CV Diseases Flashcards
restricted perfusion of heart due to atherosclerosis
angina
pan or discomfort - tight, dull or heavy and passes within a few minutes
angina
pain that radiates to left arm, neck, jaw, back following exertion or stress
angina
relief: GTN or siblingual nitrate
angina
prophylaxis: aspirin, beta blockers, calcium channel blockers, long acting nitrates, ivabradine, nicorandil
angina
surgery: coronary bypass, PCI
angina
complications: heart attack, stroke, depression
angina
prevention: statins, ACEI, antiplatelets, lifestyle changes (to prevent MI/stroke)
angina
ischaemic necrosis of a tissue of myocardium secondary to occlusion/reduction of the coronary blood supply
acute MI
severe crushing, heavy, central chest pain
acute MI
pain radiating to jaw and arms, not relieved by GTN
acute MI
severe chest pain associated with sweating, nausea and vomiting
acute MI
caused by atherosclerosis of the coronary arteries
acute MI
treatment is MONA+C
acute MI
MONA+C
morphine (and anti-emetic), oxygen, nitrates, aspirin 300mg and clopidogrel 300mg
thrombolysis, PCI, CABG, angiogram
acute MI
complications: death, arrhythmia, aneurysm, inflammation, acute LVF, cardiogenic shock
acute MI
prevention - lifestyle changes
acute MI
low cardiac output from left side of heart (acute of chronic)
left heart failure
pulmonary oedema, orthopnoea, paroxysmal nocturnal dyspnoea
left heart failure
tachycardia, fine crepitations, pleural effusion more common in chronic, third heart sound, cardiomegaly and bat wing shadows in lower zones on CXR
left heart failure
caused by ischaemic heart disease, cardiomyopathy, valvular disease
left heart failure
diagnosed by natriuretic peptide test, echo, ECG
left heart failure
treated by lifestyle changes, loop diuretic, ACEI, beta blocker, aldosterone antagonist, digoxin
left heart failure
complications - arryhythmias, depression
left heart failure
IN ACUTE LVF
sit up, oxygen, IV furosemide, IV morhpine, but not in COPD
low cardiac output from the right side of the heart
right heart failure
peripheral oedema
right heart failure
ankle/sacral oedema, elevated JVP, hepatomegaly, ascites, normal CXR
right heart failure
often caused by LVF, cor pulmonale, congenital heart failure
right heart failure
diagnosed by natriuretic peptide tet, echo, ECG
right heart failure
treatment - lifestyle changes, loop diuretic, beta blocker, aldosterone antagonist, PCI
right heart failure
complications - arrhythmias
right heart failure
prevention - lifestyle changes, treatment of lung disease
right heart failure
acute onset of focal neurological signs and symptoms due to disruption of the blood supply (ischaemic or haemorrhagic)
stroke
face dropped on one side, weakness in one arm, speech may be slurred or garbled
stroke
sudden loss of vision, dizziness, difficulty swallowing, sudden and severe headache
stroke
caused by hypertension, hyperlipidaemia, smoking
stroke
diagnosed by CT and MRI, echo, carotid ultrasound
stroke
treatment - anticoagulant, vasodilator, statin, carotid stenosis
ischaemic stroke
treatment - haemotoma evacuation, craniotomy
haemorrhagic stroke
complications - DVT
stroke
intermittent claudication, critical limb ischaemia
peripheral arterial disease
hair loss, numbness, shiny skin, non-healing ulceration of feet and legs
peripheral arterial disease
caused by atherosclerosis of the peripheral arteries
peripheral artery disease
diagnosis - ABPI (ankle-brachial pressure index), doppler ultrasound, magnetic resonance angiogram
peripheral artery disease
treatment - exercise tolerance training, angioplasty and stenting, bypass/graft surgery, revascularistion, pain management, amputation
peripheral artery disease
complications - increased risk of MI/TIA
peripheral artery disease
infection of the endothelium of the heart valves, up to 25% mortality, acute or subacute
endocarditis
overwhelming sepsis and cardiac failure
acute endocarditis
fever, malaise, weight loss, tiredness, breathlessness
subacute endocarditis
Fever, Roth spots, Oslers nodes, Murmur, Janeway lesions, Anaemia, Nail haemorrhages, Emboli (FROM JANE)
endocarditis
predisposing factors - heart valve abnormality, calcification in the elderly, congenital heart disease, post rheumatic fever, IV lines, IV drug users, prosthetic heart valve
endocarditis
pathogenesis of endocarditis
heart valve damage > turbulent flow over roughened endothelium > platelets/fibrin exposed > bacteria settle and become microbial vegetations
3x blood cultures (before abx), echo
endocarditis
treatment - high dose IV abx
endocarditis
native valve, viridans strep endocarditis
benzylpenicillin and gentamicin
prosthetic valve, MRSA, enterococcus, staph epiidermidis
vancomycin and gentamicin
staph aureus
flucloxacillin
complications - infected vegetations break off and become lodged in next capillary bed > abscesses/haemorrhages (normally left side of heart)
