Download File - Sheffield Peer Teaching Society

Cardiology
Phase 2a Revision Session
Ryad Chebbout
Abdullah Aamir
10/03/17
The Peer Teaching Society is not liable for false or misleading information…
Content
• Hypertension
• Heart Failure
• Congenital Heart
• Shock
Disease
• Limb Claudication /
• Valvular Disease
Ischaemia
• Dysrhythmias
• Ischaemic Heart Disease
• Pericarditis
Cardiac Presentation
Symptoms
• Chest Pain
• Shortness of Breath
• Palpitations
• Syncope
• Cough
Signs
• Murmur
• JVP
• Peripheral oedema
• Pulse changes
• Lung base changes
• Tachycardia, Bradycardia
• Hypotension,
Hypertension
Hypertension
Hypertension
• Modifiable CVD risk factor (e.g. IHD, ACS, CVE,
PVD)
• 95% = Essential HTN (unknown aetiology)
• Exclude secondary causes (5%)
• Check for end-organ damage (renal,
endocrine, CVD, drugs)
• Pharmacological management alongside
managing other modifiable CVD risk factors
(e.g. hyperlipidaemia, DM etc…)
Hypertensive Emergencies
Crisis = >200/>120
• Emergency: High BP + Acute End-Organ Damage
• Urgency: High BP (no end-organ damage)
Symptoms of acute end-organ damage:
• Neuro: headache, N+V, confusion, retinopathy,
papilloedema, weakness
• CVD: chest pain, SOB
• Renal: oliguria/anuria
Slowly reduce BP!!!
Congenital Heart Disease
Foetal Circulation
Congenital Heart Disease
R->L Shunts (4 T’s)
- Truncus Arteriosus
- Transposition of Great Vessels
- Tricuspid Atresia
- Tetralogy of Fallot
Early Cyanosis (blue babies)
Urgent Surgical Correction/Maintenance of PDA
Congenital Heart Disease (2)
L->R Shunts
- VSD
- ASD
- PDA
Eisenmenger Syndrome (VSD/ASD/PDA) L->R Shunt =
Increased Pulmonary Pressure = PAH = RVH = R->L Shunt
Late Cyanosis (blue kids)
Surgery
Valvular Heart Disease
Mitral Regurgitation
PATH
• MR = LA Dilatation = P. Venous
HTN = P. HTN
• MR = LV Dilatation = LV
Hypertrophy = LVF (vol.
overload)
AE
• IHD (Post-MI)
• Annular Calcification
(degenerative)
• RF/IE
SYM
• SOB
• Fatigue
SIG
• Murmur
• Displaced Hyperdynamic Apex
• AF
INV
• ECG (AF, P-mitrale, LVH)
• CXR
• Echo
Mx
• None
• Surgery
Aortic Stenosis
AE
• LV Hypertrophy = LVF
(pressure overload)
SIG
• Murmur
• Pulsus Tardus et Parvus (slowrising)
CVD RF’s
AE
• Calcification (degenerative)
• Congenital (bicuspid)
• RF
SYM
• Syncope
• Angina
• SOB
INV
• ECG (P-mitrale, LVH, LAD)
• CXR
• Echo
Mx
• None
• Surgery
Rheumatic Fever
Infective Endocarditis
Dysrhythmias
Normal Adult ECG
Bradycardia
P Waves
Each Followed by
QRS (SAN
dysfunction)
• Sinus bradycardia
• Sick sinus
syndrome
(1st Heart block)
Not Each Followed
by QRS (AVN
dysfunction)
• 2nd Heart block
• 3rd Heart block
Sinus Bradycardia
AVN/Heart Block
1st Degree
• Benign and asymptomatic.
No treatment required.
AE
• Increased vagal tone
(athletes)
• Inferior MI
• Mitral valve surgery
• AVN blocking drugs (betablockers, CCB, digoxin)
2nd Degree (Mobitz type 1)
• Progressive lengthening of
PR interval until beat is
“dropped” (excitation
completely feels to pass
through AVN/bundle of His)
AE
• AVN blocking drugs (betablockers, CCB, digoxin)
• Increased vagal tone
• Inferior MI
AVN/Heart Block
2nd Degree (Mobits type 2)
• PR interval is constant and
QRS complex dropped
• Failure of conduction
through His-Purkinje
system
• ASSOC: LBBB, bifascicular
block
• May be symptomatic
(syncope)
3rd Degree / Complete Heart
Block
• Complete absence of AV
conduction
• Rhythm is maintained by
junctional or ventricular
escape rhythm
• May be ventricular standstill
= syncope / sudden cardiac
death
AE
• Anterior MI
• Mitral valve surgery
• SLE, RF, Lyme
AE
• Inferior MI
• AVN blocking drugs (CCB,
beta-blockers, digoxin)
1st Degree Heart Block
2nd Degree Heart Block (Mobitz type I)
2nd Degree Heart Block (Mobitz type II)
3rd Degree (Complete) Heart Block
Tachycardia – Narrow Complex (SVT)
Regular
Irregular
Atrial
• Sinus tachycardia
• Atrial tachycardia
• Atrial flutter
• Atrial fibrillation
• Atrial flutter with
variable block
• Multifocal atrial
tachycardia
Atrioventricular
• AV re-entry
tachycardia (AVRT)
• AV nodal re-entry
tachycardia (AVNRT)
• Automatic junctional
tachycardia
Sinus Tachycardia
Atrial Flutter
PATH
• A type of SVT caused by a
re-entrant circuit within
the right atrium
AE
• Idiopathic, IHD, atrial
dilatation (septal defect,
PE, mitral/tricuspid
disease)
ECG
• Regular atrial rate of
~300bpm (200-400bpm,
depends on size of right
atrium)
• Ventricular rate
determined by the AV
conduction ratio: 2:1
(commonest), 3:1, 4:1,
variable rate
• ‘Sawtooth’ pattern, best
seen in II/III/VF, narrow
complex QRS
AVNRT/AVRT
Atrial Fibrillation
PATH
• AVN bombarded with depolarisation
waves of varying strength, and only
conducts in ‘all or non fashion’
• Initiating event (e.g. PAC) + Substrate for
maintenance (e.g. dilated left atrium)
• First Episode, Recurrent (>2 episodes),
Paroxysmal (self-terminates <7d),
Persistent (>7d), Permanent (>1yr)
AE
•
•
•
•
•
IHD
HTN
PE
Hyperthyroidism
Mitral Valve Disease
PRES
• Asymptomatic
• Chest Pain, Palpitations, SOB
Mx
• (acute) Cardioversion (electrical /
amiodarone)
•
•
•
•
(Chronic)
Rate Control: Beta-Blocker / CCB /
Digoxin (HF)
Rhythm Control: Cardioversion
(electrical / amiodarone)
Anticoagulation: Warfarin (postTIA/Stroke)
COMP
• CVE
Atrial Fibrillation