aortic dissection?
- ECG/cardiac enzymes - rule out MI - Chest x-ray - widening mediastinum - CT scanning- definitive imaging - echo - TTE/TOE - gold standard = CT angiography
92
what are the risk factors for mitral regurgitation?
``` female lower BMI advancing age renal dysfunction prior MI ```
93
what is the clinical presentation of atrial flutter?
``` Palpitations Breathlessness chest pain Dizziness Syncope fatigue ```
94
what are the risk factors for atrial fibrillation?
``` Over 60 Diabetes, Hypertension coronary artery disease previous MI structural heart disease ```
95
what are the causes of RBBB?
Pulmonary embolism IHD Atrial ventricular septal defect
96
what is the treatment for RBBB?
Pacemaker CRT – cardiac resynchronisation therapy Reduce blood pressure
97
what is the treatment for LBBB?
Pacemaker CRT – cardiac resynchronisation therapy Reduce blood pressure
98
what are the causes of LBBB?
IHD | Aortic valve disease
99
what are the risk factors for abdominal aortic aneurysm?
- Smoking- MAJOR - Family history - Connective tissue disorders- Marfan’s, Ehlers-Danlos - Age - Atherosclerosis - Male
100
what antibiotics are used for endocarditis?
staph = vancomycin if MRSA add rifampicin other bacteria = benzylpenicillin and gentamycin
101
what is the clinical presentation of tetralogy of fallot?
``` central cyanosis low birthweight and growth dyspnoea on exertion delayed puberty systolic ejection murmur ```
102
what are the signs of pericardial effusion?
- Muffled heart sounds - effusion obscures apex beat, and heart sounds are soft - Kussmaul’s sign – elevated jugular pressure that rises with inspiration - Fall in BP of more that 10mmHg on inspiration (result of increased venous return to right side of heart) - Bronchial breathing at left base
103
what are the investigations for pericardial effusion?
- Chest x ray shows large globular heart - ECG - low voltage QRS complexes with sinus tachycardia - Echocardiography is diagnostic - echo-free space around heart
104
what is the management for pericardial effusion?
- Most effusions resolve naturally - Underlying cause should be sought and treated - If effusion recurs despite treatment of underlying cause, excision of pericardial segment allows fluid to be absorbed - Pericardiocentesis - Diagnostic or therapeutic
105
what are the causes of AVRT?
``` Congenital Hypokalaemia Hypocalcaemia Drugs: amiodarone, tricyclic antidepressants Bradycardia Acute MI Diabetes ```
106
what is the clinical presentation of AVRT?
Palpitations Severe dizziness Dyspnoea Syncope
107
what are the investigations for AVRT?
ECG - pre excitation - short PR interval - delta waves (wide QRS complex that begins slurred)
108
what is the treatment for AVRT?
``` Vagal manoeuvre Breath holding Carotid massage Valsalva manoeuvre IV adenosine Surgery – catheter ablation of pathway ```
109
what are the investigations for AVNRT?
Sometimes ECG QRS complexes will show BBB P wave not visible or seen immediately before (normal) or after QRS complex due to simultaneous atrial and ventricular activation
110
what is the clinical presentation of coarctation of the aorta?
- right arm hypertension - bruits over scapulae and back - Murmur - headaches and - nosebleeds - hypertension in upper limbs - discrepancy in bp in upper and lower body
111
what are the investigations for coarctation of the aorta?
CXR - dilated aorta indented at the site of the coarctation ECG - left ventricular hypertrophy CT - can accurately demonstrate coarctation and quantify flow
112
what are the causes of left sided heart failure?
``` Coronary artery disease Myocardial infection Cardiomyopathy Congenital heart defects Valvular heart disease Arrhythmias ```
113
what are the causes of right sided heart failure?
``` Right ventricular infarct Pulmonary hypertension Pulmonary embolism COPD Progression of left sided heart failure Cor Pulmonale ```
114
what are the causes of systolic heart failure?
Ischaemic heart disease Myocardial infection Cardiomyopathy
115
what are the causes of diastolic heart failure?
aortic stenosis | chronic hypertension
116
ECG changes in which regions indicates a lateral MI?
lead I aVL V5 V6
117
ECG changes in which regions indicates a septal MI?
V1 | V2
118
ECG changes in which regions indicates an anterior MI?
