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Year 3 MedEd > Cardio1 > Flashcards

Cardio1 Flashcards

Chest Pain

1
Q

What is the definition for a stable angina pectoris?

A

Chest pain upon exertion due to ischaemia, which is alleviated by rest

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2
Q

What are the causes of a stable angina pectoris?

A

Atherosclerotic plaque
Decubitus angina
Prinzmetal angina
Coronary syndrome X

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3
Q

What is decubitus angina?

A

Symptoms upon lying down

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4
Q

What is Prinzmetal angina?

A

Symptoms due to coronary vasospasm

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5
Q

what is coronary syndome X?

A

Symptoms of an angina but with normal exercise tolerance and normal coronary angiograms.

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6
Q

What are the conservative management options for stable anginas?

A

Exercise
Diet
Weight loss
Stop smoking

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7
Q

What are the medical management options for stable anginas?

A

Symptomatic (GTN spray)
Anti-anginal (BB/CCB)
Risk factor reduction (statin/ACEi/aspirin)

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8
Q

What are the three pathologies categorised under acute coronary syndrome?

A

STEMI
NSTEMI
Unstable angina

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9
Q

What is a STEMI?

A

ST elevated myocardial infarction

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10
Q

What is a NSTEMI?

A

Non-ST elevated myocardial infarction

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11
Q

What is an unstable angina pectoris?

A

Chest pain at rest due to ischaemia

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12
Q

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?

A

ECG

ST elevation

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13
Q

What would you do if there was no ST elevation in the ECG and what would each finding signify?

A

Troponin levels
Troponin +ve: NSTEMI
Troponin -ve: unstable angina pectoris

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14
Q

Which cohort of Pt’s could present with silent MI’s?

A

Elderly

Diabetics

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15
Q

What can you see in an ECG in a Pt with a STEMI?

A

ST elevation
Hyper-acute T waves
New onset LBBB

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16
Q

What can you see in an ECG in a Pt with an NSTEMI/UAP?

A

ST depression

T wave inversion

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17
Q

What do pathological Q waves suggest?

A

History of an MI

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18
Q

Which leads would have ST elevation in an anterior MI and which coronary artery is affected?

A

V1-V4

Left anterior descending

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19
Q

Which leads would have ST elevation in an lateral MI and which coronary artery is affected?

A

I, aVL, V5-6

Left circumflex

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20
Q

Which leads would have ST elevation in an inferior MI and which coronary artery is affected?

A

II, III, aVF

Right coronary artery

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21
Q

Which leads would have ECG changes in an posterior MI and which coronary artery is affected?

A

Tall R waves and ST depression in V1-3

Posterior descending

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22
Q

What is the acronym for ACS management and what do they stand for?

A 
MONABASH
Morphine
Oxygen
Nitrates (GTN)
Anti-platelet (asipirin, clopidogrel)
Beta-blocker
ACEi
Statin
Heparin
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23
Q

What are the aims of treatment for a STEMI?

A

Coronary reperfusion

By PCI or fibrinolysis

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24
Q

If a Pt presents <12hrs after the onset of symptoms how should you manage them?

A

Send to the cathlab for PCI if it can happen <120min of the time that fibrinolysis could have been administered

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25
Q

If a Pt presents >12hrs after the onset of symptoms how should you manage them?

A

Coronary angiography then PCI if indicated

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26
Q

How should you treat a Pt with a NSTEMI/UAP?

A

Aspirin + another antiplatelet (clopidogrel/ticagrelor)
Fondaparinux if low risk of bleeding and not scheduled for coronary angiography within 24hrs
LMWH if coronary angiography planned

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27
Q

What should you use to stratify a patient’s risk of mortality from an ACS?

A

GRACE score

28
Q

What should you do to a patient with a high risk GRACE score?

A 
Give a GlpIIb/IIIa inhibitor (tirofiban)
Coronary angiography (<72hrs)
29
Q

What should you do to a patient with a low risk GRACE score?

A

Conservative management

control the risk factors

30
Q

What are the complications of ACS?

A 
DARTH VADER
Death
Arrhythmia
Rupture
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler's Syndrome
Embolism
Re-infarction
31
Q

What is pericarditis?

A

Inflammation of the pericardium

32
Q

What are the causes of pericarditis?

A 
Idiopathic
Infective (eg. Coxsakie B)
Connective tissue disease (eg. sarcoidosis)
Dressler's Syndrome (2-10 wks post-MI)
Malignancy
33
Q

What are the symptoms and signs of pericarditis?

