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225 Cards in this Set
- Front
- Back
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Define transudates and causes? |
<25g/l protein -due to changes in hydrostatic or oncotic P -heart/liver/renal failure -hypoalbuminaemia -pertinoeal dialysis |
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Define exudates and causes? |
>35g/l protein -due to inflammation causing inc capillary permeability -malignancy -pneumonia, TB, mesothelioma -RA, SLE -pancreatitis |
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What about protein between 25 and 35g/l? |
LIGHTS criteria exudate if: -pleural fluid divided by serum protein >0.5 -pleural LDH divided by serum LDH > 0.6 -pleural LDH > 2/3 of normal serum LDH |
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Examination findings of pleural effusion? |
tracheal devation (away) stony dull percussion bronchial breathing over effusion diminished breath sounds and expansion |
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What other characteristics of aspirated pleural fluid are you interested in? |
ph - <7.2 = infection glucose - <3.3 in empyema, RA, lupus, TB, malignancy amylase - raised in pancreatitis, malignancy cytology - ?malignancy |
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Describe SIADH? |
Important cause of hyponatraemia -urine Na>20 and osmolality >100 in the presence of plasma Na<125 and low plasma osmolality -WITHOUT hypovolaemia, oedema or diuretics |
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Causes of SIADH? |
malignancy - lung, pancreas, prostate, lymphoma CNS - stroke, subarachnoid/subdural haemorrhage, head injury, abscess respiratory - TB, pneumonia drugs - opiates, SSRIs, carbamazepine, morphine |
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Treatment of SIADH? |
treat cause then resrict fluid -slow infusion saline + loop diuretic -demeclocycline to reduce responsiveness to ADH if refractory |
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Presentation of hyponatraemia? |
anorexia, nausea and malaise >> headache, confusion, weakness, seizures |
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Causes of hyponatraemia without dehydration? |
nephrotic syndrome HF LF cirrhosis |
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Causes of hyponatraemia with dehydration and high urinary Na? |
addisons RF diuretics |
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Type 1 respiratory failure causes? |
pneumonia, pulmnary oedema, PE, asthma, emphysema, fibrosis >>give high flow O2 |
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Type 2 respiratory failure causes? |
VQ mismatch WITH alveolar hypoventilation -resp disease: asthma, COPD, end stage fibrosis -reduced drive: sedatives, CNS tumour -thoracic wall disease >>>give 24% O2 |
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Resp failure presentation? |
type 1 - agitation type 2 - drowsiness, bounding pulse, tachycardia |
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Examination findings of pneumona? |
dull percussion
bronchial breathing inspiratory crackles inc tactile vocal fremitus |
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Describe CURB65? |
determines severity of CAP -confusion -urea>7 -RR>30 -BP <60syst or >90diast -aged over 65 |
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Management of CAP? |
non severe - amoxicillin for 7 days severe - IV coamoxiclav + clarithromycin |
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Management of hospital acquired pneumonia? |
IV aminoglycoside (ie gentamicin) + penicillin |
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Define COPD? |
progressive airflow obtruction that isnt fully reversible and doesnt change over months |
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Examination findings in COPD? |
hyperinflation dec expansion hyperressonant percussion if cor pulmonale > rraised JVP + pitting oedema |
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CXR findings in COPD? |
flat hemidiaphgragm large central PA dec peripheral vascular markings bullae |
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Differentiate between pink puffer and blue bloater? |
pink puffer if emphysema primary pathology -breathless but not cyanosed -progresses to type 1 failure blue bloater if chronic bronchitis -cyanosed but not breathless -progresses to cor pulmonale but relies on hypoxic drive |
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Treatment of COPD? |
1. b-agonist or ipatropium 2. long acting antimuscarinic ie tiotropium 3. LABA + corticosteroids |
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Define bronchiectasis? |
irreversible dilation of bronchi predisposing to finfection - post infection ie pneumonia, TB, measles -aspergillosis -obstruction -CF |
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Examination findings in bronchiectasis? |
usual resp symptoms + haemoptysis, weight loss, clubbing, -coarse inspiratory creps |
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CXR findings in bronchiectasis? |
dilated bronchi with thickened walls (TRAMLINES) cystic structures |
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Management of bronchiectasis? |
postural drainage antibiotics immunisation lobectomy if only 1 lobe |
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Define CF? |
