Cardiology Flashcards
fever, pleuritic pain that is relieved by sitting up and leaning forwards
pericarditis
non productive cough, dyspnoea, flu-like symptoms, tachy-pnoea/cardia, pericardial rub
pericarditis
what can cause pericariditis
viral (coxsackie), TB, uraemia (fibrinous percarditis), trauma post MI (dresslers), connective tissue disease, hypothyroidism
saddle-shaped ST elevation, PR depression
pericarditis
dresslers syndrome triad
fever, pleuritic pain, pericardial effusion
janeway lesions/ osler’s nodes
subacute bacterial endocarditis
which valve more commonly affected by endocarditis
mitral
when does tricuspid valve get endocarditis
IV drug users- staph aureus
what are the risks for endocarditis
IV drugs, cardiac lesions, rheumatoid arthritis, dental treatment
what are the hacek organisms
normal flora in oral pharyngeal region
haemophilus, actinobacillus, cardiobacterium, eikenella, kingella
what are the causative organisms of endocarditis
staph viridans, aureus, epidermis
diphtheroids microaerophilic strep
HACEK
how is endocarditis classifies
dukes criteria
what are the major criteria in dukes
2 separate blood cultures
endocardial involvement
what are the minor dukes criteria
fever >38 degrees
IV drug user
predisposing heart condition
immunological phenomena (olser’s nodes, roth spots)
vascular phenomena (mycolytic aneurysm/ janeway lesions)
echocardiograph findings
what are the symptoms of endocarditis
fever roth spots osler's nodes new murmer janeway lesions anaemia splinter haemorrhages emboli
what investigations are done into endocarditis
blood cultures (3 SEPARATE CULTURES FROM 3 PERIPHERAL SITES)
blood for anaemia
urinalysis (microscopic haematuria)
CXR
echo (transoesophageal/ transthoracic) for vegetations
Tx for native (subacute) endocarditis
amoxicillin IV and gentamicin
Tx for native valve acute with severe sepsis endocarditis
flucloxacillin IV
TX for prosthetic valve/ suspected MRSA endocarditis
vacomycin IV and rifampicin PO and gentamicin IV
TX for native valve, severe sepsis and risk factors for resistant pathogens
vancomycin IV and meropenem IV
complications of endocarditis
heart failure, arrhythmia, abscess formation in cardiac muscle, embolic formation (stroke, vision loss, infection spread)
when do you treat bradycardia
when hr <40 bpm
tx for bradycardia
atropine, subcutaneous pacing
what is sick sinus syndrome
sinus node dysfunction causes bradycardia +/- arrest, sinoatrial block or SVT alternating with bradycardia/ systole
what can be a complication of sick sinus syndrome
AF and thromboembolism
when and how do you treat sick sinus syndrome
if symptomatic- pace
narrow complex tachycardia
SVT- QRS < 0.12seconds
tx foe SVT
vagal manoeuvres, IV adenosine or verapamil
DC shock if compromised
what is the maintenance therapy for SVT
BBs or verapamil
irregularly irregular pulse, absent P waves
AF
saw tooth baseline + 150 bpm
atrial flutter
how do you treat pre-excited AF
flecainide
broad complex tachycardia
VT
acute treatment for VT
IV amiodarone or IV lidocaine
if no response/ compromised DC shock
congenital accessory conduction pathway between atria and ventricles
WPW
short PR interval, wide QRS, delta wave, ST-T changes
WPW
how does WPW present
SVT, pre excited AF or pre excited atrial flutter
what is a pre excited beat
impulse conducted through the accessory pathway
tx for WPW
ablation
what is holiday heart syndrome
seen in binge drinking with no other heart disease, can result in SVT or AF, tx is to stop drinking
irregularly irregular
AF
slow rising pulse
aortic stenosis
collapsing pulse
aortic regurgitation
bounding pulse
acute CO2 retention, hepatic failure, sepsis
radiofemoral delay
