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Cardiology Flashcards

1
Q

Cardiac tamponade

A

compression of the heart by pericardial fluid, which can lead to cardiovascular collapse and cardiac arrest. Requires urgent pericardial paracentesis

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2
Q

Signs of Cardiac Tamponade can be remembered by Beck’s Triad.

A

Hypotension
Quiet heart sounds
Raised JVP

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3
Q

Pulsus paradoxus

A

volume decreases during inspiration because the increased blood flow through the right heart leaves less room in a rigid box for blood in the left heart.
Sign of Pericardial tamponade

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4
Q

Pericardial effusion Ix

A

ECG
- low voltage QRS complexes
- electrical alternans when the QRS complexes have different heights as a result of the heart swinging back and forth in the fluid

Xray
- Silhouette gives water bottle sign

ECHO
- Makes heart look like its dancing in pericardium

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5
Q

most common cause of myocarditis worldwide

A

Trypanosoma cruzi

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6
Q

Risk factors myocarditis

A

HIV
smallpox vaccination
autoimmune/immune-mediated diseases eg SLE
peri-partum and postnatal periods.
Prior viral syndrome
Medications

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7
Q

Symptoms of myocarditis

A

Chest pain
Dyspnoea
Orthopnea
Fatigue
Palplaitions
Rales (crackles)
Elevated neck veins
S3 gallop
Sinus tachycardia
Atrial and ventricular arrhythmias

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8
Q

Myocarditis Ix

A

FBC- haemoglobin for anaemia
CRP for inflammation
12 lead ECG
CXR- bilateral pulmonary infiltrates in the setting of myocarditis-induced CHF
Serum CK
Serum troponin I or T
Pro NT BNP
ECHO - global and regional left ventricular motion abnormalities and dilatation
Cardiac MRI

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9
Q

Myocarditis Tx

A

Systemic corticosteroids improve outcomes in patients with autoimmune-associated myocarditis
Hypersensitivity myocarditis is treated by removal of the offending agent and systemic corticosteroids.
If LV systolic dysfunction HF medications

If hemodynamically unstable :
Sodium nitroprusside and other arterial vasodilators allow rapid titration of afterload reduction in patients with tenuous blood pressure secondary to cardiogenic shock.

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10
Q

Screening of abdominal aortic aneurysm management
•If results normal (i.e. aorta diameter < 3cm)
•‘Small’ AAA
•‘Medium’ AAA
•‘Large’ AAA

A

•If results normal (i.e. aorta diameter < 3cm) → no further scans
•‘Small’ AAA (i.e. → aorta diameter 3cm- 4.4cm) → yearly scans
•‘Medium’ AAA (i.e. → aorta diameter 4.5- 5.4cm) → scan every 3 months
•‘Large’ AAA (i.e. diameter 5.5cm or greater) → referred to Vascular surgeon to discuss further management - open surgery or EVAR

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11
Q

Abdominal aneurysm symptoms

A

usually asymptomatic till rupture
epigastric pain radiating to back or hip pain if large or rapidly expanding AAA
May compress surrounding structures – vague GI symptoms
Gradual erosion of the vertebral bodies may cause non specific back pain
Embolism of thrombus or atherosclerotic debris from the aneurysm sac may cause → acute ischaemia of lower limb

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12
Q

Sign of abdominal aortic aneurysm

A

pulsatile , expansile abdominal mass is felt
may have mottled skin to show ischemic, absent pulses below site
AAA Rupture: Common Features

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13
Q

Stanford Classification aortic dissection
•Type A
•Type B

A

•Type A – involves ascending aorta only (DeBakey 1 & 2)
•Type B – does not involve the ascending aorta (DeBakey 3)

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14
Q

Presentation of Type A aortic dissection

A

Central chest pain (coronary ostia –> MI)
Dyspnoea (ascending aorta –> aortic regurgitation –>CCF)
Neck/jaw pain (aortic arch)
Horner’s (cervical sympathetic ganglia)
Symptoms of stroke (carotid arteries)

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15
Q

Presentation of Type B dissections

A

Interscapular pain (thoracic descending aorta)
Abdominal pain (abdominal descending aortic; mesenteric arteries)
Flank pain (renal arteries)

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16
Q

Classic triad or AAA rupture

A

Hypotension
Pulsatile abdo mass
flank/back pain

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17
Q

Management aortic dissection type A

A

▫EVAR surgery is preferred treatment for Stanford A dissections and complicated Stanford B dissections

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18
Q

Management aortic dissection type B

A

uncomplicated Type B dissections may be treated conservatively (bp control)

If there is evidence of end organ damage then endovascular/open repair may be performed.

