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finals > cardiology > Flashcards

cardiology Flashcards

1
Q

describe aortic stenosis

A

ejection systolic murmur radiating to carotids

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2
Q

describe aortic regurgitation

A

high pitch early diastolic murmur best heard with patient sitting forward and breath held at expiration.

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3
Q

describe mitral stenosis

A

low pitched mid diastolic murmur best heard with patient lying on left

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4
Q

describe mitral regurgitation

A

pansystolic murmur radiating to the axilla

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5
Q

classic triad of aortic stenosis

A

angina
HF
syncope

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6
Q

causes of Aortic regurg.

A

connective tissue disease
infective endocarditis
ascending aortic dissection

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7
Q

causes of aortic stenosis

A

bicuspid valve
calcification
RHD

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8
Q

presentations of mitral stenosis

A

fatigue
AF
pulmonary hypertension resulting in dyspnoea and haemoptysis,

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9
Q

which murmurs are associated with LV heave and RV heave respectively

A

aortic stenosis and mitral regurgitation

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10
Q

Management of STEMI

A

morphine
oxygen
nitrate
aspirin + ticagrelor + unfractionated heparin
PCI within 120 mins, (alteplase within 12 hours if unable)

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11
Q

what makes up the tetralogy of fallot

A

ventricular septal defect
right ventricular outflow obstruction
overriding aorta
right ventricular hypertrophy

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12
Q

what is a tet spell

A

an acute hypoxic episode in someone with TOF

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13
Q

how does a tet spell present

A 
abrubt onset of rapid shallow breathing
agitation
increasing cyanosis
LoC
loss of/decreased intensity of murmur
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14
Q

Presentation of TOF

A 
cyanosis
dyspnoea
poor somatic growth
finger clubbing
ejection systolic murmur at upper left sternal border
tet spells
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15
Q

investigations for Tetralogy of fallot

A

Transthoracic ECHO - RVH, overriding aorta, VSD
colour doppler ECHO - assesses degree of RV obstruction
CXR - boot shaped heart
ECG - right axis deviation

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16
Q

management of tet spells

A

manoeuvres that increase venous return (knee to chest, in mothers arms)
oxygen
propranolol
phenylephrine - increases venous resistance -> increases blood to the lungs
bicarbonate if acidotic

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17
Q

management of tetralogy of fallot

A

alprostadil - maintains patency of ductus arteriosus
BT shunt
ECMO
Definitive treatment = complete surgical repair

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18
Q

presentation of transposition of the great arteries

A 
cyanosis
tachypnoea
clubbing
poor weight gain/difficulty feeding
failure to thrive
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19
Q

investigations of transposition of the great arteries

A

in utero via ultrasound
Transthoracic ECHO
CXR - ‘egg on a string’

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20
Q

management of transposition of great arteries

A

prostaglandins to maintain ductus arteriosus to allow time for surgery
surgery = arterial switch or atrial switch

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21
Q

presentation of patent ductus arteriosus

A 
tachypnoea/apnoea
widened pulse pressure
gibson murmur (machine like, under left clavicle)
bounding femoral pulse
failure to thrive
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22
Q

management of patent ductus arteriosus

A

IV indomethacin/ibuprofen - COX inibitors inhibit prostaglandins
surgical ligation
percutaneous catheter device closure

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23
Q

presentation of coarctation or aorta

A

neonates - low Cardiac output, shock, collapse, weak/absent femoral pulses

older children - HTN at young age, UL BP > LL BP, radio-radial delay, radio-femoral delay, systolic ejection murmur

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24
Q

associated risk factors for congenital heart disease

A

TOF - Digoerge, Down’s
ASD - maternal alcohol, down’s
VSD - Down’s
patent ductus arteriosus - maternal rubella infection, prematurity
coarctation of aorta - turner’s, DiGeorge’s, bicuspid aortic valve

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25
Q

define aortic dissection

A

a separation of the aortic wall causing blood to flow into the new false channel composed of the inner and outer layers of the media

