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2B - GRIND > Cardio > Flashcards

Cardio Flashcards

1
Q

Sx of shock?

A

Pallor, cold peripheries, tachycardia, slow capillary refill, tachypnoea, hypotension and oliguria

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2
Q

Name the different types of shock?

A 
Hypovolaemic shock (bleeding/fluid loss)
Cardiogenic shock (ACS, arrhythmias)
Septic shock (infection)
Anaphylactic shock (allergy)
Neurogenic (spinal cord injury)
Endocrine failure (Addison's or hypothyroidism)
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3
Q

What casues sepsis?

A

Infection with any organism can cause acute vasodilation from inflammatory cytokines. Gram negative bacteria produce endotoxins which can casue a sudden spetic shock without signs of infection (fever or raised WCC)

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4
Q

Sx of sepsis?

A 
Shiver/fever/very cold
Extreme pain/discomfort
Pale/discoloured skin
Sleepy/difficult to rouse/confused
"I feel like I might die"
Short of breath
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5
Q

Tx of sepsis?

A

Sepsis 6 - complete within 1 hour

Administer oxygen, Take blood cultures, Give IV antibiotics, Give IV fluids, Check serial lactate, Measure urine output

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6
Q

What type of hypersensitivity reaction is anaphylaxis?

A

Type I (IgE mediated). Occurs in response to allergens

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7
Q

Sx of anaphylaxis?

A

Itching, sweating, D&V, erythema, urticaria, oedema, wheeze, cyanosis, tachycardia and hypotension

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8
Q

What is the primary treatment of anaphylaxis?

A

IM adrenaline 0.5mg (i.e. 0.5ml of 1:1000). Repeate every 5 mins if needed

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9
Q

Sx of peripheral arterial disease?

A

Cramping pain in the calf, thigh or buttock after walking a certain distance that is relieved by rest = intermittent claudication
This can develop into critical ischaemia = ulceration, gangrene and foot pain at rest (e.g. at night relieved by hanging the leg over the bed)

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10
Q

What would you find on examination for PAD?

A

Absent femoral, popliteal or foot pulses, cold white legs, atrophic (thin) skin, hairless, punched out ulcers and postural dependant colour change

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11
Q

Sx of acute ischaemia?

A

Pale, Pulseless, Painful, Paralysed, Paraesthetic and Perishingly cold limb

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12
Q

How can you asssess critical ischaemia?

A

Buerger’s test. Lie the patient flat and elevate both legs to 45 degrees and hold for 1-2 mins (pallor of the feet indicates ischaemia). Ask pt. to sit up and swing their legs over the bed - observe the time it takes for them to go pink red (Buerger’s time and indicated disease severity)

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13
Q

Tx of PAD?

A

Antihypertensives, statins, clopidogrel (reduce CV risk), exercise programmes, vasoactive drugs or surgical revascularisation. Amputation in extreme disease

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14
Q

How can you measure the severity of PAD?

A

Buerger’s angle (angle at which feet become pale) and time (time which feet take to get their colour back).
ABPI - 0.5-0.9 = PAD, <0.5 = critical ischaemia
Do a colour duplex US!

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15
Q

Sx of ruptured AAA?

A

Severe abdominal pain radiating to the back, collapse, expansile abdominal mass and shock.
If it ruptures anteriorly in the peritoneal cavity patient will die within minutes

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16
Q

When should you treat AAA?

A

When it is >5.5cm, if it is rapidly growing or if it is symptomatic (causing back pain)

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17
Q

Sx of aortic dissection?

A

Type A = in the ascending aorta. Type B = tears in the descending aorta.
Will cause sudden tearing chest pain which radiates to the back, unequal arm pulses

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18
Q

Sx of varicose veins?

A

Patients most often present complaining of ugly legs.

There may also be pain, cramping, tingling, restless leg, oedema, eczema and ulcers

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19
Q

How do you check for SFJ valve incompetence?

A

Place a finger on the SFJ and a finger on the end of a varicose vein. Tap the SFJ - if you feel a percussion wave in the varicose vein the valve is incompetent.

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20
Q

How does AF show on ECG?

How does atrial flutter show on ECG?

A

Tachycardic, irregularly irregular QRS complex and no P waves
Tachycardic with a sawtooth pattern

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21
Q

Briefly describe how heart block appears on ECG?

A

ALL HAVE PROLOGED PR INTERVAL
1st degree = prolonged PRi but 1:1 conduction (P:QRS)
2nd degree: MT1 = PRi becomes increasingly prolonged until a QRS wave is dropped
MT2 = PRi is constant but a QRS wave is dropped at a regular rate
3rd degree = P and QRS waves have no relation - complete heart block (patient will be very bradycardic)

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22
Q

What are the alternative names for the 2nd degree heart blocks?

A

Type 1 = Wenckebach phenomenom

Type 2 = Hay phenomeneom

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23
Q

When might you see ST elevation?

A

STEMI, acute pericarditis (saddle shaped)

24
Q

When might you see ST depression?

