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BPT > Summary Book Cardiology > Flashcards

Summary Book Cardiology Flashcards

1
Q

Which are the diastolic murmurs, early vs mid-late?

A

Early: aortic regurgitation and pulmonary regurgitation. Mid late: austin flint murmur and mitral stenosis.

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2
Q

Describe aortic stenosis

A

Ejection systolic, radiates to carotids, louder with expiration, narrow pulse pressure, LV enlarged with features of failure

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3
Q

Describe aortic coarctation

A

left third intercostal space

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4
Q

Describe aortic regurgitation

A

Heard in pulmonary area, louder with hand squeeze, early diastolic, have patient sit up / lean forward and breath out, water hammer pulse with wide pulse pressure

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5
Q

Describe pulmonary stenosis

A

Systolic, louder with inspiration, low volume pulse with narrow pressure, giant a waves, associated with tetralogy of Fallot (regurg post)

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6
Q

Describe patent ductus arteriosus

A

Pulmonary area, continuous with clubbing of only toes

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7
Q

Describe atrial septal defect

A

Pulmonary region, systolic, clubbed fingers and toes, S2 split

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8
Q

Murmurs of aortic region

A

Aortic stenosis, aortic coarctation

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9
Q

Murmurs of pulmonary region

A

Pulmonary stenosis, patent ductus arteriosus, atrial septal defect, aortic regurgitation

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10
Q

Describe tricuspid regurgitation

A

Tricuspid region, pan systolic, louder with inspiration, pulsatile liver, radiates to right lower sternal border

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11
Q

Describe HOCM murmur

A

Tricuspid region, increases with valsalva, systolic, doesn’t radiate, double or triple apex beat

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12
Q

Murmurs of tricuspid region

A

Tricuspid regurgitation, HOCM

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13
Q

Describe mitral stenosis

A

Mitral region, late diastolic, louder with expiration and left lateral position, associated with AF and pulmonary hypertension, narrow pulse pressure

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14
Q

Describe mitral regurgitation

A

Mitral region, louder with hand squeeze, pan systolic, louder with expiration and left lateral position, associated with AF, radiates to chest wall and axilla

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15
Q

Describe VSD

A

Mitral region, increased with hand squeeze, pansystolic, clubbed fingers and toes, radiates to back

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16
Q

Describe Mitral Valve Prolapse

A

Mitral region, mid systolic click with late systolic murmur

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17
Q

Mitral murmurs

A

Mitral stenosis, mitral regurgitation, VSD, mitral valve prolapse

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18
Q

Physiology of valsalva

A

Decreases preload and exacerbates HOCM and mitral valve prolapse

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19
Q

Physiology of hand squeeze

A

Increases afterload and exacerbates aortic regurgitation, mitral regurgitation, ventral septal defect

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20
Q

Regions of first hear sound

A

Mitral and tricuspid

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21
Q

Regions of second heart sound

A

Aortic and pulmonary

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22
Q

Causes of early systolic murmur

A

Acute severe mitral regurgitation

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23
Q

Causes of ejection systolic murmur

A

Aortic coarctation, aortic stenosis, flow murmur (anaemia, thyrotoxicosis), hypertrophic cardiomyopathy, pulmonary stenosis

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24
Q

Causes of late systolic murmur

A

Mitral valve prolapse

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25
Q

Causes of pan systolic

A

Mitral regurgitation, tricuspid regurgitation, ventricular septal defect

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26
Q

Cardiac findings for marfans

A

aortic regurgitation

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27
Q

Cardiac findings for turners syndrome

A

bicuspid aortic valve, coarctation (narrowing) of aorta; also short, square chest with webbed neck

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28
Q

Cardiac findings for down syndrome

A

atrioventricular septal defect, patent ductus arteriosus, tetralogy of fallot

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29
Q

Cardiac findings for ankylosing spondylitis

A

aortic regurgitation

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30
Q

Cardiac findings for Acromegaly

A

mitral and aortic regurgitation

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31
Q

If both young and cyanotic then consider

A

Eisenmenger Syndrome with atrial septal defect, ventricular septal defect, patent ductus arteriosus and aortopulmonary window

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32
Q

Causes of clubbing - cardiac / gastro / respiratory / other

A

cardiac: atrial myxoma, congenital cyanotic heart disease, infective endocarditis. gastro: coeliac, cirrhosis, IBD, lymphoma of GIT. respiratory: asbestosis, bronchial carcinoma, chronic suppurative lung disease (bronchiectasis, cystic fibrosis, empyema, abscess), idiopathic pulmonary fibrosis. other: hereditary, graves.

