Cardiology Flashcards

Question

risk factors

Answer 1

same as MI Age, male, family history (counts as first degree relative has developed has developed ischaemic heart disease before the age of 50). Hyperlipidaemia, cigarette smoking, hypertension, metabolic factors (e.g. Diabetes), diet (high in fat, low in antioxidant), lack of exercise, psychosocial factors (work stress, lack of social support, depression), elevated CRP, high alcohol intake and high levels of coagulation factors.

Answer 2

• Pathological Q waves (in particular) • Left bundle branch block • St-segment and T-wave abnormalities (for example ST-segment depression, T wave flattening, or T-wave inversion) But remember a normal ECG does not confirm or exclude angina

Answer 3

remove risk factors aspirin - reduces mortality by 34% [1] beta blocker - atenolol or CCB nitrates-GTN spray K channel activator -nicorandil coronary artery bypass graft if still not working refer if sundden onset /recurrent angina after past MI or uncontrollable

Answer 4

phosphodiesterase inhibitors (sildenafil, tadalafil, and vardenafil), often used in the treatment of erectile dysfunction

Answer 5

MI, unstable angina, Prinzmetals angina (a form of angina though to be caused by vasospasm), dissecting thoracic aneurysm, pericardial pain, acute congestive heart failure, arrhythmias. GI causes (peptic ulcer disease, GORD), MSK (costochondritis, rib fracture, osteoarthritis, osteoporosis, rheumatoid arthritis), psychological causes (anxiety, panic attacks, depression), respiratory causes (PE, pneumothorax, lung tumour), referred pain from thoracic spine

Answer 6

ivabradine - inhibit current in SA node and therefore HR trimetazidine -inhibit FA oxidation ranolazine - inhibit late NA curent

Answer 7

Chaotic irregular atrial rhythm (300-600bpm). AV node responds intermittently hence an irregular ventricular rhythm. This causes cardiac output to  by 10-20% (atria don’t prime ventricles reliably

Answer 8

* May be asymptomatic * Chest pain * Palpitations * Dyspnoea * Faintness

Answer 9

Irregularly irregular pulse Apical pulse greater than radial rate 1st heart sound of variable intensity Signs of LVF (Examine whole patient- AF often associated with non-cardiac disease)

Answer 10

``` mitral valve disease hyperthyroidism Heart failure Hypertension IHD PE Mitral valve disease Pneumonia Hyperthyroidism Caffeine Alcohol Post-op Low K+ or low Mg2+ Rare causes; endocarditis, haemochromatosis, cardiomyopathy, constrictive pericarditis ```

Answer 11

``` age >60 diabetes hypertension hypercholestermia previous MI heart failure ```

Answer 12

1. Atrial flutter 2. Atrial tachycardia 3. Wolff-Parkinson-White syndrome (extra electrical pathway between heart’s upper & lower chambers causes a rapid heartbeat

Answer 13

ECG (absent P waves, irregular QRS complexes) Blood tests; U&E, cardiac enzymes, thyroid function tests Echo (L atrial enlargement, mitral valve disease, poor LV function, other structural abnormalities) fibrosis diltation

Answer 14

acute: first line is CCB or beta blocker, 2nd is digoxin and amoridone, then consider flecanide cardioconverison same with chronic anticoagulation varies - warfarin/NOAC in chronic but in acute LMWH unless emboli risk high then warfarin. If no risk factor and stable sinus rythmn thhen no antiCoagultation needed. ``` avoid triggers aspirin and warfarin angioplasty and cathether ablation beta blockers amaridone ``` ACUTE AF If adverse signs (e.g. shock, chest pain, ECG changes); • ABCDE & senior help • Direct current (DC) cardioversion (synchronized shock) +/- amiodarone Stable & AF started <48hrs ago; • Rhythm control- DC cardiovert or give flecainide (anti-arrhythmic drug) or amiodarone • Start heparin Stable & AF started >48hrs ago/ unclear time of onset; • Rate control- bisprolol or diltiazem • If choose rhythm control- anticoagulated >3wks first Correct electrolyte imbalances Treat associated illnesses Consider anticoagulation (no anticoag if stable snus rhythm restored, no emboli risk factors & recurrence unlikely) CHRONIC AF Anticoagulation Rate control; • -blocker or rate-limiting calcium channel blocker are 1st choice (don’t give -blockers with verapamil) • If this fails consider digoxin then amiodarone Rhythm control; • Elective DC cardioversion (do echo 1st- check for intracardiac thrombi) • Elective pharmacological cardioversion- flecainide 1st choice (amiodarone if structural heart disease) • AVN ablation with pacing or pulmonary vein ablation may be considered Paroxysmal AF; • Sotalol or flecainide PRN (if; Af infreq, BP >100mmHg systolic, no past LV dysfunction) • Anticoagulate (assess need; embolic stroke risk vs risks of anticoagulation- use scores fpr each) • Consider ablation if symptomatic or frequent episodes

