Cardiovascular Flashcards
Give 4 risk factors for IHD
Modifiable: smoking, obesity, hypertension, sedentary lifestyle, diabetes, hypercholesterolaemia
Non-modifiable: Age, male, family history
Other than exertion, give 2 possible triggers of angina
Cold/windy weather
Emotion (anger/excitement)
Lying down
Vivid dreams (nocturnal angina)
Other than chest pain, give 2 symptoms a pt may experience during an episode of angina
SOB
Sweating
Feeling faint
Name 2 blood tests requested for angina and why
FBC (anaemia)
TFTs (thyrotoxicosis)
lipid profile (hypercholesterolaemia)
glucose (T2DM)
U&Es (renal vessel disease if considering ACEi)
Other than blood tests, name 3 tests used to investigate angina
Coronary angiogram (gold-standard)
ECG, exercise tolerance test, echocardiogram
How does aspirin reduce the risk of coronary events
COX-1 inhibitor, inhibiting production of Thromboxine A2 from platelets (reduces the level of platelet aggregation)
Which artery supplies the anterior territory of the myocardium?
Left anterior descending
Give 3 aspects of your immediate management plan in a STEMI
PAIN:
Perform ABC assessment and ECG
Aspirin 300mg and Another antiplatelet (ticagrelor 180mg)
IV morphine if required (with an antiemetic e.g. metoclopromide)
Nitrate (GTN spray)
What two management options are available to definitively treat a STEMI
Primary PCI
If PCI availability >120 min: thrombolysis with fibronlytic agent e.g. alteplase
Give four medications that may be started prior to discharge after a STEMI
6 A’s:
Aspirin
Another antiplatelet (ticagrelor or clopidogrel)
Atorvastatin
ACEi
Atenolol (bisoprolol more commonly)
Aldosterone antagonist (e.g. eplerenone; for those with clinical HF)
Give 3 signs of pulmonary oedema you would look for on examination
Tachycardia, tachypnoea, bilateral bibasal crackles on ausculatation, 3rd heart sound; if right-sided HF raised JVP and peripheral oedema
4 pulmonary oedema investigations
CXR (ABCDEF)
ECG
ABG (T1RF?)
Echocardiogram (EF %)
Bloods (FBC, U&E, lipids, glucose)
Cardiac enzymes (e.g. troponin)
Name 2 drugs that may be used in the treatment of acute pulmonary oedema
Oxygen
Furosemide
Morphine
Nitrates (GTN)
‘SODIUM’:
Sit up
Oxygen
Diuretics (Furosemide)
IV fluids need to be stopped
Underlying cause needs to be treated
Morphine + nitrate (severe cases)
Name one drug that may have been used in the treatment of pulmonary oedema that can cause hypokalaemia
Furosemide
Give 2 ways to raise potassium medically
Oral (sando-K)
IV (add KCI to IV fluids)
Name the leads on a 12-lead ECG in which you would expect to see ST elevation on a lateral STEMI.
Which vessel is likely to be affected?
aVL, I, V5-V6
Left circumflex
Give two abnormalities that may be seen on his ECG prior to discharge after a STEMI
T wave inversion
Pathological Q waves
DVLA rules for driving after an MI
You don’t need to tellDVLAif you’ve had an MI or a heart, cardiac or coronary angioplasty
Stop driving after MI for:
* 1 week if you had successful angioplasty
* 4 weeks if you had angioplasty but it wasn’t successful or if you didn’t have angioplasty
Give 3 possible complications of CT coronary angiogram
M-SAID
MI
Stroke (+ bleeding/haemorrhage)
Allergy to contrast
Infection
Damage to coronary vessels requiring intervention / Death
Which territory of the myocardium do leads II, III and aVF represent?
Which vessel is responsible for this territory?
Inferior
Right coronary artery
A patients pulse is no longer palpable and he’s stopped breathing, give 2 things you would do next?
- Call for help / crash team
- Start chest compressions
What is the normal QRS interval?
