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CP1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Diagnosing Stable Angina

A

FIRST LINE:
Resting ECG
FBC, HbA1c, Lipids

CONSIDER:
Exercise ECG only if known CAD
Cardiac CT Angiography

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2
Q

Treating Stable Angina

A

Sublingual Glycerol Nitrate -ALL

Anti-anginal Therapy -ALL
Beta blocker AND/OR CCB 1st line
Long acting nitrate or ranolazine if above contraindicated

Consider Antiplatelet Therapy for ALL
Aspirin OR Clopidogrel if cannot take aspirin
Can be combined

DO NOT USE VERAPAMIL WITH BETA BLOCKERS AS CAUSES HEART BLOCK

Add ACE Inhibitor if HTN, diabetes, left ventricular dysfunction, heart failure, CKD, previous MI

Statins if dyslipidaemia

Blood sugar control if hyperglycaemia

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3
Q

Diagnosing Unstable Angina

A 
FIRST LINE:
Resting ECG 
Troponin to rule out NSTEMI/STEMI
FBC for anaemia and thrombocytopenia 
U&E's + Creatinine for baseline, treatment choice and GRACE score calculations
LFTs to ascertain liver function before anticoagulation
Amylase/Lipase
TFT's 
CXR for signs of heart failure

CONSIDER:
Echo
Angiogram

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4
Q

Treating Unstable Angina

A

Antiplatelet Therapy - ALL
Aspirin OR Clopidogrel if cannot take aspirin
Can be combined

Anti Anginal Therapy - ALL
Beta Blocker OR non-dihydropyridine CCB (e.g. Verapamil)

DO NOT USE VERAPAMIL WITH BETA BLOCKERS AS CAUSES HEART BLOCK

Glycerol Trinitrate and/or Morphine for pain

Antihypertensives if HTN:
Beta Blocker
+/- ACE-I or A2RA

Statins if dyslipidaemia

Blood sugar control if hyperglycaemia

Revascularisation

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5
Q

Diagnosing NSTEMI

A

FIRST LINE
Resting ECG
Troponin
FBC for anaemia and thrombocytopenia
U&E’s + Creatinine for baseline, treatment choice and GRACE score calculations
LFTs to ascertain liver function before anticoagulation

CONSIDER
Echo
Angiogram

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6
Q

Treating NSTEMI

A 
UNSTABLE
Immediate angiography + revascularisation 
\+ Aspirin
\+ P2Y12 Inhibitor 
\+ Anticoagulation for PCI

Consider GTN, Morphine, Anti-emetic

STABLE
Aspirin
+ P2Y12-I
+ ACE-I or A2RA

Consider B-Blockers, GTN, Morphine, Anti-emetic, revascularisation

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7
Q

Diagnosing STEMI

A 
FIRST LINE 
Resting ECG 
Immediate angiography suitability assessment
Troponin 
FBC 
U&E's + Creatinine

Consider
ABG
Chest XR but must not delay reperfusion
Echo but must not delay reperfusion

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8
Q

Treating STEMI

A 
Immediate reperfusion via PCI or Fibrinolysis 
\+ Aspirin 
\+ Morphine
\+ P2Y12-I
\+ Anti-emetic
\+ Parental anticoagulation
POST STABILISATION
Dual anticoagulation 
Beta Blocker
ACE-I
Statin
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9
Q

Diagnosing Valvular Disease

A

FIRST LINE
Echo can rule in or out valve incompetencies
ECG can show signs such as
CXR for heart changes

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10
Q

Diagnosing CCF

A

FIRST LINE
Echo for systolic and diastolic function
ECG for QRS widening
CXR for cardiomegaly, vascular congestion or pulmonary oedema
BNP - below 100 suggests pulmonary cause, above 400 suggests heart failure
Baseline electrolytes

ADDITIONAL
Screening for causes e.g. TFT’s, LFT’s, Ferritin, Lipids, Glucose, HbA1C, Myocardial Bx,

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11
Q

Treating CCF

A

FIRST LINE
ACE-I or Angiotensinogen Receptor Blocker
A2RA + B Blocker if ACE-I intolerant

CAUSE DEPENDENT
Loop diuretic such as Furosemide if overloaded
Aldosterone antagonist such as Spiro if LVEF < 35%
Anti-arrhythmics such as Digoxin if AF or arrhythmia

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12
Q

Diagnosing Infective Endocarditis

A

FIRST LINE
Echo ASAP to confirm or rule out diagnosis
Blood Cultures - ideally 3 sets 1 hour apart
FBC - may show normocytic normochromic anaemia, raised neutrophils and raised leucocytes
ECG to check conduction
Urinalysis may show signs of septic emboli such as RBC/WBC casts, protein, pyuria

CONSIDER
CT - infectious embolic events
Rheumatoid facto - Dukes criteria

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13
Q

Treating Infective Endocarditis

A

FIRST LINE
Supportive care to maintain airway, breathing and circulation
Abx - broad spectrum initially then based on culture sensitivities

CONSIDER
Some patients may require surgery to remove infected tissue then repair or replace valves

