Cardiology 3 Flashcards
Which factors increase BNP levels?
Left ventricular hypertrophy Ischaemia Tachycardia Right ventricular overload Hypoxaemia (including pulmonary embolism) GFR < 60 ml/min Sepsis COPD Diabetes Age > 70 Liver cirrhosis
Which factors decrease BNP levels?
Obesity Diuretics ACE inhibitors Beta-blockers Angiotensin 2 receptor blockers Aldosterone antagonists
What are the complications of a ventricular septal defect?
aortic regurgitation* infective endocarditis Eisenmenger's complex right heart failure pulmonary hypertension: pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality
What are the ECG feature software hypokalaemia?
U waves small or absent T waves (occasionally inversion) prolong PR interval ST depression long QT
What are the features of complete heart block?
Syncope Heart failure Regular bradycardia (30-50 bpm) Wide pulse pressure JVP: cannon waves in neck variable intensity of S1
What are the types of heart block?
First degree heart block: PR interval > 0.2 seconds Second degree heart block type 1 (Mobitz I, Wenckebach): progressive prolongation of the PR interval until a dropped beat occurs type 2 (Mobitz II): PR interval is constant but the P wave is often not followed by a QRS complex Third degree (complete) heart block: there is no association between the P waves and QRS complexes
What is tetralogy of fallot?
The most common cause of cyanotic congenital heart disease*. Presents at around 1-2 months, although may not be picked up until 6 months
Characteristic features:
ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
Other features:
cyanosis
causes a right-to-left shunt
ejection systolic murmur due to pulmonary stenosis (the VSD doesn’t usually cause a murmur)
a right-sided aortic arch is seen in 25% of patients
chest x-ray shows a ‘boot-shaped’ heart, ECG shows right ventricular hypertrophy
What are the most common valvular dysfunctions secondary to heart failure?
Mitral regurgitation and tricuspid regurgitation
What ECG changes are seen in left ventricular hypertrophy?
increase in the amplitude of the R-waves in the leads corresponding to the left ventricle (1, aVL and V4-6). In addition, there will be an increase in the S wave depth in the right-sided leads (III, aVR, V1-3).
What are causes of secondary hypertension?
RENAL: Glomerulonephritis Chronic pyelonephritis Adult polycystic kidney disease Renal artery stenosis ENDOCRINE: Primary hyperaldosteronism Phaeochromocytoma Cushing's syndrome Liddle's syndrome Congenital adrenal hyperplasia (11-beta hydroxylase deficiency) Acromegaly OTHER: Glucocorticoids NSAIDs Pregnancy Coarctation of the aorta Combined oral contraceptive pill
What symptoms may a patient experience if they have very bad hypertension (>200/120)
headaches
visual disturbance
seizures
What are bundle branch blocks?
Complete block of a bundle branch is associated with a wide QRS complex (>0.12 s)with an abnormal pattern and is usually asymptomatic.
RBBB- normal healthy individuals, pulmonary embolus, right ventricular hypertrophy, ischaemic heart disease and congenital heart disease, e.g. atrial and ventricular septal defect and Fallot’s tetralogy
LBBB- aortic stenosis, hypertension, severe coronary artery disease and following cardiac surgery.
What are the clinical syndromes that present in heart failure?
Left ventricular systolic dysfunction (LVSD) (or heart failure and a reduced ejection fraction) – commonly caused by ischaemic heart disease, but can also occur with valvular heart disease and hypertension.
Right ventricular systolic dysfunction (RVSD) – occurs secondary to LVSD, with primary and secondary pulmonary hypertension, right ventricular infarction and adult congenital heart disease.
Diastolic heart failure (or heart failure with normal ejection fraction) – a syndrome consisting of symptoms and signs of heart failure but with a normal or near-normal left ventricular ejection fraction (above 45–50%) and evidence of diastolic dysfunction on echocardiography (e.g. abnormal left ventricular relaxation and filling, usually with left ventricular hypertrophy). This leads to impairment of diastolic ventricular filling and hence decreased cardiac output. Diastolic heart failure is more common in elderly hypertensive patients but may occur with primary cardiomyopathies.
What are the signs seen in heart failure?
Tachycardia Raised JVP Cardiomegaly with displaced apex beat Third and fourth heart sounds Bi-basal lung crackles Pleural effusion Ankle oedema (plus sacral oedema in bed-bound patients), Ascites Tender hepatomegaly.
What are the different types of angina?
Decubitus angina – occurs on lying down.
Nocturnal angina – occurs at night and may waken the patient from sleep.
Variant (Prinzmetal’s) angina – caused by coronary artery spasm and results in angina that occurs without provocation, usually at rest.
Unstable angina – increases rapidly in severity, occurs at rest, or is of recent onset (less than 1 month)
Cardiac syndrome X – patients with symptoms of angina, a positive exercise test and normal coronary arteries on angiogram. It is thought to result from functional abnormalities of the coronary microcirculation.
