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Jonah's Med Notes > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Name 5 risk factors for CVD?

A
  1. Previous CAD (incl. angina, MI)
  2. High Cholesterol
  3. Diabetes
  4. HTN
  5. Smoking + alcohol
  6. Kidney disease
  7. Fam hx
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2
Q

What is cachexia?

A

Weakness and wasting of the body due to severe chronic illness.

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3
Q

Name three peripheral signs of Infective Endocarditis

A

Splinter haemorrhages in the nails

Osler’s nodes (red, raised, tender papules on fingers)

Janeway’s lesions (non-tender, maculo-papular lesions on palms)

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4
Q

What are these?

A

Roth’s spots seen on fundoscopy.

Retinal hemorrhages associated with Infective Endocarditis and others.

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5
Q

What is normal P wave duration and what does longer mean?

A

Normal = <2.5 sq

(longer → LA enlargement)

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6
Q

What is normal P wave amplitute and what does higher mean?

A

Normal = <2.5sq/0.25mV

(larger → RA enlargement)

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7
Q

What is the duration of the PR (start P wave to start of QRS) interval?

What does shorter/ longer mean?

A

3-5sq

(Shorter → abnormal tract of bypassing tissue,

Longer → AV block with disease)

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8
Q

What is the Cardiac Clock and how does it impact on axis?

A

Normal: between -30 and +90 degrees

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9
Q

What is normal QRS duration?

A

Normal QRS: <2.5 sq

Bundle branch blocks (give M shaped complexes); ventricular ectopic focus; anomalous atrio-ventricular pathway; non-specific intraventricular conduction defect.

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10
Q

How is LV hypertrophey calculated?

A

S-wave in lead V1 + R-wave in either lead V5 or V6 > 35 mm

Sokolaw-Lyon criteria

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11
Q

How can you tell RV hypertrophy?

A

Lead V1: positive deflection > negative deflection (in the presence of a normal QRS duration)

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12
Q

What leads on ECG reflect ischemia in the distribution of the RCA?

A

II, III, aVF

The inferior leads.

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13
Q

What chest leads reflect ischemia in the distribution of LAD?

A

V1-V4

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14
Q

What Lateral leads reflect ischemia in the distribution of the circumflex artery?

A

aVL, I, V5, V6

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15
Q

What test is used to:

  • Confirm dx of angina. Evaluate angina.
  • Assess prognosis following MI
  • Assess coronary revascularisation
  • Exercise induced arrhythmias?
A

Stress ECG

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16
Q

Where is BNP (B-type Natriuretic peptide) secreted from?

A

Secreted by LV w/ LV systolic dysfunction (stretch, fibrosis, etc)

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17
Q

Name 5 systems that can cause chest pain and ddxs:

A
  • Anxiety/emotion
  • Cardiac:
    • Acute coronary syndrome (angina, NSTEMI, STEMI)
    • Pericarditis
    • Mitral valve prolapse
  • Aortic dissection, aortic aneurysm
  • GI
    • Oesophagitis, oesophageal spasm, Mallory-Weiss tear
  • Lungs/pleura:
    • Bronchospasm, Pulm infarct, pneumonia, tracheitis, pneumothorax
    • PE, malignancy, TB, connective tissue disease
  • MSK:
    • Osteoarthritis, rib fracture, costochondritis, intercostal muscle injury
  • Neuro:
    • Prolapsed intervertebral disc, Herpes Zoster, thoracic outlet syndrome
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18
Q

How do you initially manage (Ix, Mx, Path) chest pain?

A

Chest pain or Sx of Myocardial Ischemia -> ECG + Vitals.

Basic Mx = O2, Aspirin, IV access, Pain relief, CXR

Pathology -> cardiac biomarkers, FBC, BGL, lipids, TSH

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19
Q

What are indications for reperfusion?

A

Chest pain >30min, <12hrs.

Persistent ST elevation or new LBBB

Myocardial infarct likely from hx

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20
Q

Name 5 systems that can cause dyspnoea and their ddxs?

A
  • Acute
    • Asthma, pneumonia, pulmonary oedema, pneumothorax, pulmonary embolus, metabolic acidosis, ARDS (acute respiratory distress syndrome), panic attack.
  • Pulmonary
    • Airflow obstruction (asthma, COPD, upper airway obstruction), restrictive lung disease (interstitial lung disease, pleural effusion, resp. muscle weakness), pneumonia, pneumothorax, PE, aspiration, ARDS
  • Cardiac
    • Myocardial ischaemia, congestive heart failure, valvular obstruction, arrhythmias, cardiac tamponade
  • Metabolic
    • Acidosis, hypercapnia, sepsis
  • Haeme
    • Anaemia
  • Psych
    • Anxiety/panic attack
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21
Q

What Ix do you want for dyspnea?

A

CXR -> pneumonia, new onset HF, pneumothorax, etc.

