Cardiology Flashcards
S1 - S2 heart sound?
systoli
S2-S1 heart sound?
Diastoli
s1s2 holosystole murmur?
s1s2 cresendo-decresendo murmur?
s1-s2 late cresendo murmur?
mitral regurgitation
aortic stenosis
mitral collapse
what is s1?
mitral closure
what is s2?
aortic closure
what is s3?
rapid ventricular filling blood in HF ventricular overload
what ia s4?
forcefull atrial contraction due to ventricular stiffness or hypertrophy
when can S1 split?
RBBB due to delayed mitral closure
what is split s2?
inspiration decrease pulmonary artery pressure and pulmonary valve stays open longer
steps in describing murmurs?
that sound like real proper quality instruments
- Timing in heart cycle
- Shape
- Location of max intensity and radiation
- Radiation site
- Pitch (high, medium, low)
- Quality (blowing, harsh, musical, rumbling)
- Intensity (Levine scale)
Symptomes of aortic stenosis?
SAD
syncope
angina
dyspnea
most common cause of aortic stenosis?
calcification due to age > 60
Most common cause of mitral stenosis?
ischemic heart disease: post MI MVP LV dilation Also rheumatic fever and infective endocarditis
Describe a mitral prolaps murmur
late systolic crescendo starting with a mid systole click
what can cause mitral valve prolapse?
primary or secondary to Marfan or Ehlers-Danlos syndrome or rheumatic fever
describe mitral stenosis murmur?
lade diastole, opening snap followed by crescendo murmur
how can you asses severity of mitral stenosis when listening to the murmur?
the shorter the s1 –> opening snap, the more severe
causes of mitral stenosis?
mostly a late consequence of RF
ortner syndrom is?
hoarseness due to left recurrent laryngeal nerve palsy caused by mechanical affection of the nerve from enlarged cardiovascular structures.
Define CVD?
give examples
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels
- coronary heart disease
- cerebrovascular disease
- peripheral arterial disease
- rheumatic heart disease – damage to the heart
- muscle and heart valves from rheumatic fever,
- caused by streptococcal bacteria;
- congenital heart disease
- deep vein thrombosis and pulmonary embolism
primary and secondary CVD prevention?
Primary: High risk people prevention - lifestyle
Secondary: already PAD, CHD, TIA - lifestyle and drugs
ankle-brachial index value comfirming PVD?
< 0.9
types of hypertrophic cardiomyopathies?
HOCM
HCM
The Venturi effect?
Due to LVOT obstruction by the septal hypertrophy the increased P during systoli pusher the anterior leaflet of the mitral valve towards the outflow of blood. this causes mitral regurgitation and mimics aortic stenosis murmur upon asculatiton
heart sound heard in HOCM?
S4 gallop
why should you not give digoxin in HOCM?
decrease N/K ATPase –> decrease Na/ca exchange and increases intracellular Ca –> increased contractility
diagnosis of hypertrophic wall thickness?
> 15mm (if above 30mm high risk of sudden cardiac death)
Acute heart failure types and definition?
Acute heart failure: rapid onset of new or worsening signs and symptoms of heart failure
Acute decompensated heart failure (ADHF): acute heart failure due to decompensation of preexisting disease/cardiomyopathy (most common)
De novo heart failure: acute heart failure occurring for the first time in a patient without known cardiomyopathy (∼15% of cases)
types of CHF
HFrEF
HFpEF
normal ejection fraction?
50-70% normal
40-49% moderate
<40% severe
what decides of it is a reduced ejection or preserved ejection fraction heart failure?
Diastolic failure: pEF
Systolic failure: rEF
valves mostly effected by endocarditis?
left side of the heart - aortic and mitral
intravenous drug use endocarditis mostly effect witch valve?
tricuspid
endocarditis janeway lesions?
detached vegitations causing septic emboli in the soles and palms of the hands, also under the nail
Endocarditis Osler nodules
Ig complex aggregations causing subcutaneous nodules
main difference between viridans, epidermidis and aureus?
- aureus causes acute IE and attack healthy valves
- epidermidis causes subacute IE and attack prostetic valves
- viridans causes subacute IE and attack predamaged valves
what valvular disease presents mostly in infectious endocarditis?
