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CP3 > cardio > Flashcards

cardio Flashcards

1
Q

Contraindications of ACE inhibitors?

What condition is ACE inhibs good for?

A
  1. renal aa stenosis, hyperkalaemia, pregnancy, severe aortic stenosis, severe AKI
  2. diabetic nephropathy
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2
Q

Side effect of B blockers

A

bronchospasm, cold hands, fatigue, low blood pressure, masking hypos in DM

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3
Q

What ABG findings do you get in pulmonary oedema

A

Initially type 1 RF due to hyperventilation

Later type 2 RF due to impaired gas exchange

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4
Q

Causes of pulmonary oedema

A

Fluid overload
LVF/ valve disease/cardiomyopathy
ARDS (infection, DIC, toxins)
Hypoalbuminaemia

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5
Q

What is the management of acute heart failure causing pulmonary oedema

A 
Sit the patient upright
100% O2
IV diamorphine
IV furusomide 40-80mg
GTN puffs or buccal

If not improving

  • Nitrate IV if >100sbp
  • SBP <100 cardiogenic shock and ?ICU
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6
Q

Causes of ARDS

A

Direct inhalation: smoke, drowning, aspiration

Indirect: sepsis, pancreatitis, transfusion reactions, anaphylaxis

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7
Q

MI in which artery corresponds to this STEMI pattern:

  1. I, avL, V5, V6
  2. V1-4
  3. II, III and avF
A
  1. = Circumflex
  2. = LAD
  3. = right coronary artery
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8
Q

Why is identifying VSD/ ASD early crucial

A

Once Eisenmengers syndrome in place cant do structural reversal surgery on heart.

Only treatment is heart and lung transplant

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9
Q

Symptoms if infective endocarditis

A
  • Fever, new murmur
  • Malaise, lethargy, anorexia
  • Haematuria, splenomegaly
  • Oslers nodes, Janeway, Clubbing, Splinter, digital infarcts
  • Roth spots
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10
Q

What investigations would you do for infective endocarditis?

A
  • FBC, U+E, CRP
  • 3 cultures 3 diff types
  • Urinalysis
  • ECG
  • CXR
  • Transthoracic echo
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11
Q

What is DUKES criteria for endocarditis

A

MAJOR:
+ve cultures (2), endocardial involvement on echo
MINOR:
predisposition (valve disease, congenital defects), fever >38, vascular/immunological signs, culture/ echo not good enough for major,

Need 2 maj OR 1 minor + 3 minor

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12
Q

What signs are indicative of infective endocarditis on echo

A
  • New regurgitation
  • Vegetations
  • Abscess
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13
Q

Causes of bradycardia

A
  • b blockers
  • prev MI
  • OD
  • medications
  • endocrine e.g. hypothyroid
  • hypoxia
  • hypothermia
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14
Q

Name causes of an inverted T wave

A
  • BBB
  • MI
  • PE
  • raised ICP
  • normal in children!!!
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15
Q

What are the causes of AF

A
  • hypertension
  • valvular heart disease
  • CCF
  • IHD
  • PE
  • thyrotoxicosis
  • excess alcohol intake
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16
Q

Post MI compliations

A

ACUTE

  • Acute HF: cardiogenic shock or pulmonary oedema
  • Chorda tendon rupture > MR
  • VSD > ejection systolic rupture
  • Ventricle rupture
  • Pericarditis
  • Cardiac arrest

LONG TERM

  • CCF
  • Dresslers syndrome
  • Arrthymias: VF/ bradycardias
  • Ventricular aneurysm
17
Q

What is CHADsVASC

A 
CHF 1 point 
Hypertension 1 point 
Age >75 2 points 65-74 1 point
Dm 1 point
Stroke/ VTE prev 2 points
Vascular disease e.g. peripheral aa or angina 1 point
Sex female 1 point
18
Q

what is HASBLED

A 
Hypertension
1
Abnormal liver function
1
Abnormal renal function
1
Stroke
1
Bleeding
1
Labile INRs
1
Elderly (Age >65)
1
Drugs
1
Alcohol
Alcohol use ≥ 8u / week	
1
19
Q

Difference between 3rd and 4th heart sounds? Name the causes

A

3rd after S1 - ventricles fill to fast.
- CHF, post MI, mitral regurg, VSD

4th before S1 - ventricle walls stiff.
- LVH

20
Q

WHat causes torsade de pointes

how do you treat it?

