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Year 3 Revision > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what are the causes of left heart failure?

A

ischemic heart disease
hypertension
valvulopathy
idiopathic cardiomyopathy

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2
Q

what are the causes of right heart failure?

A

left heart failure
cor pulmonale
tricuspid valvulopathy
left to right shunts

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3
Q

what are some precipitants of heart failure?

A

ischemia
infection
anemia
arrythmia

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4
Q

what is the MADHATTER3P mneumonic of heart failure?

A 
Myocardial infarction 
Anemia
Drugs (NSAIDs, negative inotropes, compliance) 
Hypertension
Arrythmia 
Thyrotoxicosis or hypothyroidism 
Temperature 
Endoarditis/eclempsia 
Renal failure/rupture of chordae 
3P: PE, peri-operative, pregnancy
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5
Q

what is the NYHC classification of heart failure?

A 
class 1: diagnosed but w/ symptoms 
class 2: symptoms upon exertion 
class 3: symptoms upon normal activity 
class 4: symptomatic at rest
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6
Q

what the symptoms of LHF vs RHF?

A

LHF: SOB, PND, orthopnea, chronic cough w/ pinkish sputum
RHF: ankle swelling, abdominal fullness, RUQ pain/tenderness, nausea

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7
Q

what are the signs of LHF vs RHF?

A

LHF: displaced apex beat, bibasal fine crackles
RHF: elevated JVP, peripheral oedema, congestive hepatomegaly
S3 = volume overload, S4 = pressure overload (diastolic heart failure)

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8
Q

what are the signs found on the CXR?

A 
A: alveolar oedema (bat wings) 
B: kerley B lines 
C: cardiomegaly 
D: upper lobe diversion 
E: pleural effusion
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9
Q

what are the signs found on the CXR?

A 
A: alveolar oedema (bat wings) 
B: kerley B lines 
C: cardiomegaly 
D: upper lobe diversion 
E: pleural effusion
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10
Q

what is the treatment of acute decompensated HF?

A 
DRABC 
stabilize patient
LMNOP (in reverse): 
sitting upright posture, O2 supplmentation 15L/min via mask, GTN sublingual every 5 minute up to 3X, moprhine 1.5 -2 mg IV, furosemide 40 - 100mg bolus IV 
correct any precipitants
monitor fluid status, sats, RR, ABG
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11
Q

what is the treatment of acute decompensated HF?

A 
DRABC 
stabilize patient
LMNOP (in reverse): 
sitting upright posture, O2 supplmentation 15L/min via mask, GTN sublingual every 5 minute up to 3X, moprhine 1.5 -2 mg IV, furosemide 40 - 100mg bolus IV 
correct any precipitants
monitor fluid status, sats, RR, ABG
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12
Q

what is the non pharmaceutical treatment for chronic HF

A 
salt restriction (2mg/day) and water restriction (2L/day) 
smoking cessation 
weight loss and diet modification 
limit caffeine 
daily weigh monitoring 
immunization
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13
Q

pharmaceutical treatment for chronic HF?

A

nyh1=ACE-I
nyh2= ACEI + BB
nyh3= ACEI + BB + spiro
nyh4 = ACEI + BB + spiro + digoxin

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14
Q

what are the s.e of digoxin?

A 
yellow vision
digoxin toxicity (reverse tick on ECG)
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15
Q

what are the s.e of spironolactone?

A 
painful gynecomastia (can change to eplenorone) 
hyperkalemia
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16
Q

what are the cardioselective beta blockers?

A

metoprolo, bisoprolol, nebivolol, carvedilol

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17
Q

what are the indications for BiV PPM for heart failure?

A

class 3, 4 NYHF, LVEF

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18
Q

what are the indications for cardiac defibrillator?

A

LVEF 3 months after CABG, LVEF

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19
Q

what are the indications for cardiac defibrillator?

A

LVEF 3 months after CABG, LVEF

20
Q

what are the indications for BiV PPM for heart failure?

A

class 3, 4 NYHF, LVEF

21
Q

what are the indications for cardiac defibrillator?

