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Year 4 Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define coronary artery disease

A

Narrowing/blockage of the coronary arteries caused by atheroscleoris leading to angina

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2
Q

What are the modifiable and non-modifiable risk factors for CAD?

A

Modifiable - smoking, alcohol excess, obesity, inactivity, hyperlipidaemia, hypertension, OCP
Non-modifiable - male sex, increasing age, family history, genetics

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3
Q

What features of a history would make you suspect CAD?

A

Central pain/tightness in the chest which may radiate to the jaw/arm and is brought on by exertion (exercise, emotional stress)
PMH/FH of heart disease

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4
Q

What features on examination would make you suspect CAD?

A

Examination may be normal
Xanthelasma/corneal arcus - hyperlipidaemia
High BP - hypertension
Ejection systolic murmur/slow-rising pulse - aortic stenosis

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5
Q

What investigations would you do if you suspected CAD?

A

Bloods - FBC, TFTs, glucose, HbA1c, lipids, U&Es, troponin
ECG
Imaging - CXR, echo

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6
Q

How is CAD managed?

A

First line - lifestyle modifications, GTN, beta blocker, verapamil
Second line - beta blocker and dihydropyridine, isosorbide mononitrate

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7
Q

What further interventions are available for CAD and when would they be used?

A

PCI revascularisation - single vessel disease or multi-vessel disease <65 years with suitable anatomy
CABG - multi-vessel disease >65 years or diabetic

Pain management if patient is not suitable for either

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8
Q

What are the complications of PCI?

A 
Bleeding 
MI
Dissection
Haematoma 
Stroke
Death
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9
Q

What are the differential diagnoses to consider for CAD?

A 
MI
Aortic dissection 
PE
GORD
Angina
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10
Q

What are the complications of CAD?

A

MI
AV block
Arrhythmia
Sudden cardiac death

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11
Q

What is the prognosis of CAD?

A

Cardiovascular risk can be lowered with lifestyle modifications and treatment

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12
Q

How can CAD be prevented?

A

QRISK score in primary care can identify risk early
Healthy lifestyle
Secondary prevention drugs - ACEi, statin, BB, DAPT

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13
Q

Define myocardial infarction

A

Acute coronary syndrome in which cardiac myocytes die because of myocardial ischaemia, most commonly caused by atherosclerotic embolus

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14
Q

What are the modifiable and non-modifiable risk factors for MI?

A

Modifiable - smoking, alcohol excess, obesity, inactivity, hyperlipidaemia, hypertension, OCP
Non-modifiable - male sex, increasing age, family history, genetics

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15
Q

What features of a history would make you suspect MI?

A

Severe, crushing, central chest pain radiating to the jaw/arm which does not settle with GTN

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16
Q

How might an MI present differently in an elderly or diabetic patient?

A

Fatigue
Syncope
Dyspnoea

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17
Q

What features on examination would make you suspect MI?

A

Pale
Sweaty/clammy
Hypotensive

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18
Q

What investigations would you do if you suspected MI?

A

Bloods - FBC, troponin, glucose, U&Es
ECG - ST depression and T wave inversion or persistent ST elevation
Cardiac monitoring - arrhythmia

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19
Q

When should a troponin be repeated in a patient with suspected MI?

A

4-6 hours after initial sample

12 hours after pain settles

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20
Q

What is the immediate management for a MI?

A 
Oxygen 
GTN
Morphine 
Metoclopramide 
Aspirin 
Clopidogrel/ticagrelor
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21
Q

What are the 2 main treatments for MI and when would they be carried out?

A

PCI - presenting within 12 hours of symptom onset, able to transfer within 120 minutes of attending
Thrombolysis - transfer time >120 minutes

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22
Q

What is the process for a patient undergoing thrombolysis?

A

Tenecteplase given and transferred for rescue PCI (if unsuccessful) or angiography (if successful)

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23
Q

What are the contra-indications of thrombolysis?

A 
Previous intracranial haemorrhage 
Ischaemic stroke in past 6 months 
Major trauma/surgery in past 3 weeks 
Puncture 
GI bleeding 
Cerebral malignancy 
AVM
Dissection
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24
Q

What additional drug should be given to patients undergoing PCI for myocardial infarction?

