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phase 2a pain > cardio shiiiiite > Flashcards

cardio shiiiiite Flashcards

1
Q

2 for each: modifiable, clinical, non-mod RF for ischaemic heart disease

A 
Modifiable:
Smoking
Obesity
Sedentary lifestyle
Diet
clinical:
Hypertension
Diabetes
Hyperlipidaemia
Depression

Non-modifiable
Age
Genetics/Family history
Gender (M>F risk)

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2
Q

stable angina?

A

induced by effort, relieved by rest

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3
Q

unstable angina?

A

can occur on minimal/no exertion

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4
Q

decubitus angina?

A

precipitated by lying flat

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5
Q

prinzmetal angina?

A

caused by coronary artery spasm

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6
Q

angina pathology

A

restricted coronary blood flow, secondary to atherosclerosis

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7
Q

stable angina ECG

A

ST depression and T wave inversion

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8
Q

STEMI & ECG

A 
Sudden complete (100%) occlusion of a coronary artery
transmural

ST elevation
new LBBB

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9
Q

NSTEMI & ECG

A

Severely narrowed artery but the artery is not fully occluded
subendocardial

ST depression, T wave inversion
non-transmural subendocardial ischemia

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10
Q

NSTEMI test to differentiate from angina

A

troponin posi in NSTEMI

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11
Q

ACS path

A

plaque rupture > thrombosis > inflammation

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12
Q

unstable angina ECG

A

(when pain occurs) ST depression

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13
Q

list some diff diag for chest pain

A 
acute MI
angina
pericarditis
myocarditis
rib fracture
chest trauma
muscular
anxiety
PE
pneumonia
tension pneumothorax
lung cancer
GORD
oesophageal rupture
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14
Q

RF for cardiac failure

A 
65 and older
African descent
Men
Obesity
Previous MI
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15
Q

blood in right side of heart comes from…? goes to..?

A

from: body
to: lungs

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16
Q

blood in left side of heart comes from…? goes to..?

A

from: lungs
to: body

(hence thicc muscular wall)

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17
Q

symtoms of left ventricular failure

A 
LUNGS
Exertional dyspnoea 
Fatigue 
Paroxysmal nocturnal dyspnoea (PND)
Nocturnal cough – (+/-) pink frothy sputum 
Cyanosis 
Orthopnoea 
Wheeze (cardiac ‘asthma’)
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18
Q

heart signs for left ventricular failure

A 
Cardiomegaly (displaced apex beat)
3rd and 4th heart sounds 
↓BP
Narrow pulse pressure 
Pulsus alternans (alternating strong and weak beats)
Crepitations in lung bases
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19
Q

symptoms of right ventricular failure

A 
Peripheral oedema 
Ascites
Nausea 
Anorexia 
Facial engorgement
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20
Q

heart signs of right ventricular failure

A 
Raised JVP
Hepatomegaly 
Pitting oedema
Ascites 
Weight gain (fluid)
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21
Q

gold standard test for cardiac failure

A

echocardiography

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22
Q

3 signs, 3 symp of cor pumonale

A 
Symptoms:
Dyspnoea
Fatigue 
Syncope
Signs:
Cyanosis 
Tachycardia
Raised JVP 
Hypoxia
3rd heart sound
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23
Q

cor pulmonale

A

right sided heart failure caused by respiratory disease

pulmonary hypertension = back pressure of blood in right atrium, vena cava and systemic venous system

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24
Q

treat cor pulmonale

A

treat underlying cause, o2 24%, diuretic - furosemide

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25
Q

complications of hypertension

A 
retinopathy
LVH 
HF
renal failure
proteinuria
headache
nausea
vomiting
impotence
26
Q

investigate hypertension

A

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)

27
Q

hypertension lifestyle advice

A 
Weight loss
Reduce alcohol intake 
Reduce salt intake 
Stop smoking 
Regular exercise 
Stress reduction
28
Q

meds for hypertension if under 55

A 
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
29
Q

meds for hypertension if over 55 or black of any age

A 
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
30
Q

when and what should be used instead of ABCD in hypertension

A

if encephalopathy use sodium nitroprusside infusion

31
Q

causes of aortic stenosis - acquired and congenital

A 
acquired = calcification, rheumatic heart disease
congenital = bicuspid valve, william's syndrome
32
Q

path of aortic stenosis

A

obstructed LVOT = increase ventricular pressure = LVH = blood stays

33
Q

signs describe which valvular disease?
Slow rising carotid pulse
Narrow pulse pressure
Carotid radiation

