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YEAR 1 > cardio clinical > Flashcards

cardio clinical Flashcards

1
Q

aortic stenosis AEx

A

age - calcification
congenital - bicuspid
rheumatic HD

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2
Q

aortic stenosis Sx

A

LATE
syncope
angina
SOB

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3
Q

aortic stenosis SGx

A

SEM (aortic point)
radiates to carotids
low volume pulse
forceful displaced apex (LVH)

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4
Q

aortic stenosis Ix

A

CXR
ECG - LVH
echo (key)

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5
Q

aortic stenosis Tx

A

valve replacement (AVR)
(if not tolerated) TAVI -
transcatheter AV implantation (stent)

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6
Q

mitral regurg AEx

A

primary =
prolapse
myxomatous (floppy)
chordae / papillary muscle
rupture
infective endocarditis
rheumatic HD

secondary =
LV dys
cardiomyopathy
post MI

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7
Q

mitral regurg Sx

A

SOB
peripheral oedema
fatigue

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8
Q

mitral regurg SGx

A

pansystolic murmur (apex)
radiates to axilla
displaced apex
HF signs (causes)
AFib

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9
Q

mitral regurg Ix

A

CXR - cardiomegaly
ECG - AFib assoc
echo (key)

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10
Q

mitral regurg Tx

A

diuretics + ACEi (if HF)

OHS - valve repair / replace
clips if not tolerated (infancy etc)

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11
Q

aortic regurg AEx

A

infective endocarditis
rheumatic HD
bicuspid valve
connective tissue disorders (EDs / marfan’s)
aortic root disease (dissection / HTN)

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12
Q

aortic regurg Sx

A

LATE
SOB

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13
Q

aortic regurg SGx

A

early diastolic murmur (erb’s)
collapsing pulse
austin-flint murmur = diastolic rumble at apex
displaced apex

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14
Q

aortic regurg Ix

A

CXR - cardiomegaly
ECG
echo (key)
lean forward + breathe out manoeuvre

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15
Q

aortic regurg Tx

A

treat underlying cause =
ACEi
vasodilators (acute)
B blockers (marfan’s)

if symptomatic / LV threat = valve replacement

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16
Q

mitral stenosis AEx

A

rheumatic HD
age - calcification
congenital (rare)

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17
Q

mitral stenosis Sx

A

SOB
fatigue
palpations (AFib)

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18
Q

mitral stenosis SGx

A

mid-diastolic murmur (apex)
malar flush
tapping apex beat

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19
Q

mitral stenosis Ix

A

CXR - straight left heart border
ECG - AFib
echo (key)
turn to left manoeuvre

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20
Q

mitral stenosis Tx

A

diuretics
treat AFib

valve replacement
(not tolerated) balloon valvuloplasty

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21
Q

IC AEx

A

atherosclerosis

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22
Q

IC Sx

A

pain in calves on exertion
relieved by rest

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23
Q

IC Ix

A

pulses check
ABPI - ankle/brachial
<0.9 = positive
<0.4 = severe

duplex USS
angiography

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24
Q

IC Tx

A

LIFESTYLE
(managing Sx - unlikely)
angioplasty + stent
inflow or outflow bypass
amputation!

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25
Q

CLTI AEx

A

atherosclerosis

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26
Q

CLTI Sx

A

pain at rest / night
ulceration + necrosis
diminished / absent pulses
poor tissue nutrition

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27
Q

CLTI Ix

A

pulses check
ABPI - ankle/brachial
<0.9 = positive
<0.4 = severe

duplex USS
angiography

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28
Q

CLTI Tx

A

LIFESTYLE
(limb threat - more likely)
angioplasty + stent
inflow or outflow bypass
amputation!

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29
Q

DVT AEx

A

virchow’s triad =
hypercoagulable
endothelial injury
stasis

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30
Q

DVT Sx

A

calf Sx
warmth
tenderness
swelling
redness

mild fever

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31
Q

DVT Ix

A

WELLS score gives guidance
D-dimer (rule out test)
doppler USS (diagnostic)

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32
Q

DVT Tx

A

DOAC
LMWH / warfarin 2nd line

treatment length depends on HERDOO2 score
3 month min - 3-6 - life

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33
Q

PE AEx

A

DVT
AFib

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34
Q

PE Sx

A

SOB
pleuritic chest pain
DVT Sx
collapse / death
fever
haemoptysis

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35
Q

PE SGx

A

tachycardia
hypoxia
cyanosis
low BP

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36
Q

PE Ix

A

(WELLS) PE likely = CT pulmonary angiogram

PE unlikely = D-dimer, if positive then CTPA

V/Q scan in renal impairment / contrast allergy
avoiding radiation = above or leg USS

