Cardiology Flashcards
What is Beckβs triad and what does it indicate?
Cardiac tamponade; falling BP, rising JVP and muffled heart sounds
- Can also look for: pulsus paradoxys, electrical alternans
What is diagnosis and what artery is likely affected: chest pain, pale, bradycardia and hypotensive?
CHB post MI due to RCA occlusion
- RCA supplies AV node
What is TTE criteria for HCM?
β’ >15mm hypertrophy in any LV region, or
β’ 13-14mm in person with 1st degree relative with HCM
If LVOT gradient <50mmHg > perform with provocative measures > if nil outflow gradient > exercise echo > if inconclusive, the cardiac MRI
Conditions with increased LV wall thickness
Major RF for sudden cardiac death in HCM
Drugs to avoid in HOCM
β’ Vasodilating BB - cardiology, labetalol, nebivolol
β’ Avoid diuretics if able
β’ Avoid nitrates and phosphodiesterase-5 inhibitors e.g. sildenafil > exacerbate LVOT obstruction
Persistent ST elevation following recent MI, no chest pain suggests?
LV aneurysm
The ischaemic damage sustained may weaken the myocardium resulting in aneurysm formation. This is typically associated with persistent ST elevation and left ventricular failure. Thrombus may form within the aneurysm increasing the risk of stroke. Patients are therefore anticoagulated.
What BB is good for HOCM?
Non-vasodilating
- Metoprolol, propranolol, atenolol, sotolol
Alternatives if BB contraindicated
- Verapamil
- Diltiazem
HOCM what is most common murmur
Similar to AS but nil radiation to carotids; exacerbated with Valsalva or squatting
MITRAL REGURGITATION
Most common type of ASD?
Ostia secundum
Rarely genetic; if present, familial ostium secundum may be AD or linked to chromosome 5
Most common congenital heart defects associated with Down syndrome?
Atrioventricular septal defects, incl. ostium primum ASD
Most common type of VSD?
Membranous VSD
- Usually isolated anomaly
Ebsteinβs anomaly associations?
Ebsteinβs anomaly is a congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle. It is sometimes referred to as βatrialisationβ of the right ventricle.
Ebsteinβs anomaly may be caused by exposure tolithiumin-utero.
Associations
β’ Patent foramen ovale (PFO) or atrial septal defect (ASD) is seen in at least 80% of patients, resulting in a shunt between the right and left atria
β’ Wolff-Parkinson White syndrome
Clinical features
β’ Cyanosis
β’ Prominent βaβ wave in the distended jugular venous pulse
β’ Hepatomegaly
β’ Tricuspid regurgitation
β’ Pansystolic murmur, worse on inspiration
β’ Right bundle branch block β widely split S1 and S2
Deficiencies in what can lead to dilated cardiomyopathy?
Chronic deficits in thiamine, carnitine, selenium, niacin, taurine and Coenzyme Q10 in the myocardial tissues have already been associated with alterations in myocardial energy production, calcium balance or oxidative defences
Features of severe aortic stenosis?
Management
if asymptomatic then observe the patient is a general rule
if symptomatic then valve replacement
if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
options for aortic valve replacement (AVR) include:
surgical AVR is the treatment of choice for young, low/medium operative risk patients. Cardiovascular disease may coexist. For this reason, an angiogram is often done prior to surgery so that the procedures can be combined
transcatheter AVR (TAVR) is used for patients with a high operative risk
balloon valvuloplasty
may be used in children with no aortic valve calcification
in adults limited to patients with critical aortic stenosis who are not fit for valve replacement
Most common genetic markers for HOCM?
MYH7 and MYPBC3
What is a classical finding on cardiac histology in rheumatic fever?
Aschoff bodies are granulomatous nodules found in rheumatic heart fever
Most specific finding in VT?
AV dissociation (more specific than capture beats)
Which ARB are best for CCF
Valsartan, candesartan, losartan
Permanent treatment of atrial flutter?
Radiofrequency ablation of the tricuspid valve isthmus
Which anti-Plt associated with bradycardia?
Ticagrelor
High risk syncope?
Good ARB for CCF?
Valsartan, losartan, candesartan
Which drug most reduces mortality in CCF?
Metoprolol XR > MRA > ACE/ARB
Epsilon waves seen in inferior leads makes you think?
ARVC
Brugada ECG
This ECG abnormality must be associated with one of the following clinical criteria to make the diagnosis:
Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).
Family history of sudden cardiac death at <45 years old .
Coved-type ECGs in family members.
Inducibility of VT with programmed electrical stimulation .
Syncope.
Nocturnal agonal respiration.
High risk cardiac conditions to consider dental prophylaxis?
Basically previous IE, unrepaired congenital heart defects or anything foreign to body (NB balloon valvuloplasty etc. does not count)
Pressure volume loops with valvular heart disease
Anti-arrhythmic medication classes
β’ I Na - procainamide, lignocaine, flecainide
β’ II: BB
β’ III - potassium: sotolol, amiodarond
β’ IV: calcium channel: verapamil, diltiazem
