Cardiology Flashcards
Name 3 modifiable and 3 non modifiable risk factors of an ACS?
Modifiable: smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary life style
Non-modifiable: age, male, FHx of IHD
Name 4 symptoms of an ACS?
Central chest pain Nausea Sweatiness Dyspnoea Palpitations
Which tests would you order in a suspicion of ACS? 4 things
Glucose-hyperglycaemia FBC-platelets, anaemia ECG-ST elevation CXR-oedema, Cardiomegaly Cardiac enzymes-cardiac troponins T & I, creatine kinase
Give 5 aspects of managing an ACS?
Attach ECG O2 15L aiming for 95% IV Access Morphine IV + antiemetic Aspirin Nitrites (GTN spray) DVT prophylaxis-Clopidogrel/Dalteparin
PCI or thombolysis
What is the criteria for thrombolysis in ACS?
- ST elevation >1mm in 2 or more limb leads OR >2mm in 2 or more chest leads
- New LBBB
- Posterior changes
Give 5 contraindications for thrombolysis?
Internal bleeding past 4 weeks Recent surgery 3 weeks Hypertension 200/120 Previous allergic reaction Recent haemorrhagic stroke 3 months Oesophageal varices Trauma Pregnancy Active peptic ulcer disease
Give 2 thrombolysing agents that could be used in ACS?
Streptokinase (don’t repeat unless within 4 days due to immunity development)
Alteplase
What is involved in the long term management of an ACS? 3 things
DVT Prophylaxis until fully mobile Aspirin Beta blockers ACEi Statin (simvastatin) Address modifiable risk factors
What is the door to needle time in relation to ACS?
Treat MI within 36 minutes
From seeing ST elevation to PCI/Thrombolysis should be 36mins
What is bradycardia and how might you treat it?
<40bpm without symptoms
Atropine OR
Pacing wire
What is narrow complex tachycardia?
> 100bpm
QRS <120ms=3 small boxes
Give 3 options for managing SVT?
Vagal manoeuvres
IV Adenosine
IV Verapamil
DC Cardioversion
What are the complications of a STEMI? 5 things
SPREAD butter Sudden death Pump failure/Pericarditis Rupture papillary muscles/septum Embolism Aneurysm/Arrhythmias Dressler's syndrome
What is the difference between SVT an VT?
SVT slowed or terminated by vagal manoeuvres/adenosine
SVT has atrial and ventricular coupling
VT has independent atrial activity
VT can contain fusion/capture beats
Give 6 causes of AF?
Heart failure MI Hypertension Valve disease PE Pneumonia Hyperthyroidism Alcohol/Caffeine
What is the CHA2DS2VAS score?
Assesses the risk of a thrombo-embolic stroke in AF patients
Congestive Heart failure Hypertension Age >75 = 2 points Diabetes Systemic embolic event (stroke/TIA) = 2 points Vascular disease Age > 65 Sex (female)
Give 5 symptoms of Left sided HF?
Dyspnoea Fatigue Orthopnoea PND Cold peripheries Weight loss
Give 3 symptoms of right sided HF?
Peripheral oedema
Ascites
Nausea
Epistaxis
Name 3 investigations in HF?
Bloods: BNP
CXR: Cardiomegaly, dilated upper lobe vessels, alveolar shadowing etc.
Echocardiography: LV dysfunction, cause
How is the diagnosis of HF made?
Using the Framingham criteria
What are the changes seen on CXR in HF?
Alveolar oedema B lines (interstitial oedema) Cardiomegaly Dilated upper lobe vessels Effusion (pleural)
What are the 3 common causes of HF?
- Ischaemic heart disease
- Non-ischaemic dilated cardiomyopathy
- Hypertension
What are the pathophysiological changes seen in HF? 4 things
Ventricular dilatation Myocyte hypertrophy Increased ANP Salt and water retention Sympathetic stimulation Peripheral vasoconstriction
What is starlings law?
