Cardiovascular Conditions Flashcards
Define AR
Backflow of blood from aorta to LV due to insufficient valve in diastole
Aetiology AR
Aortic valve dysfunction
- Infective endocarditis
- RHD
- Bicuspid Valve
Aortic dilatation
- Severe HT
- Aortitis
Dsypnoea
Orthopnoea
Angina
Syncope
Water hammer pulse
Wide pulse pressure
Early diastolic murmur heard best over left sternal edge with pt sitting forward
Aortic Regurgitation
Investigations AR
CXR
- Cardiomegaly
- Ascending aorta dilatation
ECG
- Signs of LVH
ECHO
- Doppler echo for diagnosis
- may show underlying cause
Cardiac catherterisation
- If uncertain about state of ventricle
Define AS
Obstruction of blood flow across aortic valve due to pathological narrowing
Aetiology AS
Senile calcification due to ageing
Rheumatic heard disease
Bicuspid valve (calcification)
Angina
Syncope
HF symptoms
Narrow Pulse pressure
Slow rising pulse
Thrill in aortic area (palpable murmur)
Ejection systolic murmur at aortic area radiating to carotid
AS
Investigations AS
ECHO
- Visualises structural changes of valve
ECG
- Signs of LVH
CXR
- Calcification of valve
Cardiac angiography
- allows differentiation from other angina causes
Define MR
Backflow of blood from LV to LA due to mitral valve insufficiency
Aetiology MR
Valve leaflet abnormality
- Mitral valve prolapse
- Infective endocarditis
- Connective tissue disorders (Ehler’s Danlos, Marfans)
Annulus issue
- LV dilatation
- RHD
Chordae tendinae/papillary muscle
- Damage of papillary muscle due to MI/IHD
Exertional Dyspnoea
Maybe palpitations
Fatigue
Apex beat laterally displaces
Pan systolic murmur heard best at apex with radiation to axilla
Could be mid systolic click with late systolic murmur
MR
Investigations MR
ECG
- May show AF/broad bifid P wave (LA dilation)
CXR
- LA enlargement
- Cardiomegaly
- Mitral valve calcificaiton
ECHO
Define Mitral Stenosis
Obstruction of blood flow from LA to LV due to mitral valve narrowing
Aetiology Mitral Stenosis
RHD
Fatigue SOB Palpitations Dyspnoea Hoarseness, dysphagia, bronchial obstruction
Peripheral cyanosis
Irregularly irregular pulse
Parasternal heave
Mid-diastolic murmur
Mitral Stenosis
Investigations Mitral stenosis
ECG
- bifid p wave
- AF
CXR
- LA enlargement
- Cardiomegaly
ECHO
Cardiac catheterisation
- severity of HF
Define rheumatic fever
Inflammatory multisystem disorder, following infection with group A beta haemolytic streptococci
Aetiology rheumatic fever
Strep pharyngeal infection
Molecular mimicry to initiate tissue injury
General
- fever
- malaise
- anorexia
Joints
- painful, swollen
- decreased movement
Cardiac
- breathlessness
- palpitations
- chest pain
Rheumatic fever
Duckett Jones criteria
For assessing rheumatic fever
Investigations rheumatic fever
Bloods
- inc WCC
- inc ESR/CRP
- inc antistretolysin O titre
Throat swab
- culture for GAS
ECG
- saddle shaped ST elevations
ECHO
- pericardial effusion
- myocardial thickening
- valvular dysfunction
Define TR
backflow of blood from RV to RA
Aetiology TR
Congenital - ebstein anomaly
Functional - RV dilatation
RHD
Infective endocarditis - common in IV drug users and PICC lines
Fatigue breathlessness Palpitations headaches Nausea Anorexia Epigastric pain worse with exercise Jaundice Lower limb swelling
Irregularly irregualr pulse Inc JVP Parasternal heave Pansystolic murmur heard best at lower left sternal edge Pleural effusion Palpable liver Pitting oedema
TR
Investigations TR
Bloods
- FBC
- LFT
- Cardiac enzymes
- Blood cultures
ECG
- p pulmonale (RA hypertrophy)
CXR
- right sided enlargement
Echocardiography
