Cardiology Flashcards
Sx AAA
Epigastric pain to back which is constant or intermittent
Risk factor AAA
old men and marinas
when should you treat AAA
when >5.5cm - surgery
what is a MI
atherosclerotic plaque in coronary artery ruptures = occlusion of vessel
Sx ACS
- Central/left sided chest pain
- Pain to jaw or left arm
- Sweating
- N and V
treatment for ACS (not STEMI)
- Morphine
- Oxygen (if <94%)
- Nitrates
- Aspirin
Treatment for STEMI
MONA + clopidogrel + PCI
sx pericarditis
- Chest pain better on sitting forwards
- Cough + dyspnoea
- Pericardial rub
- Tachycardia
- ECG: ‘saddle-shaped’ ST elevation and PR depressiom
causes of pericarditis
coxsackie, TB, trauma, Marfan’s
treatment pericarditis
treat underlying cause
NSAIDs and colchicine for relief
angina treatment
statin + GTN + aspirin
CCB and B blocker
Difference between AA rupture and aortic dissection pathophys
AAA is tunica media, dissection is intima and forms new lumen
sx aortic dissection
- Severe/tearing chest pain
- Back pain
- Weak pulses
- Aortic regurgitation
Ix aortic dissection
CXRL wide mediastinum, CT angiogram
tx aortic dissection
beta blockers
cause of sudden cardiac death
arrythmogenic right ventricular cardiomyopathy
final step in atherosclerosis formation
smooth muscle from media to intima
ti which wave is cardioversion synched?
R wave
what happens if pt does not respond to 3x shocks
adenosine 300mg
sx AF
- Palpitations
- Dyspnoea
- Chest pain
treatment AF
B blockers for rate control
if at high risk of stroke what do you give in AF
DOAC - apixaban
treatment unstable AF
If unstable can cardiovert but if this fails after 3 times then give 300mg adenosi
ECG atrial flutter
sawtooth
most common primary cardiac tumour
Atrial myxoma
type 1 heart block
long PR >0.2 seconds
Type 2 mobitz 1 heart block
Progressively longer PR until drop QRS
Type 2 mobitz 2 heart block
PR constant with random drop of beat
type 3 heart block
no association between P and QRS
what do high levels of BNP indicate
heart failure
where and when is BNP produced?
LV in response to strain
functions of BNP
diuretic and vasodilator
what is Brugada syndrome
Common cause of cardiac death, issue with cardiac sodium Chanels
Treatment of brugada syndrome
cardioverter-defibrillator
what is cardiac tamponade
accumulation of pericardial fluid under pressure
sx cardiac tamponade
- Muffled heart sounds
- Increased JVP
- Hypotension
- Absent Y on JVP (TAMponade = TAMpaX)
Treatment tamponade
pericardiocentesis
coagulative necrosis
organs digested by macrophages
sx heart failure
- Dyspnoea
- Breathless on lying flat
- Fatigue
- Oedema
- Raised JVP
most common cause of heart failure
ischaemic heart disease
treatment heart failure
ACEi and B-blocker followed by aldosterone antagonist
treatment acute heart failure
loop diuretics +/- oxygen +/- nitrates
how does digoxin work
acts sats sodium potassium ATPase pump to increase intracellular calcium = increased contractility
during which part of the cardiac cycle do coronary arteries fill
diastole
venous drainage of the heart
coronary sinus -> RA
blood supply to heart
right aortic sinus -> RCA -> posterior descending including SAN and AVN
left aortic sinus -> LCA -> LAD and LCX
common cause of axis deviation
Wolff-Parkinson- White
most common type of cardiomyopathy
dilated cardiomyopathy
causes of dilated cardiomyopathy
Coxsackie/HIV
Ischaemic heart disease
muscular dystrophy
pathophysiology dilated cardiomyopathy
- Dilated heart = premature systolic dysfunction
- All4 chambers dilated but L>R
signs of dilated cardiomyopathy
systolic murmur + s3 + balloon on CXR
what are xanthelasma
yellowish papules and plaques caused by localized accumulation of lipid deposits commonly seen on the eyelid - surgically excise
treatment for hypertension for <55 or T2DM
A
A+C or A+D
A+C+D
treatment for hypertension if >55 without T2DM or afro/caribbean
C
C+A or C+D
A+C+D
causes of orthostatic hypertension
A_BLOCKERS
mx orthostatic hypertension
midodrine and fludrocortisone
pyoderma gangrenous associations
AI disease
which ulcers are assodictaed with diabetes
neuropathic - plantar surface of foot
arterial ulcers features
anterior shin, heel and toes, painful, cold and no pulse - ‘punched out’ appearance
venous ulcers features
due to hypertension, located above ankle, use compression banding for mx
cardiac condition associated with Kawasaki
coronary artery aneurysm
what is infective endocarditis
Caused by staph aureus normally - in acute presentation and intravenous drug users
Strep viridians is associated with dental health
sx infective endocarditis
fever/murmur
splinter haemorrhages
haematuria
splenomegaly
laneway lesions
Osler’s nodes
tx endocarditis
flucloxacillin
difference between Janeway lesions and Osler’s nodes
Janeway lesions are painless
what does JVP measure?
pressure in RA
meaning of each JVP wave
A = RA contraction
X = relaxation of atria
C = RV contraction, tricuspid bulges into RA
X = RV contraction (atria expand)
V = RA filling
Y = opening of tricuspid
No A waves
AF
Large A waves
RV hypertrophy
large V waves
tricuspid regurgitation
why does the ductus arteriosus close after birth?
