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Year 6 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define Aortic stenosis

A

Commonest murmur

Narrow aortic valve

ESM

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2
Q

Pulses in Aortic stenosis

A

slow-rising pulse

peripherally (as valve stenosed)

narrow pulse pressure (<30mmHg)

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3
Q

O/E precordium in Aortic Stenosis

4 points

A

pacemaker
aortic THRILL (horizontal)
forceful apex beat
ESM +/- S4 HS

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4
Q

Murmur in Aortic stenosis

A 
Ejection systolic murmur 
loudest right 2nd ICS
sitting forward on expiration
radiates to carotids
\+/- S4 (aortic contraction against stiff LV)
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5
Q

Rule out if suspected Aortic stenosis

A

Significant -ves are

Infective endocarditis
LVF
Severe AS

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6
Q

Signs of severe aortic stenosis

A

S4
Narrow pulse pressure
decompensation - LVF
slow-rising pulse

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7
Q

DDx Aortic stenosis

A 
aortic sclerosis (no radiation, normal radial pulse)
MR
HOCM 
PS
TR
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8
Q

3 Causes aortic stenosis

A

Senile calcification
Rheumatic heart disease
Bicuspid aortic valve

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9
Q

Clinical Sx severe aortic stenosis

A

Angina
Syncope
Dyspnoea

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10
Q

5 Ix for Aortic Stenosis

A

Bloods: FBC, U+E, NT-proBNP, lipids, glucose
ECG: LVH, arrhythmia

CXR: calcified AS, LVH, pulmonary oedema
Echo and doppler: assess severity, look cause, assess LV function

Cardiac catheterisation: valve gradient, assess coronary arteries if surgery planned

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11
Q

Echo features in severe AS

A

Valve area <1cm^2
pressure gradient >40mmHg
jet velocity >4m/s

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12
Q

Mx of aortic stenosis

A

MDT: GP, cardiologist, cardiothoracic surgeon, dietician, specialist nurse

Conservative: (optimise CV risk) diet, exercise, smoking
Medical: (optimise CV risk) statins, anti HTN, DM, anti plt
Surgical:
- valve replacement +/- CABG
- TAVI (transcatheter aortic valve implantation)
- balloon valvuloplasty
- regular f/up and echo

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13
Q

Indications for surgery in Aortic stenosis

A

Symptomatic AS
Severe asymptomatic AS with EF <50%
Severe AS undergoing CABG or other valve Op

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14
Q

Mortality in surgical valve replacement for AS

A

3-5% depending on pt

EuroSCORE

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15
Q

Presentation of Aortic Stenosis

A

Systolic murmur commonly associated with AS or MR
Other DDx include HOCM, ASD, VSD
Evidence that it is AS include:
1) PULSE (narrow pulse pressure, slow-rising pulse)
2) SCAR (pacemaker)
3) PALPATION (forceful apex beat, aortic thrill)
4) MURMUR (aortic area loudest, radiates to carotids, grade 3?, high pitch, ESM, heard loudest leaning forward on end expiration) +/- S4 heart sound

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16
Q

Define Mitral Regurgitation

A

Pan-systolic murmur

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17
Q

4 Causes of Mitral Regurgitation

A

Functional (LV dilatation (idiopathic or 2 to HTN)
Rheumatic heart diease
Mitral valve prolapse
Annular calcification -> contraction of valve

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18
Q

Pulse in Mitral Regurgitation

A

Can have atrial fibrillation

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19
Q

O/E Precordium in Mitral Regurgitation

4 points

A

left parasternal heave (RVH as increased preload)
Displaced apex (ventricle pump extra preload)
HS: soft S1, loud P2 if PTH
Murmure: PSM

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20
Q

Murmur in Mitral Regurgitation

A 
PSM 
blowing 
Apex
left lateral position in end expiration
radiates to axilla
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21
Q

2 clinical signs severe Mitral Regurgitation

A

LVF (LV pumps Sv plus regurgitant volume)

AF

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22
Q

Significant negatives in Mitral Regurgitation

A

Infective endocarditis !!

