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Progress test packs > Cardiovascular > Flashcards

Cardiovascular Flashcards

0
Q

HF diagnosis

A

BNP

Echo if prev MI

CXR
Alveolar shadowing - oedema
B Kerley B lines
Cardiomegaly
Dilated vessels
Effusion
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1
Q

heart failure presentation and examination

A

SOBOE, PND, orthopnoea

o/e
pulmonary oedema
pleural effusion
cardiomegaly
S3
JVP, neck veins 
hepatomeg, ankle swelling

quick weight loss on starting diuretic (4.5kg in 3d)

MAJOR
pnd
neck vein distend
acute pulm oedema
creps
cardiomegaly
weight loss>4.5 in 5 days w diuretic
S3 gallop
incread CVP

MINOR
ankles, nocturnal cough, hepato, dysp on exert, tachy>120, pleural eff, dec VC

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2
Q

heart fail mgmt

A

0) loop diuretic vs fluid
1) ace and b block

2) spironalact
hydralazine w/ nitrate

3) digoxin if AF
cardaic resynch

also: vaccines (anual flu, 1xpneumococ)

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3
Q

aortic stenosis

A

TRIAD: c.p, syncope, dyspnoe

narrow pp, slow rising
'crescendo decrescendo'
ejec murmur, S4, sustained heave
radiateto apex/carotid
lvh on ecg

severe (gradient>5mmHg) or symptomatic get AVR

calcify (>65), bicuspid (<65), williams, rheumat

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4
Q

mitral regurg

A 
pan systolic, rad to axilla
thrusting apex, ?displaced
sob, fatigue, palp
*AF common*
LVH 
- post mi (papillary muscle)
- dilated cardiomyop
- IE
- Marfan's
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5
Q

aortic regurgitation

A

high pitch early diastolic, lean forward
may be closer to LSE
DISPLACED APEX BEAT, may be thrusting

backflow signs

  • corrigans - carotid pulse
  • de musset - head
  • durosier - femoral
  • quinke - nail pulsation

like HF: dyspnoe, orthopnoea, pnd
also palpitations
collapsing pulse, wide pp

Marfans, AS, RA, syphilis
acuutely w dissection, IE

Mx: vs htn ACE-i

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5
Q

aortic regurgitation

A

assoc: connective tissue dis, arthritides

high pitch early diastolic

like HF: dyspnoe, orthopnoea, pnd
also angina, palp, syncope
collapsing pulse, wide pp
pulsations signs (corrigan, de musset, quinke)

Mx: vs htn ACE-i

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6
Q

mitral stenosis

A

mid diastolic - roll to enhance
CP, sob, palp, fatigue
may see haemoptysis
AF common

mala flush
TAPPING apex
low vol pulse
left atrial enlarge (p mitrale), pulmonary HTN and RHF

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7
Q

management mitral valve probs

A
  • rate control vs AF (b-block or CCB)
  • anticoagulate (warfarin)
  • diuretics
  • ab proph w procedures

?balloon valvuloplasty, valvotomy, replacement

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8
Q

tricuspid regurg

A

pan systolic, lower lse
louder on inspiration

signs of systemic backflow

  • jvp - big v wave
  • pulsatile hepatomegaly
  • ascites

caused by RHF which is due to LHF or cor pulmonale
see rh strain on ecg

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10
Q

AF

A

problem
1 - impair output
2 - risk clots
3 - angina

causes
w no structural disease
- hyperthyroid
- alcohol
otherwise
- mi, htn, hf,
- valve disease
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11
Q

AF causes mnemonic

A

MATCH V

M - MI
A - ALCOHOL
T - THYROTOX
C - CCF
H - HTN
V - VALVE PROB
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12
Q

acute AF

  • new, symptomatic
A

heparin

cardiovert - shock or amiod

CCB for rate control (verap diltiaz)
- bblock, digoxin also used

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13
Q

chronic AF

A

anticoag if score on chadsvas (inr 2-3)

rate: b block or CCB
- digoxin only if sedentary ie HF

rhythm control if under 65, symptomatic, CCF
- sotalol, flec (no structural disease), amiod

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14
Q

HTN treat

target 140,90
or 150,90 if over 80
or 130,90 if DM with end organ damage

A

under 55: ACE or ARB (switch if intol)
over 55 or black: CCB (amlod, nifed)
(thiazide-like if HF)

2) a+c
3) a+c+tld

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15
Q

htn classif

A

1) 140,90 clinic
135/85 home/amb

2) 160/100 clinic
150/95 home/amb

3) 180s or 110d clinic

treat stage 1 if over 40, target organ damage, cvd, dm, renal, Q score>20%

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16
Q

secondary htn

A

RENAL 80%
gn, pyelo, cystic, stenosis

ENDOCRINE
cush (cortisol), 
conn (aldosterone), 
congen adren hyp, 
phaeo, acromeg
hyperparathyroid
PREGNANCY

