CVS Flashcards
1
Q
Hypotension Muffled heart sound raised JVP tachycardia dyspnoea
A
Cardiac tamponade
2
Q
ECG = electrical alternans
A
cardiac tamponade
3
Q
Management of Cardiac tamponade
A
Urgent pericardiocentesis
4
Q
splinter haemorrhages roth spots janeway lesions new murmur (regurg) osler's nodes fever
A
Infective endocarditis
5
Q
RFs for infective endocarditis
A
valvular disease
prosthetic valve
IV drug use
6
Q
diagnostic investigations for infective endocarditis:
A
multiple +ve blood cultures (staph aureus) and ECHO (check valves)
7
Q
management for infective endocarditis:
A
penicillin amocillin and gentamicin
penicillin allergy/severe case = + vancomycin
HF signs - urgent valve replacement/surgery
8
Q
severe tearing chest pain - sometime radiation of pain to back pulse deficit/wide pulse pressure aortic regurg dyspnoea hypotension
widened mediastinum, false lumen on CT CAP/TOE
A
Aortic dissection
ascending/type A = radiate to thoracic region
descending type B = radiates to back
9
Q
type A aortic dissection mx
A
surgical repair and IV labetalol (aim for SBP - 100-120mmHg)
10
Q
Type B aortic dissection mx
A
IV labetalol
bed rest
analgesia
11
Q
ejection systolic (crescendo-decrescendo) murmur radiating to carotids
A
aortic stenosis
12
Q
early diastolic (decrescendo) murmur de mussets = head bobbing de quincke's = nailbed pulsation
A
aortic regurgitation
13
Q
dizziness, less exercise tolerance/dyspnoea, palpitations,
irregularly irregular pulse
absent p waves
A
Atrial fibrillation
14
Q
management of Atrial fibrillation
A
<48hr = heparin and cardiovert >48hr = anticoagulate (DOAC) for 3wks and cardiovert
CHA2DS2VASC = 2+ = anticoagulate ORBIT score 0-2 - low risk 3 - medium risk 4-7 - high risk
rate control of initiated if presentation>48hrs = beta blocker/diltiazem/verapamil
anticoagulation with DOACs
warfarin second line
15
Q
palpitations, dyspnoea, fatigue, syncope, SOB
ventricular rate above 300/min/very tachycardic
sawtooth appearance on ECG
A
Atrial flutter
16
Q
management of Atrial flutter
A
cardiovert
radiofrequency ablation of tricuspid valve
17
Q
ejection systolic murmur + split S2, louder on inspiration
heard in the left sternal edge
Acyanotic
symptomatic in adulthood
A
atrial septal defect
18
Q
what is the management of ASD
A
surgery
19
Q
mid-late diastolic murmur, loud S1 and opening snap best on expiration rheumatic fever hx malar flush atrial fibrillation
A
mitral stenosis
20
Q
pansystolic ‘blowing’ murmur, best @ apec and radiates to axilla
marfans/ehlers-danhlos hx
A
mitral regurgitation
21
Q
erythema marginatum subcuatneous nodules fever polyarthritis carditis/valvulitis = chest pain, SOB, regurg murmur chorea hx or sore throat a couple week back
A
acute rheumatic fever
22
Q
diagnose rheumatic fever
A
+ve throat swabs
raised ESR/CRP
ASO titre
ECHO = HF signs
23
Q
management of acute rheumatic fever
A
oral penicillin V + NSAIDs
treat HF
24
Q
usually asymptomatic
may present with headaches, visual changes or palpitations in severe cases
A
hypertension
25
HTN diagnosis and checks
a clinic reading persistently above >= 140/90 mmHg, or:
a 24 hour blood pressure average reading >= 135/85 mmHg
fundoscopy: to check for hypertensive retinopathy
urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
ECG: to check for left ventricular hypertrophy or ischaemic heart disease
26
```
breathlessness, oedema,
reduced exercise tolerance/fatigue
raised JVP
displaced apex beat
bibasal crackles
```
acute heart failure
27
```
dyspnoea
cough (frothy sputum)
orthopnoea
PND
weight loss
bibasal crackles
ankle oedema
raised JVP
hepatomegaly
```
chronic heart failure
28
heart failure Ix
```
CXR = cardiomegaly and interstitial oedema
BNP = >100mg/L
ECHO = pericardial effusion - definitive
```
29
management of heart failure
first line = ACEi + Beta blocker
second line = spironolactone
specialist care with hydralazine and ivabradine, nitrates and digoxin
offer annual influenza vaccine
offer pneumococcal vaccine every 5 years
