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Mod A > Cardio > Flashcards

Cardio Flashcards

1
Q

ACS Causes

A

plaque rupture, thrombus, inflammation

emboli, coronary spasm, vasculitis

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2
Q

ACS Risk Factors

A

age, F, FH of IHD

smoking, DM, obesity, sedentary lifestyle, hypertension, hyperlipidaemia

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3
Q

ACS S+S

A

acute central chest pain >20min, palpitations, syncope, dyspnoea, nausea, sweatiness

pallor, anxiety, weakness, change in BP and HR
signs of heart failure: inc JVP, basal creps
added heart sounds
pansystolic murmur
low grade fever
peripheral oedema, pericardial friction rub

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4
Q

ACS Ix

A

Troponin
ECG
CXR
Echo

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5
Q

Causes of Raised Trop

A

ACS, pericarditis, myocarditis, ventricular strain, tachyarrhythmias

PE, SAH, burns, sepsis, renal failure

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6
Q

ACS Rx

A

Drugs:
chest pain = GTN, morphine
antiplatelets = apsirin + clopidogrel >12m
anticoag = fondaparinux until discharge
beta-blocker or Ca blocker = bisoprolol, diltiazem, verapamil
ACE-I for LV dysfunction, DM, hypertension
statin

PCI:

  • STEMI and high risk NSTEMI = immediate/<24hr
  • intermediate NSTEMI = angiography <3d
  • if multi vessel disease = CABG

Tests:
echo to assess LV function

Modify RFs

  • diet high in oily fish, fruit, veg, high in fibre low in sat. fats
  • no smoking, more exercise, less stress
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7
Q

Aortic Disesction S+S

A 
sudden, tearing chest pain, radiation to back
radio-radio delay
aortic valve incompetence
inferior MI
cardiac arrest

carotids: hemiplegia
anterior spinal artery: paraplegia
renal artery: anuria
acute limb ischaemia

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8
Q

Aortic Dissection Rx

A 
crossmatch 10U blood
ECG
CXR
CT or TOE
ITU

Hypotensives: keep systolic 100mg
short half life beta blockers: labetalol
Ca channel blockers

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9
Q

Arrhythmias Causes

A

IHD, dilatation from regurg, cardiomyopathy, pericarditis, myocarditis, aberrant conduction

caffeine, smoking, alcohol, pneumonia, phaeo
drugs: beta 2 agonists, digoxin, L-dopa, tricyclics
metabolic imbalance: K, Mg, Ca, hypoxia, hypercapnia, acidosis, thyroid

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10
Q

Arrhythmias S+S

A

chest pain, palpitations, syncope, hypotension, pulmonary oedema

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11
Q

When to give ICD

A

ventricular arrhythmias post-MI or congenital arrhythmia

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12
Q

Sudden cardiac death causes

A

WPW
LQTS = channelopathies, prolonged repolarisation, predisposes torsades pointes
ARVC = epsilon wave, T inversion, broad QRS in ant.
Brugada = Na channelopathy, coved ST elevation in ant/, precipitated by fever, meds, electrolyte imbalances, ischaemia

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13
Q

Sick sinus syndrome

A

SAN fibrosis in elderly

sinus bradycardia + tachyarrhythmias: AF, supraventricular tachy

Rx:
thromboembolism prophylaxis if AF
pacemaker
rate slowing meds

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14
Q

Causes of AF

A

heart failure, hypertension, IHD, mitral valve disease
PE, pneumonia, hyperthyroidism
dec K, dec Mg
caffeine, alcohol, post-op

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15
Q

AF S+S

A

chest pain, dyspnoea, palpitations, faintness

irregularly irregular pulse
signs of LVH

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16
Q

AF signs on echo

A

L atrial enlargement, mitral valve disease, poor LV function

17
Q

Acute AF Rx

A

adverse signs present: ABCDE, DC cardioversion, amiodarone

if AF started <48hr ago: rate and rhythm control
= DC cardiovert, flecainide, amiodarone + heparin

if AF started >48hr: rate control = bisoprolol or diltiazem
- to rhythm control, must be anticoagulated for >3wks first

18
Q

Chronic AF Rx

A

Rate Control and Anticoagulate
(rhythm control only if symptomatic, CCF, younger, [resenting for 1st time with lone AF, persisting AF from treated cause)

