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Phase 2a Revision > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Angina

A

term which is used to describe symptomatic chest pain which is due to myocardial ischaemia.

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2
Q

Angina pathophysiology

A
  • Coronary Circulation allows blood filling in diastole
  • Atherosclerosis over time →Coronary arteries occluded → less blood flow
  • Areas of myocardium are ischaemic→ especially during exertion
  • To counteract , body increases sympathetic Stimulation → increase HR → Increase force of contraction
  • O2 demand increases even more
    Angina occurs as blood supply can’t meet demand
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3
Q

Atherosclerosis process

A

Step 1 - endothelial dysfunction
Endothelial injury causes a local inflammatory response → accumulation of LDL → become oxidised by waste products creating reactive oxygen species.

Step 2 - plaque formation
Endothelial cells attract macrophages → phagocytose the LDLs swelling to become foam cells and ‘fatty streaks’.

Step 3 - plaque rupture
Continued inflammation triggers smooth muscle cell migration → forms a fibrous cap + fatty streaks → develops into an atheroma. It causes vessel narrowing and leads to angina.

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4
Q

Stable Angina

A

Full occlusion

i) Constricting discomfort in the front of the chest/neck/shoulders/arms
ii) It is precipitated by physical exertion
iii) Relieved by rest or GTN spray in 5 minutes

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5
Q

Unstable Angina

A

Chest pain that occurs at rest, Partial occlusion
– due to rupture of plaque →incomplete occlusion of coronary artery
– ST-segment depression

Prinzmetal’s angina = ST elevation. Treated with CCB

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6
Q

Angina diagnosis

A

CT Coronary Angiography

  • Myocardial perfusion imaging (if patient has renal impairment)
  • ECG
  • Physical examination
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7
Q

Angina Treatment

A

Lifestyle management….
- GTN Spray
Secondary:
- Aspirin
- Statin
- Beta Blocker (bisoprolol) - Give CCB for Asmatics
- Ca2+ channel blocker ( amlodipine)
- ACE-I (for diabetic & hypertensive Patients)
- Isosorbide Mononitrate (long acting nitrate)

Surgical Intervention : (Stable)
→ PCI with coronary angioplasty
→ Coronary Artery Bypass Graft (CABG)

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8
Q

Revascularisation (PCI)

A

Percutaneous Coronary Intervention (PCI) involves insertion of a stent into a coronary artery to improve blood flow.

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9
Q

Revascularisation (CABG)

A

Coronary artery bypass grafting aims to restore flow within a coronary vessel

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10
Q

Angina Risk factors (Modifiable & Non- Modifiable)

A 
-> Modifiable risk factors:
High cholesterol
Hypertension
Smoking
Diabetes
Obesity
-> Non-modifiable risk factors:
Age
Family history
Male sex
Premature menopause
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11
Q

Myocardial Infarction

A

irreversible death of cardiac myocytes, which occurs due to ischaemia

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12
Q

MI Cause

A

– It is due to the rupture of a plaque which leads thrombosis and complete / Partial occlusion of the artery

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13
Q

MI risk factors

A

Non - Modifiable= Age, FH, Male

Modifiable = Smoking, Alcohol, Poor diet, low exercise

Co- morbidities = Diabetes, Hypertension, CHD

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14
Q

MI symptoms

A 
– Acute crushing central chest pain that comes on rest 
– Pain radiates 
– Sweaty and clammy
– Nausea, Vomiting and epigastric pain
- Dyspnoea
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15
Q

MI Diagnosis

A
  • ECG: ST elevation or New left bundle branch block = STEMI
  • No ST elevation = Do Troponin blood tests
  • Raised troponin levels & ST depression, T wave inversion = NSTEMI
  • Normal troponin levels & ST depression = Unstable Angina
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16
Q

STEMI

A

caused by a complete and persistent blockage of the artery resulting in myocardial necrosis

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17
Q

NSTEMI

A

NSTEMI and unstable angina a partial or intermittent blockage of the artery occurs, which usually results in myocardial necrosis in NSTEMI but not in unstable angina.

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18
Q

STEMI management

A

M = Morphine

M = Metoclopramide

O = Oxygen

N = Nitrates (IV)

A = Aspirin (300mg)

C = Clopidogrel or Trigalor (contra-ind. for haemorr.)

