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Year 4 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What type of murmur would aortic stenosis produce?

A

MRS ASS

Low pitched ejection systolic murmur best heard at aortic area, radiating to the neck

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2
Q

What type of murmur does aortic regurgitation produce?

A

High pitched (blowing) early diastolic murmur, best heard at the left sternal edge with the patient sitting forward in expiration

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3
Q

What type of murmur does mitral stenosis produce?

A

Low pitched (rumbling) mid-diastolic murmur best heard at the apex when the patient is lying on their left side

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4
Q

What type of murmur does mitral regurgitation produce?

A 
MRS ASS
High pitched (blowing) pan systolic murmur best heard at the apex radiating to the axilla
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5
Q

What is a mycotic aneurysm?

A

Dilation of an artery due to damage of the vessel wall by an infection such as staph aureus

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6
Q

In an AAA what are the indications for surgery?

A

> 5.5cm diameter in fit individuals
Rapidly increasing diameter on surveillance (>0.5cm in 6 months)
Symptomatic
Ruptured

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7
Q

What is the most common type of AAA?

A

Infrarenal - starts just below the level of the renal arteries

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8
Q

What is the AAA rupture triad?

A

Pulsatile abdominal mass
Abdominal/back pain
Hypotension

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9
Q

What has a mid-systolic click?

A

Mitral valve prolapse

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10
Q

Define heart failure.

A

Failure of the heart to pump oxygenated blood at a rate sufficient to meet the metabolic requirements of the tissue

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11
Q

What are some causes of heart failure?

A

Severe anaemia, Aortic stenosis, MI, restrictive cardiomyopathy, Renal failure, alcohol

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12
Q

What signs may be present in heart failure?

A 
Elevated JVP
3rd heart sound
Displaced apex beat
Pulmonary oedema
Pleural effusion 
Peripheral oedema
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13
Q

List some important diagnostic tests in HF.

A

Natriuretic peptides

Echo

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14
Q

What are the management options for chronic HF?

A
  1. ACEi / ARB + BB
  2. ACEi/ARB + BB + MRA
  3. BB + MRA + ARNI (sacubitril + Valsartan)
  4. ICD or Ivabradine
  5. Digoxin or isosorbide dinitrate
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15
Q

What are some complications of ACS?

A

Cardiogenic shock
Arrhythmias
Heart failure due to severe LV dysfunction
Myocardial rupture
Mitral regurgitation due to papillary muscle rupture

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16
Q

What signs may indicate a STEMI on ECG?

A

ST elevation

New LBBB

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17
Q

What is emergency repurfusion management in a STEMI?

A

Primary percutaneous coronary intervention - balloon and stenting - within 120min of ECG diagnosis
If can’t do above
Thrombolysis with Tenecteplase

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18
Q

What are the different types of MI?

A 
I- coronary event (CA plaque rupture)
II - increased oxygen demand or reduced oxygen supply
II - sudden cardiac death
IVa - PCI
Ivb - Stent thrombosis
V - cardiac surgery such as CABG
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19
Q

AF puts you at an increased risk for Stroke. What score can assess the thromboembolic risk?

A 
CHA2DS2-VASc
Cardiac failure
Hypertension
Age >75 (2 points)
Diabetes
Stroke/TIA (2 points)
Vascular disease
Age 65-74
Sex (female)
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20
Q

Define AF

A

An chaotic, irregular atrial rhythm at 300-600bpm

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21
Q

What are the types of AF?

A

Paroxysmal - lasts <48 hours and terminates spontaneously
Persistent - Remain in AF but sinus rhythm can be restored by cardioversion
Permanent - Chronic AF and can’t or its inappropriate to restore sinus rhythm

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22
Q

Define aortic stenosis

A

Obstruction to the outflow of blood from the LV into the aorta due to pathological narrowing of the aortic valve. usually due to calcification

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23
Q

What is the classic triad in AS?

A

Chest pain, heart failure and syncope

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24
Q

What are some signs of AS?

