Cardiology Flashcards
What is AF?
Irregular atrial rhythm at 300-600bpm
Signs + symptoms of AF
Palpitations, dizziness, dyspnoea, fatigue
Irregular pulse
Loss of P waves + altered QRS
Causes of AF
Age, HTN, IHD, HF, Post-MI, alcohol, caffeine, drugs, post-operatively
Treatment of AF
Anticoagulation - warfarin or DOAC (weigh up score using CHA2DS2VAS and HAS-BLED)
Rate control - beta blocker or CCB. If doesn’t work, add digoxin then consider amiodarone. DO NOT give beta-blockers with verapamil
Rhythm control - ?cardioversion or fleicanide
What is an abdominal anuerysm?
When artery >50% its normal size
True aneurysm involves all 3 layers of the artery wall
>3cm
Screening + surveillance for AAA
All men aged 65 offered 1 time USS
Surveillance if:
- 3-4.4cm every 2yrs
- 4.5 - 5.4 cm every 3m
When to operate on AAA?
- Symptomatic
- Asymptomatic but measures >5.5cm
- Asymptomatic but measures >4cm + grown >1cm in 1yr
Symptoms of AAA
- Pain radiating to back
- Expansile mass in abdomen
What is endocarditis?
Fever + new murmur = endocarditis until proven otherwise!
Infiltration of heart valves with pathogens
Causes of endocarditis
Acute - tends to be on normal valves with staph aureus or strep viridans from skin breaches, renal failure, immunosuppression, DM
In IVDU - tends to be on tricuspid valve
Endocarditis on prosthetic valves tends to present <60d post surgery - staph epidermis (poor prognosis)
Diagnosis of endocarditis
Duke Criteria
2 major: +ve blood culture, endocardium involved
Minor: predisposition e.g. IVDU, fever >38, vacular phenomena e.g. emboli/janeway lesions, immunological phenomena e.g. oslers noodes, +ve blood culture
2 major or 1 major + 3 minor or all 5 minor
Treatment of endocarditis
50% require surgery
IV abx
Immunological complex deposition in endocarditis
Oslers nodes, roth spots, splinter haemorrhages
Embolic phenomena in endocarditis
emboli may causes abscesses e.g. in skin - janeway lesions
Treatment of pericarditis
NSAIDs + aspirin + PPI protection
Colchicine can prevent recurrence
Treat cause
Signs + symptoms of pericarditis
Central chest pain, worse on lying down, relieved by sitting forward +/- fever
Friction rub may be heard
Saddle-shaped ST elevation across all leads
What is paroxysmal nocturnal dyspnoea?
Occurs 1-2hrs after going to sleep + forces pt awake
When lying down - blood redistributes and you get increased blood to the lungs which causes transudation of plasma into alveolar spaces
Systolic v diastolic HF
Systolic = impaired V contraction –> EF >40%
Causes: IHD, MI, cardiomyopathy
Diastolic = V can’t relax + fill properly. EF >50%
Causes: restrictive cardiomyopathy, tamponade, ventricular hypertrophy
NYHA classification
1 = no limitation 2 = slight limitation on moderate exercise, comfortable at rest 3 = considerable limitation, only comfortable at rest 4 = breathlessness + fatigue at rest
ABPM
Use average of at least 14 measurements taken during person’s waking hours. Check that each BP is recorded twice, 1 min apart with person sitting down. Ideally have morning + evening BP. Discard 1st day
Stages of hypertension
Stage 1: clinic of 140/90 or ABPM of 135/85
Stage 2: clinic of 160/100 or ABPM of 150/95
Severe: 180/110
Who to treat with HTN?
Refer anyone <40yrs to look for secondary causes
If stage 1, under 80 + evidence of target organ damage, DM, established CVD, renal disease or 10 year risk of >20% then treat
Treat all stage 2
Aim for BP on tx of 140/90 or 150/90 if >80
Conns disease
Primary aldosteronism - excess production of aldosterone independent of RAAS causing increased Na + H2o retention and reduced renin release
Phaeochromocytoma
Catecholamine producing tumour
Chromaffin cells
Usually found in adrenal medulla
Fam hx crucial
Classic triad: episodic headache, sweating + tachycardia
BP may be hard to control
