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Scott's Notes > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What additional clues might point you towards the indication for a midline sternotomy scar?

A 
Metallic click - metallic valve
Murumr - tissue valve/valvotomy
Leg scar - CABG
Old scar young patient - congenital heart disease
Immunosuppression - transplant
Nil else - trauma, tissue valve, CABG
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2
Q

What are the cardiac causes of clubbing?

A

Atrial myxoma
infective endocarditis
Congenital heart disease

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3
Q

What might cause a collapsing pulse?

A

Aortic regurgitation
Thyrotoxicosis
Anaemia

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4
Q

What might cause an impalpable apex beat?

A

COPD

COPD
Obesity
Pericardial effusion
Dextracardia

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5
Q

What are the features of pulmonary hypertension?

A 
Raised JVP
Peripheral oedema
Left psternal heave
Pulsatile hepatomegaly
Loud P2 and PSM of TR
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6
Q

What are the examination findings of aortic stenosis?

A

Pulse - slow rising, narrow pulse pressure

Precordium:
Pacemaker
Forceful non-displaced apex
ESM in R 2nd ICS radiating to carotids

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7
Q

What are some cauess of aortic stenosis?

A

Senile calcification
Bicuspid valve
Rheumatic fever

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8
Q

What might be some differentials for aortic stenosis?

A

Sclerosis
MR
HOCM
PS

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9
Q

What are the clinical features of severe AS?

A

Angina
Dyspnoea
Syncope

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10
Q

How would you investigate AS?

A

ECG - LVH, arrhythmias
Bloods - FBC, UnE, BNP, Lipids, glucose
CXR - Calcification, LVH, pulmonary oedema
Echo - LV function, underlying cause

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11
Q

What is the management of AS?

A

Gen - MDT, CV risk, monitor
Surgical - Valve replacement +-CABG if symptomatic
Also - TAVI, balloon valvuloplasty

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12
Q

How would you accentuate the murmur heard in AS?

A

Sat forward in end expiration

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13
Q

What are the examination findings in MR?

A

Pulse - AF
Displaced apex
Soft S1 loud S2
Blowing PSM loudest in apex radiating to axilla

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14
Q

How would you accentuate the murmur heard in MR?

A

Left lateral position in end expiration

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15
Q

What differentials might you give for MR?

A

AS

VSD

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16
Q

What are the common causes of MR?

A

LV dilatation
Calcification
Rheumatic heart disease
Mitral valve prolapse

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17
Q

What investigations would you do for MR?

A

ECG - LVH, arrhythmia, p-mitrale (bifid)
Bloods - FBC, UnE, BNP, lipids, glucose
CXR - Cardiomegaly, calcification, pulm oedema
Echo- assess function

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18
Q

What is the treatment for MR?

A

Gen - MDT, CV risk, monitor
Med - AF rate control and anticoagulate
Surg - Valve replacement if symptomatic

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19
Q

What eponymous signs might you see in AR?

A 
Quincke's - capillary pulsation in nailbed
De Musset's - head nodding
Corrigans - vigorous carotid pulsation
Traube's - pistol shot femorals
Mueller's - systolic uvular pulsations
Rosenbach's - pulsatile liver
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20
Q

What other findings are seen in AR?

A 
Collapsing pulse 
Wide pulse pressure
Displaced apex
S3
High pitched EDM loudest at LLSE
May also have ESM
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21
Q

How would you accentuate the murmur heard in AR?

A

Sitting forward end expiration

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22
Q

What are the common causes of AR?

A

Bicuspid aortic valve
Rheumatic disease
Ankspo/RA
CTD e.g. Ehlers Danlos, Marfan’s

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23
Q

What investigations would you do for AR?

A

ECG - LVH/strain
Standard bloods
CXR - Cardiomegaly, pulmonary oedema
Echo

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24
Q

What is the management of AR?

A

Gen - MDT, CV risk, monitor
Reduce afterload - ACEi/Bblockade/Diuretics
Surg - valve replacement if symptomatic

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25
Q

What examination findings might you find in a patient with MS?

A

Face - Malar flush
Pulse - AF
Precordium - Left heave, tapping non displaced apex,
MDM in apex radiating ot axilla

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26
Q

How would you accentuate the murmur heard in MS?

A

Left lateral position in end expiration - listen with the bell

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27
Q

What are some causes of MS?

A

Rheumatic fever by far commonest

Also prosthetic/congenital valves

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28
Q

What investigations might you do for MS?

A

ECG - AF, p-mitrale
Usual bloods
CXR - LA hypertrophy, calcification, pulm oedema
Echo

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29
Q

What is the management of MS?

