Cardio Flashcards
Acute coronary syndrome signs and symptoms
Stable angina: chest pain on exertion
Unstable angina: chest pain randomly
NSTEMI: chest pain, sweating
STEMI: severe radiating chest pain, sweating
Stable angina investigations
resting ECG
Lipid profile
HbA1c
CT coronary angiography
Stable angina management
1st line:
Antiplatelet: aspirin/clopidogrel
Statin
2nd line:
GTN spray
BB/CCB
Unstable angina/NSTEMI investigations
ECG: normal(UA), ST depression & T wave inversion(NSTEMI)
Troponin
FBC
CXR
GRACE score
Unstable angina/NSTEMI management
1st line:
300mg aspirin
Fondaparinux(antithrombin)
Low risk:
Aspirin +
Ticagrelor(no bleed risk)
Clopidogrel(bleed risk)
High risk:
PCI within 72h
Ticagrelor + prasugrel + aspirin
STEMI investigations
ECG: ST elevation
Troponin
Coronary angiography
STEMI management
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
Pericarditis signs and symptoms
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
Pericarditis investigations
Troponin to rule out ACS
ECG: diffuse saddle-shaped ST, PR depression
Echocardiogram
CRP
FBC to check WCC
LFT to check tamponade
CXR
Pericarditis management
Surgical:
Pericardiocentesis
Pericardiectomy if recurrent
Medical:
Idiopathic/viral->NSAID + PPI + colchicine + exercise restrict
Purulent(pus)->IV antibiotics + above, consider pericardiocentesis
Atrial fibrillation/flutter signs and symptoms
Irregularly irregular pulse
Palpitation
Chest pain
SoB
Atrial fibrillation/flutter investigations
ECG: absent P waves, unequal R-R for AFib
ECG: sawtooth patter for AFlut
Bloods
Echocardiogram
Atrial fibrillation/flutter management
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)
Supraventricular tachycardia signs and symptoms
Chest pain
Palpitations
SoB
Dizziness/syncope
WPW investigations
ECG: delta wave, broad QRS
TFT
Echocardiogram
WPW management
DC cardioversion if unstable
Avoid digoxin, verapamil, bisoprolol
Flecainide, amiodarone
Supraventricular tachycardia investigations
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
Supraventricular tachycardia management
Valsalva manoeuvre
6mg adenosine then 12mg in 1 min if no effect
Verapamil
DC cardioversion
Long term: catheter ablation
Ventricular tachycardia signs and symptoms
Syncope
Chest pain
SoB
Hypotension/tachycardia
Sudden death
Ventricular tachycardia investigations
ECG: torsades de pointes/regular broad QRS complexes
Troponin
U&E
CKMB
Ventricular tachycardia management
Torsades de pointes:
IV magnesium sulphate
Unstable:
DC cardioversion
Stable:
IV amiodarone 300mg
DC cardioversion if fail
Pulseless:
Advanced life support
Ventricular fibrillation signs and symptoms
Chest pain
Palpitation
SoB
Syncope
Unconscious
Ventricular fibrillation investigations
ECG: no discernible waves
ABG
Ventricular fibrillation management
CPR
Defibrillator
Give oxygen
1mg adrenaline IV every 5 min
300mg amiodarone IV after 3 shocks over 3 min
AV block signs and symptoms
Mobitz type II/3rd degree:
Chest pain
Syncope
Palpitation
SoB
AV block investigations
ECG
Troponin
K+, Ca2+, pH
Digoxin level
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
Vasovagal syncope signs and symptoms
Sweating/light-headed before LOC
Limb twitching
Pallor
Nausea
Vasovagal syncope investigations
ECG
Bloods
Imaging
bHCG
Vasovagal syncope management
Education and avoid triggers
Physical techniques
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)
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
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
Arterial/venous ulcer investigations
Duplex USS of lower limbs
Venous ulcer management
Compression stockings
Wound dressing
Infected: Flucloxacillin 1g QDS 7/7
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
AAA investigations
Gold standard: abdominal ultrasound
Bloods
CT angiogram can detect if ruptured
MRI if CT angiogram not possible
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
Aortic dissection investigations
Gold standard: CT angiogram->false lumen
Bloods
ECG
CXR: wide mediastinum, globular heart
Varicose veins signs and symptoms
Visible vein dilation
Leg aching, worse when prolonged standing
Swelling
Bleeding
Vein is tender/hard
