Cardiology Flashcards
What is ACS
Acute presentation of ischaemic heart disease
3 things making up ACS
STEMI
USTEMI
Unstable angina
Symptoms of ACS?
Chest pain - central and left sided, radiating to the jaw/ left arm, heavy and constricting
Certain patients e.g. diabetics and elderly may not experience any chest pain
Dyspnoea, sweating , nausea and vomiting
Physical signs of ACS
Patients presenting with ACS often have very few physical signs to ellicit, possibly tachycardic
if complications of the ACS have developed e.g. cardiac failure then clearly there may a number of findings
the patient may appear pale and clammy
Investigations for ACS
ECG
Cardiac markers e.g. troponin
Coronary artery - left anterior descending ECG changes
ANTERIOR
V1-V4
Coronary artery- right coronary ECG changes
INFERIOR
II,III, aVF
Coronary artery- left circumflex- ECG changes
LATERAL
I, V5-V6
Management of ACS
MONA
- Morphine. oxygen. nitrates. aspirin 300mg
When should you give oxygen in ACS
Only if sats are <94%
STEMI management
Dual anti platelet therapy
PCI
NSTEMI management
Aspirin 300mg
Fondaparinux if no immediate PCI planned
Estimate 6 month mortality using GRACE
If low risk - tricagrelor
If high risk - PCI + relevant drugs
Dual anti platelet - what to give?
Aspirin +
Tricagrelor if not at a high bleeding risk
Clopidogrel if high bleeding risk
GRACE
Age, HR+BP, cardiac arrest on presentation, ECG findings, troponin levels, cardio and Renal class
ACS stratifying
ACS secondary prevention
Aspirin, py12, beta blocker, ACE inhibitor, statin
Drugs with a PCI
Praugrel
Unfractioned heparin
Bailout glycoprotein IIb/IIIa inhibitor GPI
Drug eluding stents
Killip class - post MI dangers
I - no heart failure signs
II- lung crackles
III- pulmonary oedema
IV- cardiogenic shock
What is an aortic dissection
Tear in the tunica intima of the aortic wall
Associations of aortic dissection
Hypertension, trauma, bicuspid aortic valve
marfans,collagens: Marfan’s syndrome, Ehlers-Danlos syndrome, Turner’s and Noonan’s syndrome, pregnancy, syphilis
Features of an aortic dissection
Chest/back pain - severe/sharp/ tearing
Maximal on onset
Pulse deficit
Variation in systolic BP between the arms
Aortic regurgitation
Hypertension
No ECG changes
What type of pain is more common in type A vs type B aortic dissection
Chest pain more common in type A
Upper back pain more common in type. B
Spinal artery dissection effect
Paraplegia! Aortic dissection can present neurologically
Distal aorta dissection effect
Limb ischaemia
Stanford classification of aortic dissection: type A and type B
Type A: ascending aorta
Type B: descending aorta, distal to left subclavian origin
Debakey classification of aortic dissection: Type I, II and III
Type I- originates in asce
nding aorta, propagates to at least the aortic arch
Type II - originates in and confined to the ascending aorta
Type III- originates in descending aorta, rarely extends proximally
investigations of aortic dissection
CT angiography - false lumen
Chest XRAY- widened mediastinum
TOE- for patients where CT is too risky
Management of aortic dissection - type A vs type B
type A - surgical, BP medication while waiting
type B- conservative, bed rest, reduce BP with IV labetalol
Complications of aortic dissection
Backward- aortic incompetence. regurgitation. MI
Type B - Unequal arm pulses, BP, stroke, renal failure
What is a cardiac tamponade
Accumulation of pericardial fluid under pressure
What is becks triad
Used for cardiac tamponade
Hypotension, raised JVP, muffled heart sounds
Signs of cardiac tamponade
Becks triad
Dyspnoea, tachycardia
Pulsus paradoxus
Kassumuls sign
Electrical altens
What is pulses paradoxes
Abnormally large BP drop on inspiration JVP reduces
What is electrical altens
Alternating QRS complex. Swinging heart
