Meeran revision

Question 1

What are 3 similar heart conditions that causes new murmurs with bacterial causes

Answer 1

Rheumatic fever acute
Rheumatic fever chronic

and bacterial Infective endocarditis

Question 2

What is acute/chronic Rheum Fever

Answer 2

Response to strep pyogenes as children–and cross react with the heart muscle -> causes MITRIAL STENOSIS (or tricuspid regurg)

and JONES CRITERIA
carditis, arthalgia, Skin lesion, Chronic erythem migrans, Syndenhams chorea

-> CASES

chronic is the MS and AR that happens 20 years later

Question 3

What is bacterial endocarditis

Answer 3

IVDU-Strep aureus-TR
Not- Strep pyogenes from teeth-AR (it affects damaged valves!)

DUKES criteria- fever, new murmur, vegetation on echo etc

Janeway, osler, Splinter heamorghages
Fever, splenomegaly, Blood is urine
New murmur

can be acute (IVDU)
or subacute-the teeth one -usual Mitrial/aortic-cause it can only attack damaged valves

Question 4

MR signs and IX

Answer 4

Signs-
malar flush, exercise dyspnea, tired
tapping apex, non displaced (easy to find)
R heave
Blowing mid diastolic
Narrow pulse pressure
murmur with LOUD S1

causes AF
and if exercise patient- make murmur louder

Question 5

Mitrial Regurg present and causes

Answer 5

SOB, fatigue and weakness
collapsing pulse, wide pulse pressure
Corrigans sign (neck veins)
Quickes sign
Apex dilation and movement
Thrill
Quiet S1, then pansystolic murmur at axilla
S3 present (fast filling)

scar under breast
usually endocarditis , old Rheumatic fever, Marfans, syphulis

Question 6

AF causes (some)

Answer 6

HTN, MI/IHD, MS, Hyperthyroidism, alcohol, other

Rheum fever, anything that damages heart

Question 7

AF management

Answer 7

Rythm/Rate control

Bisoprolol/Verapramil
Rythm- Amiodarone/fleicanide OR dc cardioversion (<48h OR after 3w anti coag)

and CHAD-VASC-> DOAC/Warfarin

Question 8

MI side complication

Answer 8

LEFT =FAILURE (heart. failure)
Anterior, lateral, septal

RIGHT = Arrythmia (AF, HF)
Inferior, can go into posterior

Question 9

Signs of MI

Answer 9

3rd HS
Tachycardia, tachypnoae
wheeze-cardiac asthma
Bilateral creps, JVP up
ankle sacral oedema

Question 10

cardiogenic shock management

Answer 10

its life threatning hypotense
and cardiogenic-pump not working
cold extremities, s3, hypotense

give dobutamine/dopamine
can give renal dose-low dose
and more- cardiac dose

Question 11

angina presentation ix and mx

Answer 11

Stable- on exercise pain and tightness
ix- CT angiogram
MX- GTN sublingual

Question 12

SVT management

Answer 12

slow HR down- vagal maneuvres

if not -adenosine-feels aweful

Question 13

WPW management