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PACES > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Aortic stenosis causes

A

Bicuspid aortic valve
Age related calcification
Rheumatic heart disease
Rarely infective endocarditis

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2
Q

Features of severe aortic stenosis

A

Clinically

  • symptoms: SOB, chest pain, syncope
  • quiet S2
  • narrow pulse pressure
  • slow rising pulse, low volume
  • LV heave

Echocardiography

  • valve area <1cm2
  • mean valve gradient >40mmHg
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3
Q

Management of aortic stenosis

A

Valve replacement / TAVI - based on co-morbidities

  • Symptomatic disease
  • Severe disease based on echocardiographic features
  • NB: balloon valvuloplasty for highest risk patients - temporary

Medical

  • serial monitoring
  • beta blockade
  • avoid vasodilating drugs that drop preload -> crash in blood pressure (e.g. nitrates)
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4
Q

Aortic regurgitation causes

A
  • bicuspid valve
  • collagen disease e.g. Marfan’s, Ehler’s Danlos
  • aortic dissection
  • IE
  • rheumatic heart disease
  • prosthetic valve failure
  • autoimmune / rheumatological e.g. ankylosing spondylitis
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5
Q

Features of severe aortic regurgitation

A

Clinically

  • wide pulse pressure
  • collapsing pulse
  • displaced apex
  • Eponymous signs
  • —> Quincke’s - nail bed pulsation
  • —> Corrigan’s - visible neck pulsation
  • —> De Musset’s - head bobbing
  • —> Muller’s - pulsation of the uvula

Echocardiocraphic

  • regurgitant area > 30mm2
  • regurgitant volume >60ml
  • LV dilatation (end diastolic)
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6
Q

Management of aortic regurgitation

A

Valve replacement

  • symptomatic disease
  • severe echo criteria or LVEF <50%

Medical

  • serial echocardiography
  • as for heart failure -> ACEi, diuresis
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7
Q

Mitral stenosis causes

A 
Rheumatic heart disease
Mitral annular calcification
Prosthetic valve stenosis
Infective endocarditis (vegetations)
Congenital
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8
Q

Features of severe mitral stenosis

A

Clinical

  • Long mid-diastolic murmur
  • AF
  • Pulmonary hypertension
  • Right heart failure
  • Decompensated heart failure

Echocardiographic
- valve area <1cm2 (NB: <1.5cm2 is moderate and criteria for intervention)
-

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9
Q

Management of mitral stenosis

A

Valvular intervention

  • symptomatic patients
  • valve area <1.5cm2 (moderate)
  • pulmonary hypertension (PA pressure >20mmHg)

Options for valvular intervention

  • valvuloplasty is preferred if favourable anatomy
  • valve replacement

Medical

  • serial echo
  • manage AF - anticoagulation / rate control
  • manage heart failure: ACEi, beta blockade, diuresis

Pregnancy
- advise against pregnancy without prior treatment

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10
Q

Mitral regurgitation causes

A

Primary (valvular pathology)

  • papillary muscle rupture following MI
  • degenerative (annular calcification)
  • infective endocarditis
  • rheumatic heart disease
  • connective tissue disease related e.g. Marfan’s, Ehlers Danlos

Secondary (normal valve leaflets / chordae)

  • left ventricular systolic dysfunction
  • ischaemic cardiomyopathy
  • dilated cardiomyopathy e.g. alcohol, myocarditis
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11
Q

Features of severe mitral regurgitation

A

Clinical

  • displaced apex beat
  • AF
  • pulmonary hypertension - RV heave
  • decompensated heart failure

Echo

  • LV/LA dilatation
  • raised regurgitant volumes / regurgitant areas
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12
Q

Management of mitral regurgitation

A

Valve surgery (repair preferred, otherwise replacement)

  • symptomatic patients
  • declining LVEF
  • increasing LV dilatation
  • AF
  • acute valvular incompetence following MI

Medical

  • serial echo
  • manage heart failure / AF
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13
Q

Causes of pulmonary stenosis

A

Syndrome association

  • Down’s
  • Turner’s
  • Noonan’s

Carcinoid

Part of tetralogy of fallot

Acquired infections e.g. rubella

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14
Q

Features of severe pulmonary stenosis

A

Clinical

  • RV heave
  • signs of right heart failure
  • raised JVP
  • widely split S2 (non-fixed)

Echo

  • valve area <1cm2
  • valve gradient >64mmHg
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15
Q

Management of pulmonary stenosis

A

Usually asymptomatic and does not require intervention (serial monitoring)

Balloon valvuloplasty

Valve replacement if in association with PR

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16
Q

VSD features and causes

A

Features
- harsh pansystolic murmur lower left sternal edge without radiation (or radiation to the back)

Causes

  • isolated findings
  • Post septal MI
  • Congenital
  • –> Down’s
  • –> Turner’s
17
Q

VSD management

A

Septal closure

  • acute septal rupture following MI
  • significant left to right shunt
  • endocarditis
  • other concomitant heart surgery