endocarditis
prevention - abx prophylaxis
endocarditis
inflammtion of cardiac muscle, commoner in young people
myocarditis
fever, chest pain, shortness of breath, palpatations
myocarditis
arrhythmias, cardiac failure
myocarditis
caused by enteroviruses
myocarditis
supportive treatment
myocarditis
complications - heart failure, MI/stroke, arrhythmias
myocarditis
inflammation of pericardium, often occurs with myocarditis
pericarditis
chest pain is main feature, with fever, fatigue, nausea
pericarditis
pericardial rub
pericarditis
most commonly viral cause
pericarditis
symptoms, auscultation, ECG, CXR
pericarditis
treated with NSAIDs
pericarditis
complications - cardiac tamponade
pericarditis
hardening of the aortic valve
aortic stenosis
SOB, chest pain, pre-syncope, syncope
aortic stenosis
congenital, age related, rheumatic
aortic stenosis
diagnosed by ECG, echo
murmurs
valve replacement, transcatheter aortic valve implantation
aortic stenosis
complications - heart failure, cardiac arrest
aortic stenosis
back flow of blood through mitral valve due to floppy valves
mitral regurgitation
SOB, ankle swelling
mitral regurgitation
displaced apex, pansystolic murmur, maximal at apex and radiates to axilla
mitral regurgitation
rheumatic heart disease, myxomatous degeneration, andocardits, chordal rupture, ischaemia/infarction of papillary muscle, LVH
mitral regurgitation
treatment - diuretics, ACEI, digoxin, warfarin, valve replacement, valve repair, percutnaeous mitral valve repair
mitral regurgitation
complications - heart failure, AF, endocarditis, pulmonary hypertension
mitral regurgitation
hardening of the mitral valve
mitral stenosis
SOB, tiredness, palpitations
mitral stenosis
malar flush, tapping apex beat, mid diastolic murmur localised to apex
mitral stenosis
caused by rheumatic heart disease (symptom history may be absent)
mitral stenosis
treated with diuretics, beta blockers, digoxin, warfarin, valve replacement, mitral balloon valvuloplasty
mitral stenosis
complications - right heart failure, cardiac cachexia
mitral stenosis
‘soft’ aortic valve causing back flow of blood
aortic regurgitation
SOB, chest pain, dizziness
aortic regurgitation
high volume collapsing pulse, displaced apex
aortic regurgitation
early diastolic murmur ar lower left sternal edge
aortic regurgitation
caused by infective endocarditis, rheumatic heart disease, marfan’s syndrome, acute aortic dissection
aortic regurgitation
treated with ACEI, angiotensin receptor blockers, diuretics valve replacement
aortic regurgitation
complications - heart failure
aortic regurgitation
heart rate less the 60bpm, regular
sinus bradycardia
caused by high exercise tolerance (athletes), drugs, ischaemia (common in inferior STEMIs)
sinus bradycardia
treated with atropine if acute, pacing if haemodynamic compromise
sinus bradycardia
heart rate more than 100bpm, regular
sinus tachycardia
caused by anxiety, hypotension, anaemia, drugs
sinus tachycardia
treat underlying cause, beta blocker
sinus tachycardia
p waves absent or inverted after QRS
SVT
AV nodal re-entrant tachycardia, AV reciprocating tachycardia, ectopic tachycardia
SVT
treatment - increase vagal tone, valsalva manoeuvre, carotid massage
acute SVT
avoid stimulants, electrophysiologic study in young patient, beta blockers, antiarrhythmic drugs
chronic SVT
‘added’ ventricular contraction, may be a marker of inherited cardiac conditions
ventricular ectopics
caused by LVH, heart failure, ischaemic heart disease, electrolytes
ventricular ectopics
earlier than expected, wide QRS complex, without preceding p waves, often followed by compensatory pause
ventricular ectopics
treated with beta blockers
ventricular ectopics
chaotic ventricular activity which causes the heart to lose the ability to function as a pump
VT
palpitations, chest pain, pre-syncope, syncope
VT
wide QRS complexes
VT
treated with cardioversion/defibrillation
VT
chaotic and disorganised electrical activity leading to an irregular pumping mechanism
AF
can be asymptomatic, palpitations, syncope, chest pain, dyspnoea, sweatiness, fatigue
AF
risk factors - heart valve abnormality, calcification in elderly, congenital heart disease, post rheumatic fever, IV line, IV drug users, prosthetic heart valve
AF
irregularly irregular heart rate, atrial rate >300bpm, absent P waves
AF
pharmacological cardioversion, electrical cardioversion
AF
complications - stroke
AF
blood pressure over 140/90
hypertension
BP 140/90
stage 1
BP 160/100
stage 2
BP 180/110
stage 3
DBP > 130
malignant
causes - alcohol, smoking, obesity, dyslipidaemia, high salt intake
hypertension
asymptomatic, sweating, headaches, palpitations, SOB
hypertension
complications of hypertension
stroke, MI, retinopathy, kidney disease
urine test, funuscopy (retinopathy), ABPM/HBPM
