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Phase 2 Mine > Revision List CVS > Flashcards

Revision List CVS Flashcards

1
Q

What is infective endocarditis

A

Infection of the heart valves and or other endothelium lined structures

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2
Q

Types of IE

A

Left sided native IE
Left sided prosthetic IE
Right sided IE
etc

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3
Q

At risk populations for IE?

A 
IVDU
Poor dental hygiene
Prosthetic valves
Young with congenital heart disease
Elderly
Rheumatic heart disease
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4
Q

Organisms that cause IE

A

S. viridans
S. aureus/epidermidis
Diptheroids

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5
Q

Symptoms of IE

A

Fever
Night sweats
Weight loss

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6
Q

Signs of IE

A 
Petechiae
Osler's nodes
Roth spots
Splinter haemorrhages
Janeway lesions
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7
Q

Criteria used to diagnose IE?

A

Modified Duke’s Criteria

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8
Q

Major Criteria for IE?

A
  1. Positive blood culture

2. Echo evidence of IE/new valve leak

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9
Q

Minor Criteria for IE?

A
  1. Predisposing factors: heart condition/IVDU
  2. Fever>38
  3. Vascular phenomena esp. emboli
  4. Immunological phenomena: glomerulonephritis, osler’s nodes
  5. Equivocal blood culture = +ve but not notable
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10
Q

How many of each criteria is diagnostic for IE?

A

2 majors
1 major 3 minor
5 minors

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11
Q

Investigations for IE

A
  1. FBC: raised ESR/CRP, neutrophilia, normochromic normocytic anaemia + Blood CULTURES
  2. Urinalysis: haematuria
  3. CXR: cardiomegaly
  4. ECG: long PR intervals, regular
  5. Echocardiogram - Transthoracic and transoesophageal
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12
Q

Advantages and disadvantages of TTE?

A

Non invasive so less discomfort

Poor sensitivity images

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13
Q

Advantages and disadvantages of TOE?

A

Greater sensitivity - can look for mitral lesions and aortic root abscess
But… discomfort due to insertion AND risk of perforation and aspiration

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14
Q

Treating IE?

A

Abx for 6 weeks
Staphylococci - rifampicin/vancomycin
Others - penicillin

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15
Q

When do you operate in IE?

A

Recurrent infection despite Abx treatment

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16
Q

What surgical procedures are possible to help treat IE?

A

Removed infected prosthetic/Devices

Remove large vegetations before emboli

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17
Q

What are the 3 types of aortic stenosis? Most common?

A

Supravalvular
Subvalvular
Valvular - most common

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18
Q

Example of supravalvular aortic stenosis

A

congenital fibrous diaphragm above the aortic valve

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19
Q

Example of subvalvular aortic stenosis

A

Congenital fibrous diaphragm/ ridge below aortic valve

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20
Q

Acquired causes of aortic stenosis?

A

Rheumatic HD

Degenerative calcification - MOST common

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21
Q

Congenital causes of aortic stenosis?

A

Congenital aortic stenosis

Congenital bicuspid valve

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22
Q

Congenital aortic stenosis is commonly associated with?

A

Coarctation, dissection and aneurysm of aorta

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23
Q

Pathophysiology of aortic stenosis?

A

Narrowing of aorta - increased pressure gradient to LV - initially compensated by LVH but then exhausted –> function declines –> failure.

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24
Q

Clinical presentation of aortic stenosis?

A

Chest pain
Syncope
Dyspnoea

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25
Q

What may you found on examining a patient with aortic stenosis?

A
  1. Pulsus Tardus
  2. Pulsus Parvus
  3. 2nd HS = soft/absent
  4. 4th HS = prominent due to LVH
  5. Ejection systolic murmur - crescendo/decrescendo
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26
Q

What investigations may be used to analyse aortic stenosis?

A
  1. Echo: Left ventricular size/function and doppler derived gradient and valve area measured
  2. ECG: LVH, left atrial delay, left ventricular strain
  3. CXR: LVH, calcified aortic valve
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27
Q

How does LVH present on ECG?