A

Low magnesium, low potassium. common in alcoholics or malnurished

2mg Mg IV

21
Q

Describe the treatment of IHD - angina

A
  1. GTN
  2. Lifestyle modification
  3. Statins
  4. Aspirin
  5. BP control if high e.g. ACE
  6. B blocker OR calcium channel blocker (not verapamil and b blocker)

Last line > Nicurandil or Ivabradine

22
Q

Describe the treatment of heart failure

A
  1. Lifestyle
  2. Patient education
  3. ACE inhibitors + Beta blocker
  4. If cough switch to ARTI
    If kidney failure hydralazine + nitrite
    These are also second line after Ace+B’s
  5. Last line digoxin or ivabradine

NB//

  • Diuretic for symptomatic relief (thiazide if elderly or mild, loop if acute or severe) if fluid overload
  • Influenza and pneumococcal vaccine
23
Q

What are the three main causes of heart failure?

Name other causes

A

IHD, cardiomyopathy, hypertension

Other causes: valvular disease, Cor pulmonale, alcohol, anaemia, AF

24
Q

Describe the pathophysiology of heart failure

A
  1. Decreased output
  2. RAAS stimulated
    - increasing volume and pre load (good), increasing vasoconstriction and afterload (bad, increases blood pressure and cardiac work)
  3. SNS stimulated > causes myocyte apoptosis and necrosis (desensitisation to SNS, contract less efficiently)
  4. ANP released by heart - antags RAAS
25
Q

What makes up starlings law

A

Preload, afterload and myocardial contractility

26
Q

Features of ARDS

A
  • History of relevant injury
  • Increasing SOB
  • Cyanosis, increased resp rate, tachycardia
  • Bilateral fine inspiratory crackles
27
Q

What is the New York heart associated classification for heart failure

A
  1. No activity limitation
  2. SOB during normal activity
  3. SOB during minimal activity
  4. SOB at rest
28
Q

What investigations would you do for a patient with suspected heart failure?

A 
FBC, LFT, U+E, cardiac enzymes in acute failure
BNP
CXR
ECG
Echo (eject fract <45% diagnostic)
29
Q

What are the signs + symptoms of:

  1. left heart failure
  2. right heart failure
A
  1. Symptoms: exertional SOB, paroxysmal SOB, orthopnea, cough
    Signs: Bilateral course crackles, displaced apex beat, 3rd heart sound + gallop rhythm if tachycardic
  2. S+ Signs: JVP, hepatomegaly, peripheral oedema, sacral oedema, ascites

Common to both: fatigue

30
Q

Describe why the following first line medications are given in these diseases:

  1. CHF
  2. IHD
A
  1. ACE inhib, stop RAAS. B blocker, chill SNS

2. Ca channel and B blockers slow the heart rate allowing longer diastole, increasing coronary flow

31
Q

Which cardiac meds shouldnt be used in heart block?

A

Ca channel blockers, b blockers, digoxin

32
Q

What are the symptoms of digoxin toxicity

A

visual disturbances, nausea, anorexia, diarrhoea

33
Q

What are the complications of infective endocarditis

A

glomerulonephritis, CCF, valvular incompetence, systemic emboli

34
Q

What are the long term medications post ACS

A
  • B blocker
  • Clopidogrel one year
  • Aspirin for like 75mg
  • Statin
  • ACE

RF mod
Isosorbide mononitrate if angina

CP3 (6 decks)

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