Miscellaneous- Cardio Flashcards
What is becks triad, and where is it implicated
In cardiac tamponade
Hypotension
Raised JVP
Muffled heart sounds
Causes of pericardial effusion
Bacterial infection Viral Trauma Malignancy MI CHF aortic dissections
Tx for cardiac tamponade
Pericardiocentesis (5th ics close to sternum)
Complication of cardiac tamponade
Pneumothorax
Damage to myocardium
Damage to coronary vessels
Criteria for IE
Dukes (2 major or 1 major and 3 minor)
Gs investigation for IE
Echocardiography
TTE- 1st line imaging
TOE- most sensitive diagnostic test
Name 5 causes of acute pericarditis
Idiopathic Viral Autoimmune conditions- ra Malignancy Trauma Post mi Dressler’s syndrome
Describe the nature of chest pain in acute pericarditis
Sharp pleuritic unilateral chest pain
Relief on leaning forward/sitting up
Worse on inspiration
ECG changes seen in acute pericarditis
St saddle shape
Pr segment depression
Tx for acute pericarditis
1st line- NSAIDs + ppi + colchicine
Give glucocorticoids if contraindicated
Complications of acute pericarditis
Chronic pericarditis
Cardiac tamponade
Pleural effusion
What is constrictive pericarditis
Chronic inflammation of pericardium results in fibrotic thickened pericardium that impedes diastolic filing
Causes of constrictive pericarditis
Idiopathic
Viral (cksackie)
Tb
Post mi
Signs and Sx of constrictive pericarditis
Signs- kausmmal sign, raised jvp, pericardial knock
Sx- chest pain, dyspnoea, oedema, fever
Tx for constrictive pericarditis
Diuretics to relieve oedema
NSAIDs ppi and colchicine
Pericardiectomy in severe cases
1st line Ix for pad
Ankle brachial index >0.9
Moa of apaixaban/rivaroxaban
Direct factor 10a inhibitor
Moa of dabigatran
Direct thrombin inhibitor
Gs Ix and tx for PE in
A) normal person
B) pregnant or renal impairment
A) CTPA and DOAC- apixaban
B) v/a scan and LMWH
Moa of lmwh
Activates antithrombin 3
And forms complex that inhibits factor 10a
What criteria is used to stratify the risk of a DVT/PE
Wells scrore
2ndry causes of HTN
ROPES Renal artery stenosis Obesity Pregnancy Endocrine- conns, cushings, phaechromocytoma Sleep disorders
What is atrial fibrillation
A SVT with uncoordinated atrial electrical activation and consequently ineffective atrial contraction
List 5 causes of a fib
MRS SMITH (sepsis, mitral valve pathology, IHD, thyrotoxicosis, HTN)
HTN Valvular disease Thyroid disorders CAD diabetes Cardiomyopathy
What is atrial flutter
A SVT characterised by rapid atrial depolarisation
What score determines anticoagulantion in a fib
CHA2DS2-VASc
What score determines the risk of bleeding on anticoagulants
HASBLED
Key findings of a fib
Absent p waves
Iregularly irregular rhythm
Narrow QRS complex
List 5 causes of atrial flutter
Idiopathic fibrosis Atrial dilation Thyrotoxicosis Amiadorone Congenital Pericarditis
What is WPW
Causes by congenital accessory pathway which connects the atria to the ventricles bypassing AV node
This accessory pathway leads to the potential for re-enterant circuits to form leading to SVT
Features on ECG in WPW
Delta waves
Short PR interval
Broad QRS
if re-enter at circuit has developed the ECG will show narrow complex tachycardia
Tx for WFW
1st- radio frequency ablation of accessory pathway
2nd- drug tx beta blocker (sotalol) of amaiadorone
Mx of WFW syndrome in SVT
Valsalva monouvere
IV adenosine
Dc cardioverison (1st line in unstable)
What is 1st degree HB and list 3 causes
Prolonged PR interval >200ms
Hyperkalaemia
Ccb/bb
High Vagal tone (professional athletes)
What is mobitz type 1 and list 3 causes
PR Interval gets progressively longer, eventually resulting in dropped beat
MI
Ccb/bb/digoxin
High vagal tone
What is mobitz ii and list 3 causes
PR interval is constant but p waves not followed by QRS complex
Mi
Ccb/bb
Fibrosis
SLE/RA
What is third degree HB and list 3 causes
Complete signal block
Mi
Bb/ Ccb
Idiopathic fibrosis
Ecg changes in LBBB
(WILLIAM)
V1- S wave
V6- notched R. wave
ECG changes in RBBB
(MARROW)
V1- r wave
V6- S wave
List 3 causes of LBBB
IHD
MI
hyperkalaemia
Aortic stenosis
List 3 causes of RBBB
Righ ventricular hypertrophic
PE
IHD
ASD
What is a AAA
A permanent dilatation of the abdominal aorta diameter >3cm
Who is offered screening for AAA
Men in England over 65
If small AAA (3-4.4cm) – offered yearly repeat ultrasound
If medium AAA (4.5-5.4cm) – offered repeat ultrasound every 3 months
If large AAA (>5.5cm) – surgery generally recommended.