Answer 15

inflammation of the endocardium layer of the heart tissue usually involves valves

Answer 16

vegetations that can be seen in echocardiogram | made of fibrin, platelets and inflamationary cells on the chordiae tedniae

Answer 17

infective- 50-60% strep. viridans from mouth, s.aureus via skin coagulase negative staphylococci -- prosthetic valves can be acute or subacute other causes non bacterial thrombolytic endocarditis NBTE endocarditis of SLE-libman sacks disease

Answer 18

``` ivdu artiifical valves califcation of stenosis congential defects dental disease prolonged catheters Gentourinary disease dabetes wounds bowel cancer- s. bovis ```

Answer 19

``` flu-like symptoms Fever Roth spots Osler nodes- digits, painful Murmur- associated with left IE Janeway lesions - erythematous on palms and soles Anaemia Nails- splinter haemorrhage Emboli ``` immunological conditions e.g. glumeronephritis

Answer 20

subacute- less nasty, can be treated with antibiotics, lower virulence, less destructive acute- more destructive, higher virulence, surgical treatment, more nasty

Answer 21

small sterile aggregated along the valuve edge or on the cusp doesn't cause inflammation usually during hypercoaguable state such as pregnancy, dvt may rbeak off and lodge in brain or heart cancer patients increase risk due to debilating state in SLE

Answer 22

rheumatic feature is an inflammati0ory diseaseaffecting heart, brain joint and skin following GROUP A STEPTOCOCCAL PHARNYNGITIS rare vegetations - veruccae aschoff bodies- cardiac lesions, nodules in the heart cause of mitral stenosis Antibodies against M proteins of streptococci clinical features include nose bleeds, painful joints, fever, chorea- jerky movements carditis sore throat malaise

Answer 23

``` bloods- culture- microorganisms, anaemia FBC ESR, CRP for infection echocardiogram for vegetations CXR ECG ```

Answer 24

abx dependent on cause vancomycin - s.aureus pencillin if viridans beta lactam - naficliin and aminoglycoside 1st line gentamicin, benzypencillin and flucaxoacillin

Answer 25

Chronic progressive condition affecting pumping power of heart muscles- specifically refers to stage fluid builds up around heart & causes it to pump inefficiently. Veins near heart become ‘congested’ (full of blood). Term for pts with breathlessness & abnormal Na & water retention (causing oedema) Left sided failure (systolic or diastolic failure) & right sided failure that occur together= CCF

Answer 26

drop in systolic BP by 20mmHg or diastolic by 10mmHg on standing

Answer 27

``` hypovolemia after long run hypopituaritism addisons disease autonomic neuropathy parkinsons pregnancy ```

Answer 28

BP monitor in clinic posture test tilt test- lie for 15 mins and then stand/tilt up, monitor bp and heart rate for 45 mins - postural hypertension bp will drop instantly on standing

Answer 29

``` compression stockings drink more water stand slowly head of bed elevated avoid caffeine small and frequent meals if not managed then consider FLUDROCORTISONE AND MIIDODRINE/E[HDRINE ```

Answer 30

antihypertensives anti-psychotics nitrates diuretics

Answer 31

``` lightheadedness syncope blurred vision nausea ddx- vertigo asovagal syncope (collapse ```