CT -> PE, interstitial + alveolar lung disease

Modified Well’s criteria for PE

ABG, pulse oximetry, serum BNP in HF.

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22
Q

What are the cardiac causes of dyspnoea? (4)

A

Acute Left heart failure (MI, mitral regurg, AF)

Chronic Heart Failure

Arrhythmia

Angina

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23
Q

What is cardiogenic shock?

A

Impairment of tissue perfusion via acute circulatory failure, 2nd to a cardiac cause.

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24
Q

How does a massive PE cause Cardiogenic shock?

A

RV outflow obstruction -> no LV preload -> circ collapse

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25
Q

What is syncope?

A

Sudden loss of consciousness, 2nd to decreased cerebral perfusion

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26
Q

What are 3 main cardiac causes of syncope?

A
  • Cardiac syncope
    • Mechanical cardiac dysfunction, arrhythmia
  • Neurocardiogenic syncope
    • Abnormal autonomics (~vasovagal)
  • Postural hypotension
    • Vasoconstriction on standing impaired -> low BP
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27
Q

What Ix would you like for syncope?

A
  • Hx + collateral hx + exams (~Cardio + Neuro)
  • ECG
  • Cardiac -> Holter monitor, echo, Electrophysiology study
  • Neuro -> EEG, carotid Doppler, CT/MRI
  • Vasovagal -> Tilt table test
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28
Q

Why does Postural Hypotension occur? (3)

A
  • Relative hypovolaemia (dehydration, often 2nd to diuretics)
  • Autonomic (symp) degeneration -> DM, Parkinson’s, aging
  • Drug therapy -> anti-HTNs
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29
Q

What are the acute coronary syndromes?

A

Stable and unstable angina, NSTEMI, STEMI

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30
Q

Name 7 risk factors for Atherosclerosis:

A

Remember endothelial activation is the initial cause - e.g. insult

  • Age + Sex
  • Fam hx of prem disease
  • Smoking
  • HTN
  • Hypercholesterolaemia
  • DM
  • Haemostatic factors
  • Physical activity
  • Obesity
  • Alcohol
31
Q
A
32
Q

What is stable angina?

A

Ischemia 2nd to fixed atheromatous stenosis of coronary arteries
Relieved with rest

33
Q

What is unstable angina?

A

Ischemia via dynamic obstruction of a coronary artery due to plaque rupture or erosion w/ thrombosis

Not relieved with rest.

34
Q

What is the pathophy of MI?

A

Almost all from atherosclerosis.

Pathophys based on supply + demand balance.

Aetiology:

CAD: atherosclerotic plaque rupture -> thrombus/embolus formation -> occlusion of vessels.

Other:

Trauma, vasculitis, coronary vessel spasm, coronary artery dissection, coronary embolus.

35
Q

When do symtoms of MI occur?

A

Smaller epicardial vessels compensate well for large artery narrowing -> large arteries must be >70% occluded for Sx.

36
Q

What is the socrates of MI?

A

Site - central chest, poorly localised

Onset - gradual but acute

Character - discomfort, tightness, crushing.

Radiation - upper abdo, shoulders, arms, jaw, back

Associated Sx - diaphoresis, N+V, clamminess, SOB

Temporal

Exacerbated w/ exercise. GTN + rest makes it better.

37
Q

What might you expect to see on examination post MI?

A

Raised JVP, pulm crackles, tachycardia, S3 gallop, HR.

38
Q

Where are reciprocal changes for MI seen?

A

Inferior <-> lateral

None for anteroseptal.

Posterior infarct -> reciprocal ST depression in V1-4

39
Q

What is immediate care for MI?

A

M - morphine -> lower adrenergic stress + pain relief

O - oxygen -> relieve pulm oedema (where SaO2 < 95%)

A - aspirin -> early

N - nitroglycerin -> sublingual or IV

40
Q

What is the preferred intervention for MI?

A

PCI (percutaneous coronary intervention)

41
Q

When is fibrinolytic therapy used?

A

PCI unavailable. Dx made <120mins ago. Contra to PCI.

42
Q

What is secondary prevention for MI?

A
  • Dual antiplatelets - aspirin + clopidogrel 12mo
  • B-blockers - atenolol. Contra w/ brady, decompensated HF.
  • ACEi - captopril, Ramipril. All Pts.
  • Aldosterone antagonists - Spironolactone. In those w/ significant HF.
  • Statins in all pts.
  • Cardiac rehab
43
Q

What is Dressler’s syndrome?

A

Pericarditis occurring 2–10 weeks post-MI without an infective cause

Aspirin, acetaminophen

44
Q

What is the general approach to stable angina management?

A

Decrease myocardial O2 demand, increase O2 delivery.

Control RF - Control HTN, DM, CKD, smoking, dyslipidaemia, obesity.

45
Q

How does AF lead to CVA?

