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Cardiology Flashcards

1
Q

describe S1

A

closure of the mitral and tricuspid valves

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2
Q

describe S2

A

closure of the aortic and pulmonary valves

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3
Q

describe the Levin scale for grading cardiac murmurs

A 
1; very faint
2; heard by a non-expert in optimum conditions
3; easily audible
4; thrill present
5; very loud and heard over a wide area
6; heard without a stethoscope
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4
Q

what are the features of aortic stenosis?

A

ejection systolic murmur (heard shortly after S1) in the aortic region
commonly radiates to carotid arteries
loudest on expiration and when sitting forward
slow rising pulse
narrow pulse pressure
heaving apex beat
reduced, absent or splitting S2

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5
Q

what are the causes of aortic stenosis?

A

calcification of the aortic valve
congenital disorder
rheumatic heart disease

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6
Q

what are the features of mitral regurgitation?

A 
pan systolic murmur in the mitral region
radiating to the carotid arteries
loudest using the bell
loudest during expiration
displaced, hyperdynamic apex beat
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7
Q

what is the definition and causes of a pansystolic murmur?

A

heart throughout systole

mitral regurgitation
tricuspid regurgitation
ventricular septal defects

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8
Q

what are the causes of aortic regurgitation?

A 
congenital
rheumatic heart disease
infective endocarditis
aortic dissection
CT disorders
aortitis
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9
Q

what are the features of aortic regurgitation?

A 
early diastolic murmur
loudest at aortic area
loudest during expiration
Austin-Flint murmur
displaced apex beat
collapsing pulse
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10
Q

what are the causes of mitral stenosis?

A 
rheumatic heart disease
congenital
left atrial myxoma
CT disorders
Mucopolysaccharidosis
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11
Q

what are the features of mitral stenosis?

A

low pitched, rumbling, mid-diastolic murmur
loudest over the apex
loudest on expiration
low volume, irregularly irregular pulse (AF)
loud S1 with tapping apex beat
malar flush

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12
Q

define heart failure

A

the inability of the heart to maintain cardiac output to meet the metabolic demands of the body

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13
Q

define cardiac output

A

the volume of blood pumped from each ventricle per minute

SV x HR

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14
Q

define stroke volume

A

the amount blood ejected with each heart beat ml/beat

EDV - ESV

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15
Q

define ejection fraction

A

SV/EDV x 100

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16
Q

define preload

A

maximum cardiomyocyte stretch at EDV

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17
Q

define afterload

A

pressure against which the ventricle contracts

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18
Q

define the Frank Starling curve

A

as preload increases, SV increases
until a maximum
higher is increased inotropy and lower is reduced inotropy

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19
Q

define HFrEF

A

the left ventricle is filled with blood but is only able to pump up to 40% before refilling
LVEF <40%

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20
Q

define HFpEF

A

the left ventricle has stiff and thick walls
even though it pumps all of its volume it is not enough to meet the body’s needs
loss of active diastolic relaxation
LVEF >50%

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21
Q

what are the causes of HFrEF?

A 
IHD
old MI
alcohol/toxins
chemotherapy
dilated CMP
valvular HD
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22
Q

what are the causes of HFpEF?

A

HTN
hypertrophic CMP
restrictive CMP

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23
Q

what are the causes of high output HF?

A 
anaemia
thyrotoxicosis; increased T4
sepsis
AV fistula
liver disease
Paget's disease
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24
Q

what are the signs and symptoms of heart failure?

