Cardiology(MED) Flashcards
Patients culture come back with strep bovis and tricuspid valve is vegetated. How do you work out underlying cause>
Strep bovis infection is associated with colorectal carcinoma so we’d do a colonoscopy. The strep bovis in this. case has infected the tricupsid valves causing the vegetations and therefore infective endocarditis
What is a normal aortic root diameter?
1.7-3.3cm
Ultrasound surveillance time guidelines and aortic root diameter
-Patients with aortic root diameter of <4.5cm is yearly surveillance
-Patients with 4.5-5.4cm dilated is 3 monthly
What is becks triad?
-Hypotension
-Muffled heart sounds
-Raised JVP
What is the most common cause of viral myocarditis and how does the ECG present?
Coxsackie B virus
-Diffused ST elevation and elevated troponin levels
What is pulsus paradoxus and what can it be seen in ? How may the ECG present?
Pulsus paradoxus is the exaggerated drop in blood pressure >10mmHg at the end of inspiration that can be seen in cardiac tamponade
-On an ECG, heart swings like a pendulum
What is first line treatment for bradycardia and how does it work?
-Atropine 500micrograms and can give 6 doses up to 3 mg
-Works by inhibiting vagus nerve, increasing firing to SAN to increase heart rate
What are the characteristics of mitral regurgitation?
-Pan systolic murmur radiating to axilla
-Loudest on expiration
What is dukes criteria and what is included in it
For infective endocarditis:
Major criteria:
-2 positive blood cultures with typical organism
-Positive echocardiogram
Minor criteria:
-Fever>38
-Immunological phenomena
-Vascular phenomena
-predisposing heart disease
What is the mode of inheritance for hypertrophic obstructive cardiomyopathy?
Autosomal dominant
What causes digoxin toxicity in terms of potassium?
Hypokalaemia therefore keep an eye out for diuretics or drugs that may cause it like loop diuretics that aren’t K+ sparing
What is the first line treatment for infective endocarditis for an individual with a prosthetic valve?
1st line: flucloxacillin + rifampicin + gentamicin
-The Rifampicin penetrates biofilms on prosthetic material
What is the first line treatment for infective endocarditis for an individual with native valves?
Flucloxacillin
What is the water bottle sign on an x-ray?
Indicates pericardial effusion
What is the management for pericardial effusion?
pericardiocentesis
What is the most common bacteria that causes infective endocarditis?
Staph aureus
What are the target INR values for patients with metallic aortic and mitral valves?
Aortic-3
Mitral-3.5
What drugs can cause long QT interval and tossardes de points?
-Clarythromycin
-SSRIs
What is the range of K+ that we would either give spiranolactone or bisoprolol in hypertension?
Spiranolactone if <4.5
Bisoprolo if >4.5
How does mitral stenosis present and what is the most common cause?
Diastolic murmur
Loud snap in S1 sound
Most common cause is rheumatic fever
What are indications for surgical valve repair in infective endocarditis?
Indications for surgery:
- S- severe valvular incompetence (obstructed or infected)
- A- Aortic root abscess -PR interval prolongation is an indication for surgery: can be secondary to aortic root abscess
- R - resistant to ABX or fungal - (bacteriaemia or fever over 5 days since therapy)
- C- cardiac congestive HF has been caused (eg pitting oedema, SOB when lying, Ascites)
- E- emboli (recurrent after abx)
What drug does clopidgorel interact with making it less effective?
PPI such as omeprazole
what do thiazides do to glucose tolerance?
Worsen glucose tolerance causing hyperglycaemia
BASHed heart
Heart failure and what improves mortality
-Beta blockers
-Acei/ARB
-spiranolactone
-Hydralazine
Furosemide and digoxin is just symptomatic releief
What is the go to thiazide like diuretic for hypertension?
Indapamide
What is Mx for achalasia?
1st line pneumatic boon dilation
-If recurrent or unsuccessful dilation then surgical intervention involving Heller cardiomyotomy
RILE
Murmer on right side of heart best heard with inspiration
Murmer on left side of heart best heard with expiration
What drug is contraindicated in hypotension associated with ACS>
Nitrates
-cause vasodilation
What is the most common cause endocarditis and if there’s a prosthetic valve?
-Staph aureus
-W/ prostethic valve it would be staph epidermidis
What do you do if treatment fails for heart failure and they have resp failure?
CPAP
Mx for broad complex tachycardia and narrow complex
BC-IV amiodarone
NC-vagal manouvres and IV adenosine(Verapamil in asthmatics as adenosine can cause bronchospasms)
What is it if patient was just recently in for an MI and now has develpoed a pan systolic murmur and echo shows left ro right shunt?
Ventricular septal defect
How does pericarditis look like on an ECG?
PR depression in limb leads and ST elevation
What other causes, other than viral, can cause pericarditis?
Malignancy
What abnormality may arise with a patient on indapamide and why?
Hypercalcaemia
-Drug blocks Na-Cl symporter therefore more Ca2+ being reabsorbed
What is sick sinus syndrome and ECG features?
is used to describe the clinical manifestations of sinus node dysfunction. If very symptomatic, this condition can sometimes necessitate a pacemaker.
-sinus arrest
-sinus bradycardia
-sinoatrial block
What does digoxin do to QT interval?
Shortens QT interval
What arrhythmia can occur post MI and why?
Mitral regurgitation as papillary muscle may rupture
Mx for beta blocker OD
1st line Atropine
2nd line Glucagon
How does Vit A deficiency present as and who is it most common in?
-Presents with dry, rough skin, white spots in conjunctiva and difficulty in seeing in low light
-Low income households
What are signs of JVP other than the usual triad for cardiac tamponade?
-Absent Y wave descent on the JVP
-Pulsus paradoxus during inspiration
What is plummer vinson syndrome?
Plummer-Vinson syndrome is characterised by a triad of dysphagia, iron deficiency anaemia, and oesophageal webs. This condition is typically associated with chronic iron deficiency, leading to mucosal changes in the oesophagus, angular cheilitis and glossitis.
What is idiopathic pulmonary fibrosis?
-Clubbing
-Fine crackles on auscultation
What type of heart blocks warrant pacemaker?
-Mobitz type 2
-third degree