A

Heparin/enoxaparin

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25
Q

How would a patient with a MI be treated if they presented >12 hours after symptom onset?

A

Fondaparinaux

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26
Q

What are the differential diagnoses for MI?

A 
Angina 
PE
GORD
Costochondritis 
Aortic dissection
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27
Q

What are the complications of MI?

A 
HF
Myocardial rupture 
Myocardial dilatation 
VSD 
Mitral regurgitation 
Arrhythmia 
AV block 
Pericarditis
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28
Q

What is the prognosis of MI?

A

Overall mortality 1-2%

Increased risk if unstable angina, >70 years old or co-morbidities

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29
Q

What scoring systems can be used to identify risk of MI?

A

GRACE

TIMI

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30
Q

How can MI be prevented?

A

Healthy lifestyle

Secondary prevention drugs

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31
Q

Define hypertension

A

Abnormally high BP

>140/>90 mmHg (further subdivided into mild, moderate, severe)

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32
Q

What are the modifiable and non-modifiable risk factors for HTN?

A

Modifiable - diet, inactivity, obesity, alcohol, stress

Non-modifiable - increased age, male sex, ethnicity (black African), genetics

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33
Q

What are the different types of HTN?

A

Essential
Secondary
Malignant

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34
Q

What is malignant HTN?

A

Severe, rapid rise in BP >200/>130 mmHg which causes fibroinoid necrosis of vessel walls, headache, visual disturbance and LOC

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35
Q

What features of a history would make you suspect HTN?

A

Usually asymptomatic, symptoms only manifest when severe (headache, epistaxis, nocturia)

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36
Q

What features on examination would make you suspect HTN?

A

High BP

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37
Q

What investigations would you do if you suspected HTN?

A 
Ambulatory BP monitoring 
Bloods - U&amp;ES, glucose, lipids, calcium 
ECG
Urinalysis
Renal USS
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38
Q

How is HTN managed?

A

Target BP 140/85mmHg or 130/80mmHg if other co-morbidities
1 - ACEi or ARB if <55 years old OR CCB/thiazide if >55/black
2. Combine ACEi and CCB/thiazide
3. Combine all 3
4. Add further diuretic or BB

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39
Q

What drugs can be used for rapid control of BP?

A

IV sodium nitroprusside

Labetalol infusion

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40
Q

What drugs are safe to use in pregnancy for HTN? What is the target BP?

A

Methyldopa
Labetalol
Nifedipine
<150/100 mmHg

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41
Q

What are the complications of HTN?

A

Cerebrovascular - haemorrhage, infarction, seizure, dementia, stroke, TIA
CAD - pulmonary oedema, MI, LV hypertrophy, HF
Renal - haematuria, proteinuria, uraemia, CKD
PVD - atherosclerosis, aneurysm, dissection
Retinopathy - haemorrhage, exudate, papilloedema, blindness

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42
Q

What is the prognosis of HTN?

A

Can be controlled

Depends on level of BP, end-organ damage and CVD RFs

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43
Q

How can HTN be prevented?

A

Healthy lifestyle

BP monitoring

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44
Q

Define AF

A

Disorganised firing of impulses in the atria causing an irregular heartbeat

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45
Q

What scoring system can be used in AF and what does it assess?

A

CHADS2VASC

Risk of stroke in atrial fibrillation

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46
Q

What are the components of the CHADS2VASC score?

A 
Congestive HF
Hypertension 
Diabetes
Age >75, age 65-74
Stroke/TIA/embolism
Vascular disease 
Sex (female)
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47
Q

What can predispose a patient to developing AF?

A 
HF
HTN
Hyperthyroidism 
CAD
Obesity 
Surgery 
Alcohol
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48
Q

What symptoms might AF cause?

A 
Asymptomatic 
Dyspnoea
Chest pain 
Syncope 
Palpitations
LOC
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49
Q

What would be the examination findings in a patient with AF?

A

Irregularly irregular pulse

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50
Q

What investigations would you do for a patient with suspected AF?

A

Bloods - TFTs, LFTs
ECG - no P waves, fibrillation, irregular QRS, rate 120-180bpm
Echo

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51
Q

How is AF managed?

