cardiovascular Flashcards

1
Q

valvular heart disease:

- 4 commonest valve pathologies? how common? causes?

A

Mitral Regurgitation:

  • – Commonest valvular lesion. 2% prevalence
  • functional (secondary to LV dilatation)
  • annular calcification (elderly)
  • mitral valve prolapse
  • rheumatic fever
  • infective endocarditis
  • ruptured chordae tendon or papillary muscle dysfunction/rupture
  • connective tissue disease (Marfans, Ehlers-danlos)
  • old dieting pills
  • cardiomyopathy
  • congenital

Mitral Stenosis:

  • – Prevalence <1% in west, commoner in Asia and Africa
  • rheumatic
  • congenital
  • ends-cardial fibroelastosis
  • prosthetic valve

Aortic Stenosis:

  • – Prevalence 1-2% in over 65s
  • senile calcification (commonest)
  • congenital (bicuspid valve)
  • rheumatic
Aortic regurgitation (AR): 
------ <1% prevalence
--- acute
- infective endocarditis
- ascending aortic dissection
- chest trauma
--- chronic
- congenital
- connective tissue (Marfans/ehlers danlos)
- rheumatic fever
- arthritis (rheumatoid + seri-negative)
- old diet pills
(- other weird and wonderful stuff)
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2
Q

symptoms/signs of valvular heart disease?

  • mitral regurg
  • mitral stenosis

incl murmurs

  • only curative treatment?
A
mitral regurg
= symptoms
- dyspnoea
- fatigue
- palpitations
- symps of IE
= signs
- AF
- displaced hyper dynamic apex beat
- RV heave
- pan systolic murmur (radiating to axilla)
mitral stenosis
= symptoms
- dyspnoea
- fatigue
- palpitations
- chest pain
- systemic emboli
- haemoptysis
- chronic bronchitis-like picture
= signs
- MALAR flush on cheeks (dt reduced cardiac output)
- low-volume pulse
- AF common
- mid-diastolic murmur (w systolic 'snap')

valve repair or replacement surgery

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3
Q

symptoms/signs of valvular heart disease?

  • aortic stenosis
  • aortic regurg

incl murmurs

  • only curative treatment?
A
aortic stenosis
= symptoms
- exertional chest pain (angina)
- exertional dyspnoea
- exertional lightheadedness (+/- syncope)
= signs
- slow rising pulse
- LV heave
- aortic thrill
- ejection systolic murmur (radiates to carotids)
aortic regurg
= symptoms
- exertional dyspnoea
- orthopnoea
- PND
(also angina, palpitations, syncope, CCF)
= signs
- collapsing (water-hammer) pulse
- displaced, hyper dynamic apex beat
- high pitched early diastolic murmur

valve repair or replacement surgery

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4
Q

infective endocarditis:

  • who’s at risk?
  • commonest 2 causative organisms?
A
  • underlying valvular pathology/defects (incl old rheumatic heart disease)
  • mechanical valves
  • IVDU
  • poor dental hygiene
  • dental procedures
  • strep viridans
  • staph aureus

nb mechanical valve tends to be sub-acute, others tend to be acute

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5
Q

infective endocarditis:

  • symptoms? 5
  • signs? 6
  • investigations? 2
  • criteria for diagnosis?
A
  • fever
  • rigors
  • night sweats
  • weight loss
  • anaemia
  • splinter haemorrhages
  • janeway lesions
  • roth spots
  • oslers nodes
  • new/changed heart murmur
  • septic emboli to other places (eg stroke)
  • blood culture (when fever, need 2+ positive)
  • echocardiogram (see vegetations +/- cardiac thrombi) - TOE best

nb do other blood tests as well as generally unwell (CRP, U+E, LFT, FBC etc)

  • DUKES criteria

nb FBC often shows normocytic, normochromic anaemia w raised ESR + often leucocytosis

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6
Q

infective endocarditis:

- treatment?

A

empirical Abx and symptomatic treatment/resus

when cultures return, targeted Abx

surgery to repair/replace valves if severe heart failure

nb if strep bovis cultured, do colonoscopy as almost always bowel cancer

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7
Q

postural hypotension:

  • definition?
  • risk factors/causes? 10
A

drop of >20mmHg of systolic BP (+/or drop of >10mmHg diastolic BP) after 3mins of standing (vs sitting)

  • elderly
  • female
  • polypharmacy
  • iatrogenic hypovolemia (diuretics, anti-hypertensives)
  • other drugs (eg anti-psychotics)
  • addisons disease (or crisis dt sudden withdrawal of steroids)
  • dehydration
  • post-strenuous exercise
  • autonomic neuropathy
  • idiopathic (a third)
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8
Q

postural hypotension:

  • investigations? 2
  • non-pharm management? 8
  • pharm treatment?
A
  • lying and standing BP
  • tilt table test (gold)
  • lie down if feeling faint
  • stand slowly
  • review medications (+ adjust/find cause)
  • refer to falls clinic
  • manage autonomic neurpathy
  • increase water + salt intake
  • gentle exercise (build up muscle)
  • reduce alcohol intake
  • fludrocortisone (retains fluid - beware if CCF or renal probs, monitor weight + oedema)

nb if this fails refer to specialist

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