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Phase 3B > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is acute coronary syndrome?

A
  • STEMI
  • NSTEMI
  • Unstable angina
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2
Q

What is a STEMI?

A

Myocardial infarction resulting in ST elevation

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3
Q

What causes are there for Non ST elevation?

A
  • Unstable angina

- NSTEMI

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4
Q

What are non-modifiable risk factors for ACS?

A
  • increasing age
  • male gender
  • family history of premature coronary heart disease
  • premature menopause
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5
Q

What are modifiable risk factors for atherosclerosis causing ACS?

A
  • Smoking
  • DM and impaired glucose intolerance
  • Hypertension
  • Dyslipidaemia
  • Obesity
  • Physical inactivity
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6
Q

What are some non-atherosclerotic causes of ACS?

A 
-Coronary occlusion secondary to:
>vasculitis
>CHD
>cocaine use
>coronary trauma
>congenital coronary anomalies
>increase oxygen requirement
>decreased oxygen delivery
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7
Q

How does unstable angina and NSTEMIs present?

A 
-Prolonged chest pain at rest
>Sweating
>Nausea
>Vomiting
>Fatigue
>Shortness of breath
>Palpitations
>Little response to GTN spray
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8
Q

Which groups of patients may present atypically with ACS?

A
  • Diabetics

- Women

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9
Q

What are some differential diagnosis of chest pain?

A
  • Acute pericarditis
  • Myocarditis
  • AS
  • PE
  • Pneumonia
  • Pneumothorax
  • GORD
  • Acute gastritis
  • Acute pancreatitis
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10
Q

What investigations should be done for suspected ACS?

A
  • 12 lead ecg
  • Troponin (6hr and 12 hrs post chest pain onset)
  • Blood glucose
  • ECHO
  • CXR
  • Coronary angiography
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11
Q

What is the acute management for ACS?

A
  • MONA
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin (300mg) or 180mg Ticagrelor
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12
Q

What further management is required for ACS?

A
  • coronary angiography - PCI if necessary

- rate limiting medications

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13
Q

What are some lifestyle modifications that a patient can do to prevent a further ACS epsiode?

A
  • Smoking cessation
  • Weight loss
  • Exercise
  • Dietary alterations
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14
Q

What are some potential complications of ACS?

A
  • Cardiogenic shock
  • Ischaemic MR
  • Supraventricular arrhythmias
  • Ventricular arrhythmias
  • Heart block
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15
Q

What is a STEMI?

A
  • An acute myocardial infarction caused by necrosis or myocardial tissue due to ischaemia
  • Usually due to a blockage of a coronary artery by a thrombus
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16
Q

How is STEMI diagnosed?

A
  • Raise in troponin
  • Symptoms of ischaemia
  • ST elevation on ECG
  • Imaging evidence of new loss of myocardium or new regional wall motion abnormality
  • Identification of intracoronary thrombus by angiography or autopsy
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17
Q

What is the epidemiology of STEMI?

A
  • Most common cause of death in the UK
  • Affects 1 in 5 men and 1 in 10 women
  • Incidence increases with age
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18
Q

What are modifiable risk factors for an NSTEMI?

A
  • Smoking
  • DM
  • Metabolic syndromes
  • Hypertension
  • Hyperlipidaemia
  • Obesity
  • Physical inactivity
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19
Q

How does MI present?

A
  • Central/Epigastric chest pain
  • Radiates to arm, shoulders, neck, jaw (usually left side)
  • Substernal pressure, squeezing, aching, burning, sharp pain
  • Associated with sweating, nausae, vomiting, dyspnoea, fatigue, palpitations
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20
Q

What are some atypical presentations of MI?

A
  • Abdominal discomfort
  • Jaw pain
  • Altered mental state in the elderly
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21
Q

What are signs of an MI?

A
  • Low grade fever
  • Pale, cool, clammy skin
  • Dyskinetic cardiac impulse
  • Signs of congestive heart failure
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22
Q

How quickly should GTN work?

A
  • Straight away
  • Side effects: headache
  • ACS more likely if spray taken 3 times within 5 minutes and no relief
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23
Q

What are the investigations that should be done if an MI is suspected?

A
  • ECG
  • Bloods (trop)
  • CXR
  • Pulse oximetry and blood gases
  • CARDIAC CATHETERISATION AND ANGIOGRAPHY
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24
Q

What pre-hospital management is required for an MI?

