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Cardiology > Muscle > Flashcards

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
Q

What should you look for as extra to pericarditis

A 
Pericardial effusion (do echo, cardiomegaly on CXR) 
Cardiac tamponade
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26
Q

ECG in pericarditis

A

Concave (saddle-shaped) ST elevation

But may be normal or non specific o

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27
Q

Blood tests for pericarditis

A

Troponin may be raised

Blood culture for pathogen

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28
Q

Treatment of pericarditis

A

Analgesia
Treat cause
Maybe colchicine before steroids/immunosuppressants if relapse or continuing symptoms

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29
Q

% or recurrence in pericarditis

A

15-40%

30
Q

What is a pericardial effusion

A

Accumulation of fluid in the pericardial sac

31
Q

Cause of pericardial effusion

A

Any causes of pericarditis

32
Q

Clinical features of pericarditis

A

Dyspnoea
Raised JVP
Bronchial breathing at left base (large pericardial effusion can compress lower left lobe)

33
Q

Diagnosis of pericardial effusion

A

CXR shows enlarged globular heart
Echo - Echo free zone surrounding the heart
ECG - low voltage qrs and alternating QRS morphologies (electrical alternans)

34
Q

Management of pericardial effusion

A

Treat the cause

Pericardiocentesis can be diagnostic or therapeutic (tamponade)

35
Q

What is constrictive pericarditis

A

Heart is encased in a rigid pericardium

36
Q

Cause of constrictive pericarditis

A

Often unknown in UK
Elsewhere TB
OR
after any pericarditis

37
Q

Clinical features of constrictive pericarditis

A 
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
Q

Constrictive pericarditis on CXR

A

Small heart with or without pericardial calcification

39
Q

Management of constrictive pericarditis

A

Surgical excision

40
Q

What is cardiac tamponade

A

Accumulation of pericardial fluid - raises intrapericardial pressure
Therefore poor ventricular filling and fall in cardiac output

41
Q

Causes of cardiac tamponade

A 
Pericarditis
Aortic dissection
Haemodialysis
Warfarin
Post cardiac biopsy
42
Q

Signs of cardiac tamponade

A 
Tachycardia
Hypotension 
Pulsus paradoxus
Raised JVP 
Kaussmauls sign
Muffled s1 and s2
43
Q

Triad for diagnosing cardiac tamponade

A

Becks triad: falling BP, rising JVP and muffled heart sounds

44
Q

CXR in cardiac tamponade

A

Big globular heart

45
Q

ECG in cardiac tamponade

A

Low voltage QRS

With or without electrical alternans

46
Q

Echo in cardiac tamponade

A

Diagnostic
Echo free zone around the heart
May also be diastolic collapse of right atrium and right ventricle

47
Q

Management of cardiac tamponade

A

Urgent drainage of pericardial effusion - pericardiocentesis

48
Q

Significance of bicuspid aortic valve

A

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
Q

What is an atrial septal defect?

A

A hole that connects the two atria

50
Q

Two types of ASD

A

1) Ostium secundum - high in septum - most common

2) Ostium primum defect - lower down - associated with av valve anomalies

51
Q

Presentation of two ASD

A

Primum present early

Secundum often asymptomatic until early adulthood

52
Q

Why does Ostium secundum not present until adulthood

A

because left to right shunt depends on compliance of the ventricles - and compliance of left ventricle decreases with age therefore augmenting the shunt

53
Q

Symptoms of ASD

A 
Pulmonary hypertension
Cyanosis
Arrhythmia 
Haemoptysis 
Chest pain
54
Q

Signs of ASD

A 
AF
Raised JVP 
Wide, fixed split s2 
ejection systolic murmur 
Pulmonary hypertension can cause pulmonary or tricuspid regurge
55
Q

What is complication of ASD?

A

Reversal of shunt - eisenmengers complex - left to right shunt causes pulmonary hypertension - this leads to shunt reversal - causes cyanosis

56
Q

ECG in ASD Ostium primum

A

RBBB with LAD and prolonged PR interval

57
Q

ECG is Ostium secundum

A

RAD

58
Q

When do you close an ASD

A

In children before age 10

Adults if symptomatic or if pulmonary to systemic blood flow ratio of 1.5>1

59
Q

What is a ventricular septal defect?

A

Hole between the two ventricles

60
Q

Symptoms of VSD

A

May present with severe heart failure in children

Or can remain asymptomatic and be diagnosed incidentally

61
Q

Sign of VSD

A

Smaller the hole - louder the murmur
Typically harsh pan systolic murmur with systolic thrill
Larger holes - signs of pulmonary hypertension

62
Q

Complications of VSD

A

Infundibular stenosis
IE/sbe
Pulmonary hypertension
Eisenmengers complex

63
Q

ECG in small, moderate and large VSD

A

Normal - small
Lad + lvh - moderate
Lvh + RVH - large

64
Q

CXR in large VSD

A

Cardiomegaly, large pulmonary arteries and marked pulmonary plethora

65
Q

Treatment of VSD

A

Medical at first as many close spontaneously

Surgical closure if medical failed, symptomatic or shunt >3:1, IE/SBE

66
Q

What is coarctation of the aorta

A

Congenital narrowing of descending aorta

67
Q

Where does coarctation of the aorta usually occur?

A

Just distal to origin of left subclavian artery

68
Q

Associations of coarctation of the aorta

A

Bicuspid aortic valve

Turners syndrome

69
Q

Signs of coarctation of the aorta

A 
Radio femoral delay 
Weak femoral pulse
Hypertension 
Scapular bruit 
Systolic murmur (best heard over left scapula)
70
Q

Complications of coarctation of the aorta

A

Heart failure

Infective endocarditis

71
Q

Diagnosis of coarctation

A

Ct or MRI aorta gram

72
Q

Treatment of coarctation

A

Surgery or balloon dilatation/stenting

Cardiology (9 decks)

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