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finals cardio

Third heart sound (S3) Result of rapid ventricular filling during diastole Can be normal in <30 year olds Seen in LVF, dilated cardiomyopathy, constrictive pericarditis (known as pericardial knock)
Fourth heart sound (S4) Atrial contraction against a stiff ventricle Seen in aortic stenosis, HOCM, hypertension
Signs of constrictive pericarditis JVP - X Y descents, Y descent due to rapid early diastolic filling of right ventricle Third heart sound (pericardial knock)
Signs of cardiac tamponade Raised JVP with prominent x descent, absent y descent Kussmaul's sign (raised JVP with inspiration) Tachycardia, hypotension and pulsus paradoxus (decreased pulse pressure during inspiration) Faint heart sounds
Mitral regurgitation Floppy valve: Marfan's, pseudoxanthoma elasticum, Ehlers Danlos and osteogenesis imperfecta Dilation of mitral ring: dilated cardiomyopathy (alcohol), acute myocarditis, HCOM Papillary muscle rupture
12 lead ECG V1 - right ventricle V3,4 - interventricular septum V5,6 - left ventricle 2,3, AVF - inferior surface 1, AVL, V6 - lateral wall of left ventricle Axis -30 to +90 degree
Tietze's syndrome Inflammation of costosternal junctions with associated tenderness Rx NSAIDs and reassurance
Heart failure drugs Prognostic: Selective Beta Blockers (bisoprolol, carvedilol, metoprolol, nebivolol), ACE inhibitors, ARBs (candesartan, valsartan), Spironolactone (if not high K+), Ivabradine Symptomatic: Loop diuretics, digoxin, nitrates + hydralazine
Cardiac arrest causes Ventricular Fibrillation (commonest), asystole (absent QRS) and electromechanical dissociation / pulseless electrical activity (PEA)
Causes of pulseless electrical activity /electromechanical dissociation Four H's - hypovolaemia, hypothemia, hypoxia and hypo/hyper-kalaemia (plus hypocalcaemia and acidaemia) Four T's: cardiac tamponade, PE, tension pneumothorax, toxic/therapeutic disturbances
SVT management If haemodynamically unstable - DC cardioversion If not, vagotonic manoeuvres, IV adenosine (CI in asthma)
Phaeochromocytoma Tumor of adrenal gland - rule of 10%: 10% extramedullary, 10% malignant, 10% familial, 10% bilateral Management is surgical Can control BP with alpha block like phenoxybenzamine
Beri Beri B1 (thiamine) deficiency. Endemic in regions that only eat white rice that has been de-husked (husk contains thiamine) Weight loss, high output cardiac failure, wernicke's encephalopathy, sensory disturbances, pain / weakness in limbs RX IM thiamine
Wernicke's encephalopathy B1 (thiamine) deficiency. Triad of - ocular disturbances (nystagmus, paralysis of lateral rectus), changes in mental state, unsteady stance and gait.
Korsakoff's syndrome Acute onset, severe memory impairment Anterorade amnesia, aphasia, apraxia, agnosia, deficit in executive functions. Must be evidence caused by use of alcohol.
Ivabradine Reduces K and Na influx to cells in SA node via 'I-funny' channel - leading to reduction of heart rate. Shown to be as effective as atenolol at controlling angina. S/e - luminous haloes seen around objects
Pulmonary hypertension RV strain on ECG, high pulmonary artery systolic pressure (> 30mmHg)
Mitral stenosis Rumbling low pitched, mid diastolic murmur, opening snap suggests severe disease. Mitral facies (malar flush), AF, Tapping apex (palpable S1), loud S1.
Aortic stenosis Crescendo-decrescendo, ejection systolic murmur
Marfan syndrome Autosomal dominant (chromosome 15) defect of connective tissue. Defect in FBN1 gene coding for protein fibrillin 1. Skeletal disease. cardiac defects (aortic dilatation, aortic incompetence, mitral valve prolapse) and risk for PSP.
DiGeorge syndrome Deletion of a long arm of chromosome 22. CATCH-22 C - cardiac (incl tetralogy of fallot) A - abnormal facies T - thymoma (increased infections) C - cleft palate H - hypocalcaemia / hypoparathyroidism 22 - 22nd chromosome
Kartagener syndrome Primary ciliary dyskinesia. Chronic sinusitis, bronchiectasis, infertility, dextracardia
Pulsus alternans Alternating pulse with weak and strong beats. Seen in patients with severe heart failure and is associated with poor prognosis
Collapsing pulse Seen when pulse pressure is greater than diastolic pressure. Seen in aortic regurgation, PDA or AV fistula
Hyperkalaemia ECG - small P waves, peaked T waves, wide QRS with sinusoidal wave pattern. Can progress to asystole
Hypokalaemia ECG - U waves, small/absent T waves, long QT, ST depression, raised PR interval
Tetralogy of Fallot RVH, pulmonary stenosis, over-riding aorta, VSD
Management of acute LVF sit patient up - O2 - IV access - Iv diamorphine, metoclopramide and frusemide - catheter - nitrates - CPAP
ECG electrode positions V1 - 4th intercostal space, right of sternum V2 - 4th intercostal space, left of sternum V3 - halfway between V2 and V4 V4 - Apex V5 - same horizontal plane as V4, anterior axillary line V6 - same horizontal plane as V4, mid-axillary line
Tricuspid regurgitation Raised JVP with large V-waves Pansystolic murmur, left sternal edge
Created by: 506424207