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FINALS > Cardio > Flashcards

Cardio Flashcards

1
Q

what is heart rate

A

HR = CO X SV

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2
Q

What is the parasympathetic input to the heart and describe the mechanism

A
  • Vagus nerve
  • When stimulated ACH binds to M2 receptors –> decrease HR
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3
Q

What is the sympathetic input to the heart and describe the mechanism

A
  • Postganglionic fibres from cardiac plexuses
  • release noradrenaline which acts on B1 adrenoreceptors
  • Increases HR and force of contraction
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4
Q

How to increase BP

A
  • Baroreceptors detect decrease
  • Synpathetic activated
  • Cardiac accelerator centre in MO
  • HR increased, contraction increased, vasocontriction
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5
Q

How to decrease BP

A
  • Baroreceptors detect
  • Parasympathetic activated
  • GN and V nerves carry to MO = cardiac decelerator centre
  • HR reduced, vasodilation
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6
Q

What is cardiac output

A

CO = SV X HR

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7
Q

What is stroke volume

A

Difference between EDV and ESV

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8
Q

What is CVP

A

pressure in vena cava as it enters RA

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9
Q

What is TPR

A

pressure in arteries blood must overcome as it passes through them = afterload

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10
Q

Starlings law

A

the more the heart chambers fill the stronger the ventricular contraction therefore the greater the stroke volume

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11
Q

Mean arterial blood pressure

A

MAP = CO X TPR

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12
Q

Virchows triad

A
  • Stasis of blood flow
  • Hypercoagulability
  • Vessel wall injury
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13
Q

Where does the RCA supply?

A
  • Right atrium
  • Right ventricle
  • Inferior aspect of left ventricle
  • Posterior septal area
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14
Q

Where does circumflex artery supply

A
  • Left atrium
  • Posterior aspect of left ventricle
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15
Q

Where does LAD supply

A
  • Anterior aspect of left ventricle
  • Anterior aspect of septum
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16
Q

S+S of MI

A
  • Central crushing chest pain
  • Pain to jaws or amrs
  • N+V
  • Sweating
  • Doom
  • SOB and palpitations
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17
Q

STEMI ECG changes

A
  • ST segment elevation
  • New LBBB
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18
Q

NSTEMI ECG changes

A
  • ST depression
  • T wave inversion
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19
Q

Ix for MI

A
  • ECG
  • Troponin
  • Baseline bloods
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20
Q

Initial Mx for MI/ACS

A

MONA/PAIN
- Perform ECG
- Morphine
- Oxygen if sats <94
- Nitrate
- Aspirin 300mg

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21
Q

What to do if suspect ACS in last 72 hrs?

A
  • Refer to hospital for same day assessment
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22
Q

Mx STEMI

A
  • Within 120 minutes = PCI. Prasugrel (clopi of on ac) and aspirin
  • > 120 minutes = thrombolysis
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23
Q

Secondary prevention STEMI

A

ACAB
- Acei
- Clopidogrel
- Aspirin and statin
- BB

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24
Q

NSTEMI mx

A

BATMAN
- Base decision about angio and PCI on GRACE score
- Aspirin 300mg stat
- Ticagrelor 180mg stat dose
- Morphine
- Antithrombin therapy = fondaparinux
- Nitrate

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25
Q

When is angina stable?

A

Sx on exertion and relieved by GTN

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26
Q

When is angina unstable?

A
  • Sx at rest = UA is ACS and needs immediate Mx
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27
Q

Gold standard Ix for angina?

A

CT coronary angiography

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28
Q

Mx angina

A
  • Immediate relief = GTN spray
  • Longterm relief = BB and CCB (verapamil if alone, nifedipine if with BB)
  • Prevention = aspirin, astorvostatin, Acei
  • PCI or CABG if worse
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29
Q

Angina classes

A
  • 1 = angina with strenuous
  • 2 = angina during ordinary
  • 3 = angina with low levels
  • 4 = at rest or any level
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30
Q

Patho of pericarditis

A
  • Inflammation of the pericardium
  • Effusion due to inflammation response
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31
Q

Pericarditis S+S

A

-Sharp central chest pain, better sitting forward
- Pleuritic
- Low grade fever
- Pericardial friction rub

