Conditions Facts Flashcards
What is the difference between systolic and diastolic heart failure?
systolic means the ventricles fail to contract, causing decreased cardiac output
diastolic means the ventricles cannot relax, causing increased filling pressure
What can cause systolic heart failure?
ischaemia, MI, cardiomyopathy
What can cause diastolic heart failure?
constrictive pericarditis, tamponade
How does left ventricular failure present?
(paroxysmal nocturnal) dyspnoea, poor exercise tolerance, nocturanl cough with pink frothy sputum, wheeze, weight loss
How does right ventricular failure present?
peripheral oedema, ascites, nausea, anorexia, tricuspid regurgitation
What can cause right ventricular failure?
LVF, pulmonary stenosis, lung disease
What investigations should be carried out for heart failure?
ECG, B-type natriuretic peptide, CXR
What will a chest X ray show for LVF?
Alveolar oedema B lines (Kerley B) Cardiomegaly Dilated prominent upper lobe vessels Effusion of pleural category
How should heart failure be treated?
Loop diuretic to relieve symptoms (furosemide) ACE inhibitor Beta blocker (carvedilol) Spironolactone (potassium sparing) Digoxin (not always)
Who should be treated for hypertension?
Those with blood pressure (sustained) of 160/100
What is maligant hypertension?
systolic > 200 and diastolic >130
What may you also get with malignant hypertension?
headaches, blurred vision
What is the first line therapy for over 55s?
calcium channel blocker (or thiazide)
What is the first line therapy for under 55s (non black)?
ACE inhibitors
What is the combination therapy for hypertension?
ACE inhibitor + calcium channel blocker
Which calcium channel blocker must be given with a beta blocker because it causes tachycardia?
amlodipine
How is rheumatic fever diagnosed?
evidence of recent strep infection plus 2 major criteria or 1 major and 2 minor
What are the major criteria for rheumatic fever?
carditis, arthirits, erythema, sydenham’s chorea
What are minor criteria for rheumatic fever?
prolonged PR interval arthralgia previous rheumatic fever fever raised CRP or ESR
What is the treatment for rheumatic fever?
bed rest penicillin or benzylpenicillin 250-500mg 3 times per day for 5 days Analgesia Immobilise joints in arthiritis haloperidol or diazepam for chorea
What are signs of mitral stenosis?
malar flush on cheeks, palpable first beat sounds, rumbling mid diastolic murmur
How should mitral stenosis be treated?
Anticoagulation with warfarin if with AF
Diuretics to reduce pre load and pulmonary venous congestion
If all else fails, balloon valvuloplasty or mitral valvotomy
Which murmur radiates to the axilla?
mitral regurgitation
What may be felt in mitral regurgitation?
right ventricular heave
What may be felt in aortic stenosis?
left ventricular heave
Is the prognosis badfor aortic stenosis?
Yes dreadful
Which valve disease can be cause by Marfan’s?
aortic regurgitation
What may be seen on a worsening aortic regurgitation?
T wave inversion in lateral leads
Is there a collapsing pulse in aortic regurgitation?
Yes
When may an aortic thrill be felt?
aortic stenosis
Who are likely to be affected by tricupsid regurgitation?
IV drug users
What are congenital causes of pulmonary stenosis?
Turner’s Syndrome, William’s Syndrome
In pulmonary stenosis, where will the murmur radiate?
left shoulder
What is pulmonary regurgitation caused by?
pulmonary hypertension
What does valvulopasty involve?
balloon catheter inserted across valve and inflated
Describe the signs of infective endocarditis.
fever, rigors, night sweats, malaise, weight loss, anaemia, CLUBBING, murmur
How is endocarditis diagnosed?
Duke’s criteria:
2 major or 1 major and 3 minor or all 5 minor
What are the major criteria for endocarditis?
positive blood culture positive echo (vegetation, abscess) or new valvular regurgitation
What are the minor criteria for endocarditis?
predisposition e.g. IV drug user, cardiac lesion
Fever
Immunological signs
What antibiotic should be used for staphylococci endocarditis?
flucoxacillin or gentamicin
What antibiotic should be used for streptococci endocarditis?
benxylpenicillin/amoxycillin
What antibiotic should be used for enteroococci endocarditis?
amoxicillin or gentamicin
What happens to T waves in myocarditis?
t wave inversion
What is cardiac tamponade?
accumulation or pericardial fluid raising intra-pericardial pressure
What can cause cardiac tamponade?
pericarditis, aortic dissection, warfarin
What is atrial septal defect?
hole between atria
What cause cause ventricular septal defect?
congenital causes or post MI
What is an aneurysm?
When artery dilates > 150% or its original diameter
Via what artery should an aneurysm be stented?
femoral
How does aortic dissection present?
sudden tearing chest pain that radiates to back, unequal blood pressure and pulses in each arm, acute limb ischaemia
What is the difference between class A and B dissection?
class A involves the ascending aorta
If a patient is in hypovolaemic shock, what is the first line intervention?
high flow oxygen via rebreather mask
How long can compensatory mechanisms maintain blood pressure in hypovolaemia?
until >30% or blood volume is lost
In an urgent scenarios, how should fluid be given to a hypovolaemic patient?
use 2 large cannulae in large veins
500mls of 0.9% quickly
What can cause pulmonary hypertension?
hypoxia
increased flow through pulmonary circulation
blockage eg PE
loss (emphysema) of vascular bed
back pressure from LEFT sided heart failure
What lung pattern does pulmonary oedema show?
restrictive
What can cause pulmonary oedema?
increased hydrostatic pressure, cellular injury, pneumonia, adult respiratory distress syndrome
Can myocarditis cause ST elevation?
Yes
What levels of hypoalbuminaemia are required before significant oedema develops?
very low, well below 30
