Cardio Flashcards
1
Q
What is ACS
A
Acute coronary syndrome
2
Q
What makes up ACS
A
- Unstable angina
- NSTEMI
- STEMI
3
Q
What are the 2 treatment subcategories of ACS
A
NSTEMI/Unstable angina and STEMI
4
Q
What does STEMI mean and look like on ECG
A
St elevation myo infarction
5
Q
What are some clinical signs of ACS (5)
A
- CENTRAL CRUSHING CHEST PAIN
- SWEATING
- LEFT NECK AND ARM PAIN
- DYSPNOEA
5 REDNESS
6
Q
ATYPICAL presentations of ACS (3)
A
Epigatsric pain
Fatigue
Breathing problems
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)
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
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
10
Q
Risk factors for ACS (modifiable)
A
Bad diabetes control
Smoking
HTN
Bad diet
Obesity
11
Q
risk factors for ACs (NOn modifiable
A
Age (60-70)
Male. (2:1)
Fhx
12
Q
What class predicts post MI morbidity
A
Killip
13
Q
What system determines interventions ?
A
GRACE (>3.0 = angio)
14
Q
Two types of AHF
A
De novo AHF or decompensated AHF (more common)
15
Q
what is AHF
A
Acute herat failrue
16
Q
how is AHF treated
A
oxygen, diuretics, vasodilators, opiates and CPAP
17
Q
how is acute pericarditis caused?
A
viral infection, neoplasm, trauma, TB, HIV, post MI
18
Q
what acute pericarditis
A
infection of the pericardia sac
19
Q
what bedside tests are done for pericarditis
A
- FBC U&E CRP ESR TROP
- ECG
- Echo
- CHest XR/CT/RI
20
Q
What does xray/mri/ct show?
A
pleural effusions
21
Q
what does u&e show for pericarditis?
A
uraemia may be a cause
22
Q
what is shown on pericarditis ecg?
A
widespread ST elevationa and pr depression
23
Q
what does echo show on pericarditis patients?
A
effusion
24
Q
typical signs and symptoms of pericarditis?
A
pericardial rub (squeaky on auscultation)
pleuritic chest pain/retrospinal and radiate to traps
25
tx for pericarditis
nsaids and colchicine
26
what can relieve pericaridits chest pain?
leaning forward/sitting up
27
What is an aortic dissection
Pulling away of endothelial lining creating a fake lumen
28
What is the classification of aortic dissections?
Sanford and Debakey
29
What is the Sanford classification
Classifies aortic dissection into TYpe A and type B
30
What is Sanford type a?
Ascending aorta aortic dissection
31
What is Sanford type B
Descending aorta aortic dissection
32
What is debakeys classification
Aortic dissection classification
Type 1 - 3
Type 1: ascending adn aortic arch
Type 2: arch
3: descending on wards (less serious)
33
What is management for type a Sanford
Surgical repair
34
What is management for type B Sanford?
Conservative management, NSAIDS and colchicine
35
What is classified as stage 1 hypertension?
>140/90
36
what is stage 2 hypertension?
160/100
37
What is stage 3 hypertension
>180/120
38
What should be the ABPM/HBPM be stage 1?
>135/85
39
What should the HBPM/ABPM be stage 2?
150/95
40
Step 1 HTN Tx?
Diabetic type 2 OR <55 = Ace inhibitor OR ARB
41
Step 1 HTN tx?
Pt. >55 OR black = CCB
42
Step 2 HTN Tx?
Already on ACE/ARB (A) + C OR D
- CCB
- thiazide Diuretics
Already on CCB + ACE/ARB OR D
43
equation for HTN tx?
A+C, A+D, C+A, C+D
44
What drug is contraindicated in black people with HTN
ACE inhibitor, preference is CCB
45
Step 3 HTN Tx?
A+C+D
46
Step 4 HTN Tx?
Resistant HTN:
1. Postura hypotension
2. K+ < 4.5 + spironolactone
3. K+ > 4.5 + alpha/beta blocker
47
What cardiac problem increases risk of stroke?
AF
48
What is a direct thrombin inhibitor??
Anticoagulant
49
Examples of anticoagulant
Apixaban
50
After caused stroke Tx?
Warfarin, direct thrombin (apixaban) or factor Xa
51
Examples of direct thrombin inhibitors?