Ch 7 delta F508 mutation causing defective Cl secretion + inc Na absorption >>inc mucous viscosity |
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CF presentation? |
bronchiectasis steatorrhoea clubbing gallstones nasal polyps meconium ileus |
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Investigations for CF? |
immunoreactive trypsinogen (heel prick) sweat test - Na+Cl>60 CXR - hyperinflation, exaggerated bronchial markings USS - fatty liver, cirrhosis |
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Describe interstital lung disease? |
umbrella term -commonest idiopathic pulmnary fibrosis aka UIP -also hypersensitivty pneumonitis, sarcoidosis, asbestosis etc *BASAL WITH HONEYCOMBING ON CT |
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What is Meigs syndrome? |
ascites pleural effusion benign ovarian tumour |
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Describe vocal resonance? |
Normal = muffled 99 Inc = clearly audible as in consolidation Dec = effusion or pneumothorax |
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Describe surgical emphysema? |
air trapped in subcut tissues -rice crispy noise -due to pneumothorax, post drain insertion, post surgery, -usually benign |
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Describe Wernickes ? |
thiamine deficiency causing confusion, ataxia (wide gait) + opthalmoplegia (nystagmus etc) -focal areas of brain damage -progresses to korsakoffs |
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Describe korsakoffs? |
hypothalamic damage and cerebral atrophy due to thiamine deficiency -causes dec ability to make new memories, confabulation, lack of insight + apathy |
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Describe aminoglycosides? |
great for pseudomonas -has to be IV/IM or nebulised |
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Describe types of lung cancer? |
80% non small cell associated with smoking -adenocarcinoma slow growing -large cell rapidly growing |
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Describe APTT? |
normal 25-38 secs -aim to increase to 1.5-2.5x in heparin therapy |
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Describe percussion notes? |
dull in collapse or consolidation hyperresonant - hyperinflation/air stony dull - effusion |
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Causes of clubbing? |
Cyanotic heart disease Lung disease UC/Crohns Biliary cirrhosis Birth defect Infective endocarditis Neoplasm esp hodgkins GI malasbsorption |
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Describe ECG leads? |
2,3+avf = inferior v1+v2 = septal 1, avl, v5+v6 = lateral v3+v4 = anterior |
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When would you do a CABG? |
if 3 vessel disease - RCA + both branches of left OR left main branch OR 2 vessel disease involving LAD |
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Describe process of CABG? |
LIMA connected to LAD great saphenous grafted from ascending aorta to below blockage -LIMA lasts 25yrs, veins 10-15yrs, stents 5yrs -use radials if VV as dont want to use both LIMAs |
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Describe tissue v mechanical valves? |
Tissue valves only last 10-15 yrs but dont require warfarin -mechanical valves if <65yrs |
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Describe main cause of aortic stenosis? |
senile calcification but can be congenital bicuspid valve |
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Examination findings in aortic stenosis? |
LV heave
aortic thrill ejection systolic murmur radiating to carotids |
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ECG findings in aortic stenosis? |
p mitrale poor R wave progression LBBB LVH pattern |
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CXR findings in aortic stenosis? |
LVH post stenotic dilation of ascending aorta |
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Diagnosis of aortic stenosis? |
ECHO to estimate gradient across valve -severe if >50mmHg and valve <1cm NB if symptomatic 2-3yr survival without treatment |
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Describe aortic regurgiation? |
acute - IE, aortic dissection, chronic - congen, CT disorders, marfans, HT |
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Examination findings in aortic regurgitation? |
collapsing pulse displaced apex high pitched diastolic murmur - heard expiration sitting forward |
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Management of aortic regurgitation? |
reduce BP and ECHO every 6-12 months -surgery if worsens prior to significant LV dysfunction |
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Describe mitral stenosis? |
usually due to Rheumatic fever |
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Examination findings in mitral stenosis? |
malar flush due to CO2 retention low volume pulse AF opening snap rumbling mid-disastolic murmur - expiration on left side |
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ECG findings in mitral stenosis? |
AF P mitrale RVH |
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CXR findings in mitral stenosis? |
left atrial enlargement double right heart border pulmonary oedema |
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Management of mitral stenosis? |
rate control if AF warfarin diuretics then consider balloon valvuloplasty or replacement |