A

S in V1/V2 >30mm
R in V5/6 >30mm
Left axis deviation
Prolonged QRS

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28
Q

Management of aortic stenosis?

A
  1. Maintain good dental hygiene - IE risk
  2. Surgical aortic valve replacement
  3. Transcatheter aortic valve implantation - crack and insert stent
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29
Q

What is contraindicated in aortic stenosis?

A

vasodilators are contraindicated as it my trigger hypotension and syncope

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30
Q

Indications of aortic valve replacement?

A
  1. Symptomatic patient with severe aortic stenosis
  2. Decreased ejection fraction
  3. Undergoing CABG with moderate AS
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31
Q

Mitral regurgitation aetiology?

A

Abnormalities of valve leaflets:

  1. Myxomatous degeneration - most common - weakening of chordae tendinae -> floppy mitral valve
  2. Ischaemic mitral valve
  3. Rheumatic heart disease
  4. IE
  5. Dilated cardiomyopathy
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32
Q

Pathophysiology of mitral regurgitation?

A

Backflow of blood –> atrium –> left atrial enlargement and LVH as heart has to increase contractility to increase SV and maintain CO.
Pulmonary HTN –> RV dysfunction
Progressive HF ReF a.k.a systolic HF.

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33
Q

Symptoms of mitral regurgitation

A

Fatigue
Dyspnoea
Lightheaded??

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34
Q

Signs of Mitral regurgitation?

A
  1. Pansystolic murmur at apex –> radiate to axilla S3 HS
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35
Q

Investigations in MR?

A
  1. ECG: LVH, LA enlargement
  2. CXR: LA enlargement, central pulmonary artery enlargement
  3. ECHO: estimation of LA/LV size and function `
36
Q

Management of MR?

A
  1. Medication:
    a. Vasodilation - ACEi/hydralazine
    b. Betablockers/Digoxin/CCB - rate control for AF
    c. Diuretics for fluid overload
  2. IE prophylaxis
  3. Surgery if criteria fulfilled
37
Q

When to Surgery in MR?

A
  1. EF<60 or LVESD> 45mm
  2. Symptoms at rest/exercise
  3. New onset AF/increase PaP
38
Q

What is aortic regurgitation?

A

Leakage of blood back into LV during diastole valve due to ineffective capitation of aortic cusps.

39
Q

Aetiology of aortic regurgitation?

A
  1. Bicuspid aortic valve congential
  2. Rheumatic heart disease
  3. IE - acute
40
Q

Effects of aortic regurgitation?

A

Increase LV size, dilation and hypertrophy
Progressive dilation –> HF
Regurgitation –> diastolic blood pressure –> cardiac ischaemia

41
Q

Physical exams findings of AR?

A
  1. Wide pulse pressure
  2. hyper dynamic and displaced apical impulse
  3. Diastolic blowing murmur at left sternal border
  4. Austin flint murmur (apex)
  5. Systolic ejection murmur -> increased aortic valve
42
Q

Clinical presentation of AR?

A

Progressive dyspnoea - exertional, orthostatic, paroxysmal nocturnal dyspnoea
Palpitations –> increase force of contractions

43
Q

Investigation of AR?

A

Echo
CXR
ECG: LVH - tall R waves, deeply inverted T waves

44
Q

Treating AR?

A
  1. IE prophylaxis
  2. Vasodilators
  3. Serial echocardiogram to monitor progress
  4. Surgical Tx: valve replacement.
45
Q

Indications for AR surgery?

A

Any symptoms at rest or exercise

EF <50% / LV dilated

46
Q

Aetiology of MS?

A

Rheumatic HD
IE
Mitral annular calcification

47
Q

Pathophysiology of MS?

A

To maintain CO –> LA dilation/hypertrophy –> pulmonary congestion –> progressive dyspnoea
Increased transmural pressures –> LA enlargement/fibrillation
Pulmonary venous hypertension –> right heart failure symptoms
Haemoptysis –> due to elevated pulmonary pressure –> rupture of bronchial vessels

48
Q

Signs of MS?

