Cardiovascular Flashcards
AORTIC STENOSIS causes symptoms ECG features CXR features investigations management
causes - rheumatic, calcified valve
symptoms - SOB, pre/syncope, angina
ECG - LVH/LV strain pattern
CXR - none (LV dilates inwards - PO)
investigations - transthoracic doppler echo + ECG
management - valve replacement if symptomatic or gradient > 40, manage HTN
CCF examination findings differentials investigations management
findings - clubbing, c + p cyanosis, SOB, oedema, AF, crackles, hepatomegaly, cardiomegaly, displaced apex, HS3, pacemaker
investigations - BNP, ECG, echo, renal + liver function, CXR
management - lifestyle, ACEi, b-blocker, spironolactone, furosemide, CRT
ACUTE HF causes examination findings differentials investigations management
causes - decompensation, ACS, arrhythmia, volume overload, infection
findings - SOB, oedema, end-insp crackles, raised JVP
differentials - PE, pneumonia
investigations - obs, BNP, troponin, renal + liver function, ECG, CXR, transthoracic echo
management - treat cause, hi flow oxygen if sats <90, IV furosemide, IV GTN (if BP > 90)
MI causes examination findings differentials investigations management
examination findings - HS3
differentials - GORD, ulcer, costochondritis, aortic dissection, PE, panic attack, pericarditis/myocarditis
investigations - obs, glucose, renal + liver function, TFTs, troponins, ECG, CXR, coronary angiogram, later - echo
management - morphine, oxygen if <94, nitrates, aspirin 300, clopidogrel, beta blocker if NSTEMI or STEMI + haem stable, PCI
AORTIC REGURGITATION causes CXR findings ECG features differentials investigations management
causes - rheumatic, IE, HTN, marfan’s, RA, ank spond
symptoms - SOB, fatigue, palpitations, oft asymptomatic
ECG features - nil
CXR features - cardiomegaly, HF signs
differentials
investigations
management - diuretics, vasodilators, replacement if severe
MITRAL STENOSIS
causes
investigations
management
causes - rheumatic HD
investigations - echo, CXR, ECG
management - anticoagulation, rate control any AF, diuretics, balloon valvuloplasty if indicated
INFECTIVE ENDOCARDITIS causes examination findings investigations management
causes - IVDU, rheumatic, dentist
examination findings - osler + janeway, dentition, splinter haemorrhages, clubbing, splenomegaly, roth spots, microscopic haematuria
investigations - 3 blood cultures from 3 peripheral sites, FBC (anaemia), urinalysis, CXR, echo (vegetations)
management - oral hygiene, benzylpenicillin + gentamicin, valve repair/replacement
MITRAL REGURGITATION
causes
investigations
management
causes - rheumatic, IE, post-MI papillary muscle rupture, marfan’s, SLE, valve prolapse, LV dilatation
investigations - echo, CXR, ECG
management - anticoagulation, manage any AF, diuretics, ACEi (as HTN worsens MR + to reduce afterload), valve repair if severe
what are the causes of AF?
IHD hyperthyroidism pneumonia PE alcohol rheumatic
MITRAL STENOSIS timing position of stethoscope position of patient quality radiation other features systemic features CXR features ECG features
timing - mid-diastolic
position of stethoscope - apex with bell
position of patient - LHS + expiration
quality - rumbling (low pitched)
radiation - nil
other features - opening snap, tapping apex, loud HS1
systemic features - AF, RHF signs, malar flush, (crackles?), SOB, fatigue
CXR features - enlarged LA, pulmonary venous congestion
ECG features - AF common, P mitrale (bifid P waves)
how can you describe a murmur?
timing intensity position of stethoscope position of patient quality radiation systemic features
how can you describe a murmur?
timing intensity position of stethoscope position of patient quality radiation systemic features
MITRAL REGURGITATION timing position of stethoscope position of patient quality radiation
MITRAL REGURGITATION timing - pansystolic - obliterated HS2 - "BURR" position of stethoscope - apex position of patient - normal quality - blowing radiation - axilla
AORTIC STENOSIS timing position of stethoscope position of patient quality radiation
timing - ejection systolic position of stethoscope - aortic position of patient - normal quality - crescendo-decrescendo radiation - carotids
AORTIC REGURGITATION timing position of stethoscope position of patient quality radiation
timing - early diastolic stethoscope - LLSE patient - leaning forward in expiration quality - high pitched radiation - none
what are the indications for a bioprosthetic valve over metallic valve?