A

Treat underlying cause
Rate control - digoxin/verapamil/diltiazem
Rhythm control - cardioversion (medical with flecainide/amiodarone; electrical with DC shock); ablation (may need pacing)
Anticoagulation - dabigatran/warfarin

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52
Q

What are the complications of AF?

A

Stroke
MI
HF
Cardiac arrest

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53
Q

What is the prognosis of AF?

A

Can be well managed medically

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54
Q

Define supraventricular tachycardia

A

AVNRT - short + slow and long + fast AV node pathways
AVRT - accessory tract
Atrial tachycardia

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55
Q

What are the risk factors for SVT?

A

Onset usually 12-30 years

AVNRT more common in women, aggravated by stress/alcohol/caffeine

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56
Q

What is the aetiology of SVT?

A

Idiopathic

Structural heart disease

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57
Q

What features of a history would make you suspect SVT?

A

Rapid, irregular palpitations which start and stop abruptly
Palpitations are spontaneous or precipitated and terminated by Valsalva manoeuvres
Anxiety, dyspnoea, syncope, dizziness, polyuria, chest pain

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58
Q

What are vagal manoeuvres?

A

Right carotid massage
Cold water facial immersion
Valsalva (abrupt voluntary increase in intra-abdominal and intra-thoracic pressure; breathing into mouthpiece, holding breath and straining)

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59
Q

What examination finding would be in-keeping with SVT?

A

Prominent JVP

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60
Q

What investigations would you do for a patient with suspected SVT?

A

ECG - determine type of SVT although they are treated in the same way

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61
Q

Describe the appearance of AVNRT on ECG

A

Regular, narrow QRS

P waves not visible

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62
Q

Describe the appearance of AVRT on ECG

A

Short PR
Wide QRS
Slurred delta wave

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63
Q

How is SVT managed if the patient is stable?

A

Vagal manoeuvres

IV adenosine

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64
Q

How is SVT managed if the patient is unstable?

A

Immediate cardioversion

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65
Q

What are the complications of SVT?

A

VT

Sudden death

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66
Q

Define ventricular tachycardia

A

Potentially life-threatening ventricular rhythm faster than 100 bpm

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67
Q

What are the risk factors for VT?

A

Increased age
History of heart disease
FH

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68
Q

What conditions can predispose a patient to VT?

A

Cardiomyopathy
CAD
IHD
HF

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69
Q

What symptoms are caused by VT?

A 
Asymptomatic
Dizziness 
Syncope
Hypotension 
Fatigue 
Chest pain 
Cardiac arrest
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70
Q

What would the examination findings be in a patient with VT?

A

Pulse 120-200bpm
Intermittent canon waves in JVP
Variable intensity of 1st heart sound

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71
Q

How would a patient with suspected VT be investigated?

A

ECG - rapid rhythm, broad irregular QRS, AV dissociation

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72
Q

How would VT be managed if the patient was stable?

A

IV amiodarone/lidocaine

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73
Q

How would VT be managed if the patient was unstable?

A

DC cardioversion

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74
Q

How is VT managed long-term?

A

Antiarthythmic drugs
Ablation
ICD

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75
Q

What differential diagnosis should be considered for VT?

A

SVT with BBB

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76
Q

What are the complications of VT?

A 
Death 
VF
HF
Syncope 
Cardiac arrest
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77
Q

What is the prognosis of VT?

A

Normally resolves after short period

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78
Q

Define ventricular fibrillation

A

Life-threatening, very rapid and irregular ventricular activation with no mechanical effect provoked by ectopic beat which rarely resolves spontaneously

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79
Q

What conditions can predispose a patient to VF?

A

MI
Severe metabolic disturbance
Brugada syndrome

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80
Q

What would the examination findings be in a patient with VF?

A

Pulseless
Unconscious
Cardiac arrest

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81
Q

What investigation would you do in a patient with suspected VF?

A

ECG - shapeless, rapid oscillations, disorganised

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82
Q

How is VF managed?

A

Electrical defibrillation (ATLS)

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83
Q

What are the complications of VF?

A

Cardiac arrest

Death

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84
Q

What is the prognosis of VF?

A

High risk of sudden death `

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85
Q

Define sinus bradycardia

A

Sinus rate of <60bpm

86
Q

What are the causes of sinus bradycardia?

