Chest Pain and Breathlessness Flashcards
what are the 3 acute coronary syndromes?
unstable angina
NSTEMI
STEMI
what is the difference between unstable angina and an NSTEMI?
unstable angina- partial blockage of a coronary artery, troponins normal
NSTEMI- complete blockage of a minor coronary artery, troponins elevated
what are the ECG changes in NSTEMI?
may be normal but may have T wave inversion or ST depression
what are the ECG changes in STEMI?
ST elevation >2mm in limb leads or >1mm in >2 contiguous chest leads
which is the first cardiac enzyme to be raised in infarction?
myoglobin
what are the main investigations in ACS?
ECG
serial troponins
coronary angiography
echo- assess complications of the MI
what is the initial management of ACS in general?
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)
what is the initial management of NSTEMI/unstable angina?
dual anti platelet therapy (aspirin and ticagrelor/prasugrel) plus fondaparinux
what is the initial management of STEMI?
DAPT- aspirin and ticagrelor/prasugrel (prasugrel preferred if going straight for primary PCI)
urgent primary percutaneous coronary angiography (PCI)
what are the symptoms of left and right sided heart failure?
left- pulmonary oedema, crackles, SOB, paroxysmal nocturnal dysponea/ orthopnea
right- raised JVP, peripheral oedema- ankle swelling, acites
what are the signs of heart failure on a chest X-ray?
A- Alveolar oedema- bat wing sign B- kerley B lines C- cardiomegaly- >50% D- dilated upper lobe vessels E- pleural effusions
what is the management of heart failure?
diuretics (furosemide)- to reduce fluid
oxygen/ ventilation
once stable- beta blockers (bisoprolol), ACEi (ramipril)
what is the management of angina?
beta blockers- bisoprolol
GTN spray- relieves symptoms
aspirin- prevention of ACS/ stroke
surgery- bypass or PCI if symptoms uncontrolled
what are the stages of hypertension?
stage 1- clinic reading >140/90, ambulatory >135/85
stage 2- clinic reading >160/100, ambulatory >150/95
stage 3 clinic reading >180/120
what is the treatment for hypertension over 55s or those from black African or African carribean origin?
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
what is the treatment for hypertension for under 55s or people with type 2 diabetes?
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
what are the signs of AF on an ECG?
absent p waves
narrow complex tachycardia
irregularly irregular rhythm
what is the treatment of atrial fibrillation?
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
what is the gold standard investigation for valvular heat disease?
echocardiography
what are the treatments for valve disease?
valvuloplasty (stenosis) valve replacement (stenosis pr regurgitation)
what are the ECG signs in first degree heart block?
fixed prolonged PR interval >200ms/ 5 small squares
what are the ECG signs in second degree heart block (type 1 and 2)?
type 1- progressive prolongation of PR interval until a QRS is dropped
type 2- consistent PR interval with intermittently dropped QRS complexes
what are the ECG signs in complete heart block?
presence of P waves and QRS complexes which have no association with each other
which leads are associated with which aspects of the heart?
inferior- II, III and aVF
lateral- I, aVL, V5 and V6
anterior- V1, V2, V3 and V4
which coronary artery is associated the anterior leads?
left anterior descending artery
which coronary arteries are associated with the inferior leads?
right coronary artery or left circumflex artery
which coronary arteries are associated with the lateral leads?
left circumflex artery or diagonal branch of left anterior descending artery
what are the ECG signs of SVT?
regular narrow complex tachycardia usually 140-280 bpm
how is acute asthma graded?
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
what is the gold standard investigation for PE?
CT pulmonary angiography
what is the initial management for PE?
Apixaban or rivaroxaban
thrombolysis if massive PE with hypotension- altepase or streptokinase
what do spirometry tests show in COPD?
obstructive picture
FEV1 reduced, FVC normal
FEV1/FVC ratio <0.7
what are the components of a trilogy inhaler?
long acting beta-2 agonist (LABA) long acting muscarinic agonist (LAMA) inhaled corticosteroid (ICS)
what are the optimum sats to aim for in someone with COPD?
88-92
what is the scoring system for an acute exacerbation of COPD?
DECAF score
what is the scoring system used for pneumonia in the hospital?
CURB65
what are the scoring systems used for strep throat?
FEVERpain or centor
what’s the difference between type 1 and type 2 respiratory failure?
type 1- hypoxia
type 2- hypoxia and hypercapnia
what are the spirometry results in restrictive lung disease?
FEV1 and FVC reduced
FEV1/FVC ratio >70%
which conditions produce a raised TLco in diffusing capacity tests?
asthma
extra pulmonary restriction- obesity, PE, kyphoscoliosis
which conditions produce a reduced TLco in diffusing capacity tests?
COPD
interstitial lung disease
what is the treatment of an infective exacerbation of COPD?
Oxygen steroids antibiotics nebulised salbutamol non-invasive ventilation- if severe