The greater the volume of blood entering the heart during diastole, the greater the volume ejected during systolic contraction
What are some non pharmo and non surgical managements for HF? 3 things
Low level exercise Weight loss Low salt diet Stop smoking Vaccination
What are the medical options for treating HF? 4 things
DABS-DN Diuretics (furosemide) ACEi Beta blockers Spiranolactone Digoxin Nitrates
Name 3 surgical options for HF?
Revascularization
Pacemaker/ICD
Heart transplant
Left ventricular assist device
Give 2 organisms that can cause infective endocarditis?
Strep viridans
Staph aureus
What is the minor criteria in Dukes criteria for diagnosing endocarditis?
Minor •Predisposition •Fever •Vascular/immunological signs •Positive blood culture (not meeting major) •Positive echo (not meeting major)
What is the empirical treatment of endocarditis?
Ben Pen and Gentamicin
What is the characteristic symptom of pericarditis?
Chest pain worse on inspiration/lying flat
Eased on sitting forward
What is the major criteria in Dukes criteria for diagnosing endocarditis?
Major
•Positive blood culture
2 separate cultures same organism
3 cultures positive
•Evidence of endocardial involvement
Positive echo
New valve regurgitation
Name 3 pre existing diseases that could predispose to endocarditis?
Congenital heart disease
Rheumatic heart disease
Cardiac valve anomalies
Artificial heart valves
Which coronary arteries are compromised in anterior, lateral, posterior and inferior MIs?
Anterior=Left artery descending artery
Lateral=Left Circumflex artery
Posterior=Right or Left Circumflex artery
Inferior=Right coronary artery
Give 4 common causes of secondary hypertension?
Renal artery stenosis COCP Diabetes Cushing's disease Pregnancy Conns syndrome
Give 3 causes of aortic stenosis?
Calcification of valve
Congenital aortic stenosis
Rheumatic fever
Which class of medications can you use to manage high cholesterol?
Statins
Fibrates
Ezetimibe
In Pericarditis, what 2 abnormalities might be heard on auscultation?
Muffled heart sounds
Pericardial rub
What is the characteristic ECG change in pericarditis?
Saddle shaped ST segment through most of the leads
What is the CXR change seen in pericarditis?
Globular heart
Name 2 medications involved in the long term management of AF?
Digoxin
Beta blockers
Warfarin
Give 3 complications an AF patient is at risk of?
PE
Stroke
TIA
Collapse
Give 2 congenital cardiac causes of cyanosis?
Transposition of great arteries
Truncus arteriosus
Tricuspid atresia
Tetralogy of fallot
What is tetralogy of fallot?
Ventricular septal defect
Pulmonary stenosis
Over riding aorta
Right ventricular hypertrophy
Give 3 examples of narrow complex tachycardias?
Sinus tachycardia
Supraventricular tachycardia: Atrial Fibrillation, Atrial flutter, Atrial tachycardia
How do you manage narrow complex tachycardia? 3 things
DC cardioversion if haemodynamically compromised
Vagal manœuvres
Adenosine
Give 2 shockable and non shockable rhythms?
Shock: VF and pulseless VT
Non shock: Pulseless electrical activity and asystole
Give 4 indications for a permanent pacemaker?
Symptomatic bradycardias
Persistent AV block post MI
Drug resistant tachyarrythmias
Heart block: 2nd degree (type II) or 3rd degree
Give 3 causes of aortic regurgitation?
Rheumatic fever
Congenital valve disease
Infective endocarditis
Give 3 ECG changes seen in MI in order from earliest?
Hours: Hyperacute T waves, ST elevation, New LBBB
Days: T wave inversion
Weeks: Pathological Q waves
What are the drugs involved in management of Angina? 6 of them
ABC-KNS Aspirin Beta blocker (atenelol) Calcium channel blockers (amlodipine) Potassium channel activator (nicorandil) Nitrates (GTN spray) Statin
