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T year LOBs medicine > CPL CVS > Flashcards

CPL CVS Flashcards

1
Q

what are symptoms of a STEMI?

A
  • acute central/left chest pain for over 20 minutes
  • radiating pain to the left jaw or arm
  • nausea
  • sweating
  • palpitations
  • change in HR or BP
  • 4th heart sound
  • signs of LVF
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2
Q

what lead ECG changes for an inferior MI?

A

II,IIIAvF

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3
Q

what is the vessel responsible in inferior MI?

A

right coronary artery

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4
Q

what ECG leads change in anterior MI?

A

V1-V4

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5
Q

what vessel is responsible for MI anterior?

A

left anterior descending

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6
Q

what ECG leads are for the lateral aspect?

A

V5-V6

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7
Q

What vessel is responsible for lateral MI?

A

Left circumflex

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8
Q

what investigations can be done for STEMI?

A
  • ECG
  • troponin
  • BNP
  • CXR
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9
Q

what is the treatment for STEMI regardless of the reperfusion therapy?

A

Aspirin- 300mg
Ticagrelor 180mg
morphine with metoclopramide

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10
Q

what are the options for reperfusion therapy in STEMI?

A
  • primary PCI

- angiography

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11
Q

what STEMI patients can be offered PCI?

A

all patients presenting within 12 hours of onset of symptoms who can get PCI within 2 hours

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12
Q

what is the management of STEMI if they cant have PCI within 2 hours of admission?

A

fibrinolysis followed by rescue PCI or angiography

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13
Q

what is fibrinolytic treatment for STEMI?

A

often uses alteplase or reteplace and used when PCI can’t be given within 2 hours of admission

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14
Q

In STEMI if they present in 12 hours and can have PCI in the next 2 what are the PCI options?

A

angiography and stenting

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15
Q

What are causes of cardiogenic shock?

A
  • MI
  • hyperkalaemia
  • endocarditis
  • aortic dissection
  • rhythm disturbance
  • tamponade
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16
Q

what are clinical features of cardiogenic shock?

A

pale, sweaty, clammy, tachycardia, increased resp rate, P.oedema, raised JVP

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17
Q

what is the management of cardiogenic shock?

A
  • give oxygen with a target of 94-98%
  • IV access and ECG
  • noradrenaline is first choice vasopressor
  • dopamine can increase cardiac contractility
  • dobutamine and GTN can reduce after load
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18
Q

what are clinical signs of anaphylactic shocks?

A
  • general signs of shock
  • clinical history
  • wheezing
  • urticaria
  • angiodema
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19
Q

what is the management of anaphylaxis?

A
  • ensure the airway is clear
  • oxygen
  • adrenaline IM 0.5mg
  • chlorphernamine 100mg IV
  • hydrocortisone 200mg IV
  • IV saline 500ml over 15 minutes
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20
Q

how do you manage haemmorhagic shock?

A
  • when restoring CO consider blood tranfusion
  • coagulopathy: fresh frozen plasma and platelet concentrates
  • consider tranexamic acid
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21
Q

what is the management of septic shock?

A
  • broad spectrum antibiotics started within 1 hour
  • 500ml crystalloid within 15 minutes
  • oxygen if hypoxic
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22
Q

what is the septis six??

A 
Six things to do within 1 hour:
1 Oxygen administeration
2. Blood cultures
3. IV antibiotics
4. IV fluids not exceeding 30ml/kg
5. check lactate levels
6. Measure UO
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23
Q

what is the diagnostic value for hypertension?

A
  • 135/85
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24
Q

what is malignant/ accelerated hypertension?

A

A rapid rise in blood pressure leading to vascular damage with the hallmark of fibrinoid necrosis.

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25
Q

what are symptoms of hypertension?

A
  • headache

- visual disturbance

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26
Q

what are renal causes of hypertension?

A
  • glomerulonephritis
  • chronic pyelonephritis
  • polycystic kidney disease
  • renal artery stenosis
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27
Q

what are endocrine causes of hypertension?

A
  • cushiings disease
  • conns disease
  • phaeochromocytoma
  • fibromuscular dysplasia
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28
Q

what are investigations in a patient presenting with hypertension?

A
  • home monitoring to get an average
  • fasting glucose and cholesterol levels
  • ECG/ Urine
  • HbA1c
  • lipids
  • fundoscopy
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29
Q

what is the treatment goal for a normal hypertensive patient?

A

under 140/90

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30
Q

what is the treatment goal for a diabetic hypertensive?

A

below 130/80

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31
Q

what is the treatment goal in over 80’s?

