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Cardiology > Diagnosis, Investigations, Examinations & Findings > Flashcards

Diagnosis, Investigations, Examinations & Findings Flashcards

1
Q

Aortic Dissection (4)

A
  1. CXR showing:
  2. Widened Mediasteinum

BEST:
2. CT Angiography if stable
SHOWING
3. False Lumen

  1. Transoesophageal Echoe (TOE) if unstable for CT
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2
Q

Atrial Myxoma (2)

A
  1. Echo

showing:

  1. Pedunculated Heterogenous mass attached to fossa ovalis
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3
Q

Clinical Uses of BNP (3)

A
  1. R/O heart failure in dyspnoeic patients (low BNP means HF unlikely)
  2. Prognosis in Chronic HF
  3. Guiding treatment in HF - lowering BNP means Tx is working
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4
Q

Brugada Syndrome (2)

A
  1. ECG - convex st elevation, J point elevation and inverted T waves in V1-3 = Brugada sign
  2. Give Flecainide and repeat ECG - elicits sign
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5
Q

Buerger’s Disease (2)

A
  1. Angiogram shows
  2. Corkscrew Collaterals in fingertips
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6
Q

Outline how the cardiac enzyme: MYOGLOBIN reacts to stress (3)

A

Begins to rise at:
1. 1 - 2 hours

Peak value at:
2. 6 - 8 hours

Returns to normal at:
3. 1 - 2 days

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7
Q

Outline how the cardiac enzyme: CK-MB reacts to stress (3)

A

Begins to rise at:
1. 2 - 6 hours

Peak value at:
2. 16 - 20 hours

Returns to normal at:
3. 2 - 3 days

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8
Q

Outline how the cardiac enzyme: CK reacts to stress (3)

A

Begins to rise at:
1. 4-8 hours

Peak value at:
2. 16 -24 hours

Returns to normal at:
3. 2-3 days

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9
Q

Outline how the cardiac enzyme: TROPONIN-T reacts to stress (3)

A

Begins to rise at:
1. 4 - 6 hours

Peak value at:
2. 12 - 24 hours

Returns to normal at:
3. 7 - 10 days

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10
Q

Outline how the cardiac enzyme: AST reacts to stress (3)

A

Begins to rise at:
1. 12 - 24 hours

Peak value at:
2. 36 - 48 hours

Returns to normal at:
3. 3 - 4 days

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11
Q

Outline how the cardiac enzyme: LDH reacts to stress (3)

A

Begins to rise at:
1. 24 - 48 hours

Peak value at:
2. 72 hours

Returns to normal at:
3. 8 - 10 days

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12
Q

Investigating Angina-like chest pain (3)

A

1st Line:
1. CT Coronary Angiography

2nd Line:
2. Non-invasive functional testing / stress testing

3rd Line:
3. Invasive Coronary Angiography (contrast)

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13
Q

Diagnosing Heart Failure (Test and action based on result)

A
  1. NT-proBNP blood test
  2. If HIGH (>2000) - referral to specialist assessment wihtin 2 weeks (for echo)
  3. If RAISED (400 -2000) arrange for 6 weeks
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14
Q

Coarctation of the Aorta (1)

A
  1. Notching of inferior rib borders on CXR (from collateral vessels)
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15
Q

Constrictive Pericarditis (3)

A
  1. S3 or pericardial nock on auscultation
  2. CXR showing
  3. Pericardial Calcification
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16
Q

Diagnostic workup for Heart Failure (7)

A

Bloods:
1. Broad Spec to look for causes
2. BNP as a way to r/o NOT confirm it and for prognosis indication

CXR
3. Pulmonary venous congestion
4. Interstitial oedema
5. Cardiomegaly

Echo:
6. recommended for new AHF or worseneing CHF
7. May show valvular cause, ischaemia, EF etc etc

realistically you’d do an ecg too

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17
Q

What causes Heart Sound S1? (1)

A
  1. Closure of Mitral and Tricuspid Valves
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18
Q

What causes Heart Sound S2? (1)

A
  1. Closure of Aortic and Pulmonary Valves
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19
Q

Outline HS S1 and its variations / causes (3)

A
  1. Closure of M and T valves
  2. Soft if long PR or Mitral Regurg
  3. Loud in Mitral Stenosis
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20
Q

Cause of Loud S1 heart sound (4)

A
  1. Mitral Stenosis
  2. Left-Right Shunts
  3. Short PR interval - atrial premature beats
  4. Hyperdynamic states
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21
Q

Cause of quiet / soft S1 Heart Sound (2)

A
  1. Long PR interval
  2. Mitral Regurgitation
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22
Q

Outline HS S2 and its variations / causes (3)

A
  1. Closure of A and P valves
  2. Soft in AS
  3. Splitting in Inspiration is normal
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23
Q

