Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

3rd year > Cardio core conditions > Flashcards

Cardio core conditions Flashcards

1
Q

What is the presenting complaint for a patient with unstable angina?

A

Angina with increased frequency , unpredictability or at rest
Pain lasts <20mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the minimum amount of time for chest pain to last to consider the cause being a STEMI or an nSTEMI?

A

> 20mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What will an ECG show in unstable angina?

A

May be normal

May show ST depression or T wave changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is acute coronary syndrome?

A

Unstable angina and an evolving MI (STEMI or NSTEMI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What will an ECG show in a STEMI?

A

ST elevation

T wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What will an ECG show for an NSTEMI

A

ST depression or T wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens to troponin levels in UA, STEMI, NSTEMI?

A

UA: normal

STEMI and NSTEMI: elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do the majority of patients with ST elevation develop?

A

Q wave MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the the symptoms of an MI? 6

A 
1- chest pain >20mins often unresponsive to GTN spray
2-radiates to neck and down left arm 
3- nausea
4-sweating 
5- dyspnoea 
6-palpitations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do elderly or diabetic patients present with an MI? 9

A 
1- dyspnoae 
2-fatigue
3-syncope
4-epigastric pain 
5-oliguria
6-pulmonary oedema 
7-acute confused state 
8-stroke 
9- diabetic hyperglycaemic attacks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What will the pulse feel like in an MI?

A

Thready= a weak pulse that is difficult to feel or obliterated easily with slight pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens to BP in MIs?

A

It decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What other signs will be seen in an MI (aside from low BP and thready pulse)? 5

A 
1- 4th heart sounds 
2- signs of heart failure= increased JVP, 3rd heart sound, basal crepitations 
3- pansystolic murmur 
4- later a pericardial friction rub 
5- later peripheral oedema may develop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for an MI? 9

A 
1- age >65 
2- Male
3- Fh of IHD 
3- smoking 
4- hypertension
5- DM 
6- hyperlipidaemia 
7-obesity 
8- stress 
9- type A personality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What will an ECG show in a STEMI over time?

A

Hours: T wave peaks, ST segments may begin to rise

within 24 hours: T wave inverts as ST elevation begins to resolve

within a few days: pathological Q waves form, these usually persist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What will a CXR show in a MI?

A

Cardiomegaly
pulmonary oedema
widened mediastinum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What biochemical markers are tested for an MI? 3

A

Creatine kinase MB
Troponin
Myoglobin (useful for rapid diagnosis of ACS, but not specific- also found in muscles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why is creatine kinase tested less frequently now?

A

As there are low levles in the serum of normal people and people with skeletal damage, prolonged exercise, Afro-carribeans, hypothermia and hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which parts of troponin are tested for in an MI?

A

mAB against troponin T

mAB against troponin I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do each of the parts of troponin do?

A

T: attaches the complex to tropomyosin
C: binds calcium during excitation contraction coupling
I: inhibits the myosin binding site of the actin. Isn’t found in normal people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When do Troponin T levels peak and for how long post MI can they be detected?

A

12-24 hours

for a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the criteria for MI diagnosis?

A

2/3 of:
chest pain/ typical history
ECG changes
cardiac enzyme ris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you manage high death risk patients with an MI?

A

urgent coronary angiography?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you manage low risk MI patients?