→ PCI (offered within 2hrs of symptoms)
→ CABG

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19
Q

NSTEMI management

A

GRACE score
– High risk = coronary angiography (with 96 hrs)
- Low risk = Aspirin with Trigalor

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20
Q

Heart Failure

A

cardiac output which is inadequate to meet the body’s requirements.

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21
Q

Left ventricular failure features

A

Causes:

  • Pulmonary congestion
  • Systemic hypoperfusion (reduced left heart output)
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22
Q

Left ventricular failure Symptoms

A 
– Dyspnoea
- Paroxysmal nocturnal dyspnoea
- Orthopnoea (breathlessness lying down)
- Peripheral oedema 
– Gives a 3rd heart sound
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23
Q

Right Ventricular failure features

A
  • can occur due to Left heart failure

Causes:
→ venous congestion
→ Pulmonary hypoperfusion (reduced right heart output)

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24
Q

Right Ventricular failure symptoms

A

– Raised JVP
- Pitting ankle & Pulmonary oedema (bi-basal) and ascites
- Abdo. distension & discomfort
– Hepatosplenomegaly with a smooth “nutmeg” liver which is pulsatile

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25
Q

Heart Failure Diagnosis

A

i) Blood tests:
raised natriuretic peptides secreted from cardiac ventricles
(BNP, NT-proBNP)

ii) Echocardiogram
iii) ECG : abnormal, signs of Ischaemia
iv) Chest X-ray: Alveolar oedema, Kerly B lines, Cardiomegaly, Pleural effusion

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26
Q

First line management for Heart Failure

A
  • A = ACE-I (e.g. Ramipril) or ARB (e.g. Candesartan)
  • B = Beta - blockers ( e.g.Bisoprolol)
  • A = Aldosterone antagonist (e.g. Spironolactone) - manage oedema
  • L = Loop diuretics (e.g. furosemide)

→ Cardiac Resynchronisation Therapy

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27
Q

treatments which can worsen heart failure

A

– Thiazide diuretic in diabetics
– Calcium channel blockers
– NSAIDs and COX2 inhibitors
– MRA with both ARB + ACEi –> too high risk of hyperkalaemia and renal dysfunction

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28
Q

Which arteries does atherogenesis affect most commonly?

A

LAD, circumflex, RCA

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29
Q

ECG leads

A

1 & aVL & V5 & V6 = Lateral
2 & 3 & aVF = Inferior
V3 & V4 = Anterior
V1 & V2 = Septal

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30
Q

What happens when BP falls in heart failure?

A

[sympathetic system activation] BP falls → detected by baroreceptors → sympathetic activation → positively inotropic/chronotropic → CO increases

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31
Q

Causes of Heart Failure

A
  • Ischaemia
  • Valvular Heart Disease
  • Atrial Fib.
  • Hypertension
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32
Q

Cor pulmonale + causes

A

cor pulmonale = Right -sided heart failure caused by resp. disease.

Increased pressure & resistance in pulmonary arteries → Right ventricle unable to Pump blood properly → back pressure of blood in RA, Vena Cava & systemic venous system

causes:
- COPD
- Pulmonary embolism
- CF
- Pulmonary hypertension

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33
Q

Hypertension

A

Stage 1: >140/90 mmHg
Stage 2: >160/100 mmHg
Malignant: >180/110

Essential Hyp. = no identifiable cause
Secondary Hyp. = has a identifiable cause

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34
Q

Hypertension causes

A

R- Renal Disease
0 = Obesity
P= Pregnancy
E= Endocrine e.g. Conn’s (hyperaldosteronism) - most common

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35
Q

Hypertension symptoms

A

Asymptomatic

Malignant = Cerebral oedema, Papilloedema, AHF, AKI

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36
Q

Hypertension Diagnosis

A

Primary = Recheck BP over few weeks
Give ABPM
QRISK ( give statin > 10% )

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37
Q

Hypertension Treatment

A 
A = ACE - I (e.g. Ramipril) if <55yrs or T2 DM
B = Beta -blocker (e.g. Bisoprolol)
C = Calcium channel blocker (e.g. Amlodipine) if African or >55 yrs
D = Diuretics (e.g. Indapamide)
A = ARBs (e.g. Candesartan) if not ACE-I

