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phase 4 > cardiology > Flashcards

cardiology Flashcards

1
Q

pathophysiology of TGA

A

ductus arterioles is closing/has closed so pulmonary circulation supplied systemic organs causing cyanosis

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2
Q

CXR of TGA

A

egg shadow and increased pulmonary vascular markings with narrow pedicle

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3
Q

treatment of TGA

A

prostaglandin E2 keep DA open until surgery (an arterial switch procedure)

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4
Q

risk factors of coarctation of aorta

A

turners 45XO, male, bicuspid aorta, PKD, NFM-1

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5
Q

what is coartation of aorta

A

congenital narrowing of the aorta usually just distal to origin of left subclavian around DA

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6
Q

symptoms of coarctation of aorta

A

reduced blood pressure distal to coarctation and increased BP proximal

therefore HTN in upper limbs and weak femoral pulses so radiofemoral delay and higher BP in right arm compared to left

systolic murmur over left scapula

notching of inferior borders of ribs inn adults due to intercostal HTN

HF in infancy

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7
Q

investigations of coarctation or aorta

A 
4 limb BP
CXR = rib notching
ECG = LV strain
CT angiogram 
ECHO and doppler
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8
Q

treatment of coarctation of aorta in sick neonate

A

IV prostaglandins
fluids and furosemide
ventilation

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9
Q

treatment of coarctation in adult

A

balloon dilation and stunting, BB for HTN

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10
Q

symptoms of bicuspid aortic valve

A

no problems at birth but leads to stenosis and regurgitation and predisposed to IE

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11
Q

causes of PDA

A

premature

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12
Q

symptoms of PDA

A

machine like constant murmur at left subclavian due to shifting blood

wide pulse pressure with bounding and collapsing pulse

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13
Q

treatment of PDA

A

NSAIDS or IV indomethacin which are cyclooxgenase inhibitors to promote PDA closure

if this doesn’t close, give prostaglandins and surgery by 6 months

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14
Q

symptoms of VSD

A 
small = LOUD pan systolic murmur at LSE
large = quieter, and pulmonary HTN

can be asymptomatic or severe HF

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15
Q

symptoms of HF in neonates

A

breathless, sweating, poor feeds, recurrent chest infections

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16
Q

investigations in VSD

A

ECG
small = normal
large = RVH and LVH

CXR
small = mild pulmonary plethora
large = cardiomegaly and marked pulmonary plethora

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17
Q

treatment of VSD

A

if symptomatic or large = surgical closure at 3-6 months

diuretics, ACE-I, high calorie diet, surgery

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18
Q

definition of cyanosis

A

> 5g/L of deoxygenated Hb

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19
Q

complication of VSD and AVSD

A

can lead to Eisenmeiger syndrome - a shunt reversal due to pulmonary HTN

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20
Q

cyanotic heart disease in children

A

TGA and TOF due to right to left shunt so misses out the lung

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21
Q

what is tetralogy of fallot

A

abnormal separation of trunks arterioles into aorta and pulmonary artery

pulmonary stenosis
VSD
overriding aorta
RVH

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22
Q

causes of TOF

A

Di George

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23
Q

symptoms of TOF

A

infant = cyanosis, squatting, clubbing
adult = asymptomatic, cyanosis
ejection systolic murmur a LLSE

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24
Q

investigations in TOF

A

boot shaped heart

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25
Q

treatment of TOF

A

IV propranolol if cyanotic to reduce infundibular spasm and surgery to increase pulmonary arterials blood flow

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26
Q

symptoms of ASD

A

dyspnoea, PHTN, arrythmia, chest pain, AF, increased JVP, pulmonary ESM, fixed splitting

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27
Q

murmurs caused by PHTN

A

tricuspid regurgitation

pulmonary regurgitation

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28
Q

investigations of ASD

A

ECG
CXR = pulmonary plethora, cardiomegaly, pulmonary arteries
ECHO = diagnostic

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29
Q

treatment of ASD

A

trans catheter close if not spontaneous

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30
Q

complications of ASD

A

RHF, arrhythmias, paradoxical embolus

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31
Q

symptoms of innocent murmur

A

asymptomatic, soft blowing, systolic, left sternal edge, positional

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32
Q

main heart defect in downs

A

avsd

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33
Q

symptoms of AVSD

A

no murmur
cyanotic @ birth
HF @ 2-3 weeks
apical pan systolic murmur from leaky valve