A

aspirin, clopidpgrel, beta blockers and nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Whats the immediate treatment for MI patients?
``` ROMANCE(E) Reassure Oxygen Morphine + anti-emetic Aspirin- 300mg Nitrates- GTN Clopidogrel- 300mg Enoxaprin ECG ```
26
Do you give thrombolysis to STEMI or NSTEMI patients?
STEMI
27
How do you manage STEMI patients?
Urgent-ish Percutaneous coronary intervention (PCI)= angioplasty If this isn't available then TPA (tissue plasminogen activator)/ streptokinase
28
How do you manage NSTEMI patients?
elective PCI after 48-72hrs stabilisation | Stabilisation= ACE-I, B-blockers, statin, LMWH
29
What are the complications of an MI? 9
``` 1-Heart failure- LVF 2- myocardial rupture and aneurismal dilation--> death 3- ventricular septal defects 4- mitral regurgitation 5-VF- common in STEMI and reperfusion 6-AF 7-sinus bradycardia (treat with atropine) 8- bundle branch blocks 9-Dressler's syndrome ```
30
What is Dressler's syndrome and how do you treat it?
``` recurrent pericarditis pleural effusions anaemia increased ESR Fever 1-3 weeks post MI Rx= NSAIDs and steroids ```
31
What are the features of angina chest pain?
Heavy/tight/ gripping chest pain can range from mild ache to very severe pain that -->sweating and fever often associated with breathlessness
32
Where is the pain in angina?
Central/ retrosternal | radiates to jaw and left arm
33
What are the features of classical/exertional angina?
Triggered by exercise, especially after meal and in the cold pain fades within minutes of rest
34
What are the features of decubitus angina? And what causes it?
Occurs when lying down | Linked with impaired L ventricle function due to severe CAD (coronary artery disease)
35
What are the features of nocturnal angina? And what causes it?
May wake patient provoked by vivid dreams occurs in pts with critical CAD
36
What are the features of Variant (prinzmetal's angina)? What causes it? and is it more common in M or F?
``` Angina without provocation usually at rest due to coronary spasm will have ST elevation during pain F>M ```
37
What is Cardiac syndrome X?
A good history of angina +Ve exercise test but angiographically normal arteries F>M Myocardium shows abnormal response to stress
38
What are the features of unstable angina?
angina of recent onset <1 mnth | worsening angina or angina at rest
39
What are the signs of angina?
Usually no findings 4th heart sound may be heard Look for signs of anaemia, thyrotoxicosis Hyperlipidaemia- corneal arcus, xanthelasma, tendon xanthoma
40
What will an angiogram show in angina?
That collateral vessels have grown
41
What is the main cause of angina?
atherosclerosis
42
what investigations are done in angina?
Exercise ECG- confirms diagnosis and gives severity of CAD Cardiac scintigraphy- myocardial perfusion scans at rest and exercise CT coronary angiography- good for diagnosing CAD and excluding other causes e.g. PE, also for helping find out where exactly needs revascularisation
43
What prognostic therapy is available for angina?
75mg OD aspirin- decreases risk of coronary event in pts with CAD Statin- if cholesterol >4,8
44
What is the symptomatic treatment for angina?
GTN spray- works in 5 mins, lasts for 20-30mins
45
What surgical options are there for angina?
Perutaneous transluminal coronary angioplasty (PTCA)- dilating coronary artery stenosis using a balloon inserted through the femoral, radial or brachial artery Coronary artery bypass grafting (CABG)- autologous veins or arteries are anastomosed to the ascending aorta and to the native coronary arteries distal to the stenosis
46
What are the symptoms of AF? 6
``` Highly variable 30% asymptomatic Chest pain palpitations dyspnoea faintness some decrease in exercise capacity ```
47
What are the signs of AF? 2
``` Irregularly, irregular pulse Apical pulse (heard at heart) is greater than radial pulse ```
48
What are the causes of AF?
``` Hypertension= most common cause Rheumatic heart disease alcohol intoxication thyrotoxicosis hyperthyroidism ```
49
What is paroxysmal AF?
recurring sudden episodes of symptoms | comes and goes within 7 days but usually <2
50
What is persistent AF?
Lasts >7days Unlikely to revert back to normal without cardioversion treatment Even with treatment it may return
51
What is permanent/ established AF?
present long term | Heart hasn't reverted back to normal rhythm
52
What investigations should you do in AF?
``` ECG TFTs U&Es Cardiac enzymes Echocardiogram ```
53
What will an ECG of AF show?
Absent P waves Irregular, rapid QRS fast ventricular rate- 120-180 BPM
54
What might an echocardiogram show in AF?
L atrial enlargement Mitral valve disease structural abnormalities
55
How do you treat acute AF (<48 hrs)?
``` Very ill and haemodynamically unstable--> O2 Bloods Cardoversion- if available If not amiodarone ```