CXR - normal early, wedge infarct late
ECG - sinus tachy, S1Q3T3

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37
Q

PE Tx

A

DOAC
LMWH / warfarin 2nd line

thrombolysis in severe / circ failure

treatment length HERDOO2, 3m min

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38
Q

angina AEx

A

atherosclerosis

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39
Q

angina Sx

A

central / left discomfort
tight / crushing feeling
SOB
exertion - relieved on rest

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40
Q

angina Ix

A

CT coronary angiography

exercise tolerance
myocardial perfusion scan
catheter angiography

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41
Q

angina Tx

A

lifestyle + GTN

long-term -
1. B blocker
(not tolerated) = CCB
2. ^ combo
3. long acting nitrate
4. nicorandil
5. ivabradine
6. ranolazine

2nd prevention -
1. aspirin + statin
2. ACEi

surgery -
PCI
CABG

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42
Q

HTN AEx

A

gen CVD RF

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43
Q

HTN Sx

A

usually asymptomatic

malignant -
headache
blurred vision
N+V
chest pain
altered mental status

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44
Q

HTN SGx

A

pulses bruits
examine fundi (hypertensive retinopathy)

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45
Q

HTN Ix

A

monitoring -
ABPM if clinic >140/90
HBPM if ABPM declined

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46
Q

HTN Tx

A

monitor for end organ damage
lifestyle interventions

<55 -
1. ACEi / ARB (Bb in FF)
2. + CCB
3. + thiazide diuretic
4. + spironolactone

> 55 / black -
1. CCB
2. + ACEi / ARB (Bb in FF)
3. + thiazide diuretic
4. + spironolactone

statins if CVD risk >10%

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47
Q

shock Tx

A

ABCDE
high flow O2
volume replacement (HV)
inotropes (CG)
chest drain (TP)
adrenaline (APh)
vasopressors (SpT)

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48
Q

AAA AEx

A

age
men
FHx
smoking
HTN
atherosclerosis

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49
Q

AAA Sx

A

75% asymptomatic
25% central pain

ruptured - sudden onset ab pain (+ ab mass)

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50
Q

AAA SGx

A

‘trash feet’ - dusky discoloured
collapse (hypotension)
tachycardia

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51
Q

AAA Ix

A

monitoring - USS
program exists ^

ruptured - CT scan

52
Q

AAA Tx

A

RF control -
anti-hypertensives
lipid lowering

graft - EVAR or open repair
(asymptomatic only if >5.5cm)

53
Q

aortic dissection AEx

A

FHx
connective tissue disorders
trauma

54
Q

aortic dissection Sx

A

chest / interscapular pain
chest / back pain
abdominal pain
syncope

55
Q

aortic dissection SGx

A

renal / visceral / limb ischaemia
pulse deficits

56
Q

aortic dissection Ix

A

CT angiography

57
Q

aortic dissection Tx

A

lower BP

TEVAR
open repair

58
Q

unstable angina AEx

A

atherosclerosis (rupture)

59
Q

unstable angina Sx

A

crushing central chest pain
prolonged angina
no relief w/ GTN / rest
sweating
N+V
>30 mins

60
Q

unstable angina SGx

A

xanthelasma

61
Q

unstable angina Ix

A

ECG - may be normal / non-specific changes (abnormal T / ST depression)

troponin blood test - negative

62
Q

unstable angina Tx

A

morphine + antiemetic IV
DAPT (aspirin + clop)
GTN (if hypertensive)
O2 (if hypoxic)

LIFESTYLE
DAPT (aspirin + clop)
ACEi
B blocker
Statin
(GTN for angina
spiro for HF signs)

high risk consider PCI

63
Q

NSTEMI AEx

A

atherosclerosis (ruptured)

64
Q

NSTEMI Sx

A

crushing central chest pain
radiates to jaw / arms
no relief w/ GTN / rest
sweating
N+V
>30 mins

65
Q

NSTEMI SGx

A

xanthelasma

66
Q

NSTEMI Ix

A

ECG - may be normal
ST depression
deep T wave inversion
pathological Q waves (late)

troponin blood - positive

67
Q

NSTEMI Tx

A

morphine + antiemetic IV
DAPT (aspirin + clop)
GTN (if hypertensive0
O2 (if hypoxic)

LIFESTYLE
DAPT (aspirin + clop)
ACEi
B blocker
Statin
(GTN for angina
spiro for HF signs)

high risk consider PCI

68
Q

(atypical) silent MI Sx

A

women, elderly, diabetes
mild Sx, no chest pain
SOB
fatigue
aches
overall illness feeling
discomfort in back / chest / neck / jaw
heartburn
N+V
ab pain

may occur up to a month before MI -
SOB
palpitations
fatigue
sleep disturbance
anxiety
indigestion

69
Q

STEMI AEx

A

atherosclerosis (ruptured)