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34
Q

treatment of AVSD

A

surgery

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35
Q

when does eisenmerger syndrome occur

A

10-15years

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36
Q

causes of Ebstein’s anomaly

A

lithium and benzodiazepines in pregnancy

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37
Q

what is ebstein’s anomaly

A

unformed tricuspid valve (right side)

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38
Q

symptoms of tricuspid regurgitation

A

pan systolic murmur in LLSA(carvellos sign), RV heave and increased JVP, jaundice, fatigue, hepatic pain on exertion

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39
Q

causes of tricuspid regurgitation

A

infective endocarditis in IVDU due to s.aureus, PHTN, carcinoid syndrome

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40
Q

murmur/examination in mitral regurgitation

A

pansystolic murmur at left side radiating to axilla with displaced apex beat due to LVH

best heard in left lateral position with bell

left parasternal heave due to RVH

soft S1

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41
Q

why is there a soft S1 in MR

A

incomplete closure of the valve before systolic

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42
Q

CXR in MR

A

LA/LV hypertrophy, double contour on right side

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43
Q

investigations in MR

A

ECHO, CXR, ECG (p-mitrale), bloods, cardiac catheterisation

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44
Q

treatment of MR

A

valve replacement

statins, antihypertensives, DM Tx, antigcoag, AF Tx, diuretics

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45
Q

causes of mR

A

mitral valve prolapse

LV dilation, post MI pupillary muscle dysfunction, previous childhood rheumatic fever, CTD

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46
Q

causes of mitral valve prolapse

A

MI, CTD (marfans/ehlers danlos), turners, PKD

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47
Q

complications of MVP

A

MR, embolic, arrhythmias

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48
Q

murmur/examination in Mitral stenosis

A

low pitched mid diastolic murmur at apex in left lateral position, radiates to axilla (non displaced apex)

s1 snap
malar flush
AF
raised JVP

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49
Q

symptoms of MS and why

A

back flow of blood leads to increased pressure in blood vessels so increased hydrostatic pressure causes fluid to shift from vascular to interstitial causing SOB and oedema, increased venous pressure caused RHF of raised JVP, oedema and ascites

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50
Q

why is there a left parasternal heave in MS

A

due to RVH causing it to be pushed forward

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51
Q

why is there AF in MS

A

LA beats rapidly as hypertrophy and increased LA pressure due to narrow valves

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52
Q

treatment of MS

A

statins, antihypertensives, DM Tx, anticoagulant, AF Tx, diuretic

percutaenous balloon valvuloplasty

valve replacement if repair not possible

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53
Q

what is starlings law

A

SV increases due to increased blood volume in ventricles before contraction (EDV) - CO can be a measure

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54
Q

starlings law on fluid shift

A

fluid movement across capillary walls is dependent on hydrostatic and oncotic pressure gradient

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55
Q

causes of mitral stenosis

A

rheumatic fever, congenital, prosthetic valve

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56
Q

causes of aortic regurgitation

A

IE, type A aortic dissection, bicuspid aortic valve, rheumatic heart disease, CTD, autoimmune (any soon, RA)

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57
Q

symptoms/murmur of AR

A

early diastolic murmur at LSE sitting forward, displaced apex

wide pulse pressure
collapsing water hammer pulse

LVF leads to exertion dyspnoea, PND, orthopnoea, demussets, austin flint

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58
Q

what is Demusset’s and austin flints in AR

A

demussets = head nodding

austin flints = rumbling mid diastolic murmur at apex due to regurgitation in severe

