Cardiology summarise Flashcards
ACS: Stable angina
What
- cardiac chest pain on exertion
Causes
- reduced heart flow to muscle: atherosclerosis
- HTN
- smoking
- hyperlipidaemia
Management
- Short term relief
- Glyceryl trinitrate
- repeat after 5 mins, after another 5 mins if no relief- call 999
- Glyceryl trinitrate
- Long term symptomatic relief
- Beta blockers e.g. bisprolol
- Long acting nitrate e.g. isosorbide mononitrate
- Secondary prevention
- Statin
- ACEi
- Aspirin
- antiplatelet e.g. ticagrelor
- potentially revascularisation
- Percutaneous Coronary Intervention (PCI)
- CABG (great saphenous)
ACS: unstable angina
Presentation
- pain on rest
- normal ECG and troponin
Management (same as NSTEMI)
- MONA/BATMAN
- B blockers
- aspirin
- ticagrelor
- morphine
- anticoag e.g. fondaparinox (unless likely to bleed
- nitrate
ACS: MI
What
infarction of coronary vessel causing myocardium necrosis/ ischaemia- pain at test
- NSTEMI
- STEMI
Causes/triggers
- atherosclerosis
Presentation- cardiac chest pain, N and V, SOB, radiation (DM may not have pain- peripheral neuropathy)
- NSTEMI
- ST depression or T wave inversion
- troponin
- STEMI
- ST elevation or new LBBB
- troponin
Investigations
- bloods
- Xray
- echocardiogram
- CT coronary angiogram
Management
- NSTEMI: BATMAN
- STEMI
- MONA
- PCI or
- thrombolysis
Long term risk
Heart failures
What
- inability of heart to pump blood around the body
- HFrEF <40% (filling problem)
- HFpEF >40% (stretching problem- fibrotic tissue)
Causes/triggers
- Left sided
- HTN, CHD, valve problem
- Right sided
- hypoxia e.g. cor pulmonale
Presentation
- general
- tiredness
- left side
- pulmonary oedema
- orthoponiea
- PND
- right sides
- Peripheral oedema
Investigation
- BNP
- Echocardiogram
- ECG
Management
- BAD
- B blockers
- ACEi
- diuretics
- furosomide
Hypertension
What
- stage 1 >140
- stage 2 >160
- stage 3 >180
Causes/triggers
- lack of exercise
- stress
- smoking
- obesity
- too much salt
- age
Presentation
- usually asymptotic until secondary damage occurs
- emergency - >200 and end organ damage
- urgency - >180 without pathology yet
Management
- see pic
Endocarditis
What
- an infection of the inner lining of the heart which is caused by bacteria entering into the blood and travelling to the heart
- common: aortic and mitral valves
Causes/triggers
- IVDU- staphylococcus aureus
- Bad teeth: streptococcus viridans
- prosthetic valves/ bicuspid: staphyloccus epidermis
Presentation
- fever of unknown origin
- murmur
- poor appetite/ weight loss
- splinter haemorrhage
- janeway lesions
- septic arthritis
Investigations
- Bloods: FBC, U and E, LFTs, CRP
- X3 BC from diff sites
- echocardiograpm
- ECG
- CXR
Management
- Abx
- surgery if
- HF
- inadequate response to Abx
Cardiac arrest rhythm: shockable
Ventricular tachycardia
Ventricular fibrillation
cardiac arrest: non-shockable
pulseless electrical activity
asystole
tachycardia encompasses which conditions
- atrial fibrillation
- atrial flutter
- supraventricular tachycardia
- ventricular tachycardia
unstable patient with tachycardia (>100)
- 3 synchronised shocks or
- Amiodarone infusion (K+ channel blocker)
stable patient with tachycardia (>100)
- Atrial fibrillation:
- Atrial flutter:
- Supra-ventricular tachycardia:
- Atrial fibrillation: B blocker or Diltiazem (CCB)
- Atrial flutter: B blocker
- Supra-ventricular tachycardia: vagal manoever first and then adenosine
Atrial flutter
What
- re-entrant loop - electrical signal goes round and round the atrial without interupption
- atria 300bpm, ventricle 150bpm
Causes/triggers
- coronary heart disease.
- cardiomyopathy.
- heart valve disease.
- congenital heart disease.
Presentation
- sawthooth ‘ p wave after p wave’
- palpitations, fatigue, syncope, chest pain, stroke
Management (similar to AF)
- Rate/rhythm control
- B blocker or cardioversion
- Treat underlying condition
- Definitive treatment: radiofrequency ablation of re-entrant rhythm
- Anticoag based on ChadVasc e.g. DOAC
Long term risk
Atrial fibrillation
What
- irregular and often abnormally fast heart rate.
Causes/triggers
- causes
- age
- obesity
- HTN
- mitral valve problems
- sepsis
- thyrotoxicosis
- alcohol
- drugs
Presentation
- irr-irr
- absent p waves and wavey baseline
- palpitations
- SOB
- syncope
Management
- rate or rhythm control + anticoag
- rate control (non reversible cause)
- first line: B blockers (bisoprolol)
- second line: calcium channel blocker (diliziazem- not in HF)
- third line: digoxin (monitor for toxicity)
- rhythm: cardioversion (if reversible cause)
- pharmacological cardioversion: flecainide (pill in pocket) or amiodarone
- electrical
- long term control: B blockers
- Anticoagulation- use CHADVASC or HASBLED
- DOAC
- warfarin if
- prosthetic heart valve
- antiphospholipid syndrome
- rate control (non reversible cause)
Long term risk
- Risk of stroke
- HF
supraventricular tachycardia
What
- re-entry loop
- electrical signal re-enters the atria from the ventricle via the AV node
Presentation
- HR >100
Management
- Stepwise approach
- valsala
- carotid sinus massafe
- adenosine - brief systole (8-10s half life)
- verapamil (CCB)
- direct cardioversion
- Long term
- B blockers
- definitive: radiofrequency ablation
Wolf parkinson white
What
- Accessory electrical pathway (Bundle of Kent) connecting the atria and ventricles
Causes/triggers
- present at birth
Presentation
- short PR
- wide QRS
- Delta wave (slurred)
Management
- definitive treatment: radiofrequency ablation of accessory pathway
Torsades de points
What
- Polymorphic VT
Causes/triggers
- drug induced
- flecainide
- amiodarone
- macrolide
- citalopram
- low potassium or magnesium
Presentation
- polymorphic VT (variable height compared to VT)
- prolonged QT interval
Management
- correct cause e.g. electrolyte imbalance
- Mg infusion (even if normal)
- Defib
- definitive
- avoid drugs
- correct electrolyte
- B blocker
- pacemaker or implantable defib
Prognosis
- will either
- terminate
- VT → cardiac arrest