A 
Low pitched ejection systolic murmur
Murmur transmitted to carotid
Narrow PP
Pulsus parvus et tarsus - slow rising flat pulse
Loud A2
Thrills at cardiac apex
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25
Q

What valve is most commonly affected in IE?

A

Mitral

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26
Q

What valve is most commonly affected in IE in IVDU?

A

Mitral but most Tricuspid valve endocarditis is due to IVDU

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27
Q

What organism usually causes native valve endocarditis>

A

Strep viridan

enterococcus

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28
Q

What organism usually causes endocarditis in IVDU?

A

S. aureus

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29
Q

What organism causes prothetic endocarditis?

A

CoNs - staph epidermis

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30
Q

What is the criteria to diagnose IE?

A

Dukes
2 major
1 major + 3 minor
5 minor

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31
Q

What is Dukes criteria

A

Major - typical organism in 2 positive culture and positive on Echo/ new valve regurgitation
Minor - Predisposition (IVDU/heart disease), fever >38, vascular phenomenon (septic emboli), immunological phenomenon (oslers nodes), positive culture

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32
Q

What are the signs of pericardial effusion?

A

Dyspnoea, raised JVP

Bronchial breathing at left base - Ewart’s sign (compression of left lower lung lobe due to large pericardial effusion)

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33
Q

What signs may indicate constrictive pericarditis?

A

Kussmaul’s sign (JVP rising paradoxically with inspiration)

Diastolic Pericardial knock, RHF, quiet heart sounds

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34
Q

What Triad may indicate cardiac tamponade?

A

Beck’s
Falling BP - (Hypotension)
Raised JVP
Muffled heart sounds

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35
Q

What is dilated cardiomyopathy?

A

A dilated heart causing ineffective systolic squeeze of blood due to thin, weak walls. Pump failure, reduced CO and reduced O2 to the body

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36
Q

What is the most common cause of sudden death in young people?

A

Hypertrophic cardiomyopathy

LV outflow obstruction due to asymmetric septal hypertrophy

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37
Q

How would you manage a haemodynamically unstable patient such as a cardiac arrest or SBP <90mmHg?

A
  1. Oxygen via face mask
  2. NBM t prevent aspiration
  3. Peripheral venous access
  4. IV atropine 1mg bolus
  5. If delay in pacing and patient still unstable - IV Isoprenaline 0.2mg
  6. Insert a temporary pacing wire
  7. Look for and treat reversible causes
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38
Q

How would you manage a Haemodynamically unstable tachycardic patient?

A
  1. External defibrillation
  2. Sedate for analgesia and have Naloxone ready incase of respiratory depression
  3. Propafol (if not fasted ETT to prevent aspiration)
  4. 200 Joules synchronised shock
  5. If Tachy unresponsive try correct acidosis or hypokalaemia. Mg and shock again. IV Amiodarone bolus
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39
Q

How do you usually treat a sinus tachycardia?

A

IV Adenosine 6mg

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40
Q

What makes up Virchows triad?

A
  1. Hypercoagulability
  2. Endothelial wall damage
  3. Satsis of blood/ slowed blood flow
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41
Q

How can you differentiate between ventricular arrhythmia and SV arrhythmia?

A

Narrow QRS - SV

Broad QRS - V

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42
Q

What is the P:QRS ratio in atrial flutter?

A

It can be 2:1, 3:1, 4:1 - there are more P waves due to the re-entrant circuit into the RA causing the atria to depolarise. Saw tooth

43
Q

What might a Ventricular tachycardia look like?

A

~250bpm. No P waves as there is no atrial depolarisation. Broad QRS. Can be Monomorphic - QRS all look the same*
compromise to ventricular diastole - Coronary vessels - reduced blood supply - reduced CO

44
Q

What is Torsades de pointes?

A

VT - Due to prolonged ventricular repolarisation - polymorphic QRS. looks like party streamer.
Can degenerate quickly into VF.
Give Amiodarone

45
Q

What is VF?

