Cardiology Flashcards
1
Q
Angina
A
narrowing of the coronary arteries (e.g. atherosclerosis) reduces blood flow to the myocardium and causes CONSTRICTING CHEST PAIN radiating to the arm, jaw or neck
2
Q
Stable (chronic) angina
A
EXERTIONAL: symptoms are precipitated by exercise, emotion and temperature and relieved by rest or glyceryl trinitrate (GTN)
3
Q
Unstable (acute) angina
A
cardiac chest pain at rest/with crescendo pattern
not relieved by rest or GTN spray
part of the acute coronary syndromes
4
Q
Ischaemic heart disease / Coronary artery disease / Coronary heart disease
A
Primarily caused by ATHEROSCLEROSIS
- 70-80% ca sclerosed = exertional symptoms (ANGINA - main presenting feature)
5
Q
Non-modifiable IHD RFs
A
FHx
Age
Ethnicity (S. Asian)
6
Q
Modifiable IHD RFs
A
Smoking
Alcohol
HTN
Obesity
7
Q
Angina Ix
A
GOLD STANDARD: CT CORONARY ANGIOGRAPHY
Baseline Ix:
- ECG (usually normal)
- FBC (exclude anaemia)
- TFT (hypo/hyper)
- HbA1c (exclude DM)
- Lipids: LDL level
8
Q
Secondary prevention of stable angina
A
4 As: Aspirin Atorvastatin ACE inhibitor Already on a Beta-blocker for symptomatic relief
9
Q
Long term symptomatic relief of stable angina
A
Beta-blocker e.g. bisoprolol
Calcium channel blocker e.g. amlodipine
10
Q
Immediate symptomatic relief of stable angina
A
GTN spray (vasodilation)
- Take when symptoms start
- Again 5 minutes after
- If pain still there 5 minutes after repeat dose, AMBULANCE
11
Q
Surgical intervention indications in stable angina
A
Proximal or extensive disease on CTCA: PCI with coronary angioplasty
Severe stenosis: CABG
12
Q
IHD: Acute coronary syndromes
A
Sudden, reduced blood flow to the heart
Majority: thrombus from an atherosclerotic plaque blocking a CA
Unstable angina
STEMI
NSTEMI
Symptoms should CONTINUE AT REST FOR >20 MINUTES
13
Q
MI symptoms
A
Central, constricting chest pain associated with:
- Nausea + vomiting
- Sweating + clamminess
- Feelings of impending doom
- SoB
- Palpitations
- Pain radiating to the jaw or arms
- 1/3 occur in bed at night
14
Q
Silent MI
A
DIABETICS may not experience typical chest pain
15
Q
Diagnosis of ACS
A
Troponins taken at baseline and 6-12 hours after onset
ECG: ST elevation or new LBBB = STEMI
No ST elevation > Troponin: raised + other ECG changes (ST depression/T wave inversion) = NSTEMI
Normal troponin + no pathological ECG changes = UNSTABLE ANGINA
16
Q
NSTEMI
Coronary vessel > Myocardium > ECG
A
Partial occlusion > Subendocardial infarct > ST depression
17
Q
STEMI
Coronary vessel > Myocardium > ECG
A
Complete occlusion > Transmural infarct > ST elevation
18
Q
Immediate Mx of ACS at hospital
A
MONAA
Morphine Oxygen (if hypoxic) Nitrate Aspirin 300mg Anti-platelet (P2Y12)
19
Q
STEMI definitive Mx
A
PCI within 2 HOURS OF ONSET
+ DAPT
consider GPIIb/IIIa
Fibrinolysis with IV tenecteplase (if PCI is not possible within 2 hours)
e.g. alteplase
+ DAPT
20
Q
Troponin
A
regulates actin:myosin contraction
highly sensitive marker for CARDIAC MUSCLE INJURY
but NOT SPECIFIC for ACS
21
Q
Aspirin MOA
A
IRREVERISBLE inactivation of COX-1
22
Q
NSTEMI Mx
A
BATMAN Beta blockers Aspirin 300mg Ticagrelor Morphine ANTICOAGULANT e.g. Fondaparinux Nitrates (e.g. GTN)
Med/high risk:
Angiography + PCI
GRACE score = 6 month mortality + risk of further cardio events
23
Q
Secondary prevention ACS
A
ACEi
Aspirin + DAPT
Atorvastatin
Beta-blocker
24
Q
Post-MI complications
A
Death Rupture of heart septum/papillary muscles Oedema (HF) Arrythmias Aneurysm Dressler's syndrome
25
Dressler's syndrome
pericarditis 2-6 weeks after MI
26
Hypertension aetiology