Regurgitations
If there is a fever of unknown origin and a new heart murmur what should you think?
endocarditis
feautures of infectious endacarditis? FROM JANE
Fever, Roth spots, Osler nodes, Murmur, Janeway lesions, Anemia, Nail bed hemorrhage, and Emboli.
criteria to clinically diagnose infectious endocarditis?
Dukes criteris
2 main
1 main 3 minor
5 minor
physiological pericardial fluid?
50ml
causes of pericarditis
idiopathic
cocxaci virus
Dresslers syndrom
Uremic pericarditis
Ecco in pericarditis?
shows heart dancing in the pericardium
what is the name of draining fluis?
centesis
ECG in pericarditis?
starts as PR depression with ST elevation
then progress to flat or inverted T wave
what is constrictive pericarditis?
due to fibrin buildup after acute pericarditis it causes decreased CO and increased HR
what should you not give in restrictive pericarditis?
Beta blockers and calcium channel blockers should be avoided in constrictive pericarditis, as they may worsen heart failure by slowing a compensatory tachycardia!
pharmacology in pericarditis?
NSAIDS (asprin, ibuprofen)
Prednisone (Glucocorticoid antiinflammatory)
normal aortic opening?
3-4 cm2
Stenosis can be 1cm2
difference between mechanical aortic stenosis vs RF stenosis?
commissural fusion where the root of the valves fuse together
what type of anemia can aortic stenosis cause?
microangiopathic hemolytic anemia leading to chistocytes and hemoglobinuria
what does the heart do when there is decreased SV?
increases heart rate thus shorter diastole, this means less coronary filling time and decreased oxygen to the heart
what is pulse pressure?
difference between systolic and diastolic witch is normally 30-40 mmHg (S-D)
what can mimic mitral stenosis?
endocarditis with mitral vegitations atrial myxoma (neoplasia)
normal mitral valve area?
4-6cm2
below 1.5 is severe stenosis
seen on TTE
best diagnosis for mitral stenosis?
TTEcco
types of hypertention
Primary - no known cause
Secondary - due to underlying cause
what is hypertensive crisis?
Systolic > 180
Diastolic > 120
HT emergency (end organ failure)
what is defined as Hypertension by 2020 ACC/AHA?
140/90
what is resistant hypertension?
hypertension that remains uncontrolled (≥ 130/80 mm Hg) despite treatment with ≥ 3 anti hypertensives OR requires ≥ 4 medications to be controlled
what is ambulatory BP management?
The periodic measurement of blood pressure via a portable sphygmomanometer while a patient carries out routine daily activities. Typically obtained across a 24-hour period.
what is home BP measurment?
The self-measurement of blood pressure by a patient at periodic intervals outside of a clinical setting. May be used to confirm the diagnosis of hypertension and monitor anti hypertensive treatment.
thiazide diuretic?
hydrochlorothiazide
dihydropyridin CCB?
Nifedipine
Amlodipine
Non Dihydropyridine CCB?
Verapamil
Diltiazem
epithelial sodium channel blocker?
Amiloride
aldosteron antagonists?
Spironolactone
eplerenon
Direct peripheral vasodilators? which is good for pregnancy?
Hydralazine (pregnancy)
Minoxidil
causes of secondary hypertension?
renal artery stenosis cushings Conn's estrogen hyperthyroidism aorta coarctation
the main drug groups in HT treatments?
Thiazides CCB ACEI ARB B-blockers
earliest sigh of hypertension on heart?
S4 due to LV hypertrophy
mechanical valve drugs?
Warfarin + Aspirin lifelong
when is UFH usefull to give a patient?(11)
DVT PE ACS artificial valve thrombosis only drug safe for pregnancy ECMO PCI TAVI PVI ASD Afib
what must be monitored when giving UFH?
aPTT 25-39s
this is the intrinsic pathway bleeding time
what is PT time?
measure extrinsic pathway time - 12 sec
what are NOAC and DOAC?
they mean the same Non-vit K oral anticoagulants Direct oral anticoagulants they inhibit F10 and F2 also calles Noval oral anti coagulants
What is ischemic heart disease?
It’s the term given to heart problems caused by narrowed heart arteries.
drug used in pharmacological stress test?
Dobutamin
Holter montoring?
A continuous, ambulatory, battery-operated ECG recorder worn for 24–48 hours
extracardiac provoking factors of angina?
anemia hyperthyroidism HT fever hypoxemia