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33
Q

Causes of malor flush

A

Mitral and pulmonary stenosis

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34
Q

Carotid pulse - causes of slow rising, collapsing and alternans

A

Slow rising = aortic stenosis, Collapsing = aortic regurgitation, Alternans = left ventricular failure.

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35
Q

Apex beat - causes of pressure loaded, volume loaded, double impulse and tapping

A

Pressure (forceful and sustained) = aortic stenosis and hypertension, Volume (diffuse, displaced and non-sustained) = mitral regurgitation and dilated cardiomyopathy, Double impulse = HOCM, Tapping (palpable 1st heart sound) = mitral stenosis

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36
Q

Causes of S3

A

Early ventricular filling

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37
Q

Causes of S4

A

Atrial contraction against stiff ventricle

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38
Q

ECG findings for aortic stenosis

A

LVH (deep s in v2, tall r in v5) and LV strain (ST depression, TWI in 1, aVL and v5-6, left axis deviation)

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39
Q

CXR findings of aortic stenosis

A

LVH, calcified aortic stenosis

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40
Q

Markers to quantify severe aortic stenosis

A

valve area <1cm, gradient >40mmHg, velocity >4m/s

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41
Q

Aetiology of aortic stenosis

A

calcific, congenital bicuspid, rheumatic hear disease, systemic lupus erythematous, fabrys disease

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42
Q

Clinical findings of severe aortic stenosis

A

thrill, harsh murmur, prolonged murmur, split s2, s4, narrow pulse pressure, low volume late peaking pulse, left ventricular hypertrophy, left ventricular failure

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43
Q

ECG findings of aortic regurgitation

A

LVH (deep s in v2, tall r in v5)

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44
Q

CXR of aortic regurgitation

A

LV dilatation, aortic root dilatation

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45
Q

ECHO of aortic regurgitation

A

?stenosis, ?vegetations, aortic root pathology, increased left ventricular ejection fraction

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46
Q

Aetiology of aortic regurgitation - valvular vs aortic root

A

valvular = congenital, rheumatic heart disease, infective endocarditis, inflammatory rheumatologic disease, degeneration. aortic root = collagen disorders, aortitis (syphilis, vasculitis), dissection/aneurysms

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47
Q

Clinical findings of severe aortic regurgitation

A

Prolonged murmur, soft A2, s3, wide pulse pressure, water hammer pulse, left ventricular hypertrophy, left ventricular failure, austin flint murmurs

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48
Q

Management of chronic aortic regurgitation

A

Heart failure therapy (ACEi / ARB), MRA, B Blocker, diuretics, digoxin), balloon pump contraindicated, valve replacement if persistent symptoms, deteriorating ejection fraction and progressive left ventricular dilation

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49
Q

ECG of mitral stenosis

A

Afib, left atrial enlargement, right axis deviation, right ventricular hypertrophy (dominant tall R in v1, dominant deep s in v5/6)

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50
Q

CXR of mitral stenosis

A

Left atrial enlargement, mitral annular calcification

51
Q

ECHO of mitral stenosis

A

Valve area <1cm is severe, posterior mitral valve leaflet maintains anterior during diastole)

52
Q

Clinical signs of severe mitral stenosis

A

Early opening snap, narrow pulse pressure, diastolic thrill at apex, pulmonary hypertension

53
Q

Clinical signs of pulmonary hypertension

A

prominent a wave, right ventricular heave, loud or palpable p2, pulmonary regurgitation, tricuspid regurgitation

54
Q

ECG of mitral regurgitation

A

Afib, left atrial enlargement (p mitrale), LVH (deep s in v2, tall r in v5), left strain

55
Q

CXR of mitral regurgitation

A

Cardiomegaly, left atrial enlargement, mitral annular calcification

56
Q

ECHO of mitral regurgitation

A

prolapsed or thickened leaflets, decreased ejection fraction at late stage

57
Q

Clinical signs of severe mitral regurgitation

A

early diastolic murmur, soft s1, early a2, s3, small volume pulse, pulmonary hypertension, left ventricular dilation, left ventricular failure

58
Q

Aetiology of mitral regurgitation - structural vs functional

A

Structural = myxomatous (connective tissue degeneration), degeneration, rheumatic heart disease, papillary muscle dysfunction, infective endocarditis, connective tissue disease. Functional = LV dilation and LA dilation.

