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Cardiology mushkies Flashcards

1
Q

Midline sternotomy + metallic click

A

Mechanical valve

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2
Q

Midline sternotomy + murmur?

A

Tissue Valve or Valvotomy

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3
Q

Midline sternotomy + vein harvest on legs?

A

CABG

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4
Q

Midline sternotomy + old scar + young pt?

A

Repair of congenital defect

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5
Q

Midline sternotomy + immunosuppression?

A

Heart transplant

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6
Q

Midline sternotomy + nothing?

A
  1. Trauma = tamponade, aortic
  2. IMA CABG
  3. Tissue valve
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7
Q

If you see a midline sternotomy what other things should you be looking for?

A
  1. Metallic click
  2. Murmur
  3. Vein harvest on legs
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8
Q

What are the cardiac causes of clubbing?

A
  1. Infective endocarditis
  2. Congenital cyanotic heart disease
  3. Atrial myxoma
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9
Q

What are 2 examples of congenital cyanotic heart disease?

A
  1. Tetralogy of Fallot

2. Transposition of the Great Arteries

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10
Q

What is the tetralogy of Fallot?

A
  1. VSD
  2. Pulmonary stenosis
  3. RVH
  4. Overriding aorta
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11
Q

What complex are atrial myxomas associated with?

A 
Carney Complex = LAMES
Lentigines
Atrial Myxomas
Endocrine tumours
Schwannomas
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12
Q

What are the causes of a collapsing pulse?

A

A collapsing pulse is caused by hyperdynamic circulation

  1. Aortic Regurgitation
  2. Thyrotoxicosis
  3. Pregnancy
  4. Anaemia
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13
Q

What are the causes of an impalpable apex beat?

A

COPD

  1. COPD
  2. Obesity
  3. Pericardial effusion
  4. Dextrocardia
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14
Q

What are 5 features of pulmonary HTN (and thus also RHF)?

A
  1. Raised JVP
  2. Left parasternal heave
  3. Loud P2 + PSM of TR
  4. Pulsatile hepatomegaly
  5. Ascites and peripheral oedema
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15
Q

What is S1?

A

Mitral valve closure

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16
Q

What is S2?

A

Aortic valve closure

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17
Q

What is S3?

A

Rapid ventricular filling of dilated left ventricle

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18
Q

What is S4?

A

Atrial contraction against stiff ventricle

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19
Q

What must you do upon completion of a cardio exam?

A
  1. Observation chart
  2. Drug chart
  3. 12-lead ECG
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20
Q

What is S4?

A

Atrial contraction against stiff ventricle

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21
Q

What must you do upon completion of a cardio exam?

A
  1. Observation chart
  2. Drug chart
  3. 12-lead ECG
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22
Q

What are the general principles of cardio management?

A
  1. General = MDT, Optimise CV risk (statins, anti-HTN, DM, anti-platelets), Monitor (regular f/u and echo)
  2. Specific
  3. Surgical
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23
Q

Who is part of the cardio MDT?

A

GP, cardiologist, cardiothoracic surgeon, dietician, specialist nurses

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24
Q

What are the 2 pulse characteristics in aortic stenosis?

A
  1. Slow rising (anacrotic)

2. Narrow pulse pressure (<30mmHg)

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25
Q

What murmur do you hear in aortic stenosis?

A

An ejection systolic murmur in the right 2nd ICS that radiates to the carotids and is accentuated when sitting forward in end-expiration

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26
Q

What are the 3 common causes of aortic stenosis?

A
  1. Age related calcification
  2. Bicuspid aortic valve
  3. Rheumatic heart disease
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27
Q

What are the precordial findings in aortic stenosis?

A
  1. Apex = forceful, non-displaced (pressure overload)
  2. Heart sounds = quiet A2
  3. Murmur = An ejection systolic murmur in the right 2nd ICS that radiates to the carotids and is accentuated when sitting forward in end-expiration
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28
Q

What are the echo features of severe aortic stenosis?

