Cardiology Flashcards
Acute Coronary Syndrome
Spectrum of presentations caused by myocardial ischaemia ranging from unstable angina to STEMI. There is a common pathophysiology of impaired myocardial blood supply secondary to atheromatous plaque disruption and thrombus formation.
Causes of obesity
Primary elevated energy intake
Secondary to: Hypothyroidism Cushing’s syndrome PCOS Insulinoma Hypothalamic or pituitary disease Drugs Generic syndromes such as Laurence-Moon-Biedl syndrome Leptin deficiency
Causes of AF
5 most common causes: Coronary artery disease Hypertension Valvular heart disease Thyroid dysfunction Alcohol
Age Symptomatic heart failure Cardiomyopathies ASD and congenital heart defect Obesity Diabetes Chronic respiratory disease Infection High caffeine supplements
Prosthetic valves
All cause ESM as narrow outflow (aortic) and interfere with stream (mitral)
Tilting disc - Bjorn-Shiley
Bileaflet- St Jude
Above two has diastolic murmur (aortic and mitral, for different reasons)
Ball and cage - Starr Edwards
Close completely. If diastolic murmur in aorta heard then failure.
If loud systolic murmur, implies valve failure
Causes of Pericarditis
Viral (coxsackie, adenovirus, echovirus) Bacterial (mycoplasma, haemophilus, TB) Connective Tissue Disease (SLE, RA) Drugs (hydralazine, procainamide) Dresser’s syndrome (MI, post op) Uraemia
Collapsing pulse
Aortic regurgitation Anaemia Fever Pregnancy Thyrotoxicosis Patent ductus arteriosus AV fistula Severe bradycardia Severe MR
Duke’s criteria
Major:
Typical organism in BC
Echo showing vegetation, access, dehiscence
Minor: Atypical organism in BC Suggestive echo Risk factor such as prosthetic valve Pyrexial Vasculitic phenomena such as raised ESR Embolic phenomena
2M, 1M 2m, or 5m
Causes of Aortic Stenosis
Age
Biscuspid valve
Congenital
Rheumatic fever
Causes of Aortic Regurgitation
Congenital:
Bicuspid valve
Perimembranous VSD
Acquired:
Acute:
Endocarditis
Dissection
Chronic
Rheumatic fever
Connective tissue disease such as RA/ Ank Spond
Inherited disorders such as Marfan’s
Chronic aortitis - syphillis and Ank Spond
Causes of collapsing pulse
Pregnancy Patent ductus arteriosus Paget’s disease Anaemia Thyrotoxicosis
Causes of Mitral Stenosis
Congenital:
Cleft mitral valve
Acquired:
Rheumatic fever
Age
Endocarditis
Differential diagnosis of mid-diastolic murmur
Mitral stenosis
Austin-Flint murmur
Atrial myxoma
Early diastolic murmur - aortic regurgitation
Rheumatic Fever
Immunological cross reactivity between Group A Haemolytic Streptococcus and the valve tissue
Duckett-Jones diagnostic criteria
Rheumatic fever
Proven beta haemolytic strep diagnosis via throat swab, antigen test, titre test, or clinical scarlet fever AND
Major Chorea Erythema marginatum Subcutaneous nodules Polyarthritis Carditis
Minor Raised ESR Raised WCC Arthralgia Previous rheumatic fever Pyrexia Prolonged PR interval
2M or 1M 2m
Causes of Mitral Regurgitation
Congenital:
Secundum ASD
Acquired:
Acute:
Endocarditis
Rupture
Chronic:
Myxomatous degeneration
Rheumatic
Connective tissue disease
Fibrosis secondary to drugs such as fenfluramine and pergolide
Dilated LV
Calcification
Infiltrative disorders such as amyloid
Fibrosis of papillae post MI
Causes of tricuspid regurgitation
Congenital: Ebstein anomaly (atrialisation of the right ventricle and tricuspid regurgitation)
Acquired:
Acute: infective endocarditis
Chronic: functional, rheumatic, carcinoid
Indication for ICD
Primary prevention:
MI more than 4 weeks ago with
1. LVEF less than 35% and non-sustained VT and positive EP study
2. LVEF less than 35% and QRS more than 120ms
Familial condition with high risk SCD
LQTS, Brugada, HCM, CHD
Secondary prevention:
- Previous cardiac arrest
- Haemodynamically compromised VT
- VT with LVEF less than 35%
And only if NYHA three and below
Indication for CRT
Optimal medical therapy
LVEF less than 35%
NYHA I only if QRS more than 150
NYHA II to III if QRS more than 120 and LBBB
NYHA IV is QRS more than 120 alone
Causes of pericardial disease
TB and infection Trauma Tumour Therapy (radio) Tissue disease (RA, SLE) Thrombus (MI)
Causes of absent radial pulse
Acute: Embolism Dissection Catheterisation Death
Chronic: Blalock-Taussig shunt Atheroma Coarctation Takayatsu’s arteritis
Apex beat descriptions:
Aortic stenosis - sustained
Aortic regurgitation - hyperkinetic displaced
Mitral stenosis - tapping
Mitral regurgitation - volume loaded displaced
Coarctation - heaving
Patent ductus arteriosus - thrusting
HCM - double apical impulse
Tetralogy of Fallot
Overriding aorta
Pulmonary stenosis
VSD
Right ventricular hypertrophy