A
  1. ‘A’ wave in jugular venous pulsations due to pulmonary HTN and RVH
  2. RHF signs
  3. Mitral facies –> bilateral, cyanotic or dusty pink/purple colouration on cheek patches
  4. Diastolic murmur - low pitched, patient lean to left
  5. Loud opening S1 snap : apex due to abrupt halt in leaflet movement in early diastole
49
Q

Management of MS?

A

Serial echocardiography

  1. Medical: beta blockers, CCB, Digoxin = improve diastolic filling, diuretics for fluid overload
  2. Mitral valve replacement/percutaneous mitral valve balloon valvotomy
50
Q

Define acute pericarditis

A

Acute inflammation of the pericardium with or without pericardial effusion.

51
Q

What can causes of the pericarditis be divided into?

A
  1. Infectious

2. Non-infectious

52
Q

What are infectious causes of pericarditis?

A
  1. Viral - most common:
    - Enterovirus, Herpes virus, adenovirus
  2. Bacterial: M. tuberculosis
  3. Fungal: histoplasma species - more likely in immunocompromised patients
53
Q

What are non-infectious causes of pericarditis?

A
  1. Autoimmune - RA, Sjorgren’s, scleroderma
  2. Neoplastic: secondary and metastatic tumours
  3. Metabolic: uraemia, myxoedema
  4. Traumatic/iatrogenic
54
Q

Describe early onset iatrogenic cause of pericarditis?

A
  1. Direct injury, penetrating thoracic injury/oesophageal

2. Indirect injury - non penetrating thoracic injury

55
Q

Describe delayed onset iatrogenic cause of pericarditis?

A
  1. Pericardial injury syndromes, iatrogenic trauma e.g. coronary percutaneous intervention
56
Q

Describe other iatrogenic cause of pericarditis?

A
  1. Amyloidosis
  2. Aortic dissection
  3. Pulmonary arterial hypertension
  4. Chronic heart failure
57
Q

5 symptoms of pericarditis?

A
  1. Severe pleuritic chest pain
  2. Dyspnoea
  3. Cough
  4. Systemic: antecedent fever, skin rash, joint pain, weight loss
58
Q

Differential diagnosis of pericarditis?

A
  1. Pneumonia
  2. MI/ischaemia
  3. GORD
  4. PE/pneumothorax
59
Q

Signs of pericarditis?

A
  1. Pericardial rub - pathognomic - crushing snow
  2. Sinus tachycardia
  3. Fever
  4. Pulsus paradoxus, Kussmaul’s breathing
  5. Beck’s triad
60
Q

What is pulsus paradoxus?

A

Decrease in systolic Bp > 10mmHg during inspiration
Due to: decrease intrathoracic and pericardial pressure, increase venous return to RA and RV - increase RA compliance so decreased LA/LV filling.
– SIGN of tamponade

61
Q

Kussmaul’s breathing

A

Increase JVP on inspiration

62
Q

Beck’s triad?

A
  1. Raised JVP
  2. Hypotension
  3. Muffled HS
63
Q

How to diagnose pericarditis?

A
  1. ECG - diffuse ST elevation - saddle shape, PR depression
  2. Blood tests: FBC –> raised WCC, lymphocytes, ESR, CRP, troponin
  3. CXR: often normal, may have pneumonia
64
Q

Management of pericarditis?

A
  1. Sedentary activity with resolution of symptoms/ inflammatory state
  2. NSAIDs
  3. Colchicine - 3 months reduces recurrence but limited by nausea and diarrhoea
65
Q

What are major complications of pericarditis?

A
  1. Fever >38degrees
  2. Subacute onset
  3. Large pericardial effusion
  4. Cardiac tamponade
  5. Lack of response to aspirin/NSAIDs
66
Q

Minor complications of pericarditis?