A

-Ambulance
-ECG
-Oxygen saturation monitoring
-GTN spray
-Morphine
-Aspirin
MONA

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25
Q

What is the hospital management for an MI?

A
  • PCI

- Coronary bypass surgery

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26
Q

What is Atrial fibrillation?

A

-Irregular heart beat caused by irregular disorganised electrical activity from the SA node in the atria causing irregular depolarisation and therefore ineffective atrial contractions.

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27
Q

What are the ECG findings of AF?

A
  • Irregularly irregular heartbeat
  • No P waves
  • Chaotic wavy baseline
  • Fast or slwow
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28
Q

What are the 2 causes of an irregular heart beat?

A
  • AF

- Ventricular ectopics

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29
Q

Who is commonly affected by AF?

A

-The elderly

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30
Q

What conditions are associated with an increased risk of AF?

A 
-Structural heart abnormalities
>Valvular disease
>Enlarged atria
-Hypertension
-Acute MI
-Hyperthyroidism
-Alcohol and caffeine consumption
-Sleep apnoea
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31
Q

What is the treatment for AF?

A
  • Anti-arrhythmic drugs
  • Cardioversion
  • Rate control ie Beta blockers
  • Anticoagulation ie warfarin, rivaroxaban
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32
Q

How is AF classified?

A
  • Acute: episode within previous 48 hours
  • Paroxysmal AF: self limiting AF lasting <7 days
  • Recurrent AF: 2+ episodes
  • Persistent AF: >7day duration
  • Permanent AF: fails to terminate following cardioversion, relapses within 24 hours
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33
Q

What are the common causes of AF?

A
  • Ischaemic heart disease
  • Hypertension
  • Valvular heart disease
  • Hyperthyroidism
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34
Q

What are some other less common causes of AF?

A

-Rheumatic fever
-Pre-excitation syndromes (WPW syndrome)
-Heart failure
-Drugs (thyroxine, bronchodilators)
-Acute infection
-Electrolyte depletion
-Lung cancer
-PE
-Thyrotoxicosis
-Dietary/lifestyle factors
>excessive caffeine, alcohol obesity

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35
Q

What are the clinical symptoms of AF?

A
  • Asymptomatic
  • Palpitations
  • Shortness of breath
  • Syncope/dizziness
  • Chest discomfort
  • Stroke/TIA
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36
Q

What are the Complications of AF

A

-Stroke and thromboemobolism
-Heart failure
-Tachycardia induced cardiomyopathy and critical ischaemia
-Reduced quality of life
>Reduced exercise tolerance and impaired cognitive function

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37
Q

How is AF diagnosed?

A 
-ECG
>ambulatory ECG if paroxysmal
-Bloods
>TFT, FBC, U&amp;E, LEF, coagulation
-CXR
-ECHO
-CT/MRI if stroke is suspected
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38
Q

What are some differential diagnosis of AF?

A
  • Atrial flutter (characterised saw tooth pattern or regular atrial activation on ECG)
  • Ventricular ectopic beats
  • Sinus tachycardia
  • Supraventricular tachycardias
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39
Q

What is the management of the first presentation of AF?

A
  • Investigate and manage the cause of AF.
  • Rate control treatment
  • Rhythm control
  • Assess CHADSVASc for stroke risk
  • Assess HAS-BLED tool for anticoagulant
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40
Q

What are the options for rate control for a patient with AF?

A

> Beta blocker, calcium channel blocker ie bisoprolol or diltiazem
Digoxin (for sedentary pts)
Combination therapy

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41
Q

What are the options for rhythm control for patients with AF?

A
  • Cardioversion

- Pharmacological ie amiodarone or flecainide

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42
Q

What does CHADSVASc stand for?

A
  • CCF
  • Hypertension
  • Age >75
  • Diabetes
  • Stroke/TIA/VTE
  • Vascular disease
  • Age: 65-74
  • Female
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43
Q

What factors form the HAS-BLED scoring system?

A
  • Hypertension
  • Abnormal liver/renal function
  • Stroke
  • Bleeding
  • Labile INR
  • Elderly
  • Drug/alcohol use
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44
Q

When should immediate admission be arranged for a patient with AF?

