cardio shiiiiite Flashcards
2 for each: modifiable, clinical, non-mod RF for ischaemic heart disease
Modifiable: Smoking Obesity Sedentary lifestyle Diet
clinical: Hypertension Diabetes Hyperlipidaemia Depression
Non-modifiable
Age
Genetics/Family history
Gender (M>F risk)
stable angina?
induced by effort, relieved by rest
unstable angina?
can occur on minimal/no exertion
decubitus angina?
precipitated by lying flat
prinzmetal angina?
caused by coronary artery spasm
angina pathology
restricted coronary blood flow, secondary to atherosclerosis
stable angina ECG
ST depression and T wave inversion
STEMI & ECG
Sudden complete (100%) occlusion of a coronary artery transmural
ST elevation
new LBBB
NSTEMI & ECG
Severely narrowed artery but the artery is not fully occluded
subendocardial
ST depression, T wave inversion
non-transmural subendocardial ischemia
NSTEMI test to differentiate from angina
troponin posi in NSTEMI
ACS path
plaque rupture > thrombosis > inflammation
unstable angina ECG
(when pain occurs) ST depression
list some diff diag for chest pain
acute MI angina pericarditis myocarditis rib fracture chest trauma muscular anxiety PE pneumonia tension pneumothorax lung cancer GORD oesophageal rupture
RF for cardiac failure
65 and older African descent Men Obesity Previous MI
blood in right side of heart comes from…? goes to..?
from: body
to: lungs
blood in left side of heart comes from…? goes to..?
from: lungs
to: body
(hence thicc muscular wall)
symtoms of left ventricular failure
LUNGS Exertional dyspnoea Fatigue Paroxysmal nocturnal dyspnoea (PND) Nocturnal cough – (+/-) pink frothy sputum Cyanosis Orthopnoea Wheeze (cardiac ‘asthma’)
heart signs for left ventricular failure
Cardiomegaly (displaced apex beat) 3rd and 4th heart sounds ↓BP Narrow pulse pressure Pulsus alternans (alternating strong and weak beats) Crepitations in lung bases
symptoms of right ventricular failure
Peripheral oedema Ascites Nausea Anorexia Facial engorgement
heart signs of right ventricular failure
Raised JVP Hepatomegaly Pitting oedema Ascites Weight gain (fluid)
gold standard test for cardiac failure
echocardiography
3 signs, 3 symp of cor pumonale
Symptoms: Dyspnoea Fatigue Syncope Signs: Cyanosis Tachycardia Raised JVP Hypoxia 3rd heart sound
cor pulmonale
right sided heart failure caused by respiratory disease
pulmonary hypertension = back pressure of blood in right atrium, vena cava and systemic venous system
treat cor pulmonale
treat underlying cause, o2 24%, diuretic - furosemide
complications of hypertension
retinopathy LVH HF renal failure proteinuria headache nausea vomiting impotence
investigate hypertension
24hr ambulatory BP monitoring (ABPM) - at least 2 measurements per hour during the person’s usual waking hours
OR…
Multiple home BP monitoring (if patient can’t tolerate ABPM) - BP recorded twice daily
look for organ damage (urinalysis, ecg, fundoscopy)
hypertension lifestyle advice
Weight loss Reduce alcohol intake Reduce salt intake Stop smoking Regular exercise Stress reduction
meds for hypertension if under 55
ACE-I/angiotensin 2 receptor blocker add CCB add Diuretic - thiazide - add spironolactone if <4.5 K+ add alpha or beta blocker if >4.5
meds for hypertension if over 55 or black of any age
CCB add ACE-I/angiotensin 2 receptor blocker add Diuretic - thiazide - add spironolactone if <4.5 K+ add alpha or beta blocker if >4.5
when and what should be used instead of ABCD in hypertension
if encephalopathy use sodium nitroprusside infusion
causes of aortic stenosis - acquired and congenital
acquired = calcification, rheumatic heart disease congenital = bicuspid valve, william's syndrome
path of aortic stenosis
obstructed LVOT = increase ventricular pressure = LVH = blood stays
signs describe which valvular disease?
Slow rising carotid pulse
Narrow pulse pressure
Carotid radiation
aortic stenosis
investigation for valvular disease
echocardiography
treat aortic stenosis/mitral regurgitation
valve repair/replacement
causes of mitral regurgitation
mitral valve prolapse, IHD, rheumatic heart disease
path of mitral regurg
Back flow of blood leading to pure volume overload
Regurgitation → LA dilatation → LVH as ventricle swells to maintain BP
signs describe which valvular disease?
Soft S1, Displaced hyperdynamic apex beat
mitral regurgitation
prophylactic antib in aortic stenosis bc..?
prevent risk of IE
signs describe which valvular disease?
Collapsing pulse, Wide pulse pressure, Displaced apex beat
aortic regurgitation
rheumatic fever bacteria/reaction
Group A Beta-haemolytic Streptococcus (GABHS) - strep pyogenes infection
type 2 hypersens
3 things caused by rheumatic fever
leaflet thickening
commissural fusion
shortening and thickening of the tendinous cords
sinus rhythym
cardiac rhythm that starts with depolarization at the sinus node with correctly orientated p waves on an ECG
sinus tachycardia
> 100bpm + sinus rhythm
Physiological response to exercise and excitement
anaemia, infection, fever
treat with atenolol
sinus tachycardia on ecg
P waves piggyback onto the T waves = camel hump T waves
1st line management in SVT
adenosine
Irregularly irregular rhythm
Absent P waves
atrial fib
treat acute atrial fib
acute:
cardioversion (electrical/amiodarone)
correct electrolytes, rate control, anticoagulate
treat chronic atrial fib (baso same for atrial flutter)
rate control - beta blockers eg. atenolol, or CCB verapamil
rhythm control - electrical cardioversion or amiodarone
anticoag- warfarin
atrial flutter ecg
sawtooth pattern, regular atrial rate
surgery for AF
Radiofrequency catheter ablation – curative for most patients
AVNRT ECG
absent p waves
wolff parkinson white syndrome ecg
short pr interval
qide qrs
delta wave
Sinus Bradycardia
normally athletes
caused by: beta blockers, vasovagal attacks, hypothermia, hypothyroidism, raised ICP
treat intrinsic with atropine/temporary pacing
3rd degree heart block treat
IV atropine
LBBB
IHD, aortic valve disease, htn
WiLLiaM
slurred wave in V1
R wave in V6
RBBB
PE, IHD, Cor pulmonale
MaRRoW
R wave in V1
Slurred wave in V6
unruptured aortic aneurysm pres
Asymptomatic (usually), Pulsatile on palpation
ruptured aortic aneurysm
Intermittent or continuous abdominal/epigastric pain (radiates to back, iliac fossae or groins)
Collapse/Shock
Expansive abdominal mass
investigate aortic aneurysm and treat
CT angiography
Surgery (if ruptured IMMEDIATE) or Stenting (unruptured)
screen for aortic aneurysm?
All males at age 65 years
Via Aortic Ultrasound
High risk if: symptomatic, aortic diameter >5.5cm or rapidly enlarging (>1cm/year)
tetralogy of fallot
Ventricular Septal Defect (VSD)
Pulmonary Stenosis
Right Ventricular Hypertrophy (RVH)
Overriding Aorta
