Cardiology Flashcards
what are some signs of aortic stenosis?
narrow pulse pressure
slow rising pulse
ESM murmur loudest on expiration
soft S2 + S4
what are some causes of aortic stenosis?
age related calcification
bicuspid valve - turners
rheumatic heart disease
what are some general management options for valvular disease?
MDT approach - cardiologist
QRISK - statin and antiplatelete
Manage HTN, angina etc
what are some signs of atrial regurgitation?
Beckers sign - pulsating retinal artery
Mullers - pulsating uvula
De Mussets - nodding head
Quinkes - pulsatile nail beds
Corrigans - carotid pulsation
Traube - pistol shot femoral
what are some cardiac signs of aortic regurg?
wide pulse pressure
soft S2 + S3
displaced apex beat
Early diastolic murmur
what are some causes of aortic regurg?
Chronic - bicuspid aorta, RHD, autoimmune (RhA, ankylosing spondilysis), connective tissue disease
Acute - IE, aortic dissection
what is the management of aortic regurg?
General
Medical - ACEi, BBlocker, diuretics
Surgical
what are some signs of mitral stenosis?
malar flush
irregular pulse (AF)
loud S1
Mid diastolic murmur
what is the management of mitral stenosis?
RAD
RF prophylaxis - benzylpenicillin
AF prophylaxis - rate control + DOAC
Diuretic
severe - surgical ballon valvuloplasty
what are some signs for mitral regurg?
irregular pulse AF
displaced apex beat
pansystolic murmur
soft S1
what are some causes of mitral regurg?
chronic - mitral valve prolapse, RHD, calcifications, CDT
Acute - IE, IHD (post MI)
what is the management for mitral regurg?
reduce afterload - ACEi, BB, diuretic
AF prophylaxis - rate control +DOAC
what is the management for heart failure?
BASHed up heart
- Beta blocker
ACEi - Spironolocatone
- Hydralazine
Digoxin
what is the first line investigation for angina?
CT coronary angiogram to determine calcium score
non invasive functional testing - stress echo
what is the management of stable angina?
- GTN, BB or CCB (verapamil RL)
- GRN, BB and CCB (amlodipine NRL)
- long acting nitrate - isosorbide mononitrate
what are some causes of AF?
IHD, hyperthyroidism, MS, MR, bronchial cancer, alcohol, PE, infection
when do you rhythm control AF?
heart failure, new onset, reversible cause
how do you rhythm control AF?
- anticoagulate 3 weeks before electrical cardioversion and 4 weeks after
- chemical cardioversion - flecanide
how do you rate control AF?
- BB or rate limiting CCB verapimil
- digoxin
- amiodarone
when do you anticoagulate someone with AF?
according to CHADSVASc score >2 in female or >1 in male
use apixaban
what is the CHADSVASc score?
CHF
HTN
Age >75 2 points
Diabetes
Stroke - 2 points
Valvular disease
Age 65-74
Sex
how do you manage sever HTN?
180/110
ECG, urine dipstick, blood test
- if positive then start anti hypertensives
- if neg then repeat BP in 7 days
what is used first line in diabetic hypertensive pts?
ACEi (if afro-caribbean then use ARB candesartan)
what are some side effects of ACEi?
angiodema (4weeks)
cough
elevated K+
1st dose = low BP
what is the management ladder for HTN?
diabetic or <55yr
1. ACEi
2. CCB + ACEi
3. CCB+ACEi+ thiazide like diuretic
AC or >55yrs
1. CCB
2. CCB + ACEi
3. CCB + ACEi + thiazide diuretic
also start atorvastatin 20mg if CKD/T1DM or 80mg if PMH stroke or PVD
what monitoring is required for HTN meds?
ACEi - U&E before and during
- increase in creatinine of up to 30% is acceptable
- increase in K+ up to 5.5 is okay (more than that STOP)
no thiazides in CKD 4/5, DM, SLE, gout
which valves are normally affected in infective endocarditis?
normal valves - mitral
IVDU - tricuspid
what are some causes of IE?
staph aureus
staph viridans
staph epidermis
what is the dukes criteria?
2 major OR 1 major and 3 minor OR 5 minor (BE FEVER)
Bacterial culture 2, 12 hours apart
ECHO
Fever
ECHO findings
Vascular - janeway lesions, splinter haemorrhage, emboli
Evidence of microbacteria - only 1 culture needed
Risk factor - IVDU
what are some signs and symptoms of I?
FROM JANE
Fever
Roth spots
Oslers nodes
Murmur new onset
Janeway lesions
Anaemia
Nail haemorhages - splinter
Emboli
what is the management for IE?
IV benzylpenicillin 6 weeks
what is the Jones criteria for RHD?
- Evidence of group A strep infection AND
positive throat swab
step antigen +ve
ISO titre
2 Majors
Carditis
Arthritis
Subcut nodules
Erythema marginatum
Sydenham chorea
1 Major and 2 minors
Fever
Raised CRP
Arthralgia
Prolonged PR
Previous RF
how do you manage RHD?
bed rest until CRP normalises (usually 2 weeks)
analgesia - nsaids
phenoxymethlypenicillin
what is seen on biopsy for HOCM?
myofibrillar hypertrophy with chaotic and disorganised myocytes
what is seen on examination of HOCM?
jerky pulse
cannon A waves
ESM
or PSM of mitral regurg
how do you manage HOCM?
Amiodarone
Beta blocker
Cardioversion
Dual chamber pacemaker
Endocarditis prophylaxis
