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Cardiology Flashcards

1
Q

The four things to bare in mind for chest pain

A

Myocardial infarction, Dissecting aortic aneurysm, Pulmonary embolism, Pericarditis

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2
Q

Constricting pain

A

Angina/ Anxiety/ Oesophageal spasm

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3
Q

Sharp chest pain

A

Pleura, pericardium, chest wall damage

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4
Q

Precipitating factors for angina/ anxiety

A

Cold, exercise, palpitations, emotion

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5
Q

Precipitating factors for oesophageal spasm

A

Hot drinks, alcohol, lying flat, food

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6
Q

Angina causes (brief list)

A

Coronary artery disease, hypertrophic cardiomyopathy, aortic stenosis, paroxysmal supraventricular tachycardia

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7
Q

Aortic dissection pain description

A

tearing, instantaneous, retrosternal, intrascapular+ NEUROLOGICAL SYMPTOMS and uneven pulse and ST ELEVATION in inferior leads

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8
Q

Dyspnoea causes (brief list)

A

Pulmonary embolism(+PLEURITIC CHEST PAIN), anaemia, respiratory causes, pain, anxiety, left ventricular failure

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9
Q

Palpitation causes (brief list)

A

supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, ectopic beats, sinus tachycardia, anxiety, pheochromocytoma (rare)

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10
Q

Syncope causes (brief)

A

CNS- headache, aura, limb weakness, dysarthria, (PROLONGED RECOVERY= SEIZURE)/ CARDIAC- chest pain, palpitation, dyspnoea (QUICK RECOVERY= ARRHYTHMIA)

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11
Q

P wave in atrial hypertrophies

A

wide/ bifid= LAH, taller>2.5mm= RAH

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12
Q

Rate in ECG

A

300/ big squares in R-R interval

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13
Q

Left axis deviation causes

A

Left anterior hemiblock, Inferior MI, Venous tachycardia (from left ventricular focus), Wolff-parkinson White, Left ventricular hypertrophy

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14
Q

Right axis deviation causes

A

Left posterior hemiblock, Anterolateral MI, Pulmonary embolism, Wolff-parkinson White, Right ventricular hypertrophy

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15
Q

short vs long P-R interval meaning (+expected duration)

A

3-5 small square, short= fast AV conduction like WOLFF-PARKINSON WHITE. long= FIRST DEGREE HEART BLOCK

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16
Q

QRS expected duration

A

<3 small squares

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17
Q

QT expected duration and causes

A

9-10 small squares, CAUSES- low potassium, low calcium, low magnesium, low thyroid, low temperature, low treats (food), connective tissue disorders, antihistamines, antiarrhythmics, psychoactive drugs

Causes VENTRICULAR TACHYCARDIA

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18
Q

ST segment elevation/ depression

A

elevation= infarction, depression= ischaemia

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19
Q

J wave causes

A

High calcium, sub-arachnoid haemorrhage, low temperature

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20
Q

causes of Atrial Fibrillation

A

Hypertension, Ischaemic heart disease, Heart failure, Obesity, Thyrotoxicosis, Alcohol

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21
Q

causes of bradycardia

A

hypothyroidism, hypothermia, HIGH ICP, CHOLESTASIS, drugs

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22
Q

Causes of first and second degree heart blocks

A

Digoxin, beta blockers, acute myocarditis, IHD

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23
Q

Causes of complete heart block

A

Congenital, Idiopathic, IHD, Digoxin, Infiltration, Aortic valve CALCIFICATION, Cardiac surgery or trauma

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24
Q

ST elevation common causes

A

Printzmetal’s Angina, Acute pericarditis, Normal, Acute MI, Left ventricular aneurysm, AORTIC DISSECTION (in inferior leads)