A

Choatic, uncoordinated muscle fibre contraction. Ventricular fibres contract independently so NO QRS or P or T. - no cardiac output - Cardiac arrest
Direct current shock to break any disorganised electrical activity by depolarising ALL the heart cells

46
Q

What is a junctional tachycardia or SVT?

A

Tachycardia due to re-entrance circuits

most common: AVNRT (no P, regular QRS, 200-300bpm)

47
Q

What is Wolf Parkinsons White syndrome?

A

Heart beats abnormally fast our to AV re-entrant tachycardia. accessory pathway - bundle of Kent
Has a delta wave

48
Q

How can you tell the difference form a BBB and a ventricular depolarisation?

A

Both have broad QRS
BBB HAS P WAVES (look closer at V1 and V6) as impulse generated in SA in atria
V - no p waves as impulse formed in ventricles

49
Q

What is the J point?

A

the junction between QRS and ST segment

50
Q

What type of narrow complex tachycardia is best reversed with a carotid massage or valsalva maenoveer?

A

AV nodal re-entrant tachycardia

these block the AV node, restoring sinus rhythm

51
Q

What coronary vessel would be responsible for post- MI bradycardic?

A

RCA as it supplies 60% of the SA

52
Q

Give some signs seen in aortic regurgitation.

A

De mussets sign - head bobbing in time with pulse
Durozier’s sign - Femoral artery murmur audible
Quinckes sign - Visible pulsation of the capillary nail bed
Corrigans sign - Visible carotid pulsation

53
Q

What is an example of a narrow and broad complex tachycardia?

A

Narrow- SVT - AVNRT or AVRT

Broad - VT

54
Q

How long is the normal PR interval?

A

120-200ms - 3-5 small sq

55
Q

What is the normal size of QRS?

A

120ms - 3 small sq

56
Q

What is a normal QT length?

A

<450ms
Varies with HR
Prolonged in electrolyte abnormalities and medications such as Amiodarone
>450 could lead to VT

57
Q

What is an arrhythmia?

A

A depolarisation originating in another part if the heart

58
Q

What causes atrial flutter?

A

Re-entrant circuit in usually the right atria near the tricuspid valve. up to 300bpm. saw tooth. Underlying ischaemic heart disease

59
Q

What are some causes of AF?

A

Ischaemic heart disease, valvular heart disease, HTN, hyperthyroidism

60
Q

What are some ECG findings of AF?

A

Irregularly irregular
No P wave as atria not properly depolarised and so only sometimes reaches AV node conduction (strong enough electrical activity) and so irregular QRS

61
Q

Why is VT so dangerous?

A

No atrial contraction, broad QRS, V rate ~250bpm
Compromised ventricular diastole so blood to heart is reduced - ischaemia of heart muscle? and so reduced CO
Sx - chest pain, syncope, dizzy, SoB

62
Q

What causes ventricle cells to fire faster than their intrinsic rate of 20-40 in VT?

A

Stress or damage to pacemaker cells/myocytes can cause re-entrant circuits
Drugs, illicit drugs, electrolyte imbalance, ischaemia

63
Q

Give an example of a cause of torsades de pointe.

A

Hypoxia of pacemaker cells (extreme stress to them)

64
Q

What are some causes of VF?

A

Mediciation, drugs, electrolyte imbalances, ischaemia, sepsis, cardiomyopathy

65
Q

What is Wolf parkinsons white SYNDROME?

A

Wolf parkinson white pattern (bundle of kent - delta wave) PLUS Tachycardia
200-300bpm

66
Q

What are escape rhythms?

A

Different parts of the heart that can create a depolarisation sequence if the SA node fails = bradycardia
Junctional and ventricular escape rhythms

67
Q

What is a junctional escape rhythm?

A

Normal sinus rhythm initially then SA fails to generate impulse and so pacemaker cells around the AV node fire - no P waves but normal QRS

68
Q

What is ventricular escape rhythm?