A

Extrinsic - hypothermia, hypothyroidism, cholestatic jaundice, increased ICP, beta-blockers, antiarrhythmic drugs
Intrinsic - MI, sick sinus syndrome

87
Q

What investigation could be done for a patient with suspected sinus bradycardia?

A

ECG

88
Q

How is sinus bradycardia managed?

A

Treat extrinsic cause
Temporary pacing
Pacemaker

89
Q

Define the 3 types of AV heart block

A

First degree AV block - prolonged PR
Second degree AV block - Mobitz I (progressively prolonged PR until P wave drops), Mobitz II (dropped QRS without prolonged PR)
Third degree/complete AV block - narrow QRS reliable, wide QRS unreliable

90
Q

Define the 2 types of bundle branch block

A

RBBB - deep S wave in leads I and V6, tall late R wave in V1

LBBB - opposite of above

91
Q

What are the causes of complete heart block?

A 
Transposition of great vessels 
MI
Aortic stenosis 
Sarcoidosis
Amyloidosis 
CABG
Digoxin 
Amiodarone
SLE
RA
92
Q

What are the causes of RBBB?

A

Congenital anomaly
Pulmonary HTN
PE
MI

93
Q

What are the causes of LBBB?

A

Aortic stenosis
HTN
MI

94
Q

How is heart block managed?

A

Atropine

Pacing

95
Q

Define heart failure

A

Impaired ability of the heart to function as a pump to support physiological circulation

96
Q

How is HF classified?

A

Class I - no limitation
Class II - mild limitation, symptoms on normal exercise
Class III - larked limitation, symptoms on gentle exercise
Class IV - symptoms at rest

97
Q

What are the risk factors for HF?

A

Increased age
MI
DM
Dyslipidaemia

98
Q

What is the aetiology of HF?

A 
IHD
Cardiomyopathy 
Idiopathic
Toxins (alcohol, chemotherapy)
Genetics
99
Q

What are the symptoms of HF?

A 
Dyspnoea 
Orthopnoea
PND
Fatigue
Cough
100
Q

What signs would be present on examination of a patient with HF?

A 
Displaced apex beat
3rd and 4th heart sounds 
Elevated JVP
Tachycardia 
Hypotension 
Bibasal crackles (pulmonary oedema)
Peripheral oedema 
Ascites 
Tender hepatomegaly
101
Q

What investigations would you do for a patient with suspected HF?

A

Bloods - FBC, U&Es, BNP, LFTs, TFTs
Imaging - CXR, echo
ECG

102
Q

What are the radiological features of HF on a CXR?

A 
A - alveolar oedema (batwing)
B - Kerley B lines
C - cardiomegaly
D - dilation of upper lobe vessels
E - pleural effusion
103
Q

How is chronic HF managed?

A

Lifestyle modification
Monitoring - capacity, fluid status, rhythm, biomarkers
Drugs

104
Q

What drug classes can be used to manage HF? Give an example of each

A 
Diuretics (e.g. furosemide)
ACEi (e.g. enalapril)
ARBs (e.g. candesartan)
BBs (e.g. bisoprolol)
Aldosterone antagonists (e.g. spironolactone)
Glycosides (e.g. digoxin)
Vasodilators (e.g. hydralazine)
105
Q

What interventions are available for HF?

A 
Revascularisation
Pacemaker 
ICD
CRT
Transplant
106
Q

What patients are given CRT for HF?

A

Severe symptoms

Broad QRS

107
Q

What patients are given ICD for HF?

A

Symptoms

Narrow QRS

108
Q

What HF patients are suitable for a heart transplant?

A

Young
Severe symptoms
<6 months life expectancy

109
Q

What are the complications of a heart transplant?

A 
Rejection 
Infection 
HTN
Malignancy
Vascular disease 
Hypercholesterolaemia
110
Q

What are the contraindications for a heart transplant for HF?

A 
Age >60 years 
Alcohol/drug abuse 
Uncontrolled psychiatric illness 
Severe renal/liver failure 
Uncontrolled infection 
Recent thromboembolism 
Other disease with poor prognosis 
Multi-organ disease
111
Q

How is acute/decompensated HF managed?

