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Cardiovascular Flashcards

1
Q

What are the signs of stable angina?

A

hypoxia, tachycardia, S3 (heart sound) and mitral regurgitation murmur

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2
Q

What does an ECG look like in stable angina?

A

usually normal, can show ST depression, flat or inverted T waves

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3
Q

What is the gold standard investigation for stable angina?

A

CT coronary angiography
perfusion MRI (non-invasive)

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4
Q

What is the 1st line management for stable angina?

A

PRN pain relief, GTN (glyceryl trinitrate) spray
lifestyle modifications

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5
Q

what is the 2nd line treatment for stable angina?

A

beta blocker (propranolol) and or CCB (amlodipine)

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6
Q

What are some revascularisation treatments for stable angina?

A

PCI or CABG

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7
Q

What are the investigations for unstable angina?

A

ECG - may be normal, transient T wave election, T wave changes
high sensitivity troponin - no dynamic elevation (rule out MI)

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8
Q

What is the initial management for acute unstable angina?

A

aspirin and fondaparinux

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9
Q

Give an example of a P2Y12 inhibitor

A

clopidogrel, ticlopidine

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10
Q

What medication are used for secondary prevention of cardiac events?

A

ACEi
BB
dual antiplatelet (aspiprin + fondaparinux)
statin

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11
Q

What is prinzmetal angina?

A

angina due to coronary artery spasm

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12
Q

What are the key presentations of STEMI?

A

central chest pain, squeezing, dyspnoea, pallor

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13
Q

What are the gold standard investigations for STEMI?

A

ECG - ST elevation
cardiac troponin- elevated

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14
Q

What does an ECG look like in STEMI?

A

ST elevation

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15
Q

What is the initial treatment for all MIs?
(MONAC)

A

Morphine
Oxygen
Nitrates (nitroglycerin)
Aspirin
Clopidogrel

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16
Q

What is assessed initially in STEMI patient?

A

eligibility for reperfusion therapy

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17
Q

What reperfusion therapies are used for STEMI?

A

PCI
fibrinolysis (dalteparin)

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18
Q

What is the 1st line medicinal management of STEMI if reperfusion is not possible?

A

Aspirin, anti-platelet therapy (clopidogrel/ticagrelor)

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19
Q

What

A

PCI, p2y12 inhibitor, aspirin

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20
Q

How do women present with NSTEMI?

A

middle/upper back pain or dyspnoea

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21
Q

What do ECGs look like in NSTEMI?

A

St depression and/or T wave inversion, pathological Q wave

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22
Q

What is the initial medicinal treatment for NSTEMI?

A

fondaparinux
Aspirin (300mg)

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23
Q

What is the drug treatment for secondary prevention of MI? (5A’s)

A

Aspirin - 75mg once daily
Another anti-platelet (on top of aspirin) - clopidogrel
Atorvastatin - 80mg once daily
ACEi
Atenolol

