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Cardio > Cardio Conditions > Flashcards

Cardio Conditions Flashcards

1
Q

Features of Angina

A
  1. Constricting/heavy discomfort to the chest, jaw, neck, shoulders, or arms
  2. Symptoms brough on by exertion
  3. Symptoms relieved within 5min or GTN
    3 ft = Typical angina
    2 ft = atypical angina
    0-1 = non-anginal chest pain
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2
Q

Precipitants of angina

A

Emotion
Cold weather
Heavy meals

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3
Q

Ass symptoms w/ Angina

A

Dyspnoea, nausea, sweatiness, faintness

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4
Q

Causes of Angina

A 
Atheroma
Anaemia
Coronary artery spasm
AS
Tachyarrhythmias
HCM
Arteritis/small vessel disease
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5
Q

Name 4 types of angina

A

Stable angina: induced by effort, relieved by rest
Unstable angina: increasing in frequency or severity
Decubitus angina: pptated by lying flat
Variant (Prinzmetal) angina

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6
Q

Specific tests to Angina

A 
Lipids
HbA1C
Echo
CXR
ECG + Exercise ECG
Angiography
Functional imaging: MIBI scan
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7
Q

Secondary prevention of cardiovascular disease to Angina

A

Stop smoking, exercise, dietary advice, optimise hypertension and diabetes
75mg aspirin daily if not contraindicated
Address hyperlipidaemia
Consider ACE inhibitors

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8
Q

Acute Treatment to Angina

A 
GTN spray, rpt dose after 5min + call an ambulance if pain doesn’t go away
300mg Aspirin
300mg Clopidogrel
10,000Units heparin
B-blocker +/- Ca Channel Antagonist
If not tolerated trial other agents
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9
Q

Name Anti-anginal medications to Angina

A 
B-blocker
Ca Channel blocker
Long-acting nitrates
Ivabradine
Ranolazine
Nicorandil
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10
Q

Name Surgical management to Angina

A

PCI and CABG

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11
Q

Name the conditions that lead up to Acute Coronary Syndromes

A 
Unstable Angina: no trop rise
Myocardial Infarction
Ischaemia
STEMI
NSTEMI
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12
Q

What is STEMI

A

ACS which has ST-segment elevation or new-onset LBBB

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13
Q

What is NSTEMI

A

ACS with trop +ve without ST-segment elevation

ECG: ST depression, T-wave inversion, non-specific changes

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14
Q

Non-modifiable risk factors to ACS

A

Age
Male,
FH of IHD

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15
Q

Modifiable risk factors to ACS

A 
Smoking
HT
DM
Hyperliipidaemia
Obesity
Sedentary lifestyle
Cocaine use
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16
Q

Symptoms of ACS

A 
Acute central chest pain >20 mins
Nausea
Sweatiness
Dyspnoea
Palpitations
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17
Q

Signs of ACS

A 
Distress
Anxiety
Pallor
Sweatiness
Dec/inc pulse
Dec/inc BP
4th heart sound
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18
Q

Specific tests for ACS

A 
ECG
Glucose
Lipids
Toponins
Echo
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19
Q

Management of ACS

A

Antiplatelets: aspirin + clopidogrel (for 12mo)
Anticoagulate: fondaparinoux or alteplase
B-blocker: reduces myocardial demand
ACE-i: titrate up slowly, monitor renal fn
High dose statin
Echo to id LV function
Revascularisation
General advice: driving, work

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20
Q

Complications of MI

A 
Cardiac arrest
Cardiogenic shock
Left ventricular failure
Bradyarrhythmias
Tachyarrhythmias
Right Ventricular failure/infarction
Pericarditis
Systemic embolism
Cardiac tamponade
Mitral regurg
Ventricular septal defect
Late malignant ventricular arrhythmias
Dressler’s syndrome
Left ventricular aneurysm
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21
Q

Organic Cardiac causes of Arrhythmias

A 
IHD
Structural changes
Cardiomyotpathy
Pericarditis
Myocarditis
Aberrant conduction pathways
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22
Q

