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Cardiovascular > Conditions and Treatment > Flashcards

Conditions and Treatment Flashcards

1
Q

Mitral Regurgitation

A

= backflow through the mitral valve
Clinical: dyspnoea, fatigue, AF, displaced hyperdynamic apex, RV heave, soft S1, split S2
Ix: ECG, ECHO (assess LV function)
Management: Rate control and anti-coagulate if AF, diuretics and surgery

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2
Q

Treatment: Native Valve endocarditis

A

Amoxicillin

Gentamicin

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3
Q

Type A Dissection

A

Ascending aorta is involved

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4
Q

Treatment of Constrictive Pericarditis

A

Complete pericardial resection

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5
Q

Hypertension Profile

A

Clinical: usually asymptomatic, features of end/organ damage, underlying causes
Ix: fasting glucose, cholesterol, 24-HR ambulatory blood pressure monitoring

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6
Q

Endocarditis Pathophysiology

A

= formation of a microbial vegetation upon the cardiac valves which can be friable - throwing off septic emboli

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7
Q

Aortic Reguritation

A

Clinical: exertional dyspnoea, orthopnoea, PND, syncope
SIGNS - collapsing pulse, wide pulse pressure
Ix: ECG, CXR, ECHO, cardiac catheterisation to assess severity
Management: reduce systolic hypertension and later ECHO

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8
Q

Cardiac Tamponade

A

= accumulation of pericardial fluid increases intrapericardial pressure
> poor ventricular filling > reduced cardiac output
Clinical: increased pulse, pulsus parodoxus, raised JVP, muffled heart sounds
Ix:
CXR - big globular heart
ECG - low voltage QRS, ECHO is diagnostic
Management: Drain

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9
Q

Mitral Stenosis

A

Clinical: symptoms usually when <2cm
Dyspnoea, fatigue, palpitations, chest pain
Ix: ECG, ECHO (diagnostic)
Management: Rate control (AF) and anti-coagulation, may need valve replacement or balloon valvuloplasty

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10
Q

Angina

A

= a result of myocardial ischaemia
Clinical: central chest tightness or heaviness on exertion
Causes: atheroma (from hypertension), hyperlipidaemia, smoking, diabetes
Ix: ECG (ST depression)

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11
Q

Hypertrophic Cardiomyopathy

A

= can result in left ventricular outflow tract obstruction
- Leading cause of sudden cardiac death: autosomal dominant inheritance
Clinical: sudden cardiac death, angina, dyspnoea, palpitation, syncope
Ix: ECG (LVH), ECHO (asymmetrical septal hypertrophy), cardiac catheterisation

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12
Q

Strep viridans (ENDOCARDITIS)

A

Dental treatment

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13
Q

Left Sided Heart Failure

A

Clinical: dyspnoea (on exertion), orthopnoea, PND, oedema, tachycardia, crepitations, pleural effusion, apex displacement
Ix:
CXR - cardiomegaly, interstitial fluid
ECHO (may give a cause) and bloods

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14
Q

Descriptor of Aortic Regurgitation

A

= high pitched early diastolic murmur (heard in expiration with patient sat forward)

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15
Q

Descriptor of Mitral Regurgitation

A

= pansystolic murmur of apex radiating to the axilla

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16
Q

Treatment of Ventricular Tachycardia (Chronic)

A

Revascularisation
ICD
Heart Failure Therapies
NOT anti-arrhythmic drugs

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17
Q

Atrial Septal Defect

A

= hole connects the atria
Clinical: atrial fib, raised JVP, pulmonary ejection systolic murmur, pulmonary hypertension
Ix: ECG (RBBB and prolonged PR interval), CXR, ECHO (diagnostic)
Treatment: closure

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18
Q

Management of Hypertension ( <55 years)

A
  1. ACE inhibitor
  2. ACEi/ARB and calcium channel blocker
  3. ACEi/ARB and calcium channel blocker and thiazide diuretic
  4. Add further diuretic or a-blocker/B-blocker
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19
Q

Management of Dilated Cardiomyopathy

A

Treatment for Heart Failure

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20
Q

Treatment of Atrial Flutter

A
  1. Radiofrequency ablation

- Warfarin to prevent thromboembolism

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21
Q

Treatment of Monomorphic Stable VT

A

IV procainamide
Sotalol
Amiodarone
Beta Blockers

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22
Q

Ostium Secondum

A
  • Hole occurs high in the septum

- Often asymptomatic until adulthood as the L>R shunt depends on ventricular compliance

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23
Q

ECG in Ischaemia

A
  • ST depression
  • T wave inversion
  • Hyper acute R waves
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24
Q

Treatment of Acute Pericarditis

A

Bed rest and NSAIDs

Colchine can be useful

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25
Q

STEMI

A

Total occlusion of the artery

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26
Q

Claudication

A

= insufficient blood reaches the exercising muscle (felt in the legs usually)

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27
Q

Stroke

A

= acute onset of focal neurological symptoms and signs < disruption of blood supply
- Can be ischaemic or haemorrhagic
Causes: atherosclerosis, cardiac emboli
Clinical: sudden vision loss, dizziness, difficulty swallowing, sudden headache, weakness in one arm, slurred speech
Ix: CT and MRI

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28
Q

A 52-year old man with hypertension wakes up suddenly in the night feeling SOB, on examination he has bilateral basal crackles
Treatment?

