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Y3 > Cardio > Flashcards

Cardio Flashcards

1
Q

Acute coronary syndrome signs and symptoms

A

Stable angina: chest pain on exertion
Unstable angina: chest pain randomly
NSTEMI: chest pain, sweating
STEMI: severe radiating chest pain, sweating

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2
Q

Stable angina investigations

A

resting ECG
Lipid profile
HbA1c

CT coronary angiography

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3
Q

Stable angina management

A

1st line:
Antiplatelet: aspirin/clopidogrel
Statin

2nd line:
GTN spray
BB/CCB

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4
Q

Unstable angina/NSTEMI investigations

A

ECG: normal(UA), ST depression & T wave inversion(NSTEMI)
Troponin
FBC
CXR
GRACE score

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5
Q

Unstable angina/NSTEMI management

A

1st line:
300mg aspirin
Fondaparinux(antithrombin)

Low risk:
Aspirin +
Ticagrelor(no bleed risk)
Clopidogrel(bleed risk)

High risk:
PCI within 72h
Ticagrelor + prasugrel + aspirin

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6
Q

STEMI investigations

A

ECG: ST elevation
Troponin
Coronary angiography

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7
Q

STEMI management

A

Morphine
Oxygen (unless normal sats)
Nitrates (unless hypotensive)
300mg aspirin
Metoclopramide IV 10mg(anti-emetic)

Definitive:
PCI within 2h (+prasugrel), unfractionated heparin during PCI
or
Fibrinolysis within 12h of symptom onset (+antithrombin), ticagrelor after

Dual antiplatelet(aspirin75mgOD+clopidogrel75mgOD)
Ramipril 75mg OD
Bisoprolol 75mg OD
Atorvastatin 80mg OD

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8
Q

Pericarditis signs and symptoms

A

Pleuritic chest pain->worse with deep breaths & cough
Chest pain relieved by sitting up and leaning forward

Pericardial friction rub:
Scratchy sound at left sternal edge w pt leaning forward expiration

Cardiac tamponade->Beck’s triad:
Raised JVP
Hypotension
Muffled heart sounds

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9
Q

Pericarditis investigations

A

Troponin to rule out ACS
ECG: diffuse saddle-shaped ST, PR depression
Echocardiogram

CRP
FBC to check WCC
LFT to check tamponade
CXR

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10
Q

Pericarditis management

A

Surgical:
Pericardiocentesis
Pericardiectomy if recurrent

Medical:
Idiopathic/viral->NSAID + PPI + colchicine + exercise restrict
Purulent(pus)->IV antibiotics + above, consider pericardiocentesis

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11
Q

Atrial fibrillation/flutter signs and symptoms

A

Irregularly irregular pulse
Palpitation
Chest pain
SoB

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12
Q

Atrial fibrillation/flutter investigations

A

ECG: absent P waves, unequal R-R for AFib
ECG: sawtooth patter for AFlut
Bloods
Echocardiogram

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13
Q

Atrial fibrillation/flutter management

A

Haemodynamic instability:
Emergency electrical(DC) cardioversion

Stable:
Acute(<48h):
Rhythm control->DC cardioversion/amiodarone(IV)
Rate control->bisoprolol/verapamil, digoxin if poor control

Chronic(>48h):
Apixaban/rivaroxaban/warfarin
Rate control (3w later)

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14
Q

Supraventricular tachycardia signs and symptoms

A

Chest pain
Palpitations
SoB
Dizziness/syncope

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15
Q

WPW investigations

A

ECG: delta wave, broad QRS
TFT
Echocardiogram

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16
Q

WPW management

A

DC cardioversion if unstable

Avoid digoxin, verapamil, bisoprolol
Flecainide, amiodarone

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17
Q

Supraventricular tachycardia investigations

A

ECG:
AVNRT->absent p waves tachycardia
AVRT->retrograde p waves after QRS tachycardia
Bloods
TFT
Digoxin levels
Cardiac enzymes

Manoeuvres:
Valsalva
Carotid sinus massage
IV adenosine

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18
Q

Supraventricular tachycardia management

A

Valsalva manoeuvre
6mg adenosine then 12mg in 1 min if no effect
Verapamil
DC cardioversion
Long term: catheter ablation

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19
Q

Ventricular tachycardia signs and symptoms

A

Syncope
Chest pain
SoB
Hypotension/tachycardia
Sudden death

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20
Q

Ventricular tachycardia investigations

A

ECG: torsades de pointes/regular broad QRS complexes
Troponin
U&E
CKMB

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21
Q

Ventricular tachycardia management

A

Torsades de pointes:
IV magnesium sulphate

Unstable:
DC cardioversion

Stable:
IV amiodarone 300mg
DC cardioversion if fail

Pulseless:
Advanced life support

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22
Q

Ventricular fibrillation signs and symptoms

A

Chest pain
Palpitation
SoB
Syncope
Unconscious

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23
Q

Ventricular fibrillation investigations

A

ECG: no discernible waves
ABG

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24
Q

Ventricular fibrillation management

A

CPR
Defibrillator
Give oxygen
1mg adrenaline IV every 5 min
300mg amiodarone IV after 3 shocks over 3 min