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24
Q

Give an example of an ACEi

A

ramipril, enalapril

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25
Give an example of a CCB
amlodipine, diltiazem
26
Give an example of an ARB
azilsartan, candesartan
27
What is a side effect of ACEi?
coughing
28
What anit-hypertensive medications should not be given during pregnancy?
ACEi and ARBs as they cause fetotoxicity
29
Give an example of a P2Y12 inhibitor
ticagrelor, clopidogrel
30
Give and example of an aldosterone antagonist
spironolactone, eplerenone
31
What are the complications of MI? (DARTH VADER)
death arrhythmia rupture tamponade heart failure valve disease aneurysm Dresslers syndrome embolism recurrence/regurgitation
32
What score is used to assess the 6 month risk of recurrent MI/death?
GRACE score
33
What is dresslers syndrome?
a localised immune response that causes pericarditis 2-3 weeks post MI
34
How is Dressler's syndrome treated
NSAIDS in severe cases steroids (prednisolone)
35
how do you differentiate angina and NSTEMI?
unstable angina has no troponin rise
36
What is the ejection fraction in heart failure with reduced ejection fraction?
<40%
37
What is the ejection fraction in heart failure with preserved ejection fraction?
>50%
38
What is the pathophysiology of heart failure with CAD?
blocked arteries- reduced perfusion to heart- BP increases - harder to expel blood from LV - LV hypertrophy - loss of elasticity - decreased ejection fraction
39
What are the key presentations of left sided heart failure?
pulmonary oedema, dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, bibasal fine crackles, pink frothy sputum
40
What is paroxysmal nocturnal dyspnoea?
waking up in the night short of breath
41
What are the gold standard investigations for heart failure?
ECG - shows AF/any abnormality B-type natriuretic peptide (NT-proBNP)- elevated echo - EF X-ray/echocardiography- cardiomegaly
42
What is the 1st line medical treatment for heart failure?
furosemide
43
What is the 1st line medicinal treatment for heart failure with rEF?
ACEi, beta blocker
44
What is given if symptoms continue in heart failure with rEF?
Aldosterone antagonist (spironolactone)
45
What is the management for heart failure with pEF?
manage complications - hypertension, AF cardiac rehab
46
What is digoxin and what does it do?
its a cardiac glycoside, its used to treat irregular heart beats (is sometimes used to treat heart failure)
47
What are the most common causes of right sided heart failure?
pulmonary hypertension cor pulmonale
48
Why does pulmonary hypertension cause right sided heart failure?
pulmonary artery hypertension causes right sided hypertrophy
49
What are the key presentations of right sided heart failure?
peripheral oedema, raised oedema, hepatomegaly, weight gain (fluid retention), weight loss (cardiac cachexia)
50
What are the key presentations of acute heart failure?
dyspnoea, peripheral oedema, reduced exercise tolerance, fatigue, cold extremities, elevated JVP
51
How does acute heart failure effect the physiology of the body?
Activation of SNS - tachycardia, increased contractility, peripheral vasoconstriction, activation of RAAS
52
What are the investigations for acute heart failure?
ECG, natriuretic peptides - elevated echocardiography
53
What is the treatment for acute heart failure? (Pour SOD)
Pour away (stop) their IV fluids Sit up Oxygen Diuretics (furosemide 40mg)
54
What BP is considered hypertension?
>140/90 with no secondary cause
55
Apart from idiopathic, what can causes hypertension? (ROPE)
R - renal disease O - obesity P - pregnancy E - endocrine
56
What are the key presentations of hypertension?
asymptomatic raised BP retinopathy
57
What is the gold standard test for hypertension?
24hr ambulatory BP monitoring
58
What is the treatment for hypertensive patients <55 or non black?
ACEi (ramipril) or ARB (candesartan)
59
What is the treatment for hypertensive patients >55 or black or African?
CCB (amlodipine)
60
What is the 2nd line treatment for hypertension in patients <55 or non-black?
ACEi or ARB + CCB OR +thiazide-like diuretic (indapamide).
61
What is the 2nd line treatment for >55 or black hypertensive patients?
CCB + ACEi or ARB or thiazide like diuretic
62
What is the 3rd line treatment for hypertension in all patients?
ACEi or ARB + CCB + thiazide like diuretic
63
What is an example of a thiazide-like diuretic?
indapamide
64
What else can be prescribed in resistant hypertension?
if K+ <4.5 - potassium sparing diuretic (sprinolactone) if K+ >4.5 - alpha blocker (doxazosin) or beta blocker (atenolol)
65
What is a complication of hypertension treatment?
postural hypotension
66
What is Virchows triad?
Vrichows triad - vascular injury, venous stasis and hypercoagulability
