Cardiology Flashcards
ischemic change on ECG
T wave inversion
pathological Q waves
atypical presentation of ACS
elderly
diabetic
post op
what can ECHO detect
LV
valve disease
RMWA
EF
A.fib causes
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
definition for V.T
3 or more conservative ventricular complex occurs at a rate of 100 - 250 bpm
treat V.T stable
electrical cardioversion
amiodarone
Lignocaine
primary prevention of VT
ICD
use of ICD
- LV dysfunction due to presence of MI
LVEF 30-40%
NYHA II and III
complication of VT
death O2 ischemic encephalopathy acute renal insufficiency Aspiration pneumonitis trauma related
ECG of hypertrophic Cm
LVH - increase pericardial voltage
non specific ST
T wave abnormality
Deep narrow (dagger like) Q waves
Hypertrophic CM
massive hypertrophy in LEFT ventricle due to genetic mutation in sarcomere protein results in
- decrease CO
- sudden cardiac arrest - VT
- syncope with exercise
signs of hypertrophic CM
Jerky pulse JVP LARGE A WAVE 4th heart sounds Late systolic murmur - LOUD during valsalva - soft in Squat
definition of Dilated Cm
AD dilation of 4 chambers of heart resulting in systolic dysfunction and biventricular CHF
treatment HCM
Sudden cardiac death - ICD
advanced heart failure / non obstructive - TRANSPLANT
AF and stroke - drugs, Anticoagulant, ablation
restrictive CM
decrease compliance of ventricle endomyocardium resulting restrictive filling during diastole
ABRUPT ANGINA LIKE ONSET in post menopausal women with diffuse T wave inversion
Takostubo Stress CM - transient regional systolic dysfunction lV apex/ or mid - ventricle w/o obstruction coronary arteries and coronary angiogram
Diagnostic test for CM
- ECHO
- left and right ventricle dilation
decrease LV EF
MR and TR
LV thrombus - Cardiac MRI
Screening for complication test for CM
- ECG
- sinus tacky
- left atrial abnormalities
- decrease voltage - CXR
- CM
- interstitial alveolar edema
- transverse endomyocardial
therapeutic test for CM
Cardiac cauterization and ablation
treatment CM in general
Avoid (exertion, competitive spots, CCB, NSAIDS )
Family Screen
ICD HF tx biventricular pacing / AICD LVAD (left ventricular atrial device) Cardiac transplant
heart failure definition
abnormality of the cardiac striation or function leading to failure of the heart to deliver 02 at the rate required for tissues
sings of Left heart failure
S3
crackles
right heart failure
raised JVp hepatojugular reflex sacral and lower extremity edema ascots parasternal heave right upper quadrant hepatosplendomegly
diagnostic test heart failure
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)
cause of heart failure test
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
Prognostic test for heart failure
BNP / NT-proBNP
LFT’s (Hepatic congestion)
ECG
if no response LMNPO
- invasive BP motor
- GTN IV infusion
- Vasoactive agents - Dobutamine and Milirone
- New agent - Serelaxin
drugs that improve prognosis is heart failure
AAAB
ACE ARB ALDEROSTERONE INHIBITOR BB
PLUS mechanical intervention
murmurs affected with handgrip
decrease - HOCM
Increase MR. AR. VSD
murmurs affected with Squating
increase a. stenosis
decrease HOCM
risk factor for acute pericarditis
Acute Pericarditis Viral infections Recent myocardial infarction Prior cardiac surgery Prior malignancy Autoimmune disorders and vasculitides Uraemia
clinical features of acute pericarditis
Chest pain Sudden onset Anterior chest Sharp Pleuritic Exacerbated by inspiration / coughing Relieved by sitting up / leaning forward
clinical features of chronic pericarditis
Dyspnea on exertion
Fatigability
Reduced exercise capacity
clinical features of tamponade
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
what does a pericardial rub sound like
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
sings of acute pericarditis
- 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)
signs of constrictive pericarditis
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
signs of cardiac tamponade
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)
ECG pericardial disease
diffuse ST elevation (concave up)
reciprocal ST depression in aVR & V1
PR segment elevation in lead aVR
PR segment depression in V5 and V6
treatment for chronic pericarditis
Pericardiectomy (definitive treatment option)
Diuretics (temporising measure and for patients who are not candidates for surgery)
treatment for cardiac tamponade
Percutaneous drainage (catheter pericardiocentesis) Open surgical drainage with or without pericardiotomy (pericardial "window”)
NUMBER 1 cause of acute pericarditis
VIRAL
Name 2 differentials of pericardial rub
pleuropericardial rub
pleural rub
infective endocarditis definition
inflammation or colonization by infectious agents of heart valve or inner lining of the heart (mural endocardium)
pathogenesis of endocarditis
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
organism that cause endocarditis
VIRIDANS (S. mutans) GI / GU bus : E.fecalis *prostate sx Staph. aures (IVDU) and epidermidis Fungi HACEK
clinical I.E
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
dx of IE
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
gold standard to test for immunological causes of IE
Pathologic exam of valve or tissue
Major criteria IE DUKES
- at least 2 positive blood cultures at least 12 hour apart
- typical organism consistent with IE on two separate occasions
- single positive blood culture for coxeilla burnetii or IgG titre > 1:800
Minor criteria
positive Blood cultures that done meet the major criteria
fever > 38
Vascular phenomenon
Immunological phenomena
Predisposition - cardiac condition , IVDU ,
surgery indications for IE (ABSOLUTE )
Valvular dysfunction
Uncontrolled infection on antibiotics
Haemodynamic instability
Investigation cause of IE
- MSU
2. CXR - sending the tip of any lines for culture
surgery indications for IE (Relative)
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
antibiotic treatment for I.e
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
ECHO findings that require Sx
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
complication IE
Heart failure Renal failure Stroke Septic Shock Periannular complication
Carotid sinus syndrome
> 3 sec asystole
50 mmHg fall in SBP (vasodepressor )
At carotid sinus
postural hypotension definition
Orthostatic hypotension means syndrome ass. w/ being in an upright position (20mmg DROP in SBP and 10mmhg DROP in DBP)
positive carotid sinus message
> 3 second or decrease 50mmhg or decrease 30 DBP
PLUS RESP SYMPTOMS
causes of acute pericarditis
VIRAL Recent MI Cardiac Sx Malignly Autoimmune disorder (vasculitis) Uraemia
definition of pericardial knock
heart sound occurring before S3
