Cardiovascular 2 Flashcards
Risk of Aneurysms…RIPE
Rupture
Infection
Pressure effects on neighbouring structures
Emboli of thrombi to lower limb: causing acute limb ischaemia
When are left sided and right sided murmurs best heard?
Right in inspiration
Left in expiration
Sinus Invertis, Chronic sinusitis, bronchiectasis, infertility, dextrocardia
Kartanger’s syndrome
Small P waves, peaked T waves, widened QRS
Hyperkalaemia
Cardiac contusion
Bruise caused in trauma
Systolic murmur grading
Grade 1: just audible
Grade 3: Loud, without a thrill
Grade 4: Loud with a thrill
Pan systolic heart sound
May obliterate S2
Opens in the left posterior aortic sinus
Left Coronary Artery
Opens into the right atrium
Coronary Sinus (in posterior atrioventricular groove)
Is commonly associated with the atrioventricular groove
Right coronary artery
Supplies the AVN
Posterior Inter ventricular Artery
Supplies the SAN
Right coronary artery
Supplies the apex
Anterior Atrioventricular artery
Where does the circumflex artery supply?
Oxygenated blood to the lateral walls of the ventricle, the left atrium and the left posterior fasciculus of the left bundle branch (before Purkinje fibres)
Atrial ‘plop’
Cardiac myoxma
Ejection systolic murmur
Aortic stenosis
Pan systolic murmur
Mitral regurgitation
Early diastolic murmur
Aortic Regurgitation
What is the diagnostic criteria of an acute MI?
ST elevation of greater than or equal to 1mm in two adjacent limb leads
ST elevation of greater than or equal to 2mm in two adjacent precordial leads
LBBB that is new in the case of an acute history
Large “a” waves
Tricuspid regurgitation, pulmonary stenosis, pulmonary hypertension
-Are pre systolic and seen in right ventricular hypertrophy
Large “a” waves
Tricuspid regurgitation, pulmonary stenosis, pulmonary hypertension
Cannon waves
Complete heart block or ventricular tachycardia
Boot shaped heart on CXR
Fallot’s tetralogy
What is the difference between coarse inspiratory crackles and fine inspiratory crepitations?
Coarse inspiratory crackles= heart failure
Fine inspiratory crepitations= pulmonary fibrosis
When is a collapsing pulse found?
High cardiac output states: aortic regurgitation, anaemia, thyroxicosis, fever, patent ductus arteriosus
Assymetrical ventricular hypertrophy, jerky pulse and harsh ejection systolic murmur, autosomal dominant, sudden cardiac death, beta myosin mutation
Hypertrophic cardiomyopathy
Cardio clinical features associated with Turner’s Syndrome
Correction of the aorta, aortic dissection, mitral valve prolapse, congenital bicuspid aortic valve
Causes of late systolic murmur
Mitral valve prolapse, coarctation of the aorta and hypertrophic obstructive cardiomyopathy
Why should Ca channel antagonists and beta blockers not be used together?
Can cause severe AV block and hypotension
What is the mechanism of amiodarone?
Prolongs the cardiac action potential
Name some causes of low voltage QRS
Hypothyroidism, COPD and increased haemocrit
Name some ejection systolic murmurs
Aortic stenosis, pulmonary stenosis, atrial septal defect, cardiomyopathy, Fallot’s tetralogy and flow murmurs (aortic/pulmonary regurgitation)
Name some pan systolic murmurs
Mitral regurgitation, tricuspid regurgitation, VSD
Name some late systolic murmurs
Hypertrophic cardiomyopathy, mitral valve prolapse
What does the QT interval give an indication of?
Ventricular systole
Blood supply: what opens in the left posterior aortic sinus?
Left coronary artery
-lies between the left auricular appendage and the pulmonary trunk, it gives off the anterior inter ventricular artery to become the circumflex artery
Blood supply: what opens into the right atrium?
Coronary sinus
-Lies in the posterior atrio-ventricular groove, between the IVC and the right trio-ventricular valve. The sinus is a continuation of the great cardiac vein and receives most of the venous drainage of the heart
Blood supply: is most commonly associated with the atrioventricular groove?
Right Coronary Artery
Blood supply: what is the blood supply to the AVN?
Posterior interventricular artery (in 80%-90% of individuals)
Blood supply: what is the blood supply to the apex
Anterior interventricular artery
Prominence of both X and Y decent in the JVP
Constrictive pericarditis
Give some causes of constrictive pericarditis
Malignancy, TB, bacterial and fungal infections, chronic renal failure
JVP with prominent X decent but no Y decent
Cardiac Tamponade
Rise in JVP with inspiration
Cardiac Tamponade
Management of cardiac tamponade
Pericardial aspiration
Gradual onset fatigue, dysponea and ankle swelling with an apex beat in the mid axillary line, 6th intercostal space. Systolic or diastolic? What is the associated murmur?
- Dilated cardiomyopathy
- Pansystolic murmur, mitral regurgitation
58 year old with malaise, fever, night sweats and exertional dysponea . He has splinter haemmorhages and pulsations visible between the nail beds. Systolic or diastolic? What is the associated murmur?
Aortic regurgitation secondary to endocarditis
-Early diastolic murmur
What treatment should be given in a patient with VT due to hyperkalaemia
Calcium Chloride
Harsh pansystolic murmur which is loudest in the lower left sternal edge and inaudible at the apex. The apex is not displaced and does not intensify on inspiration
VSD
- If intensified on inspiration: Tricuspid regurgitation
- If intensified on expiration, displaced and lower sternal edge: Mitral regurgitation
The pulse is regular and jerky in character, cardiac impulse is hyper dynamic and non displaced. There is a mid-systolic murmur, with no ejection click, loudest at the left sternal edge
Hypertrophic cardiomyopathy
Causes of Atrial fibrillation
Rheumatic mitral valve disease, thyroxitosis, cardiomyopathies
Complications of acute MI
Arrythmias, cardiogenic shock, ventricular septal rupture, ventricular wall aneurysm, papillary muscle rupture, pericarditis
Name some associated causes of aortic regurgitation
UC and rheumatoid arthritis
What are the causes of pulseless electrical activity? 4Hs and 4Ts…
- Hypovolaemia, Hypothermia, Hypoxia, Hypo/hyper kalaemia
- Cardiac Tamponade, Pulmonary thromboembolism, Tension Pneumothorax, Toxic/Therapeutic disturbances
What drug is recommended in the treatment of pulseless electrical activity?
Calcium Chloride
Use of Verapamil
Only in treatment of SVTs
Left ventricle size in mitral stenosis
Normal
Treatment for Acute AF
- If haemodynamically unstable use Cardioversion
- Rate control with Verapamil or Bisoprolol
Treatment for Chronic AF
- Rate control: Beta blocker or Ca channel antagonist
- Anti coagulate