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32
Q

pericarditis Ix

A
  • Raised inflammatory markers
  • ECG = saddle shaped ST elevation and PR depression
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33
Q

Pericarditis Mx

A
  • Sedentary until resolution
  • NSAIDs
  • Colchicine for prophylaxis
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34
Q

What is ejection fraction

A
  • % of blood in LV squeezed out with each ventricular contraction
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35
Q

What is HF woth reduced EF

A
  • WHen the EF is <50%
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36
Q

HF with preserved EF

A
  • clinical features of HF but EF >50%
  • this is the result of diastolic dysfunction , where there is an issue with LV filling in diastole
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37
Q

S+S HF

A
  • SOB
  • Cough with pink sputum
  • Orthopnoea
  • PND
  • Peripheral oedema
  • Fatigue
  • 3rd HS, murmurs, crackles, raised JVP
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38
Q

Ix HF

A
  • BNP = >100 HF, >2000 refur urgent, 400-2000 = 6WW
  • ECG
  • Echo
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39
Q

NYHA HF classes

A

1 = no limitation
2 = comfortable rest, ordinary activity sx
3 = rest good but sx on any activity
4 = sx at rest

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40
Q

HF Mx

A

ABAL
- Acei
- BB
- Aldosterone antagonist
- Loop diuretics

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41
Q

what classes as HTN

A
  • > 140/90 clinical
  • > 135/85 at home
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42
Q

NICE recommendations for new HTN

A
  • Urine albumin creatinine ratio
  • Dipstick urine
  • Bloods
  • Fundus exam
  • ECG
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43
Q

Hypertensive emergency mx

A
  • Fundoscopy
  • IV labetalol, GTN, nicardipine
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44
Q

Aortic stenosis patho

A

endocardial injury initiates and inflammatory response leading to calcium deposition on the valve
- narrow aortic valve = restricts blood flow from LV to aorta

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45
Q

Aortic Stenosis murmur

A
  • Ejection systolic
  • crescendo-decrescendo
  • radiates to carotids
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46
Q

AS signs

A
  • thrill
  • slow rising pulse
  • narrow pulse pressure
  • exertional syncope
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47
Q

AS mx

A
  • unstable = medical therapy of balloon valvuloplasty
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48
Q

Aortic regurgitation patho

A

incompetent aortic valve = blood flows back from aorta to LV

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49
Q

AR murmur and signs

A
  • early diastolic soft murmur
  • austin flint = diastolic rumbling at apex
  • thrill, collapsing pulse, wide pp
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50
Q

mitral stenosis patho

A

narrowed mitral valve restricting blood from from LA to LV

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51
Q

MS murmur and signs

A
  • mid diastolic, low pitched rumbling murmur
  • tapping apex beat, malar flush
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52
Q

mitral stenosis commonly causes

A

atrial fibrillation

53
Q

mitral regurgitation patho

A

incompetent mitral valve = blood flow from LV to LA in systole

54
Q

MR murmur and signs v

A
  • pan systolic high pitched whistling
    -radiates to left axilla
  • thrill, HF
55
Q

Infective endocarditis patho

A
  • Infection of endothelium = inner heart surface
56
Q

Infective endocarditis RF

A
  • IVDU
  • Structural heart patho
  • CKD
  • Immunocompromised
  • IE Hx
  • Valve replaced
57
Q

S+S IE

A
  • Fever and new murmur = IE until proven otherwise
  • fever, fatigue, night sweats
  • splinter haem, petechiae, janeway lesions, oslers nodes, roth spots
58
Q

IE Ix

A
  • Blood cultures before abx
  • 3 cultures by 6 hrs 3 sites
  • Echocardiography
  • Dukes = 1 maj 3 min or 5 minor
59
Q

Major dukes criteria

A
  • Persitently +ve cultures
  • Imaging findings
60
Q

Minor dukes criteria

A
  • Predisposition
  • fever >38
  • Vascular phenomena
  • Immunological phenomena
  • Microbiological phenomena
61
Q

Mx IE

A
  • IV broad abx e.g. amoxicillin and optional gent
  • 4 weeks or 6 weeks if prosthetic valves
62
Q