A 
raised JVP
rales
bilateral ankle oedema
murmur
laterally displaced apex beat
orthopnoea/PND
increased BNP
weight loss; high levels of interleukins
poor mood
fatigue
3rd HS
gallop rhythm
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25
what are the signs specific to LSHF?
``` pulmonary oedema crackles cough wheeze blood-tinged sputum tachypnoea PND elevated pulmonary capillary wedge pressure restlessness confusion orthopnoea tachycardia exertional dyspnoea fatigue cyanosis ```
26
what are the signs specific to RSHF?
``` fatigue increased peripheral venous pressure ascites hepatomegaly and splenomegaly distended jugular veins anorexia GI distress weight gain dependent oedema ```
27
what are the causes of BNP increase?
``` LV dysfunction previous CHF age renal dysfunction ACS pulmonary disease PE high output AF ```
28
what is the management of HF?
lifestyle changes (salt, diet, exercise, rehabilitation)
29
what is the GDMT of HFrEF?
``` RAAS inhibition (ACEi, ARB, ARNI) MRA inhibitors (spironolactone, eplerenone) SNS inhibition (beta blockers) SGLT2 (dapagliflozin, empagliflozin) CRT IHD LVAD transplant ```
30
define cardiac tamponade
quick accumulation of pericardial fluid causing cardiac compression which impedes diastolic filling
31
define constrictive pericarditis
recurrent pericarditis or effusions that cause marked thickening of the pericardium
32
what are the features of acute pericarditis?
``` sharp, sudden onset, pleuritic, retrosternal chest pain worse lying back younger male recent viral infection recent MI previous cardiothoracic surgery autoimmune disease uraemia dialysis diaphoretic tachycardia pericardial rub diffuse ST elevation ```
33
what are the features of pericardial effusion/tamponade?
``` pulses paradoxus hypotension increased JVP muffled heart sounds peripheral oedema ```
34
what are the features of constrictive pericarditis?
increased JVP Kussmaul's sign pericardial knock (loud S3)
35
what is the management of acute pericarditis?
NSAIDs PPI for gastric protection colchicine steroids in severe cases
36
what is the management of pericardial effusion?
``` NSAIDs PPI for gastric protection colchicine steroids in severe cases pericardiocentesis or ECHO of evidence of tamponade surgical pericardectomy ```
37
define aortic dissection
a tear in the intimal layer of the aorta causing blood to enter the medial layer
38
name the types of aortic aneursym
saccular fusiform false
39
what are the causes of aortic aneursym?
``` bicuspid aortic valve Marfan's syndrome Ehlers-Danlos syndrome osteogenesis imperfecta turner's syndrome noonan's syndrome hypertension trauma pregnancy cocaine surgical procedures (iatrogenic) vascular inflammatory diseases ```
40
describe Marfan's syndrome
``` mutations in the FBN1 gene autosomal dominant long, long bones upwards lens dislocation and myopia high arched palate long fingers and toes Pectus excavatum scoliosis ```
41
describe Turner's syndrome
``` 45,X coarctation of aorta bicuspid aortic valve streak ovaries, amenorrhoea and infertility horseshoe kidney broad chest and widely spaced nipples webbed neck low hairline narrow, high arched palate low-set ears ```
42
describe Noonan's syndrome
``` associated with PTPN11, KRAS, SOS1 short stature pulmonary stenosis webbed neck superior or inferior Pectus excavatum cryptorchidism coagulation defects ```
43
what are the symptoms and signs of aortic dissection?
``` abrupt onset, sharp chest pain interscapular or radiates to the back collapse cold legs paraesthesia of lower limbs hypo/hypertension pulse deficit in arms new murmur (aortic regurgitation) focal neurological deficit ST elevation widened mediastinum ```
44
what are the complications of aortic dissection?
``` aortic rupture end-organ ischaemia continuing pain and hypertension early false lumen expansion large single entry ```
45
what is the management of aortic dissection?
urgent surgery (A) medical therapy, TEVAR (uncomplicated B) surgery (complicated B)
46
describe cardiac syncope