A
  1. Valve area <1cm²
  2. Pressure gradient >40mmHg
  3. Jet velocity >4m/s
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29
Q

What is the management for Aortic stenosis?

A
  1. General = MDT, optimise CV risk, monitor
  2. Specific = TAVI, balloon valvuloplasty
  3. Surgical = Valve replacement +/- CABG
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30
Q

What are the indications for surgical management of aortic stenosis?

A
  1. Symptomatic AS
  2. Severe asymptomatic AS with reduced EF (<50%)
  3. Severe AS undergoing CABG or other valve op
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31
Q

How can you classify the causes of a raised troponin?

A

ACS related and Non-ACS related

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32
Q

What are the ACS-related causes of a raised troponin?

A
  1. Acute MI
  2. Post-PCI
  3. Open heart surgery
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33
Q

What are the non-ACS causes of a raised troponin?

A

Playboy CARRTIIS
Strenuous exercise/endurance athletes
Cardiovascular = Pericarditis/Myocarditis, Aortic Dissection, Acute HF/Chronic HF
Respiratory = PE
Renal = ESRF
Trauma = Blunt chest wall trauma
Iatrogenic = Cardiotoxic chemotherapy, Cardioversion
Inflammatory = Cardiac infiltrative disorders (amyloidosis)
Systemic = sepsis, rhadbomyolysis

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34
Q

How can you classify the causes of a raised D-dimer?

A

Pathological and Non-Pathological

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35
Q

What are the non-ACS causes of a raised troponin?

A

Playboy CaRRTIIS
Strenuous exercise/endurance athletes
Cardiovascular = Pericarditis/Myocarditis, Aortic Dissection, Acute HF/Chronic HF
Respiratory = PE
Renal = ESRF
Trauma = Blunt chest wall trauma
Iatrogenic = Cardiotoxic chemotherapy, Cardioversion
Inflammatory = Cardiac infiltrative disorders (amyloidosis)
Systemic = sepsis, rhadbomyolysis

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36
Q

What are the non-pathological causes of a raised D-dimer?

A
  1. Age > 70y/o
  2. Cigarette smoking
  3. Functional impairment
  4. Postoperative
  5. Pregnancy
  6. Race (black people)
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37
Q

What are the pathological causes of a raised D-dimer?

A 
Cardiac = ACS, AF, CCF, intracardiac thrombus 
Vascular = Acute limb ischaemia, ATE/VTE
Respiratory = PE 
Renal = AKI, CKD, nephrotic syndrome 
Iatrogenic = anticoagulants, thrombolytics 
Systemic = DIC, SIRS, surgery, trauma 
Pregnancy = eclampsia/pre-eclampsia 
Infection 
Malignancy 
Hepatic 
Haem = sickle cell anaemia 
Neuro = stroke 
GI = upper GI bleed
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38
Q

What are the precordial findings for mitral regurgitation?

A
  1. Apex = displaced
  2. HS = Soft S1, S2 not heard separately from murmur +/- loud P2
  3. Murmur = blowing pan systolic murmur loudest at the apex in the left lateral position in end expiration, radiates to the axilla
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39
Q

What are the causes of mitral regurgitation?

A
  1. Functional = LV dilatation 2° to HTN/IHD
  2. Primary = Infective endocarditis, rheumatic valve disease, degenerative valve disease (Barlow’s disease and FED)
  3. Congenital causes and cardiomyopathies
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40
Q

What are the investigations for the cardio exam?

A 
Bedside = ECG 
Bloods = FBC, U&amp;E, NT-proBNP, lipids, glucose 
Imaging = CXR, Echo + Doppler, Cardiac Catheterisation
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41
Q

What is the management for mitral regurgitation?

A 
General = MDT, optimise CV risk, monitor
Specific = AF (rate control and anticoagulate), emboli (anticoagulate), reduce afterload (ACEi/BB and Diuretics) 
Surgical = valve replacement or repair
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42
Q

What is the prognosis of mitral regurgitation?

