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Year 1 - Cardiovascular (DP) > Structural Cardiac Abnormalities > Flashcards

Structural Cardiac Abnormalities Flashcards

0
Q

On which side of the heart are murmurs influenced by inspiration?

A

Right sided - Made louder

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1
Q

Where do cardiac murmurs radiate to?

A

Aortic stenosis - Carotids
Pulmonary stenosis - Shoulder
Mitral regurgitation - Axilla

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2
Q

Where and when is an innocent murmur hear?

A

Pulmonary area

Early systole

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3
Q

What are common causes of aortic stenosis?

A

Congenital bicuspid valve
Age
Rheumatic fever

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4
Q

What are the clinical signs of aortic stenosis?

A

Slow rising pulse
LV heave
Ejection systolic murmur

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5
Q

What ECG changes can be seen in a patient with aortic stenosis?j

A

Big complexes in V4-V6
Left axis deviation
(due to LVH)

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6
Q

How is aortic stenosis treated?

A

Valve replacement
Balloon aortic valvotomy
Transcatheter Aortic Valve Implantation

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7
Q

Which type of valve replacement needs lifelong anticoagulation, mechanical or bioprosthetic?

A

Mechanical

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8
Q

What are common causes of mitral regurgitation?

A 
Rheumatic fever
Endocarditis
Chordae rupture
Annular dilation
Papillary muscle Ischaemia
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9
Q

What are the signs and symptoms of mitral stenosis?

A

SoB
Ankle oedema
Displaced apex
Pansystolic murmur - radiates to axilla

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10
Q

What are the signs of mitral stenosis?

A 
Malar flush
Tapping apex
Mid-diastolic murmur
Straight left heart border on CXR - LA dilation
Can lead to AFib
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11
Q

Treatment options for mitral stenosis?

A

Diuretics
Beta blockers - lengthen diastole
Digoxin
Warfarin

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12
Q

Patients BP is 120/50
Collapsing pulse is present
Displaced apex and early diastolic murmur in the tricuspid area once sitting up.

A

Aortic regurgitation

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13
Q

What is the role of the ductus venosus in the foetus?

A

Allows umbilical blood to bypass liver

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14
Q

Which structure directs blood from the RA to the LA in the foetus?

A

Foramen ovale

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15
Q

What is the purpose of the ductus arteriosus?

A

Directs 90% of RV blood into aorta to supply body in the foetus

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16
Q

What do the following become in the postnatal child?

  1. Umbilical vein
  2. Ductus arteriosus
  3. Ductus venosus
A
  1. Ligament teres hepatis
  2. Ligament arteriosum
  3. Ligament venosus
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17
Q

Baby born healthy
Baby turns blue a few days later
Heart appears “egg-shaped” on CXR

A

Complete transposition of the great vessels

18
Q 
Newborn baby
CXR shows
- Small heart
- Uptilted apex
- Oligaemic lung fields
- Pulmonary bay
A

Tetralogy of Fallot

19
Q

What are the main features of Tetralogy of Fallot?

A

RV outflow tract obstruction
Overriding aorta
VSD
RVH - Upright T wave in V1 (and no S wave)

20
Q

What coloured top bottles are used for negative and positive culture bottles?

A

Negative - Blue

Positive - Purple

21
Q

What infections does Staph. epidermidis typically cause?

A

IV line infection
Prosthetic heart valve infection
Prosthetic joint infection

22
Q

Why do we take 3 sets of culture at different times?

A

To rule out any contaminants

23
Q

Which people are more likely to get infective endocarditis?

A

People with calcified valves
Rheumatic fever sufferers
IV drug users
People with IV lines

24
Q

What is the sequence of events in infective endocarditis?

A
  1. Heart valve damaged
  2. Turbulent blood flow
  3. Platelets deposited
  4. Bacteraemia
  5. Microbial vegetation
25
Q

What are the clinical signs of infective endocarditis?

A 
Fever
Murmur
Clubbing
Splinter haemorrhages
Haematuria
Splenomegaly
Roth spots - retinal haemorrhages
Janeway lesions - non tender lesions on palms
Osler nodes - tender lesions on finger tips
26
Q

Should cultures be taken before or after antibiotics?

A

Before

27
Q

If an echo is requested, which is better?
Transoesophageal
Transthoracic

A

Transoesophageal

28
Q

What organisms tend to cause prosthetic valve endocarditis?

A

Staph. aureus

Staph. epidermidis

29
Q

A 27 year old patient has IE of their tricuspid valve. After culture, all 3 sets are found to contain Staph. aureus. What predisposing factor is this patient likely to have?

A

They are an IV drug user

30
Q

How do we treat native valve endocarditis?

A

IV amoxicillin + IV gentamicin

31
Q

How do we treat prosthetic valve endocarditis?

A

IV vancomycin + IV gentamicin +/- PO Rifampicin

Or valve replacement

32
Q

IV flucloxacillin is used to treat IE in which patients and with what causative organism?

A

IV drug users with Staph. aureus infection

33
Q

Patient has MRSA IE, what is the treatment?

A

IV Vancomycin + PO Rifampicin

34
Q

Benzylpenicillin and IV Gentamicin are used to treat IE caused by which organism?

A

Strep. viridans

35
Q

How is IE caused by Enterococcus spp. treated?

A

Amoxicillin/Vancomycin + IV Gentamicin

36
Q

How do we treat Staph. epidermidis IE?

A

IV Vancomycin + IV Gentamicin + PO Rifampicin

37
Q

How long is antibiotic treatment usually given for?

A

4-6 weeks

38
Q

What do we tend to monitor during IE treatment?

A

Cardiac function
Temperature
CRP

39
Q

What is the most common type of cardiomyopathy and what are its clinical signs?

A 
Hypertrophic cardiomyopathy
Jerky pulse
Forceful/Double apical beat
Fourth heart sound
Mid-systolic murmur - exacerbated by Valsalva manoeuvre
40
Q

What are the histological Taurus of dilated cardiomyopathy?

A

Hypertrophy
Oddly shaped nuclei
Myocyte and myofilament loss
Interstitial fibrosis

41
Q

What type of cardiomyopathy is caused by the muscle being replaced by fibrous and fatty tissue?

A

Arrhythmogenic RV Cardiomyopathy

42
Q

What are the characteristic ECG signs of ARVCM?

A

T-wave inversion beyond V1
QRS in V1 >0.11s
Epsilon waves

43
Q

What is Brugada syndrome?

A

Cardiac sodium ion channel mutation

Year 1 - Cardiovascular (DP) (6 decks)

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