A

Gen - MDT, CV risk, monitor
Consider RhFever prophylaxis (PenV)
AF rate and anticoagulate
Surgery - Valve replacement/balloon plasty

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30
Q

What is the pathophysiology of rheumatic fever?

A

Ab cross reactivity with myosin following Strep pyogenes infection.

Aschoff bodies

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31
Q

What criteria must be met for diagnosis of RhF?

A

Revised Jones
Evidence of GAS infection + 2maj OR
1 maj + 2 min

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32
Q

What are major Jones criteria?

A

JONES

Joints - polyarthritis
O - pancarditis
N - subcutaneous nodules
E - erythema marginatum
S - Sydenham's chorea
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33
Q

What are the minor Jones criteria?

A

Arthalgia
Fever
PR prolongation
Raised inflamm markers

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34
Q

What is the treatment of rheumatic fever?

A 
Bedrest 
Benpen
Analhgesia
Oral pred if CCF
Haldol for chorea
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35
Q

What are the risk factors and organisms associated with acute and subacute infective endocarditis?

A

Acute RFs - IVDU, immunosuppression, wounds
Acute bugs - s. aureus, s. epidermis

Subacute RFs - Valve prostheses, MR
Subacute bugs - S. viridans, s. bovis

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36
Q

What are the clinical features of subacute infective endocarditis?

A 
Hands - 
Splinter haemorrhages
Osler's nodes
Janeway lesions
Clubbing
Other - 
Roth spots
Fever
Splenomegaly
Haematuria

Cardiac -
New/changing murmur

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37
Q

What diagnostic criteria must be met for a diagnosis of infective endocarditis?

A

Dukes criteria
2 major OR
1 major 3 minor OR 5 minor

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38
Q

What are the Dukes major criteria?

A

+ve blood culture in 2 separate cultures

Endocardial involvement

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39
Q

What are the Dukes minor criteria?

A 
Fever
Predisposition (cardiac lesion, IVDU)
Emboli
Immune Fx
1 +ve blood culture
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40
Q

What is the management of IE?

A

Fluclox + gent Or

BenPen + Gent

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41
Q

What might a left lateral inferior thoracotomy scar indicate?

A

MV repair/valvotomy

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42
Q

Aortic vs mitral valve replacement on auscultation?

A

Aortic - Lub click

Mitral - Click lub

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43
Q

What are the key differences between and when would you use a mechanical valve and when a biological valve?

A

Mechanical valves last longer and require lifelong anticoagulation, so are used on younger patients and on those already on anticoagulants (e.g. AF)

Biological valves are less durable and only require aspirin not warfarin. They are used in older patients and women of child bearing age.

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44
Q

What are the possible complications of having a valve replacement?

A 
Surgical mortality
Thromboembolism
Anaemia (warfarin and haemolysis)
IE
Bleeding
Failure
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45
Q

What are some common causes of AF?

A 
MS 
Thyrotoxicosis 
IHD
Rh Fever
HTN
Pneumonia
Hypokalaemia
PE
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46
Q

What investigations would you do in a patient with AF?

A

ECG - irreg irreg, no p waves
Bloods - FBC, (pneumonia), UnE (lowK), TFT, Trop, D-Dimer
CXR - oedema, calcification, pneumonia
Echo - valve dysfunction

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47
Q

What is the management of acute AF?

A 
If haemodynamically unstable ->cardiovert
If stable -> 
Rate control with B blocker
Start LMWH
Chem cardiovert (flec or amiodarone)
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48
Q

What is the management of longstanding AF?

A

Use CHADSVASC score to assess stroke risk then (if necessary) anticoagulate with Apixaban etc or Warfarin

Rate control with beta blocker or CCB

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49
Q

What are the components of the CHA2DS2VASc score?

A 
CCF
HTN
Age >75- 2 points
DM
Stroke/TIA- 2 points
Vascular disease
Age 65-74
Sex female
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50
Q

What rare the result cut offs for CHADVASC?

A

0- Aspirin

Not 0 - Warfarin/DOAC

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51
Q

What are some contraindications to warfarin therapy?

A 
Coagulopathy
Compliance issues
Fall risk
PUD
Pregnancy
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52
Q

What are the possible complications of warfarin therapy?

A

Bleeding

Osteoporosis

53
Q

Give some indications for permanent pacing

A 
Complete AVA block
Mobitz type 2
Symptomatic bradycardia
Drug resistant tachyarrhythmias
CCF
54
Q

What are the different types of pacemakers?

A

Single lead
Dual lead
Biventricular
Implantable defibrillator

55
Q

What are some complications of pacemaker insertion?