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Describe mitral prolapse? |
displacement of abnormal thick mitral valve into LA during systole commonest valvular abnormality -alone or with ASD, PDA, cardiomyopathy, turners, marfans, OI etc -asymptomatic or atypical chest pain + palpitations |
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Diagnosis + management of mitral prolapse? |
midsystolic click +/- late systolic murmur -echo to diagnose -b-blockers, surgery if severe NB found in 5% of population |
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Define an aortic aneurysm? |
any dilation >50% original diameter -true if involve all 3 layers -pseudo if blood collecting in adventitia outer layer ie after trauma -present in 3% of >50s |
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Presentation of ruptured abdominal aneurysm? |
intermittent/continuous abdo pain radiating to back, iliac fossa or groins -1 in 3 will reach hospital -only repaired if >5.5cm -operative mortality 5% |
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Normal BP? |
140/90 but 150/90 IN >80S |
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1st line treatment for HT? |
<55 = ACEI >55 or afrocaribean = CCB |
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Further treatment for HT? |
2. Add other - ACEI or CCB(dipines) 3. Add thiazide 4. consider b-blocker |
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When would you use an ARB? |
if ACEI intolerant diabetic nephropathy LVH HF post-MI |
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Contraindications to CCBs? |
HF heart block |
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Examination findings of DVT? |
warm tender pitting oedema (mild normal following surgery or immobility |
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How do you evaluate a suspected DVT? |
WELLS CRITERIA -if moderate risk do D-dimer then USS -if high risk USS straight awa NB D-dimer not helpful if on warfarin or post-op |
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Treatment of DVT? |
rivaroxaban for 3 months
compression stockings for 2 years to prevent post thrombotic syndrome |
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What are brown skin pigmentations esp on legs? |
haemosiderin deposits -seen in venous insufficiency and haemochromatosis, elderly |
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What is POTS? |
postural tachycardia syndrome -dizziness, faints, palpitations -following growth spurt, viral, systemic disase -diagnosed if HR inc of 30bmp after 10 mins standing |
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Describe hiatus hernia? |
protrusion of upper stomach through diaphragm -most often due to obesity presenting with GORD -Ba swallow to diagnose >>weight loss + symptomatic relief |
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What is Bence-Jones protein associated with? |
myeloma -they are free Ig light chains filtered by kidneys |
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Define pulse pressure? |
difference between systolic and diastolic BP -<40 indicates poor heart function ->60 predicts heart problems + athersclerosis |
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Describe MAP? |
MAP = CO x TPR - estimate = systolic + 2xdiastolic / 3 -should be 70-110mmHg -aka perfusion pressure of organs -<60 = shock |
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What is high take off? |
large T waves NOT ST elevation |
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Describe haematocrit? |
45% for men, 40% women -low in anaemia, bleeding, leukaemia -high in CHD, cor pulmonale, hypoxia, polycthaemia vera |
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Elevated lactate? |
usually tissue hypoperfusion -but also shock, alcohol, cocaine, seizures, excercise, thiamine deficiency, LF etc |
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Normal CRP? |
less than 10 |
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What is PCP? |
pneumocystis pneumonia -yeast like fungus that is main opportunistic lung infection in immunocomprimised |
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PA v AP film? |
PA standard - standing -cant comment on heart size on AP |
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Xray penetration? |
vertebrae should just be visible behind heart |
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Describe an air bronchogram? |
dark bronchi being made visible by white opacification of surrounding alveoli - due to pulm oedema, consolidation etc |
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Describe CCBs? |
rate limiting ie verapamil and non-rate limiting eg amlodipine
- vasodilate and reduce BP |
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Name a drug METABOLISED by the kidney? |
insulin |
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Describe cockroft-gault formula? |
140 - age x weight x costant / serum creatinine |
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HT drugs to beware of in renal disease? |
b-blockers thiazine diuretics K-sparing diuretics CONTRAINDICATED *also metformin |
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Describe use of loop diuretics? |
mainly HF causing pulm/peripheral oedema -can cause hypo K/Ca/Na/Mg -NOT with aminoglycosides or digoxin |
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Describe use of K-sparing diuretics?