A

below 150/90

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32
Q

what are lifestyle changes for BP?

A
  • stop smoking
  • low fat diet
  • reduce alcohol
  • reduce salt
  • weight lose
  • increase activity
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33
Q

what is the first line monotherapy for hypertension management?

A

Under 55 years and non-black: ACE inhibitors/ angiotensin OR beta blocker

Over 55 and black: calcium channel blocker OR thiazide diuretic

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34
Q

what is the second line management after monotherapy for people with hypertension?

A
  • ACE inhibitor and a calcium channel blocker

or

  • ACE inhibitor and thiazide type diuretics
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35
Q

what is step three therapy for hypertension?

A

ACE inhibitor and calcium channel blocker and thiazide diuretics

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36
Q

what is the stage 4 treatment for resistant hyper tension?

A

if potassium is below 4.5 add spironolactone

If potassium is above 4.5 use a higher doze thiazide diuretic.

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37
Q

what is the first line anti hypertensive if all diabetic patients?

A

ACE inhibitor

38
Q

what anti hypertensive medication should be avoided in people with diabetes?

A

beta blockers

39
Q

why should beta blockers not be used in hypertensive treatment of diabetic patients?

A
  • cause insulin resistance
  • impair insulin secretion
  • affect the hypoglycaemic response
40
Q

what are side effects of calcium channel blockers? (used for hypertension)

A

flushes
fatigue
gum hyperplasia
ankle oedema

41
Q

when should you not give thiazide diuretics for hypertension?

A

in patients with gout

42
Q

what are side effects of thiazide diertics?

A

hypokalaemia
hyponatraemia
impotence

43
Q

what is an example of a thiazide diuretic for hypertension?

A

chlortalidone 25-50mg

44
Q

what is an example of a calcium channel blocker used for hypertension?

A

Nifedipine 30-60mg

45
Q

what are side effects of ACE inhibitors?

A
  • cough
  • hyperkalaemia
  • renal failure
  • angiodema
46
Q

what are contraindications for ACE inhibitors?

A

bilateral renal artery stenosis

aortic stenosis

47
Q

what environmental factors can provoke angina?

A
  • exposure to the cold
  • eating a large meal
  • exertion
  • emotional stress
48
Q

what are risk factors for angina?

A
  • hypertension
  • hyperlipiaedmia
  • D.M
  • sedentary lifestyle
  • obesity
  • smoking
  • family history
49
Q

what is class I angina?

A
  • no anina with ordinary activity, angina with streneous activity
50
Q

what is class II angina?

A
  • angina during normal activites with mild limitation of activities
51
Q

what is class III angina?

A
  • angina with low levels of activity such as walking 50-100 metres on flat land. marked restriction
52
Q

what is class IV angina?

A

angina at rest or with any level of exercise

53
Q

what is unstable angina?

A

angina or recent onset or worsening with symptoms at rest

54
Q

what is refractory angina?

A

Patients with severe coronary disease where revascularisation isn’t possible and not controlled by medical therapy

55
Q

what are the suitable investigations in people with angina?

A
  • FBC,LFT, Glucose, hBa1C, lipids, GFR, troponin
  • ECG
  • echocardiography
  • CXR
56
Q

what patients after basic investigation can just be managed for stable angina without further investigations?

A

Those with typical angina and risk of disease >90%

57
Q

what is the first line treatment for stable angina?

A

A beta blocker or calcium channel blocker (can use dual therapy)

58
Q

If a patient with stable angina can’t use first line (beta blocker/ calcium channel blocker) what can then be used?

A
  • long acting nitrate
  • ivabradine
  • nicorandil
  • ranolazine
59
Q

what is the treatment for a current episode of angina?

A
  • A short acting nitrate
  • aspirin 75mg

also offer statins

60
Q

In second line therapy for angina you can use long acting nitrates, when is isosorbide mononitrate CI?

A

patients taking phosphodiesterase type 5 inhibitors

61
Q

Beta blockers are first line for stable angina, why is this?

A

They inhibit beta adrenoreceptors to reduce heart rate and myocardial oxygen consumption.

62
Q

what are SE of beta blcokers>

A

fatigue, peripheral vasoconstriction, bronchospasm, sexual dysfunction

63
Q

Calcium channel blockers can be first line for treating stable angina what are the CI?

A

severe bradycardia, LVF

64
Q

what are causes of heart failure?

A
  • ischaemic heart disease
  • cardiomyopathy
  • hypertension

valvular heart disease, congenital heart disease, alcohol, drugs, cor pulmonale, infections

65
Q

what pathophysiology occurs in heart failure?