K+ < 4.5 mmol/L = Spironolactone
Alpha- blocker = Doxazosin

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38
Q

Pericarditis

A

Inflammation of the pericardium with/ without effusion

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39
Q

Pericarditis Causes

A 
Infectious:
-> Viral (common)
Coxsackievirus
-> Bacterial
Mycobacterium tuberculosis

Non-infectious:

  • > Trauma
  • > Uraemia, MI
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40
Q

Pericarditis Symptoms/ Signs

A

Retrosternal Chest pain (sharp & pleuritic)
Relieved by sitting forward/ worse when lying down
Worsened by inspiration
Fever/ shortness of breath → sign of infection
Pericardial friction rub

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41
Q

Pericarditis Diagnosis

A

ECG (diagnostic)
Saddle- shaped ST elevation
PR depression

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42
Q

Pericarditis Management

A

NSAIDs (ibuprofen) + Colchicine

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43
Q

Pericarditis Complications

A

Cardiac Tamponade

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44
Q

Cardiac Tamponade

A

Accumulation of fluid in the pericardial space → compression of the heart chambers → decrease in venous return → decrease in filling in the heart → reducing cardiac output

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45
Q

Cardiac Tamponade signs

A 
-> Beck’s triad 
falling BP
rising JVP
muffled heart sound 
-> Pulsus paradoxus (large decrease in stroke volume
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46
Q

Cardiac Tamponade diagnosis

A

Echo

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47
Q

Cardiac Tamponade Treatment

A

pericardiocentesis (removal of the fluids from the pericardial space)

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48
Q

Infective Endocarditis

A

Infection of the inner lining of the heart/ valves (endocardium)

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49
Q

Infective Endocarditis Causes

A

Stahpylococcus aureus (most common → IVDU)

Streptococcus viridans (mouth/ oral sugery, most common→ non-IVDU)

Staphylococcus epidermis (prosthetic valves)

Streptococcus pyogenes (Rheumatic heart disease)

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50
Q

Infective Endocarditis Symptoms

A

Fever, New murmur

  • nail bed haemorrhages
  • Osler nodes
  • Janeway lesions
  • Roth spots
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51
Q

Infective Endocarditis Diagnosis

A

Transesophageal Echo
Blood cultures
Duke’s criteria (Major = +ve) (Minor = Signs/ Symptoms)

52
Q

Infective Endocarditis Treatment

A

If staphylococcus
(Flucloxacillin + rifampicin + gentamicin)
*MRSA → vancomycin + rifampicin + gentamicin

Not staphylococcus
Benzylpenicillin + gentamicin

Not sure which organism (first line)
FAG (flucloxacillin + ampilicin + gentamicin)

53
Q

Aortic stenosis Murmur

A

Ejection systolic murmur loudest over aortic region, radiating to carotids and apex

54
Q

Aortic Regurg. Murmur

A

Early diastolic (best heard when leaning forward) at left Sternal edge.

55
Q

Mitral Stenosis Murmur

A

Rumbling mid-diastolic with opening snap (best heard when lying on left side) at apex.

56
Q

Mitral Regurg. Murmur

A

Panasystolic murmur loudest in mitral area, radiating to left axilla

57
Q

Aortic Stenosis Symptoms/ Sign

A
  • Syncope
  • Angina
  • Dyspnoea
  • > Slow rising pulse
  • > Soft S2
58
Q

Mitral Stenosis Symptoms/ Sign

A
  • Exertional dyspnoea
  • Palpitations
  • Chest pain
  • Haemoptysis
  • > Atrial fib.
  • > Loud S1
59
Q

Aortic Regurg. Symptoms/ Sign

A
  • Palpitations
  • Angina
  • Dyspnoea
  • > Displaced apex
  • > De Musset’s, Quincke’s, Corrigan’s
60
Q

Mitral Regurg. Symptoms/ Sign

A
  • Palpitations
  • Fatigue
  • Weakness
  • > Atrial fib.
  • > Displaced Apex
  • > Soft/ No S1
61
Q

Cardiac Tamponade

A

fluid collects within the pericardial sac and which compresses the ventricles impeding cardiac output.

