Week 6 Flashcards
Which type of heart failure results in raised JVP?
Right sided
Elderly man of 62 years presents with shortness of breath, chest pain, and a low volume pulse. He admits to having rheumatic fever as a child. On examination there is an ejection systolic murmur radiating to the carotids. What murmur is it?
Aortic stenosis
What is the treatment for aortic stenosis?
Valve replacement (mechanical)
Bioprosthetics
Balloon aortic valvotomy
Female presents with SOB, peripheral oedema and a pansystolic murmur radiating to the axilla. What murmur is it?
Mitral regurgitation
Patient presents with SOB, fatigue, malar flush (red cheeks), with a tapping apex beat and a pandiastolic murmur. It is localised and sounds like a diastolic rumble. What murmur is this?
Mitral stenosis
What is the treatment for mitral stenosis
Diuretics, treat AF, valve replacement, balloon valvuloplasty
Man with marfans syndrome presents with SOB, collapsing pulse, wide pulse pressure and an early diastolic murmur. It does not radiate anywhere and is a whoosh cresendo. What murmur is it?
Aortic regurg.
- also common in aortic dissection
What are the vessels of the placenta and what type of blood do they carry?
Two arteries; deoxygenated blood from baby heart to mom
One vein carrying oxygenated blood
In the foetus what is the location and the function of the ductus arteriosus?
Between the pulmonary trunk bifurcation and the arch of aorta
To allow passage of deoxygenated blood to the umbilical arteries via the arch of aorta
Where is the ductus venosus and what is its function?
In the liver
Allows blood from the placenta to go directly into the IVC avoiding the liver
Where is the foramen ovale? What is its function?
Right atrium and left atrium to allow passage of oxygenated blood directly to the left side of the heart
What happens to the ductus vessels in the featus once it is born?
Become a fibrous attachment due to oxygen being a vasoconstrictor. This occurs naturally 7-10days after birth
What is PPHN in a fetus? How does it occur?
Persistent pulmonary hypertension
- when resistance to blood flow to the lungs so pressure in right side of the heart is greater than the left side so the foramen ovale remains open- mixing of blood = poor o2 saturations
What is the treatment of PPHN in babies?
Ventilarion, inhaled nitric oxide (vasodilator), inotropes (to increase systemic blood pressure)
What is acyanotic congenital heart disease?
Any condition that allows mixing of oxygenated and deoxygenated blood entering systemic circulation e.g foramen ovale open, ductus patent, ventricular septal defect
What is cyanotic heart disease
Where deoxygenated blood bypasses the lungs and enters the systemic circulation
What is pulmonary artesia? How is it managed?
Where the pulmonary trunk isnt attached to the heart so there is dependcy on the ductus arteriosus to allow blood to flow to the lungs.
Treat with prostaglandin E2 until surgery becomes available
Man presents with syncope, triggered by exercise and loud noises. He also has polymorphic VT. what type of syndrome does this man have?
Congenital long QT syndrome
What are the triggers for brugada syndrome. What is it?
Sleeping, fever, alcohol
Can cause AF and episodes of syncope, it is a sodium channelopathy, causing abnormal conduction of the heart.
How do you treat brugada syndrome ?
Implantable cardioverter defibrillator
Quinidine
Man presents with fever, malaise, weight loss, tiredness, SOB and splinter haemorrhages and finger clubbing. He has a prosthetic valve. What is the diagnosis
Endocarditis
How would you diagnose endocarditis?
Two separate positive blood cultures
Endocardiographic evidence of endocardial involvment e.g vegetation, abscess or partial dehiscence of prosthetic valve
New valvular regurgitation
What are the common organisms for endocarditis?
Staph aureus, viridans streptococci, enterococcus, staph epidermis, HACEK group
Man presents with native valve endocarditis. Treatment?
Amoxicillin IV
Gentamicin IV
IV drug user presents with endocarditis due to staph aureus. Treatment?
Flucloxacillin IV
Man presents with endocarditis due to a prosthetic valve caused by staphylococcus epidermidis. Treatment?
Vancomycin
Gentamicin
Rifampicin
