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Clinical Care Year 3 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Acs how does it occur

A

Atherosclerosis where ldl deposits into the tunica intima

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2
Q

Angina is

A

Pain when there is a mismatch between demand and supply

Results in pain may see ecg changes

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3
Q

Risk factors for angina

A 
Hypertension
Hyperlipidaemia 
Diabetes 
Sendentary lifestyle 
Obesity 
Smoking 
Family history
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4
Q

Stable angina

A

Episodic

Recurrent, predictable,

Will have own gtn

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5
Q

Unstable angina

A

Deterioration of stable

May occur at rest increase in frequency, severity and duration

May not relieved by gtn and aspirin

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6
Q

MI occurs when

A

Occlusion to coronary artery resulting in infarction

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7
Q

Clinical features of MI

A

Change in biochemical marker like troponin

Symptoms of ischaemia

St changes

Q wave development

Imaging evidence

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8
Q

Give for STEMI

A

Oxygen guided by SpO2
Antiplatelet - aspirin, clopidogrel
Nitrates - GTN

Pain management

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9
Q

Cocaine toxicity can cause

A

Coronary spasms as stimulates the CNS

Can then result in stroke, MI, seizures

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10
Q

Heart failure is

A

Heart can not maintain adequate cardiac output will compensate for this

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11
Q

Treatment for acute LVF

A

Sit upright - reduces preload

High flow oxygen - corrects hypoxia

Nitrates - reduced preload and after load

Furosemide - combats fluid overload

Cpap - in hospital it increase the pressure in the lungs

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12
Q

Cardiac tamponade is when

A

An increase in pericardial fluid leads to pericardial effusion and tamponade.

The heart then gets squished and can’t pump blood

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13
Q

Clinical signs of tamponade

A

Looks very ill
SOB, chefs tightness, faint

Becks triad - JVD, hypotension, muffled heart sounds

Cold pale mottled cyanosis
Tachycardia
Narrowing pulse pressure (early sign)
Pulsus paradoxus - change of 10 mmhg in inspiration phase (late sign)

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14
Q

What is becks triad

Indication of

A

JVD
Hypotension
Muffled heart sounds

Tamponade

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15
Q

What hospital do for cardiac tamponade

A

Pericardiocentesis - needle inserted into pericardial space to drain (aspirate)

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16
Q

Infective endocarditis

A

Infection of lining of heart can affect valves as well

Seen in in drug users, after major operation

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17
Q

Pericarditis is

Will see

A

Infection of pericardium

See widespread ST elevation

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18
Q

Kusmaulls sign

A

Increase in JVP that occurs during inspiration

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19
Q

Canon wave indicates

A

Complete heart block

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20
Q

Where is apex beat

A

5th intercostal mid clavicular

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21
Q

Remember the heart valves

A

All paramedics take medicine

Aortic - 2nd ic right eternal
Pulmonary - 2nd ic left sternal
Tricuspid - 4th/5th lower left sternal
Mitral - 5th right sternal edge

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22
Q

S2 is the

A

Closure of pulmonary and aortic valves

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23
Q

What is buergers test

A

Lie patient supine

Raise legs to 45 degrees

Watch for pallor

Then ask to sit upright should be loss of pallor
Spreading redness = positive

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24
Q

Why do we give IV fluids in MI

A

Possibility for reduced preload due to MI this keeps blood flow up

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25
Q

What happens if right coronary artery occluded

A

Get bradycardia as blood supply for SA node is supplier by the RCA

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26
Q

What proportion of pts does mi not show on ecg

A

30-40%

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27
Q

What is the timeframe for developing a life threateninf arryrhmia post infarct

A

4 hours

28
Q

Where does the right coronary artery supply

A

Right atrium

Both portions of ventricles

29
Q

Where does left coronary artery supply

A

Blood to the left ventricle
Left atrium
Interventricular septum

30
Q

What is the Cardiac cycle

A

Systole
Ventricles contract and blood is ejected
Diastole
Ventricles relax and blood fills the heart

31
Q

What is stroke volume

A

Difference between end diastolic and end systolic

32
Q

What is ejection fraction

A

Stroke volume divided by end diastolic

33
Q

What is preload

A

Work or load imposed on the heart before the contraction begins

34
Q

What is Starlings law

A

The increased force of contraction that accompanies an increase in ventricular end diastolic volume

