Cardiovascular Flashcards
Common conditions: ACS, AF
ACS.
a) Give the three types
b) What do they all have in common?
c) Define them in terms of ECG and troponin findings
STEMI - acute chest pain and persistent ST elevation (>20 mins)
NSTEMI - acute chest pain w/o persistent ST elevation but with raised troponins
Unstable angina - acute chest pain w/o persistent ST elevation and normal troponins
a) ECG findings other than STE indicative of ACS
b) ECG finding indicative of previous MI
c) Other than Q, ST and T changes, what ECG finding is indicative of new ischaemia?
a) Transient (<20 mins) ST elevation, ST depression, T wave inversion/ flattening/ pseudonormalisation.
b) Pathological Q wave (>25% depth of associated R wave)
c) New LBBB
Atherosclerosis.
a) Process
b) 5 modifiable RFs
c) 4 non-modifiable
a) Chronic endothelial injury, inflammation and accumulation of plaque (fat, cholesterol, calcium), hardens over time and narrows the arteries
b) smoking, DM, HTN, dyslipidaemia, obesity, poor exercise
c) age, male, FHx, premature menopause
ACS presentation.
a) Chest pain lasting longer than ___mins or ___-onset
b) Features of the pain
c) 5 other common Sx
d) CV examination findings:
a) 20 mins or new onset
b) Radiation to arm/jaw, central crushing
c) Diaphoresis, nausea, vomiting, SOB, palpitations
d) Low-grade fever, pale and clammy, dyskinetic cardiac impulse, S3 and S4, pansystolic (MR) murmur
ACS differentials
a) Differentials for chest pain: what 3/4 systems?
b) Other symptoms - give DD i) Syncope, ii) Fever, iii) Haemodynamic instability, iv) Previous leg symptoms, v) Tenderness over area, vi) Worse lying flat, vii) Cough, vii) SOB, reduced unilateral chest movement
c) For PE suspected - i) score, ii) tests, iii) treatment
a) CV, resp, GI, psych?
b) i) AS/AF, ii) Pneumonia, pericarditis, iii) Aortic dissection, massive PE, iv) DVT, v) costochondritis, vi) pericarditis, GORD, vii) pneumonia, viii) pneumothorax
c) i) Wells - suspected DVT (3), alternative less likely than PE (3), tachycardic (1.5), immobile >3 days in last 4wks (1.5), Hx of VTE (1.5), haemoptysis (1), malignancy (1)
ii) Leg U/S, D-dimer, CTPA,
iii) ABC, O2, IV access, analgesia, LMWH (5/7 and INR 2-3), then warfarin 3/12
ACS primary investigations
a) Name the main two
b) What troponins are measured?
c) How long post-infarction are troponins detectable? And how long do they stay raised for?
d) When do troponin levels peak?
e) When are troponins tested for?
f) Other cardiac enzyme (lower sensitivity/specificity)
a) ECG, trops
b) I and T
c) 3-6h until up to 14 days
d) 12-24h post-MI
e) At 6h and 12h post-MI
f) Cardiac creatine kinase (CK-MB)
ACS other investigations
a) Why is FBC useful?
b) Give 5 other blood tests done
c) Gold standard for assessing the presence and severity of coronary artery disease
d) Other imaging
a) Baseline clotting for anticoagulation, anaemia, leucocytosis common
b) U&E, creatinine, glucose, lipids, clotting screen, TFT, CRP,
c) Coronary angiography
d) CXR
GTN
a) Should response to GTN be used in assessment of ACS?
b) MoA
c) Patient with pre-existing angina - advice for GTN
a) no
b) vasodilator
c) Attack occurs»_space; stop and rest»_space; 1st GTN»_space; 2nd GTN at 5mins if still pain»_space; 3rd GTN after further 5 mins if still pain»_space; call 999 if still pain 15 mins post-onset or getting worse or feeling unwell
MI prehospital management
a) 3 (or 4 drugs) - give loading dose for one
b) If initial call to hospital arrival is likely to be >30 mins, or it is likely that onset to PCI is likely to be >120 mins, do what? (what is given prehospital)
a) Morphine, Aspirin (300mg), GTN
b) Thrombolysis - reteplase or tenecteplase
MI primary hospital management
a) Two main treatments
b) What is the cut-off time to decide between the two?
c) What thrombolytics are given in hospital (vs pre-hospital) - how are they administered?
d) Cut-off time point for thrombolysis. - outside of this what should be given?
e) In what cases is CABG used for acute MI? (rare)
a) PCI or medical thrombolysis
b) <120 mins since onset: PCI; >120 mins: thrombolyse
c) Streptokinase or alteplase (IV infusion)
d) Within 12h - give aspirin, clopidigrel and heparin
e) Failed PCI, refractory symptoms post-PCI, cardiogenic shock, multi-vessel disease
Other initial MI management
a) 2 antiplatelets
b) 4 other CV drugs classes
c) Who should receive oxygen?
d) Who should receive nitrates?
e) If sublingual GTN is ineffective, what other nitrates might be tried?
a) Aspirin, clopidogrel (or ticagrelor)
b) BBs, ACE, statin, anticoagulant
c) Hypoxic, or evidence of pul oedema or continued ischaemia
d) Those in pain
e) IV GTN or IV isosorbide dinitrate
Long term management
a) Continue what drugs long-term from above
b) Prescribe what PRN
a) aspirin, clopidogrel, BB, ACE, statin
b) GTN
Atrial Fibrillation (AF).
a) The most common…?
b) Characterised by an…?
c) Effects: i) Cardiac, ii) Thromboemboli - how?
a) Sustained cardiac arrhythmia
b) Irregularly irregular pulse
c) Reduced CO, blood stagnation in atria
AF terminology.
a) Acute
b) Paroxysmal
c) Recurrent
d) Persistent
e) Permanent
a) Onset within previous 48h
b) Spontaneous termination within 1 week
c) Two or more episodes
d) Not self-terminating; lasting >1 week or requiring cardioversion
e) > 1 year, not successfully resolved through cardioversion
AF aetiology.
a) Most common causes
b) Valvular cause
c) Other
a) CHD, HTN,
b) Mitral stenosis
c) Hyperthyroid, alcohol, cocaine, caffeine, obesity
