Cardiology Flashcards
What is the dose of aspirin and ticagrelor given during an M.I?
Aspirin 300mg
Ticagrelor 180mg
STAT
What are the cautions for ticagrelor?
Asthma
COPD
Bradycardia
What are some cardiac and non cardiac causes of elevated BNPs?
Cardiac:
- Heart failure
- ACS
- Myocarditis
Non- cardiac:
- advance age
- ischemic stroke
- SAH
- COPD
- Burns
In an echocardiogram for heart failure, what are you looking for?
LV systolic function - ejection fracture
LV dimision
Valvular abnormalities
Diastolic function
What are the levels of ejection fracture?
Normal >55%
Mild 45-55%
Moderate 36-44%
Severe <35%
What signs may be seen on ultrasound of a P.E?
RV dilation
RV hypokinesis
Pulmonary hypertension
What murmur may be heard with aortic dissection?
Aortic regurgitation
- due to widen of the aortic outlet causing back flow.
intussusception may occur
What are the indications for CABG?
> 50% stenosis of the main left artery “critical main left stem disease”
2-3 Artery involvement “triple disease”
Poor ventricular function associated with multi-vessel disease
When a patient is put on cardiopulmonary bypass - what must they be given and then what follows this?
Heparin to avoid clots within the machine.
this is revered with protamine once the blood returns to the patient.
*blood is drained via the great veins, either IVC or SVC and returned directly into the aorta
What drug is given to stop the heart during a cardiopulmonary bypass?
Cardioplegia
- high K+ load.
doesn’t cause ischemia
What is the procedure of choice for aortic stenosis, and what is the alternative for those who are not fit for surgery?
Aortic valve replacement is treatment of choice.
TAVI is the option for those who are unfit for surgery.
Contrast the differences between mechanical and tissue AVRs
mAVR:
- lifelong
- Durable
- requires anticoagulation
- clicks
- haemolysis
tAVR:
- 10-15years
- non-durable
- doesn’t require anticoagulation
- non-audible
- vegetations grow
What are the indications for a mitral valve replacement?
Severe MR
Severe symptoms
Papillary muscle rupture - usually post M.I
When would you only control the rate in someone with AF?
Structurally abnormal heart
> 65 years old
Persistent AF
Hypertension
Previously failed treatment
Less symptomatic
What type of aortic dissection will have a weak/ absent radial pulse? and what is the management?
Stanford type B
- it is distal to subclavian
- Medical management
- to control BP
What are the indications for surgery in aortic dissection?
Type A
Persistent pain
Failure of medical management
Aortic rupture
What conditions are associatted with VSD?
Down’s syndrome
Edwards syndrome
Patau’s syndrome
What is the most common congenital heart disease, and what syndrome is it highly associated with?
Bicuspid Aortic valve
Turner’s syndrome
What heart murmur would you expect to hear with coarctation of the aorta?
Systolic murmur in between the shoulder blades, usually nearer the left
Harsh systolic ejection over the left side
What are some of the systemic outcomes of Eisenmenger’s syndrome?
Increased erythrocytes
- increased blood viscosity and clots
Damaged endothelium due to high pressure
- increased bleeding and poor platelet activation
Gout
Acne
What are some of the systemic signs of Eisenmenger’s syndrome?
Dyspnea
Syncope
Cyanosis
Finger clubbing
Right ventricular heave
List some conditions where pregnancy is contraindicated:
Primary pulmonary hypertension
- carries a mortality of 30-50%
Marfan’s syndrome with dilated aortic root
Severe aortic stenosis
Severe mitral stenosis
Severe LVSD
What congenital heart disease is associated with berry aneurysms?
coarctation of the aorta
What vessels maybe used in bypass graft?
venous
- great saphenous vein
Arterial
-left internal mammary artery
If a patient continually suffers from collapse, outwith the direct disease/ condition, what other factors should one consider?
Hydration status
Excessive diuresis
Medications - polypharmacy
Age
Why does Aortic stenosis cause chest pain?
Two fold:
- Left ventricular hypertrophy, demands more blood but does not receive it as well
- Reduced blood following into the coronary sinuses due to hypokinetic valves blocking entrance
What are the characteristics of pericarditis pain?
