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MEDICINE FINALS > CVS > Flashcards

CVS Flashcards

1
Q

Which murmurs would you expect to hear during systole?

A
  1. aortic stenosis
  2. mitral regurgitation
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2
Q

Which murmurs would you expect to hear during diastole?

A
  1. Aortic regurgitation
  2. mitral stenosis
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3
Q

How would you know if a murmur was systolic or diastolic?

A

Systolic -> occurs simultaneously with carotid pulse
Diastolic -> murmur occurs between carotid pulses

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4
Q

What are the symptoms of aortic stenosis?

A

SAD!
Syncope (exertional)
Angina
Dyspnoea

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5
Q

What are 3 causes of aortic stenosis?

A
  1. Congenital bicuspid valve
  2. degenerative calcification
  3. atherosclerosis
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6
Q

What would you hear on auscultation of someone with AS?

A

Ejection systolic murmur radiating to carotids
Louder on expiration
Silent S2

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7
Q

What is the management for aortic stenosis?

A

If asymptomatic -> manage conservatively with outpatient TTE every 1/2 years and safety netting r.e. dental hygiene and increased risk of IE

If symtpomatic -> aortic valve replacement/ TAVI

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8
Q

What would you expect to find on auscultation of someone with mitral regurgitation?

A

pansystolic murmur heard loudest over mitral area - radiating to axilla

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9
Q

What are 3 causes of mitral regurgitation?

A
  1. Infective endocarditis
  2. Acute MI
  3. Cardiomyopathy
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10
Q

What would you expect to find on auscultation of someone with aortic regurgitation?

A

Decrescendo early diastolic murmur heard loudest of left sternal edge

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11
Q

What would you expect to find on auscultation of someone with mitral stenosis?

A

low pitched, rumbling, mid-diastolic murmur heard loudest over apex

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12
Q

What would you expect to find on auscultation of someone with mitral stenosis?

A

low pitched, rumbling, mid-diastolic murmur heard loudest over apex

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13
Q

What signs might you expect to find in someone with aortic regurg? (2)

A
  1. waterhammer pulse
  2. wide pulse pressure
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14
Q

What ECG changes would you expect to see in someone with hypokalaemia?

A

U have no Pot and no T
but a long PR and a long QT
(u waves, small/absent T waves)

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15
Q

What ECG changes would you expect to see in someone with hyperkalaemia?

A
  • tall, tented T waves
  • broad QRS complexes
  • loss of P waves
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16
Q

Give 5 causes of RBBB

A
  1. normal variant (old peeps)
  2. RVH
  3. PE
  4. MI
  5. cor pulmonale
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17
Q

What is the main feature of bundle branch blocks on ECG?

A

Broad QRS (>120ms)

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18
Q

Which leads should you look at to identify bundle branch clock?

A

V1 and V6

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19
Q

How would you identify atrioventricular delay on an ECG?

A

PR interval >0.2 secs/ 5 small squares

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20
Q

You are handed an ECG which shows progressive prolongation of PR interval until eventually QRS complex is dropped. What does this suggest?

A

Second degree AV block (type 1)
- i.e. Mobitz type 1/Wenckebach

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21
Q

What is the difference between 1st and 3rd degree heart block?

A

1st = fixed PR interval
3rd = no relationship between A&V

22
Q

What would you see in an ECG of someone with Wolff Parkinson White syndrome? (3)

A
  • Short PR interval (<3 squares)
  • delta wave
  • tachycardia
23
Q

What medications should someone be started on post-MI?

A
  • ACE inhibitor (or ARB)
  • Dual antiplatelet therapy (aspirin + clopidogrel)
  • beta-blocker.
  • statin.
24
Q

What is the first line pharmacological treatment for angina?

A

ANTI-ANGINALS
- GTN spray
- Beta blocker OR calcium channel blocker

2 PREVENTION
- aspirin
- statin

25
Q

What is the second line pharmacological treatment for angina?

A

1 - Increase dose of first line therapy
2 - Switch to either BB or CCB
3 - prescribe both CCB AND BB
4 - Long acting nitrate e.g. isosorbide mononitrate/nicorandil

(max 2 drugs before referral to cardiology)

26
Q

What is the first/second/third line drug therapy for chronic heart failure?

A

1 - ACE-i + Beta blocker (one at a time)
2 - Add aldosterone-antagonist e.g. spironolactone
3- Add SGLT-2 inhibitor e.g. canagliflozin
4 - specialist input

(+loop diuretic for symptomatic relief! furosemide)

27
Q

Other then main drug therapy, what additional care do chronic heart failure patients need?

A
  • one off pneumococcal vaccine
  • annual flu vaccine
  • statin + aspirin
  • cardiac rehab
  • depression screen
28
Q

What is the management for someone having a STEMI?

