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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
When is angina stable?
Sx on exertion and relieved by GTN
26
When is angina unstable?
- Sx at rest = UA is ACS and needs immediate Mx
27
Gold standard Ix for angina?
CT coronary angiography
28
Mx angina
- 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
29
Angina classes
- 1 = angina with strenuous - 2 = angina during ordinary - 3 = angina with low levels - 4 = at rest or any level
30
Patho of pericarditis
- Inflammation of the pericardium - Effusion due to inflammation response
31
Pericarditis S+S
-Sharp central chest pain, better sitting forward - Pleuritic - Low grade fever - Pericardial friction rub
32
pericarditis Ix
- Raised inflammatory markers - ECG = saddle shaped ST elevation and PR depression
33
Pericarditis Mx
- Sedentary until resolution - NSAIDs - Colchicine for prophylaxis
34
What is ejection fraction
- % of blood in LV squeezed out with each ventricular contraction
35
What is HF woth reduced EF
- WHen the EF is <50%
36
HF with preserved EF
- clinical features of HF but EF >50% - this is the result of diastolic dysfunction , where there is an issue with LV filling in diastole
37
S+S HF
- SOB - Cough with pink sputum - Orthopnoea - PND - Peripheral oedema - Fatigue - 3rd HS, murmurs, crackles, raised JVP
38
Ix HF
- BNP = >100 HF, >2000 refur urgent, 400-2000 = 6WW - ECG - Echo
39
NYHA HF classes
1 = no limitation 2 = comfortable rest, ordinary activity sx 3 = rest good but sx on any activity 4 = sx at rest
40
HF Mx
ABAL - Acei - BB - Aldosterone antagonist - Loop diuretics
41
what classes as HTN
- >140/90 clinical - >135/85 at home
42
NICE recommendations for new HTN
- Urine albumin creatinine ratio - Dipstick urine - Bloods - Fundus exam - ECG
43
Hypertensive emergency mx
- Fundoscopy - IV labetalol, GTN, nicardipine
44
Aortic stenosis patho
endocardial injury initiates and inflammatory response leading to calcium deposition on the valve - narrow aortic valve = restricts blood flow from LV to aorta
45
Aortic Stenosis murmur
- Ejection systolic - crescendo-decrescendo - radiates to carotids
46
AS signs
- thrill - slow rising pulse - narrow pulse pressure - exertional syncope
47
AS mx
- unstable = medical therapy of balloon valvuloplasty
48
Aortic regurgitation patho
incompetent aortic valve = blood flows back from aorta to LV
49
AR murmur and signs
- early diastolic soft murmur - austin flint = diastolic rumbling at apex - thrill, collapsing pulse, wide pp
50
mitral stenosis patho
narrowed mitral valve restricting blood from from LA to LV
51
MS murmur and signs
- mid diastolic, low pitched rumbling murmur - tapping apex beat, malar flush
52
mitral stenosis commonly causes
atrial fibrillation
53
mitral regurgitation patho
incompetent mitral valve = blood flow from LV to LA in systole
54
MR murmur and signs v
- pan systolic high pitched whistling -radiates to left axilla - thrill, HF
55
Infective endocarditis patho
- Infection of endothelium = inner heart surface
56
Infective endocarditis RF
- IVDU - Structural heart patho - CKD - Immunocompromised - IE Hx - Valve replaced
57
S+S IE
- Fever and new murmur = IE until proven otherwise - fever, fatigue, night sweats - splinter haem, petechiae, janeway lesions, oslers nodes, roth spots
58
IE Ix
- Blood cultures before abx - 3 cultures by 6 hrs 3 sites - Echocardiography - Dukes = 1 maj 3 min or 5 minor
59
Major dukes criteria
- Persitently +ve cultures - Imaging findings
60
Minor dukes criteria
- Predisposition - fever >38 - Vascular phenomena - Immunological phenomena - Microbiological phenomena
61
Mx IE
- IV broad abx e.g. amoxicillin and optional gent - 4 weeks or 6 weeks if prosthetic valves
62
Most common cause IE
- Staph aureus
63
AF definition
- Electrical activity in atria becomes disorganised
64
AF patho
- Chaotic electrical activity overrides SAN activity = passes through the ventricles nd causes irregulary irregular ventricular contraction
65
AF S+S
- tachy - irreg irreg pulse - HF - SOB, dizzy
66
AF Ix
- ECG = no p waves,narrow QRS - Echo
67
AF Mx
- Rate control = BB 1st line, CCB2nd - Rhythm control = cardioversion - DOAC for anticoagulation
68
ORBIT score
- Older age >75 - Renal impairment = GFR<60 - Bleeding hx - Iron = low - Taking antiplatelets
69
What is SVT
- Abnormal electrical signals from above the ventricles cause tachy
70
SVT patho
- Electrical signal re-enters atria from ventricles - Self-perpetuating electrical loop = narow complex tachy
71
SVT ECG
- P waves often buried in the T waves - Regular rhythm
72
WPW def and ECG
- Extra electrical pathway connecting atria and ventricles - SHort PR , wide QRS, delta
73
Acute mx SVT
1 = vagal manouvers 2 = adenosine = 6,12,18 3 = verapamil or BB 4 = cardioversion
74
what are the shockble rhythms
- ventricular tachycardia - ventricular fibrillation
