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Med Finals - Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define atherosclerosis

A

Combination of atheroma’s - fatty deposits - and sclerosis - hardening or stiffening - affecting medium to large arteries, caused by chronic inflammation leading to deposition of lipids and formation of plaques.

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2
Q

Risk factors for atherosclerosis

A

Age
FH
Male
Smoking
Alcohol
High sugar and fat diet low fruit and veg
Low exercise
Obesity
Poor sleep stress
Diabetes
HTN
CKD
Rheumatoid
Atypical antipsychotics

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3
Q

Complications of atherosclerosis

A

Angina
MI
TIA
Stroke
Peripheral vascular disease
Mesenteric ischaemia

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4
Q

Prevention of CVD

A

Diet, exercise and weight improvement
Stop smoking
Stop drinking
Tightly treat co-morbidities

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5
Q

Score the determine risk of stroke or MI in next 10 years

A

QRISK3 - if >10% risk, offer statin

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6
Q

Secondary prevention of CVD

A

AAAA
Aspirin
Atorvastatin
Atenolol
ACE inhibitor

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7
Q

Define stable angina

A

Narrowing of the coronary arteries such that during time of high demand, exercise, insufficient blood supply to the hear causing chest pain. Stable when symptoms are relieved by rest or GTN.

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8
Q

Investigations in stable angina

A

CT coronary angiogram - gold standard diagnostic
Physical examination
ECG
Bloods - FBC, UE, LFT, Lipid, Thyroid, HbA1c

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9
Q

Management of stable angina

A

RAMP
Refer to cardiology
Advise about diagnosis management and when to phone ambulance
Medical treatment
Procedural or surgical interventions

GTN - every 5 mins
Beta blockers, CCBs are first line
Long acting nitrites, ivabradine, nicorandil, ranolazine
2dry prevention - AAAA
Surgery - PCI, stents, balloon dilation, CABG

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10
Q

Define acute coronary syndrome

A

Term used to describe a range of conditions associated with sudden reduced blood flow to the hear.

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11
Q

Main types of ACS

A

Unstable angina
STEMI
NSTEMI

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12
Q

What is supplied by the Right Coronary artery

A

Inferior aspect
Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior aspect of septal area

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13
Q

What is supplied by the circumflex artery

A

Lateral aspect
Left atrium
Posterior aspect of the left ventricle

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14
Q

What is supplied by the Left anterior descending

A

Anterior aspect
Anterior aspect of the left ventricle
Anterior aspect of the septum

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15
Q

How to differentiated types of ACS

A

Chest pain = ECG
ST elevation - STEMI
No elevation = troponin
Raised trops +- other ECG changes - NSTEMI
Trops normal - unstable angina (or msk pain)

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16
Q

History of ACS

A

Central crushing chest pain
Nausea and vomiting
Sweating and clamminess
Feeling of impending doom
Shortness of breath
Palpitations
Pain radiates to jaw/arm
Symptoms continue at rest
Diabetic often have silent MIs - no pain

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17
Q

ECG changes in STEMI

A

ST segment elevation
New left bundle branch block

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18
Q

ECG changes in NSTEMI

A

ST depression
Deep T wave inversion
Pathological Q waves

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19
Q

Alternative causes for raised troponins

A

Chronic renal failure
Sepsis
Myocarditis
Aortic dissection
Pulmonary embolism

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20
Q

Investigations in ACS

A

Physical exam
ECG
Bloods - FBC, UE, LFT, Lipid, Thyroid, HbA1C
CXR
Echo - post event
CT coronary angiogram

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21
Q

Immediate management of ACS

A

MONA
Morphine
Oxygen (if low sats)
Aspirin 300mg
Nitrates - GTN

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22
Q

Management of STEMI

A

Primary PCI - if available within 2 hours
Thrombolysis - in PCI not available

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23
Q

Management of NSTEMI

A

BATMAN
Betablockers
Aspirin 300mg
Ticagrelor 180mg stat
Morphine
Anticoagulation - fodaparinux
Nitrates GTN

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24
Q

Complications of MI

A

Heart failure DREAD
Death
Rupture of heart septum or papillary muscles
Edema - heart failure
Arrhythmia + Aneurysm
Dressler’s Syndrome