67
What are the key presentations of DVT?
calf swelling, localised pain, Dilation or distension of superficial veins, redness and warmth, sometime asymptomatic
68
What is the 1st line investigation for DVT?
quantitative D-dimer level - shows that body is forming and breaking down clots (doesnt confirm diagnosis)
69
What is the gold standard investigation for DVT?
compression ultrasound
70
What is VTE prophylaxis?
venous thromboembolism prophylaxis - prevention of clot with low molecular weight heparin (LMWH) (dalteparin/fondaparinux) or DOAC
71
What do you do if DVT is suspected?
immediate DOAC - apixaban or rivaroxiban
72
What are the long term treatments for DVT?
DOAC, LMWH (1st line in pregnancy) or VKA (warfarin)
73
What are the complications of DVT?
PE, complications associated with anticaogs
74
What are the key presentations of PE?
dyspnoea, pleuritic chest pain, hypoxaemia
75
What are the main investigations for PE?
D-dimer - elvated CTPA - computed tomography pulmonary angiography - will show occlusion
76
What can be done to stop PEs from happening?
VTE prophylaxis, hyrdation, mobilisation, compression stockings
77
What are the treatments for PE?
supportive care->resp support,O2 initially use LMWH swap to long term anticoag
78
What is peripheral arterial disease?
a range of symptoms caused by atherosclerotic obstruction of lower-extremity arteries
79
What are the key presentations of peripheral arterial disease? (6P's)
Pain Pulselessness pallor perishingly cold paraesthesia paralysis
80
What is the 1st line investigation for peripheral arterial disease?
ankle brachial index (ABI) ratio of ankle to brachial systolic BP <0.9
81
What is the gold standard investigation for peripheral arterial disease?
CTA/MRA - to see where occlusions are
82
What is the 1st line treatment for acute limb ischaemia?
assessment for revascularisation or amputation + anti-platelet (aspirin/ticagrelor) + analgesia + anticoag (warfarin, DOACS, heparin)
83
What is the treatment for ongoing claudication (pain in arms/legs while walking/running)?
anti- platelet therapy, exercise, risk factor mod
84
what is the treatment for chronic severe limb ischaemia?
assessment for revasc + anti-platelet therapy + risk factor mod
85
What is infective endocarditis?
infection of the endocardial surface of the heart (valves, chordae tendinae)
86
What is the most common cause of infective endocarditis?
bacterial infection - S. viridans
87
What are the other causes of infective endocarditis?
fungi (candida), lupus, malignancy
88
What are the key presentations of infective endocarditis?
fever/malaise/fatigue/weight loss finger clubbing, splinter haemorrhages, janeway lesions, osler nodes, roth spots
89
What are splinter haemorrhages?
longitudinal red brown haemorrhage under nail
90
What are janeway lesions?
irregular non tender haemorrhagic macules on the palms and plantar surfaces of feet
91
What is the gold standard investigation for IE?
blood cultures - Dukes criteria transoesophageal echocardiogram
92
How do you manage IE?
antibiotics (6 weeks), 2 weeks IV 4 weeks oral surgery Abx prophylaxis if high risk
93
What are the complications of IE?
acute heart failure, system embolisation, AKI
94
What are the causes of pericarditis?
idiopathic (80-90%) viruses, autoimmune, malignancy, neoplasm
95
What are the key presentations of pericarditis?
severe, sharp chest pain, exacerbated by lying down, relieved by sitting forward
96
What does and ECG look like in pericarditis?
ECG upwards concave ST segment elvation, PR depressions
97
What is the criteria for pericarditis diagnosis?
2 of... chest pain friction rub ECG changes pericardial effusion (build up of fluid of pericardium)
98
What can be prescribed to manage pericarditis?
NSAIDS + PPI (omeprazole) + colchicine (3 weeks)
99
What non medicine treatments are there for pericarditis?
pericardiectomy - in restrictive pericarditis
100
What are the complications of pericarditis?
cardiac tamponade, pericardial effusion chronic constructive pericarditis
101
What is pericardial effusion?
fluid in the pericardial space exceeding 50mL
102
What is cardiac tamponade?
a medical emergency where pericardial effusion is enough to raise pericardial pressure
103
What are the key presentations of pericardial effusion?
distant heart sounds, pulsus paradoxus, dyspnoea, elevated JVP, hypotension, tachycardia
104
What is the gold standard investigation for pericardial effusion?
transthoracic echocardiography
105
What is the treatment for stable pericardial effusion (pre tamponade)?
anti inflammatory treatment + gastroprotection + observation (treatment of pericarditis)
106
What is the treatment for unstable pericardial effusion (tamponade)?
pericardiocentesis or surgical drainage
107
