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Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the description of angina?

A

Restricted perfusion to the heart due to atherosclerosis.

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2
Q

What are the types of angina?

A

Stable, unstable and mixed

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3
Q

What are some symptoms of angina?

A

Chest pain/discomfort which is tight and heavy and passes within a few minutes
Pain can radiate to the jaw, neck and back
Pain is normally caused by exertion
Shortness of breath

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4
Q

What is the cause of angina?

A

Atherosclerosis due to hypertension, diabetes, obesity, age, sex, hyperlipidaemia and smoking

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5
Q

How do you diagnose angina?

A 
Presentation of symptoms 
Test for high blood pressure
ECG
Exercise tolerance test
Coronary angiography
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6
Q

What is the treatment for angina?

A

Relief: GTN or sublingual nitrate
Prophylaxis: Aspirin, Beta blockers, calcium channel blockers, long acting nitrates, ivabridine, nicorandil.
Surgery: Coronary bypass, percutaneous coronary invasion

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7
Q

What are the potential complications of angina?

A

MI, stroke, depression

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8
Q

What is the description of an acute MI?

A

The ischaemic necrosis of a tissue of myocardium secondary to occlusion/reduction of the coronary blood supply

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9
Q

What are some of the symptoms of an acute MI?

A

Severe crushing and heavy, central chest pain which radiates to jaw and arms (longer than 20 mins duration)
Is not relieved by GTN
Also associated with sweating, nausea and vomiting.

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10
Q

What is the cause of an acute MI?

A

Atherosclerosis of the coronary arteries

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11
Q

How do you diagnose an acute MI?

A

Symptoms
ECG showing: ST elevation, T wave inversion, Q waves (but may be normal)
Cardiac enzymes

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12
Q

What is the treatment of an acute MI?

A 
M- Morphine + anti emetic
O- Oxygen
N- Nitrates
A- Aspirin 300mg + Clopidogrel 300mg

Reperfusion therapy: thrombolysis, percutaneous coronary intervention, coronary artery bypass
, angiogram
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13
Q

What are some complications of an acute MI?

A

Death, arrhythmia,

structural: aneurysm, inflammation
functional: acute LVF, cardiogenic shock

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14
Q

What are some methods of prevention for an acute MI?

A

Lifestyle changes

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15
Q

What is the description of left heart failure?

A

Low cardiac output from left side of heart.

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16
Q

What are some of the symptoms of left heart failure?

A

Pulmonary oedema
Orthopnoea
Paroxysmal nocturnal dyspnoea

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17
Q

What are some of the signs of left heart failure?

A 
Tachycardia
Fine crepitations
Pleural effusion more common in chronic
Third heart sound
Cardiomegaly and bat wing shadows in lower zones on CXR
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18
Q

What is the cause of left heart failure?

A

Ischaemic heart disease, cardiomyopathy, valvular disease

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19
Q

How do you diagnose left heart failure?

A

Natriuretic peptide test, Echo, ECG

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20
Q

What is the treatment of left heart failure?

A

Life style changes, loop diuretic, ACEI, beta blocker, aldosterone antagonist, digoxin

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21
Q

What are some complications of left heart failure?

A

Arrhythmias, depression

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22
Q

What is the treatment of acute left heart failure?

A

Sit up, oxygen, IV furosemide, IV morphine

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23
Q

What is the description of right heart failure?

A

Low cardiac output from right side of heart

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24
Q

What are some of the symptoms of right heart failure?

A

Peripheral oedema

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25
Q

What are some of the signs of right heart failure?

A

Ankle/sacral oedema, elevated JVP, Hepatomegaly, ascites (excess fluid in abdomen), normal CXR

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26
Q

What is the cause of right heart failure?

A

Often caused by LVF, cor pulmonale, congenital heart failure

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27
Q

How do you diagnose right heart failure?

A

Natriuretic peptide test, Echo, ECG

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28
Q

What is the treatment of acute right heart failure?

A

Life style changes, loop diuretic, ACEI, beta blocker, aldosterone antagonist, percutaneous coronary invasion

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29
Q

What are some complications of right heart failure?

A

Arrhythmias

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30
Q

What is the description of peripheral vascular disease?

