CVS Flashcards
Which murmurs would you expect to hear during systole?
- aortic stenosis
- mitral regurgitation
Which murmurs would you expect to hear during diastole?
- Aortic regurgitation
- mitral stenosis
How would you know if a murmur was systolic or diastolic?
Systolic -> occurs simultaneously with carotid pulse
Diastolic -> murmur occurs between carotid pulses
What are the symptoms of aortic stenosis?
SAD!
Syncope (exertional)
Angina
Dyspnoea
What are 3 causes of aortic stenosis?
- Congenital bicuspid valve
- degenerative calcification
- atherosclerosis
What would you hear on auscultation of someone with AS?
Ejection systolic murmur radiating to carotids
Louder on expiration
Silent S2
What is the management for aortic stenosis?
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
What would you expect to find on auscultation of someone with mitral regurgitation?
pansystolic murmur heard loudest over mitral area - radiating to axilla
What are 3 causes of mitral regurgitation?
- Infective endocarditis
- Acute MI
- Cardiomyopathy
What would you expect to find on auscultation of someone with aortic regurgitation?
Decrescendo early diastolic murmur heard loudest of left sternal edge
What would you expect to find on auscultation of someone with mitral stenosis?
low pitched, rumbling, mid-diastolic murmur heard loudest over apex
What would you expect to find on auscultation of someone with mitral stenosis?
low pitched, rumbling, mid-diastolic murmur heard loudest over apex
What signs might you expect to find in someone with aortic regurg? (2)
- waterhammer pulse
- wide pulse pressure
What ECG changes would you expect to see in someone with hypokalaemia?
U have no Pot and no T
but a long PR and a long QT
(u waves, small/absent T waves)
What ECG changes would you expect to see in someone with hyperkalaemia?
- tall, tented T waves
- broad QRS complexes
- loss of P waves
Give 5 causes of RBBB
- normal variant (old peeps)
- RVH
- PE
- MI
- cor pulmonale
What is the main feature of bundle branch blocks on ECG?
Broad QRS (>120ms)
Which leads should you look at to identify bundle branch clock?
V1 and V6
How would you identify atrioventricular delay on an ECG?
PR interval >0.2 secs/ 5 small squares
You are handed an ECG which shows progressive prolongation of PR interval until eventually QRS complex is dropped. What does this suggest?
Second degree AV block (type 1)
- i.e. Mobitz type 1/Wenckebach
What is the difference between 1st and 3rd degree heart block?
1st = fixed PR interval
3rd = no relationship between A&V
What would you see in an ECG of someone with Wolff Parkinson White syndrome? (3)
- Short PR interval (<3 squares)
- delta wave
- tachycardia
What medications should someone be started on post-MI?
- ACE inhibitor (or ARB)
- Dual antiplatelet therapy (aspirin + clopidogrel)
- beta-blocker.
- statin.
What is the first line pharmacological treatment for angina?
ANTI-ANGINALS
- GTN spray
- Beta blocker OR calcium channel blocker
2 PREVENTION
- aspirin
- statin
What is the second line pharmacological treatment for angina?
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)
What is the first/second/third line drug therapy for chronic heart failure?
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)
Other then main drug therapy, what additional care do chronic heart failure patients need?
- one off pneumococcal vaccine
- annual flu vaccine
- statin + aspirin
- cardiac rehab
- depression screen
What is the management for someone having a STEMI?
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)
What is the management for someone having an NSTEMI or unstable angina?
1 - aspirin 300mg
2 - fondaparinux
3 - calculate GRACE score (6m mortality)
Low risk (<3%) = ticagrelor
High risk = PCI + ticagrelor
A couple of hours post MI and pt is suddenly breathless and coughing up frothy pink sputum - cause?
Acute heart failure
How would Dressler’s syndrome present?
2-4 weeks post MI with mild fever and pleuritic chest pain
Give 5 causes of acute pericarditis
- viral infections
- post MI
- connective tissue disease
- malignancy
- trauma
What symptoms/signs would you see in someone with acute pericarditis? (5)
- pleuritic chest pain, relieved on sitting forwards
- non-productive cough
- SOB
- flu like symptoms
- pericardial rub
What is Beck’s triad and what does it indicate?
Cardiac tamponade
- hypotension
- muffled heart sounds
- raised JVP
What would you find on ECG of someone with acute pericarditis?
WIDESPREAD saddle-shaped ST elevation AND
PR depression
How would you investigate someone with suspected acute pericarditis?
transthoracic echo !
bloods
- inflamm markers raised
- troponin may be raised
How would you treat a pt with acute pericarditis?
can be managed as outpatients if T<38 and no raised trops
- treat underlying cause
- no strenuous activity until its resolved
- NSAIDs and COLCHICINE
What are the typical features of acute limb ischaemia?
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.
What are features of intermittent claudication?
- intermittent, progressive cramp-like pain in the calf, thigh or buttock on walking which is RELIEVED BY RESTING
What are features of critical/chronic limb ischaemia?
1 or more of:
- rest pain in foot for more than 2 weeks
- ulceration
- gangrene
(patients hang leg out of bed to ease pain)
What is acute limb ischaemia?
rapid onset of ischaemia in a limb, typically due to a thrombus/embolism
What is critical limb ischaemia?
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.
Describe a typical arterial ulcer (7)
Small
Deep
Well defined borders
Have a “punched-out” appearance
Occur peripherally (e.g., on the toes)
Have reduced bleeding
Are painful
Describe a typical venous ulcer (7)
-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)
How would you investigate someone with peripheral arterial disease?
- handheld doppler
- ABPI
How would you manage someone with acute limb ischaemia? (6)
- A-E
- NBM
- 15L oxygen, morphine, fluids, ECG, ABG
- HEPARIN bolus + infusion
- tissue viability/doppler USS
- angioplasty/embolectomy
Who gets a DOAC?
People with non-valvular AF for prevention of stroke and systemic embolism in adults
CHADSVASC score of 2+ or men with score of 1+
Give 6 potential causes of new onset AF
PIRATES
PE
Ischaemia
Resp disease
Atrial enlargement
Thyroid disease
Ethanol
Sepsis
How do you manage AF in someone with SOB/chest pain/tachy/hypotensive ?
ADMIT TO HOSPITAL
- electro cardioversion
- flecainide
How could you modify risk factors for bleeding in someone about to start a DOAC?
- Treat uncontrolled hypertension.
- Get better control of INR in people taking a vitamin K antagonist.
- Address harmful alcohol consumption.
- Treat reversible causes of anaemia.
How would you manage new onset AF in a stable patient?
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
What risk factors are involved in CHADSVASC scoring system?
CCF
HTN
Age>75 (2)
Diabetes
Stroke (prev or TIA) (2)
Vascular disease
Age>65
Sex = F