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what is coarctation of the aorta?
aorta narrows at sight of insertion of ductus arterioles
what are the signs and symptoms of coarctation of aorta?
- arterial hypertension in the right arm
- normal to low BP in lower extremities
- weak peripheral pulses
- if coarctation before left subclass then synch radial pulses
- radio-femoral delay on the right (not left)
which syndrome is assoc. with coarctation?
When is a 4th HS heard?
just before the 1st
what is the 4th HS caused by?
abnormally forceful atrial contraction against a stiff ventricle caused by hypertrophic cardiomyopathy and systemic HTN
what % of the EDV volume is ejected in systole?
which valve closes first, aortic or pulm?
In AS why would you get angina?
severe LVH in the presence of normal coronary arteries
why would you get chest pain in mitral stenosis?
- RV ischaemia
- coronary embolisation
what are the 4 CV conditions assoc. with turners? (XO)
- coarctation of aorta
- aortic dissection
- congenital bicuspid aortic valve
- aortic regurgitation
if someone with migraine gets central chest pain and palps and no signs of HF, what is the cause?
coronary artery vasospasm
how is coronary artery vasospasm treated?
- only add BB when FIXED coronary artery disease
which criteria is used to diagnose rheumatic fever?
revised Jones criteria
how is the diagnosis of rheumatic fever made?
- evidence of recent strep infection and
- 2 major OR
- 1 major + 2 minor criteria
what are the evidence of strep infection?
- recent strep infection (sore throat)
- history of scarlet fever
- positive throat swab
- increase in ASOT > 200iu/l
- increase in DNAse B titre
what are the major criteria for jones criteria? remember pneumonic
- carditis: tachy, murmur, pericardial rub, CCF, cardiomegaly
- arthritis: flitting polyarthritis
- subcutaneous nodules: extensor surfaces
- erythema marginatum: red raised edge and clear centre on trunk, thigh, arm
- sydenham's chorea: St Vitus dance= invol semi-purposeful movements
what is the key pathological feature of acute rheumatic fever?
aschoff body: focal inflammatory lesion in heart (small, sterile veg)
what is the Rx of acute rheumatic fever?
- bed rest
- benzylpenicillin stat then penicillin V
- analgesia for carditis, arthritis
- haloperidol/diazepam for chorea
what % of acute rheum fever develop chronic?
what is the secondary prophylaxis for pts with acute rheum fever, what age?
- under 30 (as when over no longer at risk)
- penicillin V
What is the commonest cause of subacute bacterial endocarditis?
what is the commonest cause of endocarditis in prosthetic valve or IVDU?
which valve is most commonly affected by IE?
which valve in IVDU is most commonly affected in IE?
what is the classification of IE?
- native valve
- prosthetic valve: < or > 6 months from insertion
what are the causes of native valve IE?
- strep viridans (gram +)
- staph aureus
- HACEK bacteria
what are strep viridans?
- normal flora of oropharynx e.g. strep mutans, sanguis, mitis
- gut flora: strep bovis
what kind of haemolysis is assoc. with strep viridans?
alpha haemolysis (turns blood agar green hence viridans)
what are the causes of EARLY prosthetic valve IE?
- staph aureus
- coagulase negative staph eg staph epidermidis
what are the causes of LATE prosthetic valve IE?
- same as native.
- strep viridans: eg mutilans sanguis, mitis, bovis
- staph aureus
- HACEK bacteria
what is the difference in presentation between strep viridans and staph aureus?
- strep viridans: more subacute presentation so have peripheral stigmata of IE e.g. splinters, roth spots
- staph aureus: present quickly: hours-days so no peripheral stigmata of IE, flash pulmonary oedema as aortic valve is damaged, or stroke
what is the treatment of staph aureus IE?
- high dose iv flucloxacillin and gentamicin
- 4-6 weeks
- need to give both as fluclox opens the cell wall (of G+ as thick cell wall) and so gentamicin can get in and inhibit protein synthesis
how is IE diagnosed?
- modified dukes criteria
- need 2 major or
- 1 major and 3 minor or
- 5 minors
what are the 3 major criteria for IE?
- positive blood cultures
- endocardial involvement: echo
- new valve regard (murmur)
what are the minor criteria for IE?
- GN - microscopic haematuria
what is the empirical treatment for native valve IE?
amoxicillin and gentamicin iv
what is the empirical treatment for prosthetic valve IE?
vancomycin and gentamycin iv
what is the Rx of strep viridans IE in native valve?
- benzylpenicillin and gentamicin
- 2 weeks
what is the treatment for MRSA and MRSE IE?
- vancomycin and gentamicin
- 4-6 weeks
what is the treatment of enterococcal endocarditis?
- amoxicillin and gentamicin 4 weeks
- if allergic to pen or resistant to amox then give vancomycin instead of amox
what is brugada's syndrome?
- abnormal Na channel transport in the heart
- results in SCD often due to VF
what is the best treatment for brugadas?
what are the ECG features of brugadas?
why do you get haemoptysis in mitral stenosis?
due to pulmonary HTN
why is AF assoc. with Mitral stenosis?
due to left atrial enlargement
when you put someone on digoxin, what needs to be monitored regularly?
- renal function
- deranged renal function increases chance of digoxin toxicity
what is the MOA of carvedilol? 2, and 2 uses?
- non selective beta blocker
- alpha 1 block
- good for CHF and HTN
in which murmur do u get a 3rd HS and why?
- mitral regurg
- in diastole blood rushing back into ventricle
when do you hear a left parasternal heave?
- RV enlargement eg pulmonary stenosis, cor pulmonale, ASD
- also in mitral regurgitation due to left atrial distension in systole
Loud first heart sound, opening snap and pulmonary hypertension are suggestive of…?
Give 4 indications for thrombolysis in MI
- STE >2mm in at least 2 chest leads
- STE >1mm in at least 2 limb leads
- new onset LBBB
- posterior MI signs: positive R wave and STD in V123
what is the time limit for thrombolysis?
12 hours of ECG findings
what are the CI for thrombolysis?
- recent haemorrhage esp. brain
- recent surgery or injury
- severe HTN
- peptic ulcer disease
- previous hypertensive stroke
- proliferative diabetic retinopathy
what is pulmonary artery hypertension definition (numbers)
- >25mmHg at rest
- >30mmHg on exercise