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YEAR 3 & 5 CORE CONDITIONS > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What causes an MI to occur?

A

The rupture/erosion of an atheromatous plaque in a coronary artery causing a blockage to blood flow

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2
Q

What do platelets release that cause vasoconstriction?

A

Serotonin and thromboxane A2

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3
Q

What makes up ‘Acute Coronary Syndrome’?

A
  1. STEMI
  2. NSTEMI
  3. Unstable angina
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4
Q

How do you differentiate between a STEMI and unstable angina in terms of symptoms?

A

STEMI lasts for longer than 20 mins and is not relieved GTN spray.
Unstable angina lasts for less than 20 mins and is relieved by GTN spray

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5
Q

Where would you feel pain in ACS? and describe the pain of an MI.

A

Chest
Arms
Back
Jaw

Pressure (like an elephant sitting on my chest)
Crushing
Burning

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6
Q

How might the patient look during an MI?

A

Grey, clammy, sweaty, cyanosed, short of breath, vomiting

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7
Q

What would the ECG look like in a STEMI depending on what time it was taken post-STEMI?

A

5-30 mins - tall peaked T waves
Hours - ST elevation
Days - inverted T waves, development of Q waves
Months - Q waves remain

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8
Q

What does ST elevation in leads II, III, aVF indicate?

A

Inferior MI in the right coronary artery

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9
Q

If there were ST elevation across all leads, what does that mean?

A

Pericarditis

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10
Q

At what hours post-pain onset do troponin levels rise?

A

the levels increase 3-12 hours from pain onset
they peak at 24-48 hours
return to baseline 5-14 days

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11
Q

Aside from troponin, what is another cardiac enzyme you can monitor after an MI?

A

Creatinine kinase

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12
Q

What is the acute management of an MI?

A

MONAC

Morphine 2.5-5mg
Oxygen 15L/min
Nitrates - GTN spray
Aspirin/Clopidogrel 300mg loading dose

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13
Q

What intervention would you do for an MI?

A

PCI = percutaneous coronary intervention

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14
Q

Stable angina typically has 3 factors:

A
  1. constricting discomfort in chest, neck, shoulder, jaw, arms
  2. precipitated by physical exertion
  3. relieved by rest or GTN spray within 5 mins
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15
Q

What is Prinzmetal angina? What are the risk factors?

A

also known as variant angina.

It is caused by coronary artery vasospasm

Smoking, cocaine, low magnesium

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16
Q

How do you describe the rhythm of atrial fibrillation?

A

Irregularly irregular

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17
Q

What are the most common causes of AF?

A

Coronary artery disease
Hypertension
Valvular heart disease
Hyperthyroidism

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18
Q

What is paroxysmal AF and how would you investigate it?

A

When the symptoms of AF last less than 48 hours.

Investigate with a 24 hour ambulatory ECG

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19
Q

What is the treatment for AF? Think about rate control, rhythm control and thromboprophylaxis

A

Rate control - beta-blockers, calcium channel blockers, digoxin, amiodarone

Rhythm control - electrical DC cardioversion

Thromboprophylaxis - warfarin or a DOAC

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20
Q

What score do you have to calculate before starting someone of thromboprophylaxis?

A

CHADs VASc score

Congestive cardiac failure
Hypertension
Age 65-74 yrs
Diabetes
Stroke

Vascular disease
Sex - female

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21
Q

On examination of someone with hypertension what signs might you find?

A
  • high blood pressure
  • retinopathy
  • left ventricular hypertrophy which gives heaves on palpation
  • renal bruits
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22
Q

What signs are there in coarctation of the aorta? What syndrome is it common in?

A
  • radio-radial delay
  • radio-femoral delay

Turner’s syndrome (45, XO)

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23
Q

What are the 4 steps in the treatment of hypertension?

A

Step 1: <55 years - ACE inhibitor
> 55 years or black of any age - calcium channel blocker

Step 2: ACE inhibitor + calcium channel blocker

Step 3: ACEi + Ca channel blocker + thiazide diuretic

Step 4: step 3 + further diuretic or beta blocker

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24
Q

When would a DVT cause bilateral swelling?

A

If the iliac bifurcation is involved

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25
Q

What is the name of the diagnostic score for DVT?

