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RCSI Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

ischemic change on ECG

A

T wave inversion

pathological Q waves

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2
Q

atypical presentation of ACS

A

elderly
diabetic
post op

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3
Q

what can ECHO detect

A

LV
valve disease
RMWA
EF

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4
Q

A.fib causes

A 
CARDIAC:
-	HTN 
-	Valvular disase (MS/MR) – rheumatic fever 
-	HCM 
-	Ischemic heart disease 
PULMONARY CAUSES
-	pneumonia 
-	PE 
-	Pul HTN 
METABOLIC :
-	hyperthyroidism 
-	Hyperkalemia, Mg and Ca 
Iatrogenic  
-	aortic valve replacement 
-	lidocaine and cocaine 
-	B-agonst 
Others: 
-	alcohol 
- caffeine intake
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5
Q

definition for V.T

A

3 or more conservative ventricular complex occurs at a rate of 100 - 250 bpm

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6
Q

treat V.T stable

A

electrical cardioversion
amiodarone
Lignocaine

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7
Q

primary prevention of VT

A

ICD

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8
Q

use of ICD

A
  • LV dysfunction due to presence of MI
    LVEF 30-40%
    NYHA II and III
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9
Q

complication of VT

A 
death 
O2 ischemic encephalopathy 
acute renal insufficiency 
Aspiration pneumonitis 
trauma related
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10
Q

ECG of hypertrophic Cm

A

LVH - increase pericardial voltage
non specific ST
T wave abnormality

Deep narrow (dagger like) Q waves

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11
Q

Hypertrophic CM

A

massive hypertrophy in LEFT ventricle due to genetic mutation in sarcomere protein results in

  • decrease CO
  • sudden cardiac arrest - VT
  • syncope with exercise
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12
Q

signs of hypertrophic CM

A 
Jerky pulse 
JVP LARGE A WAVE 
4th heart sounds 
Late systolic murmur 
- LOUD during valsalva 
- soft in Squat
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13
Q

definition of Dilated Cm

A

AD dilation of 4 chambers of heart resulting in systolic dysfunction and biventricular CHF

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14
Q

treatment HCM

A

Sudden cardiac death - ICD
advanced heart failure / non obstructive - TRANSPLANT
AF and stroke - drugs, Anticoagulant, ablation

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15
Q

restrictive CM

A

decrease compliance of ventricle endomyocardium resulting restrictive filling during diastole

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16
Q

ABRUPT ANGINA LIKE ONSET in post menopausal women with diffuse T wave inversion

A

Takostubo Stress CM - transient regional systolic dysfunction lV apex/ or mid - ventricle w/o obstruction coronary arteries and coronary angiogram

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17
Q

Diagnostic test for CM

A
  1. ECHO
    - left and right ventricle dilation
    decrease LV EF
    MR and TR
    LV thrombus
  2. Cardiac MRI
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18
Q

Screening for complication test for CM

A
  1. ECG
    - sinus tacky
    - left atrial abnormalities
    - decrease voltage
  2. CXR
    - CM
    - interstitial alveolar edema
    - transverse endomyocardial
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19
Q

therapeutic test for CM

A

Cardiac cauterization and ablation

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20
Q

treatment CM in general

A

Avoid (exertion, competitive spots, CCB, NSAIDS )

Family Screen

ICD 
HF tx 
biventricular pacing / AICD 
LVAD (left ventricular atrial device) 
Cardiac transplant
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21
Q

heart failure definition

A

abnormality of the cardiac striation or function leading to failure of the heart to deliver 02 at the rate required for tissues

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22
Q

sings of Left heart failure

A

S3

crackles

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23
Q

right heart failure

A 
raised JVp 
hepatojugular reflex 
sacral and lower extremity edema 
ascots 
parasternal heave 
right upper quadrant 
hepatosplendomegly
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24
Q

diagnostic test heart failure

A 
CXR 
T.T.ECHO
BNP or NT-proBNP 
Morphology Cardiac MRI imaging (CMR)
- scar burden 
- EF 
- infiltrative process 
Coronary Angiography (Ventriculogram)
- b/c 60% HF pts have CAD
Heart Catheterisation (Left and right)
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25
Q

cause of heart failure test

A 
ECHO
ECG
FBC (Anaemia) 
TFT’s
Coronary Angiography (CAD)
Urinalysis (looking for proteinuria) 
Serology for HIV, Rheumatological Conditions, Viral, Haemochromatosis and Genetic testing.
Iron studies
Fasting lipids
PFT’s

