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Year 3 CardioResp > Cardio > Flashcards

Cardio Flashcards

1
Q

What is ACS

A

Acute coronary syndrome

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2
Q

What makes up ACS

A
  1. Unstable angina
  2. NSTEMI
  3. STEMI
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3
Q

What are the 2 treatment subcategories of ACS

A

NSTEMI/Unstable angina and STEMI

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4
Q

What does STEMI mean and look like on ECG

A

St elevation myo infarction

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5
Q

What are some clinical signs of ACS (5)

A
  1. CENTRAL CRUSHING CHEST PAIN
  2. SWEATING
  3. LEFT NECK AND ARM PAIN
  4. DYSPNOEA
    5 REDNESS
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6
Q

ATYPICAL presentations of ACS (3)

A

Epigatsric pain
Fatigue
Breathing problems

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7
Q

First line treatment for ALL ACS

A

300mg aspirin
Oxygen if sats less than 94
Morphine if BAD chest pain (contraindicated otherwise)
Nitrates (HYPER TENSIVE NOT HYPO TENSIVE and chest pain)

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8
Q

STEMI tx?

A

ECG and angio and trop
300 mg aspirin
Oxygen/morphine if needed
Nitrates

PCI (if within 12 hours or 120 mins)
Thrombolysis
With antithrombin

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9
Q

NSTEMI tx

A

ECG and if n stem no angio
300 mg aspirin
Nitrates
Oxygen/morpine

Dual antiplatelet - aspirin and unfractioned heparin/fondaparinux

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10
Q

Risk factors for ACS (modifiable)

A

Bad diabetes control
Smoking
HTN
Bad diet
Obesity

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11
Q

risk factors for ACs (NOn modifiable

A

Age (60-70)
Male. (2:1)
Fhx

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12
Q

What class predicts post MI morbidity

A

Killip

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13
Q

What system determines interventions ?

A

GRACE (>3.0 = angio)

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14
Q

Two types of AHF

A

De novo AHF or decompensated AHF (more common)

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15
Q

what is AHF

A

Acute herat failrue

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16
Q

how is AHF treated

A

oxygen, diuretics, vasodilators, opiates and CPAP

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17
Q

how is acute pericarditis caused?

A

viral infection, neoplasm, trauma, TB, HIV, post MI

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18
Q

what acute pericarditis

A

infection of the pericardia sac

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19
Q

what bedside tests are done for pericarditis

A
  1. FBC U&E CRP ESR TROP
  2. ECG
  3. Echo
  4. CHest XR/CT/RI
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20
Q

What does xray/mri/ct show?

A

pleural effusions

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21
Q

what does u&e show for pericarditis?

A

uraemia may be a cause

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22
Q

what is shown on pericarditis ecg?

A

widespread ST elevationa and pr depression

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23
Q

what does echo show on pericarditis patients?

A

effusion

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24
Q

typical signs and symptoms of pericarditis?

A

pericardial rub (squeaky on auscultation)
pleuritic chest pain/retrospinal and radiate to traps

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25
Q

tx for pericarditis

A

nsaids and colchicine

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26
Q

what can relieve pericaridits chest pain?

A

leaning forward/sitting up

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27
Q

What is an aortic dissection

A

Pulling away of endothelial lining creating a fake lumen

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28
Q

What is the classification of aortic dissections?

A

Sanford and Debakey

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29
Q

What is the Sanford classification

A

Classifies aortic dissection into TYpe A and type B

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30
Q

What is Sanford type a?

A

Ascending aorta aortic dissection

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31
Q

What is Sanford type B

A

Descending aorta aortic dissection

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32
Q

What is debakeys classification

A

Aortic dissection classification
Type 1 - 3
Type 1: ascending adn aortic arch
Type 2: arch
3: descending on wards (less serious)

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33
Q

What is management for type a Sanford

A

Surgical repair

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34
Q

What is management for type B Sanford?

A

Conservative management, NSAIDS and colchicine

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35
Q

What is classified as stage 1 hypertension?

A

> 140/90

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36
Q

what is stage 2 hypertension?

