Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

New Cards > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Hypertension

Stages 3
Rx 4
Normal targets 2
Lifestyle advice

A

Def…
Stage 1: ≥140/90, then ABPM/HBPM of ≥135/85
Stage 2: ≥160/100, then ABPM/HBPM of ≥150/95
SEVERE: sys≥180, dias≥110

Rx…
1. A or C
2. A + C
3. A + C + D
4. Add spiro if K ≤4.5, or (stronger thiazide diuretic if greater)
If further diuretic contraindicated/ineffective then + B (alpha or beta blocker)
If no response then - RESISTANT HYPERTENSION therefore refer

Normal…
Less than 80 yo: <140/90 (clinic), <135/85 (ambulatory/home)
Over 80 yo: <150/90, <145/85

Lifestyle…

  • Reduce salt (<6mg/d, ideally 3mg/d) and caffeine
  • Lower weight and regular exercise
  • Stop smoking and lower alcohol intake
  • Balanced diet (rich in fruit and veg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for CVD

Non-mod 4; Mod 7

A

Non-mod:

  1. Age
  2. FH
  3. Male
  4. Ethnicity

Mod:

  1. BP
  2. Lipids
  3. Smoking
  4. Alcohol
  5. Exercise
  6. Weight
  7. Diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

QRISK every 5 years, except with…

5

A
  1. Hx of CVD
  2. Familial hypercholesterolaemia
  3. Age ≥85
  4. T1DM (sometimes QRISK3 helpful)
  5. CKD (sometimes QRISK3 helpful)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If 10% 10-year CVD risk…

3

A
  1. Discuss pros and cons of statin (atorvastatin 20mg)
  2. Lifestyle discussion
  3. Treat co-morbidities, e.g. BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Offer statins in over 10% QRISK2 score and…

2

A
  1. T1DM if >40, DM for 10 years, nephropathy
  2. Over 85 - consider(!) offering statin

[T2DM - carry out QRISK2 as normal]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chest pain causes

Causes by system - 6

A
  1. Cardiac
  2. Resp
  3. GI
  4. Msk
  5. Psych
  6. Non-specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chest pain causes

Features - subcategories - 4

A
  1. Tight, pressure, central, radiation to shoulder/jaw/arm/neck —> ISCHAEMIC
  2. Pleuritic —> think PE
  3. Tearing, between shoulder blades —> think DISSECTING AORTIC ANEURYSM
  4. Relieved by sitting forward —> think PERICARDITIS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

?ACS

Referral (3)

A

999

Pain right now
ECG new changes

Rx: GTN (&/or opioid, e.g. IV diamorphine), O2 if sats <94%, Aspirin 300mg (unless CI)

  • SAME-DAY ASSESSMENT* - currently pain-free
  • Pain in last 12h, normal ECG, no complications
  • Pain 12-72h, no complications

WITHIN 2 WKS - currently pain free
- Pain >72h, no complications
(Can consider assessment for ACS in 1º care - ECG, trop - & consider aspirin 75mg, GTN stat —> 5 mins —> 999)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ACS Severity Heirarchy

3

A

Unstable angina —> NSTEMI —> STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Unstable angina & NSTEMI Mx

Initial; High risk; If insufficient; Long-term

A

INITIAL

  • Oxygen
  • Nitrates
  • Morphine
  • Aspirin + Clopidogrel / Prasrugrel (if undergoing PCI)
  • also: LMWH, B-blockers indefinitely (if CI, then diltiazem or verapamil)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Secondary prevention (+ statins)

Offer ____ (1)

If history of ____ (5 eg)

A

Offer ATORVASTATIN 80mg (seek specialist advice if contraindicated)

If history of CVD
- eg MI, angina, stroke, TIA, PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Statin side-effects

3

A

Headache

GI disturbance

Myalgia

(N.B. Remember link with grapefruit juice - may increase statin concentration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Monitoring of statins

3

A
  1. Lipids - at 3/12, aim for 40% drop in non-HDL cholesterol
  2. LFTs - at 3/12 and 12/12
  3. CK - if unexplained muscle symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Angina…

…caused by myocardial ischaemia (5)

A
  1. CAD (atheroma)
  2. Aortic stenosis
  3. HOCM
  4. Htn
  5. Coronary artery spasm (Prinzmetal’s)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Angina…

…Ix (3)

A
  1. Resting ECG may be normal
  2. Exercise ECG may show ST depression
  3. Exercise myocardial perfusion scans may be useful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Angina…

