Cardiology Flashcards
List 5 cardiac causes of chest pain
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
List 4 pulmonary causes of chest pain
Pulmonary Embolism
Pneumonia
Pleuritis
Pneumothorax
List 4 musculoskeletal causes of chest pain
Cosochondritis
Arthritis
Muscular spasm
Bone tumour
List any 2 vascular causes of chest pain
Aortic aneurism
Aortic dissection
Neurological causes of chest pain
Cervical nerve root
Zoster
List 4 GIT causes of chest pain
Peptic ulcer
GERD
Pancreatitis
Cholecystitis
How does atherosclerosis develop
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
What are the risk factors for artherosclerosis
Age, gender, fx hx, high blood cholesterol, high BP, no exercise, obesity, smoking, diabetes, poor diet
Where does chest pain associated with angina normally radiate
Left arm
Jaw
Nausea and vomiting May occur
List the 6 immediately life-threatening conditions with chest pain as PPP
Acute coronary syndrome
Acute aortic coarctation
Pulmonary embolism
Tension pneumothorax
Pericarditis temponade
Mediastinitis
How is angina managed
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
Describe the type of pain associated with Angina
Retrosternal
Radiates to left arm or into jaw
Crushing or pressing in character
Worse on physical activity
Which dx test would you use for angina
ECG : ST elevation myocardial infarction (STEMI)
How can you treat coronary artery occlusion besides using antithrombolitics
Primary percutaneous catheter intervention
Or Google says :Coronary arterybypass against coronary occlusion or Coronary artery bypass graft (CABG)
What are lifestyle changes would you recommend for someone who has had angina
Stop smoking
Exercise
Lose weight
Healthy diets
Ways to cope with stress
Moderate Alcohol
Long therapy for angina/MI
The big 5
P2Y12 inhibitor eg Clopidogrel
Aspirin
Statin
Beta blocker
ACE inhibitors
Also address Diabetes and HPT so it’s controlled
What investigations would you do for a pt presenting with chest pain
(You suspect angina)
ECG
Effort stress test
FBC
Renal fx
Fasting glucose
Fasting lipogram
TSH
Discuss management of stable coronary disease
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
Which drug should you never give to a pt with wide complex tachycardia
Verapamil and Adenosine
Immediate to for wide complex ventricular tachycardia
DC cardio version
List some of the causes of sinus node dysfunction
Lots of Hs)
Extrinsic (from underlying cause)
Hyperkalemia
Hypothermia
Hypothyroidism
Hypoxia
Hypercarbia
Head injury
Drugs
Hypervagotonia
Drugs
What are the causes of heart block
Degenerative (most common)
Inferior STEMI
Congenital
Infiltration (sarcoidosis, amyloid)
Drugs-Digoxin
Hyperthyroidism
Connective tissues disease
Aortic root abscess
What are the clinical features of a complete heart block (5)
Systolic hypertension
Bradycardia 30-40 bpm
Variable first heart sound
Cannon a waves due to AV dissociation
Usually with intermittent dizziness, syncope
Medical emergency
List 3 main causes of mitral stenosis
Rheumatic heart disease
Infective endocarditis
Degenerative causes- annular calcification.
associated with elderly, HPT, atherosclerosis and aortic aneurism
Congenital - abnormalities in subvalvular apparatus
Describe the pathophysiology of mitral stenosis
(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
Differentiate between Haemoptysis and haematemesis
What would you expected to find on CXR in a pt w/mitral stenosis
Normal in mild MS
LA enlargement: splaying at carina, double shadow on RH boarder and straightened LH boarder
Pulmonary oedema / congestion
Enlarged PA
What are the ecg changes you expect to find on mitral stenosis
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
Descuss the treatment of mitral stenosis according to severity
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
Therapy for mitral stenosis
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
What is the prophylaxis for infective endocarditis
dental procedures
☑️ Amoxicillin 2g orally 1 hour before procedure
☑️ if penicillin allergic:Clindamycin 600mg orally 1h before procedure
What are the causes of mitral stenosis
Degenerative-
Wear and tear
Hypertension
Hypercholestrolemia
Platelet-fibrin deposits
Abnormal flow dynamics
Congenital: Bicuspid valve
Rheumatic
Describe the ECG findings on Aortic stenosis
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
Treatment for aortic valve disease
Aortic valve replacement