56
What do you give patients with paroxysmal AF to take PRN (as needed)?
Flecainide an antiarrythmic agent
57
Who do you offer ventricular rate control to in chronic AF?
``` >65 primary accepted AF persistent tachycardias failed previous cardioversion attempts AF >1yr On going reversible cause e.g. thyrotoxicosis ```
58
What is the ventricular rate control treatment in chronic AF?
B-blocker or Ca2+ channel blocker (diltiazem) | warfarin
59
How do you check if rate control treatment for chronic AF is working?
ECG in elderly | ambulatory 24hr holter monitor and exercise stress test in younger pts
60
When do you offer rhythm control therapy in AF?
If symptomatic in CCF younger pts presenting for the first time
61
What are the rythm control options?
Cardoversion: DV shock or IV infusion of flecainide or amiodarone} if structural abnormality
62
Are biphasic or monophasic shocks better in AF?
Biphasic
63
What is the main risk of AF and how is this managed?
Stroke | Warfarin or NOAC
64
What is the INR target in AF?
2.0-3.0
65
What are the indications for giving warfarin in AF?
1 of the major factors or 2 of the moderate ones: Major: Prosthetic heart valve rheumatic mitral valve disease history of CVA/TIA ``` Moderate: age >75yo Congestive heart failure Hypertension Diabetes mellitus ```
66
What is the CHADS2 score?
``` To determine whether to give warfarin or aspirin in AF Congestive heart failure Hypertension Age >75 DM Previous stroke/ TIA- scores 2 score 0= aspirin score 1= use clinical judgement 2= warfarin ```
67
What are the symptoms of hypertension?4
often asymptomatic sweating palpitations headaches
68
What are the symptoms of severe hypertension? 5
``` headaches epistaxis nocturia SOB angina ```
69
What is normal BP?
<120/<80
70
What is pre HTN?
130-139 and/or 85-89
71
What is grade 1 (mild) HTN?
140-159/ 90-99
72
what is grade 2 (mod) HTN?
160-179/ 100-109
73
What is grade 3 (severe) HTN?
>180/ >110
74
What will be seen in fundoscopy of grade 1 HTN?
Tourtuous renal arteries with increased reflectiveness (silver wiring)
75
What will be seen in fundoscopy of grade 2 HTN?
Grade 1 + AV nicking
76
What will be seen in fundoscopy of grade 3 HTN?
Grade 2 + splinter haemorrhages and soft exudates (cotton wool) due to infarcts
77
What will be seen in fundoscopy of grade 4 HTN?
Grade 3 + pailloedema (blurring margins of optic disc)
78
What are grade 3 and 4 HTN diagnostic of?
malignant hypertension
79
Is HTn more common in F or M?
M
80
What are the risk factors for HTN? 6
``` Age obesity smoking alcohol stress sodium/salt ```
81
What are the metabolic causes/risk factors of HTN? 5
``` DM Glucose intolerance decrease HDL hypertriglyceridaemia central obesity ```
82
What are the congenital causes of HTN? 3
adrenal hyperplasia aortic coarctation II hydroxylase deficiency
83
What are the renal causes of HTN? 5
``` diabetic nephropathy chronic glomerulonephritis adult polycystic kidney disease chronic tubulointestinal nephritis renovascular disease e.g. renal artery stenosis ```
84
What are the endocrine causes of HTN? 5
Conn's syndrome (primary hyperaldosterone) Adrenal hyperplasia Phaeochromocytoma- tumour of the adrenal gland Cushing's syndrome- high cortisol acromegaly
85
Which drugs cause HTN? 4
The pill NSAIDs cyclosporine steroids
86
What are the signs of pre-eclampsia?
preganncy induced HTN + proetinuria
87
What investigations should you do in HTN?
ECG urine dipstick- protein and blood Fasting blood for lipids (total and HDL) and glucose serum urea creatinine and electrolytes CXR- if coarctation of the aorta is suspected
88
When do you not treat severe HTN?
if it's malignant
89
when do you treat moderate HTN?
If CV complications DM Target organ damage Once HTN has been confirmed over 4 weeks (if mild HTN do the same but confirm over 12 weeks)
90
Who is likely to have low-renin HTN?
Black pts and >55yo
91
What is the first line Rx for <55s?
ACEis e.g. inopril, benazepril, captopril If this isn't tolerated the ARBs e.g. candesartan, losartan
92
When do you use ARBs preferentially?
Chronic kidney disease
93
What is the first line for black pts and >55s?
Calcium channel blockers e.g. amlodipine, diltiazem or Thiazide diuretics e.g. hydochlorothiazide, chlorthalidone
94
What is the second line therapy for anyone with HTN?
ACEIs+ thiazide diuretics | or ACEIs+ Ca channel blockers
95
What are the complications of HTN?
``` Cerebrovascular disease CAD prone to renal failure Peripheral vascular disease PAD ```
96
What are the symptoms of a DVT? 7
``` 65% asymptomatic Calf pain swelling redness warmth engorged superficial veins ankle oedema ```
97
What is Homan's sign?
Dorsiflexion of the foot in the presence of a DVT --> calf pain Shouldn't be done as may dislodge the clot
98
What happens if a DVT completely occludes the vein?