V3 | V4
119
ECG changes in lateral regions are caused by which artery in an MI?
lateral = circumflex
120
ECG changes in inferior regions are caused by which artery in an MI?
inferior = RCA
121
ECG changes in anterior regions are caused by which artery in an MI?
anterior = LAD
122
A blockage in the LAD will cause ECG changes in which regions?
anterior - V3, V4 | septal - V1, V2
123
A blockage in the RCA will cause ECG changes in which regions?
inferior - leads II, III, aVF
124
A blockage in the circumflex artery will cause ECG changes in which regions?
lateral - lead I, aVL, V5, V6
125
what pharmacological treatments can be used for mitral stenosis?
- beta blockers - atenolol - digoxin - diuretics - furosemide
126
what pharmacological treatments can be used for mitral regurgitation?
Vasodilation - ACEi - ramipril - hydralazine - smooth muscle relaxer HR control - B blockers - atenolol - CCB - digoxin fluid overload - loop diuretic - furosemide AF/atrial flutter - anticoagulation
127
what is the management for SVT?
1st line = valsalva manoeuvre 2nd = carotid sinus massage 3rd = cardioversion with adenosine 4th = DC cardioversion with defibrillator
128
what type of murmur is heard in a ventricular septal defect?
pansystolic
129
which microorganism causes rheumatic fever?
group A streptococcus - s.pyogenes
130
what is the pathophysiology of hypertrophic cardiomyopathy?
thickened septum below aortic valve causes outflow tract obstruction -> causes left ventricular hypertrophy
131
What are the side effects of colchicine?
Diarrhoea and nausea
132
where is the mitral valve best auscultated?
5th intercostal space midclavicular line
133
where is the tricuspid valve best auscultated?
4th/5th intercostal space lower sternal edge
134
where is the pulmonary valve best ausculated?
2nd intercostal space | left sternal edge
135
where is the aortic valve best ausculated?
2nd intercostal space | right sternal edge
136
what is the presentation of an arterial ulcer?
location = distal extremities (tips of toes, lateral malleolus, phalangeal heads) characteristics - punched-out appearance - pale/necrotic wound tissue - minimally exudative - pale, shiny, taut, thin skin - absence of hair
137
what is the presentation of a venous ulcer?
location = gaiter area, lower calf to medial malleolus characteristics - irregular shape - granular appearance - exudative - haemosiderin staining - lipodermatosclerosis / subcutaneous fibrosis - hardening of skin - firm oedema
138
what is the gold standard investigation for peripheral artery disease?
contrast angiography
139
give 7 signs of shock
``` pale sweaty cold pulse is weak and rapid reduced urine output confusion weakness/collapse ```
140
what can cause hypovolaemic shock
loss of blood | loss of fluid
141
what is class 1 shock?
``` 15% blood loss pulse <100bpm BP normal PP normal resp rate 14-20 urine output >30ml/hr ```
142
what is class 2 shock
``` 15-30% blood loss pulse >100bpm BP normal PP decreased resp rate 20-30 urine output 20-30ml/hr ```
143
what is class 3 shock
``` 30-40% blood loss pulse >120bpm BP decreased PP decreased resp rate 30-40 urine output 5-15ml/hr ```
144
what can cause cardiogenic shock
cardiac tamponade PE acute MI fluid overload
145
what is septic shock
systemic inflammatory response assoicated with infection
146
what causes hypertrophic cardiomyopathy?
inherited | sarcomeric gene mutations
147
what can cause arrhythmogenic cardiomyopathy (ARVC/ALVC)?
desmosome gene mutations
148
what is the inheritance pattern for cardiomyopathy?
autosomal dominant
149
what is the pathophysiology of hypertrophic cardiomyopathy?
systole = normal diastole is affected heart is unalbe to relax due to thickening of ventricular walls
150
what is the pathophysiology of dilated cardiomyopathy
ventricular dilation and dysfunction - poor contractility
151
what is the pathophysiology of arrhythmogenic cardiomyopathy (ARVC/ALVC)?
desmosome mutations lead to being pulled apart and ventricles are replaced with fatty fibrous tissue
152
what is restrictive cardiomyopathy/
poor dilation of the heart restricts diastole
153
what is the classification system for PVD
fontaine classification
154
what might an ECG look like in hypertrophic cardiomyopathy?
large QRS complexes | large inverted T waves
155
what might an ECG look like in arrhythmogenic cardiomyopathy
epsilon waves
156
give 2 ECG signs of PE
sinus tachycardia | atrial fibrillation
157
what is Wolff-Parkinson-White syndrome?
AVRT
158
what does the ECG show in Wolff-Parkinson-White syndrome?
short PR interval wide QRS complex delta wave
159
what is the treatment for WPW syndrome?
1. vagal manoeuvre 2. IV adenosine 3. catheter ablation

Phase 2A revision (38 decks)

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