A

160/100

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37
Q

What is stage 3 hypertension

A

> 180/120

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38
Q

What should be the ABPM/HBPM be stage 1?

A

> 135/85

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39
Q

What should the HBPM/ABPM be stage 2?

A

150/95

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40
Q

Step 1 HTN Tx?

A

Diabetic type 2 OR <55 = Ace inhibitor OR ARB

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41
Q

Step 1 HTN tx?

A

Pt. >55 OR black = CCB

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42
Q

Step 2 HTN Tx?

A

Already on ACE/ARB (A) + C OR D
- CCB
- thiazide Diuretics

Already on CCB + ACE/ARB OR D

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43
Q

equation for HTN tx?

A

A+C, A+D, C+A, C+D

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44
Q

What drug is contraindicated in black people with HTN

A

ACE inhibitor, preference is CCB

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45
Q

Step 3 HTN Tx?

A

A+C+D

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46
Q

Step 4 HTN Tx?

A

Resistant HTN:
1. Postura hypotension
2. K+ < 4.5 + spironolactone
3. K+ > 4.5 + alpha/beta blocker

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47
Q

What cardiac problem increases risk of stroke?

A

AF

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48
Q

What is a direct thrombin inhibitor??

A

Anticoagulant

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49
Q

Examples of anticoagulant

A

Apixaban

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50
Q

After caused stroke Tx?

A

Warfarin, direct thrombin (apixaban) or factor Xa

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51
Q

Examples of direct thrombin inhibitors?

A

Bivalirudin

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52
Q

Examples of factor Xa inhibitor??

A

Apixiban, rivaroxiban etc

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53
Q

What is a common antiplatelet drug

A

Clopidogrel

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54
Q

When should prasurgrel be used in ACS

A

Prior to PCI, if patietn is NOT on oral anticoagulant

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55
Q

When should Clopidogrel be used over prasugrel?

A

Clopidogrel used if patient is already taking an anticoagulant

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56
Q

When PCI is not possible what tx would you use?

A

Antithrombin (ban) and ticagrelor

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57
Q

What is SVT

A

Supraventricular tachycardia, tachycardia that occurs anywhere but the ventricles

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58
Q

What is seen on the ECG of SVT

A

Narrow complex tachycardias

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59
Q

What management is used for SVT

A

Vagal manoeuvres
IV adenosine
Electrical cardioversion

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60
Q

what are examples of vagal manoeuvres

A

Valsalva manoeuvre
Carotid sinus massage

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61
Q

When is IV adenosine not to be used?

A

Asthmatics

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62
Q

What does LAD stand for and perfume?

A

Left anterior descending - septum and anterior left ventricle

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63
Q

Right coronary arteries perfume what?

A

SAN and AVN

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64
Q

PDA stands for what and perfumes what?

A

Posterior descending artery and posterior left ventricle

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65
Q

Left circumflex supplies what?

A

Left atria and left ventricle

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66
Q

What is atherosclerosis

A

Build up of plaque underneath blood vessel walls causing narrowing or potential occlusion of vessels

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67
Q

What disease can atherosclerosis cause?

A

Stable/unstable angina

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68
Q

What is a key symptom of stbale angina?

A

Chest pain/dyspnoea on exercise

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69
Q

What relieves stable angina?

A

GTN (sublingual spray)

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70
Q

How to investigate someone with potential angina?

A

ABCDE
OBS - HR, BP, RR, SATS
ECG

BLOODS - FBC, U+E,LFT, TFT TROPONIN
CXR
CTPA

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71
Q

What is the baseline treatment for ACS/angina?

A

MONA
- morphine
- oxygen if under 94%
- nitrates if not hypotension
- 300mg aspirin

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72
Q

How does STEMI present on ECG?

A

Hyperacute T wave and ST elevation

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73
Q

What leads does LBBB/RBBB indicate

A

WilliaM MarroW (V1&6)

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74
Q

Changes to leads I + V5,V6 indicate what?

A

Issues with left circumflex artery (lateral issue on heart)

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75
Q

Changes to lead II, III, aVF indicate?

A

Issues to right coronary arteries (inferior)

76
Q

Changes to leads V1,2,3,4 indicate what?

