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Internal Medicine Block > Cardiology > Flashcards

Cardiology Flashcards

1
Q

List 5 cardiac causes of chest pain

A

Angina
Pericarditis
Pulmonary Hypertension
Myocarditis
Hypertrophic Cardiomyopathy
Mitral valve prolapse
Aortic valve disease

Hint: look at the heart generally, affected structures is the pericardium, myocardium and the valves

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2
Q

List 4 pulmonary causes of chest pain

A

Pulmonary Embolism
Pneumonia
Pleuritis
Pneumothorax

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3
Q

List 4 musculoskeletal causes of chest pain

A

Cosochondritis
Arthritis
Muscular spasm
Bone tumour

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4
Q

List any 2 vascular causes of chest pain

A

Aortic aneurism
Aortic dissection

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5
Q

Neurological causes of chest pain

A

Cervical nerve root
Zoster

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6
Q

List 4 GIT causes of chest pain

A

Peptic ulcer
GERD
Pancreatitis
Cholecystitis

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7
Q

How does atherosclerosis develop

A

Endothelium of blood vessels dysfunction occurs
Oxidised LDL (bad fat), is retained, this oxidised LDL is taken up by macrophages leading to
Complexed inflammatory cascade» atherosclerotic plaque

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8
Q

What are the risk factors for artherosclerosis

A

Age, gender, fx hx, high blood cholesterol, high BP, no exercise, obesity, smoking, diabetes, poor diet

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9
Q

Where does chest pain associated with angina normally radiate

A

Left arm
Jaw

Nausea and vomiting May occur

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10
Q

List the 6 immediately life-threatening conditions with chest pain as PPP

A

Acute coronary syndrome
Acute aortic coarctation
Pulmonary embolism
Tension pneumothorax
Pericarditis temponade
Mediastinitis

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11
Q

How is angina managed

A

Oxygen if saturation <90%
Nitrates
Morphine 3-5 mg IV
Rest

Later, Antithrombic tax
Aspirin initially 150-300mg then 75-100 mg/day
P2Y12 inhibitor - loading dose of clopidogrel

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12
Q

Describe the type of pain associated with Angina

A

Retrosternal
Radiates to left arm or into jaw
Crushing or pressing in character
Worse on physical activity

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13
Q

Which dx test would you use for angina

A

ECG : ST elevation myocardial infarction (STEMI)

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14
Q

How can you treat coronary artery occlusion besides using antithrombolitics

A

Primary percutaneous catheter intervention

Or Google says :Coronary arterybypass against coronary occlusion or Coronary artery bypass graft (CABG)

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15
Q

What are lifestyle changes would you recommend for someone who has had angina

A

Stop smoking
Exercise
Lose weight
Healthy diets
Ways to cope with stress
Moderate Alcohol

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16
Q

Long therapy for angina/MI

A

The big 5
P2Y12 inhibitor eg Clopidogrel
Aspirin
Statin
Beta blocker
ACE inhibitors

Also address Diabetes and HPT so it’s controlled

17
Q

What investigations would you do for a pt presenting with chest pain
(You suspect angina)

A

ECG
Effort stress test
FBC
Renal fx
Fasting glucose
Fasting lipogram
TSH

18
Q

Discuss management of stable coronary disease

A

A. ASPIRIN, ANTI-ANGINALS, ACE-INHIBITORS
B. BETA-BLOCKERS AND BLOOD PRESSURE
CHOLESTEROL, CIGARETTES AND CALCIUM
ANTAGONISTS
D. DIET AND DIABETES
E. EDUCATION AND EXERCISE
F. FAMILY, FRIENDS, FINANCIAL SUPPORT

19
Q

Which drug should you never give to a pt with wide complex tachycardia

A

Verapamil and Adenosine

20
Q

Immediate to for wide complex ventricular tachycardia

A

DC cardio version

21
Q

List some of the causes of sinus node dysfunction

A

Lots of Hs)
Extrinsic (from underlying cause)
Hyperkalemia
Hypothermia
Hypothyroidism
Hypoxia
Hypercarbia
Head injury
Drugs
Hypervagotonia
Drugs

22
Q

What are the causes of heart block

A

Degenerative (most common)
Inferior STEMI
Congenital
Infiltration (sarcoidosis, amyloid)
Drugs-Digoxin
Hyperthyroidism
Connective tissues disease
Aortic root abscess

23
Q

What are the clinical features of a complete heart block (5)

A

Systolic hypertension
Bradycardia 30-40 bpm
Variable first heart sound
Cannon a waves due to AV dissociation
Usually with intermittent dizziness, syncope
Medical emergency

24
Q

List 3 main causes of mitral stenosis

A

Rheumatic heart disease
Infective endocarditis
Degenerative causes- annular calcification.
associated with elderly, HPT, atherosclerosis and aortic aneurism
Congenital - abnormalities in subvalvular apparatus

25
Q

Describe the pathophysiology of mitral stenosis

A

(Pathophysiology is the effect after after exposure and disease)

LA pressure increases to maintain cardiac output
Pressure is transmitted to pulmonary veins and capillaries
Exercise, motion, infx demand increased flow across valve
Results in an increase in LA pressure

26
Q

Differentiate between Haemoptysis and haematemesis

A
27
Q

What would you expected to find on CXR in a pt w/mitral stenosis

A

Normal in mild MS
LA enlargement: splaying at carina, double shadow on RH boarder and straightened LH boarder
Pulmonary oedema / congestion
Enlarged PA

28
Q

What are the ecg changes you expect to find on mitral stenosis

A

LA enlargement: Broad p wave in lead II
In VI dominant, main,y negative deflection

RV Hypertrophy:
Right axis deviation and tall R in VI

Atrial fibrillation or flatter

29
Q

Descuss the treatment of mitral stenosis according to severity

A

NYHA I : Asymptomatic : Do nothing, anticoagulant if in AF, eg, prophylaxis

NYHA II Mild symptoms: if mobile valve, consider valvulopasty

NYHA III Moderate to severe symptoms: if mobile valve-valvulotomy. If immobile-surgery

Diuretics (lower LA pressure esp in fibrillation.)
Beta blockers (Slower rate to increase diastolic filling time)
Contraceptive and pregnancy planning

30
Q

Therapy for mitral stenosis

A

Diuretics for heart failure

Betablockers – mainstay of therapy – slow down heart rate and increase diastolic filling time

Anticoagulation if in AF – all rheumatic patients in AF need anticoagulation; no need to CHADSVASC scoring (that’s only for non-valvular AF)

Endocarditis prophylaxis

Rheumatic fever prophylaxis

31
Q

What is the prophylaxis for infective endocarditis

A

dental procedures
☑️ Amoxicillin 2g orally 1 hour before procedure
☑️ if penicillin allergic:Clindamycin 600mg orally 1h before procedure

32
Q

What are the causes of mitral stenosis

A

Degenerative-
Wear and tear
Hypertension
Hypercholestrolemia
Platelet-fibrin deposits
Abnormal flow dynamics
Congenital: Bicuspid valve
Rheumatic

33
Q

Describe the ECG findings on Aortic stenosis

A

Left Ventricular Hypertrophy Criteria

Sokolow-Lyon Voltage Criteria
If S wave in V1+Rwave in V5-V6 >35mm (>50 for under age 35)
R wave > 11mm in aVL or I

Also
LVH is more likely with a strain pattern or ST segment changes
LA may be enlarged
Axis usually remains normal

34
Q

Treatment for aortic valve disease

A

Aortic valve replacement

Internal Medicine Block (9 decks)

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