A

Intermittent claudication: when insufficient blood reaches exercising muscle
Critical limb ischaemia

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31
Q

What are some of the symptoms of peripheral vascular disease?

A

Hair loss on feet and legs
Leg weakness and/or numbness
Cold legs
Difficult finding a pulse in the legs

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32
Q

What is the cause of peripheral vascular disease?

A

Atherosclerosis

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33
Q

How do you diagnose peripheral vascular disease?

A

Presentation of symptoms
Ankle-brachial index (test that compares bp in the arm with bp in the ankle)
Doppler and ultrasound (Duplex) imaging
Angiography

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34
Q

What is the treatment for peripheral vascular disease?

A

Lifestyle changes - regular physical activity, diet changes to lower cholesterol, smoking cessation
Statins and anti-hypertensive medications

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35
Q

How do you prevent peripheral vascular disease?

A

Smoking cessation and diet changes

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36
Q

What is the description of endocarditis?

A

An infection of the endothelium of the heart valves.
Up to 25% mortality
Can be acute of subacute

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37
Q

What are some symptoms of endocarditis?

A

Acute: sepsis, cardiac failure, emboli, new murmur

Subacute (usually on abnormal valves): Fever, chest pain, shortness of breath, new murmur, malaise, tiredness

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38
Q

What are some signs of endocarditis?

A

F - Fever
R - Roth spots
O - Osler’s nodes
M - Murmur

J - Janeway lesions
A - Anaemia
N - Nail haemorrhages (splinter haemorrhages)
E - Emboli

Also clubbing and splenomegaly

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39
Q

What are the causes of endocarditis?

A

Bacteraemia

Most commonly caused by Streptococcus viridans. Also caused by Staph aureus or Staph epidermidis.

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40
Q

What are some predisposing factors for endocarditis?

A

Having a heart valve abnormality, calcification in elderly patients, congenital heart disease, post-rheumatic fever, IV lines, IV drugs users, prosthetic heart valve

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41
Q

How do you diagnose endocarditis?

A

Do 3 sets of blood cultures at different times from different sites at peak of fever (Duke’s criteria - 2 major or 1 major and 3 minor or all 5 minor criteria)
CXR may show cardiomegaly
ECG will show long PR interval at regular intervals

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42
Q

What is the treatment of endocarditis?

A

Blind therapy:
Native valve - Amoxicillin + gentamicin IV (use vancomycin if penicillin resistant)
Prosthetic valve - Vancomycin + gentamicin + rifampicin

Known organism:
Staphylococcus - native valve => flucloxacillin
- prosthetic valve => flucloxacillin + gentamicin + rifampicin

Streptococcus - sensitive to penicillin => benzylpenicillin
- not sensitive to penicillin => vancomycin and gentamicin

Enterococcus - Amoxicillin and gentamicin

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43
Q

What complications can occur in endocarditis?

A

Infected vegetations break off and become lodged in next capillary bed abscesses/ haemorrhage

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44
Q

How can endocarditis be prevented?

A

Antibiotic prophylaxis

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45
Q

What is the description of hypertension?

A

A blood pressure of higher than 140/90mHg.

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46
Q

What are the types of hypertension?

A

Isolated systolic hypertension - The most common form of hypertension. Results from atherosclerosis of the large arteries. Systolic bp >130 but diastolic bp <80.

Malignant hypertension - Rapid rise in bp leading to vascular damage. Causes headaches and viral disturbance. More common in black patients and younger patients. Must be treated immediately. Systolic bp >200 and diastolic bp >130

Essential (primary) hypertension - Cause unknown, 95% of cases

Secondary hypertension - 5% of cases. Causes include renal disease and endocrine disease

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47
Q

Who is treated for hypertension?

A

Patients with bp > 160/100 mmHg and some patients with bp 140/90mmHg who have a high risk of coronary events.

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48
Q

What are some signs and symptoms of hypertension?

A

Usually asymptomatic

However, there may be signs of end-organ damage e.g. left-sided heart failure, retinopathy and proteinuria.

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49
Q

How do you diagnose hypertension?

A

If the clinic blood pressure is more than 140/90mmHg, offer ambulatory blood pressure monitoring (ABPM). This is when blood pressure is monitored for 24 hours via a small monitor which attaches to the patient’s belt and connects to a cuff around their arm.