A 
IV Furosemide (loop diuretic)
Helps relieve the symptoms of shortness of breath due to acute peripheral oedema
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29
Q

Myocarditis

A

= inflammation of the myocardium
Causes: idiopathic, viral, bacteria, drugs
Clinical: fatigue, dyspnoea, chest pain, fever, palpitations, tachycardia
Ix: ECG (ST T wave abnormalities), viral serology and PCR

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30
Q

Pulmonary Stenosis

A

= usually congenital
Clinical: dyspnoea, fatigue, oedema, ascites, RV heave, ejection systolic murmur
Ix: ECG, CXR, ECHO
Management: pulmonary valvuloplasty

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31
Q

Treatment of Atrial Fibrillation (Rate Control)

A

Digoxin (when HF also)
Beta Blockers
Verapamil/diltiazem
Adenosine

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32
Q

Tricuspid Regurgitation

A

Causes: functional, rheumatic fever, infective endocarditis
Clinical: fatigue, hepatic pain, ascites, oedema, RV heave, pansystolic murmur
Management: treat underlying cause

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33
Q

Restrictive Cardiomyopathy

A

Causes: idiopathic, amyloidosis, sarcoidosis
Clinical: presents like constrictive pericarditis, features of RVF
Ix: Cardiac catheterisation and treatment

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34
Q

Treatment of Ventricular Ectopics

A

Beta Blockers

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35
Q

Right Sided Heart Failure

A

Causes: LVF, pulmonary stenosis, lung disease
Clinical: peripheral oedema, ascites, nausea, anorexia, elevated JVP, hepatomegaly
Ix: Bloods, CXR, ECHO

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36
Q

Treatment of S.viridans endocarditis

A

Pencillin (or some form) e.g. benzylpenicillin

Gentamicin IV

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37
Q

Treatment of Ventricular Tachycardia (ACUTE)

A

! DC Cardioversion (defibrillation)

Adenosine

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38
Q

Treatment of S.aureus endocarditis

A

Flucloxacillin IV

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39
Q

Ventricular Septal Defect

A

= hole connects the ventricles
Clinical: severe heart failure in infancy
SMALLER - louder murmurs
LARGER - pulmonary hypertension
Ix: ECG, may see LVH, CXR (enlarged if big defect)
Management: medical (may close spontaneously)

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40
Q

What treatments could you give in acute left sided heart failure?

A

Sit the patient up
High flow oxygen (not in COPD)
IV Diamorphine (not/careful in COPD)
IV GTN (only if blood pressure not too low)

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41
Q

Treatment of terminal Congestive Heart Failure

A

Aim to use furosemide to reduce swelling

  • Thiazide and loop diuretic
  • Spironolactone could be used
  • B Blocker (if no hypotension)
  • Could use S-V instead of ACEI
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42
Q

If ACEi/ARB intolerant in heart failure

A

Hydralazine and Isosorbide Dinitrate

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43
Q

Ix for PAD

A

Bloods (exclude diabetes etc)
Ankle brachial pressure index (ankle P/brachial P)
CT/MRI angiography

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44
Q

Management of Chronic Heart Failure

A 
Diuretics (loop)
ACEi - left ventricular dysfunction
B-Blockers - good in long term
Spironolactone (decreases mortality)
Digoxin
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45
Q

Management of Acute MI

A 
Oxygen
Morphine (anti-emetic)
GTN sublingual
Aspirin 300mg
Clopidogrel 
(Thrombolysis or PCI)
46
Q

Treatment of MRSA endocarditis

A

Vancomycin

Rifampicin

47
Q

Treatment of Atrial Fibrillation (Rhythm Control)

A 
Restore NSR 
- AADs e.g. amiodarone
! DC Cardioversion
Maintain NSR 
- AADs
- Catheter ablation of the atrial focus (pulmonary veins) 
- Surgery
48
Q

Signs of Endocarditis

A

Fever
Roth Spots
Oslers nodes
Murmur

Janeway lesions
Anaemia
Nail Haemorrhages (splinter)
Emboli

49
Q

ACS (Conditions and Pathophysiology)

