Random Flashcards
What is Beçet’s disease?
a disorder causing blood vessel inflammation throughout the body
Main symptoms: genital and mouth ulcers, red painful eyes, blurred vision, acne like spots, headaches, painful stiff joints
Can flare up and relapse
What is Disseminated Intravascular Coagulation?
small blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive bleeding.
What is Activated Partial Thromboplastin Time (APTT)?
it characterises coagulation
The aPTT evaluates factors I (fibrinogen), II (prothrombin), V, VIII, IX, X, XI and XII.
what are the 4 ECG changes seen in hyperkalaemia?
low flat p waves, broad bizarre QRS, slurring into the ST segment, tall tented T waves
what are the indications for a pacemaker?
Sick sinus syndrome
Complete heart block
AV nodal ablation
Resynchronisation therapy
what are the 6 qualities of pericardial pain?
sharp and worse on inspiration (like pleurisy)
retrosternal and radiates to left (shoulder not arm) (like angina)
worse lying flat and eased by sitting up and forward
what do the 1st and 2nd heart sounds represent?
1st: lub, closing of the AV valves
2ud: dub, closing of the aortic and pulmonary valve
what are 4 causes of a 4th heart sound? (remember a 4th heart sound is always pathological!)
diastolic HF
MI
Cardiomyopathy
HTN–>pressure overload
will the apex beat be displaced in pressure overload?
no displacement of the apex beat. It is the muscle wall of the heart that hypertrophies inwards
can a third heart sound be normal?
yes in children and young adults up to 30
what are some causes of a pathological third heart sound?
HF MI cardiomyopathy HTN-->pressure overload mitral and aortic regurgitation (volume overload) constrictive pericarditis
what happens to the apex beat in volume overload ?
the apex beat is displaced as the left ventricle becomes dilated
what are the 4 stages of clubbing?
stage 1: increased fluctuancy of the nail
stage 2: loss of angle between nail and nail bed
stage 3: increased curvature of the nail
stage 4: expansion of the terminal phalanx
if you think a patient has clubbing how would you phrase this to the examiner?
there is evidence of digital clubbing
in a patient with a midline sternotomy scar they may have had a valve replacement or a coronary artery bypass graft- how do you know which one they have had without asking the patient directly?
look at the leg for evidence of vein harvesting. (in the case of CABG)
when doing the collapsing pulse test (feeling the beat at the wrist with palm on the wrist and lifting) what else should you do?
check if the patient has any pain in their shoulder
look at their neck for corrigans sign
what does a collapsing pulse and corrigans sign indicate?
aortic regurgitation
What are the 2 possible explanations for an irregular irregular pulse and how would you distinguish between them without an ECG?
AF and multiple ventricular ectopics
To distinguish between the 2 i would exercise the patient– ectopics would be abolished.
as rate increases, diastolic filling time is reduced.
how would you assess if atrial fibrillation is well controlled?
time apical beat with stethoscope
if <80 at rest then good control.
this is the reason for rate control in AF management - to abolish the pulse deficit
why is there a difference between the pulse rate taken at the wrist and the HR timed at the apex?
Because of a pulse deficit. the radial pulse is deficient vs the apical beat.
What are 2 indications for warfarin over DOACs?
mitral stenosis
metal heart valve
what are 4 indications for a permanent pacemaker?
1) sino atrial disease: sick sinus syndrome/tachybrady syndrome
2) AV nodal disease: symptomatic second and complete degree heart block
3)Atrial fibrillation with a slow ventricular rate or refractory fast AF treated with AV nodal ablation
4) cardiac resynchronisation therapy for heart failure
SCAR: sick sinus syndrome, complete heart block, AV nodal ablation, Resynchronisation therapy
what are some complications of pacemaker insertion?
1) pulse generator: haematoma, infection, skin erosion, device failure
2) Venous access: pneumothorax, air embolus
3) Leads: lead displacement/fracture, venous thrombosis, endocarditis, cardiac perforation
What are the major indications for an echocardiogram?
- Diagnosis and assessment of valvular heart disease
- Diagnosis and assessment of heart failure
- Diagnosis and assessment of infective endocarditis
- Diagnosis and assessment of pericardial disease
