Cardiovascular Flashcards by Mo Yang

What investigation gives a definitive diagnosis of ACS?

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

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

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

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What is the pharmacological early management of STEMI?

Aspirin + clopidogrel
Morphine
Nitrates
Oxygen (if hypoxic)

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What are the two reperfusion options for STEMI?

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

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what is the pharmacological treatment of NSTEMI?

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

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what is a typical post-ACS management?

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

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Hypertension medication for patients under 55?

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

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hypertension medication for patients over or equal 55 or black?

calcium channel blocker (eg. amlodipine)

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

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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How do you diagnose hypertension?

with ABPM or HBPM if clinic reading > 140/90

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What is stable/ classical angina?

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

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what is unstable angina?

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

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What is variant angina (prinzmetal)?

Angina that is due to coronary artery spasm.

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What are the 3 features of angina?

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

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What investigations are relevant to IHD?

ECG/ stress, exercise ECG

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

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What revascularisation options are there for IHD?

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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What is the pharmacological management of IHD?

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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What is a typical medication regimen for someone with angina?

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

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Symptoms of AF?

Palpitations
Chest pain
breathlessness, dizziness

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What are the ECG features of AF?

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

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

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

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What is the management of chronic AF?

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

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Define paroxysmal AF.

Spontaneous termination within 7 days, usually within 48hrs.

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Define recurrent AF.

Two or more episodes of paroxysmal AF.

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Define persistent AF.

Non self terminating, lasting longer than 7 days.

Define permanent AF.

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

Describe features of AV nodal reentry tachycardia.

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.

What does it mean by SVTs are "narrow complex"?

QRS < 0.12s

What is the treatment of SVTs?

1st) Vagal manœuvres (valslalva manoeuver) | 2nd) Adenosine IV

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

Narrow QRS complexes (distance between each is regular) | Hidden P-waves

What is the accessory conducting pathway in WPW syndrome called?

Bundle of Kent (congenital)

What are the ECG findings in WPW?

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

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

Bundle of His

Which pathway conducts electrical impulses within the ventricles?

Purkinje fibres

What is Wolf-Parkinson-White syndrome?

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

What is seen in an ECG during Atrial Flutter?

"saw tooth baseline"

What are the symptoms of left ventricular failure?

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

What are the symptoms of right ventricular failure?

Peripheral oedema. Ascites Raises JVP

What investigations are relevant for heart failure?

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

How do you treat heart failure?

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

Name two cardiac causes of pulmonary oedema.

Congestive cardiac failure (left ventricular failure) | Mitral stenosis

What are symptoms of pulmonary oedema?

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

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

IV Furosemide (loop)

What is hypertrophic cardiomyopathy?

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

What investigation is used to definitively diagnose valvular diseases?

Echo

List features of mitral stenosis.

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

List features of mitral regurgitation.

``` Pansystolic murmur (radiates to axilla) Soft S1 ```

List features of aortic stenosis.

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

List features of aortic regurgitation.

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

What does a "continuos machine like murmur" indicate?

Patent ductus arteriosus

What is the cause of acute respiratory distress syndrome?

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

What are the symptoms of ARDS?

cyanosis tachypnoea tachycardia bilateral crackles

How do you diagnose ARDS?

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

how do you treat ARDS?

Fix hypoxia - continuos positive airway pressure (CPAP)

Define first degree heart block.

PR interval > 0.2 secs

Define second degree heart block (Mobitz type I)

Progressive prolongation of PR interval until a dropped beat occurs.

Define second degree heart block (Mobitz type II)

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

define complete heart block (third degree)

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

What is Dressler's syndrome?

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

What is pericarditis?

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

What ECG changes are caused by left ventricular aneurysm?

Persistent ST elevation. | left ventricular aneurysm can be a complication of a recent MI

What occurs in left ventricular free wall rupture?

Acute heart failure, secondary to cardiac tamponade. | left ventricular free wall rupture can be a complication of recent MI

What is cardiac tamponade and what are its signs?

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

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

Acute heart failure associated with pansystolic murmur

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

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

What sounds do Cor pulmonale produce?

split S2 and loud pulmonary heart sound.