A
  1. Often asymptomatic for >10 yrs

2. Symptomatic = 25% mortality at 5 years

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43
Q

What are the 7 eponymous signs associated with Aortic regurgitation?

A
  1. Quincke’s = capillary pulsation in nail beds
  2. Corrigan’s = visible rigorous carotid pulsation
  3. De Musset’s = head nodding
  4. Traube’s = pistol-shot sound over femorals
  5. Duroziez’s = systolic murmur over the femoral artery with proximal compression and diastolic murmur with distal compression
  6. Mueller’s = systolic pulsations of the uvula
  7. Rosenbach’s = systolic pulsations of the liver
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44
Q

What are the pulse characteristics of aortic regurgitation?

A
  1. Collapsing pulse

2. Wide pulse pressure e.g. 180/45

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45
Q

What are the precordial findings of aortic regurgitation?

A
  1. Aortic thrill
  2. Apex = displaced (volume overload)
  3. Heart sounds = soft S2 +/- S3
  4. Murmur = high pitched end diastolic murmur loudest at LLSE when sitting forward in end expiration
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46
Q

What are the additional murmurs that may be heard in aortic regurgitation?

A
  1. Ejection systolic flow murmur
  2. Austin-Flint murmur = rumbling mid diastolic murmur at apex secondary to a regurgitant jet fluttering the anterior mitral valve
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47
Q

How can you classify the causes of aortic regurgitation?

A

Acute vs. Chronic

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48
Q

What are the acute causes of aortic regurgitation?

A
  1. Infective endocarditis

2. Type A Aortic Dissection

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49
Q

What are the chronic causes of aortic regurgitation?

A
  1. Bicuspid aortic valve
  2. Rheumatic heart disease
  3. Autoimmune = ankylosing spondylitis, RA
  4. Connective tissue = Marfan’s, Ehler’s Danlos
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50
Q

What is the management of aortic regurgitation?

A
  1. General = MDT, optimise CV risk, monitor
  2. Specific = reduce afterload (ACEi/BB and Diuretics)
  3. Surgical = aim to replace the valve before significant LV dilation and dysfunction
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51
Q

Which valvular diseases may result in AF on pulse examination?

A

Mitral regurgitation and Mitral stenosis

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52
Q

What are the precordial findings of mitral stenosis?

A
  1. Left parasternal heave
  2. Apex = tapping (palpable S1), non-displaced
  3. HS = loud S1, early diastolic opening snap
  4. Murmur = rumbling mid-diastolic murmur at apex LLP in end expiration with the bell, radiates to the axilla, pre-systolic accentuation if pt in sinus rhythm
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53
Q

What additional murmur may be heard in mitral stenosis?

A
  1. Graham Steele murmur = end-diastolic murmur due to pulmonary regurgitation
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54
Q

What are the causes of mitral stenosis?

A
  1. Rheumatic heart disease

2. Other causes are rare = prosthetic valve, congenital

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55
Q

What is the management of mitral stenosis?

A
  1. General = MDT, optimise CV risk risk, monitor
  2. Specific = Rheumatic fever prophylaxis (e.g. Pen V), AF (rate control and anticoagulate), diuretics provide symptom relief
  3. Surgical = indicated in moderate-severe MS, percutaneous balloon valvuloplasty is treatment of choice, otherwise surgical valvotomy/commissurotomy or valve replacement
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56
Q

What is rheumatic fever?

A

An antibody-mediated type II hypersensitivity reaction due to cross-reaction following an S.pyogenes infection, with antibodies cross-reacting with myosin, muscle glycogen and smooth muscle cells

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57
Q

How is rheumatic fever diagnosed?

A

Revised Jones criteria

  1. Evidence of GAS infection +
    a. 2 major criteria or
    b. major and 2 minor criteria
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58
Q

What are the major criteria for rheumatic fever?