A
  • Rapid pulse >150bpm

- Low bp <90mmHg systolic

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45
Q

What is 1st degree heart block?

A

-Delay in conduction of the electrical impulse through the AV node

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46
Q

What is the diagnostic criteria on ECG for heart block?

A

-Long constant PR interval. (>5 small squares = >200ms)

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47
Q

What may be the cause of slowed conduction through the AV node?

A
  • Disease processes ie ischaemia

- Drugs ie beta blockers

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48
Q

What condition is associated with 1st degree heart block?

A

-AF

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49
Q

What is the management for 1st degree heart block?

A
  • Watch and wait
  • Monitor for any progression
  • Pacemaker is not usually required as the heart rate is unaffected
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50
Q

What are the 2 types of 2nd degree heart block?

A

-Type 1 (Wenkebank)
>lengthening prolonged PR interval until a QRS is missed
-Type 2
>constantly prolonged PR intervals with occasional missing beats

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51
Q

What is the electrophysiology of Type 1 (2nd degree) heart block?

A
  • Some but not all P waves are conducted to the ventricles
  • Increasing PR intervals until a QRS is dropped or missing
  • Blockage is commonly within the AV node/bundle of His
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52
Q

When might a pacemaker be required for someone with Type 1 (2nd degree) Heart block?

A

-If the atrial contraction rate is low

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53
Q

What are some medications that can cause/worsen heart block?

A
  • Calcium channel blockers

- Beta blockers

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54
Q

Is Type 1 or type 2 (2nd degree) heart block more likely to progress to 3rd degree heart block?

A

-Type 2

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55
Q

What are the causes of Type 1 (2nd degree) Heart blockl?

A
  • Ischaemia (AV node branch of RCA)
  • High vagal tone in athletes
  • Heart surgery
  • Medications that suppress the AV node
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56
Q

What are the findings of type 2 2nd degree heart block on ECG?

A

-Regular prolonged PR intervals with occasional missing beats

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57
Q

What is the clinical significance of type 2 2nd degree heart block?

A
  • May require a pacemaker if the atrial contraction rate is low
  • Can progress to 3rd degree heart block
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58
Q

What are the causes of type 2 2nd degree heart block?

A
  • Ischaemia
  • Fiboriss within the conducting system
  • Heart surgery
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59
Q

What is 3rd degree heart block?

A

-There is no communication of electrical conduction between the atria and ventricles

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60
Q

What are the findings on ECG of 3rd degree heart block?

A
  • Slow ventricular rate
  • Irregular or regular rhythm
  • P waves>QRS
  • No PR interval
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61
Q

What is the electrophysiology behind 3rd degree heart block?

A

-None of the P waves are conducted to the ventricles
-2 individual pacemakers produce individual impulses
>One of the pacemakers is below of the heart block

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62
Q

What is the clinical significance of 3rd degree heart block

A 
-Symptomatic bradycardia
>Low cardiac output (hypotensive)
-Weak
-Dizziness
-Decreased exercise tolerance
-SOB
-Angina
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63
Q

What are the causes of 3rd degree heart block?

A
  • Ischaemia or infarction
  • Fibrosis or sclerosis of the conducting fibres
  • Heart surgery
  • Cardiomyopathy
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64
Q

What is heart failure?

A

-A clinical syndrome resulting in reduced cardiac output and/or elevated intracardiac pressures at rest of during stress characterised by typical signs and symptoms

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65
Q

What are the typical symptoms of heart failure?

A
  • Breathlessness
  • Fatigue
  • Ankle swelling
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66
Q

What are the typical signs of heart failure?

A
  • Tachycardia
  • Tachypnoea
  • Pulmonary rales
  • Pleural effusion
  • Raised JVP
  • Peripheral oedema
  • Hepatomegaly
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67
Q

What are the ways in which heart failure can be classified?

A

-Acute:
>new-onset heart failure (in pts without known cardiac dysfunction)
>acute decompensation of heart failure
-Chronic:
>long standing heart failure
-Ejection fraction:
>Heart failure with reduced or preserved ejection fraction

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68
Q

What groups of people are affected by heart failure?

A
  • Older people

- Older females

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69
Q

What are the most common causes of heart failure?

A
  • Coronary heart disease

- Hypertension

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70
Q

What are the valvular causes of heart failure?

