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Y3 Core Conditions > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Acute Coronary Syndromes

A

Group of symptoms attributing to obstruction of the coronary arteries including STEMI, NSTEMI and unstable angina

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2
Q

Chest pain duration in an Unstable Angina

A

<20 minutes in unstable angina and over 20 minutes in NSTEMI or STEMI

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3
Q

Troponin level in Unstable Angina, STEMI and NSTEMI

A

Normal in UA, increased in STEMI and NSTEMI

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4
Q

How common are STEMI

A

5/1000

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5
Q

Causes of Stable Angina

A

Atherosclerosis –> narrowing of coronary artery –> cardiac oxygen needs are not met –> myocardial ischaemia –> chest pain

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6
Q

Causes of Unstable Angina

A

Rupture of atherosclerotic plaque –> platelets stimulated –> thrombolysis –> more frequent and severe pain

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7
Q

Causes of Myocardial Infarction

A

Thrombus forms and occludes artery

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8
Q

Symptoms of Acute Coronary Syndromes

A

Chest pain lasting >20 minutes, radiating to neck and left arm, nausea, sweating, dyspnoea, palpitations

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9
Q

Differential Diagnosis of Acute Coronary Syndromes

A

Stable Angina: pain on exertion, relieved by rest
Acute pericarditis: burning/ sharp pain, radiates to neck, worse on coughing
GORD, Aortic dissection, myocarditis, PE

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10
Q

Investigations for Acute Coronary Syndromes

A

ECG, CXR, Markers: Creatinine-Kinase MB, cardiac troponin, myoglobin

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11
Q

How does a STEMI show on an ECG

A

ST elevation, Q wave, New LB, tall T waves

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12
Q

How does a NSTEMI show on an ECG

A

Inverted T Waves

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13
Q

Risk Stratification for Acute Coronary Syndromes

A
  • Thrombolysis in Myocardial Infaction (TIMI) Score

- Global Registery of Acute Coronary Events (GRACE) prediction score

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14
Q

Immediate treatment for Acute Coronary Syndromes: ROMANCE

A 
Reassure
Oxygen
Morphine 5-10mg IV, repeat after 5-10 mins 
Aspirin 300mg PO
Nitrates GTN Spray
Clopidogrel 300mg PO
Enoxaprin/ Fondaparinum 2.5mg 
ECG
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15
Q

Treatment for NSTEMI

A

B-Blocker: atenolol 5mg IV
Fondaparinux
Nitrates

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16
Q

Treatment for STEMI

A
  • Percutaneous Coronary Intervention (PCI) or angioplasty
  • Fibrinolysis if PCI not possible
  • B-blocker: Atenolol 5mg IV
  • ACEi
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17
Q

Prognosis of Acute Coronary Syndromes

A

50% of deaths occur within 2hrs of onset of symptoms

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18
Q

Complications of Coronary Acute Syndromes

A

Cardiac Arrest, Unstable Angina , Heart Failure, Cardiogenic Shock, Myocardial rupture, Ventricular Septal Defects, Mitral Regurgitation, Cardiac arrhythmias, Post MI Pericarditis and Dressler’s Syndrome

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19
Q

Dressler’s Syndrome

A

Recurrent pericarditis, pleural effusions, anaemia, increase ESR, fever, 1-3 weeks after MI

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20
Q

Angina Pectoris

A

Chest pain that accompanies periods of myocardial ischaemia

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21
Q

Signs on examination of Angina Pectoris

A

4th Heart sound may be heard
Anaemia
Thyrotoxicosis
Hyperlipidaemia - corneal arcus, xanthelasma, tendon xanthoma

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22
Q

Symptoms of Angina Pectoris

A

Chest pain, pain radiating to jaw and left arm, SOB, sweatiness

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23
Q

Unstable Angina

A

Pain at rest and on exertion, more severe, unpredictable and frequent pain

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24
Q

Prinzmetal’s (Variant) Angina

A
  • Pain on rest and no risk factors for atherosclerosis
  • Due to coronary artery spasm
  • ECG shows ST elevation
  • Treated with Ca channel blockers and nitrates not aspirin or beta-blockers as can aggravate ischaemic attacks
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25
Q

Decubitus Angina

A

Pain occurs lying down, severe coronary artery disease

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26
Q

Nocturnal Angina

A

Pain at night, vivid dreams, severe coronary artery disease

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27
Q

Cardiac Syndrome X

A

pain unpredicatable, occurs at rest or on exertion, intense pain, lasts for longer period of time than stable angina

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28
Q

Cardiac Syndrome X

A
  • Angina with normal coronary arteries
  • Pain unpredicatable, occurs at rest or on exertion, intense pain, lasts for longer period of time than stable angina
  • ECG shows ST depression (opposite to Prinzmetal’s)
  • Treated with Ca blockers, beta-bockers and nitrates
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29
Q

Aortic Dissection

A

Pain migrated down aorta, no ECG changes, syncope

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30
Q

Aortic Dissection

A
  • Tear in inner wall of aorta allows blood to flow between layers
  • Medical EmergencyPain migrated down aorta, no ECG changes, syncope
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31
Q

Investigations for Angina

A

ECG, Scintigraphy, echocardiography, MRI, coronary angiography

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32
Q

Treatment for Angina

A

Aspirin, Nitrates, B-blockers, Calcium Channel Blockers

33
Q

Medical Treatment for Angina

A

Aspirin, Nitrates, B-blockers, Calcium Channel Blockers

34
Q

Surgical Treatment for Angina

A
  • Percutaneous transluminal Coronary Angioplasty (PTCA)
  • PCI with coated stents
  • Coronary Artery Bypass Grafts (CABG)
35
Q

Percutaneous transluminal coronary angioplasty (PTCA)

A

Dilating coronary artery stenosis using an inflatable balloon introduced into the arterial circulation via the femoral, radial or brachial artery

36
Q

CABG

A

Veins or arteries are anastomosed to the ascending aorta and to the native coronary arteries distal to the area of stenosis, decreased angina symptoms, increased exercise tolerance, increase 10 year survival

37
Q

Atrial Fibrillation

A

Cardiac Arrhythmia characterised by an irregularly irregular ventricular rate

38
Q

Pathology of AF

A

Dilation of the atria can lead to decrease in atrial muscle mass and fibrosis. The muscles generate random disorganised electrical impulses overriding the SA node.

39
Q

Causes of AF (PIRATES)

A 
Pulmonary Disease
Ischemia
Rheumatic Heart Disease
Anemia/ Atrial Myxoma 
Thyrotoxicosis
Ethanol/Endocarditis
Sepsis/ Sick Sinus Syndrome
40
Q

Risk factors of AF

A

Age, obesity, HTN, diabetes metabolic syndrome, caffeine, alcohol, smoking

41
Q

Symptoms of AF

A

Asymptomatic, chest pain, palpitations, dyspnoea, faintness

42
Q

Signs of AF

A

Irregularly irregular pulse rhythm

43
Q

Differentials of AF

A

Atrial flutter
Supraventricular tachyarrhythmia
Wolff-Parkinson-White Syndromes
Ventricular tachycardia

44
Q

AF on an ECG

A

Irregularly Irregular rhythm
No p waves
Irregular baseline
Narrow QRS

45
Q

Treatment for AF

A

Oxygen
Amiodarone or flecainide
Anticougulant
Verapamil, bisprolol, amiodarone

46
Q

Complications of AF

A

Storke

Heart Failure

47
Q

Hypertension

A

Blood pressure >140/90mg

48
Q

Causes of HPT

A

Genetics, low foetal birth weight, obesity, smoking, alcohol, stress, sodium, Metabolic Syndrome (Increased BP, sugar, body fa and cholesterol),Adrenal hyperplasia, aortic coarctation, II hydroxylase deficiency, renal disease, endocirne disease, the pill, NSAID, cyclosporin, Steroids, pregnancy, white coat syndrome

49
Q

Symptoms of HPT

A

Headache, visual disturbances, sweating, palpitations, epistaxis

50
Q

Signs of HPT

A

Radio-femoral delay in coarctation of aorta

Renal artery bruits in Renovascular disease

51
Q

Grade 1, 2 and 3 HPT

A

140/90
160/100
180/110

52
Q

Differentials for HPT

A

Malignant HPT (short onset)
Gestational HPT/ Pregnancy-induced HPT
Pre-eclampsia (during pregnancy with proteinuria0