hypertension
treatment - ACEI, beta blockers, CCB, thiazide diuretics
hypertension
prolonged of PR interval
1st degree heart block
progressive PR interval prolongation, followed by dropped QRS
2nd degree heart block, Mobitz 1
dropped QRS but no progressive PR interval prolongation
2nd degree heart block, Mobitz 2
dissociation between P-wave and QRS (lonely P waves)
3rd degree heart block
paroxysmal AF
recurrence lasting less than 48hrs
persistent AF
lasts over 48hrs but can be cardioverted
permanent AF
unable to cardioconvert to NSR
broad QRS complexes, deep S waves in I and V6, tall R waves in V1
right BBB
broad QRS complexes deep S waves in V1, tall R waves in I and V6, abnormaal Q waves
left BBB
IV atropine, temporary or permanent pacing
heart block
asymptomatic if non-ruptured, severe back pain, hypotension, tachycardia, anaemia, pulsatile/expansile abdominal mass, discoloured peripheries
abdominal aortic aneurysm
treatment - lifestyle advice, endovascular stenting, fitness testing, open surgery
abdominal aortic aneurysm
PE-like features, ankle oedema, calf pain, swelling or redness,
DVT
PTP scoring, d-dimers, doppler ultrasound
DVT
treatment - anticoagulation, caval filters, TED stockings
DVT
back pressure due to incompetent valves causes blood to pool in superficial veins
varicose veins
caused by DVT
varicose veins
treated with stockings or foam sclerotherapy or endovenous ablation
varicose veins
local superficial inflammation with secondary thrombosis, often associated with varicose veins
thrombophlebitis
pain, tenderness, redness, swelling
thrombophlebitis
analgesics, elevation of limb, fondaparinux
thrombophlebitis
central cyanosis (congenital heart disease)
right to left shunt
pulmonary hypertension (congenital heart disease)
left to right shunt
clubbing (congenital heart disease)
prolonged cyanosis
paradoxical embolisms (congenital heart disease)
patent foramen ovale
pressure in left ventricle greater than pressure in right ventricle
left to right shunt
loud pansystolic murmur, LA and LV dilation, heart failure symptoms
ventricular septal defect
superior part of septum near SVC/inferior part of septum near IVC
sinus venosus defect
mid septum (fossa ovalis, not the same as patent foramen ovale
ostium secendum defect
lower part of atrial septum
ostium primum (AV septum) defect
dyspnoea, exercise intolerance, atrial arrhythmias from aatrial dilation, RV heave, pulmonary mid-systolic murmur
atrial septal defect
persistent communication between pulmonary artery and descending aorta (left to right shunt)
patent ductus arteriosus
bounding pulse, machine gun murmur
patent ductus arteriosus
narrowing of aorta at/just distal to insertion of ductus arteriosus
coarctation of the aorta
associated withbicuspid aortic valve, PDA, VSD, mitral valve disease, circle of willis aneurysm
coarctation of the aorta
headaches, nosebleeds, diminished/absent lower limb pulses, rib-notching of CXR
coarctation of the aorta
VSD, overriding aorta, RV outflow obstruction, RV hypertrophy
tetralogy of fallot
cyanosis due to increased right-sided pressure (right to left shunt)
tetralogy of fallot
squatting relieves spasm of muscle (postural manoeuvres)
tetralogy of fallot
harsh systolic ejection murmur, often associated with a left parasternal heave
tetralogy of fallot
right ventricle gives rise to the aorta, left ventricle gives rise to pulmonary artery
transposition of the great vessels
babies born cyanosed
transposition of great vessels
hypertrophy of the myocardium in the absence of other disease
hypertrophic cardiomyopathy
double apex pulsation, S4, chest pain, dyspnoea, syncope, jerky carotid pulse, systolic murmur, LV outflow obstruction
hypertrophic cardiomyopathy
treatment - beta blockers +/- verapamil, amiodarone
hypertrophic cardiomyopathy
dilation of ventricles with systolic dysfunction, with preserved wall thickness
dilated cardiomyopathy
arrhythmias, heart failure, thromboembolism
dilated cardiomyopathy
fatty/fibro-fatty replacement of myocytes leading to partial or complete RV dilation, LV can be involved
arrhythmogenic right ventricular cardiomyopathy
ventricular arrhythmias, syncope, RHF in later stages
arrhythmogenic right ventricular cardiomyopathy
T-wave inversion, epsilon waves after QRS comples, RBBB
arrhythmogenic right ventricular cardiomyopathy
treated with beta-blockers for non-life threatening arrhythmias, amiodarone or sotalol for symptomatic arrhythmias
arrhythmogenic right ventricular cardiomyopathy
decresed volume of both ventricles with bi-atrial enlargement, normal wall thickness, impaired filling
restrictive cardiomyopathy
heart failure symptoms, hepatic enlargment, ascites
restrictive cardiomyopathy
CXR shows pulmonary venous congestion, echo shows impaired ventricle filling, ECG shows low-voltage QRS
restrictive cardiomyopathy
