Quesmed Csfdiology 2 Flashcards
What is a contraindication for adenosine in management of adult tachycardia
Asthma due to adenosine stimulating respiratory fibres and causing bronchospasm that results in shortness of breath. Instead, verapamil shold be offered.
What is the alternative to adenosine?
Verapamil, a CCB
How does cardiac myxoma present?
Arises from the cardiac mesenchyme:
Fatigue
Clubbing
Haemoptysis
Atrial fibrillation
Dyspnoea
What is a typical cardiac tumour?
Cardiac myxoma, composed of unspecialised mesenchymal cells, which typically originate in the left atrium. It causes clubbing, fever, weight loss and variable murmur position due to atrial obstruction.
There is a high risk of tumours embolising so surgery is important.
There may be valvular insufficiency of mitral valve, so annuloplasty is required.
How is a cardiac myxoma diagnosed?
Echocardiography and cardiac MRI.
Definitive treatment is with surgical removal with a trio Tommy
What is cardiac tamponade?
Fluid build up in the pericardial space, which reduces cardiac output and results in hypotension and tachycardia.
Immediate treatment is required through pericardiocentesis
What is a key feature of cardiac tamponade e?
Pulsus paradoxus:
During inspiration, the blood pressure , stroke volume and systolic BP will drop more significantly than normal as the negative pressure from inspiration is exacerbated by the fluid build up and causes the interventricular septum to shift to the left.
What are the causes of cardiac tamponade?
Chest trauma
Malignancy
Infection
What are the clinical features of cardiac tamponade?
Beck’s triad: raised JVP, hypotension and quiet heart sounds.
Coughing, dyspnoea, weakness, chest pain, and abdominal pain
Absent Y descent on JVP.
Tachycardia
Electrical alteran on ECG
What is Beck’s triad?
Raised JVP, quiet heart sounds and hypotension
What is electric alteran?
QRS complex of different height in cardiac tamponade
What is the first line treatment for haemodynamically unstable patient with cardiac tamponade?
Pericardiocentesis
-> there is a risk of pneumothorax
When is intervention indicated in aortic stenosis?
Symptomatic patients all require surgical intervention.
What causes absent a awaves?
Atrial fibrillation
What causes cannon a waves?
Complete heart block, where atria contracts against closed tricuspid valve
How does JVP change during breathing?
It drops on inspiration and rises on expiration
What causes JVP to rise on inspiration?
Constriction of right heart expansion, known as Kussmaul’s sign. It occurs due to pericardial effusion, tamponade or pericardial constriction
What causes absent Y descent on JVP?
Cardiac tamponade due to impaired right ventiruclar filling
What are cardiac resyncrhnoisation devices used for?
Heart failure to stop ventiruclar dyssynchrony
What is Pulsus parvus et tarsus?
Slow rising weak pulse in aortic stenosis
What is Pulsus paradoxus?
Drop in blood and pulse pressure in inspiration due to cardiac tamponade.
What is Pulsus bigeminus?
Two pulses occur simultaneously followed by a long gap, associated with digoxin toxicity
What is Pulsus bisferiens?
Seen in hypertrophic cardiomyopathy due to systolic anterior valve motion
What are the indications for permanent pacing?
Complete heart block
Sick sinus syndrome
What is a feature of atrail pacing?
Spike is before P wave
What is a feature of ventiruclar pacing?
Spike is before QRS complex
How does right ventiruclar pacing present on ECG?
Right bundle branch block
How does left ventiruclar pacing present on ECG?
Similar to right bundle branch block
What causes a spike before P wave and QRS complex?
Dual chamber pacemaker rhythm
What is the cause of an ejection systolic murmur that is quieter when squatting with normal?
Hypertrophic cardiomyoapthy which is loudest at the apex. There would be pansystolic murmur.
What is cholesterol embolism?
Cholesterol crystals embolism spontaneously, disrupting blood supply to abdominal viscera. Symptoms include dermatological manifestations like rash across the legs.
What is the management for Stanford Typee A aortic dissection?
Surgical intervention
What is the management for Type B Stanford aortic dissection?
Managed conservatively with morphine and beta blockers. Evidence of end organ damage should be managed with open repair.
What are the clinical signs with aortic dissection?
Radio-radial delay and radio-femoral delay
Blood pressure difference between arms
What are the complications with aortic dissection?
->Stroke
-> Limb ischaemia
->Death due to internal haemorrhage
-> Cardiac tamponade
-> Mesenteric ischaemia
How does left ventricular free wall rupture present?
Rapid hypotension, tachycardia and cardiogenic shock, which generally occurs after an anterior STEMI
What is the cause of early diastolic murmur at the left sternal border?
Aortic regurgitation
How is potassium adminsitered for patients with heart failure?
Slow infusion over 12 hours
Which type of bundle branch block is normal?
Right bundle branch block
What is aortic sclerosis associated with?
Age related degeneration best heard in the aortic area, typical in patients under age 60
