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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
Decubitus Angina
Pain occurs lying down, severe coronary artery disease
26
Nocturnal Angina
Pain at night, vivid dreams, severe coronary artery disease
27
Cardiac Syndrome X
pain unpredicatable, occurs at rest or on exertion, intense pain, lasts for longer period of time than stable angina
28
Cardiac Syndrome X
- 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
29
Aortic Dissection
Pain migrated down aorta, no ECG changes, syncope
30
Aortic Dissection
- Tear in inner wall of aorta allows blood to flow between layers - Medical EmergencyPain migrated down aorta, no ECG changes, syncope
31
Investigations for Angina
ECG, Scintigraphy, echocardiography, MRI, coronary angiography
32
Treatment for Angina
Aspirin, Nitrates, B-blockers, Calcium Channel Blockers
33
Medical Treatment for Angina
Aspirin, Nitrates, B-blockers, Calcium Channel Blockers
34
Surgical Treatment for Angina
- Percutaneous transluminal Coronary Angioplasty (PTCA) - PCI with coated stents - Coronary Artery Bypass Grafts (CABG)
35
Percutaneous transluminal coronary angioplasty (PTCA)
Dilating coronary artery stenosis using an inflatable balloon introduced into the arterial circulation via the femoral, radial or brachial artery
36
CABG
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
Atrial Fibrillation
Cardiac Arrhythmia characterised by an irregularly irregular ventricular rate
38
Pathology of AF
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
Causes of AF (PIRATES)
``` Pulmonary Disease Ischemia Rheumatic Heart Disease Anemia/ Atrial Myxoma Thyrotoxicosis Ethanol/Endocarditis Sepsis/ Sick Sinus Syndrome ```
40
Risk factors of AF
Age, obesity, HTN, diabetes metabolic syndrome, caffeine, alcohol, smoking
41
Symptoms of AF
Asymptomatic, chest pain, palpitations, dyspnoea, faintness
42
Signs of AF
Irregularly irregular pulse rhythm
43
Differentials of AF
Atrial flutter Supraventricular tachyarrhythmia Wolff-Parkinson-White Syndromes Ventricular tachycardia
44
AF on an ECG
Irregularly Irregular rhythm No p waves Irregular baseline Narrow QRS
45
Treatment for AF
Oxygen Amiodarone or flecainide Anticougulant Verapamil, bisprolol, amiodarone
46
Complications of AF
Storke | Heart Failure
47
Hypertension
Blood pressure >140/90mg
48
Causes of HPT
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
Symptoms of HPT
Headache, visual disturbances, sweating, palpitations, epistaxis
50
Signs of HPT
Radio-femoral delay in coarctation of aorta | Renal artery bruits in Renovascular disease
51
Grade 1, 2 and 3 HPT
140/90 160/100 180/110
52
Differentials for HPT
Malignant HPT (short onset) Gestational HPT/ Pregnancy-induced HPT Pre-eclampsia (during pregnancy with proteinuria0
53
Keith-Wagener classification of Retinopathy
Grade 1-4 | Grade 3 and 4 diagnostic of malignant hypertension
54
QRisk Score
Provides risk of suffering MI or stroke within next 10 years based on age, sex, ethnicity, smoking status, family Hx etc
55
Target BP when treating HPT
<140/90
56
Treating Grade 3 HPT of over 180/120 (Malignant HPT)
1. Medical Emergency- Refer for same day specialist treatment 2. Investigate for end-organ damgage 3. Give lifestyle advice
57
Treating Grade 1 and 2 HPT
Offer antihypertensive drug treatment
58
Treating HPT with Anti-hypertensive Drugs
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
Treating a QRisk score >20%
Treat with statin as primary prevention for CVD
60
Target Organ Disease for complications of HPT
Kidneys, Heart and Brain
61
Consequences of Malignant HPT
Acute hypertensive encephalopathy, renal failure, papiloedema, retinal haemorrhages
62
Pre-eclampsia
Gestation HPT and proteinuria after 20 weeks gestation and up to 6 weeks after delivery. Can develop into Eclampsia (seizures during pregnancy)
63
Deep Vein Thrombosis
A venous thrombus in the deep veins of the legs or pelvis. Venous Thomboembolism (VTE) refers to both DVT and PE
64
Causes of DVT
Changes to Virchows Triad: blood flow, vessel, hypercoagulability
65
Risk Factors for DVT
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
Signs and Symptoms of DVT
Asymptomatic in 65%, calf pain, calf swelling, redness, warmth, ankle swelling, mild fever, cyanotic, ulceration, erythema, mild fever, Homan's sign
67
Homan's Sign
Sign of DVT. Discomfort behind the knee upon forced dorsiflexion of the foot while knee is fully extended
68
Differentials for DVT
Cellulitis, Venous eczema, Ruptured Baker's Cyst
69
Investigation for DVT
Two-Level DVT Wells Score
70
What to do with a patient scoring 2 or more on Wells Score
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
Treatment for DVT
- 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
Cardiac Failure
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
Systolic Cardiac Failure
Inability of the ventricle to contract properly with ejection fraction <40%
74
Diastolic Cardiac Failure
Inability of the ventricle to relax and fill normally causing increased filling pressures but ejection fraction fraction >50%.
75
What's Diastolic Cardiac Failure also known as?
Heart Failure with preserved LV function Heart Failure with normal ejection Fraction (HFNEF) Heart Failure with preserved systolic function (HFPSF)
76
Congestive Cardiac Failure
When both sides of the heart aren't working properly
77
4 most common fibrinolytics for MI (STAR)
Streptokinase Tenecteplase Alteplase Reteplase
78
Leading cause of death post-MI
Ventricular tachycardia Ventricular fibrillation Pulseless electrical activity Asytole

Y3 Core Conditions (13 decks)

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