95% = idiopathic (essential)
```
5%: ROPE
Renal disease
Obesity
Pregnancy (pre-eclampsia)
Endocrine (Conn's)
```
27
HTN diagnostic criteria
Stage 1:
BP > 140/90 in clinic (white coat syndrome)
BP >135/85 with ABPM/home reading
Stage 2:
>160/90
>150/95
Stage 3:
>180/120 in clinic (with organ damage; medical emergency)
28
HTN modifiable RFs
```
Alcohol
Sedentary lifestyle
DM
Sleep apnoea
Smoking
```
29
HTN non-modifiable RFs
Age (>65)
FHx
Ethnicity (afro-caribbean)
30
Further investigations HTN
Renal failure
- urine ACR: proteinuria
- dipstick: haematuria
- bloods: GFR, Hb
CVD complications
- ECG
HTN retinopathy
- fundus examination
Other:
HbA1c
Lipids
31
HTN treatment pathway: Type 2 DM, OR, Age <55 AND not of black African or African-Caribbean family origin
Step 1: [ACEi or ARB]
Step 2: [ACEi or ARB] PLUS [CCB] OR [thiazide diuretic]
Step 3: [ACEi or ARB] PLUS [CCB] PLUS [thiazide diuretic]
32
HTN treatment pathway: Age >55 OR black African or African-Caribbean family origin (any age)
Step 1: [CCB]
Step 2: [CCB] PLUS [ACEi or ARB]
Step 3: [CCB] PLUS [ACEi or ARB] PLUS [thiazide diuretic]
33
HTN treatment pathway step 4
Discuss adherence
Check for postural HTN
Low dose spironolactone (if K+ <4.5)
OR
Alpha-blocker or beta-blocker (if K+ >4.5)
34
Aneurysm
weakening of vessel wall followed by dilation due to increased wall stress
35
The most common vessel aneurysm
Abdominal Aortic Aneurysm (AAA)
| - commonly infrarenal arteries
36
AAA RFs
```
SMOKING
FHx
Connective tissue disorders
Age
Atherosclerosis
Male
```
37
Major complication of aneurysms
RUPTURE
Thromboembolisms
Fistula formation
38
1st line Ix aortic aneurysm
US
39
Mx aortic aneurysm
Ruptured = urgent repair
Symptomatic = repair regardless of diameter
Asymptomatic (detected incidentally) = surveillance until diameter >5.5 (men) or >5 (women)
40
Ruptured AAA Px + Tx
Acute onset of SEVERE, TEARING ABDOMINAL PAIN with RADIATION TO BACK, FLANK + GROIN
Painful pulsatile mass
Hypovolaemic shock
Syncope
Nausea, vomiting
Tx: URGENT SURGERY + maintain haemodynamic stability
- EVAR (endovascular aneurysmal repair)
41
Aortic dissection
tear in the INTIMAL layer of the aorta = collection of blood between intima and medial layer
- as the dissection propagates, flow through false lumen can occlude branches of aorta e.g. coronary, brachiocephalic, iliac
most often occurs in middle aged men
65% of cases = ASCENDING aorta
42
Aortic dissection RFs
```
HTN (MOST COMMON)
Trauma
Vasculitis
Cocaine use
Connective tissue disorders (young adults)
```
43
Aortic dissection Px
sudden and SEVERE TEARING PAIN in CHEST radiating to the back
Hypotension
Asymmetrical blood pressure
Syncope
44
Aortic dissection Dx
ECG
CXR
CT (definitive)
45
Aortic dissection Tx
Maintain haemodynamic stability: fluid resus, inotropes, noradrenaline
Opioid analgesia for pain control
Surgical intervention: endovascular stent-graft repair
Anti-HTs
46
Peripheral vascular disease (PVD, PAD) pathophysiology
Atherosclerosis (most commonly) > claudication of vessels
47
PVD RFs
```
Smoking
Diabetes
HTN
Sedentary lifestyle
Hyperlipidaemia
History of CAD
Age <40
```
48
PVD Px
Pain in lower limbs on exercise, relived by rest (intermittent claudication)
Severe: unremitting pain in foot (especially at night - hang foot out of bed)
Leg may be pale, cold, loss of hair, skin changes
49
PVD Ix
Ankle brachial pressure index (ABPI) = doppler ultrasonography
- ratio arm:ankle
- <0.9 (normal = 1)
Buergers test (angle to which the leg has to be raised to become pale whilst lying down)
50
PVD Tx
```
Control RFs:
Smoking cessation
