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Anatomy (make or break marks) > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What investigation gives a definitive diagnosis of ACS?

A

Troponin levels. (ECG for all patients presenting with chest pain)

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2
Q

What are the symptoms of an ACS, including associated symptoms?

A

severe, prolonged chest pain. nausea/vomiting. breathlessness. sweating. sense of impending doom.

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3
Q

What is the pharmacological early management of STEMI?

A

Aspirin + clopidogrel
Morphine
Nitrates
Oxygen (if hypoxic)

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4
Q

What are the two reperfusion options for STEMI?

A

PCI (1st line. move onto thrombolysis if unavailable in 90mins)
Thrombolysis (Streptokinase, t-pA)

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5
Q

what is the pharmacological treatment of NSTEMI?

A

Beta-blocker (iv)
Aspirin + clopidogrel
Nitrates (iv)
(BAN)

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6
Q

what is a typical post-ACS management?

A

Statin (eg. simvastatin)
Aspirin
Beta-blocker (or rate-limiting CCB if contraindicated)
ACEi

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7
Q

Hypertension medication for patients under 55?

A 
ACE inhibitors (side effect, dry cough)
(If intolerant, give angiotensin II receptor blocker-ARB- eg. Losartan)
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8
Q

hypertension medication for patients over or equal 55 or black?

A

calcium channel blocker (eg. amlodipine)

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9
Q

What is the 2nd, 3rd and 4th line management of hypertension?

A

2nd) ACEi + CCB
3rd) ACEi + CCB + thiazide diuretic (eg. bendroflumethiazide)

4th) if K+ > 4.5, increase dose of thiazide
if K+

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10
Q

How do you diagnose hypertension?

A

with ABPM or HBPM if clinic reading > 140/90

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11
Q

What is stable/ classical angina?

A

angina that is over 1 month, with symptoms induced by effort and relieved with GTN/ rest.

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12
Q

what is unstable angina?

A

worsening of pre-existing angina. Symptom often at rest.

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13
Q

What is variant angina (prinzmetal)?

A

Angina that is due to coronary artery spasm.

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14
Q

What are the 3 features of angina?

A

Central chest pain
often provoked by physical exertion
and relieved by rest or GTN

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15
Q

What investigations are relevant to IHD?

A

ECG/ stress, exercise ECG

Angiography (gold standard, can then give PCI if necessary)

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16
Q

What revascularisation options are there for IHD?

A

PCI - given to all patients with single vessel disease.
given to patients under 65 with multi-vessel.

CABG - given to patients over 65 with multi-vessel disease.
suitable for diabetics.

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17
Q

What is the pharmacological management of IHD?

A

Beta-blocker OR CCB (rate-limiting)
(if symptoms still not under control with monotherapy, consider giving both - switch CCB to amlodipine)
If both contraindicated, use isosorbide mononitrate

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18
Q

What is a typical medication regimen for someone with angina?

A

Beta-blocker
Aspirin
Nitrates (GTN and/or isosorbide mono [used for phrophylaxis])
Statin

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19
Q

Symptoms of AF?

A

Palpitations
Chest pain
breathlessness, dizziness

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20
Q

What are the ECG features of AF?

A

Absence of P-waves
irregular QRS complex (but normal shape)
irregular base line

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21
Q

What is used in pharmacological cardioversion in a haemodynamically unstable AF patient?

A 
Amiodarone iv
(flecainide iv if there is no structural heart disease)
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22
Q

What is the management of chronic AF?

A

1st) CCB (rate-limiting) or Beta-blocker
2nd) add digoxin
3rd) add amiodarone
(all the while, anticoagulate with warfarin)

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23
Q

Define paroxysmal AF.

A

Spontaneous termination within 7 days, usually within 48hrs.

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24
Q

Define recurrent AF.

A

Two or more episodes of paroxysmal AF.

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25
Q

Define persistent AF.

A

Non self terminating, lasting longer than 7 days.

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26
Q

Define permanent AF.

A

AF for over 1 year which cannot be terminated with either DC or drug cardioversion.

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27
Q

Describe features of AV nodal reentry tachycardia.

A

Most common type of SVT in those with structurally normal heart.
May resolve spontaneously, not usually life threatening.
Can occur in the young and fit.

28
Q

What does it mean by SVTs are “narrow complex”?

A

QRS < 0.12s

29
Q

What is the treatment of SVTs?

A

1st) Vagal manœuvres (valslalva manoeuver)

2nd) Adenosine IV

30
Q

Describe the ECG findings in AV nodal reentry tachycardia. (SVT)

A

Narrow QRS complexes (distance between each is regular)

Hidden P-waves

31
Q

What is the accessory conducting pathway in WPW syndrome called?

A

Bundle of Kent (congenital)

32
Q

What are the ECG findings in WPW?

A

Delta waves
short P-R interval (due to decrease in AV nodal delay)
Wide QRS complex
“slurred upstroke”

33
Q

What pathway conducts impulses from the AV node to the ventricles?

