cardiovascular Flashcards
MI/ACS:
- most common cause?
- non-modifiable risk factors? 3
- modifiable risk factors? 8
rupture/erosion of the fibrous cap of atheromatous plaque in coronary artery -> platelet-rich clot + vasoconstriction produced by platelet release of serotonin + thromboxane
nb can rarely be dt vasospasms or vasculitis
- older age
- male
- FH (1st degree relative had IHD <50)
- hyperlipidaemia
- hypertension
- metabolic conditions (diabetes)
- poor diet
- lack of exercise
- stress/depression
- smoking
- cocaine use
MI/ACS:
- symptoms? 8
- what is a silent MI?
- who is most likely to get a silent MI? 2
- acute central chest pain (>20 mins)
- pain in L arm, jaw or back
- anxiety (impending doom)
- fatigue
- nausea
- sweatiness
- palpatations
- SOB
MI presents without chest pain
- elderly
- diabetics
MI/ACS:
- signs? 3
nb history often more important!
- pale/grey
- sweaty (can’t fake!)
- high pulse
nb may be signs of heart failure (^JVP, , 3rd heart sound, basal crepitus)
nb may also hear pericardial rub
MI/ACS:
- bloods? 5
- other investigations? 1
- troponin
nb creatinine Kinase -MB rarely used now - FBC
- U+Es
- glucose
- lipids
- ECG (ST elevation or new LBBB)
nb in 20% of ACS, ECG is normal initially!
can do CXR to exclude differentials but don’t delay treatment to do!
MI/ACS:
- initial pharm treatment? 7 (acronym)
- treatment for STEMI? 2
BROMANCE
- beta-blockers
- reassurance
- oxygen
- morphine (IV)
- aspirin
- nitrates (GTN)
- clopidogrel
- antiEmetics (eg metoclopramide)
(nb sometimes give a NOAC as well for VTE prophylaxis)
nb don’t give B blockers if:
- bradycardiac
- hypotensive
- heart failure
- asthmatic
- fibrinolytics (rTPA)
- PCI surgery
MI/ACS
- long-term pharm treatments? 5
- long-term non-pharm treatments? 4
- aspirin
- clopidogrel
- statin
- B blocker (norm metoprolol)
- ACE inhibitor
- more exercise
- control diabetes (if relevant)
- better diet
- stop smoking
differential diagnosies for MI/ACS:
- cardiovascular? 5
- resp? 2
- GI? 3
- other? 1
- angina
- pericarditis
- myocarditis
- aortic dissection
- PE
- pneumonia
- pneumothorax
- oesophageal spasm
- GORD
- acute pancreatitis
- MSK pain
Angina pectoris:
- three types?
- pathophysiology?
- stable angina
- unstable angina
- prinzmetal (variant) angina
normally atheroma -> reduced O2 supply to heart muscle -> pain
(other rarer causes)
variant angina = spasms in coronary artery
Angina pectoris:
- modifiable risk factors? 4
- unmodifiable risk factors? 6
- high fat diet
- smoking
- lack of exercise
- psychological stress
- age
- male
- FH (IHD <50yrs)
- diabetes
- hypertension
- elevated CRP
Angina pectoris:
- three features of stable angina (according to NICE)?
- triggers for stable angina, bar physical exertion? 3
- associated symptoms? 4
- constricting discomfort in:
- – front of chest
- – neck
- – shoulders
- – jaw
- – arms
- precipitated by physical exertion
- relieved by rest or GTN within about 5 mins
- emotion
- cold weather
- heavy meals
- dyspnoea
- nausea
- sweating
- light-headedness
Angina pectoris:
- symptoms that make diagnosis of stable angina unlikely? 5
- continuous or very prolonged pain
- pain unrelated to exertion/other triggers
- pain brought on by breathing
- pain associated with dizziness
- pain associated with palpitations, tingling or difficulty swallowing
Angina pectoris:
- ECG changes? 3
- pathological Q waves (in particular)
- LBBB
- ST- segment + T-wave abnormalities (eg ST-segment depression, T-wave flattening or inversion)
a normal ECG does not confirm or exclude angine!
Angina pectoris:
- non-pharm management? 3
- pharm management? 4
- stop smoking
- loose weight
- more exercise
- GTN spray (contraindicated w Viagra)
(- consider long-acting nitrate) - Beta-blocker (or Ca channel blocker)
- Aspirin
- Statin (if high chol)
nb can give K+ channel activator (eg nicorandil) if unresponsive
nb get diabetes and HTN under control too
nb consider surgery if bad
Angina pectoris differentials:
- CVS? 7
- Resp? 3
- GI? 4
- MSK? 4
- psych? 1
CVS
- MI
- unstable angina
- prinzmetal angina
- dissecting thoracic aneurysm
- pericarditis
- acute HF
- arrhythmias
Resp
- PE
- pneumothorax
- pneumonia
GI
- peptic ulcer
- ruptured oesophagus (boerhaves*)
- GORD
- pancreatitis
MSK
- costochondritis
- rib fracture
- arthritis
- pulled muscle
Psych
- anxiety/panic attack
AF
- commonest causes? 4
- other causes?
- what percentage are idiopathic (‘lone AF’)?
common:
- IHD (+/ MI or heart failure)
- HTN
- valvar heart disease
- hyperthyroidism
other:
- congenital heart disease
- caffeine/alcohol/stimulants
- sick sinus syndrome
- wolf-parkinson white
- acute infection (e.g. pneumonia)
- PE
- low K or Mg
10% are idiopathic