Cardiovascular Flashcards
what are clinical signs of unstable angina?
Chest pain with increasing frequency
Can occur at rest
Can have a fourth heart sound
what are differentials of pleuritic chest pain?
- pleurisy
- pneumothorax
- pneumonia
- pericarditis
- PE
what are risk factors of coronary artery disease?
- male over 60
- smoking
- hypertension
- high LDL/ low HDL
- diabetes
- inactivity
- obesity
- family history
- drug use
what are symptoms of an acute MI?
- chest pain that can radiate to the left arm or jaw
- dyspnoea
- pallor
- hypotension
- tachycardia
- dizzy
how can a MI be diagnosed?
- risk factors
- ECG
- troponin
- angiogram
what is the immediate management for MI?
- pain relief (morphine and an anti emetic)
- oxygen
- aspirin
what is the further management of a stemi?
- PCI if they present within 12 hours of onset and can get PCI within 120 minutes
- if PCI can’t be given within 120 minutes then fibrinolytic treatment/thrombolysis
in MI when PCI can’t be offered what is often used for thrombolysis?
alteplase
reteplase
what ECG leads are for the anterior section of the heart?
V1-V4
what coronary artery supplies the anterior section of the heart?
left anterior descending
what coronary artery supplies the inferior section of the heart?
right coronary artery
what leads correspond to the inferior section of the heart?
- II,III, AVF
what leads correspond to the lateral aspect of the heart?
- V5-V6
what artery supplies the lateral aspect of the heart?
- left circumflex
what leads correspond to the posterior heart?
V8,9
What supplies the posterior heart?
right circumflex
what long term primary care drug therapy can be given after MI?
ACE inhibitor
dual antiplatelet therapy: ticagrlor with aspirin
beta blocker
statin
what is the P wave of an ECG?
- atrial depolarisation
what is QRS of an ECG?
- depolarisation of the ventricles
what is ST of an ECG?
- the plateu of an action potential
what is the T wave of an ECG?
repolarisation
what is the cause of a bifid P wave in lead II?
P.mitrale caused by mitral stenosis
what is the ECG change in first degree heart block?
- a fixed PR interval over 0.2
what is the ECG change in mobitz I?
a gradual increase in the PR interval then it drops
what is the ECG change in mobitz II?
PR interval is constant then drops at random
what change shows an ECG ‘saw tooth’ pattern?
Atrial flutter
what are delta waves a sign off?
wolff Parkinson white
what chest pain can be reported by someone with arrhythmias?
- palpitations
- chest pain
- syncope
- hypotension
- pulmonary oedema
what is AVNRT?
- a supraventricular tachycardia
There is a re-entrant loop in the node itself that can send impulses up into the atria or down into the ventricles.
what can terminate AVNRT?
vagal discharge
what is AVRT?
- a supraventricular tachycardia
- an accessory pathway so two circuits are running.
Normal pathway via AVN and the accessory pathway.
what are clinical features of the supra-ventricular tachycardias? (AVNRT and AVRT)
rapid palpitations anxiety dizzy central chest pain weakness polyuria
what are causes of atrial fibrillation?
- alcohol
- pneumonia
- hyperthyroidism
- PE
- mitral valve pathology
- pulmonary hypertension
what are extrinsic causes of sinus bradycardias?
- hypothermia
- hypothyroidism
- cholestatic jaundice
- raised intracranial pressure
- beta blockers
what are intrinsic causes of sinus bradycardias?
- acute ischaemia
- chronic degenerative changes
what are causes of complete heart block?
- autoimmune; SLE
- structural heart disease ; transposition of the great vessels
- levs disease
- lenegres disease
- acute MI
- ischaemic cardiomyopathy
- calcific aortic stenosis
- digoxin, beta blockers, calcium channel blockers
endocarditis, lyme disease
what are causes of general bradycardias?
D- drugs (aantiarrythmics, beta blockers, calcium channel blockers, digoxin
I- ischaemic/ infection
V- vagal hypertonia (athletes, vasovagal syncope, carotid sinus syndrome
I- infection: viral myocarditis, rheumatic fever, infective endocarditis
S- sick sinus syndrome
I- infiltration/ restrictive. autoimmune, sarcoid, haemochromatosis, amyloid, muscular dystrophy
O- hypothyroidism, Hypokalaemia, hypothermia
N- neuro; raised ICP
what is the pattern in an ECG of ventricular tachycardia?
Broad complex tachycardia (tomb stone)
what is the management of heart block?
asymptomatic and over 40bpm- no need for treatment
symptoms and below 40bpm- atropine
no response with atropine; pacing wire
what is the management of AVNRT?
- adenosine
- vagal discharge
symptom relief: beta blockers, calcium channel blockers.
last line: ablation
what is the treatment of AVRT?
- Adenosine
- atrial pacing
- catheter ablation
what is the management for wolf Parkinson white?
- procainamide
- if hypotension cardiovert
what is the management of AF?
- coagulation
- rate control
- rhythm control
- cardioversion if unstable
what can be used in rhythm control in AF?
- amiodarone
- flecainide
- cardioversion
- ablation
what can be used for rate control in af?
- beta blocker
- calcium channel blocker
what is given for ventricular tachycardia?
- NOT verapamil
- amiodarone or lidocaeine
what is given for atrial flutter?
- vaso-vagal activity
- adenosine
what bradycardias are recommended elective permanent pacing?
- mobitz II
third degree heart block
AF
sick sinus syndrome
what is the CHADSVASC score?
Congestive heart failure Hypertension Age over 75 Diabetes.M Stroke/ TIA/ thromboembolism Vascular disease Age 65-74 Female
what is the CHADVASC score used for?
assessing need for anti coagulation
what are signs of left sided heart failure?
