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Cardiovascular Flashcards

1
Q

Pericarditis presentation

A
  • Central chest pain worse lying flat
  • ?Fever
  • ?Pericardial rub
  • ECG- saddle shaped
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2
Q

Diastolic Murmurs

A
  1. Aortic Regurg
  2. Mitral Stenosis
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3
Q

Heart Failure Management

A
  • Acute- sit up, morphine, GTN, furosemide, NIV
  • ACEi/ ARB, Aspirin, Atorvastatin, Beta blocker, Diuretic
  • Avoid NSAIDs, CCB!
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4
Q

Features of Aortic Stenosis

A
  • Murmur- upper R sternal border –> carotids. Systolic crescendo-decrescendo
  • Sx Triad- Chest pain, SOB, syncope
  • Cause- esp senile calcification
  • Tx- valve replacement
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5
Q

Features of Mitral Regurgitation

A
  • Murmur- Apex –> axilla. Pansystolic rumble. S
  • x- palpitations, SOB
  • Causes- senile, infectiove endocarditis, marfans
  • Tx- valve replacement
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6
Q

Syncope differentials

A
  • Orthostatic BP- hypovolaemia, drug induced, PD, diabetic neuropathy
  • Neurally mediated- Carotid sinus sensitivity, situational
  • Neurocardiogenic- vasovagal
  • Cardiac- arrhythmias
  • Cardiac- structural
  • Cardiocascular- MI, PE, aortic dissection
  • Non-syncopal- CVA, metabolic, epilepsy, intoxication, falls
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7
Q

Heart Failure CXR findings

A
  • Alveolar oedema (bats wings)
  • kurley B lines
  • Cardiomegaly
  • Dilated upper lobe vessels
  • Effusion (pleural)
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8
Q

Management of ACS

A
  1. ABCDE
  2. Morphine + metoclopramide
  3. Aspirin 300 mg 1 dose –> 75mg
  4. GTN spray
  5. Clopidogrel/ ticagrelor
  6. LMWH- Fundoparineux
  7. Revascularisation- PCI/ CABG
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9
Q

Hypertensive Crisis and Tx

A
  • Hypertensive crisis= BP >200/120
  • Absence of end organ damage –> PO
  • End organ damage –> IV hydralazine/labetalol/nitroprusside/ GTN
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10
Q

Pericarditis treatment

A

NSAIDs, colchicine

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11
Q

Wolf-Parkinson-White ECG

A

Short PR interval and delta wave

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12
Q

Degrees of Heart Block and ECG features

A
  • 1st- Consistently prolonged PR
  • 2nd degree Mobitz 1- PR progressively lengthened –> dropped QRS
  • 2nd degree Mobitz 2- Prolonged PR, QRS regularly dropped
  • 3rd degree- no relation between p waves and QRS ==> Tx: pacemaker
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13
Q

Features of cardiac syncope

A
  • Sudden onset and recovery
  • No prodrome
  • Sx- palpitations, SOB, chest pain FHx????
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14
Q

Infective Endocarditis management

A
  • ABx- ampicillin + flucloxacillin + gentamicin IV
  • Surgical debridement/ valve replacement
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15
Q

Types fo ACS

A
  • Unstable Angina
  • NSTEMI
  • STEMI
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16
Q

Causes of sudden cardiac death

A
  • Coronary artery disease
  • Cardiomyopathies- Dilated, hypetrophic (children/athletes), restrictive, arrhythmogenic R ventricular cardiomyopathy
  • Inherited arrhythmia syndromes- long QT, CPVT
  • Valvular heart disease
  • Channelopathies eg Brugada syndrome
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17
Q

What is this ECG?

A

Atrial Fibrillation

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18
Q

Heart Failure Ix

A

ECG, BNP, ECHO

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19
Q

Symptoms of RHF

A

PeRipheral Oedema:

  • Ankle swelling
  • Ascites
  • Nausea
  • Anorexia
  • Facial engorgement
  • Epistaxis
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20
Q

Signs of familial hyperlipidaemia

A
  • Tendon xanthoma
  • Corneal arcus
  • Xanthelasma
  • Palmar xanthoma
  • Tuberoeruptive xanthoma
  • Eruptive xanthoma
  • Lipaemia retinalis
21
Q

Narrow complex tachycardias + Tx

A
  • AF –> beta blocker/ diltiazem –> digoxin –> amiodarone
  • SVT –> vagal manoevers –> adenosine 6mg –> 12mg –> 12mg Atrial flutter –> HELP! and beta blocker
22
Q

Treatment of bradycardia

A
  • Atropine 500 micrograms IV (repeat max 3mg)
  • Isoprenaline
  • Adrenaline
  • Transcutaneous pacing
23
Q

What is the Cushing’s reflex?

A

Raised ICP –> bradycardia and hypertension

24
Q

Features making SVT more likely than sinus tachycardia

A
  • ++HR and drops suddenly
  • Rate doesn’t vary with respiration
  • Hard to see p waves
  • Responds to vagal manoevers
  • ++ Sx and palpitations
25
Q

Broad complex tachycardias + Tx

A
  • VT –> amiodarone/ D/C cardioversion. PULSE?
  • AF with BBB
  • Torsades de Pointes –> Magnesium 2g IV over 10mins
26
Q

Presentation of Infective Endocarditis

A
  • New heart murmur
  • Fever + signs of sepsis
  • Immune complex deposition- vasculitis, AKI, glomerulonephritidies, Roth spots, splinter haemorrhages, osler nodes
  • Embolic phenomena- Abscesses, janeway lesions
27
Q

Infective Endocarditis diagnostic criteria

A

Dukes:

  • Major: +ve blood culture x2, + ECHO
  • Minor: Predisposed, Fever >38, Vascular/ immunological signs, +ve blood culture/ ECHO that don’t meet criteria.
  • Dx: 2x major OR 1x major and 3x minor OR 5x minor
28
Q

What is QRISK2?