A 
Oxygen 
Diuretics (e.f. furosemide)
Vasodilators (e.g. GTN infusion)
Inotropes (e.g. dobutamine)
Noradrenaline 
Mechanical assist device
112
Q

What should always be considered for patients with HF presenting with an acute/decompensated episode?

A

Identify underlying cause - ACS, HTN emergency, arrhythmia, acute mechanical cause, infection, PE

113
Q

What are the differential diagnoses to consider for HF?

A 
COPD
PE
Pneumothorax
Anaphylaxis
Asthma 
Foreign body obstruction 
ACS
114
Q

What are the complications of HF?

A

Arrhythmia
Thromboembolism
Hepatic congestion
Pulmonary congestion

115
Q

What is the prognosis of HF?

A

Chronic - 50% survival at 5 years

Acute - 10% 60 day mortality

116
Q

How can HF be prevented?

A

Healthy lifestyle
Optimal treatment of DM, HTN and hypercholesterolaemia
Pharmacological secondary preventative therapy following MI

117
Q

Define endocarditis

A

Infection of the inner lining of the heart valves leading to growth of vegetation

118
Q

What is the most common bacteria to cause IE?

A

Staphylococcus aureus, followed by streptococcus viridans

119
Q

What are the risk factors for IE?

A

Male
Elderly
IVDU
Valve abnormality

120
Q

What is the most common bacteria to cause native valve, IVDU and prosthetic valve endocarditis?

A

NVE - streptococcus viridans
IDVU - staphylococcus aureus
PVE - coagulase negative staphylococcus

121
Q

What is the aetiology of IE?

A 
Poor dental hygiene 
IVDU
Soft tissue infection 
Dental treatment 
Cardiac surgery 
Pacemaker
122
Q

What are the bacterial causes of IE?

A 
Coagulase negative staphylococci
Staphylococcus aureus
Streptococcus viridans
Enterococci
E.coli
Pseudomonas aeruginosa
HACEK organisms (haemophilus, aggregatibacter, cardiobacterium hominis, eikenella corrodens, kingella)
123
Q

What are the fungal causes of IE?

A

Candida

124
Q

What zoonotic bacterium can cause IE?

A

Coxiella burnetti

125
Q

What percentage of IE is culture-negative, and why might this be?

A

5-10%
Previous antibiotic therapy
Fastidious organisms which fail to grow

126
Q

What features of a history would make you suspect IE?

A 
Fever 
Prosthetic material in heart
Predisposition 
Malaise
Arthralgia
127
Q

What features would be seen on examination of a patient with IE?

A 
Clubbing 
New murmur 
Sepsis 
Embolic events 
Haematuria 
Splinter haemorrhages 
Peripheral abscesses 
Osler's nodes 
Janeway lesions 
Roth spots 
Conjunctival petechiae
128
Q

How is IE diagnosed?

A

Duke’s criteria

IE is defined as 2 major/1 major + 3 minor/5 minor criteria fulfilled

129
Q

What are the minor Duke’s criteria?

A

Predisposition (e.g. heart condition or IVDU)
Fever >38˚C
Vascular phenomena (e.g. septic emboli)
Immunological phenomena (e.g. Osler’s nodes)
Positive blood cultures which don’t meet major criteria

130
Q

What are the major Duke’s criteria?

A

Typical organism in 2 separate blood cultures
Positive echocardiogram
New valve regurgitatio

131
Q

What investigations would you do for a patient with suspected IE?

A

Bloods - cultures, FBC, U&Es, LFTs, CRP
ECG
Imaging - CXR, echo

132
Q

How is IE managed?

A

Prolonged antibiotic therapy for 4-6 weeks

133
Q

What antibiotic is most suitable to treat IE caused by streptococcus?

A

Benzylpenicillin (+/- gentamicin)

134
Q

What organism causing IE is targeted by treatment with amoxicillin/vancomycin?

A

Enterococcus

135
Q

What antibiotic is most suitable to treat IE caused by staphylococcus aureus?

A

Flucloxacillin (+/- gentamicin)

Vancomycin used for MRSA

136
Q

What organism causing IE is targeted by treatment with vancomycin/rifampicin?

