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Flashcards in Cardio II Deck (46)
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1

Define cardiogenic shock

Inadequeate tissue perfusion primarily due to cardiac dysfunction

2

Causes of cardiogenic shock

MI
Hyperkalaemia
Endocarditis
Aortic dissection
Rhythm disturbance
Tamponade

3

List three causes of aortic stenosis

1. Senile calcification
2. Congenital
3. Rheumatic fever

4

A patient presents with angina, dyspnoea and syncope. . She also complains of coughing up a white frothy sputum and needing to sleep with three pillows at night.

O/E you note that she has a slow rising pulse with a narrow pulse pressure. The apex beat is forceful and not displaced.

What is a possible dx? What type of murmur is associated with this condition

Aortic Stenosis

Ejection systolic murmur which radiates to the carotids. Heard loudest at the 2nd ICS when the patient is sitting forward.

5

Outline the investigations you would do in a patient with suspected aortic stenosis.
What would you see on an ECG

Bloods: FBC, U&E's, Glucose, Lipids
ECG:
- LVH
- LV strain
- Tall R waves
- ST depression
- T wave inversion

6

Outline the signs seen in patients presenting with aortic regurgitation

Collapsing pulse pressure, Corrigan's pulse
Wide pulse pressure
Displaced apex beat
Soft/absent S2
Early diastolic murmur +/- Austin Flint murmur

7

Pathophysiological changes as a result of mitral stenosis

1. Valve narrows, increase in LA pressure, loud S1 and atrial hypertrophy resulting in AF

2. Pulmonary oedema, pulmonary HTN, Loud P2.

3. RVH with a left parasternal heave

4. Raised JVP, oedema and ascites

8

Clinical signs seen in patients presenting with mitral stenosis

Low volume pulse pressure
Af
Raised JVP
Tapping non displaced apex beat
Rumbling mid diastolic murmur

**Gratham steel murmur: high pitched decrescendo murmur loudest on inspiration.

9

Causes of mitral regurgitation

Mitral valve prolapse
LV dilation
Post MI
Rheumatic fever
Connective tissue disorders

10

Patient presents complaining of fatigue, breathlessness and palpations
O/E you note a loud P2 and a blowing pansystolic murmur which radiates to the axilla.
An ECG shows P mitrale
What is your diagnosis?
What is p mitrale?
What would the CXR findings be in this patient?

Mitral regurgitation

P mitrale is an ECG finding of a P wave shaped like an M. It is indicative of a bulky left atrium, most commonly in left atrial hypertrophy

CXR
- LA and LV hypertrophy
- Mitral valve calcification
- Pulmonary oedema

11

Cardiac side effect of erythromycin

Prolongs the QT interval
Produces Torsades de Pointes

12

What are the contra indications for thrombolysis

Pregnancy
Bleeding
Recent stroke
Severe HTN
GI malignancy

13

What are the features of tetralogy of fallot

VSD
Pulmonary stenosis
Over riding aorta
Right ventricular hypertrophy

14

List the ECG findings of digoxin toxicity

Results in ECG abnormalities
Reverse tick phenomen
ST segement depression
Accentuated U wave

15

List the causes of cardiomyopathy, classifying them under the following
- dilated
- restrictive
- hypertrophic

Hypertrophic
- Genetic
- Sporadic mutations

Restrictive
- Idiopathic
- Amyloidosis
- Sarcoidosis
- Haemochromatosis

Dilated
- Post viral
- Alcohol
- Pregnancy
- Chagas disease

16

List the treatments for heart failure

1) ACEi, B blocker, diuretic (spiro) watch K+

2) Siagoxin/ ivabarine

17

List the treatments for angina

Aspirin
Statins
ACEi +/- B blockers
+/- GTN spray

18

List potential causes of HTN in young people

Endo
- Cushing's
- Conn's
- Acromegaly

Renal
- Renal artery stenosis
- Polycystic kidney disease
- Renal malignant tumours

19

ECG changes of pericarditis

Wide spread ST elevation (saddle shaped)
PR depression
Variable T wave ( flattening and inversion)

20

Causes of 1st degree heart block

Increased vagal tone
Athletes
Inferior MI
Mitral valve disease

21

Name four types of supraventricular tachycardia

Atrial Flutter
Atrial Fibrillation
Atrioventricular Reentry Tachy (AVRT)
Atrioventricular Nodal Reentry Tachy (AVNRT)

22

Causes of atrial fibrillation

Ischaemic heart disease
Hypertension
Valvular heart disease (esp. mitral stenosis / regurgitation)
Acute infections
Electrolyte disturbance (hypokalaemia, hypomagnesaemia)
Thyrotoxicosis
Drugs (e.g. sympathomimetics)
Pulmonary embolus
Pericardial disease
Acid-base disturbance
Pre-excitation syndromes
Cardiomyopathies: dilated, hypertrophic.
Phaeochromocytoma

23

Causes of 1st degree heart block

Increased vagal tone
Athletic training
Inferior MI
Mitral valve surgery
Myocarditis (e.g. Lyme disease)
Electrolyte disturbances (e.g. Hyperkalaemia)
AV nodal blocking drugs (beta-blockers, calcium channel blockers, digoxin, amiodarone)
May be a normal variant

24

Causes of Mobtiz II

Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone
Increased vagal tone (e.g. athletes)
Inferior MI
Myocarditis
Following cardiac surgery (mitral valve repair, Tetralogy of Fallot repair)

25

Causes of Mobitz II

Anterior MI (due to septal infarction with necrosis of the bundle branches).
Idiopathic fibrosis of the conducting system (Lenegre’s or Lev’s disease).
Cardiac surgery (especially surgery occurring close to the septum, e.g. mitral valve repair)
Inflammatory conditions (rheumatic fever, myocarditis, Lyme disease).
Autoimmune (SLE, systemic sclerosis).
Infiltrative myocardial disease (amyloidosis, haemochromatosis, sarcoidosis).
Hyperkalaemia.
Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone.

26

Causes of complete heart block

Inferior myocardial infarction
AV-nodal blocking drugs (e.g. calcium-channel blockers, beta-blockers, digoxin)
Idiopathic degeneration of the conducting system (Lenegre’s or Lev’s disease)

27

Causes of aortic regurgitation

ACUTE
- Rheumatic fever
- Aortic dissection

CHRONIC
- Congenital
- Rheumatic heart disease
- Connective tissue disease marfans
- Autoimmune (Ank spon)

28

Signs of aortic regurgitation

Collapsing pulse
Wide pulse pressure
Displaced apex beat
Early diastolic murmur
(+/- Austin Flint murmur)

29

Signs of aortic stenosis

Slow rising pulse
Narrow pulse pressure
Ejection systolic murmur
Forceful non dispalced apex beat

30

Management of aortic stenosis

Medical
- Monitor with f/up echo
- Angina: Beta blockers
- Rx HF (ACEi, diuretics)

Surgery
- Valve replacement
- TAVI