Pump through these Flashcards
What is the function of phosphocreatine in cardiac muscle tissue?
Allows mitochondrial ATP to be used in the cytosol
Familial hypercholesterolaemia is caused by mutations in what gene that code for a receptor?
This receptor is involved in extracting cholesterol from LDL or HDL?
What are the clinical criteria for diagnosis/signs & symptoms?
apoB/E gene
LDL
LDL >500mg/dL untreated or >300mg/dL treated + cutaneous/tendon nodules <10yo
What sort of murmur does mitral regurgitation give?
What sort fo murmur does aortic stenosis give?
Pan-systolic murmur
Ejection systolic murmur
Is S3 or S4 a ventricle gallop heart sound?
What intensifies these heart sounds?
What is S3 found in?
What is S4 found in?
S3 = ventricle. S4 = atrial gallop
Exercise or sustained hand grip
Severe chronic mitral regurgitation, dilated cardiomyopathy diastolic HF
HTN heart disease, aortic stenosis & hypertrophic cardiomyopathy
What causes a mid-diastolic murmur with opening snap?
What position increases the sound of this murmur?
Mitral stenosis
Left lateral
What sort of murmur does a PDA cause? Why? Diagnosis? When is early operative closure recommended? % that close spontaneously?
Machinery aortic pressure higher -> continuous flow through the ductus Clinical findings + echo Defect persisted over 6 months 50%
Ascites, swollen ankles and raised JVP - what does this indicate?
Right sided heart failure
Weak pulse with slow upstroke on carotid artery palpating - what is most likely causing this?
What are the common signs and symptoms for this disease?
What is the treatment?
Aortic stenosis
Heart failure, angina, syncope, heaving apex beat
Treatment = minor medical role, primarily the is need for aortic valve replacement
Opening snap and rumbling mid-diastolic murmur - what disease causes this?
What is the usual presentation?
What s the management for this?
Mitral stenosis
Exertional dyspnoea/decrease exercise tolerance
Follow-up echo’s 1-5yearly depending on severity
Warfarin, beta blocker + diuretic if symptomatic
Valve replacement if severe + symptoms
What are 3 structural causes of left ventricle hypertrophy?
What causes Right atrial enlargement?
What is the chance of this closing?
VSD
PDA
Coarctation of the aorta
Right atrial = ASD, 80% if <8mm
What are the 5 signs and symptoms of left atrial myxoma?
AF Apical end diastolic murmur Circulating immunoglobulins Syncope Systeic embolism
What is the pathophysiology behind giant ‘A’ waves?
What is Kussmaul’s sign and what can it indicate?
Poorly compliant right ventricle OR tricuspid stenosis causes increased pressure against which the right atrium has to eject blood.
Kuss = rise in JVP with inspiration
Can indicate constrictive pericarditis
What is Dressler’s syndrome?
What is the cause?
Pericarditis that occurs 2-6wks after anterior myocardial infarction or heart surgery
Cause = autoimmune response to myocardial antigens
What sort of shunting causes cerebral abscesses?
Right to left shifts
What are the signs of cardiac failure in an infant?
HR >180
RR >30
Hepatomegaly
Excessive perspiration
What is the most common cause of cyanotic congenital heart disease?
What are the signs of this disease?
Tetralogy of Fallot! Pulmonary valve stenosis Overriding aorta Right ventricle hypertrophy Ventricle septal defect
What classifies murmurs as innocent on examination?
What does fixed splitting of the 2nd heart sound indicate?
What does a murmur radiating to the axilla imply?
What is the murmur of aortic incompetence?
Short duration and vary with posture
Atrial septal defect
Mitral incompetence
High-pitched early diastolic murmur best heard at the lower left sternal edge with the patient leaning forward with breath held in expiration
When do VSD’s present in a new born?
What would a chest x-ray show?
Do they require surgery?
What does central cyanosis indicate?
After 1st month of life
Pulmonary plethora
No, most cases resolve spontaneously
Reversal of the shunt and pulmonary hypertension
What is more common in Down’s infants: VSD or atrio-ventricular septal defect?
How is this treated?
Atrio-ventricular septal defect
Surgically
What are the two most common causes of acute pulmonary oedema?
What are two less common causes coming from other organs?
Ischaemia heart disease and hypertensive cardiac failure Volume overload (renal failure) and shock (trauma or sepsis)
What disease can cause murmurs to be heard over the chest and back with claudication?
What other signs and symptoms may be present?
What is an important x-ray finding?
Coarctation of the aorta
Hypertension, claudication, headache, epistaxis
Notching of the ribs due to erosion by collateral S
What four drugs used in cardiology are known to cause photosensitive rashes?
Amiodarone
Thiazide diuretics
ACE inhibitors
A2RBs
What is the mechanism of action of Simvastatin?
Decrease hepatic cholesterol synthesis
What is Beck’s triad of cardiac tamponade?
Hypotension
Raised JVP
Muffled heart sounds
Describe pulsus alternans
What does it indicate?
What is associated with a ‘jerky’ pulse?
What does the Valsava manoeuvre do?
Regular alternation of the force of the arterial pulse felt (felt at the radius)
Severe left ventricular failure
Jerky = Hypertrophic obstructive cardiomyopathy (HOCM)
Makes the murmur louder
What is the most common cardiac abnormality seen in Marfan’s syndrome?