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25
Define Dressler's syndrome
Also called post MI syndrome. Usually occurs 2-3 weeks post MI. Caused by local immune response and causes pericarditis. Pleuritic chest pain, low grade fever, pericardial rub , effusion./
26
Secondary prevention post MI
6 As Aspirin - 75g OD Another antiplatelet Atorvastatin ACE inhibitor Atenolol Aldosterone - if heart failue
27
Define left ventricular failure
The left ventricle is unable to adequately move blood throught the left side of the heart. Causes back pressure into the pulmonary system and they leak fluid causing pulmonary oedema.
28
Common causes of left ventricular failure
Iatrogenic - aggressive fluids in frailty Sepsis MI Arrhythmia
29
History of left ventricular failure
Shortness of breath - worse on lying. Cough p frothy white/pink sputum
30
Clinical signs of left ventricular failure
High RR Low O2 Tachycardia 3rd heart sound Bilateral basal crackles Hypotension Peripheral oedema
31
Investigations in left ventricular failure
ECG ABG CXR Bloods - BNP Echo
32
CXR findings in heart failure
ABCDE Alveolar oedema - bat wings Kerley B lines - interstitial oedema Cardiomegaly Dilated prominent upper lobe vessels/Upper lobe Diversion Effusion
33
Management of left ventricular failure
Pour sod Pour away IV fluids - fluid balance Sit up Oxygen Diuretics
34
History of chronic heart failure
Breathlessness worse on exertion Cough - white pink frothy sputum Orthopnoea - SOB on lying Paroxysmal nocturnal dyspnoea Peripheral oedema
35
Management of Chronic heart failure
ABAL ACE inhibitor Beta Blocker Aldosterone - when controled with A or B Loop diuretics - furosemide for symtom management
36
Define Cor pulmonale
Is right sided hear failure caused by respiratory disease, increased pressure in the pulmonary arteries results in right ventricle being unable to pump effectively causing back pressure.
37
Common causes of Cor Pulmonale
COPD Pulmonary embolism Interstitial lung disease Cystic fibrosis Primary pulmonary hypertension
38
History of Cor Pulmonale
Shortness of breath - also caused by respiratory condition Peripheral oedema Syncope Chest pain
39
Clinical signs of Cor Pulmonale
Hypoxia Cyanosis Raised JVP Peripheral oedema Third heart sound Murmur - pan-systolic in tricuspid regurg Hepatomegaly - due to back pressure
40
Management of Cor Pulmonale
Treat underlying cause Manage symptoms
41
Define hypertension
High blood pressure - 140/90 in clinic or 135/85 at home/ambulatory
42
Common causes of hypertension
ROPE Renal disease - artery stenosis Obesity Pregnancy - pre-eclampsia Endocrine - Conns (Hyperaldosteronism)
43
Complications of hypertension
Ischaemic heart disease Cerebrovascular accident - stroke, haemorrhage Hypertensive retinopathy Hypertensive nephropathy Heart failure
44
Stages of hyper tension
Stage 1 - >140/90 (135/85) Stage 2 - >160/100 (150/96) Stage 3 - >180/120
45
Management of hypertension
ABCD ACE inhibitor ARB Beta blocker Calcium channel blocker Diuretics ACEi first line then CCB >55 CCB first or black ACEi always in diabetics
46
Define heart murmur
Extra or unusual sounds heard when ascultating the heart. Caused by turbulent blood flow through the heart, or opening or closing of valves
47
What causes S1 Sound
Closing of the atrioventricular valves - tricuspid and mitral Heard at the start of systolic contraction
48
What causes S2 sound
The closing of the semilunar valves - aortic and pulmonary Heard once systolic contraction is complete
49
What causes S3 sound
Heard rapidly after S2 caused by rapid ventricular filling - chordae tendineae pull to full length - can be normal in ages 15-40 Indicates heart failure in older people.
50
What causes S4 sound
Heard directly before S1 Caused by turbulent flow from an atria contracting against a non-compliant ventricle. Suggests a stiff or hypertrophic ventricle
51
What vale condition cause hypertrophy
Stenosis - mitral and aortic Heart works hard to push against stiff valve
52
What valve conditions cause dilation
Regurgitation
53
What murmur is heard in mitral stenosis
A low rumbling mid-diastolic murmur Caused by low blood flow through stenosed valve during atrial contraction
54
What heart murmur is heard in mitral regurgitation
Pan-systolic high pitched murmur Caused by blood leaking back into the atria during ventricular contraction
55
What is associated with mitral stenosis
Malar flush - back pressure into pulmonary system causing rise in CO2 and vasodilation AF - left atria struggling to push through stenotic valve
56
What does a mitralregurgitation murmur radiate to
Left axila -
57
Cause of mitral regurgitation
Idiopathic - ischaemic heart disease Infective endocarditis Rheumatic heart disease Connective tissue disorders - ehlers danlos/marfans
58
What murmur is heard in aortic stenosis