Severe MR

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23
Q

DDx of Mitral Regurgitation

A

Aortic stenosis
VSD
TR

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24
Q

Ix for Mitral Regurgitation

A

Bloods: FBC, U+E, NT-proBNP, lipids, glucose
ECG: LVH, AF, p-mitrale

CXR: LA or LV hypertrophy, mitral valve calcification, pulmonary oedema
Echo and doppler: assess severity, assess LV function

Cardiac catheterisation: assess coronary arteries if surgery planned

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25
Q

Echo features in severe Mitral Regurgitation

A

Jet width >0.6cm
systolic pulmonary flow reversal
regurgitant volume >60ml

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26
Q

Mx for Mitral Regurgitation

A

MDT: GP, cardiologist, cardiothoracic surgeon, dietician, specialist nurse

Conservative: (optimise CV risk) diet, exercise, smoking
Medical: (optimise CV risk) statins, anti HTN, DM, anti plt
Surgical:
- valve replacement or repair if SYMPTOMATIC
Specific
AF - rate control and anticoagulate
emboli - anticoagulate
decrease afterload - ACEi or BB, diuretics

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27
Q

Prognosis of Mitral Regurgitation

A

Asymptomatic for >10 years

symptomatic 25% mortality at 5 years

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28
Q

Definition of Infective Endocarditis

A

Colonisation of endocardium 2 to bacteraemia

Typically valvular surfaces

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29
Q

Subtypes of Infective Endocarditis

A

Acute
- Sx Days - weeks
Spiking fever, tachy,fatigue, damage cardiac surfaces
-ve Janeway/Oslers
Often septic emboli sx - stroke, septic joint, splenic infarct

Subacute
Sx Weeks -months
Consitutional Sx (fever + FLAWS
+ve for Janeway/Oslers

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30
Q

Organisms of acute IE

A

Staphylococcus aureus

Streptococcus pyogenes

31
Q

Organisms of subacute IE

A

Streptococcus viridans
Staphylococcus epidermidis
HACEK, Coxiella, Mycoplasma

32
Q

Murmur/ organism of IE + IVDU

A

Right sided valves

Staph aureus

33
Q

Risk factors of IE

LIFESTYLE
MEDICAL
SURGICAL

A 
LIFESTYLE
	• IVDU
	• Poor dental hygiene
MEDICAL
	• PMH of IE
	• Immunosuppression: chronic renal failure, DM
	• Congenital heart disease
	• Soft tissue infection 
SURGICAL
	• Dental surgery
           Cardiac surgery e.g. prosthetic valve
34
Q

Murmur in IE

A

New murmur + fever

Usually mitral/aortic valve MR/AR (unless IVDU)

35
Q

Immune phenomena in IE

A

Oslers nodes
Roth spots
Haematuria

36
Q

Thromboembolic phenomena in IE

A

Janeway lesions

Splinter haemorrhages

37
Q

O/E hands in IE

4 points

A
  • Clubbing
    • Splinter haemorrhages (on nails)
    • Janeway lesions -painless
    • Oslers -painful
38
Q

O/E cardiac in IE

A

new murmur

MR> AR

39
Q

7 Ix in IE

A 
• FBC - anaemia, raised ESR
	• U+Es - baseline
	• Urinalysis - haematuria 
	• Blood cultures 
	• ECG - e.g. increasing PR interval
          Echo
          Fundoscopy
40
Q

Diagnostic criteria for IE

A

Duke’s criteria

2 MAJOR
1 MAJOR + 3 MINOR
5 MINOR

41
Q

Major Duke’s Criteria for IE

A

Positive blood culture of typical IE organisms or 2 +ve >12 hrs apart

Vegetation/abscess on echo or new regurgitant murmur

42
Q

Minor Duke’s Criteria for IE

A

• Risk factor e.g. IVDU, congenital abnormality,
prosthetic valve
• Fever >38
• Thromboembolic phenomena
• immune phenomena
• +ve blood culture not meeting major criteria (NB
HACEK are culture -ve)

43
Q

Mx of Infective endocarditis

A

Broad spectrum antibiotics as blood cultures taken
Then treat according to sensitivity + trust guidelines
• Acute: Flucloxacillin if MSSA, IV Vanc + Met if MRSA
• Subacute: IV Benpen + Gent or Vancomycin for 4 wk

NB prophylactic Abx for IE not recommended

44
Q

DDx of IE

A

rheumatic fever

atrial myxoma

45
Q

Define rheumatic fever

A

T2 hypersensitivity reaction / Molecular mimicry

 - cell mediated immunity + Ab  to Strep Ag 
- cross-react with myocardial Ags (myosin/SM cells)
46
Q

