CV Flashcards
1
Q
P wave normal value
A
<0.12s
2
Q
QRS normal value
A
0.12s or less
3
Q
PR normal value
A
0.12-0.2s
4
Q
Define IHD…
A
myocardial demand for O2/nutrients greater than deliver from coronary arteries
5
Q
What is the most common cause of IHD?
A
atherosclerosis
6
Q
Give some other causes of IHD…
A
.
7
Q
Name some modifiable and non-modifiable risk factors for IHD
A
.
8
Q
Name some clinical and psychosocial factors for IHD
A
.
9
Q
Describe the chest pain associated with stable angina…
A
.
10
Q
What investigations can you do for angina?
A
- resting ECG- usually normal
- stress ECG- usually +ve (see ST depression)
- Angiogram if uncertain or intervention likely
11
Q
Management of angina
A
1) lifestyle changes + aspirin + statin
2) if symptomatic: GTN (acute attacks), BB, nitrates, CCBs
3) long term = PCI
12
Q
What is the main side effect of GTN?
A
headache
13
Q
Describe an NSTEMI
A
NSTEMI = myocardial infarction do get damage
If troponin stable at 12 hours suggests
14
Q
What are the investigation for ACS?
A
ECG
Toponin
Bloods
15
Q
What is the management of a STEMI?
A
ABCDE Morphine IV O2 Nitrates- dilate vessels Aspirin Send for emergency PCI or if contraindicated thombolysis
16
Q
After an MI how long can you not drive for?
A
1 month
17
Q
What are the complications of an MI?
A
early =
late = DVT, PE, aneurysm, Dressler syndrome
18
Q
HTN is a major risk factor for which conditions?
A
MI, HF, PVD
19
Q
How can you divide hypertension?
A
Primary or Essential
Primary = idiopathic (95%), genetic, obesity, alcohol, too much salt, increased stress
Secondary = RARE
- renal- renovascular/parenchymal disease
- endocrine- conn, adrenal insufficiency
- CV- coarctation
- drugs: OCP, steroids, NSAIDs
- pregnancy
20
Q
How can you divide hypertension?
A
Primary or Essential
Primary = idiopathic (95%), genetic, obesity, alcohol, too much salt, increased stress
Secondary = RARE
- renal- renovascular/parenchymal disease
- endocrine- conn, adrenal insufficiency
- CV- coarctation
- drugs: OCP, steroids, NSAIDs
- pregnancy
21
Q
What investigations would you do in HTN?
A
Look for target-organ damage:
- urine dipstick: proteinuria, haematuria
- serum creatinine, electrolytes and eGFR
- 12 lead ECG (looking for LVH or signs of CHD)
22
Q
Management of HTN?
A
- Non-pharm: more exercise, stop smoking, reduce alcohol
23
Q
Who do you need to treat for HTN?
A
>80 DO NOT TREAT treat under 80 if: - stage 1 + end organ failure - Q-RISK > ANY STAGE 2 no matter what age
24
Q
Drugs used to treat hypertension…
A
.
25
Describe the antihypertensive drug treatment...
.
26
Define HF
heart unable to maintain sufficient CO to provide a physiologically normal circulation
27
What are the causes of LHF?
More cardiac based:
28
What are the clinical features of LHF?
Cardiac based >> back up into lungs therefore lung symptoms
29
What are the causes of RHF?
.
30
What are the clinical features of RHF?
.
31
What are the ABCDE features of HF?
```
A
B
C
D
E
```
32
Investigations for HF
ALWAYS DO A SERUM BNP (if normal excludes HF)
33
Management of HF:
non pharm- education (no cure), lifestyle factors, optimise risk factors, correct aggravating medical factors, VACCINATE against
- driving unrestricted
34
Drugs used in HF?
.
35
What are the surgical treatments for HF?
- CABG
36
What are the causes of congenital heart disease?
1) maternal factors: maternal rubella, foetal alcohol syndrome
2) genetic/chromosomal = trisonomy 21, Turners syndromes (one X)
37
Which congenital heart diseases are acyanotic and cyanotic?
cyanotic = ASD, VSD, PDA
38
What common diseases are associated with congenital heart disease?
- central cyanosis
- congestive HF
- pulmonary HTN
- polycythaemia
- Eisenmengers syndrome
39
What is atrial septic defect?
acyanotic
left to right shunt
mid-systolic ejection murmur and split S2
Usually asymptomatic
Sig shunt symptoms = dyspnoea, fatigue, ex intolerance
40
Investigations for ASD?
