Cardiovascular Flashcards
1
Q
What is an aneurysm?
A
Dilated area of vasculature due to weakness of vessel walls
2
Q
What is a true aneurysm?
A
Involves all layers of arterial wall
3
Q
What is a false aneurysm?
A
Involves a collection of blood in the outer layer only
4
Q
What is an AAA classified as?
A
> 50% dilation of aortic diameter
5
Q
Name 3 risk factors for AAAs
A
Age
- ) Male sex
- ) Family history
- ) Smoking
- ) Hypertension
- ) Hypercholesterolaemia
6
Q
How are AAAs found?
A
Clinically silent, found on abdominal examination or plain XR
7
Q
Name 4 things rapid expansion or rupture of an AAA may cause
A
- ) Severe pain
- ) Hypotension
- ) Tachycardia
- ) Profound anaemia
- ) Hypovolaemic shock
- ) Sudden death
8
Q
What type of pain is there in an AAA rupture?
A
Severe, epigastric pain radiating to the back
9
Q
Who is screened for an AAA?
A
All men >65
10
Q
What is the treatment for an AAA?
A
Stent, graft, lifestyle changes
11
Q
What size AAA should be operated on?
A
> 5.5cm or growing at >1cm/year
12
Q
In who do ascending TAAs occur?
A
Marfan’s syndrome, hypertensives
13
Q
In who do descending TAAs occur?
A
Atherosclerosis
14
Q
Rapid expansion of a TAA causes what 4 symptoms?
A
- ) Severe chest pain
- ) Stridor
- ) Haemoptysis
- ) Hoarseness
15
Q
What is an aortic dissection?
A
A tear in the intima of the aorta allows blood to be pumped under, creating a false lumen between the layers
16
Q
What is the precursor to dissection?
A
Intramural haematoma
17
Q
What occurs in IMH?
A
Rupture of vasa vasorum in aortic media
18
Q
Who has a predisposition to aortic dissection?
A
Autoimmune rheumatic disease, Marfan syndrome, Ehlers-Danos syndrome
19
Q
What are the 2 ways of classifying aortic dissection?
A
Length of time between onset of symptoms and diagnosis being made, anatomically
20
Q
What are the 2 anatomical types of aortic dissection?
A
Type A (70%), type B (30%)
21
Q
What does type A of aortic dissection involve?
A
Aortic arch and aortic valve proximal to L subclavian artery, includes De Bakey type 1 and 2
22
Q
What does type B of aortic dissection involve?
A
Descending thoracic aorta distal to L subclavian artery, includes De Bakey 3
23
Q
Name 4 symptoms of an aortic dissection
A
- ) Sudden tearing chest pain and possible radiation to back
- ) Hemiplegia
- ) Unequal arm pulses
- ) Unequal BP
- ) Acute limb ischaemia
- ) Paraplegia
- ) Anuria
24
Q
Name 3 other symptoms of an aortic dissection
A
- ) Shock
- ) Neurological
- ) Aortic regurgitation
- ) Inferior MI
- ) Cardiac tamponade
- ) Acute kidney failure
- ) Acute lower limb ischaemia
25
What does a CXR of an aortic dissection show?
Widened mediastinum
26
Which type of aortic dissection should have surgery?
Type A
27
What medical treatment of aortic dissection is there?
Antihypertensives, IV beta blockers (metoprolol), vasodilators (GTN)
28
What is angina?
Condition of chest pain arising from the heart as a result of myocardial ischaemia
29
What is an example of an ischaemic metabolite?
Adenosine
30
What are the 3 main types of angina?
Stable/classic, unstable, Prinzmetal's
31
Which angina is induced by effort and relieved by rest?
Stable/classic
32
Which angina is caused by coronary artery spasm, and when does it occur?
Prinzmetal's, rest
33
What is unstable angina?
Angina of increasing frequency or severity, occurs on minimal exertion or at rest, associated with very increased MI risk
34
When do symptoms occur? (in relation to the lumen)
Diameter of the lumen below 75% of original
35
Name 3 causes for angina
Atherosclerosis, thrombosis, thromboembolism, artery spasm, collateral blood vessels, arteritis
36
What are the pathophysiological steps of angina? (5)
1) Resistance high due to sclerosis
2) Resistance tries to fall in exercise to increase the flow
3) Resistance cannot fall anymore, so flow cannot meet metabolic demand
4) Myocardium becomes ischaemic, pain
5) Resting reduces demand and thus pain
37
Name 5 risk factors for angina
DM, smoking, hyperlipidaemia, hypertension, family history, physical inactivity, stress, sex (male), increasing age, obesity
38
What is the presenting complaint of angina?
Central, crushing, tight/heavy chest pain that may radiate to arms, neck, jaw, teeth
39
What is angina bought on by?
Exertion
40
What is angina relieved by?
Rest
41
What is angina exacerbated by? (3)
Emotion, cold weather, heavy meals
42
What are other symptoms of angina?
Dyspnoea, nausea, sweating, faintness, dizziness
43
What are the criteria of chest pain for angina? (3)
1) Heavy, central chest pain radiating to arms, jaw, neck
2) Bought on by exertion/exercise
3) Relieved by rest/ sublingual GTN spray
44
What scores are given in the chest pain criteria for angina? (3)
3/3 - typical angina
2/3 - atypical angina
<1/3 - non-anginal pain
45
What is the medical treatment for angina?
- ) Statins (if hyperlipidaemia)
- ) Aspirin
- ) GTN nitrate spray for pain
- ) Beta blockers (atenolol, propranolol)
- ) Calcium channel blockers (if b blockers CI)
- ) Anti platelets (clopidogrel)
46
What is the surgical treatment for IHD?
CABG, PCI, PTCA
47
What does CABG stand for?
Coronary artery bypass graft/surgery
48
What does PCI stand for?
Percutaneous coronary intervention
49
What does PTCA stand for?
Percutaneous transluminal coronary angioplasty
50
What 3 conditions does ACS refer to?
STEMI (Q wave infarction), NSTEMI (non Q wave), unstable angina (UA)
51
What is the common pathology of ACS?
Plaque rupture, thrombosis and infarction
52
What are the 2 main differences between an MI and UA?
1) MI has myocardial damage
| 2) MI has rise in serum troponins
53
Name 3 non-modifiable risk factors for ACS
Age, male gender, family history of IHD
54
Name 3 modifiable risk factors for ACS
Smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use
55
What are 2 possible risk factors for ACS?
Stress, type A personality, LVH, raised fibrinogen
56
When does a MI occur?