Regular exercise
Weight reduction
BP control, DM control
STATIN
```
DAPT
51
Critical limb ischaemia Px
End stage PVD
```
6 Ps:
Pain
Paraesthesia
Pulselessness
Pallor
Paralysis
Perishingly cold
```
PVD Tx PLUS:
Revascularisation
Amputation
52
Mitral stenosis
Aetiology:
- Rheumatic HD
- IE
Px: malar flush, pulmonary congestion (SoB, haemoptysis), AF
MURMUR: mid-DIASTOLIC, low-pitched, rumbling
53
Aortic regurgitation
Aetiology:
- Idiopathic
- EDS/Marfans
Px: corrigan's pulse (collapsing pulse)
MURMUR: early-diastolic, soft, rumbling; Austin Flint at apex
54
Mitral regurgitation
Aetiology:
- Idiopathic
- IHD
- IE
- Rheumatic HD
- EDS/Marfans
MURMUR: pan-systolic, high-pitched, whistling
Complication: Congestive HF
55
Aortic stenosis
MOST COMMON
Aetiology:
- Idiopathic
- Rheumatic HD
Px: exertional syncope, slow rising pulse, narrow pulse pressure
MURMUR: ejection-systolic, high-pitched, crescendo-decrescendo; radiating to carotids
56
Cardiogenic shock
Aetiology: pump failure, MI
Patho: decreased CO + MAP
Px: tachycardia + pnoea, decreased UO + BP, cold peripheries, chest pain
Tx: ABCDE, resus
57
Hypovolaemic shock
Aetiology: low fluid volume, haemorrhage, GI bleed, dehydration (D&V), severe burns, pancreatitis
Patho: decreased CO + MAP
Px: tachypnoea, weak rapid pulse, cyanosis
Tx: ABCDE, resus, fluids, GTN
58
Septic shock
Aetiology: toxins in blood
Patho: decreased MAP + derangement in physiology
Px: tachycardia, D+V, decreased UO + O2 + BP
BOUNDING PULSE
Tx: Broad spectrum IV Abx, FLUIDS, O2
59
Anaphylactic shock
Aetiology: severe allergic reaction
Patho: histamine release, vasodilation, hypoxia
Px: rash
Tx: resus, adrenaline
60
Structural heart defects Ix
echo, ECG
61
Eisenmenger's syndrome
shunting of septal defect is from RIGHT to LEFT = deoxygenated blood in systemic circ
62
Tetralogy of fallot
```
4 defects:
large ventricular septal defect
overriding aorta
RV outflow obstruction (pulmonary stenosis)
RV hypertrophy
```
63
Heart failure definition
CO is inadequate for the body's requirements
64
Heart failure definition
CO is inadequate for the body's demands
Pathophysiological changes take place to compensate for CO
65
Types of heart failure
Systolic: contraction failure
Diastolic: relaxation failure
Systolic or diastolic:
LVF
RVF
Acute: new onset or decompensation of chronic
Chronic: gradual progression and arterial pressure well maintained until late
66
LVF aetiology
```
IHD (MOST COMMON CAUSE)
Myocardial infection
Cardiomyopathy
Congenital heart defects
Valvular disease
Arrhythmias
```
67
RVF aetiology
```
Right ventricular infarct
PHT
PE
COPD
Progression of LVF
Cor pulmonale
```
68
Systolic HF aetiology
IHD
Myocardial infection
Cardiomyopathy
69
Diastolic HF aetiology
Aortic stenosis
| Chronic hypertension
70
HF pathophysiology
1. HF = increased preload
2. compensatory hypertrophy > increases myocardial oxygen demand
3. ischaemia = fibrosis = reduced contractibility
4. more force needed to maintain CO = cells become tired = pathological
71
HF signs
```
Tachycardia
Elevated JVP
Cardiomegaly
3rd or 4th heart sounds
Ascites
Tender hepatomegaly
Bi-basal crackles
Pleural effusion
```
72
HF Ix
ECG
- indicate cause of HF e.g. MI, ventricular hypertrophy
BNP (brain natriuretic peptide)
- marker of HF
- directly correlated to ventricular myocardial wall stress and severity of HF
CXR: ABCDE
- Alveolar oedema (bat wing shadowing)
- Kerley B lines
- Cardiomegaly
- Dilated UPPER LOBE vessels of lungs
- Effusions (pleural)
73
HF Mx
Lifestyle changes
Diuretics: reduce preload and pressure on the ventricles
- Loop diuretics e.g. furosemide
