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Phase 2a > CV > Flashcards

CV Flashcards

1
Q

P wave normal value

A

<0.12s

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2
Q

QRS normal value

A

0.12s or less

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3
Q

PR normal value

A

0.12-0.2s

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4
Q

Define IHD…

A

myocardial demand for O2/nutrients greater than deliver from coronary arteries

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5
Q

What is the most common cause of IHD?

A

atherosclerosis

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6
Q

Give some other causes of IHD…

A

.

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7
Q

Name some modifiable and non-modifiable risk factors for IHD

A

.

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8
Q

Name some clinical and psychosocial factors for IHD

A

.

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9
Q

Describe the chest pain associated with stable angina…

A

.

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10
Q

What investigations can you do for angina?

A
  1. resting ECG- usually normal
  2. stress ECG- usually +ve (see ST depression)
  3. Angiogram if uncertain or intervention likely
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11
Q

Management of angina

A

1) lifestyle changes + aspirin + statin
2) if symptomatic: GTN (acute attacks), BB, nitrates, CCBs
3) long term = PCI

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12
Q

What is the main side effect of GTN?

A

headache

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13
Q

Describe an NSTEMI

A

NSTEMI = myocardial infarction do get damage

If troponin stable at 12 hours suggests

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14
Q

What are the investigation for ACS?

A

ECG
Toponin
Bloods

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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
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16
Q

After an MI how long can you not drive for?

A

1 month

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17
Q

What are the complications of an MI?

A

early =

late = DVT, PE, aneurysm, Dressler syndrome

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18
Q

HTN is a major risk factor for which conditions?

A

MI, HF, PVD

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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
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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
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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)
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22
Q

Management of HTN?

A
  1. Non-pharm: more exercise, stop smoking, reduce alcohol
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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
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24
Q

Drugs used to treat hypertension…

A

.

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25
Q

Describe the antihypertensive drug treatment…

A

.

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26
Q

Define HF

A

heart unable to maintain sufficient CO to provide a physiologically normal circulation

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27
Q

What are the causes of LHF?

A

More cardiac based:

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28
Q

What are the clinical features of LHF?

A

Cardiac based&raquo_space; back up into lungs therefore lung symptoms

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29
Q

What are the causes of RHF?

A

.

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30
Q

What are the clinical features of RHF?

A

.

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31
Q

What are the ABCDE features of HF?

A 
A
B
C
D
E
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32
Q

Investigations for HF

A

ALWAYS DO A SERUM BNP (if normal excludes HF)

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33
Q

Management of HF:

A

non pharm- education (no cure), lifestyle factors, optimise risk factors, correct aggravating medical factors, VACCINATE against
- driving unrestricted

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34
Q

Drugs used in HF?

A

.

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35
Q

What are the surgical treatments for HF?

A
  • CABG
36
Q

What are the causes of congenital heart disease?

A

1) maternal factors: maternal rubella, foetal alcohol syndrome
2) genetic/chromosomal = trisonomy 21, Turners syndromes (one X)

37
Q

Which congenital heart diseases are acyanotic and cyanotic?

A

cyanotic = ASD, VSD, PDA

38
Q

What common diseases are associated with congenital heart disease?

A
  • central cyanosis
  • congestive HF
  • pulmonary HTN
  • polycythaemia
  • Eisenmengers syndrome
39
Q

What is atrial septic defect?

A

acyanotic
left to right shunt
mid-systolic ejection murmur and split S2
Usually asymptomatic
Sig shunt symptoms = dyspnoea, fatigue, ex intolerance

40
Q

Investigations for ASD?

A
  • CXR- dilated pulm artery
  • ECG- right axis deviation (right side larger as holding more blood)
  • Echo- hypertrophy and dilation of right side
41
Q

Treatment for ASD?

A

.

42
Q

Name a complication of ASD

A

paradoxical embolism

43
Q

What is VSD?

A 
acyanotic
left to right shunt
pan systolic murmur, systolic thrill and heave
small = loud murmur and asymptomatic
large =
44
Q

What are investigations and management?

A
  • 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
Q

What is patent ductus arteriosus?

A

failure of ductus arteriosus to close after birth (should close within 10 days after birth)

46
Q

What is the cause of patent ductus arteriosus?