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59
Q

investigations in AR

A 
bloods
ecg
echo
cxr 
cardiac catheterisation
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60
Q

what is seen in echo on AR

A

LVH, reduced function, shows severity, shows vegetations

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61
Q

treatment of AR

A

statins, antihypertensives, tx dm, anticoagulants

valve replacement if HF sx or LV dysfunction

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62
Q

what should be screening for in AR

A

marfans and ehlers danlos via genetic testing

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63
Q

how to monitor AR

A

ECHO

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64
Q

what would an echo show in MR

A

LA/LV hypertrophy, mitral valve calcification

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65
Q

clinical features in severe aortic stenosis

A

angina, arrhythmias, dyspnoea, syncope, PND, orthopnoea, frothy sputum

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66
Q

murmur/examination in AS

A

ejection systolic murmur in right ICS sitting forward at the end of expiration and radiates to carotids

slow rising narrow pulse pressure, arrhythmias

apex forceful and non displaced

S4

audible click for ejection

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67
Q

investigations n AS

A

ECG, ECHO, doppler, cardiac catheterisation and angiography, CXR, bloods, exercise stress test

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68
Q

what will ECHO show in AS

A

LVH, thick calcified immobile valve cusps

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69
Q

which valve disorders have p mitral

A

the systolic ones - AS and MR
and MS
due to LAH

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70
Q

ECG in AS

A

LBBB, LVH, p mitrale

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71
Q

common causes of AS

A

degenerative calcification
bicuspid valve
rheumatic fever

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72
Q

symptoms of aortic sclerosis

A

ejection systolic murmur with no radiation, only valve thickening

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73
Q

treatment of AS

A

statins, anticoagulant, antihypertensive, DM Tx, angina/HF Tx

valve replacement
balloon valvuloplasty
TAVI

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74
Q

types of aortic valve replacement

A

mechanical - need anticoagulation

bio prosthetic - doesn’t last as long but also doesn’t need anticoagulation

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75
Q

complications of AS

A

AF, IE, emboli, CHF, angina, death

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76
Q

symptoms of HOCM

A

angina, dyspnoea, palpitations, chest pain, exertion syncope, bisferens pulse, harsh ejection systolic murmur, sudden death

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77
Q

pulse in HOCM

A

bisferens pulse (2x systolic beats), jerky pulse

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78
Q

investigations of HOCM

A

ECG, CXR, ECHO, bloods, exercise stress with holder monitor, genetic testing

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79
Q

CXR in HOCM

A

atrial enlargement

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80
Q

ECHO in HOCM

A

atrial septal hypertrophy and left ventricular thickening

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81
Q

pathophysiology of HOCM

A

atrial septal thickening caused by AD mutation in B-myosin heavy chains leading to disorganised cardiomyocytes - leads to LVH, impaired diastolic filling so reduced SV

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82
Q

treatment of HOCM

A 
ICD
negative inotropes (BB and verapamil) 
amiodarone (rhythm control)
anticoagulants 
septal myomectomy
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83
Q

what is an ICD

A

implantable cardio defibrillator

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84
Q

examples on negative inotropes

A

BB and verapamil

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85
Q

how do negative inotropes work

A

reduce ventricular contractility

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86
Q

risks of HOCM

A

sudden death from VT/VF

AF and emboli due to blood stasis in the atria

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87
Q

rhythm control in HOCM

A

amiodarone

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88
Q

main cause of dilated cardiomyopathy

A

alcohol

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89
Q

other causes of dilated cardiomyopathy

A 
DILATE
dystrophy (muscular)
infection (myocarditis)
late pregnancy (post partum)
SLE
toxins (alcohol, cyclophosphamide, cocaine)
endocrine (thyrotoxicosis)
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90
Q

CXR in dilated cardiomyopathy

A

pulmonary oedema
HF
cardiomegaly

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91
Q

ECHO in dilated cardiomyopathy

A

global dilation

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92
Q

ECG in dilated cardiomyopathy

A

T inversion

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93
Q

investigations in dilated cardiomyopathy

A

ECHO, ECG, CXR, catheter + biopsy

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94
Q

treatment of dilated cardiomyopathy

A

bed rest, diuretics, ACE-I, digoxin, anticoagulants

biventricular pacing, ICD, heart surgery

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95
Q

symptoms of dilated cardiomyopathy

A 
LVF, RVF (HF Sx)
arrthymias 
raised JVP
displaced apex 
s3 gallop 
MR/TR
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96
Q

causes of restrictive cardiomyopathy

A 
miSSHAPEN
sarcoid
systemic sclerosis
haemochromatosis
amyloidosis
primary end-myocardial fibrosis 
eosinophilia
neoplasia
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97
Q

