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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
What is the first line treatment for hypertension in an over 55 year old/ afrocarribean?
Calcium channel blocker
26
If combining an ACEi and calcium channel blocker is ineffective, what is the next step?
Add a thiazide diuretic
27
What further investigations should be carried out if someone has high blood pressure?
24 hour BP monitor Fasting blood glucose Cholesterol
28
In what type of heart failure in there a loss of output due to reduced contraction?
Systolic
29
In what type of heart failure is there an increasing filling pressure due to an inability to relax?
Diastolic
30
What signs would you expect to find in someone with left ventricular heart failure?
- Pulmonary oedema & peripheral - Tachycardia (compensates for reduced output) - Galloping 3rd heart sound +/- murmur - Displaced apex beat - Raised JVP - Wheeze
31
What are reduced exercise tolerance orthopnoea, PND, nocturnal cough +/- pink frothy sputum all symptoms of?
Left ventricular heart failure
32
What is the blood marker of heart failure?
BNP | B type Natriuretic Peptide
33
How is heart failure managed with medication?
Diuretic - furosemide ACEi/ARB Beta Blocker Vasodilator: isosorbide diNITRATE
34
What lifestyle factor changes can improve heart failure symptoms?
Reduced salt, smoking & alcohol | Exercise
35
What can cause right ventricular failure?
LVF Pulmonary stenosis Lung disease
36
Why can the heart pumping less efficiently cause fluid build up?
Causes the kidneys to go into retention
37
What is considered to be major criteria in the diagnosis of congestive cardiac failure? (2 Major or 1 Major & 2 Minor)
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
What is considered to be minor criteria in the diagnosis of congestive cardiac failure (2 minor + 1 major)
- Bilateral ankle oedema - Dyspnoea on exertion - Tachycardia - Nocturnal cough - Hepatomegaly - Pleural effusion - Vital capacity reduced by 1/3
39
What type of murmur would be heard in mitral stenosis?
Loud S1 with rumbling mid-diastolic murmur
40
What type of murmur would be heard in mitral regurg?
Pansystolic murmur at apex, radiating to axilla
41
What type of murmur would be heard in mitral valve prolapse?
Mid systolic click +/- late systolic murmur
42
What is the classic triad for aortic stenosis?
Angina Syncope Heart failure
43
What type of murmur would be heard in aortic stenosis?
Ejection systolic murmur - may radiate to the carotids
44
Why does aortic sclerosis occur?
Old age - degeneration
45
What time of murmur would be heard in aortic sclerosis?
Also ejection systolic - with no carotid radiation
46
What does a collapsing water hammer pulse suggest?
Aortic regurg
47
What murmur would be heard in aortic regurg?
High pitched early diastolic. | Sat forwards on expiration.
48
What presentation needs to have infective endocarditis excluded as a cause?
Fever & New murmur
49
What bugs can cause infective endocarditis?
S.Aureus | Strep viridans
50
What are the features of infective endocarditis?
``` Fever Roth spots Oslers nodes Murmur Janeway lesions Anaemia Nail splinter haemorrhages/clubbing Emboli Splenomegaly ```
51
What is the criteria called for diagnosis of infective endocarditis?
Duke's criteria
52
What is Duke's criteria?
MAJOR - positive blood cultures - positive echo of endocardial involvement MINOR - Predisposition - Fever above 38 - Vascular/immunological signs
53
What investigations are required if infective endocarditis is suspected?
3 blood cultures from different sites at peak of fever Blood tests: normochromic normocytic anaemia, neutrophilia ECG - prolonged PR ECHO Urine dip
54
What antibiotics are given if there is infective endocarditis in a patient with their own valves?
Amoxicillin and gentamicin
55
What antibiotics are given if there is a prosthetic valve?
Vancomycin, gentamicin and rifampicin
56
When might surgery be considered in infective endocarditis?
- Heart failure - valve obstruction - repeated emboli - fungal - persistent bacteraemia - abscess
57
What are the risk factors for infective endocarditis?
- Valve disease - Coarctation - PDA/VSD - IV drug use (tricuspid) - Prosthetic valve - Wound post op - Diabetes - Renal failure - Dermatitis
58
What is the definition of postural hypotension?
Drop in 20 systolic / 10 diastolic after standing for 3 mins
59
What drugs can cause postural hypotension?
- Nitrates (advised to rest for 15 mins after) - Diuretics - Anti-hypertensives - Anti-psychotics - Alpha blockers
60
What conditions can cause postural hypotension?
- Hypovolaemia - Addison's - Hypopituitarism reducing ACTH - Diabetic autonomic neuropathy
61
What is advised to those suffering with postural hypotension?
- 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

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