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25
ST depression common causes
downward sloping= DIGOXIN, horizontal= angina, NSTEMI, Acute POSTERIOR MI (in V1-3)
26
T inversion in V1-3/ V2-5/ V4-6 and avL/ 2,3 and avF
V1-3= RBBB, RV strain (like Pulmonary embolism)/ Anterior ischaemia V2-5= Hypertrophic cardiomyopathy, Sub-arachnoid Haemorrhage V4-6 and avL= LBBB, LVH, Lateral ischaemia, DIGOXIN 2,3 and avF= Inferior ischaemia
27
Myocardial infarction ECG changes (few hours, 1 day, few days)
few hours= ST elevation and PEAKED T wave 1 day= INVERTED T wave and if ST is still high- CORONARY ARTERY SPASM few days= pathological Q waves
28
ADP receptor antagonists
GREL- less gastric irritation
29
DOACs examples
Apixaban, rivaroxaban, dabigatran (GIVE FOR AF)
30
BETA BLOCKERS
can cause bradycardia, bad for heart failure/ breathing problems, can mask blood sugar (in diabetics)
31
ACE INHIBITORS contraindications
avoid in acute kidney disease, hyperkalemia, dehydration
32
LOOP DIURETICS (like FUROSEMIDE) side effects
side effects- ototoxic, LOW Na, Ca, K
33
THIAZIDE DIURETICS side effects
side effects- LOW Mg, K, HIGH Ca and URATE (gout), Erectile Dysfunction
34
VASODILATORS examples and side effects
Nitrates, hydralazine, prazosin Nitrates side effects- headaches and LOW BP
35
CALCIUM ANTAGONISTS examples and side effects
-PINEs used w/ BETA BLOCKERS (to avoid reflux tacycardia VERAPAMIL/ DILTAZEM- don't use with BETA BLOCKERS S/E- gum hypertrophy, ankle oedema, DECREASE in LV FUNCTION, FLUSHES
36
DIGOXIN (contraindications and side effects)
CI- WPW+ HCM, LOW Mg/K/ HIGH Ca (same as THIAZIDE side effects), elderly (use lower doses) S/E- Gynaecomastia, Yellow eyes, Nausea, ARRHYTHMIA, CONFUSION
37
Na blockers examples and contraindications
1A (procainamide) and 1B (lidocaine) used to terminate VENTRICULAR TACHYCARDIA 1C (flecainide) used for ATRIAL FIBRILLATION and for ARRHYTHMIA PROPHYLAXIS in WPW CI- Heart failure, Heart block, IHD, Valve disease
38
AMIODARONE uses and side effects
Used in supraventricular and ventricular tachycardia S/E- pulmonary fibrosis, peripheral neuropathy, thyroid disease, liver disease
39
IVABRADINE facts and contraindications
DOESN'T AFFECT BP, blocks funny current CI- bradycardia, long QT, acute MI, CCB used, Shock
40
STATINS facts and side effects
inhibit HMG-COA REDUCTASE- de novo synthesis of cholesterol in liver- decreases LDL, more effective at night S/E- increase in CK/ TRANSAMINASE, muscle aches, myocytosis
41
Drugs to avoid in WPW
Digoxin, verapamil, adenosine
42
Typical angina 3 features
constricting pain (<30s) radiating to chest, neck, arms, shoulders, jaw relieved by GTN/ rest made worse by exercise
43
VASOSPASTIC/ PRINTZMETAL ANGINA
Don't use ASPIRIN or BETA BLOCKERS
44
Angina treatment
first line- BETA BLOCKER +/- CCBs Long acting nitrates/ ivabradine Ranolazine Nicorandil
45
Ranolazine contraindications
Heart failure Elderly Low weight Prolonged QT
46
Nicorandil contraindications
LV failure Acute pulmonary oedema Severe hypotension Hypervolaemia
47
VASOSPASTIC (PRINZTMETAL) ANGINA treatment