Non-cardiac causes of Arrhythmias

A 
Caffeine
Smoking
Alcohol
Pneumonia
Drugs: beta agonists, digoxin, L-dopa, tricyclics doxorubicin
Metabolic imbalance incl thyroid disease
Phaeochromocytoma
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23
Q

Tests specific to Arrhythmias

A 
Glucose
Ca, Mg
TSH
ECG: 24h monitoring (halter)
Echo: structural heart disease
Provocation tests: exercise ECG, cardiac catheterisation +/- electrophysiological studies
24
Q

Name 5 types of Continuous ECG monitoring

A 
Telemetry
Exercise ECGs
Holter Monitors
Loop recorders
Pacemakers and ICDs
25
Q

Causes of Atrial fibrillation and flutter

A 
PE, Pneumonia
Mitral valve disease
Hyperthyroidism
Post-op, Hypo K, Hypo Mg
Heart failure, HT, IHD, Caffeine, Alcohol
26
Q

Symptoms of AF and flutter

A 
Asymp
Chest pain
Palpitations
Dyspnoea
Faintness
27
Q

Signs of AF and flutter

A

Irregularly irregular pulse

Signs of LVF

28
Q

Managing AF and flutter

A

ABCDE, get senior input
DC cardioversion +/- amiodarone
Heparin
Rhythm control: DC cardiovert or flecainide or amiodarone (<48h)
Rate control
Correct electrolyte imbalance, Rx ass illnesses

29
Q

What medications allow for cardiac rate-control?

A

B-blocker or rate limiting Ca blocker
Add digoxin
Then consider amiodarone
Do not give b-blockers with verapamil

Amioderone, b-blocker, CCB, digoxin

30
Q

How do you treat Paroxysmal AF?

A

Pill in pocket (sotalol or fleicanamide PRN)
Anticoagulation
Consider ablation if symptomatic

31
Q

Treatment of Atrial flutter

A 
B-blocker and Ca blocker
Add digoxin
Then consider amiodarone
Pill in pocket (sotalol or fleicanamide PRN) + anticoagulated
DC cardioversion + amiodarone IV
32
Q

What are the indications for a temporary cardiac pacing

A

Symptomatic bradycardia which is unresponsive to atropine
After acute anterior MI
After inferior MI
Suppression of drug-resistant tachyarrhythmias
General anaesthesia, cardiac surgery, electrophysiological studies, drug OD

33
Q

Indications for permanent pacemaker

A 
Complete AV block
Mobitz type II AV block
Persistent AV block after anterior MI
Symptomatic bradycardias
HF
Drug resistant tachyarrhythmias
34
Q

Pacemaker letter codes

A

1st letter the chamber being paced
2nd letter the chamber sensed
3rd letter the pacemaker response
4th letter: rate modulation, programmable, multiprogrammable
5th letter P = pace, S = shock, D = dual, 0 = neither

35
Q

What are the classifications of heart failure

A 
Systolic
Diastolic
Left ventricular failure
Right ventricular failure
Acute heart failure
Low-output heart failure
High-output heart failure
36
Q

Signs of HF

A 
Cyanosis
Low BP
Narrow pulse pressure
Pulsus alternans
Displaced apex (LV dilatation)
RV heave (pulmonary HT)
37
Q

Specific tests to HF

A

BNP, CXR, ECG
ECHO
Rarely: endomyocardial biopsy

38
Q

For HF, what do u see on CXR

A 
A – alveolar odema (Bat’s wings)
B – Kerley B lines (interstitial oedema)
C – Cardiomegaly 
D – dilated prominent upper lobe vessels
E – pleural effusion
39
Q

Symptoms of Left ventricular failure

A 
Dyspnoea
Poor exercise tolerance
Fatigue
Orthopnea
Paroxysmal nocturnal dyspnoea
Nocturnal cough – nocturia
Cold peripheries
Wt loss
40
Q

Causes of RVF

A

LVF
Pulmonary stenosis
Lung disease

41
Q

Symptoms of RVF

A

Peripheral oedema, Ascites, Facial engorgement
Nausea, anorexia
Epistaxis

42
Q

Acute HF means….