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26
Q

presentation of aortic dissection

A

typically men over 50 (younger in those with predisposing factors such as marfan’s, ehlers danlos)
sudden tearing chest pain radiating through to the back
hemiplegia
unequal arm BP
acute limb ischaemia

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27
Q

investigation for aortic dissection

A

CT CAP - shows flap of the intima
CXR - exclude pneumothorax
ECG - exclude MI
Hb/G&S/x match

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28
Q

management of aortic dissection

A

noradrenalin
oxygen
fluids
inotropes

labetalol - aim for SBP 100-110 (as the walls are already thinned, prevents further dissection and rupture)
Add IV nitrates if BB insufficient
opioid analgesia
endovascular/open stent-graft repair

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29
Q

cause of pericarditis

A 
viral infection (coxsackie, HIV, VZV)
bacterial (pneumonia, TB)
MI
drugs (penicillin, isoniazid)
RA, SLE
malignancy
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30
Q

presentation of pericarditis

A

central chest pain worse on inspiration and lying flat, relived by sitting forward
pericardial rub
pericardial effusion

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31
Q

symptoms/signs of pericardial effusions

A

dyspnoea
raised JVP
bronchial breathing at left base

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32
Q

investigations for pericarditis

A

ECG - concave ST elevation, PR depression
FBC, CRP, ESR, troponin, blood cultures, viral serology, TFTs
CXR - enlarged globular heart if effusion
ECHO - identifies effusion
pericardiocentesis if effusion ( culture, ZN stain of TB, cytology)

33
Q

management of pericarditis

A

pericardiocentesis if large symptomatic effusion/suspicious of tamponade, infection or neoplasia
NSAIDs, colchicine

34
Q

define cardiac tamponade

A

the accumulation of pericardial fluid, blood, pus, or air within the pericardial space that creates an increase in intra-pericardial pressure, restricting cardiac filling and decreasing cardiac output

35
Q

becks triad

A

triad of falling BP, raised JVP, muffled heart sounds found in cardiac tamponade

36
Q

presentation of a cardiac tamponade

A

becks triad
tachycardia
pulsus paradoxus
dyspnoea

37
Q

treatment of cardiac tamponade

A

pericardiocentesis

38
Q

define constrictive pericarditis

A

heart becomes encase in a rigid pericardium impeding diastolic filling

39
Q

features of constrictive pericarditis

A

RHF (raised JVP, hepatomegaly, ascites, peripheral oedema)
quite heart sounds
CXR - small heart, pericardial calcifications

40
Q

what are the 4 subtypes of cardiomyopathy

A

hypertrophic
dilated
restrictive
arrhythmogenic right ventricular

41
Q

define hypertrophic cardiomyopathy

A

LV outflow tract obstruction due to asymmetrical septal hypertrophy

42
Q

presentation of hypertrophic cardiomyopathy

A

angina, dyspnoea, palpitations
jerky pulse, double apex beat, harsh systolic ejection murmur
ECG - AF, VT, deep q waves

43
Q

management if hypertrophic cardiomyopathy

A 
beta blockers/CCB
amiodarone (AF, VT)
anticoagulation if AF
surgical myomectomy
implantable defibrillator
44
Q

define dilated cardiomyopathy

A

dilated ventricles results in a weak heart

45
Q

presentation of dilated cardiomyopathy

A 
fatigue
dyspnoea
pulmonary oedeme
RVF
AF, VT
46
Q

management of dilated cardiomyopathy

A 
diuretics
b-blockers
ACEI
anticoagulation
biventricular pacing/implantable cardioverter
transplant
47
Q

define restrictive cardiomyopathy

A

the walls of the heart are rigid (but not thickened) leading to it being unable to stretch and fills poorly

48
Q

presentation of restrictive cardiomyopathy

A

chest pain
dyspnoea
palpitations
RVF - raised JVP, hepatomegaly, ascites, oedema

49
Q

management of restrictive cardiomyopathy

A

diuretics

treat underlying cause (amyloidosis, haemochromatosis, sarcoidosis)

50
Q

define arrhythmogenic RV cardiomyopathy

A

progressive replacement of myocardium with fibro-fatty tissue.

