Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Matrix > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How do you differentiate between AS and HOCM?

A

Valsalva - AS will be softer and HOCM will be louder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the differential diagnoses of an ejection systolic murmur?

A

Ejection systolic murmur may occur during a hyperdynamic state requiring more blood to be pumped out (tachycardia).

  • AS
  • HOCM
  • Atrial Septal Defect (normal S1, S2; fixed splitting of S2, doesn’t vary between inspiration/expiration)
  • Pulmonary stenosis (louder on inspiration)
  • Anaemia
  • Hyperthyroidism
  • Pregnancy
  • Sepsis (normal S1, S2)
  • End stage liver failure
  • Coarctation of aorta (normal S1, S2; radio-femoral delay)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the triggers of AF?

A

P - PE/COPD

I - Ischaemia

R - Rheumatic fever

A - Anaemia

T -Thyrotoxicosis

E - Endocarditis

S - Sepsis/SSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the differential diagnoses of a pan-systolic murmur?

A
  • Tricuspid regurgitation
  • Mitral regurgitation
  • Ventricular septal defect (normal heart sounds)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of mitral regurgitation?

A
  • Mitral valve prolapse
  • Rheumatic heart disease
  • IHD –> rupture of chordae tendinae/valve attachment
  • Dilated cardiomyopathy
  • Infective endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the features of aortic stenosis?

A
  • Syncope
  • Angina
  • Dyspnoea
  • Harsh ejection systolic murmur best heard at aortic area radiating to carotids
  • Narrow pulse pressure
  • Low volume/plateau/slow-rising carotid pulse
  • Softer A2
  • LVH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you differentiate between aortic stenosis and aortic sclerosis?

A

Aortic sclerosis has no radiation to the carotids, no apex beat displacement, a normal A2 and no thrill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs of left heart failure?

A
  • Orthopnoea
  • PND
  • Pulmonary oedema
  • Fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the causes of left heart failure?

A
  • Iscahemia
  • HTN
  • CM
  • VHD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the precipitants of heart failure?

A

I - Ischaemia

I - infection

A - arrhythmia

A - anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the NYHA classification?

A

I - normal (no limitation on physical activity)

II - mild (comfortable at rest but SOB on physical activity)

III - moderate (comfortable at rest but SOB on mild activity)

IV - severe (SOB at rest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the signs of right heart failure?

A
  • Peripheral oedema
  • Elevated JVP
  • Ascites
  • Tender hepatomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the symptoms of right heart failure?

A

F - Fatigue

A - Ankle swelling

C - Cerebral (faints)

I - Increased urinary freq

A - Anorexia

L - Liver congestion

P - Palpitations

A - Ascites

N - Nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the causes of aortic stenosis?

A
  • Senile calcification
  • Congenital bicuspid valve
  • Rheumatic fever
  • Severe hypercholesterolaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the causes of aortic regurgitation?

A
  • Rheumatic fever + subacute IE
  • Bicuspid valve
  • RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of mitral stenosis?

A
  • Rheumatic heart disease
  • Congenital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the symptoms of mitral regurgitation?

A
  • Palpitations
  • SOBOE
  • Fatigue/weakness
  • Orthopnoea (pulmonary oedema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs of mitral regurgitation?

A
  • Pan-systolic murmur best heard at apex, radiating to the axilla
  • LVD
  • S1 soft, S3 present
  • LV failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are markers of severity of mitral regurgitation?

A
  • S3
  • LVF
  • diffuse displaced apex beat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the symptoms of aortic regurgitation?

A
  • Palpitations
  • Dizziness
  • Symptoms of LVF (dyspnoea)
  • Angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the signs of aortic regurgitation?

A
  • Early diastolic rumbling murmur (Austin-flint)
  • Collapsing water-hammer pulse, ‘head-nodding’
  • Nail bed pulsation
  • Wide pulse pressure
  • LVH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the symptoms of mitral stenosis?

A
  • Progressive SOBOE
  • Pulmonary congestion (Orthopnoea, PND, Cough/haemoptysis)
  • Later –> RV failure
  • Palpitations due to paroxysmal AF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the signs of mitral stenosis?

A
  • Mid-diastolic murmur heard loudest at the apex
  • Mitral flush
  • Low volume pulse +/- AF
  • Low pulse pressure
  • Tapping apex beat
  • L parasternal heave
  • Diastolic thrill
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the causes of dilated cardiomyopathy?

A
  • Idiopathic (50%)
  • Genetic (25%)
  • Alcohol
  • Inflammatory (SLE, SS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the signs and symptoms of dilated cardiomyopathy?