A
  • Includes unstable angina and MI

Plaque rupture > Thrombosis > Inflammation

50
Q

Management of Hypertrophic Cardiomyopathy

A

B-blockers or Verapamil

51
Q

Pre-disposing factors for Endocarditis

A

Heart valve abnormality, congenital heart disease, post-rheumatic fever, IV drug users, prosthetic valve

52
Q

Staph aureus (ENDOCARDITIS)

A

IV drug users (person who injects drugs)

53
Q

Acute Pericarditis

A

= inflammation of the pericardium
Can be idiopathic/2y to virsuses/bacteria
Clinical: central chest pain, worse on inspiration, relief on sitting forward, pericardial rub
Ix: saddle shaped ST elevation - may be normal, blood tests, cardiomegaly

54
Q

Treatment of Enterococcus species

A

Amoxicillin/Vancomycin

Gentamicin IV

55
Q

Abdominal Aortic Aneurysm

A

= artery with dilation >50% original diameter
- True aneurysm involves all layers of the arterial wall
RF: Fx, gender, age, smoking, vascular disease
Clinical: can be asymptomatic
RUPTURED - abdominal pain (radiates to back), collapse, exspansile abdominal mass, shocky
Management: elective repair
RUPTURED - cross clamp aorta, stent placement

56
Q

Treatment of SVT

A
  1. Valsalva manoeuvre (if haemodynamically stable)
  2. IV Adenosine
  3. DC cardioversion (if unstable)
57
Q

Treatment of SVT (Chronic)

A 
Avoid stimulants 
Radiofrequency ablation 
Anti-arrhythmic Drugs
- Beta Blockers 
- Calcium Channel Blockers
58
Q

Treatment of Sinus Bradycardia (Haemodynamic Compromise)

A

Pacing

59
Q

A 45-year old woman complains of palpitations and investigation confirms the diagnosis of thyrotoxicosis and atrial fibrillations with ventricular rate of 110 per minute
Treatment?

A

Bisoprolol

Useful for the rapid relief of thyrotixic symptoms e.g. AF

60
Q

Managment of Ischaemic Stroke

A

Anticoagulant
Vasodilator
Statin

61
Q

Treatment: Drug User endocarditis

A

Flucloxacillin IV

62
Q

Aortic Dissection

A

= blood splits the aortic media
Clinical: sudden chest pain, ripping/tearing, radiate to back, hemiplegia, unequal BP
Management: Type A = surgery, Type B = medical
CXR, ECG, CT/MRI (time permitting)

63
Q

Treatment of PAD

A

Risk Factor modification

Percutaneous Transluminal Angioplasty (PTA) or surgical reconstruction

64
Q

Enterococcus faecalis

A

Genito-Urinary Surgery

65
Q

Cardiomegaly

A

Enlarged heart (compensating by getting bigger as cannot pump properly)

66
Q

Aortic Stenosis

A

Clinical: elderly patient, chest pain, exertional dyspnoe or syncope
SIGNS - slow rising pulse, heaving apex, LV heave
Ix: ECG and ECHO (diagnostic)
Management: usually surgery (prompt valve replacement)

67
Q

NSTEMI

A

Non-complete occlusion of the artery

68
Q

Management of Myocarditis

A

Bed rest and treatment of underlying cause

69
Q

Treatment: Prosthetic Valve endocarditis

A

Vancomycin
Gentamicin
Rifampicin
(usually also need valve replacement)

70
Q

Classic description of VSD

A

Harsh pansystolic murmur heard at the left sternal edge with/without left parasternal heave

71
Q

Treatment of Sinus Bradycardia

A

Isoprenaline

72
Q

1st Line Investigation for AAA

A

Ultrasound

73
Q

Subacute Presentation of Endocarditis

A 
Fever
Malaise
Weight loss
Tiredness
Breathlessness
74
Q

Dilated Cardiomyopathy

A

= dilated ‘flabby’ heart of unknown cause
Seen in males more than females
Clinical: fatigue, dyspnoea, pulmonary oedema, right ventricular failure
Ix: serum BNP is sensitive and specific in diagnosing heart failure, CXR, ECG, ECHO

75
Q

Galloping Rhythm

A

Third, fast heart sound (both the tachycardia and 3rd heart sound make it appear as ‘galloping’)

76
Q

ECG findings of STEMI

A

ST elevation
Hyperacute T waves
New LBBB

77
Q

Management of Hypertension (>55 years/black)

A
  1. Calcium channel blocker or Thiazide diuretic
  2. ACEi/ARB and thaizide diuretic OR ACEi/ARB and calcium channel blocker
  3. ACEi/ARB and calcium channel blocker and thiazide diuretic
  4. Add further diuretic or a-blocker/B-blocker
78
Q

Descriptor of Mitral Stenosis

A

= mid-late diastolic murmur with loud S1

  • Associated malar flush
  • Tapping non-displaced apex beat
79
Q

Treatment of Sinus Bradycardia (Acute)