Ejection systolic high pitched murmur Crescendo-decrescendo character Caused by turbulent blood flor across the valve during ventricular contraction
59
Where might an aortic stenosis murmur radiate to
Carotids
60
Other examination findings in aortic stenosis
Slow rising pulse Narrow pulse pressure Exertional syncope
61
Causes of aortic stenosis
Idiopathic Rheumatic
62
What murmur is heard in aortic regurgitation
Early diastolic soft murmur Caused by immediate back flow of blood through competent valve
63
What other clinicals signs of aortic regurgitation might be found
Collapsing pulse Austin flint murmur - early diastolic rumbling murmur heard at the apex
64
Define atrial fibrilation
Contraction of the atria is uncoordinated, rapid and irregular due to disorganised electrical activity that overrides the normal activity of the sinoatrial node
65
Define atrial fibrillation
Contraction of the atria is uncoordinated, rapid and irregular due to disorganised electrical activity that overrides the normal activity of the sinoatrial node
66
History of atrial fibrillation
Asymptomatic Palpitations Shortness of breath Syncope Stroke,
67
What are the two differentials of irregularly irregular pulses
AF Ventricular ectopic
68
Signs of AF on ECG
Absent P waves Narrow QRS Irregularly irregular ventricular rhythm
69
Common causes of AF
SMITH Sepsis Mitral valve pathology Ischaemic heart disease Thyrotoxicosis Hypertension
70
Main principles of managing AF
Rate or Rhythm control Anticoagulation
71
Why use rate control in AF
Atria are very inefficient If atria contracting fast, they are even less efficient Despite reducing rate you increase cardiac output by increasing atrial filling
72
When should you not use rate control to manage AF
First line unless: Reversible cause New onset Causing heart failure Remain symptomatic despite rate controll
73
Options for rate control in AF
Beta blocker - first line - atenolol 50mg CCB - diltiazem - not in heart failure Digoxin - sedentary people
74
What is the aim of rhythm control
Returning to sinus rhythm Single cardioversion or long term medical rhythm control
75
When to use immediate cardioversion
AF present for <48 hours or severely haemodynamically unstable
76
When to use delayed cardioversion
If AF present for >48 hours and they are stable
77
How long should you be anticoagulated before delayed cardio version
At least 3 weeks - also rate control whilst waiting.
78
Options for cardioversion in AF
Pharmacological - flecanide, amiodarone Electrical cardioversion Long term - beta blockers, dronedarone, amiodarone
79
Scoring system to assess risk of stroke in AF
CHADSVASc (Orbit score for bleeding)
80
Define arrhythmia
Abnormal heart rhythms, they result from interruption to the normal electrical signals that coordinate the contraction of the heart
81
What are the shockable rhythms
Ventricular tachycardia Ventricular fibrillation
82
What are the non-shockable rhythms
Pulseless electrical activity Asystole
83
Management of Narrow complex tachycardia in stable patients
Atrial fibrilation - rate control with beta blocker or diltiazem Atrial flutter - rate control with beta blocker Supraventricular tachy cardia - treat with vagal manoeuvres and adenosine
84
Management of broard complex tachycardias in stable patients
Amiodarone
85
Define atrial flutter
Caused by a re-entrant rhythm in the atrium which stimulates the atria to contract rapidly
86
Management of atrial flutter
Rate/rhythm control - betablockers or cardioversion Treat cause Radiofrequency ablation of the re-entrant rhythm Anticoagulation - CHADSVASC
87
Define supraventricular tachycardia
Cause by electrical signal re-entering the atria from the ventricles, causing a narrow complex tachycardia.
88
Define wolff-parkinson white syndrome
Extra electrical pathway that connects the atria and ventricles.
89
ECG changes in wolff-parkinson white syndrome
Delts wave - slurred upstroke on QRS Short PR Wide QRS
90
Define first degree heart block
Delayed atrioventricular conduction through the AV node PR interval >0.2 (1 big square)
91
Define second degree heart block
Failure of atrial impulse to pass the AV node
92
Main types of second degree heart block
Mobitz Type 1 - Wenckebach's phenomenon Mobitz type 2
93
Define second degree heart block Mobitz type 1
Gradual lengthening of the PR interval until there is failure in conduction
94
Define second degree heart block Mobitz type 2
Intermittent failure to conduct atrial impulses Usually in set ratio - 2:1, 3:1
95
Define third degree heart block
Complete heart block - no observable relationship between P waves and QRS complexes Big risk of asystole
96
Management of hear block
Unstable mobitz type 2 or 3 - atropine

Med Finals - Medicine (10 decks)

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