Bivalirudin
52
Examples of factor Xa inhibitor??
Apixiban, rivaroxiban etc
53
What is a common antiplatelet drug
Clopidogrel
54
When should prasurgrel be used in ACS
Prior to PCI, if patietn is NOT on oral anticoagulant
55
When should Clopidogrel be used over prasugrel?
Clopidogrel used if patient is already taking an anticoagulant
56
When PCI is not possible what tx would you use?
Antithrombin (ban) and ticagrelor
57
What is SVT
Supraventricular tachycardia, tachycardia that occurs anywhere but the ventricles
58
What is seen on the ECG of SVT
Narrow complex tachycardias
59
What management is used for SVT
Vagal manoeuvres
IV adenosine
Electrical cardioversion
60
what are examples of vagal manoeuvres
Valsalva manoeuvre
Carotid sinus massage
61
When is IV adenosine not to be used?
Asthmatics
62
What does LAD stand for and perfume?
Left anterior descending - septum and anterior left ventricle
63
Right coronary arteries perfume what?
SAN and AVN
64
PDA stands for what and perfumes what?
Posterior descending artery and posterior left ventricle
65
Left circumflex supplies what?
Left atria and left ventricle
66
What is atherosclerosis
Build up of plaque underneath blood vessel walls causing narrowing or potential occlusion of vessels
67
What disease can atherosclerosis cause?
Stable/unstable angina
68
What is a key symptom of stbale angina?
Chest pain/dyspnoea on exercise
69
What relieves stable angina?
GTN (sublingual spray)
70
How to investigate someone with potential angina?
ABCDE
OBS - HR, BP, RR, SATS
ECG
BLOODS - FBC, U+E,LFT, TFT TROPONIN
CXR
CTPA
71
What is the baseline treatment for ACS/angina?
MONA
- morphine
- oxygen if under 94%
- nitrates if not hypotension
- 300mg aspirin
72
How does STEMI present on ECG?
Hyperacute T wave and ST elevation
73
What leads does LBBB/RBBB indicate
WilliaM MarroW (V1&6)
74
Changes to leads I + V5,V6 indicate what?
Issues with left circumflex artery (lateral issue on heart)
75
Changes to lead II, III, aVF indicate?
Issues to right coronary arteries (inferior)
76
Changes to leads V1,2,3,4 indicate what?
Issues in Left Anterior Descending artery (left v and atria), anterior
77
Management of a STEMi with possibility of PCI?
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
Treatment of STEMI without possibility of PCI
Thrombolysis/Fibrinolysis
- give antithrombin (tpa/alteplase)
- Offer ECG after fibrinolysis
- ticagrelor and aspirin unless high bleeding risk
- Clopidogrel aspirin if high bleeding risk
79
What should be given first line instead of Clopidogrel if NOT at bleed risk
Ticagrelor
80
What antithrombin should be given in thrombolysis/ fibrinolysis
Tpa and Alteplase
81
Management of NSTEMI
Aspirin 300mg
Fondaparinux
GRACE score (>3%) = PCI
(<3%) = ticagrelor management (Clopidogrel if bleed risk)
82
What is Killip Class?
Measure post-MI mortality
83
What does Class 1 Killip mean?
No problems
84
What does class 2 Killip mean?
Bibasal lung crackles
85
What does Class 3 Killip mean?
Pulmonary oedema and elevated JVP
86
What does class 4 Killip mean?
Cardiogenic shock
87
Stage 3 HTN?
180/ Diastolic >120
88
Stage 2 HTN?
160/100 - clinical
HBPM/ABPM - 150/95
89
Stage 1 HTN?
140/90 - clinical
135/85 - HBPM/ABPM
90
What are 2 key symptoms of HTN
Headaches and visual disturbances/changes - hypertensive retinopathy
91
What are mai causes of hTN
Family history?
Renal disease
Renal artery stenosis
Conns syndrome
Phaeochromocytoma
92
HTN with T2DM treatment pathway
Ace inhibitor (ARB if black)
Ace + CCB
Ace + CCB + Thiazide diuretic
Ace + CCB + Diuretic + spironolactone/beta
93
HTN treatment without T2DM
CCB if (+55 and black)/ARB (if <55)
CCB + Ace/ARb
CCB + Ace/ARB + Diuretic
CCB + aCE/ARB + Diuretic + Spironolactone/beta
94
Investigation for arrhythmias?