Cause of soft S2 HS? (1)

A
  1. Aortic Stenosis
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24
Q

Cause of Loud S2 HS? (1)

A
  1. HTN
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25
Q

Cause of Splitting of S2 (non-pathological) (1)

A
  1. Deep Inspiration
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26
Q

Causes of Fixed Splitting of S2 (pathological) (1)

A
  1. ASD
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27
Q

Causes of Wide Splitting of S2 (pathological) (3)

A
  1. RBBB
  2. Pulmonary Stenosis
  3. Severe Mitral Regurgitation
28
Q

Cause of Reversed Splitting (P2 before A2) of S2 (pathological) (4)

A
  1. LBBB
  2. Severe AS
  3. WPW Type B (casues early P2)
  4. Patent Ductus Arteriosus
29
Q

Outline HS S3 and its variations / causes (5)

A
  1. Caused by diastolic filling of ventricles
  2. Normal if <30 years old (or <50 in women)

Heard in:
3. LV Failure (eg DCM)

  1. Constrictive Pericarditis (pericardial knock as heart slaps against pathologically stiff pericardium in diastole)
  2. Mitral Regurgitation
30
Q

Outline HS S4 and its variations / causes (6)

A

May be heard in:
1. AS
2. HOCM
3. HTN

  1. Caused by Atrial contraction against a stiff ventricle
  2. thus coincides with P wave on ECG
  3. in HOCM a double apical beat may be felt as a result of a palpable S4
31
Q

Cause of HS S4 (1)

A
  1. Atrial contraction against a stiff ventricle
32
Q

Where do you listen to the Pulmonary Valve? (2)

A
  1. Left 2nd IC space
  2. Upper Sternal border
33
Q

Where do you listen to the Aortic Valve? (2)

A
  1. Right 2nd IC space
  2. Upper sternal border
34
Q

Where do you listen to the Mitral Valve? (2)

A
  1. Left 5th IC space
  2. Just medial to Mid Clavicular line
35
Q

Where do you listen to the Tricuspid Valve? (2)

A
  1. Left 4th IC space
  2. Lower left sternal border
36
Q

Investigations needed after a HTN diagnosis (6)

A

check for end-organ damage basically or for future CVD risk

  1. Fundoscopy - HTN retinopathy?
  2. Urine Dipstick - checking for renal disease as cause or result of HTN
  3. ECG - assess LVH or IHD

Bloods:
4. U&Es - assess renal function

  1. Lipid Profile: Checking for CVD risk due to hyperlipidaemia
  2. HbA1c - r/o DM
37
Q

How to do Ambulatory BP Monitoring (2)

A
  1. At least 2 measurements per hour during waking hours
  2. Use average of at least 14 measurements
38
Q

How to do Home BP Monitoirng (4)

A
  1. for each recoridng take 2 BPs 1 min apart sat down.
  2. Record twice daily in AM and PM
  3. Atleast 4-7 days
  4. Discard day 1 and use the rest for average
39
Q

HOCM (9)

A
  1. ECHO showing:
    MR SAM ASH
  2. Mitral Regurgitation
  3. Systolic Anterior Movement of Mitral valve
  4. ASymmetric Hypertrophy
  5. ECG showing:
  6. LVH
  7. Non specofic ST segment and T changes
  8. Deep Q waves
  9. Occaisonally AFib
40
Q

Diagnosing Infective Endocarditis (4)

A

DUKE Criteria

Diagnosed if:

  1. 2 major criteria
  2. 1 Major and 3 minor
  3. 5 Minor
  4. Pathology confirms it form tests like material from surgery and biopsy
41
Q

Major Criteria for DUKEs criteria (Infective Endocarditis) (6)

A

POSITIVE BLOOD CULTURES:
1. TWO positive cultures showing consitent Endocarditis organisms - viridans, HACEK etc

  1. Persistant bacteraemia in 2 cultures >12hrs apart with less specific organisms - S.Aureus, Staph Epidermidis
  2. Postive serology for Coxiella burnetii, Bartonella or Chlamydia psittaci
  3. Positive molecular assays for specific gene targets

EVIDENCE OF MYOCARDIAL INVOLVEMNT:
5. Positive Echo = oscillating structures, abcess formation, new valve regurg, dihescence of prosthetic valves
6. New Valve regurg

42
Q

Minor Criteria in DUKES criteria for Infective Endocarditis (5)

A
  1. Predisposing heart condition or IVDU
  2. Microbiology doesn’t satisfy major criteria
  3. fever >38 degrees
  4. Vascular phenomena: Major emboli, splenomegaly, clubbing, splinter haemorrhages, janeway lesions, petechia or purpura
  5. Immunological phenomena: Glomerulonephritis, Osler’s nodes, Roth spots
43
Q

Mitral Stenosis (2)

A
  1. CXR showing left atrial enlargement
  2. Echo showing tight mitral valve cross sectional area of <1 cm squared
44
Q

2 Causes of an Ejection Systolic Murmur that is louder on expiration (2)

A
  1. AS
  2. HOCM

Tet of Fallot will also cauase an ESM

45
Q

2 causes of an Ejeciton Systolic Murmur that is louder on Expiration (2)

A
  1. Pulmonary Stenosis
  2. ASD

Tet of Fallot will also cause a ESM

46
Q

2 causes of a Holosystolic / pansystolic murmur (

A
  1. Mitral or Tricuspid Regurgitation (high pitched blowing)
  2. VSD (harsh in character)
47
Q

How to differentiate the Pansystolic murmur heard in Mitral Regurg from that of Tricuspid Regurg? (2)

A
  1. Tricuspid regurg gets louder on INSPIRATION
  2. Mitral does not
48
Q

2 Causes of a late diastolic murmur (2)

A
  1. Mitral Valve Prolapse
  2. Coarctation of the Aorta
49
Q

2 causes of Early Diastolic Murmur (2)

A
  1. Aortic Regurgitation (high pitched and blowing)
  2. Graham-Steel murmur - Pulmonary Regurgitation (high pitched and blowing also)
50
Q

2 Causes of Mid-Late Diastolic Murmur (2)

A
  1. Mitral Stenosis

(rumbling caused by atria firing against a stenotic valve, to remeber timing remeber that diastole refers to VENTRICULAR diastole, which is actually when the atria contract - hence this is a “diastolic” murmur in relation to ventircles but is actually an atrial systolic murmur iygm)

  1. Austin-Flint murmum from severe Aortic Regrug (rumbling also)
51
Q

Cause of continuous “Machine like murmur” (1)

A
  1. Patent Ductus Arteriosis
52
Q

How to remember which murmurs are made louder by inspiration vs expiration? (1)

A
  1. RILE

Right sided=
Inspiration

Left sided =
Expiration

53
Q

Myocarditis (6)

A

Bloods:
1. Inflammatory Markers raised in 99%
2. Raised cardiac enzymes
3. Raised BNP

ECG:
4. Tachycardia
5. Arrhythmias
6. ST/T wave changes including elevation and T inversion

54
Q

Orthoststic Hypotension (definition) (1)

A
  1. A drop of >20mmHg after 3 mins of standing
55
Q

Pulsus Paradoxus (define and 2 causes) (3)

A
  1. Greater than a normal 10mmHg drop in BP on INSPIRATION

Causes:
2. Severe asthma

  1. Cardiac Tamponade
56
Q

Cause of Slow-rising / Plateau Pulse (1)

A
  1. Aortic Stenosis
57
Q

Causes of Collapsing Pulse (3)

A
  1. Aortic Regurgitation
  2. Patent Ductus Arteriosus
  3. Hperkinetic States (hyper blood-flowey staes) eg Anaemia, thyrotoxicosis, exercise, preganancy)
58
Q

Definitiona nd 1 cause of Pulsus Alternans (2)

A
  1. Regularly alternating force of pulse
  2. Severe LVF
59
Q

Define and give 2 causes of Bisferiens Pulse

A
  1. Double-pulse, two systolic peaks felt
  2. Mixed Aortic valve disease
  3. HOCM occaisionally
60
Q

Cause of a’ Jerky’ Pulse (1)

A
  1. HOCM
61
Q

Diagnostic Criteria for Rheumatic Fever (2)

A
  1. 2 Major criteria

or

  1. 1 Major + 2 Minor
62
Q

List the Major Criteria for diagnosing Rheumatic Fever (5)

A
  1. Erthema Marginatum
  2. Sydenham’s chorea - late feature
  3. Polyarthritis
  4. Carditis and valvulitis - regurg murmur
  5. Subcutaneous nodules

probably dont memorise this its super rare in the west

63
Q

Minor Criteria for Rheumatic Fever (4)

A
  1. Raised ESR or CRP
  2. Pyrexia
  3. Arthralgia
  4. Prolonged PR Interval

probably dont memorise its super rare in UK

64
Q

Syndrome X (3)

A

Basically this is angina and ST changes without any artery issues on angiography - an ACS mimicker we don;t understand yet

  1. Angina-like CP
  2. ST depression on stress test
  3. Normal coronaries on Angiography
65
Q

Takayasu’s Arteritis (2)

A
  1. MRA (MRI angiography of aorta)
  2. CT Angiography (CTA Aorta)
66
Q

Stages of HTN according to NICE (3)

A
  1. Stage 1 - Clinic 140/90, Abulatory - 135/85
  2. Stage 2 - Clinic 160/100, Ambulatory - 150/95
  3. Severe >180 / 120

Cardiology (8 decks)

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