59
Q

Commonest heart lesion

A

mitral valve prolapse

60
Q

Mitral valve prolapse - murmur description / exacerbated by / ECHO findings

A

mid systolic click and late systolic murmur. Murmur prolonged by valsalva. prolapse of greater than 1cm into atrium.

61
Q

ECG of tricuspid regurgitation

A

right acis deviation, right atrial enlargement (p pulmonale), right ventricular hypertrophy (dominant tall R in v1, dominant deep s in v5/6), right heart strain (ST changes and TWI in right precordial leads and inferior leads as well as right axis deviation, dominant R in V1, and dominant S in V5/6)

62
Q

CXR of tricuspid regurgitation

A

Cardiomegaly, right ventricular enlargement (seen on lateral cxr)

63
Q

Features of right ventricular failure

A

Right ventricular heave, hepatomegaly, ascites, lower limb oedema

64
Q

Causes of Tricuspid Regurgitation - structural vs functional

A

Structural = myxomatous (tricuspid prolapse), degenerative, rheumatoid heart disease, infective endocarditis, connective tissue disease, trauma, congenital (ebsteins anomaly - septal and posterior leaflets displaced downward to apex). Functional = right ventricular dilation and pulmonary hypertension.

65
Q

Pathophysiology of HOCM

A

obstruction of left ventricular blood flow

66
Q

ECG of HOCM

A

LVH (deep s in v2, tall r in v5) and LV strain (ST depression, TWI in 1, aVL and v5-6, left axis deviation), deep Q waves inferiolaterally.

67
Q

CXR of HOCM

A

LV enlargement

68
Q

ECHO of HOCM

A

asymmetric septal hypertrophy, systolic anterior motion of the mitral valve, early aortic valve closure, prominent diastolic dysfunction

69
Q

Exercise stress test and cardiac catheterisation of HOCM

A

Stress - induced outflow tract obstruction or ventricular arrhythmias. Cath - dynamic outflow tract obstruction

70
Q

Epidemiology and aetiology of HOCM

A

Affects 1:1500 causing sudden death in young. Due to autosomal dominant mutations in sarcomeric proteins.

71
Q

Management of HOCM

A
  1. Avoid diuretics, vasodilators and positive inotropes. 2. Aggressive management of tachyarrhythmias. 3. Negative inotropes and chronotropes. 4. Automatic implantable cardioverter defibrillator (required if ventricular arrhythmias, history of sudden cardiac death, unexplained syncope and LV ejection fraction less than 50%). 5. Surgical myomectomy or alcohol septal ablation.
72
Q

ECG of pulmonary stenosis

A

R atrial enlargement (p pulmonale), right axis deviation, right ventricular hypertrophy (dominant tall R in v1, dominant deep s in v5/6)

73
Q

CXR of pulmonary stenosis

A

right atrial enlargement, right ventricular hypertrophy on lateral

74
Q

Clinical signs of severe pulmonary stenosis

A

late peak of systolic murmur, soft p2, s4, right ventricular failure, tricuspid regurgitation

75
Q

Causes of pulmonary stenosis

A

Iatrogenic, congenital, carcinoid syndrome

76
Q

ECG of pulmonary hypertension

A

R atrial enlargement (p pulmonale), right ventricular hypertrophy (dominant tall R in v1, dominant deep s in v5/6), right heart strain (ST changes and TWI in right precordial leads and inferior leads as well as right axis deviation, dominant R in V1, and dominant S in V5/6)

77
Q

CXR of pulmonary hypertension

A

right sided cardiomegaly

78
Q

ECHO of pulmonary hypertension

A

RA dilation, tricuspid regurg, pulmonary regurg, elevated right ventricle and pulmonary artery pressures

79
Q

Diagnosis of pulmonary hypertension

A

right heart catheterisation with mean pulmonary pressure greater than 25mmHg

80
Q

Management of pulmonary hypertension

A
  1. Medication: A. calcium channel blockers (nifedipine), B. endothelin receptor antagonists (bosentan), C. PDE 5-inhibitors (sildenafil), D. prostacyclin agonists (selexipag), E. guanylate cyclase inhibitors (riociguat). Also oxygen therapy, avoidance of pregnancy and heart lung transplant.
81
Q

