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1
Q

What shows on an IE ECG and why?

A

A new conduction disorder due to vegetation on the Bundle of his or purkinje fibres
Appears as Long PR (AV block) or broad QRS

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2
Q

What is non-infective endocarditis and what causes it?

A

Non-bacterial Thrombotic Endocarditis (NBTEC)
Fibrin-platelet vegetation due to disturbance of the valve endothelium
Electrodes/catherters - Degenerative - Local Inflammation - Rheumatic heart disease

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3
Q

When do you do surgery in endocarditis?

A

If complicated by:

  • Uncontrolled Infection
  • HF
  • AV block
  • Embolism
  • PV dysfunction
  • Leaflet Perforation
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4
Q

Risk factors for IE?

A 
IVDA
Immunocompromised (incl. Aids)
Burns
Prosthetic Valve
Previous IE
Old
Male
Diaebets
Heart Disease
Recent Surgery
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5
Q

What does a CXR show in IE?

A

Pulm. Abscesses and HF

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6
Q

What tests are done for IE?

A 
CXR - ECHO
ECG
Urinalysis
FBC - CRP - ESR - U&E
Blood Culture
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7
Q

What are the duke criteria?

A 
Major:
2 seperate +ve blood cultures
Persistant +ve blood cultures
\+ve culture for coxiella burnetti
\+ ECHO
New Murmur

Minor:

  • Immunologic Signs
  • Vascular Signs
  • Microbiological evidence not worthy of Major score
  • Pyrexia
  • Predisposition (e.g. IVDA or Immunocompromised)
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8
Q

What tests are there for aortic dissection?

A

TOE
CXR (Effusion - Tamponade - Tracheal Deviates - Loss of Aortic Knob)
CTA/MRA

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9
Q

How do we treat takayasus arteritis and what consewuences are there of it?

A

Steroids and surgery

Neuro effects - Renal artery stenosis - Aortic stenosis - Aneurysm - Thrombosis

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10
Q

What are the clinical signs of a false aneurysm?

A

Thirll - Bruit - Pulsatile Mass

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11
Q

How does Varicose veins progress to CVI?

A

Gravity

  • > Superficial venous reflux
  • > Varicose Veins
  • > deep veins acting as collateral circ.

That plus gravity again leads to CVI:

  • > Deep venous reflux
  • > Hypertensive Veins
  • > Exudate
  • > Inflammation
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12
Q

What re the symptoms of varicose veins?

A 
Discomfort
Red discolouration
Nocturnal Cramps
Oedema
Pruritis
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13
Q

What causes constrictive pericarditis?

A

Post-Pericarditis
TB
Idiopathic

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14
Q

How does constrictive pericarditis present?

A

With Symptoms of RHF:
Fatigue - Dyspnoea - Malaise/Weakness
Raised JVP - Ascites - Peripheral Oedema - Hepatomegaly

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15
Q

How do we test for constrictive pericarditis?

A

ECHO
CXR -> CT/MRI
Cardiac Catherterisation

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16
Q

What causes Tamponade?

A

Aortic Dissection
Surgery
Warfarin
Pericarditis

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17
Q

How does tamponade present?

A

Low BP - High HR - Muffled Heart Sounds - Raised JVP

Dyspnoea - Cough - Central Chest Pain - Fatigue - Dizziness/syncope

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18
Q

How do we Diagnose tamponade?

A

Becks TRiad - Low BP/High JVP/Muffled Heart Sounds
ECG - Low Voltages
ECHO - Large pericardium and Collapsing ventricles
CXR - Large globular heart
Pericardiocentesis + PCR

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19
Q

What causes Acute Pericarditis?

A 
Infection
Rheumatic Heart Disease
SLE
Malignancy
MI
Idiopathic
Trauma/Surgery
20
Q

How does acute pericarditis present?

A

Central Chest Pain - Pericardial Rub and maybe Fever

21
Q

How do we treat/investigate acute pericarditis?

A 
Investigate:
ECG - Saddle (concave) ST elevation
CXR - ECHO
Blood Cultures and Serology
FBC - U&E - CRP - ESR
Cardiac Enzymes e.g. cTn
22
Q

What causes myocarditis?