What is the most common cause of aortic stenosis?
calcification of trileaflet valve
108
What is the pathophysiology of aortic stenosis?
endocardial injury-> inflammation->leaflet fibrosis+deposition of calcium on valve->calcification and limited mobility of valve
109
What are the key presentations of aortic stenosis?
chest pain, exertional dyspnoea/syncope, fatigue, ejection systolic murmur
110
What is the main investigation for aortic stenosis?
transthoracic echocardiogram (LV size and function) + doppler
111
What is the management for clinically unstable aortic stenosis ?
medical therapy or ballon valvuloplasty
112
What is the management for clinically stable aortic stenosis?
aortic valve replacement, antibiotic prophylaxis long term anticoag
113
What is aortic regurgitation?
diastolic leakage of blood from the aorta into the LV
114
What are the valvular causes of aortic regurgitation?
congenital, infective endocarditis, rheumatic fever, rheumatoid arthritis, prosthetic malfunction
115
What are the non-valvular aortic regurgitation causes?
aortic dissection, chest trauma
116
what are the key manifestations of aortic regurgitation?
diastolic murmur
117
What are the symptoms of aortic regurgitation?
dyspnoea, fatigue, chest pain, pink frothy sputum, wheeze
118
What is the gold standard investigation for aortic regurgitation?
echocardiography
119
What is the management of acute aortic regurgitation?
inotropes (dopamine), vasodilators (ACEi), urget aortic valve replacement
120
What is the management of chronic aortic regurgitation?
treatment of underlying cause, vasodilator or ACE therapy, aortic valve replacement
121
What is the pathophysiology of mitral stenosis?
increased left atrial pressure referred to lungs, limited LV filling, atrial pressure increase, pulmonary vasoconstriction and pulmonary hypertension
122
What are the key presentations of mitral stenosis?
dyspnoea, orthopnoea (SOB lying flat), opening snap on auscultation, diastolic murmur, loud P2, neck vein distension
123
What are the main symptoms of mitral stenosis?
flushed cheeks, palpitations, chest pain, dizziness, hemoptysis (bronchial haemorrhage)
124
What is the 1st line investigation for mitral stenosis?
ECG, chest X ray, trans thoracic echocardiogram (gold standard)
125
What is the 1st line treatment for mitral stenosis?
no therapy or diuretic
126
What are other treatments for mitral valve stenosis?
balloon valvotomy, valve replacement/rapair beta blocker (bisoprolol) or ivabradine (reduces heart rate)
127
What are the complications of mitral valve stenosis?
AF, stroke, warfarin-induced haemorrhage
128
What is the pathophysiology of mitral regurgitation?
increased LA pressure = pulmonary congestion = dyspnoea
129
What are the key presentations of mitral regurgitation?
dyspnoea on exertion decreased exercise tolerance lower body oedema holosystolic murmur
130
What is the 1st line investigation for mitral regurgitation?
transthoracic echo ECG
131
What is the gold standard investigation for mitral regurgitation?
echocardiography
132
How do you manage mitral valve regurgitation?
surgery diuretics (furosemide) /beta blocker (bisoprolol) / ACEi (ramipril) intra-aortic balloon counterpulsation (EF<30%)
133
What are the key presentations of AF?
palpitations irregular pulse tachycardia
134
What are the symptoms of AF?
dyspnoea chest pain fatigue dizziness polyuria syncope
135
What is the 1st line investigation for AF?
ECG (gold standard) irregularly irregular R-R intervals, absence of distinct P waves
136
How do you manage HR in AF? (1st line)
beta blocker (bisoprolol) /CCB (amlodipine)/digoxin
137
What medications can be used for pharmacological cardioversion?
flecainide/amiodarone (antiarrhythmetics)
138
What are the long term treatments for AF?
beta blocker/dronedarone/amiodarone
139
What else might be given in AF to prevent stroke?
anticoag - warfarin/DOACs
140
What are the key presentations of atrial flutter?
worsening HF or pulmonary symptoms
141
What are the symptoms of atrial flutter?
palpitations, fatigue, chest pain, dyspnoea, sycnope
142
What are the 1st line investigations for atrial flutters?
ECG (gold standard) - continuous regular electrical activity, saw tooth pattern
143
What are the managements of atrial flutter?
same as AF: beta blocker cardioversion anticoag
144
What is wolff-parkinson-white syndrome?
Delay of conduction in the AV node, conduction from atria reaches ventricles by accessory pathways
145
What is AV reentrant tachycardia (AVRT)?
Electrical impulses travelling down normal AV node and accessory pathway (AP) causing rapid atrial contraction
146
What are the symptoms of AVRT/WPW?
Palpitations, dizziness, dyspnoea, chest pain
147
What is the 1st line and gold standard investigation for AVRT/WPW?
12 lead ECG
148
