Cardio1 Flashcards
Chest Pain
What is the definition for a stable angina pectoris?
Chest pain upon exertion due to ischaemia, which is alleviated by rest
What are the causes of a stable angina pectoris?
Atherosclerotic plaque
Decubitus angina
Prinzmetal angina
Coronary syndrome X
What is decubitus angina?
Symptoms upon lying down
What is Prinzmetal angina?
Symptoms due to coronary vasospasm
what is coronary syndome X?
Symptoms of an angina but with normal exercise tolerance and normal coronary angiograms.
What are the conservative management options for stable anginas?
Exercise
Diet
Weight loss
Stop smoking
What are the medical management options for stable anginas?
Symptomatic (GTN spray)
Anti-anginal (BB/CCB)
Risk factor reduction (statin/ACEi/aspirin)
What are the three pathologies categorised under acute coronary syndrome?
STEMI
NSTEMI
Unstable angina
What is a STEMI?
ST elevated myocardial infarction
What is a NSTEMI?
Non-ST elevated myocardial infarction
What is an unstable angina pectoris?
Chest pain at rest due to ischaemia
What is the first investigation to do on a Pt with central, crushing chest pain, radiating to the jaw, and what are you looking for?
ECG
ST elevation
What would you do if there was no ST elevation in the ECG and what would each finding signify?
Troponin levels
Troponin +ve: NSTEMI
Troponin -ve: unstable angina pectoris
Which cohort of Pt’s could present with silent MI’s?
Elderly
Diabetics
What can you see in an ECG in a Pt with a STEMI?
ST elevation
Hyper-acute T waves
New onset LBBB
What can you see in an ECG in a Pt with an NSTEMI/UAP?
ST depression
T wave inversion
What do pathological Q waves suggest?
History of an MI
Which leads would have ST elevation in an anterior MI and which coronary artery is affected?
V1-V4
Left anterior descending
Which leads would have ST elevation in an lateral MI and which coronary artery is affected?
I, aVL, V5-6
Left circumflex
Which leads would have ST elevation in an inferior MI and which coronary artery is affected?
II, III, aVF
Right coronary artery
Which leads would have ECG changes in an posterior MI and which coronary artery is affected?
Tall R waves and ST depression in V1-3
Posterior descending
What is the acronym for ACS management and what do they stand for?
MONABASH Morphine Oxygen Nitrates (GTN) Anti-platelet (asipirin, clopidogrel) Beta-blocker ACEi Statin Heparin
What are the aims of treatment for a STEMI?
Coronary reperfusion
By PCI or fibrinolysis
If a Pt presents <12hrs after the onset of symptoms how should you manage them?
Send to the cathlab for PCI if it can happen <120min of the time that fibrinolysis could have been administered
If a Pt presents >12hrs after the onset of symptoms how should you manage them?
Coronary angiography then PCI if indicated
How should you treat a Pt with a NSTEMI/UAP?
Aspirin + another antiplatelet (clopidogrel/ticagrelor)
Fondaparinux if low risk of bleeding and not scheduled for coronary angiography within 24hrs
LMWH if coronary angiography planned
What should you use to stratify a patient’s risk of mortality from an ACS?
GRACE score
What should you do to a patient with a high risk GRACE score?
Give a GlpIIb/IIIa inhibitor (tirofiban) Coronary angiography (<72hrs)
What should you do to a patient with a low risk GRACE score?
Conservative management
control the risk factors
What are the complications of ACS?
DARTH VADER Death Arrhythmia Rupture Tamponade Heart failure Valve disease Aneurysm Dressler's Syndrome Embolism Re-infarction
What is pericarditis?
Inflammation of the pericardium
What are the causes of pericarditis?
Idiopathic Infective (eg. Coxsakie B) Connective tissue disease (eg. sarcoidosis) Dressler's Syndrome (2-10 wks post-MI) Malignancy
What are the symptoms and signs of pericarditis?