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19
Q

Medical Tx of aortic dissection

A

High flow oxygen, iv access, bloods, x match
Aim to control blood pressure as often patients present as a hypertensive emergency
Aim for bo 100 or less ( permissive hypotension) excess rehydration can dislodge any of the clots
usually sodium nitroprusside plus a beta-blocker, are given intravenously to reduce the heart rate and blood pressure.
Oxygen and analgesia for symptom control

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20
Q

Cardiac output (CO) =
Mean arterial pressure (MAP) =

A

Cardiac output (CO) = heart rate (HR) x stroke volume (SV)
Mean arterial pressure (MAP) = Diastolic BP + (Systolic BP-Diastolic BP)/3
MAP = CO x SVR.

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21
Q

Beck’s triad

A

the combination of raised JVP, hypotension and muffled heart sounds, a feature of cardiac tamponade.

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22
Q

Management cardiac tamponade

A

pericardiocentesis where fluid is aspirated and subsequently drained from the pericardium. Insert a needle just left to xiphoid process, aiming towards left shoulder

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23
Q

IE most common cause

A

Staph aureus
IVDU users more likely to be infected with this

24
Q

IE cause if recent valvular surgery (<2m ago).

A

Staph epidermis

25
IE cause when there is poor dentition
Strep Viridans
26
IE cause linked with CRC
Strep bovis/gallolyticus are linked with CRC so patients should have a scope.
27
Osler nodes
painful erythematous subcutaneous nodules on the tips of digits
28
Janeway lesions
nontender hemorrhagic macules on the palms or soles
29
Mnemonic for the signs and symptoms of endocarditis is “FROM JANE”:
Fever Roth's spots Osler's nodes Murmur Janeway lesions Anemia Nail hemorrhage (splinter hemorrhages) Emboli
30
Endocarditis Ix
Blood cultures (3 cultures) should be taken at different times from various sites. Echocardiography and sometimes other imaging modalities (TOE if TTE positive) Clinical criteria
31
Major dukes diagnostic criteria include
Positive Blood cultures: >1 +ve blood culture (typical organism in 2 separate cultures or persistently positive blood cultures or single positve culture for coxiella burnetti) Evidence of endocardial involvement: positive echocardiogram findings of vegetation, abscess or abscess prosthetic valve, new valvular regurgitation
32
Minor dukes criteria include:
predisposition (cardiac lesion, IV drug abuse); fever over 38 °C; vascular signs, e.g. mycotic emboli, Janeway lesions (painless palmar/plantar macules); immunological signs e.g. Oslers nodes (painful swelling fingers/toes), positive RhF, glomerulonephritis microbiological evidence not fitting major criteria. (1 positive blood culture or not a common organism)
33
Endocarditis dx
Diagnosis is made on 2 major, 1 major/3minor or >5 minor criteria.
34
Endocarditis Mx
IV antibiotics Sometimes valve debridement, repair, or replacement Dental evaluation and treatment Removal of potential source of bacteremia (eg, internal catheters, devices)
35
Endocarditis Cx
Complete heart block Acute valvular insufficiency causing heart failure Neurologic complications e.g. stroke, abscess, haemorrhage (mycotic aneurysm) Embolic complications causing infarction of kidneys, spleen or lung Infection e.g. osteomyelitis, septic arthritis
36
Chest x-ray findings in heart failure
can be remembered by the ABCDEF mnemonic: A: Alveolar oedema (with 'batwing' perihilar shadowing) B: Kerley B lines (caused by interstitial oedema) C: Cardiomegaly (cardiothoracic ratio >0.5/ > 50% on PA film, measuring cardiothoracic ratio on CXR not that helpful ( not the same as Size of heart on echo) D: upper lobe blood diversion E: Pleural effusions (typically bilateral transudates) F: Fluid in the horizontal fissure
37
Pericarditis triad
chest pain, pericardial friction rub, and serial electrocardiographic changes.
38
Causes of pericarditis
Idiopathic Viral infections Systemic autoimmune disorders post-MI syndrome called dressler syndrome
39
Causes of pericarditis
Idiopathic Viral infections Systemic autoimmune disorders post-MI syndrome called dressler syndrome
40
Symptoms of pericarditis
