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AMK > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Primary Prevention

A

QRISK 3 Score - percentage risk of stroke or MI in 10years.
>10% = start a statin - atorvastatin 20mg night
Also CKD and diabetes T1 patient = atorvastatin 20mg
Aim for > 40% reduction in non-HDL cholesterol. Check at months.
SE statin- can cause rise in ALT, AST in first few weeks so LFTs check in 3months. (<3x rise from normal)
Myopathy - check creatine kinase if muscle pain

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2
Q

Secondary prevention

A

4 A’s
Aspirin + second antiplatelet - clopidogrel.
Atorvastatin 80mg
Atenolol (betablocker) or bisoprolol to max tolerated dose
ACE inhibitor - Ramipril to max titrated dose

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3
Q

PCI

A

Percutaneous Coronary Intervention
Angioplasty- dilating the blood vessel with ballon or stent.
Proximal or extensive disease on CTa

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4
Q

CABG

A

Coronary artery bypass graft
Severe stenosis
Open surgery - along sternum (midline sternotomy) graft vein from leg - graft saphenous vein. Bypass stenosis. Higher complication rate to PCI, longer recovery.
ISCES- check for fem/brach / chest scars.

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5
Q

Angina

A

Stable - Sx relived by rest or GTN
Unstable- type of ACS
Pain can radiate to jaw or arms. Constricting

Investigations: CT Coronary angiogram = gold standard 
Phy exam- BMI, Hr Sounds, signs Hr failure
ECG
FBC (anaemia )
LFT’s (prior to statin)
U&Es (prior to ACEI)
Lipid profile 
Thyroid tests
HbA1C and fasting glucose.
Management: RAMP
Refer to cardiology 
Advise
Medical Tx
Procedural or surgical interventions

GTN - immediate relief, 5min x2
Beta blocker- bisoprolol 5mg OD
Calcium channel blocker - amlodipine 5mg OD
Long acting nitrates - isosorbide mononitrate

Prevention: AAAA
Aspirin 75mg OD
Atorvastatin 80mg OD
Ace I
Already on BB
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6
Q

Acute coronary Syndrome

A 
Thrombus from AS Plaque - made up mostly of platelets (fast flowing artery)
3 types: 
Unstable Angina
ST elevation MI - STEMI
NSTEMI

Diagnosis:
ECG - if elevation/ new LBBB = STEMI
Troponin ^ or other ECG changes (depression, t wave inversion, Path Q waves )= NSTEMI
Non= unstable angina or MSK chest pain.

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7
Q

ACS Sx

A 
Central constricting Chet pain associated with:
Nausea and vomiting
Sweating and clamminess 
Feeling of impending doom 
SoB
Palpitations
Pain radiating to jaw or arms

Sx should continue at rest for >20mins. Diabetics - silent MI

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8
Q

Troponin levels

A

Elevate within 3-4 hours after damage, remain high for 14days.
Other causes ^ trop = myocarditis, PE, drug abuse, vasculitis, sepsis, renal failure, aortic dissection .

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9
Q

Acute STEMI Tx

A

Within 2hr = PCI

If PCI not available within 2hr = thrombolysis - fibrinolytic - streptokinase, alteplase, tenecteplase.

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10
Q

Acute NSTEMI Tx

A 
BATMAN
Beta blocker
Aspirin 300mg stat
Ticagrelor 180mg stat (or clopidogrel 300mg)
Morphine 
Anticoagulant LMWH - Enoxaparin 1mg/kg BD 2-8days
Nitrates - GTN to relieve spasm 
O2 only if stats below 95%

GRACE score - PCI in NSTEMI
6month risk of death or repeat MI <5%, 5-10%, >10%
Med, high risk considered for early PCI within 4 days.

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11
Q

Cor Pulmonale

A

Right Sided heart failure - resp disease
Back pressure into vent, atrium, VC and systemic venous system.
Causes: COPD, PE, Interstitial lung disease, CF, 1 Pulmonary HT
Pres: Often asymptomatic, SoB, Peripheral oedema, syncope, chest pain.
Signs: hypoxia, cyanosis, raised JVP, Edema, third heart sound, murmur ( pan-systolic in tricuspid regurgitate ), hepatomegaly.
Man: LT O2 therapy often, Tx cause.