Sharp, central stabbing pain Pleuritic Relieved by sitting forward Fever/flu-like (if viral) Pericardial friction rub Tamponade (if pericardial effusion)
What investigations would you perform on a Pt with pericarditis?
ECG
Bloods (CRP, ESR)
CXR
What would you see on an ECG in a Pt with pericarditis?
Widespread saddle-shaped ST elevation
What is atrial fibrillation?
Chaotic, and ineffective contraction of the atria
What are some causes of AF?
Lots Pneumonia PE Hyperthyroidism IHD Alcohol Pericarditis
What are the symptoms and signs of AF?
Dizziness
Palpitations
Symptoms of underlying cause
Irregularly irregular pulse
What investigations would you perform on a Pt with AF?
ECG
Investigations for the underlying cause
What would you see on an ECG in a Pt with AF?
Irregularly irregular tachycardia with absent P waves
What should you do to a Pt with AF who is haemodynamically unstable?
DC cardioversion
What means of rhythm control should you give a Pt with an onset of AF <48hrs?
DC cardioversion or
Chemical cardioversion (flecainide/amiodarone)
[Flecainide is contra-indicated if IHD Hx]
What means of rhythm control should you give a Pt with an onset of AF >48hrs?
Anticoagulate for 3-4 weeks before cardioversion
What means of rate control should you give a Pt with AF?
Verapamil
Beta-blockers
Digoxin
What score is used to calculate the risk of stroke in AF patients?
CHA2DS2VASc
What should you give a Pt with a low CHADSVASc score?
Aspirin/nothing
What should you give a Pt with a high CHADSVASc score?
Warfarin (and heparin)
What does a supraventricular tachycardia look like on an ECG?
A regular narrow-complex tachycardia with no P waves
What are the symptoms of an SVT?
Syncope
Palpitations
Dyspnoea
Chest discomfort
What is AVNRT?
A local circuit forms in the AV node
What is AVRT?
A re-entry circuit forms between the atria and ventricles via an accessory pathway (Bundle of Kent)
What would an ECG show after the termination of an AVNRT?
No abnormalities
What would an ECG show after the termination of an AVRT?
Delta waves (slurred QRS upstroke) Wolff-Parkinson-White Syndrome
What should you do to treat a Pt with an SVT and is haemodynamically unstable?
DC cardioversion
What should you first do to treat a Pt with an SVT and is haemodynamically stable?
Valsalva manouvres
What should you first do to treat a Pt with an SVT and Valsalva manouvres failed to succeed?
IV adenosine 6mg
IV adenosine 12mg (if failed)
IV adenosine 12mg (if failed again)
What should you first do to treat a Pt with an SVT and IV adenosine failed to succeed?
One of: IV B-blocker (metoprolol) IV amiodarone IV digoxin DC cardioversion
What condition contraindicates the use of adenosine and what should you use as a substitute?
Asthma
Verapamil
What is syncope?
Loss of consciousness due to a lack of perfusion to the brain
What are the causes of syncope?
VAOP Vasovagal Arrhythmia Obstructive Postural hypotension
What is the pathophysiology of a vasovagal collapse and what are some symptoms?
Increased vagal activity (eg. sight of blood)
Sweating/pale
What is the pathophysiology of an arrhythmia collapse and what are some symptoms?
Reduced cardiac output
Palpitations
What are some causes of an obstructive collapse?
Hypertrophic obstructive cardiomyopathy
Aortic stenosis
What are the typical findings of someone with HOCM?
Jerky carotid pulse
Double apex beat
Ejection systolic murmur
FHx of sudden death <65yrs
What is the pathophysiology of a postural collapse and what are some causes?
Lack of compensation for the hypotension that occurs upon standing
Medications (anti-hypertensives)
Dehydration
What are some non-syncopal causes of collapse?
Intoxication
Head trauma
Metabolic (eg. hypoglycaemia)
Epileptic seizure
What would you give a Pt with hyperkalaemia?
10ml 10% calcium gluconate