Pain located retrosternally
Pain not associated with exertion
Sharp/ shooting pain. Not constrictive
Radiates to left shoulder
Relieved by sitting forward
Outline the management of cardioversion of AF:
<48 hours
- herparinse
- Electro- Cardioversion
- Pharmacological (amiodarone if structural heart disease)
> 48 hours
- 4 week anti-coagulation
or
- confirm with transesophageal US
What investigation can be done to establish if there is a thrombus present prior to cardioverting in a patient with AF?
Transoepahgeal US
Outline the management of heart failure:
- ACE + Beta blocker
- Mineral receptor blocker
- this is specialist input
- Ivabrindine (<35% EF and >75bpm sinus)
- Dixogin (AF present)
- Sacubitril/ valsartan (<35%)
- this is specialist input
- LVAD
- CRD
- flu vaccine yearly
- one off pneumococcal vaccine
What signs may you see regarding the liver in heart failure?
Enlarged smooth liver which is pulsatile
How can the pulmonary arterial pressure be measured, how can the pulmonary venous and left atrium pressures be measured?
Cardiac catheterisation passed into a vein and through right side of heart and into the pulmonary vessels.
- direct measuring can then occur
To measure the Pulmonary venous pressure or left atrium the catheter whilst in the pulmonary circulation can wedge off the arterial flow
- thus only measuring the venous and atrial pressures
- pulmonary capillary wedge pressure
What type of cardiac catherization is used to assess left ventricular function including aortic regurgitation?
Arterial catherization
Accessed via the:
- Right femoral
or
- Radial
What are some of the indications for cardiac catherization?
Diagnosis and assessment of coronary arterial disease
+
Therapeutic intervention (angioplasty, Stenting)
Valvular disease - diagnosis and assessment
+
Therapeutic intervention
Congenital heart disease - diagnosis and assessment
+
Therapeutic intervention
Electrophysiology for diagnosis and therapeutic intervention
Measuring pressures
Outline some of the pre-procedural management for cardiac catheterisation and list some complications:
Bloods:
- FBC
- U&Es
- Coagulation studies
- LFTs
CXR
ECG
IV access (on the left)
Complications:
- Haemorrhage from enter site
- Angina
- Arrhythmias
- Vessel spasm (causing loss of distal pulses)
- Aortic dissection
- Infection at sight
What is the most common type of primary cardiac tumour?
Atrial Myxoma
What are the symptoms of obstructive cardiomyopathy?
*obstruction due to spetal hypertrophy.
most common cause of sudden death in young person.
- AD pattern
- sporadic mutation
Symptoms:
- syncope/ presyncope on effort
- dyspnoea
- Chest pain
- asymptomatic
Signs:
- Double apical pulsation
- Jerky carotid pulse (rapid ejection followed by obstruction)
- ejection systolic murmur
What ECG findings might you see with obstructive cardiomyopathy?
Left ventricular hypertrophy
Twave inversion
Non-specific ST changes
What investigations and treatments are there for obstructive cardiomyopathy?
Investigations:
- ECG
- Echo
- MRI of heart
Management:
- Beta blocker +/- calcium channel blockers
- ICD
*ACE inhibitors are contraindicated due to reduced expansion of pre-load = reduced cardiac output
What are the causes of dilated cardiomyopathy?
Familial Alcohol Myocarditis Thyroidtoxicosis Neuromuscular - Duchene
What are the signs and symptoms of dilated cardiomyopathy?
Symptoms:
- Heart failure symptoms
- AF
- VTEs
Signs:
- dynamic Apex beat
- High HR
- Low BP
- Hepatosplenomegaly
- Raised JVP
How is dialted cardiomyopathy investigated and treated?
Investigations:
- Bloods - BNP and U&Es
- ECG (Non-specific findings)
- Echocardiogram
- Heart MRI
Management:
- Heart failure management
- VTE prophylaxis
- Heart transplant (if indicated)
What are the causes of mitral stenosis and when is it considered severe?
Rheumatic fever
- most common valve
Congenital
Lutembacher’s syndrome
- ASD + mitral stenosis
Severe is when the annulus is <1cm in diameter
Symptoms appear after <2cm
What are some of the signs of mitral stenosis and what does the murmur sound like?
Face:
- Malar flush
Pulse:
- AF
Jugular:
- distended - right sided heart failure
Palpation
- palpable first heart sound
Right ventricular heave
- when the right side is affected.
Murmur:
Mid diastolic murmur with opening snap- rumble sound
- apex
*heard best with patient in the left lying position
Loud S1 sound
