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3B General Care > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Causes of angina

A 
atheroma
anaemia
Aortic Stenosis 
tachyarrhythmias
hypertrophic cardiomyopathy 
arteritis/small vessel disease (microvascular angina/cadiac syndrome X)
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2
Q

Types of angina

A

Stable- induced by effort, relieved by rest
Unstable - angina of increasing frequency or severity, occurs on minimal exertion. Associated with increased risk of MI
Decubitus angina precipitated by lying flat
Variant (Prinzmetal’s) angina - coronary artery spasm, pain during rest

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3
Q

Variant Angina (prinzmetal’s)

A 
coronary artery spasm
pain during rest
ECG during pain shows ST elevation that resolves as pain subsides
Rx- CCB ± long acting nitrates
avoid B-blockers
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4
Q

ECG in angina

A

usually normal
may show ST depression

exclude precipitating factors - anaemia, DM, hyperlipidaemia, thyrotoxicosis, temporal arteritis

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5
Q

Management of Angina

A

Modify risk factors- smoking, exercise, HTN, DM
aspirin
B-Blockers- atenolol
Nitrates - GTN or isosorbide mononitrate
long acting calcium agonists - amlodipine
K+ channel activator- nicorandil

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6
Q

Definitions of ACS

A

unstable and evolving MI
ACS with ST segment elevation or new onset LBBB
ACS without ST segment elevation

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7
Q

Risk Factors for ACS

A

Non-modifiable- age, male, FHx of IHD
Modifiable- smoking, HTN, DM, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use

Controversial - stress, type A personality, LVH, raised fibrinogen, hyperinsulinaemia, homocystiene

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8
Q

Diagnosis of ACE

A

Raise and then fall in cardiac biomarkers (troponin) and:
- symptoms of ischaemia, ECG changes of new ischaemia, development of pathological Q waves or loss of myocardium on imaging

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9
Q

Symptoms of ACS

A

Acute central chest pain lasting more than 20mins
Nausea, sweatiness, dyspnoea, palpitations

May be silent or present atypically

  • syncope, pulmonary oedema, epigastric pain and vomiting, post-operative hypotension, oliguria, acute confusional state, stoke, diabetic hyperglycaemic states
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10
Q

Signs of ACS

A

Distress, anxiety, pallor, sweatiness, raised or low pulse or BP, 4th heart sound
May be signs of heart failure (raised JVP, 3rd heart sound)
pansystolic murmur- papillary muscle dysfunction/ rupture, `VSD

Later- pericardial friction rub or peripheral oedema

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11
Q

ECG changes in ACS

A

Hyperacute tall T waves
ST elevation or new LBBB
T wave inversion + pathological Q waves over hours-days

ST depression, T wave inversion , non-specific changes

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12
Q

CXR in ACS

A

cardiomegaly
pulmonary oedema
widened mediastinum (aortic rupture)

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13
Q

Differential diagnosis in ACS

A 
Angina
Pericarditis
Myocarditis
Aortic dissection
Pulmonary embolism 
Oesophageal reflux/ spasm
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14
Q

Pre-hospital managment of ACS

A

300mg aspirin chewed
GTN sublingual
analgesia- 5-10mg morphine iV + metoclopramide 10mg IV

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15
Q

In hospital management of ACS

  • ST segment elevation
A

O2, IVI, morphine, aspirin

  • primary angioplasty/thrombolysis if not CI
  • B-blocker (atenolol)
  • ACE-i if normotensive
  • consider clopidogrel 300mg loading dose, 75mg/day for 30 days
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16
Q

In hospital management of ACS

ACS without ST segment elevation

A 
O2, IVI, morphine, aspirin
-B-Blocker
- antithrombotic (fondaparinux or LMWH)
- Assess risk e.g. GRACE score
-High risk pts- GPIIb/IIIa agonist (tirofiban) or bivalirudin
angiography within 96hrs
clopidogrel
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17
Q

Subsequent management of ACS

A 
Bed rest
Daily examination 
Prophylaxis against thromboembolism until fully mobile 
Aspirin
Long term B-Blockade
Continue ACE-i
Start a statin
Address modifiable risk factors 
Assess LV function 
Return to work 2/12
avoid sex for 1/12
exercise daily
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18
Q

Complications of MI

A 
Cardiac arrest, cardiogenic shock 
unstable angina
Bradycardias or heart block 
Tachyarrhthmias
Consider implantable cardiac defibrillator
RV failure/infarction 
pericarditis
DVT/PE
systemic embolism 
Cardiac tamponade 
Mitral regurgitation
VSD
Late malignant ventricular arrhythmias 
Dressler's syndrome 
LV aneurysm
19
Q

Dressler’s syndrome

A 
Recurrent pericarditis
pleural effusions
fevere
anaemia 
elevated ESR 1-3/52 post MI

Treat with NSAIDs or steroids

20
Q

Causes of arrhythmias

Cardiac

A 
MI 
Coronary artery disease
LV aneurysm
Mitral valve disease 
Cardiomyopathy
Pericarditis
Myocarditis
Abberant conduction pathways
21
Q