coarctation of aorta
jerky pusle
HOCM, mitral regurg
pulsus bisferiens
mixed aortic valve disease, HOCM
pulsus paradoxus
constrictive pericarditis, cardiac tamponade
describe a slow rising pulse
time to peak increase, whole pulse flattened and small
describe a pulsus bisferiens
2 peaks in pulse (brachial/ femoral)
describe a pulsus paradoxus
systolic pressure drop >10mm Hg with inspiration
what is hypertension
> 140/90
young patients with acute onset hypertension with a history of renal or endocrine disorders
secondary hypertension
what can cause secondary hypertension
diabetes complications (diabetic nephropathy), polycystic kidney disease, glomerular disease, renovascular hypertension, cushing syndrome, aldosteronism, pheochromocytoma, thyroid problems
lifestyle factors contribute: stress, smoking and obesity
what is pre hypertension
120-130/ 80-89
what is stage one hypertension
140-159/90-99
stage 2 hypertension
160-179/100-109
what is severe hypertension
> /= 180/ >/= 110
what bloods should be done for hypertension
FBC, LFTs, U/Es, creatinine, serum urea, cGRR, lipid levels, glucose, serum Ca2+
what might be seen on an ECH in hypertension
LV hypertropy
what might be seen in hypertension in a urine dipstick
haematuria and proteinuria
what are the complications of hypertension
MI, heart failurem renal impairment, stroke, hypertensive retinopathy
how is resistant hypertension treated
higher doses of thiazide or spironolactone. add alpha or beta blocker if Diuretic insufficient
rib notching on CXR
coarctation of the aorta- due to dilatation of the intercostal arteries
cyanosis first day of birth, boot shaped heart
tetralogy of fallot
components of tetralogy of fallot
overriding aorta, pulmonary stenosis, ventricular septal defect, RV hypertrophy
wide, fixed split S2, ejection systolic murmur 2nd/3rd intercostal space
atrial septal defect
radiofemoral delay, hypertension
coarctation of the aorta
harsh pansystolic murmur at the left sternal edge
ventricular septal defect
continuous machinery murmur below left clavicle
persistent ductus arteriosus
cyanosis first day of birth, egg shaped ventricles
transposition of great vessels
what congenital heart problems making you cyanotic
tetraology of fallot
transposition of great arteries
tricus. artresia
pulmonary stenosis
when does fallots usually present
1-2 months
louder in left lateral position on expiration
mitral stenosis
tappping apex, loud S1, rumbling mid-diastolic
mitral stenosis
soft S2, ejection systolic, radiates to carotids, crescendo decrescendo, slow rising pulse, heaving
aortic stenosis
soft S2
aortic stenosis
loud s1
mitral stenosis
bets heard on expiration leaning forwards
mitral regurg
large systolic JVP ‘v’ waves, pansystolic at lower left sternal edge
tricuspid regurgitation
what murmurs can rheumatic heart disease cause
MR, MS, AS
causes of mitral stenosis
calcification, RA, AS, malignant carcinoid, SLE
what can cause mitral regurgitation
papillary muscle rupture muscle rupture, infective endocarditis, prolapse
raised fixed JVP
superior vena cava obstruction
JVP rising on inspiration
cardiac tamponade, constrictive pericarditis- look for pulsus paradoxicus
large v waves
tricuspid regurgitation
absent a waves
atrial fibrillation
cannon a waves
complete heart block, AV dissociation, ventricular arrhythmias
what is jvp an indicator of
central venous pressure
a wave
atrial contraction
c wave
tricuspid valve bulging into atrium
v wave
rise in atrial pressure during filling
blurred yellowing vision headache
digoxin toxicity
s2 split during inspiration
normal
s3
normal if <30 (in women up to 50)
may be heard in LVF and constrictive pericarditis
s4
HOCM, hypertension