How do you manage AVRT/WPW?
Direct current cardioversion, carotid sinus massage/valsalva manoeuvre, IV adenosine, AV nodal blocking drugs, antiarrythmetics, catheter ablation
149
What are the key presentations of AVNRT?
palpitations, dizziness, diuresis
150
What are the symptoms of AVNRT?
diaphoresis (sweating), neck pulsations, fullness of chest, dyspnoea, chest pain, (pre)syncope
151
What is the 1st line and gold standard AVNRT?
12 lead ECG
152
How do you manage heamodynamically unstable AVNRT?
cardioversion, IV amiodarone
153
How do you manage haemodynamically stable AVNRT?
vagal manoeuvre - valsalva manoeuvre IV adenosine
154
How do you manage recurrent AVNRT?
catheter ablations
155
What is heart block?
impaired conduction from atria to ventricles
156
How does 1st degree heart block effect the heart?
delays communications between atria and ventricle - prolonged PR interval
157
What can cause first degree heart block?
hypokalaemia myocarditis inferior MI AV blocking drugs (BB, CCB, digoxin)
158
How does 2nd degree, mobitz type 1, show on an ECG?
is transient PR intervals get bigger and bigger until QRS complex is missed
159
What can cause type 1 mobitz heart block?
AV blocking drugs, inferior MI, fit athlete due to vagal toning
160
How does 2nd degree, mobitz type 2, heart block effect the ECG?
constant prolonged PR interval and QRS dropped every so often
161
What can cause mobitz type 2 heart block?
anterior MI Lyme disease Rheumatic fever
162
What is 3rd degree heart block?
P wave is not associated with QRS at all
163
What can cause 3rd degree heart block?
structural heart disease MI hypertension endocarditis
164
What are the key presentations of heart block?
syncope, heart rate <40
165
What are the symptoms of heart block?
syncope, fatigue, dyspnoea, chest pain
166
What is the first line investigation for heart block?
12 lead ECG serum troponin
167
What is the gold standard treatment for heart block?
12 lead ECG
168
How do you manage heart block?
monitor it, discontinuation of AV nodal blocking medications, resynchronisation therapy, temporary pacing (ASAP for 3rd degree)
169
What is bundle branch block (BBB)?
complete or partial interruption of electrical pathways between the 2 ventricles
170
What is the pathophysiology of Right BBB?
early part of QRS normal but RV activation delayed - secondary R wave in precordial leads and wide slurred S wave in lateral leads normal cardiac axis
171
What is the pathophysiology of left BBB?
conduction travels from RV then to LV, tall R waves in lateral leads and deep S waves in the right precordial leads, M shaped R wave in lateral leads (extended QRS)
172
What are the symptoms of BBB?
sometimes asymptomatic RBBB can make HF symptoms worse dyspnoea fatigue syncope
173
What is the first line and gold standard investigation for BBB?
12 lead ECG
174
What does the ECG look like in LBBB?
QRS>120 dominant S wave in V1 broad R wave in lateral leads absence of Q waves in lateral leads prolonged R wave >60 ms in V5-6
175
What does the ECG look like in RBBB?
QRS duration >120ms RSR pattern in V1-3 wide, slurred S wave in lateral leads
176
What is the management of BBB?
symptom management treat underlying condition pacemaker resynchronisation therapy
177
What are the key presentations of a ruptured abdominal aortic aneurism (AAA)?
abdominal pain collapse expansile abdominal mass shock
178
What are the signs of AAA?
palpable pulsatile abdominal mass hypotension abdominal distension
179
What are the symptoms of AAA?
abdominal flank loss of consciousness fever pallor
180
What is the 1st line and gold standard investigation for AAA?
aortic ultrasound
181
How do you manage abdominal aortic aneurysm?
surgical repair resus measures abx risk management
182
What is (thoracic) aortic dissection?
a separation in the intima of the aorta allowing blood to flow in between the layers of media
183
What are the key presentations of thoracic aortic dissection?
acute severe chest pain interscapular and low pain left/right BP change pulse deficit diastolic murmur
184
What are the symptoms of thoracic aortic dissection?
syncope dyspnoea paraplegia abdo pain limb pain/pallor
185
What are the first line investigations for aortic dissection?
ECG imaging
186
what are the gold standard investigations for aortic dissection?
CT - chest abdo pelvis
187
What is the initial management of aortic dissection?
advanced life support + haemodynamic support + opioid analgesic
188
What is the management for acute aortic dissection?
1st line - beta blocker/ non-dihydropyridine CCB + opioid open surgery/endovascular repair
189
What is the 1st line management for chronic aortic dissection?
beta blocker, lifestyle advice/risk factor management
190
What is type A aortic dissection?