A

Sinus then SA fails. After a pause there is a single wide QRS

69
Q

How might you tell if a BBB if from ischaemia?

A

LBBB - T wave inversion as well as BBB changes in V5 and V6, I, aVL
RBBB - T wave inversion in V1-V3 and BBB changes

70
Q

What is the patten in RBBB?

A

MaRroW
RsR in V1
QRS in v6 - but key is the DEEP, wide S wave (may not be qrs)

71
Q

What might a BBB and axis deviation indicate?

A

Fasicular block
Left axis deviation + RBBB = bifasicular block (as just RBBB should have a normal axis, so left anterior fascicle must also be involved)

72
Q

What are some causes of BBB?

A

LBBB - AS, anterior MI, HTN, dilated cardiomyopathy

RBBB- atrial septal defect, PE, cor pulmonale, cardiomyopathy

73
Q

How can you tell is the ST elevation is due to ischaemia or pericarditis?

A

Ischaemia - ST shape - convex, straight upsloping, straight horizontal, straight downslopinng
Pericarditis - Concave or saddle shape

74
Q

What are some causes of an SVT causing a broad complex tachycardia (wide QRS)?

A

SVT + Aberrancy (BBB) - Past ECG shows BBB
SVT + Pre-excitation (from e.g. SA node - somewhere outwith the AV node)
SVT + Anti-arrhythmic Flecanidie - Class 1c
Antidromic AVRT - Retrograde conduction via AV node and anterograde via accessory pathway

75
Q

What might a PE look like on ECG?

A

Sinus tachycardia

76
Q

What are the causes of sinus bradycardia?

A

Sleep, young athlete - physiological
Chronic degeneration of the sinus or AV node or atria
Drugs - BB, morphine, Amiodarone, Ca channels, lithium
Cholestatic jaundice
MI or Ishcaemia of the SA node
Increased vagal tone - vasovagal attack, N&V
Hypothyrodism, hypothermia, raised ICP

77
Q

What are some causes of heart/AV block?

A

Ischaemic heart disease, conduction system fibrosis (raging), calcific arotic stenosis, cardiomyopathy, hypothermia, infection, connective tissue disease, IE

78
Q

List some clinical features seen in acute pericarditis?

A

Central chest pain that is worse on inspiration or lying flat and relieved by sitting forward
Pericardial friction rub, fever
May be pericardial effusion or cardiac tamponade

79
Q

How would you manage acute pericarditis?

A

Analgesia - ibuprofen 400mg/8h
Treat cause (primary - idiopathic or 2ndary to RA, SLE, HIV, EBV, TB, Strep, uraemia, fungus, penicillin, isoniazid, trauma, radiotherapy)
Colchicine (inhibits neutrophil migration)
Steroids - if relapsing or continuing Sx

80
Q

What are some signs of cardiac tamponade?

A 
Becks Triad - raised JVP, muffled heart sounds, falling BP
Thready pulse (rapid)
Pulses paradoxus (drop in SBP >10mmHg on inspiration)
Low O2 - SoB, restless, lightheaded, dizzy
81
Q

What is restrictive cardiomyopathy and what are some causes?

A

When the myocardium is stiffened and so it cannot fill or stretch and so there is reduced CO and pump failure
HH, amyloidosis, sarcoidosis, scleroderma, idiopathic
Because there is reduced ventricular filling - diastolic dysfunction

82
Q

What is the treatment for AF?

A

AF = BCD AF E
Beta blocker (cardioselective - atenolol, bisprolol)Or
Calcium channel (Verampamil, diltazem) And or 2nd line
Digoxin
Amiodarone or Flecanide
Electrical cardio version

83
Q

List some non coronary causes of an elevated troponin.

A 
Congestive heart failure
Apical ballooning syndrome
PE
Anything that stresses the heart - critical illness
Sepsis
Tachyarrythmia
84
Q

What is Brugada syndrome?