A
  • ventricular dilation
  • myocyte hypertrophy
  • increased collagen synthesis
  • altered myosin gene expression
  • salt and water retention
  • peripheral vasoconstriction
66
Q

how does afterload change with heart failure?

A
  • Increases causing a decrease in cardiac output

This increase in afterload causes dilatation in the ventricular wall which can affect LaPlaces law

67
Q

How does myocardial contractility change with heart failure?

A
  • decreases due to down regulation of beta receptors
68
Q

what is the neurohormonal changes in heart failure?

A

There is salt and water retention and decreased CO meaning decreased renal perfusion. This causes RAAS activation and worsening of salt and water retention

69
Q

what are causes of right sided heart failure?

A
  • left ventricular failure
  • cor pulmonale
  • triscupid and pulmonary valve disease
70
Q

what are signs of right sided heart failure?

A
  • weight loss
  • nausea
  • increased JVP
  • tender smooth hepatomegaly
  • pitting oedema
  • ascites
71
Q

what are some causes of left sided heart failure?

A

Cardiomyopathy
hypertension
mitral and aortic valve disease

72
Q

what are signs of left sided heart failure?

A
  • fatigue
  • orthopneoa
  • exertional dyspnoea
  • nocturnal cough
  • muscle wasting
  • AF
  • gallop rhythm
  • pulmonary oedema
73
Q

what are the chest X ray finding in heart failure?

A 
A- alveolour oedema
B- kerley B lines
C- Cardiomegaly
D- dilated prominent upper lobe vessels
E- pleural effusion
74
Q

what tests are helpful for heart failure?

A

CXR
BNP
ECG
echocardiography

75
Q

what is class I in the new york classification of heart failure?

A

heart disease present but no undue dyspneoa from ordinary activity

76
Q

what is class II in the new york classification of heart failure?

A

comfortable at rest, dyspnoea during ordinary activity

77
Q

what is class III in the new york classification of heart failure?

A

Less than ordinary activity causes dyspnoea which is limiting

78
Q

what is class IV in the new york classification of heart failure?

A

dyspnoea present at rest all activity causes discomfort

79
Q

what is framingham criteria?

A

A criteria for the diagnosis of heart failure

You need 2 major criteria or 1 major with 2 minors

80
Q

What are the major criteria of framingham for diagnosing heart failure?

A

PND, abdominojugular reflex, neck vein distension, S3, basal creps, cardiomegaly, acute pulmonary oedema, increased CVP, weight loss

81
Q

what are the minor critera of framingham for the diagnosis of heart failure?

A

bilateral ankle oedema, SOBOE, tachycardia, nocturnal cough, hepatomegaly, pleural effusion, decrease 30% vital capacity

82
Q

what lifestyle advice can be given to manage chronic heart failure?

A
  • smoking cessation
  • alcohol cessation
  • diet changes
  • salt reduction
83
Q

what medications can be used in a patient with chronic heart failure?

A
  • loop diuretics such as furosemide to relieve symptoms
  • ACE inhibitors for symptoms and mortality
  • Beta blockers to improve mortality
  • mineralocorticoid receptor antagonists improve mortality
84
Q

what is a side effect and alternative of furosemide for heart failure?

A

hypokalaaemia. swap with spiroloactone

85
Q

what is the emergency management of acute heart failure?

A
  • sit the patient upright
  • high flow oxygen
  • diamorphiine 1.25-5mg IV
  • furosemide 40-80mg IV
  • GTN spray
86
Q

what are causes of acute pulmonary oedema?

A
  • left ventricular failure
  • arrhythmia
  • malignant hypertension
  • acute respiratory distress syndrome
  • fluid overload
  • heart failure
  • neurogenic
87
Q

what are symptoms of acute pulmonary oedema?

A 
dyspnoea
orthopnea
pink frothy sputum
distressed
pale
sweaty
tachycardia
increased JVP
lung crackles
gallop rhythm
wheeze
often sits up/sleeps with pillows
88
Q

what is seen on a CXR of someone with pulmonary oedema?

A
  • cardiomegaly
    bilateral shadowing
    effusions at the costophrenic angles
    kerley B lines
89
Q

what is the management of acute pulmonary oedema

A
  • treat the underlying causes
  • sit the patient upright
  • nitrates
  • morphine
  • IV frusemode
  • dobutamine is hypotension or reduced perfusion
90
Q

what are indications for incubation in acute pulmonary oedema?

A
  • hypercapnia, hypoxia, acidosis despite CPAP
  • physical exhausion
  • decreased consciousness
  • cardiogenic shock

T year LOBs medicine (11 decks)

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