CARDIOLOGY Flashcards
TIA definition
Transient episode of neuro. deficit without infarct.
Not time-based but tissue-based.
TIA Fx
- Unilateral weakness or sensory loss
- Aphasia or dysarthria
- Ataxia, vertigo or loss of balance
- Visual problems
o Sudden transient vision loss
o Diplopia
o Homonymous hemianopia
TIA assessment + referral
- Immediate anti-thrombolytic therapy
o Aspirin 300mg
Unless:
1. Bleeding disorder or taking anticoagulant
2. Already on low dose aspirin
3. Aspirin is CI - More than 1 TIA, sus cardioembolic source or severe carotid stenosis:
o Discuss need for admission or obv urgently under stroke specialist - Sus TIA in <7days
o **Urgent assess (<24hrs) by specialist ** - Sus TIA >7days
o Refer asap <7days
Should not drive until seen by a specialist
TIA investigations
- Neuroimaging
o CT
o MRI (detect ischemia, haemorrhage or alternative path.) - Carotid imaging
o All urgent carotid doppler (carotid endarterctomy)
CT unless sus alterantive dx
MRI should be done on the same day as speci
TIA further mx
2nd prevention + carotid artery
- Antiplatelet
o Clopidogrel (if has stroke)
o Alternative: aspirin + dipyridamole - Lipid modification
o High-intensity statin (atorvastin 20-80mg) - Cartoid artery endarterectomy
o If stroke/ TIA in carotid territory
o Carotid stenosis >70%* or
o >50%**
*In accordance with European carotid surgery trialists collab group crit
Patent formale ovale (PFO)
FX, Affects, Complications, Associated heart abnormalities
- Hole in the heart connecting atriums - naturally closes shortly after birth
- Affects 1 in 4
- Normally no complications
o Some may include: SOB, migraines, low arterial blood O2 - No intervention unless heart problems
- Cardiac catheterisation
- Asso. atrial septal aneurysm, Chiari network
- Cause atrial septal defect
Patent ductus ateriosus (PDA)
DF, Commonly seen
Congenital heart defect
-
Extra blood vessel found before birth and after birth
o Normally shrinks and closes own it’s own after a few days (usually with first breaths*) - otherwise extra flow to the lungs - Common in premature, born at high altitiudes or maternal rubella infections
~Classed as “acyanotic”
- Uncorrected can result in late cyanosis in the lower extremities (differential cyanosis)
*Due to increased pulmonary flow enhances prostaglandins clearance
Patent ductus ateriosus (PDA) FX
Congenital heart defect
- Left subclavicular thrill
- Continous ‘machinery’ murmur
- Large volume, bounding, collapsing pulse
- Wide pulse pressure
- Heaving apex beat
Patent ductus ateriosus (PDA) MX
Congenital heart defect
-
Indomethacin or ibuprofen*
o To neonate- If ass. with another cong heart def - amendable surgery then prostaglanding E1 (to keep duct open until after surgical repair)
*Inhibitis prostaglandin synthesis - closes connection
Tetralogy of Fallot (TOF) PX and Characterstics
Most common cause of cyanotic heart disease
Congenital heart defect
PX
- 1-2M (up to 6M when picked up)
4 characteristics:
1. Ventricular spetal defect (VSD)
- Right ventricular hypertrophy
- Right ventricular outflow tract obstruction, pulmonary stenosis
- Overriding aorta
Tetralogy of Fallot (TOF) FX
CXR, ECG
Congenital heart defect
- Cyanosis
o ~develop ‘tet’ spells (tachypnoea, sever cyansosis - loss of consciouness) - Right - Left shunt
- Ejection systolic murmur (due to pul stenosis)
- Right sided aortic arch
- CXR: boot-shaped heart, ECG: R ventiruclar hypertrophy
TET ~ from crying or feeding
Tetralogy of Fallot (TOF) MX
- Surgical repair (~in 2 parts)
- Cyanotic episodes ~ helped with BB
- Acute Mx
o Knee to chest position
Congenital heart defect
