500 SBA's - Cardiology Flashcards
Histological changes wise, whats the difference between STEMI and NSTEMi
STEMI = infarction NSTEMI = ischaemia
What ECG changes do you expect to see with left circumflex artery occlusion?
ST elevation in V5 V6
Pt presents with HF and underlying cause of aortic stenosis. What signs do you expect to find OE?
And what signs should you not expect to find and why?
OE: bilateral basal crackles/crepitation
Because aortic stenosis will first cause left heart failure.
You wont expect to find: raised JVP and peodeal odema - these are right heart failure signs
You wont find pleural effusion YET - this is a late sign of HF, pulmonary oedema turns to effusion.
Whats the mechanism of aortic stenosis causing left heart failure?
Because the aorta is stenose the Left ventricle has to push against an increased pressure. This results in a backlog of blood and pressure into the pulmonary veins resulting in pulmonary oedema hence the first/early sign you would expect on LHF is bilateral basal crackles.
What are the signs you expect to find on CXR for HF?
A - Alveolar shadowing B - Kerley B lines C - Cardiomegaly D - Upper lobe diversion E - Effusion (oedema first)
Which stenosis is mainly associated with AF?
Mitral stenosis - because the enlarged atrium disrupts the normal electrical pathways
A murmur heard louder on inspiration points towards what?
A right sided valve lesion
Where would you hear the aortic valve/murmur?
right intercostal space and MCL
How would you hear a mitral regurgitation murmur best?
When the patient lies in the left lateral position
What main 3 signs do you expect to find on examination of aortic regurgitation?
- Early diastolic murmur S1 S2IIIII S1
- Wide pulse pressure
- Collapsing waterhammer pulse
What manoeuvre do you do to accentuate an aortic regurg murmur?
Sit patient front and make them hold their breath
What’s the chad2 score used for?
To predict the stroke risk in AF patients
Congestive HF Hypertension Age >75 Diabetes mellitus S2 Previous stroke or TIA
low risk - mx with aspirin
high risk - mx with warfarin
Acute coronary syndromes on ECG and troponin levels of each:
STEMI: elevated ST, elevated troponin
Aborted MI: elevated ST, normal troponin
NSTEMI: no st elevation, raised troponin
Unstable angina: no st elevation, normal troponin
What is the classic PC of PE?
MODERATE: SOB Pleuritic chest pain - on inspiration Haemoptysis Leg pain
MASSIVE: Severe central pleuritic chest pain Shock Collapse Acute right heart failure Sudden death
What are the signs OE of PE?
Pleural rub
Coarse crackles
Atrial FIbrillation
What are the signs OE of a massive PE?
Raised JVP
Raised RR
Raised HR
Hypotension
What are the causes of thrombus PE?
95% arise from DVT in the lower limbs
Rarely arises in the right atrium (in AF * patients)
What are embolic PE causes?
Amniotic fluid Air Fat Tumour Mycotic
What are the risk factors for PE?
Risk Factors: Surgical patients Immobility Obesity OCP Heart failure Malignancy
Identify appropriate investigations for pulmonary embolism
Bloods - ABG, thrombophilia screen
ECG -May be normal
May show tachycardia, right axis deviation or RBBB
May show S1Q3T3 pattern
CXR - often NORMAL but helps exclude other diagnoses
Spiral CT Pulmonary Angiogram (right)
FIRST LINE INVESTIGATION Poor sensitivity for small emboli
VERY sensitive for medium to large emboli
Ventilation-Perfusion (VQ) Scan
Identifies areas of ventilation and perfusion mismatch, which would indicate an area of infarcted lung
Pulmonary Angiography
Invasive
Rarely necessary
Doppler US of Lower Limb - allows assessment of venous thromboembolism
Echocardiography - may show right heart strain
What is the scoring system for PE? What is it used for exactly?
The Well's Score is used to determine the best investigation for PE Low Probability (Wells 4 or less) - use D-dimer High Probability (Wells > 4) - required imaging (CTPA)
Whats the mx for a primary prevention of PE?
Generate a management plan for pulmonary embolism Primary Prevention Compression stockings Heparin prophylaxis for those at risk Good mobilisation and adequate hydration
Whats the mx for PE if the pt is haemodynamically stable?
If haemodynamically stable O2 Anticoagulation with heparin or LMWH Switch over to oral warfarin for at least 3 months Maintain INR 2-3 Analgesia
What’s the mx for PE if the pt is haemodynamically UNSTABLE?
aka massive pe mx
If haemodynamically UNSTABLE (massive PE)
Resuscitate
O2
IV fluids
Thrombolysis with tPA may be considered if cardiac arrest is imminent
Surgical or radiological
Embolectomy
IVC filters - sometimes used for recurrent PEs despite adequate anticoagulation or when anticoagulation is contraindicated
Identify the possible complications of pulmonary embolism
Death
Pulmonary infarction
Pulmonary hypertension
Right heart failure
What does a mid systolic click and late systolic murmur indicate?
• Mitral Valve Prolapse
barlow syndrome/ click murmur syndrome
What is an Austin Flint murmur?
o Heard over the apex
o Caused by turbulent reflux hitting the anterior cusp of the mitral valve causing a physiological mitral stenosis
What would a patent ductus arteriosus sound like on auscultating?
Constant machinery murmur
Pt presents with severe tearing chest pain radiating towards the back/jaw
what is this
Classic aortic dissection
Will either radiate to back or jaw - it depends on where the aorta dissected exactly.
What is clopidogrel?
Clopidogrel, is an ANTIPLATELET medication used to reduce the risk of heart disease and stroke in those at high risk. It is also used together with aspirin in heart attacks and following the placement of a coronary artery stent. It is taken by mouth