A

Issues in Left Anterior Descending artery (left v and atria), anterior

77
Q

Management of a STEMi with possibility of PCI?

A

Everyone gets 300mg aspirin
If symptoms have lasted less than 12 hours, and, can get a PCI in 120 mins - PCI is done
- praugrel (Clopidogrel if DOAC is already being taken or if at bleeding risk)
- unfractioned hep/ bailout glycoprotein (radial access)

78
Q

Treatment of STEMI without possibility of PCI

A

Thrombolysis/Fibrinolysis
- give antithrombin (tpa/alteplase)
- Offer ECG after fibrinolysis
- ticagrelor and aspirin unless high bleeding risk
- Clopidogrel aspirin if high bleeding risk

79
Q

What should be given first line instead of Clopidogrel if NOT at bleed risk

A

Ticagrelor

80
Q

What antithrombin should be given in thrombolysis/ fibrinolysis

A

Tpa and Alteplase

81
Q

Management of NSTEMI

A

Aspirin 300mg
Fondaparinux
GRACE score (>3%) = PCI
(<3%) = ticagrelor management (Clopidogrel if bleed risk)

82
Q

What is Killip Class?

A

Measure post-MI mortality

83
Q

What does Class 1 Killip mean?

A

No problems

84
Q

What does class 2 Killip mean?

A

Bibasal lung crackles

85
Q

What does Class 3 Killip mean?

A

Pulmonary oedema and elevated JVP

86
Q

What does class 4 Killip mean?

A

Cardiogenic shock

87
Q

Stage 3 HTN?

A

180/ Diastolic >120

88
Q

Stage 2 HTN?

A

160/100 - clinical
HBPM/ABPM - 150/95

89
Q

Stage 1 HTN?

A

140/90 - clinical
135/85 - HBPM/ABPM

90
Q

What are 2 key symptoms of HTN

A

Headaches and visual disturbances/changes - hypertensive retinopathy

91
Q

What are mai causes of hTN

A

Family history?
Renal disease
Renal artery stenosis
Conns syndrome
Phaeochromocytoma

92
Q

HTN with T2DM treatment pathway

A

Ace inhibitor (ARB if black)
Ace + CCB
Ace + CCB + Thiazide diuretic
Ace + CCB + Diuretic + spironolactone/beta

93
Q

HTN treatment without T2DM

A

CCB if (+55 and black)/ARB (if <55)
CCB + Ace/ARb
CCB + Ace/ARB + Diuretic
CCB + aCE/ARB + Diuretic + Spironolactone/beta

94
Q

Investigation for arrhythmias?

A

ECG (lead 2 changes)
Bloods (fbc,LFT,u+e,tft + TROP)
STRUCTURAL ISSUE = toe

95
Q

Examples of arrhythmia?

A

Brady or tachy

96
Q

Types of tachy?

A

Broad or narrow

97
Q

Examples of broad complex tachy?

A

VF VT

98
Q

Examples of narrow complex tachy

A

SVT
- af/ flutter
- sinus tachy

99
Q

What is define as narrow complex tachy

A

QRS <120m/s
SVT (above AV Node)

100
Q

what are symptoms of narrow complex tachy?

A

Chest pain/left arm + neck pain
SOB
palpitations
Pre-syncope

101
Q

What sign is seen in lead 2 for sinus tachy?

A

Upright p wave

102
Q

What sign is seen on ECG for atrial flutter?

A

Sawtooth ECG

103
Q

What is atrial flutter

A

Slow depolarisation due to a single irritable foci Location: RA/tricuspid valve

104
Q

Treatment of atrial flutter?

A

Verapamil or DCC if serious

105
Q

Treatment of sinus tachy

A

Beta blocker +/- CCB

106
Q

What is AF

A

Atrial fibrillation caused by multiple irritable foci

107
Q

What is an ECG sign for AF

A

No p wave

108
Q

Tx for AF

A

Flecanide if no structural problem or amiodarone

109
Q

What is AVRT

A

Atrioventricular re-entry tachy (WPW)

110
Q

What can be seen on ECG with AVRT

A

200-300bpm, ST depression and positive aVR

111
Q

What is the main issue with AVRT

A

Doesn’t allow ventricles to fully fill and gives reduced CO (cardiac output)

112
Q

What is AVNRT

A

Av node Reentry tachy - Reentry pathway in the AV node

113
Q

Management for SVT?