Peak age of Rheumatic fever

A

5-15 years

47
Q

Pathophysiology of Rheumatic fever

A

Aschoff bodies

Anitschkow myocytes

48
Q

Criteria for Rheumatic fever

A

Jones Criteria

2 major or
1 major + 2 minor

49
Q

Onset of Rheumatic fever Sx

A

2-4 weeks after strep throat infection

50
Q

Evidence of Group A Strep in Rheumatic fever

4

A

+ve throat culture
Rapid strep Ag test
high ASOT (blood)
recent scarlett fever

51
Q

Systems affected in Rheumatic Fever

A

Heart
Joints
Skin
CNS

52
Q

Sx of Rheumatic fever

HEART
JOINTS
SKIN
CNS

A 
HEART
pancarditis, valve disease (regurg -> stenosis)
JOINTS
arthritis, synovitis
SKIN
erythema marginatum, subcutaneous nodules
CNS
encephalopathy, Sydenham's chorea
53
Q

Jones’ Major Criteria

JONES

A 
Joint-arthritis
Pancarditis
Nodules subcut
Erythema marginatum
Sydenham's chorea
54
Q

Jones Minor Criteria

A 
fever
high ESR/CRP
arthralgia 
prolonged PR interval
previous rheumatic fever
55
Q

Ix for Rheumatic fever

A

Bloods - FBC, ESR, ASOT
ECG

ECHO

56
Q

Murmur in Rheumatic fever

A

Mitral Regurg (PSM) is commonest

M>A >T >P

REGURG -> STENOSIS

57
Q

Ms Rheumatic fever

A

Bed rest until CRP normal
Benpen 0.6-1.2mg IM for 10 days
Erythromycin if penicillin allergic

Analgesia for carditis/arthritis- NSAID/aspirin
Oral Pred if: CCF, cardiomegaly
Chorea- Haldol

Prevent recurrence - Pen V 250mg/12h PO for 5-10yrs

58
Q

Prognosis in Rheumatic fever

A

attacks approx 3m long

if carditis more likely to have chronic rheumatic heart disease

59
Q

Factors increase risk recurrent rheumatic fever

A

further strep infection
pregnancy
OCP

60
Q

Classify causes of chest pain

A 
Cardiac
Respiratory
Chest Wall
Gastrointestinal
Psychiatric
61
Q

Causes of Cardiac CP

A 
IHD/ACS (STEMI, NSTEMI, unstable angina)
Aortic dissection
Unstable or crescendo angina
Decubitus angina 
Prinzmetal  or variant angina
Syndrome X
St Vincents angina
62
Q

Features of ACS/IHD

A

CP = tight, heavy, non-specific
precipitated by exercise
relieved by rest/GTN

63
Q

Features MI

A

sweating/diaphoresis
nausea
vomiting

64
Q

Features aortic dissection

A

Tearing CP

mediastinal widening on CXR

65
Q

Features of silent MI

A

sweating
feel scared
no other features (i.e. no CP)
in OLD, DM pts (rare as have to lose nerve supply to heart_

66
Q

Features unstable angina

A

CP at rest
may be trop -ve
treat as increased risk NSTEM - i.e. be bound + ACS protocol

67
Q

Features crescendo angina

A

decreased exercise tolerance +
CP BETTER at rest
may be trop -ve

68
Q

Features decibitus angina

A

old man with aortic regurg

CP worse on lying down

69
Q

Features Prinzmetal/variant angina

A

transient ST elevation due to coronary vasospasm
Females age 20-50
Tx = daltiezam (nitrates, CCBs)

70
Q

Features Syndrome X

A

= microvascular angina
ST depression (ischaemia) on exercise ECG
NORMAL angiogram
cannot stent but high risk MI, give meds

71
Q

What is St Vincent’s angina

A 
pharyngitis
Tropherema Pharentii (Brazil)
72
Q

Features Tietze’s

A

costochondral tendereness

recreated by palpating chest

73
Q

Features Bornholm’s

A

epidemic myalgia
primary school teachers
raised CRP + pleuritic CP
muscle tenderness due to Coxsackie B + Echovirus

Year 6 (9 decks)

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