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50
Q

What is the treatment of hypertension?

A

Lifestyle changes - low-fat diet, smoking cessation, reduce alcohol and salt intake, increase exercise, reduce weight if obese

If under 55: ACEI (or ARB)
If 55+ or African/Caribbean of any age:
Ca Channel Blocker or thiazide

Add on: ACEI/ARB + Ca Channel Blocker
Add on: Thiazide Diuretic

If resistant: Further diuretic therapy with low-dose spironolactone

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51
Q

What is the description of myocarditis?

A

Inflammation of the myocardium (heart muscle)

Occurs more commonly in younger people

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52
Q

What are the symptoms of myocarditis?

A 
Fatigue
Dyspnoea/ shortness of breath
Chest pain
Fever
Palpitations
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53
Q

What are the signs of myocarditis?

A

Tachycardia
Arrhythmias
Cardiac failure

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54
Q

What are some causes of myocarditis?

A

Viral (flu, hepatitis, mumps, polio, HIV)
Bacterial (TB, clostridia, meningococcus)
Idiopathic
Drugs (cyclophosphamide, perception, penicillin)

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55
Q

How do you diagnose myocarditis?

A

ECG
Troponin test (positive troponin I or T confirms the diagnosis)
Viral culture

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56
Q

What is the treatment for myocarditis?

A

Supportive treatment (treat the underlying cause)

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57
Q

What are some complications of myocarditis?

A

Heart failure, heart attack, stroke, arrhythmias

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58
Q

What is the description of pericarditis?

A

Inflammation of the pericardium, often occurs with myocarditis.

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59
Q

What are the symptoms of pericarditis?

A

Sharp pain in the chest worse when inspiration or laying flat, that may decrease when leaning forward
Shortness of breath (esp. when reclining)
Palpitations
Fever

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60
Q

What is one sign of pericarditis?

A

Pericardial rub may be heard upon auscultation

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61
Q

What are the causes of pericarditis?

A

Idiopathic
Viral (most commonly) - Flu, Epstein-Bar, mumps
Bacterial - Pneumonia, rheumatic fever, TB
Myocardial Infarction or Dressler’s syndrome

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62
Q

How do you diagnose pericarditis?

A

Presentation of symptoms
ECG => saddle-shaped ST elevation
CXR => may indicate pericardial effusion

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63
Q

What is the treatment for pericarditis?

A

Analgesia e.g. NSAIDs

Treat the cause

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64
Q

What are some complications of pericarditis?

A

Pericardial effusion

Cardiac tamponade

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65
Q

What is the description of pericardial effusion?

A

Accumulation of fluid in the pericardial sac

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66
Q

What are the signs and symptoms of pericardial effusion?

A

Dyspnoea
Raised JVP
Bronchial breathing at left base (Ewart’s sign - large effusion compressing left lower lobe)

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67
Q

What are the causes of pericardial effusion?

A

Any cause of pericarditis i.e. bacterial, viral, MI, idiopathic

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68
Q

How do you diagnose pericardial effusion?

A

Presentation of symptoms
CXR => Enlarged, globular heart
ECG => low voltage QRS complexes
Echo => echo-free region around the heart

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69
Q

How do you treat pericardial effusion?

A

Treat the cause

Pericardiocentesis may be diagnostic (suspected bacterial pericarditis) or therapeutic (cardiac tamponade)

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70
Q

What is the description of cardiac tamponade?

A

Accumulation of pericardial fluid leads to poor ventricular filling and fall in cardiac output.

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71
Q

What are some signs and symptoms of cardiac tamponade?

A

High heart rate
Low blood pressure
Pulsus paradoxus (abnormal decrease in stroke volume)
High JVP
Kussmaul’s sign (rise in JVP during inspiration)
Muffled S1 and S2

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72
Q

What are the causes of cardiac tamponade?

A 
Pericarditis
Aortic dissection
Warfarin
Transeptal puncture at cardiac catheterisation
Post cardiac biopsy
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73
Q

How do you diagnose cardiac tamponade?