A
  • 10 year CVD risk. >10% –> treat with statins. Involves:
    • Age
    • Sex
    • Ethnicity
    • Post-code
    • Smoking status
    • DM
    • MI
    • <60y
    • CKD
    • BP
    • RA
    • BMI
29
Q

MI Diagnostic criteria

A

Troponin 99th Percentile + rise or fall of 20% and 1 of the following:

  1. Ischaemic Sx
  2. ECG- ST elevation/ new LBBB
  3. ECG- pathological Q wave
  4. Imaging- loss of viable myocardium
  5. Angiography- intracoronary thrombus
30
Q

Hypertension Stages

A
  1. >140/90 (135/85)
  2. >160/100 (150/95)
  3. >180/110. EMERGENCY
31
Q

Features of Aortic Regurgitation

A
  • Murmur- LSE, ++ leaning forward. Early diastolic decrescendo.
  • Sx: SOB, collapsing pulse, palpitation, syncope
  • Causes: Infective endocarditis, Marfan’s
  • Tx: ACEi, valve replacement
32
Q

Symptoms of LHF

A

PuLmonary Oedema:

  • SOB, orthopnoea, PND
  • Poor exercise tolerance
  • Nocturnal cough +/- pink frothy sputum
  • Cold peripheries
  • Weight loss
33
Q

Definition of Hypotension

A

SBP <100 mmHg

34
Q

Types of Hyperlipidaemia

A
  • Common primary (70%)
  • Familial primary hyperlipidaemia
  • Secondary hyperlipidaemia- Cushing’s, hypothyroid, nephrotic syndrome, renal failure, drugs eg corticosteroids
35
Q

Systolic Murmus

A
  • Aortic Stenosis
  • Mitral Regurg
36
Q

Target BP

A
  • <80y= 140/90
  • >80y= 150/90
  • Established CVD, DM + kidney/eye disease= 130/80
37
Q

Secondary causes of hypertension and Ix

A
  • Renal artery stenosis –> urine dip
  • Phaeochromocytoma –> urine catecholamines and plasma metanephrines
  • Conn’s
  • Thyroid dysfunction –> TFTs
  • Acromegaly –> IGF-1
  • Cushings –> urinary free cortisol and dexamethasone suppression
  • Obstructive Sleep apnoea
38
Q

Treatment of hyperlipidaemia

A
  • 1st = lifestyle
  • 2nd= atorvastatin
  • 3rd= fibrates
39
Q

ACS Post-Hospital discharge

A
  • ACEi/ Aspirin
  • Beta blockers/ BP<140
  • Cholesterol (atorvastatin)
  • Diet/ Diabetes control/ Driving (stop 1-4w)
  • Education/ Exercise
  • Cardio rehab
40
Q

Rheumatic Fever management

A

Bed rest, analgesia, Ben Pen

41
Q

Definition of postural hypotension

A

BP drop >20/10mmHg measured 1 min after standing from lying position

42
Q

Features of Mitral Stenosis

A
  • Murmur- Apex, ++ rolling patient to side. Mid-diastolic rumble.
  • Sx: SOB, malar flush, haemoptysis, chest pain, palpitations
  • Causes: Esp rheumatic fever
  • Tx: AF control, diuretics, valve replacement
43
Q

Time course of Rheumatic fever

A

Pharyngeal infection with Strep –> RF 2-4w later

44
Q

AF management

A
  • Rhythm control <48h- D/C electrical shock or amiodarone/ flecainide
  • Rate control- beta blocker/ CCB (verapmil, diltizem)
  • Anticoagulation based on CHA2DS2VASc and HASBLED
45
Q

Tachyarrhythmia + adverse features action

A

D/C shock x3 –> Amiodarone 300mg –> Repeat shock –> Amiodarone 900mg over 24h

46
Q

Treatment of Hypertension

A
  1. <55y= ACEi/ ARB >55y or Afro-Caribbean= CCB eg amlodipine (hydralazine for Afro-Caribbean)
  2. ACEi + CCB
  3. ACEi + CCB + Thiazide diuretic
  4. ACEi + CCB + Thiazide diuretic + Increase dose of diuretic/ switch diuretic, or add beta blocker
47
Q

Management of angina pectoris

A
  1. Stop CVS RF
  2. 75mg aspirin
  3. PRN GTN (2x –> ambulance)
  4. Antianginals: beta blocker/ CCB –> isosorbide mononitrate
  5. Revascularisation
48
Q

Causes, features, Ix, Tx of cardiac tamponade

A
  • Causes- trauma, lung/ breast Ca, MI, pericarditis
  • Signs:
    • Pulsus paradoxus
    • Beck’s triad- falling BP, rising JVP, muffled HS
    • Raised JVP on inspiration
  • Ix:
    • ECG- electrical alternans
    • CXR- globular heart
    • ECHO diagnostic
  • Tx: pericardiocentesis ASAP!

Finals!!! (19 decks)

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