Real causes:

  • heart: IHD, HTN, valvular, tachyarrythmia
  • OTHER: alcohol, hyperthyroisiam, DM, Acromegly, VIRAl infection, heamochrmatosis, illicit drug
26
Q

Prognostic test for heart failure

A

BNP / NT-proBNP
LFT’s (Hepatic congestion)
ECG

27
Q

if no response LMNPO

A
  1. invasive BP motor
  2. GTN IV infusion
  3. Vasoactive agents - Dobutamine and Milirone
  4. New agent - Serelaxin
28
Q

drugs that improve prognosis is heart failure

A

AAAB
ACE ARB ALDEROSTERONE INHIBITOR BB

PLUS mechanical intervention

29
Q

murmurs affected with handgrip

A

decrease - HOCM

Increase MR. AR. VSD

30
Q

murmurs affected with Squating

A

increase a. stenosis

decrease HOCM

31
Q

risk factor for acute pericarditis

A 
Acute Pericarditis
Viral infections
Recent myocardial infarction
Prior cardiac surgery
Prior malignancy
Autoimmune disorders and vasculitides
Uraemia
32
Q

clinical features of acute pericarditis

A 
Chest pain
Sudden onset
Anterior chest
Sharp
Pleuritic
Exacerbated by inspiration / coughing
Relieved by sitting up / leaning forward
33
Q

clinical features of chronic pericarditis

A

Dyspnea on exertion
Fatigability
Reduced exercise capacity

34
Q

clinical features of tamponade

A 
Can be of sudden onset post cardiac procedure
Can be insidious as in SLE or malignancy
Vague atypical chest pain
Syncope or presyncope
Dyspnea and tachypnea
Peripheral oedema
35
Q

what does a pericardial rub sound like

A

Pericardial Rub
Scratchy / Squeaking Quality
Intermittent (hours) and Variable Intensity
best heard with the stethoscope diaphragm (firm pressure applied)
loudest over the left sternal border
Loudest with patient leaning forward & holding breath

36
Q

sings of acute pericarditis

A
  • fever
  • pericardiac rub
  • Suspension of respiration during auscultation permits distinction of a pericardial friction rub from a pleuropericardial or pleural rub (only heard during inspiration)
37
Q

signs of constrictive pericarditis

A

Cachexia
Elevated jugular venous pressure (JVP)
Pulsus paradoxus
Kussmaul’s sign (the lack of an inspiratory decline in JVP)

Chest
Pericardial knock (heart sound occurring prior to S3)
pleural effusion (stony dull on percussion)

Abdomen
Ascites
Pulsatile hepatomegaly

Lower Limbs
Peripheral edema

38
Q

signs of cardiac tamponade

A 
Tachypnea
Sinus tachycardia
Hypotension
Elevated jugular venous pressure 
Venous distension in the forehead and scalp
Muted or muffled heart sounds
Pulsus paradoxus 
(Exaggerated drop in systolic blood pressure >10 mmHg on inspiration)
39
Q

ECG pericardial disease

A

diffuse ST elevation (concave up)
reciprocal ST depression in aVR & V1
PR segment elevation in lead aVR
PR segment depression in V5 and V6

40
Q

treatment for chronic pericarditis

A

Pericardiectomy (definitive treatment option)

Diuretics (temporising measure and for patients who are not candidates for surgery)

41
Q

treatment for cardiac tamponade

A 
Percutaneous drainage (catheter pericardiocentesis)
Open surgical drainage with or without pericardiotomy (pericardial "window”)
42
Q

NUMBER 1 cause of acute pericarditis

A

VIRAL

43
Q

Name 2 differentials of pericardial rub

A

pleuropericardial rub

pleural rub

44
Q

infective endocarditis definition

A

inflammation or colonization by infectious agents of heart valve or inner lining of the heart (mural endocardium)