rapid onset short duration spontaneous and prompt recovery may be associated with a prodrome
47
describe presyncope
prodrome without syncope
48
what is the cause of cardiac syncope?
cerebral hypo perfusion secondary to fall in MAP
49
describe a carotid sinus massage
``` >40 years pressure applied to carotid sinus for >5s positive if pause >5s used to terminate SVT avoided in previous stroke, TIA ```
50
describe reflex syncope
``` typically younger patient prolonged standing crowding hot places prodrome of autonomic innervation (pallor, sweating) ```
51
what is the management of reflex syncope?
``` adequate fluid/solute intake avoiding situations counterpressure maneouvres physical activity fludrocortisone midodrine stop/reduce hypotensive drugs pacing ```
52
describe the mechanism of fludrocortisone and midodrine
increases renal sodium reabsorption expands plasma volume alpha agonist frequent dosing
53
describe POTS
rise in heart rate associated with change in posture sustained increase no significant reduction in BP
54
what is the management of POTS?
adequate fluid/solute intake encourage physical activity beta blockers/ivabradine
55
what are the causes of regular rhythm on an ECG?
``` sinus atrial flutter SVT VT complete heart block ```
56
what are the causes of irregular rhythm on an ECG?
``` sinus arrhythmia Mobitz T1 Mobitz T2 AF ectopics ```
57
describe LBBB
RBB is still functioning and depolarises first wave of depolarisation spreads across to LV ventricular depolarisation is overall slower
58
what are the causes of LBBB?
``` IHD cardiomyopathy LVH aortic dysfunction conduction system fibrosis ```
59
what are the causes of RBBB?
``` relatively common in normal hearts cor pulmonale PE IHD ASD conduction system fibrosis ```
60
name the pathological tachycardias
AF atrial flutter supraventricular tachycardias (AVNRT, AVRT)
61
what is the management of AF?
anticoagulant | rate vs rhythm control
62
what is the management of adult tachycardia with adverse features (shock, MI, HF, syncope)?
``` 3x synchronised DC shock seek expert help amiodarone 300mg IV 10-20min repeat shock amiodarone 900mg/24hr ```
63
what is the treatment of VT?
amiodarone 300mg IV/20-60min | then 900mg/24hr
64
what are the risk factors for asystole?
recent asystole Mobitz T2 AV block complete heart block with broad QRS ventricular pause >3s
65
what is the treatment of asystole?
atropine 500mcg IV repeat to a max of 3mg or transcutaneous pacing
66
what are the risk factors for atherosclerosis?
``` CVD smoking HTN dyslipidaemia DM FHx premature CVD ```
67
what are the complications of HTN?
``` LVH microalbuminuria declining GFR retinal disease atherosclerosis ```
68
what are the secondary causes of HTN?
``` primary hyperaldosteronism Cushing's syndrome pheochromocytoma renal artery stenosis intrinsic renal disease coarctation of the aorta ```
69
what is the management of HTN for those with diabetes or caucasians <55 yrs
ACEi or ARB CCB thiazide-like diuretic
70
what is the management of HTN for those who are black African or caucasians >55 yrs
CCB | ACEi or ARB or thiazide-like diuretic
71
define familial hypercholesterolaemia
LDL disorder that increases the risk of premature cardiovascular disease
72
describe the mechanism of FH
faulty LDL-receptor (majority) faulty Apo-B100 gain of function PCSK9 less LDL taken into cells and increased cell production of LDL
73
what are the signs of FH?
corneal arcus tendon xanthoma total cholesterol >7.5mmol/L personal/family Hx of premature CAD
74
what is the treatment of familial hypercholesterolaemia?
lifestyle changes statin ezetimibe PCSK9 inhibitor
75
what are the causes of cardiac decompensation?
``` myocardial ischaemia/infarction arrhythmia (AF, heart block) valve dysfunction respiratory tract infection alcohol cardiomyopathy fluid retention secondary to other organ failure non-adherence to medication ```
76
what is the management of heart failure?