A 
CASES
Pancarditis
Arthritis
Sydenham's Chorea
Erythema Marginatum 
Subcutaneous Nodules
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59
Q

What are the minor criteria for rheumatic fever?

A

FEAPP
Fever
ESR or CRP raised
Arthralgia (not if arthritis is a major)
Prolonged PR interval (not if carditis is a major)
Previous rheumatic fever

60
Q

What are the investigations for rheumatic fever?

A

ECG
Bloods = FBC, ESR, ASOT
Echo

61
Q

What is the management of rheumatic fever?

A
  1. Bed rest until CRP normal for 2 weeks
  2. Analgesia for carditis/arthritis = aspirin/NSAIDS
  3. Benpen 0.6-1.2mg IM for 10 days
  4. Add oral prednisolone if CCF/cardiomegaly/3rd degree heart block
  5. Chorea = Haloperidol or diazepam
62
Q

What is the prognosis of rheumatic fever?

A
  1. Attacks last around 3m
  2. 60% carditis develop chronic rheumatic heart disease
  3. Recurrence ppt by further strep infection/pregnancy/OCP
  4. Valve disease = regurgitation –> stenosis
63
Q

Which valves are affected by rheumatic fever?

A
  1. Mitral = 70%
  2. Aortic = 40%
  3. Tricuspid = 10%
  4. Pulmonary = 2%
64
Q

What is secondary prophylaxis for rheumatic fever?

A

Pen V 250mg/12h PO for 5-10yrs

65
Q

What are risk factors for acute endocarditis?

A
  1. IVDU
  2. Skin wounds
  3. Immunosuppression
66
Q

What organisms cause acute endocarditis?

A

S. aureus and S. epidermidis

67
Q

What are risk factors for subacute endocarditis?

A
  1. Prosthetic valves

2. Valve disease

68
Q

What organisms cause subacute endocarditis?

A

S. viridans and S. bovis

HACEK –> culture negative IE

69
Q

What are the HACEK organisms?

A

The HACEK organisms are a group of fastidious gram-negative bacteria that are an unusual cause of infective endocarditis
Haemophilus e.g. influenzae/para/haemolyticus/para
Aggregatibacter e.g. aphrophilus
Cardiobacterium e.g. hominis
Eikenella e.g. corrodens
Kingella e.g. kingae

70
Q

What are the clinical features of infective endocarditis?

A
  1. Hands x4 = clubbing, splinters, Janeway lesions, Oslers nodes
  2. Other x5 = fever, Roth spots, splenomegaly, haematuria, anaemia
  3. Cardiac = new/changing murmur, MR (85%), AR (55%)
71
Q

How do you diagnosis infective endocarditis?

A

Duke Criteria = 2 major OR 1 major + 3 minor OR 5 minor

72
Q

What are the major Duke Criteria?

A
  1. +ive blood culture = typical organism in 2 separate cultures OR persistent positive blood cultures taken >12h apart OR 3 or more positive cultures taken over 12hr
  2. Endocardial involvement = positive echo findings of of vegetations OR new valvular regurgitation
73
Q

What are the minor Duke Criteria x5?

A
  1. Predisposition = heart condition/IVDU
  2. Fever = >38C
  3. Vascular phenomena e.g. splinters/Janeway
  4. Immunologic phenomena e.g. GN/Oslers
  5. Blood culture growing organism but doesnt fulfil major criteria
74
Q

What do you see on histology of rheumatic fever?

A

Aschoff bodies and Anitschkow myocytes

75
Q

Is Abx prophylaxis to solely prevent IE recommended?

76
Q

What is the empiric management of infective endocarditis?

A
  1. Acute severe = fluclox/vanc + gent IV

2. Subacute = benpen + gent IV

77
Q

What are the 2 main questions to task when examining a pt with a valve replacement?

A
  1. When and where is the closing prosthetic sound?

2. Are there any murmurs?

78
Q

How many artificial sounds are there with a Starr-Edwards aortic valve?

A

3 artificial sounds

79
Q

How many artificial sounds are there with a tilting disc/bileaflet valve?