A 
Infection
Autoimmune (e.g. Sarcoid, Rheumatic fever or SLE)
Drugs incl. Chemo
Cocaine
Idiopathic
23
Q

How does myocarditis present?

A 
Chest Pain
Dyspnoea
Tachycardia/Tachypnoea
Arthralgia
Cyanosis
Plus general infection symptoms if infection (Sore Throat - Malaise - Fatigue - Headache - Sweats/Chills)
24
Q

How do we treat myocarditis?

A

Anti-biotics/Anti-fungals/IV Immunoglobulins as necessary

Nsaids/CCS

25
Q

What investigations do we do for myocarditis?

A 
Cardiac Enzymes (cTn)
Echo
MRI/Ct/CXR
ECG
Biopsy + PCR
FBC incl. Antibody levels
26
Q

How does sacubitril work and what do we use it for?

A

Inhibits Neprilysin allowing naturietic peptides to work

27
Q

What tests are there for CHF?

A 
Echo
CXR
ECG
CT/MRI
Stress Test
FBC - BNP - LFT- RFT - TFT
Biopsy
Radionuclide Angiography
28
Q

How does williams syndrome present?

A

Facies - Hypercalcaemia - aortic Stenosis

29
Q

How does digeorge syndrome present?

A

PTA/VSD/Tetralogy

Cleft Palate - Hypothyroidism - Thymic Hypo/Aplasia - Abnormal Facies

30
Q

How does Noonan/Costello syndromes present?

A

Pulm. stenosis - Cryptorchidism - Short - Face - Neck webbing
Costello (adds Thick skin folds and cardiomyopathy)

31
Q

How do we treat long QT?

A

Class 1b anti-arrythmics - Lidocaine

K+ Supplements

32
Q

What does a CXR show on Marfan’s?

A

Apical Blebs

33
Q

How do we treat Marfan’s

A

Beta blocker + ARB to slow Sinus of valsalva dilation

Prophyllactic Surgery at 5.5cm or 5% a yr

34
Q

How is Marfan’s Inherited?

A

Autosomal Dominant

35
Q

How do we treat Sinus Bradycardia?

A 
B1 agonist (Isoprenaline) 
Pacemaker
36
Q

Whats the valsalva maneouver have to do with SVT?

A

Incrases Vagal Tone so terminates SVT

37
Q

How do we test for Afib?

A

ECHO
ECG
Bloods especially TFT

38
Q

How do we treat A fib?

A

Rate Control - Class 2,4,5 - Beta blocker, RL CCB & Digoxin
Rhythm Control:
Electrical - Defib
Chemical - Class 1c,3 - Flecainide & Amiodarone

39
Q

How does HCM present?

A

Asymptomatic for a long time then:

Fatigue - Pain - Dyspnoea - Palpitations - Tachycardia - Presyncope - Arrythmias OE
Notched Pulse - Raised JVP - Systolic Murmur which is worse on valsalva maneuover

40
Q

What tests do we do for RCM?

A

Biopsy - Amyloid and sarcoid
Serum Fe - Haemochromatosis
Echo - Biatrial enlargement and patchy fibrosis
CXR - Pulm Congestion (normal sized ehart)
MRI
ECG

41
Q

What treatments are there for each Cardiomyopathy?

A

Heart Transplant
Treat Cause
Warfarin
ICD

Dilated:
= Reduce Strain - Bblocker/Spironolactone/Diuretic/ACEI
= Increase Contractility - Digoxin

Restrictive:
Reduce Strain - ACEI/Bblocker/Diuretic

Hypertrophic:
= Redcue Strain - Bblocker & Lower exercise
= Surgery on outgrowing septum (Myomectomy or Percutaneous Septal Ablation)

42
Q

What causes RCM?

A 
Amyloidosis
Sarcoidosis
Haemochromatosis
Other firbosis (e.g. MI, Radiation, Idiopathic or Drugs)
Diabetes
Genetic Factor
43
Q

Why might we implant an ICD in a cardiomyopathy?

A

To prevent Vfib

44
Q

What do we call the PDA murmur?

A

A “machinery” murmur (also its ocntinuous)

45
Q

In waht border is the cardiac notch found?

A

Anterior

CardioVascular (49 decks)

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