< 120 ms
What is a capture beat?
Sinus impulse conducts through the AV node producing a normal QRS complex between wide QRS complexes of ventricular tachycardia
Regular, tachycardia, broad QRS complexes with an occasional capture beat, what is the rhythm disturbance?
Ventricular tachycardia
Name the shockable rhythms
VF and pulseless VT
Give 2 drugs that may be used during cardiac arrest
Adrenaline
Amiodorone
Oxygen
What system is used to classify the severity of heart failure?
NYHA classification
1. no symptoms
2. mild / ordinary activity
3. symptoms occur with minimal activity / significant limitation
4. symptoms occur at rest/ severe limitations
Give 3 symptoms of left ventricular failure
SOB (3):
Orthopnoea (exacerbated by lying flat)
On exertion / reduced exercise tolerance
Paroxysmal noctural dyspnoea
Cough (2):
Nocturnal
Frothy white or pink sputum
Give 3 signs of heart failure on a CXR
ABCDEF of pulmonary oedema
Alveolar oedema (‘bat wings’)
Kerley B lines
Cardiomegaly
Diversion (upper lobe)
Effusion (blunted costophrenic angles)
Fluid in the fissures
How and where does furosemide act?
‘LOOP diuretic’
Inhibits the Na-K-2Cl co-transporter in the Loop of Henle (keeping Na in the urine) which therefore diminishes the osmotic gradient for water reabsorption (water follows salt)
Which drug used in AF and HF caused ST depression (reverse tick) and T wave inversion in V4-6 on ECG
Digoxin
BMI equation and classifications
weight in kg / height in m (sq)
<18.5: underweight
18.5 to 24.9: healthy
25 to 29.9: overweight
30 to 39.9: obese
>40: severely obese
3 pieces of lifestyle advice for overweight patient with hypertension
Aim to lose weight
Increase exercise
Stop smoking
Reduce alcohol intake
Low fat diet
Low salt intake
Class of anti-hypertensive drug 1st line for 52 year old white pt with no co-morbidities
ACEi
Class of anti-hypertensive drug 1st line for 56 year old white pt with no co-morbidities
CCB
Class of anti-hypertensive drug 1st line for 52 year old patient with african-caribbean ethnicity
CCB
Class of anti-hypertensive drug 1st line for 58 year old patient with T2DM
ACEi
2 side effects to be aware of before starting an ACEi
Dry cough
Hypotension
Renal impairment
Hyperkalaemia
2 signs that may be visible on the retina of someone with hypertensive retinopathy
CRASH:
Cotton wool spots
Retinal haemorrhages
AV nipping
Silver wiring
Hard exudates
3 complications of essential hypertension
HF
IHD
Stroke
CKD
Hypertensive retinopathy
PVD
Mechanism of action of simvastatin
Inhibits HMG-CoA reductase (rate-limiting step in cholesterol synthesis)
2 signs of hypercholesterolaemia on examination
Xanthelasma
Tendon xanthoma
Corneal arcus
One drug used to treat acute phase of gout
NSAID (ibuprofen, diclofenac, naproxen)
Colchicine
3 common causes of AF
SMITH:
Sepsis
Mitral valve pathology
IHD
Thyrotoxicosis (hyperthyroidism)
HTN
2 features of AF on ECG
Irregular QRS complexes
Absent P waves
2 associated symptoms of AF
Syncope
SOB
Chest pain
2 methods of cardioversion in AF (rhythm control)
Electrical (DC cardioversion; on the R wave)
Pharmacological (flecainide or amiodorone)
2 medications that may be used long term in AF
Beta-blocker
CCB
co-existing HF:
Digoxin
Amiodorone
2 complications of AF
Stroke
TIA
HF
Fever, night sweats, SOB, high-pitched early diastolic murmur, coarse crepitations at lung base → immediate management plan
(infective endocarditis)
ABCDE approach
Organism most likely to be responsible for infective endocarditis
Staphylococcus aureus
Name of boat-shaped retinal haemorrhage with pale centre seen on fundoscopy of infective endocarditis patient
Roth spot
Criteria used for infective endocarditis diagnosis
Modified duke criteria
Major: persistently positive blood cultures and vegetation on echo
Minor (RF): IVDU, valve pathology, fever (>38), vascular features e.g. janeway lesions, immunological features e.g. oslers nodes, microbiological features e.g. positive culture
Other than early diastolic murmur, give 3 signs of aortic regurgitation
Collapsing pulse
Corrigan’s sign (carotid pulsation)
Quinckes sign (nail bed pulsation)
Austin flint murmur (mitral cusp fluttering from regurg causing mid-diastolic murmur)
Pan systolic murmur with RV heave - what valve disease has caused the infective endocarditis?
