Cardiology Flashcards
Define the diagnostic criteria for abdominal aortic aneurysm
Diameter of >3cm or >50% larger than normal size
Recall 3 groups of risk factors for AAA and give examples of each
CV: hyperlipidaemia, atherosclerosis
Inflammatory: takasayu’s arteritis
Connective tissue: Marfan’s, Ehlers-Danlos
Where is pain felt in a ruptured AAA?
Abdomen, back or loin
Describe the nature of pain in a rutured AAA
sudden + severe
Recall the symptoms of a ruptured AAA
Pain
Syncope
Shock
Recall the signs of AAA
3Bs: bulging, bruits, bruising
Pulsatile and laterally expansile mass
Abdominal bruit
Grey Turner’s sign
What is Grey Turner’s sign?
Flank bruising
What causes Grey-Turner’s sign in AAA?
Retroperitoneal damage
What scans can be used to detect AAA?
US can see aneurysm but not rupture
CT contrast can see rupture
Define aortic dissection
Tear in aortic intima –> blood surge into aortic wall
What is the difference between types A and B aortic dissection?
Type A = in ascending aorta
Type B = in descending aorta
How can surrounding arteries be damaged in aortic dissection?
Expansion of the false lumen can obstruct the subclavian/ coeliac/ carotid or renal arteries
What is the main risk factor for aortic dissection?
HTN
Between which 2 layers of the aortic wall does a false lumen develop in aortic dissection?
Inner and outer tunica media
What is the main symptom of aortic dissection?
Tearing chest pain that may radiate to the back between the shoulder blades
If the carotid artery is obstructed by an aortic aneurysm, what would the symptoms be?
Hemiparesis
Dysphasia
Loss of consciousness
Why might an aortic dissection present with abdominal pain?
Obstruction of coeliac artery
Recall the signs of aortic dissection
Wide Pulse Pressure
Aortic Regurgitation
Back Murmur
Blood pressure difference between arms
What might hypotension with aortic dissection indicate?
Cardiac tamponade
What form of specialised imaging could be used in aortic dissection as well as CXR and CT?
Cardiac catheterisation and aortography
Define aortic regurgitation
Reflux from aorta into left ventricle during diastole
Recall the 2 groups of causes of aortic regurgitation and give examples of both
- Valve abnormality: infective endocarditis, trauma
2. Aortic root dilatation: HTN, aortitis, arthritides, aortic dissection
What arthritides are present in the case of aortic regurgitation?
Aortic valve incompetence due to reumatoid arthritis
Which 2 measures of cardiac output are changed by aortic regurgitation and why is this?
End Diastolic Volume (EDV) and Stroke Volume (SV) are elevated due to LV dilatation
Recall the consequence of chronic and acute aortic regurgitation
Chronic: leads to heart failure
Acute: leads to a sudden CV collapse
Important: Recall the 4 key signs of aortic regurgitation
Early diastolic murmur
Collapsing pulse
Wide Pulse Pressure
Displaced and heavy apex beat
Define aortic stenosis
Narrowing of left ventricular outflow at level of aortic valve
What is the most common cause of aortic stenosis?
Rheumatic heart disease
When symptomatic, what symptoms may aortic stenosis cause?
Angina
Syncope on exercise
Symptoms of left heart failure: dyspnoea and orthopnoea
Recall the signs of aortic stenosis
Narrow Pulse Pressure Ejection Systolic Murmur Thrusting Apex Beat Aortic Thrill Slow-rising Pulse
Think of 2 ECG signs that may be seen in aortic stenosis
Signs of LV hypertrophy
LBBB
Which patients are most at risk of arterial ulcer?
Those with severe atheroma
What is the hallmark symptom of arterial ulcers?
Night pain
Describe the appearance of an arterial ulcer
Punched-out
Hairless
What are the effects of an arterial ulcer downstream of the artery it affects?
Nail dystrophy
Absence of pulses
What is the key investigation for arterial ulcers?
Duplex ultrasonography of lower limbs
What are the 3 subdivisions of atrial fibrillation?
Permanent
Persistent
Paroxysmal
What symptoms are possible with atrial fibrillation?
Palpitations
Syncope
What is the main complication risk of atrial fibrillation?
Thromboembolism
Describe the pulse in atrial fibrillation
Irregularly irregular
What key examination finding is indicative of atrial fibrillation?
Difference between apical beat and radial pulse
Which electrolytes need to be measured in AF, and why?
