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General Medical > Cardiac > Flashcards

Cardiac Flashcards

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USMLE® Step 1 flashcards
1
Q

What is left-sided heart failure?

A

Failure of the left side of heart. Mostly by systolic failure (ineffective pumping). Ischaemic heart disease is most common cause. Another cause is chronic hypertension. The left-side of the heart constantly has to overcome high systemic pressures therefore hypertrophies. This causes increased oxygen demand and also less area and volume of blood pumped out each beat. Dilated cardiomyopathy can also cause LHF

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2
Q

Describe diastolic left sided heart failure?

A

Diastolic failure refers to problems with filling. Such as with chronic hypertension which leads to hypertrophy- this creates less room for filling. Another cause is aortic stenosis and hypertrophic cardiomyopathy which both cause hypertrophy of the left ventricle. Restricted myopathy also causes diastolic failure as the heart is able to stretch

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3
Q

Symptoms of left-sided heart failure?

A

Backup of blood into the pulmonary system, this causes pulmonary oedema. This causes delayed oxygen exchange which leads to dyspnoea and orthopnoea
Persistent cough, crackles and wheeze on auscultation
cyanosis

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4
Q

Medications for left-sided heart failure?

A

ACE inhibitors to dilate blood vessels and increase blood flow
Diuretics- reduce fluid overload

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5
Q

What is right sided heart failure?

A

Often caused by left-sided heart failure or by congenital heart defect with a left to right shunt. Chronic lung diseases another cause isolated RHF- in response to hypoxia, pulmonary arterioles constrict which increases pulmonary blood pressure which leads to right sided hypertrophy and failure

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6
Q

Symptoms of right-sided heart failure?

A

Systemic congestion- jugular venous distention, hepatospleenomegaly- can eventually lead to cirrhosis and liver failure.
Ascites
Pitting oedema

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7
Q

Risk factors for MI?

A

Atherosclerosis, male, age, fam history, ethnicity, smoking, hypertension, dyslipidemia

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8
Q

Difference between STEMI and NSTEMI

A

NSTEMI- partial occlusion of the coronary artery. Ischaemia occurs proximally to where the vessel supplies. STEMI is complete occlusion of the artery causing myocyte death and ischaemia distally and moving proximally until it is resolved

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9
Q

Clinical presentation of ACS?

A

Central crushing chest pain- may radiate down left arm, neck/jaw or back
Diaphoresis
Nausea and vomiting
Feeling of impending doom

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10
Q

Differentials of central chest pain?

A

Tamponade, pericarditis, aortic aneurism, anxiety, PE, pneumothorax, oesophageal rupture

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11
Q

What is troponin?

A

A protein that is attached to tropomyosin and helps with muscle contraction. Cardiac specific troponin is troponin 1 and T

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12
Q

When are troponin levels first detected, peak, and how long do they stay elevated for?

A

Troponin is detectable 4-8hours post onset of symptoms, peaks 12-24hours and stay elevated for 10 days

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13
Q

Diagnosis of MI with Troponin?

A

Initial troponin levels and then repeated at 3-6 hours. normal < 0.03 µg/L

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14
Q

Chest pain clinical pathway?

A 
Vitals and ECG and review by MO within 10 mins
02
Aspirin 300mg, nitrates
IV access- troponin, FBC, U&amp;Es
pain relief 
continuous cardiac monitoring
chest xray

If chest pain for more than 30mins but less than 12hrs and ST elevation in 2 leads- Primary PCI within 90mins of costact- if not available- thrombolysis

Antithrombolitic therapy- 300mg aspirin, Clopidogrel 600mg with planned PCI and 300mg with thrombolytic intervention
Heparin or enoxaparin

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15
Q

What is MOAN acronym for ACS?

A

Morphine
Oxygen (if under 93%)
Aspirin and clopidogrel
Nitrates

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16
Q

What is endocarditis and risk factors?

A

Infection of the endococardium most commonly by staph aureus. Risks: congenital heart defects, surgical devices ie pacemaker, artificial valve, rheumatoid arthritis, IV drug use, certain dental and medical procedures

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17
Q

Presentation endocarditis?

A

Symptoms of acute infection occur within a week, symptoms of subacute may take weeks or months to develop
Flu-like symptoms
heart murmur
aching muscles or joints
janeway lesions (non-tender, small erythematous or haemorrhagic macular or nodular lesions)
osler nodes (painful, red, raised lesions found on the hands and feet)
Roth spots- retinal hemorrhages with a pale centre
splinter haemorrhages
haematuria- glomerularnephritis

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18
Q

Diagnosis endocarditis?

A

Modified Duke Criteria (2 major or 1 major and 3 minor)

Clinical presentation
ECG
Positive blood cultures- need at least 2 its drawn 12hours apart
Rule out rheumatoid factor
TTE or TOE showing mass on valve, access or new dehiscence of prosthetic valve

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19
Q

Management for endocarditis?

Complications of endocarditis?

A

IVABs dependent on bacteria and if community or hospital acquired and if native or prosthetic valve
Community acquired: Benzylpenicillin + Fluclox + Gent for 1-2 weeks

Complications: MI, pericarditis, mycotic aneurysm, CHF

20
Q

What is pericarditis and cause?

A

Inflammation of the pericardium which surrounds the heart. Main cause is viral infection, can also be bacterial or fungal. Can also occur following MI, heart surgery, trauma or uraemia. Or due to autoimmune disease: Lupus

21
Q

What are symptoms of pericarditis?

A

Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain
Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation
Pain is worse in the supine position or upon inspiration (breathing in)
Pericardial rub on auscultation
Tachypnoea
Tachycardia
Fever

22
Q

Complications of pericarditis

A

Pericardial effusion which can lead to tamponade

23
Q

What is cardiac tamponade and signs?