A

Well’s diagnostic algorithm

Clinical features that scores points:

  • Active cancer
  • Paralysis or recent plaster immobilisation of the leg
  • Recent major surgery
  • Local tenderness along distribution of deep venous system
  • Entire leg swollen
  • Calf swelling >3cm
  • Pitting oedema
  • Collateral superficial veins (non-varicose)
  • Previous DVT
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26
Q

What test can you do for suspected DVT?

A

D-dimer

It is sensitive but has low specificity

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27
Q

What is first line treatment for DVT?

A

LMWH

Offer unfractioned heparin if renal impairment

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28
Q

What does the leg look like in a DVT?

A

Red, hot, swollen calf or thigh
Distention of superficial veins
Pain and tenderness

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29
Q

What is post-thrombotic syndrome?

A

It develops after trauma to deep veins and their valves due to chronic venous hypertension
It is a common complication of DVT.
You get pain, swelling, hyperpigmentation, dermatitis, ulcers and gangrene

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30
Q

How does heart failure affect breathing?

A

Short of breath
Reduced exercise tolerance
Orthopnoea
Paroxysmal nocturnal dysponoea

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31
Q

What is the cough like in heart failure?

A

Nocturnal cough

Pink frothy sputum

32
Q

On auscultation of heart failure what would you hear?

A

Gallop rhythm due to the presence of S3

Bilateral basal end-inspiratory crackles

33
Q

If no previous MI, what investigations do you do for heart failure?

A

B-type natriuretic peptide (BNP)
It is released when the myocardium is stressed and is related to left ventricular pressure
It distinguishes heart failure from other causes of dyspnoea

34
Q

What chest X-Ray signs do you see in pulmonary oedema?

A

ABCDEF

Alveolar oedema - Bat's wings
B - Kerley B lines = interstitial oedema 
Cardiomegaly 
D - upper lobe diversion
Effusions
Fluids in fissures
35
Q

Describe the pulse pressure in heart failure

A

Narrow pulse pressure

36
Q

How do you treat heart failure with a preserved ejection systolic fraction?

A

Loop diuretic

Lifestyle changes - less smoking. alcohol, salt, lose weight

37
Q

What is the treatment of heart failure with a decreased ejection systolic fraction?

A
  1. Loop diuretic e.g. furosemide 40mg
  2. ACE inhibitors
  3. Beta-blocker
  4. Potassium-sparring diuretic e.g. spironolactone
  5. Digoxin
  6. Vasodilators
38
Q

What is the most common valvular heart disease and what most commonly causes it?

A

Mitral regurgitation

Mitral valve prolapse

39
Q

What are the 4 grades of hypertensive retinopathy?

A
  1. Tortuous arteries
  2. AV nipping
  3. Flame haemorrhages and cotton-wool spots
  4. Papilloedema
40
Q

What time of murmur is mitral regurgitation and where would you hear it?

A

Pansystolic
Heart at apex with the diaphragm
Radiates to axilla - listen with bell

41
Q

What are the 2 systolic murmurs?

A

Mitral rergugitation

Aortic stenosis

42
Q

What signs do you see in mitral stenosis?

A

Malar flush
Raised JVP
Right ventricular hypertrophy - laterally displaced apex beat, RV heave

43
Q

What are the 2 diastolic murmurs and where do you hear them?

A

Mitral stenosis - at apex with bell

Aortic regurgitation - at tricuspid area with patient leaning forward and holding breath

44
Q

What is the pulse like in aortic regurgitation?

A

Collapsing water hammer pulse

Wide pulse pressure

45
Q

What is De Musset’s sign?

A

Head-bobbing due to aortic regurgitation

46
Q

What is the classic triad of aortic stenosis?

A

Angina
Syncope
Heart failure

47
Q

What are the ‘end pieces’ for cardiovascular examination?

A

Abdominal examination
Peripheral vascular examination
Lying and standing blood pressure
Fundoscopy

48
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

49
Q

What is the most common cause of aortic stenosis?

A

Calcification of a congenital bicuspid valve

50
Q

What is the order of the most commonly affected valves in Rheumatic heart disease?

