Corrections 3 Flashcards
What murmur is heard in coarctation of the aorta?
Systolic murmur heard under the L clavicle and over the back.
What valvular disorder is associated with polycystic kidney disease?
mitral valve prolapse & mitral regurgitation
Define unstable angina
Patients with ischaemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram changes indicative of ischaemia.
i.e. can have ECG changes but no rise in troponin
What monitoring is required in statins?
LFTs at baseline, 3 months and 12 months
What 3 electrolytes imbalances can cause long QT?
1) hypokalaemia
2) hypocalcaemia
3) hypomagnesaemia
What is the most common form of cardiomyopathy?
Dilated cardiomyopathy (90%)
Causes of dilated cardiomyopathy?
1) idiopathic (most common)
myocarditis: e.g. Coxsackie B, 2) HIV, diphtheria, Chagas disease
3) IHD
4) peripartum
5) HTN
6) iatrogenic: e.g. doxorubicin
7) substance abuse: e.g. alcohol, cocaine
8) inherited: either a familial genetic predisposition to DCM or a specific syndrome e.g. Duchenne muscular dystrophy
9) infiltrative e.g. haemochromatosis, sarcoidosis
Echo findings in dilated cardiomyopathy?
1) Reduced LV EF
2) Dilated LV
3) No regional wall motion abnormalities
What is used to treat cardiac tamponade when the patient has a neoplastic disease, which is melanoma in this case?
Percutaneous balloon pericardiotomy
Most common causes of infective endocarditis:
1) <2m post valve surgery
2) >2m post valve surgery
1) staph. epidermis
2) staph. aureus
What is action of fibrinolytic drugs (e.g. atelplase, streptokinase) used in thrombolysis?
Plasminogen activators (into plasmin).
Plasmin breaks down fibrin in clots.
A previous stroke in what time period is a contraindication to thrombolysis?
<3m
What are 3 indications for thrombolysis?
1) STEMI
2) Massive PE + hypotension
3) Ischaemic stroke
What does the GRACE score predict?
6m mortality post NSTEMI
What does LV aneurysm post-MI increase the risks of?
Thrombus may form within the aneurysm increasing the risk of stroke.
Patients are anticoagulated.
What is the diagnostic test for Lyme disease?
Antibody titres for Borrelia burgdorferi
How can lyme disease affect the heart?
Can cause myocarditis –> ST elevation on an ECG
For STEMI patients receiving thrombolysis, what should they be given alongside this?
Antithrombin e.g. fondaparinux
What does severe hyperkalaemia in the context of an AKI require?
Immediate discussion with critical care/nephrology to consider haemofiltration/haemodialysis
What diameter defines an AAA?
> 3cm
Who is an elective repair for AAA considered in? (3)
1) diameter growing >1cm per year
2) ≥5.5cm
3) symptomatic
What is the gold standard imaging for diagnosing a ruptured AAA?
CT angiogram (only in stable patients)
Describe Stanford system classification of aortic dissection
Type A (ascending) –> affects aorta before the brachiocephalic artery
Type B (descending) –> affects descending aorta AFTER left subclavian artery
What is the single most common cause of 2ary hypertension?
1ary hyperaldosteronism (including Conn’s syndrome)
What clinic BP readings define:
1) Stage 1 HTN
2) Stage 2 HTN
3) Stage 3 HTN
1) 140/90
2) 160/100
3) 180/120
What 2 eye signs may be seen in malignant HTN?
1) papilloedema
2) retinal haemorrhages
Management of malignant HTN?
1) SAME DAY referral
2) Fundoscopy exam –> to look for key findings
How can statins affect the liver?
Can cause a transient and mild rise in ALT and AST in first few weeks.
Stop statins if rise is >3x baseline.
What 2hr OGTT result implies impaired glucose tolerance?
7.8-11.1 mmol/L
If new BP >= 180/120 mmHg + no worrying signs but no signs of papilloedema/retinal haemorrhages, what is next step?
Urgent investigations for end-organ damage (e.g. bloods, urine ACR, ECG)
What do questions regarding Takayasu’s arteritis commonly refer to?
An absent limb pulse.
It is more common in younger females (e.g. 10-40 years) and Asian people.
What 2 medications can be used for pharmacological conversion in AF?
1) flecainide
2) amiodarone