30
heavy constricting chest pain
relieved by rest or GTN spray
~10-15mins
Stable angina
31
Management of stable angina
beta-blocker or CCB (verapamil/diltiazem)
long acting nitrate if not controlled with adjunct tx Ivabradine, nicorandil or ranolazine if contraindicated - third drug only added if awaiting pci/cabg
32
chest pain typically at rest
very short lived
radiated to the back
SOB
transient ST elevation in ECG
prinzmetal angina
33
management of prinzmetal angina
CCB - reduce no, of spasms
GTN fo symptomatic relief
34
heavy constricting chest pain
radiation to left arm, jaw, or neck
not releievd by rest/GTN
unstable angina
35
management of unstable angina
unstable angina - no ECG changes and no trop raise
aspirin + ticagrelor and fondaparinux
36
```
central/left-sided chest pain, heavy and constricting
radiation to the left jaw, neck and arm
dyspnoea
sweating
palpitations
```
Acute myocardial infarction
37
Initial management of acute MI
1. 300mg Aspirin
2. Oxygen - if O2 stats are <94%
3. Morphine IV for pain
4. Nitrates - IV or sublingual
STEMI = need to have PCI done - if not available with 120mins/2hrs then start fibrinolysis
NSTEMI = fondaparinux and GRACE assessment
high risk - PCI within 72hrs (have patient on ticagrelor and heparin)
low risk - ticagrelor
38
differentiate between first and second degree heart block
First degree = PR interval is >0.20s (usually asymptomatic)
delayed conduction
Second degree
type 1 = progressive prolongation of the PR interval till the missed beat
type 2 = constant PR interval till a missed beat
39
```
syncope
heart failure
regular bradycardia
wide pulse pressure
variable intensity of S1
```
ECG = no association of P and Q waves
3 degree heart block
40
heart failure in infancy / low birth weight
HTN in adults
radio-femoral delay
mid-systolic murmur (more over back)
notching of the border of the ribs in young children
link to Turner's syndrome
more common in males
coarctation of the aorta
41
Definitive Ix for coarctation of the aorta
ECHO
| ECG &CXR are the other
42
management of coarctation of the aorta
treat any resulting heart failure, HTN symptoms
| Ultimately surgery is required to repair narrowing
43
```
classic HF findings
systolic murmur (mitral/tricuspid regurg)
S3 heart sound
systolic dysfunction
```
Dilated cardiomyopathy
44
Investigation for dilated cardiomyopathy
CXR = balloon appearance
45
managment of dilated cardiomyopathy
lifestyle measures
HF medication
Surgery or heart transplant if severe
46
most common . in young pts
can often be asymptomatic
exertional dyspnoea/syncope
angina
sudden death
syncope often following exercise/exertion
ejection systolic murmur - increased by valsava and decreased by squatting
autosomal dominant - FHx
hypertrophic obstructive cardiomyopathy
47
Ix for hypertrophic obstrcutive cardiomyopathy
ECHO = mitral regurg, systolic anterior motion & asymmetric hypertrophy
ECG = LVH, deep Q waves, ST segment changes, T wave abnormalities
48
management of hypertrophic obstructive cardiomyopathy
```
A = amiodarone
B = beta blockers
C = cardioverter defibrillator
D = dual chamber pacemaker
E = endocarditis prophylaxis
```
49
```
SOBOE
orthopnea
fatigue
leg and ankle swelling
cough
```
usually caused by amyloidosis, post radiotherapy or loeffers endocarditis
restrictive cardiomyopathy
50
Ix of choice for restrictive cardiomyopathy
ECHO - thickened walls
51
Management for restrictive cardiomyopathy
```
manage HF
amiodarone for arrhythmias
anticoagulation
implantable cardioverter defibrillator
surgery indicated in some cases
```
52
sudden onset of palpitations/heart beating faster
tired
weak or lightheaded
nauseous
ECG findings
narrow QRS complexes
rate 140-280
absent p waves
supraventricular tachycardia
53
management of SVT
acute = vasovagal maneuvers = either valsave or carotid sinus massage
IV adrenaline 6mg, then 12m and then another 12mg (verapamil in asthmatics)
electrical cardioversion if all else fails.