A

Vagal manoeuvres (carotid massage, valsalva)
Adenosine
Verpamil
DCC

114
Q

How does adenosine work??

A

Slows electrical conductivity

115
Q

How does verapamil work?

A

Calcium channel blocker (blocks calcium and thus contractility of the heart and causes blood vessel dilatation)

116
Q

What is broad complex tachy defined as?

A

QRS>120 ms

117
Q

What is VT

A

Ventricular tachycardia
Has 2 subgroups sustained and non-sustained

118
Q

What is non-sustained VT

A

> 3 consecutive episodes that resolve that are <30sec
Re-entry due to ischaemic changes of the heart (usually post-MI)

119
Q

What is sustained ventricular tachycardia

A

Consecutive fitting >30secs
EMERGENCY (iv amiodarone if stable)
DCC needed

120
Q

what is VF

A

Ventricular fibrillation

Uncoordinated quivering of the ventricles

121
Q

Main problem with VF

A

NO CARDIAC OUTPUT

122
Q

What is a shockable rhythm?

A

VF and VT

123
Q

Management of VF

A

2 shocks of defib, 1mg adrenaline, 2 shocks, 1 more defib, 300mg amiodarone

124
Q

What are non0shockable rhythms

A

Pulseless electrical activity or asystole

125
Q

What is prolonged QT interval

A

460ms + in women
440ms + in men

126
Q

What is depolarisation

A

Contraction of ventricles

127
Q

What is repolarisation

A

Recovery period of myocyets (heart muscle)

128
Q

What is the problem with prolonged repolarisation

A

Spontaneous depolarisaions can occur

129
Q

What is an afterdepolarisation

A

Spontaneous depolarisations before full repolarisation is done

130
Q

What is Torsades de pointes

A

Recurrent contractions without proper repolarisation
- subtype of VT

131
Q

What can cause prolonged QT

A

Long QT syndorme (inherited)
Medications such as antipsychotics or sotalol
Hypokalaemia, hypomagnesameia and hypo calcaemia

132
Q

Management of prolonged QT

A

Stop medications causing it
Correct electrolyte disturbances
Beta blockers (NOT SOTALOL)
Pacemaker

133
Q

What is ventricular ectopics?

A

Random skipped beats completely normal in healthy people otherwise seek cardiac specialist help

134
Q

What is a Brady arrhythmia?

A

Sinus HR of <60BPM

135
Q

When is a pacemaker needed in Brady cardia

A

Sinus Brady
Sick sinus syndrome
Junctional escape rhythm s

136
Q

What is sick sinus rhythms

A

Deterioration if SAN

137
Q

What is junctional escape rhythms

A

AVN trying to send impulses, NO P WAVE ON ECG

138
Q

What are the types of Heart Block

A

First degree
Second degree (mobitz 1/wenckebach OR mobitz 2)
Third degree

139
Q

What is first degree heart block

A

Problems conduction post AVN but every atria signal does eventually cause ventricular contraction

140
Q

ECG changes on first degree heart block?

A

PR interval >0.2secs
Every p wave is followed by qrs

141
Q

What is second degree heart blocks

A

Some atrial impulses dont make it past AVN = sometimes not ventricular contraction = no QRS

142
Q

ECG changes on second degree

A

P waves are not always followed by QRS

143
Q

What is mobitz 1/webnkeback when doiscussing ECG

A

Eventual prolongation of pR internal until QRS is eventually dropped
(SAN is getting to AVn but struggling until failure)

144
Q

What is mobitz type 2

A

Random dropped beats due to AVN not contracting 3 p waves (SAN impulses) for every 1 QRS (AVN contraction)

145
Q

tx for second type 2 heart block

A

Pacing as risk of asystole

146
Q

What is 3rd degree heart block

A

Complete heart block - no relationship between p or QRS. Not conducted.

