Cardiology Flashcards
Causes of aortic stenosis
CRABS (increasing age)
Congenital (congenital ring, HOCM, Williams syndrome)
Rheumatic fever (esp females and rheumatoid arthritis)
Atherosclerosis
Bicuspid AV calcification (40-60)
Senile calcific degeneration (60+)
Aortic stenosis - PC
Angina Arrhythmias LVH Exertional syncope Emboli - TIA/ stroke
Aortic stenosis - Ix
ECG, CXR, Echo, Catheter
Aortic stenosis - Rx and contraindicated drugs
Medical - statins, antiplatelet
Contraindicated meds - nitrates, ACE inhib., Ca antagonists
SBE prophylaxis
Surgical - Valvuplasty, valve replacement, myomectomy
Causes of aortic regurgitation
- Ring dilation -
a) pressure: hypertension, aortic dissection, trauma
b) Weak connective tissue eg ehlos danlos or marfans, syphilis, cor bovium - Cusp contraction -
a) infection: Rheum fever, infective endocarditis
b) autoimmune: seronegative arthropathies eg. ank spondylitis, Reiter’s
c) toxins: cabergoline, pergolide - Poor fitting
a) biscupid aortic valve disease
b) supracrital VSD
Aortic Regurgitation - PC
- Arrhythmias
- Emboli (from vegetation), TIA: amaurosis fugax, CVA
- Eccentric LVH, LVF, RVF
Aortic Regurgitation - Ix
ECG, CXR, Echo, Catheter
Aortic Regurgitation - Tx
Medical: Nifedipine (avoid in HF), ACE inhibitors
SBE prophylaxis
Surgical: valve replacement
Presentation of mitral stenosis
- Left atrial enlargement – AF, hoarseness, dysphasia, bronchiectasis
- emboli
- pulmonary oedema/recurrent respiratory tract infection
- pulmonary hypertension/RSH failure; ischaemia/cachexia
Mitral stenosis – investigations
ECG CXR echo catheter
Mitral stenosis – treatment
- Anticoagulate
- SBE prophylaxis
- surgical – closed valvotomy, open valvotomy, valve replacement
Causes of mitral regurgitation
a) Ring dilatation 1. LV dilatation (volume overload; AR, pressure overload; AS, HT)
2. Cardiomyopathy: HOCM, dilated, restrictive
3. Trauma/mechanical valve leak
b) Cusp contraction 1. infection e.g. rheumatic fever, SBE
2. Autoimmune e.g. RA, SLE, ankylosing spondylitis
3. ASD, primum
4. Senile calcification degeneration
c) subvalvular apparatus dysfunction e.g. MI, mitral valve prolapse (Marfan’s, VSD, polycystic kidney disease, straight back, ischaemic heart disease, neuroses/women)
Mitral regurgitation – PC
- AF
- pulmonary oedema/recurrent RTI
- pulmonary hypertension/RSH failure
- MVP PC – chest pain, palpitations, syncope, SOB, fatigue
Mitral regurgitation – Ix
ECG CXR echo catheter
Mitral regurgitation - Rx
Anticoagulate in AF, SBE prophylaxis, surgical valve replacement
Causes of atrial fibrillation
A.T.R.I.A.L S.W.I.T.C.H
Acute: PE, MRI, infection, post surgery Thyrotoxicosis Rheumatic heart disease Ischaemic heart disease ABP increased/alcohol/ASD/aortic regurgitation Lung: bronchial carcinoma, PE
Sick sinus syndrome Wolff Parkinson White syndrome Inflammation: pericarditis, myocarditis, endocarditis Toxin: digoxin toxicity Cardiomyopathy e.g. sarcoid Cancer: atrial myxoma Hypokalaemia
Pathophysiology of AF
Parts of the atria lose their refractoriness before the end of atrial systole enabling recurrent but unco-ordinated atrial contraction.
This may be due to atrial enlargement, conduction velocity decreased e.g. information, fibrosis, decreased refractory period e.g. ischaemia, T4, sympathetic tone increase
Management of AF
- Underlying cause
- Rate control – beta-blocker, diltiazem, digoxin
- Rhythm control – amiodarone, flecainide if no ischaemic or structural heart disease, cardioversion
- Anticoagulation – CHADSVASC
Causes of ventricular tachycardia
I.M. Q.V.I.C.K
Infarction
Myocarditis
QT interval increased
Valve abnormality: mitral valve prolapse, aortic stenosis.
Iatrogenic – Digoxin, antiarrhythmics, catheterisation, surgery.
Cardiomyopathy, especially dilated.
K+ low, Mg2+ low, O2 low, acidosis
Causes of bradycardia
D.I.V.I.S.I.O.N.S.
Drugs - (ABCD) antiarrhythmic’s, beta-blockers.calcium antagonists, digoxin
Ischaemia/infarction – inferior or anteroseptal MI
Vagus hypotonia – athletes, vasovagal syncope, hypersensitive carotid sinus syndrome.
Infection
Sick sinus syndrome
Infiltration – restrictive or dilated cardiomyopathy e.g. sarcoid, haemochromatosis, amyloid, muscular dystrophy.