NOT CAUSED BY HIGH CHOLESTEROL OR BP, caused by CORONARY ARTERY SPASM Treatment- Correct low magnesium PRN GTN CCB AVOID ASPIRIN, BETA BLOCKERS, TRIPTAN
48
Cardiac tamponade signs
Low cardiac output Pulsus paradoxus on inspiration Kussmaul's sign on inspiration Muffled heart sounds treat with pericardial aspiration
49
Heart failure causes
Coronary artery disease hypertrophic cardiomyopathy atrial fibrillation valve disease infective endocarditis cor pulmonale endocrine disorders ANAEMIA CARDIOMYOPATHIES
50
Heart failure signs
``` Major- Paroxysmal nocturnal OEDEMA Acute pulmonary oedema Increased heart size/ CVP Neck vein dilatation S3 gallop ``` ``` Minor- Pleural effusion Ankle oedema Increased heart rate Nocturnal cough ``` HIGH BNP in BLOOD
51
Heart failure treatment
``` ACE Beta blockers CANDOSARTAN (if not ACE) Digoxin Diuretics- FUROSEMIDE Spironolactone ```
52
Heart failure CXR signs
``` ALVEOLAR OEDEMA Kerley B lines Cardiomegaly Dilated upper lobe vessels Pleural effusion ```
53
5 signs of RIGHT SIDED HEART FAILURE
``` Ascites Distended JVP Raised peripheral venous pressure Weight gain HEPATOMEGALY/ SPLENOMEGALY ```
54
6 signs of LEFT SIDED HEART FAILURE
``` Paroxysmal nocturnal dyspnoea Cyanosis Tachycardia Pulmonary congestion Fatigue Orthopneoa ```
55
2 things that increase pulse pressure
Less compliant aorta | Increased stroke volume
56
AORTIC STENOSIS sound and pulse
NARROW pulse pressure Soft S2 SLOW RISING pulse Crescendo-decrescendo- EJECTION SYSTOLIC murmur- radiates to CAROTIDS
57
AORTIC REGURGITATION sound and pulse
WIDE pulse pressure COLLAPSING pulse WATERHAMMER pulse Traube's sign- pistol shot over femoral artery De Musset's sign- head nodding in time with heart beat Quincke's sign- pulse felt in nail Decrescendo- EARLY DIASTOLIC murmur
58
MITRAL STENOSIS sound and pulse
LOW VOLUME pulse Loud S1 Opening snap Tapping apex beat Low pitch MID DIASTOLIC murmur
59
MITRAL REGURGITATION sound and pulse
harsh PAN SYSTOLIC murmur radiating to AXILLA Displaced apex beat
60
RAAS AFFECTS ___LOAD
RAAS affects PRELOAD
61
Sympathetic nervous system affects ____LOAD
Sympathetic nervous system affects AFTERLOAD
62
Visible signs of MI
Raised JVP, Increased pulse, Pallor
63
CXR of MI
cardiomegaly, widening of mediastinum, pulmonary oedema
64
Immediate management of MI
Morphine, Oxygen, Nitrates (GTN), Anticoagulants (ASPIRIN and ANTIEMETIC), Beta blockers
65
Management on discharge for MI
ACE Aspirin Beta blocker (or CCB if CI)
66
Surgical treatment of MI
PCI | Fondaparinux or LMWH can be given if NSTEMI patients aren't having immediate PCI
67
Complications of MI
Cardiogenic shock/ cardiac arrhythmia (AF INCREASES RISK OF STROKE SO START ANTICOAGULANTS) Pericarditis Emboli Aneurysm Rupture of Ventricle Dressler's Syndrome Rupture of free wall Papillary muscle rupture
68
Risk factors for Infective Endocarditis
RHD Cardiac lesions IV drug user DENTAL TREATMENT
69
Causative agents for Infective Endocarditis
Strep viridans Staph aur Staph Epid Diptheroids Microaerophilic strep HACEK- Haemophilia, Actinobacillus, Cardiobacterium, Eikenella, Kingella
