Quesmed Cardiology 3 Flashcards
What is the cause of exertional dyspnoea and fatigue with an early diastolic murmur?
Aortic regurgitation which is found between the 2nd and 3rd intercostal spaces at the right sternal border which is louder on expiration.
Why does Malar flush occur?
Vasodilation in facial capillaries due to hypoxia from reduced cardiac output and increased pulmonary blood pressure.
How does acute aortic regurgitation present?
Sudden cardiovascular collapse
How does chronic aortic regurgitation present?
Insidious onset of exertional dyspnoea and fatigue
Which groups are at risk of aortic regurgitation?
Older populations
Men
Congenital aortic valve like bicuspid aortic valve and Marfan’s syndrome
What are the causes of acute aortic regurgitation?
Infective endocarditis
Aortic dissection
Chest trauma or deceleration jury damaging valve leaflets
Valve replacement
What are the causes of chronic aortic regurgitation?
Rheumatic heart disease
Connective tissue disorders
Infective endocarditis
Rheumatological coniditons
Age-related calcification
What is the intervention for a low CHAD2DS2-VASCULAR score?
Score of 0- request echocardiogram
When are anticoagulants indicated for the CA2DS2-VASC score?
Score above in 1 men
Score above 2 in women
What does apical to radial pulse deficit indicate?
Atrial fibrillation as not all atrial impulses are conducted to the ventricles
How does atrial fibrillaiton affect JVP?
Single valve form due to loss of a wave which represents atrial contraction
Which beta blocker is used for afib?
Bisoprolol
Which CCB is used in afib?
Diltiazem
What dug is given to older sedentary patients with atrial fibrillaiton?
Amiodarone
What is sotalol?
Beta blocker with additional K+ channel blocker action
What are the aspects of the CHAD2VASC score?
C: 1 point for congestive cardiac failure.
H: 1 point for hypertension.
A2: 2 points if the patient is aged 75 or over.
D: 1 point if the patient has diabetes mellitus.
S2: 2 points if the patient has previously had a stroke or transient ischaemic attack (TIA).
V: 1 point if the patient has known vascular disease.
A: 1 point if the patient is aged 65-74.
Sc: 1 point if the patient is female.
What are the components of the ORBIT score?
Sex
Haemoglobin (<13mg/Dl in males, <12mg<dL in females) 2 points
Age (>74) 1 point
Bleeding history 2 points
Renal function (eGFR <60) 1 point
Concomitant use of anti-platelets 1 point
What is HASBLED score calculate?
Bleeding risk
H: Hypertension 1 point
A: Abnormal renal or liver function 2 points if both are present
S: Stroke (previous) 1 point
B: Major bleed (previous) 1 point
L: Labile INR 1 point
E: Elderly (>65) 1 point
D: Drugs/alcohol 1 point for drug or alcohol use (2 points if both are present
How can echocardiogram indicate severe aortic stenosis?
Peak trans-valvular pressure gradient over 40mmHg.
What are the major criteria for rheumatic fever?
Arthritis
Pancarditis
Syndenham’s chorea
Erythema marginatum
Subcutaneous nodules
What is Syndenham’s chorea?
Neurological disorder consisting of abrupt, non-rhythmic, involuntary movements along with muscular weakness and emotional disturbance. They are more frequently marked on one side and cease during sleep
What is erythema marginatum?
pink/red, nonpruritic rash involving mainly the trunk, thighs and arms. Characteristically, the rash has raised, sharp outer edges with a diffuse clear centre, making a ring
What are the minor Jones criteria?
Fever arthraliga
Raised acute phase proteins
Prolonged PR interval on ECG
Which valvular pathology occcurs due to rheumatic fever?
Mitral stenosis-> most common
Mitral regurgitation
Aortic regurgitation
Aortic stenosis
Tricuspid regurgitation/stensosi
Mid-diastolic murmur with early snap, loudest on expiration
Mitral stenosis
How is ventiruclar tachycardia managed?
Amiodarone 3000mg IV
What is corrigan’s sign?
Bounding carotid pulse, presenting as neck pulsations in aortic regurgitation
What is Muller’s sign?