A
  • Aortic stenosis ->left ventricular hypertrophy
  • Aortic/mitral regurgitation
  • ASD, VSD
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71
Q

What drugs cause HF?

A
  • Beta blockers
  • Calcium channel blockers
  • Anti-arrhythmics
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72
Q

What toxins cause HF?

A
  • Alcohol
  • Cocaine
  • Mercury
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73
Q

What endocrine diseases cause HF?

A
  • DM
  • Hyperthyroidism
  • Hypothyroidism
  • Cushing’s syndrome
  • Phaeochromoctyoma
74
Q

What nutritional deficiencies can cause heart failure?

A
  • Obesity
  • Cachexia
  • Thiamine deficiency
75
Q

What infiltrative causes can cause HF?

A
  • Sarcoidosis
  • Amyloidosis
  • Connective tissue disease
76
Q

What conditions that increase peripheral demand cause HF?

A
  • Anaemia
  • Pregnancy
  • Sepsis
  • Hyperthyroidism
  • Paget’s disease of the bone
  • AV malformation
  • Beriberi
77
Q

How does heart failure present?

A
  • Dyspnoea on exertion and fatigue
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Fluid retention
  • Nocturnal cough (+/- pink frothy sputum)
  • Syncope
78
Q

What are the signs on examination of HF?

A
  • Tachycardia at rest
  • Hypotension
  • Displaced apex beat (with LV dilatation)
  • Raised JVP
  • Gallop rhythm
  • Murmurs
  • Bilateral basal crackles
  • Tachypnoea
  • Pleural effusions
  • Tender hepatomegaly
79
Q

What investigations should be done to investigate HF?

A
  • BNP elevation (>2000ng/L)
  • ECG
  • ECHO
  • Cardiac MRI
80
Q

What is the New York Association of HF?

A
  • Stage 1: no symptoms on ordinary physical activity
  • Stage 2: slight limitation of physical activity by symptoms
  • Stage 3: less than ordinary activity leads to symptoms
  • Stage 4: inability to carry out any activity without symptoms
81
Q

What reasons may heart failure decompensate?

A
  • Further/worsening ischaemia
  • MI
  • Additional valvular/diastolic dysfunction
  • Infections
  • Arrhythmias (AF)
  • Electrolyte imbalance
  • New medications
  • Worsening comorbidities
82
Q

What is the non-drug management for HF?

A

-Patient education
-Lifestyle modification
>smoking cessation, diet and fluid intake/restriction, exercise, limit alcohol
-Mental health support
-Immunisations

83
Q

What medications should be used to control heart failure?

A

-Diuretics
-ACEi and Beta blockers
-Pain relief
-Prevention of cardiovascular morbidity
>statins
>anticoagulants if appropriate

84
Q

What is hypertension?

A

-Elevated blood pressure in the arteries

85
Q

What is stage 1 hypertension?

A

> 140/90mmHg
or
ambulatory bp >135/85

86
Q

What is stage 2 hypertension?

A

> 160/100
or
150/95

87
Q

What is severe hypertension?

A

> 180/110mm Hg

88
Q

What is the leading risk factor for premature death, stroke and heart disease?

A

-Hypertension`

89
Q

What causes essential hypertension?

A
  • Primary (often the cause is unknown). Most common cause in the elderly
  • Secondary hypertension (commonly caused by renal disease, endocrine conditions and pregnancy)
90
Q

What renal diseases cause hypertension?

A
  • Intrinsic renal disease ie glomerulonephritis, PCKD, systemic sclerosis
  • Renovascular disease ie atheromatous, fibromuscular dysplasia
91
Q

What endocrine conditions cause hypertension?

A
  • Cushing’s syndrome
  • Conn’s syndrome
  • Thyroid dysfunction
  • Acromegaly
  • Hyperparathyroidism
92
Q

What phamacological substances cause hypertension?

A
  • Alcohol
  • Cocaine
  • Amphetamines
  • Antidepressant
  • OCP
  • Ciclosporin
93
Q

What are some modifiable risk factors which can cause hypertension?

A
  • Excess weight
  • Excess salt
  • Lack of physical activity
  • Excess alcohol intake
  • Stress
94
Q

What are some non-modifiable risk factors?

A
  • Older age
  • Ethnicity
  • Family history
  • Gender (male)
95
Q

How does hypertension usually present?