``` sit up to relieve dyspnoea oxygen therapy if hypoxic loop diuretic (furosemide) ACEi or ARB cardioselective beta blocker (nebivolol) MRA (spironolactone or eplerenone) ivabradine and sacubitril valsartan SGLT2 inhibitors ``` ``` dietary salt restriction alcohol reduction smoking cessation fluid restriction exercise ```
77
define hypertension
SBP > 140mmHg or DBP > 90mmHg
78
what are the signs of end-organ hypertensive damage?
hypertensive retinopathy on fundoscopy (silver wiring, arteriovenous nipping, haemorrhages, papilloedema)
79
what are the signs of atherosclerotic changes?
arterial bruits (carotid, groin, abdomen, aorta, renal)
80
what are the signs of ECF volume depletion?
``` thirst tachycardia hypotension (postural) reduced CRT dry mucous membranes decreased skin turgor decreased urine output ```
81
what are the causes of cardiogenic shock?
severe dysfunction of LV due to ischaemia papillary muscle rupture intraventricular septum rupture LV wall rupture (causing tamponade)
82
why do patients develop hypoxia in cardiogenic shock?
normally the LV contracts with more force but it cannot because it is severely ischaemic and dysfunctional blood does not get pumped out of the left side of the heart and it pools in the pulmonary circulation = pulmonary oedema and hypoxia
83
what are the risk factors for ischaemic heart disease?
FHx smoking HTN hyperlipiaemia DM (long-term corticosteroid therapy increases risk of DM) CKD highly calcified blood vessels (due to abnormal bone mineral metabolism in CKD)
84
what are the features of Buerger's disease
symptoms similar to critical limb ischaemia young male upper limb involvement
85
what are the features that distinguish Buerger's disease and critical limb ischaemia?
CLI; unlikely to affect anyone <40yrs uncommon to affect upper limbs vascular risk factors; DM, HTN chronic condition that presents as intermittent claudication, worsening over time
86
what is the differential diagnosis of Buerger's disease?
critical limb ischaemia scleroderma raynaud's SLE
87
what are the ECG features of digoxin toxicity?
``` down-sloping ST depression flattened/inverted T waves short QT interval arrhythmias; AV block bradycardia ```
88
define nephrotic syndrome
proteinuria (>3.5g/24hr) hypoalbuminaemia (25g/L) oedema often see hypercholesterolaemia
89
what is the difference between nephrotic and nephritic syndrome?
nephritic syndrome has red blood cells in the urine
90
what are the primary causes of nephrotic syndrome?
mesangiocapillary GN minimal change disease membranous nephropathy focal segmental glomerulosclerosis
91
what are the secondary causes of nephrotic syndrome?
``` hep B and C amyloidosis SLE diabetic neuropathy paraneoplastic NSAIDs penicillamine ```
92
what are the symptoms and signs of nephrotic syndrome?
``` lethargy foamy urine anasarca periorbital oedema pleural effusion ascites anaemia dyspnoea ```
93
what is the treatment of nephrotic syndrome?
``` dietary water/salt restriction loop diuretics ACEi/ARB anticoagulants manage BP immunosuppression; cyclophosphamide, corticosteroids ```
94
describe the clinical presentation of nephrotic syndrome
``` severe, rapidly progressing pitting oedema in areas of low tissue resistance characteristically in the morning positive protein urine dip hypoalbuminaemia BP normal/increased eGFR normal/mildly impaired ```
95
what is the management of nephrotic syndrome?
children; mostly minimal change disease, steroids | adults; biopsy
96
what are the complications of nephrotic syndrome?
susceptibility to infections thromboembolism hyperlipidaemia growth retardation
97
what are the causes and consequences of RSHF?
intrinsic lung disease causing pulmonary hypertension right sided cardiomyopathy hepatomegaly raised JVP bilateral limb oedema ascites
98
describe CCF
fluid overload caused by LV dysfunction | RV failure due to pulmonary hypertension
99
what are the CXR signs of heart failure?
``` alveolar oedema (bat’s wing) kerley B lines cardiomegaly dilated prominent upper lobe vessels pleural effusion ```
100