Aetiology of Pulmonary Hypertension

A

5 Groups. 1. primary pulmonary arterial hypertension (idiopathic, heritable), connective tissue disorders (scleroderma, RA, SLE, MCTD), HIV, congenital heart disease, drugs (chemotherapy, cocaine, meth). Group 2 (PCWP >15). left sided cardiac failure, elevated pulmonary capillary wedge pressure. Group 3. chronic hypoxic pulmonary disease (COPD, IPF). Group 4. chronic thromboembolic pulmonary hypertension. Group 5 - miscellaneous. sarcoidosis, chronic haemolytic anaemias, myeloproliferative disorders, glycogen storage disorders.

82
Q

Symptoms of pulmonary hypertension

A

dyspnoea, chest pain, syncope

83
Q

Clinical signs of congenital cyanotic heart disease

A

cyanosis, clubbing, pulmonary hypertension, right ventricular failure, dysmorphic features (down’s syndrome)

84
Q

7 steps of management for cyanotic heart disease

A
  1. right heart catheterisation, 2. pulmonary hypertension medications, 3. oxygen therapy, 4. endocarditis prophylaxis, 5. avoidance of pregnancy, 6. do not close shunt if flow is right to left, 7. heart lung transplant
85
Q

Tetrad of TOF

A
  1. pulmonary outflow tract obstruction. 2. overriding aorta. 3. VSD. 4. right ventricular hypertrophy
86
Q

Post surgical complications of TOF

A

Pulmonary regurgitation (most common, needs replacement), endocarditis risk, right ventricular hypertrophy and failure, right ventricular and atrial arrhythmias, aortic root dilation with regurgitation

87
Q

Endocrine investigations for systemic hypertension

A

TFT, parathyroid hormone, calcium, early morning cortisol, renin aldosterone ration, potassium, metanephrines/catacholamines

88
Q

Pathophysiology of eisenmenger syndrome

A

Congenital pulmonary hypertension with left to right shunt, with associated cyanosis

89
Q

ECG of eisenmenger

A

RBBB, right ventricular hypertrophy (dominant tall R in v1, dominant deep s in v5/6), right heart strain (ST changes and TWI in right precordial leads and inferior leads as well as right axis deviation, dominant R in V1, and dominant S in V5/6)

90
Q

Management of eisenmenger

A

right heart catheterisation, pulmonary hypertension medications, oxygen therapy, endocarditis prophylaxis, avoidance of pregnancy, heart lung transplant

91
Q

Complications of infective endocarditis

A

CCF, arrhythmia, valvular disease

92
Q

Typical organisms for infective endocarditis

A

staph aureus, viridians strep, strep bovis, community acquired enterococcus, HACEK

92
Q

Management of infective endocarditis

A

Current antibiotics, duration of treatment, PICC. Need for surgery if: moderate to sever heart failure, prosthetic valve involvement, uncontrolled infection, aortic root abscess, resistant organism, 1st degree heart block

93
Q

Investigations for infective endocarditis

A

TOE, blood culture, ECG

94
Q

Risk factors for infective endocarditis

A

IVDU, prosthetic valves, rheumatic heart disease, previous IE, immunosuppressants (transplant, chemotherapy)

95
Q

Duke Criteria

A

2major, 1major and 3minor or 5minor. Major: persistently positive blood culture, ECHO demonstrate vegetation/abscess, new valvular regurgitation, Coxiella burnetii infection. Minor: predisposition heart condition or IVDU, fever, vascular = emboli or immuno (osler nodes, roths spots), positive blood culture which doesn’t meet criteria

96
Q

Complications for IHD

A

CCF, arrhythmia, valvular disease, PVD

97
Q

Management of IHD

A

Farmington Assessment Tool - cardiovascular risk. Adjust risk factors (diabetes HbA1c <6.5, HTN <130, smoking/EtOH cessation, regular exercise, weight loss, low salt/fat diet, total cholesterol <4, LDL <1.8, HDL <1.0, TG <1.7). Cardiac rehab. Long term drug MI treatment (anti-platelet, beta blocker, ACEi, statin). Previous treatment (stent vs meds). Cardiothoracic referral if >50% stenosis of left main, >70% of proximal LAD, triple vessel disease, 2 vessel disease with diabetes.