A

1 artificial sound

80
Q

What are the sounds like with a biological valve?

A

Often normal heart sounds

81
Q

What does an artificial aortic valve sound like?

82
Q

What does an artificial mitral valve sound like?

83
Q

What are the types of mechanical heart valves?

A
  1. Ball and cage = Starr-Edwards
  2. Tilting disc = Bjork-Shiley
  3. Bileaflet = St. Jude (most common)
84
Q

What is the lifespan of a mechanical valve, and what INR are you aiming for?

A

Approx 20 yrs, INR 3-4

85
Q

What are the types of biological valves?

A
  1. Porcine valve = Carpentier Edwards

2. Bovine pericardium sewn into a metal frame = discontinued

86
Q

What are the 4 most common causes of AF?

A
  1. IHD
  2. RHD
  3. Thyrotoxicosis
  4. HTN
87
Q

What are the ‘other’ causes of AF

A
  1. Pneumonia
  2. PE
  3. Post-op
  4. Hypokalaemia
  5. Alcohol
  6. RA
88
Q

What is a pulse deficit and what is it a sign of?

A

A difference in HR between the wrist and apex, found in AF

89
Q

What is the management of acute AF (<48hrs)?

A
  1. Haemodynamically unstable = cardioversion
  2. Haemodynamically stable = rate control (diltiazem or metoprolol), start LMWH, cardiovert (DC or medical (flecainide or amiodarone))
90
Q

What is the management of paroxysmal AF (recurrent episodes lasting <7d)?

A
  1. Pill in pocket = flecainide/amiodarone

2. Prevention = BB/Sotalol

91
Q

What is persistent AF? How do you manage it?

A

Lasting >7d

Rate control or rhythm control

92
Q

What is rate control?

A

1st line = BB or rate-limiting CCB

2nd line = Add digoxin (not monotherapy)

93
Q

What is permanent AF and how do you manage it?

A

Failed cardioversion/unlikely to succeed –> rate control

94
Q

What are non-medical ways of managing AF?

A
  1. RFA of AVN
  2. Maze procedure
  3. Pacing
95
Q

What is the CHA2DS2VASc score?

A

Determines necessity of anticoagulation in AF

96
Q

What are the components of the CHA2DS2VASc score?

A
  1. CCF
  2. HTN
  3. Age ≥ 75 (2pts)
  4. DM
  5. Stroke/TIA (2pts)
  6. Vascular disease
  7. Age 65-74
  8. Sex category: female
97
Q

How does one use the CHA2DS2VASc score?

A

A score ≥ 2 –> anticoagulation with warfarin or NOAC

98
Q

What are the complications of warfarin?

A
  1. Bleeding

2. Osteoporosis

99
Q

What are the 6 contraindications of warfarin?

A

BCR PPP

  1. Bleeding diatheses
  2. Compliance issues e.g. dosing, monitoring
  3. Risk of falls
  4. Peptic ulcer disease
  5. Pregnancy
  6. Pt choice
100
Q

What fruit must one avoid whilst on warfarin?

A

Grapefruits

101
Q

What must one wear when on warfarin?

A

A medic alert bracelet

102
Q

What do the letters mean when classifying pacemakers?

A
  1. Pacing = O/A/V/D
  2. Sensing = O/A/V/D
  3. Action = O/Inhibited/Triggered/Dual
  4. Programmability = O/Programmable/Multiprogrammable/Communicating/Rate modulation
  5. Anti-tachycardia functions = O/Pacing/Shock/Dual
103
Q

What 3 things should you ask for after examining a pacemaker and why?

A
  1. ECG (look for pacing spikes, evidence of ischaemia)
  2. CXR (no. leads, ICD wire (thick lead))
  3. Echo (valvular pathology, LV function, structural abnormalities)
104
Q

What are the indications for permanent pacing?