When there is the death of cardiac myocytes due to prolonged myocardial ischaemia
57
What is troponin?
Protein complex that regulates actin and myosin contraction, highly sensitive marker for cardiac muscle injury, can be positive in other conditions
58
What is the pathophysiology of an MI?
Rupture/erosin of a coronary artery atheromatous plaque can lead to the prolonged occlusion of the coronary artery
59
Name 4 symptoms of an MI
- ) Central crushing chest pain >20 minutes
- ) Sweatin
- ) Breathlessness
- ) Nausea
- ) Vomiting
- ) Restlessness
- ) Pale &grey
- ) Syncope
- ) Pulmonary oedema
60
Name 4 signs of an MI
- ) Distress
- ) Anxiety
- ) Pallor
- ) Raised/lowered pulse
- ) Raised/lowered BP
- ) 4th heart sound
- ) Signs of HF
- ) Pan systolic murmur
- ) Low grade fever
61
What will be seen on an ECG in an MI?
ST elevation (STEMI only), tall peaked T waves, T wave inversion after few hours, pathological Q waves (not always)
62
What does a CXR show in an MI?
Cardiomegaly, pulmonary oedema, wide mediastinum
63
What are the 2 biochemical cardiac markers, and when do they peak in an MI?
1) Cardiac troponin - peaks at 24-48
| 2) Creatinine kinase - peaks at 24
64
Name 3 differential diagnoses of an MI
Angina, pericarditis, myocarditis, PE, aortic dissection
65
What are the 5 mainstays of MI treatment?
1) Symptom control (pain)
2) Modify risk factors
3) Optimise cardioprotective medications
4) Revascularisation
5) Manage complications
66
What 2 drugs do we manage chest pain with?
GTN nitrate PRN and opiates
67
What are the 5 main drugs given in an MI?
1) Antiplatelets (aspirin and clopidogrel)
2) Anticoagulate (fondaparinux)
3) Beta blockers (start low and increase slowly)
4) ACEI or ARB (in LV dysfunction, hypertension, DM)
5) Statin (atorvastatin)
68
What may be given with anti platelets?
PPI for gastric protection
69
What drug may we give if a beta blocker is contraindicated?
Calcium blocker (verapamil or diltiazem)
70
What is the surgical treatment for an MI?
STEMI and high risk NSTEMI - angiography and PCI
71
What should patients with multi vessel disease have in an MI?
CABG
72
Name 5 complications of an MI
Cardiac arrest, cariogenic shock, LV failure, bradyarrhythmias, tachyrrhythmias, RV failure/infarction, percicarditis, systemic embolism, cardiac tamponade, mitral regurgitation, ventricular septal defect, late malignant ventricular arrhythmias, Dressel's syndrome, LV aneurysm
73
Define cardiac failure
The failure of the heart to transport blood out
74
What is cardiogenic shock?
Severe failre
75
What is HFREF and HFPEF?
HFREF - redused ejection fraction HF <40%
| HFPEF - preserved ejection fraction HF >50%
76
What is the most common cause of HF?
Myocardial dysfunction from IHD
77
Name 3 other causes of HF
Hypertension, alcohol excess, cardiomyopathy, valvular disease, anaemia, endocardial disease, pericardial disease
78
What is the pathophysiology of HF?
1) Compensatory mechanisms become overwhelmed
2) CO increases as venous return increases
3) Stretch capability of sarcomeres exceeded
4) Cardiac contraction force diminishes
5) Limit to pericardial contraction
79
Name 4 symptoms of HF
Breathlessness, tiredness, cold peripheries, leg swelling, increased weight
80
Name 4 signs of HF
- ) Tachycardia
- ) Displaced apex beat
- ) Added heart sounds and murmurs
- ) Raised JVP (when R side affected)
- ) Hepatomegaly
- ) Ascites
- ) Oedemas
81
What are the 8 types of HF?
1) Systolic HF
2) Diastolic HF
3) LV failure
4) RV failure
5) Acute HF
6) Chronic HF
7) Low-output HF
8) High-output HF
82
What occurs in systolic HF?
Ventricle is unable to contract properly, reduced CO and EF <40%
83
What occurs in diastolic HF?
Ventricles unable to relax and fill properly, increase in filling pressure, stiffer heart, EF >50%
84
What occurs in LV failure?
LV unable to pump out sufficient blood
85
What occurs in RV failure?
RV unable to pump blood out properly
86
What is congestive cardiac failure?
LV and RV failure together
87
What occurs in acute HF?
New onset acute or decompensation of chronic characterised by pulmonary and/or peripheral oedema +/- peripheral hypoperfusion
88
What occurs in chronic HF?
Progresses slowly, venous congestion common
89
What occurs in low output HF?
CO is decreased and fails to increase normally with exertion
90
What occurs in high output HF
Output is normal or increased in the face of significantly increased demands, normal or somewhat raised CO fails to meet these needs
91
Name 5 symptoms of LV failure
Dyspnoea, nocturnal cough, wheeze, nocturne, cold peripheries, muscle wasting, weight loss
92
Name 5 symptoms of RV failure
Peripheral oedema, ascites, nausea, anorexia, facial engorgement, neck and face pulsation, epistaxis
93
Name 3 causes of RV failure
LVF, pulmonary stenosis, lung disease
94
What are the 4 classes of HF?
Class I - no limitation, asymptomatic
Class II - slight limitation, mild
Class III - marked limitation, moderate
Class IV - inability to carry out any physical activity without discomfort, severe
95
What are the 4 stages of HF?
A - high risk of HF
B - asymptomatic HF
C - symptomatic HF
D - end stage HF
96
What are the major Framingham criteria for the diagnosis of HF? (8)
```
SAW PANIC
S3 heart sound
Acute pulmonary oedema
Weight loss
Paroxysmal nocturnal dyspnoea
Abdominojugular reflux
Neck vein distension
Increased cardiac shadow on XR
Crepitation
```
97
What are the minor Framingham criteria for the diagnosis of HF? (7)
```
HEART ViNo
Hepatomegaly
Effusion
Ankle oedema, bilateral
Exceptional dyspnoea
Tachycardia
Vital capacity decreased by 1/3
Nocturnal cough
```
98
What shows on a CXR of HF?
```
ABCDE
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
```
99
What do we look for in bloods in HF?
B type natriuretic peptide, BNP
100
If ECG and BNP are normal, is HF likely?
No
101
What further test should be done with abnormal ECG and BNP?
Echo
102
What are the 4 parts of non medical treatment of HF?
