Cardiology Flashcards
ST elevation in leads 1, Avl, V5 and V6 - which artery affected
right coronary artery (inferior territory MI)
ST elevation in leads V1 - V4 - which artery affected
anterior MI - left anterior descending artery
ST elevation in leads 2, 3 and AVF - which artery affected
lateral MI - left circumflex artery
findings in hypertensive retinopathy on fundoscopy
- papilloedema
- cotton wool spots
- flame haemorrhages
eye findings in infective endocarditis
roth spots
2 x signs of hypercholesterolaemia on examination
xanthelasma
corneal arcus
findings on chest x ray in pulmonary oedema (heart failure)
alveolar oedema (batwing distribution) Kerley B lines cardiomegaly Diversion (upper lobe diversion) pleural effusions fluid in fissures
^ABCDEF
which classification system is used for heart failure
new york heart association
name 3 cardiac enzymes that can indicate ischaemia / muscle damage
- troponin
- lactate dehydrogenase
- creatinine kinase
what criteria is used for a diagnosis of infective endocarditis
Duke criteria
name the components of duke criteria (infective endocarditis)
major criteria:
positive blood cultures (2 x samples)
evidence of cardiac involvement: ECG changes / new valvular regurg, new murmur, worsening of pre existing murmur
minor:
predisposing heart condition
IVDU
fever
vascular phenomena eg arterial emboli, janeway lesions, conjunctival haemorrhage
immune phenomena: oslers nodes, glomerulonephritis, roth spots
microbiological evidence
how do you manage acute pulmonary oedema
- oxygen
- nitrates (in the case of heart failure)
- IV furosemide or bumetanide (loop)
what is the most common complication of an MI
ventricular fibrillation (most common cause of death) and ventricular tachycardia
which type of arrythmia is common following an inferior MI
AV block
what is dresslers syndrome
a complication that occurs around 2-3 weeks post-MI usually due to an autoimmune reaction when the myocardium is recovering
CP: fever, pleuritic chest pain + raised ESR
management of dresslers syndrome
NSAIDS
common complication following a transmural MI
pericarditis
occurs in 48 hours of MI
CP: pleuritic chest pain, pericardial rub on ausciltation
symptoms of left ventricular aneurysm post mi
extreme tiredness increasing SOB if clot forms can cause a stroke palpitations / new arrhythmia oedema
how should you manage pts with a left ventricular aneurysm post MI
anticoagulate bc at increased risk of a clot firing off
how long after an MI does a left ventricular free wall rupture occur
1-2 weeks after
how does a left ventricular free wall rupture present
1-2 weeks post MI, acute heart failure secondary to a cardiac tamponade:
raised JVP, SOB, cough, frothy white / pink sputum, peripheral oedema, chest pain
syncope
pulsus paroxodus
diminished heart sounds
what is pulsus paradoxus
an abnormally large decrease in stroke volume, systolic BP and pulse wave amplitude during inspiration
drop has to be over 10mmhg
management of cardiac tamponade
urgent pericardiocentesis + thoracotomy
acute heart failure 1 week post MI with a pan systolic murmur
ventricular septal defect caused by MI
acute heart failure with sharp chest pain and collapse 2 weeks post MI with pulsus paradoxus and diminished heart sounds
ventricular free wall rupture
signs on examination in aortic regurg
- early diastolic murmur heart at left sternal edge 3rd intercostal
- collapsing pulse
3.
slow rising pulse
aortic stenosis
presentation of infective endocarditis
high persistent fever generally unwell - myalgia, arthraliga, malaise palpitations - new murmur SOB headache anorexia night sweats
findings on examination of a pt with infective endocarditis
janeway lesions (palms) roth spots (eyes) osler nodes splinter haemorrhages (nails) petechiae / purpura splenomegaly new or changing murmur
what diagnostic criteria is used for infective endocarditis
modified duke criteria
2 major criteria in duke criteria for IE
evidence of endocardial involvement on echo or auscultates a new valve regurg or new/changing murmur
2x positive blood cultures showing a typical organism eg strep viridans or persistent bacteraemia from a less specific organism eg staph aureus.