sx of restrictive cardiomyopathy

A

same as constrictive pericarditis

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98
Q

diagnosis of restrictive cardiomyopathy

A

catheterisation

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99
Q

treatment of restrictive cardiomyopathy

A

treat the cause and symptoms

100
Q

causes of myocarditis

A 
viral - coxsackie B, flu, HIV
bacterial - s.aureus, syphilis
drugs - cyclophosphamide, perception, phenytoin
autoimmune giant cell myocarditis 
electric shock
101
Q

investigations in myocarditis

A

bloods (FBC, WCC, ESR) and culture
ecg
CK raised
+ve troponin

102
Q

symptoms of myocarditis

A

flu prodrome

dyspnoea, fatigue, fever, chest pain, arrhythmia

103
Q

treatment of myocarditis

A

treat the cause
anticoagulation
antibiotics
+ve inotropes (increase ventricular contractility)

104
Q

complication of myocarditis

A

dilated cardiomyopathy

congestive heart failure

105
Q

what is cardiac myxoma

A

rare, benign cardiac tumour

106
Q

causes of pericarditis

A 
viral (coxsackie B, flu, HIV)
bacterial (pneumonia, rheumatic fever, TB, staphs)
dresslers (post MI >2 weeks)
drugs - penicillin, isonazid
SLE
uraemia 
cancer and radiotherapy
107
Q

symptoms of pericarditis

A

pericardial friction rub - scratchy and louder on inspiration
pleuritic chest pain sharp and worse lying down and relieved sitting forwards, radiates to left shoulder
fever
signs of pleural effusion or cardiac tamponade

108
Q

what is cardiac tamponade

A

accumulation of pericardial fluid which leads to poor ventricular fillin

109
Q

symptoms of cardiac tamponade

A

BECKS TRIAD
muffled heart sounds
hypotension
raised JVP

PULSUS PARADOXUS - pulse fades on inspiration

KUSSMAULS signs - raised JVP on inspiration

110
Q

investigations in pericarditis

A

ECG, CXR, ECHO, bloods (FBC, WCC, CRP/ESR, cultures)

111
Q

treatment of pericarditis

A

ABCDE
NSAIDs (+PPI cover)
steroids

112
Q

ECG in pericarditis

A

saddle shaped ST elevation

PR depression

113
Q

ECHO in pericarditis and cardiac tamponade

A

globular heart, pericardial calcification, water bottle

114
Q

what is constrictive pericarditis

A

heart encased in rigid pericardium

115
Q

symptoms of constrictive pericarditis

A 
kussmauls (raised JVP on inspiration)
RHF
HSM
ascites
oedema
116
Q

investigations in constrictive pericarditis

A

ECG, ECHO, bloods, cultures, CXR

cardiac catheterisation

117
Q

treatment of constrictive pericarditis

A

urgent pericardiocentesis
send fluids for cytology, ziehl nelson stain and culture
O2
positive inotropes

118
Q

causative organisms in rheumatic fever

A

group A beta haemolytic strep progenies

119
Q

when does rheumatic fever occur

A

2-4 weeks post strep throat/skin infection

120
Q

symptoms of rheumatic fever

A 
JONES PEACE
joint arthritis 
ocarditis (pericarditis)
nodules - subcutaneous on extensors 
erthythema margitanum 
sydenhams chorea 
PR interval prolonged/depression as peri
ESR raised
arthralgia 
riased CRP
elevated temp >39

valve disorders - MS mainly but can be all

121
Q

investigations in rheumatic fever

A 
bloods and cultures - FBC, WCC, ESR, CRP
ECG - pericarditis = saddle shape ST elevation and PR depression/prolongation
ECHO - valve disorders/pericarditis
throat culture - strep throat (pyogenes)
antistreptolysin O titre
DNAse B titre
122
Q

treatment of rheumatic fever

A 
bed rest
NSAIDs
eradicate strep 
if chorea = haloperidol of diazepam 
analegsia
123
Q