A

1 - oxygen ONLY if <94%
2 - 300mg aspirin
3 - Ticagrelor
4 - <12hrs + PCI in 120mins
5 - fibrinolysis if <12hrs and >120mins to PCI

(+nitrates/morphine for pain)

29
Q

What is the management for someone having an NSTEMI or unstable angina?

A

1 - aspirin 300mg
2 - fondaparinux
3 - calculate GRACE score (6m mortality)

Low risk (<3%) = ticagrelor
High risk = PCI + ticagrelor

30
Q

A couple of hours post MI and pt is suddenly breathless and coughing up frothy pink sputum - cause?

A

Acute heart failure

31
Q

How would Dressler’s syndrome present?

A

2-4 weeks post MI with mild fever and pleuritic chest pain

32
Q

Give 5 causes of acute pericarditis

A
  • viral infections
  • post MI
  • connective tissue disease
  • malignancy
  • trauma
33
Q

What symptoms/signs would you see in someone with acute pericarditis? (5)

A
  • pleuritic chest pain, relieved on sitting forwards
  • non-productive cough
  • SOB
  • flu like symptoms
  • pericardial rub
34
Q

What is Beck’s triad and what does it indicate?

A

Cardiac tamponade
- hypotension
- muffled heart sounds
- raised JVP

35
Q

What would you find on ECG of someone with acute pericarditis?

A

WIDESPREAD saddle-shaped ST elevation AND
PR depression

36
Q

How would you investigate someone with suspected acute pericarditis?

A

transthoracic echo !

bloods
- inflamm markers raised
- troponin may be raised

37
Q

How would you treat a pt with acute pericarditis?

A

can be managed as outpatients if T<38 and no raised trops
- treat underlying cause
- no strenuous activity until its resolved
- NSAIDs and COLCHICINE

38
Q

What are the typical features of acute limb ischaemia?

A

ACUTE ONSET

Pain — constantly present and persistent.

Pulseless — ankle pulses are always absent.

Pallor (or cyanosis or mottling).

Power loss or paralysis.

Paraesthesia or reduced sensation or numbness.

Perishing with cold.

39
Q

What are features of intermittent claudication?

A
  • intermittent, progressive cramp-like pain in the calf, thigh or buttock on walking which is RELIEVED BY RESTING
40
Q

What are features of critical/chronic limb ischaemia?

A

1 or more of:
- rest pain in foot for more than 2 weeks
- ulceration
- gangrene

(patients hang leg out of bed to ease pain)

41
Q

What is acute limb ischaemia?

A

rapid onset of ischaemia in a limb, typically due to a thrombus/embolism

42
Q

What is critical limb ischaemia?

A

End-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest.

43
Q

Describe a typical arterial ulcer (7)

A

Small
Deep
Well defined borders
Have a “punched-out” appearance
Occur peripherally (e.g., on the toes)
Have reduced bleeding
Are painful

44
Q

Describe a typical venous ulcer (7)

A

-Occur after a minor injury to the leg
-Large
-Superficial
-Have irregular, gently sloping borders
-Affect the gaiter area of the leg (from the mid-calf down to the ankle)
-Are less painful than arterial ulcers
-Occur with other signs of chronic venous insufficiency (e.g., haemosiderin staining and venous eczema)

45
Q

How would you investigate someone with peripheral arterial disease?

A
  • handheld doppler
  • ABPI
46
Q

How would you manage someone with acute limb ischaemia? (6)

A
  1. A-E
  2. NBM
  3. 15L oxygen, morphine, fluids, ECG, ABG
  4. HEPARIN bolus + infusion
  5. tissue viability/doppler USS
  6. angioplasty/embolectomy
47
Q

Who gets a DOAC?

A

People with non-valvular AF for prevention of stroke and systemic embolism in adults
CHADSVASC score of 2+ or men with score of 1+

48
Q

Give 6 potential causes of new onset AF

A

PIRATES
PE
Ischaemia
Resp disease
Atrial enlargement
Thyroid disease
Ethanol
Sepsis

49
Q

How do you manage AF in someone with SOB/chest pain/tachy/hypotensive ?

A

ADMIT TO HOSPITAL
- electro cardioversion
- flecainide

50
Q

How could you modify risk factors for bleeding in someone about to start a DOAC?

A
  • Treat uncontrolled hypertension.
  • Get better control of INR in people taking a vitamin K antagonist.
  • Address harmful alcohol consumption.
  • Treat reversible causes of anaemia.
51
Q

How would you manage new onset AF in a stable patient?

A

1 - Prescribe beta blocker OR rate limiting CCB
2- Calculate CHADSVASC and ORBIT score and discuss results with patient
2 - If CHADSVASC score >1 in men or >2 in women then prescribe DOAC
3 - if DOAC not suitable prescribe warfarin

52
Q

What risk factors are involved in CHADSVASC scoring system?

A

CCF
HTN
Age>75 (2)
Diabetes
Stroke (prev or TIA) (2)
Vascular disease
Age>65
Sex = F

MEDICINE FINALS (19 decks)

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