A
  • Asymptomatic and picked up incidentally
  • GP should measure adult’s bp every 5 years
  • If bp >140/90 in surgery, then home blood pressure monitoring should be done
96
Q

What investigations can be done to investigate hypertension?

A 
-Bloods: 
>serum electrolytes and creatinine, eGFR, fasting glucose and lipids
-Urinalysis
-Renal USS
-ECHO
-MRI of renal arteries
-Plasma calcium
97
Q

What is a malignant hypertension?

A

->200/130 with end organ damage
>ie encephalopathy, dissection, pulmonary oedema, nephropathy, eclampsia, papilloedema
-Immediate treatment required

98
Q

What is a hypertensive urgency?

A
  • > 180/120 without end organ damage
99
Q

What lifestyle interventions should be advised to a patient with hypertension?

A
  • Healthy diet = weight loss
  • Smoking cessation
  • Physical exercise
100
Q

What medications should be initiated first line for a pt who is under 55 for hypertension?

A

-ACEi (or ARB if intolerable)

101
Q

What medication should be prescribed to a patient under 55 who’s already on an ACEi for hypertension?

A

-Calcium channel blocker or a diuretic

=ACEi + (CBB or diuretic)

102
Q

What medication should a patient be on 3rd line?

A

-ACEi + CBB + diuretic

103
Q

What is 4th line treatment for hypertension?

A

++ further diuretic therapy

or alpha blocker or beta blocker and seek specialist advice

104
Q

What medication should be started for a hypertensive patient who is black or >55?

A

-Calcium channel blocker
or
-Diuretic

105
Q

What is renal artery stenosis?

A

-Impairment of renal perfusion caused by disease affecting teh arterial supply of the kidneys
>Renal hypoperfusion leads to hyperactivation of teh renin-angiotensin-aldosterone axis

106
Q

What is the most common cuase of renal artery stenosis?

A

-Atherosclerosis

107
Q

What are risk factors for renal artery stenosis?

A
  • Hypertenion
  • Advanced age
  • Evidence of renal impairment
  • Evidence of peripheral arterial or CVA disease
  • DM
  • Smoking
  • Family history of CVD
  • Hyperlipidaemia
  • White racial background
108
Q

How does renal artery stenosis present?

A

-Usually asymptomatic. Hypertension is detected incidentally.

109
Q

When should renal artery stenosis be suspected in a patient with hypertension?

A
  • Abrupt onset of hypertension (especially in middle aged pts)
  • Resistant hypertension (to medical therapy)
  • Hypertension in a pt with known peripheral vascular/cerebrovascular/cardiovascular disease
  • In pts with no family history of HTN
  • Hypertension with hypokalaemia
110
Q

What are the differential diagnosis of renal artery stenosis?

A
  • Essential hypertension
  • Other causes of renal impairment (glomerulonephritis)
  • Iatrogenic renal impairment
  • Malignant primary hypertension
111
Q

What investigations should be done to investigate renal artery stenosis?

A 
-Urine and blood tests
>eGFR, U&amp;E, blood glucose
>24hr urinary protein excretion
-urinalysis
-Renal USS
-CT angiography
-MRI
112
Q

What is the management for renal artery stenosis?

A 
-Lifestyle advice
>smoking cessation
>DM control
>Statins
>Adequate hypertensive theray
>Avoid ACE/ARB/NSAIDs
-Angiography + stenting
113
Q

What is a pulmonary obstruction?

A

-An obstruction within the pulmonary arterial tree
-Emboli caused by:
>thrombosis (usually arisen from a distant vein and travelled to the lungs via a venous system)
>fat
>amniotic fluid
>air

114
Q

What are major risk factors for a PE?

A
  • Surgery
  • Obstetrics
  • Lowe limb problems (fractures, varicose veins)
  • Malignancy
  • Reduced mobility
  • Previous VTE
  • Major trauma
  • Central venous lines
115
Q

How do PE’s present?

A
  • Dyspnoea
  • Pleuritic chest pain, retrosternal chest pain
  • Cough and haemoptysis
  • Chest symptoms with symptoms of DVT
  • Tachypnoea
  • Tachycardia
  • Hypoxia
  • Pyrexia
  • Elevated JVP
  • Pleural rub
  • Systemic hypotension
116
Q

What is Well’s score?