Tap test
Varicose veins investigations
Gold standard: duplex ultrasound
Can be used to exclude DVT
Varicose veins management
Conservative:
Compression stockings
Exercise, weight loss
Endovascular:
Radio frequency ablation
Endovenous laser ablation
Microinjection scleropathy
Surgery:
Stripping
Ligation
DVT signs and symptoms
Erythema
Warmth
Swollen
Painless
Varicosities
Recent surgery, pregnancy, malignancy, long haul travel
DVT investigations
Gold standard: Doppler ultrasound
D dimer
Venometry
ECG, CXR, ABG if suspect PE
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
LHF signs and symptoms
Dyspnoea: exertional, orthopnoea
Fatigue
Displaced apex beat
Tachycardia
Tachypnoea
Crackles at lung base(pulmonary oedema)
RHF signs and symptoms
Fatigue
Ascites
Raised JVP
Hepatomegaly
Peripheral oedema
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)
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
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
Cardiomyopathy investigations
Echocardiogram
Bloods
BNP
CXR->Cardiomegaly for DCM
ECG
Family history->HCM is AD
Amyloidosis->RCM
Myocarditis signs and symptoms
Flu-like prodrome(coxsackie B virus common)
Chest pain, worse when lying down
SoB
Palpitation
Myocarditis investigations
ECG
Cardiac bio-markers: CK, troponin
Endo-myocardial biopsy(diagnostic but not usually done)
Valvular disease murmurs
Aortic/pulmonary stenosis: ejection systolic
Aortic/pulmonary regurgitation: early diastolic
Mitral/tricuspid stenosis: late diastolic
Mitral/tricuspid regurgitation: pansystolic
Valvular disease investigations
Bloods
ECG(mitral valve disease usually has AF)
CXR
Echocardiogram
Valvular disease management
Valve replacement e.g. TAVI
Metallic + warfarin or animal tissue
Hypertension risk factors and causes
Age
Family history
Renal: glomerulonephritis
endocrine: cushing’s, conn’s, pcc
iatrogenic
Hypertension diagnosis
Clinic BP > 140/90
BP > 180/120, refer for:
Retinal haemorrhage and/or papilloedema
Chest pain, heart failure, acute kidney failure
Phaeochromocytoma
Hypertension classifications
Stage 1:
135/85 - 149/94
Stage 2:
150/95
Stage 3:
180/120
Hypertension investigations
ECG
Urine dipstick(proteinuria)
Cholesterol
HbA1c
U&E
Fundoscopy
Hypertension BP targets
<80: 135/85
>80: 145/85
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
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
Hypertension complications
Cardiovascular: ACS, HF
Neurological: stroke, vascular dementia
CKD
peripheral artery disease
Post MI VSD management
Analgesia
Ionotropic support
Consider:
Coronary angiography
Intra aortic balloon pump
Positive pressure ventilation
Swann-Ganz pulmonary artery catheter
Aortic dissection management
IV sodium nitroprusside + BB
Oxygen
Analgesia
Aortic root replacement/repair/stent
Rheumatic fever signs and symptoms
Carditis
Mitral murmur
Arthritis
Conduction defects
Pericardial rub
PR prolongation
Rheumatic fever management
Rest
Aspirin if needed
Benzylpenicillin 1.2g IM stat
Oral penicillin
Infective endocarditis signs and symptoms
Poor dentition is a RF
Nail splinter haemorrhages
Fever
Fatigue
New murmur
Acute limb ischaemia signs and symptoms
Pulseless
Pale
Painful
Paralysed
Paraesthetic
Perishingly cold
Acute limb ischaemia management
Initial:
IV opioids
IV unfractionated heparin
Definitive:
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation
Hypothermia investigations
ECG: J wave
Temperature <35, 32 if severe
Hypothermia management
Warm room, hot drink
Slow rewarming if elderly to prevent vasodilation->shock->death
1-2 degrees per hour
Peripheral vascular disease management
Stop smoking
Exercise
Statin
Clopidogrel
Endovascular revascularisation(angioplasty + stent)
surgical revascularisation(bypass/endarterectomy)
AAA management
Reduce rupture risk:
Stop smoking
Open surgical repair: men<70
Endovascular aneurysm repair (EVAR): men>70/women
Infective endocarditis investigations
transthoracic/transoesophageal echocardiogram
Dukes criteria
Infective endocarditis management
Amoxicillin
Staph:
Flucloxacillin
Vancomycin + rifampicin(pen allergy)
Strep:
Benzylpenicillin
Vancomycin + gentamicin (pen allergy)
Stenosis/regurg -> valve repair