- Thiazide diuretics e.g. bendroflumethiazide
- Aldosterone antagonist e.g spironolactone (potassium sparing)
ACEi: LVSD
- Ramipril
- SE of cough: ARB
B-blocker: decrease mortality
- e.g. bisoprolol
Digoxin: LVSD symptoms
74
Tachycardia
>100 bpm
Abnormal P waves
Normal QRS
AVNRT: absent P waves
VT: absent P + T waves, wide QRS
75
Bradycardia
<60bpm
76
Atrial fibrillation rhythm/rate
chaotic IRREGULAR rhythm with an IRREGULAR ventricular rate
patho: continuous rapid activation of the atria with no organised mechanical action at 300-600bpm
77
HTN medication
```
ABCD ARB
ACEi e.g. ramipril
Beta blocker e.g. bisoprolol
Calcium channel blocker e.g. amlodipine
Diuretic
Angiotensin II Receptor Blocker e.g. candesartan
```
78
Atrial fibrillation
chaotic IRREGULAR rhythm with an IRREGULAR ventricular rate
patho: continuous rapid activation of the atria with NO ORGANISED mechanical action at 300-600bpm
79
AF aetiology + risk factors
```
Idiopathic
HTN
HF
CAD
Valvular HD
```
```
60+
Diabetes
High BP
CAD
Past MI
```
80
AF Tx
Cardioversion
- Give a LMWH e.g. dalteparin (to decrease risk of stroke)
- Shock with defibrillator
81
Atrial flutter
ORGANISED atrial rhythm at a rate of 250-350bpm
82
Atrial flutter ECG
Saw-tooth pattern (F waves)
| = definitive diagnosis
83
Atrial flutter main risk factor
Atrial fibrillation
84
Atrial flutter Tx
Cardioversion
Catheter ablation
IV amiodarone (restores sinus rhythm)
85
Bundle Branch Block
a block in the conduction of one of the bundle branches (bundle of his splits off into left and right) so the ventricles don't receive impulses at the same time
86
RBBB
V1 MaRRoW V5+V6
| Wide QRS
87
LBBB
V1+V2 WiLLiaM V4-V6
Wide QRS + notched top
T wave inversion in lateral leads
88
Bundle Branch Block
a block in the conduction of one of the bundle branches so one ventricle receives impulse first then spreads to the next
Often asymptomatic
Tx:
- Pacemaker
- CRT (cardiac resynchronisation therapy)
- Reduce blood pressure
89
RBBB
V1 MaRRoW V6
Wide QRS
Aetiology:
PE
IHD
AV septal defect
90
LBBB
V1 WiLLiaM V6
Wide QRS + notched top
T wave inversion in lateral leads
Aetiology:
IHD
Aortic valve disease
91
1st degree HB
PR interval >200ms
Asymptomatic
92
2nd degree HB Mobitz I
Progressive lengthening of PR interval then one non-conducted P wave, repeats with shorter PR interval
= Wenckebach
Light headedness, dizziness, syncope
93
2nd degree HB Mobitz II
Occasional non-conducted P-waves (3:1, 2:1), wide QRS
SoB, postural hypotension, chest pain
94
3rd degree HB
Complete HB: no relationship between P waves and QRS waves, abnormally shaped QRS
Dizziness, blackouts
Tx: permanent pacemaker, IV atropine
95
Heart block aetiology
Atheletes
IHD (esp MI)
Acute myocarditis
Drugs
96
HB Tx
Cardioversion
Catheter ablation
IV amiodarone
97
Prolonged QT causes
Congenital (syndrome)
Hypokalaemia
Hypocalcaemia
Drugs e.g. amiodarone, TCA
98
Wolf-Parkinson-White syndrome
accessory pathway for conduction - the impulse can travel to the AVN and also to the ventricle quicker than the normal pathway
ECG
= short PR interval
= wide QRS complex that begins slurred (delta wave)
Tx: catheter ablation of pathway
99
WPW causes
Congenital
Hypokalaemia
Hypocalcaemia
Drugs e.g. amiodarone, TCA
100
Pericarditis
Inflammation of the pericardium -/+ effusion
Pericardium: fibrous layer, serous layer
- Fibrinous (DRY)
- Effusive (purulent SEROUS exudate; HAEMORRHAGIC exudate)
101
Acute pericarditis aetiology
Idiopathic
Post-cardiac injury (Dressler's)
Infectious (enteroviruses e.g. Coxsackie B, adenoviruses, TB)
Autoimmune (RA, SLE)
