Cardiology & Vascular Flashcards by Amelia Crew

Types of Aortic dissection

Type A = Ascending aorta (most common) - proximal to left SCA
Type B = Descending aorta - distal to left SCA

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Acute management of Type A Aortic dissection

ABCDE, O2, fluids, X-match

BP control + urgent surgery (Aortic root replacement +/- aortic valve replacement

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Acute management of Type B Aortic dissection

ABCDE, O2, fluids, X-match

Control BP (<120 mmHg)
IV then PO antihypertensives

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Long term management of aortic dissection

Antihypertensives
Surveillance imagining (at 3m, then 6m, then yearly)
If Type B get complications —> surgical repair

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Complications of Aortic dissection

End organ damage
Cardiac tamponade (retrograde spread into pericardial sac)
Aortic regurgitation
Rupture —> massive haemorrhage

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Presentation of aortic dissection

Sudden TEARING Chest pain
Radiates to back/arm
Marked Hypertension
Signs of distal trunk occlusion (decreased peripheral pulses)
Murmur: aortic regurgitation

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4 risk factors for aortic dissection

Atherosclerosis
HTN
CTD (marfans/Ehlers-danlos)
Male sex

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Which type of aortic dissection has radio-radial delay

Type A

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Which type of aortic dissection has radio-femoral delay

Type B

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Clinical presentation of infective endocarditis (MAJOR PEN)

Murmur & Microscopic haematuria
Anaemia
Janeway lesions (spots on palms)
Osler’s nodes (nodules on fingers)
Roth spots (eyes)
Pyrexia
Emboli
Nail splinter haemorrhages

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Modified Dukes Criteria for Infective endocarditis - MAJOR criteria

2 positive blood cultures
Positive echo
New valvular regurgitation

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Modified Dukes Criteria for Infective endocarditis - MINOR criteria

Predisposing heart condition
IVDU
Fever > 38
Vascular phenomena (major emboli, splinter haem, janeway lesions, petechiae/purpura)
Immunological phenomena (glomerulonephritis, osler’s nodes, roth spots)

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What is Kussmaul’s sign

Raised JVP that doesn’t fall with inspiration - seen in constrictive pericarditis
Paradoxical rise in right atrial pressure during inspiration (usually declines with inspiration)
Can be used to differentiate cardiac tamponade from constrictive pericarditis

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What is Pulsus Paradoxus

Occurs in cardiac tamponade (and rarely in constrictive pericarditis)
Exaggerated drop in systemic BP during inspiration

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What is Takayasu’s arteritis

Large vessel arteritis
Typically causes occlusion of the aorta and absent limb pulse
Young Asian women
Associated with Renal artery stenosis
Unequal blood pressure in upper limbs
Upper and lower limb claudication
Systemic features (malaise, headache)
carotid bruit and tenderness

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Features of autonomic neuropathy

Postural hypotension
Loss of respiratory arrhythmia
Erectile dysfunction

Caused by: diabetes, Parkinson’s

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Treatment of torsades de pointes

IV magnesium sulphate

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Causes of torsades de pointes

Associated with long QT interval
E.g. caused by - antiarrhythmics, TCAs, Antipsychotics, hypothermia, electrolyte disturbances (Hypocalacemia, hypokalaemia, hypomagnesaemia)

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Consequence of torsades de pointes

—> VF —> sudden death

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Drop in BP required to diagnose orthostatic hypotension

Drop in systolic BP of at least 20 mmHg +/or drop in diastolic BP of at least 10 mmHg after 3 mins standing

Pharmacological treatment of orthostatic hypotension

Fludrocortisone
Midodrine

ECG abnormality seen with hypercalcaemia

Shortening of the QT interval

ECG abnormality seen with hyperkalaemia

T waves: Tall tented
P waves: small
QRS: Widened

ECG abnormalities seen with hypokalaemia

U waves
PR interval: Elongated
ST: Depression

CVS cause of horners syndrome (ptosis, miosis, anhidrosis)

Due to compression on the sympathetic trunk - aortic dissection - carotid artery dissection