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adjunct to diuretics in HT or HF -can cause hyperkalaemia or hyponatraemia |
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Differentiate between restrictive and obstructive lung disease?
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Obstructive - cant get air out -eg asthma, COPD, bronchiectasis, CF Restrictive - cant get air in -eg ILD, sarcoidsosis, obesity -both FVC + FEV1 reduced q |
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Management of non-severe and severe CAP? |
non-severe - amoxicillin severe - co-amoxiclav + clari if atypical or fluclox if staph |
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Management of hospital acquired pneumonia? |
if <4 days from admission treat as CAP non severe - amoxicillin Severe - coamoxiclav +/- gentamicin |
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Describe SARS? |
severe acute respiratory distress syndrome -contagious pneumonia due to coronavirus -fevers,chills, rigors, myalgia, dry cough, dec WCC -can lead to resp failure + ARDS -1-50% mortality -supportive treatment only |
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Presentation of bronchiectasis? |
copious puruluent sputum intermittent haemoptysis persistent ough |
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Treatment of bronchiectasis? |
postural drainage antibiotics |
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Presentation of CF? |
cough wheeze bronchiectasis pneumothorax haemoptysis cor pulmonale meconium ileus rectal prolapse >>cyanosis, clubbing, coarse crackles |
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Investigations for lung cancer? |
sputum + pleural fluid cytology FNA CT radinuclide bone scan |
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Management of different types of lung cancer? |
non small cell - excision if peripheral + no mets, chemo +/- radiotherapy small cell - nearly always disseminated at presentation - may respond to chemo but usually relapse - palliative radiotherapy for bronchial or SVC obstruction - median survival 3 months ,1-1.5yrs with treatment |
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Describe stages of lung cancer? |
Stage 4 - any mets Stage 3b if nodes on contralateral side |
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Define asthma? |
bronchial smooth muscle spasm , mucosal inflammation and inc mucous |
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Signs of asthma/ |
hyperinflated chest hyperresonant percussion dec air entry usually DEC CO2 unless severe |
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Treatment pathway for asthma? |
1. SABA ie salbutamol 2. Inhaled corticosteroid ie beclometasone 3. LABA ie salmeterol 4. Higher dose beclometasone OR LRA ie montelukast 5. Oral prednisolone |
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Treatment acute asthma?
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1. salbutamol 5mg nebs with O2 2. hydrocontrisone 100mg IV OR pred 3. O2 if sats <92 4.salbutamol neb every 15 mins + ecg 5.ipatropium neb 6.MgSo4 |
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Define components of COPD?
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chronic bronchitis - productive cough on most days for 3 months for 2yrs emphysema - enlarged air spaces distal to terminal bronchioles with alveolar wall destruction |
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Management of COPD?
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1. inhlated antimuscarinic eg tiotropium or b2 agonist 2.LABA + corticosteroids 3. steroid terial |
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Management of acute COPD?
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1. salbutamol nebs + ipratropium 2. 24-28% O2 if sats <88 3. iV STEROIDS 4. Antibiotics if inection 5. IV aminophylline |
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Define ARDS?
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inflammation causing inc capillary permeability,pulm oedema + multi organ failure -direct injury or secondary to systemic illness |
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Signs of hypercapnia?
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headache peripheral vasodilation bounding pulse tremor/flap confusion drowsiness |
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Differentiating type 1 + 2 resp failure managamenet?