VASCULAR

  • coarctation
  • renal artery stenosis

alcohol

rare: MAO-i (depression) with cheese

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17
Q

renal artery stenosis

A

resistant to htn treatment
get worse with ace/arb if bilat
FLASH pulmonary oedema

US: show renal asym

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18
Q

angina (stable chest pain) diagnosis

A

get percentage CAD score

typical angina plus 90% score =diagn
below 90% need investigation before managing as angina
-over 60: angiogram
-30-60: functional - mps/stress echo
-below 30: ca score ct
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19
Q

angina mgmt

A

aspirin and statin

atenolol is first line anti-anginal
(ccb if pvd/asthma/heart block)

nitrate (can devel tol)

nicornadil
PCI

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20
Q

STEMI

A

MONAC

PCI or thrombolysis

B blocker IV
ACE

longterm: Aspirin, B block, aCe-i

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21
Q

NTSEMI and unstable angina

A 
acute
ASPIRIN 300
NITRATE
MORPHINE
? oxygen if hypoxic

LMWHep
B blocker IV

calculate 6 month mortality
if over 1.5: clopidog for12m
if over 3: tirofiban, angiogram

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22
Q

mi ecg territories

A

inferior (RCA): ii, iii, avf

anteroseptal (LAD): V1 - V4

anterolateral (LC): V4 - V6

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23
Q

ecg territories

A

AS - v1/4 - LAD

AL - V4/6,I,aVL - LAD or LC

L - I, aVL, V5/6 - LC

Inf - II,III,aVF - RC (see bradycardia and vom)

posterior - tall r waves v1/2 - LC or RCA

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24
Q

pericardits

A

pleuritic pain - relieved by sitting
?cough dysp
percardial rub on ausc
tachycard/tachydysp

post virus - coxsackie b
post mi (dresslers)
bact is rarer - staph, tb

ecg - saddle ST elev widespread
pr depression

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25
Q

pericarditis ecg

A 
widespread ST (saddle) elevation - across territories
trop may be slightly raised
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26
Q

pericardial effusion

A

2dry to pericarditis
HF (sob, jvp, pleural effusion, ascites)
low voltage ecg

pericardiocentesis

if accumulates–>tamponade (low bp, high pulse)

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27
Q

constrictive pericarditis

A

2dry to pericarditis
RHF signs
CXR: calcification

t: surgical excision

28
Q

aortic dissec

A

sudden severe - max at onset
rad to back
pulse deficit and bp difference

may get neuro/cog impair
may get inferior mi (take out rca)

cxr may show small pleural eff, wide mediastinum

I: ct angiogram
M: control blood pressure, refer to sugery

29
Q

PE

A

haemoptysis
dyspnoea
tachycardia
pleuritic pain

see respiratory alkalosis w low oxygen

wells score
CTPA, heparin
thrombolysis
anticoag

30
Q

ventricular ectopics

A

missed beats
disappear w exercise

if symptomatic investigate - echo, exercise ecg

31
Q

ventric tachy VT

A

broad complex tachy (>120)

  • stable - amiod
  • unstable - shock

correct hypokal/hypomag

32
Q

QT elongation

A

can be inherited syndrome
torsade de pointes
risk of getting VT

drugs:
tca, ssri
amiodarone
methadone
TERFEADINE (ant hist)
chloroquine (anti malaria)
erythromycin
  • hypo cal,kal,mag,thermia
33
Q

svt

A

narrow complex (<120 - 3 small)

flutter (sawtooth, w 2:1 block gives 150)
junctional

compromised - cardioversion
stable - VAGAL
           - ADENOSINE (ci in asthma)
prevention - b-block
ablation

*SEE POLYURIA AFTER DUE TO ANP RELEASE

34
Q

torsade de pointes

A

polymorphic wide complex tachy

causes

  • electrolytes - hypomag, hypokal
  • post mi
  • drugs - amiod, methadone
  • congenital
  • aut dom: romano ward
  • aut recess: lange nielsen

M: replace electrolytes Mg then K

35
Q

heart block

A

1st degree - prolonged pr

2nd degree
type 1 successive increases until dropped beat
type 2 2:1 or 3:1

3rd degree total - no relation

36
Q

cardiomyopathy

A

ISCHAEMIC
post MI

DILATED - test BNP
alcohol
htn
autoimmune

HYPERTROPHIC
hocm - autosomal dominant
t: bblock, implan defib, amiod for arryth

RESTRICTIVE/INFILTRATIVE
amyloid, haemochromatosis, sarcoidosis, scleroderma

37
Q

acute myopathy

A

post viral or bact infect
drugs: cyclophosphamide, herceptin

causes acute HF, cp, palp
troponin slight
may cause chronic HF

38
Q

infective endocarditis

A

FEVER
MURMUR
EMBOLI
systemic symptoms

risk: heart defect, valve prob, iv drug, new valve, dental

50% normal vlaves, acute, HF, staph A
50% abn valves, subacute, strep viridans (alpha haem)