A

Symptom presentation - Beck’s triad => low bp, high JVP, muffled heart sounds
CXR - shows large, globular heart
ECG - low-voltage QRS
Echo- is diagnostic, shows large echo-free zone around the heart

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74
Q

What is the treatment of cardiac tamponade?

A

Drainage of fluid around the heart i.e. pericardiocentesis

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75
Q

What is the description of constrictive pericarditis?

A

The heart is encased in a rigid pericardium

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76
Q

What are some signs and symptoms of constrictive pericarditis?

A 
Breathing increases in difficulty
Chest pain
Fatigue and weakness
High JVP
Kussmaul's sign (JVP raising paradoxically with inspiration)
Soft, diffuse apex beat
Muffled heart sounds
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77
Q

What are the causes of constrictive pericarditis?

A

Often unknown (western countries)
TB (in other countries)
Or after any pericarditis

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78
Q

How do you diagnose constrictive pericarditis?

A

Symptom presentation
CXR - small heart +/- pericardial calcification
Echo - cardiac catheterisation

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79
Q

What is the treatment for constrictive pericarditis?

A

Surgical excision (pericardiectomy)

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80
Q

What is the description of dilated cardiomyopathy?

A

A dilated, flabby heart, leading to less effective pumping of blood.
Usually begins in the left ventricle and can spread to the other chambers

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81
Q

What are some signs and symptoms of dilated cardiomyopathy?

A 
Fatigue
Dyspnoea
Pulmonary oedema
Right ventricular failure
Atrial fibrillation
Increased pulse, high JVP, low BP
Displaced diffuse apex
82
Q

What are the causes of dilated cardiomyopathy?

A 
It is associated with:
Higher alcohol intake
High BP
Haemochromatosis
Viral infection
Autoimmune disease
Congenital
83
Q

How do you diagnose dilated cardiomyopathy?

A

Presentation of symptoms
Bloods - plasma BNP is sensitive to heart failure, decreased Na+ indicates a worse prognosis
CXR - cardiomegaly and pulmonary oedema
ECG - tachycardia, non-specific T wave changes
Echo - dilated, hypokinetic heart, with low ejection fraction

84
Q

What is the treatment for dilated cardiomyopathy?

A

Diuretics
Digoxin
ACE inhibitors
Anti-coagulation

85
Q

What is the description of hypertrophic cardiomyopathy?

A

A disease which causes the myocardium to abnormally thicken.
Leading cause of sudden cardiac death in young people.
Is autosomal dominant inherited but most cases are sporadic.

86
Q

What are some symptoms of hypertrophic cardiomyopathy (HCM)?

A 
Angina
Dyspnoea
Palpitations 
Synchope
Sudden cardiac death
Congestive heart failure
87
Q

What are some signs of hypertrophic cardiomyopathy (HCM)?

A

Jerky pulse
A wave in JVP
Double apex beat
Systolic thrill at lower left sternal edge

88
Q

How do you diagnose hypertrophic cardiomyopathy (HCM)?

A

Presentation of symptoms
ECG - Left ventricular hypertrophy, progressive T wave inversion, deep Q waves, AF
Echo - asymmetrical septal hypertrophy, small left ventricular cavity
Cardiac cauterisation may provoke VT
Exercise test or Holter 24h monitor may be needed to confirm diagnosis

89
Q

What is the treatment for hypertrophic cardiomyopathy (HCM)?

A

Symptom control - Beta-blockers or verapamil
Arrhythmias - Amiodarone
AF or systemic emboli - Anti-coagulate
Consider an implantable defibrillator

90
Q

What is the description of restrictive cardiomyopathy (RCM)?

A

A disease which causes the myocardium to become rigid but not thicken.

91
Q

What are some signs and symptoms of restrictive cardiomyopathy (RCM)?

A 
Presentation similar to constrictive pericarditis
Prominent features:
High JVP
Hepatomegaly
Oedema
Ascites
92
Q

What are the causes of restrictive cardiomyopathy (RCM)?

A

Idiopathic, haemochromatosis, sarcoidosis

93
Q

How do you diagnose restrictive cardiomyopathy (RCM)?

A

Presentation of symptoms

Cardiac catheterisation

94
Q

What is the treatment for restrictive cardiomyopathy (RCM)?

A

Treat the cause

95
Q

What is the description of a cardiac myxoma?