reduced PGE2 levels
treatment for patent ductus arteriosus
ibuprofen = decreased prostaglandin synthesis
what does DA connect
pulmonary artery to aorta
normal flow of blood
- Placenta
- Body
- Vena cava
- RA
- RV
- Pulmonary artery
- Lungs
- Pulmonary vein
- LA
- LV
- Aorta
sx PDA
- Machinery murmur
- Large volume, collapsing pulse
- Heaving apex beat
which sided shunt is PDA
l to r
patent foramen ovale
blood passes from RA to LA
intermittent claudication
intermittent claudication: aching or burning in the leg muscles following walking
patients can typically walk for a predictable distance before the symptoms start
usually relieved within minutes of stopping
not present at rest
statin treatment for CVD
atorvastatin 80mg
treatment for peripheral arterial disease
statin + clopidogrel
definition of pulmonary arterial hypertension
mean pulmonary artery pressure of >25
sx pulmonary hypertension
- Exertional dyspnoea
- Syncope, chest pain
- Peripheral oedema
- Cyanosis
tx pulmonary hypertension
vasodilators
sx PE
- Pleuritic chest pain
- Dyspnoea
- Haemoptysis
- Tachycardia
What is S1Q3T3
large S wave in lead 1, large Q wave in lead 3 and inverted T wave in lead 3
for PE
Ix PE
CTPA - interim coagulant is DOAC
Tx PE
DOAC >3m
how to differentiate between COPD and heart failure
heart failure has orthopnoea
causes of long QT
hypokalaemia
hypocalcaemia
amoidarone
TCA
macrolides
cardiac side effect of Friedrich’s ataxia
hypertrophic obstructive cardiomyopathy
where does the aorta rupture due to trauma
bifurcation (thoracic) aorta
Torsades de pointes ECG
‘twisting’ around baseline and long QT
management torsades de pointes (long QT)
magnesium sulphate
how quickly do you want to do PCI
<120 mins
treatment for AF if haemodynamically unstable
cardioversion
what is transposition of great arteries
Aorta leaves RV and pulmonary trunk leaves LV
sx transposition of great arteries
cyanosis
tachypnoea
loud S2
“egg-on-side’ CXR
mx transposition of great arteries
prostaglandins to keep DA open -> surgery
what are varicose veins
Superficiel veins that occur secondary to incompetent valves - most commonly in legs
mx of varicose veins
ablation
what is wolff-parkinson white syndrome
Accessory conducting pathway between atria and ventricles = atrioventricular re-entry tachycardia → can rapidly degenerate to VF
ECG changes wolff-parkinson white
- Short PR
- Wide QRS with delta wave
- Opposite side deviation to the accessory pathway formed
what is a ventricular septal defect?
hole between ventricles, due to down’s/edward’s/patau’s
Pathophys Eisenmenger’s complex
LHS is at higher pressure which causes L→R shunt
Over time, this causes pulmonary hypertension
Pulmonary hypertension can cause right side to be at higher pressure than left so causes R→L shunt (Eisenmenger’s complex, causes cyanosis and clubbing)
Sx VSD
- Failure to thrive
- Hepatomegaly
- Tachycardia
- Pallor
- Pan-systolic murmur
four components of tetralogy of fallot
- Ventricular septal defect
- Right ventricular hypertrophy
- Right ventricular outflow tract obstruction
- Overriding aorta
pathophys tetralogy of allot
narrow RV outflow means RV hypertrophies to overcome this stenosis. This pressure, in addition to VSD created a R->L shunt (cyanosis and clubbing). The aorta overrides and moves position to maximise outflow
What is Dressler’s syndrome?
post-MI pericarditis from autoimmune reaction to antibodies
sx Dressler’s syndrome
pleuritic chest pain, fever, pleuritic rub
mx Dressler’s syndrome
aspirin and ibuprofen
how to treat heart blocks/BBB
pacemaker - stop BB/CCb
boot shaped heart
tetralogy of fallot
batwings and Kelley B lines
heart failure
left sided heart failure
LV failure due to ischaemia and fatigue leads to decreased CO, sx include pulmonary oedema and breathlessness, coarse crackles, raised JVP and S3
right sided heart failure
Peripheral oedema, increased JVP, S3, weight gain and fatigue
cor-pulmonale
RSHF secondary to respiratory cause like COPD
congestive HF
L and R failure - breathlessness and peripheral oedema
gold standard for dignosing angina
ct coronary angiogram
hypertrophic obstructive cardiomyopathy
thicker walls of LV mean it is harder to pump blood out (heart failure)
Obstruction of LV outflow tract gives you crescendo-decrescendo murmur - similar to aortic stenosis - because blood struggles to get out
valsalva manoeuvre means reduced preload so ventricle not stretched as much so murmur louder
what are the shockable rhythms?
VF and pulseless VT
how often can you give adrenaline?
3-5 mins
sawtooth appearance ECG
atrial flutter
tx unstable atrial flutter
synchronised DC cardioversion
tx stable atrial flutter
rate control - BB or CCB if asthma
mx wolff parkinson white
catheter ablation of accesssory conduction pathway
short PR, wide QRS, pre-excitation and delta wave
WPW syndrome
how to differentiate VF and VT ecg
VT looks more regular, with same baseline
tx VF
shock - unsynchronised cardioversion
how to treat tornadoes du pointes
magnesium sulphate
what bp for dc cardioversion?
diastolic <60
tx pathway for regular, narrow QRS
Vagal maneouvres
IV adenosine 6mg
IV adenosine 12mg
IV adenosine 18mg
BB/verapamil
DC shock
tx pathway for irregular, narrow QRS
BB/CCB if asthma
Digoxin/amiodarone
Anticoagulant
tx pathway regular, broad QRS
VT: amiodarone
DC shock
maximum dose atropine
3mg - 6x 500mcg dose
treatment for bradycardia if life threatening sx - shock/syncope/MI etc
IV atropine 500mcg
no PR elongation followed by drop
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