Common Cardiac Conditions Flashcards
Which leads on the ECG relate to the coronary arteries?
Lateral leads: I, aVL, V5, V6 - left circumflex
Anterior leads: v1-v4 - LAD
Inferior leads: II, III, aVF - Right coronary
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What are some common modifiable cardiovascular risk factors?
- Smoking
- High cholesterol
- HTN
- Obesity
What are some common non-modifiable cardiovascular risk factors?
- Age
- Family Hx of heart/ cardiovascular disease
- Gender (more common in men< 50 then equals out)
- Race (African american greatest risk )
What is the immediate management of a patient with a STEMI?
- IV acess
- Pain relief (morphine)
- Anti-emetic e.g. metoclopramide
- Oxygen
- Aspirin 300mg
- Digoxin (if systolic BP ok)
- Clopidogrel loading dose (600mg)
- PPCI
What does cardiac rehabilitation entail?
Medically supervised exercise programme for people who have had cardiac intervention
Mix of exercise and education sessions
What are some of the possible complications of acute MI?
- Arrythmia
- Hypotension
- Ventricular septal rupture
- Left ventruicular free wall rupture
- Left ventriculat aneurysm formation
What is the long term medication that should be initiated after a patient has an MI?
Dual Antiplatelet therapy Clopidogrel 75mg OD / Prasugrel 10mg OD
Blood pressure control ACEi e.g. Ramipril 2.5mg OD or ARB e.g. Losartan 25mg OF
Beta blocker e.g. bisoprolol 1.25 mg OD
Cholesterol lowering agent - Statin e.g. atorvastatin 80mg OD
What features in a patients history would suggest heart failure?
- Increasing breathlessness and reduced exercise tolerance
- Oedema
- Orthopnoea (breathless lying flat)
- PND (paroxysmal nocturnal dyspnoea)- shortness of breath when asleep
- Nocturnal cough
- Wheeze
- Anorexia
What are some of the common causes of heart failure?
- Ischemic heart disease (most common)
- AF
- Valvular heart disease e.g. rheumatic fever
- Hypertension
- Cardiomyopathy
- Previous cancer/ chemotherapy
- Chronic lung disease
- HIV
Why do patients with HF develop ankle oedema?
Cardiac output is low so kidneys are poorly perfused. This activates RAAS which causes Na+ and H2O retention leading to fluid overload
The RV does not pump efficiently causing reduced venous return so fluid remains in peripheries
What type of oedema are you more likely to get in left vs right sided HF?
Left: pulmonary oedema
Right: peripheral oedema
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How do you manage an acute presentation of HF?
- Sit patient upright
- Give high flow O2 if SpO2 is low
- Get IV access and monitor ECG
- Diamorphine 1.25-5 mg IV - slowly
- Furosemide 40-80mg IV - slowly
- GTN spray if chest pain
How do you manage a chronic presentation of HF?
-
Diuretics
- Furosemide (IV) / Bumetanide (oral)
- ACEi if patient hypertensive
- ARB
- Sacubotril / Valsartan (Angiotensin Receptor Neprilysin inhibitor) only if NYHA II-IV
-
Beta blockers - start low go slow.
- only if HR >60 and SBP >100mmHg
- Vasodilators
- Ivabradine - later add on must be in sinus rhythm
- Nitrates - reduce preload
How do you manage a patient with acute SVT?
- Try Valsalva manouvre if haemodynamically stable in unsuccessful:
- Adenosine 6mg stat (can increase to 12mg if unsuccessful)
- Start heparin or IV flecainide
What is the indication for electrical DC cardioversion?
If the patient has AF + adverse signs:
- shock
- MI (chest pain/ ECG change
- syncope
- HF
What drugs are used in the long term management of permanent AF?
- Beta blocker 1st line
- Digoxin if this fails
- Anticoagulation with DOAC
What are the common complications of severe aortic stenosis?
- HF
- Stroke
- Blood clots
- Arrythmia
- Bleeding
- Death
Where do you ausculate the heart valves?
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How do you manage aortic stenosis?
Conservative management: manage CV risk factors
Definitive management: valve replacement or TAVI
What are some of the common causes of valvular heart disease?
- Infective endocarditis
- Congenital: connective tissue disorders
- Rheumatic fever
- Calcification
What are the clinical signs and symtpoms of aortic regurgitation?
Symptoms
- Exertional dyspnoea
- Orthopnea
- PND
Signs:
- Collapsing pulse
- Hyperdynamic apex beat
- High pitched early diastolic murmur
- Quinke’s sign
- Pistol sound on ausculation of femoral artery
What are the clinical signs of mitral stenosis?
- Malar flsuh
- low volume pulse
- +/- AF
- RV heave
- Opening snap on auscultation of S1 (diastolic murmur)
What are the clinical signs of mitral regurgitation?
- AF
- Displaced hyperdynamic apex
- Pan systolic murmur at apex radiates to axilla
What are the clinical signs of infective endocarditis?
- Janeway lesions
- Splinter haemmorhage
- Clubbing
- Oler’s nodes
What are the common pathogens that cause infective endocarditis?
- Streptococcus viridans
- Staphylococcus aureus
How is a definitive diagnosis of infective endocarditis made?
Modifed DUKE criteria
- + ve blood culture for typical organism
- + ve endocardiogram for vegetation, abscess
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What initial antibiotic therapy is indicated for infective endocarditis?
If native valve/ prosthetic valve >1 year ago: ampicillin, flucloxacillin, gentamycin
If prostethic valve <1 year ago: vancomycin, gentamycin, rifampicin
What are some of the common secondary causes of high blood pressure?
-
renal disease
- 75% intrinsic renal
- 25% renovascular disease
-
Endocrine:
- cushing’s
- phaeocromatoma
- acromegaly
- Pregnancy
- Steroids
- Liquorice
What non-pharmacological advice can be given to help lower BP?
- Stop smoking
- Weight loss
- Decrease salt intake
- Exercise
- Decrease alcohol consumption
What are some of the common drug classes used to treat HTN and their common side effects?
ACEi - dry cough
ARBs - dizziness
CCBs - flushing/ headache/ ankle swelling
How is the choice of antihypertensive agent made?
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What are the common complications of untreated HTN?
- End organ damage e.g. to kidneys
- Increased risk of IHD
- Encephalopathy (headache, focal CNS signs, seizure, coma)
- Dementia
- Retinopathy
What will you see on fundoscopy if patient has hypertensive retinopathy?
Flame haemorrhages
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Which patients is Prasugrel post MI contraindicated in?
- Age 75 +
- Weigh less than 60kg
- Have had previous TIA or stroke
What are the 3 main causes of aortic stenosis?
- Bicuspid heart valve most common
- Age related calcification
- Rheumatic fever
What is the common triad of symtpoms in aortic stenois?
- Dyspnoea
- Syncope
- Angina
Which murmurs are systolic?
S-ASMR
Aortic Stenosis
Mitral Regurgitation
Which murmurs are diastolic?
D-ARMS
Aortic regurgitation
Mitral stenosis
How can you distinguish between regurgitations and stenosis when feeling for the left ventricle?
Left ventricle displaced? - regurgitation due to volume overload
Non displaced? - stenosis due to pressure overload
What are the common causes of AF?
SMITH
- Sepsis
- Mitral valve pathology (mitral valve stenosis or mechanical valve)
- Ischaemic heart disease
- Thyrotoxicosis
- Hypertension