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CP3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

List 6 categories of differentials for acute chest pain

A

Ischaemic, dissection, infective (pericarditis), respiratory ( pleurisy, PE, pneumonia) GI (ulcer perf) MSK

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2
Q

Describe the pathology leading to STEMI and NSTEMI

A

atheromatous plaque in coronary arteries
ulceration and platelet aggregation
localised thrombosis, vasoconstriction and ischaemia

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3
Q

Define unstable angina

A

Chest pain occuring at rest or a sudden increased frequency/severity of existing angina

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4
Q

What does the R coronary AA supply and what leads see an infarct from it

A

RA, RV posterior septum

posterior-inferior infarct seen in leads II III avF

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5
Q

What does the L coronary AA split into and what leads see an infarct from it

A

Circumflex and left anterior descending artery
massive antero-lateral MI
I avL V1-6

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6
Q

What does the circumflex coronary AA supply and what leads see an infarct from it

A

LA and LV
lateral MI
leads I aVL V5/6

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7
Q

What does the L ant descending coronary AA supply and what leads see an infarct from it

A

LV and anterior septum
antero-septal MI
V1-4

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8
Q

Initial Investigations in ACS

A

ECG, repeat every 15 mins or continuous whilst in pain

Troponin (FBC, U&E, glucose down, lipids up

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9
Q

What is the timing of troponin rise in ACS

A

rise 4-8 hours from onset of symptoms
peaks at 24 hours
detectable for 10 days

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10
Q

what thickness of damage do STEMI and NSTEMI usually result in

A

full thickness in STEMI, partial in NSTEMI

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11
Q

ECG changes in an NSTEMI

A

ST depression, T wave inversion + non-specific changes

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12
Q

ACS early management

A

A-E, oxygen if sats <94%, baseline bloods with trop and clotting
300mg aspirin chewed
5mg morphine plus 10mg metoclopromide
GTN spray/iv unless hypotensive
ECG
STEMI- PCI
NSTEMI- GRACE score and Clopidogrel 300mg + Fondaparinoux (lmwh)

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13
Q

when would an NSTEMI go to PCI

A

elective PCI if GRACE score >3% in 6 months or raised trop, persistent pain, or diabetes

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14
Q

long term ACS management

A 
Thromboprophylaxis
Clopidogrel 75mg for a year
Aspirin 75mg for life
Bisoprolol for life
after 48 hours start ACEi and statin
LIFESTYLE MODS
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15
Q

Immediate complication of MI

A

Arrhythmias- VF, VT AF or brady with block if SAN/AVN affected

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16
Q

5 Short term complications of MI

A 
pulmonary oedema
cardiogenic shock
thromboembolism
VSD
ruptured chordae tendinae or ventricular wall
17
Q

3 long term complications of MI

A

Heart failure
dresslers syndrome (immune mediated pericarditis)
ventricular aneurysm

18
Q

3 categories of causes of myocardial ischaemia in angina

A

reduced perfusion (atheroma, thrombus, emboli, spasm)
reduced blood oxygenation (anaemia, CO poisoning)
increased tissue demands (cardiac hypertrophy)

19
Q

How much of a coronary artery needs to be stenosed to start feeling symptoms

A

70%

20
Q

Difference between atheriosclerosis, atherosclerosis and atheroma

A

a) small artery non specific thickening and sclerosis
b) large artery thickening and sclerosis
c) fatty denegerative disease of large/med arteries

21
Q

4 stages of atheroma formation

A

1) damage to endothelium allowing entry of LDLs into intima
2) lipid taken up by macrophages formiing a fatty streak
3) inflammatory mediators (cytokines) leads to collagen deposition and the plaque becomes fibrotic
4) collagen forms dense fibrous cap, white and hard

22
Q

what is prinzmetals angina

A

angina which occurs without provocation at rest as the result of coronary artery spasm (ST elevation during the elevation so consider if st el and no trop rise)

23
Q

Treatment of angina

A

Modify lifestyle and treat co-moridities
GTN spray and BB/CCB as fine line
refractory disease: BB and CCB (not rate limiting) or nicorandil

24
Q

Side effects of Nitrates

A

headaches
flushing
postural hypotension
tolerance

25
Q

Side effects of beta blockers

A 
bronchospasm
cold extremities
bradycardia
hypoglycaemia
fatigue
26
Q

Side effects of calcuim channel blockers

A

peripheral oedema
headache
flushing
constipation

27
Q

When is CABG used

A

symptom control for those unsuitable for PCI

those with severe three vessel disease (better survival(

28
Q

Do the DVLA need to be notified post ACS

A

no

CP3 (1 decks)

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