Pulsation of the uvula associated with aortic regurgitation
What is De Musset’s sign?
Head. Nodding associated with aortic regurgitation
What is the NICE guidance for aortic stenosis referral?
*Vmax (peak aortic jet velocity) more than 5 m/s
*aortic valve area less than 0.6 cm2
*left ventricular ejection fraction (LVEF) less than 55%
*B‑type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) level more than twice the upper limit of *normal
symptoms unmasked on exercise testing
What is an indication of severe aortic stenosis?
Soft second heart sound, indicating that the valve has become immobile
When is congenital bicuspid aorti valve the most common cause of aortic stenosis?
In under 65 year olds
How long should anticoagulation be prior to cardioversion for atrial fibrillation?
DOAC like apixaban for 3 weeks
What is a risk with direct current cardioversion?
Risk of embolism with an intra-atrial thrombus.
Trans-oesphageal echocardiogram is ideal to look for left atrial appendage thrombus and heparinisation
How should young patients with atrial fibrillation be managed?
Pill in pocket strategy wit sotalol or flecainide
What are the auscultation findings of aortic regurgitation?
Diastolic decrescendo murmur at left sternal border
Wide pulse pressure
What is a temporary pacing wire given for/
Bradycardia
How should metallic heart valves be managed with anticoagulants?
Warfarin
What can induce digoxin toxicity?
Hypokalemia and results in dizziness and yellow discolouration of vision
Which drug can precipitate digoxin toxicity?
Bumetanide
What aortic jet velocity indicates severe aortic stenosis?
Greater than 4 m/
How should atrial fibrillation over 48 hours be managed?
Beta blocker
How should atrial fibrillation less than 48 hours be managed?
Synchronised cardioversion
What causes a shorten QT interval?
Hypercalcaemia can cause shortened QT.
When is an intervention indicated for mitral valve stenosis?
Mitral valve area less than 1.5cm
What is pulsus alterans?
pulse volume alternating between strong and weak. This occurs in patients with severe congestive heart failure
What is an indication for DC cardioversion with heart failure?
Bibasal crackles on auscultation
What is the guideline for pulseless electrical activity for ventricular tachycardia?
Chest compressions at 100-120 per minute and deliver unsynchronised shock
What is a shockable rhythm?
Pulseless Torsades de pointes which requires immediate unsynchronised DC cardioversion
How should pulseless ventricualr tachycardia be managed?
IV amiodarone 300mg over 10-60 minutes
Second line is to adminstering synchronised DC shocks
What is the treatment for rheumatic fever?
IV benzylpenicillin with a following ten day course of phenoxymethylpenicillin
Which diagnostic test is used for rheumatic fever?
Group A streptococcus
What is the longterm management for patients with rheumatic fever?
Secondary prophylaxis with long-term penicillin
What causes widespread downsloping ST segment?
Digoxin
What medication can cause Mobitz type 1 block?
Amiodarone
How does phenytoin affect the ECG?
Causes hypocalcaemia which prolongs QT interval
How does amitriptylline affect ECG?
Causes prolonged QT interval
Which antibiotic causes prolonged QT?
Erythromycin, a macrolide antibiotic
What are the symptoms of digoxin toxicity?
Gastrointestinal upset like nausea and constipation
Vertigo
Confusion
Arrythmia
-> This is precipitated by hypokalemia, which can be caused by furosomide
What is a cause of broad QRS complex above AV node?
Supraventricular tachycardia with bundle branch block
What is a side effect of rifampicin?
Inducer of cytochrome P450 enzymes and reduces circulating levels of drugs. St John’s wort has a similar effect on P450 enzyme
What is the treatment for dioxin toxxicity?
Digibind, which is a digoxin specific antibody preventing digoxin acting on ion pumps
How is beta blocker overdose treated?
Atropine
How is hyperkalemia treated?
Nebulised salbutamol
What are the risk factors of digoxin toxicity?
Hypokalemia
Increasing age
What is ortner’s syndrome?
Recurrently laryngeal nerve palsy with hoarseness of voice from cardiovascular disease