A

Rare, benign cardiac tumour usually found in the intratrial septum

96
Q

What are some signs and symptoms of a cardiac myxoma?

A

Symptoms can mimic:
Infective endocarditis - fever, weight loss, clubbing
Mitral stenosis - left atrial obstruction, systemic emboli
A tumour “plop” may be heard on auscultation

97
Q

What is the cause of a cardiac myxoma?

A

Usually sporadic but may be familial

98
Q

How do you diagnose a cardiac myxoma?

A

Presentation of symptoms

Echocardiogram - mass in the atrium

99
Q

What is the treatment for cardiac myxoma?

A

Surgical excision

100
Q

What is the description of aortic stenosis?

A

A narrowing of the aortic valve opening.

101
Q

What are some symptoms of aortic stenosis?

A 
Chest pain
Exertional dyspnoea
Angina
Syncope or dizziness
Heart failure
102
Q

What are some signs of aortic stenosis?

A 
Low volume
Slow rising pulse
Narrow pulse pressure
Aortic thrill
Ejection systolic murmur best heard over the aortic area
103
Q

What are the causes of aortic stenosis?

A

Calcification of the valve
Congenital (William’s syndrome)
Rheumatic heart disease

104
Q

How do you diagnose aortic stenosis?

A

Presentation of symptoms
ECG - left ventricular hypertrophy, left anterior hemiblock, left bundle branch block
Echo - diagnostic, doppler can estimate extent of disease

105
Q

What is the treatment of aortic stenosis?

A

If symptomatic - surgery
Valve replacement
Transcatheter aortic valve implantation (TAVI)

106
Q

What is the description of aortic regurgitation?

A

Leaking of the aortic valve of the heart that causes blood to flow in the reverse direction

107
Q

What are some symptoms of aortic regurgitation?

A 
Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Palpitations
Angina
Synchope
Congestive heart failure
108
Q

What are some signs of aortic regurgitation?

A 
Collapsing pulse
Wide pulse pressure
Carotid pulsation 
Displaced hyper dynamic apex beat
Early diastolic murmur best heard over the aortic area with the patient sitting forward and holding their breath
109
Q

What are some causes of aortic regurgitation?

A

Acute: Infective endocarditis, ascending aortic dissection, chest trauma

Chronic: Congenital connective tissue disorders, Marfan’s syndrome, rheumatic fever, rheumatoid arthritis

110
Q

How do you diagnose aortic regurgitation?

A

ECG - Left ventricular hypertrophy
CXR - Cardiomegaly, dilated ascending aorta, pulmonary oedema
Echo - diagnostic
Cardiac catheterisation- to assess severity of lesion

111
Q

What is the treatment of aortic regurgitation?

A

ACE inhibitors, angiotensin receptor blockers, diuretics
Echo every 6-12 months to monitor
Surgery - if enlarging heart on echo and increasingly severe symptoms - valve replacement surgery

112
Q

What is the description of aortic sclerosis?

A

Calcification of the aortic vavle

113
Q

What are the characteristics of aortic sclerosis?

A

Ejection systolic murmur
No radiation to carotids
Normal pulse

114
Q

What is the description of mitral stenosis?

A

A narrowing of the mitral valve opening

115
Q

What are some symptoms of mitral stenosis?

A 
Dyspnoea
Fatigue
Palpitations
Chest pain
Systemic emboli
116
Q

What are some signs of mitral stenosis?

A

Malar flush on cheeks, due to reduced cardiac output
Low volume pulse
Tapping non-displaced apex beat
Mid-diastolic murmur best heard on apex, with the patient on their side
AF is common

117
Q

What are the causes of mitral stenosis?

A

Rheumatic disease
Congenital
Mucopolysaccharidosis
Prosthetic valve

118
Q

How do you diagnose mitral stenosis?

A

Presentation of symptoms
ECG - AF common
CXR - Left atrial enlargement, pulmonary oedema, mitral valve calcification
Echo - diagnostic, significant stenosis of mitral valve

119
Q

What is the treatment for mitral stenosis?

A

If AF - anticoagulate with warfarin
Also diuretics

If this fails to control symptoms - balloon valvuloplasty, valve replacement

120
Q

What are some complications of mitral stenosis?