A

ECG abnormality with a high incidence of sudden cardiac death In structurally normal hearts. Mutation in cardiac Na channel. coved ST elevation in >1 of V1-V3 and >1 of:
Documented VF, polymorphic VT, FH of sudden cardiac death, coved ECG in family member, syncope, nocturnal agonal respiration

85
Q

What drugs can affect wound healing?

A

Steroids and NSAIDs reduce skin healing

BB reduce peripheral blood flow

86
Q

What is chronic venous insufficiency?

A

When venous valves are not working effectively and so there is pooling and stasis of blood
Pain worse on standing, varicose veins, pruritus, hyper pigmentation, oedema, venous ulceration

87
Q

What are varicose veins?

A

Dilated and tortuous segments of vein due to valvular incompetence - SC veins >/= 3mm, with a demonstrable reflux

88
Q

Give some features of a venous ulcer?

A

Between lower calf and medial malleolus

Shallow and flat margins with moderate to heavy exudate and slough at the base with granulation tissue

89
Q

What is Acute Limb Ischaemia?

A

A sudden decrease in limb arterial perfusion compromising the viability of the limb. onset < 2 weeks

90
Q

What are the signs and symptoms of Acute limb ischaemia?

A

6 Ps

Pulseless, pallor, perishingly cold, paralysis, painful, paraesthesia

91
Q

When might surgical treatment be indicated for AAA?

A 
Diameter >5.5cm in fit individuals 
Rapid increase in diameter on surveillance scans
Ruptured
Symptomatic 
Ascending thoracic aneurysm
92
Q

What is a AAA?

A

Dilation of the abdominal aorta greater than 3cm

93
Q

What are the 2 different types of aneurysms (not locations)?

A

True - Abnormal dilations involving all 3 layers

False - outer layer only

94
Q

Treatment for acute limb ischaemia?

A

IV heparin
Thrombo-embolectomy - catheter-delivered lysis
Lysis and stenting
Amputation

95
Q

What scoring tool is used in acute limb ischaemia?

A

Rutherford
I - viable, IIa - marginally threatened, IIb - Immediately threatened, III - Irreversible (major tissue loss and permanent nerve damage - paralysis and sensory loss)

96
Q

What is chronic limb ischaemia?

A

Peripheral arterial disease that results in a symptomatic reduction in blood flow to the limbs.

97
Q

What scoring tools can be used in chronic limb ischaemia?

A

Rutherford - grade 0-6

Fontaine - stage I - IV

98
Q

Define intermittent claudication.

A

Reproducible ischaemic muscle pain on exertion caused by inadequate blood flow which is relieved by rest.
Should be on aspirin + statin

99
Q

Define chronic limb threatening ischaemia.

A

A clinical syndrome defined by the presence of PAD combined with gangrene, rest pain or lower limb ulceration > 2weeks. Use Buergers test to distinguish from cellulitis (limb goes pale with CLTI)

100
Q

What are the 3 ways in which critical limb ischameia can be clinically defined.

A
  1. ABPI < 0.5
  2. Ishcaemic rest pain for > 2 weeks requiring opiate analgesia
  3. Ischaemic lesions or gangrenen attributable to arterial occlusive disease
101
Q

When does the external iliac become the femoral artery?

NAV Y VAN

A

Inguinal ligamant

From public tubercle and ASIS
You can feel the femoral pulse half way between the pubic symphysis and the ASIS

102
Q

Where can the pulse be felt in the leg?

A

Dorsalis pedis - off ant tibial
posterior tibial
Femoral
Popliteal

103
Q

How would you manage a patient in acute HF?

A
  1. sit them up
  2. Give O2
  3. diamorphine IV
  4. furosemide IV
  5. GTN
  6. Isosorbite dinitrate or more furosemide
  7. CPAP
104
Q

When would you not give flecanide?

A

If the patient has underlying cardiac disease

Give amiodarone instead

Year 4 (14 decks)

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