Traumatic + iatrogenic
102
Pericarditis pathophysiology
Inflammation
- pericardial vascularisation: FLUID moves into pericardial tissues THICKENING the layers
- polymorphnuclear LEUKOCYTE INFILTRATION
= NARROWING of pericardial space + scarring
103
Complications of pericarditis if left untreated
Build up of exudate can lead to PERICARDIAL EFFUSION
= puts pressure on the cardiac myocytes
= cardiac dysfunction (tamponade physiology) = decrease in CO
Immune cell adhesions = fibrosis > CONSTRICTIVE PERICARDITIS = decreased SV (compensatory increased HR)
104
Signs of rheumatic fever
```
Tachycardia
Murmur (dependent on valve)
Pericardial rub
Erythema marginatum (red rings)
Prolonged PR interval
```
105
Pancarditis
Inflammation of ALL LAYERS of the heart
- endocarditis
- myocarditis
- pericarditis
106
Jones Criteria for RF
Recent streptococcal infection (2-3 weeks) + 2 major or 1 major + 2 minor
E.g strep throat 2 weeks ago + carditis + polyarthritis
```
Major:
Polyarthritis
Carditis
Subcutaneous nodules
Erythema marginatum
Sydenham chorea
```
Minor:
Fever
Raised inflammatory markers
Prolonged PR
107
ESR
Fibrinogen causes RBC to fall to the bottom of the test tube faster
108
Aortic regurgitation murmur
Diastolic decrescendo
109
Aortic stenosis murmur
Systolic crescendo/decrescendo
110
Mitral regurgitation
Pan-systolic (intensity high throughout systole)
111
Mitral stenosis murmur
Diastolic decrescendo / pre-systolic crescendo
112
Pericarditis symptoms
Fever
Severe, sharp, pleuritic chest pain: WORSE when LAYING FLAT and heavy inspiration, RELIEVED by SITTING FORWARD
Dyspnoea
113
Pericarditis signs
Pericardial rub on auscultation
Tachycardia
Peripheral oedema
Effusion: muffled heart sounds
114
Pericarditis Ix
ECG: DIAGNOSTIC
SADDLE SHAPED ST ELEVATION
PR DEPRESSION
CXR: effusion may cause cardiomegaly (water bottle)
Auscultation
115
Pericarditis Tx
Reduce physical activity
NSAIDs (ibuprofen, aspirin)
Colchicine (inhibits neutrophil migration - decreases recurrence risk)
Pericardiocentesis (in cases of severe effusion)
116
Cardiomyopathy types
Hypertrophic
Dilated
Restricted
117
Dilated cardiomyopathy aetiology
```
Idiopathic
Ischaemia
Alcohol abuse
Thyroid disorder
Genetic e.g HFE
```
118
Dilated cardiomyopathy pathophysiology
Dilation of left ventricle with THIN muscle = poor contraction = lower SV
Diffuse interstitial fibrosis
Biventricular congestive systolic HF
119
Dilated cardiomyopathy Px
SoB, fatigue, dyspnoea
HF, arrhythmia, thromboembolism, increased JVP
120
Dilated cardiomyopathy Ix
CXR (enlargement)
ECG
Echo
121
Hypertrophic cardiomyopathy aetiology
GENETIC - autosomal dominant
| 50% sporadic
122
Signs of hypertrophic cardiomyopathy
Left ventricular outflow obstruction (muscle gets in the way, increasing blood velocity)
Ejection systolic crescendo decrescendo murmur
Jerky carotid pulse
123
Symptoms hypertrophic cardiomyopathy
```
SUDDEN DEATH (may occur with no prior symptoms)
Chest pain/angina
Dyspnoea
Dizziness
Palpitations
Syncope
```
124
Hypertrophic cardiomyopathy Ix
ECG: T wave inversion, Deep Q waves
| Genetic analysis
125
Pathophysiology hypertrophic cardiomyopathy
Gene mutation for sarcomere protein
Impaired diastolic filling (less chamber room and muscles less complaint)
Reduced SV
Reduced CO
= diastolic HF
Ischaemia (muscle demand) > fast arrhythmias
126
Hypertrophic cardiomyopathy Tx
Amiodarone (anti-arrhythmic)
CCCB e.g. verapamil
Beta blocker e.g. atenolol
CONTRAINDICATED: Digoxin (increases contraction force which can increase obstruction)
127
Causes of restrictive cardiomyopathy