What is “broken heart syndrome”

Takotsubo cardiomyopathy Presents with Sx and ECG changes of a STEMI but normal angiogram I.e. no obstructive coronary artery disease

Causes of ST elevation

STEMI Pericarditis / myocarditis Normal variant - ‘high take off’ Left ventricular aneurysm Coronary artery spasm (Prinzmetal’s angina) Takotsubo cardiomyopathy (broken heart syndrome) Rarely - subarachnoid haemorrhage

Name 8 MI complications

1. Cardiac arrest (due to VF) 2. Cardiogenic shock 3. Chronic HF 4. Arrthymias - Tachyarrhythmias (VF) /Bradyarrthymias (AVN block) 5. Pericarditis 6. Left ventricular aneurysm 7. Left ventricular wall rupture / cardiac tamponade 8. Acute mitral regurgitation - ischaemia/rupture of the papillary muscle —> acute hypotension and pulmonary oedema

First line imaging in peripheral arterial disease

Duplex ultrasound

3 main patterns of presentation in patients with peripheral arterial disease

Intermittent claudication Critical limb ischaemia Acute limb-threatening ischaemia

What is a normal Ankle Brachial Pulse Index (ABPI)

1 = normal

What are abnormal ABPI values

0.9-0.6 = claudication 0.3 - 0.6 = rest pain <0.3 = impeding gangrene

Differential diagnoses for intermittent claudication (4)

Spinal stenosis Venous claudication Sciatica Popliteal artery entrapment

What is critical limb-threatening ischaemia

Ischaemic rest pain > 2 weeks + ABPI < 0.4 Can cause development of ulcers & gangrene (increased risk if DM)

What is Buerger’s angle

Angle leg is raised before pallor in peripheral arterial disease < 20 degrees

Medical management of peripheral arterial disease

Anti platelet - 75mg Clopidogrel Vasoactive drugs

Surgical management of Peripheral arterial disease

Percutaneous transluminal angioplasty (PTA) or stenting Surgical reconstruction (bypass graft) Last resort - amputation

Common sites for atherosclerosis

Coronary arteries Major branches of aortic arch Visceral branches of abdo aorta Terminal abdominal aorta + branches

What is upper lobe vessel diversion?

Look like stag antlers (Antler sign/inverted moustache sign) Normal: Lower lobe vessels = more prominent than upper lobe vessels on normal chest X-ray due to the effect of gravity. In pulmonary venous hypertension, they become less prominent due to vasoconstriction in the lower zones so that there is a redistribution of pulmonary blood flow to the upper zones. It is a sign of acute HF / early sign of pulmonary oedema reflecting increased left atrial pressure

Which murmurs are diastolic?

Aortic regurgitation Mitral stenosis Tricuspid stenosis Pulmonary regurgitation

Which murmurs are systolic

Aortic stenosis Mitral regurgitation Tricuspid regurgitation

Most common cause of an irregular broad complex tachycardia in a stable patient

Atrial fibrillation with bundle branch block

What is used in the interim between suspecting a DVT and diagnosing a DVT

DOAC - interim therapeutic anticoagulation

# Management: High INR + Major bleeding

Stop warfarin Give intravenous vitamin K 5mg Prothrombin complex concentrate - if not available then FFP

# Management: Minor bleeding + INR > 8.0

Stop warfarin Give intravenous vitamin K 1-3mg Repeat dose of vitamin K if INR still too high after 24 hours Restart warfarin when INR < 5.0

# Management: No bleeding + INR > 8.0

Stop warfarin Give **vitamin K** 1-5mg **PO** Repeat dose of vitamin K if INR still too high after 24 hours Restart when INR < 5.0

# Management: Minor bleeding + INR 5.0-8.0

Stop warfarin Give IV vitamin K 1-3mg Restart when INR < 5.0

# Management INR 5-8 + no bleeding

Withhold 1 or 2 doses of warfarin Reduce subsequent maintenance dose

Types of heart block thats a normal varient in atheletes

Mobitz type 1 (wenckebach phenomenon) sinus bradycardia junctional rhythm first degree heart block