54
hypotension
collapse
acute HF
```
ECG = broad QRS complexes
HR = >100bpm
```
ventricular tachycardia
55
management of ventricular tachycardia
amiodarone, lidocaine and procainamide
| if this fails, electrophysiological study & ICD
56
often occurs following an MI
chaotic, irregular deflections of varying amplitudes
no identifiable P waves ,QRS complexes or T waves
ventricular fibrillation/flutter
57
management of VF
defibrillation and stop all antiarrhythmics
in the long run - ICD implantation
58
lead V1 = M shaped QRS
lead V6 = W shaped QRS
split S2
RBBB
59
Lead V1 = W shaped QRS
| Lead V6 = M shaped QRS
LBBB
60
What is a new onset LBBB a sign of ?
Myocardial Infarction
61
management of bundle branch blocks
Cardiovert and manage the complications
62
often asymptomatic
| may have complaints of headaches, visual disturbance or in very severe cases seizures
Hypertension
63
diagnosis of HTN?
a clinic reading persistently above >= 140/90 mmHg,
or:
a 24 hour blood pressure average reading >= 135/85 mmHg
OTHER CHECKS:
fundoscopy: to check for hypertensive retinopathy
urine dipstick: to check for renal disease, either as a cause or consequence of hypertension
ECG: to check for left ventricular hypertrophy or ischaemic heart disease
64
management of HTN
if under 55/not african-caribbean/diabetic
= start on ACEi/ARB
(Then stepwise addition of CCB or thiazide and then triple therapy)
If above 55/non-diabetic/African-carribbean
= start on CCB
(add on thiazide or ACEi/ARB, and then triple therapy)
if still hypertensive - check K+ level
- if above 4.5mmol/L = alpha/beta blocker
- if below 4.5mmol/L = low dose spironolactone
65
describe stages of HTN
Stage 1 hypertension — clinic blood pressure ranging from 140/90 mmHg to 159/99 mmHg and subsequent ABPM daytime average or HBPM average blood pressure ranging from 135/85 mmHg to 149/94 mmHg.
Stage 2 hypertension — clinic blood pressure of 160/100 mmHg or higher but less than 180/120 mmHg and subsequent ABPM daytime average or HBPM average blood pressure of 150/95 mmHg or higher.
Stage 3 or severe hypertension — clinic systolic blood pressure of 180 mmHg or higher or clinic diastolic blood pressure of 120 mmHg or higher.