A

Bundle of His

34
Q

Which pathway conducts electrical impulses within the ventricles?

A

Purkinje fibres

35
Q

What is Wolf-Parkinson-White syndrome?

A

A type of atrioventricular re-entry tachycardia (SVT).
Diagnose with 24 hour Holter (ambulatory) ECG.
Treat as you would all other SVTs (Vagal, IV adenosine)
Definitive treatment is radiofrequency ablation of accessory pathway - bundle of Kent

36
Q

What is seen in an ECG during Atrial Flutter?

A

“saw tooth baseline”

37
Q

What are the symptoms of left ventricular failure?

A

Pulmonary oedema.
Breathlessness (exertional), orthopnea, paroxysmal nocturnal dyspnoea
S3

38
Q

What are the symptoms of right ventricular failure?

A

Peripheral oedema.
Ascites
Raises JVP

39
Q

What investigations are relevant for heart failure?

A

Echocardiograph (definitive)
ECG
B-type natriuretic peptide (BNP, increased)

40
Q

How do you treat heart failure?

A

1st) Beta-blocker + ACEi
2nd) add spironolactone (aldosterone antagonist)
add ARB

41
Q

Name two cardiac causes of pulmonary oedema.

A

Congestive cardiac failure (left ventricular failure)

Mitral stenosis

42
Q

What are symptoms of pulmonary oedema?

A

Orthopnea, dyspnea, paroxysmal nocturnal dyspnoea.
Bibasal crackles
S3 gallop

43
Q

What can be used to provide rapid relief of symptoms due to pulmonary oedema?

A

IV Furosemide (loop)

44
Q

What is hypertrophic cardiomyopathy?

A

Hypertrophy of myocardium. An autosomal dominant disease and the most common cause of sudden cardiac death in young healthy adults.
Investigation = echo

45
Q

What investigation is used to definitively diagnose valvular diseases?

A

Echo

46
Q

List features of mitral stenosis.

A

Mid-diastolic murmur (localised to apex, best heard in left lateral position)
Tapping apex
Loud S1
Malar flush, breathlessness

47
Q

List features of mitral regurgitation.

A 
Pansystolic murmur (radiates to axilla)
Soft S1
48
Q

List features of aortic stenosis.

A

Ejection systolic/ crescendo decrescendo murmur (may radiate to carotids)
Slow rising pulse
Narrow pulse pressure
S4

49
Q

List features of aortic regurgitation.

A

Early diastolic murmur
collapsing pulse (corrigan’s sign)
wide pulse pressure

50
Q

What does a “continuos machine like murmur” indicate?

A

Patent ductus arteriosus

51
Q

What is the cause of acute respiratory distress syndrome?

A

acute severe pulmonary oedema (due to increase in capillary permeability)

52
Q

What are the symptoms of ARDS?

A

cyanosis
tachypnoea
tachycardia
bilateral crackles

53
Q

How do you diagnose ARDS?

A

Pulmonary capillary wedge pressure (gold standard for determining cause of acute pulmonary oedema)
CXR —> bilateral infiltrates
ABG (hypoxic?)

54
Q

how do you treat ARDS?

A

Fix hypoxia - continuos positive airway pressure (CPAP)

55
Q

Define first degree heart block.

A

PR interval > 0.2 secs

56
Q

Define second degree heart block (Mobitz type I)

A

Progressive prolongation of PR interval until a dropped beat occurs.

57
Q

Define second degree heart block (Mobitz type II)

A

PR interval is constant but P wave often not followed by QRS complex.

58
Q

define complete heart block (third degree)

A

when there is no association between P waves and QRS complexes.

59
Q

What is Dressler’s syndrome?

A

Complication of recent MI. Causing pleuritic chest pain, fever, pericardial effusion.

60
Q

What is pericarditis?

A

Complication of recent MI. Chest pain, worse on lying flat and relieved by sitting up. May hear pericardial friction rub.

61
Q

What ECG changes are caused by left ventricular aneurysm?

A

Persistent ST elevation.

left ventricular aneurysm can be a complication of a recent MI

62
Q

What occurs in left ventricular free wall rupture?

A

Acute heart failure, secondary to cardiac tamponade.

left ventricular free wall rupture can be a complication of recent MI

63
Q

What is cardiac tamponade and what are its signs?

A

fluid accumulation in pericardial sac, constricting the heart.
This results in a raised JVP, pulsus paradoxus and diminished heart sounds.

64
Q

What occurs in ventricular septal defect (complication of recent MI)?

A

Acute heart failure associated with pansystolic murmur

65
Q

What murmur is caused by acute mitral regurgitation (as a complication of recent MI)?

A

early-to-mid systolic murmur (due to ischaemia of papillary muscles)

66
Q

What sounds do Cor pulmonale produce?

A

split S2 and loud pulmonary heart sound.

Anatomy (make or break marks) (9 decks)

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