Cardiology Flashcards
Is there an association with delta waves + prolongation of the QT interval and Marfan’s syndrome?
No
What condition is the Ghent criteria used in?
What is it comprised of?
Marfan’s syndrome.
Family hx, aortic root size, ectopia lentis, FBN1 gene, positive systemic score (of >= 7)
What is Kussmaul’s sign?
When the JVP paradoxically increases with inspiration.
It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart dysfunction
Aortic dissection: what effect can a complete tear have?
Exsanguination into body cavity or pericardium
Aortic dissection: what effect can a partial tear going forwards along aorta have?
Causes stroke
Paraplegia
Renal failure, and
Lost limb pulses due to interruptions with vessels supplying brain, limbs, spine and kidneys.
Aortic dissection: what effect can a partial tear going backwards towards heart have?
MI
Aortic regurgitation, and
Tamponade.
What conditions can predispose to aortic dissection?
Drugs (such as cocaine) Increased blood pressure Syphilis Systemic lupus erythematosus (SLE) Ehlers-Danlos syndrome Coarctation and dissection can occur in Turner's syndrome Trauma Pregnancy, and Marfan's syndrome.
What is pulsus bisferiens?
It is a palpable double pulse which occurs in hypertrophic obstructive cardiomyopathy (HOCM) or mixed aortic valve disease. The first beat is the percussion wave of normal systole and the second wave is formed by recoil of the vascular bed (dicrotic wave).
What is pulsus alterans?
Pulsus alternans - beats are regular in timing but alternating weak - strong in strength. This can be due to severe LVF or as a compensatory mechanism in tachycardia
What is pulsus bigeminus?
Pulsus bigeminus - weak premature ectopic beats follow every normal beat - regularly irregular pattern.
What is pulsus paradoxus?
Pulsus paradoxus - exaggeration of normal reductions in systolic blood pressure (SBP) and pulse pressure during inspiration. If the SBP falls by more than 10 mmHg this is abnormal.
List potential causes of an elevated troponin
Trauma Cardioversion Rhabdomyolysis Pulmonary embolism Pulmonary hypertension Hypertension Hypotension, especially with arrhythmias Hypertrophic obstructive cardiomyopathy Myocarditis including Kawasaki's disease Sepsis Burns Subarachnoid haemorrhage and stroke Infiltrative/autoimmune disorders including sarcoidosis, amyloidosis, haemochromatosis and scleroderma. Drugs including Adriamycin, Herceptin and 5-fluorouracil.
Causes of first degree heart block include:
Increased vagal tone (such as in trained athletes)
Ischaemic heart disease
Rheumatic fever
Hyperkalaemia
Hypokalaemia, and
Drug therapy such as digoxin or beta-blockers.
List poor prognostic factors in infective endocarditis
Old age
Presence of prosthetic valve endocarditis
Insulin dependent diabetes mellitus
Severe co-morbidities
Other:
- Endocarditis due to fungus or Gram negative bacilli
- Endocarditis complications including heart failure, renal failure, stroke, septic shock and periannular complications, and
- Echocardiographic findings including severe left sided valve regurgitation, low left ventricular ejection fraction, pulmonary hypertension, large vegetations and severe prosthetic valve dysfunction
List indications for surgery in native infective endocarditis
- Aortic or mitral infective endocarditis with severe regurgitation, valve obstruction, fistula into a cardiac chamber or pericardium causing refractory pulmonary oedema or cardiogenic shock
- Aortic or mitral infective endocarditis with severe acute regurgitation and persisting heart failure or echocardiographic signs of poor haemodynamic tolerance (early mitral closure or pulmonary hypertension)
- Locally uncontrolled infection
- Persisting fever and positive blood culture more than 7-10 days, and
- Infection caused by fungi or multiresistant organisms.
