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 armnormal to low BP in lower extremitiesweak peripheral pulsesif coarctation before left subclass then synch radial pulsesradio-femoral delay on the right (not left)
which syndrome is assoc. with coarctation?
turners
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?
50-70%
which valve closes first, aortic or pulm?
aortic
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 ischaemiacoronary embolisation
what are the 4 CV conditions assoc. with turners? (XO)
coarctation of aortaaortic dissectioncongenital bicuspid aortic valveaortic 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?
CCBnitratesonly 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 OR1 major + 2 minor criteria
what are the evidence of strep infection?
recent strep infection (sore throat)history of scarlet feverpositive throat swabincrease in ASOT > 200iu/lincrease in DNAse B titre
what are the major criteria for jones criteria? remember pneumonic
CASEScarditis: tachy, murmur, pericardial rub, CCF, cardiomegalyarthritis: flitting polyarthritissubcutaneous nodules: extensor surfaceserythema marginatum: red raised edge and clear centre on trunk, thigh, armsydenham'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 restbenzylpenicillin stat then penicillin Vanalgesia for carditis, arthritishaloperidol/diazepam for chorea
what % of acute rheum fever develop chronic?
60%
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?
strep viridans
what is the commonest cause of endocarditis in prosthetic valve or IVDU?
staph aureus
which valve is most commonly affected by IE?
aortic
which valve in IVDU is most commonly affected in IE?
tricuspid
what is the classification of IE?
native valveprosthetic valve: < or > 6 months from insertion
what are the causes of native valve IE?
strep viridans (gram +)staph aureusenterococciHACEK bacteria
what are strep viridans?
normal flora of oropharynx e.g. strep mutans, sanguis, mitisgut 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 aureuscoagulase negative staph eg staph epidermidis
what are the causes of LATE prosthetic valve IE?
same as native.strep viridans: eg mutilans sanguis, mitis, bovisstaph aureusenterococciHACEK 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 spotsstaph 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 gentamicin4-6 weeksneed 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 criterianeed 2 major or 1 major and 3 minor or5 minors
what are the 3 major criteria for IE?
positive blood culturesendocardial involvement: echonew valve regard (murmur)
what are the minor criteria for IE?
ivdufeverICH petechiaeGN - microscopic haematuriaoslersRhF
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 gentamicin2 weeks
what is the treatment for MRSA and MRSE IE?
vancomycin and gentamicin4-6 weeks
what is the treatment of enterococcal endocarditis?
amoxicillin and gentamicin 4 weeksif 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?
ICD
what are the ECG features of brugadas?
RBBBST elevation/change
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 functionderanged renal function increases chance of digoxin toxicity
what is the MOA of carvedilol? 2, and 2 uses?
non selective beta blockeralpha 1 blockgood for CHF and HTN
in which murmur do u get a 3rd HS and why?
mitral regurgin diastole blood rushing back into ventricle
when do you hear a left parasternal heave?
RV enlargement eg pulmonary stenosis, cor pulmonale, ASDalso in mitral regurgitation due to left atrial distension in systole
Loud first heart sound, opening snap and pulmonary hypertension are suggestive of�?
MITRAL STENOSIS
Give 4 indications for thrombolysis in MI
STE >2mm in at least 2 chest leadsSTE >1mm in at least 2 limb leadsnew onset LBBBposterior 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?
coagulopathyrecent haemorrhage esp. brainrecent surgery or injurypregnancysevere HTNpeptic ulcer diseaseprevious hypertensive strokeproliferative diabetic retinopathy
what is pulmonary artery hypertension definition (numbers)
>25mmHg at rest>30mmHg on exercise