Tricuspid regurgitation
Most likely organism causing infective endocarditis in an IVDU
Staphylococcus aureus
How should blood cultures be taken in infective endocarditis
3 samples from different venepuncture sites 30 minutes apart from each other
*All cultures should be collected prior to commencing antibiotics unless septic
Other than blood tests, what imaging investigations should be used in infective endocarditis?
Echocardiogram
CXR (PE)
ECG (AF from damaged valves)
Urine dip (microscopic haematuria)
Other than IVDU, give 2 examples of pre-existing cardiac disease that increases risk of infective endocarditis?
Prosthetic valve
Mitral valve disease
Aortic valve disease (e.g. bicuspid aortic valve)
PDA
VSD
Coarctation
4 medications used for secondary prevention in stable angina
Aspirin
Atorvastatin
ACE inhibitor
Beta blocker
Medication and dose for bradycardia
Atropine 500 mcg (repeat if unsuccessful)
Non-pharmacological management option for bradycardia
Transcutaneous pacing
Name 2 reflexes you could check when verifying a death
Pupillary
Corneal
3 components of Cushing’s reflex
Hypertension
Bradycardia
Irregular breathing pattern
Describe 3 signs of expanding EDH as it enlarges and before it ultimately results in coning
Nausea and vomiting
Brief lucid interval
Rapid deterioration in consciousness (following lucid interval)
CN III palsy / ‘down and out’ pupil
Seizures
Reduced GCS
What is ‘coning’?
(Raised intracranial pressure causes)
Herniation of the cerebellar tonsils through the foramen magnum
Leads to compression to the brainstem
(and respiratory arrest)
Name 4 clinical signs on examination of infective endocarditis
Roth spots
Osler’s nodes
Splinter haemorrhages
Splenomegaly
Janeway’slesions
Petechiae
Name 2 classes of drugs used first-line in HF which help to reduce mortality
ACEi
Beta blockers
List 2 causes of distributive shock
system wide vasodilation
Septic
Anaphylactic
Neurogenic
List 2 causes of hypovolaemic shock
fluid loss
Haemorrhagic
Burns
Causes of mediastinal widening
Aortic dissection
Aortic aneurysm
Lung mass
Murmur associated with aortic dissection
Early diastolic decrescendo
Loudest at left sternal edge
Aortic dissection investigation in
a) stable
b) unstable
a) CT CAP (chest abdo pelvis)
b) TOE
Classification system for aortic dissection
Stanford classification (Type A or B)
1st line medical management for aortic dissection
IV labetalol to control BP
2 clinical signs that would support coarctation of the aorta
Radio-femoral delay
Ejection systolic murmur (i.e. aortic stenosis)
2 diagnostic tests for coarctation of the aorta
Echo
CT aorta
2 ways you could exclude a renal cause of hypertension
U&E
Renal USS
2 options for long term management of coarctation of aorta
Conventional open surgery
Balloon angioplasty and stent insertion
Bedside investigation to confirm diagnosis of PVD
Ankle-brachial pressure index (ABPI)
3 definitive management options for proximal arterial occlusion in PVD
Bypass graft surgery
Angioplasty
Stent
leg MI
