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Final Year > Cardiomyopathy and Valvular pathology > Flashcards

Cardiomyopathy and Valvular pathology Flashcards

1
Q

What is aortic regurgitation?

A

leaking of aortic valve of the heart
> blood to flow in reverse direction during ventricular diastole

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2
Q

Causes of aortic regurgitation?

A

aortic valve problem
distortion or dilation of the aortic root and ascending aorta

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3
Q

Early diastolic murmur
collapsing pulse wide pulse pressure
quincke signs
SOB

A

aortic regurgitation

QUINCKE - nailbed pulsation

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4
Q

First heart sound?

A

Atrioventricular valves closing
at start of systolic contraction of the ventricles

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5
Q

Second heart sound?

A

closing of the semilunar valves - pulmonary and aortic valves

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6
Q

3rd heart sound

A

Chordae tendineae
Pull to their full length and twang

‘gallop rhythm’

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7
Q

4th heart sound

A

directly before S1
always abnormal

stiff / hypertrophic ventricle
caused by turbulent flow form the atria

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8
Q

Murmurs
what to hear low pitched?

high pitch?

A

Bell

Diaphragm

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9
Q

Erb’s point

A

3rd intercostal space on left sternal border

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10
Q

4 areas to listen

A

pulmonary - 2nd intercostal space left sternal border
aortic - 2nd intercostal space right sternal border
Tricuspid 5th intercostal space, left sternal border

Mitral - 5th intercostal space MCL

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11
Q

assessing a murmur?
SCRIPT

A

Site: where is it loudest?
Character:
Radiates?
Intensity:
Pitch:
Timing: systolic /diastolic

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12
Q

“This patient has a harsh Grade 2 systolic murmur, heard loudest in the aortic area, that does radiates to the carotids. It is high pitched and has a crescendo / decrescendo shape. This is suggestive of a diagnosis of

A

aortic stenosis.”

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13
Q

Mitral stenosis

A

can cause left atrial hypertrophy

mid diastolic, rumbling, low pitched murmur due to low blood flow velocity

loud S1 due to thick valves
opening SNAP after S2 which triggers onset of murmur

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14
Q

Mitral regurgitation

A

pan systolic high pitched whistling murmur

radiates to left axilla

3rd heart sound

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15
Q

Tricuspid regurgitation

A

pan systolic murmur
split 2nd heart sound

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16
Q

aortic regurgitation

A

Early diastolic
soft murmur

Austin-Flint murmur - heard at apex ‘rumbling’

collapsing pulse / waterhammer pulse

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17
Q

Aortic stenosis

A

Ejection-systolic high pitched murmur

crescendo-decrescendo
radiates to carotids

slow rising pulse w a narrow pulse pressure

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18
Q

Most common valvular heart disease?

A

Aortic stenosis > Mitral regurgitation

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19
Q

Minimally invasive mitral valve surgery?

A

right sided mini thoracotomy incision

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20
Q

Valve replacement types?

A

biprosthetic - 10years and from pigs /Porcine

Mechanical valves: goodlifespan >20 years
warfarin for life

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21
Q

Warfarin INR target range for mechanical valves?

A

2.5-3.5

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22
Q

Atrial fibrillation target INR warfarin

A

2-3

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23
Q

Mechanical valves - Starr-Edwards

A

ball in a cage
but high risk of thrombus formation

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24
Q

Tilting disc or St Jude which has smaller risk of thrombus formation?

