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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
Q

Complications from mechanical heart valves?

A

Thrombus
Infective endocarditis
Haemolysis causing anaemia

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26
Q

Transcatheter aortic valve implantation

A

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

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27
Q

surgical valve replacement causes infective endocarditis in how many patients?

A

2.5%
1.5% in YAVI

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28
Q

causes of Infective endocarditis?

A

gram positive cocci

> staphylococcus
streptococcus
enterococcus

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29
Q

HOCM

A

left ventricle becomes hypertrophic ; thickened of the muscle

asymmetry of septum of heart
blocked flow of blood out of the left ventricle

LVOT obstruction

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30
Q

Examination findings for HOCM

A

ejection systolic murmur at lower left sternal border

fourth heart sound
thrill at lower left sternal border

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31
Q

Investigating HOCM

A

ECG
CXR
Echo
genetic testing

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32
Q

Mx of HOCM

A

beta block
surgical Myectomy

alcohol septal ablation
implantable Cardioverter defibrillator
heart transplant

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33
Q

HOCM advised to avoid?

A

intense exercise
heavy lifting
dehydration

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34
Q

Dilated cardiomyopathy?

A

thin and dilated heart

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35
Q

Restrictive cardiomyopathy

A

rigid
stiff
impaired diastolic ventricular filling

36
Q

causes of A fib?

A

sepsis
mitral valve pathology
ishcaemic heart disease
thyrotoxicosis
hypertension

alcohol / caffeine

37
Q

Examination findings for afib?

A

irregularly irregular pulse
afib

38
Q

ECG atrial fibrillation?

A

p wave absent
narrow QRS tachycardia
irregular irregular ventricular rhythm

39
Q

Paroxysmal A fib?

A

reoccur and spontaneously resolve back to sinus rhythm
30 seconds > 48 hours

monitor with an ambulatory ECG holter monitor

40
Q

Managing atrial fibrillation

control rate and /or rhythm
anticoagulate - strokes

A

Beta block for rate / bisoprolol
DOAC

41
Q

Rate control A fib

A

bring heart rate below 100
extend diastolic time - ventricles can fill

42
Q

Rate control drugs

A

beta block - atenolol or bisoprolol

CCB- verapamil / diltiazem

Digoxin

43
Q

Rhythm control is offered when?

A

reversible cause of a fib
new onset within 48 hours
HF
symptomatic despite effective rate

44
Q

How to get heart in a fib back to normal sinus rhythm?

A

Synchronised DC cardioversion
long term rhythm control medications

45
Q

Immediate cardioversion? AFib

A

less than 48 hours of Atrial fibrillation
life threatening haemodynamic instability

46
Q

Pharmacological option for immediate cardioverting?

A

Flecainide
amiodarone

47
Q

Delayed cardioversion

A

Patient is stable
anticoagulated for at least 3 weeks

48
Q

Types of DOACs?

A

Direct Xa inhibitors : Apixaban, Edoxaban, Rivaroxaban

Direct thrombin inhibitor
Dabigatran

49
Q

Reversal of apixaban or rivaroxaban?

A

Andexanet alfa

50
Q

Dabigatran reversal agent?

A

Idarucizumab

51
Q

warfarin is?

A

Vitamin K antagonist

Vit K normally carboxylates glutamate residues - enabling them to bind to calcium and function properly in clotting cascade

52
Q

Vitamin K dependent clotting factors?

A

prothrombin / Factor II
Factor VII
Factor IX
Factor X

protein C
protein S

53
Q

what does warfarin affect?

A

prothrombin time - increases it

54
Q

what is INR?

A

international normalised ratio

55
Q

what does an INR of 2 mean?

A

prothrombin time twice of average healthy adult - twice as long to clot

56
Q

what is the target INR for atrial fibrillation?

A

2-3

57
Q

what is time in therapeutic range?

A

TTR is % of time taht the INR is in the target range

58
Q

metabolism of warfarin involves which cytochrome?

A

p450 in the liver

affected by antibiotics

59
Q

INR affected by?

A

VIt k foods : leafy green veg
P450 system : cranberry juice and alcohol

60
Q

warfarin has a half life?

A

1-3 days

61
Q

Cha2ds2-Vasc

A

Congestive heart failure
Hypertension
Age 2 points >75

Diabetes
Stroke/TIA - 2

Vasc
Vascular
age : 65-74
Sex (female)

62
Q

CHA2DS2-VASc score when you offer anticoagulant?

A

2 or more

63
Q

ORBIT score is what?

A

bleeding risk

Older - >75 years
Renal impairment - GFR <60
Bleeding : GI / Intracranial
I : iron low
T : taking antiplate

64
Q

Left atrial appendage
what is this?

A

small pouch in wall of left atrium
most common thrombus site

65
Q

SVT is caused by?

A

electrical signals re entering atria from ventricles

electrical loop

narrow complex tachy

66
Q

what is a paroxysmal SVT?

A

reoccurs and remits in same patient over time

67
Q

on a normal ECG strip 0.12 seconds is denoted by?

A

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
Q

narrow complex tachycardia

A

sinus tachycardia
SVT
atrial fibrillation
atrial flutter

69
Q

how to differentiate between SVT and sinus tachycardia

A

regular rhythm and no saw tooth as p: QRS wave isnt 2:1

Appears at rest
abrupt onset and a very regular pattern

70
Q

Types of SVT?

A

Atrioventricular nodal re -entrant tachycardia

Atrioventricular re-entrant tachycardia

Atrial tachycardia

71
Q

Atrioventricular nodal re -entrant tachycardia

A

when the issue is that the abberant electrical impulse going back acts through the atrioventricular node itsefl

72
Q

Atrioventricular re-entrant tachycardia

A

there is an additional accessory pathway connecting atria and ventricles

pre excitation syndrome

  • sometimes called Bundle of Kent
73
Q

what is a delta wave?

A

slurred upstroke in QRS

electricity is prematurely entering ventricles

74
Q

Definitive treatment for WPW?

A

radiofrequency ablation

75
Q

Why are anti-arrhythmic drugs contraindicated in WPW patients that develop AF or flutter?

A

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
Q

Acute Mx of SVT
vagal manouvre

A

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
Q

Valsalva manouvre

A

exhale forcefully

78
Q

Acute Mx of SVT
w/o life threatening features

A

vagal
adenosine
verapamil /beta block

Synchronised DC cardioversion

79
Q

WPW atrial arrhythmia mx?

A

procainamide
Electrical cardioversion

80
Q

carotid sinus massage

A

stimulate baroreceptors

stimulate baroreceptors

81
Q

Adenosine

A

slows cardiac conduction - AV node
resets to sinus rhythm

<10 seconds half life

RAPID bolus

can cause a period of asystole / bradycardia

82
Q

adenosine contraindications

A

Asthma
COPD
Heart failure
Heart Block
HTN

83
Q

how is adenosine given?

A

rapid IV bolus into large proximal cannula

grey cannula
antecubital fossa

84
Q

dose attempts of adenosine?

A

6mg
12mg
18mg

85
Q

when / what is a synchronised Electrical cardioversion avoiding

A

shocking during a t wave
= ventricular fibrillation = cardiac arrest

86
Q
A

Final Year (23 decks)

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