70
Q

STEMI Sx

A

crushing central chest pain
radiates to jaw / arms
no relief w/ GTN / rest
sweating
N+V
>30 mins

71
Q

STEMI SGx

A

xanthelasma

72
Q

STEMI Ix

A

ECG - ST elevations / LBBB

troponin positive

73
Q

STEMI Tx

A

morphine + antiemetic IV
DAPT (aspirin + clop)
GTN (if hypertensive0
O2 (if hypoxic)

LIFESTYLE
DAPT (aspirin + clop)
ACEi
B blocker
Statin
(GTN for angina
spiro for HF signs)

PCI if <2 hours onset
thrombolysis >2 hours

74
Q

AFib AEx

A

HTN
HF
congenital / valve disease
hyperthyroidism
electrolyte disturbance
inflammation (sepsis / rheumatic HD / gen -itis)
post MI

lone AF = idiopathic

75
Q

AFib Sx

A

30% incidental finding
rapid palpitations
SOB
chest pain
dizziness / syncope

76
Q

AFib SGx

A

irregularly irregular pulse

77
Q

AFib Ix

A

ECG - atrial rate >300bpm
irregularly irregular rhythm
no p waves, ‘f’ waves
narrow QRS
vent rate variable

78
Q

AFib Tx

A

treat cause if possible
RATE CONTROL -
B blocker
CCB
digoxin

2nd line -
ablation of AV + pacemaker

RHYTHM CONTROL -
reversible - new onset - HF - rate control failed
cardioversion - DCCV or pharmacological (ami)
(after = antiarrhythmic dugs, B blocker 1st line)

2nd line -
LA catheter ablation
maze procedure

long-term -
DOAC in patients w/ valve disease or CHADS2-VASc score of >2
(2nd line = warfarin)

79
Q

atrial flutter AEx

A

HTN
HF
congenital / valve disease
hyperthyroidism
electrolyte disturbance
inflammation (sepsis / rheumatic HD / gen -itis)
post MI

80
Q

atrial flutter Sx

A

mostly asymptomatic
mild arrhythmia Sx
(palpations etc)

81
Q

atrial flutter Ix

A

ECG - atrial rate >300bpm
ventricular rate 150bpm
narrow QRS
regular rhythm (possibly variable)

82
Q

atrial flutter Tx

A

symptomatic + acute = cardioversion

catheter ablation
(or class 3 / AV nodal blocking)

DOAC to prevent stroke

83
Q

SVT AEx

A

AVNRT
most common
women love her

AVRT
accessory pathway
common in WPW syn

ectopic (EAT)

84
Q

SVT Sx

A

palpations
SOB

85
Q

SVT Ix

A

ECG - fast narrow complex tachy
bpm >150
rarely visibly p waves

86
Q

SVT Tx

A

EAT -
spontaneous + normal heart = reassure
bad Sx = B blocker
avoid stimulants

acute -
increase vagal tone (valsalva, carotid massage)
IV adenosine
DCCV if ^ fails

long-term -
B blockers, CCB, ami
radiofrequency ablation
avoid stimulants

87
Q

VTACH AEx

A

most have significant CVD
CAD - past MI - HF
inherited cardiomyopathy / channelopathy
idiopathic
iatrogenic (meds)

monomorphic - increased re-entry (past MI)
polymorphic - abnormal vent repolarisation (long QT / drug tox / electrolytes)

88
Q

VTACH Sx

A

dizziness
syncope
hypotension
cardiac arrest

can be remarkably well tolerated in some

89
Q

VTACH SGx

A

pulse rate generally 120-220bpm

90
Q

VTACH Ix

A

ECG - monomorphic + polymorphic

91
Q

VTACH Tx

A

unstable w/ pulse = DCCV
stable = pharma CV, DCCV
pulseless = defib

long-term -
correct triggers
anti-arrhythmics generally ineffective (often used + ICD for Sx)
ICD in recurrence risk
catheter ablation

92
Q

AVB AEx

A

age
acute MI
myocarditis
infiltrative disease (amyloid / sarcoid)
drugs = B blockers, CCB
calcific aortic valve disease
aortic valve surgery
genetic (Lenegre’s / myotonic dystrophy)

93
Q

long QT syndrome AEx

A

congenital

Jervell-Lange-Nielson - autosomal recessive, assoc deafness
Romano-Ward syndrome - autosomal dominant, isolated

acquired = electrolyte im, drugs, diabetes, acute MI

94
Q

long QT syndrome Sx

A

syncope
SCD (due to TdP)

95
Q

long QT syndrome SGx

A

polymorphic VTACH (TdP)
lone AF
heart block

96
Q

long QT syndrome Ix

A

ECG - Torsades de Pointes
long QT interval

97
Q

long QT syndrome Tx

A

acute = treat underlying cause
Mg infusion
DCCV of VTACH

long-term -
B blockers
avoid QT prolonging drugs
pacemaker therapies
avoid triggers (breath holding / sudden auditory stim / sleep)