involves ascending aorta with or without involvement of arch and descending aorta -70%
191
What is type B aortic dissection?
dissection does not involve ascending aorta involves only descending thoracic and/or abdominal aorta -30%
192
What is rheumatic fever?
an autoimmune disease following group A streptococcal (S.pyrogenes) throat infection
193
What are the key presentations of rheumatic fever?
fever joint pain
194
What are the symptoms of rheumatic fever?
recent sore throat/scarlet fever dyspnoea chest pain swollen joint
195
How do you diagnose rheumatic fever?
Jones critera 2 major OR 1 major + 2 minor MAJOR:carditis, arthritis, chorea, erythema, subcutaneous nodules MINOR:raised ESR or CRP, pyrexia, arthralgia
196
What is the 1st line treatment for rheumatic fever?
abx - penicillin OR erthyromycin
197
What is the treatment for RF with arthritis?
abx + salicylate therapy
198
What is the treatment for RF with HF?
abx + diuretic/ACEi
199
What is the treatment for RF with AF?
abx + amiodarone/digoxin
200
What is the treatment for RF with valve leaflet/CT rupture?
abx + emegency valve therapy
201
What do you give for RF and chorea?
abx + anticonvulsants
202
What are ectopic heartbeats?
changes to a normal heartbeat that cause extra or skipped heartbeats
203
What are the key presentations of ectopic heart beats?
palpitations syncope chest pain fatigue
204
What are the symptoms/signs of ectopic beat
feeling like heart has stopped, sudden forceful beat
205
What is the gold standard and first line investigation for ectopic heartbeat?
ECG
206
What does an ECG with ventricular ectopic heart beat look like?
ventricular trigeminy - premature ventricular contraction in pattern of three beats
207
What is the management of ventricular ectopic?
lifestyle changes - limit caffeine, alcohol, exercise only treat if symptoms are severe beta blocker, CCB
208
What are the key presentations of QT syndrome?
syncope during: heightened adrenergic tone, arousal or suprise syncope with bradycardia palpitations
209
What are the symptoms of QT syndrome?
periodic paralysis dizziness oliguria tetany cold/pale extemities
210
What is the first line treatment for QT syndrome?
ECG - for long QTs (gold standard) hypokalaemia/magnesemia/calcaemia
211
How do you manage QT syndrome?
beta blocker lifestyle modification pacing implantable cardioverter-defibrillator mexiletine (fix irregular heartbeats)
212
What are the three types of shock?
cardiogenic shock - heart not working hypovolemic shock - low fluid distributive shock - change in fluid status
213
What are the three types of distributive shock?
septic - abnormal response to infection neurogenic - loss of sympathetic tone anaphylactic
214
What are the key presentations of shock?
hypotension skin changes oliguria mental state changes chest pain dyspnoea hypoxaemia
215
What are the first line tests for shock?
VBG/ABG glucose FBC/U&Es ECG
216
What is the 1st line treatment for all shock patients?
supportive management of airway + breathing treat underlying cause
217
What is the treatment for cardiogenic shock?
IV fluids loop diuretic vasodilator vasoactive drug
218
What is the treatment for haemorrhagic shock?
major haemorrhage protocol (blood transfusion) consider IV fluids
219
What is the treatment of anaphylactic shock?
IM adrenaline - 0.5mg IV chlorpheniramine + hydrocortisone
220
What is the treatment for neurogenic shock?
vasopressor -> dopamine/adrenaline/noradrenaline
221
what is the treatment for septic shock?
abx +/- other antimicrobials + fluids + oxygen
222
What are the 4 common finding in pts with tetralogy of fallot (TOF)?
ventricular septum defect RV hypertrophy pulmonary artery obstruction overriding aorta (aorta placed over VSD)
223
What are the key presentations of TOF?
hypercyanotic spell (episodes of severe cyanosis(blueskin/lips)) harsh systolic ejection murmur cyanosis tachypnoea (shock)
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What are the first line investigations for TOF?
pulse oximetry ECG (gold standard) echo
225
How can you manage hypercyanotic spells (1st line)?
valsalva manoeuvre sitting to squatting
226
What are the 2nd and 3rd line treatments for hypercyanotic spells?
2 - beta blocker 3 phenylephrine
227
What is the treatment for non-remitting severe cyanosis?
1st line - surgical shunt extracorporeal membrane oxygenation (ECMO)
228
what is the treatment for a neonate with profound cyanosis and severely limited pulmonary blood flow?
1st line - alprostadil supportive care
229
What is coarctation of the aorta?
narrowing of the aorta at the site of the ductus arteriosus
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What is the cause of coarctation of the aorta?
normally congenital malformation
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What are the key presentations of coarctation of the aorta?