cyanotic discolouration | severe oedema
99
What does chronic venous obstruction in DVT lead to?
single swollen limb and may lead to ulceration= post phlebitis syndrome
100
where do the majority of DVTs occur?
in deep veins of the legs around the valves
101
What are the majority of the thrombi?
Red cells + fibrin= red thrombi
102
what are the risk factors for DVT? 19
- varicose veins - age - obesity - stasis - pregnancy - thrombophilia - Any blood clotting disorder eg. thrombphilia, protein C or S deficiency, factor V leiden etc - Sickle cell anaemia - recent MI or stroke - IBD - nephrotic syndrome - central venous catheter - paroxysmal nocturnal haemoglobinuria - paraproteinaemia - myeloproliferative disorders - resp failure - surgery - malignancy - trauma
103
What does a negative D-dimer test show?
rules out thrombosis
104
What should be done following a positive D-dimer test?
Compression USS of leg | Lung scintigraphy/CT
105
What might cause false positives of D-Dimer tests? 8
``` Liver disease high rheumatoid factor inflammation malignancy trauma pregnancy recent surgery age ```
106
When should you do a thrombophilia test in DVT?
If there are no known risk factors if they have recurrent DVTs or FH of DVTs
107
How do you treat DVTs?
LMWH then warfarin LMWH is kept until INR is in the correct range (2-3 normally) Warfarin is normally continued for 3 months
108
What happens in LV failure?
decreased cardiac output and increased pulmonary venous pressure
109
What are the symptoms of LV failure? 10
``` Productive cough- frothy or blood tinged mucus decreased urine output sleep with several pillows- reduce SOB fatigue, weakness, faintness Irregular or rapid pulse palpitations SOB paroxysmal nocturnal dyspnoea fluid retention Displaced apex beat ```
110
What are the signs of LV in infants? 3
failure to thrive weight loss poor feeding
111
What are the two types of LVF?
Systolic and diastolic
112
What happens in systolic LVF?
The left ventricle loses it's ability to contract normally. | The heart can't pump with enough force to push enough blood into circulation
113
What happens in diastolic LVF?
The LV can't relax (muscles are stiff). | Heart can't properly fill with blood during the resting period between each beat
114
What are the causes and risk factors of LVF? 7
``` Alcohol MI Myocarditis hypertension hypothyroidism narrowed or leaking heart valves Children- congenital causes ```
115
What investigations should you do in LVF? 7
``` TFTs LFTs Kidney function coronary angiogram ECG heart stress test echocardiogram ```
116
What is are the consequences of LVF? 3
RVF pulmonary oedema circulatory collapse
117
What is backward cardiac failure?
Ventricle fails to pump blood rapidly enough to prevent the atria from overfilling --> backpressure in the pulmonary system rises
118
What is forward failure>
Ventricles fail to pump enough blood to maintain normal circulation --> Renin-angiotensin system retains sodium and water
119
What causes acute failure?
happens within mins of an MI, often due to valvular collapse
120
What is a common cause of chronic RH failure?
Mitral stenosis | Chornic obstructive lung disease= Cor pulmonale
121
What is a common cause of chronic failure?
ischaemia
122
Which occurs first LVF or RHF?
LHF
123
What is low output cardiac failure?
decreased cardiac output that fails to increase normally on exercion
124
What are the symptoms of RHF? 5
``` Increase JVP (due to tricuspid regurg) Gravitational oedema- ankle oedema, sacral if lying down Hepatic congestion= nutmeg liver --> ascites RV parasternal heave ```
125
What are the signs of CCF? 8
``` elevated JVP tachycardia at rest tachypnoea hypotension bi-basal end-inspiratory crackles/ wheeze ankle oedema ascites tender hepatomegaly- in triscupid regurg ```
126
What is the most common causes of CCF?
Coronary heart disease and hypertension
127
What are the cardiac causes of CCF? 4
valvular heart disease Coronary heart disease MI ischaemia
128
What drugs can cause CCF? 4
B-blockers Calcium antagonists anti-arrhythmics cytotoxics
129
What are the endocrine causes of CCF? 6
``` DM Hypo and hyperthryoidism Cushing's adrenal insufficiency excessive growth hromone phaeochromocytoma ```
130
What are the nutritional deficiencies that can cause CCF? 3
Thiamine selenium Carnitine
131
What are the infiltrative causes of CCF? 5
``` Sarcoidosis amyloidosis haematochromatosis Loffler's eosinophilia connective tissue disease ```
132
What are the infective causes of CCF? 2
Chaga's disease | HIV
133
What are the causes of high output failure? 6
``` anaemia pregnancy hyperthyroidism Paget's bone disease arteriovenous malformations Beri-Beri ```
134
What investigation should be done in CCf with previous MI?
