Cardiology - Miscellaneous Flashcards
Effect of diabetes on cardiac?
- higher CAD risk
- abnormal LV systolic and diastolic dysfunction
- coronary MICROVASCULAR disease
- endothelial dysfunction
- autonomic dysfunction
Thiamine deficiency (Beri Beri) effects of cardiac system?
High output failure
Dilated cardiomyopathy
Hyperhomocysteinaemia effects on cardiac system?
Premature atherosclerosis
Obesity effects on cardiac system?
- LVH
- Excessive LV filling presure on exertion
HypERthyroidism effect on cardiac system?
SVT
HTN
AF (in 15%)
Means-Lerman Scratch: systolic pleuropericardial rub at left 2nd ICS on EXPIRATION
Means-Lerman Scratch
= systolic pleuropericardial rub at left 2nd ICS on EXPIRATION
Hypothyroidism effects on cardiac disease
- decreased cardiac output
- decreased stroke volume
- decreased HR
- decreased pulse pressure
Cardiac Tumours:
What is the most common cancer to metastasise to the heart?
Metastatic melanoma
Cardiac Tumours:
What is Carney Complex?
Carney Complex: mutation in tumour suppressor PRKAR1A Autosomal Dominant Blue naevi Myxoma Endocrine overactivity - Cushing's - Testicular tumor - Pituitary adenoma
Cardiac Tumours:
What mutation is seen in Carney Complex?
Mutation in tumour suppressor gene PRKAR1A
What clinical features would represent an atrial myxoma?
- AF
- Mid-diastolic murmur with ‘tumour plop’
- Embolism
What murmur do you hear with an atrial myoxoma?
Mid-diastolic murmur with ‘tumour plop’
If a Carney Complex atrial myxoma what is the problem with surgical resection?
Carney complex myxoma often recur.
Normal myxoma recurrence in 5-15% after resection
What is Loeffler’s Endocarditis?
Eosinophilic endocardial disease
Associated with restrictive cardiomyopathy
What is Fabry’s Disease and how is it related to the heart?
X linked recessive deficiency of alpha-galactosidase A.
Associated with restrictive cardiomyopathy
What is Kaussmaul’s sign?
INCREASE in JVP on inspiration
Is carotid sinus hypersensitivity more common in males or females?
Which age group?
Males more common
Increased age
Also more commonly right-sided hypersensitivity
On carotid massage when is it diagnostic for carotid sinus hypersensitivity?
Reproducible on massage and if:
- Asystole >3 seconds (indicates cardioinhibitory CSH)
- Decrease in SBP of >50mmHg independent of HR (indicates vasodepressor CSH)
When would you do a pacemaker in carotid sinus hypersensitivity?
If it is cardioinhibitory (ie carotid sinus massage reproduces symptoms and has asystole >3 seconds)
or if mixed carotid sinus hypersensitivity
A patient has syncope/dizziness/falls on turning their head or tight fitted collars….what do you think of?
Carotid sinus hypersensitivity
How does DIGOXIN work? (5 ways)
1) Cardiac Glycoside: direct VASOCONSTRICTION in smooth muscle (arterial and venous)
2) POSITIVE Inotrope:
Direct inhibition of membrane bound NaK-ATPas –> increases intracellular Ca
- associated increase in slow inward Ca current during action potential
3) SLOWED conduction
4) INCREASED REFRACTORY PERIOD by stimulation of vagal tone
5) PARASYMPATHETIC PROPERTIES: hypersensitises carotid baroreceptor and stimulates central vagal nuclei
Causes of supratherapeutic digoxin level:
1) renal impairment
2) MI and acidosis –> suppression of Na/K ATPase
3) Hypothyroidism –> decreased renal excretion
4) Drugs
Drugs that INCREASE digoxin level
Verapamil/Diltiazem
Erythromycin
Tetracyclines
Paroxetine