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Common Cardiac Conditions Flashcards

1
Q

Which leads on the ECG relate to the coronary arteries?

A

Lateral leads: I, aVL, V5, V6 - left circumflex

Anterior leads: v1-v4 - LAD

Inferior leads: II, III, aVF - Right coronary

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2
Q

What are some common modifiable cardiovascular risk factors?

A
  • Smoking
  • High cholesterol
  • HTN
  • Obesity
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3
Q

What are some common non-modifiable cardiovascular risk factors?

A
  • Age
  • Family Hx of heart/ cardiovascular disease
  • Gender (more common in men< 50 then equals out)
  • Race (African american greatest risk )
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4
Q

What is the immediate management of a patient with a STEMI?

A
  1. IV acess
  2. Pain relief (morphine)
  3. Anti-emetic e.g. metoclopramide
  4. Oxygen
  5. Aspirin 300mg
  6. Digoxin (if systolic BP ok)
  7. Clopidogrel loading dose (600mg)
  8. PPCI
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5
Q

What does cardiac rehabilitation entail?

A

Medically supervised exercise programme for people who have had cardiac intervention

Mix of exercise and education sessions

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6
Q

What are some of the possible complications of acute MI?

A
  • Arrythmia
  • Hypotension
  • Ventricular septal rupture
  • Left ventruicular free wall rupture
  • Left ventriculat aneurysm formation
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7
Q

What is the long term medication that should be initiated after a patient has an MI?

A

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

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8
Q

What features in a patients history would suggest heart failure?

A
  • Increasing breathlessness and reduced exercise tolerance
  • Oedema
  • Orthopnoea (breathless lying flat)
  • PND (paroxysmal nocturnal dyspnoea)- shortness of breath when asleep
  • Nocturnal cough
  • Wheeze
  • Anorexia
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9
Q

What are some of the common causes of heart failure?

A
  1. Ischemic heart disease (most common)
  2. AF
  3. Valvular heart disease e.g. rheumatic fever
  4. Hypertension
  5. Cardiomyopathy
  6. Previous cancer/ chemotherapy
  7. Chronic lung disease
  8. HIV
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10
Q

Why do patients with HF develop ankle oedema?

A

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

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11
Q

What type of oedema are you more likely to get in left vs right sided HF?

A

Left: pulmonary oedema

Right: peripheral oedema

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12
Q

How do you manage an acute presentation of HF?

A
  1. Sit patient upright
  2. Give high flow O2 if SpO2 is low
  3. Get IV access and monitor ECG
  4. Diamorphine 1.25-5 mg IV - slowly
  5. Furosemide 40-80mg IV - slowly
  6. GTN spray if chest pain
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13
Q

How do you manage a chronic presentation of HF?

A
  1. Diuretics
    1. Furosemide (IV) / Bumetanide (oral)
  2. ACEi if patient hypertensive
  3. ARB
  4. Sacubotril / Valsartan (Angiotensin Receptor Neprilysin inhibitor) only if NYHA II-IV
  5. Beta blockers - start low go slow.
    1. only if HR >60 and SBP >100mmHg
  6. Vasodilators
  7. Ivabradine - later add on must be in sinus rhythm
  8. Nitrates - reduce preload
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14
Q

How do you manage a patient with acute SVT?

A
  1. Try Valsalva manouvre if haemodynamically stable in unsuccessful:
  2. Adenosine 6mg stat (can increase to 12mg if unsuccessful)
  3. Start heparin or IV flecainide
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15
Q

What is the indication for electrical DC cardioversion?

A

If the patient has AF + adverse signs:

  • shock
  • MI (chest pain/ ECG change
  • syncope
  • HF
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16
Q

What drugs are used in the long term management of permanent AF?

A
  • Beta blocker 1st line
    • Digoxin if this fails
  • Anticoagulation with DOAC
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17
Q

What are the common complications of severe aortic stenosis?

A
  • HF
  • Stroke
  • Blood clots
  • Arrythmia
  • Bleeding
  • Death
18
Q

Where do you ausculate the heart valves?

19
Q

How do you manage aortic stenosis?

A

Conservative management: manage CV risk factors

Definitive management: valve replacement or TAVI

20
Q

What are some of the common causes of valvular heart disease?

A
  • Infective endocarditis
  • Congenital: connective tissue disorders
  • Rheumatic fever
  • Calcification
21
Q

What are the clinical signs and symtpoms of aortic regurgitation?

A

​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
22
Q

What are the clinical signs of mitral stenosis?

A
  • Malar flsuh
  • low volume pulse
  • +/- AF
  • RV heave
  • Opening snap on auscultation of S1 (diastolic murmur)
23
Q

What are the clinical signs of mitral regurgitation?

A
  • AF
  • Displaced hyperdynamic apex
  • Pan systolic murmur at apex radiates to axilla
24
Q

What are the clinical signs of infective endocarditis?

A
  • Janeway lesions
  • Splinter haemmorhage
  • Clubbing
  • Oler’s nodes
25
What are the common pathogens that cause infective endocarditis?
* Streptococcus viridans * Staphylococcus aureus
26
How is a definitive diagnosis of infective endocarditis made?
Modifed DUKE criteria * **+** ve blood culture for typical organism * **+** ve endocardiogram for vegetation, abscess
27
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*
28
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**
29
What non-pharmacological advice can be given to help lower BP?
* Stop smoking * Weight loss * Decrease salt intake * Exercise * Decrease alcohol consumption
30
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
31
How is the choice of antihypertensive agent made?
32
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
33
What will you see on fundoscopy if patient has hypertensive retinopathy?
**Flame haemorrhages**
34
Which patients is Prasugrel post MI contraindicated in?
* Age 75 + * Weigh less than 60kg * Have had previous TIA or stroke
35
What are the 3 main causes of aortic stenosis?
* **Bicuspid heart valve** most common * Age related calcification * Rheumatic fever
36
What is the common triad of symtpoms in aortic stenois?
* Dyspnoea * Syncope * Angina
37
Which murmurs are systolic?
**S-ASMR** Aortic Stenosis Mitral Regurgitation
38
Which murmurs are diastolic?
**D-ARMS** Aortic regurgitation Mitral stenosis
39
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
40
What are the common causes of AF?
**SMITH** * **Sepsis** * **Mitral valve pathology** (mitral valve stenosis or mechanical valve) * **Ischaemic heart disease** * **Thyrotoxicosis** * **Hypertension**

Junior Medicine (6 decks)

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