chest pain - retrosternal, pleurite, stabbing, relief with sit-up /leaning forward Fever Myalgia/malaise Dyspnoea
41
Signs of pericarditis
Pericardial friction rub - high pitched, heard best at the left lower sternal edge and cardiac borders with the patient leaning forward at end-expiration Signs of right sided heart failure Look out for features of cardiac tamponade
42
Pericarditis Ix
ECG - ST elevations (global upwardly concave ,saddle - PR segment depressions in most leads Blood tests - WCC, UE (uraemia cause) , ESR, CRP, troponin slight elevation (myopericarditis) Pericardial fluid/blood culture CXR - often normal unless there is an associated large pericardial effusion, in which a water bottle-shaped enlarged cardiac silhouette is seen ECHO helps differentiate from ACS,detects pericardial effusion CT/MRI
43
Pericarditis Dx
diagnosis is confirmed in the presence of at least 2 of the 4 clinical criteria: typical chest pain pericardial friction rub widespread ST elevation and pericardial effusion
44
Pericarditis Tx
Pericardiocentesis is indicated for clinical tamponade or symptomatic effusion - needle is inserted subcostally in the midline aiming towards the left shoulder purulent - urgent percutaneous pericardiocentesis with rinsing of the pericardial cavity and intravenous antibiotics - NSAIDS plus PPI non purulent - NSAIDS eg ibuprofen plus PPI -Colchicine 3m - In cases of idiopathic pericarditis, if chest pain has not resolved after 2w, a corticosteroid can be considered once an infectious cause has been excluded Most patients with uremic pericarditis respond to intensive dialysis within 1 to 2 weeks Exercise should be restricted until chest pain resolves and inflammatory markers have normalised
45
Atrial myxoma presentation
symptoms of mitral valve obstruction, followed by embolic manifestations fever, fatigue, and weight loss Raynaud's phenomenon, arthralgia
46
Endocarditis Mx
IV antibiotics Sometimes valve debridement, repair, or replacement Dental evaluation and treatment Removal of potential source of bacteremia (eg, internal catheters, devices)
47
Endocarditis Cx
Complete heart block Acute valvular insufficiency causing heart failure Neurologic complications e.g. stroke, abscess, haemorrhage (mycotic aneurysm) Embolic complications causing infarction of kidneys, spleen or lung Infection e.g. osteomyelitis, septic arthritis
48
Abdominal aneurysm symptoms
usually asymptomatic till rupture epigastric pain radiating to back or hip pain if large or rapidly expanding AAA May compress surrounding structures – vague GI symptoms Gradual erosion of the vertebral bodies may cause non specific back pain Embolism of thrombus or atherosclerotic debris from the aneurysm sac may cause → acute ischaemia of lower limb
49
Rheumatic fever causative organism
group A beta-haemolytic streptococcal, typically streptococcus pyogenes causing tonsillitis
50
Rheumatic fever clinical presentation
occurs 2 – 4 weeks following infection Fever Joint pain Rash- Erythema marginatum (snake like, red, begins on trunks/arms, forms rings) Shortness of breath Chorea Nodules Murmurs from valvular heart disease, typically mitral valve disease
51
Rheumatic fever Ix
Throat swab for bacterial culture ASO antibody titres Echocardiogram, ECG and CXR
52
Rheumatic fever Ix
Throat swab for bacterial culture ASO antibody titres Echocardiogram, ECG and CXR
53
Jones Criteria for Diagnosis
evidence of recent streptococcal infection, plus: Two major criteria OR One major criteria plus two minor criteria Major Criteria: J – Joint arthritis O – Organ inflammation, such as carditis N – Nodules E – Erythema marginatum rash S – Sydenham chorea Minor Criteria: Fever ECG Changes (prolonged PR interval) without carditis Arthralgia without arthritis Raised inflammatory markers (CRP and ESR)
54
Rheumatic fever Tx
Tonsillitis caused by streptococcus should be treated with phenoxymethylpenicillin (penicillin V) for 10 days. Mx rheumatic fever involves - NSAIDs for joint pain - Aspirin and steroids are used to treat carditis - Prophylactic antibiotics
55
Risk factors that increase risk of arrhythmia in Brugada syndrome
Fever Excess alcohol intake Dehydration Medication anti dysrhythmics like flecainide verapamil antidepressants like amitriptyline Electrolyte abnormalities

Medicine (72 decks)

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