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Cardiology > Cardio Disease > Flashcards

Cardio Disease Flashcards

1
Q

What are the indications for PCI?

A
  1. STEMI,
  2. High risk acute coronary syndrome,
  3. Refractory angina
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2
Q

What are the indications for a CABG?

A
  1. Advanced 3 vessel disease
  2. Left main disease
  3. Multivessel + diabetes
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3
Q

What are the four causes of an anterior mediastinal mass?

A

Thymoma
Teratoma
Terrible lymphoma

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4
Q

Peripheral Artery Disease

A

Definition: Atherosclerosis, thromboembolism or vasculitis, causing limited flow to the limbs

Risk Factors: Dyslipidemia, hypertension, diabetes, smoking etc. Often goes along with CAD

Symptoms: 
Claudiacation: discomfort in legs during exercise, relieved with rest
Signs:
Peripheral bruits (renal)
Loss of distal pulses
Ulcers/gangrene, shiny skin, hair loss
Postive Buerger's test

Diagnosis:
Ankle blood pressure vs brachial (ABI)= 1)
Arterial doppler ultrasound
CT angiography (see stenosis)

Management:
Medical: risk factor management
Anti-platelet therapy

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5
Q

Critical limb ischemia

A
  1. Chronic ischemic pain occurs at rest= BAD
  2. 50% amputation rate
  3. More aggressive and invasive interventions
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6
Q

Acute limb ischemia

A

Definition: Sudden decrease in limb perfusion that threatens limb viability
Etiology: Emboli (atrial or ventricular fib)
Symptoms:
Acute onset, motor weakness, sensory loss
6P’s (pulseless, pallor, PAIN…)

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7
Q

Abdominal aortic aneurysm

A

Definition: Prominent dilatation of the aorta
Often due to high blood pressure, and weak arterial walls due to atherosclerosis.
May rupture… DEATH!

Signs:
Physical exam- feel laterally pulsating abdominal pulses.

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8
Q

What is the CCS angina classification?

A
  1. Chest pain only with strenuous, rapid, prolonged exertion
  2. Slight limitation of ordinary activity, chest pain with walking or climbing stairs rapidly
  3. Chest pain with low levels of exertion (1-2 blocks walking or
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9
Q

How do we predict probability that chest pain is due to CAD?

A

Low (90%): Men over 40 with angina, women with typical angina over 60

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10
Q

How does the pretest probability of CAD impact the utility of stress testing?

A

Small gain in low and high ends: if low probability, very unlikely that they tested positived. If high, very likely that they did test positive. In between, big gain from testing.

At upper end, testing may be more useful prognostically than diagnostically

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11
Q

What tests can be used to evaluate coronary artery disease?

A

Framingham risk score
Exercise stress test (are sx reproducible)
Stress test plus nuclear imaging (good for heart blocks, increases sensitivity)
Pharmacologic stress testing
Coronary angiography

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12
Q

What is Prinzmetal angina?

A

A coronary artery spasm in the ABSENCE of overt atherosclerotic lesions.

Intense vasospasm reduces coronary oxygen supply

Potentially due to increased sympathetic input

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13
Q

What are the signs of right heart failure?

A
  1. Elevated JVP
  2. Hepatomegaly
  3. Peripheral edema
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14
Q

What is an aoritic dissection and what are the types?

A

Dissection= tear of intima (inner layer) of aorta, propagates between layers down the length of the aorta.

  1. Type A: ascending aorta (aging, connective tissue disorders)
  2. Type 2: descending & abdominal (atherosclerosis)
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15
Q

What are the symptoms of aortic dissections? What tests are done to diagnose?

A
  1. Sudden, severe, midline, sharp, ripping pain
  2. Syncope, decreased LOC, coma
  3. Hemodynamic insufficiency, cardiogenic shock
  4. DEATH

Tests:
CT with contrast- best chance
MRI- for type B or chronic (too slow for A!)

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16
Q

How are aortic dissections treated?

A
  1. Type A: ALWAYS SURGICAL (repair flap) (mortality still 26%)
  2. Type B: Medically: beta blockers, vasodilators,
17
Q

Where is the peripheral arterial disease if pain is felt in the:

  1. Buttocks, hips, thighs,
  2. Calves
  3. Arms
A
  1. Distal aorta or iliac arteries
  2. Femoral or popliteal
  3. Subclavian or axillary
18
Q

What ECG changes are seen in infarct and ischemia?

A
  1. Peaked or inverted T waves
  2. ST depression in ischemia
  3. ST elevation in infarction
  4. Deep Q waves in late or old infarct
  5. Poor R wave progression
19
Q

What causes ECG left axis deviation?

A
  1. Inferior wall MI

2. Left anterior fascicular block

20
Q

What causes ECG right axis deviation?

A
  1. Right ventricular hypertrophy
  2. Acute right heart strain
  3. Left posterior fasiscular block
21
Q

How should stable angina be treated?

A
  1. Aspirin and anti-anginals ( nitro)
  2. Beta blockers
  3. Cholesterol (lower with statin) and cigarettes (smoking cessation)
  4. Diet and diabetes (good diet, prevent diabetes or manage)
  5. Education and exercise
22
Q

What is treatment for acute coronary sydromes?

A
  1. Anti-ischemic therapy- beta blockers, nitrates, CCB
  2. 5 Aspirin-immediately on presentation
  3. Clopidogrel (inhibit more pathways of platelet activation)
  4. anti coagulate ( LMWH, NOAC)
  5. Thrombolytics for stemis, possible cardiac catheterization
  6. Ace inhibitors and statins ( limit adverse remodelling, mortality)
23
Q

When do cardiac enzymes become positive in ACS?

A
  1. Troponins: rise 3-4h after, peak 18-36h, present for about 10 days
  2. Creatine kinase: rises 3-8 hours, peaks 24, normal around 72
24
Q

In what other conditions may cardiac enzymes be elevated?

A
  1. Heart failure
  2. Myocarditis
  3. Pulmonary embolism causing RV strain
25
Q

When is an S3 a normal finding?

A
  1. In children and young adults
26
Q

What is protocol for atrial fib that has been present for more than 48 hours?

A
  1. More than 48 h may predispose to thrombus

2. So anticoagulation and slow HR for at least 3 weeks before chemical/electrical cardioversion to sinus rhythm

27
Q

What kind of embolism does a fib cause?

A
  1. Systemic (goes to brain and body)
28
Q

Which medication is the most effective at maintaining sinus rhythm?

A

Amiodarone (class 3 antiarrhythmic)

29
Q

Syncope definition

A

Transient loss of consciousness due to global cerebral hypo perfusion

30
Q

What are the causes of syncope?

A
  1. Obstructive: emboli, aortic stenosis
  2. Arrhythmic: Bradycardia/ 3rd degree heart block, tachycardia
  3. Reflex: **vasovagal, carotid sinus, acute inferior MI
  4. Orthostatic: hypovolemia, hypotensive drugs (*beta blockers)
31
Q

What typically causes myocarditis?

A
  1. Viral: coxsackievirus
  2. Parasites
  3. Inflammatory
  4. Thyroid
32
Q

Plus us parvus et tardus

A

Aortic stenosis

33
Q

Wide pulse pressure

A

Aortic regurg

34
Q

Double impulse pulse

A

AI or HOCM

35
Q

Fixed split S2

A

ASD

36
Q

Opening snap

A

Mitral stenosis

37
Q

Ejection click

A

Bicuspid aortic valve

38
Q

Mid systolic click

A

Mitral valve prolapse

39
Q

CV wave

A

Tricuspid regurgitation

Cardiology (20 decks)

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