Lifestyle changes, treatment of underlying cause, treatment of exacerbating factors, avoidance of exacerbating factors
103
What are the 6 drugs that should be given in HF?
1) Diuretics (loop, furosemide)
2) ACE-I or ARB
3) Beta-blockers (start low and go slow, carvedilol)
4) Mineralocorticoid receptor antagonists (still symptomatic, spironolactone)
5) Digoxin
6) Vasodilators (if intolerant to ACE-I and ARBs, hydrazine and isorbide dinatrate)
104
Give an example of a K+ sparing diuretic
Spironolactone
105
Give an example of a thiazide diuretic
Metolazone
106
What is the Fontan procedure?
Palliative surgical procedure for hearts with only one useable ventricle
107
What is a bicuspid aortic valve associated with? (2)
Coarctation and dilation of the ascending aorta, predisposition to IE
108
What is an atrial septal defect?
A hole in the septum that connects the artia
109
What are the 3 main types of atrial septal defect?
Primum, secundum, sinus venosus
110
What are secundum defects?
Most common, high up in septum
111
Which direction is the shunt in secundum defects?
L to R (not blue!) because pressure in LA is higher than in RA
112
Name 4 symptoms for atrial septal defects
- ) Dyspnoea
- ) Hypertension
- ) Cyanosis
- ) Arrhythmia
- ) Haemoptysis
- ) Chest pain
- ) Pulmonary flow murmur
- ) Fixed split-second heart sound (lub dub dub)
113
What 3 things are seen on a CXR for atrial septal defects?
Big pulmonary arteries, big heart, small aortic knuckle
114
What does the ECG for atrial septal defects show? (primum and secundum)
Primum - RBBB with L axis deviation and prolonged PR interval
Secundum - R atrial deviation
115
What symptoms does a large hole have (atrial septal defect) that a small hole doesn't?
SOBOE, increased chest infections
116
What is a complication of atrial septal defects?
Eisenmenger's complex
117
What is a ventricular septal defect?
A hole in the septum that connects the ventricles
118
What are the symptoms of a small ventricular septal defect?
Asymptomatic, signs of loud systolic murmur and thrill
119
What are the symptoms of a large ventricular septal defect?
Very high pulmonary blood flow, breathlessness, poor feeding, failure to thrive, increased resp rate, tachycardia, big heart on CXR
120
Which direction is the shunt in ventricular septal defects?
L to R
121
What are atrio-ventricular septal defects?
Holes in the centre of the heart, involving ventricular and atrial septum and mitral and tricuspid valves
122
What are the 2 types of atrio-ventricular septal defects?
1) Complete
| 2) Partial
123
What are the symptoms of a complete atrio-ventricular septal defect?
Breathlessness, poor weight gain, poor feeding
124
When does a partial atrio-ventricular septal defect present?
Late adulthood
125
What are the 3 locations for an atrio-ventricular septal defect to be?
1) Interatrial
2) Interatrial and interventricular
3) Interventricular
126
In what syndrome do atrio-ventricular septal defects often occur?
Down's syndrome
127
What is coarctation of the aorta?
Congenital narrowing of the descending aorta
128
Where does a coarctation of the aorta usually occur?
Just distal to the origin of the L subclavian artery (at the site of insertion of the ductus arteriosus)
129
What is coarctation of the aorta associated with? (2)
Bicuspid aortic valve and Turner's syndrome
130
What does severe coarctation of the aorta present with?
Collapse with HF
131
What does mild coarctation of the aorta present with?
Hypertension, incidental murmur
132
How do we repair coarctation of the aorta?
Surgery or balloon and stenting
133
Name 3 clinical signs of coarctation of the aorta
1) R arm hypertension
2) Bruits (buzzes) over scapulae and back
3) Murmur
4) Radiofemoral delay and weak femoral pulse
134
Name 3 long term problems of coarctation of the aorta
1) Hypertension (CAD, strokes, sub arachnoid haemorrhage)
2) Re-coarctation
3) Aneurysm formation at site of repair
135
What is tetralogy of Fallot?
Most common cyanotic congenital heart disorder, due to abnormalities in separation of truncus arteriosis into the aorta and pulmonary arteries
136
What are the 4 features of tetralogy of Fallot?
1) Ventricular septal defect
2) Pulmonary stenosis
3) RVH
4) Aorta overriding the septal defect
137
Which way is the shunt in tetralogy of Fallot?
R to L
138
Is tetralogy of Fallot cyanotic (blue?)
YES
139
Name 4 symptoms of tetralogy of Fallot
Child - restless, agitated, squatting, difficulty feeling, clubbing, failure to thrive
140
What does an ECG show in tetralogy of Fallot?
RVH with RBBB
141
What is the classic sign of tetralogy of Fallot on a CXR/echo?
Boot shaped heart
142
How do we treat tetralogy of Fallot? (5)
1) Oxygen
2) Place patient in knee to chest position (increases peripheral vascular resistance and decreases shunt)
3) Morphine (relaxes pulmonary outflow)
4) Long term beta blockers
5) Surgical repair with Blalock-Taussig shunt
143
What is Eisenmenger's syndrome?
Reversal of shunt direction to R to L
144
Why does Eisenmenger's syndrome occur?
High pressure pulmonary blood flow, resistance to blood flow to lung increases, RV pressure increases
145
What colour is the patient in Eisenmenger's syndrome?
Blue
146
What is a patent ductus arteriosus?
Ductus arteriosus (between aortic arch and pulmonary artery) doesn't close
147
What are 2 clinical signs of a patent ductus arteriosus?
Continuous 'machinery' murmur, Eisenmenger's syndrome
148
What is pulmonary stenosis?
Narrowing of the outflow of the R ventricle
149
What are the 4 types of pulmonary stenosis?
1) Valvar
2) Sub valvar
3) Supra valvar
4) Branch
150
What are the symptoms and signs of a severe pulmonary stenosis?
RV failure as neonate, collapse, poor pulmonary blood flow, RVH, tricuspid regurgitation
151
What are 2 methods of treating pulmonary stenosis?
Balloon valvuloplasty, shunt
152
What is Marfan's syndrome?
Connective tissue disorder with a decrease in extracellular microfibril formation and poor elastic fibres
153
What are the 4 major diagnostic criteria for Marfan's syndrome?
1) Lens dislocation
2) Aortic dissection or dilatation
3) Dural ectasia
4) Skeletal features (arachnodactyly, arm span > height, pectus deformity, scoliosis)
154
How many major criteria are needed for a diagnosis of Marfan's?