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type 1 - 35-60% O2 type 2 - start at 24% O2 but if causes PCO2 rise then consider NIVPP |
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Describe types of o2 therapy?
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Nasal cannula - preferred by patient, allows 1-4L/24-40% O2 Face masks imprecise so not in hypercapnia or type 2 Venturi mask most precise + colour coded Non rebreathing mask - 60-90% O2 |
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Presentation of PE? |
pleuritic pain haemoptysis dizziness syncope cyanosis hypotension pleural rub/effusion |
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Investigations for PE? |
D-dimer only if low probability CXR - low circulation in affected segement, dilated PA, partial collapse, small effusion, wedge shaped opacities |
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ECG in PE?
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normal or RBBB
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Treatment of PE? |
O2 + morphine -immediate thrombolysis if severe -start heparin -colloids if syst <90 -noradrenaline -if still low systolic then thrombolysis -warfarin for 3 months |
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Presentation of pneumothorax?
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sudden onset dysnpnoa + pleuritic pain reduced expansion hyperressonant percussion |
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Briefly define transudate and exudate causes?
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Transudate - inc venous P or hypoproteinaemia Exudate - leaking capillaries due to infection/inflammation or malignancy |
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CXR in pleural effusion?
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blunt costophrenic angles shadows with concave upper borders |
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Presence of neutrophils in pleural fluid?
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parapneumonic PE |
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Presence of lymphocytes in pleural fluid? |
malignancy TB RA SLE Sarcoidosis |
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Describe sarcoidosis?
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multisystem granulomatous dirsorder of unkown cause -adults 20-40yo -acute form presents with erythema nodosum + polyarthralgia and resolves spontaneously |
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Pulmonary presentation of sarcoidosis?
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bilateral hilar lymphadenopathy fibrosis pulmonary infiltrates dry cough progressive dynspnoea chest pain |
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Extra-pulmonary presentation of sarcoidsosi?
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Skin Arthritis Respiratory Calcium Orbit Interstitial fibrosis Deranged Liver + kidney |
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Treatment of sarcoidosis?
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NSAIDS prednsiolone reducing over 1 yr -80% cure |
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Causes of bilateral hilar lymphadenopathy?
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sarcoidosis TB malignancy |
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Describe interstitial lung disease? |
umbrella term for diffuse lung parenchyma disease -most commonly idiopathic pulmonary fibrosis -3 categories: known causes, systemic disorder or idiopathic |
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Presentation of ILD?
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dynspnoea non productive paroxysmal cough (outbursts) restrictive spirometry |
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Causes of upper zone fibrotic shadowing on CXR? |
TB extrinsic allergic albeolitis sarcoidosis |
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Causes of lower zone fibrotic shadowing on CXR?
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idiopathic pulmonary fibrosis asbestosis |
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Presentation of idiopathic pulmonary fibrosis?
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dry cough malaise weight loss arthralgia cyanosis clubbing fine creps -ANA +Ve in 30% -lower zone shadows -honeycombing if advanced |
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Treatment of idiopathic pulmonary fibrosis?
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O2, rehab, opiates, pallatiative -50% 5YS |
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Presentation of asbestosis? |
progressive dysnpnoea clubbing fine crackles pleural plaques -risk of mesothelioma |
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Describe malignant mesothelioma?
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usually pleura -90% have previous asbestos exposure -latency up to 45yrs |
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Presentation of malignant mesothelioma?
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dysnpnoea weight loss clubbing recurrent pleural effusions pleural thickening bloody pleural fluid >>>chemo can improve survival |
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Describe cor pulmonale? |
RHF due to chronic pulmonary arterial HT |
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Causes of cor pulmonale? |
lung - COPD, bronchiectasis, severe asthma vascular - PHT, ARDS, sickle cell, emboli thoracic cage - kyphosis, scoliosis neuromuscular hypoventilation - apnoea, |
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Presentation of cor pulmonale?
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raised JVP RV heave hepatomegaly oedema fatigue -secondary polycythaemia -graham steel murmur of pulm regurg -pansystolic murmur of tricsuspid regurg |
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ECG in cor pulmonale?