…symptom control
3

A
  1. Acute —> GTN
  2. Prevention 1 —> B blocker OR Ca channel blocker
  3. Prevention 2 —> monotherapy: Long-acting nitrate (ISMN) / Nicorandil / Ivabradine / Ranolazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Angina…

…Interventions (2)

A
  1. PTCA
    = percutaneous transluminal coronary angioplasty - inflating a balloon to correct atheromatous obstructions
  2. CABG
    = coronary artery bypass grafting - multivessel disease, failed PTCA, etc (a vessel, e.g. internal mammary artery, is used to bypass the blocked areas)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Angina…

…2º prevention
3

A
  1. Consider antiplatelet - usually aspirin 75mg OD (may already be on clopidogrel)
  2. Consider ACEi if diabetes (other conditions as per NICE guidance)
  3. Statin/Hypertension treatment as per NICE guidance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MI definition

A

= myocardial infarction

= death of heart muscles due to ischaemia, usually due to ruptured plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MI diagnosis

3

A

Overall: symptoms + ECG + troponin

  1. Features: pale, sweaty, cardiac pain, unwell
  2. ECG: STE, T wave inversion, tall T waves, STD, Q waves
  3. Troponin, CK, AST, LDH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MI types

2

A

STEMI (usually full blockage)

NSTEMI (usually partial blockage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MI treatment

2

A

Reperfusion by PCI (PTCA) preferred

OR

Fibrinolysis (if PCI not possible within 120 minutes)
E.g. with streptokinase/alteplase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Post-MI Mx

3

A
  1. Lifestyle (eg smoking, diet)
  2. Cardiac rehab programme & exercise
  3. Medication (4A’s)

ACEi or ARB (A) - indefinite
Beta-blocker (A - atenolol) - at least 12/12
Statin (A - atorvastatin) - indefinite
Antiplatelets (A)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Post-MI Antiplatelets

2

A
  1. If medially managed (NSTEMI or STEMI):

Aspirin 75mg OD + Ticagrelor 90mg BD - 12/12

(If high risk of bleeding, continue for at least one month)

(If high ischaemic risk can consider continuing for up to 36/12 - w ticagrelor dose of 60mg BD)

  1. ACS + PCI:

Aspirin 75-100mg BD + one of following for UP TO 12/12

  • Prasrugrel 10mg OD (5mg if <60kg / >75yo)
  • Ticagrelor 90mg BD
  • Clopidogrel 75mg OD (if above two are not suitable)

Then aspirin alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Lifestyle modification (Lipids modification)

4

A
  1. Stop smoking
  2. Alcohol (14 units male/female)
  3. 150 mins per week of moderate intensity exercise
  4. Diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Diet modification (lipids modification)

7

A
  1. Fat intake <30% total energy intake (saturated <7%)
  2. Olive oil/rapeseed oil instead of butter
  3. 5 portions fruit/veg per day
  4. 2 portions fish per week (1 oily)
  5. 4-5 portions unsalted mixed nuts/seeds per week (1 portion approx 30g)
  6. Whole grain cereals/breads, etc
  7. Salt low (<6g/day), sugar low

BONOFFS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Heart failure definition

A

Cardiac output / BP inadequate for body’s needs

Poor prognosis - 50% 5y mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Types of heart failure

2

A
  1. LEFT - ischaemia, hypertension, valve disease, etc

2. RIGHT - 2º to left, cor pulmonale (lung disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Heart failure signs/symptoms

Sx 5; signs 6; CXR 4

A

Sx

  1. Orthopnoea
  2. PND
  3. SOBOE
  4. Fatigue
  5. Pink frothy sputum

Signs

  1. Bibasal creps
  2. Raised JVP
  3. Tachycardia
  4. Displaced apex
  5. 3rd HS
  6. Oedema

CXR

  1. CARDIOMEGALY!
  2. Kerly B lines
  3. Upper lobe diversion
  4. Pleural effusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Heart failure:

Acute Mx

A
  1. FBC, U&E, BNP, CXR, ECG, echo
  2. IV diuretic

(No routine use of opioids, nitrates, inotropes, vasopressors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If suspected heart failure, how to act with BNP levels…

A

> 2000: special assessment & echo within 2 weeks

400 - 2000: specialist assessment & echo within 6 weeks

<400: consider alternatives

32
Q

Heart failure:
Long term Mx

(3)

A
  1. Reduced EF:
    ACEi and licensed B-blocker (start one at a time)
  2. Preserved EF:
    Specialist advice
3. Consider:
Antiplatelet
Statin
Treat medical causes
Review drug causes
Annual flu jab
33
Q

Hypertension:
Causes

(2)

A
  1. 90-95% essential

2. 5-10% other (renal, endocrine, vascular)