A

Coagulase negative staphylococcus

137
Q

What are the indications for surgical management of IE?

A

HF
Uncontrollable infection
Prevention of embolism

138
Q

What is the prognosis of IE?

A

Significant morbidity and mortality even with treatment

139
Q

How can IE be prevented?

A

Good dental hygiene
Avoid skin infection (piercings, tattoos, IVDU)
Prophylactic antibiotics before cardiac surgery

140
Q

Define postural hypotension

A

Low BP (decrease of 20 mmHg systolic or 10 mmHg diastolic) when going from lying/sitting to standing (after 3 minutes)

141
Q

What are the risk factors for PH?

A 
Older age 
Medications
Pregnancy
Alcohol
Bed rest
142
Q

What is the aetiology of PH?

A

Autonomic failure - DM, amyloidosis, PD, ageing
Drugs - TCAs, nitrates, CCBs, alpha blockers
Prolonged bed rest
Volume depletion - dehydration, blood loss

143
Q

What are the symptoms of PH?

A 
Feeling dizzy
Blurred vision 
weakness
Syncope
Headache 
Confusion 
Nausea
144
Q

What features would be seen on examination of a patient with PH?

A 
Depends on cause 
Murmur - HF/MI
Cogwheeling - PD
Dry mucous membranes - dehydration 
Impotence/incontinence - autonomic failure 
Peripheral oedema - venous insufficiency
145
Q

What investigations should be done in a patient with suspected PH?

A

Bloods - FBC, U&Es, glucose, cortisol
Imaging - CXR, echo, CT/MRI
Sitting and standing BP
Tilt-table testing

146
Q

What are the differential diagnoses for PH?

A 
Anaemia 
Arrhythmia 
HF
MI
Valvular heart disease 
Anxiety
147
Q

Define dyslipidaemia

A

Broad term encompassing hypercholesterolaemia, hyperlipidaemia and mixed dyslipidaemia in which disturbance of fat metabolism leads to changes in lipid concentration in the blood

148
Q

What are the risk factors for dyslipidaemia?

A 
Older age
Obesity 
Diabetes
Smoking 
Diet 
Male sex
149
Q

What is the aetiology of dyslipidaemia?

A

Primary - familial hypercholesterolaemia, familial combined hyperlipidaemia, familial hyperlipoproteinaemia
Secondary - hypothyroidism, CKD, nephrotic syndrome, obesity, alcohol, drugs (diuretics, BBs, OCP, HRT, steroids, ciclosporin, phenytoin)

150
Q

What features of a history would suggest dyslipidaemia?

A

Asymptomatic
Symptoms of CVD - chest pain, palpitations, dizziness, oedema
FH of premature CVD

151
Q

What signs would be seen on examination of a patient with dyslipidaemia?

A

Corneal arcus
Tendon xanthoma
Xanthelasma

152
Q

What investigations should be done for a patient with suspected dyslipidaemia?

A

Bloods - lipid profile (total cholesterol, LDL, HDL, triglycerides(

153
Q

What are the differential diagnoses for dyslipidaemia?

A

Primary and secondary causes
Alcohol abuse
Diabetes mellitus
Pancreatitis

154
Q

What are the risk factors for mitral stenosis?

A

Rheumatic fever
Female sex
Developing country

155
Q

What are the risk factors for mitral regurgitation?

A 
MI
IHD
Endocarditis
Rheumatic fever
Congenital disease
Older age
156
Q

What are the risk factors for aortic stenosis?

A

Smoking
Older age
Male sex

157
Q

What are the risk factors for aortic regurgitation?

A

Older age
Congenital disease
Infections

158
Q

What is the most common aetiology of mitral stenosis?

A

Rheumatic fever

159
Q

What is the most common aetiology of mitral regurgitation?

A

Degeneration

160
Q

What is the most common aetiology of aortic stenosis?

A

Calcification

161
Q

What is the aetiology of aortic regurgitation?

A 
Rheumatic fever 
Arthritides
HTN
Endocarditis 
Marfan syndrome
162
Q

What features of a history would suggest mitral stenosis?

A 
Asymptomatic
Dyspnoea 
Cough 
Blood-tinged/frothy sputum 
Palpitations 
Weakness/fatigue
163
Q

What features of a history would suggest mitral regurgitation?