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p pulmonale - p >2.5mm in inf leads indicating RA enlargement right axis deviation RVH/strain |
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Treatment of cor pulmonale?
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treat underlying cause -diuretics, K-sparing if necessary -venesection if haematocrit >55 >>50% 5YS |
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Describe types of chest pain?
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constricting - angina, oes spasm sharp - pleura or pericardium dull/crushing - MI |
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Describe aortic dissection pain? |
instantaneous tearing interscapular |
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Pain eased by leaning forward?
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pericarditis
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Describe antiplatelets?
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COX inhibitors - aspiring ADP receptor antagonists - clopidogrel if aspirin intolerant |
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Describe antiocoagulants?
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warfarin - for AF + mechanical valves LMWH Xa inhibitors eg apixiban |
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Describe action of b-blockers?
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antagonist symp nervous system -b1>dec pulse by dec SA firing -b2 > peripheral vasoconstriction + bronchoconstriction -propanolol non-selective but bisoprolol b1 selective |
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Side effects of b-blockers? |
headache erectile dysfunction nightmares lethargy |
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Describe CCBs? |
promotes coronary + peripheral vasodilation -dihydropyridines ie amylodipine -non-dihydropyridines ie verapamil rate limiting |
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Side effects of CCBs? |
flushes headaches diuretic unresponsive oedema NOT in heart block |
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Decribe digoxin? |
use to slow pulse in fast AF -weak positive iontrope so inc strength of contractions |
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Describe statins? |
HMG-CoA reductase inhibitor that synthesis cholesterol -causes muscle aches, abdo discomfort |
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Side effects of ACEI? |
DRY COUGH hypotension taste disturbance |
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What is decubitus angna? |
precipitated by lying flat |
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ECG in angina? |
may be normal ST depression, flat/inverted T-waes -exclude anaemia, DM, lipids, thyrotoxicosis |
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Management of angina? |
statin if cholesterol >4 spirin b-blocker nitrate CCBs if b-blockef contraindicated |
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Describe a silent infarct? |
syncope epigastric pain vomiting hypotension pulmonray oedema *common in elderly or diabetics |
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ECG following MI? |
tall T-waves ST elevation new LBBB t-wave inversion + q-waves developing in following days |
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Describe cardiac enzymes? |
troponin T+I - peaks at 24-48hrs CK-MB peaks at 24hrs -both take 3 hrs to rise |
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Prehospital/immediate management of MI? |
aspirin 300mg chewed GTN morphine metoclopramide |
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Management of stemi? |
PCI if within 120 mins fibrinolysis otherwise |
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Management of nstemi? |
LMWH b-blocker |
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Complications of MI? |
arrhythmias heart block mitral regurgitation VSD pericarditis |
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Treatment of bradycardia? |
atropine if rate <40 |
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Describe SVT? |
narrow complex tachycardia -DC cardioversion if acute otherwise identify rhythm -if needed give adenosine to cause transient block + convert to sinus rhythm -then b-blocker |
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Describe VT? |
broad complex tachycardia with HR>100 -amiodarone -shock if necessary |
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Describe first degree heart block? |
PR interval >200ms -no treatment required |