fever, conjunctivitis, bright red cracked lips, strawberry tongue, cervical lymphadenopathy, red palms of hands/ soles of feet
kawasaki disease
how is kawasaki treated
aspirin (high dose), IV immunoglobulins, ECHO
complications of kawasaki
coronary artery syndrome
why is aspirin not usually indicates in children
reye’s- swelling in liver and brain while recovering from viral infection
SV x TPR =
CO
MAP formulas
((2 x diastolic) + systolic) / 3
diastolic + 1/3 (systolic -diastolic)
where to place the chest leads:
V1
right sternal edge, 4th intercostal space
where to place the chest leads:
V2
left sternal edge, 4th intercostal space
where to place the chest leads:
V3
halfway between V2 and V4
where to place the chest leads:
V4
5th intercostal space, mid clavicular line
where to place the chest leads:
V5
anterior axillary line
where to place the chest leads:
V6
mid axilliary line
tall tented P waves, prominent U waves (and wide QRSs)
hyperkalaemia- muscle weakness, cramps, tetany
flattened T waves, prominent U waves (and wide QRS’s)
hypokalaemia- muscle weakness, cramps
long q t interval
hypocalcaemia
absent p wave
sinoatrial block
bifid p wave
LA hypertrophy (e.g mitral stenosis)
peaked P waves
right atrial hypertrophy (e.g. pulmonary hypertension, tricuspid stenosis)
ST depression
myocardial ischaemia
ST elevation
acute MI, LV aneursym
LBBB
W seen in V1, V2
M seen in V4-V6
RBBB
M seen in V1
W seen in V5-V6
what can cause RBBB
age, RV hypertrophy, cor pulmonale (raised RV pressure), MI, atrial septal defect, cardiomyopathies, myocarditis
how long is a P wave and what is it
atrial depolarisation
0.08-0.1s
how long is the QRS complex and what is it
ventricular depolarisation <0.12s
what is the T wave
ventricular repolarisation
how long should the PR interval be
0.12-0.2s
how to calculate heart rate from an ECG
if regular 300/ large boxes between beats
if irregular no of QRS in 30 large squares and multiply by ten
how long is a large box
0.2 secs
how long is a small box
0.04 secs
normal ecg axis
complexes in I and II and predominantly positive
lead 1 pos lead aVF +
normal axis
lead 1 + leade aVF -
left axis deviation
lead 1 - lead aVF +
RAD
lead 1 - lead a VF -
extreme axis deviation
what can cause LAD
left anterior hemiblock, inferior MI, VT from LV focus, WPW syndrome, LVH
what can cause RAD
RVH, PE, anterolateral MI, WPW syndrome, left posterior hemiblock
hyperacute T waves (inverts later), ST elevation, Q wave fromation
localising infarct
II, III, aVF
inferior MI
right coronary leads
II, III, aVF (inferior)
I, aVL, V2-6
anterolateral
LAD/ left cicumflex leads
(anterolateral) I, aVL, V2-6
V2-5
anterior
LAD leads
V2-5 (anterior)
V1-4
anteroseptal (LAD)
subendocardial infarct
ST and T changes with no Q waves
posterior MI
V1,2 (tall R waves, ST depression, tall upright T waves)
what artery is posterior
left circumflex, right coronary
where do atrial ectopic beats originate from
pulmonary veins
pathophysology of A fib
atrial ectopic beats cause dysfunction of electric signalling
what are the causes of A fib
idiopathic, ischaemic heart disease, heart failure, valve disease, hypertension, hyperthyroidism, alcohol induced, familial
abscent P waves, irreg R-R intervals, undulating baseline
A Fib
investigations into A fib
ECG, holter monitoring (ambulatory ECG), ECHO, Thyroid function tests, CXR
what are the complications of A fib
stroke heart failure, sudden death
what is the treatment for A fib
restore rate BB CCB Digoxin amiodarone
restore rhythm
BB
DC cardioversion
amiodarone
anticoagulant- warfarin, apixaban, dabigatran , rivaroxaban
sense of impeding doom
MI
what are the acute coronary syndromes
