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TCBL > Chest Pain and Breathlessness > Flashcards

Chest Pain and Breathlessness Flashcards

1
Q

what are the 3 acute coronary syndromes?

A

unstable angina
NSTEMI
STEMI

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2
Q

what is the difference between unstable angina and an NSTEMI?

A

unstable angina- partial blockage of a coronary artery, troponins normal
NSTEMI- complete blockage of a minor coronary artery, troponins elevated

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3
Q

what are the ECG changes in NSTEMI?

A

may be normal but may have T wave inversion or ST depression

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4
Q

what are the ECG changes in STEMI?

A

ST elevation >2mm in limb leads or >1mm in >2 contiguous chest leads

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5
Q

which is the first cardiac enzyme to be raised in infarction?

A

myoglobin

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6
Q

what are the main investigations in ACS?

A

ECG
serial troponins
coronary angiography
echo- assess complications of the MI

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7
Q

what is the initial management of ACS in general?

A

Morphine- IV PRN for pain
Oxygen- sats 95-98
Nitrates- GTN or IV
Aspirin- 300mg STAT

STEMI- DAPT (aspirin and ticagrelor/prasugrel (if going for primary PCI) and primary perctuaneous coronary angiography (PCI)

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8
Q

what is the initial management of NSTEMI/unstable angina?

A

dual anti platelet therapy (aspirin and ticagrelor/prasugrel) plus fondaparinux

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9
Q

what is the initial management of STEMI?

A

DAPT- aspirin and ticagrelor/prasugrel (prasugrel preferred if going straight for primary PCI)
urgent primary percutaneous coronary angiography (PCI)

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10
Q

what are the symptoms of left and right sided heart failure?

A

left- pulmonary oedema, crackles, SOB, paroxysmal nocturnal dysponea/ orthopnea
right- raised JVP, peripheral oedema- ankle swelling, acites

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11
Q

what are the signs of heart failure on a chest X-ray?

A 
A- Alveolar oedema- bat wing sign 
B- kerley B lines 
C- cardiomegaly- >50%
D- dilated upper lobe vessels 
E- pleural effusions
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12
Q

what is the management of heart failure?

A

diuretics (furosemide)- to reduce fluid
oxygen/ ventilation
once stable- beta blockers (bisoprolol), ACEi (ramipril)

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13
Q

what is the management of angina?

A

beta blockers- bisoprolol
GTN spray- relieves symptoms
aspirin- prevention of ACS/ stroke
surgery- bypass or PCI if symptoms uncontrolled

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14
Q

what are the stages of hypertension?

A

stage 1- clinic reading >140/90, ambulatory >135/85
stage 2- clinic reading >160/100, ambulatory >150/95
stage 3 clinic reading >180/120

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15
Q

what is the treatment for hypertension over 55s or those from black African or African carribean origin?

A

step 1: calcium channel blocker (amlodipine)
step 2: ACEi (ramipril), ARB (Losartan) or thiazide like diuretic (indapamide)
step 3: ACEi or ARB plus calcium channel blocker plus thiazide like diuretic

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16
Q

what is the treatment for hypertension for under 55s or people with type 2 diabetes?

A

step 1: ACEi or ARB
step 2: calcium channel blocker or thiazide like diuretic
step 3: ACEi or ARB plus calcium channel blocker plus thiazide like diuretic

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17
Q

what are the signs of AF on an ECG?

A

absent p waves
narrow complex tachycardia
irregularly irregular rhythm

18
Q

what is the treatment of atrial fibrillation?

A 
rate control (beta blocker or calcium channel blocker) or rhythm control (cardioversion- electrical or pharmacological (amiodarone) or long term (beta blocker))
anticoagulation- if stroke risk outweighs bleeding risk warfarin or DOAC
19
Q

what is the gold standard investigation for valvular heat disease?

A

echocardiography

20
Q

what are the treatments for valve disease?

A 
valvuloplasty (stenosis) 
valve replacement (stenosis pr regurgitation)
21
Q

what are the ECG signs in first degree heart block?

A

fixed prolonged PR interval >200ms/ 5 small squares

22
Q

what are the ECG signs in second degree heart block (type 1 and 2)?

A

type 1- progressive prolongation of PR interval until a QRS is dropped
type 2- consistent PR interval with intermittently dropped QRS complexes

23
Q

what are the ECG signs in complete heart block?

A

presence of P waves and QRS complexes which have no association with each other

24
Q

which leads are associated with which aspects of the heart?

A

inferior- II, III and aVF
lateral- I, aVL, V5 and V6
anterior- V1, V2, V3 and V4

25
Q

which coronary artery is associated the anterior leads?

A

left anterior descending artery

26
Q

which coronary arteries are associated with the inferior leads?

A

right coronary artery or left circumflex artery

27
Q

which coronary arteries are associated with the lateral leads?

A

left circumflex artery or diagonal branch of left anterior descending artery

28
Q

what are the ECG signs of SVT?

A

regular narrow complex tachycardia usually 140-280 bpm

29
Q

how is acute asthma graded?

A

moderate- peak expiratory flow rate (PEFR)- 50-75% of expected
severe- (PEFR)- 33-50% predicated, RR >25, HR >110, unable to complete sentences
life threatening- PEFR-<33%, SATS <92%, becoming tired, no wheeze, haemodynamic instability

30
Q

what is the gold standard investigation for PE?

A

CT pulmonary angiography

31
Q

what is the initial management for PE?

A

Apixaban or rivaroxaban

thrombolysis if massive PE with hypotension- altepase or streptokinase

32
Q

what do spirometry tests show in COPD?

A

obstructive picture
FEV1 reduced, FVC normal
FEV1/FVC ratio <0.7

33
Q

what are the components of a trilogy inhaler?

A 
long acting beta-2 agonist (LABA)
long acting muscarinic agonist (LAMA)
inhaled corticosteroid (ICS)
34
Q

what are the optimum sats to aim for in someone with COPD?

A

88-92

35
Q

what is the scoring system for an acute exacerbation of COPD?

A

DECAF score

36
Q

what is the scoring system used for pneumonia in the hospital?

A

CURB65

37
Q

what are the scoring systems used for strep throat?

A

FEVERpain or centor

38
Q

what’s the difference between type 1 and type 2 respiratory failure?

A

type 1- hypoxia

type 2- hypoxia and hypercapnia

39
Q

what are the spirometry results in restrictive lung disease?

A

FEV1 and FVC reduced

FEV1/FVC ratio >70%

40
Q

which conditions produce a raised TLco in diffusing capacity tests?

A

asthma

extra pulmonary restriction- obesity, PE, kyphoscoliosis

41
Q

which conditions produce a reduced TLco in diffusing capacity tests?

A

COPD

interstitial lung disease

42
Q

what is the treatment of an infective exacerbation of COPD?

A 
Oxygen 
steroids 
antibiotics 
nebulised salbutamol 
non-invasive ventilation- if severe

TCBL (4 decks)

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