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Describe second degree heart block? |
Mobitz I - progressive PR elongation until non-conducted P-wave - doesnt usually require treatment Mobitz II - constant PR interval with intermittend non-conducted P-wave - always sinister so pace - due to bundle of His |
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Describe third degree heart block? |
complete AV node dissociation -ventricular escape rhythm with no relation to atrial rhythm/rate -pacemaker |
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Describe WPW syndrome? |
tachycardia due to congenital accessory conduction pathways between atria + ventricles -short PR interval, wide QRS -delta upstroke at start of Qrs -presents with SVT >>Ablation |
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Describe ventricular ectopics? |
commonest post-MI arrhythmia -due to electrical instability with risk of VF -if >10/min consider amiodarone |
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Describe torsades du pointes? |
looks like VF but is VT with varying axis -due to increased QT interval which is side effect of antiarrhythmic so consider stopping -give Mg SO4 |
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Describe AF/Flutter? |
chaotic electrical rhythm with AV node responding intermittently thus irregular ventricular rate -CO drops by 10-20% -main risk is embolic stroke |
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Presentation of AF/flutter? |
chest pain, palpitations, dynspnoea, faint -irregularly irregular pulse -absent p-waves + irregular QRS complexes |
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Treatment of acute AF? |
O2 emergency cardiovesion or IV amiodarone |
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Treatment of chronic AF? |
RATE CONTROL + anticoag -rhythm control with cardioversion or flecainide only needed if symptompatic, CCF, young etc |
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Types of HF? |
systolic if problem with contraction leading to <40% ejection fraction - due to IHD, MI diastolic failure if inability to relax properly - due to constrictive pericarditis, tamponade, HT |
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Presentation of LV failure? |
SOB, fatigue, orthopnoea paroxysmal noctural dyspnoea nocturnal cough weight loss |
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Presentation of RV failure? |
peripheral oedema ascies nausea epistaxis **due to LVF, pulmonary stenosis or lung disease |
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Define congestive HF? |
heart not pumping enough blood out to meet bodys demands |
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Describe high output HF? |
rarer -normal or inc CO>circulatory overloads>HF -anaemia, pregnancy, hyperthyroid, pagets |
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Diagnosis of HF? |
FRAMINGHAM CRITERIA (2 major or 1 major+2minor) |
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Presentation of HF? |
cool peripheries cyanosis low BP narrow pulse pressure pulsus alternans (weak + Strong) RV heave |
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CXR in HF? |
perihilar batwing shadowing (consolidation) fluid in fissures Kerley B lines - thickened interlobular septae, horizontal lines at periphery Alveolar oedema (batwings) kerley B lines Cardiomegaly Dilated upper lobe vessels Effusion |
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Management of HF? |
1. Diuretics eg frusomide 2. ACEI 3. B-blocker 4. spironolactone 5. digoxin 6. vasodilators |
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Describe natriuretic peptides? |
ANP -inc urine + Na BNP - closely related to LV pressure *released in MI + LV dysfunction -act to dec renal Na absorption + preload |
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Describe natriurtic peptides in HF? |
plasma BNP >100 diagnoses HF from other causes of dyspnoea |
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What is malignant hypertension? |
sudden rise in bp to systolic>200 with bilateral retinal haemorrhages + exudate -causes organ damage -90% 1Y mortality untreated |
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Causes of secondary HT? |
Renal Endocrine - cushings, conns, acromegaly, hyperparathyroid pregnancy steroids |
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Describe rheumatic fever? |
pharyngeal infection with b-haemolytic strep triggering rheumatic fever 2-4wks later -5-15y/o -antibody reacts with valves causing damage - 70% mitral, 40% aortic |
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Presentation of mitral stenosis?