STEMI, NSTEMI, unstable angina
how long do MI symptoms have to last to become worrying
> 20 mins
who gets a silent MI
diabetics
what are the signs (not symptoms) of an MI
raised JVP, increased pulse + BP changes, pallor and anxiety
transmural infarct
all of myocardial wall, ST depression
what is seen on an ECG of an MI
ST elevation/depression, inverted T waves, LBBB, pathological Q waves
what is seen on an MI CXR
cardiomegaly, pulmonary oedema, widening of mediastinum
what bloods for MI
troponin I and T
what is PCI
angiography-images coronary vessels can be used for MI surgical intervention
what is the acute treatment for an MI
MONA T morphine + anti emetic oxygen nitrates anticoagulants
ticagrelor
drugs for discharged MI
aspirin, ACEi, BB (2nd CCB), statin
what are the complications of MI
cardiogenic shock arrhythmia pericarditis emboli aneurysm rupture of ventricle dresslers syndrome rupture of free wall papillary muscle rupture
can you give PCI in NSTEMI
yes
what do you give if you cant do PCI immediately
fondaparinux or LMWH (subcutaneously)
malar (cheek) flush
mitral stenosis
pulsatile hepatomegaly
tricuspid regurgitation
carotid pulsation (corrigans)
aortic regurg
head nodding (de musset’s sign)
aortic regurg
capillary pulsations in nail bed
aortic regurgitation
pisto shot heart over femorals
aortic regurgitation
roth spots (boat shaped retinal haemorrhages)
infective endocarditis
olsers nodes (painful, hard swellings on fingers/toes)
infective endocarditis
janeway lesions (painless erythematous blanching macules seen on palmar surface)
infective endocarditis
what criteria asses severity of heart failure
framingham (2 major/ 1 major + 2 minor)
what are the major criteria for heart failure
paroxysmal nocturnal dyspnoea acute pulmonary oedema increased heart size/ CVP neck vein dilatation S3 gallop
what are the minor criteria for heart failure
pleural effusion, ankle oedema, increased HR, nocturnal cough
new york heart assoc classification of CCF
I- no limitation
II-slight
III-marked
IV- inability to carry out physical activity
what are the signs of RVF
peripheral oedema and ascites
what can cause RVF
LVF, tricus/pulm valve disease, pulmonary vascular disease
what are the signs of LVF
PND, wheeze, nocturnal cough with pink sputum (pulmonary oedema)
what can cause LVF
coronary artery disease, hypertension, aortic/ mitral disease, myocardial disease
LVF and RVF both cause
ischameic injury and reduction in myocardial efficiency
-causes increased work load, decreased CO and contractility
what are the compensatory mechanisms of heart failure
RAAS, SNS activation, increase in myocyte size
what does activation of RAAS cause
Na+ ion and H2O retention and peripheral vasoconstriction= increased preload and venous return
what does SNS activation cause
increased HR, peripheral vasoconstriction, increasing afterload
what does chronic activation of heart failure compensatory mechanisms cause
makes heart failure worse
how does heart failure cause hepatomegaly
congestion of the hepatic portal system
causes of angina pectoris
atherosclerosis, anaemia, tachyarrhythmia
what can precipitate angina
exercise, cold weather, heavy metals
decubitus angina
triggered y lying flat
prinzmetal angina
coronary artery spasm
which type of angina causes ST elevation
prinzmetal
what investigations for angina
ECG, CT scan, Caclium score (measured on CT), coronary angiography (gold standard), thallium scan
complications of angina
MI and stroke
process of atheroma formation
fatty streak, fibrolipid plaque formation, complicated atheroma (prone to rupture)
drugs for angina
GTN, aspirin, BB, CCB, K+ channel acitvator (nicorandil)
surgery for angina
PCTA, or CABG