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14
Q

Diagnosing hypertension

A

Blood pressure readings exceeding 140/90
ECG to check for CAD
HbA1C/fasting glucose
Lipids
FBC and U&E’s for baseline and to check for metabolic disease, kidney damage etc.
Electrolytes inc. calcium
Urinalysis to check for protein which would suggest renal compromise

CONSIDER
Plasma renin if hypokalaemia
Plasma aldosterone if HTN is persistently over 150/90 or resistant top treatment
Fundoscopy to check for retinopathy
Renal CT/US if young or renal bruit present

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15
Q

Investigating Malignant Hypertension

A

BP normally 180/120 but use clinical judgement
Creatinine as AKI with raised creat may be the only sign of a hypertensive emergency
FBC with smear for haemolytic anaemia
Urinalysis for blood and protein

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16
Q

Treating malignancy hypertension

A

Patients need to be beta-blocked slowly to prevent them having a stroke
Labetalol is first line
Nicardine (CCB) is second line
Fenoldopam (Dop-1-agonist) is third line

17
Q

Stable Angina Symptoms

A

Typical Angina:

1) Squeezing chest pain or pressure
2) Induced by exercise
3) Relieved by rest or GTN

Atypical angina will only include 2 symptoms

Less commonly pain can radiate into arm, jaw, epigastric area

18
Q

Unstable angina symptoms

A

Anginal chest pain which occurs at rest and may radiate to arms, jaw or neck

May also cause sweating, SOB, back pain, epigastric pain or syncope

19
Q

NSTEMI Symptoms

A

Chest pain which can radiate to arms, back, jaw or neck
Marked sweating
Nausea and vomiting
Arrhythmia

Some patients may have SOB, epigastric pain, syncope or back pain

20
Q

STEMI Symptoms

A 
Severe crushing chest pain which can radiate to arms, back, jaw or neck
Dyspnoea 
Pallor
Peripheral vasoconstriction
Marked sweating
Nausea and vomiting 
Arrhythmia 
Palpitations 
Anxiety
Dizziness
21
Q

Compromised Aortic Valve Symptoms

A 
AORTIC REGURGITATION
Diastolic murmur 
Below symptoms arise from progressive LV dysfunction:
Dyspnoea and nocturnal dyspnoea 
Fatigue 
Weakness
Orthopnoea 
Collapsing pulse 
AORTIC STENOSIS 
Crescendoing systolic murmur between S1 and S2
Dyspnoea most common complaint 
Angina like chest pain
Syncope
22
Q

Compromised Mitral Valve Symptoms

A

MITRAL REGURGITATION
Pan-systolic murmur at apex which radiates
Exercise induced dyspnoea, reduced exercise tolerance, fatigue and lower limb oedema are common presenting complaints
Palpitations, orthopnoea and nocturnal dyspnoea may occur

MITRAL STENOSIS
Diastolic murmur heard between S2 and S1
Increased left atrial pressure can lead to dyspnoea, orthopnoea and nocturnal dyspnoea

23
Q

CCF Symptoms

A 
FRAMINGHAM MAJOR
Pulmonary oedema 
Neck vein distension 
S3 heart sound 
Cardiomegaly 
Fine crackles 
Nocturnal dyspnoea or orthopnoea 
Hepatojugular Reflex
Weight loss > 4.5kg with diuretics 
FRAMINGHAM MINOR
Anke Oedema 
Exertion Dyspnoea
Hepatomegaly 
Nocturnal cough 
Pleural effusion 
Tachycardia
24
Q

Infective Endocarditis Symptoms

A 
Murmur
Anaemia 
Janeway Lesions 
Osler Nodes
Roth Spots
Pyrexia 
Emboli
Nail Haemorrhage 
Other symptoms from septic emboli or immune deposits:
Back pain from discitis 
Chest pain
Meningeal signs 
Arthralgia 
Weakness 
Glomerulonephritis
25
Q

Common organisms in infective endocarditis

A

Native Valves - Staph Aureus or Strep in 80% of cases

Prosthetic Valves - Tends to be Staph Epidermis

IVDU - Skin flora such as Staph Aureus

Enterococcus
Brucella
Culture negative endocarditis

26
Q

Complications of Endocarditis

A

Heart failure due to rapid onset valve disease
Peri-valvular abscess
Septic emboli leading to stroke, discitis, splenic infarction, renal infarction
Metastatic abscesses
Mycotic aneurism

27
Q

ECG changes in angina

A

May be normal or have any of the following:

ST depression
T way inversion
Ischaemia seen in V4-V6

28
Q

Reasons for CABG to be used over PCI

A

PCI has failed
Diabetic patients
Unsuitable anatomy for PCI

29
Q

Complications of Acute Coronary Syndrome

A 
Cardiac Arrhythmias such as AF
Fatal Arrhythmia such as ventricular fibrilation
Cardiac failure 
Ventricular Septal Defect
Ruptured Chordae Tendinae
Cardiac Tamponade 
Dressler's Syndrome AKA post-infarction pericarditis 
Cardiogenic Shock
Heart Block
30
Q

Causes of CCF

A 
Coronary Artery Disease 
Hypertension
Valvular Disease
Myocarditis 
Cardiomyopathy 
Endocrine Problems 
Systemic Vascular Disease (e.g. lupus)
Toxins

CP1 (13 decks)

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