A

Decreased atrial contraction -> stasis -> thrombus -> stroke + systemic embolism.

46
Q

How is Atrial Fibrillation Stroke Risk calculated?

A

CHA₂DS₂-VASc Score

47
Q

How is a CHA₂DS₂-VASc calculated?

A
  • Congestive Heart Failure 1 point
  • HTN hx 1 point
  • Age > 75yrs 2 points
  • DM 1 point
  • Stroke of TIA hx 2 points
  • Vascular disease 1 point
  • Age 65-74 yrs 1 point
  • Sex Category female 1 point
48
Q

What are the implications of a CHA₂DS₂-VASc Score?

A

0 points total = no prophylaxis

1 point = consider oral anti-coag or aspirin

2 points = oral anti-coag

49
Q

How is SVT managed?

A

Carotid sinus massage or Valsalva.

IV adenosine. ~verapamil.

Recurrent -> catheter ablation OR B-blocker prophylaxis.

50
Q

How is Torsades de Pointes managed?

A

Correct underlying cause.

Give IV Mg

Atrial pacing

51
Q

How do B-Blockers work?

A

Reduce SA node depol + relative block of AV node.

Useful for rate control.

52
Q

Why does Renal Failure occur in Advanced Cardiac Failure?

A

Via poor renal perfusion. Exacerbated by ACEi.

53
Q

Why can Hypokalaemia occur in Advanced Cardiac Failure?

A

Diuretics + hyperaldosteronism (RAAS activation)

54
Q

Why can Hyperkalaemia occur in Advanced Cardiac Failure?

A

Potassium sparing diuretics (spironolactone) + renal dysfunction.

55
Q

Why can Hyponatremia occur in Advanced Cardiac Failure?

A

Diuretics

56
Q

How can Impaired Liver Function result in Advanced Cardiac Failure?

A

Hepatic venous congestion, poor arterial perfusion -> mild jaundice, abnormal LFTs, coagulation changes.

57
Q

Why does Thromboembolism occur in Advanced Cardiac Failure?

A

Stasis (low CO + forced immobility), emboli from AF.

58
Q

What signs are found on X-ray of Heart Failure?

A

A -Alveolar oedema

B - Kerley B lines (interstitial oedema)

C -Cardiomegaly

D- Dilated prominent upper lobe vessels

E - Pleural Effusion

59
Q

How is Bacterial Endocarditis investigated?

A
  • Blood culture
  • Echo -> vegetations + inflame changes
  • Non-specific:
  • FBC -> normocytic + normochromic anaemia, leucocytosis.
  • CRP, ESR
  • Urinalysis -> protein + haematuria
  • ECG + CXR ~> normal
60
Q

What is the criteria used for Bacterial Endocarditis?

A

Modified Duke’s Criteria

61
Q

What are the two Major Criteria for Bacterial Endocarditis in Duke’s Criteria?

A
  1. +ve Blood culture
  2. Echo changes -> vegetations, new valvular regurg.
62
Q

Name 3 minor criteria of Duke’s Criteria?

A
  • Predisposing valvular/cardiac anomaly
  • IV drug use
  • Fever >38
  • Embolic phenomenon -> petechiae, peripheral, splinter haemorrhages, CVA
  • Vasculitic phenomenon -> janeway/oslers, clubbing, Roth’s spots
  • Inconclusive blood cultures
  • Suggestive echo
63
Q

Name 5 causes of Secondary Hypertension

A

Renal - glomerulonephritis, reflux nephropathy, renal artery stenosis, diabetes.

Endocrine - Conn’s syndrome, Cushing’s, phaeochromocytoma, etc.

Other - Drugs, pregnancy, etc

64
Q

What 3 drugs cause the triple whammy?

A

ACEi + diuretic + NSAID

65
Q

What are the 3 adverse effects of ACEis?

A

Cough (bradykinin build up)

Postural hypotension

Decreased GFR

66
Q

How do Dihydropyridine CCBs work?

A

Predominantly vasodilators

67
Q

How do non-hydropyridine CCB’s work?

A

Negative cardiac inotropic/chronotropic effects + moderate vasodilation

68
Q

What causes an S3 Murmur?

A

Early diastolic murmur.

Ken-tucky

Passive left ventricle filling when blood stikes a compliant left ventricle.

69
Q
A
70
Q

Quinke’s sign (nailbed pulsation) is a clinical sign of:

A

Aortic Regurgitation

71
Q
A
72
Q

How is the cardiac membrane stabilised is Hyperkalaemia?

A

Intravenous calcium gluconate

73
Q

What is Dresslers Syndrome?

A

It is a condition characterised by an autoimmune response mounted by the body after injury to myocardium or pericardium, in the case of this gentleman - a myocardial infarction. The condition comprises of fever, pericarditis, pleuritic pain +/- pericardial effusion.

74
Q
A

Jonah's Med Notes (8 decks)

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