A

New onset acute or decompensation of chronic heart failure

43
Q

Causes of Low-output HF

A

Excessive preload
Excessive afterload
Chronic excessive afterload
Pump failure

44
Q

Causes for High-output HF

A

Anaemia, pregnancy, hyperthyroidism
Paget’s disease
Arteriovenous malformation
Beriberi

45
Q

Treatment of HF

A 
ACE-i
B-blockers
Diuretics
Digoxin
Mineralocorticoid receptor antagonists
Vasodilators
46
Q

Inpatient management of HF

A

Minimal exertion, Na+ and fluid restriction
Opiates and IV nitrates may relieve symptoms
Give DVT prophylaxis: heparin + TED stockings
Metolazone and IV furosemide
Weigh daily – freq U+E

Consider: cardiac resynchronisation, LV assist device, transplantation

47
Q

Name the four classes of HT

A

Primary or essential HT
Secondary HT
Malignant or accelerated phase HT: rapid rise in BP, vascular dmg – slowly decrease it over time
White coat HT: elevated clinic pressure

48
Q

Symptoms of HT

A 
Asymptomatic
Headache +/- visual disturbance
Signs of renal disease
Radiofemoral delay
End-organ dmg: proteinuria, LVH, retinopathy
Palpable kidneys
49
Q

Specific tests to HT

A 
ABPM or home BP monitoring
ECG or echo
Urine analysis (protein and blood, K+ and Ca)
Renal US
24h urinary meta-adrenaline
Urinary free cortisol
Renin aldosterone
MR aorta (coarctation)
50
Q

Causes for secondary HT

A

Renal disease: glomerulonephritis, polyarteritis nodosa (PAN), systemic sclerosis, chronic pyelonephritis, polycystic kidneys
Endocrine disease: Cushing’s, Conn’s, hyperparathyroidism
Other: coarctation, pregnancy, liquorice
Drugs: steroids, MAOI, OCP, cocaine, amphetamines

51
Q

Management of HT

A

Lifestyle changes
Drugs: monotherapy, dual therapy, triple therapy
ACE-I or ARB
B-blocker
Ca Ch blocker
Dual therapy: add thiazide
Quad therapy: add spironolactone + monitor U+E

52
Q

Rheumatic fever is diagnosed using which criteria

A

Jones criteria
- Evidence of Group A b-haemolytic strep infection
- Major criteria
Carditis, arthritis, subcutaneous nodules, erythema marginatum, sydenham’s chorea
- Minor criteria
Fever, raised esr/crp, athralgia, prolonged PR interval, previous rheumatic

53
Q

How do u manage rheumatic fever

A 
Bed rest for 2w
Benzylpenicillin
Analgesia for carditis/arthritis
Immobilise joints in severe arthritis
Haloperidol or diazepam for the chorea
Secondary prophylaxis: Penicillin 250mg/12h PO
54
Q

What causes Infective endocarditis?

A

Bacteraemia (HACEK – haemophilus, actinobacillus, cardiobacterium, eikenella, kingella) and chlamydia
Fungi
SLE
Malignancy

55
Q

Signs of IE

A

Septic signs: fever, rigors, night sweats, malaise
Cardiac lesions: new murmur
Immune complex deposition: vasculitis
Embolic phenomenon

56
Q

How do u diagnose IE

A

Modified Duke criteria

  • Blood cultures
  • Blood tests
  • Urinalysis: haematuria
  • CXR: cardiomegaly, pulmonary oedema
  • Regular ECGs
  • Echo
  • CT
57
Q

Risk factors for IE

A

Skin breaches (dermatitis, IV lines, wounds)
Renal failure
Immunosuppression
DM

Cardio (3 decks)

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