A
  1. Nodal disease = symptomatic bradycardia (SSS), drug-resistant tachyarrhythmia
  2. Conduction problems = complete AV block, Mobitz II, symptomatic Mobitz I
  3. Assistance = BVP in chronic HF
105
Q

How can you classify the complications of pacemakers?

A

Insertion and post-insertion

106
Q

What are the complications of inserting pacemakers?

A

Bleeding and arrhythmias

107
Q

What are the complications post-insertion of pacemakers?

A

PLEM

  1. Erosion
  2. Lead malfunction
  3. Pocket infection
  4. Malfunction
108
Q

What is the definition of HF?

A

HF is a clinical syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral oedema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress.§

109
Q

What are the causes of left sided HF?

A
  1. IHD
  2. HTN
  3. Mitral/aortic valve disease
  4. Idiopathic DCM
110
Q

What are the symptoms of left sided HF?

A 
FEPONW
Fatigue 
Exertional dyspnoea 
PND
Orthopnoea 
Nocturnal cough (+/- pink, frothy sputum)
Weight loss and muscle wasting
111
Q

What do you call the wheeze you sometimes get with chronic HF?

A

Cardiac asthma

112
Q

What are the causes of right sided HF?

A
  1. LVF
  2. Cor pulmonale
  3. Tricuspid/pulmonary valve disease
113
Q

What are the symptoms of RHF?

A

Anorexia and Nausea

114
Q

What are the signs of RHF?

A
  1. Raised JVP
  2. Left parasternal heave
  3. Loud P2 + PSM of TR
  4. Pulsatile hepatomegaly
  5. Ascites and peripheral oedema
115
Q

What are the NYHA classes of HF?

A
  1. No SOB
  2. SOB with moderate exertion
  3. SOB with mild exertion
  4. SOB at rest
116
Q

What are 3 POI about NT-proBNP

A
  1. It is secreted from the ventricles in response to increased stretch and HR
  2. Raised levels are the most diagnostic indicator of HF
  3. NICE recommends that HF is not dx w/o raised NT-proBNP
117
Q

What is the A-F of chronic HF on CXR?

A
  1. Alveolar shadowing
  2. Kerley B lines
  3. Cardiomegaly
  4. Diversion of upper lobe
  5. Effusions
  6. Fluid in fissures
118
Q

What may ECG show on HF?

A
  1. Ischaemia
  2. Hypertrophy
  3. AF/other arrhythmia
119
Q

What is the specific management of chronic HF?

A
  1. Triple therapy with ACEi + BB + Spironolactone
  2. Consider digoxin
  3. Consider CRt
120
Q

What is the surgical management for chronic HF?

A
  1. LVAD

2. Heart transplant

121
Q

Causes of absent radial pulse?

A
  1. Dead
  2. Trauma
  3. Thrombosis/embolism
  4. Coarctation of the aorta
  5. Takayasu’s arteritis
122
Q

AS Ix?

A
  1. Bedside = ECG (LVH, arrhythmias)
  2. Bloods = FBC, U&E, NT-proBNP, lipids, glucose
  3. CXR = calcified AV, LVH, pulmonary oedema
  4. Echo + doppler = valve area, cause, LV function, other valve function
  5. Cardiac catheterisation = valve gradient and assess coronaries
123
Q

5 bloods that you could do for any cardio condition?

A
  1. FBC
  2. U&E
  3. NT-proBNP
  4. Lipids
  5. Glucose
124
Q

MR Ix?

A
  1. Bedside = ECG (LVH, arrhythmias, p-mitrale)
  2. Bloods = FBC, U&E, NT-proBNP, glucose, lipids
  3. CXR = LA and LVH, mitral valve calcification, pulmonary oedema
  4. Echo + doppler = severity, LV function, other valve function
  5. Cardiac catherisation
125
Q

Prognosis of aortic stenosis?

A
  1. Angina = 50% dead in 5 years
  2. Syncope = 50% dead in 3 years
  3. Dyspnoea = 50% dead in 2 years
126
Q

AR Ix?