- shortness of breathe
- orthopnea
- pulmonary oedema
- displaced apex beat
- fine end inspiratory crackles
- dull lung bases
what are causes of left sided heart failure?
- coronary artery disease
- hypertension
- idiopathic
- valve disease
what valves can cause left sided heart disease?
mitral and aortic
what are signs of right ventricular failure?
- increased JVP
- oedema
- ascites
what are causes of right sided heart failure?
- left sided heart failure
- pulmonary hypertension
- right ventricular cardiac myopathy
- tricuspid valve disease
- cor pulmonale
- pulmonary valve disease
what valves are linked to right sided heart failure?
- mitral
- pulmonary
what are the major criteria in the Framingham criteria?
- paroxysmal nocturnal dyspnoea
- neck vein distension
- cracles
- cardiomegaly
- acute pulmonary oedema
- S3 gallop
- increased CVP
- hepatojugular reflex
- weight loss
what are the minor criteria in the Framingham criteria?
- bilateral ankle oedema
- nocturnal cough
- dyspnoea on normal exertion
- hepatomegaly
- pleural effusion
- decrease in vital capacity by 1/3
- ## tachycardia
what is the Framingham criteria for?
the diagnosis of congestive heart failure. Need 2 major criteria of 1 major and 2 minors
what is the class of one of new York heart association classification of heart failure?
- Class one: no limitations. normal physical exercise doesn’t cause fatigue, dyspnoea or palpitations
what is the class two of new York heart association?
Mild limitation. comfortable at rest but normal physical activity causes fatigue, dyspnoea or palpitation
what is the class three of the new York classification of heart failure?
Marked limitation. comfortable at rest but gentle physical activity produces marked symptoms of heart failure
what is the class four of the new York classification of heart failure?
symptoms of heart failure occur at rest and made work by physical activity
what drugs improve symptoms in heart failure?
Antiemetic
loop diuretics
what drugs improve survival in heart failure?
ACE inhibitor
BETA blockers
spironolactone
vasodilators: hydralazine isosorbide dinitrate
what is the emergency management of a patient with heart failure?
- IV access
- sit up
- oxygen
- diuretics
- morphine to reduce preload
- anti emetics
- nitrates
- ionotropes
what are the xray signs of congestive heart failure?
- alveolour shadowing
- kerley b lines
- cardiomegaly
- upper lobe diversion
- effusion
- fluid in the fissures
what are indications for ACE inhibitors?
- first/ second line treatment for hypertension
- first line for heart failure
how do ACE inhibitors work?
- prevent formation of angiotensin II (a vasoconstrictor)
- no AG II means no aldosterone
- sodium and water excretion
what are side effects of ACE inhibitors?
hypotension
persistant dry cough
hyperkalaemia
what are indications for beta blockers?
- first line in ischaemic heart disease
- first line in chronic heart failure
- first line if AF
- first line in supraventricular tachycardia
where are beta 1 receptors found?
the heart
what patients shouldn’t be given beta blockers?
ASHTMA
what are the lub dub heart sounds?
S1- closure of mitral and tricuspid
S2- closure of aortic and pulmonary valves
what are the systolic murmurs?
Aortic stenosis (late in systole) Mitral regurgitations
what are the diastolic murmurs?
aortic regurgitation
mitral stenosis
what are signs of aortic stenosis?
- ejection systolic murmur
- crescendo decrescendo murmur
- narrow pulse pressure
- S4
- systolic thrill
what are signs of an aortic sclerosis?
- valve thickening
- doesn’t radiate to the carotids
- ejection systolic murmur
- slow rising pulse
- no thrill heard
what are signs of mitral regurgitation?
- pan systolic murmur
- ## pulmonary oedema
what are signs of tricuspid regurgitation?
- same symptoms as right sided heart failure
- palpable liver
- blowing pansystolic murmur
what is S3?
normal under 30 years
also in left ventricular failure, constrictive pericarditis, mitral regurgitation.
what is S4?
atrial contraction against a stiff ventricle. heard in aortic stenosis
what is the pathology in anaphylaxis?
An IgE mediated activation of mast cells leading to release of multiple factors.
what are the main mediators in anaphylaxis?
- histamine
- prostaglandin D2
what causes the later reaction in anaphylaxis?
IL5
what is the most common cause of obstructive shock?
PE leading to RV failure.
what are features of hypovolaemic shock?
- decreased skin turgor
- dry skin
- dry tongue
- oral mucosa
- postural hypotension
- decreased JVP
- increased vascular resistance
- cold peripheries
- slow cap refill
what are features of septic shock?
- hypotension even after fluid resuscitation
- decreased vascular resistance
what are features of anaphylactic shock?
- facial, tongue or throat swelling
- stridor
- wheeze
- syncope
- high mast cell tryptase
- decreased vascular resistance
what types of shock have decreased vascular resistance?
- septic shock
- anaphylaxis shock
what types of shock have high CVP?
- cardiogenic shock
what types of shock cause low central venous pressure?
- hypovoelamic shock
- anaphylactic shock
- septic shock
what are complications of a massive blood transfusion?
- temperature change causing hypothermia, vasoconstriction and arrhythmia
- coagulopathy as it has no platelets or clotting factors
- hypocalcaemia as the citrate binds calcium
- increased oxygen affinity due to reduced 2,3DBG content
- hyperkalaemia
- microemboli
large blood transfusions can cause coagulopathy what can be given?
fresh frozen plasma
platelet concentrates
what is given in fluid resuscitation?
0.9% sodium chloride 500ml over 15 minutes
what are properties of crystalloids?
- made up of smaller molecules
- good for volume expansion
- leave the vascular space
what does ventricular fibrillation look like on an ECG?
- no p wave
- highly irregular
- no qrs clear complexes
what are two shockable rhythms?
- VT
- VF
