Cardio Core Conditions Flashcards
Who has an MI?
> 50 (risk increases with age)
M>F (pre menopause, post menopause risk is equal)
Causes of MI?
Clot in CA due to atheroma beginning to rupture Clot travelling to the heart Inflammation of the CAs Stab to the heart Cocaine use
Risk factors for MI?
HTN High cholesterol Lack of exercise Alcohol Smoking Hyperglycaemia Age FHx Hypercholesterolaemia Angina Ethnicity
Symptoms of an MI?
Severe chest pain for >20 mins Not relieved with GTN Pain moves up jaw, down L arm Elderly/diabetics may complain of dyspnoea, fatigue, syncope Pale, clammy, sweating Hypotensive, tachy or brady ST-elevation on ECG
Differentials for MI?
ACS Anxiety Aortic dissection Asthma Endocarditis Oesophagitis Gastritis GORD Hypotension Pancreatitis PE Shock VSD
Investigations for MI?
ECG
Cardiac troponins, FBC, U+E, BM
Echocardiography for pericarditis, PE, aortic dissection
Treatment for MI?
MONAC
Fibrinolysis (reteplase, tenecteplase)
PCI
Who gets angina?
> 50y/o
M>F
Can occur in those younger as well
Causes of angina?
Narrowing of CAs due to atheroma
Artery spasm (variant)
Caused by exertion, lying down, nocturnal
Cardiac X syndrome (+ve exercise test, angiography = normal, good prognosis, highly symptomatic)
Unstable angina
Risk factors for MI?
HTN High cholesterol Lack of exercise Alcohol Smoking DM Age FHx
Symptoms of angina?
Pain, ache, discomfort Tightness in chest Ease on rest (not unstable) SOB Nausea Fatigue Dizzy/restless Check for anaemia, thyrotoxicosis, hyperlipidaemia Check BP Exclude aortic stenosis
Differentials for angina?
MI Acute pericarditis MSK pain GORD Pleuritic chest pain Aortic dissection Biliary colic
Investigations for angina?
ECG
FBC, U+E, BM, fasting cholesterol and triglycerides, LFTs, TFTs, troponin (emergency admission)
Treatment for angina?
GTN
B blockers or Ca blocker
+ in a long standing nitrate, ivabradine or tanolazine
Use slow release Ca blocker if on a beta blocker/ivabradine alongside the Ca blocker
Aspirin/clopidogrel
Stable angina + DM = ACEi
Statins if stable and due to atherosclerosis
Coronary revasc if high risk or unresponsive to therapy
Who gets AF?
M>F
Older
Causes of AF?
HTN Rh heart disease Alcohol intoxication Thyrotoxicosis Heart failure Idiopathic/lone Seen post CA bypass in 1/3rd of patients Complication of IHD Valve problems Cardiomyopathy Pericardial disease
Risk factors for AF?
Congenital heart disease Obesity Caffeine Smoking Amphetamine and cocaine use
Symptoms of AF?
30% asymptomatic Fast irregular pulse Palpitations SOB Tired Dizzy Chest pain Loss of exercise capability
Classifications of AF?
Paroxysmal (sudden bursts)
Persistent
Permanent (cardioversions unsuccessful)
Differentials for AF?
Atrial flutter Supraventricular tachyarrhythmias AVN re-entrant tachycardia WPW syndrome Ventricular tachycardia
Investigations for AF?
ECG
FBC, TFTs, U+E, LFTs, coag screen
CXR
CT/MRI of head if evidence of TIA
Treatment for AF?
Thromboprophylaxis
Treat underlying cause
Cardioversion (anticoag 3 weeks prior and 4 weeks post)
Control arrhythmias (amiodarone, disopyramide, flecainide, propafenone)
Paroxysmal AF 1st line = B Blockers
Digoxin can only be used if patient is sedentary
What percentage of adult HTN is essential HTN?
80-90%
Who gets HTN?
M>F
Adults
Causes of HTN?
FHx Low birth weight Lack of exercise Obesity Alcohol Smoking Stress High salt/fat diet Type II DM
Risk factors for HTN?
> 65
Ethnicity (black African)
Same as causes
Symptoms of HTN?
Persistent headache Blurred vision Nosebleeds SOB May be asymp >140/90mmHg each time it is taken Can be systolic, diastolic or both
Differentials for HTN?
Anxiety Sleep apnoea Cardiomyopathy Cocaine Congestive heart failure PE Hyperaldosteronism Hyperthyroidism MI Stroke
Investigations for HTN?
Urinalysis (protein/blood)
U+E, creatinine, cholesterol, BM
ECG
Risk factor calculator (>2/10 = risk of developing cardio disease in next 10 years)
Treatment for HTN?
Lifestyle changes (lose weight, exercise eat healthy, restrict caffeine/alcohol, stop smoking) Diuretics ACEi Angiotensin II receptor antagonist Ca channel blockers B blockers
How many people per year in the UK have DVT?
1 in 1,000
Who gets DVT?
Anyone
Risk increases with age
Causes of DVT?
Inactivity Post-surgery Damage to vessels (narrowing, vasculitis, varicose veins, chemo) Cancer Heart and lung disease Hepatitis RhA Thrombophilia Hughes syndrome Pregnancy OCP and HRT
Risk factors for DVT?
Previous DVT/PE FHx Obesity Smoking Trauma
Symptoms of DVT?
Can be asymp Red, hot, tender, swollen calf Engorged surface veins Ankle oedema Homan's sign Unilateral (usually) PE = SOB, pleuritic chest pain, sudden collapse
Differentials for DVT?
Baker's cyst Cellulitis Congestive HF Calf muscle haematoma Pelvic/thigh mass/tumour compressing venous outflow Thrombophlebitis
Investigations for DVT?
Clinical picture
D-dimer levels
Ileofemoral thrombosis confirmed using B mode venous compression and doppler
Venography (contrast + XR)
Treatment for DVT?
Warfarin and LMWH
Once warfarin is in a good INR range heparin is stopped
Compression stockings
Exercises
What % of hospital admissions are due to HF?
5%
Who gets LV-HF?
Increases with age
M>F (young men are at higher risk of ischaemic heart disease)
Causes of LV-HF?
Ischaemic heart disease HTN Cardiomyopathy following infection Drug abuse Side effect of prescription drugs AF Valvular heart disease Anaemia Hyperthyroidism
Risk factors for LV-HF?
Male
Increasing age
Congenital cardiac disease
Cardiovascular risk factors
Symptoms of LV-HF?
Exertional dyspnoea Orthopnoea PND Fatigue Oedema Haemoptysis Pleural effusion Cardiomegaly 3rd and 4th heart sounds Elevated JVP Tachycardia Hypotension
How is LV-HF classified?
1) No limitation in physical activity
2) Mild limitation
3) Marked limitation
4) Symptomatic at rest
Differentials for LV-HF?
Acute renal failure ARDS COPD Cirrhosis Emphysema MI Nephrotic syndrome PE
Investigations for LV-HF?
FBC, U+E, cardiac enzymes, BNP, TFT CXR ECG Echo Stress Echo Cardiac MRI
Treatment for LV-HF?
Diet and weight control Stop smoking Alcohol in moderation Exercise Flu vaccination Diuretics ACEi Angiotensinogen II receptor antagonist Beta blocker Aldosterone antagonists Cardiac glycosides (dig) Vasodilators Nitrates Aspirin and statins (IHD) Oral anticoags (AF) Ivabradine reduces HR by inhibiting channels in the SAN) Revascularisation Implanter cardioverter defib Pacemakers Cardiac transplant
Who gets congestive cardiac failure?
Older people (uncommon in the young)
Causes of CCF?
IHD HTN Infective cardiomyopathy Cor pulmonale Alcohol and drug abuse Side effect of prescribed drugs AF Valvular disease Anaemia Hyperthyroidism LV HF --> CCF
Risk factors for CCF?
Male
Congenital heart disease
Cardiovascular risk factors
Symptoms of CCF?
Fatigue Ankle oedema Leg/abdo oedema Exertional dyspnoea PND Nausea Abdo pain Increased urination Cold peripheries Weight loss Muscle wasting Tachypnoea Peripheral +/- central cyanosis Displaced apex bear RV heave 3rd and 4th heart sound Raised JVP Mitral/arotic murmurs Bilateral crackles Wheeze Pleural effusion Tender hepatomegaly (pulsatile in tricuspid regurg) Reduced peak flow
Differentials for CCF?
Aging Physical inactivity COPD Pulmonary fibrosis Pneumonia PE Post-partum cardiomyopathy Cirrhosis Nephrotic syndrome Pericardial disease DVT
Investigations for CCF?
FBC, U+E, cardiac enzymes, BNP, TFT CXR ECG Echo (inc stress test) Cardiac MRI
Treatment for CCF?
Lifestyle changes Diuretics ACEi ARA B Blockers Aldosterone antagonists Cardiac glycosides Vasodilators and nitrates Aspirin and statins (IHD) Anticoag (AF) Ivabradine to reduce HR Revascularisation Implantable cardioverter defib Pacemaker Cardiac transplant