Right heard catheterisation
Define IE
Infection of the intracardiac endocardial structures
Aetiology IE
Common organisms
- Streptococci - mainly S. viridans and S.bovis
- Staphylococci - S. aureus and S.epidermis
- Enterococci - E.faecalis
- HACEK
- Haemophilus
- Acinobacter
- Cardiobacterium
- Ekinella
- Kingella
RISK FACTORS
- Prosthetic heart valves
- Abnormal valves
- Recent dental work
- IV drug use
Fever
Roth’s Spots
Oslers Nodes
Murmurs
Janeway lesions Anaemia Nail - splinter haemorrhages Emboli Clubbing
Infective endocarditis
Investigations IE
Blood cultures - 3 different sites at 3 different times
Bloods
- FBC –> inc neutrophils
- Inc ESR/CRP
- U&Es
- Rheumatoid factor +ve
Urinalysis - microscopic haematuria, proteinuria
CXR
- cardiomegaly
- septic pulmonary emboli
Echo
- detection and visualisation of heart valves
Management of Infective Endocarditis
Blind therapy of native valve: amox +/- gentamicin
Blind therapy of prosthetic valve: vancomycin + gentamycin + rifampicin
Streptococci: Benzylpenicillin & gentamicin
Staphylococci: Flucloxacillin & Gentamicin
Enterococci: Amox & gentamicin
Culture -ve: Vancomycin & Gentamicin
Surgery - valve replacement
AB prophylaxis for anyone going high risk procedure with IE hx
Complications of IE
Valve incompetence Intracardiac fistulae Aneurysm formation HF Renal failure Glomerulonephritis
Define myocarditis
Inflammation (& necrosis) of cardiac muscle
Aetiology myocarditis
Viruses
- Coxsackie B
- Echovirus
- EBV
- CMV
- Adenovirus
- Influenza
Bacteria
- Post-strep
- TB
- Dipthieria
- Clostridia
Fungal - Cadidiasis
Protozoal - Trypanosomiasis
Helmiths - Trichinosis
Non infective - SLE, sarcoidosis
Drugs
Fever Malaise Fatigue Lethargy Breathlessness Palpitations Sharp chest pain
Myocarditis
Define pericarditis
Inflammation of the pericardium
Aetiology pericarditis
Idiopathic Infective - Coxsackie B - Echovirus - Mumps - Streptococci - Staphylococci
Connective tissue disease
DRESSLER’S syndrome - months following acute MI
Malignancy
Sharp central chest pain, aggravated by deep inspiration. Pain relieved by sitting forward
Fever
Friction rub - best heard @ lower L sternal edge with pt leaning forwards
Becks triad - inc JVP, dec BP, muffled heart sounds
Tachycardia
Pulsus paradoxus
Pericarditis
Inc JVP with inspiration Pulsus paradoxus Hepatomegaly Ascites Oedema Pericardial knock AF
Constricitive Pericarditis
Investigations Pericarditis
ECG
- Widespread ST elevation with saddle shape
ECHO
- assess pericardial effusion and cardiac tamponade
Bloods
- FBC –> WCC
- CRP/ESR
- Cardiac enzymes (usually normal)
CXR
- GLobular shadowing if effusion
- Pericardial calcification seen in constricitve pericarditis
Management pericarditis
Acute - pericardiocentesis drainage
Medical - treat underlying cause, NSAIDS for pain management
Surgical - surgical excision of pericardium
Complications pericarditis
Pericardial effusion
Cardiac tamponade
Cardiac arrhythmia
Define arterial ulcer
Localised area of damage and breakdown of skin due to inadequate arterial blood supply
Aetiology arterial ulcer
Lack of blood flow to capillary beds of lower extremities
RISK FACTORS
- CHD
- Diabetes
- Hx of Stroke
- HT
Seen at dorsum of foot or between toes
Elliptical with clearly defined edges and base contains grey granulation edges
NIGHT PAIN IN LEG
Hairless skin
Cold limb
Absent pulse
Wasting of calf muscles
Arterial ulcer
Investigations for arterial ulcer
Duplex USS ABPI - measure difference between BP in arm and leg ECG Lipids, blood glucose and HbA1c FBC - anaemia can worsen ischaemia
