Cardio Flashcards
Unstable Angina characteristics?
ST Depression
T-wave inversion
Constricting Pain @ rest of increasing frequency and severity
What will the ST be and what will the exercise test will be on a patient with Prinzmetal’s angina?
ST elevation
(-)tive stress test
Other
Pain when they go to bed
Cardiac Biomarkers may be elevated since vasospasm can lead to myocardial dmg
List the actions of nifedipinde and amlodipine? and its SE?
^peripheral vasodilation (reflex tachy!)
^coronary dilation
Acts on VSMC
SE: Ankle swelling Hypotension Reflex Tachycardia - Palpitations Headache Constipation
Answer T or F to the following: Is GTN effective at reducing.. 1) Chest pain? 2) Oesophageal Spasm? 3) Skeletal Muscle Pain? 4) Pleuritic Pain?
1) T
2) T
3) F
4) F
A 60yo woman presents post inferior coronary artery MI with pan-systolic murmur, SOB, ankle swelling, elevated JVP, tachycardia, 6th ICS mid-axillary line apex beat, crackles on lung auscultation.
What is wrong with her?
Posteromedial papillary muscle rupture causing mitral regurgitation (which can be heard by the pansystolic murmurs). Her mitral regurgitaiton has caused pulmonary odema - crackles, SOB, and she needs urgent surgery (vasodilating agents to reduce afterload + positive inotropes (to correct hypotension) should be used to stabilize her until then)
Post MI you can get rupture of papillary muscles. Inferior MI –> posteromedial, Anterolateral = anterolaterl papillary muscles. If you rupture all papillary muscle you are fucked, since there is wide open MR
What is decompensated cardiac failure?
A chronically failing heart may decompensate -> it is basically sudden worsening of symptoms of HF
Symptoms of pericarditis? and complications (2)?
Sharp pain
Worse when supine + inspiration
felt retrosternally
releaved by sitting forwards
Complications
Tamponade
Restrictive pericarditis
Other
Inflammation in pericarditis is either due to direct viral attack or the subsequent inflammatory reaction
Bloods may suggest raised inflammatory biomarkers
RFs of pericarditis?
RFs prior viral infection post MI male uraemia & autoimmune diseases such as SLE & RA neoplasm (local tumor invasion)
Which is more the more urgent of the two aortic dissection types?
What is diagnostic of aortic dissection (hallmark)?
What will the CXR show in an ascending aorta dissection?
- Type A - requires emergency surgery (involves ascending aorta)
Type B - can be managed later if there is no abdominal organ ischaemia (involves abdominal aorta) - BP difference between arms is a hallmark
- Widened mediastinum
Symptoms of PE?
Pleuritic chest pain
cough ± haemoptysis
SOB
filling lightheaded/dizzy
RFs for a PE?
Pregnancy (strong RF) long haul flight recent surgery obesity thrombophilia (e.g. factor V Leiden) prolonged bed rest oral contraceptive pill
What is an acute coronary syndrome?
An ACS consists of myocardial ischamia caused by an STEMI, NSTEMI, unstable angina.
STEMI is a medical emergency and requires percutaneous coronary intervention or thrombolytics.
NSTEMI or UA do not benefit from this
ECG and blood biomarkers (e.g. troponing) are useful in confirming the diagnosis
What is costochondritis?
How does it present?
1st line of treatment?
inflammation of costal cartilage.
Anterior wall chest pain made worse by movements and deep inspiration.
Pain worse when palpating 2nd to 5th costochondral ribs.
1st line of treatment are NSAIDs.
Distinguish between RVF and LVF?
RVF: causes backwards logging of blood which leads to congestion + systemic oedema, ascites, hepatomegaly + nutmeg liver.
±Nocturia
LVF causes pulmonary congestion so respiratory symptoms including: SOB, orthopnea, PND (ask how many pillows they sleep in), crackles due to p. oedema
Is chest pain a necessary symptom for an MI?
No - people can have silent MIs. Silent MIs are more common in those with DM due to neuropathy.