what is the treatment of heart failure?
``` diuretics ACEi/ARB beta blockers amlodipine digoxin cardiac rehab cardiac transplant biventricular pacing palliatve care in ESHF ```
101
what are the causes of acute heart failure?
``` decompensation of chronic HF ACS hypertensive crisis acute arrhythmia valvular regurgitation severe aortic stenosis severe acute myocarditis volume overload sepsis severe brain insult drug/alcohol abuse phaeochromocytoma thyrotoxicosis anaemia ```
102
what is the treatment of acute heart failure?
``` loop diuretics morphine nitrates (normal BP and no contraindication) oxygen therapy position upright ``` inotropic support CPAP intubate and ventilate mechanical assisted device
103
describe fulminant hepatic failure
massive necrosis of liver cells leading to severe impairment of liver function
104
what is the standard calibration of an ECG?
speed of 25 mm/s | gain of 10 mm/mV
105
what is the amplitude of an ECG affected by?
myocardial mass net vector of depolarisation thickness and properties of intervening tissues distance between electrode and myocardium
106
what are the causes of sinus bradycardia?
``` acute MI inferior MI sleep (high vagal tone) beta blockers CCB digoxin amiodarone hypothyroidism hypothermia sick sinus syndrome jaundice raised ICP ```
107
what are the causes of sinus tachycardia?
``` stress exercise anxiety fever hypothyroidism salbutamol theophylline ```
108
what should the normal axis of the heart fall between?
+90 and -30
109
which ECG leads should be positive and which should be negative?
I, II and III should be positive and aVR should be negative
110
what is seen in LAD?
leads II, III and aVF are negative | the axis falls between -30 and -90
111
what is seen in RAD?
lead I is negative | the axis falls between +90 and +180
112
describe P wave abnormalities
``` P pulmonale (RA enlargement) is P waves with a height >2.5 small squares P mitrale (LA enlargement) is P waves with a width >3 small squares ```
113
describe a pathological Q wave
>1 small squares in width and >2 small squares in depth
114
describe poor QRS complex progression
when the R wave does not progressively increase from V1 to V6
115
describe RBBB on an ECG
wide, notched rSR pattern in V1 and V2
116
describe LBBB on an ECG
negative complex on V1, wide notched QRS
117
describe tombstone ST elevation
the QRS complex, ST segment and T wave all fuse together and form a tombstone-like complex
118
describe pericarditis on an ECG
saddle-shaped ST elevation
119
where does an inferior infarction occur?
RCA
120
where does a lateral infarction occur?
left coronary or circumflex arteries
121
where does an anterior or septal infarction occur?
LAD
122
what are the signs of myocardial ischaemia on an ECG?
tall T waves biphasic T waves T wave inversion
123
what are the causes of angina pectoris?
``` atherosclerotic coronary obstruction anaemia thyrotoxicosis aortic stenosis hypertrophic cardiomyopathy ```
124
what are the features of typical angina?
``` heaviness, pressure, weight, squeezing radiation to inner arm, jaw, neck, shoulder, epigastrium predictable onset lasts 3-15 minutes relieved with rest/GTN ```
125
what are the features of atypical angina?
``` sharp, pleuritic, choking, pulsating radiates inframammary, chest wall random onset lasts seconds-days variable relief ```
126
what are the signs of angina?
``` smoking hypercholesterolaemia cardiac arrhythmia carotid bruits HTN valvular disease HF ```
127
what is the treatment of angina?
non-pharmacological; stop smoking, exercise and weight control, dietary modifications vascular protectors; aspirin, ACEi, clopidogrel, statins anti-anginal medication; beta blockers, CCB, nitrates, nicorandil, ivabradine PCI CABG
128
describe ACS
STEMI NSTEMI unstable angina
129
what are the causes of chest pain?
``` ACS PE pneumothorax PUD pericarditis valvular disease aortic dissection ```
130
what is the immediate treatment of ACS?
``` pain relief oxygen aspirin clopidogrel statin LWMH cardiac monitoring fibrinolytic therapy (STEMI) GP 2b/3a inhibitor for NSTEMI or UA PCI CABG ```