hypertension at a young age diminished lower extremity pulse different upper and lower body pulses
232
What are the signs of coarctation of aorta?
systolic ejection murmur systolic ejection click
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What are the symptoms of coarctation of the aorta?
claudication headache
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What is the gold standard investigation for coarctation of aorta?
echocardiogram
235
What is the first line investigation for coarctation of aorta?
ECG
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What is the treatment for acute coarctation of the aorta?
maintenance of ductal patency/surgical repair
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What is the treatment for ongoing coarctation of the aorta?
<1 yrs - surgical repair >1yrs - surgical or percutaneous repair (stent)
238
What two factors determine the effects of ventricular septal defect?
the size of defect pulmonary vascular resistance
239
What is it called when the VSD causes pulmonary pressure to rise so much that the shunt reverses?
Eisenmengers syndrome
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What are the key presentations of VSD?
systolic murmur SOB
241
What are the first line tests for VSD?
ECG chest x - ray echo (gold standard)
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What is the 1st line treatment for congenital medium or large VSDs?
supportive medical therapy with pulmonary vasodilators prophylactic abx adjunct treatment of hyperviscosity
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What is 2nd line treatment for congenital VSDs?
heart-lung transplantation
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What is the treatment for acquired VSDs?
corrective closure following intra-aortic balloon pump insertion coronary bypass graft adjunct in all but eisenmengers - abx
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What are the key presentations of atrial septal defect (ASD)?
Systolic ejection murmur fixed splitting of second heart sound
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What are the symptoms of ASD?
finger clubbing cyanosis CHF symptoms of atrial arrhythmias
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What are the investigations for ASDs?
echocardiogram (gold standard) ECG chest Xray
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What are the treatments for reversible ASDs
corrective closure prophylactic abx
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What are the treatments for eisenmengers syndrome (irreversible)?
supportive medical therapy vasodilators prophylactic abx 2nd line - heart-lung transplant
250
What is PDA?
patent ductus arteriosus
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When does PDA show?
in infancy
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What are the signs of PDA?
tachypnoea low diastolic BP machine-like continuous murumer/gibson murmur
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What are the symptoms of PDA?
SOB apnoea diaphoresis irritability
254
What are the investigations for PDA?
ECG Xray echocardiogram (gold standard)
255
What are the treatments for PDA?
IV indomethacine/ibuprofen surgical ligation percutaneous catheter device closure diuretic
256
What is cardiomyopathy?
disease of heart muscle
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What are the three types of cardiomyopathy?
dilated cardiomyopathy hypertrophic cardiomyopathy restrictive cardiomyopathy
258
What are the key presentations of cardiomyopathy?
dyspnoea orthopnoea paroxysmal nocturnal dyspnoea hypertrophic specifically - asymptomatic and sudden death
259
What are the signs of cardiomyopathy?
S3 gallop systolic murmur (hypertrophic)
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What are the symptoms of cardiomyopathy?
symptoms increase during exercise - syncope - angina - dyspnoea weakness and fatigue oedema ascites
261
What are the 1st line investigations for cardiomyopathy?
echocardiogram (gold standard) chest xray ECG troponin cardiac MRI
262
What does an ECG look like in hypertrophic cardiomyopathy?
deep Q waves
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What does the ECG look like in restrictive cardiomyopathy?
low voltage QRS
264
What are the pharmaceutical treatments for cardiomyopathy?
diuretics (spironolactone - K+ sparing diuretic) - or fluid restriction ACEi beta blocker
265
What are the surgical treatment for cardiomyopathy?
heart transplant implantable cardioverter defibrillator(ICD)
266
What is assessed initially in STEMI patient?
eligibility for revascularisation

medicine phase 2 a (10 decks)

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