Accelerated (or malignant) hypertension is a severe increase in blood pressure to 180/120 mmHg or higher (and often over 220/120 mmHg) with signs of retinal haemorrhage and/or papilloedema (swelling of the optic nerve). q
66
pain
erythema around the affected area
may be able to feel harder lumps underneath the skin
phlebitis/thrombophlebitis
67
management of phlebitis/thrombophlebitis
Oral NSAIDs/heparinoids
compression stocking (measure ABPI prior)
LMWH/fondaparinux
US may be done to exclude DVT
68
aching/burning in muscles following exertion
relieved within minutes of stopping exertion or resting
calves affected > than thigh/buttock
ABPI = 0.6-0.9
intermittent claudication
69
```
pale
pulseless
painful
paralysed
paresthetic
poikilothermic (cold)
```
arterial occlusion/acute limb ischaemia
70
management of peripheral arterial disease
intermittent claudication
- supervised exercise programme
- optimise comorbidities 80mg atrovastatin and 75mg clopidogrel 3-6/12
- naftiodrofuryl oxalate
Acute limb ischaemia
- Vasc MDT
- paracetamol/opiods
- endovascular or surgical options
```
acute limb-threatening ischaemia
- ABC and IV opioids
- IV UFH
emergency assessment by vasc specialist
definitive - endovascular therapies or surgical interventions
```
71
Ix of choice for peripheral arterial disease
duplex ultrasound
72
aching, throbbing or itching in the lower limbs
tortuous superficial veins
RFs = female, pregnant, obesity and increasing age
varicose veins
conservative management = leg elevation, weight loss, regular exercise & graduated compression stockings
possible Txs
- endothermal ablation
- foam scleropathy
73
```
unilateral localised throbbing pain particularly on walking
or weight bearing
calf swelling & tenderness
oedema, redness and warmth
vein distension
```
DVT
74
Assessing for DVT
compare the circumference between the legs - >3cm
Wells DVT score - 2 or more is likely
1 or below = unlikely
75
management of unlikely DVT
offer D-dimer in 4hrs if not offer interim anticoagulation
D-dimer +ve = doppler US
D-dimer -ve = stop anticoagulation
76
management of likely DVT
proximal leg vein US within 4hrs
| if not D-dimer and interim anticoagulation (DOAC - apixaban)
77
management in provoked and unprovoked DVT
provoked DVT = continue for 3 months
| unprovoked DVT = consider undiagnosed cancer and thrombophilia testing
78
tetralogy of fallot characteristics?
ventricular septal defect
overriding aorta
right pulmonary stenosis
right ventricular hypertrophy
cyanosis and ejection systolic murmur
79
management of tetralogy of fallot
surgical repair and beta blocker
80
failure to thrive
HF symptoms - hepatomegaly, tachycardia/pneoa
pallor
pan-systolic murmur
ventricular septal defect
81
management of VSD
small VSD = usually asymptomatic - requires close monitoring and typically closes spontaneously
moderate-large VSD = nutritional support, diuretics for HF, surgical closure of the defect
82
```
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
left subclavicular thrill
continuous 'machinery murmur'
```
patent ductus arteriosus
83
patent ductus arteriosus management
indomethacin or ibuprofen (inhibition of prostaglandin synthesis closes the connection)
84
```
mid-diastolic murmur (expiration>>)
SI opening snap
malar flush
low volume pulse
AF, raised JVP and displaced apex beat
```
mitral stenosis
85
typically asymptomatic
some fatigue, SOB and oedema
pan-systolic 'blowing murmur', split S2
mitral regurg
86
management for mitral regurg
medical mx = nitrates/diuretics, digoxin, intra-aortic balloon pump
signs of HF = ACEi, BB and spironolactone
severe = surgery
87
atypical chest pain/palpitations
mid-systolic click
later systolic murmurs
varies when sitting/standing
common cause = myxomatous degeneration
mitral valve prolapse
88
management of mitral valve prolapse
dependent on severity
no tx
beta blockers
surgical repair/replacement
89
systolic murmur louder on inspiration
Pulmonary stenosis
90
pansystolic murmur louder on inspiration
tricuspid regurg
91
a drop in BP (usually >20/10 mm Hg) within three minutes of standing
presyncope
syncope
orthostatic hypotension
92
management of orthostatic hypotension
treatment options include midodrine and fludrocortisone