62
Q

Cardiac Tamponade Causes

A

– Pericarditis
– Myocardial rupture
– Aortic dissection
– Malignancy

63
Q

Cardiac Tamponade Diagnosis

A

– CXR shows enlarged, globular heart
– Echocardiogram
– ECG

64
Q

Cardiac Tamponade Symptoms

A

– Classic Beck’s triad –> Hypotension, Raised JVP, Muffled heart sound
- Kussmaul’s Sign

65
Q

Cardiac Tamponade Treatment

A

Pericardiocentesis

66
Q

Deep Vein Thrombosis

A

formation of a clot which occurs usually in the femoral, popliteal or iliac veins in the leg

67
Q

Deep Vein Thrombosis Causes

A

due to the stasis of blood which brings pro-coagulants in contact with each other

68
Q

Deep Vein Thrombosis Symptoms

A
  • Leg swelling

Pain, Pallor, Pulselessness, Paraesthesia

69
Q

Deep Vein Thrombosis diagnosis

A
  • D-dimer
  • Doppler US (Gold)
  • Wells score
70
Q

Deep Vein Thrombosis treatment

A

– Anticoagulation with a DOAC (e.g. apixaban or rivaroxaban)

  • Low molecular Weight Heparin is 1st Line in Pregnancy
71
Q

Pulmonary Embolism

A

embolus which becomes lodged in the pulmonary circulation

72
Q

Pulmonary Embolism Cause

A

deep vein thrombosis (DVT) in the femoral, iliac or popliteal veins.

73
Q

Pulmonary Embolism Symptoms

A

– Pleuritic unilateral chest pain, shortness of breath and haemoptysis
– Tachycardia + Tachypnoea
– Pleural rub

74
Q

Pulmonary Embolism Diagnosis

A
  • Wells Score
  • CT Pulmonary Angiogram - Gold
  • D-dimer = High sensitivity, low specificity
    – Pulse oximeter –> Low SpO2
    – ABG
75
Q

Pulmonary Embolism Treatment

A

thrombolysis - alteplase

LMWH (e.g. Dalteparin) & Warfarin

DOAC (Direct acting Oral AntiCoagulant)

e.g. Apixaban / Rivaroxaban

76
Q

Atrial fibrillation

A

chaotic irregularly irregular atrial rhythm at over 400bpm. Asymptomatic

77
Q

Atrial fibrillation Pathophysiology

A
  • contraction of atria is uncoordinated, rapid & irregular

- Due to disorganised electrical activity that overrides the normal activity from SA node

78
Q

Atrial fibrillation Cause

A 
S = sepsis
M = Mitral value
I = Ischaemic HD 
T= (Hyper) Thyroidism
H= Hypertension
79
Q

Atrial fibrillation symptoms

A

Irregularly irregular ventricular contractions

Tachycardia - Palpitations

Heart failure - Dyspnoea

Syncope (Fainting)

80
Q

Atrial fibrillation Diagnosis

A 
ECG: same as in hyperkalaemia
P waves absent – replaced by f waves.
– Rhythm is irregularly irregular
– Patient usually tachycardic
–  narrow QRS complexes
81
Q

Atrial fibrillation Treatment

A
  1. Beta-blocker = (e.g. Bisoprolol/ Atenolol) -not for asthmatics.
  2. Calcium - channel blocker = (e.g. Verapamil or Amlodipine) - for asthmatics.
  3. Cardiac Glycoside = Digoxin
  4. Anti - arrhythmic = Amiodarone
  5. Factor Xa inhibitor anticoagulant = Apixaban/ Rivaroxaban
82
Q

Atrial flutter

A

supraventricular tachycardia characterized by a fast atrial rate of around 200-400bpm.
Due to acute MI, mitral disease

83
Q

Atrial flutter symptoms

A

asymptomatic or cause chest pain, palpitations, hypotension

84
Q

Atrial flutter Diagnosis

A

ECG:
- NO P waves
– They give a “saw-toothed” appearance and are called flutter (F) waves.
– Normal QRS waves

C = Congestive heart failure
H = Hypertension
A2 = Age> 75
D = Diabetes
S2 = Stroke / TIA
v = Vascular disease
A = Age - 65-74
S = Sex (female)
85
Q

Atrial flutter Treatment

A

Short- term :
Beta-blocker or CCB
Then add Digoxin

Definitive - Catheter Ablation

86
Q

1st degree heart block

A

impulses from the atria are consistently delayed by a certain amount at the AV node.