2
155
What are 3 minor signs of Marfan's syndrome?
1) Mitral valve prolapse
2) Joint hypermobility
3) High arched palate
156
What is the treatment of Marfan's syndrome?
Beta blockers to slow dilatation, annual echos, elective surgical repair when aorta >5cm
157
What gene causes Marfan's syndrome?
Autosomal dominant fibrillin gene FBN1
158
Name 4 causes of mitral stenosis
- ) Rheumatic fever
- ) Infection with group A beta-haemolytic streptococcus
- ) Congenital
- ) Prosthetic valve
- ) Mucopolysaccharidoses
- ) Endocardial fibroelastosis
- ) Malignant carcinoid tumours
159
What are the steps of pathogenesis in mitral stenosis? (6)
1) Inflammation
2) Mitral thickening
3) Cusp fusion
4) Calcium deposition
5) Severely narrowed valve orifice
6) Progressive immobility of valve cusps
160
What do compensatory mechanisms in mitral stenosis lead to?
Compensatory mechanisms of increased LA pressure leads to LA hypertrophy and dilatation, thus pulmonary venous, pulmonary arterial, and right heart pressures also increase
161
What can the increase in pulmonary capillary pressure in mitral stenosis lead to?
Pulmonary oedema, particularly when there is AF with tachycardia
162
What does pulmonary hypertension lead to in mitral stenosis?
RVH, dilatation and failure with subsequent tricuspid regurgitation
163
When do symptoms begin in mitral valve stenosis? (size)
<2cm^2
164
Name 5 symptoms of mitral valve stenosis
Dyspnoea, fatigue, palpitations, chest pain, systemic emboli, haemoptysis, cough, chronic bronchitis like picture
165
Name 4 signs of mitral stenosis
1) Malar flush on cheeks
2) Low volume pulse
3) Palpable S1, opening snap, mid diastolic murmur
4) Right HF
166
What may a CXR in mitral stenosis show?
- ) LA enlargement
- ) Pulmonary oedema
- ) Calcification of valve
167
What does an ECG show in mitral stenosis?
P-mitrale (bifid P wave) if sinus rhythm, features of RVH, right axis deviation and tall R waves, AF common
168
What is the diagnostic test for mitral stenosis?
Echocardiography
169
What are the medical treatments of mitral stenosis? (4)
1) Management of rate control in AF
2) Anticoagulation with warfarin
3) Diuretics (to decrease preload)
4) Penicillin as prophylaxis against rheumatic fever
170
What are the surgical treatment of mitral stenosis?
1) Cardiac catheterisation
2) Balloon valvuloplasty
3) Open mitral valvotomy/valve replacement
171
What is mitral regurgitation?
Mitral valve doesn't close properly
172
Name 4 causes of mitral regurgitation
- ) Degenerative diseases
- ) IHD
- ) Rheumatic heart disease
- ) IE
- ) Diseases of the myocardium (DCM and HCM)
- ) Rheumatic autoimmune diseases (SLE)
- ) Collagen diseases (Marfan's, Ehlers-Danos)
- ) Drug disorders
173
How is mitral regurgitation accommodated for over time?
Large LA
174
Why is there an enlarged LV in mitral regurgitation?
1) Proportion of stroke volume being regurgitated
| 2) SV increases to maintain CO
175
What are 4 symptoms of mitral regurgitation?
- ) Dyspnoea
- ) Orthopnoea
- ) Fatigue and lethargy
- ) Palpitations
176
What are 4 signs of mitral regurgitation?
- ) IE
- ) AF
- ) Displaced apex beat
- ) RV heave
- ) Soft S1
- ) Cardiac cachexia
177
What are 3 signs of mitral regurgitation on a CXR?
1) Big LA and LV
2) Mitral valve calcification
3) Pulmonary oedema
178
What 2 other tests are used in mitral regurgitation?
- ) Echocardiogram (LV function and aetiology)
| - ) Doppler echo (size and site of regurgitant jet)
179
What is used to confirm diagnosis in mitral regurgitation?
Cardiac catheterisation
180
What are 4 options of treatment for mitral regurgitation?
- ) Rate control if AF
- ) Anticoagulants
- ) Diuretics
- ) Surgery - repair/replace valve
181
What is aortic stenosis?
Narrowing of orifice from LV to aorta
182
What does aortic stenosis include?
- ) Calcific stenosis of a tricuspid aortic valve
- ) Stenosis of a congenitally defected bicuspid valve
- ) Rheumatic stenosis
183
What are the 3 most common causes of aortic stenosis?
1) Calcific aortic valve disease (CAVD)
2) Bicuspid aortic valve (BAD)
3) Rheumatic fever
184
Name 2 other causes of aortic stenosis
- ) CKD
- ) Paget's disease of bone
- ) Previous radiation exposure
- ) SLE
185
Why does compensatory LVH occur in aortic stenosis?
Obstruction to LV emptying causes an increase in LV pressure
186
Name 4 symptoms of aortic stenosis
1) Exercise induced syncope
2) Angina
3) Dyspnoea
4) Chest pain
187
Name 4 signs of aortic stenosis
1) HF
2) Systemic emboli (if IE)
3) Slow rising pulse
4) Narrow pulse pressure
5) Heaving, non-displaced apex beat
6) LV heave
7) Aortic thrill
8) Ejection systolic murmur
188
What does an ECG show in aortic stenosis? (5)
P-mitrale, LVH, poor R wave progression, LBBB, complete AV block
189
What does a CXR show in aortic stenosis? (3)
LVH, calcified aortic valve, post-stenotic dilatation of ascending aorta
190
What test is used for diagnosis in aortic stenosis?
Echocardiogram
191
What is the treatment for aortic stenosis?
Valve replacement
192
What is acute aortic regurgitation caused by?
IE, ascending aortic dissection, chest trauma
193
What is chronic aortic regurgitation caused by?
Congenital, connective tissue disorders, rheumatic fever/arthritis, Takayasu arteritis, SLE, hypertension
194
Name 2 symptoms of aortic regurgitation
Exertional dyspnoea, orthopoena, palpitations, angina, syncope
195
Name 3 signs of aortic regurgitation
Collapsing pusle, wide pulse pressure, displaced hyper dynamic apex beat, high pitched early diastolic murmur
196
What does an ECG show in aortic regurgitation?
LVH
197
What does CXR show in aortic regurgitation?
Dilated ascending aorta, pulmonary oedema
198
Which test is diagnostic in aortic regurgitation?