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25
Q

AV block signs and symptoms

A

Mobitz type II/3rd degree:
Chest pain
Syncope
Palpitation
SoB

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26
Q

AV block investigations

A

ECG
Troponin
K+, Ca2+, pH
Digoxin level

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27
Q

AV block management

A

1st degree/mobitz type I:
Monitor
Discontinue av blockers if symptomatic

Mobitz type II/3rd degree:
Discontinue av blockers
Pacemaker/CRT/ICD

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28
Q

Vasovagal syncope signs and symptoms

A

Sweating/light-headed before LOC
Limb twitching
Pallor
Nausea

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29
Q

Vasovagal syncope investigations

A

ECG
Bloods
Imaging
bHCG

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30
Q

Vasovagal syncope management

A

Education and avoid triggers
Physical techniques

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31
Q

Peripheral vascular disease signs and symptoms

A

Intermittent claudication/critical limb ischaemia:
Hair loss
Slow growing nails
Ulcer
Strophic skin
Pain on exertion(IC)
Pain at rest(CLI)

32
Q

Peripheral vascular disease investigations

A

Gold standard: ankle brachial pressure index-> abnormal is <0.9
Beurger’s test: lift leg->leg has pallor, swing leg down->reactive hyperaemia
BP, HR, bloods, ECG

33
Q

Arterial/venous ulcer signs and symptoms

A

Arterial:
Deeper, punched out
“Dry”/scabbed
Lateral/over bony areas
Hair loss
Absent pulse
Pain worse when leg lifted

Venous:
Large and shallow
“Wet”
Medial
Swelling, varicose veins
Pain better when leg lifted

34
Q

Arterial/venous ulcer investigations

A

Duplex USS of lower limbs

35
Q

Venous ulcer management

A

Compression stockings
Wound dressing
Infected: Flucloxacillin 1g QDS 7/7

36
Q

AAA signs and symptoms

A

Unruptured:
Asymptomatic
Abdo/back pain

Ruptured:
Sudden severe pain around area
Syncope
Shock

Pulsation expansile mass
Abdominal bruit
Grey turner sign

37
Q

AAA investigations

A

Gold standard: abdominal ultrasound
Bloods
CT angiogram can detect if ruptured
MRI if CT angiogram not possible

38
Q

Aortic dissection signs and symptoms

A

Sudden central chest pain radiating to back
Carotid->syncope
Coronary->angina
Subclavian->LOC
Renal->renal failure

Hypertension
Difference in bp between arms
AR murmur

39
Q

Aortic dissection investigations

A

Gold standard: CT angiogram->false lumen
Bloods
ECG
CXR: wide mediastinum, globular heart

40
Q

Varicose veins signs and symptoms

A

Visible vein dilation
Leg aching, worse when prolonged standing
Swelling
Bleeding
Vein is tender/hard
Tap test

41
Q

Varicose veins investigations

A

Gold standard: duplex ultrasound
Can be used to exclude DVT

42
Q

Varicose veins management

A

Conservative:
Compression stockings
Exercise, weight loss

Endovascular:
Radio frequency ablation
Endovenous laser ablation
Microinjection scleropathy

Surgery:
Stripping
Ligation

43
Q

DVT signs and symptoms

A

Erythema
Warmth
Swollen
Painless
Varicosities

Recent surgery, pregnancy, malignancy, long haul travel

44
Q

DVT investigations

A

Gold standard: Doppler ultrasound
D dimer
Venometry
ECG, CXR, ABG if suspect PE

45
Q

DVT management

A

Compression stocking
Exercise

No comorbidity:
Apixaban/rivaroxaban 3/12
LMWH

Anti phospholipid syndrome:
LMWH + warfarin 5/7 til INR>2 then stop LMWH

46
Q

LHF signs and symptoms

A

Dyspnoea: exertional, orthopnoea
Fatigue
Displaced apex beat
Tachycardia
Tachypnoea
Crackles at lung base(pulmonary oedema)

47
Q

RHF signs and symptoms

A

Fatigue
Ascites
Raised JVP
Hepatomegaly
Peripheral oedema

48
Q

HF investigations

A

BNP(sensitive but not specific)
Transthoracic echocardiogram (gold standard)
ECG, FBC, U&E, LFT, TFT
CXR:
Alveolar oedema
B lines Kerley
Cardiomegaly
Dilated vessels
Effusion(pleural)

49
Q

Chronic HF management

A

Avoid NSAIDs

Preserved EF:
Treat underlying
Lifestyle: exercise, diet, stop smoking

Reduced EF:
ACEi/ARB + BB
Spironolactone/epleronone
Neprilysin inhibitor, SGLT2i
ICD
CRT if BBB