A
  1. ECG = LVH, LV strain, arrhythmias
  2. Bloods = FBC, U&E, Nt-proBNP, glucose, lipids
  3. CXR = cardiomegaly, pulmonary oedema
  4. Echo + doppler = cause, severity, LV function, other valve function
  5. Cardiac catherisation = assess coronaries
127
Q

4 reasons to do echo an any cardio valve problem pt?

A
  1. Cause
  2. Severity
  3. LV function
  4. Other valve function
128
Q

Mitral stenosis Ix?

A
  1. ECG = AF, p mitrale
  2. Bloods = FBC, U&E, NT-proBNP, glucose, lipids
  3. CXR = LA hypertrophy –> splaying of carina, calcified mitral valve, pulmonary oedema
  4. Echo + doppler = cause, severity, LV function, other valve function
  5. TOE = LA thrombus if intervention is planned
129
Q

Histology of myocardium in rheumatic fever?

A

Aschoff bodies and Anitschkow mycocytes

130
Q

What kind of murmur will a well seated valve replacement produce?

A

A soft flow murmur

131
Q

What kind of murmur will a poorly seated valve replacement produce?

A

Regurgitant murmurs (aortic = diastolic murmur, mitral = systolic murmur)

132
Q

Lifespan of a biological valve?

A

<10 years, less durable than mechanical

133
Q

Pt groups that would receive a biological valve?

A
  1. Pregnant
  2. Old
  3. Bleeding risk e.g. peptic ulcer, frequent falls
134
Q

Complications of valve surgery?

A
  1. Complications of surgery = 5% mortality

2. Complications of valve

135
Q

Complications of valve after surgery?

A

FABIT

  1. Failure = acute (dehiscence, breakage, thrombus) or chronic (stenosis or incompetence)
  2. Anaemia = warfarin and haemolysis
  3. Bleeding
  4. IE
  5. Throboembolism = 1-2% per annum despite warfarin
136
Q

AF Ix?

A
  1. ECG = irregularly irregular, p waves, cause (ischaemia, p mitrale)
  2. Bloods = FBC, U&E, TFTs, Troponin, D dimer
  3. CXR = Pulmonary oedema, calcified mitral valve, pneumonia
  4. Echo = valve pathology, LV function
  5. TOE = LA thrombus
  6. Cardiac catheterisation
137
Q

2 causes of an irregularly irregular pulse?

A
  1. AF

2. Multiple ventricular ectopics

138
Q

How to differentiate b/w AF and MVE as a cause of an irregularly irregular pulse?

A

Exercise the pt

  1. AF = stays irregularly irregular
  2. MVE = regular pulse (reduced diastole time closes window for ectopics)
139
Q

Causes of tricuspid regurgitation?

A
  1. Congenital = Ebstein’s anomaly

2. Acquired = Acute (Infective Endocarditis), Chronic (functional, rheumatic, carcinoid syndrome)

140
Q

What could cause a double right heart border on CXR?

A

Enlarged RA

141
Q

Mx of Tricuspid regurgitation?

A
  1. Medical = triple therapy and support stocking for oedema

2. Surgical = valve repair/annuloplasty if medical tx fails

142
Q

Causes of pulmonary stenosis?

A
  1. Tetralogy of Fallot
  2. Noonan’s syndrome
  3. Functional
  4. Carcinoid syndrome
143
Q

Pulmonary stenosis on CXR?

A

Oligaemic lung fields

144
Q

Mx of pulmonary stenosis?

A
  1. Pulmonary valvotomy
  2. Percutaneous pulmonary valve implantation
  3. Surgical repair/replacement
145
Q

How does carcinoid syndrome cause pulmonary stenosis?

A

Secreted mediators cause right sided heart valve fibrosis resulting in stenosis/regurgitation

146
Q

Mx of carcinoid tumour?

A
  1. Medical = octreotide

2. Surgical = resection

Medicine and Surgery Mushkies (52 decks)

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