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Long Case > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Definition of unstable angina

A

Pain comes on at rest, negative troponins, no change on ecg

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2
Q

Definition of stable angina

A

Pain comes on by exercise/emotion, relieved by rest. negative troponins and no ecg changes

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3
Q

Things to ask about in chronic history

A 
OPTICPR
Onset
Presentation
Treatment
Investigations
Complications
Progression
Recovery
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4
Q

Associated symptoms of ischemic heart disease

A

Nausea, vomiting, dyspnoea,sweating, exercise tolerance, relieved by GTN

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5
Q

Background info with ischemic heart disease

A

Hospital admissions
Procedures-angioplasty, thrombolysis, stents (drug eluting/bare metal)
Medications started
Complications (arrhythmias/ heart failure/embolic events)
Participation in cardiac rehab program

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6
Q

Risk factors for ischemic heart disease

A 
Previous IHD
Hyperlipidemia
DM
Hypertension
Smoking
OCP
Family history
Obesity
Physical inactivity
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7
Q

Differentials for IHD

A

GORD
Oesophageal spasm
PE
MSK

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8
Q

Investigations for IHD

A 
ECG
Troponins (usually don't rise until 6 hours post so order a repeat. Remain elevated for 2 weeks)
Exercise tolerance test
ECHO
Angiogram
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9
Q

Immediate management of angina

A

Stable: GTN spray (caution with sildenafil) consider BBlockers
Unstable: Aspirin, GTN, consider BBlockers

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10
Q

Acute Management of STEMI

A

Morphine, GTN, O2 (if hypoxic), aspirin, ticagrelor, metoclopramide
Patients presenting within 12 hours consider for PCI
Otherwise thrombolysis with IV tenecteplase
Admit to CCU

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11
Q

Acute management of Non-stemi

A

Morphine, GTN, O2 (if hypoxic), aspirin, ticagrelor, metoclopramide
Admit to CCU

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12
Q

Secondary prevention of IHD

A

Pharmacological: consider BBlockers, Statins, ACE inhibitors, aspirin forever, ticagrelor for one year, nitrates

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13
Q

Indications for CABG?

A

Three vessel disease
Significant LAD stenosis
Significant left main coronary artery stenosis

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14
Q

Classic presentation of infective endocarditis

A

Fever, acute heart failure, new murmur

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15
Q

Risk factors for infective endocarditis

A

Recent dental, endoscopic, or operative procedure, valve disease, rheumatic fever, heart disease, IV drug use, immunosuppression

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16
Q

Most commonly affected valve in infective endocarditis

A

Mitral (mitral regurgitation) caused by strep viridans

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17
Q

How to diagnose infective endocarditis

A 
Duke's criteria
Major
1. Typical organism on 2x blood cultures
2.Evidence of endocardic involvement on echo
Minor
1. Predisposing cardiac condition/IV drug use
2. Fever >38
3. Vascular phenomena
4. Positive blood culture
5. Echo abnormality
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18
Q

Differentials for infective endocarditis

A

Rheumatic fever
Atrial myxoma (tumour)
SLE

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19
Q

Investigations for infective endocarditis

A

Bloods: Cultures for staph aureus and Step viridans
Check for inflammatory markers (FBC and ESR will be high)
Imaging: CXR (HF, cardiomegaly) ECHO
MSU (haematuria from emboli)

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20
Q

Management for infective endocarditis

A

IV antibiotics dependent on organism sensitivities
4 weeks but 6-8 weeks if prosthetic valves
Consider cardiac surgery
Consider antibiotic prophylaxis

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21
Q

What are the key formulae for the physiology of heart failure

A

Cardiac output= Stroke Volume x Heart Rate
Stroke Volume= diastolic volume-end systolic volume
Mean arterial pressure= diastolic pressure + 1/3pulse pressure

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22
Q

Difference in symptoms between left and right heart failure on history

A 
Left: dyspnoea and poor ETT
Orthopnea/PND
Wheeze
Nocturia
Cold peripheries
Pink frothy sputum
Right: peripheral oedema
ascites
nausea (biliary congestion)
facial engorgement
epistaxis
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23
Q

Cardiac precipitants of heart failure

A 
Arrhythmia
MI
Valve injury
Hypertension
Cardiomyopathy/congenital
24
Q

Respiratory precipitants of heart failure

A

Chronic lung disease/cor pulmonale

Pulmonary embolism

25
Q

Non cardiac/resp precipitants of heart failure

A 
Discontinuation of diuretic
Drugs which cause salt and water retention
Anemia
Thyrotoxicosis
Infection
Anaesthesia
26
Q

HF risk factors

A 
Hypertension
Hyperlipidemia
DM
Smoking
Obesity
Physical inactivity
Coronary artery disease
Family history
27
Q

Dilated cardiomyopathy risk factors

A

Alcohol intake
Family history
Haemochromatosis

28
Q

Difference in signs between right and left heart failure on exam

A

Left: cool peripheries, bibasal crackles, stony dullness, cyanosis
Right: peripheral pitting oedema, raised JVP, ascites, hepatomegaly
Both: murmur, AF, parasternal heave, displaced apex beat, S3, palmar crease/conjunctival pallor

29
Q

Describe the Framingham Major criteria for congestive cardiac failure

A 
PND
Crepitations
S3 gallop
cardiomegaly
elevated JVP
weight loss >4.5kg in 5 days in response to treatment
Neck vein distension
Acute pulmonary oedema
Hepatojugular reflex
30
Q

Describe the Framingham Minor criteria for CCF

A 
bilateral ankle oedema
Dyspnoea on ordinary exertion
tachycardia
decrease in vital capacity by 1/3
nocturnal cough
hepatomegaly
pleural effusion
31
Q

Differentials for heart failure

A

Nephrotic syndrome
Liver disease
Pneumonia
COPD

32
Q

Which bloods for investigating heart failure?