95% left
right (tricuspid) with drug users

d: 3 blood cultures, echo (veg,regurg)
t: iv gent and benzylpen

39
Q

congenital heart disease

in order of freq in adults

A

bicuspid aorta - AS

ASD (L to R shunt)

  • pulm htn. hf
  • eisenmenger (pulm htn reverse shunt; cyanoisis sob, infec, rhf)

VSD
- pulm htn, hf

COARC
- turners

PULM STEN

40
Q

tetralogy of fallot

A

VSD
overriding aorta
pulm stenosis
RVH

right to left shunt
CYANOTIC

41
Q

vsd

A

young patient - it is congenital
monitor for eissenmenger’s

loud pan systolic murmur
loudest at lse but widespread

42
Q

ASD

A

fixed splitting of second heart sound

43
Q

PFO

A

DVT can lead to stroke instead of PE

44
Q

Rheumatic fever features

follows infection w group A beta haemolytic (pyogenes)

A 
carditis (tachy, murmur, rub, ccf, arrhth)
arthritis
subcutaneous nodules
erythema marginatum
sydenhams chorea
45
Q

rheumatic fever treat and prog

A

rest
penicillin
high dose aspirin for carditis/arthritis

acute attck can take 3m to clear
60% chronic heart disease
can recur

46
Q

hypo/hyperkalaemia ecg

A

hyperkal (spiro, ace, renal fail, addisons, acidosis)

  • tall tented T
  • small P
  • wide QRS

hypokal (diuretics, vom/diar, alk, conns)

  • U
  • small T
  • long pr
47
Q

breathlessness - new york classification

A

1 - heart disease but no dysp
2 - dysp not at rest but on ordinary activity - walking/stairs
3 - dysp on basic activities - making tea
4 - dysp at rest

48
Q

atrial myxoma

A

throws off clots –> stroke

cause of clubbing

49
Q

cardiac myxoma pres

A

like endocard: fever, clubbing

like m stenosis: af, congestion

50
Q

s3 and s4

A

s3 - heart failure

s4 - AS, hocm, htn

51
Q

thiazide

A

hyponatraemia is main se
avoid in gout
K depletion
-u waves, no T, long qt/pr

52
Q

j waves

A

hypothermia

53
Q

delta waves

A

wolf parkinson white

cause of rentry tachycardia
bundle of kent
–> ablate

54
Q

digoxin

A

can cause heart block
can cause down sloping ST, T inversion

se - any arryth, yellow vision, nausea, gynecomast
antidote: digoxin immune fab (digibind)

55
Q

stop exercise testing

A 
symptoms
ST > 1mm
ST downsloping is diagnostic
fall in bp
arryth
reach max hr (220-age)
56
Q

driving

A

MI w angioplast 1 week
pacemaker 1 week

MI no angioplast - 4 weeks
CABG - 4 weeks

57
Q

libman sacks endocarditis

A

afebrile endocarditis
just new murmur and emboli –> stroke

assoc w SLE (ana) and other connective tisssues

58
Q

ACE se

A

cough
first dose hypo
hyperkal

rarer - tongue and face swelling
- can last up to 6m once stopped

59
Q

amlodipine se

A

oedema - ankles
flushing

in overdose - pulmonary oedema

60
Q

nitrate se

A

headache

can devel tolerance

61
Q

dilitazem/verap se

A

constipation

62
Q

b blocker se

A

slow hr
peripheral vasoconst
- cold peripheries
- erectile dysf

ci: asthma

63
Q

spironalactone se

A

hyperkalaemia

64
Q

swanz gatz catheter

A

sits in pulmonary artery
used mostly in critical care - continual monitoring

diagnostic info

  • hf - ie post mi, cardiogenic shock
  • pulm htn (wedge pressure)
  • assess therapy response
  • assess fluid need
66
Q

central line uses

A

sits in internal jugular
- sometime femroal or subclavian

deliver drugs
- amiod, chemo

monitoring

  • central venous oxygen sat
  • central venous pressure

sometimes in haemodialysis

67
Q

AAA

A

risk: smoke, htn, age, male, fh

Defined when diam > 3cm
Usually above umbilicus
- after renal arteries

Screening programme for men aged 65

Once over 6cm risk of rupture outweighs risk of surgery (endovascular stent)

  • 10% annual risk of rupture
  • surgery mortality is 2-7%

Symptomatic if enlarging/leaking
- constant/severe abdo pain (epigastric) rad to back
Rupture - collapse and death

67
Q

svt vs vt

A

svt

  • often young no underlying heart disease
  • palpitation +/- syncope
  • vagal then adenosine or dc

vt

  • stronger symptoms - syncope
  • often underlying heart disease
  • dc or amiod (or ligno)

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