A

unknown but maternal rubella

47
Q

What are the symptoms and management of PDA?

A

.

48
Q

What are people with PDA at risk of?

A

endocarditis

49
Q

What is tetralogy of fallot?

A

1.
2.
3.
4.

50
Q

What are the symptoms and signs of tetralogy of fallot?

A

symptoms = cyanosis, failure to thrive due to feeding difficulty

51
Q

How do children present with tetralogy of fallot?

A

Hypercyanotic spells and may squat (kinks feral arteries increases P and reverses shunt)

52
Q

How does the heart present on x-ray in tetralogy of fallot?

A

Boot shaped heart

53
Q

What is the management of tetralogy of fallot?

A

.

54
Q

What is coarctation of the aorta?

A

.

55
Q

How would pressures change in coarctation of the aorta?

A

Radiofemoral delay BP arm > leg

56
Q

Why do you get lung symptoms in mitral stenosis?

A

the blood is struggling to get into the heart and therefore backing up into lungs

57
Q

What are the causes of pericarditis?

A

Coxsackie B and echovirus (will have had viral symptoms for last week)
- if immunocompromised may be different cause to usual?

58
Q

Describe the history of chest pain in pericarditis?

A

central, substernal
sharp
worse on breathing/lying flat
RELIEVED BY SITTING FORWARD

59
Q

On examination what would you see in pericarditis?

A

Pericardial friction rub

60
Q

On an ECG what would you see in pericarditis?

A

saddle shaped ST elevation

61
Q

How would you treat pericarditis?

A

ONLY GIVE ANTIBIOTICS IF KNOW BACTERIAL CAUSE

1) NSAIDs + rest
2) corticosteroids

62
Q

How would you treat pericarditis?

A

ONLY GIVE ANTIBIOTICS IF KNOW BACTERIAL CAUSE

1) NSAIDs + rest
2) corticosteroids

63
Q

When does peripheral vascular disease occur?

A

sig narrowing of

64
Q

How can you classify chronic PVD?

A 
Fontane classification:
Stage I
Stage II
Stage III- rest pain
Stage IV - necrosis/gangrene
65
Q

PVD symptoms

A 
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
Q

What are the signs of PVD?

A
  • cold
  • dry skin
  • pulse diminished
  • ulceration
67
Q

What investigations would you do in PVD?

A
  • pulses
  • ABP index
  • duplex US (can show narrowing in arteries)
68
Q

What is the management in PVD?

A
  • aggressive risk factor management (more at risk of CV problems than losing leg/foot)
  • statin
  • aspirin
69
Q

What would you see in acute limb ischaemia?

A 
The 6 P's
Pain
Pallor
Pulseless
Paraesthesia
P
P
70
Q

Arrhythmia’s may cause….

A

asymptomatic, palpitation, dizziness, syncope (unlikely = sudden death)

71
Q

What is sinus arrhythmia?

A

fluctuation in autonomic tone results in changes in sinus discharge rate

72
Q

When is sinus bradycardia normal?

A

during sleep and in athletes

73
Q

What are the common causes of heart block?

A

CAD
cardiomyopathy
fibrosis in conductive tissue

74
Q

What is a AVNRT?

A

.

75
Q

What is AVRT?

A

.

76
Q

How can you get an idea of the sinus rhythm of the heart from the patient?

A

Get patient to tap out the rhythm

77
Q

What is the most common arrhythmia?

A

atrial fibrillation

78
Q

What pulse is seen in AF?

A

Irregularly irregular

79
Q

In AF what are you at high risk of?

A

Embolic events e.g. stroke

80
Q

What would you seen on an ECG in atrial fibrillation?

A

No P waves, rapid irregular QRS

81
Q

What is used to assess a patients risk of stroke?

A

CHADS2VASc score

82
Q

What is the normal diameter of the aorta?

A

2cm

83
Q

For anyone with renal colic what should you suspect unless proven otherwise?

A

AAA

84
Q

What would you see on examination in AAA?

A

pulsatile, expansible mass

85
Q

What is the valsalvar manoeuvre

A

a forceful expiration against a closed airway- increased intensity of murmur in hypertrophic cardiomyopathy

Phase 2a (7 decks)

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