147
Q

What is a main symtpom of chronic heart failure

A

Pulmonary oedema
( backlog of blood in ventricles/atria/pulmonary veins and lugs = more pressure and fluid in the space = pressure of blood filtration into interstitial space = oedema)

148
Q

What is ejection fraction

A

percentage of blood that leaves left ventricle in each contraction

149
Q

What is normal ejection fraction

A

> 50%

150
Q

What is persevered ejection fracture heart failrue

A

Diastole has issues (ventricle isn’t opening up/refilling properly leading issue to space.= more pressure etc)

151
Q

What are the main causes?

A
  • ischaemia
  • valvular disease
  • HTN
  • arrhythmia
  • cardiomyopathy
152
Q

What investigations would you do for heart failure

A

BNP
ECH
Echo (ejection fraction)
Bloods CXR/Lung function

153
Q

what is the New York heart association classification (NYHAC)

A

SEVERITY OF SYMPTOMS

154
Q

What is class 1 NYHAC

A

NO LIMITATION

155
Q

What is class 2 NYHAC

A

Comfortable at rest but symptoms with ordinary activities

156
Q

What is class 3 NYHAC

A

Comfortable at rest but symptomatic with any activity

157
Q

what is class 4 NYHAC

A

Symptomatic at rest

158
Q

Tx for chronic heart failure

A

ABAL

159
Q

what does ABAL mean

A

Ace inhibitor (ramipril) (ARB can be used if not tolerated or valve disease)
Beta blocker (Bisoprolol)
Aldosterone antagonist (spironolactone)
Loop diuretic (furosemide/bumetanide)

160
Q

4 types of valvular disease?

A

Aortic stenosis
Aortic regurg
Mitral stenosis
Mitral regurg

161
Q

What is the most common valvular disease

A

Aortic stenosis

162
Q

What does aortic stenosis stop the heart doing

A

Narrows valve = reduced blood flow from left ventricle to aorta to body

163
Q

What sound does aortic stenosis make

A

Crescendo decrescendo

164
Q

Where does an aortic stenosis murmur radiate

A

Carotids in the neck

165
Q

OSCE tip to emphasise murmur of aortic stenosis

A

Sit forward
Deep breath
Exhale
Hold

166
Q

Usual cause of aortic stenosis

A

Calcification (age related)
Bicuspid aortic valve
Rheumatic disease

167
Q

What is aortic regurg

A

Incompetent aortic valve
Always back flow from aorta (after contraction) back into left ventricle

168
Q

What sound does aortic regurg make

A

Early diastolic (soft) murmur
Decrescendo

169
Q

What is the S1 sound depicting

A

Closure of atrioventricular valve
- tricuspid
- bicuspid

170
Q

What is S2 sound depicting

A

Closure of the semilunar valves
- pulmonary
- aortic

171
Q

What is systole

A

Contraction

172
Q

Austin flint?

A

Murmur heard at apex beat in aortic regurg, rumbling

173
Q

Collapsing pulse is seen in?

A

Aortic rgeurg

174
Q

Causes of aortic regurg

A

Age related weakness
Bicuspid
Connective tissue discords (marfans/ehlers danlos)

175
Q

What is mitral stenosis

A

Narrowing of the bicuspid valve restricting blood flow from left atrium to left ventricle

176
Q

What sound does mitral stenosis give?

A

Mid-diastolic, low pitched rumbling (low blood flow velocity)

177
Q

Other signs of mitral stenosis?

A

Malar flush

178
Q

Causes of mitral stenosis

A

Rheumatic
Infective endocarditis

179
Q

What is mitral regurg

A

Incompetent mitral valve allow back flow from left ventricle to left atrium

180
Q

What complications come from mitral valve regurg

A

Back flow of blood = CHF
Reduced ejection fracture

181
Q

What sounds does the mitral regurg murmur sound like

A

Pansystolic murmur

182
Q

Where does mitral valve regurg radiate

A

Left axilla,

183
Q

Causes of mitral regurg

A

Age
Ischameia
Rheumatic
Connective tissues

184
Q

OSCE tips to hear mitral regurg murmur

A

Lying on left

185
Q

Investigations for valvular disease

A

Echo

Year 3 CardioResp (3 decks)

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