Presentations Flashcards
1
Q
Aortic Dissection (5)
A
- Chest (typer A) /Upper Back pain (type B)
- typically severe, sharp, tearing
- worst at onset - Pulse Deficit:
- weak or absent femoral, carotid or brachial pulses
- difference of > 20mmHg between arms - Aortic Regurg
- HTN
- Other artery deficits due to involvement
- Spinal - paraplegia
- coronaries - angina
- distal aorta - limb ischaemia
1
Q
Aortic Regurgitation (6)
A
- Early Diastolic Murmur - worsened by handgrip manoeuvre
- Collapsing pulse
- Wide PP
- Quincke’s sign - pulsing nail bed
- De Musset’s Sign (head bobbing)
- Austin Flint murmur Mid diastole if bad
2
Q
Aortic Stenosis (7)
A
- Chest Pain
- Syncope
- Dyspnoea
- Ejection Systolic Murmur - radiating carotids and reduced with valsalva
- Narrow PP
- Slow rising Pulse
- LVH/LVF
3
Q
Atrial Myxoma (5)
A
- Generic Cancer symptoms
- Emboli
- AFib
- Mid-diastolic murmur “tumour plop”
- ECHO: pedunculated heterogenous mass attached to fossa ovalis
4
Q
Brugada Syndrome (5)
A
- Sudden Cardiac Death
- Syncope
- SOB
- Palps - worse at rest or after meals
- Chest Pain
5
Q
Buerger’s Disease (3)
A
- Young male smoker
- Painful reynauds / discoloured fingertips
- +/- Ulcers
6
Q
Cardiac Tamponade (9)
A
BECKS TRIAD
1. Hypotension
2. Raised JVP
3. Muffled heart sounds
- Dyspnoea
- Tachycardia
- Pulsus Paradoxus - abnormally large drop in BP on inspiration
- Absent Y wave on JVP
- +/- kussmaul’s sign - rare
- Electrical Alternans on ECG (alternating QRS heights low to high from beat to beat)
7
Q
Outline Beck’s Triad (3)
A
- Hypotension
- Raised JVP
- Muffled Heart Sounds
Suggestive of Tamponade
8
Q
Define Anginal chest pain acording to NICE (3)
A
- Constricting discomfort in front of chest, neck, shoulders, jaw or arms
- Precipitated by physical exertion
- relieved by rest or GTN in about 5 minutes
9
Q
Categorise Anginal Chest Pain according to NICE (3)
A
- All 3 definition Sxs = TYPICAL
- 2 our of 3 = ATYPICAL
- 1 out of 3 = NON-ANGINAL chest pain
10
Q
Coarctation of the Aora (6)
A
- Infancy: HF in a child
- Adulthood: HTN
- Radio-femoral delay
- Mid Systolic Murmur loudest on the back
- Apical Click from aortic valve
- Notching of the inferior rib borders on CXR from collateral vessels
11
Q
Complete Heart Block (5)
A
- Syncope
- Heart Failure
- Regular Brady 30 -50 bpm
- JVP: Cannon Waves in neck
- Variable S1 intensity
12
Q
Constrictive Pericarditis (5)
A
- Dyspnoea
- Right HF: elevated JVP, ascites, oedema, hepatomegaly
- JVP shows prominent X and Y descent
- Pericardial Knock as heart slaps rigid pericardium
- Kussmaul’s sign positive
13
Q
Dilated Cardiomyopathy (4)
A
- HF Sxs
- Systolic Murmur - stretching of valves may cause Mitral/Tricuspid Regurg
- S3
- Balloon appearance of heart on CXR
14
Q
Symptoms of Heart Failure (4)
A
- SOB
- Reduced Ecercise Tolerance
- Oedema
- Fatigue
15
Q
Signs of Heart Failure (8)
A
- Cyanosis
- Tachycardia
- Elevated JVP
- Displaced Apex Beat
- Bibasal crackles +/- wheeze
- HS = I + II + S3
- 90% have normal or raised BP
- If viral of ischamic may present with Sxs of underlying condition eg CP, Fevers etc
16
Q
Sxs of Chronic Heart Failure (8)
A
- SOB
- Cough - pink frothy sputum, worse at night
- Orthopnoea
- PND
- Wheeze
- Wt Loss - can be hidden due to wt gain from oedema
- Bibasal Crackles
- Sxs of Right sided failure - JVP ankle oedema, hepatomegaly/jaundice
17
Q
Symptoms typically associated more with Right sided HF than Left (5)
A
- Peripheral oedema
- Raised JVP
- Hepatomegaly
- Wt gain from oedema
- Anorexia
18
Q
Symptoms typically associated more with Left sided HF than Right (5)
A
- Pulmonary Oedema
- SOB
- PND
- Orthopnoea
- Bibasal Crackles