A

LVEF 3 months after CABG, LVEF

22
Q

59/M gradually worsening CP over days, 2/24 Hx of central squeezing CP, occurred at rest, worse with exertion, Hx of IHD (previous MI with PCI), HTN, HLD, father and brother died from AMI; ECG shows sinus rhythm, trops and CK-MB normal

A

unstable angina

23
Q

75/M increasingly frequent episodes of dizziness on standing; O/E slow rising pulse, systolic murmur radiating to carotids

A

aortic stenosis

24
Q

24/F sudden sharp central CP, aggravated by movement, respiration and lying, relieved by sitting forward; vitals stable; ECG shows diffuse ST elevation

A

pericarditis

25
Q

27/M gradual worsening SOB over 2/7, now SOB at 50m, a/w orthopnoea, PND; ECG and trops normal, TTE shows 4 chamber enlargement, EF 25%, normal valves and wall thickness

A

dilated cardiomyopathy

26
Q

45/F, previously well, 1/52 Hx of fevers, SOB, palpitations; O/E pansystolic murmur radiating to axilla, Roth spots on fundoscopy, urine dipstick blood 2+; ECG shows complete heart block

A

infective endocarditis

27
Q

22/M central CP while playing football; O/E ESM over left sternal edge; ECG shows LVH; he remarked that his uncle had died suddenly at 25yo on the football field

A

HOCM

28
Q

22/M central CP while playing football; O/E ESM over left sternal edge; ECG shows LVH; he remarked that his uncle had died suddenly at 25yo on the football field

A

HOCM

29
Q

what is the diagnostic criterion of myocardial infarction?

A

typical rise and fall of cardiac biomarker w/ at least one of the following:
clinical symptoms of ischemia
ecg ST elevation or new LBBB
pathological q waves
imaging evidence of loss of viable myocardium or new regional wall motion abnormality

30
Q

what is the diagnostic criterion of myocardial infarction?

A

typical rise and fall of cardiac biomarker w/ at least one of the following:
clinical symptoms of ischemia
ecg ST elevation or new LBBB
pathological q waves
imaging evidence of loss of viable myocardium or new regional wall motion abnormality

31
Q

what are the ECG and biomarker changes of ACS?

A

unstable angina - no trops raise, pain at rest, no ecg change
NSTEMI -

32
Q

what are top causes of aortic stenosis

A

rheumatic heart disease
calcific disease
congenital bicuspid valve/unicuspid valve

33
Q

what are some features of acute rheumatic heart disease?

A

ashkoff bodies, ooooo??

34
Q

what are the symptoms of aortic stenosis?

A

SAD on exertion

syncope comes first, and angina comes last

35
Q

what are some findings of aortic stenosis

A 
plateau pulse 
narrow pulse pressure 
non displaced apex beat 
heaving apex beat (pressure overload) 
presence of S4
36
Q

what are the ausculatation findings of AS

A

beast heard RHS 2nd intercosatal space parasternal
ejection sytolic crescendo decrescendo
s4 heart sound

37
Q

what are the severity findings of AS

A

paraodoxical splitting of s2
absent a2
grade 4 intensity
late peaking

38
Q

what are the severity findings of AS

A

paraodoxical splitting of s2 (prolonged LV ejection time)
absent a2
grade 4 intensity
late peaking

39
Q

what are some findings of AS on echo

A

thickened/calcifeid leafelts with reduced excursion

LV chamber normal size but concentrically hypertorphied

40
Q

what are some findings of AS on echo

A

thickened/calcifeid leafelts with reduced excursion

LV chamber normal size but concentrically hypertorphied

41
Q

what is the voltage criteria for ECG for LVH

A

s wave in v1 and tallest r wave in v5/v6 > 25 mm

42
Q

what are the indications for AS surgical repair?

A

severe on echo + symptomatic

severe on echo + LVEF

43
Q

what are the indications for AS surgical repair?

A

severe on echo + symptomatic

severe on echo + LVEF

44
Q

what are the causes of acute AR?

A

IE
dissecting aorta
failure of prosthetic valve

45
Q

what is the difference btwn acute and chronic AR presentation?

A 
acute AR: low pitched early diastolic
chronic AR (compensated); holo-diastolic decrescendo, high pitched blowing quality

acute AR presents as sudden CVS collapse, while chornic AR will present as a left ventricular failure patient

chronic AR will have widened pulse pressure, while acute AR will experience acute hypotension

46
Q

what is the difference btwn acute and chronic AR presentation?

A 
acute AR: low pitched early diastolic
chronic AR (compensated); holo-diastolic decrescendo, high pitched blowing quality

acute AR presents as sudden CVS collapse, while chornic AR will present as a left ventricular failure patient

chronic AR will have widened pulse pressure, while acute AR will experience acute hypotension

47
Q

differentiating between AR severity

A

mild AR = murmur only in early diastole and blowing
severe = holodiastolic, displaced left ventriclar impulse, wide pulse pressure, as it gets more severe murmur may become soft or absent

Year 3 Revision (7 decks)

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