98
Q

Investigations of IHD

A

CAG, ECG, stress testing, ECHO, MPS

99
Q

IHD examination

A

cardio, fluid assessment, BMI, diabetes, stroke

100
Q

Medical management of heart transplant

A

ciclosporin, diltiazem (reduce dose of ciclosporin), MMF/tacrolimus

101
Q

Heart transplant investigations

A

last endometrial biopsy, angiogram, ECHO, also investigate for complications of immunosuppressants (inc. CMV load)

102
Q

Presentation for heart transplant

A

Heart failure secondary to cardiomyopathy, rheumatoid heart disease, congenital heart disease. Requirement of inotropes or admission. Chest pain secondary to MI/pericarditis, acute CCF, ecg changes. Signs of previous rejection or surgery. Complications of immunosuppression.

103
Q

When is a cardiac defibrillator required

A

if EF <35%, class 2 or 3, on optimal meds for 3 months, 40/7 since CABG or MI

104
Q

Management of CCF

A

treat underlying condition, fluid + salt restriction with daily wt, optimise risk factors, medications (ACEi, beta blocker, spironolactone, diuretics), consider CRT-D if LBBB (QRS>120) and meds optimised, screening family if HOCM (autosomal dominant)

105
Q

Investigations for CCF

A

CXR, BNP, ECHO, stress test, cardiac MRI

106
Q

Risk factors for CCF

A

Ischaemic cardiomyopathy = hypertension, lipids, diabetes, smoking, obesity. Concurrent cardiac factors = MI, AF. Other causes = alcohol, congenital (HOCM), viral, amyloid, haemochromatosis.

107
Q

Classes of New York Heart Association

A

Class 1 no symptoms. Class 2 strenuous activity. Class 3 limiting daily activities. Class 4 rest.

108
Q

Indications for ICD

A
  1. CCF with LBBB (QRS > 120) w CRT. 2. VF/VT without acute MI. 3. VF/VT beyond medical management. 4. Symptomatic long QT sydrome.
109
Q

Complications of AF

A

stroke, cardiomyopathy

110
Q

Parts of CHADSVAS and HASBLED

A

CHF / HPT / AGE 75 / DM / Stroke / Vasc Disease / AGE 65 / Sex. HPT / Abnormal Renal or Liver / Stroke / Bleeding / Labile INR / Elderly >65 / Drugs + EtOH.

111
Q

Management for AF

A

anticoag (CHADSVAS), anti-arrhythmic, DCCV, EPS

112
Q

Management of SVT

A

adenosine, Valsalva

113
Q

Management of bradycardia

A

PPM

114
Q

Management of VF/VT

A

Defibrillator

115
Q

Indications for PPM

A

Complete heart blocker with failure, type 2 second degree block, symptomatic sinus bradycardia, pauses over 3 seconds

116
Q

Investigations for arrhythmias

A

ECG, holter, EPS, ECHO, MRI - amyloid

117
Q

Risk factors for arrhythmias

A

drugs/alcohol, IHD, valvular disease (MS in AF), hypertension, thyroid, obesity, OSA, family history of sudden cardiac death (prolonged QT, Brugada)

118
Q

Complications of hypertension

A

end organ damage - MI/stroke/LVF/PVD/CKD/retinopathy

119
Q

Management of hypertension

A

Non-pharmacological = wt. loss, exercise, cease EtOH/smoking, reduce salt. Pharmacological = CCB, ACEi, thiazide - target < 120 if cardiac/diabetes/renal or <130 if general or <140 if elderly.

120
Q

Investigations for hypertension

A

UEC, proteinuria, ECG, ECHO. Secondary causes = endocrine (conn’s, cushings, hyperthyroid, parathyroid, acromegaly), renal (CKD, renal artery stenosis), cardiopulmonary (OSA, aortic coarctation), drugs (NSAIDs, caffeine, amphetamines, steroids, CNI (tacrolimus/ciclosporin))

121
Q

Risk factors for hypertension

A

obese, low exercise, alcohol, drugs

122
Q

Risk factors for postural hypertension

A

BP/parkinson’s meds, diabetes, addisons, dialysis, amyloid, parkinson’s plus, shock

BPT (11 decks)

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