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CCs > Cardio > Flashcards

Cardio Flashcards

1
Q

What conditions make up Acute Coronary Syndrome?

A

NSTEMI
STEMI
Unstable angina

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2
Q

What investigation helps determine whether an event is an NSTEMI or unstable angina?

A

Bloods - troponin: will be positive in NSTEMI (after 12 hours)

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3
Q

What can exist permanently on an ECG following a STEMI?

A

Pathological q waves

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4
Q

What can exist for weeks to months on an ECG following a STEMI?

A

T wave inversion

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5
Q

What may be present on an ECG within hours of MI onset?

A

Tall T waves
ST elevation
New LBBB

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6
Q

Who is at risk of silent MIs?

A

Diabetics

Elderly people

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7
Q

Classic MI presentation?

A

Acute central crushing chest pain for more than 20 minutes. With:

  • SOB
  • Nausea
  • Sweating/clammy
  • Palpitations
  • Grey in colour
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8
Q

Treatment of a STEMI?

A 
Morphine 
Oxygen 
Nitrates 
Aspirin
Clopidogrel/ Tricagrelor
LMWH

Refer for primary percutaneous coronary intervention: PCI

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9
Q

When should a primary PCI be performed?

A

In a STEMI within 12 hours if there is ongoing ischaemia.

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10
Q

What is the initial management of an NSTEMI?

A
  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin
  • Clopidogrel/Tricagrelor
  • LMWH
  • Refer
  • ACEi, Statin, beta blocker
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11
Q

What can be seen on a CXR in an MI?

A
  • Cardiomegaly

- Pulmonary oedema

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12
Q

What can cause AF?

A
  • Heart failure
  • Ischaemia & MI
  • Hypertension
  • HypERthyroidism
  • Caffeine/alcohol
  • Low potassium & magnesium
  • PE
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13
Q

What symptoms can occur due to AF?

A

None.
Chest pain & palpitations
Short of breath
Syncope/light headed

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14
Q

How is AF managed in an acute setting if the patient is unwell and haemodynamically unstable?

A

Emergency cardioversion with amiodarone.
Beta blocker to control ventricular rate
LMWH
Oxygen

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15
Q

What is the criteria for cardioversion in chronic AF?

A
  1. New onset with reversible cause
  2. Worsened heart failure/ heart failure caused by AF
  3. Atrial flutter
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16
Q

What is the general treatment for AF?

A

Rate control with a Beta blocker
Rhythm control if within criteria
Anticoagulation with warfarin/DOAC

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17
Q

In AF is there just one additional focus stimulating contraction, or multiple? When might the other option be the case?

A

AF - multifoci

Atrial flutter - single focus

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18
Q

Where does the chest pain radiate to in angina?

A

Arms, neck, jaw and teeth

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19
Q

What associated symptoms can occur in angina?

A

Sweating
Nausea
SOB
Fainting

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20
Q

What type of angina is induced by exertion and relieved by rest?

A

Stable

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21
Q

What type of angina increases in frequency and severity, and has a greater MI risk?

A

Unstable/crescendo

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22
Q

What type of angina is induced by lying flat?

A

Decubitus

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23
Q

What drugs are involved in the management of angina?

A 
GTN spray 
Aspirin
Statin 
Beta blocker 
Calcium channel blocker
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24
Q

What is the definition of hypertension?

A

Systolic above 140, diastolic above 90

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25
Q

What is the first line treatment for hypertension in an over 55 year old/ afrocarribean?

A

Calcium channel blocker

26
Q

If combining an ACEi and calcium channel blocker is ineffective, what is the next step?

A

Add a thiazide diuretic

27
Q

What further investigations should be carried out if someone has high blood pressure?

A

24 hour BP monitor
Fasting blood glucose
Cholesterol

28
Q

In what type of heart failure in there a loss of output due to reduced contraction?

A

Systolic

29
Q

In what type of heart failure is there an increasing filling pressure due to an inability to relax?

A

Diastolic

30
Q

What signs would you expect to find in someone with left ventricular heart failure?

A
  • Pulmonary oedema & peripheral
  • Tachycardia (compensates for reduced output)
  • Galloping 3rd heart sound +/- murmur
  • Displaced apex beat
  • Raised JVP
  • Wheeze
31
Q

What are reduced exercise tolerance orthopnoea, PND, nocturnal cough +/- pink frothy sputum all symptoms of?

A

Left ventricular heart failure

32
Q

What is the blood marker of heart failure?

A

BNP

B type Natriuretic Peptide

33
Q

How is heart failure managed with medication?

A

Diuretic - furosemide
ACEi/ARB
Beta Blocker
Vasodilator: isosorbide diNITRATE

34
Q

What lifestyle factor changes can improve heart failure symptoms?