A

Pulmonary hypertension, emboli, right heart failure

121
Q

What is the description of mitral regurgitation?

A

Leaking of the mitral valve of the heart that causes blood to flow in the reverse direction

122
Q

What are some symptoms of mitral regurgitation?

A

Dyspnoea
Fatigue
Ankle swelling

123
Q

What are some signs of mitral regurgitation?

A 
Displaced hyper dynamic apex
Right ventricular heave
Split S2
Soft S1
AF
124
Q

How do you diagnose mitral regurgitation?

A

Presentation of symptoms

ECG - p-mitrale,

125
Q

How do you diagnose mitral regurgitation?

A

Presentation of symptoms
ECG - p-mitrale, AF
Echo - to assess LV function and severity for mitral valve repair rather than replacement
Cardiac cauterisation to confirm diagnosis

126
Q

What is the treatment of mitral regurgitation?

A

Control rate if AF - Digoxin
Anti-coagulate if AF, history of embolism, prosthetic valve - Warfarin
Diuretics improve symptoms
Surgery to repair/ replace the valve

127
Q

What are some complications of mitral regurgitation?

A

Heart failure, AF, endocarditis, pulmonary hypertension

128
Q

What is the description of mitral prolapse?

A

When the flaps of the mitral valve don’t close properly.

Most common type of valvular disease.

129
Q

What are some symptoms of mitral prolapse?

A

Asymptomatic or atypical chest pain and palpitations

Some patients have anxiety, panic attacks and syncope

130
Q

What are some signs of mitral prolapse?

A

Mid-systolic click

Late-systolic murmur

131
Q

What are some causes of mitral prolapse?

A

Congenital

Connective tissue disorders (Marfan’s syndrome)

132
Q

How do you diagnose mitral prolapse?

A

Presentation of symptoms
ECG - inferior t-wave inversion
Echo - diagnostic

133
Q

What are some complications of mitral prolapse?

A

Mitral regurgitation
Cerebral emboli
Sudden death

134
Q

What is the treatment of mitral prolapse?

A

Beta-blockers may help chest pain and palpitations

In case of severe mitral regurgitation, surgery is needed

135
Q

What is the description of tricuspid regurgitation?

A

Leaking of the tricuspid valve which causes blood to flow in the reverse direction.

136
Q

What are some symptoms of tricuspid regurgitation?

A

Fatigue
Hepatic pain on exertion
Ascites and oedema
Dyspnoea and orthopnoea

137
Q

What are some signs of tricuspid regurgitation?

A

V waves in JVP
Right sternal heave
Pan-systolic murmur best heard at the lower left sternal edge on inspiration

138
Q

What are the causes of tricuspid regurgitation?

A

Rheumatic fever
Infective endocarditis
Congenital

139
Q

How do you diagnose tricuspid regurgitation?

A

ECG

Echo

140
Q

What is the treatment for tricuspid regurgitation?

A

Treat the underlying cause
Drugs - Diuretics, digoxin, ACE inhibitors
Surgery - Valve replacement surgery

141
Q

What is the description of tricuspid stenosis?

A

A narrowing of the tricuspid valve opening.

142
Q

What are some symptoms of tricuspid stenosis?

A

Fatigue

Ascites and oedema

143
Q

What are some signs of tricuspid stenosis?

A

Giant a wave and slow y decent in JVP

Early diastolic murmur heard at the left sternal edge in inspiration

144
Q

What are some causes of tricuspid stenosis?

A

Rheumatic fever

Almost always occurs with mitral or aortic valve disease

145
Q

How do you diagnose tricuspid stenosis?

A

Echo

146
Q

What is the treatment for tricuspid stenosis?

A

Diuretics

Surgical repair

147
Q

What is the description of pulmonary stenosis?

A

A narrowing of the pulmonary valve opening

148
Q

What are some symptoms of pulmonary stenosis?

A

Dyspnoea
Fatigue
Oedema and ascites

149
Q

What are some signs of pulmonary stenosis?

A

Prominent a waves in JVP
Right sternal heave
Ejection systolic murmur which radiates to the left shoulder

150
Q

What are the causes of pulmonary stenosis?