98
Q

brugada syndrome AEx

A

congenital - autosomal dominant

cardiac Na + K channels

99
Q

brugada syndrome Sx

A

risk of polymorphic VTACH + VFib
AFib common

100
Q

brugada syndrome Ix

A

ECG - ST elevation + RBBB in v1-v3
findings may be intermittent / change

ECG changes only diagnostic w/ provocative testing (drugs to block Na channels)

101
Q

brugada syndrome Tx

A

genetic testing (+ family)
ICD
avoid triggers (rest or sleep / fever / excessive alcohol / large meals / B blockers / psychotropics / analgesics / anaesthetics)

102
Q

hypertrophic cardiomyopathy AEx

A

genetic - autosomal dominant

103
Q

hypertrophic cardiomyopathy Sx

A

asymptomatic
SCD
SOB
AFib
syncope
palpitations
angina

104
Q

hypertrophic cardiomyopathy Ix

A

ECG - LVH
ST+T wave changes
abnormal Q waves
(usually diagnostic)

105
Q

hypertrophic cardiomyopathy Tx

A

SCD risk = ICD

chest pain / SOB = B blockers / verapamil

106
Q

ARCV AEx

A

genetic - autosomal dominant + recessive forms

fibro-fatty replacement of cardiomyocytes in RV

107
Q

ARVC Sx

A

mostly asymptomatic
vent arrhythmia
syncope
SCD

108
Q

ARVC Ix

A

ECG usually normal
echo
cardiac MI
genetic testing

109
Q

ARVC Tx

A

B blockers for arrhythmias
ICD in SCD risk

110
Q

infective endocarditis AEx

A

organisms in bloodstream:
PWID
ICD
intravascular lines
sepsis

abnormal cardiac endo:
rheumatic HD
congenital HD
valvular degeneration (age)
prosthetic heart valve

staph aureus
viridans strep
enterococcus sp
staph epi

111
Q

infective endocarditis Sx

A

acute -
overwhelming sepsis
failure
(aggressive organisms)

subacute -
fever
malaise
weight loss
tiredness
SOB

112
Q

infective endocarditis SGx

A

new heart murmur
finger clubbing
splinter haemorrhages
splenomegaly
roth spots
janeway lesions
osler nodes
microscopic haematuria

113
Q

infective endocarditis Ix

A

blood culture (3 sets)
echo - vegetations

serology - if blood cultures negative look for atypicals

114
Q

infective endocarditis Tx

A

empirical =
native valve - amoxicillin + gentamycin IV
prosthetic valve - vancomycin + gentamycin IV (+ rifampicin PO 3-5d)
PWID - fluclox IV

specific =
staph aureus - fluclox IV
viridans strep - benzylpenicillin + gentamycin IV
enterococcus sp - amoxicillin / vancomycin + gentamycin IV
staph epi - vancomycin + gentamycin IV (+ rifampicin PO)

115
Q

myocarditis AEx

A

young people - SCD cause
enteroviruses (+ others)
may also be a hypersensitivity reaction

116
Q

myocarditis Sx

A

fever
SOB
chest pain
palpitations

117
Q

myocarditis SGx

A

third heart sound
arrhythmias
tachycardia
cardiac failure

118
Q

myocarditis Ix

A

viral PCR - diagnostic
ECG, bloods, CXR

119
Q

myocarditis Tx

A

supportive treatment

120
Q

pericarditis AEx

A

myocarditis assoc
viral, bacteria less common

dressler’s syndrome - 4-6 weeks post MI

121
Q

pericarditis Sx

A

chest pain - worse on inspiration, relieved by sitting up
low grade fever

122
Q

pericarditis Tx

A

supportive treatment

123
Q

HF AEx

A

ischaemic HD
dilated cardiomyopathy
HTN

other cardiomyopathies, valvular disease, arrhythmias, pericardial disease, infection, alcohol, diabetes, congenital HD

124
Q

HF Sx

A

exertional SOB
orthopnoea
paroxysmal nocturnal dyspnoea
fatigue

125
Q

HF SGx

A

tachycardia
raised JVP
cardiomegaly
S3 + S4
bi-basal crackles
pleural effusions
peripheral oedema
ascites
tender hepatomegaly

126
Q

HF Ix

A

ECG - arrhythmias, past MI, LVH
CXR - cardiac silhouette (size + shape), fluid accum on lungs

bloods - BNP (cardiac hormone) rule out test for symptomatic patients
echo - diagnostic

127
Q

HF Tx

A

LIFESTYLE
ACEi (or ARNi if uncontrolled)
B blocker
spironolactone
loop diuretic (Sx)

ivabradine
digoxin (Sx)

YEAR 1 (11 decks)

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