50
Q

Acute HF management

A

Sit up right
60-100% Oxygen
diamorphine IV 2.5-5mg
Hypoperfusion(cold): inotrope, mechanical support
Congestion(wet): Furosemide IV 40-80mg, GTN
Avoid NSAIDs

51
Q

Cardiomyopathy investigations

A

Echocardiogram
Bloods
BNP
CXR->Cardiomegaly for DCM
ECG
Family history->HCM is AD
Amyloidosis->RCM

52
Q

Myocarditis signs and symptoms

A

Flu-like prodrome(coxsackie B virus common)
Chest pain, worse when lying down
SoB
Palpitation

53
Q

Myocarditis investigations

A

ECG
Cardiac bio-markers: CK, troponin
Endo-myocardial biopsy(diagnostic but not usually done)

54
Q

Valvular disease murmurs

A

Aortic/pulmonary stenosis: ejection systolic
Aortic/pulmonary regurgitation: early diastolic
Mitral/tricuspid stenosis: late diastolic
Mitral/tricuspid regurgitation: pansystolic

55
Q

Valvular disease investigations

A

Bloods
ECG(mitral valve disease usually has AF)
CXR
Echocardiogram

56
Q

Valvular disease management

A

Valve replacement e.g. TAVI
Metallic + warfarin or animal tissue

57
Q

Hypertension risk factors and causes

A

Age
Family history
Renal: glomerulonephritis
endocrine: cushing’s, conn’s, pcc
iatrogenic

58
Q

Hypertension diagnosis

A

Clinic BP > 140/90

BP > 180/120, refer for:
Retinal haemorrhage and/or papilloedema
Chest pain, heart failure, acute kidney failure
Phaeochromocytoma

59
Q

Hypertension classifications

A

Stage 1:
135/85 - 149/94

Stage 2:
150/95

Stage 3:
180/120

60
Q

Hypertension investigations

A

ECG
Urine dipstick(proteinuria)
Cholesterol
HbA1c
U&E
Fundoscopy

61
Q

Hypertension BP targets

A

<80: 135/85
>80: 145/85

62
Q

Hypertension management

A

Lifestyle:
Smoking cessation
Reduce alcohol intake
Reduce dietary sodium and caffeine
Weight loss if overweight
Exercise

Medication:
T2DM or <55: ACEi or ARB
Black or >55: CCB

63
Q

Antihypertensive side effects

A

ACEi/ARB:
Cough
Renal impairment
Postural hypotension
Dry mouth
Hyperkalaemia

CCB:
Flushing
Headache
Palpitations
Abdominal pain
Ankle swelling

Thiazide diuretics:
Skin reaction
Erectile dysfunction
Hypokalaemia
Hyperuricaemia
Hyperglycaemia

64
Q

Hypertension complications

A

Cardiovascular: ACS, HF
Neurological: stroke, vascular dementia
CKD
peripheral artery disease

65
Q

Post MI VSD management

A

Analgesia
Ionotropic support

Consider:
Coronary angiography
Intra aortic balloon pump
Positive pressure ventilation
Swann-Ganz pulmonary artery catheter

66
Q

Aortic dissection management

A

IV sodium nitroprusside + BB
Oxygen
Analgesia

Aortic root replacement/repair/stent

67
Q

Rheumatic fever signs and symptoms

A

Carditis
Mitral murmur
Arthritis
Conduction defects
Pericardial rub
PR prolongation

68
Q

Rheumatic fever management

A

Rest
Aspirin if needed
Benzylpenicillin 1.2g IM stat
Oral penicillin

69
Q

Infective endocarditis signs and symptoms

A

Poor dentition is a RF
Nail splinter haemorrhages
Fever
Fatigue
New murmur

70
Q

Acute limb ischaemia signs and symptoms

A

Pulseless
Pale
Painful
Paralysed
Paraesthetic
Perishingly cold

71
Q

Acute limb ischaemia management

A

Initial:
IV opioids
IV unfractionated heparin

Definitive:
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation

72
Q

Hypothermia investigations

A

ECG: J wave
Temperature <35, 32 if severe

73
Q

Hypothermia management

A

Warm room, hot drink
Slow rewarming if elderly to prevent vasodilation->shock->death
1-2 degrees per hour

74
Q

Peripheral vascular disease management

A

Stop smoking
Exercise

Statin
Clopidogrel

Endovascular revascularisation(angioplasty + stent)

surgical revascularisation(bypass/endarterectomy)

75
Q

AAA management

A

Reduce rupture risk:
Stop smoking

Open surgical repair: men<70
Endovascular aneurysm repair (EVAR): men>70/women

76
Q

Infective endocarditis investigations

A

transthoracic/transoesophageal echocardiogram
Dukes criteria

77
Q

Infective endocarditis management

A

Amoxicillin

Staph:
Flucloxacillin
Vancomycin + rifampicin(pen allergy)

Strep:
Benzylpenicillin
Vancomycin + gentamicin (pen allergy)

Stenosis/regurg -> valve repair

Y3 (9 decks)

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