What can this lead to?
What can happen during pregnancy?
Dilation of aortic sinuses causing a dilated aortic root
Aortic root rupture or dissection
Aortic incompetence due to greater cardiovascular workload
What are the 5 poor prognostic markers for hypertrophic cardiomyopathy?
Syncope
Family history of HCM and sudden cardiac death
Maximum left ventricular wall thickness greater than 3 cm
Blood pressure drop during peak exercise on stress testing, and
Documented runs of non-sustained VT on 24 hour tape.
What is the mechanism of action of Verapamil?
What is the physiological result of this?
What drug can it not be given with and why?
Negative inotropic calcium-channel blocker
Reduces cardiac output, slows heart rate and may impair AV conduction
ß-blockers - risk of hypotension and asystole
What are the 1st, 2nd, 3rd and 4th line medications for chemical control of AF?
When is the 3rd line drug used? What are it’s contraindications?
When is the 4th line drug used?
1st = ß-blocker
2nd = Calcium-channel blocker
3rd = Digoxin
- used if hypotensive
- Contraindications = hypersensitivity or VF
4th = Amiodarone - everything else contraindicated!
What is pulmonary capillary wedge pressure used to measure?
When is it used?
Indirect measure of left atrial pressure
Used to measure fluid replacement for hypoperfusion following right ventricle ischaemia to ensure patient isn’t fluid overloaded
- When diseases cause xanthelasma and corneal arcus seen?
- What diseases cause tendon xanthomata?
- What disease cause eruptive xanthomata?
- What diseases cause striate xanthomata (palm creases)?
1 = familial combined hyperlipidaemia and familial hypercholesterolaemia 2 = familial hypercholesterolaemia and remnant hypercholesterolaemia 3 = familial hypertriglyceridaemia 4 = remnant hypercholesterolaemia
Describe pulsus paradoxus
Pulse volume/pressure falling during inspiration
Occurs due to negative intra-throracic pressure during inspiration enhancing normal fall in blood pressure
Is hypo or hyper thyroidism more likely to cause AF?
Is ASD or VSD more likely to cause AF?
Is alcoholism or PE more likely to cause AF?
Hyperthyroidism
ASD
BOTH!
What is the difference between apex beats for aortic stenosis vs aortic regurgitation?
What about in mitral stenosis?
AS = heaving but undisplaced AR = thrusting and displaced (due to fluid overload) MS = tapping due to opening snap of mitral valve
What is the half-life of digoxin?
What is its mechanism of action?
What happens to vision in digoxin toxicity?
36-48hrs
Decrease AV node conduction and increases force of cardiac muscle contraction through inhibition of Na/K ATPase pump
Yellow-green vision
When does P wave repolarisation occur on an ECG?
During the QRS complex
What cytochrome is Warfarin metabolised by in the liver?
Name 2 drugs that inhibit this and 2 that induce this.
Cytochrome P450
Inhibit = SSRI’s (Fluoxetine) NSAID’s, Amiodarone
Induce = Phenytoin and Carbamazepine
What causes the following JVP waves?
Small A waves?
Large A waves?
Cannon A waves?
Small = AF Large = Right ventricular hypertrophy, tricuspid stenosis Cannon = complete heart block
What are the 3 branches off of the ascending aorta? In order
What are the first two branches from the first branch?
What structure lies anterior to all branches?
Brachiocephalic artery, left common carotid and left subclavian
1st 2 branches = right subclavian and right common carotid
Left brachiocephalic vein
Is paroxysmal nocturnal dyspnoea related to diastolic or systolic dysfunction?
Diastolic
What is the physiological mechanism of S4 heart sound?
Occurs in diastole or systole?
What is the physiological mechanism of S3 heart sound?
Occurs in diastole or systole?
S4 = forceful atrial contraction, in late diastole S3 = rapid movement of blood into ventricles, occuring in early diastole
ECG signs for hypokalaemia?
ECG signs for hyperkalaemia?
Hypo = U waves, small/absent T waves, prolonged P-R interval Hyper = tall tented T waves, small/absent P waves, broad QRS complexes
What is the breakdown of fluid distribution in the body?
Total vs Intracellular vs Extracellular vs Intravascular
Total = ~42L
2/3 intracellular (~28L), 1/3 extracellular (~14L).
1/3 of extracellular = intravascular ~5L
What type of STEMI requires fluids?
Why?
Inferior STEMI
Due to the functional impact on RV which requires extra fluid to overload the pulmonary system to force extra blood through the LV
How can aortic stenosis and aortic regurgitation be differentiated by BP?
Stenosis = narrow pulse pressure eg. 110/90 Regurgitation = wife pulse pressure eg. 180/90
How does Aspirin and Clopidogrel differ in their effects?
Which is more damaging to the stomach?
Aspirin = inhibition of prostaglandins and thromboxanes through COX-1 inhibition Clopidogrel = inhibits platelet aggregation by inhibit ADP receptors on platelets Aspirin = more damaging
How is shock measured?
When does blood pressure changed?
How does tennis scores help?
Class I-IV
BP = III
Tennis = % of blood loss, 0-15, 15-30, 30-40, 40
What ECG changes occur in hypocalcaemia?
When is Torsades more likely to occur?
QT prolongation
Hypokalaemia
What is the heart sound for aortic sclerosis?
Systolic Crescendo-decrescendo