A

st jude valves - bileaflet valves

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25
Complications from mechanical heart valves?
Thrombus Infective endocarditis Haemolysis causing anaemia
26
Transcatheter aortic valve implantation
TAVI > severe aortic stenosis > insert catheter into femoral artery > feed wire using xray to location of aortic valve > inflate balloon to stretch stenosed aortic valve > implant bioprosthetic valve
27
surgical valve replacement causes infective endocarditis in how many patients?
2.5% 1.5% in YAVI
28
causes of Infective endocarditis?
gram positive cocci > staphylococcus >streptococcus >enterococcus
29
HOCM
left ventricle becomes hypertrophic ; thickened of the muscle asymmetry of septum of heart blocked flow of blood out of the left ventricle LVOT obstruction
30
Examination findings for HOCM
ejection systolic murmur at lower left sternal border fourth heart sound thrill at lower left sternal border
31
Investigating HOCM
ECG CXR Echo genetic testing
32
Mx of HOCM
beta block surgical Myectomy alcohol septal ablation implantable Cardioverter defibrillator heart transplant
33
HOCM advised to avoid?
intense exercise heavy lifting dehydration
34
Dilated cardiomyopathy?
thin and dilated heart
35
Restrictive cardiomyopathy
rigid stiff impaired diastolic ventricular filling
36
causes of A fib?
sepsis mitral valve pathology ishcaemic heart disease thyrotoxicosis hypertension alcohol / caffeine
37
Examination findings for afib?
irregularly irregular pulse afib
38
ECG atrial fibrillation?
p wave absent narrow QRS tachycardia irregular irregular ventricular rhythm
39
Paroxysmal A fib?
reoccur and spontaneously resolve back to sinus rhythm 30 seconds > 48 hours monitor with an ambulatory ECG holter monitor
40
Managing atrial fibrillation control rate and /or rhythm anticoagulate - strokes
Beta block for rate / bisoprolol DOAC
41
Rate control A fib
bring heart rate below 100 extend diastolic time - ventricles can fill
42
Rate control drugs
beta block - atenolol or bisoprolol CCB- verapamil / diltiazem Digoxin
43
Rhythm control is offered when?
reversible cause of a fib new onset within 48 hours HF symptomatic despite effective rate
44
How to get heart in a fib back to normal sinus rhythm?
Synchronised DC cardioversion long term rhythm control medications
45
Immediate cardioversion? AFib
less than 48 hours of Atrial fibrillation life threatening haemodynamic instability
46
Pharmacological option for immediate cardioverting?
Flecainide amiodarone
47
Delayed cardioversion
Patient is stable anticoagulated for at least 3 weeks
48
Types of DOACs?
Direct Xa inhibitors : Apixaban, Edoxaban, Rivaroxaban Direct thrombin inhibitor Dabigatran
49
Reversal of apixaban or rivaroxaban?
Andexanet alfa
50
Dabigatran reversal agent?
Idarucizumab
51
warfarin is?
Vitamin K antagonist Vit K normally carboxylates glutamate residues - enabling them to bind to calcium and function properly in clotting cascade
52
Vitamin K dependent clotting factors?
prothrombin / Factor II Factor VII Factor IX Factor X protein C protein S
53
what does warfarin affect?
prothrombin time - increases it
54
what is INR?
international normalised ratio
55
what does an INR of 2 mean?
prothrombin time twice of average healthy adult - twice as long to clot
56
what is the target INR for atrial fibrillation?
2-3
57
what is time in therapeutic range?
TTR is % of time taht the INR is in the target range
58
metabolism of warfarin involves which cytochrome?
p450 in the liver affected by antibiotics
59
INR affected by?
VIt k foods : leafy green veg P450 system : cranberry juice and alcohol
60
warfarin has a half life?
1-3 days
61
Cha2ds2-Vasc
Congestive heart failure Hypertension Age 2 points >75 Diabetes Stroke/TIA - 2 Vasc Vascular age : 65-74 Sex (female)
62
CHA2DS2-VASc score when you offer anticoagulant?
2 or more
63
ORBIT score is what?
bleeding risk Older - >75 years Renal impairment - GFR <60 Bleeding : GI / Intracranial I : iron low T : taking antiplate
64
Left atrial appendage what is this?
small pouch in wall of left atrium most common thrombus site
65
SVT is caused by?
electrical signals re entering atria from ventricles electrical loop narrow complex tachy
66
what is a paroxysmal SVT?
reoccurs and remits in same patient over time
67
on a normal ECG strip 0.12 seconds is denoted by?
3 small squares - so if QRS is less than 3 boxes it is narrow and if the HR is high that is a narrow QRS = SVT
68
narrow complex tachycardia
sinus tachycardia SVT atrial fibrillation atrial flutter
69
how to differentiate between SVT and sinus tachycardia
regular rhythm and no saw tooth as p: QRS wave isnt 2:1 Appears at rest abrupt onset and a very regular pattern
70
Types of SVT?
Atrioventricular nodal re -entrant tachycardia Atrioventricular re-entrant tachycardia Atrial tachycardia
71
Atrioventricular nodal re -entrant tachycardia
when the issue is that the abberant electrical impulse going back acts through the atrioventricular node itsefl
72
Atrioventricular re-entrant tachycardia
there is an additional accessory pathway connecting atria and ventricles pre excitation syndrome - sometimes called Bundle of Kent
73
what is a delta wave?
slurred upstroke in QRS electricity is prematurely entering ventricles
74
Definitive treatment for WPW?
radiofrequency ablation
75
Why are anti-arrhythmic drugs contraindicated in WPW patients that develop AF or flutter?
increase risk of chaotic atrial activity can pass through the accessory pathway into ventricles = polymorphic complex tachys >200/300BPM > V fibrillation > Cardiac arrest when you give anti arryhtmics you might promote conduction through the accesory pathway
76
Acute Mx of SVT vagal manouvre
Stimulate vagus nerve helps control HR blowing into a syringe / through a straw bearing down which helps stimulate the nerve applying cold to your face
77
Valsalva manouvre
exhale forcefully
78
Acute Mx of SVT w/o life threatening features
vagal adenosine verapamil /beta block Synchronised DC cardioversion
79
WPW atrial arrhythmia mx?
procainamide Electrical cardioversion
80
carotid sinus massage
stimulate baroreceptors stimulate baroreceptors
81
Adenosine
slows cardiac conduction - AV node resets to sinus rhythm <10 seconds half life RAPID bolus can cause a period of asystole / bradycardia
82
adenosine contraindications
Asthma COPD Heart failure Heart Block HTN
83
how is adenosine given?
rapid IV bolus into large proximal cannula grey cannula antecubital fossa
84
dose attempts of adenosine?
6mg 12mg 18mg
85
when / what is a synchronised Electrical cardioversion avoiding
shocking during a t wave = ventricular fibrillation = cardiac arrest
86

Final Year (24 decks)

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