A

Reduced salt, smoking & alcohol

Exercise

35
Q

What can cause right ventricular failure?

A

LVF
Pulmonary stenosis
Lung disease

36
Q

Why can the heart pumping less efficiently cause fluid build up?

A

Causes the kidneys to go into retention

37
Q

What is considered to be major criteria in the diagnosis of congestive cardiac failure?
(2 Major or 1 Major & 2 Minor)

A

MAJOR:

  • PND
  • S3 Gallop
  • Increased central venous pressure
  • > 4.5kg/5 days weight loss
  • > 50% cardio/thoracic ratio
  • Acute pulmonary oedema
  • Crepitations
  • Neck vein distension
  • Hepatojugular reflex
38
Q

What is considered to be minor criteria in the diagnosis of congestive cardiac failure (2 minor + 1 major)

A
  • Bilateral ankle oedema
  • Dyspnoea on exertion
  • Tachycardia
  • Nocturnal cough
  • Hepatomegaly
  • Pleural effusion
  • Vital capacity reduced by 1/3
39
Q

What type of murmur would be heard in mitral stenosis?

A

Loud S1 with rumbling mid-diastolic murmur

40
Q

What type of murmur would be heard in mitral regurg?

A

Pansystolic murmur at apex, radiating to axilla

41
Q

What type of murmur would be heard in mitral valve prolapse?

A

Mid systolic click +/- late systolic murmur

42
Q

What is the classic triad for aortic stenosis?

A

Angina
Syncope
Heart failure

43
Q

What type of murmur would be heard in aortic stenosis?

A

Ejection systolic murmur - may radiate to the carotids

44
Q

Why does aortic sclerosis occur?

A

Old age - degeneration

45
Q

What time of murmur would be heard in aortic sclerosis?

A

Also ejection systolic - with no carotid radiation

46
Q

What does a collapsing water hammer pulse suggest?

A

Aortic regurg

47
Q

What murmur would be heard in aortic regurg?

A

High pitched early diastolic.

Sat forwards on expiration.

48
Q

What presentation needs to have infective endocarditis excluded as a cause?

A

Fever & New murmur

49
Q

What bugs can cause infective endocarditis?

A

S.Aureus

Strep viridans

50
Q

What are the features of infective endocarditis?

A 
Fever 
Roth spots
Oslers nodes
Murmur 
Janeway lesions 
Anaemia 
Nail splinter haemorrhages/clubbing 
Emboli 
Splenomegaly
51
Q

What is the criteria called for diagnosis of infective endocarditis?

A

Duke’s criteria

52
Q

What is Duke’s criteria?

A

MAJOR

  • positive blood cultures
  • positive echo of endocardial involvement

MINOR

  • Predisposition
  • Fever above 38
  • Vascular/immunological signs
53
Q

What investigations are required if infective endocarditis is suspected?

A

3 blood cultures from different sites at peak of fever
Blood tests: normochromic normocytic anaemia, neutrophilia
ECG - prolonged PR
ECHO
Urine dip

54
Q

What antibiotics are given if there is infective endocarditis in a patient with their own valves?

A

Amoxicillin and gentamicin

55
Q

What antibiotics are given if there is a prosthetic valve?

A

Vancomycin, gentamicin and rifampicin

56
Q

When might surgery be considered in infective endocarditis?

A
  • Heart failure
  • valve obstruction
  • repeated emboli
  • fungal
  • persistent bacteraemia
  • abscess
57
Q

What are the risk factors for infective endocarditis?

A
  • Valve disease
  • Coarctation
  • PDA/VSD
  • IV drug use (tricuspid)
  • Prosthetic valve
  • Wound post op
  • Diabetes
  • Renal failure
  • Dermatitis
58
Q

What is the definition of postural hypotension?

A

Drop in 20 systolic / 10 diastolic after standing for 3 mins

59
Q

What drugs can cause postural hypotension?

A
  • Nitrates (advised to rest for 15 mins after)
  • Diuretics
  • Anti-hypertensives
  • Anti-psychotics
  • Alpha blockers
60
Q

What conditions can cause postural hypotension?

A
  • Hypovolaemia
  • Addison’s
  • Hypopituitarism reducing ACTH
  • Diabetic autonomic neuropathy
61
Q

What is advised to those suffering with postural hypotension?

A
  • Stand slowly
  • Increased water
  • Falls clinic
  • Cross legs, sqautting
  • Eat little and often: reducing carbs and alcohol
  • Prop self in bed - increases renin secretion
  • Sympathomimetics
  • Fludrocortisone to retain fluid

CCs (12 decks)

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