Cardiovascular conditions Flashcards
What is acute coronary syndrome?
Refers to any group of symptoms attributed to obstruction of the coronary arteries including STEMI, NSTEMI and unstable angina
What is often seen on ECG in NSTEMIs?
Tall tented T waves or inverted T waves
Rises in which 3 enzymes are seen after an ACS episode?
Troponin, CK-MB, myoglobin
Management of MI?
Morphine, Oxygen, Nitrates (GTN), Aspirin
STEMI: primary angioplasty or thrombolysis. iv beta blocker, ACE-i, clopidogrel
NSTEMI: iv beta blocker, iv nitrates, antithrombotic fondaparinux or LMWH, consider clopidofrel
What are some causes of angina pectoris?
Atheroma, anaemia, tachyarrhythmias, hypertrophic cardiomyopathy, arteritis/small vessel disease.
Other precipitating factors: cold weather, emotion
What is seen on ECG in angina pectoris?
Usually normal, may show ST depression/flat or inverted T waves/Q waves indicate previous MI
What test confirms the diagnosis of angina pectoris?
Exercise ECG, also shows severity of the CAD
Causes of Atrial Fibrillation?
Idiopathic, heart failure/ischaemia, HTN, MI, PE, mitral valve disease, pneumonia, hyperthyroidism, caffeine, alcohol, post-op, low K+, low Mg++
Atrial flutter, a differential for A.Fibrillation, produces what appearance on ECG?
Saw-toothed ECG
What is seen on ECG in atrial fibrillation?
Irregularly irregular, no p waves, irregular baselines, narrow QRS complexes
Management of AF?
Acute AF: if very ill give oxygen, emergency cardioversion, LMWH
Paroxysmal AF: pill in pocket (flecainide PRN)
Chronic AF: Rate control (beta blocker or Ca+ channel blocker), rhythm control (cardioversion), anticoagulation (warfarin/aspirin/dabigatran)
What is the blood pressure of someone with essential hypertension?
At least 140/90mmHg
What percentage of hypertension is essential/primary/idiopathic?
95%
What drugs can cause HTN?
OCP, NSAIDs, cyclosporin, steroids
What are the blood pressure targets for those being treated for HTN?
140/90mHg
Diabetes: 130/80
>80 years old: 150/90
What tends to make up the thrombus in veins?
RBCs and fibrin
Risk factors for VTE?
Increasing age, pregnancy, synthetic oestrogen, trauma, surgery, past DVT, cancer, obesity, immobility, thrombophilia
What is the name of the scoring system that can help to determine the likelihood of the problem being a DVT?
Wells score
What measures are taken to help prevent DVTs occurring?
Stop OCP 4 weeks pre-op, mobilize early after op, prophylactic LMWH for at-risk patients, stockings, Fondaparinux
Defeine Cardiac Failure
Cardiac output is inadequate to meet body’s requirements. Can be due to a number of things including IHD, cardiomyopathy, cardiac tamponade, heart block, exercise-induced, HTN and aortic stenosis
Symptoms of left sided heart failure?
Dyspnoea, tachypnoea, paroxysmal noctrunal dyspnoea, fatigue, orthopnoea, haemoptysis, wheeze, nocturia, cold peripheries, weight loss, muscle wasting
Symptoms of right sided heart failure?
Peripheral/sacral oedema, nocturia, ascites, nausea, anorexia, facial engorgement, pulsation in neck/face, epistaxis
Symptoms of congestive heart failure?
Paroxysmal nocturnal dyspnoea, neck vein distension, crepitations, acute pulmonary oedema, S3 gallop, hepatojugular reflex, cardiomegaly, increased central venous pressure
Management of heart failure?
Lifestyle changes, treat underlying cause and any exacerbating factors, avoid NSAIDs and verapamil
Drugs: 1. Diuretics 2. ACE-i 3. beta blockers 4. spironolactone 5. Digoxin 6. vasodilators
The presence of which 2 things constitutes infective endocarditis until proven otherwise?
Fever and new murmur
What is the most common cause of infective endocarditis?
S.aureus
Strep viridans (35%)
Staph epidermis, diphtheroids, microaerophilic streps
Which valves are most often affected by infective endocarditis?
In order:
- Mitral
- Aortic
- Combined mitral and aortic
- Tricuspid
- Pulmonary
What is the mnemonic to remember signs of infective endocarditis?
F - Fever R - Roth's spots O - Osler's nodes M - Murmur J - Janeway lesions A - Anaemia N - Nail (splinter) haemorrhage E - Emboli
Management of infective endocarditis?
Iv Abx - adjust according to blood culture, surgery indicated in some cases
What test confirms postural hypotension?
Tilt-table testing
Why is valvular disease more common on the left side of the heart than the right?
Higher pressures on left
Mitral stenosis is most often caused by what?
Rheumatic heart disease.
It is the most common valvular disease in pregnancy
What is the most commoin valvular heart disease in the Western world?
Aortic stenosis
What is the most common valvular heart disease worldwide?
Mitral regurgitation
What is the type of murmur heard in each of mitral stenosis, aortic stenosis, mitral regurg and aortic regurg?
Mitral stenosis: Mid-diastolic
Aortic stenosis: Ejection systolic
Mitral regurg: Pansystolic
Aortic regurg: Early diastolic murmur