A 
Usually congenital (Turner's syndrome, William's syndrome, Fallot's tetralogy)
Rheumatic fever
151
Q

How do you diagnose pulmonary stenosis?

A

Presentation of symptoms
ECG - p-pulmonale, right bundle branch block
CXR - prominent pulmonary arteries caused by post-stenotic dilatation.
Cardiac catheterisation is diagnostic

152
Q

What is the treatment of pulmonary stenosis?

A

Pulmonary valvuloplasty or valvotomy

153
Q

What is the description of pulmonary regurgitation?

A

Leaking of the pulmonary valve which causes blood to flow in the reverse direction.

154
Q

What are the causes of pulmonary regurgitation?

A

Any cause of pulmonary hypertension

155
Q

What are some signs of pulmonary regurgitation?

A

A decrescendo diastolic murmur can be heard at the left sternal edge

156
Q

What is the description of rheumatic fever?

A

A complication that can develop after a throat infection. Group A beta-haemolytic streptococci triggers rheumatic fever 2-4 weeks after, in 2% of the population.

157
Q

What are some signs and symptoms of rheumatic fever?

A 
A high fever of 38 degrees or more
Redness, pain and swelling of the joints
Erythema marginatum
Chest pain, breathlessness and tachycardia
Jerky, uncontrollably movements
158
Q

How do you diagnose rheumatic fever?

A

Use the Jones criteria - Two major criteria or 1 major and two minor, as well as evidence of a recent strep infection.

Evidence of group A beta-haemolytic streptococcal infection:

  • Positive throat culture
  • Elevated streptococcal antibody titre
  • Rapid streptococcal antigen test +ve

Major criteria:

  • Carditis = Tachycardia, murmurs, congestive cardiac failure, pericardial rub
  • Arthritis
  • Subcutaneous nodules
  • Erythema marginatum
  • Syndenham’s chorea (sudden, jerky movements)

Minor criteria:

  • Fever
  • Raised ESR or CRP
  • Previous rheumatic fever
  • Prolonged PR interval
159
Q

What is the management for rheumatic fever?

A

Bed rest until CRP is normal for 2 weeks
IV benzylpenicillin and then penicillin (if can’t use penicillin, use erythromycin)
Analgesia
Immobilise joints in severe arthritis

160
Q

What is the prognosis of rheumatic fever?

A

60% with carditis will develop chronic rheumatic disease

Patients develop valve abnormalities mostly in the mitral and aortic valves.

161
Q

What secondary prophylaxis is there for rheumatic fever?

A

Penicillin or erythromycin twice daily

For anywhere from 5 years to lifelong

162
Q

What is the description of atrial septal defect (ASD)?

A

There is a hole which connects the two atria.

163
Q

What are some signs of atrial septal defect (ASD)?

A 
AF
High JVP
Fixed split S2
Pulmonary ejection systolic murmur
Pulmonary hypertension
164
Q

What are some symptoms of atrial septal defect (ASD)?

A

Cyanosis
Arrhythmia
Haemoptysis
Chest pain

165
Q

What are some complications of atrial septal defect (ASD)?

A

Emboli

Pulmonary hypertension

166
Q

How do you diagnose atrial septal defect (ASD)?

A

ECG - Right branch bundle block, prolonged PR interval;
CXR - Small aortic knuckle, progressive atrial enlargement
Echo - Diagnostic

167
Q

What is the treatment for atrial septal defect (ASD)?

A

In children, surgery to close the defect is recommended

In adults, if symptomatic, transcatheter closure is recommended.

168
Q

What is the description of ventricular septal defect (VSD)?

A

There is a hole which connects the ventricles.

169
Q

What are some symptoms of ventricular septal defect (VSD)?

A

Severe heart failure in infancy

May remain asymptomatic

170
Q

What are some signs of ventricular septal defect (VSD)?

A

Harsh pan systolic mums is heard at the left sternal edge with a systolic thrill

171
Q

What are some causes of ventricular septal defect (VSD)?

A

Congenital

Post-MI

172
Q

What are some complications of ventricular septal defect (VSD)?

A

Pulmonary hypertension

173
Q

How do you diagnose ventricular septal defect (VSD)?

