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Y6 Senior Med > Cardio > Flashcards

Cardio Flashcards

1
Q

What is Heart Failurw

A

Inability of CO to meet body’s metabolic demands despite maintained venous pressures

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2
Q

How do you classify HF

A 
LOW OUTPUT (low EF: EF<40)
or 
HIGH OUTPUT (normal EF)
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3
Q

What are causes of low output HF

A

LHF:

  • HTN
  • IHD
  • cardiomyopathy
  • valve disease / regurg

RHF:

  • secondary to LHF (congestive cardiac failure)
  • IHD, cardimyopathy
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4
Q

What are symptoms of chronic LHF

A

dyspnoea
orthopnoea
PND
fatigue

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5
Q

what are sx of acute LHF

A

dyspnoea
wheeze
cough
pink frothy sputum

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6
Q

what are sx of RHF

A

swollen ankles
increased weight
fatigue
anorexia, nausea

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7
Q

what are signs of LHF

A

bibasal crackles, S3 gallop

if acute: cyanosis, pulsus alternans

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8
Q

what are signs of RHF

A

raised JVP
hepatomegaly
ascites
pitting oedema

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9
Q

How can yoou classify LHF?

A

New York Heart Association Classificationo
1- no limit on activity
2- comfortable at rest, dyspnoea on ordinary activity
3- dyspnoea on less than ordiinary activity
4- dyspnoea at rest

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10
Q

What ix for acute HF?

A 
Bloods: FBC U&EE LFT CRP Gluc LIpids TFT
ABG, trop, BNP 
CXR 
ECG
Echo (assess ventricular dysfunction)
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11
Q

How d you manage HF if haemodynamically stable?

A

BASHeD heart

  1. BB (if low EF, OR loop diuretiic if preserved EF) + ACEi
  2. BB + ACEi + aldosterone antagonist
  3. Specialist
    • Hydralazine + nitrate
    • DIgoxin
      • Ivabradinie
      • sacubitri-valsartan
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12
Q

What is AF?

A

irregularly irregular pulse

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13
Q

What are sx of AF

A 
dyspnoea 
chest pain 
fatigue 
dizziness 
syncope
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14
Q

What are AF findings on ECG

A

irreg irreg
absent P wave

– atrial flutter = sawtooth

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15
Q

How can you split causes of AF, and what are they

A

CARDIAC

  • IHD
  • rheumatic heart disease
  • cardiomyopathy
  • sick sinus
  • pericarditis

SYSTEMIC

  • hyperthyroid
  • infection
  • alcohol

RESP

  • PE
  • bronchial cancer
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16
Q

what is the first key split in AF management pathway, and what are conditions for each

A

RHYTHM vs RATE control

RHYTHM CONTROL if:

  • AF is reversible
  • coexistent HF (caused by AF)
  • new onset AF

RATE CONTROL if:
permanent AF

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17
Q

How do you RHYTHM control someone?

A

<48h: DC cardiovert (3 synchronous shocks) > pharm cardiovert (fleicanide or amiodarone)

> 48h from onset of AF: anticoag for 4 weeeks before cardioverting

THEN LONG TERM BETA BLOCKER

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18
Q

How do you rate control someone

A

Beta blocker or CCB
Second line: digoxin
Third line: amiodarone

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19
Q

When do you give fleicanide or amiodarone for DC cardioversion

A

Fleicanide: young, no structural heart disease
Amiodarone: old, structural heart disease

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20
Q

What else must you do in someone with AF

A

CHADS VASC SCORE vs HAS-BLED risk

to determine stroke risk compared to risk of bleeding
if low: aspitrin
if high: warfarin

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21
Q

what are symptoms of infectious endocarditis

A
  • Fever with sweats/chills/rigors
  • Malaise, fatigue
  • Weight loss
  • Arthralgia
  • Myalgia
  • Confusion
  • Skin lesions
  • Ask about recent dental surgery or IV drug use
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22
Q

what are signs of infectious endocarditis

A

FROM MS JANE

Fever
Roth spots on retina
Osler’s nodes (tender nodules on finger/toe pads)
Murmur (new, regurgitant)

Microscopic haematuria (due to damage to kidneys) 
Splenomegaly (due to emboli damage to spleen )

Janeway lesions (painless macules on the palms which blanch on pressure)
Anaemia
Nail clubbind and haemorrhage (splinter)
Emboli

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23
Q

What ix do you do for IE

A 
•	Bloods
o	FBC - high neutrophils, normocytic anaemia
o	High ESR/CRP 
o	U&Es
o	 rheumatoid factor positive

• Urinalysis
o Microscopic haematuria
o Proteinuria

  • Blood Culture - with microscopy and sensitivities as well
  • Echocardiography - Transthoracic or transoesophageal (produces better image)
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24
Q

What classifications do you use for IE

A

DUKES classification - 2 majors OR 1 major + 3 minor OR 5 minors

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25
Q

What mx do you give for IE

A

Abx 6 weeks (initially IV > PICC line)

start broad spec (amox + gent), then guided by culture results

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26
Q

What is pericarditis

A

inflammation of pericardium

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27
Q

What are causes of pericarditis

A 
Vascular: post-MI, Dressler 
Infection - viral (cocksackie, HIV), TB, mumps 
Trauma 
AI (, SLE,) 
Metabolic (Uraemia)
Inflamm (sarcoid, scleroderma)
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28
Q

What are sx of periicarditis

– explain the type of pain

A

Pleuritic chest pain (sharp, central., radiatimg to shoulders, relieved by sitting forward)
Non productive cough
Dyspnoea
Flu like sx

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29
Q

What is audible on ascultation in pericarditis

A

pericardial RUB

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30
Q

What is finding on ECG in periicarditis

A

widespread saddle shaped ST elevation

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31
Q

MANAGEMET OF periciarditis

A

NSAID + colcichine

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32
Q

How do you assess for cardiac arrest?

A

Shout for help. Does this patient have a DNACPR?
Call 2222
A- Head tilt chin life, ask someone to hold jaw thrust
B- Look, listen and feel for signs of life, Breathing, chest movement
C- check central pulse

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33
Q

what are shockable rhythms

A

VF, pulseless VT

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34
Q

What are non-shockable rhythms

A

pulseless electrical activity, asystole

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35
Q

What do you do once you have ascertained no breathing and no central pulse

A

COMMENCE CPR 30 chest compressions : 2 rescue breaths via bag valve mask
Call 2222 for cardiac arrest
Continue CPR until crash team arrive with resus trolley

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36
Q

What do you do once crash team arrive

A

Place defib pads on chest, look at rhythm

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37
Q

What do you do for shockable rhythm

A

Stand clear - Defib max 1x (150J)

Reassess - if no change, Continue CPR for 2 minutes
repeat shock

You can repeat this cycle (CPR-shock) max 3 times
then continue CPR + give adrenaline 1mg IV + amiodarone 300mg IV

Restart CPR 2mins > rhythm check > shock – with adrenaline after alternate shock

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38
Q

What do you do for PEA/Asystole

A

continue CPR
Give 1mg Adrenaline IV
Secure airway with LMA /igel – otherwise hold jaw thrust

CPR for 2 mins > reassess > give adrenaline at alternate reassesses

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39
Q

What do you do if patient has spontaneous return of circulation

A

Send to ITU
Document
Debrief
Datix

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40
Q

what symptoms do you get with stable angina

A

chest pain on exertion relieved by rest

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41
Q

what is the pathophysiology of stable angina

A

mismatch in oxygen supply and demand to myocardium

due to constricted coronary

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42
Q

what is the first line ix for stable angina

A

CT coronary angiography CTCA
(but check renal function first as it requires contrast)

using this look at CALCIUM SCORE

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43
Q

what is management for stable angina

A

CONSERVATIVE: lifestyle changes

MEDICAL:

  1. BB/CCB + GTN spray
    - —- use nonDHP CCB e.g. verapamil / diltaziem
  2. BB + CCB + GTN spray
    - —- use DHP CCB with BB (otherwise total HB!!!) eg nifedipine
  3. AAA (Aspirin, ACEi, Atorvastatin)
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44
Q

what is definition of HTN

A

SBP > 140 and / or DBP >90 on three separate occasions

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45
Q

How can you divide causes of HTN

A 
Primary (essential/idiopathic) 
Secondary 
- renal (RAS, PKD, CKD) 
- endocriine (hyperthyroid, cushing's, Conn's, phaeo) 
- cardiovascular (aortic coarct)
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46
Q

what is aortic coarctation

A

congenital narrowing of the aorta

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47
Q

where does aortic coarctation usually occur, and how does this result in different signs?

A
  • usually AFTER left subclavian artery > radiofemoral delay

- rarely BEFORE left subclavian > radioradial delay

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48
Q

what are complications of aortic coarctation

A

upper extremity HTN
LV hypertrophy
malperfusion of abdomen and LL

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49
Q

how do you diagnose and tx aortic coarct

A

echo
CT / MR angio

Tx: angioplasty or surgery

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50
Q

when do you need to admit someone with hypertension?

A

when BP >180/110

will usually present with signs of deterioration e.g. retinal haemorrghage, papilloedema, confusion, AKI, chest pain etc

51
Q

what do we define as severe HTN

A

BP > 180/110

52
Q

what medication do you need to give first line for HTN

A

if <55 and not afrocarribean: ACEi or ARB

if >55 or afrocarrib: CCB

53
Q

what med do you give second line for HTN

A

add the one you weree not giving before or thiazide-like diuretic

SO:
if <55 and not afrocarribean: (ACEi or ARB) + (CCB or thiazide-like diuretic)
if >55 or afrocarrib: CCB + (ACEi or ARB or TLD)

54
Q

what med do you give third line for HTN

A

ACEi or ARM + CCB + TLD

55
Q

what med do you give first line for HTN if pt had T2DM, regardless of demographiocs

A

ACEi or ARB

if black, give ARB only

56
Q

what investigations do you do for HTN

A

exclude secondary causes

ambulatory BP monitoring > if declined / white coat syndrome, monitor at home

57
Q

What is the cause of rheymatic fever

A

group A beta haemolytic strep e.g. S Pyogenes&raquo_space; SCARLET FEVER

antibodies cross react with myosin, muscle glycogen and VSMC

can cause long term damage

58
Q

What are signs and symptoms of ACUTE rheumatic fever + typical pt

A

in children 5-15yo
pharyungeal infection > latent interval of 2-6 weeks

then: polyarthritis (tender joints, swelling), pericarditis (endocarditis, myocarditis, pericarditis),

later (up to 6 months later) sydenam’s chorea

59
Q

What is sydenham’s chorea

A

St vitus dance - involuntary movements

60
Q

what criteria do you use for rheymatic fever dx

A

JONES CRITERIA

61
Q

Explain Jones criteria

A
  1. Evidence of Group A infection + throat culture + / rapid strep antigen +
    2a. 2 majors
    2b. 1 major + 2 minors
62
Q

what are major criteria for Jones Cit

A

CASES

Carditis 
Arthiris 
Subcut nodules 
Erythema marginatum 
Sydenams chorea
63
Q

What are minor crit for Jones

A 
FRAPP 
Fever 
Raised ESR or CRO 
Arthralgia 
Prolonged PR 
Previous RF
64
Q

How o you manage Rh F

A

Acutely (attack lasts 3 months)

  • bed rest
  • analgesia (NSAID, aspirin)
  • phenoxymethylpen QDS 10/7
65
Q

what is Rh F prophylaxis

A

Once monthly IM benzathine pen

OR

BD PO 250mg phenoxymethylpen

66
Q

What is a AAA

A

localised enlargement of the abdominal aorta

- diameter > 3cm or >50% normal

67
Q

WHat are RF for AAA

A
  • male
  • FH
  • smoking, HTN, hypercholesteraemia
  • connective tissue disease
68
Q

What are symptoms for unruptured AAA

A

unruptured: asymptomatic

69
Q

What are signs for unruptured AAA

A

pulsatile lateral expansile mass

abdominal bruits

70
Q

what are sx of ruptured AAAA

A

pain in abdo/ back, sudden and severe
syncope
shock

71
Q

what additional sign may be visible on the abdomen in ruptured triole A

A

Grey turner (retroperitoneal bleeding9

72
Q

what investigation must you get in suspected AAA q

A

BLloods: FBC, clotting, LFT, UE, X match
Imaging: USS (if unruptured), CTA with contrast if ruptured

73
Q

How do you manage a ruptured AAA

A

volume resus, anaglesia, VTE prophylaxis

EVAR (endovascular aneurysm repair)

74
Q

what is the genetic inheritance of HOCM

A

Autosomal DOMINANT

1 in 500

75
Q

How does HOCM happen?

A

defect in gene for contractile protein > diastolic dysfunction> LV hypertrophy > decreased compliance > decreased CO

76
Q

What shows up on HOCM bippsu

A

myofibrillar hypertrophy with chaotic and disorganised fashion myocytes

77
Q

signs and sx of hocum

A

often asymptomatic
suden deathh in family
exertional: dyspnoea, angina, syncope
examiination: jerky carotid pulse, large A waves, double apex beat

78
Q

what two ix must you get for HOCM

A

Echo

ECG

79
Q

What are HOCM findings on Echo

A

MR SAM ASH
Mitral regurg
Systolic anterior motion of anterior miitral valve leaflet SAM
Asymmetric hypertrophy ASH

80
Q

Management of HOCM

A 
ABCDE 
Amiodaroe 
beta blocker / verapamil for sx 
cardioverter defib 
dual chamber pacemaker 
endocarditis prophylaxis
81
Q

what is cor pulmonale

A

pulmonary heart disease

presenting as RV HYPERTROPHY and RV DILATION

82
Q

why does cor pulmonale occur?

A

due to:

- pumonary HTN (either primary or COPD, interstitial lung disease)

83
Q

what are signs of cor pulmonale

A

due to backup of blood into systemic venous system:

  • ascites
  • jaundice
  • hepatomeg
  • raised JVP

due to difficulty in allowing blood to reach lungs:

  • SOB
  • wheeze
84
Q

how do calcium channel blockers work

A

reduce calcium uptake into cell > vascular smooth muscle relaxaton> decreases systemic vascular resistance > lowers HTN

85
Q

give an example of a CCB

A

Amlodipine

86
Q

give an example of an ARB

A

losartan

candesartan

87
Q

give an example of an ACEi

A

ramipril

enalapril

88
Q

what are DVLA rules for driving after MI

A

Stop driving for:

  • 1 week if angioplasty was successful, no further procedures
  • 4 weeks if angioplasty was unsuccessful, if they had an MI with no angioplasty, CABG surgery
89
Q

How do you identify orthostatic hypotension

A

3-2-1 drop:

3 minutes of standing, then a drop of 20/10 in BP

90
Q

what can cause long QT syndrome

A

Congenital
Drugs
Endocrine (hypocalcaemia, hypokalaemia, hypomagnaesaemia)
Vascular (MI, myocarditis

91
Q

what congenital conditions can cause long QT

A

jervell-Lange Nielsen syndrome (deafness)

Romano-Ward syndrome (no deafness)

92
Q

What drugs can cause Long QT

A

METH CATS

Methadone
Erythromycin 
Terfenadine 
Haloperidol 
Clarythromycin 
Amiodarone 
TCA 
SSRI
93
Q

what is the danger of long QT

A

leads to VT > death

94
Q

What is torsade de pointes and how do you manage it

A

a type of VT

Manage with IV magnesium sulphate

95
Q

what type of drug should you start in HF if EF is <30%

A

SGLT2 inhibitor

96
Q

what is cardiac tamponade

A

Buildup of fluid in pericardial sac > compression of heart

97
Q

What are causes of cardiac tamponade

A 
vascular (MI, rupture, aortic dissection)
infection 
trauma (incl cardiac surgery)
Malignancy 
Inflamm (pericarditisi)
98
Q

what is Becks triad

A

Triad that identifies cardiac tamponade (cardiac tamponade generally occurs with pericarditis)

  • low BP
  • high JVP
  • muffled heart sounds
99
Q

what is special feature of Cardiac Tamponade?

A

PULSUS PARADOXUS (BP drops by 10mmHg with every inspiration)

100
Q

how do you manage cardiac tamponade

A

pericardiocentesis

101
Q

which beta blocker offers prognostic benefit in heart fsailure

A

CARVEDILOL

102
Q

what condition does JVP have an absent A wave=

A

AF

103
Q

whayt condition has a heaving apical pulse

A

aortic stenosis

104
Q

what murmur has a WATERHAMMER PULSE

A

Aortic regurg (also called Corrigan’s opulse)

105
Q

What murmur has a TAPPING APEX BEAT?

A

Mitral stenosis (sound is made as the valve shuts - because it is so stiff)

106
Q

what are pacemakers for?

A

PACING OUT THE HEART

  • SA node pathology
  • AF
  • HF
107
Q

What are Implantable Cardioverter Defibrillators for

A

Shocking the heart into feasible rhythm

used for tachyarrhythmias

108
Q

What causes CANNON A WAVES?

A

Complete heart bloc (due to synchronous contractions of atria and ventricles)

109
Q

what is pulmonary HTN

A

RAISED pulmonary artery pressure

so an umbrella term for conditions which cause increased pressure in the pulmonary artery

110
Q

causes of pulmonary HTN - categories

A
  • Pulmonary artery obstruction (PE, or rarely an intravascular tumour)
  • lung disease (COPD, interstitial lung disease> cause backflow)
  • Left heart disease (LVD, valve disease, cardiomyopathy)
  • Pulmonary arterial HTN in absence of other causes (iaatrogemic, RF connective tissue diseases)
111
Q

What bacterium causes ACUTE IE, and who is this common in ?

A

S aureus – IVDU

112
Q

what valve does S aureus affect and why

A

tricuspid valve - as is the first reached from systemic circulation

113
Q

What bacterium causes chronic IE, and from where does it come

A

Strep viridans

from brushing your teeth

114
Q

what valve does S viridans affect and why

A

Mitral valve - because it is a much weaker and less quantity of bacterium, so it only affects already damaged valve !!

115
Q

what is the chadsVASC score component

A 
CHF 
HTN 
Age >= 75 
Diabetes
Stroke 
Age >=65
Sex Category (female)

Age and Stroke are worth 2 points

116
Q

how do you treat pericarditis / dressler’s post MI?

A

NSAIDs

117
Q

what is dresslers and how does it occur

A

post MI – 6 weeks

because myocardium has been damaged > you have made autoantibodies to it

118
Q

what condition for a long time after an MI causes prolonged ST elevation?

A

left ventricular aneurysm

119
Q

what is QRISK used for

A

Scoring system

for 10 year risk of developing cardiovasc disease

120
Q

What are the parameters of QRisk for which different treeatments are employed?

A

QRISK >10% = high risk of CVD = high dose statin

QRISK <10% = lifestyle modification

121
Q

when do you need to treat HTN

A

> 140/90 if >80 + end organ damage, CVD, CKD, diabetes, QRisk >10

in everyone else treat if >160/100

122
Q

give an example of a thiazide like diuretic

A

indapamide

123
Q

what are major and minor criteria for Duke’s (IE)

A

Major: BE
Bacteraemia, Echo findings

Minor: FEVEER
Feever
Echo findings other
Vascular phenomena (emboli, splinter haemorrhages, janeway lesions)
Evidence of immune involvcement (Osler nodes, Roth spots, RF)
Evidence of microbio envolvement (+ve culture)
RF: IVDU, heart condition

Y6 Senior Med (29 decks)

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