A 
Hb -exclude anemia as precipitant
Electrolytes and creatinine (hyperkalemia for arrhythmias and hyponatremia may mean long standing HF)
BNP
eGFR (renal cause or consequence)
TFTs (thyrotoxicosis)
33
Q

Signs of HF on chest xray?

A 
A: alveolar oedema
B: kurley b lines
C: cardiomegaly
D: distended superior pulmonary vessels
E: effusion
34
Q

Other investigations for HF

A

ECG(LVH/LBBB)
Echo (infarct/dilation/estimate EF)
Coronary angiography (exclude coronary artery disease)
Endomyocardial biopsy if cause elusive

35
Q

Management acute heart failure

A 
Sit patient upright
High flow O2
Morphine
Furosemide
GTN
CONTRAINDICATED=BBLOCKERS
36
Q

Management non-pharmacological chronic heart failure

A

Treat underlying cause( CABG/thyroid disease/valve replacement)
Flu vaccine
Control risk factors
Low salt diet

37
Q

Management pharmacological chronic heart failure

A
  1. Furosemide 40mg OD
  2. Cilazapril 1-2.5 mg/ Metoprolol 23.75mg
  3. add other
  4. Spironolactone
  5. ARB/digoxin/anticoag
  6. Entresto (neprolysin and ARB)
    Avoid calcium channel blockers (-ve inotropes) and NSAIDs (fluid retention)
38
Q

Grades of hypertension

A

Grade 1: 140-159
Grade 2: 160-179
Grade 3: 180

39
Q

Key things in hypertension history

A

When diagnosis was made
readings before and after treatment
how blood pressure is measured
treatments (past/present/side effects)
any complications (stroke/HF/renal failure)
any potential secondary cause
Check for symptoms of malignant hypertension (severe headache)

40
Q

Key things to check in hypertension exam

A

Fundoscopy
BP in both arms
Check radiofemoral delay
Signs of cushings

41
Q

Investigations for hypertension

A 
U/E/creatinine: check for renal issues
ECG
CXR
Urine analysis
HbA1c
Lipids
Aldosterone/renin ratio (Conns)
24 hour catecholamines (phaeo)
9am serum cortisol (cushings)
Renal artery doppler (renal artery stenosis)
Ambulatory BP
42
Q

How do we diagnose hypertension?

A

BP of over 140/90 on three separate occasions, preferably ambulatory to prevent white coat HTN

43
Q

Treatment ladder of HTN

A

Depends on cardiovascular risk profile
if <10%: primarily lifestyle advice
10-20%: begin BP lowering med and statin
20%+: BP lowering, statin and anticoag

44
Q

Pharmacological treatment HTN

A
  1. if age <55 begin with ACEi if >55 begin with CCB
  2. add other
  3. thiazide
  4. add bblocker or spironolactone
    Dont give ACEi to females of reproductive age
    Swap ACEi for ARB if cough
45
Q

List the precipitants for AF

A 
ATMISHAP
Age
Thyrotoxicosis
Mitral valve disease
Ischaemic heart disease
Surgery/sleep apnoea/smoking
Hypertension
Alcohol/caffeine
PE
46
Q

Differential diagnosis for irregularly irregular beat

A

AF
Ventricular ectopic
Atrial flutter
Complete heart block with variable ventricular escape

47
Q

Investigations for arrhythmia

A 
ECG-either resting or 24 halter monitor
Electrophysiological studies (assess inducibility of arrhythmias)
ETT (if IHD)
Echo
U+E, TFTs, serial trops
48
Q

Management symptomatic bradycardia

A

Consider permanent pacemaker if complete heart block, second degree AV block or sinus node dysfunction

49
Q

Management ventricular tachycardia

A

Consider implanted cardioverter-defibrillator if VF/VT with instability, contraindications to drug treatment or symptomatic long QT

50
Q

Management of acute AF (<48 hrs)

A

DC cardioversion if unstable

Medical cardioversion with 5mg/kg amiodarone over an hour with subsequent infusion if necessary

51
Q

Management of acute AF (>48 hrs)

A

Do not cardiovert unless have been shown to be free of a thrombus
Rate control: With calcium channel blockers (diltiazem) or bbblockers (metoprolol). Digoxin as 3rd choice
Thromboprophylaxis: LMWH then warfarin/dabigatran

52
Q

Management of AF chronic

A

Begin with rate control: bblockers, ccb, digoxin 3rd line
Consider rhythm control: 3 weeks anticoagulation before cardioversion (flecainide or amiodarone), AF ablation
Anticoagulation based on CHADSVSc score >1 (male) or >2

53
Q

CHA2DSVS

A 
Congestive HF
HTN
Age
Diabetes
Stroke/TiA
Vascular disease
Sex F
54
Q

How many seconds are little and big squares on an ECG?

A

Big: 0.2seconds
Little: 0.04 seconds

55
Q

What is the new york heart association classification for heart failure

A

1 No limitation of physical exertion
2 Angina/dyspnoea on moderate activity
3 Angina/dyspnoea on mild activity
4 Angina/dyspnoea at rest

Long Case (11 decks)

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