A
  1. Mitral valve
  2. Aortic
  3. Mitral and aortic
  4. Tricuspid
  5. Pulmonary - v rare
51
Q

What are the most common organisms to cause infective endocarditis?

A

Strep Viridans - most common (usually sub-acute)
Staph aureus - most common in prosthetic valves and IVDU
Strep Bovis - must do colonoscopy because there may be a tumour

52
Q

How would infective endocarditis present (symptoms)?

A

With non-specific symptoms such as fatigue, low grade fever, flu-like symptoms, polymyalgia

53
Q

What are the signs for endocarditis?

A

FROM JANE

Fever
Roth’s spots = retinal haemorrhages
Osler’s nodes
Murmur - most commonly aortic regurgitation

Janeway lesions
Anaemia
Nail haemorrhages (i.e. splinter haemorrhages)
Emboli

54
Q

What is the diagnostic criteria for infective endocarditis?

A

Duke’s criteria

55
Q

What are the 2 major Duke’s criteria for diagnosis of infective endocarditis?

A
  1. Positive blood culture

2. Evidence of endocardial involvement - abscess, oscillating intracardiac mass on valve, new regurgitation

56
Q

What are the minor Duke’s criteria for diagnosis of infective endocarditis?

A
  1. Predisposing heart condition/IVDU
  2. Fever over 38 degrees
  3. Vascular phenomena e.g. splinter haemorrhages
  4. Immunological phenomena e.g. Osler’s nodes, Roth’s spots
57
Q

How do you define postural hypotension?

A

A drop of blood pressure greater than 20/10 mmHg within 3 min of standing

58
Q

What is the first line drug treatment for postural hypotension?

A

Fludrocortisone - it retains fluid

59
Q

On an ECG, what do the following segments indicate:

  • P wave
  • PR interval
  • QR
  • S
  • T
A

P wave = depolarisation of atria
PR interval = AV node holding onto depolarisation, allowing ventricles to fill
QR = down the bundle of His (towards the lead)
S = purkinje fibres
ST = beginning of ventricular repolarisation
T = repolarisation of ventricles

60
Q

What can cause bradycardia?

A
  • fitness
  • beta-blockers
  • heart block
  • hypothermia
  • hypothyroidism
  • Verapamil (non-dihydropyridine calcium channel blocker)
61
Q

In left axis deviation, which lead would be negative and which would be positive?

A

lead III = negative
lead I = positive

Leaving

62
Q

In right axis deviation, which lead would be negative and which would be positive?

A

lead I = negative
lead III = positive

Reaching

63
Q

What change occurs on an ECG in 1st degree heart block?

A

Prolonged PR interval

64
Q

What change occurs on an ECG in 2nd degree heart block and differentiate between each type.

A 
Mobitz I (problem with AV node)- PR interval gets longer and longer until a QRS is dropped
Mobitz II (problem is after AV node i.e. bundle of His) - fixed PR interval but QRS complexes are regularly missed
65
Q

What change occurs on an ECG in 3rd degree heart block?

A

P waves and QRS complexes appear independently of each other

66
Q

What do you see on an ECG in hyperkalaemia?

A

Tall tented T waves

67
Q

What is the normal range for the PR interval?

A

0.12-2s (3-5 small squares)

68
Q

What syndrome gives a short PR interval?

A

Wolf-Parkinson-White syndrome

It also has additional delta waves seen in the QR area

69
Q

What is the triad of cardiac tamponade?

A

Raised JVP
Hypotension
Muffled heart sounds

70
Q

What condition can thiazides precipitate?

A

Gout

71
Q

What condition can thiazides unmask?

A

Diabetes - thiazides cause higher levels of glucose, LDLs and triglycerides

72
Q

What is a side effect of thiazides that can cause poor compliance in men?

A

Impotence

73
Q

When should you not give nitrates?

A

Aortic stenosis

74
Q

Before starting ACE inhibitors, what should you do?

A

Check renal function

75
Q

What are the 2 types of calcium channel blockers and what are they selective for?

A

Dihydropyridine - amlodipine, nifedipine - selective for vasculature - give in hypertension

Non-dihydropyridines - verapamil, diltiazem - selective for heart - give in SVT e.g. AF

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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