A
  1. Myopericarditis
  2. Immunosuppression
  3. Trauma
  4. Oral anticoagulant therapy
67
Q

What is pericardial effusion?

A
  1. Collection of fluid within potential space of serous pericardial surface
68
Q

Does pericardial effusion usually result in cardiac tamponade?

A
  1. Chronic accumulation allows adaptation of parietal pericardium - compliance reduces effect on diastolic filling of chambers
69
Q

What is cardiac tamponade?

A

Rapid fluid accumulation with enough pressure to adversely affect heart function.
Ventricular filling is compromised.

70
Q

Clinical presentation of cardiac tamponade?

A
  1. raised HR, low BP
  2. Raised JVP
  3. Muffled 1st and 2nd HS
  4. Kussmaul’s sign = raised JVP and neck vein distension during inspiration
  5. Pulsus paradoxus
71
Q

What is constrictive pericarditis?

A
  1. Long term pericardial inflammation –> pericardium thickens, fibrotic, inelastic pericardium restricts cardiac filling and affects heart function.
72
Q

Risk factors for peripheral vascular disease?

A
  1. Smoking
  2. Diabetes
  3. Hypercholesterolaemia
  4. Hypertension
  5. Physical inactivity
  6. Obesity
73
Q

Clinical presentation of mild ischaemia (critical limb ischaemia)?

A
  1. Stress induced physiological function
    - exercise induced angina
    - intermittent claudication
74
Q

Clinical presentation of moderate ischaemia (critical limb ischaemia)?

A
  1. Structural and functional breakdown
    - ischaemic cardiac failure
    - critical limb ischaemia –> rest pain, typically nocturnal, no reserve available for increased demand
    - vascular dementia
75
Q

Clinical presentation of severe ischaemia (critical limb ischaemia)?

A
  1. Infarction - gangrenes/infection risk
76
Q

Clinical presentation of intermittent claudication?

A
  1. Muscle cramps on walking - calf, thigh, buttock
77
Q

Clinical presentation of critical leg ischaemia?

A
  1. Rest pain, ulceration, gangrene
78
Q

Acute limb ischaemia clinical presentation?

A 
Pale
Pulseless
Paraesthesia
Perishingly cold
Paralysis
Pain
79
Q

General symptoms of peripheral vascular disease?

A

Absent femoral, popliteal or foot pulses

Cold white legs

80
Q

Diagnosis of peripheral vascular disease?

A
  1. ESR/CRP
  2. FBC –> exclude anaemia/polycythaemia
  3. ECG to look for cardiac ischaemia
  4. Ankle/brachial pressure index –> measure severity of disease
  5. Colour duplex ultrasound
  6. MR/CT angiography to assess extent and location of stenoses and quality of distal vessels
81
Q

What is ABPI?

A

Measurement of cuff pressure at which blood flow is detectable by Doppler in the posterior tibial or anterior tibial arteries compared to brachial artery.

82
Q

Treatment of peripheral vascular disease - risk factor modification?

A
  1. Smoking cessation
  2. Treat HTN, hyperlipidaemia and diabetes
  3. Antiplatelet agent e.g. P2Y12 inhibitor
  4. Exercise and weight loss
83
Q

Treatment of peripheral vascular disease - revascularisation for critical ischaemia?

A
  1. Percutaneous transluminal angioplasty
  2. Bypass procedure
  3. Amputation if severe
84
Q

Treatment of PVD - - acute ischaemia?

A
  1. Surgical emergency requiring revascularisation within 4-6 hours to save limb
  2. Intra-arterial thrombolysis
  3. Surgical removal of embolus
85
Q

Intermittent claudication key features?

A
  1. Ischaemic leg pain
  2. Tissue suffering/not dying
  3. Oxygen debt –> build up of lactic acid result in pain
86
Q

Key features of critical ischaemia?

A
  1. Tissue dying and suffering at rest
  2. Blood supply is inadequate to allow basal metabolism
  3. No reserve for increased demand
  4. Nocturnal resting pain
  5. Gangrene/ infection risk

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