A 
Sharp, central stabbing pain
Pleuritic
Relieved by sitting forward
Fever/flu-like (if viral)
Pericardial friction rub
Tamponade (if pericardial effusion)
34
Q

What investigations would you perform on a Pt with pericarditis?

A

ECG
Bloods (CRP, ESR)
CXR

35
Q

What would you see on an ECG in a Pt with pericarditis?

A

Widespread saddle-shaped ST elevation

36
Q

What is atrial fibrillation?

A

Chaotic, and ineffective contraction of the atria

37
Q

What are some causes of AF?

A 
Lots
Pneumonia
PE
Hyperthyroidism
IHD
Alcohol
Pericarditis
38
Q

What are the symptoms and signs of AF?

A

Dizziness
Palpitations
Symptoms of underlying cause
Irregularly irregular pulse

39
Q

What investigations would you perform on a Pt with AF?

A

ECG

Investigations for the underlying cause

40
Q

What would you see on an ECG in a Pt with AF?

A

Irregularly irregular tachycardia with absent P waves

41
Q

What should you do to a Pt with AF who is haemodynamically unstable?

A

DC cardioversion

42
Q

What means of rhythm control should you give a Pt with an onset of AF <48hrs?

A

DC cardioversion or
Chemical cardioversion (flecainide/amiodarone)
[Flecainide is contra-indicated if IHD Hx]

43
Q

What means of rhythm control should you give a Pt with an onset of AF >48hrs?

A

Anticoagulate for 3-4 weeks before cardioversion

44
Q

What means of rate control should you give a Pt with AF?

A

Verapamil
Beta-blockers
Digoxin

45
Q

What score is used to calculate the risk of stroke in AF patients?

A

CHA2DS2VASc

46
Q

What should you give a Pt with a low CHADSVASc score?

A

Aspirin/nothing

47
Q

What should you give a Pt with a high CHADSVASc score?

A

Warfarin (and heparin)

48
Q

What does a supraventricular tachycardia look like on an ECG?

A

A regular narrow-complex tachycardia with no P waves

49
Q

What are the symptoms of an SVT?

A

Syncope
Palpitations
Dyspnoea
Chest discomfort

50
Q

What is AVNRT?

A

A local circuit forms in the AV node

51
Q

What is AVRT?

A

A re-entry circuit forms between the atria and ventricles via an accessory pathway (Bundle of Kent)

52
Q

What would an ECG show after the termination of an AVNRT?

A

No abnormalities

53
Q

What would an ECG show after the termination of an AVRT?

A 
Delta waves (slurred QRS upstroke)
Wolff-Parkinson-White Syndrome
54
Q

What should you do to treat a Pt with an SVT and is haemodynamically unstable?

A

DC cardioversion

55
Q

What should you first do to treat a Pt with an SVT and is haemodynamically stable?

A

Valsalva manouvres

56
Q

What should you first do to treat a Pt with an SVT and Valsalva manouvres failed to succeed?

A

IV adenosine 6mg
IV adenosine 12mg (if failed)
IV adenosine 12mg (if failed again)

57
Q

What should you first do to treat a Pt with an SVT and IV adenosine failed to succeed?

A 
One of:
IV B-blocker (metoprolol)
IV amiodarone
IV digoxin
DC cardioversion
58
Q

What condition contraindicates the use of adenosine and what should you use as a substitute?

A

Asthma

Verapamil

59
Q

What is syncope?

A

Loss of consciousness due to a lack of perfusion to the brain

60
Q

What are the causes of syncope?

A 
VAOP
Vasovagal
Arrhythmia
Obstructive
Postural hypotension
61
Q

What is the pathophysiology of a vasovagal collapse and what are some symptoms?

A

Increased vagal activity (eg. sight of blood)

Sweating/pale

62
Q

What is the pathophysiology of an arrhythmia collapse and what are some symptoms?

A

Reduced cardiac output

Palpitations

63
Q

What are some causes of an obstructive collapse?

A

Hypertrophic obstructive cardiomyopathy

Aortic stenosis

64
Q

What are the typical findings of someone with HOCM?

A

Jerky carotid pulse
Double apex beat
Ejection systolic murmur
FHx of sudden death <65yrs

65
Q

What is the pathophysiology of a postural collapse and what are some causes?

A

Lack of compensation for the hypotension that occurs upon standing
Medications (anti-hypertensives)
Dehydration

66
Q

What are some non-syncopal causes of collapse?

A

Intoxication
Head trauma
Metabolic (eg. hypoglycaemia)
Epileptic seizure

67
Q

What would you give a Pt with hyperkalaemia?

A

10ml 10% calcium gluconate

Year 3 MedEd (29 decks)

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