Causes of Arrhythmias

Non-cardiac

A

Smoking
Alcohol
Pneumonia
Drugs (B2agonists, digoxin, L-dopa, tricyclics, doxorubicin)
Metabolic imbalance (K+/Ca2+/Mg2+/ hypoxia/hypercapnia/ metabolic acidosis/ thyroid disease)
Phaeochromocytoma

22
Q

Presentation of Arrhythmias

A 
Palpitations
Chest pain 
presyncope/syncope
Hypotension 
Pulmonary oedema
23
Q

Tests for arrhythmias

A 
FBC
U&Es
glucose 
Ca2+
Mg2+
TSH 
ECG (24hr monitoring)
ECHO
Provocation tests- exercise ECG, cardiac catheterisation + electrophysiological studies
24
Q

Treatment of Bradycardia

A

Asymptomatic, HR >40 bpm - no treatment
Look for causes - drugs, sick sinus, hypothyroifism
stop B-Blockers, digoxin

Symptomatic, HR<40 - atropine, pacing wire, isoprenaline infusion or external cardiac pacing

25
Q

Sick sinus syndrome treatment

A

causes bradycardia ± arrest, sinoatrial block or SVT alternating with bradycardia/asystole (tachy-brady syndrome)
AF and thromboembolism may occur

Pace if symptomatic

26
Q

Treatment of SVT

A

Narrow complex tachycardia (rate >100bpm, QRS with <120ms)
Acute management- vagotonic manouvers followed by IV adenosine or verapamil
DC shock compromise if compromised
Maintenance therapy- B-Blockers or verapamil

27
Q

Treatment of AF/atrial flutter

A

control ventricular rate with B-blocker or verapamil
alternatives- digoxin or amiodarone
DC shock if compromised

28
Q

Treatment of VT

A

Broad complex tachycardia
acute management IV amiodarone or IV lidocaine
No response/compromise - shock
Amiodarone loading dose then maintenance (Monitor LFT &TFT)

29
Q

Narrow complex tachycardias

Definition

A

ECG shows rate of >100bpm and QRS complex duration of <120ms

30
Q

Differential diagnosis

Narrow complex tachycardias

A

Sinus tachycardia - normal p wave follwoed by normal QRS
SVT - P wave absent or inverted after QRS
AF- absent P wave, irregular QRS
Atrial flutter

31
Q

Definition of heart failure

A

Cardiac output is inadequate for the body’s requirements

Prognosis is poor with ~25-50% pts dying within 5yrs of diagnosis

32
Q

Systolic heart failure

A

inability of the ventricle to contract normally
results in reduced cardiac output
Ejection fraction <40%

Causes- IHD, MI, cardiomyopathy

33
Q

Diastolic heart failure

A

inability of ventricle to relax and fill normally
causes increased filling pressures
EF >50%

Causes- constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension

34
Q

Left ventricular failure

symptoms

A 
Dyspnoea
poor exercise tolerance
fatigue
orthopnoea
paroxysmal nocturnal dyspnoea
nocturnal cough + pink frothy sputum
wheeze (cardiac asthma)
nocturia
cold peripheries
weight loss 
muscle wasting
35
Q

Right ventricular failure

causes

A

Left ventricular failure
pulmonary stenosis
lung disease

36
Q

Symptoms of right ventricular failure

A 
peripheral oedema
ascites 
nausea
anorexia
facial engorgement 
pulsation in the neck and face (tricuspid regurgitation)
epistaxis
37
Q

Acute heart failure

A

new onset or decompensated of chronic heart failure
characterised by pulmonary/peripheral oedema
±signs of peripheral hypoperfusion

38
Q

Chronic heart failure

A

develops or progresses slowly

venous congestion is common but arterial pressure is maintained until very late

39
Q

low out put heart failure

A

cardiac output is low and fails to normally increase with exertion
- causes- pump failure, excessive preload, chronic excessive afterload

40
Q

high output heart failure

A

rare
output is normal or increased in the face of very high need
Causes: anaemia, pregnancy, hyperthyroidism, Paget’s disease, AVM, beri-beri

41
Q

Signs of heart failure

Major criteria

(2 major/ 1 major + 2 minor = HF)

A 
paroxysmal nocturnal dyspnoea
crepitations
S3 gallop
Cardiomegaly
INcreased central venous pressure
weight loss >4.5kg in 5days in response to treatment
Neck vein distention 
acute pulmonary oedema
hepatojugular reflux
42
Q

Signs of heart failure

Minor criteria

(1 major + 2 minor = HF)

A 
Bilateral ankle oedema
Dyspnoea on ordinary exertion 
Tachycardia 
Decrease in vital capacity by 1/3 from maximum recorded 
Nocturnal cough 
Hepatomegaly
Pleural effusion
43
Q

Investigations in HF

A

ECHO
FBC, U&E, LFT, BNP
CXR- prominent upper lobe veins, peribronchial cuffing, diffuse interstitial or alveolar shadowing

3B General Care (8 decks)

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