A
  • Signs of CCF
  • Syncope
  • Sudden cardiac death (esp. in young children whilst playing sports)
  • New onset murmur (regurgitant type)
  • AF
  • Diffuse apex beat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the investigations for dilated cardiomyopathy?

A
  1. Bedside: ECG - non-specific changes
  2. Bloods: FBE, UEC, LFTs
  3. Imaging - CXR - global/ball shaped heart
    - Echo - dilatation of L/R/both ventricles
    - Angiogram - to rule out CAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the management of dilated cardiomyopathy?

A
  1. Managing heart failure symptoms:
    - ACEi/ARBs
    - B-Blockers
    - Spironolactone
  2. Managing arrhythmias/SCD:
    - PPM/ICD (if EJ heart transplant (but quite rare & long waiting period)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the causes of HOCM?

A
  • Familial/genetic
  • Acquired due to chronic HTN
  • Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How would you rate control a patient with AF?

A
  • Metoprolol/dilitaizem (1st line)
  • Digoxin
  • Anti-coagulation if necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How would you rhythm control a patient with AF?

A
  • Medical: Amiodarone
  • Electrical: DC cardioversion
  • Anti-coagulation if necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

After how many times do you need to have AF to have ‘recurrent AF’?

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What characterises paroxysmal AF?

A

Self-terminating episode within 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What characterises persistent AF?

A

Not self-terminating within 7 days

34
Q

What characterises long-standing persistent AF?

A

Having AF for more than 1 year

35
Q

What characterises permanent AF?

A

More than 1 year in which rhythm control interventions are not pursued or are unsuccessful

36
Q

What are the causes of cardiac arrest?

A

H - Hypovolaemia

H - Hypothermia

H - Hypokalaemia/metabolic

H - Hypoxia

T - Toxin

T - Tamponade

T - Thrombosis

T - Tension pneumothorax

37
Q

What is the management of a patient in cardiac arrest with a shockable rhythm?

A
  • DRSABCD
  • Oxygen
  • Waveform capnography
  • IV/IO access
  • Adrenaline 1mg after 2nd shock (then every 2nd cycle)
  • Amiodarone 300 mg after 3rd shock

Post-Resuscitation

  • Re-evaluate DRSABCD
  • 12 lead ECG
  • Treat cause
  • Re-evaluate oxygenation and ventilation
  • Temperature control if cold
38
Q

What is the management of a patient in cardiac arrest with a non-shockable rhythm?

A
  • DRSABCD
  • Oxygen
  • Waveform capnography
  • IV/IO access
  • Adrenaline 1mg immediately (then every 2nd cycle)

Post-Resuscitation

  • Re-evaluate DRSABCD
  • 12 lead ECG
  • Treat cause
  • Re-evaluate oxygenation and ventilation
  • Temperature control if cold
39
Q

How do you calculate the CHADS2VASc score for a patient with AF?

A
  • CCF = 1
  • HTN = 1
  • Age 65 - 74 = 1
  • Diabetes = 1
  • Stroke (previous) = 2
  • Vascular disease = 1
  • Age 75+ = add 1
  • Sex (female) = 1

If 0 = aspirin

If 1 = aspirin/warfarin

If 2 = warfarin

40
Q

What is the prophylactic management of angina?

A

Beta blockers (atenolol/metoprolol) +/- CCB (amlodipine/nifedipine)

41
Q

What are the investigations for ACS?

A
  • Bedside: ECG
  • Labs/bloods: FBE, UEC, LFT, cardiac enzymes (troponins/CK), INR + group and hold, blood glucose, fasting lipid levels
  • CXR
  • Special tests: angiography (not really in the acute setting unless therapeutic), stress testing, echocardiogram

Note: troponin is a marker for necrosis/tissue death not ischaemia

42
Q

What is the acute management of ACS/chest pain?

A
  • Morphine
  • Oxygen
  • N - GTN (as required/patch)
  • Aspirin (300mg) chewed/dissolved before swallowing
43
Q

What is the management of STEMI?

A
  • MONASH + C:
    • M - Morphine
    • O - Oxygen (if hypoxic)
    • N - GTN (as required/patch)
    • A - Aspirin 300 mg chewed/dissolved before swallowing
    • S - Statin + stent (PCI)
    • H - Heparin (prior to PCI)
    • C - Clopidogrel
44
Q

Where do you expect ST elevation for:

  • Inferior MI
  • Lateral MI
  • Anteroseptal MI
A
  • Inferior MI: 2, 3 avF
  • Lateral MI: I, avL, V5, V6
  • Anteroseptal: V1-4
45
Q

Bare metal stent vs drug eluting stent for PCI

A
46
Q

PCI vs CABG

A

PCI - day procedure, less invasive

CABG

  • Indications:
    • triple vessel disease
    • left main disease
    • diabetic patient
  • No need for repeated re-vascularisation
  • Internal thoracic vessel/radial artery/saphenous vein
47
Q

What are the discharge medications for ACS?