131
what is the secondary prevention of ACS?
smoking cessation | exercise, diet and weight control
132
what is occuring if there is no electrical activity on an ECG?
asystole
133
what pathologies have an irregular rhythm?
atrial fibrillation sinus rhythm with ectopics sinus rhythm with 2nd degree heart block (Mobitz type 1)
134
what pathologies have narrow QRS complexes?
atrial arrhythmias | nodal arrhythmias
135
what pathologies have wide QRS complexes?
ventricular arrhythmias | atrial arrhythmias aberrantly conducted
136
what pathologies have atrial activity?
sinus rhythm atrial flutter atrial tachycardia
137
describe 1st degree AV block
prolonged PR interval
138
describe mobitz type 1
PR intervals get progressively longer until one is not followed by a QRS complex and then the cycle starts again
139
describe mobitz type 2
every 2nd P wave conducts through to the ventricle and is followed by a QRS complex
140
describe 3rd degree AV block
no relationship between the P waves and the QRS complexes
141
what are the causes of AF?
``` idiopathic HTN heart disease rheumatic heart disease sick sinus syndrome thyrotoxicosis alcohol misuse cardiomyopathy post-cardiac surgery chronic pulmonary disease ```
142
define ventricular tachycardia
3+ ventricular extrasystoles in succession at a rate of more than 120bpm
143
define torsades de pointes
the hallmark arrhythmia associated with delayed repolarisation (QT prolongation)
144
describe ventricular fibrillation
chaotic appearance very fast rate always associated with cardiac arrest
145
what are the types of AF?
paroxysmal persistent permanent
146
what are the causes of AF?
``` HTN IHD hyperthyroidism mitral valve disease alcohol cardiomyopathy post-operative pulmonary disease HF sinus node disease lone ```
147
what else involved in the management of AF?
long-term antithrombotic therapy | except in those with contraindications to warfarin and those with lone AF <60 (aspirin)
148
what are the 1st line drugs for rate control?
digoxin beta blockers CCB
149
what are the 1st line drugs for rhythm control?
amiodarone flecainide occasionally propafenone and sotalol
150
what are the symptoms of aortic stenosis?
chest pain dyspnoea dizziness blackouts
151
what are the complications of aortic stenosis?
HF blackouts/sudden death infective endocarditis
152
what is the treatment of aortic stenosis?
``` education dental hygiene surgical replacement percutaneous artificial valve replacement avoid vasodilators ```
153
what are the causes of aortic incompetence?
``` HTN Marfan’s syndrome aortic dissection syphilis congenital rheumatic infective endocarditis trauma ankylosing spondylitis annulaortic ectasia ```
154
what are the symptoms of aortic incompetence?
mostly asymptomatic irreversible LV dysfunction; fatigue, dyspnoea, exercise intolerance angina
155
what is the treatment of aortic incompetence?
surgical replacement vasodilator therapy dental hygiene education
156
what are the chronic causes of mitral regurgitation?
myxomatous mitral leaflet prolapse annular dilatation (LV dysfunction) rheumatic heart disease papillary muscle dysfunction
157
what are the acute causes of mitral regurgitation?
infective endocarditis | papillary muscle dysfunction
158
what are the symptoms of acute mitral regurgitation?
cardiogenic shock | acute pulmonary oedema
159
what are the complications of acute mitral regurgitation?
``` arrhythmias LV enlargement (cardiomegaly) infective endocarditis pulmonary oedema cardiogenic shock ```
160
what is the treatment of mitral regurgitation?
treatment of pulmonary congestion; ACEi, loop diuretics, beta blockers, digoxin dental hygiene treatment of associated conditions mitral valve replacement/repair (those with a mechanical valve require long-term warfarin therapy)
161
what are the symptoms of mitral stenosis?
``` dyspnoea exercise intolerance orthopnoea, PND fatigue syncope cough haemoptysis wheeze hoarseness ```
162