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12
Q

Causes AF

A 
SHIMMERS
Soaring BP, hypertension 
Heart failure
Ischemic heart disease
Myocardial infarction 
Mitral value disease 
Ethanol / endocrine Eg thyrotoxicosis 
Resp causes; pneumonia, PE , bronchial carcinoma, rheumatic heart disease 
Sick sinus syndrome/ Sepsis
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13
Q

Medical cardioversion

If heamodynamically stable

A

IV flecanide or amiodarone if evidence of structural heart disease
Within 48hrs and stable

Plus rate control - bisoprolol

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14
Q

IV adenosine

A

Atrial flutter
PVST: paroxysmal supraventrical tachy
Wolff Parkinson white syndrome

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15
Q

Natural rate of heart parts

A

SA node: 60-100
AV node: 40-55
Bundle of his: 25-40
Bundle branches: 25-40

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16
Q

2 weeks post MI
Fever
Pleuritic chest pain
Pericardial rub on auscultation

A

Dressler’s syndrome
Local immune response causing pericarditis / pericardial effusion
Rarely a tamponade
Diagnosis: ECG- global ST elevation and T wave inversion
Echo
Raised CRP, ESR
Management: NSAIDs , severe cases steroids (prednisolone)
May need pericardiocentesis to remove fluid

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17
Q

Secondary prevention of MI medical management 6 As

A

Aspirin 75mg daily
Another anti platelet : clopidogrel for up to 12months
Atorvastatin 80mg
Ace inhibitor Ramipril
Atenolol
Aldosterone antagonist - those in clinical HF , eplerenone

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18
Q

SVT

A

Narrow QRS complex because rapid excitation of ventricles

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19
Q

VT

A

From ectopic focus
Wide QRS, 120-200 bpm
1. Monomorphic- classically myocardial scarring due to MI
2. Polymorphic - ischemia, not associated with scarring, different areas of V, brugada syndrome (autosomal dominate, Asian, st elevation, pseudo RBBB)
Tornadoes de pointes (k channels effected, prolonged QT interval)- Tx MgSO4

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20
Q

QT prolongation drugs

A 
Anti arrhythmics 
B antibiotics macrolides 
C antipsychotics - olanzepine, haloperidol 
D antidepressants - TCA 
E antiemetics   - ondansetron
21
Q

Shockable rhythms

A

Ventricular tachycardia
Ventricular fibrillation
SVT- shock to cardioversion if other Tx fail

22
Q

Non shockable rhythms

A

Pulseless activity

Asystole

23
Q

External cause of 3rd degree heart block

A

Lyme disease
Meds: b blockers, amiodarone, digoxin, calcium channel blockers, adenosine
Neonatal lupus- congenital heart block
Av block may be normal in athletes

24
Q

Rbbb

A 
Wide QRS 
V123 RSR configuration - right side 
MaRRoW
Causes: R ventricular hypertrophy, R HF, pulmonary embolism 
Can be normal
25
Q

Lbbb

A 
Qrs wide 
Lead V5,6 , aVL, 1 
Broad S wave in V1
WiLLoW 
Causes: never in normal hearts
Hypertension
Ischemia
Dilated cardiomyopathy 
Aortic stenosis 
May be sign of MI
26
Q

SVT

A

Within AV node
Alcohol and coffee
Absence of normal p waves
150-250 bpm

Collapses for a few seconds

Tx : Vagal manoeuvre-carotid sinus stimulated - Vargas nerve - slows HR
Adenosine -15seconds , indending dome,

27
Q

Sinus bradycardia

A

Hypothyroidism
Inferior MI
Anorexia
Cushing reflex - (Brady, hypertension, irregular resp pattern), from increased ICpressure, May indicate brain herniation so emergency
Meds: b blockers, opioids, calcium blockers

