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Muscle Flashcards

1
Q

Symptoms and signs of myocarditis

A 
Fatigue
Dyspnoea 
Chest pain 
Fever
Palpitations 
Tachycardia
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2
Q

What is myocarditis

A

Inflammation of the myocardium

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3
Q

ECG is myocarditis

A

ST elevation or depression
T wave inversion
Atrial arrhythmias
Transient AV block

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4
Q

Clinical diagnosis of myocarditis

A

+ve troponin I or T

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5
Q

Test which -ve excludes myocarditis

A

Antimyosin scintigraphy

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6
Q

Management and prognosis of myocarditis

A

Supportive and treat the cause

Patients may recover or get intractable heart failure

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7
Q

What is dilated cardiomyopathy

A

Dilated, flabby heart of unknown cause

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8
Q

Associations of dilated cardiomyopathy

A

HTN, alcohol, haemochromatosis, viral infection, autoimmune, pregnancy, thryrotoxicosis, congenital

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9
Q

Presentation of dilated cardiomyopathy

A 
Fatigue, dyspnoea, pulmonary oedema 
RVF 
Emboli 
AF 
VT
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10
Q

Signs of dilated cardiomyopathy

A 
Tachycardia 
Hypotension
Raised JVP
Displaced diffuse apex 
AV valve regurge 
Pleural effusion 
Oedema jaundice and ascites
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11
Q

CXR in dilated cardiomyopathy

A

Cardiomegaly

Pulmonary oedema

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12
Q

Echo in dilated cardiomyopathy

A

Low ejection fraction

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13
Q

Management of dilated cardiomyopathy

A 
Bed rest
Diuretics 
Digoxin 
Ace -I 
Anticoagulation
Pacing 
Transplant
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14
Q

What is hypertrophic cardiomyopathy

A

LV outflow tract obstruction from asymmetric septal hypertrophy

Leading cause of sudden cardiac death in young

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15
Q

Inheritance of hypertrophic cardiomyopathy

A

Autosomal dominant inheritance
50% are sporadic
Mutations in myosin and troponin

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16
Q

Symptoms and signs of HCM

A

Sudden death may be first sign

Or angina, dyspnoea, palpitations, syncope, CCF

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17
Q

ECG in HCM

A 
Lvh
Progressive t wave inversion
Deep Q waves 
AF
Ventricular ectopics 
VT
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18
Q

Treatment of HCM

A 
Beta blockers or verapamil for symptoms 
Amiodarone for arrhythmias 
Anticoagulate if AF 
Rarely dual chamber pacing 
Maybe implantable defibrillator
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19
Q

Presentation of restrictive cardiomyopathy

A

Same as constrictive pericarditis

Features of RVF predominate

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20
Q

What is cardiac myxoma?

A

Benign rare cardiac tumour

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21
Q

Presentation of cardiac myxoma

A

Mimic infective endocarditis (weight loss, fever, clubbing, raised ESR)
Or mitral stenosis

Treat with excision

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22
Q

What is pericarditis

A

Inflammation of pericardium

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23
Q

Causes of acute pericarditis

A

Idiopathic or secondary to infection, MI, drugs

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24
Q

Clinic features of pericarditis

A

Central chest pain worse on inspiration or lying flat
Relief by sitting forward
Might hear pericardial friction rub