A 
Asymptomatic 
Palpitations 
Dyspnoea 
Orthopnoea 
Fatigue 
Cardiac cachexia
Subacute IE
164
Q

What features of a history would suggest aortic stenosis?

A

Asymptomatic
Exercise-induced syncope
Angina
Dyspnoea

165
Q

What features of a history would suggest aortic regurgitation?

A 
Asymptomatic 
Palpitations 
Angina 
Dyspnoea 
Arrhythmia
166
Q

What features would be seen on examination of a patient with mitral stenosis?

A 
Malar flush 
Small volume pulse 
Increased JVP
Loud snap followed by low pitched rumbling
Mid-diastolic murmur
167
Q

What features would be seen on examination of a patient with mitral regurgitation?

A

Forceful, displaced apex beat
Soft first heart sound
Pansystolic murmur

168
Q

What features would be seen on examination of a patient with aortic stenosis?

A

Small volume carotid pulse
Ejection systolic murmur (crescendo-decrescendo)
Radiation to carotids

169
Q

What features would be seen on examination of a patient with aortic regurgitation?

A

Bounding/collapsing pulse
Displaced apex beat
High-pitched early diastolic murmur

170
Q

What is the best way to hear a mitral stenosis murmur?

A

Bell at apex

Patient lying on left side in expiration

171
Q

What is the best way to hear a aortic regurgitation murmur?

A

Left sternal edge

Patient leaning forward and holding breath in expiration

172
Q

How should a patient with a murmur be further investigated?

A

ECG
CXR
Echo, Doppler

173
Q

What are the differential diagnoses for valvular heart disease?

A 
Thyrotoxicosis 
Anaemia
Pregnancy 
AV fistula
ACS
IE
Pulmonary/tricuspid disease
174
Q

Define cardiomyopathy

A

Group of diseases of the myocardium which affect the mechanical/electrical function of the heart

175
Q

What is the aetiology of CM?

A

Primary - HCM, AC, DCM

Secondary - amyloidosis, haemochromatosis, alcohol, sarcoidosis, Friedreich’s ataxia, beriberi, SLE, doxorubicin

176
Q

What are the symptoms of CM?

A 
Asymptomatic 
Chest pain 
Dyspnoea
Syncope
Dizziness
Arrhythmia 
Sudden death
177
Q

What are the examination findings in CM?

A

4th heart sound due to forceful atrial contraction
Jerky carotid pulse
Ejection systolic/pansystolic murmur

178
Q

What are the differential diagnoses for CM?

A

ACS
Pericarditis
Cardiac tamponade
Hyperthyroidism

179
Q

What congenital heart diseases are cyanotic?

A

Tetralogy of Fallot
Transposition of great vessels
Severe pulmonary stenosis
Tricuspid/pulmonary atresia

180
Q

What congenital heart diseases are acyanotic?

A

ASD
VSD
Patent DA

181
Q

What are the main features of VSD?

A

Most common

Left-to-right shunt

182
Q

What are the main features of ASD?

A 
Often diagnosed in adulthood
Most common in women 
Left-to-right shunt 
Dilation of pulmonary artery
Right heart overload
183
Q

What are the main features of patent DA?

A

Persisting communication between proximal left pulmonary artery and descending aorta
Left-to-right shunt
Indometacin can be used to stimulate closure
Bounding pulse, machinery murmur

184
Q

What are the main features of coarctation of the aorta?

A

Narrowing of the aorta distal to the origin of the left subclavian vein
Most common in men
Associated with Turner syndrome and bicuspid aortic valve
Radiofemoral delay, asynchronous radial pulse

185
Q

What are the main features of tetralogy of Fallot?

A

VSD, overriding aorta, RV outflow tract obstruction, RV hypertrophy
Progressive pulmonary stenosis leads to cyanosis
Right-to-left shunt

186
Q

What are the main features of transposition of the great arteries?

A

RV -> aorta
LV -> pulmonary artery
Incompatible with life
Severe cyanosis

187
Q

What are the risk factors for congenital heart disease?

A 
Sex (depending on type)
Rubella
Diabetes
Alcohol
Smoking 
Family history
188
Q

What is the aetiology of congenital heart disease?