A
  • SAAB+C:
    • Statin
    • ACE-i
    • Aspirin
    • Beta-blocker
    • Clopidogrel
48
Q

3 days after discharging Mr A, who had a STEMI & undergone PCI, he was brought in to the ED with severe dyspnoea. On auscultation, you hear a diastolic murmur. What would you be concerned about?

A.Pericarditis
B.Aortic stenosis
C.HOCM
D.Mitral valve prolapse
E.Another STEMI

A

D. Mitral valve prolapse

49
Q

What are the post-MI complications?

A

Early

  • Cardiogenic shock
  • Reinfarction
  • Arrhythmias (VT/VF)

Late (few weeks after)

  • Congestive heart failure
50
Q

What is the pathology timeline post-AMI?

A
51
Q

Does CK or troponin peak first, if so when and when does the other peak?

A

CK peaks first, but drops after 2-3 days
Troponin peaks later (may be normal first, but MUST do trops every 6 hours) & remains elevated for up to 6 weeks

52
Q

What are the causes of infective endocarditis?

A
53
Q

What is the risk stratification for infective endocarditis?

A

High risk: prosthetic valve, previous IE, congenital heart defects, cardiac transplant with valve disease

Moderate risk: other congenital cardiac defects, acquired valvular dysfunction, HOCM

Low risk/opportunistic: IVDU, indwelling catheter, poor dentition, mucosal injury

54
Q

What are the HACEK organisms for infective endocarditis and what makes them special :D

A
  • Haemophillus species
  • Aggregatibacter species
  • Cardiobacterium hominis
  • Ekinella corrodens
  • Kingella species
  • They are all culture negative!
55
Q

What is Duke’s Criteria for infective endocarditis?

A

Major:

  • +ve blood culture (2 out of 3 sets)
  • Echo: +ve vegetation/valve involvement (TOE)

Minor:

  • Fever > 38oc
  • Immunlogical phenomena
  • Vascular phenomena
  • Predisposing conditions (IVDU, abnormal heart valves)
  • +ve blood cultures but not enough to meet major criteria
56
Q

How must the blood cultures be taken if infective endocarditis is suspected?

A

Blood cultures must be taken from 3 different sites and must be 1 hour apart

57
Q

How much of each major and minor criteria for Duke’s criteria is required to diagnose infective endocarditis?

A

2 major criteria OR

1 major + 1 minor criteria OR

5 major criteria

58
Q

What are the investigations for infective endocarditis?

A

Labs:

  • FBE + blood cultures
  • UECs + LFTs (checking for function + baseline)
  • Cardiac enzymes

Imaging: Echocardiogram (TOE/TTE)

59
Q

What is the management for infective endocarditis (empirical and specific)?

A
  • Empirical: BenPen + Flucloxacillin + Gentamicin
  • Specific:
    • Staph aureus: flucloxacillin
    • MRSA: vancomycin
    • S. viridans: BenPen + gentamicin
    • HACEK: ceftriaxone
  • BenPen targets gram -ve
  • Flucloxacillin targets gram +ve
  • Gentamicin targets gram -ve (pseudomonas, proteus, serratia) & gram +ve staph
60
Q

What are the immunological phenomena of infective endocarditis?

A
  • Osler’s nodes
  • GN
  • Arthritis
  • Roth’s spots
61
Q

What are the vascular (embolic) phenomena of infective endocarditis?

A
  • Petechiae
  • Splinter haemorrhages
  • Janeway lesions
  • Focal neurological signs
  • Headaches
  • Splenomegaly
  • Microscopic haematuria + flank pain +/- active sediments
62
Q

What are the causes of pericarditis/myocarditis?

A
63
Q

What are the differences in presentation between pericarditis and myocarditis?

A
64
Q

What is the management of pericarditis/myocarditis?

A
65
Q

What are the investigations for cardiac tamponade?

A
  1. Bedside: ECG (electrical alternans + small voltages)
  2. Labs:
    1. FBE, UEC, LFTs
    2. Troponins/CK/CKMB
    3. ESR/CRP
  3. Imaging:
    1. CXR
    2. Echocardiogram** (TOE)
66
Q

What are the investigations for aortic dissection?

A
  1. Bedside: ECG
  2. Labs:
    1. FBE, UEC, LFTs
    2. CK/troponins, myoglobin, D-dimer, LDH
    3. Blood group and hold
  3. Imaging:
    1. CXR
    2. CT
    3. Echocardiogram (TTE/TOE)
67
Q

What is the management of aortic dissection?

A
  1. DRSABCD (ensure pt is haemodynamically stable)
  2. Vitals monitoring
  3. Analgesics
  4. Stanford A
    • Immediate surgical correction - cardiopulmonary bypass + excise intimal tear and replace with synthetic graft
  5. Stanford B
    • Control BP (keep it within normal limits)
    • Endovascular interventions (percutaneous stenting/fenestration technology)
68
Q

What is the clinical presentation of aortic aneurysm?

A
  • Usually asymptomatic but can present with:
    • Vague back pain
    • Hypotension
    • Pulsatile EXPANSILE abdominal mass
69
Q

What are the differences between true and pseudoaneurysms?

A

True aneurysms: involve all 3 walls

Pseudoaneurysms: not all layers/covered by fascia

70
Q

What are the investigations for aortic aneurysm?

A
  1. Bedside: Abdo U/S (beware if aortic dilation is 1.5x more - aneurysm)
  2. Labs:
    1. FBE, UEC, LFTs
    2. ESR/CRP
    3. Group and hold
    4. Blood cultures (if suspect mycotic)
  3. Imaging:
    1. CT
    2. MRI
    3. Aortography
71
Q

What is the management of aortic aneurysm?

A
  • If < 5.5cm in diameter
    • Keep for observation
    • Follow up
  • If > 5.5cm in diameter
    • Immediate surgical management
      • Dacron graft
      • Bentall procedure (replace damaged section + aortic valve)
      • David procedure (replace damaged section + reimplant aortic valve)
  • Medical
    • Labetalol + GTN
    • CCB
72
Q

What are the dynamic maneouvers for murmurs?

A
73
Q

What are the differences between a tissue valve (allograft/xenograft) and a mechanical valve?

A
  • Tissue valve (allograft/xenograft)
    • Better in older patients
    • Lasts for 5 years
    • No need anti-coags
  • Mechanical valve
    • Better in younger patients
    • Last longer
    • Need to be on anti-coags for life
74
Q

What is the management for HOCM?

A
  1. Medication:
    • Beta-blockers
    • CCBs
  2. Surgical/intervention:
    • Alcohol ablation
    • Holter monitoring + ICD (dual)
    • Biventricular PPM
    • Septal myomectomy
75
Q

What is the definition of restrictive cardiomyopathy?

A

Impaired ventricular filling, dilation of atria and thrombus formation. Usually ideopathic.

76
Q

What is restrictive cardiomyopathy associated with?

A
  • Amyloidosis
  • Sarcoidosis
  • Loeffler’s endocarditis*
  • Endocardial fibrosis*
  • * = associated with eosinophillia
77
Q

What are the signs and symptoms of restrictive cardiomyopathy?

A
  • Dyspnoea, fatigue and embolic symptoms*
  • Elevated JVP
  • High jugular pressure with diastolic collapse (Friedrich’s sign)
  • Elevation of venous pressure with inspiration (Kussmaul’s sign)
  • S4 (“a stiff wall”)
  • Signs of heart failure
78
Q

What is Friedeich’s sign and what is it a sign of?

A

Friedreich’s sign is high jugular pressure with diastolic collapse and a sign of restrictive cardiomyopathy. Early diastolic filling not inhibited but filling becomes impaired in the last two0thirds of diastole when the explanding ventricle hits the rigid pericardium à pressure rises to higher-than-normal level.

79
Q

What is Kussmaul’s sign and what is it a sign of?

A

Kussmaul’s sign is elevation of venous pressure with inspiration, occurring in restrictive cardiomyopathy.

80
Q

What are the investigations for restrictive cardiomyopathy?

A
  1. Bedside: ECG (low voltages, non specific ST-T changes)
  2. Labs: FBE, UEC, LFT
  3. Imaging: CXR (pulmonary venous congestion), Echocardiogram (myocardial thickening, normal EF, impaired filling)
  4. Others
    • Cardiac catheterisation/haemodynamic studies (differentiate from constrictive pericarditis)
    • Endomyocardial biopsy (useful –> diagnosis of amyloidosis = apple-green bifringent crystals)
81
Q

What is the magnagement of restrictive cardiomyopathy?

A
  • No specific treatment for restrictive cardiomyopathy
  • Usually just treat the symptoms
  • Primary amyloidosis = melphalan + prednisilone (may improve survival)
  • Other choice: heart transplant (but may reoccur)

Matrix (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions