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Phase 2a > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Pathology of angina

A

o Restricted coronary blood flow
o Mismatch between O2 supply and demand –
diameter <75% for symptoms

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2
Q

Causes of angina

A

o Almost always atheroma
o Rarely – anaemia, coronary artery spasm,
tachyarrhythmias

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3
Q

Non-modifiable risk factors for angina and ACS

A

Gender, FH, age, personal history

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4
Q

Modifiable risk factors for angina and ACS

A

Smoking, HTN, high cholesterol, sedentary lifestyle

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5
Q

‘Controversial’ modifiable/non-modifiable risk factors for angina and ACS

A

Stress, type A personality, diabetes

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6
Q

Signs and symptoms of angina

A

Chest pain:
o Heavy, central, tight, radiation to arms, jaw, neck
o Precipitated by exertion
o Relieved by rest/GTN spray

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7
Q

Definition of stable angina

A

Angina induced by effort, relived by rest

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8
Q

Definition of unstable angina

A

Angina with increasing frequency or severity, occurs on minimal exertion or at rest

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9
Q

Definition of decubitus angina

A

Angina precipitated by lying flat (nocturnal)

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10
Q

Definition of varient angina

A

Angina caused by coronary artery spasm

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11
Q

Investigations for suspected angina

A 
o	ECG – usually normal, signs of IHD (ST elevation)
o	Echo and/or CXR
o	Bloods – FBC, U+E, TFTs lipids, HbA1C
o	Angiography 
o	Exercise stress treadmill
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12
Q

Management of angina

A

o Symptoms relief - GTN spray/sublingual tablets
o Betablockers and/or CCB
o Surgical – PCI, CABG
o Prevention - aspirin and statin

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13
Q

Secondary prevention of CVD

A

o Qrisk calculated
o Lifestyle changes – diet, exercise, smoking
cessation
o Pharmacological – antihypertensives, statins,
diabetes treatment
o Surgical – PCI, CABG

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14
Q

Definition of acute coronary syndromes (ACS)

A

Umbrella term, includes unstable angina and MI

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15
Q

Symptoms of ACS

A

o Acute chest pain >20mins
o Nausea, sweatiness, dyspnoea, palpitations
o Can be silent in elderly and diabetic

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16
Q

Signs of ACS

A

o Distress, anxiety, pallor, sweatiness
o Pulse and BP ↓/↑
o 4th heart sound and/or pansystolic murmur
o Signs of HF

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17
Q

Investigations for suspected ACS

A

o ECG:
- STEMI – large T-waves, ST elevation -> T-
wave inversion and pathological Q-waves
- NSTEMI/unstable angina – ST depression, T-
wave inversion, or normal
o CXR – cardiomegaly, pulmonary oedema
o Bloods – FBC, U+E, lipids, troponin

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18
Q

Differential diagnosis of suspected ACS

A

Stable angina, pericarditis, myocarditis, aortic dissection, PE, reflux, pneumothorax, musculoskeletal pain

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19
Q

Management of ACS

A

o Acute attack - 300mg aspirin + call 999 -> pain relief,
anti-platelet, BB, anti-anginal
o Pharmacological:
- DUAL ANTIPLATELET THERAPY – aspirin +
clopidogrel
- Anticoagulant – heparin +/- fondaparinux
- General cardiac medication – BB -> ACEi -> CCB
o Surgical – patients not responding to drugs -> PCI

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20
Q

Complications of ACS

A

HF, arrhythmias, pericarditis, systemic embolism, cardiac tamponade, mitral regurgitation

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21
Q

Definition of heart failure

A

Cardiac output is inadequate for the body’s requirements

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22
Q

Pathology of systolic failure

A

o Inability of ventricle to contract normally -> ↓cardiac output
o EF < 40%

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23
Q

Causes of systolic failure

A

IHD, MI, cardiomyopathy

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24
Q

Pathology of diastolic failure

A

o Inability of ventricle to relax normally -> ↑filling
pressure
o EF >50% (preserved EF)

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25
Q

Causes of diastolic failure

A

Tamponade, obesity, ventricular hypertrophy

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26
Q

Symptoms of left ventricular failure (LVF)

A

Dyspnoea, poor exercise tolerance, fatigue, nocturnal cough, wheeze, cold peripheries, weight loss

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27
Q

Causes of right ventricular failure (RVF)

A

LVF, pulmonary stenosis, lung disease

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28
Q

Symptoms of RVF

A

Peripheral oedema, ascites, anorexia, facial engorgement, epistaxis (nose bleeds)

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29
Q

Definition of congestive cardiac failure (CCF)

A

Both LVF and RVF

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30
Q

Definition of acute HF

A

New-onset acute or decompensation of chronic HF characterized by pulmonary/peripheral oedema with or without signs of peripheral hypoperfusion

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31
Q

Definition of chronic HF

A

HF that develops or progresses slowly, venous congestion is common but arterial pressure is well maintained until very late

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32
Q

Definition of low-output HF

A

CO is reduced and fails to increase normally with exertion

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33
Q

Causes of low-output HF

A

o Excessive preload – mitral regurgitation or fluid
overload
o Pump failure – systolic and/or diastolic HF,
decreased heart rate (betablockers, heart block,
post MI)
o Chronic excessive afterload – aortic stenosis, HTN

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34
Q

Causes of high output HF (rare)

A

Anaemia, pregnancy, hyperthyroidism

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35
Q

Signs of HF

A
  • Cyanosis
  • Low BP
  • Narrow pulse pressure displaced apex
  • RV heave (PH)
  • Signs of valve diseases
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36
Q

New York Classification of HF

A

• I – no undue dyspnoea from ordinary activity
• II – comfortable at rest, dyspnoea during ordinary
activities
• III – less than ordinary activity causes dyspnoea,
limiting
• IV – dyspnoea at rest, all activity causes discomfort

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37
Q

Investigations for suspected HF

A

• ECG - Evidence of ischaemia, MI or ventricular
hypertrophy, rarely normal in HF
• Echo – may indicate cause and can confirm
presence or absence of LV dysfunction
• Bloods – test for BNP

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38
Q

Management of HF

A
  • ACE-I - ramipril - 1st line, standard
  • BB’s - propanalol - 1st line, standard
  • Spironolactone
  • Digoxin
  • Nitrates – arterial and venous dilators
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39
Q

Spirolactone pathology and therefore SE’s

A

Aldosterone agonist -> renal failure and hyperkalaemia

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40
Q

ACE-i commonest SE

A

Cough -> switch to ARB

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41
Q

How should BB’s be used

A

“start low and go slow”

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42
Q

Why are diuretics used in HF?

A

Relieve oedema and dyspnoea

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43
Q

Which patient group are ACE-i’s not as effective in?

A

Black patients

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44
Q

Why and how is digoxin used to manage HF?

A

On top of standard therapy (ACE-i and BB), helps symptoms

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45
Q

Complications of HF

A
  • Renal dysfunction
  • Rhythm disturbances
  • Systemic thromboembolism
  • Hepatic dysfunction
  • Neurological + Psychological complications
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46
Q

Definition of hypertension (HTN)

A

Chronic high blood pressure (>140/90mmHg)

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47
Q

What is white coat HTN?

A

Elevated clinical pressure but normal ABPM (day average <135/85)

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48
Q

What is malignant/accelerated phase HTN?

A

Rapid BP rise -> vascular damage, requires urgent treatment

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49
Q

Cause of primary HTN

A

Unknown

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50
Q

Causes of secondary HTN

A

o Renal disease
o Endocrine disease – Cushing’s, Conn’s,
acromegaly, hyperparathyroidism
o Others – coarctation, pregnancy, liquorice, drugs
(steroids)

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51
Q

Symptoms of HTN

A

• Usually asymptomatic
• Underling cause; renal failure, weak pulses
• End-organ damage; LVH, retinopathy and
proteinuria

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52
Q

Investigations to diagnose HTN

A

o ABPM or home BP monitoring

o BP >135/85mmHg

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53
Q

Investigations to look for end organ damage in HTN

A

ECG or echo, urine analysis

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54
Q

Tachycardia definition

A

Heart rate >100bpm

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55
Q

Bradycardia definition

A

Heart rate <60bpm

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56
Q

Definition of atrial fibrillation

A

Irregularly irregular rhythm at 300-600bpm due to the AV node responding intermittently

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57
Q

Causes of AF

A

HTN, IHD, Rheumatic HD, mitral valve disease, pneumonia, hyperthyroidism, caffeine, alcohol

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58
Q

Why does AF increase stroke risk (x5)?

A

Atrial activity chaotic and mechanically ineffective -> blood stagnates in atria -> thrombus formation and risk of embolism

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59
Q

Why does AF lead to HF?

A

Atrial activity is chaotic and mechanically ineffective -> reduction in CO -> HF

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60
Q

Symptoms of AF

A 
o	Asymptomatic 
o	Chest pain 
o	Palpitations 
o	Dyspnoea 
o	Faintness
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61
Q

Signs of AF

A

o Irregularly irregular pulse,

o 1st heart sound is of variable intensity

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62
Q

Investigations for suspected AF

A

o ECG - absent P waves and irregular QRS complexes
o Bloods - U&E, cardiac enzymes, thyroid function
tests
o Echo - look for structural abnormalities

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63
Q

Management of AF

A

o Rate control – BB/CCB’s -> digoxin -> amiodarone
Digoxin 2nd line
o DC cardioversion
o Anticoagulate – warfarin

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64
Q

Atrial flutter definition

A

Atrial rate = 300bpm, Ventricular rate = 150bpm

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65
Q

What does ECG show in atrial flutter?

A

Sawtooth flutter waves (F waves)

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66
Q

Management of atrial flutter

A

Like AF - radiofrequency catheter ablation as recurrence rates high

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67
Q

Definition of heart block

A

Block in AV node or bundle of His

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68
Q

Pathology/ECG of 1st degree heart block

A

PR interval prolonged and unchanging, no missed beats

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69
Q

Causes of heart block

A

Inferior MI, drugs (BB’s, CBB’s), cardiac surgery, trauma

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70
Q

Pathology/ECG of 2nd degree heart block (Mobitz I)

A

o Some atrial pulses fail to reach ventricles
o PR interval becomes longer and longer until a QRS is
missed, then pattern resets (Wenckebach
phenomenon)

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71
Q

Symptoms of heart block

A

Dizziness, syncope, chest pain, SOB, postural HTN

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72
Q

Pathology/ECG of 2nd degree heart block (Mobitz II)

A

o Some atrial impulses fail to reach ventricles

o QRS’s regularly missed, may progress to complete heart block

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73
Q

Pathology/ECG of 3rd degree (complete) heart block

A

No impulses passed from atria to ventricles so P waves and QRS’s appear independently of each other

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74
Q

Management of heart block

A

Atrophine if symptomatic (IV if complete HB), pacemaker

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75
Q

Pathology of bundle branch block

A

RBB/LBB no longer conducts an impulse and the two ventricles do not receive an impulse simultaneously (first left then right)

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76
Q

Causes of RBBB

A

Normal variant, pulmonary embolism, cor pulmonale

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77
Q

Symptoms of bundle branch block

A

Asymptomatic

78
Q

ECG in RBBB

A

M pattern in V1 and slurred S wave (W) in V5 - MaRRoW

79
Q

Management of bundle branch block

A

Treat underlying cause, pacemaker

80
Q

ECG in LBBB

A

W pattern in V1, M pattern in V6 - WiLLiaM

81
Q

Causes of LBBB

A

IHD, LV hypertrophy, aortic valve disease

82
Q

Causes of sinus tachycardia

A

Infection, pain, exercise, anxiety, dehydration, bleeding, drugs, fever, pregnancy

83
Q

Management of sinus tachycardia

A

Do NOT cardiovert, treat cause, rate control with beta blockers

84
Q

Definition of supraventricular tachycardia

A

Rapid heart rhythm originating at/above the AV node

85
Q

Causes of supraventricular tachycardia

A

Drugs, alcohol, caffeine, anaemia, fever

86
Q

Management of supraventricular tachycardia

A
  1. Vagal manouveres
  2. Adenosine
  3. Verapamil
  4. DC cardioversion
87
Q

Definition and pathology of Wolff-Parkinson-White syndome

A

Congenital accessory pathway between atria and ventricles -> removes AVN delay -> ventricles contract early

88
Q

WPW syndrome ECG

A

Short PR interval, wide QRS, delta wave

89
Q

WPW syndrome management

A

Radiofrequency catheter ablation of accessory pathway

90
Q

Causes of ventricular tachycardia

A

Congenital, drugs, MI, HOCM

91
Q

Ventricular tachycardia ECG

A

Broad QRS, tachycardia

92
Q

Management of VT/VF

A

Amiodarone, DC cardioversion

93
Q

Symptoms of ventricular extrasystoles (ectopic)

A

Palpitations, thumbing sensation, heart “missing a beat”

94
Q

ECG for ventricular extrasystoles (ectopic)

A

Broad QRS complexes, may be single or in patterns

95
Q

Definition of long QT syndromes (LQTS)

A

Channelopathies that result in prolonged repolarisation phases -> predisposition to ventricular arrhythmias

96
Q

Definition of aortic aneurysm

A

Aortic diameter >3cm

97
Q

Epidemiology of aortic aneurysm

A

o Male:female > 3:1

o Less common in diabetics

98
Q

Which population group is invited for aortic aneurysm screening in the UK?

A

All males at age 65

99
Q

Risk factors for aortic aneurysm

A

HTN, male, smoking, family history

100
Q

Cause/pathology of aortic aneurysm

A

Degeneration of elastic lamellae and smooth muscle loss, genetic component

101
Q

Signs and symptoms of unruptured aortic aneurysm

A

o Often none
o May cause abdominal/back pain
o Often discovered incidentally on abdominal
examination

102
Q

Signs and symptoms of ruptured aortic aneurysm

A 
o  Intermittent or continuous abdominal pain (radiates 
    to back or groin)
o  Collapse
o  Expansile abdominal mass
o  Shock
103
Q

Management of unruptured aortic aneurysm

A

o Elective surgery - >5.5cm or expanding at >1cm/yr, or
symptomatic
o Stenting – allows major surgery to be avoided

104
Q

Management of ruptured aortic aneurysm

A

o ECG
o Straight to theatre (CT only if patient stable)
o Prophylactic antibiotics
o Surgery – aorta clamped above leak and Dacron
graft inserted

105
Q

Pathophysiology of aortic dissection

A

o Tear in aortic intima -> high pressure blood into

aortic wall -> false lumen

106
Q

What is the difference between type A and type B aortic dissection?

A

Type A = ascending aorta involved

Type B = ascending aorta not involved

107
Q

Risk factors for aortic dissection

A

Atherosclerosis, high BP, cocaine, aortic aneurysm, smoking

108
Q

Signs and symptoms of aortic dissection

A

o Initial tear – sudden severe chest pain, pulse loss ->
diastolic murmur
o Later symptoms – aortic branch occlusion =
hemi/paraplegia, anuria

109
Q

Investigations for suspected aortic dissection

A

ECG (ischaemia/MI), USS and MRI (site and severity)

110
Q

Management of aortic dissection

A

Stenting -> surgery if dissection is progressing

111
Q

Complications of aortic dissection

A

Aortic rupture, cardiac tamponade = syncope and hypotension

112
Q

Pathology of peripheral arterial disease (PAD)

A

Atherosclerosis -> stenosis of peripheral arteries

113
Q

RF’s for PAD

A
  • Smoking
  • HTN
  • Hypercholesterolaemia
114
Q

Symptoms of PAD

A

asymptomatic -> exercise claudication (intermittent) -> critical ischaemia (pain, pulseless, pale, paralysed, pins and needles, perishingly cold)

115
Q

Signs of PAD

A

Absent femoral/popliteal/foot pulse, ulcers/gangrene, cold white

116
Q

Investigations for suspected PAD

A
  • ECG – CHD evidence

* Doppler ultrasonography confirms diagnosis

117
Q

Management of PAD

A
  • Antiplatelet – clopidogrel
  • Modify risk factors
  • Surgery (angioplasty vs reconstruction)
  • Amputation
118
Q

Causes of pericarditis

A 
o	Viral - HIV
o	Bacterial – TB, rheumatic fever
o	Autoimmune – SLE 
o	Drugs – chemo
o	Trauma
o      Cancer mets
119
Q

Symptoms of pericarditis

A 
o	Chest pain – sever, sharp, rapid onset, radiates to 
        arms, relieved sitting 
o	Dyspnoea 
o	Cough 
o	Hiccups (phrenic)
120
Q

What is the normal area of the aortic valve?

A

3-4cm2

121
Q

At approximately what point do aortic valve stenosis symptoms begin?

A

Symptoms occur when valve area is 1/4th of normal

122
Q

Causes of aortic stenosis

A

o Congenital
o Bicuspid valve
o Degenerative calcification (common),
o Rheumatic heart disease

123
Q

What is the pathophysiology of symptomatic aortic stenosis?

A

pressure gradient develops between LV and aorta -> increased afterload -> LV function declines

124
Q

Why is aortic stenosis not always symptomatic?

A

LV function initially maintained by compensatory pressure hypertrophy

125
Q

Symptoms of aortic stenosis

A

o Syncope on exertion
o Angina
o Dyspnoea (especially on exertion)
o Sudden death

126
Q

Signs of aortic stenosis

A

o Slow rising carotid pulse and decreased pulse
amplitude
o Absent 2nd heart sound
o Ejection systolic murmur

127
Q

Investigations for suspected aortic stenosis

A

Echocardiography

128
Q

Management of aortic stenosis

A 
o   Fastidious dental hygiene/care –  IE prophylaxis
o   Surgical replacement or TAVI
o   Indications for intervention:
      - symptomatic patient
      - decreasing EF
      - undergoing CABG with AS
129
Q

Definition of mitral regurgitation

A

Backflow of blood from LV to LA during systole

130
Q

Causes of mitral regurgitation

A

o Myxomatous degeneration (MVP)
o Ischaemic MR
o Rheumatic heart disease
o Infective endocarditis

131
Q

Pathophysiology of mitral regurgitation

A

Pure volume overload -> LA and LV hypertrophy -> progressive HF and PAH

132
Q

What are the compensatory mechanisms in mitral regurgitation?

A

Left atrial enlargement, LVH and increased contractility

133
Q

Signs and symptoms of mitral regurgitation

A

o Soft S1 and pansystolic murmur at
the apex radiating to the axilla
o Exertion dyspnoea
o HF

134
Q

Investigations for suspected mitral regurgitation

A 
o   ECG – LA enlargement, AF and LV hypertrophy if 
     severe
o   CXR – LA enlargement
o   Echo – valve 
     structure assessment
135
Q

Management of MR

A 
o   IE prophylaxis 
o   Vasodilators - ACEI
o   If w/AF - warfarin and BB
o   Serial echocardiograms 
o   Surgical treatment if symptomatic
136
Q

Definition of aortic regurgitation

A

Leakage of blood into LV during diastole due to ineffective coaptation of aortic cusps

137
Q

Causes of aortic regurgitation

A

o Bicuspid aortic valve
o Rheumatic fever
o Infective endocarditis

138
Q

Pathophysiology of aortic regurgitation

A

Combined pressure and volume overload -> progressive LV dilation -> HF

139
Q

Compensatory mechanisms in aortic regurgitation

A

LV dilation, LVH

140
Q

Signs of aortic regurgitation

A

o Wide pulse pressure
o Hyperdynamic and displaced apical impulse
o Diastolic blowing murmur, systolic ejection murmur

141
Q

Symptoms of aortic regurgitation

A

o Dyspnoea
o Fatigue
o Chest pain

142
Q

Investigations for suspected aortic regurgitation

A

o CXR – enlarged cardiac silhouette and aortic root

o Echo - evaluation of the AV

143
Q

Management of aortic regurgitation

A

o IE prophylaxis
o Vasodilators - ACEI
o Serial echocardiograms
o Surgical treatment if symptomatic

144
Q

What is the normal area of the mitral valve?

A

4-6cm2

145
Q

What is the most common cause of mitral valve stenosis?

A

Rheumatic heart disease

146
Q

Definition of shock

A

• Circulatory failure resulting in inadequate organ
perfusion
• Low BP, systolic < 90mmHg

147
Q

Basic mechansism of septic shock

A

Infection with any organism -> acute vasodilation from inflammatory cytokines

148
Q

Basic mechanism of anaphylactic shock

A

Type-1 IgE-mediated hypersensitivity, release of histamine

149
Q

Causes of neurogenic shock

A

Spinal cord injury, epidural or spinal anaesthesia

150
Q

Causes of hypovolaemic shock

A

Bleeding, trauma, ruptured aortic aneurysm, GI bleed

151
Q

Signs and symptoms of septic shock

A

o Temperature >38⁰C or <36⁰
o Tachycardia >90bpm
o Resps >20/min
o WBC very high or very low

152
Q

Management of septic shock

A

o ABC – airways, breathing, circulation

o Blood cultures before antibiotics

153
Q

Definition of cardiomyopathy

A

Deterioration of myocardium’s ability to contract, without any heart disease involvement

154
Q

What is dilated cardiomyopathy?

A

A dilated, flabby heart of unknown cause

155
Q

What is dilated cardiomyopathy associated with?

A

Alcohol, HTN, chemotherapy, haemochromatosis, viral infections, autoimmune, congenital

156
Q

Symptoms of dilated cardiomyopathy

A

Fatigue, dyspnoea, pulmonary oedema, RVF, emboli, AF, VT

157
Q

Signs of dilated cardiomyopathy

A

Tachycardia, hypotension, displaced and diffuse apex, mitral or tricuspid regurg, oedema, ascites

158
Q

Investigations for suspected cardiomyopathy

A

o Bloods – BNP
o ECG – tachycardia, abnormal
o CXR – cardiomegaly, pulmonary oedema
o Echo – dilation and low EF

159
Q

Management of dilated cardiomyopathy

A

o Bed rest
o BB’s, ACE-i, anticoagulants
o Biventricular pacing
o Transplant

160
Q

What is hypertrophic cardiomyopathy?

A

LV outflow tract (LVOT) obstruction from asymmetric septal hypertrophy

161
Q

Epidemiology of hypertrophic cardiomyopathy

A

Leading cause of sudden cardiac death in the young – ask about family history of sudden death

162
Q

What is the main cause of hypertrophic cardiomyopathy?