53
Q

Keith-Wagener classification of Retinopathy

A

Grade 1-4

Grade 3 and 4 diagnostic of malignant hypertension

54
Q

QRisk Score

A

Provides risk of suffering MI or stroke within next 10 years based on age, sex, ethnicity, smoking status, family Hx etc

55
Q

Target BP when treating HPT

A

<140/90

56
Q

Treating Grade 3 HPT of over 180/120 (Malignant HPT)

A
  1. Medical Emergency- Refer for same day specialist treatment
  2. Investigate for end-organ damgage
  3. Give lifestyle advice
57
Q

Treating Grade 1 and 2 HPT

A

Offer antihypertensive drug treatment

58
Q

Treating HPT with Anti-hypertensive Drugs

A
  1. For people <55yo and not of African origin, offer ACEi or ARB
    For people over 55yo or of African origin, offer a CCB or a Diuretic
  2. If not controlled offer combined therapy of ARB, ACE and Diuretic
59
Q

Treating a QRisk score >20%

A

Treat with statin as primary prevention for CVD

60
Q

Target Organ Disease for complications of HPT

A

Kidneys, Heart and Brain

61
Q

Consequences of Malignant HPT

A

Acute hypertensive encephalopathy, renal failure, papiloedema, retinal haemorrhages

62
Q

Pre-eclampsia

A

Gestation HPT and proteinuria after 20 weeks gestation and up to 6 weeks after delivery. Can develop into Eclampsia (seizures during pregnancy)

63
Q

Deep Vein Thrombosis

A

A venous thrombus in the deep veins of the legs or pelvis. Venous Thomboembolism (VTE) refers to both DVT and PE

64
Q

Causes of DVT

A

Changes to Virchows Triad: blood flow, vessel, hypercoagulability

65
Q

Risk Factors for DVT

A

Increasing age, Obesity, varicose veins, long travel, immobility, pregnancy, PE, thrombophilia, Antithrombin deficiency, Protein C or S deficiency, Factor V Leiden, Prothrombin gene variant, Antiphospholipid antibody, Oestrogen therapy, Plasminogen deficiency

66
Q

Signs and Symptoms of DVT

A

Asymptomatic in 65%, calf pain, calf swelling, redness, warmth, ankle swelling, mild fever, cyanotic, ulceration, erythema, mild fever, Homan’s sign

67
Q

Homan’s Sign

A

Sign of DVT. Discomfort behind the knee upon forced dorsiflexion of the foot while knee is fully extended

68
Q

Differentials for DVT

A

Cellulitis, Venous eczema, Ruptured Baker’s Cyst

69
Q

Investigation for DVT

A

Two-Level DVT Wells Score

70
Q

What to do with a patient scoring 2 or more on Wells Score

A

An USS within 4 hours and if negative, a D-Dimer Test

If not within 4 hours, a D-Dimer test and a 24 hour dose of a parenteral anticoagulant

71
Q

Treatment for DVT

A
  • LMWH: Fondaparinux for 5 days until INRis less than 2
  • Warfarin with LMWH for 3 months then review
  • Catheter-directed thrombolytic therapy
  • Compression stockings
  • Inferior vena caval filters
72
Q

Cardiac Failure

A

When the heart is unable to supply a sufficient cardiac output to meet the body’s needs secondary to any structural or functional cardiac disorder.

73
Q

Systolic Cardiac Failure

A

Inability of the ventricle to contract properly with ejection fraction <40%

74
Q

Diastolic Cardiac Failure

A

Inability of the ventricle to relax and fill normally causing increased filling pressures but ejection fraction fraction >50%.

75
Q

What’s Diastolic Cardiac Failure also known as?

A

Heart Failure with preserved LV function
Heart Failure with normal ejection Fraction (HFNEF)
Heart Failure with preserved systolic function (HFPSF)

76
Q

Congestive Cardiac Failure

A

When both sides of the heart aren’t working properly

77
Q

4 most common fibrinolytics for MI (STAR)

A

Streptokinase
Tenecteplase
Alteplase
Reteplase

78
Q

Leading cause of death post-MI

A

Ventricular tachycardia
Ventricular fibrillation
Pulseless electrical activity
Asytole

Y3 Core Conditions (13 decks)

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