A

Atropine

80
Q

Coarctation of the Aorta

A

= congenital narrowing of the descending aorta, just distal to the origin of left subclavian
Assoc: bicuspid, Turner’s syndrome
Clinical: radiofemoral delay, weak femoral pulse, increased BP, systolic murmur
Ix: CT or MRI angiogram
Treatment: surgery (balloon dilation + stenting)

81
Q

Ventricular Septal Perforation after MI

A
  • Dead wall is necrotic, friable tissue

- Rupture happens due to the pressure created by the heart

82
Q

Treatment of Sinus Tachycardia

A

Beta Blockers

Treat the underlying cause

83
Q

Peripheral Arterial Disease Physiology and Features

A

= atherosclerosis causes stenosis of the arteries
Clinical: cramping pain after walking, ulceration, paroxysmal foot pain, absent peripheral pulses, cold white legs, increased cap refill

84
Q

Complications of MI

A 
Arrhythmias
Ventricular Septal Perforation
Ischaemic Mitral Regurgitation
Systemic Embolism
Pericarditis
Cardiogenic Shock
85
Q

Treatment of SVT (ACUTE)

A

Vagal Manourvres e.g. carotid massage
Adenosine
Verapamil

86
Q

Strep milleri (ENDOCARDITIS)

A

Prosthetic valves

87
Q

Descriptor of Aortic Stenosis

A

= ejection systolic murmur with S4, radiates to carotids

88
Q

Bicuspid Aortic Valve

A
  • Work well, go unnoticed at birth

- Many eventually develop aortic stenosis/regurgitation

89
Q

Management of Angina

A

Relief - GTN spray
Prophylaxis - aspirin, B-blockers, long acting nitrates
Surgery - bypass, PTCA

90
Q

Fallot’s Tetralogy

A

VSD
Pulmonary Stenosis
Right Ventricular Hypertrophy
Overriding aorta

91
Q

Normal person ejection fraction

A

~60% = blood that moves from the ventricle to the aorta

92
Q

Staphylococcus epidermis endocarditis

A

Vancomycin and Gentamicin IV

Rifampicin PO

93
Q

Management of Haemorrhagic Stroke

A

Evacuation of haematoma

Craniotomy

94
Q

Constrictive Pericarditis

A 
= heart enclosed in rigid pericardium
Clinical: similar to RVF, raised JVP, diffuse apex beat, quiet heart sounds
Ix: 
CXR - small heart
ECHO/CT/MRI
95
Q

Treatment of Hypertension (WHO?)

A
  • All with BP >160/100 mmHg

- Those with BP >140/90 mmHg (dependent on risk)

96
Q

Type B Dissection

A

Ascending aorta is not involved

97
Q

Ostium Prium

A
  • Associated with AV valve anomalies

- Present earlier in life

98
Q

Large A waves

A

Tricuspid Stenosis
Pulmonary Stenosis
Pulmonary Hypertension

99
Q

Cannon A waves

A

Ventricular Tachycardia

100
Q

Absent A waves

A

Atrial Fibrillation

101
Q

Giant V waves

A

Tricuspid regurgitation

102
Q

The pulse is regular and jerky in character. The cardiac impulse is hyperdynamic and not displaced. There is a mid-systolic murmur with no ejection click, loudest at the left sternal edge

A

Hypertrophic Cardiomyopathy

103
Q

SLE, verrucous vegetations

A

Libman-Sacks endocarditis

104
Q

Signs of Tamponade

A

Hypotension
Pulsus Paradoxus
Quiet heart sounds
High JVP that rises further on inspiration

105
Q

Kussmaul’s sign

A

JVP that rises further on inspiration

106
Q

A 50-year old woman with breast cancer presents with breathlessness and collapse. She has a weak pulse 120/min, BP 90/40 mmHg
Heart sounds are faint and QRS complexes are small

A

Pericardial Effusion with Tamponade

107
Q

Right Ventricular Hypertrophy surface landmark

A

4th intercostal left parasternal area

108
Q

Treatment of AF NPMH

A

Flecanide

109
Q

Treatment of VT

A

Amiodarone

110
Q

Treatment of VT related to Digoxin

A

Digibind

111
Q

A 19-year old man comes to the clinic for review. His girlfriend is extremely worried about him as he has had a number of syncopal attacks over the past few months and has noticed some violent nightmares and thrashing about in bed.
What is this?
Treatment?

A

Brugada syndrome

Implantable cardiac defibrillator

112
Q

Chronic Rheumatic Heart Disease

A

= result of untreated pharyngitis
- subcutaneous nodules
- involuntary movements of large joints
MITRAL STENOSIS

Cardiovascular (7 decks)

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