Meeran Finals Day - Cardiology Flashcards
infective endocarditis
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3 hand signs
1 chest sign
2 abdominal signs
1 systemic sign
4 bonus signs
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hand - clubbing, splinter haemorrhages, petechiae
changing / new heart murmur
abdo - splenomegaly, microscopic haematuria
fever
(Roth spots, Janeway lesions, Osler’s nodes, arthralgia)
main 2 causes of infective endocarditis
viridans strep
staph after IV drug use
summarise acute rhematic fever
5 main criteria
Carditis Erythema marginatum Subcutaenous Nodules Polyarthritis Sydenham's chorea
what is acute rheumatic fever?
occurs following strep throat or scarlet fever
nowadays would only occur if these weren’t treated well
rasied ASO, group A strep (pyogenes)
why is rheumatic fever relevant?
chronically can cause heart murmurs (MS, AR)
7 key features of mitral stenosis
malar flush middle aged female AF tapping apex non displaced apex right ventricular heave blowing mid diastolic murmur
3 features of mitral stenosis CXR
straightening of atrial appendage / aortic arch due to dilatation of left atrium
widespread pulomonary oedema
evidence of haemosiderosis
mitral regurgitation 6 features from slides
displaced apex apical thrill quiet first heart sound pansytolic murmur with axillary radiation S3 present (rapid ventricular filling) check for valvulotomy scar
9 features of aortic regurgitation
collapsing pulse Corrigan's sign (visible neck pulsation) De Musset's sign (head nods with pulse) Quincke's sign (capillary bed pulsation) dynamic apex end diastolic murmur louder leaning forward systolic flow murmur
patient may be marfanoid, ank spond, reactive arthritis
give a selection of causes of AF (7 to be found!)
ischaemic heart disease rheumatic heart disease thyrotoxicosis PE cardiomyopathy cancer of the bronchus alcohol
AF 3 key ECG findings
irregularly irregular rhythm with narrow QRS complexes and absent p waves
left bundle branch block ECG findings, view the ECG too
loose W shape in v1, loose M shape in v6
also:
widening of QRS
loss of R wave progression
upward QRS deflection lead 1 + left chest leads (v4-6)
downward QRS deflection in right chest leads (v1-3)
picture why!!
right bundle branch block ECG findings, view the ECG too
loose M shape in v1, loose W shape in v6
also:
widening of QRS
downward QRS deflection in left chest leads (v4-6)+ lead 1
upward QRS deflection in right chest leads (v1-3)
pericarditis ECG, view the ECG too
ST elevation across most leads with PR depression
explain the groupings of the ECG leads in terms of which view of the heart they offer
II, III, and aVF: inferior surface of the heart
V1 to V4: anterior surface
I, aVL, V5, and V6: lateral surface
V1 and aVR: right atrium and cavity of left ventricle
view first degree heart block ECG, say what you’re expecting and ensure can identify
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view second degree Mobitz 1 heart block ECG, say what you’re expecting and ensure can identify
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view second degree Mobitz 2 heart block ECG, say what you’re expecting and ensure can identify
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view third degree heart block ECG, say what you’re expecting and ensure can identify
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summarise MI treatment + complications
sit up, o2 only if sats low Beta blocker unless HF Aspirin 300mg stat Ticragrelor 180mg stat Morphine 5-10mg Anticoagulate (enoxaparin 1mg/kg) Nitrates - GTN
STEMI obviously has PCI or if not had one in 2 hours, give alteplase thromobolysis agent
complications of MI
arrhythmias heart failure embolism pericarditis aneurysm rupture of muscle / valve
6 weeks post - Dressler’s
late changes in MI ECG
pathological Q waves after 6 hours (look up pic)
T wave inversion after ST normalises
look at PE imaging
angiogram
VQ scan
CTPA
ECG changes in PE
sinus tachycardia
right ventricular strain pattern (T inversion in v1-4)
clockwise rotation in R/S transition point
(the ‘classic’ but rare thing is S1Q3T3)
look up if can’t picture
define cardiogenic shock
acute heart failure leading to inability to perfuse heart+brain
define shock
severe life-threatening hypotension
define heart failure
cardiac output insufficient to meet tissue demands
SVT
narrow complex tachycardia
adenosine