Echocardiography
199
What is the medical treatment of aortic regurgitation?
ACEI, echo to monitor
200
What is the surgical treatment of aortic regurgitation?
Replace valve before significant LV dysfunction
201
What is a cardiomyopathy?
A disease that affects the heart's mechanical and electrical function
202
What are the 3 types of cardiomyopathy?
1) Hypertrophic cardiomyopathy (HCM)
2) Arrhythmogenic cardiomyopathies (ACMs)
3) Dilated cardiomyopathy (DCM)
203
What is the genetic cause of HCM?
Sarcometric protein gene mutations
204
Which part of the heart does HCM generally affect?
Septum
205
Which cardiomyopathy is the most common cause of sudden cardiac death in young people?
HCM
206
Name 4 symptoms of HCM
- ) Many asymptomatic
- ) Angina
- ) Dyspnoea
- ) Palpitations
- ) Dizzy spells
- ) Syncope
- ) Jerky carotid pulse sign and ejection systolic murmur in LVOT obstruction
- ) Temporary tachycardia
207
What does an ECG show in HCM?
LVH, ST and T wave changes, abnormal Q waves in inferolateral leads
208
What does an echo show in HCM?
Classically asymmetrical LVH involving septum more than posterior wall, systolic anterior motion of mitral valve, vigorously contacting ventricle
209
If a patient has 2 or more risk factors for sudden cardiac death, what should they be given in HCM?
Implantable cardiverter defibrillator (ICD)
210
If a patient has 1 or no risk factors for sudden cardiac death, what should they be given in HCM?
Amiodarone
211
What 3 drugs should be given in HCM?
1) Beta-blockers
2) Verapamil
3) Anticoagulants
212
What is ACM?
Rare inherited condition that predominantly affects the RV with fatty/fibro-fatty replacement of the myocytes, resulting in dilatation
213
75% of cases of ACM also involve which part of the heart?
LV
214
What is the genetic cause of ACM?
Desmosome protein gene mutations
215
Name 4 symptoms of ACM
- ) Asymptomatic
- ) Ventricular arrhythmia
- ) Syncope
- ) Sudden death
- ) Symptoms and signs of right HF
216
What does an ECG and ECHO show in ACM?
ECG - usually normal, may show T wave inversion of small amplitude waves at end of QRS complex
ECHO - usually normal, more advanced cases may show RV dilatation and aneurysm formation
217
Clinical diagnosis is made with which 5 criteria for ACM?
1) Structural abnormalities of RB and RVOT
2) Fibro-fatty replacement of myocytes on tissue biopsy
3) Repolarisation and conduction abnormalities on ECG
4) Ventricular tachycardia
5) FHx of ACM/sudden premature death due to ACM
218
What are the 2 medical treatment for ACM?
Betablockers and amiodarone (for symptomatic)
219
What are the 2 surgical treatments for ACM?
ICD, heart transplant
220
What is DCM characterised by?
Dilatation of ventricular chambers and systolic dysfunction with preserved wall thickness
221
What is the heart like in DCM? (2)
1) Contractibility impaired
| 2) Enlarged, heavy, dilated heart
222
Is HCM autosomal dominant or recessive?
Dominant
223
Is DCM autosomal dominant or recessive?
Dominant
224
What is the genetic cause of DCM?
Cytoskeletal gene mutations
225
Name 4 symptoms DCM can present with
- ) Fatigue
- ) Dyspnoea
- ) Pulmonary oedema
- ) RVF
- ) Emboli
- ) AF
226
What does an ECG show in DCM?
Tachycardia, non-specific T wave changes, poor R wave progression
227
What does a CXR show in DCM?
Generalised cardiac enlargement
228
Name 5 signs of DCM
- ) Increased pulse
- ) Decreased BP
- ) Increased JVP
- ) Diffuse and displaced apex
- ) S3 gallop
- ) Mitral/tricuspid regurgitation
- ) Pleural effusion
- ) Oedema
- ) Jaundice
- ) Hepatomegaly
- ) Ascites
229
What is the treatment in DCM?
Diuretics, ACEI, anticoagulants, pacemakers, ICDs, transplantation
230
What is acute pericarditis?
Inflammation of the pericardium
231
Name 4 secondary causes of acute pericarditis
- ) Viruses (coxsackie, echovirus, EBV, adenovirus, HIV)
- ) Bacteria (TB, staph aureus)
- ) Fungi and parastitis
- ) Autoimmune (SLE, RA)
- ) Drugs (chemo, penicillin)
- ) Metabolic
- ) Other (trauma, surgery, malignancy, radio, chronic HF, MI)
232
What does acute pericarditis present as?
Central chest pain worse on inspiration or lying flat and relief by sitting forwards
233
What is the classic clinical sign of acute pericarditis?
Pericardial friction rub
234
What does an ECG show in acute pericarditis?
Concave ST segment and PR depression
235
What may a CXR show in acute pericarditis?
Cardiomegaly, indicates pleural effusion
236
A diagnosis for acute pericarditis is made from 2/3 of
1) Chest pain
2) Friction rub
3) ECG changes
237
What is the treatment for acute pericarditis?
NSAIDs/aspirin with PPI, steroids if not effective
238
What is a pericardial effusion?
Accumulation f fluid in the pericardial sac
239
What is cardiac tamponade?
A pericardial effusion that raises intrapericardial pressure, reducing ventricular filling and thus dropping CO
240
What are 3 causes of pericardial effusions?
- ) Pericarditis
- ) Myocardial rupture
- ) Aortic dissection
- ) Pericardium filling with pus
- ) Malignancy
241
What are 3 clinical features of a pericardial effusion?
- ) Dyspnoea
- ) Chest pain
- ) Compression symptoms (hiccoughs, nausea)
242
What are 4 signs of cardiac tamponade?
- ) Increased pulse
- ) Decreased BP
- ) Pulsus paradoxus
- ) Increased JVP
- ) Kussmaul's sign (rise in JVP/neck distension on inspiration)
- ) Muffled S1 and S2
243
What does a CXR show in a pleural effusion?
Enlarged globular heart
244
What does an ECG show in a pleural effusion?
Low voltage QRS complexes, possibly electrical alternans/alternating QRS morphologies
245
What is a diagnostic test for a pleural effusion?
Pericardiocentesis (removal of fluid)
246
What is the treatment for a pleural effusion?
Treat cause
247
What is the treatment for cardiac tamponade?
Periardiocentesis
248
What is constrictive pericarditis?
The heart is encased in a rigid pericardium
249
What are the causes of constrictive pericarditis?
