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Sheff 91 core clinical problems > 45 - cardiac arrest / sudden death , 46 chest pain, 54 - palps > Flashcards

45 - cardiac arrest / sudden death , 46 chest pain, 54 - palps Flashcards

1
Q

Lifestyle factors to prevent cardiac disease

A

smoking cessation, salt and sat. fat reduction, increase physical activity, weight loss, stress, alcohol consumption reduction.

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2
Q

How do statins work?

A

Statins inhibit HMG-CoA and reduce the body’s synthesis of cholesterol

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3
Q

When to use statins for prevention

T1/2DM? CKD?

A

. If lipids 5+, work out cardiovascular risk and see if statins are appropriate.

T1DM: If 40+, 10+ of DM, renal involvement or other CVD factors
T2DM: if 10% risk daily
CKD: If eGFR is 30ml or more but 40% reduction of non-HDL not achieved.

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4
Q

Drugs all Pts post MI

A

ACE-inhibitor, aspirin, clopidogrel, betablocker and a statin.

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5
Q

Hypertension Mx

A

A: 55+ or Black Carribbean: Amlopidine
A2: ACE inhibitor or ARB if under 55.

B: Combine the two

C: Add thiazide diuretic.

D: Specialist care.

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6
Q

causes of pulsless arrest

A

Hs and Ts

Hypoglycaemia
Hypvolemia
Hypoxia
Hydrogen ions
Hyper/hypokalemia
Hypothermia
Toxins
Tamponade
Tension pneumothorax
Thrombus
trauma
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7
Q

Normal ECG
Rythm
rate
axis

A

Rhythm: sinus

Rate: 60-100bpm

Heart Axis: -30 and 90 degrees

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8
Q

What does the p wave indicate

A

atrial conduction

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9
Q

What does QRS indicate

A

ventricular conduction

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10
Q

How long does PQ interval have to be for heart block?

A

0.2s or 5 small squares

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11
Q

What condition can give very short PQ

A

WPW

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12
Q

What does QT indicate

A

speed of ventricular repolarisation

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13
Q

How long QT before classes as prolonged?

A

450ms / 11 small squares

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14
Q

left / right axis deviation using leads I II and AVF

A

Left: If +ve in I and –ve in II and aVF
(LEAVING each other)

Right: If –ve in I and aVF is +ve
(REACHING)

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15
Q

What is atherosclerosis?

What are complications?

A

Arterial wall thickening as it is infiltrated by foam cells (a type of WBC) and cholesterol (LDL).

Eventually smooth muscle proliferation occurs with calcium and other mineral deposits entering the lesion.

Usually asymptomatic for decades until the arteries gradually narrow (stenosis).

The fibrous cap may rupture and produce a thrombus

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16
Q

What is angina

A

chest pain caused by ischemia from obstruction or spasm of coronaries

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17
Q

What is in GTN spray

A

Nitroglycerin

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18
Q

What is classes as unstable angina

A

Any of:

crescendo : worsening
onset at rest
>15 mins

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19
Q

ACS Mx

A

Sit ‘em up and give oxygen if sats lower than 94%
Obs

12 lead ECG
FBC, U and E, cardiac enzymes,

GTN (if haemodynamically stable)+ IV morphine 2.5mg

Evidence suggests labetalol has better long term outcomes than GTN
Aspirin 300mg

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20
Q

Some ECG changes in MI

A

ST elevation: STEMI

ST depression. May indicate Posterior MI if no accompanying elevation (reciprocal changes)

T wave inversion
P wave changes (may indicate LV problems, along with SOB)

Q waves indicate scar formation and take time to develop.

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21
Q

Mx of STEMI

A

Thrombolysis/PCI within 2 hours for best results.

tPa (altepase) , LMWH

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22
Q

Mx of NSTEMI

A

As with unstable angina.

Aspirin and clopidogrel.

GTN/Beta blocker if haemodynamically stable

Statins.

Angiography (out patient if low risk)

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23
Q

Normal path of heart conduction

A

SAN -> AVN -> L/R bundle branches and purkinje fibres

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24
Q

ECG features of WPW

A

Short PR , Broad QRS with a delta wave

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25
Q

Mx of WPW

A

ablation

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26
Q

What is a stokes adams attack?