Rate control
- 1st: Beta-blocker or rate limiting Ca channel blocker
- If fail, add digoxin
- If fail, add amiodarone
- Digoxin as monotherapy only in sedentary patients
- DO Not give beta-blockers with verapamil
- Aim HR<90bpm at rest and 200-age bpm on exertion
Rhythm control
- Elective DC cardioversion
○ Do echo first to check for intracardiac thrombi
○ If inc risk of cardioversion failure (past failure or recurrence) give amiodarone for 4wks before procedure and 12m after
- Elective pharmacological cardioversion
○ Flecainide
- Refractory cases: AVN ablation with pacing, pulmonary vein ablation, maze procedure

Paroxysmal AF (infrequent AF, BP>100mmHg systolic, no past LV dysfunction)

- Pill in pocket: sotalol or flecainide PRN
- Anticoagulate
- Ablation if symptomatic or frequent episodes
19
Q

AF Anticoagulation

A

Heparin
DOAC or warfarin if high risk of emboli/long term
CHA2DS20VASc score = assess embolic stroke risk

20
Q

CHA2DS20VASc score

A

Assesses risk of embolic stroke

Congestive cardiac failure (1)
Hypertension (1)
Age 65-74 (1)
Age >74 (2)
DM (1)
Previous stroke/TIA/thromboembolism (2)
Vascular disease (1)
Sex (1 if F)
	- Anticoagulate if score >0 in M, >1 in F
21
Q

HAS-BLED score

A

Assesses risk of anticoagulation

1 point for each:
	Labile INR
	Age >65
	Meds that predispose bleeding (NSAIDs, antiplatelets)
	Alcohol abuse
	Uncontrolled hypertension
	Hs of major bleeding
	Renal disease
	Liver disease
	Stroke history
22
Q

Risk Factors for IE

A 
○ Past IE or rheumatic fever
○ IVDU
○ Damaged or replaced valve
○ PPM or ICD
○ Structural congenital heart disease (but not simple ASD, fully repaired VSD, patent ductus)
○ Hypertrophic cardiomyopathy
23
Q

Causes IE

A
  • Acute = normal valves, may present with acute heart failure + emboli
    ○ Commonest: Staph aureus
    ○ RFs: skin breaches (dermatitis, IV lines, wounds), renal failure, immunosuppression, DM
  • Subacute = abnormal valves
    ○ RFs: aortic and mitral valve disease, tricuspid valves in IV drug users, coarctation, patent ductus arteriosus, VSD, prosthetic valves
    ○ Prosthetic valves endocarditis may be early (within 60d of surgery, usually Staph epidermis, poor prognosis) or late

Bacteria

  • Strep viridans (subacute)
  • Staph aureus
  • Strep bovis (need colonoscopy, tumour likely portal of entry)
  • Enterococci
  • Coxiella burnetti
  • Rare: HACEK Gram -ve - (Haemophilus, Actinobacillus, Cardiobacerium, Eikenella, Kingella), diphtheroids, chlamydia
Fungi
- Candida, aspergillus, histoplasma
- Usually IV drug abusers, immunocompromised, prosthetic valves
- Need surgical management
Other
- SLE = Libman-Sacks endocarditis
- Malignancy
24
Q

IE S+S

A
  • Septic signs: fever, rigors, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing
  • Cardiac lesions: new murmur, change in pre-existing murmur
    ○ vegetations can cause valve destruction, severe regurgitation, valve obstruction
    ○ Aortic root abscess causes prolonged PR interval, can cause AV block
    ○ LVF common cause of death
  • Immune complex deposition: vasculitis, microscopic haematuria, glomerulonephritis, AKI, Roth spots (boat shaped retinal haemorrhage with pale centre), splinter haemorrhages, Osler’s nodes
  • Embolic: emboli causing abscesses in any organ, Janeway lesions
25
Q

IE Duke’s Criteria

A

2 major OR 1 major and 3 minor OR 5 minor

Major:
Positive blood culture
- typical organism in 2 cultures
- 3 positive cultures >12hr apart
- positive for Coxiella
Endocardium
- positive ECHO: abscess, vegetations, pseudoaneurysm, dehiscence of prosthetic
- abnormal activity around prosthetic on PET/CT
- paravalvular lesions on CT

Minor

  • fever >38
  • predisposition
  • vascular phenomena
  • immunological phenomena
  • positive blood culture that does not meet major
26
Q

IE Rx

A

Blind native or prosthetic >1y = ampicillin, flucloxacillin, gentamicin
Blind prosthetic = vancomycin, gentamicin, rifampicin

Staph native = flucloxacillin
Staph prosthetic = flucloxacillin, rifampicin, gentamicin

Strep = benzylpenicillin +/- gentamicin

Enterococci = amoxicillin, gentamicin

HACEK = ceftriaxone

Candida = amphotericin
Aspergillus = voriconazole

Mod A (5 decks)

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