Rf for AAA
HTN, hyperlipidemia, diabetes, obesity, smoking, CT disorder, increased age, infections (staph and salmonella)
Most common site for AAA
BETWEEN RENAL AND INFERIOR MESENTERIC ARTERIES
tx for AAA
Open repair via laparotomy
EVAR- Endovascular aneurysm repair
What is a aortic dissection
Tear in the tunica intima of the aorta
Rf of aortic dissection
Ct disorders Aortic vale replacement Co-arctation of aorta HTN Bicuspid aortic valve
Classification of aortic dissections
Type a Stanford- ascending aorta before braciocephalic trunk
Type b Stanford- descending aorta after left subclavian artery
Gold standard Ix of aortic dissection
Ct angiogram
1st line tx for aortic dissection
Beta blockers- control hr and bp, manage stress and analgesia
List 3 complications of aortic dissection
Stroke
Cardiac tamponade
MESENTERIC ischameia
Death
What is RHD
An autoimmune disease that occurs following a group A beta haemolytic strep throat infection
Sx of RHD
Murmurs- mitral valve most common (MR- Pansystolic)
Joint pain
Fever
Recent throat infection
Subcut nodules
Erythematous marginatum rash (pink rings)
What is the name for granulomatous nodules found in rheumatic fever
Aschoff bodies
What criteria is used to make a diagnosis of RHD
Jones criteria
2 major or 1 major and 2 minor
Ix for rheumatic fever
Throat swab
ASO antibody titres
Echo/ech/CXR
Tx for rheumatic fever
Treat strep infection- benzoyl penicillin for 10 days
NSAIDS for joint pain]
Aspirin/steroids treat carditis
What is long QT syndrome
Prolonged ventricular repolarisation
What causes long qt
Inherited- mutations in sodium and potassium channels
Acquired- drugs, electrolyte imbalances
What is a complocation of long qt
Tosarde de pointes
What is the tx for tosardes de pointes in
A) stable pt
B)unstable pt
A- IV magnesium sulphate
B- Dc cardio version
Tx for ventricular tachycardia
Stable- amiadoarone (300mg)
Unstable- Dc cardioverison (3 attempts),
amaiadorone
What are the 4 features in tetralogy of fallout
Over-riding aorta
RV hypertrophy
VSD
Pulmonary stenosis
Most common congenital defect
VSD
Name the 4 categories of shock
Hypovolaemic
Cardiogenic
Neurogenic
Obstructive
What blood test confirms the diagnosis of anaphylaxis
Serum tryptase
What is the management of anaphylaxis
Remove precipitating cause DR ABCDE IM adrenaline (500 micro grams)-breadminister after 5. In’s if no changes IV Fluid bolus \+/-Chloramphenamine- antihistamine Measure serum tryptase
What is sepsis 6
Give O2 Take cultures Give broad spectrum antibiotics Give IV fluids Measure lactate Measure urine output
Name a cyanosis heart defect
TOF
What is eisenmengers syndrome
When the shunt reverses thus R>L
What is the GS Ix for TOF
Echocardiography
CXR finding of TOF
Boot shaped heart
What is co-arctation of the aorta
Congenital narrowing of the aorta
What are the 2 forms of coarctation of the aorta
1) infant form
patent ductus arteriosus (PA>aorta)
lower extremity cyanosis
-70%
2) adult form
no patent ductus arteriosus
coarctation happens distal to aortic arch
upstream issues- cerebral aneurysm due to high bf
downstream issues- decrease bp in lower extremities, activation of RAAS, HTN
Associations of VSD
Foetal alcohol syndrome
Down’s syndrome
Symptoms of VSD
Failure to thrive Sob Poor feeding Finger clubbing Holosytolic murmur High pulmonary blood flow
Sx of ASD
Pulmonary flow murmur Right heart dilatation SOBOE increase chest infections S-pitting S2
During development what substance keeps the Ductus arteriosus open
Prostaglandin E2
What is the tx for PDA
Indomethacin to babies in post natal period
Gibson murmur associated with what disease
PDA
Causes of HCM
Inherited autosomal dominant Frederichs ataxia (autosomal recessive)
What is dilated cm
Heart muscle becomes weakened and enlarged
Causes of DCM
Idiopathic Viral infection Alcohol abuse Haemochromotosis Duchenne muscular dystrophy Cocksackie
List the Sx of all SVT
Palpitations Sob Chest pains Dizziness Syncope