A

aortic stenosis

34
Q

investigation for valvular disease

A

echocardiography

35
Q

treat aortic stenosis/mitral regurgitation

A

valve repair/replacement

36
Q

causes of mitral regurgitation

A

mitral valve prolapse, IHD, rheumatic heart disease

37
Q

path of mitral regurg

A

Back flow of blood leading to pure volume overload

Regurgitation → LA dilatation → LVH as ventricle swells to maintain BP

38
Q

signs describe which valvular disease?

Soft S1, Displaced hyperdynamic apex beat

A

mitral regurgitation

39
Q

prophylactic antib in aortic stenosis bc..?

A

prevent risk of IE

40
Q

signs describe which valvular disease?

Collapsing pulse, Wide pulse pressure, Displaced apex beat

A

aortic regurgitation

41
Q

rheumatic fever bacteria/reaction

A

Group A Beta-haemolytic Streptococcus (GABHS) - strep pyogenes infection
type 2 hypersens

42
Q

3 things caused by rheumatic fever

A

leaflet thickening
commissural fusion
shortening and thickening of the tendinous cords

43
Q

sinus rhythym

A

cardiac rhythm that starts with depolarization at the sinus node with correctly orientated p waves on an ECG

44
Q

sinus tachycardia

A

> 100bpm + sinus rhythm
Physiological response to exercise and excitement
anaemia, infection, fever
treat with atenolol

45
Q

sinus tachycardia on ecg

A

P waves piggyback onto the T waves = camel hump T waves

46
Q

1st line management in SVT

A

adenosine

47
Q

Irregularly irregular rhythm

Absent P waves

A

atrial fib

48
Q

treat acute atrial fib

A

acute:
cardioversion (electrical/amiodarone)
correct electrolytes, rate control, anticoagulate

49
Q

treat chronic atrial fib (baso same for atrial flutter)

A

rate control - beta blockers eg. atenolol, or CCB verapamil
rhythm control - electrical cardioversion or amiodarone
anticoag- warfarin

50
Q

atrial flutter ecg

A

sawtooth pattern, regular atrial rate

51
Q

surgery for AF

A

Radiofrequency catheter ablation – curative for most patients

52
Q

AVNRT ECG

A

absent p waves

53
Q

wolff parkinson white syndrome ecg

A

short pr interval
qide qrs
delta wave

54
Q

Sinus Bradycardia

A

normally athletes
caused by: beta blockers, vasovagal attacks, hypothermia, hypothyroidism, raised ICP
treat intrinsic with atropine/temporary pacing

55
Q

3rd degree heart block treat

A

IV atropine

56
Q

LBBB

A

IHD, aortic valve disease, htn
WiLLiaM
slurred wave in V1
R wave in V6

57
Q

RBBB

A

PE, IHD, Cor pulmonale
MaRRoW
R wave in V1
Slurred wave in V6

58
Q

unruptured aortic aneurysm pres

A

Asymptomatic (usually), Pulsatile on palpation

59
Q

ruptured aortic aneurysm

A

Intermittent or continuous abdominal/epigastric pain (radiates to back, iliac fossae or groins)
Collapse/Shock
Expansive abdominal mass

60
Q

investigate aortic aneurysm and treat

A

CT angiography

Surgery (if ruptured IMMEDIATE) or Stenting (unruptured)

61
Q

screen for aortic aneurysm?

A

All males at age 65 years
Via Aortic Ultrasound
High risk if: symptomatic, aortic diameter >5.5cm or rapidly enlarging (>1cm/year)

62
Q

tetralogy of fallot

A

Ventricular Septal Defect (VSD)
Pulmonary Stenosis
Right Ventricular Hypertrophy (RVH)
Overriding Aorta

phase 2a pain (27 decks)

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