A

70% have mutations in genes encoding sarcomere proteins (50% are sporadic)

163
Q

Symptoms of hypertrophic cardiomyopathy

A

Sudden death, angina, dyspnoea, palpitations, syncope

164
Q

Signs of hypertrophic cardiomyopathy

A

Jerky pulse, double apex beat, harsh ejection systolic murmur

165
Q

Investigations for suspected cardiomyopathy

A

o ECG – LVH, AF, ectopics
o Echo – asymmetric septal hypertrophy
o cMRI
o Exercise test to risk strategise

166
Q

Management of cardiomyopathy

A

o BB for symptoms
o Amiodarone for arrhythmias
o Septal myomectomy surgery if severe
o Implantable defibrillator

167
Q

Causes of restrictive cardiomyopathy

A

Idiopathic, haemochromatosis, sarcoidosis, endomyocardial fibrosis

168
Q

Signs and symptoms of restrictive cardiomyopathy

A

Right heart failure with elevated JVP, like constrictive pericarditis, hepatomegaly, oedema, ascites

169
Q

Management of restrictive cardiomyopathy

A

Treat cause (haemochromatosis, sarcoidosis, endomyocardial fibrosis)

170
Q

What is arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A

RV myocardium is replaced with fibro-fatty material

171
Q

Symptoms of ARVC

A

Palpitations and syncope during exercise

172
Q

What is the main ECG change seen in ARVC?

A

Epsilon wave

173
Q

What are the causes of tetralogy of fallot?

A

Congenital, 22q11 deletion, Down’s syndrome

174
Q

What are the four features of tetralogy of fallot?

A
  1. Ventricular septal defect
  2. Overriding aorta
  3. Pulmonary stenosis
  4. Right ventricular hypertrophy
175
Q

Symptoms of tetralogy of fallot

A

Bluish skin, SOB, syncope, clubbing of fingers and toes

176
Q

Signs of tetralogy of fallot

A

Cyanosis, harsh systolic ejection murmur, children may squat

177
Q

What investigations should be done for a suspected structural heart defect?

A

o Echo
o ECG
o CXR

178
Q

What might a CXR show in tetralogy of fallot?

A

Boot-shaped heart

179
Q

Management of tetralogy of fallot

A

Complete surgical repair, monitor for pulmonary valve replacement

180
Q

Pathology of a ventricular/atrial septal defect

A

o Opening in the interventricular/interatrial septum

o LV pressure > RV -> blood flows from LV to RV

181
Q

Signs and symptoms of a ventricular septal defect

A 
o   Increased respiratory rate
o   Tachycardia
o   Harsh pansystolic murmur 
o   Thrill
o   Pulmonary hypertension
182
Q

Management of a ventricular septal defect

A

PA band or complete repair in infancy, nothing if small

183
Q

What is Eisenmengers syndrome?

A

Structural heart defect -> long-standing left-to-right cardiac shunt -> high pulmonary BP -> damages pulmonary vasculature -> increased resistance in lungs -> RV pressure increases -> shunt direction reverses -> patient becomes blue

184
Q

Signs and symptoms of an atrial septal defect

A 
o   Pulmonary flow murmur 
o   Fixed split second heart sound
o   SOB
o   Palpitations 
o   Oedema 
o   Pulmonary hypertension
185
Q

Management of atrial septal defect

A

Repair if right heart strain

186
Q

What is coarctation of the aorta?

A

Narrowing of the aorta at the site of insertion of the ductus arteriosus

187
Q

Signs of coarctation of the aorta

A

o Right arm HTN
o Bruits (buzzes) over scapulae
o Murmur (left scapula)
o Cold feet

188
Q

Management of torsades de pointes

A

IV magnesium sulphate

189
Q

What is the classification system for peripheral vascular disease (PVD)?

A

Fontaine

190
Q

Give 5 signs of heart failure seen on a chest x-ray

A 
ABCDE:
    Alveolar oedema 
    kerley B lines 
    Cardiomegaly 
    Dilated prominant upper lobe vessels 
    pleural Effusion
191
Q

Describe torsades de pointes on ECG

A

Broad complex tachycardia, irregular, increasing and decreasing amplitudes when in circuit (torsades de pointes)

Phase 2a (9 decks)

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