A

Abnormal accumulation of pericardial fluid creates pressure and causes impairment in diastolic filling of the heart.
Features include tachypnoea, tachycardia and atrial arrhythmias- eg AF, Kussmaul sign (a paradoxical rise in JVP on inspiration) and pulses paradoxus

24
Q

What is pulses paradoxus?

A

A decrease in systolic blood pressure greater than 10mmHg during inspiration. To perform use stethoscope and BP cuff, find systolic, sounds should not be heard on inspiration, slowly lower cuff pressure until kormokoff sounds also heard on inspiration, difference should be less than 10

25
Q

Diagnosis of pericarditis?

A

Clinical findings
Bloods- may be normal, may have raised troponin due to damage to myocytes
ECG- PR depression, concave (‘saddle-shaped’) ST elevation, Reciprocal ST depression and PR elevation in aVR and V1
Echo
CXR if suspected effusion

26
Q

Management Pericarditis?

A

Symptom management
NSAIDs
Pericardiocentesis if effusion/tamponade

27
Q

What is an aortic aneurysm? What are the different types?

A

An enlargement of the aorta greater than 1.5 times its normal size. Types: aortic root aneurism, thoracic aneurism or abdominal aortic aneurism- most common. With AAA 95% are located below renal arteries

28
Q

What is a true or false AAA?

A

True: Fusiform- bulge is symmetrical along the vessel. Involve all 3 layers of the vessel wall, and are defined as being >3cm in diameter or having increase >50% from baseline.
Usually false: Saccular (berry)- the bulge is only on one side of the vessel and doesn’t involve all layers.

29
Q

What is the cause of aortic aneurysm?

A

Weakness in vessel wall and increased pressure cause ballooning of the vessel. This such as hypertension can cause hyaline arteriosclerosis causing narrowing of the vessel leading to ischaemia of the vessels suppling the aorta =weakness. Or connective tissue disorder, bacterial infections

30
Q

Risk factor for aortic aneurysm?

A

Male, >60yrs, smoking, hypertension, Marfans syndrome, Ehlers-Danlos- disruption in forming collagen proteins

31
Q

Symptom of intact and ruptured aortic aneurysm?

A

Intact: Can be asymptotic, however can sometimes cause abdominal or back pain.
Ruptured: Severe pain typically in back, or +abdomen, circulatory compromise and shock. Atypical presentation in elderly (may mimic sciatica, severe chronic back pain

32
Q

Diagnosis of AAA?

A

Palpable pulsatile abdominal mass, incidental finding on imaging- USS or CT abdominal

33
Q

Management of AAA if stable or ruptured?

A

Stable: refer to vascular, depends on size and presence/ absence of symptoms
2-5.5 cm diameter and asymptomatic-follow up
> 5.5 cm- surgical intervention- endovascular stent grafting

Ruptured: ABCs, resus, immediate open repair

34
Q

What is AVNRT?

A

AV node re-entry tachycardia (AVNRT) most common, sudden spontaneous onset- coffee, alcohol. More common in women.
Prem atrial complex causes fast pathway to be in refractory period therefore slow pathway conducts signal to ventricle and continues to create a circuit. This causes AV node to contract atria before complete filling.

35
Q

Symptoms of SVT (AVNRT)?

A

Tachycardia, palpitations, hypotension, presyncope/syncope, anxiety, chest tightness

36
Q

ECG AVNRT?

A

P waves hidden in QRS
Regular tachycardia
Rate 140-280bpm

37
Q

Management of SVT?

A

Vagal stimulation- carotid massage, valsalva manœuvre
Adenosine- slows conduction through AV node
Beta-blockers/CCB- slow rate
Cardioversion if chemical unsuccessful

38
Q

What is AVRT?

A

Atrioventricular reentrant tachycardia. Can be orthodromic (clockwise) or antidromic (anti-clockwise). Most commonly associated with WPW. Uses an accessory pathway- Bundle of Kent. This pathway is not rate slowing like AV node therefore allows all signals from atria to ventricle

39
Q

AVRT ECG?

A

200-300bpm
Buried P waves
Narrow QRS
ST depression

40
Q

What is AF and causes?

A

Type of SVT, disorganisation of electrical impulses in atria. Cause: IHD, HTN, thyrotoxicosis, WPW

41
Q

AF ECG?

A

Irregular tachycardia
Absence of P waves
Fibrilatory waves
Narrow QRS

42
Q

What are 3 classifications of AF?

A

Recurrent- more than 2 episodes
Paroxysmal- self- terminating <7 days
Persistent- Not self-terminating >7 days

43
Q

Management of AF?

A

Anticoagulants- risk of stroke due to blood stasis
Rate/rhythm control- cardioselective BBlockers- Metoprolol, CCB- Verapamil, or Cardiac glycoside- digoxin
Cardioversion

44
Q

Discuss airway in resuscitation?

A

Chin tilt/jaw thrust
Assess for obstruction
Suction if vomit, remove foreign body
Oro/nasopharangeal airway- only use In unconscious patient
Bag and mask- max 02- deliver ~15bpm or every 4-5seconds
LMA- ideal if not trained in intubation
Intubation- monitor waveform capnography (end-tidal c02)
If upper airway obstruction consider emergency tracheostomy

45
Q

Discuss breathing in rests?

A

Consider causes of obstructed breathing

Pneumothorax- thoracostomy

46
Q

Discuss circulation in rests?

A

Start CPR and attach defibrillator and cardiac monitor
IV/ IO access- bolus if hypovolemic
Bloods- FBC, UandEs, lactate, cardiac enzymes, gases
Assess if shockable- VF, pulses VT- 150kj
Meds- 1ml of 1:1000 adrenaline every 2nd cycle

General Medical (9 decks)

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