51
Q

presentation of arrhythmogenic RV cardiomyopathy

A

palpitations
syncope
RVF - oedema, fatigue
LVF - dyspnoea, orthopnoea

52
Q

management of arrhythmogenic RV cardiomyopathy

A 
sotalol - BB with class 3 antiarrhythmic properties
catheter ablation 
implantable cardioverter defibrillator
53
Q

presentation of right heart failure

A 
peripheral oedema
ascites
hepatomegaly
raised JVP
GI tract congestion (anorexia, GI upset, wt loss)
54
Q

presentation of left heart failure

A 
activity intolerance
cyanosis
dyspnoea, orthopnoea, PND
cough with frothy sputum
third heart sound
55
Q

investigations of HF

A 
elevated BNP
ECHO
CXR
ECG
U&Es, LFTs, TFTs, lipids, glucose
56
Q

signs on CXR for HF

A 
Alveolar shadowing
kerly b lines
cardiomegaly
upper lobe diversions
effusion
57
Q

management of acute heart failure

A

oxygen
furosemide
IV GTN
inotropes if hypotensive (adrenaline, dopamine)

58
Q

pharmacological management of chronic heart failure

A

beta blocker + ACEI
MRA (spironolactone)
replace ACEI with sacubitril
consider Ivabradine , hydralazine or digoxin

59
Q

Device therapy for HF

A

if LVEF < 35%
implantable cardioverter defibrillator
cardiac resynchronisation therapy - biventricular pacing

others
intra-aortic balloon pump
ventricular assist devices (LAD)
ECMO (used will waiting for transplant/implantation of LAD)

60
Q

presentation of AF

A 
palpitations
irregularly irregular pulse
dizziness
dyspnoea
murmurs - ?underlying valve disease
61
Q

ECG findings in AF

A

absent p waves
varying fibrillatory waves
irregularly irregular QRS complexes

62
Q

investigations for AF

A 
ECG
TFTs
CXR - HF, pneumonia
ECHO - valve disease
troponin - MI
63
Q

management of AF

A 
rate control (bisoprolol or verapamil) 
anticoagulation (enoxaparin + warfarin)
rhythm control ( flecainide, amiodarone)
64
Q

risk factors for AF

A 
valve disease
heart failure
hypertension
hyperthyroidism
COPD
AKI/dehydration
pneumonia
65
Q

ECG of paroxysmal supraventricular tachycardia (AVNRT)

A

absent p waves
narrow complex tachycardia
rate usually >180

66
Q

Management of PSVT

A

vagal manoeuvres
adenosine (up to three boluses) - verapamil if contraindicated (asthma)
DC cardiovert if adverse features (shock, syncope, ischaemia, HF)

67
Q

ECG of ventricular tachycardia

A

broad complex tachycardia
regular rhythm
usually > 120bpm

68
Q

management of VT

A

amiodarone if stable

if not synchronised DC cardioversion

69
Q

causes of VT

A

post MI
cardiomyopathy
myocarditis
congenital heart disease

70
Q

ECG of torsades de pointes

A

varying amplitudes/shape of QRS complexes

HR around 200bpm

71
Q

management of torsades de pointes

A

IV magnesium

synchronised DC cardioversion

72
Q

describe second degree heart block mobitz type 1

A

Gradually prolonged PR interval before dropping QRS complex

73
Q

describe second degree heart block mobitz type 2

A

prolonged but regular PR intervals followed by a random dropped beat

74
Q

describe first degree heart block

A

prolonged PR interval (>200ms)

75
Q

describe 3rd degree heart block

A

complete dissociation between p waves and QRS complexes

76
Q

management of fist degree heart block

A

monitor

withhold causative medications if possible

77
Q

management of mobitz type 1

A

IV atropine

78
Q

management of mobitz type 2

A

implanted pacemaker

79
Q

management of complete heart block

A

IV atropine - can repeat up to 3 times
inotropic support - IV adrenaline
Pacemake

finals (13 decks)

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