45
Q

pathogenesis of endocarditis

A

cardiac valves become infection by micro emboli from bacteria or fungi in the circulation –> forms thrombi –> vegetation –> micro-organism into body –> systemic findings

Dextran (step mutant ) -> virulence factor that promotes adherence

coagulase negative bacteria - BIOFILM - promotes adherence

Endocardial surface - previously damagesd, previous endocarditis, prior Sx or pacemaker

46
Q

organism that cause endocarditis

A 
VIRIDANS (S. mutans) 
GI / GU bus : E.fecalis *prostate sx
Staph. aures (IVDU) and epidermidis 
Fungi 
HACEK
47
Q

clinical I.E

A

Flu like - myalgia , dry cough, fatigue
Low grade fever
WL
Cardinal symptoms

Vascular: 
New cardiac murmur
Splinter Haemorrhage
Janway lesions (Painless)
Splenomegaly
Hematuria
infracts / emboli/ mycotic aneurysm / Intercranial haemorrhage / conjunctival haemorrhage 
IMMUNE: GROR 
GN 
Roth (Bulls' eye lesion) 
Osler node 
Rheumatoid factor
48
Q

dx of IE

A

Clinical

(Blood Culture) -3 sets in 12-14 hour period

ECHO (TTE/TEE)
- first line, repeat 7-8 days
THEN REDO IF - complication, operation, following operation

49
Q

gold standard to test for immunological causes of IE

A

Pathologic exam of valve or tissue

50
Q

Major criteria IE DUKES

A
  1. at least 2 positive blood cultures at least 12 hour apart
  2. typical organism consistent with IE on two separate occasions
  3. single positive blood culture for coxeilla burnetii or IgG titre > 1:800
51
Q

Minor criteria

A

positive Blood cultures that done meet the major criteria
fever > 38
Vascular phenomenon
Immunological phenomena
Predisposition - cardiac condition , IVDU ,

52
Q

surgery indications for IE (ABSOLUTE )

A

Valvular dysfunction
Uncontrolled infection on antibiotics
Haemodynamic instability

53
Q

Investigation cause of IE

A
  1. MSU

2. CXR - sending the tip of any lines for culture

54
Q

surgery indications for IE (Relative)

A

Onset of AV block – aortic root abscess
Fungal etiology
Relapse s/p appropriate therapy
Recurrent emboli despite appropriate antimicrobial therapy
Persistent fever (≥ 10 days) despite empiric antimicrobial therapy for culture negative endocarditis
Recurrent endocarditis
Prosthetic Valve Endocarditis

55
Q

antibiotic treatment for I.e

A

Native value subacute infection : B/A + G
Native valve septic infection: V+G OR B/A + F +G
Prostethic Valvue or MRSA: V+G +R
IVDU: B+ F + G OR V+G

56
Q

ECHO findings that require Sx

A

Vegetation
Persistent vegetation after system. emboli Ant. MV vegetation >10mm
>1 embolic - w.i 1st 2 weeks of ab
Increasesveg size depiste Ab

Valvular dysfunction 
AR or MR w/ VF  
HF unresponsible to medical therapy
Valve perforation or rupture
Perivalvular extension
Valvular dehiscence
New Heart Block
Large abscess or extension of abscess despite appropriate antimicrobial therapy
57
Q

complication IE

A 
Heart failure
Renal failure
Stroke
Septic Shock
Periannular complication
58
Q

Carotid sinus syndrome

A

> 3 sec asystole
50 mmHg fall in SBP (vasodepressor )
At carotid sinus

59
Q

postural hypotension definition

A

Orthostatic hypotension means syndrome ass. w/ being in an upright position (20mmg DROP in SBP and 10mmhg DROP in DBP)

60
Q

positive carotid sinus message

A

> 3 second or decrease 50mmhg or decrease 30 DBP

PLUS RESP SYMPTOMS

61
Q

causes of acute pericarditis

A 
VIRAL 
Recent MI 
Cardiac Sx 
Malignly 
Autoimmune disorder (vasculitis)
 Uraemia
62
Q

definition of pericardial knock

A

heart sound occurring before S3

RCSI Medicine (6 decks)

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