Unknown, TB, after any pericarditis
250
Name 4 signs of constrictive pericarditis
- ) Right HF with increased JVP
- ) Kussmaul's sign
- ) Soft, diffuse apex beat
- ) Quiet heart sounds
- ) S3
- ) Hepatsplenomegaly
- ) Ascites
- ) Oedema
- ) Diastolic pericardial knock
251
What does a CXR show in constrictive pericarditis?
Small heart +/- pericardial calcification
252
What is the treatment for constrictive pericarditis?
Surgical excision of pericardium
253
What is the most important risk factor for premature death and CVD?
Hypertension
254
What is the diagnostic definition of hypertension?
BP >140/90mmHg on >2 readings on separate occasions
255
What % of cases are primary/essential hypertension, and what is their cause?
95%, unknown
256
What are the main causes of secondary hypertension? (3)
- ) Renal disease (glomeruloneprhtis, poly arthritis nods, sclerosis, PKD)
- ) Endocrine disease (Cushing's, Conn's, hyperPTH)
- ) Coartation, pregnancy, liquorice, drugs (steroids, pill, cocaine)
257
Name 5 risk factors for hypertension
- ) Older age
- ) FHx
- ) Male sex
- ) Afro-Caribbean origin
- ) High salt
- ) Sedentary lifestyle
- ) Obesity
- ) Smoking
- ) Excess alcohol
258
What are the symptoms of hypertension?
Asymptomatic! Except in malignant hypertension
259
How do we find hypertension?
Signs of underlying cause, look for end organ damage and retinopathy
260
What is malignant/accelerated phase hypertension?
A rapid rise in BP leading to vascular damage (pathological hallmark is fibrinoid necrosis)
261
What 2 things can confirm diagnosis of hypertension?
Ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM)
262
What are the clinic BPs at stage 1, 2 and severe hypertension?
Stage 1 - >140/90
Stage 2 - >160/100
Severe - systolic >180 and/or diastolic >110
263
What are the ABPMs at stage 1, 2 and severe hypertension?
Stage 1 - >135/85
Stage 2 - >150/95
Severe - >180/110
264
What other tests are there for hypertension?
- ) Fasting glucose and cholesterol (overall risk)
- ) ECG (organ damage)
- ) U&Es (cause)
265
What clinic BP should a patient have to be treated for hypertension?
>160/100 or >140/90 with other risk factors
266
What is our treatment BP goal in hypertension?
<140/90mmHg
267
What is the treatment for hypertension in >55s or Afro-Caribbeans?
Calcium channel blockers (amlopidine, nifedipine)
268
What is the treatment for hypertension in <55s?
ACE-I (lisinopril) or ARB (candesartan)
269
If intolerance or CI to ACEI/ARB, what do we give to treat hypertension?
Beta blockers (bisoprolol)
270
What do we give if BP is uncontrolled in hypertension treatment?
ACEI and calcium channel blocker/diuretic (cholartalidone)
271
What is peripheral vascular disease caused by?
Atherosclerosis
272
What are the 4 stages of the Fontine classification system for peripheral artery disease?
I - asymptomatic
II - intermittent claudication
III - ischaemic rest pain
IV- ulceration/necrosis/gangrene (critical)
273
What are 4 symptoms and signs of chronic lower limb ischaemia?
- ) Exertional discomfort relieved by rest
- ) Pain in calf, bottom, thigh
- ) Possible erectile dysfunction
- ) Severe pain in foot that stops from sleeping
- ) Cold lower limbs
- ) Dry skin, no hair
- ) Diminished/absent pulses
274
What is the treatment of chronic lower limb ischaemia?
- ) Lifestyle modification
- ) Cilostazol (phosphodiesterase III inhibitor increases cAMP levels, causes vasodilation, inhibits platelet aggregation)
- ) PCTA in severe disease
- ) Amputation
275
What is acute lower limb ischaemia often due to?
Thrombus in situ or an embolus
276
What are the symptoms of acute lower limb ischaemia?
```
6Ps!!!!
Pale
Pulseless
Pain
Paralysed
Paraesthesia
Perishingly cold
```
277
What is the treatment for acute lower limb ischaemia? (2)
Surgery - angioplasty, embolectomy, local thrombolysis
| Medical - anticoagulant with heparin
278
Is acute lower limb ischaemia a medical emergency?
Yes
279
What is shock?
Circulatory failure resulting in inadequate organ perfusion
280
What is shock often defined as?
Systolic BP <90mmHg or MAP <65mmHg
281
What can shock result from, using an equation?
MAP = CO x SVR (systemic vascular resistance)
1) Reduction in CO
2) Loss of SVR
3) Both
282
What 2 things can cause a reduction in CO?
1) Hypovolaemia (bleeding/fluid loss)
| 2) Pump failure (cariogenic shock/secondary causes)
283
What can cause a loss of SVR? (5)
1) Sepsis
2) Anaphylaxis
3) Neurogenic
4) Endocrine failure
5) Drugs (anaesthetics, antihypertensives, cyanide poisoning)
284
How do we assess shock?
ABCDE
285
What type of shock does cold and clammy suggest?
Cardiogenic
286
What type of shock does warm and well perfused with bounding pulse points suggest?
Septic
287
What typeof shock does a wheeze suggest?
Anaphylactic
288
What is sepsis?
Life threatening organ dysfunction caused by a dysregulated host response to infection
289
What is the key to treating sepsis?
Early recognition!
290
What is the management of septic shock?
- ) Broad spectrum antibiotics within 1hr (tazocin with gentamicin)
- ) Fluids within 1hr
- ) Give fluid boluses of crystalloids
- ) Oxygen as required
291
What is anaphylactic shock?
A type 1 IgE-mediated hypersensitivity reaction
292
What does the release of histamine and other agents cause in anaphylactic shock?
Capillary leak, wheeze, cyanosis, oedema (lips, tongue, eyelids, larynx) and urticarial (rash)
293
Give 3 examples of precipitants of anaphylactic shock
- ) Drugs (penicillin)
- ) Latex
- ) Stings
- ) Eggs
- ) Fish
- ) Peanuts
- ) Strawberries
- ) Semen (rare)
294
Give 5 signs and symptoms of anaphylactic shock
- ) Itching
- ) Sweating
- ) Diarrhoea and vomiting
- ) Erythema
- ) Urticaria
- ) Oedema
- ) Wheeze
- ) Laryngeal obstruction
- ) Cyanosis
- ) Tachycardia
- ) Hypotension
295
What are the management steps of anaphylactic shock? (8)
1) Secure airway and give 100% O2
2) Remove cause and raise feet to improve circulation
3) Give adrenaline IM and repeat every 5 mins as needed (resp and BP guided)
4) Secure IV access
5) Chlorphenamine and hydrocortisone (antihist and steroid)
6) IV fluid if needed
7) Salbutamol if asthma
8) Admission if still hypotensive
296
What does neurogenic shock result from?