Jones criteria

A

2 major or w/ antistreptolysin O titre/DNAse B titre

1 major and 2 minor

124
Q

complications of rheumatic fever

A 
valve disease
pericarditis
syndenhams chorea 
nodules 
joints
125
Q

what is infective endocarditis

A

cardiac valves develop vegetations of bacteria and platelets to create fibrin thrombus

126
Q

symptoms of infective endocarditis

A

FEVER and NEW MURMUR

from jane
fever
roth spots
osler nodes
murmur 
janeway lesions
anaemia/arthritis 
nail haemorrhages 
emboli phenomena (haematuria and glomerulonephritis)
weight loss
127
Q

risk factors of infective endocarditis

A

valve disease, prosthetic joint, cardiac heart disease, IVDU, infection, dental caries, rheumatic fever, previous IE, valve surgery

128
Q

main valves affected in infective endocarditis

A 
viridian's = mitral = normal
s.aureus = tricuspid = IVDU
129
Q

main organsims in infective endocarditis

A 
GRAM +ve
strep viridans
staph aureus 
strep epididymus 
pseudomonas

GRAM -ve
haemophilis

130
Q

diagnosis of infective endocarditis

A

dukes criteria
2 major
1 major and 3 minor
5 minor

131
Q

major dukes criteria

A

+ve blood culture in 2 sepatre cultures

endocardium involvement (+Ve ECHO from vegetation of abscess, or new valvular regurgitation)

132
Q

minor dukes criteria

A 
predisposition (cardiac lesion, IVDU)
fever >38
emboli 
immune phenomenon 
\+ve blood culture
133
Q

treatment of infective endocarditis

A

ABX - usually amoxicillin and gentamicin

134
Q

causes of hypertension

A

PREDICTION
primary, renal artery stenosis, endocrine (cushings, conns, pheochromocytoma), drugs, raised ICP, Coarctation of aorta, toxaemia of pregnancy, increased viscosity, overload of fluid, neurogenic

135
Q

investigations in HTN

A 
BP - lying standing, both arms 
ABPM 24hr if BP >140/90
urinalysis - haematuria, renin:angiotension, albumin:creatinine, free cortisol
fundoscopy
dexamethasone suppression test 
blood - FBC, U+E, cr + u, eGFR, glucose, lipids, HbA1c
ECG
Q risk
136
Q

when to do an ABPM

A

when BP >140/90 to confirm diagnosis before treatment, unless severe >180/100

137
Q

aims of BP in HTN treatment

A

<80 years = <140/90
<80 years and EOD e.g. DM = <130/80
>80 years = <150/90

138
Q

HTN Tx if <55, white, no DM

A

ACE-I

139
Q

HTN Tx if >55, afro-carribean or DM

A

CCB (Thiazide diuretic)

140
Q

further HTN treat

A

ACE-I, CCB, TD then add either spironolactone, a-blocker, BB

141
Q

when could you use BB in HTN treatment

A

in the young who can’t have ACE-I/ARB

142
Q

example of ARB

A

candesartan

143
Q

what is a HTN crisis

A

malignant/accelerated
200/130
evidence of end organ damage

144
Q

treatment of HTN crisis

A

reduce BP to avoid stroke with atenolol or long acting CCB

145
Q

types of EOD in HTN

A 
retinpathy
nephropathy
neuropathy
HF
eclampsia
encephalopathy
146
Q

what would be seen in fundoscopy of HTN

A

retinopathy, AV nipping, flame haemorrhages, cotton wool spots, papilloedema, silver wiring

147
Q

lifestyle changes in HTN

A

quit smoking, reduce alcohol, healthy weight, reduce salt, reduce stress, exercise, reduce caffeine

148
Q

what is qrisk

A

QRISK is an algorithm for predicting cardiovascular risk. It estimates the risk of a person developing cardiovascular disease (CVD) over the next 10 years - >20% consider statin

149
Q

other medications to consider in HTN treatment

A

statins, aspirin

150
Q

treatment of encephalopathy in HTN

A

furosemide and nitroprusside/labetolol IV
aim to reduce BP to 110 over 4 hours
need intra arterial monitoring