K+, Mg2+, Ca2+
There is a risk of digoxin toxicity if potassium or magnesium are low, or if calcium is high
What is the characteristic appearance of atrial flutter on ECG?
Saw tooth baseline
How is rhythm controlled in acute atrial fibrillation?
If <48 hours: DC cardioversion, chemical cardioversion (amiodarone/flecainide)
If >48 hours since onset: anticoagulate, then do as above
Recall 3 drugs used to control rate in AF
Digoxin
Verapamil
Beta blockers
How is longterm medication for AF decided?
Depends on stroke risk
Low risk patients = aspirin
High risk patients = warfarin
How do you measure stroke risk?
CHADS-vasc score
Recall the reversible causes of cardiac arrest
4 Hs and 4Ts Hypokalaemia Hypothermia Hypovolaemia Hypoxia Tamponade Tension pneumothorax Thromboembolic Toxins
What drug is given in cases of asystole?
Atropine
Which drugs are given between each round of CPR in VF cardiac arrest?
shock + no drug CPR shock + adrenaline CPR shock + amiodarone
What are the defining characteristics of heart failure?
Cardiac output does not equal demand
Venous pressure is NORMAL
Recall the mnemonic for and the causes of left heart failure
Heart failure leaves you sitting in a CHAIR Cardiomyopathy Hypertension Aortic valve disease Ischaemic heart disease Regurgitation (mitral)
Recall 5 causes of right heart failure
Cardiomyopathy Tricuspid regurgitation Respiratory causes Infarction As secondary to LHF
Recall 4 causes of biventricular heart failure
Cardiomyopathy
Myocarditis
Arrhythmia
Drug toxicity (–> arrhythmia)
Recall 3 causes of HIGH output heart failure
Demand is increased so:
Pregnancy
Anaemia
Hyperthyroidism
Recall the 3 key symptoms of left heart failure
Dyspnoea
Paroxysmal nocturnal dyspnoea
Orthopnoea
Recall one weird sign that is present in acute left ventricular failure
Pink frothy sputum
What are left heart failure symptoms a result of?
Pulmonary congestion
Recall the symptoms of right heart failure
Swollen ankles and oedema
Reduced exercise tolerance
Fatigue
In which type of heart failure is the apex beat displaced?
Left
In which type of heart failure is there tachycardia and tachypnoea?
Left, acute LV
Which type of heart failure can produce hepatomegaly?
Right
Which type of heart failure presents with a murmur, and what is it?
Left
Mitral regurgitation
Which type of heart failure causes a raised JVP?
Right
Bilateral basal crackles are present in which type of heart failure?
Left
What is the key sign to look for in any LV systolic impairment?
Pulsus alternans
Which 2 specific markers do you need to remember to order in the blood tests during acute cardiac failure?
Troponin
BNP
What do inverted T waves show on an ECG?
Ischaemic changes
What do you use to measure valve wedge pressures?
Swan-Ganz catheter
How do you treat cardiogenic shock in acute cardiac failure?
Inotropes like dobutamine
Recall the types of cardiomyopathy
Dilated
Restrictive
Hypertrophic
Give 3 causes of dilated cardiomyopathy
Post-viral
Thyrotoxicosis
Drugs/alcohol
Recall 3 causes of restrictive cardiomyopathy
sarcoidosis
amyloidosis
haemachromatosis
Which type of cardiomyopathy is usually asymptomatic?
hypertrophic
Recall the general symptoms of heart failure
TOAD: Tired/ thromboembolism Arrhythmias Oedema Dyspnoea
In which types of cardiomyopathy would the JVP be raised?
dilated + restrictive
Recall 3 signs of dilated cardiomyopathy
JAM
JVP raised
Apex beat displaced
Mitral AND tricuspic regurgitation
Which type of cardiomyopathy can result in hepatomegaly?
Restrictive
How will restrictive cardiomyopathy affect an ECG?
Low voltage complexes
Define constrictive pericarditis
Chronic pericardial inflammation leading to thickening and scarring of cardiac tissue
Recall the usual aetiology of constrictive pericarditis
Usually idiopathic but can be viral
What is the usual timeline of onset of constrictive pericarditis?
Gradual
In advanced cases of constrictive pericarditis, how does the patient appear?
Jaundiced and cachexic
May have signs of right heart failure
What is the diagnostic test for constrictive pericarditis?
Echocardiogram
What must you always examine for in cases of DVT?
PE
How does DVT feel for the patient?
May actually be painless, just a swollen limb