A
  • Clinically suspected DVT (leg swelling, pain on palpation of deep veins)
  • Tachycardia
  • Alternative diagnosis less likely in PE
  • Immobilisation for >3 days, surgery in last 4 weeks
  • History of DVT/PE
  • Haemoptysis
  • Malignancy
117
Q

What investigations should be done for suspected PE?

A
  • ECG
  • Baseline investigations (o2 sats, trop and bnp)
  • ABG
  • CXR
  • ECHO
  • D dimers
  • Leg ultrasound
  • CTPA
118
Q

What are the ECG findings of a PE?

A

-Tachycardia
-S1Q3T3
>deep s waves in lead 1, Q waves in lead 3, inverted t waves in lead 3

119
Q

How should a PE be managed?

A 
-Initial resuscitation
>Oxygen, IV access, analgesia, circulation monitoring
-Anticoagulation therapy
>LMWH or fondaparinux
>rivaroxaban
120
Q

What is mitral regurgitation?

A

-The mitral valve does not close properly causing abnormal leaking of blood from the left ventricle through the mitral valve into the left atrium during contraction

121
Q

What causes primary MR?

A
  • Degenerative changes
  • Papillary muscle rupture
  • Infective endocarditis
  • Trauma
122
Q

What is secondary MR?

A

-When the valve is structurally normal, but the structures around the valve causes the valve to not work properly. ie cardiomyopathy

123
Q

What are the causes of MR?

A
  • Degenerative
  • Coronary artery disease
  • Infective endocarditis
  • SLE
  • Acute rheumatic fever
  • Acute LV dysfunction
  • Congenital heart disease
124
Q

How does MR present?

A
  • Acute MR: rapid pulmonary odoedma
  • Chronic MR: heart failure (breathlessness) from dilatation of the LV
  • Auscultation = pansystolic murmur at the apex
125
Q

What investigations should be done for MR?

A
  • CXR (enlarged LA + LV)
  • ECG (broad P wave - LA enlargement)
  • ECHO
  • Cardiac MRI
  • Coronary angiography
126
Q

What is the management of MR?

A
  • Surgery
  • Medical therapies ie nitrates, diuretics
  • Percutaneous intervention
127
Q

What is aortic stenosis?

A

-Tight aortic valve usually cause by a calcified degenerative aortic valve

128
Q

What is a risk factor for AS?

A

-Congenital bicuspid valve

129
Q

How does AS present?

A
  • Shortness of breath
  • Angina
  • Dizziness
  • Syncope
  • Ejection systolic murmur (radiates to the carotids)
  • Slow rising, flat character pulse
  • Narrow pulse pressure
130
Q

What investigations should be done for AS?

A
  • ECG: LVH
  • CXR: cardiac enlargement, calcification of aortic ring
  • ECHO
  • Exercise testing
  • Cardiac MRI
  • Coronary angiography
131
Q

What is the management for AS?

A
  • Aortic valve replacement
  • Baloon valvuloplasty
  • Transcatheter aortic valve implantation
  • Medical therapy: digoxin, diuretics, ACEi, control of HTN
132
Q

What is syncope?

A

-Transient loss of consciousness caused by a transient global cerebral hypoperfusion characterised by rapid onset, short duration and spontaneous complete recovery

133
Q

What are the different causes of neurally mediated syncope?

A
  • Vasovagal syncope
  • Situational syncope
  • Carotid sinus hypersensitivity
  • Glossopharyngeal neuralgia
134
Q

What are the different causes of orthostatic hypotension (causing syncope)

A 
-Autonomic failure:
>multiple system atrophy, parkinsons, >medications
>post-exercise
>post prandial
-Hypovolaemia
>haemorrhage
>D+V
>Addisons
135
Q

What cardiac arrhythmias can cause syncope?

A
  • Paroxysmal supraventricular tachycardia, ventricular tachycardia
  • Inherited syndromes ie long QT
  • Drug induced
136
Q

What structural cardiac disease/cardiopulomary disease causes syncope?

A
  • Obstructive valvular disease
  • Acute coronary syndrome
  • Hypertrophic obstructive cardiomyopathy
  • -Aortic dissection
137
Q

What are some cerebrovascular and psychogenic causes of syncope?

