Cardiology Flashcards
what are the causes of left heart failure?
ischemic heart disease
hypertension
valvulopathy
idiopathic cardiomyopathy
what are the causes of right heart failure?
left heart failure
cor pulmonale
tricuspid valvulopathy
left to right shunts
what are some precipitants of heart failure?
ischemia
infection
anemia
arrythmia
what is the MADHATTER3P mneumonic of heart failure?
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
what is the NYHC classification of heart failure?
class 1: diagnosed but w/ symptoms class 2: symptoms upon exertion class 3: symptoms upon normal activity class 4: symptomatic at rest
what the symptoms of LHF vs RHF?
LHF: SOB, PND, orthopnea, chronic cough w/ pinkish sputum
RHF: ankle swelling, abdominal fullness, RUQ pain/tenderness, nausea
what are the signs of LHF vs RHF?
LHF: displaced apex beat, bibasal fine crackles
RHF: elevated JVP, peripheral oedema, congestive hepatomegaly
S3 = volume overload, S4 = pressure overload (diastolic heart failure)
what are the signs found on the CXR?
A: alveolar oedema (bat wings) B: kerley B lines C: cardiomegaly D: upper lobe diversion E: pleural effusion
what are the signs found on the CXR?
A: alveolar oedema (bat wings) B: kerley B lines C: cardiomegaly D: upper lobe diversion E: pleural effusion
what is the treatment of acute decompensated HF?
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
what is the treatment of acute decompensated HF?
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
what is the non pharmaceutical treatment for chronic HF
salt restriction (2mg/day) and water restriction (2L/day) smoking cessation weight loss and diet modification limit caffeine daily weigh monitoring immunization
pharmaceutical treatment for chronic HF?
nyh1=ACE-I
nyh2= ACEI + BB
nyh3= ACEI + BB + spiro
nyh4 = ACEI + BB + spiro + digoxin
what are the s.e of digoxin?
yellow vision digoxin toxicity (reverse tick on ECG)
what are the s.e of spironolactone?
painful gynecomastia (can change to eplenorone) hyperkalemia
what are the cardioselective beta blockers?
metoprolo, bisoprolol, nebivolol, carvedilol
what are the indications for BiV PPM for heart failure?
class 3, 4 NYHF, LVEF
what are the indications for cardiac defibrillator?
LVEF 3 months after CABG, LVEF
what are the indications for cardiac defibrillator?
LVEF 3 months after CABG, LVEF
what are the indications for BiV PPM for heart failure?
class 3, 4 NYHF, LVEF
what are the indications for cardiac defibrillator?
LVEF 3 months after CABG, LVEF
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
unstable angina
75/M increasingly frequent episodes of dizziness on standing; O/E slow rising pulse, systolic murmur radiating to carotids
aortic stenosis
24/F sudden sharp central CP, aggravated by movement, respiration and lying, relieved by sitting forward; vitals stable; ECG shows diffuse ST elevation
pericarditis
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
dilated cardiomyopathy
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
infective endocarditis
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
HOCM
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
HOCM
what is the diagnostic criterion of myocardial infarction?
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
what is the diagnostic criterion of myocardial infarction?
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
what are the ECG and biomarker changes of ACS?
unstable angina - no trops raise, pain at rest, no ecg change
NSTEMI -
what are top causes of aortic stenosis
rheumatic heart disease
calcific disease
congenital bicuspid valve/unicuspid valve
what are some features of acute rheumatic heart disease?
ashkoff bodies, ooooo??
what are the symptoms of aortic stenosis?
SAD on exertion
syncope comes first, and angina comes last
what are some findings of aortic stenosis
plateau pulse narrow pulse pressure non displaced apex beat heaving apex beat (pressure overload) presence of S4
what are the ausculatation findings of AS
beast heard RHS 2nd intercosatal space parasternal
ejection sytolic crescendo decrescendo
s4 heart sound
what are the severity findings of AS
paraodoxical splitting of s2
absent a2
grade 4 intensity
late peaking
what are the severity findings of AS
paraodoxical splitting of s2 (prolonged LV ejection time)
absent a2
grade 4 intensity
late peaking
what are some findings of AS on echo
thickened/calcifeid leafelts with reduced excursion
LV chamber normal size but concentrically hypertorphied
what are some findings of AS on echo
thickened/calcifeid leafelts with reduced excursion
LV chamber normal size but concentrically hypertorphied
what is the voltage criteria for ECG for LVH
s wave in v1 and tallest r wave in v5/v6 > 25 mm
what are the indications for AS surgical repair?
severe on echo + symptomatic
severe on echo + LVEF
what are the indications for AS surgical repair?
severe on echo + symptomatic
severe on echo + LVEF
what are the causes of acute AR?
IE
dissecting aorta
failure of prosthetic valve
what is the difference btwn acute and chronic AR presentation?
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
what is the difference btwn acute and chronic AR presentation?
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
differentiating between AR severity
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