A

Unknown
Maternal rubella/alcohol misuse/drugs/radiation
Genetic/chromosome abnormality

189
Q

How do adolescents/adults with congenital heart disease present?

A 
Endocarditis 
Valvular lesions
Arrhythmia 
Sudden cardiac death 
Right HF
End stage HF
190
Q

What are the symptoms of congenital heart disease?

A

Sycope
Dyspnoea
Tiredness/fatigue

191
Q

What are the examination findings in a patient with congenital heart disease?

A 
Central cyanosis 
Pulmonary HTN 
Finger clubbing 
Polycythaemia 
Growth retardation
Squatting posture
192
Q

What are the differential diagnoses for congenital heart disease?

A

Cardiomyopathy
Metabolic disorder
Anaemia

193
Q

Outline the anatomy of the pericardium

A

Protective covering of the heart

Outer fibrous pericardial sac and inner serous pericardium (inner visceral, outer parietal) containing pericardial fluid

194
Q

Define pericarditis

A

Inflammation of the membrane covering the heart in which fibrinous material is deposited into the pericardial space and a pericardial effusion often occurs

195
Q

What is a pericardial effusion?

A

Collection of fluid in the potential space of the serous pericardial sac

196
Q

What is cardiac tamponade?

A

Large volume pericardial effusion which compromises ventricular filling

197
Q

What is constrictive pericarditis?

A

Chronic condition causing thick, fibrous, calcified pericardium

198
Q

What are the risk factors for pericarditis?

A 
Male 
Age 20-50
MI
Autoimmune disease 
Trauma
Infection
199
Q

What is the aetiology of pericarditis?

A 
Idiopathic 
Viral - coxsackie B, echovirus
Bacterial - staph, strep
TB
Fungal - candida 
MI
Malignant
Uraemic
Autoimmune 
Post-radiation/surgery/traumatic 
Familial
200
Q

What are the symptoms of pericarditis?

A

Sharp central chest pain exacerbated by movement/respiration/lying down and relieved by sitting forwards
Fever
Dyspnoea

201
Q

What are the examination findings of pericarditis?

A

Pericardial friction rub
Raised WCC
Pericardial effusion

202
Q

What are the examination findings of pericardial effusion?

A

Soft/distant heart sounds
Obscured apex beat
Ewart’s sign - compression of left lung base causing dull percussion

203
Q

What are the examination findings of cardiac tamponade?

A 
Raised JVP
Kussmaul's sign 
Friedreich's sign 
Pulsus paradoxus 
Reduced CO
204
Q

What are the examination findings of constrictive pericarditis?

A

Raised JVP, Kussmaul’s sign, Friedreich’s sign, pulsus paradoxus
Ascites, oedema, hepatomegaly
Dyspnoea, cough, orthopnoea, PND
Pericardial knock

205
Q

What are the differential diagnoses for pericarditis?

A 
Angina
Pleurisy 
PE
Aortic dissection
GORD
206
Q

Define aortic dissection

A

Injury to the intima of the aorta allowing blood to penetrate the diseased medial layer, leading to cleavage of the layers

207
Q

What are the 2 types of aortic dissection?

A

Type A - proximal

Type B - distal

208
Q

What are the risk factors for aortic dissection?

A 
Smoking
Autoimmune rheumatic disorders
HTN
Marfan and Ehler-Danlos syndrome
Atherosclerosis
Cardiac surgery 
Coarctation of the aorta 
Pregnancy
209
Q

What is the aetiology of aortic dissection?

A

Unknown

HTN contributing factor

210
Q

What are the symptoms of aortic dissection?

A 
Sudden severe central chest pain radiating to back/arms which is tearing in nature 
Dyspnoea 
Syncope
Dizziness 
Weakness
211
Q

What are the examination findings of a patient with aortic dissection?

A

Neurological symptoms related to loss of blood supply to spinal cord
Aortic regurgitation
Coronary ischaemia
Cardiac tamponade
Acute kidney failure/lower limb ischaemia
Shock

212
Q

What are the differential diagnoses for aortic dissection?

A

MI
PE
Mechanical back pain
Cardiogenic shock

Year 4 Medicine (2 decks)

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