ECG (lead 2 changes)
Bloods (fbc,LFT,u+e,tft + TROP)
STRUCTURAL ISSUE = toe
95
Examples of arrhythmia?
Brady or tachy
96
Types of tachy?
Broad or narrow
97
Examples of broad complex tachy?
VF VT
98
Examples of narrow complex tachy
SVT
- af/ flutter
- sinus tachy
99
What is define as narrow complex tachy
QRS <120m/s
SVT (above AV Node)
100
what are symptoms of narrow complex tachy?
Chest pain/left arm + neck pain
SOB
palpitations
Pre-syncope
101
What sign is seen in lead 2 for sinus tachy?
Upright p wave
102
What sign is seen on ECG for atrial flutter?
Sawtooth ECG
103
What is atrial flutter
Slow depolarisation due to a single irritable foci Location: RA/tricuspid valve
104
Treatment of atrial flutter?
Verapamil or DCC if serious
105
Treatment of sinus tachy
Beta blocker +/- CCB
106
What is AF
Atrial fibrillation caused by multiple irritable foci
107
What is an ECG sign for AF
No p wave
108
Tx for AF
Flecanide if no structural problem or amiodarone
109
What is AVRT
Atrioventricular re-entry tachy (WPW)
110
What can be seen on ECG with AVRT
200-300bpm, ST depression and positive aVR
111
What is the main issue with AVRT
Doesn’t allow ventricles to fully fill and gives reduced CO (cardiac output)
112
What is AVNRT
Av node Reentry tachy - Reentry pathway in the AV node
113
Management for SVT?
Vagal manoeuvres (carotid massage, valsalva)
Adenosine
Verpamil
DCC
114
How does adenosine work??
Slows electrical conductivity
115
How does verapamil work?
Calcium channel blocker (blocks calcium and thus contractility of the heart and causes blood vessel dilatation)
116
What is broad complex tachy defined as?
QRS>120 ms
117
What is VT
Ventricular tachycardia
Has 2 subgroups sustained and non-sustained
118
What is non-sustained VT
>3 consecutive episodes that resolve that are <30sec
Re-entry due to ischaemic changes of the heart (usually post-MI)
119
What is sustained ventricular tachycardia
Consecutive fitting >30secs
EMERGENCY (iv amiodarone if stable)
DCC needed
120
what is VF
Ventricular fibrillation
Uncoordinated quivering of the ventricles
121
Main problem with VF
NO CARDIAC OUTPUT
122
What is a shockable rhythm?
VF and VT
123
Management of VF
2 shocks of defib, 1mg adrenaline, 2 shocks, 1 more defib, 300mg amiodarone
124
What are non0shockable rhythms
Pulseless electrical activity or asystole
125
What is prolonged QT interval
460ms + in women
440ms + in men
126
What is depolarisation
Contraction of ventricles
127
What is repolarisation
Recovery period of myocyets (heart muscle)
128
What is the problem with prolonged repolarisation
Spontaneous depolarisaions can occur
129
What is an afterdepolarisation
Spontaneous depolarisations before full repolarisation is done
130
What is Torsades de pointes
Recurrent contractions without proper repolarisation
- subtype of VT
131
What can cause prolonged QT
Long QT syndorme (inherited)
Medications such as antipsychotics or sotalol
Hypokalaemia, hypomagnesameia and hypo calcaemia
132
Management of prolonged QT
Stop medications causing it
Correct electrolyte disturbances
Beta blockers (NOT SOTALOL)
Pacemaker
133
What is ventricular ectopics?
Random skipped beats completely normal in healthy people otherwise seek cardiac specialist help
134
What is a Brady arrhythmia?
Sinus HR of <60BPM
135
When is a pacemaker needed in Brady cardia
Sinus Brady
Sick sinus syndrome
Junctional escape rhythm s
136
What is sick sinus rhythms
Deterioration if SAN
137
What is junctional escape rhythms
AVN trying to send impulses, NO P WAVE ON ECG
138
What are the types of Heart Block
First degree
Second degree (mobitz 1/wenckebach OR mobitz 2)
Third degree
139
What is first degree heart block
Problems conduction post AVN but every atria signal does eventually cause ventricular contraction
140
ECG changes on first degree heart block?