A

fainting due to asystole

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27
Q

Features of stokes adams

A

Dizzy, angina, SOB

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28
Q

Cause of stokes adams? Mx?

A

Caused by sarcoid, amyloid, Chagas. Anything scarring the SAN.

Needs a pacemaker.

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29
Q

Types of heartblock

A

1: PR longer than 0.2 seconds (5 squares)
2: 1: Wenckebach: PR interval progressively lengthens until a dropped QRS resets it
2: 2: Mobitz II: fixed ratio of impulses not propagated. Ie, one in every three.
3: complete. SAN impulse does not pass through to ventricles. P to P and R to R regularity, but PR variability.

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30
Q

ECG changes in brugada

A

(ST elevation in V1-3 + RBBB

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31
Q

Sudden death syndrome in which conditions

A

Long QT
brugada
Hypertrophic cardiomyopathy

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32
Q

What cause premature ventricular contractions?

Are they safe?

A

Often benign. May be felt as palpitations or skipped beats.
Type of ectopic
[Increased risk of sudden death]

Many causes: drugs, MI, cardiomyopathy, stress, endocrine

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33
Q

VF Mx

A

Start CPR! Urgent Defib! Precordial thump.
Check Hs and Ts
Advanced life support + cardioversion.

34
Q

If VF is going up and down on ECG it is?

A

Torsades de pointes

35
Q

Drugs used for ALS cardio problems.

Arrest? Vtachy? brady? acidosis? torsades?

A

Adrenaline: arrest

Amiodarone: Vtach (unless unstable, then cardiovert) and Vfib, Afib,

Atropine: bradycardia. No longer used in asystole or PEA

Sodium bicarb: acidosis.

Magnesium sulphate: torsades de pointes

36
Q

AF seen on ECG?

A

Irregularly irregular

No p waves

37
Q

Rfs for AF

A

heart disease, thyroid disease, diabetes, rheumatic fever, age

38
Q

Assess risk of what in AF?

A

Stroke - CHADVASC

CCF
Hypertension
Age 65-74 and 75+
DM
Stroke (2)
Sex
Vascular Disease

Compare score with HASBLED to evaluate pros and cons of anticoagulation

39
Q

AF Mx

A

Admit if symptomatic.

Rate control with beta blocker (no sotalol) or CCB (veramapil or diltiazem)

Rhythm control with cardioversion if: new onset, reversible (such as chest infection), atrial flutter, heart failure

Cardioversion is electrical or with amiodarone.

40
Q

HASBLED parts

A 
Hypertension
Abnormal Liver function
Abnormal renal function
Stroke
Bleeding
Labile INRs
Elderly
Drugs
Alcohol
41
Q

Rfs for PE

A

: cancer, pregnancy, obesity, COCP, surgery, sedentary, smoking

DVT obvs

42
Q

Score to evaluate risk of PE

A

Wells

43
Q

Prevention of PE

A

heparin

44
Q

Mx of PE

A

LWMH if shocked. Monitor INR.
May need surgery
Oxygen and analgesia if required.

45
Q

What is an aortic dissection? Sx

A

Tear in the wall of the aorta allows blood in. Wall separates.

Sudden severe chest and back pain. Vomiting, sweating, shock.

46
Q

Rfs for aortic dissecrtion?

A

hypertension, Marfans, cocaine, smoking

47
Q

Mx of aortic dissection

A

Needs urgent imaging and treatment.

Surgical repair and beta blockers.

48
Q

Some signs of AS

A

Orthopnea, PND, swollen legs, pallor, flushing, slow rising pulse.

49
Q

How to assess CVD risk? What score to offer what?

A

QRISK

> 10% -> statin

50
Q

Parts of QRISK

A

Age, sex, ethnicity
Smoking, diabetes, family history, CKD, AF, HTN, RA
Cholesterol/HDL ratio, BP, BMI,

51
Q

DDx of chest pain - Name 4

A

Cardiovascular: ACS, aortic dissection, pericarditis, arrhythmia, myocarditis, aneurysm

Respiratory: PE, pleurisy, pneumothorax, haemothorax, bronchitis, pneumonia, TB, cancer

GI: GORD, oesophageal rupture, hiatus hernia,

Other: Anxiety (panic attacks), costochondritis, breast disease, herpes zoster,

52
Q

Rfs for aneurysms

A

diabetes, obesity, HTN, smoking, alcoholism, high cholesterol, cocaine, Ehler-Danlos, Marfan

53
Q

Specific Rf for berry aneurysms ?

A

PKD

54
Q

What is pleurisy?

Commonest cause?

A

inflammation of pleurae

virus spreading from lungs

55
Q

Sx of pleurisy?

A

Pleuritic chest pain: sharp pain during breathing.

May be associated with other signs of infection: tachycardia, fever, chills, SOB, dry cough.

Associated with pleural effusion

56
Q

mx of pleurisy?

A

NSAIDs - pain
codeine - cough / pain

mx underlying cause

57
Q

What is a pleural effusion?

A

Fluid accumulation within pleural space.

Fluid can be serous, blood, pus,

58
Q

Classes of pleural effusion?

A

Transudates: organ failures (heart, liver and renal) low protein

Exudates: PE, infection, pancreatitis, trauma. High protein causes.

59
Q

Diagnositic Ix for pleural effusion? Mx

A

thoracentesis and Light’s criteria.

Needs draining.
-Don’t let the sun go down on undrained pus.

60
Q

Couple signs of pleural effusion

A

Can impair breathing. Causes pleuritic pain, dullness to percussion and asymmetric chest rising.

Other symptoms based on cause.

61
Q

what is a pneumothorax?

Sx?

A

Collection of air in the pleural space.
Leads to hypoxia, pleuritic pain, shock
Hyperresonant chest.

62
Q

Causes of pneumothorax

A

spontaneous
trauma
iatrogenic

63
Q

Diagnosis of pneumothorax

A

CXR

64
Q

Mx of pneumothorax?

A

If less than 2cm and no breathlessness, conservative MGMT advised.

If larger then needs a chest tube in the safe triangle in the axilla

May need a pleurectomy.

No air travel for a week. No diving.

65
Q

Some signs of tension pneumothorax?

A

Trachea forced away from affected side. Tachycardia, hypoxia, tachypnea, cyanosis. Displaced apex, hyperresonant chest.

66
Q

Mx of tension pneumothorax ? Why so quick ?

A

Requires urgent treatment. Needle decompression (cannula) until a chest tube can be inserted. Second rib space, midclavicular line.

Can lead to cardiac arrest

67
Q

Sx of pericarditis

A

Fever, weakness, SOB, palpitations.

Pain: chest pain better sitting up and worse lying down

68
Q

Eg of two common causes of pericarditis?

A

Usually viral.

Dressler’s syndrome (post-MI autoimmune on heart tissue)

69
Q

Dx of pericarditis?

A

Cardiac US

Pericardial rub on auscultation

70
Q

Complication of pericarditis

A

Cardiac tamponade

71
Q

What is cardiac tamponade

A

fluid in the pericardium builds up, resulting in compression of the heart
-> cardiogenic shock

72
Q

What is the becks triad of tamponade?

A

jugular venous distention
muffled heart sounds,
pulsus paradoxus (hypotension inspiration)

73
Q

Causes of tamponade?

A

infection, TB, uremia, iatrogenic, cancer, pericarditis

74
Q

Complication of tamponade?

A

arrest

75
Q

Mx of tamponade

A

drain via pericardiocentesis or pericardectomy

76
Q

Type of lung disease is asbestosis? signs?

A

Industrial lung disease. Chronic and inflammatory.

Causes restrictive shortness of breath.

Inspiratory crackles.

Can -> cor pulmonale

77
Q

Cor pulmonale is?

A

enlargement of R heart due to increased pressure in pulm

78
Q

Complication of asbestosis?

A

mesothelioma

79
Q

Following diagnosis of asbestosis what do you get

A

compensation

80
Q

Sx of mesothelioma? Common locations?

A

Cancer of mesothelium. Commonly lungs. Can be abdomen, heart, testes too.
SOB, cough, pleuritic pain, fever, night sweats, weight loss, loss of appetite.

81
Q

Causes of mesothelioma

A

almost always asbestos

82
Q

Dx of mesothelioma

A

Confirm with imaging and biopsy.

Sheff 91 core clinical problems (51 decks)

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