Cardio Conditions Flashcards
Features of Angina
- Constricting/heavy discomfort to the chest, jaw, neck, shoulders, or arms
- Symptoms brough on by exertion
- Symptoms relieved within 5min or GTN
3 ft = Typical angina
2 ft = atypical angina
0-1 = non-anginal chest pain
Precipitants of angina
Emotion
Cold weather
Heavy meals
Ass symptoms w/ Angina
Dyspnoea, nausea, sweatiness, faintness
Causes of Angina
Atheroma Anaemia Coronary artery spasm AS Tachyarrhythmias HCM Arteritis/small vessel disease
Name 4 types of angina
Stable angina: induced by effort, relieved by rest
Unstable angina: increasing in frequency or severity
Decubitus angina: pptated by lying flat
Variant (Prinzmetal) angina
Specific tests to Angina
Lipids HbA1C Echo CXR ECG + Exercise ECG Angiography Functional imaging: MIBI scan
Secondary prevention of cardiovascular disease to Angina
Stop smoking, exercise, dietary advice, optimise hypertension and diabetes
75mg aspirin daily if not contraindicated
Address hyperlipidaemia
Consider ACE inhibitors
Acute Treatment to Angina
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
Name Anti-anginal medications to Angina
B-blocker Ca Channel blocker Long-acting nitrates Ivabradine Ranolazine Nicorandil
Name Surgical management to Angina
PCI and CABG
Name the conditions that lead up to Acute Coronary Syndromes
Unstable Angina: no trop rise Myocardial Infarction Ischaemia STEMI NSTEMI
What is STEMI
ACS which has ST-segment elevation or new-onset LBBB
What is NSTEMI
ACS with trop +ve without ST-segment elevation
ECG: ST depression, T-wave inversion, non-specific changes
Non-modifiable risk factors to ACS
Age
Male,
FH of IHD
Modifiable risk factors to ACS
Smoking HT DM Hyperliipidaemia Obesity Sedentary lifestyle Cocaine use
Symptoms of ACS
Acute central chest pain >20 mins Nausea Sweatiness Dyspnoea Palpitations
Signs of ACS
Distress Anxiety Pallor Sweatiness Dec/inc pulse Dec/inc BP 4th heart sound
Specific tests for ACS
ECG Glucose Lipids Toponins Echo
Management of ACS
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
Complications of MI
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
Organic Cardiac causes of Arrhythmias
IHD Structural changes Cardiomyotpathy Pericarditis Myocarditis Aberrant conduction pathways
Non-cardiac causes of Arrhythmias
Caffeine Smoking Alcohol Pneumonia Drugs: beta agonists, digoxin, L-dopa, tricyclics doxorubicin Metabolic imbalance incl thyroid disease Phaeochromocytoma
Tests specific to Arrhythmias
Glucose Ca, Mg TSH ECG: 24h monitoring (halter) Echo: structural heart disease Provocation tests: exercise ECG, cardiac catheterisation +/- electrophysiological studies
Name 5 types of Continuous ECG monitoring
Telemetry Exercise ECGs Holter Monitors Loop recorders Pacemakers and ICDs
Causes of Atrial fibrillation and flutter
PE, Pneumonia Mitral valve disease Hyperthyroidism Post-op, Hypo K, Hypo Mg Heart failure, HT, IHD, Caffeine, Alcohol
Symptoms of AF and flutter
Asymp Chest pain Palpitations Dyspnoea Faintness
Signs of AF and flutter
Irregularly irregular pulse
Signs of LVF
Managing AF and flutter
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
What medications allow for cardiac rate-control?
B-blocker or rate limiting Ca blocker
Add digoxin
Then consider amiodarone
Do not give b-blockers with verapamil
Amioderone, b-blocker, CCB, digoxin
How do you treat Paroxysmal AF?
Pill in pocket (sotalol or fleicanamide PRN)
Anticoagulation
Consider ablation if symptomatic
Treatment of Atrial flutter
B-blocker and Ca blocker Add digoxin Then consider amiodarone Pill in pocket (sotalol or fleicanamide PRN) + anticoagulated DC cardioversion + amiodarone IV
What are the indications for a temporary cardiac pacing
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
Indications for permanent pacemaker
Complete AV block Mobitz type II AV block Persistent AV block after anterior MI Symptomatic bradycardias HF Drug resistant tachyarrhythmias
Pacemaker letter codes
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
What are the classifications of heart failure
Systolic Diastolic Left ventricular failure Right ventricular failure Acute heart failure Low-output heart failure High-output heart failure
Signs of HF
Cyanosis Low BP Narrow pulse pressure Pulsus alternans Displaced apex (LV dilatation) RV heave (pulmonary HT)
Specific tests to HF
BNP, CXR, ECG
ECHO
Rarely: endomyocardial biopsy
For HF, what do u see on CXR
A – alveolar odema (Bat’s wings) B – Kerley B lines (interstitial oedema) C – Cardiomegaly D – dilated prominent upper lobe vessels E – pleural effusion
Symptoms of Left ventricular failure
Dyspnoea Poor exercise tolerance Fatigue Orthopnea Paroxysmal nocturnal dyspnoea Nocturnal cough – nocturia Cold peripheries Wt loss
Causes of RVF
LVF
Pulmonary stenosis
Lung disease
Symptoms of RVF
Peripheral oedema, Ascites, Facial engorgement
Nausea, anorexia
Epistaxis
Acute HF means….
New onset acute or decompensation of chronic heart failure
Causes of Low-output HF
Excessive preload
Excessive afterload
Chronic excessive afterload
Pump failure
Causes for High-output HF
Anaemia, pregnancy, hyperthyroidism
Paget’s disease
Arteriovenous malformation
Beriberi
Treatment of HF
ACE-i B-blockers Diuretics Digoxin Mineralocorticoid receptor antagonists Vasodilators
Inpatient management of HF
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
Name the four classes of HT
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
Symptoms of HT
Asymptomatic Headache +/- visual disturbance Signs of renal disease Radiofemoral delay End-organ dmg: proteinuria, LVH, retinopathy Palpable kidneys
Specific tests to HT
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)
Causes for secondary HT
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
Management of HT
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
Rheumatic fever is diagnosed using which criteria
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
How do u manage rheumatic fever
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
What causes Infective endocarditis?
Bacteraemia (HACEK – haemophilus, actinobacillus, cardiobacterium, eikenella, kingella) and chlamydia
Fungi
SLE
Malignancy
Signs of IE
Septic signs: fever, rigors, night sweats, malaise
Cardiac lesions: new murmur
Immune complex deposition: vasculitis
Embolic phenomenon
How do u diagnose IE
Modified Duke criteria
- Blood cultures
- Blood tests
- Urinalysis: haematuria
- CXR: cardiomegaly, pulmonary oedema
- Regular ECGs
- Echo
- CT
Risk factors for IE
Skin breaches (dermatitis, IV lines, wounds)
Renal failure
Immunosuppression
DM
