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Cardio > General cardio > Flashcards

General cardio Flashcards

1
Q

How should you mx acute pulmonary odema in HF?

A

furosemide or other loop dieuretics + thiazide if bad
GTN
opioids last line
Aim is to decrease preload

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2
Q

Describe HFpEF and what ejection fraction it occurs at?

A

> 40%
Patients with HFpEF have the clinical signs of heart failure with normal or near-normal left ventricular function and no significant valvular abnormalities

The pathogenesis of diastolic dysfunction involves abnormalities of active ventricular relaxation and passive ventricular compliance, which lead to ventricular stiffness and higher diastolic pressures.1 These pressures are transmitted through atrial and pulmonary venous systems, reducing lung compliance.

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3
Q

What is cardiac output?

A

Amount of blood ejected by ventricle in one minute

SV (vol bld in ventricles per beat) x HR (conduction rate)

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4
Q

What is a chronotrope?

A

Influences HR

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5
Q

What are the positives chronotropes?

A

Increase HR:
symp NS e.g. adrenaline
atropine

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6
Q

What are the negative chronotropes?

A

Decrease HR:
parasymp e.g. Ach
adenosine

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7
Q

What is preload?

A

Amount of blood entering ventricles during diastole aka end diastolic volume

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8
Q

What influences preload?

A

venous return
fluid volume
atrial contraction

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9
Q

What is afterload

A

Resistance ventricles must overcome to circulate blood in systole

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10
Q

What increases afterload?

A

atherosclerosis

vasoconstriction

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11
Q

what is an inotrope?

A

Something that affects contractility

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12
Q

What is contractility?

A

How hard the myocardium contracts for a given preload

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13
Q

Give examples of positive inotropes

A

symp NS - adrenaline

dubetamine

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14
Q

Give examples of negative inotropes

A

parasymp NS - Ach
Beta blockers
CCB

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15
Q

Describe the cardiac cycle

A

Atrial depolarisation → atrial p increases so blood goes into ventricles, only small part of blood flow as most has passively flowed into ventricles through open AV valves

S1→ Atrial pressure falls and AV valves close

isovolumetric contraction→ SL currently closed, ventricle p very high as ventricle contract (isovolumetric contraction as no blood leaves due to all valves being closed)

Rapid ejection → pressure in ventricles higher than arteries so SL open

Reduced ejection → Ventricular pressure drop and SL close for S2

Isovolumetric relaxation → relax with all valves close, pressure drops but volume stays the same

Ventricular filling → Atria fill with blood, pressure in atria rises above those in the ventricles, AV valves open

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16
Q

What are S1 and S2?

A 
S1 = lub, closure AV valves
S2= dub, closure SL valves
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17
Q

What is S3?

A

S3= chordae tendaniae being pulled, normal 15-40 yr olds but in older pts indicates HF
lub de dub

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18
Q

What is S4?

A

S4= before S1, abnormal, stiff/ hypertrophic ventricles causing turbulent flow of atria contracting against non-compliant ventricles
le lub dub

19
Q

What should the diaphragm vs bell be used for stethoscope?

A

low pitch = bell - think deep church bong

high pitch = diaphragm- think high pitched scream

20
Q

Where are the different heart areas and what valve are they best for?

A

Aortic area = 2nd intercostal R sternal border
Pulmonary area =2nd intercostal L sternal border
Tricuspid area - 5th intercostal space L sternal border
Mitral area = 5th intercostal space in mid-clavicular line

21
Q

What is the special manoevere for AS and MR?

A

AS: radiate to carotids/ clavicles
MR: radiates to axilla

22
Q

What are the special manoevres for MS and AR?

A

MS: lie left side
AR: sit up and hold breath

23
Q

What is a water hammer pulse associated with?

A

AR

24
Q

How do you describe a murmur?

A

Site
Caracter - soft/ blow/ crescendo/ decresndo
Radiation - axilla or carotids
Intensity - grade i.e. how loud
Pitch - low or high which indicates velocity
Timing - systolic or diastolic

25
Q

What is associated with a stenotic valve?

A

hypertrophy due to heart working harder to overcome stenosis

26
Q

What is associated with a reggurgitating valve?

A

dilatation as blood flows back into previous chamber

27
Q

What causes MS?

A

RF

IE

28
Q

What are the features of MS?

A

Murmur: low pitched mid diastolic and rumbling

loud S1, due to AV valves being thicked –> also causes tapping apex beat
LUB dub durrr

malar flush due to back pressure blood into pulmonary system causing rise CO2

Associated with AF due to atrial strain

29
Q

What are the features of mitral regurgitation?

A

pansystolic murmur
high pitched due to high velocity blood flow
burrrr sound
radiates to axilla

associated with HF due to reduced EF - so may also be S3

30
Q

What are the causes of mitral regurgitation?

A 
age
IHD
IE
RF
connective tissue disorder eg EDS
31
Q

What are the features of aortic stenosis?

A

ejection systolic murmur, high pitched so high velocity
crescendo decrescendo
burrr dub

radiates to carotids

narrow pulse pressure

syncope; dyspnoea and angina OE due to difficulty maintaining bld to CA/ brain through narrow valve to stop BP from falling

32
Q

What are the causes of AS?

A

age!!

RF

33
Q

What are the features of AR?

A

mid diastolic murmur, soft
lub tarrr

corrigans pulse aka collpasing pulse due to action of regurgitation - blood intitially comes out and then goes back in

can lead to HF due to pressure back on heart

34
Q

Causes of AR?

A

connective tissue disorder - can causes regurg as make weak leaflets
age

35
Q

How do you mx chronic HF?

A

thiazide/ loop diuretic treat sx but don’t improve prognosis
ACE-i
BB also tx - NOT in acute HF /AF;
Aldosterone antog (spironolactone/ eplerenone) - good for prognosis
Ivabradine
Dapagliflozin

36
Q

What would indicate the need for a CABG?

A

more than one CA involved in disease

37
Q

What is the definition of IE?

A

bacteria + abnormal endocardium

38
Q

What are RF for IE?

A

any prosthetics, operations, immunocomp, IVDU, dental surgery

39
Q

What are the causitive organisms of IE?

A

most virulent = s. aureus

most common = strep viridans

40
Q

How does acute vs subacute IE present?

A

acute = septic
generally unwell, fever, CP, HF sx, new regurg murmur
vascular phenomena: janeway lesions, splinter haemorrhages, stroke, other emboli
immunological phenomena: RF positive, roth spots, osler’s nodes (painful)

41
Q

Describe Duke’s criteria

A

major: two typical organism +ve cultures + typical echo features
minor: fever; IVDU/ other RF; immunological phenomena; vascular phenomena; echo or culture positive but doesn’t meet major criteria
2 major; 1 major + 3 minor; 5 minor

42
Q

What is a complication of IE to look out for? How do you do so?

A

Abscess

ecg (pressure AVN -> T1HB) and CXR

43
Q

Is abx prophylaxis still recommended for IE?

A

No - NICE risk: benefit decided no, used to be rec for dental/ GI/ UTI/ ENT etc. procedures

Cardio (5 decks)

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