Doppler echocardiograpphy within 2 weeks | If there is no obvious abnormality test serum natriuretic peptides
135
What investigations should be done in CCF? 16
b-type natiruretic peptide (BNP) N-terminal pro-BNP (NT-proBNP) ^ both are released into blood when myocardium is stressed 12 lead ECG Echocardiography- if raised BNP or NT-proBNP or abnormal ECG FBC, U&Es, creatinine, fasting lipids, glucose, TFTs Cardiac enzymes if MI possible CXR Urinalysis Lung function tests Cardiac MRI exercise testing Ct angiography
136
What will a CXR show in CCF? 7
``` Cardiomegaly Ventricular hypertrophy prominent upper lobe veins peribronchial cuffing Diffuse interstitial or alveolar shadowing- bats wings Fluid in fissures pleural effusions ```
137
How do you treat stage a, high risk with no symptoms, CCF?
reduce risk factors treat hypertension, DM, dyslipidaemia May star ACEis or ARBs in some
138
How do you treat stage B, structural heart disease no symptoms?
ACEis or ARBs in all patients | B-blockers in selected ones
139
How do you treat stage C, structural disease previous or current symptoms?
``` ACEis and ARBs in all patients Dietary Na restriction Diuretics digoxin (if they have AF) Cardiac resynchronisation if they have bundle branch block revascularisation Mitral valve surgery ```
140
What is the most prevalent valvular disease?
aortic stenosis | the mitral regurg, aortic regurg, mitral stenosis
141
What are the causes of aortic stenosis? 3
Degenerative congenital rheumatic
142
What are the causes of aortic regurg? 5
``` congenital rheumatic infective endocarditis aortic dissection Marfan's3 ```
143
What are the causes of mitral stenosis?4
mainly rheumatic malignancy rheumatoid arthrtis SLE
144
What are the causes of mitral regurg? 6
``` Mitral valve prolapse rheumatic fever infective endocarditis IHD Marfan's SLE ```
145
What are the risk factors for valvular disease? 3
age IHD heart failure
146
Which of AS, AR, MS and MR are more in common in M or F?
AS and MR= M (Mr looks like mister) | AR and MS and rheumatic heart disease= F
147
What are the signs and symptoms of atrial stenosis? 6
``` Angina exertional syncope exertional dyspnoea small and slow rising pulse 4th heart sound Ejection systolic murmur radiating to both carotids ```
148
What are the signs and symptoms of atrial regurgitation? 6
``` exertional dyspnoea paroxysmal nocturnal dyspnoea orthopnea collapsing pulse pistol shots heard over femoral artery De Musset sign- head nodding with every heart beat ```
149
What are the signs of mitral stenosis? 10
``` Dyspnoea cough haemoptysis chest pain systemic embolism AF raised JVP diastolic thrill Mid diastolic murmur- opening snap and low pitched rumbling ```
150
What are the signs of mitral regurgitation? 3
Dyspnoea Pansystolic murmur Systolic click due to mitral valve prolapse
151
What investigations should you do in valvular disease?
ECG- AF can complicate valvular lesions and worsen symptoms in AS and MS AS shows LV hypertrophy CXR -may show cardiomegaly or pulmonary congestion
152
What is the commonest organism to cause infective endocarditis?
Strep viridans
153
What other organisms cause infective endocarditis? 3
enterococci staph A epidermidis
154
What are the risk factors for infective endocarditis? 6
``` Poor dental hygiene IVDU soft tissue infection dental treatment cannulas Heart surgery ```
155
What are the symptoms of infective endocarditis? 15
Fever + new murmur= infective endocarditis until proven otherwise ``` Septic signs: Fever rigors night sweats weight loss anaemia splenomegaly clubbing ``` Embolic events e.g. RHS may --> pulmonary abscess Haematuria glomerulonephritis janeway lesions Osler's nodes splinter haemorrhages Roth spots
156
What investigations should be done in infective endocarditis?
FBC- normocytic, normochromic anaemai and leucocytosis U&Es- renal dysfunction common in sepsis LFTs CRP ESR- all raised Urine dipstick- haematuria, proteinuria CXR- HF or in RHS pulmomnary emboli or abscess Echo
157
How do you manage infective endocarditis?
Long course 4-6weeks ABx: Penicillins or vancomycin or teicoplanin if allergic ``` Surgery if: in HF valve obstruction repeated emboli fungal endocarditis persistent bacteraemia myocardial abscess unstable prosthetic valve ```
158
What is postural hypotension?
Drop in systolic BP >20mmHg or diastolic >10mmHg after standing for 3mins
159
What causes postural hypotension? 9
Hypovolaemia- early sign Drugs: nitrates diuretics antihypertensives ``` Addison's disease Hypopituitarism- decrease in ACTH DM Multisystem atrophy idiopathic orthostatic hypotension ```
160
When is postural hypotension worse?
After prolonged bed rest | and in the mornings
161
How do you do a lying and standing BP?
Lie patient down for 5 mins - take BP | stand for 1 min- Take BP

3rd year (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions