Cardio Core Conditions Flashcards

(54 cards)

1
Q

Who has an MI?

A

> 50 (risk increases with age)

M>F (pre menopause, post menopause risk is equal)

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2
Q

Causes of MI?

A
Clot in CA due to atheroma beginning to rupture 
Clot travelling to the heart 
Inflammation of the CAs
Stab to the heart
Cocaine use
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3
Q

Risk factors for MI?

A
HTN
High cholesterol
Lack of exercise 
Alcohol 
Smoking 
Hyperglycaemia
Age
FHx
Hypercholesterolaemia
Angina 
Ethnicity
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4
Q

Symptoms of an MI?

A
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
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5
Q

Differentials for MI?

A
ACS
Anxiety 
Aortic dissection 
Asthma
Endocarditis 
Oesophagitis
Gastritis
GORD
Hypotension 
Pancreatitis
PE 
Shock 
VSD
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6
Q

Investigations for MI?

A

ECG
Cardiac troponins, FBC, U+E, BM
Echocardiography for pericarditis, PE, aortic dissection

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7
Q

Treatment for MI?

A

MONAC
Fibrinolysis (reteplase, tenecteplase)
PCI

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8
Q

Who gets angina?

A

> 50y/o
M>F
Can occur in those younger as well

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9
Q

Causes of angina?

A

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

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10
Q

Risk factors for MI?

A
HTN
High cholesterol
Lack of exercise 
Alcohol
Smoking 
DM
Age
FHx
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11
Q

Symptoms of angina?

A
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
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12
Q

Differentials for angina?

A
MI
Acute pericarditis 
MSK pain 
GORD
Pleuritic chest pain 
Aortic dissection 
Biliary colic
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13
Q

Investigations for angina?

A

ECG

FBC, U+E, BM, fasting cholesterol and triglycerides, LFTs, TFTs, troponin (emergency admission)

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14
Q

Treatment for angina?

A

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

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15
Q

Who gets AF?

A

M>F

Older

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16
Q

Causes of AF?

A
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
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17
Q

Risk factors for AF?

A
Congenital heart disease 
Obesity 
Caffeine
Smoking 
Amphetamine and cocaine use
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18
Q

Symptoms of AF?

A
30% asymptomatic 
Fast irregular pulse 
Palpitations 
SOB 
Tired
Dizzy 
Chest pain 
Loss of exercise capability
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19
Q

Classifications of AF?

A

Paroxysmal (sudden bursts)
Persistent
Permanent (cardioversions unsuccessful)

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20
Q

Differentials for AF?

A
Atrial flutter
Supraventricular tachyarrhythmias 
AVN re-entrant tachycardia
WPW syndrome 
Ventricular tachycardia
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21
Q

Investigations for AF?

A

ECG
FBC, TFTs, U+E, LFTs, coag screen
CXR
CT/MRI of head if evidence of TIA

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22
Q

Treatment for AF?

A

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

23
Q

What percentage of adult HTN is essential HTN?

24
Q

Who gets HTN?

25
Causes of HTN?
``` FHx Low birth weight Lack of exercise Obesity Alcohol Smoking Stress High salt/fat diet Type II DM ```
26
Risk factors for HTN?
>65 Ethnicity (black African) Same as causes
27
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 ```
28
Differentials for HTN?
``` Anxiety Sleep apnoea Cardiomyopathy Cocaine Congestive heart failure PE Hyperaldosteronism Hyperthyroidism MI Stroke ```
29
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)
30
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 ```
31
How many people per year in the UK have DVT?
1 in 1,000
32
Who gets DVT?
Anyone | Risk increases with age
33
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 ```
34
Risk factors for DVT?
``` Previous DVT/PE FHx Obesity Smoking Trauma ```
35
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 ```
36
Differentials for DVT?
``` Baker's cyst Cellulitis Congestive HF Calf muscle haematoma Pelvic/thigh mass/tumour compressing venous outflow Thrombophlebitis ```
37
Investigations for DVT?
Clinical picture D-dimer levels Ileofemoral thrombosis confirmed using B mode venous compression and doppler Venography (contrast + XR)
38
Treatment for DVT?
Warfarin and LMWH Once warfarin is in a good INR range heparin is stopped Compression stockings Exercises
39
What % of hospital admissions are due to HF?
5%
40
Who gets LV-HF?
Increases with age | M>F (young men are at higher risk of ischaemic heart disease)
41
Causes of LV-HF?
``` Ischaemic heart disease HTN Cardiomyopathy following infection Drug abuse Side effect of prescription drugs AF Valvular heart disease Anaemia Hyperthyroidism ```
42
Risk factors for LV-HF?
Male Increasing age Congenital cardiac disease Cardiovascular risk factors
43
Symptoms of LV-HF?
``` Exertional dyspnoea Orthopnoea PND Fatigue Oedema Haemoptysis Pleural effusion Cardiomegaly 3rd and 4th heart sounds Elevated JVP Tachycardia Hypotension ```
44
How is LV-HF classified?
1) No limitation in physical activity 2) Mild limitation 3) Marked limitation 4) Symptomatic at rest
45
Differentials for LV-HF?
``` Acute renal failure ARDS COPD Cirrhosis Emphysema MI Nephrotic syndrome PE ```
46
Investigations for LV-HF?
``` FBC, U+E, cardiac enzymes, BNP, TFT CXR ECG Echo Stress Echo Cardiac MRI ```
47
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 ```
48
Who gets congestive cardiac failure?
Older people (uncommon in the young)
49
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 ```
50
Risk factors for CCF?
Male Congenital heart disease Cardiovascular risk factors
51
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 ```
52
Differentials for CCF?
``` Aging Physical inactivity COPD Pulmonary fibrosis Pneumonia PE Post-partum cardiomyopathy Cirrhosis Nephrotic syndrome Pericardial disease DVT ```
53
Investigations for CCF?
``` FBC, U+E, cardiac enzymes, BNP, TFT CXR ECG Echo (inc stress test) Cardiac MRI ```
54
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 ```