35
Q

What is after load

A

Pressure the heart must generate to live blood into the aorta

36
Q

What is cardiac output

A

Volume of blood pumped through the heart per minute

37
Q

How to work out cardiac output

A

CO=SVxHR

38
Q

Types of shock

A 
Cardiogenic 
Hypovolaemia 
Neurogenic 
Anaphylaxis 
Septic
39
Q

Definition of shock

A

A failure of the cvs system to adequately perfuse the tissue
Leads to disruption in the cell metabolism
Leads to organ failure

40
Q

Why does hypovolaemic shock occur

What will they arrest into to

A

Most commonly due to blood loss, heart is working but reduced circulating volume

Will arrest into PEA

41
Q

Why does cardiogenic shock occur

A 
Cardiac output too low to deliver oxygenated blood to the cells 
Causes 
Decreased contractility 
Impaired diastolic volume 
Obstruction 
So pump is not working
42
Q

What is neurogenic shock and causes

A 
Wide spread vasodilation 
Imbalance between parasympathetic and sympathetic nervous system 
Causes 
Stimulation of parasympathetic activity 
Inhibition of sympathetic activity 
Damage to spinal cord or medulla 
Drugs
43
Q

What is anaphylactic shock

A

Begins as an allergic reaction - hypersensitivity
Immune and inflammatory response
Vascular affects include vasodilation and increase vascular permeability
Swelling in airway

44
Q

What is septic shock

A

Bacteria can cause fever, local inflammation and increased vascular permeability
When bacteria or toxins enter the blood stream
Reduce blood pressure - vasodilation
Oxygen demand higher

45
Q

Chest pain differentials

A 
Acute coronary syndrome 
Chest infection/pneumonia 
Pericarditis 
LVF 
Pulmonary embolism 
Pneumothorax 
Aortic dissection 
Indigestion 
Peptic ulcer 
Msk reasons
46
Q

Management of STEMI

A 
Aspirin 
Gtn 
Pain scores 
Pain relief 
SpO2 recorded
47
Q

Inferior MI what to do …

A 
V4R 
40% of stemis are inferior 
Preload sensitive so can develop severe hypotension 
Consider fluids 
Cautious with gtn
48
Q

What decreases venous return

A

Nitrates, beta blockers, diuretics and morphine

49
Q

Causes of heart failure

A 
Coronary artery disease 
Hypertension 
Dilated cardiomyopathy 
Valvular heart disease
Secondary to an mi
50
Q

Difference between systolic heart failure and diastolic heart failure

A

Systolic - contraction problems

Diastolic - filling problems

51
Q

How to assess congestion (heart failure)

A

Pulmonary oedema
Peripheral oedema
Elevated jugular venous pressure

12 lead ecg unlikely to be normal

52
Q

Hospital consideration for heart failure

A

CPAP
BiPAP

Opens the alveoli and increased alveolar pressure helps shift fluid into alveoli back into capillaries

53
Q

How does aortic aneurysm dissect

A

Separation of the arterial wall
Begins once intima is torn
Creates a false channel between the intimal and medial layers of the wall

54
Q

What does chronotropic mean

A

Affects the rate

55
Q

What does inotropic mean

A

Affects force of contraction

56
Q

What does dromotropic mean

A

Alters the rhythm or electrical conduction through the heart muscle

57
Q

What do beta blockers do

A

Inhibit activity and decrease the rate and force of contraction as act on beta -1 and beta-2 receptions
Blocks the release of adrenaline and noradrenaline

58
Q

What do calcium channel blockers do

A

Inhibit the calcium influx into muscle that initiates contraction
Vasodilator acts directly on smooth muscle

Decrease contractility, av conduction and automaticity

59
Q

What is ischemia

A

More negative than surrounding tissues not getting enough oxygen
Causes st deferment depression and flipped Ts

60
Q

What is injury (heart)

A

Remains more positive than surrounding tissue leading to st segment elevation
Zone of injury does not repolarise

61
Q

What is infarction

A

Dead tissue

Does not generate any action potentials is electrical neutral

62
Q

Which artery is anterior on ecg

A

LAD (left anterior descending)

63
Q

Which artery is inferior

A

Right coronary artery sometimes the left circumflex artery

64
Q

What artery is posterior

A

Right coronary artery or left circumflex artery

65
Q

Left bundle branch block criteria

A

QRS complex wider than 0.12
Then look in V1
Positive - RBBB
Negative - LBBB

Clinical Care Year 3 (18 decks)

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