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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
Q

first line in the treatment of a patient under 55 with HTN

A

ACEi

26
Q

First line in treatment of a black patient under 55 with HTN

A

CCB or thiazide diuretic

27
Q

Third line treatment of HTN

A

ACEi + CCB + Diuretic

28
Q

4th line treatment of HTN

A

add further diuretic therapy or,
add alpha blocker or
add beta blocker

29
Q

differential diagnoses for DVT

A

Cellulitis
venous eczema
Ruptured Baker’s cyst

30
Q

What score is used to calculate DVT risk

A

Wells Score
2+ points = DVT likely
1 or less = DVT unlikely

31
Q

Treatment for DVT?

A 
LMWH/Fondaparinux
Warfarin
Aim for INR >2 for at least 24hrs
catheter directed thrombolytic therapy
compression stockings for at least 2 years
32
Q

presentation of LVF?

A

SoB, fluid retention (peripheral and pulmonary oedema), orthopnoea, paroxysmal nocturnal dyspnoea (PND), cold peripheries, haemoptysis (frothy, pink)

33
Q

Presentation of RVF?

A

peripheral oedema (legs, sacrum), ascites, pulsation in the neck, hepatomegaly

34
Q

describe systolic and diastolic failure?

A

Systolic - ventricles unable to contract with ejection fraction <40%
Diastolic - ventricles cannot relax and fill normally, increased filling pressure but normal ejection fraction

35
Q

Is congestive cardiac failure left or right sided?

A

Both - when the two occur together

36
Q

causes of heart failure?

A

IHD, cardiomyopathy, constrictive pericarditis, cardiac tamponade, heart block, post MI, hypertension

37
Q

what is a cardiac tamponade?

A

fluid build up in the pericardium, causing compression of the heart
causes - cancer, trauma, kidney failure, pericarditis

38
Q

How would you investigate heart failure?

A

ECG or CXR

if abnormal, then echocardiography

39
Q

Treatment of heart failure?

A 
Diuretics to prevent fluid overload
ACEi, consider ARB is cough is a problem
beta blockers
spironolactone
Digoxin
vasodilators and nitrates
40
Q

what is Variant / Prinzmetal’s angina

A

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
Q

how do you determine and treat variant angina

A

pt usually wont have normal risk factors for atherosclerosis

treat with CCBs and long acting nitrates

42
Q

what is an aortic dissection

A

tear in inner wall of aorta, blood flows between the layers

severe, “tearing”, chest pain

43
Q

which valves are commonly affected in VHD

A

Mitral and aortic (left), more common than tricuspid and pulmonary

44
Q

what are the common causes of valvular heart disease

A

stenosis or incompetency
congenital (ToF)
rheumatic disease
endocarditis

45
Q

Infective endocarditis is?

A

Fever + new murmur

IE until proven otherwise

46
Q

common causative organisms for infective endocarditis?

A 
Staph aureus - especially if valve replacement
strep viridans (35%)
(also staph epidermidis in surgical cases)
47
Q

Which valves are most commonly affected in IE

A

1) Mitral
2) Aotric
3) Mitral + aortic
4) tricuspid
5) pulmonary (rare)

48
Q

signs and symptoms of IE?

A

Pyrexial, murmur, petechiae, Janeway lesions, Osler’s nodes, splinter haemorrhages, arthritis

Year 3 Drugs + Core Conditions (23 decks)

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