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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
What is the name of the diagnostic score for DVT?
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
26
What test can you do for suspected DVT?
D-dimer | It is sensitive but has low specificity
27
What is first line treatment for DVT?
LMWH | Offer unfractioned heparin if renal impairment
28
What does the leg look like in a DVT?
Red, hot, swollen calf or thigh Distention of superficial veins Pain and tenderness
29
What is post-thrombotic syndrome?
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
30
How does heart failure affect breathing?
Short of breath Reduced exercise tolerance Orthopnoea Paroxysmal nocturnal dysponoea
31
What is the cough like in heart failure?
Nocturnal cough | Pink frothy sputum
32
On auscultation of heart failure what would you hear?
Gallop rhythm due to the presence of S3 Bilateral basal end-inspiratory crackles
33
If no previous MI, what investigations do you do for heart failure?
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
What chest X-Ray signs do you see in pulmonary oedema?
ABCDEF ``` Alveolar oedema - Bat's wings B - Kerley B lines = interstitial oedema Cardiomegaly D - upper lobe diversion Effusions Fluids in fissures ```
35
Describe the pulse pressure in heart failure
Narrow pulse pressure
36
How do you treat heart failure with a preserved ejection systolic fraction?
Loop diuretic | Lifestyle changes - less smoking. alcohol, salt, lose weight
37
What is the treatment of heart failure with a decreased ejection systolic fraction?
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
What is the most common valvular heart disease and what most commonly causes it?
Mitral regurgitation | Mitral valve prolapse
39
What are the 4 grades of hypertensive retinopathy?
1. Tortuous arteries 2. AV nipping 3. Flame haemorrhages and cotton-wool spots 4. Papilloedema
40
What time of murmur is mitral regurgitation and where would you hear it?
Pansystolic Heart at apex with the diaphragm Radiates to axilla - listen with bell
41
What are the 2 systolic murmurs?
Mitral rergugitation | Aortic stenosis
42
What signs do you see in mitral stenosis?
Malar flush Raised JVP Right ventricular hypertrophy - laterally displaced apex beat, RV heave
43
What are the 2 diastolic murmurs and where do you hear them?
Mitral stenosis - at apex with bell | Aortic regurgitation - at tricuspid area with patient leaning forward and holding breath
44
What is the pulse like in aortic regurgitation?
Collapsing water hammer pulse Wide pulse pressure
45
What is De Musset's sign?
Head-bobbing due to aortic regurgitation
46
What is the classic triad of aortic stenosis?
Angina Syncope Heart failure
47
What are the 'end pieces' for cardiovascular examination?
Abdominal examination Peripheral vascular examination Lying and standing blood pressure Fundoscopy
48
What is the most common cause of mitral stenosis?
Rheumatic heart disease
49
What is the most common cause of aortic stenosis?
Calcification of a congenital bicuspid valve
50
What is the order of the most commonly affected valves in Rheumatic heart disease?
1. Mitral valve 2. Aortic 3. Mitral and aortic 4. Tricuspid 5. Pulmonary - v rare
51
What are the most common organisms to cause infective endocarditis?
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
How would infective endocarditis present (symptoms)?
With non-specific symptoms such as fatigue, low grade fever, flu-like symptoms, polymyalgia
53
What are the signs for endocarditis?
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
What is the diagnostic criteria for infective endocarditis?
Duke's criteria
55
What are the 2 major Duke's criteria for diagnosis of infective endocarditis?
1. Positive blood culture | 2. Evidence of endocardial involvement - abscess, oscillating intracardiac mass on valve, new regurgitation
56
What are the minor Duke's criteria for diagnosis of infective endocarditis?
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
How do you define postural hypotension?
A drop of blood pressure greater than 20/10 mmHg within 3 min of standing
58
What is the first line drug treatment for postural hypotension?
Fludrocortisone - it retains fluid
59
On an ECG, what do the following segments indicate: - P wave - PR interval - QR - S - T
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
What can cause bradycardia?
- fitness - beta-blockers - heart block - hypothermia - hypothyroidism - Verapamil (non-dihydropyridine calcium channel blocker)
61
In left axis deviation, which lead would be negative and which would be positive?
lead III = negative lead I = positive Leaving
62
In right axis deviation, which lead would be negative and which would be positive?
lead I = negative lead III = positive Reaching
63
What change occurs on an ECG in 1st degree heart block?
Prolonged PR interval
64
What change occurs on an ECG in 2nd degree heart block and differentiate between each type.
``` 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
What change occurs on an ECG in 3rd degree heart block?
P waves and QRS complexes appear independently of each other
66
What do you see on an ECG in hyperkalaemia?
Tall tented T waves
67
What is the normal range for the PR interval?
0.12-2s (3-5 small squares)
68
What syndrome gives a short PR interval?
Wolf-Parkinson-White syndrome | It also has additional delta waves seen in the QR area
69
What is the triad of cardiac tamponade?
Raised JVP Hypotension Muffled heart sounds
70
What condition can thiazides precipitate?
Gout
71
What condition can thiazides unmask?
Diabetes - thiazides cause higher levels of glucose, LDLs and triglycerides
72
What is a side effect of thiazides that can cause poor compliance in men?
Impotence
73
When should you not give nitrates?
Aortic stenosis
74
Before starting ACE inhibitors, what should you do?
Check renal function
75
What are the 2 types of calcium channel blockers and what are they selective for?
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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