Medical
- serial echos for surveillance

18
Q

ASD features and causes

A

Features

  • ESM upper left sternal edge (increased pulmonary flow)
  • fixed splitting of the second heart sound

Haemodynamically signficant ASD features

  • AF
  • laterally displaced apex
  • systolic thrill pulmonary area
  • mid diastolic rumble tricuspid (increased left -> right shunt and tricuspid blood flow)

Causes

  • 70% ostium secundum defect
  • –> usually subclinical
  • –> ECG: RBBB, RAD
  • 15% ostium primum defect
  • –> more clinically relevant
  • –> associated syndromes: Down’s, Noonan’s, sometimes Turner’s
19
Q

ASD management

A

Septal closure (surgical / percutaneous)

  • symptomatic
  • significant right to left shunt / right heart failure

Medical
- serial echos

20
Q

Complications of ASD / VSD

A

Arrhythmias
Paradoxical embolism
Infective endocarditis
Right heart failure (left to right shunting -> volume overload)
Development of right to left shunt -> Eisenmenger’s

21
Q

PDA clinical features

A

Continuous murmur, loudest in systole, pulmonary area, radiates to back, loudest in expiration

22
Q

Causes and features of severe PDA

A

Causes

  • idiopathic
  • prematurity
  • associated with syndromes: Down’s, Noonan’s

Clinical

  • collapsing pulse
  • LV failure
  • PHT: loud P2, RV heave, raised JVP, TR
  • Eisenmenger’s - cyanosis

Echo

  • raised pulmonary pressures
  • LV dysfunction (Eisenmenger’s more likely)
  • RV dilatation
  • TR
23
Q

Management of PDA

A

If part of cyanotic heart disease in neonates
- keep open whilst awaiting definitive procedure! - prostaglandin infusion

Closure

  • right or left sided heart failure
  • continued surveillance thereafter if associated PHT or LV dysfunction

Medical
- serial echos

24
Q

Tetralogy of fallot components

A

Overriding aorta
Right ventricular outflow tract obstruction
VSD
Right ventricular hypertrophy

25
Q

Management of tetralogy of fallot

A
  • PDA infusion at birth to keep PDA open
  • Blalock Taussig shunt (palliative, plumbing subclavian into pulmonary artery to increase pulmonary blood flow)
  • or total corrective surgery)
26
Q

Causes of dextrocardia

A

Primary ciliary dyskinesia

  • Kartagener’s
  • –> dextrocardia
  • –> situs invertus
  • –> sinusitis
  • –> subfertility
  • Turner’s
27
Q

Duke’s criteria

A

Infective endocarditis diagnosis

  • 2 major
  • 1 major + 3 minor
  • 5 minor

Major

  • typical positive organism in 2x blood culture (S aureus, strep viridans, strep bovis HACEK group)
  • endocardial involvement on echo

Minor

  • fever
  • positive blood cultures not meeting major criteria
  • echocardiographic features not meeting major criteria
  • immune phenomena: Osler nodes, glomerulonephritis
  • embolic phenomena: splinter haemorrhages, septic emboli (lung, brain)
28
Q

Jones criteria

A

Rheumatic fever diagnosis
- evidence of recent group A strep infection
+ 2 major
OR 1 major + 2 minor

Evidence of recent group A strep infection

  • ASOT
  • +ve throat swab
  • recent scarlet fever
  • +ve strep antigen testing

Major

  • polyarthritis
  • carditis (including valvular incompetence)
  • sydenham’s chorea
  • erythema marginatum
  • subcutaneous nodules

Minor

  • polyarthralgia
  • fever
  • prolonged PR
  • raised inflammatory markers
29
Q

Split second heart sound cause

A

NORMALLY: P2 after A2 (reduced afterload)

Fixed
- ASD

Wide but variable

  • pulmonary stenosis
  • RBBB
  • VSD
  • MR

Reversed splitting

  • LBBB
  • severe AS
  • coarctation
30
Q

Features of co-arctation of the aorta

A
  • systolic or continuous murmur: left infraclavicular anteriorly and posteriorly
  • large volume right radial pulse
  • radio-radio or radio-femoral delay
  • chest wall collaterals
  • heaving undisplaced apex

Post surgical

  • left thoracotomy
  • normal right radial
  • no delay
  • left radial may be weak
  • normal heart sounds
31
Q

Causes of co-arctation

A

Congenital

  • Turner’s
  • Marfan’s
32
Q

Management of co-arctation

A

Surgical correction
- left thoracotomy approach

Percutaneous balloon angioplasty

Medical
- hypertension

33
Q

Complications of co-arctation

A

Hypertension
Hypertensive heart failure
Infective endocarditis

34
Q

Types of valves

A

Bioprosthetic

Metallic

  • ball & cage
  • –> rattles on opening & clicks on closing
  • single leaflet (tilting disc)
  • bileaflet

PACES (6 decks)

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