A

Insertion - bleeding, arrhythmia

Post insertion - Erosion, lead migration, infection, malfunction

56
Q

What are some common causes of left heart failure/

A
  1. IHD
  2. Idiopathic dilated cardiomyopathy
  3. Systemic HTN
  4. Mitral/aortic valve disease
57
Q

What are some common causes of right heart failure?

A

Left heart failure
Pulmonary hypertension
Tric/pulm valve disease

58
Q

What are the signs and symptoms of left heart failure?

A 
Signs:
Cyanosis
AF
Cardiomegaly w displaced apex
S3 gallop tachy
Wheeze
Creps
Symptoms:
Dyspnoea on exertion
fatigue
Orthopnoea + PND
Nocturnal cough
59
Q

What are the signs and symptoms of right heart failure?

A 
Raised JVP
Pulsatile hepatomegaly
Pitting oedema
Ascites
Anorexia& nausea
60
Q

What are the Xray features of chronic heart failure?

A

ABCDEF

Alveolar shadowing
Kerley B lines
Cardiomegaly
Diversion to upper lobes
Effusions
Fluid
61
Q

What is the management of chronic heart failure?

A

Gen: MDT, CV risk, monitor

SPecific:

  1. ACEi + BBlocker + furosemide
  2. Add spiro
  3. Digoxin
  4. Resynchronisation therary

Surgery
LVAD (external)
Transplant

62
Q

Which leads and vessels supply the inferior view of the heart?

A

Leads: II, III, aVF
Vessel: RCA

63
Q

Which leads and vessels supply the anterolateral view of the heart?

A

Leads: I, aVL, V5, V6
Vessel: L circumflex

64
Q

Which leads and vessels supply the anteroseptal view of the heart?

A

Leads: V2-4
Vessel: LAD

65
Q

Which leads and vessels supply the anterior view of the heart?

A

Leads: V2-6
Vessel: Left main stem

66
Q

Which leads and vessels supply the posterior view of the heart?

A

Leads: V1-3 (recip)
Vessel: RCA

67
Q

What might cause broad QRS complexes?

A

Ventricular initiation
Conduction deficit
WPW

68
Q

What are some causes of QT prolongation?

A

TIMME

Toxins - Macrolides, antiarrhythmics, TCAs, antihistamines
Ischaemia
Mitral valve prolapse
Myocarditis
Electrolytes (any)
69
Q

What are some causes of T wave inversion?

A 
Strain
Ischaemia
Ventricular hypertrophy
BBB
Digoxin
70
Q

What are U waves

A

Occur after T waves in hypokalaemia

71
Q

What are J waves

A

Occur between QRS and ST due to:
Hypothermia
SAH
HyperCa

72
Q

What causes left and right BBB?

A

LBBB:
Inferior MI
Congenitals
RVH

RBBB:
Fibrosis
LVH
Inf MI
Coronary HD
73
Q

Name and describe some narrow complex tachycardias (SVTs)

A 
Sinus tachy
AVNRT - absent p waves, normal QRS
AVRT - p waves present, normal/broad QRS
Atrial flutter - Saw toothed baseline with ratio
AF- irreg irreg
74
Q

Name and describe some broad complex tachys

A

VT - no ps, regular wide QRS, no Ts
VF - completely shapeless (V frantic)
Torsades - AM

75
Q

What are and what causes p pulmonale and p mitrale?

A

P pulmonale - peaked P wave caused by pulmonary HTN, tric sten

P mitrale - bifid p wave caused by MS

76
Q

RVH vs LVH on ECG?

A

RVH - Tall R in V1 and Deep S in V6

LVH - Deep S in V1 and Tall R in V6

77
Q

What are the ECG findings of Wolf Parkinson White?

A

Delta wave - slurred upstroke before QURS

78
Q

What is S1Q3T3?

A

Deep S wave in lead 1
Pathological Q wave in lead 3
T wave inversion in lead 3

79
Q

How do hyper and hypokalaemia affect ECG/

A

HyperK:
Tented T waves
Broad QRS
Absent p waves

HypoK:
Flattened T waves
ST depression
QT prolongation
U waves
80
Q

When and how would you treat a bradycardia?

A

Treat when symptomatic

  1. Manage underlying cause
  2. IV Atropine
  3. External pacing

May receive permanent pacing if problem recurs

81
Q

How do you manage an SVT?

