Cardiovascular Flashcards
Causes of:
Aortic stenosis
Aortic regurgitation
Mitral regurgitation
Mitral stenosis
Aortic stenosis - rheumatic heart disease, bicuspid valve, calcification
Aortical regurgitation - rheumatic heart disease, bicuspid valve, connective tissue disorders
Mitral regurgitation - rheumatic heart disease, calcification, connective tissue disorders
Mitral stenosis - rheumatic heart disease
or
All - rheumatic heart disease
Systolic - calcification
Aortic - bicuspid valve
Regurgitation - connective tissue disorders
Murmur investigations
Bloods: BNP, lipids
Imaging: CXR (hypertrophy), echo
Murmur management
MDT for regular follow-up
QRISK to determine whether statins, etc. are needed
Transcatheter implant
Open valve replacement: artificial/biological
Regurgitations: reduce afterload with ACEi, BB, diuretics
Heart failure causes
Myocardial (coronary artery disease, HTN)
Valvular
Pericardial (constrictive)
Arrhythmias
Non-cardiac: high output (sepsis), volume overload (CKD, nephrotic syndrome)
New York Heart Association classification for heart failure
1 - no limitation
2 - dypnoea on activity
3 - marked limitation on activity
4 - dyspnoea at rest
Ejection fraction classification for heart failure
HFpEF: >= 50% (LV unable to relax)
HFrEF: <40% (LV unable to contract properly)
Chronic heart failure investigations
Bedside - ECG
Bloods - BNP: 400-2000 (echo within 6 weeks), >2000 (echo within 2 weeks)
CXR - alveolar oedema, Kerley B lines, cardiomegaly, upper lobe diversion, pleural effusion
Chronic heart failure management
- ACE inhibitor, ARB, or beta-blocker
- Spironolactone, SGLT-2 inhibitor (e.g. dapagliflozin) or entresto if HFrEF
- Hydralazine with nitrate
Influenza and pneumococcal vaccine
Hypertension stages
Stage 1 >140/90
Stage 2 >160/100
Severe >180 or/110
Hypertension investigations
- Ambulatory BP monitoring
- Home BP monitoring
Hypertension management (age <55, not Black, T2DM)
- ACEi / ARB
- Add CCB or thiazide-like diuretic
- Triple
Hypertension management (age >55 or Black)
- CCB
- Add ACEi/ARB or thiazide-like diuretic
- Triple
What to do if hypertension resistant to initial treatment
Confirm with ABPM/HBPM
Low dose spironolactone if potassium <4.5
Alpha-blocker or beta-blocker if potassium >4.5
Seek expert advice
Infective endocarditis most common valves
Mitral (50%)
Tricuspid (IVDU)
Infective endocarditis bacteria in acute, subacute, and prosthetics
Acute - Staph. aureus
Subacute - Strep. viridans
Prosthetics - Coag. neg staph
Dukes major criteria
Positive blood cultures
Echo findings/new valvular regurgitation
Patient had scarlet fever 3 weeks ago, pathology shows verrucae, Aschoff bodies, and Anitschkov myocytes. What is the diagnosis and management?
Rheumatic fever / rheumatic heart disease
Bed rest until CRP normal for 2 weeks
NSAIDs
Phenoxymethylpenicillin
Corticosteroids if heart problems
Haloperidol or diazepam if Sydenham’s chorea
Rheumatic fever prophylaxis
IM benzathine pencillin (once a month)
Acute pericarditis investigations
Bedside - ECG (widespread ST elevation, PR depression)
Bloods - troponin (varies)
Imaging - TTE
Acute pericarditis management
Treat cause (e.g. TB, malignancy, Dressler’s from MI)
NSAIDs + colchicine
Pulmonary hypertension imaging
CXR (pruning, enlarged vessels)
Transthoracic doppler echo
Gold standard: right heart catheterisation
WPW syndrome (AVRT) ECG finding
Short PR interval
Delta wave
Axis deviation dependent on side of accessory pathway
WPW syndrome types (2x)
A: left-sided pathway, RAD, dominant R wave in V1
B: right-sided pathway, LAD
WPW management (acute, general medical, definitive)
Acute
Stable - vagal manoeuvres -> adenosine
Unstable - Electrical cardioversion
Medical
Sotalol (avoid in AF)
Flecainide
Amiodarone
Definitive
Radiofrequency ablation of accessory pathway
Anteroseptal ECG territories and coronary artery
V1-V4
Left anterior descending
Inferior ECG territories and coronary artery
II, III, aVF
Right coronary
Anterolateral ECG territories and coronary artery
V1-6, I, aVL
Left anterior descending
Lateral ECG territories and coronary artery
I, aVL (, V5-6)
Left circumflex
Posterior ECG territories and coronary artery
V1-3 (ST depression)
Confirmed with V7-9 showing ST elevation
Left circumflex and right coronary
Left bundle branch block ECG features
W in V1
M in V6
Broad R wave
Is a new LBBB pathological?
Yes, always
Cause of LBBB and RBBB
LBBB - aortic stenosis, anterior MI, HTN, dilated cardiomyopathy
RBBB - right ventricular hypertrophy, PE
RBBB ECG features
M in V1-V3
Slurred S wave in I, aVL, V5-6 (lateral)
Left atrial enlargement on ECG
bifid P wave (p mitrale)
First degree heart block on ECG and treatment
PR interval >0.2 seconds
Common and doesn’t need treatment
Second degree Mobitz Type I on ECG, physiological cause, and treatment
Progressive prolongation of PR interval until dropped beat
Cause: AV cells fatigue
Treatment: Atropine
Second degree Mobitz Type II on ECG, cause, and treatment
PR interval constant, not always followed by QRS
Cause: structural damage
Treatment: pacemaker
Third degree (complete) heart block on ECG and treatment
No association between P and QRS
Treatment: pacemaker
AVNRT on ECG
Narrow QRS
Tachycardia
AVNRT (SVT) management
Vagal manoeuvres
Adenosine (6 -> 12 -> 18 -> electrical cardioversion)
Verapamil in asthmatics
Catheter ablation if medical not working
Risk factor for ventricular tachycardia and its causes
Prolonged QT
Drugs: clarithromycin, erythromycin, metaclopramide, haloperidol
Electrolyte imbalance: hypokalaemia, hypocalcaemia
Hypothermia
MI
Ventricular fibrillation and TdP ECG
VF: Squiggles and no complexes (may initially be normal then change)
TdP: Squiggles getting bigger and smaller
Ventricular fibrillation and TdP ECG
VF: Squiggles and no complexes (may initially be normal then change)
TdP: Squiggles getting bigger and smaller
Shockable cardiac arrest rhythms
Ventricular fibrillation (squiggles)
Pulseless ventricular tachycardia (broad jumping QRS)
Non-shockable cardiac arrest rhythms
Asystole (flatline)
Pulseless electrical activity
What type of heart problem is WPW?
AVRT
Axis deviation opposite to side of accessory pathway (RAD = left-accessory pathway, so I and III reaching)
VT treatment
Haem stable: IV amiodarone (ideally central line)
Haem unstable: DC cardioversion
Don’t use verapamil in VT