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Year 3 Drugs + Core Conditions > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is acute coronary syndrome?

A

Group of conditions caused by reduced flow in the coronary arteries
STEMI, NSTEMI, Unstable angina

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2
Q

Define unstable angina

A

Angina with high frequency, unpredictability or at rest
pain for <20mins
normal troponin

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3
Q

What is a NSTEMI

A

> 20mins chest pain
ST depression or T wave inversion
raised troponin

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4
Q

What is a STEMI

A

> 20mins chest pain
ST elevation
raised troponin

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5
Q

How does unstable angina differ from stable

A

Stable is pain on exertion due to oxygen insufficiency

Unstable is rupture of plaque, thrombolysis and more frequent and severe pain

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6
Q

order of severity of ACS conditions

A

Chest pain - 70% narrowing
Downstream ischaemia - NSTEMI/ Unstable angina
100% block = infarct - STEMI

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7
Q

Presentation of ACS

A

chest pain - unresponsive to GTN, radiates to neck and down left arm
nausea, sweating, dyspnoea, palpitations, distress, pallor, tachy

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8
Q

Differential diagnoses for ACS

A

Stable angina, acute pericarditis, GORD, aortic dissection, myocarditis, PE

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9
Q

Describe some biochemical markers used in ACS

A

Creatinine-kinase-MB
Cardiac Troponin (best)
Myoglobin

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10
Q

What are the TMI and GRACE scores and what do they represent?

A

Thrombolysis in Myocardial Infarction
Global Registry of Acute Coronary Events
predictive scores, risk of death in 14/30 days

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11
Q

Describe the immediate management of ACS?

A 
ROMANCEE
Reassure
Oxygen - sats >94%, 2-4L/min
Morphine
Aspirin
Nitrates
Clopidogrel
Enoxaparin/ Fondaparinux
ECG
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12
Q

How does management of a STEMI differ from an NSTEMI

A

NSTEMI - IV beta blocker, thrombolysis - fondaparinux, LMWH, nitrates
STEMI - PCI, angioplasty, IV beta blocker, ACEi

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13
Q

What is angina pectoris?

A

The most mild form of angina
brought on by exercise, resolved by rest
impaired blood flow to the heart

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14
Q

What is unstable angina?

A

Angina lasting >15mins,
worsening attacks
sudden onset angina

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15
Q

causes of angina pectoris

A

coronary artery disease, anaemia, arrhythmias, heart failure, aortic stenosis

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16
Q

Presentation of angina pectoris?

A

more chest discomfort than pain
pressure, tightness
radiate to abdomen, back, neck, jaw, shoulders

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17
Q

ECG findings for angina pectoris?

A

ST elevation during periods of pain

normal appearance if no pain

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18
Q

ECG findings in atrial fibrillation

A 
irregular distances between QRS complexes
Lack of P waves
narrow QRS complex
sawtooth appearance
irregularly irregular
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19
Q

How is atrial fibrillation managed?

A

Control rhythm or rate
Rate - beta blockers, CCBs, digoxin
Rhythm - amiodarone, pacemaker
thromboprophylaxis

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20
Q

How is the risk of stroke in AF calculated?

A 
CHA2D2VASC score (max 9 points)
CCF
Hypertension
Age >75
Diabetes
Stroke/TIA
Vascular disease
Age 65-74
Sex (female)
score 0 = no treatment
1 = aspirin or anticoagulant
2+ = anticoagulant
21
Q

What are the different types of atrial fibrillation?

A

Acute - onset within 48hrs
Paroxysmal -terminates within 7 days
Persistent - longer than 7 days
Permanent - longer than a year, cardioversion unsuccessful

22
Q

what is essential hypertension

A

idiopathic raised blood pressure

>140/90

23
Q

How would you investigate hypertension?

A 
24hr BP is gold standard, if not then several home readings
ECG (?LVH)
urine dipstick for protein/blood
cholesterol, glucose
serum urea, creatinine, electrolytes
24
Q

what is the goal in essential hypertension

A

to reduce BP to 140/85

135/80 in diabetics

25
first line in the treatment of a patient under 55 with HTN
ACEi
26
First line in treatment of a black patient under 55 with HTN
CCB or thiazide diuretic
27
Third line treatment of HTN
ACEi + CCB + Diuretic
28
4th line treatment of HTN
add further diuretic therapy or, add alpha blocker or add beta blocker
29
differential diagnoses for DVT
Cellulitis venous eczema Ruptured Baker's cyst
30
What score is used to calculate DVT risk
Wells Score 2+ points = DVT likely 1 or less = DVT unlikely
31
Treatment for DVT?
``` LMWH/Fondaparinux Warfarin Aim for INR >2 for at least 24hrs catheter directed thrombolytic therapy compression stockings for at least 2 years ```
32
presentation of LVF?
SoB, fluid retention (peripheral and pulmonary oedema), orthopnoea, paroxysmal nocturnal dyspnoea (PND), cold peripheries, haemoptysis (frothy, pink)
33
Presentation of RVF?
peripheral oedema (legs, sacrum), ascites, pulsation in the neck, hepatomegaly
34
describe systolic and diastolic failure?
Systolic - ventricles unable to contract with ejection fraction <40% Diastolic - ventricles cannot relax and fill normally, increased filling pressure but normal ejection fraction
35
Is congestive cardiac failure left or right sided?
Both - when the two occur together
36
causes of heart failure?
IHD, cardiomyopathy, constrictive pericarditis, cardiac tamponade, heart block, post MI, hypertension
37
what is a cardiac tamponade?
fluid build up in the pericardium, causing compression of the heart causes - cancer, trauma, kidney failure, pericarditis
38
How would you investigate heart failure?
ECG or CXR | if abnormal, then echocardiography
39
Treatment of heart failure?
``` Diuretics to prevent fluid overload ACEi, consider ARB is cough is a problem beta blockers spironolactone Digoxin vasodilators and nitrates ```
40
what is Variant / Prinzmetal's angina
due to coronary artery spasm pain at rest, worse at night ST elevation on ECG diagnosis of exclusion after treadmill stress test and coronary angiogram
41
how do you determine and treat variant angina
pt usually wont have normal risk factors for atherosclerosis | treat with CCBs and long acting nitrates
42
what is an aortic dissection
tear in inner wall of aorta, blood flows between the layers | severe, "tearing", chest pain
43
which valves are commonly affected in VHD
Mitral and aortic (left), more common than tricuspid and pulmonary
44
what are the common causes of valvular heart disease
stenosis or incompetency congenital (ToF) rheumatic disease endocarditis
45
Infective endocarditis is?
Fever + new murmur | IE until proven otherwise
46
common causative organisms for infective endocarditis?
``` Staph aureus - especially if valve replacement strep viridans (35%) (also staph epidermidis in surgical cases) ```
47
Which valves are most commonly affected in IE
1) Mitral 2) Aotric 3) Mitral + aortic 4) tricuspid 5) pulmonary (rare)
48
signs and symptoms of IE?
Pyrexial, murmur, petechiae, Janeway lesions, Osler's nodes, splinter haemorrhages, arthritis

Year 3 Drugs + Core Conditions (23 decks)

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