A

ECG - Normal or LVH or LVH and RVH

CXR - Cardiomegaly, large pulmonary arteries

174
Q

What is the treatment for ventricular septal defect (VSD)?

A

Medical therapy, but surgical closure if that fails

175
Q

What is the description for coarctation of the aorta?

A

Congenital narrowing of the descending aorta

More common in boys

176
Q

What is coarctation of the aorta associated with?

A

Turner’s syndrome

177
Q

What are the signs of coarctation of the aorta?

A

Radiofemoral delay
Weak femoral pulse
High BP
Systolic murmur best heard over scapula

178
Q

What are some complications of coarctation of the aorta?

A

Heart failure

Infective endocarditis

179
Q

How do you diagnose coarctation of the aorta?

A

CT or MRI - shows narrowed aorta

CXR- rib notching

180
Q

What is the treatment for coarctation of the aorta?

A

Surgery or balloon dilatation

181
Q

What is the description of Fallot’s tetralogy?

A

Consists of 4 typical features:

  • Ventricular septal defect (VSD)
  • Pulmonary stenosis
  • Right ventricular hypertrophy
  • The aorta overriding the VSD
182
Q

What is the presentation of Fallot’s tetralogy?

A

Infants may be acyanotic at birth, with a pulmonary stenosis murmur as the only initial finding.
Gradually, they become cyanotic due to decreasing blood flow to the lungs.

183
Q

How do you diagnose Fallot’s tetralogy?

A

CXR - May be normal or boot-shaped heart

Echo - Can show the degree of stenosis

184
Q

What is the management of Fallot’s tetralogy?

A 
Give oxygen
Place the child in knee-chest position
Morphine
Long term beta-blockers
Surgery is usually done before 1yr of age
185
Q

What is the description of an arrhythmia?

A

A disturbance in cardiac rhythm.

186
Q

What are the causes of arrhythmias?

A

MI
Coronary artery disease
Cardiomyopathy
Smoking, alcohol, drugs

187
Q

What is the presentation of arrhythmias?

A

Palpitations
Chest pain
Synchope
Hypotension

188
Q

How do you diagnose arrhythmias?

A

FBC, glucose, Ca2+, Mg2+
ECG - Signs of AF, short PR interval, long QT interval
24 hour ECG
Echo - Structural artery disease

189
Q

What is the treatment for bradycardia?

A

Atropine

Pacing if haemodynamic compromise

190
Q

What is the treatment for sick sinus syndrome?

A

Pacing if symptomatic

191
Q

What is the treatment for sinus tachycardia?

A

Treat underlying cause

Beta-blockers

192
Q

What is the treatment for supra ventricular tachycardia?

A

Acute - Vagotonic manoeuvres (breath holding, vasalva manoeuvre, carotid massage) followed by IV adenosine or verapamil

Maintenance - beta blockers or verapamil, avoid stimulants

193
Q

What is the treatment for ventricular tachycardia?

A

High-flow oxygen
IV amiodarone
Defibrillation

194
Q

What is the treatment for ventricular fibrillation?

A

Defibrillation

195
Q

What is the treatment for ventricular extrasystoles (ectopics)?

A

Most common post-MI arrhythmia

IV amiodarone

196
Q

What is the treatment for torsades de pointes?

A

Magnesium sulphate

197
Q

What is the description of atrial fibrillation (AF)?

A

Chaotic and disorganised electrical activity with an irregular heartbeat.
Can be paroxysmal (less than 48h), persistent (more than 48h) or permanent.

198
Q

What are some symptoms of AF?

A

Palpitations, presyncope, syncope, chest pain, dyspnoea, sweatiness, fatigue

199
Q

What is a sign of AF?

A

Irregularly irregular pulse

200
Q

What are some causes of AF?

A

Predisposing Factors
Heart valve abnormality, calcification in elderly, congenital heart disease, post rheumatic fever, IV lines, IV drugs users, prosthetic heart valve.

201
Q

How do you diagnose AF?

A

ECG: Irregularly irregular, atrial rate >300bpm, absence of P waves

202
Q

What is the treatment for AF?

A

Anti-coagulation
Rate control - beta-blocker or calcium-channel blocker
Rhythm control - cardio version or flecainide

Medical Conditions (3 decks)

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