Spinal cord injury, epidural or spinal anaesthesia
297
Give 4 symptoms/signs of neurogenic shock
- ) Hypotension
- ) Warm flushed skin
- ) Low BP
- ) Priapism
- ) Bradycardia
- ) Diaphragmatic breathing if below C5
- ) Respiratory arrest if above C3
298
What are the 4 drugs given for neurogenic shock?
1) Dopamine
2) Vasopressin
3) Noradrenaline
4) Atropine (bradycardia)
299
What is cardiogenic shock?
A stat of inadequate tissue perfusion primarily due to cardiac dysfunction
300
Give 5 causes of cardiogenic shock
- ) MI
- ) Arrhythmias
- ) Pulmonary embolus
- ) Tension pneumothorax
- ) Cardiac tamponade
- ) Myocarditis
- ) Valve destruction
- ) Aortic dissection
301
What are the management steps for cardiogenic shock? (8)
1) MI treatment
2) Oxygen
3) Dimorphine IV
4) Investigations and monitoring
5) Correct arrhythmias, U&E abnormalities
6) Optimise filling pressure
7a) If underfilled, use a plasma expander
7b) If overfilled, give inotropic support
8) Look for and treat cause
302
What is haemorrhagic shock?
Type of hypovolaemic shock that occurs from bleeding
303
What are the management steps for haemorrhagic shock? (4)
1) Stop bleeding if possible
2) Give fluid bolus and repeat if needed
3) If still in shock, crossmatch blood
4) Give fresh frozen plasma with red cells
304
What is infective endocarditis?
Infection of endocardial lined cardiovascular structures
305
Give 3 examples of endocardial lined cardiovascular structures
- ) Cardiac valves
- ) Atrial and ventricular endocardium
- ) Large intrathoracic vessels
- ) Intracardiac foreign bodies (prosthetic valves, pacemaker leads)
306
What is the most common organism in acute IE?
Staph. aureus
307
Name 4 risk factors for acute IE
Skin breaches, renal failure, immunosuppression, DM
308
Name 4 risk factors for subacute IE
Aortic/mitral valve disease, tricuspid valves in IVDU, coarctation, patent ductus arteriosus, VSD, prosthetic valves
309
Which type of valves are in acute/subacute IE?
Acute - normal
| Subacute - abnormal
310
What is the most common organism in subacute IE?
Strep. viridans
311
Give an example of a fungi in IE
Candida
312
Why is there an increased risk of IE with abnormal valves or previous IE?
Damaged endocardium promotes platelet and fibrin deposition
313
Give 4 symptoms/signs of IE
- ) Septic signs
- ) New murmer/change in murmur
- ) Roth spots, splinter haemorrhages, Osler's nodes
- ) Janeway lesions
- ) Embolic events
- ) Neurological dysfunction
- ) Splenomegaly, petechiae, clubbing
314
Give 5 septic signs
Fever, riggers, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing
315
Whose criteria do we use to diagnose IE?
Duke's
316
What are the 2 Duke's major criteria to diagnose IE?
1) Positive blood culture (2 separate cultures)
| 2) Endocardium involvement (positive echocardiogram etc)
317
What are the 5 Duke's minor criteria to diagnose IE?
1) Predisposition
2) Fever >38'C
3) Vascular phenomena
4) Immunological phenomena
5) Positive blood culture (not major)
318
How many of each Duke's criteria do we need to diagnose IE?
- ) 2 major
- ) 1 major and 3 minor
- ) 5 minor
319
Is TTE or TOE more sensitive and thus better for diagnosing IE?
TOE
320
What does TTE stand for?
Transthoracic echo
321
What does TOE stand for?
Transoesophageal echo
322
What do blood tests show in IE?
Anaemia, neutrophilic, high ESR?CRP, RH
323
What drug do we give to treat IE?
Antibiotics
1) Native/old prosthetic valve - ampicillin, flucloxacillin and gentamicin
2) Prosthetic valve - vancomycin, gentamicin, rifampicin
324
Give 4 reasons a patient may need surgery to treat IE
- ) HF
- ) Valvular obstruction
- ) Repeated emboli
- ) Fungal IE
- ) Persistent bacteraemia
- ) Myocardial abscess
- ) Unstable infected prosthetic valve
325
What is the organism in rheumatic fever?
Lancefield group A beta haemolytic streptococci
326
What is the pathogenesis of rheumatic fever?
An antibody to the carbohydrate cell wall of he streptococcus cross-reacts with valve tissue
327
How do we diagnose rheumatic fever?
With evidence of a recent strep infection plus 2 major criteria/1 major and 2 minor
328
What is rheumatic fever a risk factor for/predisposer to?
IE
329
What is myocarditis?
Inflammation of the myocardium
330
What is myocarditis often associated with?
Pericardial inflammation (myopericarditis)
331
Give 3 causes of myocarditis
- ) Idiopathic
- ) Viral
- ) Bacteria
- ) Spirochaetes
- ) Protozoa
- ) Drugs
- ) Toxins
- ) Immunological
332
Give 2 symptoms of myocarditis
ACS-like symptoms, HF symptoms, palpitations, tachycardia, soft S1, S3 gallop
333
What does an ECG show in myocarditis?
ST changes and T wave inversion, atrial arrhythmias, transient AV block, QT prolongation
334
What is the gold standard for diagnosis of myocarditis?
Endomyocardial biopsy
335
What is a channelopathy?
An inherited arrhythmia caused by ion channel protein gene mutations (K, Na, Ca)
336
What are channelopathies associated with? (2)
1) Long QT syndrome
| 2) Brugada syndrome
337
Which is the most common cardiac tumour?
Cardiac myxoma
338
What sort of symptoms does a cardiac myxoma usually produce?
Obstructive
339
Where does a cardiac myxoma show bias towards?
Atria
340
What is atheroma?
Degeneration of the walls of arteries caused by accumulated fatty deposits and scar tissue
341
What is atherosclerosis?
Disease where there is hardening and narrowing of the artery due to plaques
342
What are 2 ways a plaque can cause damage?