151
Q

what is cariogenic shock

A

inadequate tissue perfusion leading to cardiogenic dysfunction

152
Q

management of cariogenic shcok

A 
ABCDE
O2, IV access
diamorphine, metaclopramide 
correct arrhymias, electrolyte disturbances, acid base abnormalities 
dobutamine (inotrope)
153
Q

right heart failure symptoms

A

ascites, oedema, raised JVP, HSM, TR, neck vein dilation, facial engorgement

154
Q

left heart failure symptoms

A

dyspnoea, syncope, pink frothy sputum, PND, pulses alterus, orthopnoea, PND

155
Q

what is pluses alterus

A

one weak beat then one strong beat

156
Q

heart failure symptoms

A

weight loss, pulmonary oedema, tender hepatomegaly, SOBOE, pleural effusion, bibasal creps, cardiomegaly

157
Q

what is BNP

A

secreted from ventricles in response to increased pressure/stretch in the heart, leading to increased GFR, reduced renal absorption, reduced pre load

158
Q

investigations in HF

A

BNP, ECHO, CXR, ECG, bloods (WCC, ESR/CRP, culture), NYHA, ABG

159
Q

CXR is HF

A 
alveolar oedema 
kersey b lines
cardiomegaly
dilated pulmonary vessels
pleural effusion
160
Q

ECHO in HF

A

hypertrophy

valve lesions

161
Q

what is the NYHA

A

1 - no limitation of activity
2 - mild limitation, none at rest
3 - limitation
4 - dyspnoea at rest

162
Q

what do BNP readings mean

A

<100 no HF
100-400 - do 6ww ECHO
>400 - 2ww for ECHO and doppler

163
Q

what does BNP correlate to

A

LV dysfunction and mortality

164
Q

what is starlings law and an equation to show this

A

stroke volume is directly proportional to end diastolic volume, therefore increased pre load, increased SV

SV = EDV-ESV

165
Q

how does ventricle dilation effect diastolic volume

A

ventricle dilation causes increase diastolic volume due to stretch of myocardial fibres

166
Q

how does RAAS affect the heart

A

causes salt and water retention to maintain SV

167
Q

how does SNS affect the heart

A

increases the HR and increases heart contraction

168
Q

acute HF treatment

A 
NOMF
nitrates - isoboride mononitrate IV
O2
diamorphine IV
furosemide IV

vasodilators (hydralazine), inotropes, CPAP

169
Q

medications to improve prognosis in HF

A

ACE-I, spironolactone, BB

170
Q

medications to improve symptoms in HF

A

furosemide
vasodilators
thiazide diuretic
digoxin

171
Q

things to monitor in HF treatment

A

BP, weight, potassium, renal function, inform DVLA

172
Q

surgical options in HF

A

cardiac resychronisation +ICD

transplant

173
Q

pathophsyiology of acute coronary syndrome

A

plaque rupture, thrombosis and inflammation

coronary spasm

174
Q

symptoms of ACS

A 
acute central chest pain which radiates to jaw and down left arm
sweating
nausea
anxiety
dyspnoea
palpitations
raised pulse and BP
175
Q

Ddx of ACS

A

angina, STEMI, NSTEMI, costochondritis, pericarditis, PE, pneumothorax, GORD, anxiety

176
Q

investigations in ACS

A 
ECG
troponin
CK/CKMB
LDH
FBC 
glucose
lipids
clotting
U+E
CXR
177
Q

when should troponin be tested in ACS

A

on admission and 3 hours later to see if doubles

ideally 6hours post symptom onset

178
Q

when is troponin raised

A

MI, CKD, infections, sepsis, trauma, PE

179
Q

Cxr in ACS

A

cardiomegaly, pulmonary oedema, widened mediastinum, aortic rupture

180
Q

what is the GRACE score

A

assesses severity of NSTEMI

181
Q

acute management of STEMI

A 
ABCDE - o2, ecg, iv fluids, bloods, arg
MONA - morphine, o2 if sats <94%, nitrates (GTN), aspirin and clopidogrel (dual antiplatelet)
metaclopromide 
anticoagulant 
inform cardiac catheterisation lab 
PCI or thrombolysis
182
Q

when should you PCI in STEMI

A

if <12 hours - ideally <90 mins

183
Q

what is a PCI

A

insert wire into groin artery and thread unto the heart to insert some dye to assess where is blocked and then use balloon to blow up a stent to open veseel