A
  1. O2 and IV access
  2. Assess rhythm
    2a. Regular rhythm - Continue trace, vagal manouvres, Adenosine 6mg IV bolus
    Reasess; If no adverse signs (low BP, HF, LoC, tachy) then digoxin/amiodarone infusion.
    If adverse signs then sedate followed by DC cardioversion or Amiodarone infusion
    2b. Treat as AF -
    Rate control with B blockade
    Consider cardioversion w amiodarone if <48 hrs, consider anticoag
82
Q

How do you manage a VT?

A
  1. Assess pulse
    a. No pulse -> CPR
    b. Pulse -> O and IV access
  2. Assess adverse signs (hypo, tachy, HF, CP, LoC)
    a. Yes -> Sedate, DC, Amiodarone
    b. No -> Correct electrolyte abnormality and reassess
83
Q

What are the risk factors for ACS?

A 
Modifiable:
HTN
Smoking
Obesity
DM
Cholesterol
Non-modifiable
Age
Ethnicity
FHx
Gender
84
Q

What is the progression of ECG changes in STEMI?

A 
Normal
ST elevation and hyperacute T waves
Q waves (full thickness)
ST normalisation
T wave inversion
85
Q

What is the timing of troponin rise in STEMI?

A

Elevated from 3-12 hours
Peaks at 24 hours
2 high readings required for confirmation

86
Q

What investigation results point to an NSTEMI over a STEMI?

A

Positive trop with typical symptoms but no ST elevation

87
Q

What is the management of STEMI and NSTEMI?

A

STEMI: PCI or thrombolysis
NSTEMI: Angio +- PCI/CABG

88
Q

What are the complications of an MI?

A

Death Passing PRAED st

Death
Pump fa
ilure

Pericarditis (early, fever, positional, saddle STelev)
Rupture:
LV wall -> tamponade
Chordae -> MR w. PSM
Septum -> PSM, JVP, HF

Arrhythmias (Tachy or brady) and Aneurysm

Embolism - 3/12 warfarin

Dressler’s -> Pneumopericarditis at 2-6 weeks

89
Q

What is the management pathway of a STEMI?

A
  1. ECG
  2. Target SpO2 94-98%
  3. IV access + bloods
  4. Brief Hx + exam
  5. 300 Asp 300 Clopi
  6. Analgesia - MnM
  7. GTN & B-blockade
  8. LMWH
  9. CCU for monitoring
  10. PCI or thrombolysis
90
Q

What should be done regarding secondary prevention of MI?

A

ABCDS + lifestyle

ACEi
B-blocker
Cardiac rehab group
DVT prophylaxis till movile
Statin (atorva 80)

Stop smoking, diet, exercise etc.

Clopi continue for 1 month, aspirin is lifelong

91
Q

What are some non atheromatous causes of angina?

A

Anaemia
AS
Tachyarrhythmia
Arteritis

92
Q

What are the different types of angina/

A 
Stable - exertional
Unstable - constant
Decubitus - on lying
Prinzmetal - vasospasm during rest
Syndrome X - Angina and ST elevation on exercise but no evidence of atherosclerosis
93
Q

What secondary prevention is given to patients with angina/

A

Aspirin 75 OD
ACEi
Statins (simva 40)
Antihypertensives

94
Q

What symptomatic relieve can be given to angina patients?

A

GTN spray + either BB or CCB

95
Q

What is the management of treatment resistant angina?

A

PCI or CABG

96
Q

Complications of CABG?

A 
MI
Stroke
Tamponade
Postperfusion syndrome (neurocognitive imp)
AF
Sternum nonunion
Graft stenosis
97
Q

What is the management algorithm for severe pulmonary oedema?

A
  1. Sit pt up
  2. 15L non rebreathe O2
  3. IV access, bloods, ECG
  4. MnM
  5. 40mg IV furosemide
  6. GTN
  7. Hx, CXR, ?echo
  8. Start nitrate infusion if SBP >100 (aim for >90)
  9. Consider CPAP, furosemide, nitrates, haemofiltration
  10. If SBP <100 consider inotropes
98
Q

What are the causes of flash pulmonary oedema/

A

Cardiogenic -
MI
Arrhythmia
Fluid overload

Non-cardiogeniic
ARDS
Upper airway obstruction
Neurogenic

99
Q

What is Beck’s triad and when would you see it?

A

Hypotension
Raised JVP
Muffled heart sounds

Seen in cardiac tamponade

100
Q

What is the treatment algorithm for hypertension/

A

<55

  1. ACEi
  2. ACEi +CCB
  3. ACEi + CCB + Thiazide

> 55 or black

  1. CCB
  2. CCB + ARB
  3. CCB + ARB + Thiazide
101
Q

What are the causes of a mitral valve prolapse?