1) Angina - occludes vessel lumen resulting in restriction of blood flow
2) Thrombus formation - rupture
343
What is an atheromatous plaque characterised by?
Distorted endothelial surface containing lymphocytes, macrophages, smooth muscle cells and a variably complete endothelial surface
344
What are the 3 things the distribution of plaques is governed by?
1) Changes in flow turbulence
2) Wall thickness changes
3) Altered gene expression in the key cell types
345
What are the steps of the progression of atherosclerosis? (5)
1) Fatty streaks
2) Intermediate lesions
3) Fibrous plaques/advanced lesions
4) Plaque rupture
5) Plaque erosion
346
Give 3 complications of a plaque rupture
Acute occlusion, chronic narrowing, aneurysm change, embolism of thrombus
347
What is vasculitis?
An inflammatory and variably necrotic progress centred on blood vessels
348
What is vasculitis initiated by?
Viral infection
349
What 2 features of vasculitis are immune related?
1) Deposition of immune complexes
| 2) Direct attack on vessels by antibodies
350
What is an arrhythmia?
Disturbance of cardiac rhythm
351
Give 4 common presentations of arrhythmias
- ) Palpitations
- ) Chest pain
- ) Presyncope/syncope
- ) Hypotension
- ) Pulmonary oedema
- ) Asymptomatic (AF)
352
Give 4 cardiac causes of arrhythmias
- ) IHD
- ) Structural changes
- ) Cardiomyopathy
- ) Pericarditis
- ) Myocarditis
- ) Aberrant conduction pathways
353
Give 4 non cardiac causes of arrhythmias
- ) Caffeine
- ) Smoking
- ) Alcohol
- ) Pneumonia
- ) Drugs
- ) Metabolic imbalance
354
Give 2 tests we do for arrhythmias
1) 24 hour ECG monitoring
| 2) Echo - structural heart disease
355
What can we look for on an ECG for arrhythmias?
Signs of IHD, AF, short PR interval, long QT interval, U waves
356
What is a narrow complex tachycardia?
Rate of >100bpm and QRS complex duration of <120ms
357
What can be given to slow the ventricular rate so we can see the ECG more clearly?
Adenosine
358
What is a broad complex tachycardia?
Rate of >100 and QRS complexes >120ms
359
What is atrial fibrillation?
A chaiotic, irregular atrial rhythm at 300-600bpm
360
Give 3 causes of AF
HF, hypertension, IHD, PE, mitral valve disease, pneumonia, hyperthyroidism, caffeine, alcohol, post op, decreased K, decreased Mg
361
What type of pulse does AF have?
Irregularly irregular
362
What does an ECG show in AF?
Absent P waves, irregular QRS complexes
363
What do we use to rate control chronic AF?
Beta blocker or rate limiting calcium blocker
364
Which artery does lead I lateral relate to?
Circumflex artery
365
Which artery does lead V1 septal relate to?
Left anterior descending artery
366
Which artery does lead V4 anterior relate to?
Right coronary artery
367
Which artery does lead II inferior relate to?
Right coronary artery
368
Which artery does lead aVL lateral relate to?
Circumflex artery
369
Which artery does lead V2 septal relate to?
Left anterior descending artery
370
Which artery does lead V5 lateral relate to?
Circumflex artery
371
Which artery does lead III inferior relate to?
Right coronary artery
372
Which artery does lead aVF inferior relate to?
Right coronary artery
373
Which artery does lead V3 anterior relate to?
Right coronary artery
374
Which artery does lead V6 lateral relate to?
Circumflex artery
375
What is a tachycardia's rate?
>100bpm
376
What is a bradycardia's rate?
<60bpm
377
What is heart block?
Disrupted passage of electrical impulses through AVN
378
What are the 4 types of heart block?
1) 1st degree
2) 2nd degree (Mobitz I)
3) 2nd degree (Mobitz II)
4) 3rd degree (complete HB)
379
What is 1st degree HB?
The PR interval is prolonged and unchanging, no missed beats
| If the R is far from the P, then you have a first degree!
380
What is 2nd degree Mobitz I HB?
PR interval becomes longer and longer until a QRS is misses, then resets, Wenckebach phenomenon
Longer, longer, longer drop! Then you have a Wenckebach
381
What is a 2nd degree Mobitz II HB?
QRS regularly missed, may progress to complete HB, due to loss of conduction in bundle of His and Purkinje fibres
If some Ps don't get through, then you have Mobitz II!
382
What is a 3rd degree HB?
No impulses are passed from the atria to the ventricle, P waves and QRSs appear independently of each other
If Ps and Qs don't agree, then you have a 3rd degree!
383
What type of rhythm is there in 3rd degree HB?
Bradycardic
384
What pattern is in a LBBB?
wiLLiam
| W and M pattern
385
What is LBBB caused by?
IHD, hypertension, cardiomyopathy, idiopathic fibrosis
386
What pattern is RBBB?
maRRow
| M and W pattern
387
What is RBBB caused by?
Normal variants, pulmonary embolisms, cor pulmonale
388
What are ectopic beats?
Most common arrhythmia, types of palpitations, generally benign
389
What can high burden ventricular ectopics cause?
HF
390
What can high burden atrial ectopics progress to?
AF
391
Is atrial or ventricular mechanical contraction lost in AF?
Atrial
392
How do we restore sinus rhythm in acute AF?
Electrical cardioversion
393
What does an ECG show in pericarditis at rest?
Saddle shaped ST and PR depression
394
What does an ECG show in hyperkalaemia at rest?
Tall tented T waves and pathological Q waves
395
What does an ECG show in STEMI at rest?
ST elevation
396
What does an ECG show in angina in a stress test?
ST depression
397
What does an ECG show in AF at rest?
Absent P wave
398
What does a early diastolic murmur indicate? (2)
Mitral stenosis, aortic regurgitation
399
What does an early systolic click indicate? (2)
Mitral valve replacement, pulmonary stenosis
400
What does an ejection systolic crescendo-decrescendo indicate?
Aortic stenosis
401
What does a pan systolic murmur indicate? (2)
Mitral regurgitation, tricuspid regurgitation
402
How does heparin work?
Inhibits thrombin and factor Xa
403
How do CCBs work?
Increases cGMP and reduces intracellular Ca2+
404
How do NSAIDs work?
Inhibits cyclooxygenase (COX) reducing production of thromboxane A2
405
How does warfarin work?
Inhibits production of vitamin-K dependent clotting factors
406
Where are roth spots found?
Eyes
407
What is the definition of blood pressure?
Cardiac output x total vascular resistance