Exertional chest tightness relieved with rest.

87
Q

1st degree heart block Cause

A
  • MI
  • Hyperkalaemia
  • Drugs : Digoxin, Beta-blockers, CCB
88
Q

1st degree heart block ECG

A

PR interval is prolonged, no missed beats.

PR > 200ms

89
Q

2nd degree Mobitz 1 heart block + Cause

A

Due to reversible conduction block at the AV node.

Characterised by Progressive PR interval → P wave fails to conduct QRS

Cause :

→ MI
→ Drugs (Beta-Block., CCB, Digoxin)

90
Q

2nd degree Mobitz 1 heart block ECG

A

– PR interval is more and more prolonged each beat, until you miss a beat completely, drop in QRS complex.

91
Q

2nd degree Mobitz 2 heart block + Symptoms

A

impulses from the SAN are occluded at the AV node and fail to pass to the ventricles.
Dyspnea, fatigue, light-headedness, pain, hypotension

92
Q

2nd degree Mobitz 2 heart block ECG

A

– Constant PR interval but many P waves are not followed by QRS

93
Q

3rd degree heart block

A

impulses from SAN are completely blocked at AV node.

– Patient becomes very bradycardic and go into hypotension and cardiogenic shock

94
Q

3rd degree heart block Cause

A

Inferior wall MI, congenital, aortic valve calcification + digoxin toxicity

95
Q

3rd degree heart block Symptom

A

Dyspnea, fatigue, light-headedness, pain, hypotension

96
Q

3rd degree heart block ECG

A

No relation between P waves and QRS waves

97
Q

Abdominal Aortic Aneurysm

A

dilation of the abdominal aorta > 3cm.

Commonly between renal & inferior mesenteric arteries.

98
Q

Abdominal Aortic Aneurysm Symptoms

A

central abdominal pain radiating to back

99
Q

Abdominal Aortic Aneurysm Management

A

> 65 - Screening using abdo. ultrasound scan

if < 3cm = Discharge (offer yearly repeat)
if > 3cm = Repeat in 12 weeks & Refer
if > 5.5 cm = Open Surgery
or Endovascular Aneurysm Repair

100
Q

Chronic MI management

A
  • Aspirin
  • Another Antiplatelet = Clopidogrel
  • Atorvastatin
  • ACE -I = Ramipril
  • Beta blocker = Atenolol
  • Aldosterone antagonist = Spironolactone
101
Q

STEMI & NSTEMI ECG changes

A

STEMI= ST elevation , New Left Bundle Branch block

NSTEMI= ST depression, T wave inversion, Q waves

102
Q

Arteries involved in MI, supply and ECG leads

A

LCA → circumflex & LAD = I, aVL, V3-6

RCA - Supplies the: RA, RV, Inferior aspect of LV, Posterior septal area = II,III, aVF

Circumflex - Supplies the: LA, Posterior aspect of LV = l, aVL, V5-6

LAD - Supplies the: Anterior aspect of LV, Anterior aspect of septum = V1-4

103
Q

Coarctation of Aorta

A

Congenital condition where there’s narrowing of aortic arch usually around the ductus arteriosus.

This reduces pressure of blood to arteries that are distal to narrowing

Increases pressure in areas proximal to narrowing

104
Q

Presentation of Coarctation of aorta

A
  • Tachypnoea
  • Grey and floppy baby
  • Poor feeding
105
Q

Management of Coarctation of dorita

A

Surgery to correct coarctation & to ligate ductus arteriosus

106
Q

Tetralogy of Fallot pathologies

A
  • ventricular septal defect
  • Overriding aorta
  • Pulmonary value stenosis
  • Right ventricular hypertrophy
107
Q

Tetrology of fallot Risk factors

A
  • Rubella infection
  • Increased age of mother
  • Alcohol during pregnancy
  • Diabetic mother
108
Q

Tetralogy of Fallot Signs & Symptoms

A
  • Cyanosis
  • Clubbing
  • Poor feeding & sweating
109
Q

Tetrology of Fallot Treatment

A
  • Supplementary oxygen
  • Beta -blockers
  • IV fluids
  • Morphine
  • Sodium bicarb
  • Phenylephrine infusion

Neonates = Prostoglandin infusion - to maintain ductus arteriosus

110
Q

Aortic Dissection

A

Tear forms in inner layer of aorta → allowing blood to Flow between intima & media layers of wall of aorta.