what are the complications of mitral stenosis?
``` arrhythmias (AF) systemic embolism acute pulmonary oedema pulmonary HTN RVH tricuspid regurgitation right HF infective endocarditis ```
163
what is the treatment of mitral stenosis?
``` treatment of pulmonary congestion - loop diuretics, digoxin, beta blockers, ACEi antibiotic prophylaxis treatment of arrhythmias anticoagulation mitral valve replacement/repair catheter balloon commisurotomy ```
164
what are the causes of aortic dissection?
``` atherosclerosis HTN trauma iatrogenic inflammatory diseases (syphilis, vasculitis, aortitis) toxic Marfan syndrome Ehler-Danlos syndrome ```
165
what are the symptoms and signs of aortic dissection?
``` sharp pain dyspnoea syncope neurological symptoms/stroke tachycardia weak/uneven pulses hyper/hypotension diastolic murmur of aortic regurgitation ```
166
what are the complications of aortic dissection?
``` acute renal failure aortic regurgitation acute HF acute coronary occlusion cardiac tamponade ischaemic bowel stroke Leriche’s syndrome aortic perforation (haemoptysis, haematemesis, haemothorax) ```
167
describe the DeBakey classification of aortic dissection
type I - originates in the ascending aorta and beyond the aortic arch type II - originates and confined to the ascending aorta type III - originates and confined to the descending aorta
168
describe the Stanford classification of aortic dissection
type A - involves the ascending aorta | type B - does not involve the ascending aorta
169
what is the treatment of aortic dissection?
type A - surgery type B - medical management, surgery in tractable chest pain, risk of rupture, end organ ischaemia, periaortic or mediastinal haematoma, percutaneous stenting
170
what are the causes of HCM?
AD mutations of the beta-myosin heavy chain gene and the myosin-binding protein C gene
171
what are the complications of HCM?
``` diastolic dysfunction MI LV outflow obstruction arrhythmias infective endocarditis sudden cardiac death ```
172
what are the symptoms of HCM?
``` mostly asymptomatic exertional dyspnoea angina syncope palpitations ```
173
what are the signs of HCM?
``` prominent a wave in JVP rapid upstroke carotid pulse ejection systolic murmur heard across praecordium ECG - LVH, LBBB, giant T wave inversion asymmetrical septal hypertrophy enlarged LA LVOT obstruction systolic anterior motion of mitral valve mitral regurgitation or prolapse ```
174
what is the treatment of HCM?
``` beta blockers verapamil disopyramide surgical myectomy non-surgical (alcohol) ablation ICD exercise (avoid intensive and burst exercise) ```
175
define IE
a microbial infection of the endovascular wall of the heart
176
what is the classification of endocarditis?
active/treated | diagnostic status - presumed/confirmed
177
what are the causes of IE?
``` streptococcus viridans, bovis staphylococcus aureus enterococci HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella) fungi ```
178
what are the risk factors for IE?
``` valve replacement valvular heart disease structural congenital heart disease HCM previous infective endocarditis IV narcotic abuse haemodialysis IV devices piercings/tattoos ```
179
what are the symptoms of IE?
``` fever malaise weakness weight loss pale myalgia and arthralgia dyspnoea cough chest pain heart failure neurological symptoms ```
180
what are the signs of IE?
``` Janeway lesions Osler’s nodes Roth spots finger clubbing splinter haemorrhages splenomegaly vasculitic rash glomerulonephritis (urine test) neurological ```
181
what are the complications of IE?
``` valve (destruction, incompetence, chordae rupture) heart failure heart block mycotic aneurysm emboli pulmonary infiltrates pneumonia abscesses ```
182
what is the treatment of IE?
antibiotics (depending on micro-organism) surgery (haemodynamic compromise, persistent fever, abscess/fistula development) antibiotic prophylaxis (for those at-risk) dental hygiene

Clinical Practice (14 decks)

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