elderly - ie if valve will outlast pt
CI to warfarin - childbearing age (F)
patient choice
differentials for crackles
HF pneumonia/LRTI renal failure fibrosis COPD
differentials for raised JVP
RHF - PE (as infarction in pulmonary artery), right sided MI
fluid overload - eg renal failure
cor pulmonale
liver failure - congestive backup + hypoalbuminaemia
JVP goes up cos heart not pumping properly
IE - big 5 signs
2 in hands - clubbing + splinters
1 in heart - changing murmurs
2 in abdo - splenomegaly + microscopic haematuria (assoc GN)
rarities - osler, roth, janeway
commonest causes of splinter haemorrhages
gardening/microtrauma
IE
vasculitis
causes of AF
IHD
RHD
thyrotoxicosis
alcoholic HD
HTN
main 2 reasons for an irreg irreg pulse + how can you differentiate?
AF
multiple ventricular ectopics - diminish w exercise/increased HR
what causes ventricular ectopics?
scar tissue
what happens to the ventricle in AS? how is this on examination?
pressure overload - ventricle enlarges inwards, causing a powerful apex/beat which is not displaced
what happens to ventricle in AR?
volume overload - ventricle enlarges outwards, displacing the apex/beat
causes of powerful but undisplaced apex beat (ie causes of pressure overload)
HTN
AS
coarctation
HOCM
how do the HS sound in MS + why?
loud HS1 - high LA pressure keeps valve open til late diastole then systole slams it shut
opening snap - hi pitched sound just after HS2
what causes a left parasternal heave?
RVH
why is the apex beat displaced in AR?
volume overload due to leakage - LV enlarges outwards
what long term condition can cause AR? what is one sign on examination of this long term condition?
Marfan’s - mARfan’s causes AR
high arched palate
mechanical prosthetic valve on examination - how does it differ from the sound of a bioprosthetic valve?
scar
starr edwards has 2 sounds - closing sound louder:
opening click → ejection murmur from turbulent flow over ball in systole → loud closing sound
bi-leaflet valves - only 1 (closing) prosthetic sound
permanent pacemaker - indications
SAN disease
AVN disease - symptomatic 2nd degree + complete heart block
AF with slow ventricular rate
refractory fast AF treated with AVN ablation
cardiac resynchronisation therapy for HF
cardiac scars OE
midline sternotomy - CABG, valve replacement
apex intercostal scar - mitral valvotomy
legs - CABG
reasons for a non-palpable apex
DOPE Dextrocardia Obesity Pericardial effusion Emphysema
MITRAL REGURGITATION
other features on examination
CXR features
ECG features
other features - AF, HS3, thrusting, displaced apex, audible click
CXR features - cardiomegaly, HF signs
ECG features - AF common, VEBs
AORTIC STENOSIS - examination findings
slow rising pulse + narrow pp
heaving apex (not displaced - inward enlargement - PO)
ejection click
AORTIC REGURGITATION - examination findings
head bobbing nailbed pulsation exaggerated carotid pulse collapsing pulse + wide pp thrusting, displaced apex HS3
MITRAL REGURGITATION - other features (eg symptoms)
HF + SOB from LV dilation - may get eg PND
fatigue
what is the role of an ICD?
implantable cardioverter-defibrillator
constantly monitors HR. if it detects an abnormal rhythm it can either do:
1) pacing – a series of low-voltage electrical impulses (paced beats) at a fast rate to try and correct the heart rhythm
2) cardioversion – one or more small electric shocks to try and restore the heart to a normal rhythm.
3) defibrillation – one or more larger electric shocks to try and restore the heart to a normal rhythm
when is an ICD indicated?
implantable cardioverter-defibrillator
1) had a life-threatening arrhythmia + are at risk of having it again
2) tests show you are at risk of one in the future - eg cardiomyopathy, long QT, brugada
2) another heart + circulatory condition eg HF + are at risk of having a life-threatening arrhythmia + other treatments to correct rhythm have been unsuccessful
types of pacemaker
1) single-chamber – 1 wire to either the right atrium or right ventricle
2) dual-chamber – 2 wires, 1 to right atrium and 1 to right ventricle
3) CRT - biventricular pacemaker – 3 wires, to right atrium, right ventricle + left ventricle
most pacemakers are demand pacemakers - sensor turns them off when HR rises above a certain level + reactivates when the HR too slow. other type is fixed-rate.
indications for a pacemaker
persisting symptomatic bradycardia AV block: complete; 2nd degree mobitz II AF refractory to meds sick sinus syndrome some dilated cardiomyopathy or HOCM pts persistent AV block post anterior MI neurocardiogenic syncope resistant tachyarrhythmias
and CRT for HF i assume?