A

Primary myxomatous degeneration frequently in young women
MI
CTD
Turner’s

102
Q

What are the signs of an MV prolapse?

A

Mid systolic click +- a late systolic murmur

103
Q

What are the complications of an MV prolapse?

A

MR
Stroke
Arrhythmia

104
Q

What are the causes of tricuspid regurg?

A

RV dilatation
RhFever
IE
Carcinoid

105
Q

What are the signs of TR?

A 
Raised JVP
Ascites/oedema
PSM at LLSE on inspiration
Pulsatile hepatomegaly
Jaundice
106
Q

What are the features of tricuspid stenosis?

A

Fatigue, ascites oedema,
Opening snap
EDM at LLSE on inspiration

107
Q

What are the featuers of pulmonary stenosis?

A

Dyspnoea, ascites, oedema
Ejection click
ESM at ULSE on inspiration

108
Q

What are the causes of acute pericarditis?

A

Viral, bacterial, fungal
MI (Dressler’s)
Drugs - penicillin, isoniazid
Other - uraemia, RA, SLE, sarcoid

109
Q

WHat is a classic (and other) sign(s) of constrictive pericarditis?

A

Kussmaul’s sign - Raised JVP on inspiration
RHF
Hepsplenomegaly
Fluid

110
Q

What is a classic feature of a pericardial effusion?

A

Ewart’s sign - large effusion compressing lower lobe causing bronchial breathing at the left lung base

111
Q

Which three signs are seen in cardiac tamponade?

A

Kussmaul
Beck’s triad
Pulsus paradoxus (pulse fades on inspiration)

112
Q

What are the causes of acute myocarditis?

A

Idiopathic in 50%
Any infection
Drugs - cyclophosphamide, carbamazepine, phenytoin
Autoimmune - GCA, SLE

113
Q

What are the clinical featuers of acute myocarditis?

A 
Flu like prodrome
Dyspnoea, fatigue
Chest pain
Arrhythmia/palps
S4 gallop
114
Q

What are the investigations and treatment for myocarditis?

A

ECG - ST elev/dep
T inv
+ve trop, CK elevation

Treat the cause

115
Q

What is the pathophysiology and inheritance pattern of HOCM?

A

LVOT obstruction due to septal hypertrophy

AD inheritance - ask re family Hx of sudden death

116
Q

What are the clinical features of HOCM?

A 
Angina
Dyspnoea
Palps
Exertional syncope
Double apex beat
ESM @ LLSE
117
Q

What is the management of HOCM?

A

Med -
-ve inotropes (BBlock/verapamil)
Amiodarone for arrhythmia
Anticoagulate if AF

Non-med - septal myomectomy if severe

118
Q

What are the causes of dilated cardiomyopathy?

A

DILATE

Dystorphy
Infection
Late pregnancy
Autoimmune  - SLE
Toxins (ETOH)
Eosinophilia
Neoplasia (Carcinoid)
119
Q

What are the clinical and investigation findings in DCM?

A 
Clin - 
Displaced apex
Massive JVP
S3 gallop
Hypotension
MR/TR

CXR - c-megaly, oedema
ECG - T inversion
Echo - dilation and hypokinesis

120
Q

What is the management of DCM?

A

Bed rest
Diuretics, ACEi, digoxin, anticoagulate
Biventricular pacing
Transplant

121
Q

What are the complications and features of an ASD?

A

Eismenger’s syndrome (R->L shunt) due to raised RA pressure

Dyspnoea
Pulm HTN
Arrhythmia
Chest pain
AF
JVP
ESM
122
Q

How do you diagnose and manage an ASD?

A

Echo

Transcatheter closure

123
Q

What are the features of coarctation of the aorta?

A

RF delay w weak femorals
HTN
Systolic murmur

124
Q

What how does a VSD commonly present?

A

Severe HF in infancy or incidentally later in life with harsh PSM at LLSE

125
Q

What are the components of Tetralogy of Fallot/

A

VSD
Pulmonary stenosis
Overriding aorta
RVH

126
Q

How does Marfan’s present?

A

Cardiac -
Aortic aneurysm/dissection
Aortic root dilatation -> AR
MV prolapse

Ocular - Upper lens dislocation

MSK - 
High arched palate
Pes planus
Arachnodactyly
Scoliosis
Pectus excavatus
Hypermobility
127
Q

What hat might you see on CXR of a Marfan’s pt?

A

Widened mediastinum
Scoliosis
Pneumothorax

128
Q

What are the features of Ehler’s Danlos?

A

Hyperelastic skin
Hypermobility
Cardiac - valves and aneurysms
Fragile vessels and poor healing.

Scott's Notes (21 decks)

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