PR interval >0.2secs
Every p wave is followed by qrs
141
What is second degree heart blocks
Some atrial impulses dont make it past AVN = sometimes not ventricular contraction = no QRS
142
ECG changes on second degree
P waves are not always followed by QRS
143
What is mobitz 1/webnkeback when doiscussing ECG
Eventual prolongation of pR internal until QRS is eventually dropped
(SAN is getting to AVn but struggling until failure)
144
What is mobitz type 2
Random dropped beats due to AVN not contracting 3 p waves (SAN impulses) for every 1 QRS (AVN contraction)
145
tx for second type 2 heart block
Pacing as risk of asystole
146
What is 3rd degree heart block
Complete heart block - no relationship between p or QRS. Not conducted.
147
What is a main symtpom of chronic heart failure
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
What is ejection fraction
percentage of blood that leaves left ventricle in each contraction
149
What is normal ejection fraction
>50%
150
What is persevered ejection fracture heart failrue
Diastole has issues (ventricle isn’t opening up/refilling properly leading issue to space.= more pressure etc)
151
What are the main causes?
- ischaemia
- valvular disease
- HTN
- arrhythmia
- cardiomyopathy
152
What investigations would you do for heart failure
BNP
ECH
Echo (ejection fraction)
Bloods CXR/Lung function
153
what is the New York heart association classification (NYHAC)
SEVERITY OF SYMPTOMS
154
What is class 1 NYHAC
NO LIMITATION
155
What is class 2 NYHAC
Comfortable at rest but symptoms with ordinary activities
156
What is class 3 NYHAC
Comfortable at rest but symptomatic with any activity
157
what is class 4 NYHAC
Symptomatic at rest
158
Tx for chronic heart failure
ABAL
159
what does ABAL mean
Ace inhibitor (ramipril) (ARB can be used if not tolerated or valve disease)
Beta blocker (Bisoprolol)
Aldosterone antagonist (spironolactone)
Loop diuretic (furosemide/bumetanide)
160
4 types of valvular disease?
Aortic stenosis
Aortic regurg
Mitral stenosis
Mitral regurg
161
What is the most common valvular disease
Aortic stenosis
162
What does aortic stenosis stop the heart doing
Narrows valve = reduced blood flow from left ventricle to aorta to body
163
What sound does aortic stenosis make
Crescendo decrescendo
164
Where does an aortic stenosis murmur radiate
Carotids in the neck
165
OSCE tip to emphasise murmur of aortic stenosis
Sit forward
Deep breath
Exhale
Hold
166
Usual cause of aortic stenosis
Calcification (age related)
Bicuspid aortic valve
Rheumatic disease
167
What is aortic regurg
Incompetent aortic valve
Always back flow from aorta (after contraction) back into left ventricle
168
What sound does aortic regurg make
Early diastolic (soft) murmur
Decrescendo
169
What is the S1 sound depicting
Closure of atrioventricular valve
- tricuspid
- bicuspid
170
What is S2 sound depicting
Closure of the semilunar valves
- pulmonary
- aortic
171
What is systole
Contraction
172
Austin flint?
Murmur heard at apex beat in aortic regurg, rumbling
173
Collapsing pulse is seen in?
Aortic rgeurg
174
Causes of aortic regurg
Age related weakness
Bicuspid
Connective tissue discords (marfans/ehlers danlos)
175
What is mitral stenosis
Narrowing of the bicuspid valve restricting blood flow from left atrium to left ventricle
176
What sound does mitral stenosis give?
Mid-diastolic, low pitched rumbling (low blood flow velocity)
177
Other signs of mitral stenosis?
Malar flush
178
Causes of mitral stenosis
Rheumatic
Infective endocarditis
179
What is mitral regurg
Incompetent mitral valve allow back flow from left ventricle to left atrium
180
What complications come from mitral valve regurg
Back flow of blood = CHF
Reduced ejection fracture
181
What sounds does the mitral regurg murmur sound like
Pansystolic murmur
182
Where does mitral valve regurg radiate
Left axilla,
183
Causes of mitral regurg
Age
Ischameia
Rheumatic
Connective tissues
184
OSCE tips to hear mitral regurg murmur
Lying on left
185
Investigations for valvular disease
Echo