- CXR- dilated pulm artery
- ECG- right axis deviation (right side larger as holding more blood)
- Echo- hypertrophy and dilation of right side
41
Treatment for ASD?
.
42
Name a complication of ASD
paradoxical embolism
43
What is VSD?
```
acyanotic
left to right shunt
pan systolic murmur, systolic thrill and heave
small = loud murmur and asymptomatic
large =
```
44
What are investigations and management?
- CXR- dilated pulm artery
- ECG- right axis deviation (right side larger as holding more blood)
- Echo- hypertrophy and dilation of right side
Management = conservative and surgery
45
What is patent ductus arteriosus?
failure of ductus arteriosus to close after birth (should close within 10 days after birth)
46
What is the cause of patent ductus arteriosus?
unknown but maternal rubella
47
What are the symptoms and management of PDA?
.
48
What are people with PDA at risk of?
endocarditis
49
What is tetralogy of fallot?
1.
2.
3.
4.
50
What are the symptoms and signs of tetralogy of fallot?
symptoms = cyanosis, failure to thrive due to feeding difficulty
51
How do children present with tetralogy of fallot?
Hypercyanotic spells and may squat (kinks feral arteries increases P and reverses shunt)
52
How does the heart present on x-ray in tetralogy of fallot?
Boot shaped heart
53
What is the management of tetralogy of fallot?
.
54
What is coarctation of the aorta?
.
55
How would pressures change in coarctation of the aorta?
Radiofemoral delay BP arm > leg
56
Why do you get lung symptoms in mitral stenosis?
the blood is struggling to get into the heart and therefore backing up into lungs
57
What are the causes of pericarditis?
Coxsackie B and echovirus (will have had viral symptoms for last week)
- if immunocompromised may be different cause to usual?
58
Describe the history of chest pain in pericarditis?
central, substernal
sharp
worse on breathing/lying flat
RELIEVED BY SITTING FORWARD
59
On examination what would you see in pericarditis?
Pericardial friction rub
60
On an ECG what would you see in pericarditis?
saddle shaped ST elevation
61
How would you treat pericarditis?
ONLY GIVE ANTIBIOTICS IF KNOW BACTERIAL CAUSE
1) NSAIDs + rest
2) corticosteroids
62
How would you treat pericarditis?
ONLY GIVE ANTIBIOTICS IF KNOW BACTERIAL CAUSE
1) NSAIDs + rest
2) corticosteroids
63
When does peripheral vascular disease occur?
sig narrowing of
64
How can you classify chronic PVD?
```
Fontane classification:
Stage I
Stage II
Stage III- rest pain
Stage IV - necrosis/gangrene
```
65
PVD symptoms
```
Intermittent claudication
- calf pain
- exertion discomfort relieved by rest
Rest pain (in bed)
- severe unremitting pain in feet
- relived by dangling feet over edge of bed
```
66
What are the signs of PVD?
- cold
- dry skin
- pulse diminished
- ulceration
67
What investigations would you do in PVD?
- pulses
- ABP index
- duplex US (can show narrowing in arteries)
68
What is the management in PVD?
- aggressive risk factor management (more at risk of CV problems than losing leg/foot)
- statin
- aspirin
69
What would you see in acute limb ischaemia?
```
The 6 P's
Pain
Pallor
Pulseless
Paraesthesia
P
P
```
70
Arrhythmia's may cause....
asymptomatic, palpitation, dizziness, syncope (unlikely = sudden death)
71
What is sinus arrhythmia?
fluctuation in autonomic tone results in changes in sinus discharge rate
72
When is sinus bradycardia normal?
during sleep and in athletes
73
What are the common causes of heart block?
CAD
cardiomyopathy
fibrosis in conductive tissue
74
What is a AVNRT?
.
75
What is AVRT?
.
76
How can you get an idea of the sinus rhythm of the heart from the patient?
Get patient to tap out the rhythm
77
What is the most common arrhythmia?
atrial fibrillation
78
What pulse is seen in AF?
Irregularly irregular
79
In AF what are you at high risk of?
Embolic events e.g. stroke
80
What would you seen on an ECG in atrial fibrillation?
No P waves, rapid irregular QRS
81
What is used to assess a patients risk of stroke?
CHADS2VASc score
82
What is the normal diameter of the aorta?
2cm
83
For anyone with renal colic what should you suspect unless proven otherwise?
AAA
84
What would you see on examination in AAA?
pulsatile, expansible mass
85
What is the valsalvar manoeuvre
a forceful expiration against a closed airway- increased intensity of murmur in hypertrophic cardiomyopathy