LEFT WILL CAUSE RIGHT MUCH FASTER THAN RIGHT WILL CAUSE LEFT - you can go for ages with a pure right sided failure but a left sided failure will fairly quickly clogg the lungs and cause a Right sided failure too
19
Q
Definition and Causes of xanthelasma and xanthomata (4)
A
- Xanthoma - fatty deposits on palms
- Erruptive xanthoma - beyond palsm to extensor surfaces
- Xanthelasma - yellowish papules on eyelids
- All a sign of hyperlipidaemia
20
Q
Possible Sxs of HTN (3)
A
Only really there if over 200 mmHg
- Headaches
- Visual disturbance
- Seizures
21
Q
HOCM (8)
A
- Often ASx
- Exertional SOB
- Angina
- Syncope - following exercise
- SCD
- Jerky pulse, Large A waves , Double apex beat
Systolic Murmurs
7. ESM due to aortic outlfow obstruction - INCREASES with valsalva and DECREASES on squatting
- Pansystolic Murmur - due to mitral regurgitation from systolic anterior motion of the valve
22
Q
Infective Endocarditis (10)
A
- Fever
- Night Sweats/rigors
- SOBOE
- Chest Pain occaisionlly
IF RENAL INVOLVEMENT:
5. Haematuria - glomerulonephritis from septic emboli immune deposition
- Janeway Lesions - PAINLESS, palms, soles, cutaneous microemboli
- Splinter haemorrhages - capillary damage
- Osler Nodes - PAINFUL locla immune reaction red spots on fingers and toes (NOT palms and soles like janeway which are also PAINLESS)
- blackening of extremeties if emboli have damaged bloodflow
- New Heart Murmur
23
Q
Long QT Syndrome 1 (1)
A
- Usually exertional syncope, often when swimming
24
Long QT Syndrome 2 (3)
Syncope following
1. Exercise
2. Emotional Stress
3. Auditory Stimuli
25
Long QT syndrome 3
1. syncope / Sxs at night and at rest
26
Mitral Regurgitation (3)
1. Largely ASx
2. May present with HF symptoms as heart thickens over time to account for less blood being sent to the body (as some goes back to atria) and slowly loses function towards CHF
3. Arrhythmias possible
27
Mitral Stenosis (8)
1. SOB - increased L atrial pressure = pulmonary venous hypertension
2. Haemoptysis - ranging from pink frothy sputum to haemoptysis from rupture - all due to venous congestion / HTN in lungs
3. Mid-late Diastolic Murmur - best on expiration
4. Loud S1
5. Opening SNAP
6. Low Volume Pulse
7. Malar FLush
8. AFib - secondary to increase L atrial pressure and L atrial enlargement
28
Features of severe Mitral Stenosis (2)
1. Prolonged murmur length
2. Opening snap becomes closer to S2
29
Dressler's Syndrome (AI attack on pericardium 2-6 weeks following MI) (4)
1. Fever
2. Pleuritic Pain
3. Pericaridal Effusion
4. Raised ESR
Tx with NSAIDS
30
Myocarditis (3)
1. Acute CP in young patient
2. SOB
3. +/- Arrhythmias
31
Adverse signs suggesting a Bradycardia is Peri-arrest (4)
1. Shock - hypotension <90, sweaty clammy
2. Syncope
3. Myocardial Ischaemia on ECG
4. HF Sxs
basically haemodynamic instability + arrhythmia
32
Signs for potential risk of Asystole in a brady cardia (even after Atropine treatment) (4)
GET A SPECIALIST
1. Complete Heart Block with wide QRS
2. Recent Asystole - high reccurence
3. Mobitz 2 AV block
4. Ventricular pauses >3 seconds
Basically a fucked ECG in bradycardia - worry and call a specialist
33
Signs of a Peri-arrest Tachycardia (4)
Same as with Brady
1. Shock: Hypotension, clammy, shutdown
2. Syncope
3. Ischaemia on ECG
4. HF Sxs
basically haemodynamic instability + arrhythmia
34
Takayasu's Arteritis (6)
1. Sysrtemic Vasculitis Sxs - haedache, malaise
2. Unequal Limb BPs
3. Carotid bruit / tenderness
4. Absent or weak peripheral pulses
5. Upper and lower limb claudification
6. Aortic Regurg (20%)
35
VSDs (4)
1. Found on 20wk inutero scan
2. Failure to Thrive
3. Sxs of HF - tachycardia, tachypnoea, hepatomegaly etc etc
4. Pan-systolic murmur louder with smaller defects (more turbulent)