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25
What should you look for as extra to pericarditis
``` Pericardial effusion (do echo, cardiomegaly on CXR) Cardiac tamponade ```
26
ECG in pericarditis
Concave (saddle-shaped) ST elevation | But may be normal or non specific o
27
Blood tests for pericarditis
Troponin may be raised | Blood culture for pathogen
28
Treatment of pericarditis
Analgesia Treat cause Maybe colchicine before steroids/immunosuppressants if relapse or continuing symptoms
29
% or recurrence in pericarditis
15-40%
30
What is a pericardial effusion
Accumulation of fluid in the pericardial sac
31
Cause of pericardial effusion
Any causes of pericarditis
32
Clinical features of pericarditis
Dyspnoea Raised JVP Bronchial breathing at left base (large pericardial effusion can compress lower left lobe)
33
Diagnosis of pericardial effusion
CXR shows enlarged globular heart Echo - Echo free zone surrounding the heart ECG - low voltage qrs and alternating QRS morphologies (electrical alternans)
34
Management of pericardial effusion
Treat the cause | Pericardiocentesis can be diagnostic or therapeutic (tamponade)
35
What is constrictive pericarditis
Heart is encased in a rigid pericardium
36
Cause of constrictive pericarditis
Often unknown in UK Elsewhere TB OR after any pericarditis
37
Clinical features of constrictive pericarditis
``` Mainly those of right heart failure Raised JVP Kaussmals sign (JVP raises with inspiration) Soft diffuse apex beat Quiet heart sounds High pitched s3 ```
38
Constrictive pericarditis on CXR
Small heart with or without pericardial calcification
39
Management of constrictive pericarditis
Surgical excision
40
What is cardiac tamponade
Accumulation of pericardial fluid - raises intrapericardial pressure Therefore poor ventricular filling and fall in cardiac output
41
Causes of cardiac tamponade
``` Pericarditis Aortic dissection Haemodialysis Warfarin Post cardiac biopsy ```
42
Signs of cardiac tamponade
``` Tachycardia Hypotension Pulsus paradoxus Raised JVP Kaussmauls sign Muffled s1 and s2 ```
43
Triad for diagnosing cardiac tamponade
Becks triad: falling BP, rising JVP and muffled heart sounds
44
CXR in cardiac tamponade
Big globular heart
45
ECG in cardiac tamponade
Low voltage QRS | With or without electrical alternans
46
Echo in cardiac tamponade
Diagnostic Echo free zone around the heart May also be diastolic collapse of right atrium and right ventricle
47
Management of cardiac tamponade
Urgent drainage of pericardial effusion - pericardiocentesis
48
Significance of bicuspid aortic valve
Work work at birth Can go on to develop aortic stenosis with or without aortic regurge This predisposes to infective endocarditis and subacute bacterial endocarditis Also risk of aortic dilatation/dissection Intense exercise may accelerate complications - therefore yearly echos
49
What is an atrial septal defect?
A hole that connects the two atria
50
Two types of ASD
1) Ostium secundum - high in septum - most common | 2) Ostium primum defect - lower down - associated with av valve anomalies
51
Presentation of two ASD
Primum present early | Secundum often asymptomatic until early adulthood
52
Why does Ostium secundum not present until adulthood
because left to right shunt depends on compliance of the ventricles - and compliance of left ventricle decreases with age therefore augmenting the shunt
53
Symptoms of ASD
``` Pulmonary hypertension Cyanosis Arrhythmia Haemoptysis Chest pain ```
54
Signs of ASD
``` AF Raised JVP Wide, fixed split s2 ejection systolic murmur Pulmonary hypertension can cause pulmonary or tricuspid regurge ```
55
What is complication of ASD?
Reversal of shunt - eisenmengers complex - left to right shunt causes pulmonary hypertension - this leads to shunt reversal - causes cyanosis
56
ECG in ASD Ostium primum
RBBB with LAD and prolonged PR interval
57
ECG is Ostium secundum
RAD
58
When do you close an ASD
In children before age 10 | Adults if symptomatic or if pulmonary to systemic blood flow ratio of 1.5>1
59
What is a ventricular septal defect?
Hole between the two ventricles
60
Symptoms of VSD
May present with severe heart failure in children | Or can remain asymptomatic and be diagnosed incidentally
61
Sign of VSD
Smaller the hole - louder the murmur Typically harsh pan systolic murmur with systolic thrill Larger holes - signs of pulmonary hypertension
62
Complications of VSD
Infundibular stenosis IE/sbe Pulmonary hypertension Eisenmengers complex
63
ECG in small, moderate and large VSD
Normal - small Lad + lvh - moderate Lvh + RVH - large
64
CXR in large VSD
Cardiomegaly, large pulmonary arteries and marked pulmonary plethora
65
Treatment of VSD
Medical at first as many close spontaneously | Surgical closure if medical failed, symptomatic or shunt >3:1, IE/SBE
66
What is coarctation of the aorta
Congenital narrowing of descending aorta
67
Where does coarctation of the aorta usually occur?
Just distal to origin of left subclavian artery
68
Associations of coarctation of the aorta
Bicuspid aortic valve | Turners syndrome
69
Signs of coarctation of the aorta
``` Radio femoral delay Weak femoral pulse Hypertension Scapular bruit Systolic murmur (best heard over left scapula) ```
70
Complications of coarctation of the aorta
Heart failure | Infective endocarditis
71
Diagnosis of coarctation
Ct or MRI aorta gram
72
Treatment of coarctation
Surgery or balloon dilatation/stenting

Cardiology (9 decks)

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