70
Investigations for Infective Endocarditis
Bloods for ANAEMIA Urinalysis- MICROSCOPIC HAEMATURIA CXR Transoesophageal/ Transthoracic ECHO for vegetations
71
Signs and Symptoms for Infective Endocarditis
Fever Roth's spots Osler's nodes New Murmur Janeway lesions Anaemia Nails- splinter haemorrhages Emboli
72
Treatment for Infective Endocarditis
generally- BENZYLPENICILLIN and GENTAMYCIN Strep- BENZYLPENICILLIN and AMOXICILLIN Staph- FLUCLOXALLIN and GENTAMYCIN Aspergillus- MICONAZOLE
73
Aortic Stenosis Causes and Symptoms
Causes- RHD Congenital bicuspid valve Atherosclerosis Symptoms- Syncope Angina Dyspnoea
74
Investigations for Aortic Stenosis
ECG- LVH and AV block CXR- post-stenotic dilatation of ASCENDING AORTA/ calcification of valve
75
Complications of Valve Diseases
Heart failure Infective endocarditis Arrhythmia
76
Causes of Aortic Regurgitation (Acute and Chronic)
ACUTE- Cusp rupture Perforation (secondary to infection) Aortic DISSECTION Connective tissue disorder CHRONIC- RA Ankylosing Spondylitis Syphilis
77
Investigations for Aortic Regurgitation
ECG- LVH CXR- cardiomegaly/ pulmonary oedema
78
Symptoms of Aortic Regurgitation
Heart Failure Angina Dyspnoea
79
Causes of Mitral Stenosis
RA Ankylosing Spondylitis SLE RHD Valve calcification Malignant carcinoid
80
Symptoms of Mitral Stenosis
Heart Failure Palpitations (if AF) Haemoptysis Dyspnoea
81
Signs of Mitral Stenosis
MALAR FLUSH Tapping Apex Beat HOARSE VOICE
82
Investigations for Mitral Stenosis
ECG- AF/ Bifid P waves CXR- enlarged left atrium/ pulmonary oedema
83
Causes of Mitral Regurgitation
Papillary muscle rupture INFECTIVE ENDOCARDITIS RHD Prolapse
84
Symptoms of Mitral Regurgitation
Heart Failure Palpitations (if AF) Symptoms of INFECTIVE ENDOCARDITIS Dyspnoea
85
Investigations of Mitral Regurgitation
ECG- AF/ Bifid P waves CXR- pulmonary oedema/ cardiomegaly ECG of MS/ CXR of AR
86
Hypertension treatment (<55yo)
ACE (or ARB if CI) or CCB Then ACE and CCB Then ACE and CCB and Diuretic (ARB can also be used instead of ACE if CI)
87
Hypertension treatment (>55yo or black)
Diuretic (Thiazide) Then ACE (or ARB) and Diuretic Then ACE (or ARB) and CCB and Diuretic
88
What does Angiotensin 2 stimulate? (4 things)
Aldosterone secretion from Zona Glomerulosa Vasoconstriction Sympathetic NS ADH release from posterior pituitary
89
Signs and Symptoms of Atrial Fibrillation
Palpitation EXERCISE INTOLERANCE Normal Dyspnoea Fatigue Irregularly irregular pulse Syncope HEART FAILURE
90
PATHOPHYSIOLOGY of Atrial Fibrillation
Atrial ectopic beats thought to originate in PULMONARY VEINS Atria no longer contract in coordinated manner Atria fail to empty adequately Blood accumulates- high risk of clotting/ embolic strokes
91
Treatment for Atrial Fibrillation
Treat UNDERLYING CAUSE Rate- - Beta blocker - CCB - Amiodarone - Digoxin Rhythm- - Beta blocker - Cardioversion - Amiodarone Anticoagulant- - WARFARIN - Apixaban - Dabigatran - Rivaroxaban

Medicine (15 decks)

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