75
Atrial flutter
- re-entrant rhythm = round atrium without interruption - 2:1 conduction - sawtooth appearance
76
Prolonged QT
- represents prolonged repolarisation - medications = antipsychotics, citalopram, flecainide, amiodarone, macrolides - HypoK,Mg and ca
77
Torsades
- Height of qrs gets prog smaller then larger
78
1st degree heart block
- delayed conduction through AV node - PR >0.2s - long PR complexes = she does pick up just taking longer
79
Mobitz type 1
- 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
Mobitz type 2
- intermittent failure of conduction through AVN - set ratio of P waves to QRS complexes - no pr lengthening
81
3rd degree HB
- complete HB - no relationship between P and QRS
82
Aortic dissection definition
- tear in aorta allowing blood to flow between layers - enters intima and media of aorta and false lumen formed
83
AD RF
- HTN - PAD - conditions that affect aorta
84
AD S+S
- Ripping tearing chest pain - anterior chest or back -HTN - difference in BP between arms - Radial pulse deficit - Diastolic murmur - Abo pain - Collapse
85
AD Ix
- ECG = ST depression - CXR - CT angiogram - MRI angiogram
86
AD Mx
- surgical emergency - Fluid resus, inotropes, noradrenaline - analgesia - BB - Surgery
87
Hypertrophic obstructive cardiomyopathy
- LV becomes hypertrophic - = Blood flow can block out of left ventricle - Autosomal dominant
88
Findings for HOCM
- ES murmur - 4th HS - thrill
89
Mx HCOM
- BB - surgery - septal ablation
90
VTE prophylaxis
- LMWH = aparins - Stockings
91
Ix DVT
- Wells - D Dimer - Doppler USS - CTPA = PE
92
DVT Mx
- treatment dose apixaban or rivaroxaban immediate if sspected
93
How long anticoagulation for in DVT?
- Reversible cause = 3 months - Unclear cause = >3m - active cancer = 3-6m
94
Peripheral arterial disease definition
- Narrowing of arteries supplying limbs - Claudication
95
PAD main symptoms
- Claudication intermittent
96
Features of acute limb ischaemia
- Pain - Pallor - Pulseless - Paralysis - Paraesthesia - Perishing cold
97
PAD Ix
- ABPI - Duplex USS - Angiography
98
Claudication mx
= Lifestyle changes - Exercise training - Statin, clopidogrel, naftidrofuryl oxalate
99
AAA definition
- Dilation of abdominal aorta >3cm
100
AAA screening
- Men = USS at age 65 - Yearly scan if 3-4.4cm - 3M if 4.5-5.4cm
101
Px AAA
- Non specific abdo pain - Pulsatile and expansile mass in abdomen
102
Ix AAA
- USS - CT angiogram
103
AAA Mx
- Treat reversible RF - Surgical repair - >6cm inform DVLA and stop driving if 6.5
104
Ruptured AAA S+S
- severe abdo pain radiating to back - Haemodynamic instability - Pulsatile mass - Collapse, LOC
105
pericardial effusion
- potential space of pericardial cavity fills with fluid - Inward pressure on heart = difficult to expand during diastole
106
Pericardial tamponade definition
- effusion large enough to raise intra-pericardial pressure - reduced filling of heart during diastole - emergency
107
S+S effusion
- Queit heart sounds - Pulsus paradoxus - Hypotension - Raised JVP - Fever - Pericardial rub
108
Cause of arterial ulcers
- Insufficient blood supply to the skin due to PAD
109
Cause of venous ulcers
- pooling of blood and waste products in the skin secondary to venous insufficiency
110
Features of arterial ulcers
- 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
venous ulcers
- 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
Mx arterial ulcers
- Surgical revascularisation - treat underlying arterial disease
113
Mx venous ulcers
- tissue viability - cleaning, debridement and dressing - Compression therapy
114
myocarditis
- inflammation of middle muscular layer of heart - differential for chest pain - infection can cause
115
Becks Triad
Seen in tamponade - Hypotension - Raised JVP - Muffled heart sounds
116
what drug if 49 yo black african male with T2DM HTN
losartan - ARB over ACEi for african/carribean origin
117
Anteroseptal MI ECG and artery
- V1 - V4 - LAD
118
Inferior MI ECG and artery
- II, III, aVF - Right coronary
119
Anterolateral MI
- V1 - 6, I, aVL - LAD proximal
120
Lateral MI
- I, aVL +/- V5-6 - Left circumflex
121
Posterior MI
- V1-3 - Left circumflex
122
Mx if shocked and bradycardia
- atropine 500mcg IV up to 3mg - isoprenaline or adrenaline - Transcutaneous pacing - transvenous pacing
123
shockable arrest rhythms
- ventricular fibrillation - pulseless ventricular tachycardia
124
non shockable rhythms
- asystole - pulseless electrical activity
125
mitral stenosis causes
left atrial hypertrophy - because muscle has to try harder to push against stenotic valve
126
aortic stenosis causes
left ventricular hypertrophy
127
mitral regurg causes
left atrial dilatation - because leaky valve allows blood flow back into chamber = stretches the muscle
128
aortic regurg causes
left ventricular dilatation

FINALS (32 decks)

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