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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
AV block signs and symptoms
Mobitz type II/3rd degree: Chest pain Syncope Palpitation SoB
26
AV block investigations
ECG Troponin K+, Ca2+, pH Digoxin level
27
AV block management
1st degree/mobitz type I: Monitor Discontinue av blockers if symptomatic Mobitz type II/3rd degree: Discontinue av blockers Pacemaker/CRT/ICD
28
Vasovagal syncope signs and symptoms
Sweating/light-headed before LOC Limb twitching Pallor Nausea
29
Vasovagal syncope investigations
ECG Bloods Imaging bHCG
30
Vasovagal syncope management
Education and avoid triggers Physical techniques
31
Peripheral vascular disease signs and symptoms
Intermittent claudication/critical limb ischaemia: Hair loss Slow growing nails Ulcer Strophic skin Pain on exertion(IC) Pain at rest(CLI)
32
Peripheral vascular disease investigations
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
Arterial/venous ulcer signs and symptoms
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
Arterial/venous ulcer investigations
Duplex USS of lower limbs
35
Venous ulcer management
Compression stockings Wound dressing Infected: Flucloxacillin 1g QDS 7/7
36
AAA signs and symptoms
Unruptured: Asymptomatic Abdo/back pain Ruptured: Sudden severe pain around area Syncope Shock Pulsation expansile mass Abdominal bruit Grey turner sign
37
AAA investigations
Gold standard: abdominal ultrasound Bloods CT angiogram can detect if ruptured MRI if CT angiogram not possible
38
Aortic dissection signs and symptoms
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
Aortic dissection investigations
Gold standard: CT angiogram->false lumen Bloods ECG CXR: wide mediastinum, globular heart
40
Varicose veins signs and symptoms
Visible vein dilation Leg aching, worse when prolonged standing Swelling Bleeding Vein is tender/hard Tap test
41
Varicose veins investigations
Gold standard: duplex ultrasound Can be used to exclude DVT
42
Varicose veins management
Conservative: Compression stockings Exercise, weight loss Endovascular: Radio frequency ablation Endovenous laser ablation Microinjection scleropathy Surgery: Stripping Ligation
43
DVT signs and symptoms
Erythema Warmth Swollen Painless Varicosities Recent surgery, pregnancy, malignancy, long haul travel
44
DVT investigations
Gold standard: Doppler ultrasound D dimer Venometry ECG, CXR, ABG if suspect PE
45
DVT management
Compression stocking Exercise No comorbidity: Apixaban/rivaroxaban 3/12 LMWH Anti phospholipid syndrome: LMWH + warfarin 5/7 til INR>2 then stop LMWH
46
LHF signs and symptoms
Dyspnoea: exertional, orthopnoea Fatigue Displaced apex beat Tachycardia Tachypnoea Crackles at lung base(pulmonary oedema)
47
RHF signs and symptoms
Fatigue Ascites Raised JVP Hepatomegaly Peripheral oedema
48
HF investigations
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
Chronic HF management
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
Acute HF management
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
Cardiomyopathy investigations
Echocardiogram Bloods BNP CXR->Cardiomegaly for DCM ECG Family history->HCM is AD Amyloidosis->RCM
52
Myocarditis signs and symptoms
Flu-like prodrome(coxsackie B virus common) Chest pain, worse when lying down SoB Palpitation
53
Myocarditis investigations
ECG Cardiac bio-markers: CK, troponin Endo-myocardial biopsy(diagnostic but not usually done)
54
Valvular disease murmurs
Aortic/pulmonary stenosis: ejection systolic Aortic/pulmonary regurgitation: early diastolic Mitral/tricuspid stenosis: late diastolic Mitral/tricuspid regurgitation: pansystolic
55
Valvular disease investigations
Bloods ECG(mitral valve disease usually has AF) CXR Echocardiogram
56
Valvular disease management
Valve replacement e.g. TAVI Metallic + warfarin or animal tissue
57
Hypertension risk factors and causes
Age Family history Renal: glomerulonephritis endocrine: cushing’s, conn’s, pcc iatrogenic
58
Hypertension diagnosis
Clinic BP > 140/90 BP > 180/120, refer for: Retinal haemorrhage and/or papilloedema Chest pain, heart failure, acute kidney failure Phaeochromocytoma
59
Hypertension classifications
Stage 1: 135/85 - 149/94 Stage 2: 150/95 Stage 3: 180/120
60
Hypertension investigations
ECG Urine dipstick(proteinuria) Cholesterol HbA1c U&E Fundoscopy
61
Hypertension BP targets
<80: 135/85 >80: 145/85
62
Hypertension management
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
Antihypertensive side effects
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
Hypertension complications
Cardiovascular: ACS, HF Neurological: stroke, vascular dementia CKD peripheral artery disease
65
Post MI VSD management
Analgesia Ionotropic support Consider: Coronary angiography Intra aortic balloon pump Positive pressure ventilation Swann-Ganz pulmonary artery catheter
66
Aortic dissection management
IV sodium nitroprusside + BB Oxygen Analgesia Aortic root replacement/repair/stent
67
Rheumatic fever signs and symptoms
Carditis Mitral murmur Arthritis Conduction defects Pericardial rub PR prolongation
68
Rheumatic fever management
Rest Aspirin if needed Benzylpenicillin 1.2g IM stat Oral penicillin
69
Infective endocarditis signs and symptoms
Poor dentition is a RF Nail splinter haemorrhages Fever Fatigue New murmur
70
Acute limb ischaemia signs and symptoms
Pulseless Pale Painful Paralysed Paraesthetic Perishingly cold
71
Acute limb ischaemia management
Initial: IV opioids IV unfractionated heparin Definitive: intra-arterial thrombolysis surgical embolectomy angioplasty bypass surgery amputation
72
Hypothermia investigations
ECG: J wave Temperature <35, 32 if severe
73
Hypothermia management
Warm room, hot drink Slow rewarming if elderly to prevent vasodilation->shock->death 1-2 degrees per hour
74
Peripheral vascular disease management
Stop smoking Exercise Statin Clopidogrel Endovascular revascularisation(angioplasty + stent) surgical revascularisation(bypass/endarterectomy)
75
AAA management
Reduce rupture risk: Stop smoking Open surgical repair: men<70 Endovascular aneurysm repair (EVAR): men>70/women
76
Infective endocarditis investigations
transthoracic/transoesophageal echocardiogram Dukes criteria
77
Infective endocarditis management
Amoxicillin Staph: Flucloxacillin Vancomycin + rifampicin(pen allergy) Strep: Benzylpenicillin Vancomycin + gentamicin (pen allergy) Stenosis/regurg -> valve repair

Y3 (9 decks)

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