184
Q

complications of PCI

A

failure, bleed, infection, emboli, arrhythmia

185
Q

when to thrombolysis in STEMI

A

12-24hours

186
Q

what is used for thrombolysis in STEMI

A

streptokinase/alteplase

187
Q

complications of thrombolysis

A

bleed, stroke, failure, allergic, arrhythmia

188
Q

contraindications of thrombolysis

A

aortic dissection, GI bleed, allergic, recent surgery, severe HTN >200/120, trauma

189
Q

longterm treatment of STEMI

A 
aspirin indefinitely 
ACE-I
BB
cardiac rehab
DVT prophylaxis for 3 months
statins
190
Q

lifestyle advice for post MI

A

anxiety is normal
bath and shower as normal
no driving for 4 weeks (6 and inform DVLA id HGV or carrying vehicle and will need to have successful exercise test) contact car insurnace
light housework/garndeing when feel ready
4 weeks until sex, may have trouble first few attempts
limit alcohol, can interfere with medications
3-4 until work
6 weeks for heavy work
no fly for 3 months
stop smoking
improve diet

191
Q

Ddx of chest pain

A

GOD, MI, pericarditis, PE, MSK, pneumonia, pneumothorax, endocarditis, dissecting aorta

192
Q

types on anticoagulant treatment in STEMI

A

fondaparinux (if no CTPA in 24 hours)

heparin if <24 hours CTPA

193
Q

reversible causes of arrests

A

4Hs - hypothermia, hypovolaemia, hypoxia, hyperkalaemia

4Ts - tension pneumothorax, thrombosis, tamponade, toxins

194
Q

pathophysiology of angina

A

atherosclerosis leads to ischaemia + LVH leading to increased resistance and decreased blood flow due to stenosis and reduced O2 binding capacity due to anaemia and increased demand

195
Q

types of angina

A

stable - induced by effort
unstable - occurs at rest/minimal exertion
decubitus - induced by lying down
prize mental - induced at rest due to coronary artery spasm

196
Q

investigations in angina

A 
ECHO
CXR
ECG
bloods
ABG
TFTs
exercise test 
perfusion scan 
angiography
197
Q

treatment of angina

A 
lifetsyle
GTN spray
BB or CCB
aspirin
HTN meds 
statins 
PCI/CABG
198
Q

difference between inotropic and chronotropic

A

inotropic affects contractility of the heart

chronotropic affects rhythm of the heart

199
Q

how do BB affect the heart

A

decrease O2 demand and decrease sympathy action on the heart

200
Q

how do CCB affect the heart

A

dilate peripheral vessels

201
Q

how do nitrates affect the heart

A

reduce venous return via venous dilation and increasing diastolic filling time

202
Q

pathophysiology of AF

A

left atrium lose refractioness before end of atrial systole leading to recurrent uncoordinated contraction - leads to HF and stasis of blood in atria and reduced CO

203
Q

causes of AF

A 
PIRATES
PE
ischaemia
resp
atrial enalagrment (valves)
thryoid
ethanol
sepsis
204
Q

investigations in AF

A 
ECG
TFTs
toxicology screen
CXR
ECHO
bloods 
cardiac enzymes 
U+Es
205
Q

symptoms of AF

A 
irregularly irregular pulse
tachycardia
dyspnoea
palpitaitons
arrhythmia 
chest pain
faintness
206
Q

acute management of unstable AF

A

emergency cardioversion via DC cardioverion, IV amiodarone, IV flecainide

LMWH

rate control via BB or CCB

207
Q

types of AF

A

paroxysmal = <7days
persistant >7days
permanent >1 year and not terminated by DC

208
Q

management of paroxysmal AF

A

rhythm control = flecanide
prevention = BB, stall or amiodarone
anticoag assessment via CHADS2VASC