Stanford Type A = Ascending & arch of aorta

Stanford Type B = Descending of aorta

111
Q

Aortic dissection Risk factors

A
  • Hypertension
  • Bicuspid aortic value
  • Coarctation of aorta
  • Aortic valve replacement
  • CABG
112
Q

Aortic dissection presentation

A

-hypertension

  • Radial pulse delay
  • Diastolic murmur
  • Chest & abdo. pain
  • Syncope
113
Q

Aortic dissection Diagnosis

A
  • CT angiogram
  • Echo
  • MRI angiogram
  • ECG & Chest X-Ray
114
Q

Aortic dissection Management

A
  • Analgesia (e.g. Morphine)
  • Beta - blockers IV (e.g. Atenolol & Bisoprolol)
  • Surgical intervention (for Type A)
115
Q

Aortic dissection complications

A
  • MI
  • Stroke
  • Cardiac tamponade
116
Q

Peripheral arterial disease - Intermittent
Claudication

Differential Diagnosis:

Symptoms

Investigation

Management

A

D.D = DVT (but DVT causes swelling not cramping)

Sym. = Cramping, goes away at rest, walking limited on stairs (inclined). Affects Popliteal Artery

Inves. = Ankle Brachial Pressure Index (ABPI) & Duplex Ultrasound scan

Man. = Stop smoking, Exercise, Stents, Bypass grafts

117
Q

Supraventricular Tachycardia

Symptoms

ECG

Management

A

Symp. = Palpitations, SOB, Dizziness, Chest pain

ECG = Narrow. complex tachycardia of regular rhythm

Man.:

1= Valsalva Manoeuvre
2= Carotid sinus massage
3= Adenosine (gives feeling of impending doom) or CCB (Verapamil)
4= Direct current cardioversion
118
Q

ACE-I adverse effects

A
  • Inhibits angiotensin-II
  • leads to vasodilation
  • S. E= Dry cough
  • Causes hyperkalaemia ( Tall- tented T waves )
119
Q

Right Bundle Branch Block

ECG leads

Features

Cause

A

ECG L. = V1 - V6

Features = MaRRoW (M shape)

  • Wide QRS
  • rSR pattern in V1 & QRS in V6

Cause: Pulmonary Embolism

120
Q

Left Bundle Branch Block

ECG leads

Features

A

ECG L. = V1-V6

Features = WiLLiaM (W shape)

  • Wide QRS width
  • notched top in V5
  • RS in V1
121
Q

Atrial septal Defect murmur

A

Soft mid-systolic with wide fixed splitting of S2.

122
Q

Coagulation Cascade Meds

A

Warfarin = Inhibits Synthesis of factor 9, 8, 2, 10 - by blocking vit. K.

Heparin = Inhibits thrombin lla & 10a

Rivaroxaban = Inhibits 10a

123
Q

Hypertrophic Cardiomyopathy

A

⇒ Genetic disorder where left ventricular hypertrophy causes diastolic ventricular dysfunction.
Due to thick Septum below aortic valve.

124
Q

Types of Shock

A
  • Hypovolaemic (blood loss)
  • Septic
  • Anaphylactic
  • Cardiogenic (Poor cardiac output)
  • Neurogenic
  • Obstructive
125
Q

Septic Shock Management

A
  1. Bloods
  2. Oxygen <94%
  3. IV Antibiotics
  4. Blood cultures
  5. Crystalloid
  6. Catheterisation
126
Q

Hypovolaemic Shock in trauma management

A
  1. IV Crystalloid

2. Blood transfusion

127
Q

6 p’s of limb ischaemia

A 
P: Pulselessness 
p: Pain
p: Pale
P: Paralysis
P: Paraesthesia
P: Perishingly cold

Phase 2a Revision (9 decks)

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