Cardiology Flashcards
what are the causes of heart failure
- ischaemic heart disease
- HTN
- valvular heart disease
- Afib
- chronic lung disease
- cardiomyopathy
- previous cancer chemo drugs
- HIV
what are the two different types of heart failure?
HFREF - heart failure with reduced ejection failure
HFNEF - heart failure with normal ejection failure -> elderly, HTN, afib, overweight
what investigations are done to diagnose heart fialure?
- BLOODS:
- renal function
- FBC
- LFT’s hepatic congestion
- TFT’s thyroid disease
- ferritin and trasnferrin
- brain natriuretic peptide - CXR
- ECHO !!!
- Cardiac MRI
what signs are seen on CXR of heart failure?
- cardiomegaly
- pleural effusions
- air bronchograms
- increased vascular pedicle
- perihilar shadowing/consolidations
- alveolar oedema
what lifestyle modification is needed to manage heart failure?
- smoking cessation
- reduce alcohol consumption
- salt restriction
- fluid restriction and daily weight monitoring
what medication is given to patients with heart failure?
- DIURETICS: furosemide 40-500mg OD (or bumetanide)
- ACEi
- AngII RB: valsartan/candesartan
- ANgiotensin receptor-neprilysin inhibitor
- Beta blockers: START LOW + GO SLOW -> onyl if >100mg systolic and >60 bpm HR (bisoprolol)
vasodilators, ivabradine, nitrates
what are the two main types of pacemaker?
and what do they do?
CRT: cardiac resynchronisation pacemaker (used in LBBB)
ICD: implantable cardiac defibrillators (prevents sudden death in heart failure)
what are the main symptoms of aortic stenosis?
angina, heart failure, syncope, decrease in exercise tolerance, dyspnoea on exertion
what are the commenest cuases of aortic stenosis?
age related
congenital bicuspid valve
chronic kidney disease
previous rheumatic fever
describe the murmur of aortic stenosis.
heard on the right sternal border 2nd intercostal space
ejection systolic murmur radiating to the carotid/neck
what aortic valve area is considered mild, moderate and severe?
mild >1.2cm^2
moderate 1-1.2cm^2
severe <1cm^2
what is the treatment for aortic stenosis?
TAVI - transcatheter aortic valve implantation (especially is older patients with significant comorbidities)
what are teh initial symptoms of aortic regurg?
exertional dyspnoea and reduction in exercise tolerance
what are the main cuases of aortic regurgitation?
- idiopathic dilatation of the aorta (pulling valve leaflets apart)
- congenital abnormalities of aortic valve (biscuspid valves)
- calcific degeneration
- rheumatic disease
- infective endocarditis
- marfan syndrome
what are the main signs on examination of aortic regurgitation?
- murmur is best heard at the left sternal edge and is an early diastolic blowing murmur
- collapsing pulse
- De Musset’s sign (head bobbing)
what medication is most commonly given to treat aortic regurg?
ACEi to reduce afterload which slows rate of left ventricular dilatation
what is the gold standard assessment for aortic and mitral regurg?
echocardiogram
is surgical intervention needed in patietns with mitral regurgitation?
most commonly not
patients are mostly asymptomatic and if they have chronic MR with mild-moderate disease then less likely to need surgery
what two medical conditions have a higher rate of mitral vlave prolapse?
marfans syndrome and pectus excavatum
what are teh main cuases of mitral valve regurg?
- marfans
- pectus excavatum
- rheumatic heart disease
- IHD
- infective endocarditis
- certain drugs
- collagen vascualr disease
what type of murmur is mitral regurg described as?
pan systolic blowing murmur best heard over mitral area (5th intercostal space, left mid clavicular line) and radiates to the axilla
what medications can be given in a patient with mitral regurg?
- DIURETICS
- if patient has functional or ischaemic MR then ACEi given
- if LV systolic dysfunction present then ACEi and beta blockers (bisoprolol or carvedilol) beneficial to reduce MR
what are the predisposing cardiac conditions for infective endocarditis?
- mitral valve prolaps
- presence of prosthetic material (valves and patches, NOT stents)
- rheumatic heart disease
- degenerative and bicuspid aortic valve disease
- congenital heart disease
- intravascular device
what are teh most common causative organisms for infective endocarditis?
- viridans group of streptococci (50%)
- staph aureus (20%) (common in IV users)
- perioperative ‘early’ IE (up to 1yr after) usually caused by staphylococci and ‘late’ IE usually caused by viridans streptococci, staph aureus and coagulase neg staphylococci
- entrococcal (10%)
- fungi (2-10%) - common in immunosupression, IV drug use, cardiac surgery, prolonged exposure to antimicrobials and IV feeding