209
Q

treatment of AF if persistant

A

rhythm control

rate control

210
Q

rhythm control for AF

A 
ECHO first to look for structural abnormalities 
anticoagulation
sotalol
BB
amiodarone
211
Q

rate control for AF

A

BB or rate limiting CCB
add digoxin (not as mono therapy)
amiodarone

212
Q

what happens if BB and CCB togtehr

A

bradycardia

213
Q

invasive options for AF tx

A

radio frequency ablation, maze procedure, pacing

214
Q

anticoagulant options in AF

A

warfarin or NOAC if >1 CHADS

215
Q

what is cha2ds2vasc

A 
congestive heart failure
HTN
age >75
DM
stroke/vte/TIA
vascular disease
>65
female
216
Q

what is hasbled

A

used to assess bleed risk in those on anticogulants in AF

217
Q

contraindications of flecainde

A

strutural defects in the heart

218
Q

management of flutter

A

like AF

amiodraone to restore sinus

219
Q

examples of narrow complex tachycardias

A

AF, flutter, atrial tachycardia, AVRT, AVNRT

220
Q

medications to avoids in WPW

A

BB, CCB, adenosine, digoxin as leads to VF

221
Q

what is WPW

A

congenital accessory conducting pathway between atria and ventricles

222
Q

treatment of WPW

A

radio frequency ablation of the accessory pathway
amiodarone
sotalol
NOT DIGOXIN

223
Q

acute management in narrow complex tachycardia (supraventricular tachycardia) with no regular rhythm

A

treat like AF

224
Q

acute management in narrow complex tachycardia (supraventricular tachycardia) with regular rhythm

A

ECG
vagal manoeuvres
adenosine 6mg IV, then 12mg then 12mg
if no relief, and no adverse signs then give digoxin, amiodarone, verapamil or atenolol, if no relied, DC

225
Q

why not digoxin in WPW

A

as reduces ventricular rate but increasing conduction through bundle of his

226
Q

treatment of VT with pulse and no adverse signs

A

correct electrolytes
regular = amiodarone
irregular = AF tx
failure = DC

227
Q

treatment of VT with pulse and adverse signs

A

DC x 3 then amiodarone then ICD

228
Q

cause of VT

A

recent MI

229
Q

treatment of VF

A 
dc
dc
adrenaline
dc
amiodarone

longterm = BB +ICD
if witness = 3xDC then CPR

230
Q

treatment of tornadoes de pointes

A

mgso4

then BB and ICD

231
Q

complication of tornadoes de pointes

A

can lead to VF

232
Q

what is brugada

A

ad inheritance

defective sodium channel leading to restricted movement of sodium channel

233
Q

treatment of brugada

A

if abnormal ECG - defibrillator

234
Q

what should be avoided in brugada

A

phenytoin, TCAs, illicit drugs, high temp, low K+

235
Q

how to enhance ECG change in brugade

A

give flecanide as it is a sodium channel blocker

236
Q

management of pulseless electrical activity

A 
CPR
airway monitor 
adrenaline 1ml in 10,000 Iv central line every 3-5 minutes 
CPR
once shockable rhythm DC 
CPR
adrenaline 
DC
amiodarone
237
Q

causes of bradycardia

A 
sinus
heart block
drugs
vagal hypertonia 
hypothyroidism 
dilated cardiomyopathy
238
Q

treatment of bradycardia

A

atropine IV
adrenaline
external pacing
permanent pacing

239
Q

management of AAA

A 
O2
large bore cannula
major haemorrhage protocol 
vascular surgeon before rupture 
analgesic

if <5.5 then monitor via US

240
Q

symptoms of ruptured AAA

A

sudden onset severe abdo pain
collapse and shcok
expansible abdo mass

241
Q

investigations of AAA

A

AXR
abdo US
CT/MRI
angiography

242
Q

stages of limb ischaemia

A

intermittent claudication
critical limb ischaemia
leinches syndrome
burgers disease

243
Q

6ps of peripheral vascular disease

A

pain, pulseless, perishingling cold, paraestheisa, paralysis, pale

244
Q

symptoms of limb ischaemia

A

raised CRT, ulcers, nail dystrophy, skin 6ps, venous guttering, burgers angle/sign

245
Q

what is the fontaine classification

A

asymptomatic
intermittent claudication
ischaemia rest pain
ulceration and gangrene

246
Q

investigations in critical limb ischaemia

A 
doppler waveforms
ABPI
walk test
bloods
imaging - colour duplex US, CT/MR angiogram contrast

phase 4 (19 decks)

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