O – hypOthyroidism, hypOkalaemia, hypOthermia, obstructive jaundice
Neuro: raised intracranial pressure
Septal defect: ASD; Surgery or catheterisation
MI – Complications
S - Sudden death P - Pump failure / Pericarditis R - Rupture papillary muscles or septum E - Embolism A - Aneurysm / Arrhythmias D - Dressler’s syndrome
Causes of shock
S.H.O.C.K.I.N.G.
Septic
Hypovolaemia
Organ failure
Cardiogenic
K anaphylaxis
Iatrogenic – blood transfusion: haemolytic reaction, anaesthesia, drugs
Neurogenic – pain, stroke, seizure, autonomic neuropathy
Glands – diabetes mellitus, diabetes insipidus, Addison’s disease, hypothyroidism
Causes of hypertension
P.R.E.D.I.C.T.I.O.N
Primary – essential or isolated systolic
Renal – vascular, glomerulonephritis or tubular nephritis, structural (APKD, tumour)
Endocrine - stress hormones (epinephrine, cortisol, GH, T4); hypermineralocorticoidism (hyper/hypo aldosteronism), other (somatostatinoma, hyperPTHism, ACP)
Drugs
Intracranial pressure
Co-optation of aorta
Toxaemia of pregnancy
Increased viscosity
Overloaded with fluid
Neurogenic
End organ damage of hypertension
C.A.R.N.A.G.E
Cardiac – IHD, LVH, CCF, AR, MR
Aortic – aneurism comedy section
Renal – proteinuria, chronic renal failure
Neurological – CVA, headache, dizzy, syncope
Anaemia
GIT – N and V
Eyes – retinopathy
Causes of heart failure
Fluid overload – iatrogenic, renal failure
High-output – hyperdynamic circulation (ATPmoleculeS)
anaemia, alcohol, AVM, aortic regurgitation
thyrotoxicosis, temperature, toxins
pregnancy, proliferative,
severe obesity, systemic e.g. CO2 retention, cirrhosis
Low output – LVH or RVH
Causes of cardiogenic shock
T.H.E. C.H.O.P. M.E.A.T
Tension pneumothorax
Hypovolaemia
Electrolytes (increased calcium, decreased potassium, acidosis)
Cardiac tamponade
Hypothermia
Overdose/hypOxaemia
Pulmonary embolism
Myocardial infarction
Endocarditis, myocarditis, septicaemia
Arrhythmia
Toxins e.g. beta-blockers, verapamil
Rheumatic fever – PC
Revised Jones criteria
P.A.S.S.E.S
Pancarditis
Arthritis
Subcutaneous nodules
Sydenham’s chorea
Erythaema marginatum
Streptococcal infection in recent past
Extra symptoms: fever, arthralgia
ESR increased (or WCC, CRP), increased PR interval
Ever had rheumatic fever before
Causes of pericardial disease
I.A.M.H.U.R.T.I.N
Infection
Autoimmune
Myocardial infarction
Haemorrhage
Uraemia
Radiotherapy
Thyroid decreased/cholesterol increased
Iatrogenic: hydralazine
Neoplasia
Pericardial effusion types
Transudative (congestive heart failure, myxoedema, Nephrotic syndrome),
Exudative (tuberculosis, spread from empyema)
Hemorrhagic (trauma, rupture of aneurysms, malignant effusion).
Chyle
Malignant (due to fluid accumulation caused by metastasis)
Myxoma – PC
F.L.E.C.K.S.fall off
Failure, cardiac
Loss of consciousness or sudden death
Emboli: CVA, PVD, MRI
Clubbing
Koagulation: polycythaemia, thrombocytosis – DVT, PE
Systemic: fever, loss of weight, myalgia
Pathology and causes of hypertrophic cardiomyopathy
H.O.C.M
Hypertrophy: asymmetric septal hypertrophy or concentric LVH
Obstruction: systolic anterior motion of anterior leaflet mitral valve
Catecholamine (neural crest cell disorder: associated hypertension, phaeochromocytoma) and calcium excess (impaired relaxation and diastolic failure)
Myosin: beta myosin heavy chain mutation
Causes of dilated cardiomyopathy
DILATED
Dystrophy: primary, muscular dystrophy, myotonic dystrophy, glycogen storage disease
Infection: myocarditis
Late pregnancy: third trimester to 6 months postpartum
Autoimmune: SLE
Toxin: alcohol, cocaine, cyclophosphosamide and radiotherapy
Endocrine: dysthyroidism, acromegaly, Addison’s, diabetes
Diet: osteomalacia, selenium deficiency
Causes of restrictive cardiomyopathy
SHAPEN
Sarcoidosis/systemic sclerosis
Haemochromatosis
Amyloidosus
Primary: endomyocardial fibrosis
Eosinophilia
Neoplasia: carcinoid, carcinoma,, lymphoma
Pathophysiology of Fallot’s tetralogy
Failure of bulbis cordis to rotate
Pulmonary stenosis
Ventriculoseptal defects
Right ventricular hypertrophy
Overriding aorta
Describe the murmur/cyanosis variability in fallots tetralogy
Through the pulmonary artery, so that: louder the murmur the less cyanosis
CXR – radiological signs of heart failure
ABCD E
Airspace shadowing
kerley B lines
Cardiomegaly
Diversion blood to off load
Efusions