Most common cause IE

A
  • Staph aureus
63
Q

AF definition

A
  • Electrical activity in atria becomes disorganised
64
Q

AF patho

A
  • Chaotic electrical activity overrides SAN activity = passes through the ventricles nd causes irregulary irregular ventricular contraction
65
Q

AF S+S

A
  • tachy
  • irreg irreg pulse
  • HF
  • SOB, dizzy
66
Q

AF Ix

A
  • ECG = no p waves,narrow QRS
  • Echo
67
Q

AF Mx

A
  • Rate control = BB 1st line, CCB2nd
  • Rhythm control = cardioversion
  • DOAC for anticoagulation
68
Q

ORBIT score

A
  • Older age >75
  • Renal impairment = GFR<60
  • Bleeding hx
  • Iron = low
  • Taking antiplatelets
69
Q

What is SVT

A
  • Abnormal electrical signals from above the ventricles cause tachy
70
Q

SVT patho

A
  • Electrical signal re-enters atria from ventricles
  • Self-perpetuating electrical loop = narow complex tachy
71
Q

SVT ECG

A
  • P waves often buried in the T waves
  • Regular rhythm
72
Q

WPW def and ECG

A
  • Extra electrical pathway connecting atria and ventricles
  • SHort PR , wide QRS, delta
73
Q

Acute mx SVT

A

1 = vagal manouvers
2 = adenosine = 6,12,18
3 = verapamil or BB
4 = cardioversion

74
Q

what are the shockble rhythms

A
  • ventricular tachycardia
  • ventricular fibrillation
75
Q

Atrial flutter

A
  • re-entrant rhythm = round atrium without interruption
  • 2:1 conduction
  • sawtooth appearance
76
Q

Prolonged QT

A
  • represents prolonged repolarisation
  • medications = antipsychotics, citalopram, flecainide, amiodarone, macrolides
  • HypoK,Mg and ca
77
Q

Torsades

A
  • Height of qrs gets prog smaller then larger
78
Q

1st degree heart block

A
  • delayed conduction through AV node
  • PR >0.2s
  • long PR complexes = she does pick up just taking longer
79
Q

Mobitz type 1

A
  • 2nd degree HB
  • conduction through AVN takes longer until fails and resets
  • Increasing PR until P not followed by QRS
  • she takes longer and longer to answer then wont pick up
80
Q

Mobitz type 2

A
  • intermittent failure of conduction through AVN
  • set ratio of P waves to QRS complexes
  • no pr lengthening
81
Q

3rd degree HB

A
  • complete HB
  • no relationship between P and QRS
82
Q

Aortic dissection definition

A
  • tear in aorta allowing blood to flow between layers
  • enters intima and media of aorta and false lumen formed
83
Q

AD RF

A
  • HTN
  • PAD
  • conditions that affect aorta
84
Q

AD S+S

A
  • Ripping tearing chest pain
  • anterior chest or back
    -HTN
  • difference in BP between arms
  • Radial pulse deficit
  • Diastolic murmur
  • Abo pain
  • Collapse
85
Q

AD Ix

A
  • ECG = ST depression
  • CXR
  • CT angiogram
  • MRI angiogram
86
Q

AD Mx

A
  • surgical emergency
  • Fluid resus, inotropes, noradrenaline
  • analgesia
  • BB
  • Surgery
87
Q

Hypertrophic obstructive cardiomyopathy

A
  • LV becomes hypertrophic
  • = Blood flow can block out of left ventricle
  • Autosomal dominant
88
Q

Findings for HOCM

A
  • ES murmur
  • 4th HS
  • thrill
89
Q

Mx HCOM

A
  • BB
  • surgery
  • septal ablation
90
Q

VTE prophylaxis

A
  • LMWH = aparins
  • Stockings
91
Q

Ix DVT

A
  • Wells
  • D Dimer
  • Doppler USS
  • CTPA = PE
92
Q

DVT Mx

A
  • treatment dose apixaban or rivaroxaban immediate if sspected
93
Q

How long anticoagulation for in DVT?