A

NSTEMI, angina

25
When might you see T wave inversion?
NSTEMI, V1-V3 = RBBB, V4-V6 = LBBB and sometimes in hypokalaemia (may just be small)
26
What are the ECG changes seen in hypercalcaemia/hypocalacemia?
``` Hyper = short QT interval Hypo = long QT interval and small T waves ```
27
What are the ECG changes seen in hyperkalaemia?
Tall tented T waves, wide QRS wave, absent P waves
28
What is the significance of QRS width? (<0.12 or >0.12 secs)
``` Narrow = ventricles are being depolarized by the normal pathway e.g. AF or atrial flutter Wide = ventricular depolarization is slowed e.g. VF, VT, BBB ```
29
Sx of coarctation of the aorta?
Radiofemoral delay, weak femoral pulses, hypertension, bruits over the scapula and systolic murmur
30
Sx of Atrial septal defect?
Chest pain and palpitations. L-R shunt leads to pulmonary hypertension = dyspnoea, haemoptysis Ostium primum presents in childhood (downs syndrome) - near the AV valve Ostium secundum presents 40-60 as HF
31
Sx of Ventricular septal defect?
Harsh pansystolic murmur, dyspnoea, haemoptysis. | Large holes present as severe HF in infancy
32
What is Eisenmenger's sydnrome?
A complication of ASD/VSD where pulmonary hypertension (due to L-R shunt) causes the shunt to shift (R-L). This leads to cyanosis
33
What is Tetralogy of Fallot?
MOST COMMON CYONOTIC CONGENITAL HD | Ventricular spetal defect, pulmonary stenosis, RV hypertrophy and an overriding aorta
34
Sx and Dx for Tetralogy of Fallot?
Causes cyanosis, dypnoea, palpitations and clubbing. Toddlers will squat RBBB on ECG, boot shaped heart on x-ray
35
How do the 4 main valvular heart diseases sound on auscultation?
Mitral regurg = pansystolic murmur and displaced apex beat Mitral stenosis = rumbling mid-diastolic murmur and a non-displaced apex beat Aortic stenosis = ejection systolic murmur and a non-displaced apex beat Aortic regurg = high pitched early diastolic murmur and a displaced apex beat
36
What are the commonest causes of IE?
Staph. aureus or Strep. viridans
37
Sx of IE?
FROM JANE | Fever, Roth spots, Oslers nodes, Murmur, Janeway lesions, Anaemia, Nail spliter haemorrhages, Emboli
38
Sx of dilated cardiomyopathy?
Fatigue, dyspnoea, pulmonary oedema/ankle swelling, hypotension, tachycardia, displaced apex beat
39
Sx of hypertrophic cardiomyopathy?
Sudden death, angina, dyspnoea, palpitations, syncope, CCF
40
What is the commonest cause of pericarditis? How do you treat?
TB | Rifampicin, isoniazib, pyrazinamide and ethambutol
41
Sx of pericarditis?
Central chest pain which is worse on inspiration/lying flat and relieved by sitting forward. Fever and pericardial friction rub heard on auscultation
42
Dx and Tx for pericarditis?
Pericardial friction rub is heard, ECG = saddle shaped ST elevation and PR depression NSAIDs with PPI, colchicine. Rest until symptoms resolve
43
Sx of pericardial effusion?
Dyspnoea, chest pain, phrenic hiccupps, muffled heart sounds and Ewart's sign (bronchial breathing at the left base)
44
Causes of pericardial effusion?
Pericarditis, myocardial rupture e.g. penetrating stab wound, and aortic dissection
45
Sx of cardiac tamponade?
Tacycardia, hypotension, pulsus paradoxus, kussmauls sign, increased JVP and muffled heart sounds. Becks triad = falling BP, Kussmaul's sign and rising JVP
46
Describe Pulsus Paradoxus and Kussmaul's sign
Pulsus paradoxus = abnormally large decrease in systolic blood pressure on inspiration Kussmaul's sign = abnormally large increase in JVP on inpiration
47
Sx of heart failure?
Fatigue, dyspnoea and oedema = cardinal. LVHF = poor exercise tolerance, orthopnoea, PND, wheeze, nocturnal cough with pink frothy sputum and nocturia RVHF = ascites, nausea, facial engorgement and epistaxis Also hypotension and cyanosis
48
Dx and Tx for HF?
BNP and ECHO | Diuretics, ACEi, Beta-blockers
49
What do you see on x-ray in HF?
ABCDE: Alveolar oedema, keryl B lines, Cardiomegaly, Dilated upper lobe veins, pleural Effusions
50
Describe the NYHA classification of HF?
``` I = Heart disease but no dyspnoea from ordianry activity II = Comfortable at rest, dyspnoea on ordinary activity III = Dyspnoea on light activity - limits acitvity IV = Dyspnoea at rest - all activity causes discomfort ```
51
How can you differentiate between stable and unstable angina?
``` Stable = chest pain and dyspnoea brought on by exercise and relieved by rest Unstable = chest pain and dyspnoea of increasing frequency and severity - occurs at rest ```
52
How does angina appear on ECG?
ST depression, T wave inversion - may appear normal!
53
Tx of angina?
``` GTN spray for acute flare ups. Beta-blocker or CCB, 75mg aspirin, statin, hypertensive treatment Consider revascularisation (PCI with dual anti-platelet therapy of aspirin and clopidogrel or CABG) ```
54
Tx of MI?
MONAC = Morphine, Oxygen, Nitrates (GTN), Aspirin (300mg) and Clopidogrel/Tricagrelor Beta-blockers, Anti-hypertensives, statins. Tirofiban if undergoing PCI or streptokinase if not
55
Dx of STEMI and NSTEMI?
``` Both = raised troponin STEMI = ST elevation, pathological Q waves and new LBBB NSTEMI = ST depression and T wave inversion ```

2B - GRIND (11 decks)

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