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Medicine > Cardiology > Flashcards

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
Q

IE cause when there is poor dentition

A

Strep Viridans

26
Q

IE cause linked with CRC

A

Strep bovis/gallolyticus are linked with CRC so patients should have a scope.

27
Q

Osler nodes

A

painful erythematous subcutaneous nodules on the tips of digits

28
Q

Janeway lesions

A

nontender hemorrhagic macules on the palms or soles

29
Q

Mnemonic for the signs and symptoms of endocarditis is “FROM JANE”:

A

Fever
Roth’s spots
Osler’s nodes
Murmur
Janeway lesions
Anemia
Nail hemorrhage (splinter hemorrhages)
Emboli

30
Q

Endocarditis Ix

A

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
Q

Major dukes diagnostic criteria include

A

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
Q

Minor dukes criteria include:

A

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
Q

Endocarditis dx

A

Diagnosis is made on 2 major, 1 major/3minor or >5 minor criteria.

34
Q

Endocarditis Mx

A

IV antibiotics
Sometimes valve debridement, repair, or replacement
Dental evaluation and treatment
Removal of potential source of bacteremia (eg, internal catheters, devices)

35
Q

Endocarditis Cx

A

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
Q

Chest x-ray findings in heart failure

A

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
Q

Pericarditis triad

A

chest pain, pericardial friction rub, and serial electrocardiographic changes.

38
Q

Causes of pericarditis

A

Idiopathic
Viral infections
Systemic autoimmune disorders
post-MI syndrome called dressler syndrome

39
Q

Causes of pericarditis

A

Idiopathic
Viral infections
Systemic autoimmune disorders
post-MI syndrome called dressler syndrome

40
Q

Symptoms of pericarditis

A

chest pain - retrosternal, pleurite, stabbing, relief with sit-up /leaning forward
Fever
Myalgia/malaise
Dyspnoea

41
Q

Signs of pericarditis

A

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
Q

Pericarditis Ix

A

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
Q

Pericarditis Dx

A

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
Q

Pericarditis Tx

A

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
Q

Atrial myxoma presentation

A

symptoms of mitral valve obstruction, followed by embolic manifestations
fever, fatigue, and weight loss
Raynaud’s phenomenon, arthralgia

46
Q

Endocarditis Mx

A

IV antibiotics
Sometimes valve debridement, repair, or replacement
Dental evaluation and treatment
Removal of potential source of bacteremia (eg, internal catheters, devices)

47
Q

Endocarditis Cx

A

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
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

49
Q

Rheumatic fever causative organism

A

group A beta-haemolytic streptococcal, typically streptococcus pyogenes causing tonsillitis

50
Q

Rheumatic fever clinical presentation

A

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
Q

Rheumatic fever Ix

A

Throat swab for bacterial culture
ASO antibody titres
Echocardiogram, ECG and CXR

52
Q

Rheumatic fever Ix

A

Throat swab for bacterial culture
ASO antibody titres
Echocardiogram, ECG and CXR

53
Q

Jones Criteria for Diagnosis

A

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
Q

Rheumatic fever Tx

A

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
Q

Risk factors that increase risk of arrhythmia in Brugada syndrome

A

Fever
Excess alcohol intake
Dehydration
Medication
anti dysrhythmics like flecainide
verapamil
antidepressants like amitriptyline
Electrolyte abnormalities

Medicine (72 decks)

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