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fatigue, palpitations etc malar flush low vol pulse AF mid-disatolic murmur P-mitrale |
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Presentation of mitral prolapse? |
asymptomatic or atypical chest pain + palpitations -midsystolic click -commonest valvular abnoramlity |
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Presentation of aortic stenosis? |
narrow pulse pressure apex heave LV heave aortic thrill ejection systolic murmur |
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Presentation of aortic regurgitation? |
acute due to IE or trauma -orthopnoea -collapsing pulse -wide pulse P |
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Presentation of tricuspid regurgitation? |
hepatic pain on exertion ascites oedema pulsatile hepatomegaly jaundice *due to PHT, Rh fever, IE, ASD |
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Describe pulmonary stenosis? |
usually congenital - turners, noonans, williams -oedema -ascites -RV heave -ejection click >>valvuloplasty or valvotomy |
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Describe CABG? |
LIMA attached to LAD from origin at subclavian long saphenous used to bypass blockage elsewhere |
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Presentation of infective endocarditis? |
fever + new mumur - IE until proven otherwise -acute so presents wwith HF +/- emboli -subacute if prosthetic valve -usually staph aureus |
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Causes of IE? |
staph aureus strep viridans |
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IE presentation? |
Fever Roth spots - retinal haemorrhages Oslers nodes Murmur Janeway lesions Anaemia Nail haemorrhages Emboli |
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Describe oslers nodes and janeway lesions? |
Oslers - painful red raised lesions on hands + feet Janeway lesions - small non-tender erythematous, haemorrhagic or nodular lesions on palms or soles |
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Investigations of IE? |
blood cultures - x3 from 3 different sites normochromic normocytic anaemia neutrophilia microscopic haematuria long PR interval on ECG >>>DUKES CRITERIA TO DIAGNOSE |
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Management of native IE?? |
blind - amoxicillin + gentamicin staph - fluclox IV for >4wks |
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Management of prosthetic IE? |
blind - vanc, gentamicin + rifampicin staph - flucox, rifamp + gentamicin 6 wks |
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Cause of acute myocarditis? |
viral bacterial drugs - cyclophosph, herceptin, penicillin |
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Presentation of acute myocarditis? |
fatigue, fever, palpitations -Twave inversion +ve troponin >>supportive treatment + treat cause > recovery or HF |
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What is dilated cardiomyopathy? |
dilated flabby heart of unkown cause -associated with alcohol, viral, autoimmune |
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Presentation of dilated cardiomyopathy? |
pulmonary oedema RVF AF displaced apex mitral/tricuspid reurgitation jaundice hepatomegaly ascites |
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Treatment of dilated cardiomyopathy? |
bed rest diuretics ACEI anticoag -40% 2Y mortality |
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Describe hypertrophic cardiomyopathy? |
LV outflow obstruction from asymmetric septal hypertrophy -leading cause of sudden cardiac death in young -AD but 50% sporadic |
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Presentation of hypertrophic cardiomyopathy? |
systolic thrill or harsh ejection systolic murmur angina, dyspnoea, palpitations |
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ECG in hypertrophic cardiomyopathy? |
LVH T-wave inversion AF WPW ventricular ectopic |
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Management of hypertrophic cardiomyopathy? |
b-blockers for symptoms anticoag implantable defib -6%mortality per yr if <14yrs, 2.5% if >14yrs |
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Describe restrictive cardiomyopathy? |
rigid ventricle walls causing impaired fillng - central chest pain worse on inspiration or lying flat |
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Causes of resrictiv cardiomyopathy? |
amyloidosis haemachromatosis sarcoidosis scleroderma |
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Causes of acute pericarditis? |
viral bacteria post MI (Dresslers syndrome) drugs - penicillin etc RA SLA radiotherapy |
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Presentation of acute pericarditis? |
central chest pain worse on inspiration + lying flat, relieved by sittng forward pericardial friction rub -concave/saddle shaped ST segment elevation on ECG` |
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Management of acute pericarditis? |
treat cause + analgesia -steroids -15-40% recurr |
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Describe pericardial effusion? |
fluid acculumation in pericardial sac -same causes as pericarditis |
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Presentation of pericardial effusion? |
dysnpnoea, raised jvp -bronchial breathing L-base -Ewarts sign - dull percussion left lower lung -low volatage QRS on ECG -echo free zone around heart on echo |
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Treatment of pericardial effusion? |
treat cause -pericardiocentesis to diagnose or therapeutic |
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Describe constrictive pericarditis? |
heart encased in rigid pericardium -often unknown cause or after any pericarditis |
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Presentation of constrictive pericarditis? |
raised JVP kussmauls sign - raised JVP on inspiration quiet heart sounds hepatosplenomegaly ascites small heart on CXR >>>> surgical excision |
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What is cardiac tamponade? |
pericardial fluid accumulation > raised pressure > poor filling > dec cardiac output |
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Causes of cardiac tamponade? |
any pericarditis warfarin trans-septal puncture during cardiac catheterisation |
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Presentation of cardiac tamponde? |
inc bulse, dec BP pulsus paradox raised JVP kussmauls sign low voltage QRS |
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What is Becks triad? |
Distant heart sounds Distended jugular veins Decreased BP |