A
  • Vascular steal syndromes
  • Factitious
  • Anxiety
  • Panic attaches
  • Hyperventilation
138
Q

What is the most common cause of syncope?

A

-Neurally mediated syncope

139
Q

What is the most common cause of syncope in the elderly?

A
  • Cardiac causes
  • Orthostatic
  • Postprandial
  • Polypharmacy
140
Q

What are the differentials of syncope?

A
  • Falls/trauma
  • Epilepsy
  • Narcolepsy/catoplexy
  • Drop attacks
  • Dizziness
  • Alcohol/drug abuse
  • TIA/Stroke
  • Psychogenic pseudosyncope
141
Q

What is psychogenic pseudosyncope?

A
  • Lasts longer than syncope
  • Attacks are involuntary and usually related to stress
  • Commonly affects young people and teenagers
  • Symptoms are vague, sweatiness and pallor are absent
142
Q

What investigations are there for syncope?

A
  • Orthostatic blood pressure monitoring
  • ECG
  • FBC
  • Fasting blood glucose
  • Secondary care iX: carotid sinus massage, exercise testing, cardiac bloods, tilt testing
143
Q

What is the management for neurally mediated syncope?

A
  • Medication review and stop offending drugs
  • Avoid alcohol
  • Encourage oral fluids
  • Raise head of the bed
  • Leg crossing and arm tensince
  • Treat the underlying cause of the syncope
144
Q

What are the rules about driving in a patient suffering with syncope?

A
  • If the episode is triggered and due to strong Provocation, associated with prodromal symptoms and posture
  • ie an episode is unlikely to occur if the person is sitting or lying
145
Q

What is infective endocarditis?

A

-An infection of the endocardium within the heart

146
Q

What are the intracardiac effects of infective endocarditis?

A

-Valvular insufficiency

147
Q

What are the systemic effects of infective endocarditis?

A
  • Emboli

- Immunological response

148
Q

What is the epidemiology of infective endocarditis?

A
  • Increased age
  • Increased prevalence with indwelling cardiac devices
  • Commonly caused by staph (from invasive procedures)
149
Q

What are the risk factors for infective endocarditis?

A
  • Valvular heart disease with stenosis or regurgitation
  • Valve replacement
  • Structural congenital heart disease
  • Previous IE
  • Hypertrophic cardiomyopathy
  • IVDU
  • Invasive vascular procedures
150
Q

What is the pathogenesis causing infective endocarditis?

A

-All starts with a non-bacterial thrombotic endocarditis as the prerequisite for adhesion and invasion

151
Q

What is the pathogenesis of acute IE?

A

-Thrombus may be produced by invading organism or by valvular trauma ie placing wires

152
Q

What is the pathogenesis of subacute IE?

A

Sufficient inoculum of bacteria required to allow invasion of thrombus, bacterial clumping with production of aggutinating antibodies

153
Q

What is the non-bacterial thrombotic endocarditis?

A

-Results from CKD, neoplasia, SLE, nutrition

154
Q

Which valves are most commonly affected (and in what frequency) in infective endocarditis?

A
  • Mitral valve
  • Aortic valve
  • Combined mitral and aortic
  • Tricuspid
155
Q

What organisms cause infective endocarditis?

A 
-Staph. aureus
>most common organisms in prosthetic valves, acute IE, IE in IVDU
-Strep
-Pseudomonas
-HACEK organisms
>Haemophillus, aggreatibacter, cardiobacterium, eikenella, kingella
-Fungi
-Enterococci
156
Q

How does IE present?

A 
-Acute
>rapidly progressive infection
>poor appetite
>weight loss
-Chronic
>fatigue
>low grade fever
>flu like illness
>polymyalgia
>loss of appetite
>back pain
>pleuritic pain
>abdo symptoms
157
Q

What are the signs of IE?

A

-Heart murmurs
-Immunological phenomena
>Splinter haemorrhages
>Roth’s spots
>Glomerulonephritis
>Osler nodes
>Janeway lesions

158
Q

What are the investigations required for IE?

A 
-Blood investigations
>FBC, inflammatory markers, blood cultures
-CXR
-ECG
-ECHO
-MRI, CT angiography
159
Q

What is Duke’s criteria?

A
  • 2 major or
  • 1 major and 3 minor or
  • 5 minor criteria to diagnose IE
160
Q

What are the major criteria of Duke’s criteria for IE?

