Cardiology Flashcards
1
Q
Causes of Clubbing
A
- Common
- Cardiovascular
- cyanotic congenital heart disease
- Infective endocarditis
- Respiratory
- Lung ca
- Chronic pulmonary suppuration(bronchiectasis, lung abscess, empyema)
- Idiopathic pulmonary fibrosis
- Cardiovascular
- Uncommon
- cystic fibrosis
- asbestosis
- mesothelioma
- cirhhosis
- IBD
- Coeliac disease
- idipathic or familial thyrotoxicosis
2
Q
Loud S1
A
- Mitral stenosis
- reduced diastolic filling time (eg tachycardia)
3
Q
Soft S1
A
- Prolonged diastolic filling time - first-degree heart block
- delayed onset of left ventricular systole - left bundle branch block
- failure of the leaflets to coapt normally - mitral regurgitation
4
Q
S2
1) Loud aortic component
2) Soft aortic component
3) Loud pulmonary component
A
- Systemic Hypertension and congenital aortic stenosis
- Aortic valve is calcified and leaflet movement is reduced, or in aortic regurgitation when the leaflets cannot coapt.
- Pulmonary hypertension
5
Q
Increased normal splitting of the S2
A
Caused by any delay in right ventricular empyting
- right bundle branch block (delayed right ventricular depolarisation)
- pulmonary stenosis (delayed right ventricular ejection)
- VSD( increased right ventricular volume load)
- Mitral regurgitation (earlier aortic valve closure leading to more rapid left ventricular emptying)
6
Q
Apex beats
A
- Pressure loaded
- hyperdynamic, systolic overloaded
- forceful and sustained impluse that is not displaced
- Volume loaded
- hyperkinetic, diastolic overloaded
- forceful but unsustained impluse that is displaced down and laterally
- aortic or mitrac regurgitation
- Dysskinetic = cardiac failure generally, and is palpable over a larger area than normal and moves in an incoordinated way.
- Tapping apex beat = mitral stenosis (palpable first heart sound)
- Double or triple apical impluse = hypertrophic cardiomyopathy
7
Q
Killip Class
A
- Class I - no evidence of heart failure
- Class II - mild heart failure, crackles over the lower third or less of the lungs, systolic BP>90.
- Class III - pulmonary oedema, crackles more than one third of the chest, systolic BP>90.
- Class IV - cardiogenic shock, pulmonary oedema, crackles more than one third of the chest, BP<90.
Class III/IV is associated with a >5 fold mortality risk.
Class II is associated with a >3 fold risk compared to Class I.
8
Q
Clinical Classification of Angina
A
- Typical angina meets all 3 of the following characteristics:
- characteristic retrosternal chest discomfort - typical quality and duration
- provoked by exertion or emotion
- relieved by rest or glyceryl trinitrate or both
- Atypical angina meets 2 of the above characteristics
- Non-cardiac chest pain meets 1 or none of the above charactersitcs
9
Q
Causes of Orthopnoea
A
*Cardiac failure*
Uncommonly
- massive ascites
- pregnancy
- bilateral diaphragmatic paralysis
- large pleural effusion
- severe pneumonia
10
Q
Differential of ankle oedema
A
Heart failure
- history of cardiac failure
- other symptoms of heart failure
- elevated JVP
Hypoproteinaemia
- Normal JVP
- Odema pits and refills in 2-3 seconds
DVT/Cellulitis
- Unilateral
- Skin erythema
- Calf tenderness
Drug induced - takes a calcium channel blocker
Lymphoedema
- not worse at the end of the day
- not pitting when chronic
Lipodema
- not pitting
- spares foot
- obese woman
11
Q
Drugs and syncope
A
Associated with QT interval prologation and ventricular arrythmia
- Anti-arrythmics: amiodarone, procainamide
- Gastric motility promotr-cisapride
- Antibiotics: clarithromycin and erythromycin
- Antipsychotics: chlorpromazine and haloperidol
Associated with bradycardia
- beta blockers
- verapimil and diltiazem
- digoxin
Associated with psotural hypotension
- most antihypertensives but especially prazosin and calcium channel blockers
- anti-parkinsonian drugs
12
Q
Risk factors for coronary artery disease
A
- previous ischaemic heart disease
- hypercholesterolaemia
- smoking
- hypertension
- family history of coronary artery disease
- diabetes mellitus
- chronic kidney disease
13
Q
Causes of a regular bradycardia
A
- Physiological - athletes, during sleep
- Drugs - beta blockers, digoxin, amiodarone
- Hypothyroidism
- Hypothermia
- Raised ICP
- 3rd degree atrioventricular block or 2nd degree
- myocardial infarction
- vasovagal syncope
- jaundice
14
Q
Causes of irregular bradycardia
A
Irregularly irregular
- atrial fibrillation (in combination with conduction sustem disease or av nodal block due to):
- alcohol
- post-thoracotomy
- idiopathic
- mitral valve disease or any cause of left ventricular enlargment
- frequent ectopic beats
Regularly irregular
- sinus arrythmia
- Type 1 2nd degree av block
- pulse deficit
15
Q
Cause of a regular tachycardia
A
- hyperdynamic circulation
- exercise/emotion
- fever (allow 15-20 beats per minute for every degree celsius above normal)
- pregnancy
- thyrotoxicosis
- anaemia
- a-v fistula
- beri-beri
- congestive cardiac failure
- constrictive pericarditis
- drugs - salbutamol
- denervated heart )diabetic resting at 106-120)
- hypovolaemic shock
- supraventricular tachycardia (>150)
- atrial flutter
- ventricular tachycardia (>150)
- sinus tachycardia
- thyrotoxicosis
- pulmoary embolism
- myocarditis
- myocardial ischaemia
- fever, acute hypoxia or hypercapnia
- multifocal atrial tachycardia