Tx: IV atropine

28
Q

Reentrant arrhythmias

A

PSVT
Atrial flutter
AF

29
Q

Atrial flutter

A

250-350bpm
Usually 2:1 av conduction
Around tricuspid value

30
Q

Holiday heart syndrome

A

VF after binge drinking

31
Q

Wolff Parkinson white syndrome

A

Preexcitation syndrome - can lead to SV arrhythmias, PSVT
Bundle of Kent between atria and ventricle
ECG: shortening of PR interval, widening of QRS, presence of delta wave (upward slurring of QRS complex)
Delta wave indicates V activation earlier than it should be
Mostly Asx

32
Q

Commonest cause of viral myocarditis

A

Coxsackie B virus

33
Q

Slurred upstroke of QRS

A

Delta wave

Wolff Parkinson white syndrome

34
Q

Splinter haemorrhages
Osler nodes
Jane way lesions

A

Infective endocarditis

35
Q

MI management

A 
High flow O2
Aspirin and clopidogrel
GTN spray 
Morphine 
B blocker
36
Q

SVTtreatment

A

Carotid sinus massage and vagal manoeuvres
Cardioversion
Adenosine
Catheter ablastion

37
Q

Systolic murmur heard loudest on back below left scapula.

Infancy

A

Coarctation or aorta. - Narrowing
Sx: difficulty breathing, pale, sweating, irritable or asymptomatic
Signs: high BP, headaches, nosebleeds, muscle weakness, cramps, chest pain.
BP difference in arms vs legs
Murmur
Weak or delayed pulse in legs

38
Q

Systolic murmur best heard upper left sternal edge radiating to left shoulder / back
Loudest during inspiration

A

Pulmonary stenosis
During inspiration increases preload
Quiet in valsalva because decreased preload.

39
Q

Ejection systolic murmur best heard over second intercostal space RHS
Radiated to carotid arteries
Quiet second heart sound

A

Aortic stenosis

Murmur softens with standing or valsalva manoeuvre

40
Q

Hypertrophic obstructive cardiomyopathy

A

HOCM
syncope
Ejection systolic murmur loudest between apex and left sternal border
Can radiate to super-sternal notch but NOT carotids.
Murmur typically louder with decrease in preload such as valsalva manoeuvre and standing.

41
Q

ECG changes stay for how long after MI STEMI
Days:
Weeks/ months :
Years:

A

ST elevation
t waves
Q Waves

42
Q

Chronotrophic drugs

Effect HR

A

Beta blockers
Some calcium antagonists - verapamil diltiazem
Digoxin
Ivabradine

43
Q

Low amp oscillations
Irregular irregular
Absence of P waves
Ventricular rate often 100-80

A

A fib

44
Q

CHA2DS2VASc

A

Atrial fib stroke risk scoring system

  • congestive heart failure
  • hypertension
  • age >75
  • diabetes mellitus
  • stroke / TIA / thromboembolism
  • vascular disease ( previous MI, peripheral artery disease)
  • age 75-74
  • sex - female
45
Q

HAS BLED

A

Major bleeding risk

Hypertension
Abnormal liver / renal function
Stroke history

Bleeding tendency / predisposition
Labile INR
Elderly >65
Drugs (aspirin, NSAIDs , alcohol)

46
Q

Cardiac tamponade triad

A

Becks triad :

Distant heart sounds
Distended Jugular veins
Decreased arterial pressure

Tx : pericardiocentesis
- needle under ultrasound

47
Q

25yo male with syncope following palpitations
ECG shows Delta waves in V1
No other med Hx generally fit and well.

A

Wolf Parkinson white syndrome

Accessory pathway - fast atrial rhythm
Can lead to SVT - syncope

48
Q

Cardioversion for VT

Stable vs unstable

A

Stable - chemical - amiodarone or lidocaine

Unstable - electrical DC cardioversion (pulseless/ hypotensive)

49
Q

Types of stroke

A
  1. Ischemic 85%
    - atherosclerosis, afib, small vessel D
  2. Haemorrhagic 15%
    - intracerebral, subarac, aneurysm, anticoagulant meds
  3. TIA
Tx: thrombolytics within 4.5hours alterplase 
Thrombectomy 
Aspirin 
Clopidogrel 
Anticoagulant: warfarin, or apixiban

AMK (21 decks)

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