Cardiology Flashcards
Symptoms of cardiovascular disease
Chest pain Breathlessness Ankle swelling Fatigue Palpitations Syncope
Mechanism that cause peripheral oedema
RaisedSystemic venous pressure
Fluid retention
Decrease albumin
Increase vascular permeability
CV factors considered when calculating absolute risk.
Age Smoking Serum lipid Waist circumference and BMI Nutrition Physical exercise Alcohol intake FmHx of premature heart disease SoHx of social status, mental health Diabetes Urine micro albumin and protein Hypercholesteroleamia Evidence of AF
Risk factors for IHD
Age Male Menopause Positive FmHx Modifiable: Hyperlipidaemia Smoking Hypertension Weaker: Obesity Type A personality Inactivity Plasma Homocysteine
DDx for chest pain
IHD GORD Oesophageal spasm Peptic ulcer Cholecystitis Aortic dissection Pericarditis Hyperventilation, air swallowng and other psychosomatic disorder
Ix for IHD
ECG and stress ECG: horizontal or downsloping ST segment depression greater then 2mm - Typical ischaemic symptoms - dysrhythmias - fall in BP Ambulatory ECG Coronary angiography
Mx of IHD - stable angina
Stop smoking
Aspirin, statin and ACE i
1st: beta blocker
2rd & 3rd: calcium blocker the nitrate
4th: Nicorandil
Finally: revascularisation
Acute management of ACS
Aspirin 300mg A- B- O2 C- IV cannula and Bloods (U & E, Troponin), ECG Morphine with metoclopramide Thrombolytic therapy: streptokinase or Tpa (tissue plasminogen activator) Consider B Blocker Look for HF.
Contraindications to thrombolysis in ACS
Recent Hx of haemorrhage
Trauma, surgery, recent childbirth or vascular injury
Active peptic ulceration
Recent Hx of stroke, particularly hemorrhagic
Uncontrolled HTN, liver disease or varies
Active proliferative diabetic retinopathy at risk of bleeding
Pregnancy
Long term management of ACS
Non drugs - Cardiac Rehab, education, exercise, risk factor modification Drugs - Aspirin - b blocker - ACE i - Statin if > 4
Immediate mx of STEMI
If less then 12 hrs and ECG changes is indicated for repercussion
- if less than 1 hr of presentation = PCI and abciximab (glycoprotein IIb/IIIa)
- Fibrinolytic therapy (Alteplase)
Aspirin
GTN
Morphine
Oxygen
Immediate mx of NSTEMI
Risk stratification
- High risk: Aspirin, beta blocker, LMWH
- Intermediate risk: aspirin, Observation for at least 8 hours, ECG, troponin 6-8hr, if all negative then stress test prior to D/C.
- Low risk: outpatient appointment within 2 weeks.
High risk stratification in NSTEMI
Ongoing pain
ST depression or deep T wave inversion in 3 or more leads
Elevated serum troponin
Recent (within 1yr) hx of infarction or revascularisation
Heart failure, shock or syncope
Intermediate risk stratification in NSTEMI
Hx of prolonged, repetitive chest pain or pain at rest
Recent onset of angina (less then 2wk)
A remote(more than 1yr) hx of infarction or revascularisation
Age over 65 yr
diabetes
No high risk features
Low risk stratification in NSTEMI
A worsening anginal syndrome without prolonged, repetitive or resting chest discomfort
Normal ECG
No detectable troponin
No high or intermediate risk features