A
  • Reversible cause = 3 months
  • Unclear cause = >3m
  • active cancer = 3-6m
94
Q

Peripheral arterial disease definition

A
  • Narrowing of arteries supplying limbs
  • Claudication
95
Q

PAD main symptoms

A
  • Claudication intermittent
96
Q

Features of acute limb ischaemia

A
  • Pain
  • Pallor
  • Pulseless
  • Paralysis
  • Paraesthesia
  • Perishing cold
97
Q

PAD Ix

A
  • ABPI
  • Duplex USS
  • Angiography
98
Q

Claudication mx

A

= Lifestyle changes
- Exercise training
- Statin, clopidogrel, naftidrofuryl oxalate

99
Q

AAA definition

A
  • Dilation of abdominal aorta >3cm
100
Q

AAA screening

A
  • Men = USS at age 65
  • Yearly scan if 3-4.4cm
  • 3M if 4.5-5.4cm
101
Q

Px AAA

A
  • Non specific abdo pain
  • Pulsatile and expansile mass in abdomen
102
Q

Ix AAA

A
  • USS
  • CT angiogram
103
Q

AAA Mx

A
  • Treat reversible RF
  • Surgical repair
  • > 6cm inform DVLA and stop driving if 6.5
104
Q

Ruptured AAA S+S

A
  • severe abdo pain radiating to back
  • Haemodynamic instability
  • Pulsatile mass
  • Collapse, LOC
105
Q

pericardial effusion

A
  • potential space of pericardial cavity fills with fluid
  • Inward pressure on heart = difficult to expand during diastole
106
Q

Pericardial tamponade definition

A
  • effusion large enough to raise intra-pericardial pressure
  • reduced filling of heart during diastole
  • emergency
107
Q

S+S effusion

A
  • Queit heart sounds
  • Pulsus paradoxus
  • Hypotension
  • Raised JVP
  • Fever
  • Pericardial rub
108
Q

Cause of arterial ulcers

A
  • Insufficient blood supply to the skin due to PAD
109
Q

Cause of venous ulcers

A
  • pooling of blood and waste products in the skin secondary to venous insufficiency
110
Q

Features of arterial ulcers

A
  • Distal = toes or dorsum of foot
  • Absetn pulses, pallor, intermittent claud
  • smaller and deeper than venous
  • well defined borders, punched out
  • pale and less likely to bleed
  • painful
  • worse at night
111
Q

venous ulcers

A
  • occur between top of foot and bottom of calf
  • Chronic venous changes
  • After minor injury
  • Larger and more superficial
  • Irregular borders
  • Less painful, more bleeding
112
Q

Mx arterial ulcers

A
  • Surgical revascularisation
  • treat underlying arterial disease
113
Q

Mx venous ulcers

A
  • tissue viability
  • cleaning, debridement and dressing
  • Compression therapy
114
Q

myocarditis

A
  • inflammation of middle muscular layer of heart
  • differential for chest pain
  • infection can cause
115
Q

Becks Triad

A

Seen in tamponade
- Hypotension
- Raised JVP
- Muffled heart sounds

116
Q

what drug if 49 yo black african male with T2DM HTN

A

losartan
- ARB over ACEi for african/carribean origin

117
Q

Anteroseptal MI ECG and artery

A
  • V1 - V4
  • LAD
118
Q

Inferior MI ECG and artery

A
  • II, III, aVF
  • Right coronary
119
Q

Anterolateral MI

A
  • V1 - 6, I, aVL
  • LAD proximal
120
Q

Lateral MI

A
  • I, aVL +/- V5-6
  • Left circumflex
121
Q

Posterior MI

A
  • V1-3
  • Left circumflex
122
Q

Mx if shocked and bradycardia

A
  • atropine 500mcg IV up to 3mg
  • isoprenaline or adrenaline
  • Transcutaneous pacing
  • transvenous pacing
123
Q

shockable arrest rhythms

A
  • ventricular fibrillation
  • pulseless ventricular tachycardia
124
Q

non shockable rhythms

A
  • asystole
  • pulseless electrical activity
125
Q

mitral stenosis causes

A

left atrial hypertrophy
- because muscle has to try harder to push against stenotic valve

126
Q

aortic stenosis causes

A

left ventricular hypertrophy

127
Q

mitral regurg causes

A

left atrial dilatation
- because leaky valve allows blood flow back into chamber = stretches the muscle

128
Q

aortic regurg causes

A

left ventricular dilatation

FINALS (31 decks)

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