4 minor criteria in duke criteria for IE
predisposing heart condition
IVDU
persistent fever over 38 degrees
vascular phenomenon: splinter haemorrhages, janeway lesions, purpura/petechiae
immunological phenomenon: osler nodes, roth spots, glomerulonephritis
most common causative organism for infective endocarditis
staph aureus
causative organisms for infective endocarditis
staph aureus
strep viridans
staph epididermis
most common organism for infective endocarditis after valve surgery
staph epididermis
most common organism for infective endocarditis in IVDU
staph aureus
name 5 risk factors for infective endocarditis
IVDU recent prosthetic heart valvue surgery prev IE infection poor dental hygeine SLE (can cause non-infective endocarditis) congenital heart defects eg PDA rheumatic valve disease recent piercings / tattoo
what is the strongest risk factor for infective endocarditis
previous episode of IE
name 3 complications of infective endocarditis
aortic abscess
heart failure
death
which organism that causes infective endocarditis carries the worst prognosis
staph aureus
management of infective endocarditis initially (before cultures back)
amoxicillin +low dose gent if normal valve
vancomycin if pen allerg
Vancomycin + low dose gent + rifampicin if prosthetic valve
management of infective endocarditis with prosthetic valve + staph infection
flucloxacillin + rifampicin + low dose gent
management of infective endocarditis with normal valve and staph infection
Flucloxacillin + low dose gent
management of infective endocarditis with normal valve and strep infection
Benzylpenicillin and low dose gent
management of infective endocarditis with prosthetic valve and strep infection
Rifampicin, Benzylpenicillin and low dose gent
what antibiotic do you use in infective endocarditis for pen allergic patients
Vancomycin + low dose gentamicin
what antibiotic do you add in patients with a prosthetic heart valve for infective endocarditis
Rifampicin
what investigations would you order in a patient with suspected infective endocarditis
- 2 x blood cultures taken 12 hours apart
- sepsis 6
- echo
- ECG
5 - FBC U+E LFT CRP ESR - complement levels - used for prognosis
- autoimmune antibodies if thinking sle
what is the most common type of cardiomyopathy
dilated
name the cardiomyopathies that are primarily systolic dysfunction
dilated = weakens and thins the muscles = cant contract properly bc weak = systolic dysfunction
name the cardiomyopathies that are primarily diastolic dysfunction
hypertrophic = muscle too big = makes the area inside the ventricles smaller = cant fill properly = diastolic problem
restrictive = a hard and stiff ventricle = doesnt move to open up to fill properly = increased ventricular pressure all the time due to it being stiff so gets backflow of blood = diastolic problem
which chambers become dilated in dilated cardiomyopathy
all 4 chambers become dilated, but left ventricle dialted more than the right
name 4 causes of a dilated cardiomyopathy
alcohol coxsackie B virus HTN cocaine duchenne muscular dystrophy
what is cor pulmonale
right sided heart failure caused by an increase in pulmonary vessel pressures (pulmonary hypertension)
name 4 causes of cor pulmonale
COPD
interstitial lung disease
cystic fibrosis
PE
how does cor pulmonale present
often asymptomatic to begin with
then right side heart failure symptoms: raised JVP, peripheral oedema, hepatomegaly, heart murmur, cyanosis, syncope, SOBOE
symptoms of right heart failure
peripheral oedema ascites raised JVP hepatomegaly sacral oedema
symptoms of left heart failure
pulmonary oedema (pink frothy sputum) nocturnal paroxysmal dyspnoea orthopnoea nocturnal cough weight loss cool peripheries SOB fatigue poor exercise tolerance
name 2 causes of high output heart failure
anaemia
thyrotoxicosis
what 4 investigations would you do to diagnose heart failure and why
- BNP
- echo - to look at EF and look for a cause
- ECG - to look for hypertrophies or ischaemic changes
- bloods = U+E for any meds going to start, FBC for anaemia that may be making heart failure worse
what is pre load
the pressure needed to over come to pump blood into ventricles - so stretching of cardiac myocytes on filling
what is afterload
the pressure left in the ventricle needed to overcome to pump blood out on systole
how do you work out cardiac output
HR x stroke volume
what is ejection fraction
amount of blood pumped out of the heart with each contraction
what is stroke volume
amount of blood pumped out of the left ventricle in one contraction
what is end diastolic volume
amount of blood in the ventricles at the end of diastole
what is end systolic volume
amount of blood left in the ventricles at the end of systole
how does left ventricular hypertrophy show up on ECG
left axis deviation
T wave inversion in leads 1, avl and v5 and v6
how does right ventricular hypertrophy look on ECG
right axis deviation
very tall R waves in v1-v3
T wave inversion in leads v1-v3
Management of chronic heart failure (essential drugs)
Ace - i
beta blocker
Aldosterone antagonist! spironolactone / epelerone
Loop diuretic - furosemide
ABAL
which type of anti hypertensive should be avoided in patients with valvular heart disease unless indicated by a specialist
ace inhibitors
what are the 3 typical anginal symptoms
heavy chest pain
on exertion
relieved by rest or GTN