A
  • Positive blood culture x2 seperate occasions

- Evidence of endocardial involvement on ECHO

161
Q

What are the minor criteria of Duke’s criteria for IE?

A
  • Predisposition (ie heart condition, IVDU)
  • Fever: >38
  • Vascular phenomena
  • Immunological phenomena
  • Microbiological phenomena
  • PCR confirmation
  • ECHO
162
Q

What are the vascular phenomena associated with IE?

A
  • Major arterial emboli
  • Septic pulmonary infarcts
  • Mycotic aneurysms
  • Intracranial haemorrhage
  • Conjunctival haemorrhages
  • Janeway lesions
163
Q

What are the immunological henomena associated with IE?

A
  • Glomerulonephritis
  • Osler’s nodes
  • Roth’s spots
  • Rheumatoid factor
164
Q

What are the microbiological phenomena associated with IE?

A

-Positive blood culture

165
Q

What is the management of infective endocarditis?

A 
-Empirical antibiotics
>amoxicillin and gentamycin
-Consult with micro
-Surgery
>for heart failure, uncontrolled infection, prevention of embolism
166
Q

What is myocarditis?

A
  • Inflammation of the myocardium (acute or chronic)
  • Can present similarly to MI
  • Myocardial dysfunction may lead to dilated cardiomyopathy
167
Q

What is the aetiology of myocarditis?

A
  • Infection
  • Immune mediated
  • Drugs causing hypersensitivty reaction
  • Toxic myocarditis
  • Physical agents
168
Q

What infectious causes are there of myocarditis?

A
  • Viral (most common)

- Diphtheria (most commo bacterial worldwide)

169
Q

What are the immune mediated causes of myocarditis?

A
  • Sarcoidosis
  • SLE
  • Scleroderma
  • Churg-strauss
  • IBD
  • T1DM
  • Kawasaki
  • Myasthenia Gravis
  • Thyrotoxicosis
170
Q

What drugs can cause myocarditis via a hypersensitivity reaction?

A
  • Clozapine
  • Amitriptyline
  • Colchicine
  • Furesomide
  • Methyldopa
  • Penicillin
171
Q

What are toxic causes of myocarditis?

A

-Drugs
>ethanol, cocaine, amphetamines, lithium
-Heavy metal poisoning
>lead, copper iron

172
Q

What physical agents can cause myocarditis?

A
  • Electric shocks
  • Hyperpyrexia
  • Radiation
173
Q

How does myocarditis present?

A 
-Variable
>can be asymptomatic,
>heart failure
>arrhythmias
>sudden cardiac death
174
Q

What are the symptoms of myocarditis?

A
  • Fatigue
  • Chest pain
  • Fever
  • Dyspnoea
  • Palpitations
  • Tachycardia
  • Heart sounds: soft s1/s4 rhythm
  • Signs of heart failure
175
Q

What investigations are done to investigate myocarditis?

A

-ECG:
>St elevation/depression, t wave inversion, transient AV block
-Bloods: FBC, U+E (^creatinine), inflammatory markers
-CXR
-Viral serology
-Endomyocarial biopsy
-Cardiac MRI

176
Q

How is myocarditis treated?

A
  • Treat the underlying cause

- Acute myocarditis –> ITU treatment

177
Q

What is chronic pericarditis?

A
  • Long lasting gradual inflammation of the pericardium causing accumulation of fluid in the pericardial space
  • Precedned by acute pericarditis
  • Can be effusive or constrictive
178
Q

What is the aetiology of pericarditis?

A
  • Idiopathic
  • Infective
  • Inflammatory
  • Metabolic
  • CVD
  • Neoplastic
  • Drugs, Irradiation, trauma
179
Q

How does pericarditis present?

A
  • Dyspnoea on exertrion
  • Chest pain, pressure, discomfort
  • Syncope
  • Dizziness
  • Can be asymptomatic
  • Fatigue, anexiety, confusion
180
Q

Investigations for pericarditis?

A

ECG - saddle shaped ST segment

  • CXR: calcification
  • ECHO: diagnostic
  • MRI: measures thickness of the pericardium
181
Q

How should pericarditis be managed?

A
  • Pericardiectomy
  • Surgical drainage
  • Catheter pericardiocentesis

Phase 3B (14 decks)

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