Amyloidosis (TTR deposits in myocardium)
Sarcoidosis (granuloma in myocardium)
End-myocardial fibrosis
Haemochromatosis
128
Restrictive cardiomyopathy Px
Dyspnoea, fatigue, embolic symptoms
```
Signs:
Increased JVP, diastolic collapse, elevated on inspiration
Hepatic enlargement
Ascites
Oedema
3rd + 4th heart sounds
```
129
Diagnostic Ix restrictive cardiomyopathy
Cardiac catheterisation
130
Pathophysiology restrictive cardiomyopathy
Impaired ventricle filling (RIGID myocardium RESTRICTS ventricular filling - without hypertrophy)
= diastolic HF
131
Most common cardiomyopathy
Dilated
132
Most common cause of sudden death in young people
Hypertrophic cardiomyopathy
133
Fever + new murmur
Infective endocarditis until proven otherwise
134
Causes of non infective endocarditis
Pancreatic adenocarcinoma
| SLE
135
Infective endocarditis aetiology
```
Viridans strep (poor dental hygiene) - MOST COMMON CAUSE IN ADULTS
Staph aureus (IV drug use, surgery)
Staph epidermidus (prosthetic valve, catheter)
```
136
Infective endocarditis pathophysiology
Turbulent blood flow > cardiac endothelial damage > blood clot formation (non-bacterial thrombotic endocarditis)
Microbial infection in BLOODSTREAM > tricuspid valve from venous system
Adherence/biofilm at blood clot = Vegetation
Virulent organisms destroy the valve = valve regurgitation + HF
Detachment of vegetations = septic emboli
137
Endocarditis risk factors
```
IV drug use (MOST CASES)
Prosthetic valves
Valvular disease
Congenital defect
Rheumatic heart disease
```
138
IV drug use affects which side of the heart in endocarditis
Right
139
Symptoms of endocarditis
```
FEVER
Rigours
Night sweats
Malaise
Weight loss
```
140
Signs of endocarditis
```
NEW MURMUR (turbulent blood flow past damaged valve)
Sepsis of unknown origin
Embolic events of unknown origin
Hands: splinter haemorrhages, Janeway lesions; Osler’s nodes (antigen-antibody complexes)
Eyes: Roth spots
Skin: petechiae, embolic skin lesions
Anaemia
Splenomegaly
Clubbing
```
141
Endocarditis diagnostic criteria
Duke Criteria
- 3 positive cultures
- Echocardiography (trans-oesophageal echo): visualise vegetations or valve changes
142
Endocarditis treatment
Antibiotics
- Staph: vancomycin (if MRSA: add rifampicin)
- benzylpenicillin and gentamicin
Treat any complications e.g. HF
Surgery (severe cases): valve replacement
Prevention: good oral health, no IV drug use, education
143
What is disseminated intravascular coagulation?
Disorder of primary and secondary hemostasis
- Microvascular thrombosis
- Consumption coagulopathy (bleeding due to depletion of platelets and clotting factors)
Often occurs after INFECTION (sepsis)
Petechial rash:
144
Abdominal aorta bifurcation into right and left common iliac
L4
145
Irregular RR interval
Atrial fibrillation
146
Clear lung sounds + pan systolic murmur louder on expiration
Right sided heart failure secondary to tricuspid regurgitation
147
Murmur from ATRIOVENTRICULAR regurgitation
(Mitral and tricuspid)
| Pan systolic
148
Becks triad
149
Heart valve most commonly affected in infective endocarditis
Tricuspid (50%) = first heart valve to be encountered after blood has returned from SYSTEMIC circulation
150
Postural hypotension definition and Tx
Systolic drop >20 mmHg or if systolic BP drops to less than 90
Tx: Fludrocortisone
151
Unstable angina 1st line Tx
GTN spray and either a B-blocker (atenolol) or CCB (verapamil)
152
Schobers test
```
Standing
Locate L5
10cm above + 5cm below
Bend over as far as possible
Distance of <20cm = reduced lumbar movement > ankylosing spondylitis indication
```
