Cardiovascular Flashcards
Give an example of an Angiotensin Type I Receptor Antagonist?
Losartan, Valsartan
What is starlings law?
The Stroke Volume is directly proportional to the diastolic filling
What is the commonest cause of myocarditis?
Viral infection - particularly Coxsackie
How is Pulmonary Embolism diagnosed?
D Dimer - elevated but not specific - need to have an initial low risk score
Spiral CT with intravenous contrast
Radionucleide lung scan (V/Q scan)
What would you see on the ECG of someone with left axis deviation?
Lead I Positive and Leads II and III negative
What are the signs for mitral regurgitation?
Apex beat is displaced laterally, with diffuse thrusting character
First heart sound is soft
Pansystolic Murmur, loudest at apex and radiating to axilla.
Third heart sound often present
What are the signs for Mitral Stenosis?
Mitral facies or malar flush - cyanotic on upper cheeks
Pulse is low volume and may become irregular
Apex Beat is ‘tapping’ in quality as a result of a combination of palpable first heart sound and left ventricular backward displacement.
Loud first heart sound
Rumbling mid-diastolic murmur
Parasternal Heave
Elevated JVP
What are the modifiable risk factors for Coronary Artery Disease?
Hyperlipidaemia Cigarette Smoking Hypertension Metabolic Factors - Diabetes Mellitus Diets high in fats and low in antioxidants Lack of Exercise
What would a wide QRS complex indicate?
When there is delayed conduction, for example with left bundle branch block
What would a ‘tearing’ chest pain indicate?
Aortic Dissection
How does Chest Pain present in Pericarditis?
Sharp pain aggravated by movement, respiration and changes in posture
What would you see on the ECG of somebody experiencing a myocardial infarction?
ST Elevation
If the P Wave of an ECG is broad and notched, what does this indicate?
Left Atrial Enlargement, e.g. P mitrale - mitral stenosis
Which investigations should be performed when heart failure is indicated?
Chest X Ray
ECG
Blood Tests
Echocardiography
Give an example of an Ace Inhibitor?
Ramipril, Lisinopril
How are NSTEMI and unstable angina treated?
Aniplatelet therapy - aspirin
Antithrombins - Heparin LMW SC for at least 48 hours
Anti-ischaemia agents - Nitrates sublingually
Plaque Stabilisation - Statins
ACE-I
How is acute pericarditis diagnosed?
ECG - Concave upwards (saddle shaped) ST elevation
How are Unstable Angina and Non ST Elevation MI differentiated?
NSTEMI the occluding thrombus is sufficient to cause myocardial damage and there will be serum markers of myocardial damage such as troponin and creatinine kinase?
How is pulmonary embolism treated?
Thrombolysis
High flow oxygen if hypoxaemic
Analgesia - morphine - relieves pain and anxiety
Prevention of further emboli - LMWH and oral warfarin
IV Fluids
How is Atrial Fibrillation treated long term?
Rate Control and Rhythm Control
Rate Control aims to reduce heart rate at rest and during excercise. Beta blockers or Calcium Antagonists (such as verapamil) are the predominant treatments
Rhythm Control is used in patients who are younger than 65 and highly symptomatic. Electrical DC cardioversion is used followed by beta blockers. If with underlying heart disease amiodarone is commonly used.
When is Sinus Bradycardia a normal rate?
During Sleep
Well-trained Athletes
What causes long QT syndrome?
Congenital - mutations in sodium and potassium channel genes
Electrolyte Disturbance - hypokalaemiaa, hypocalcaemia, hypomagnesaemia
Variety of Drugs - tricyclic antidepressants, phenothiazines, macrolide antibiotics
What might be seen on an ECG of somebody having an NSTEMI?
ST Depression and T Wave inversion
What are the conditions covered in acute coronary syndrome?
Unstable Angina
Non-St Elevation MI
St-Elevation MI
What are the signs of aortic stenosis?
Carotid Pulse is slow rising
Apex Beat Thrusting
Harsh Systolic Ejection Murmur (A thrill on palapation) at right upper sternal border radiating to neck.
Second Heart Sound Soft or Inaudible
What are the 5 stages of Athersclerosis?
Fatty Streaks Intermediate Lesions Fibrous plaques or Advanced Lesions Plaque Rupture Plaque Erosion
What is the most common arrhythmia?
Atrial Fibrillation
What are the serum markers of myocrdial infarction?
Troponin
Creatinine Kinase
What are the clinical features of acute heart failure?
Acute Decompensation of Chronic Heart Failure Hypertensive Heart Failure Acute Pulmonary Oedema Cardiogenic Shock High Output Cardiac Failure Right Heart Failure
What ECG changes would be seen in left ventricular hypertrophy?
Tall R Waves in left ventricular leads V5 and V6
Deep S Waves in right ventricular leads V1, V2
ST Depression
T Wave flattening or inversion
What are the clinical features of acute pericarditis?
Sharp retrosternal chest pain which is relieved by leaning forward. Pain may be worse on inspiration and radiate to neck and shoulders. Pericardial friction rub.
In what conditions could D Dimer be elevated?
Pulmonary Embolism
Cancer
Pregnancy
Post-operatively
What would you see on the ECG of someone with right axis deviation?
Lead I Negative and Lead III positive
What is Wenckebach phenomenon?
Mobitz Type I Atrioventricular Block - caused by aV node block - results in progressive PR interval prolongation until a P wave fails to conduct (absent QRS after the P wave). The PR interval then returns to normal and the cycle repeats itself.
If the P Wave of an ECG is tall and peaked, what does this indicate?
Right Atrial Enlargement - eg pulmonary hypertension - P pulmonale
Which disease commonly causes valvular disease?
Rheumatic Fever
What is the commonest cause of ischaemic heart disease?
Coronary Artery Atheroma
What classification is used for diagnosis of infective endocarditis?
Duke Criteria: Direct evidence from histology or culture Two major criteria One major and three minor Five minor
What are the main causes of heart failure?
Ischaemic Heart Disease
Cardiomyopathy
Hypertension
How long after a cardiac arrest does irreversible brain damage occur?
3 minutes of no change