34
Q

HTN:
Sx

(Sx 4; signs 3)

A

Sx

  1. Headache
  2. Vision change
  3. Fits
  4. Epistaxis

Signs

  1. Retinopathy
  2. Proteinuria
  3. LVH on ECG
35
Q

HTN:

Dx (2) & stages(4)

A

(Suspect if clinic BP 140/90)

CONFIRM with

  • ABPM: 2 measures per hour, average of at least 14 measurements
  • HBPM: 2x daily for at least 4 days - ideally 7 - and then average

STAGES:

  1. Clinic 140/90 and ABPM/HBPM 135/85
  2. Clinic 160/100 and ABPM/HBPM 150/95
  3. Severe - clinic sys 180 or dias 120
  4. Accelerated - clinic >180/120 with papilloedema/retinal haemorrhage (—> same day admit!)
36
Q

HTN Rx:
When to treat
(4)

A
  • Offer treatment to all at stage 2
  • D/w those aged <80 with stage 1…
    …w end organ damage, CVD, renal disease, diabetes, >10% 10yr CVD risk
  • Consider Rx for those <60yo with stage 1 and <10% 10yr CVD risk
  • Consider specialist advice if <40yo with HTN
37
Q

HTN Rx:
Steps

(4)

A 
A = ACE (ARB)
B = beta blocker
C = CCB
D = diuretic
1. A
If T2DM (any age or family origin)
Under 55 (and not African/Afro-Caribbean origin)

Or

  1. C
    If >55 (and no diabetes)
    African/Afro-Caribbean origin (and no diabetes)
  2. A+C
    A+D
    C+D
  3. All 3
    A + C + D
  4. 4th drug (A blocker, B clocker, spironolactone)
    Refer…
38
Q

Bradycardias:
Sx

(4)

A

(Defn <60bpm)

  1. Chest pain
  2. Collapse
  3. Dizziness
  4. SOB
39
Q

Bradycardia:
Causes

(2)

A
  1. Sinus - usually asymptomatic
    May be normal in athletes/elderly
    Hypothyroid, hypothermia, drugs (eg B-blockers)
  2. Sick sinus syndrome, SA block, AV block
40
Q

Bradycardia:
Rx

(2)

A

Generally think…

  1. Atropine

Or

  1. Pacing
41
Q

Pacemakers

4

A
  • Electrical stimuli cause heart contraction when electrical activity is slow or absent
  • Indications include symptomatic bradycardia, heart block
  • Consist of pulse generator (can be internal or external) and pacing leads
  • Can be temporary or permanent
42
Q

Tachycardias:
Narrow complex

(4)

A

NARROW COMPLEX:

  • QRS complex shorter than 120ms
  • Can be asymptomatic
  • Can have CP, palpitations, dizziness, syncope
  • Sinus tachycardia, AF, re-entrant tachycardias
43
Q

Tachycardias:
Broad complex

(5)

A
  • QRS longer than 120ms
  • Ventricular or supraventricular
  • Present: collapse, palpitations, pain, failure
  • ECG: usually regular, wide QRS, tachy (up to 130), classic ‘capture beats’, ‘fusion beats’
  • ABC, life support, may need DC shocks, amiodarone
44
Q

AF:
Types

(3)

A
  1. Paroxysmal (recurrent, 30 seconds-7 days)
  2. Persistent (>7 days)
  3. Permanent/long-standing (despite cardioversion)
45
Q

AF:
Presentation

(4)

A
  1. Causes: usually cardiac + hyperthyroid
  2. Presentation: palpitations, chest pain, SOB, stroke/TIA
  3. Irregularly irregular pulse
  4. Absent P-waves on ECG, check TFTs
46
Q

AF:
Mx

(3)

A

Rate-control generally preferred to rhythm control, except…
…new onset (48hr) / reversible cause / heart failure

  1. Initial rate-control Mx: MONOTHERAPY
    B-blocker / rate-limiting CCB (diltiazem, verapamil)
    Digoxin if non-paroxysmal AF and sedentary lifestyle
  2. If rate not controlled: DUAL THERAPY
    B-blocker / diltiazem / digoxin (cardiology advice with b-b/d combo)
  3. If rate still not controlled: CARDIOLOGY within 4 weeks
47
Q

AF:
Rhythm control

(2)

A
  1. Electrical cardioversion

2. Pharmacological, e.g. flecainide/amiodarone

48
Q

AF:
CHA2DS2-VASc

(2)

A
  1. For stroke risk

2. Offer anticoagulation if score of 2 or men with score of 1

49
Q

AF:

HAS-BLED

A

For bleeding risk (look for score of 3)

If on balance need to anticoagulation, either warfarin or NOAC

50
Q

Atrial flutter

5

A
  1. Less common than AF
  2. Many causes including non-cardiac (eg obesity/alcohol)
  3. Saw-tooth flutter waves on ECG
  4. Main aim usually cardioversion/medications (eg amiodarone/sotalol) but may need ablation if persistent/recurrent
  5. Antithrombotic therapy as with AF
51
Q

PVD:
Key details

(7)

A
  • = reduced blood supply to legs
  • Key lifestyle: smoking++; other CVD risk factors
  • Key Sx: Cramping in calf/thigh/buttock, relieved by rest (=IC)
  • Red flags (signs of critical ischaemia): Night/rest pain
  • Key exam: pale, cold, skin shiny, hair loss, weak/absent pulses
  • Key Ix: CVD exam, FBC, lipids, glucose, ECG, consider thrombophilia screen, ABPI, angiography (CT/MRI)
  • Key DDx: spinan stenosis (relieved by leaning forwards), neuropathy, MSK problems
52
Q

PVD:
ABPI

(2)

A

<0.9 = PVD

<0.5 = critical ischaemia - needs urgent vascular referral!

53
Q

Intermittent Claudication:
Mx

(3)

A
  1. Supervised exercise programme if available (2 hours per week for 3/12)
  2. Refer for ?angioplasty, ?bypass if no improvement
  3. Consider NAFTIDROFURYL OXALATE if pt doesn’t want referral/surgery

(If PVD and bus/coach/lorry driver then —> DVLA)

54
Q

Varicose veins

Def (1)

RFs (4)

Sx (6)

Exam (2)

Ix (1)

Mx (2)

A

Defn= Tortuous/dilated veins in leg - usually due to back flow of blood through valves in veins

RFs

  1. Pregnancy
  2. Obesity
  3. Age
  4. Prolonged standing

Sx

  1. Cosmetic concern
  2. Itching
  3. Burning
  4. Cramps
  5. Oedema
  6. Discomfort

Exam

  1. Fluid thrill over incompetent vein?
  2. Chronic insufficiency changes including venous eczema, ulcers, pigementation, lipodermatitis

Ix
- usually Duplex USS

Mx

  1. Medical: compression stockings (exclude arterial disease)
  2. Surgical: eg foam sclerotherapy, endothermal ablation, stripping
55
Q

DVT:
Sx

(4)

A

(= clot in deep veins, usually in leg)

Sx:

  1. Swelling
  2. Redness
  3. Tenderness
  4. Pain behind calf (or thigh)
56
Q

DVT:
RFs

(8)

A
  1. Previous Hx
  2. COCP
  3. Long flights
  4. Cancer
  5. Immobility
  6. Smoking
  7. Age
  8. Obesity
57
Q

DVT:
Well’s score

(2)

A

DVT likely if score ≥2

If LIKELY —> USS within 4 hours

(If not possible then D-dimer, anticoagulant, USS in 24 hours)

If UNLIKELY —> check D-dimer

(If D-dimer raised, USS within 4 hours - if not possible then as above)

58
Q

DVT:
Rx

(3)

A
  1. Initially LMWH or fondaparinux
  2. Will need ongoing anticoagulation for AT LEAST 3/12 (warfarin/NOAC)
  3. No travel for at least 2 weeks

(Unprovoked DVT —> screen for cancers, thrombophilia screen)

59
Q

Murmurs

4

A
  1. Ejection systolic
    (AS, HOCM, ASD)
  2. Pansystolic
    (MR, TR, VSD)
  3. Early diastolic
    (AR, PR)
  4. Mid diastolic
    (MS, TS)
60
Q

Early diastolic murmurs

4

A
  1. Aortic stenosis
  2. Aortic sclerosis
  3. HOCM
  4. ASD
61
Q

Pansystolic murmurs

3

A
  1. Mitral regurgitation
  2. Tricuspid regurgitation
  3. VSD
62
Q

Early diastolic murmurs

2

A
  1. Aortic regurgitation

2. Pulmonary regurgitation

63
Q

Mid-diastolic murmurs

2

A
  1. Mitral stenosis

2. Tricuspid stenosis

64
Q

Murmurs in children

3

A
  1. Often innocent systolic flow murmurs
  2. Can change with posture
  3. Should have no symptoms/rest exam normal
65
Q

Asymptomatic cardiomyopathy (diseases of heart muscle)

3

A
  1. Heart failure
  2. Arrhythmia
  3. Sudden death
66
Q

Dilated cardiomyopathy

Def; Causes 3; Rx

A

= weakened walls lead to dilation and poor contraction

Due to:

  1. Ischaemia
  2. Alcohol
  3. Thyrotoxicosis

Rx: usually medical (eg of HF symptoms)

67
Q

Hypertrophic cardiomyopathy

Def, cause, consequence

A

= hypertrophy of an undilated LV

Autosomal dominant (most common genetic CV disease) or sporadic mutation (rare)

—> sudden death in younger people - Rx surgery

68
Q

Restrictive cardiomyopathy

Def; causes; consequence; Rx

A

= rigid ventricular walls

Multiple causes eg amyloidosis, sarcoidosis

—> reduced filling

Symptomatic Rx usually medically

69
Q

Rheumatic fever

Cause; Sx 6; Dx; Ix 4; Rx 4; consequences 2

A

Much less common now

CAUSE:
Group A beta haemolytic streptococci

Sx:

  1. Sore throat
  2. Fever
  3. Can affect heart (e.g. pancarditis)
  4. Joints (e.g. arthritis)
  5. Skin (e.g. erythema marginatum)
  6. Nervous system (e.g. chorea)

Dx:
Jones criteria used to diagnose (using major and minor criteria)

Ix:

  1. Throat swab
  2. Antistreptococcal antibodies
  3. Echo
  4. ESR/CRP

Rx:

  1. Bed rest
  2. Treat infection (penicillin)
  3. Treat inflammation (e.g. aspirin/steroids/NSAIDs)
  4. Treat heart failure

Can —> mitral stenosis, CCF

70
Q

Pericarditis

Def; Cause 3; Sx 2; Rx 2

A

= inflammation of the pericardium

Most common cause:

  1. Viral (e.g. Coxsackie)
  2. MI (Dressler’s syndrome)
  3. Renal failure

Sx:

  1. Sharp pain - relieved by leaning forward
  2. Pericardial rub

Rx:

  1. Treat any underlying disorder
  2. Analgesia (NSAIDs)
71
Q

Myocarditis

Def; Cause 3; Sx; Rx

A

= inflammation of myocardium

Cause:

  1. Usually viral (e.g. Coxsackie)
  2. Metabolic
  3. Connective tissue disease

Sx:
Similar to MI

Rx:
Depends on underlying disease

72
Q

Endocarditis

Think; RFs; Cause; Sx 4; Exam 7; Ix 2; Dx; Rx 2

A

New murmur + Fever —> must think endocarditis!

RFs:
Other heart conditions, e.g. valve conditions, valve surgery

Cause:
Staphylococcus aureus most common organism - can be others (e.g. strep)

Sx:
Wide range of presentation...e.g.
1. Fever
2. Fatigue
3. Back pain
4. Abdo pain

Exam:

  1. Fever
  2. Murmur
  3. Splinter haemorrhages
  4. Petechia (e.g. hands/mouth)
  5. Clubbing
  6. Osler’s nodes
  7. Janeway lesions

Ix:
Include
1. Blood cultures
2. Echo

Dx:
Modified Duke Criteria (major/minor criteria)

Rx:

  1. Usually IV Abx
  2. May need surgery
73
Q

AAA

RFs 5; Sx 4

A

Can be abdominal (AAA) or thoracic

Cause usually unknown but RFs include:

  1. Atherosclerosis
  2. Male
  3. FH
  4. Smoking
  5. Age

Can present without symptoms, e..g screening in UK
- males, once, 65 years, USS used to measure diameter

Sx:

  1. Back pain
  2. Pulsatile mass
  3. Distal ischaemia
  4. Rupture (shock, hypotension, pale, acute, abdomen, collapse)
74
Q

AAA:

Un-ruptured vs Ruptured

A

UN-RUPTURED:

  • CVD assessment, USS/CT/MRI
  • If <5.5cm generally medical management (USS monitoring, RFs), consider surgery >5.5cm (open vs endovascular)

RUPTURED:

  • Surgical emergency with high mortality
  • Repair may be possible, e.g prosthetic graft
75
Q

CVD

5

A
  1. Angina
  2. MI
  3. Stroke
  4. TIA
  5. PVD
76
Q

Offering statins

3

A
  1. T1DM pt - offer statin if >40, DM for 10 years, nephropathy
  2. T2DM: carry out QRISK2 as normal
  3. > 85yo - consider offering statin
77
Q

ACS umbrella term

3

A
  • Unstable angina
  • Non-STEMI

(Above 2 are caused by narrowing/partial blockage or coronary artery)

  • STEMI
    (Caused by complete occlusion)

New Cards (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions