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VASCULAR SYSTEM AND MEDICAL EMERGENCIES 303 > CV Disease I and II > Flashcards

CV Disease I and II Flashcards

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USMLE® Step 1 flashcards
1
Q

What could go wrong, relating to the CV system?

A

MI, angina = chest pain
Tachycardia = palpitations, breathlessness
Bradycardia = dizzy, blackout
Heart failure
Die = ventricular tachycardia, fibrillation
Endocarditis

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2
Q

What questions should you ask when faced with pts with definite or possible CV disease?

A

Will they tolerate treatment?
Will my treatment complicate their condition or treatment?
Will their condition or treatment complicate my treatment?
Should I tell anyone about them? - Yes if cardiac symptoms or signs

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3
Q

List the functions and consequences of malfunction of the myocardium, valves, conduction system and coronary blood supply

A

Myocardium = heart failure
Valves = heart failure, endocarditis
Conduction system = Arrhythmia (tachy, brady, sudden death)
Coronary blood supply = angina, myocardial infarction

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4
Q

List the common causes of heart failure

A

Previous MI, high BP, genetic causes, drugs (chemo), idiopathic

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5
Q

Name the standard assessment of pump function

A

Transthoracic endocardiography

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6
Q

Symptoms of heart failure?

A

Reduced CO = increase fluid pressure in lungs, reduces venous return to the heart via vena cava, fluid retention and vasoconstriction = Breathlessness (increased fluid pressure in lungs)
Swelling (increased fluid pressure in venous system)
Dizziness, tiredness, weight loss

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7
Q

Clinical signs of heart failure?

A 
Low BP
High pulse rate
Crepitations in lungs
Raised jugular venous pressure
Pitting ankle oedema
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8
Q

What causes the same symptoms as heart failure?

A

Regurgitant or stenosed valves

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9
Q

What causes valve disease?

A 
Degeneration
Rheumatic fever
Congenitally abnormal valve
Endocarditis
Papillary muscle rupture after MI
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10
Q

What is infective endocarditis?

A

Systemic infection, infected lumps in blood stream causing embolic complications and heart valves damage = valve regurgitation and heart failure
= night sweats, fever, rigors, weightloss

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11
Q

When is infective endocarditis more likely?

A

Artificial valves, abnormal valves, elderly, IV drug abusers, previous endocarditis

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12
Q

What organisms usually cause infective endocarditis?

A

Streptococcal, staphlococcal

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13
Q

What does infective endocarditis cause?

A

Valve damage and embolisation

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14
Q

Types of arrhythmia?

A

Tachycardia >100bpm

Bradycardia <60bpm

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15
Q

ECQ - What does P measure?

A

Atrial depolarisation

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16
Q

What does QRS measure?

A

Ventricular depolarisation

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17
Q

What does the T wave indicate?

A

Ventricular repolarisation

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18
Q

Closer QRS complexes indicate what?

A

Faster HR

19
Q

Name the types and symptoms of Tachyarrhythmia

A

Atrial fibrillation - palpitations, dizziness
Atrial flutter - as above
Supraventricular tachycardia (SVT) - palpitations
Ventricular tachycardia - palpitations, sudden death
Ventricular fibrilation - sudden death
Ectopic beats - palpitations, skipped beats

20
Q

Types and symptoms of bradyarrhythmia?

A

Sinus bradycardia - tiredness
Slow atrial fibrillation - tired/dizziness
2nd degree heart block - dizziness
Complete heart block - tired/dizziness/sudden death
Asystole - sudden death

21
Q

Risk factors for coronary artery disease?

A 
Smoking
High cholesterol
High BP
Diabetes
Overweight
Poor diet
Stroke, peripheral vascular disease
Family history
Genetics
Male
Age
22
Q

What causes angina?

A

When coronary artery disease becomes obstructive

23
Q

How does angina prevent thrombosis?

A

The plaque is stable = strong fibrous cap protects the blood from exposure to the liquid core of the lesion

24
Q

What is angina?

A

Recurrent feeling of chest pressure/heaviness/pain/indigestion, sometimes radiating to arm, neck or back

25
Q

What is unstable angina?

A

Increasing frequency of pain, duration or onset at rest = risky

26
Q

When does a MI occur?

A

When an atherosclerotic plaque in a coronary artery ruptures = thrombus formation = permanent dead of some of the myocardium

27
Q

When to know the difference between angina and an MI?

A

Angina rarely lasts more than 10 mins - MI pain is longer

28
Q

How to tell if someone has coronary artery disease

A

Exercise ECG: inaccurate
Myocardial perfusion scan: more accurate
Angiography: by CT or invasive angiography

29
Q

How to treat coronary artery disease?

A 
Lifestyle modification: 
Stop smoking, exercise, healthy diet, weightloss
Cholesterol lowering
Antiplatelets 
Address risk factors
30
Q

How to treat CAD if it’s causing angina?

A

CAD treatment plus
Medication to reduce anginal attacks - nitrates
If medication not working/side effects; stenting or coronary artery bypass grafting

31
Q

How to investigate heart failure?

A

Transthoracic echocardiography to detect ventricular impairment
Tests for elevated serum B-type natriuretic peptide (BNP)
Cardiac MR

32
Q

How to treat heart failure?

A 
ACE inhibitors, betablockers, aldosterone antagonists, diuretics, ivabradine 
Correction of other causes (anaemia)
Manage complications (arrhythmia) 
CRT (pacemaker type)
33
Q

How to investigate valve disease?

A

Transthoracic echocardiography

Transoesophageal echocardiography = better image of mitral valve, unpleasant for pt

34
Q

How to treat valve disease?

A

Symptomatic = valve surgery
- Metallic valves = requires lifelong warfarin, only stopped if bridged with heparin

Aortic stenosis = TAVI

35
Q

How to investigate arrhythmia?

A

Diagnosis by ECG at time of symptoms

Look for causes - valve disease, family testing

36
Q

What devices can be fitted to treat bradyarrhythmia?

A

Dual chamber pacemaker

37
Q

What devices can be fitted to treat ventricular tachycardia or VF?

A

Implantable cardioverter/defibrillator

38
Q

What device treats heart failure?

A

Cardiac resynchronisation Therapy (CRT)

39
Q

When should you defer dental treatment?

A

Increasing pain with stable angina
Increasing breathlessness and oedema with stable heart failure
Recent MI (6 weeks) - defer until 3-6 months post MI
Frequent attacks of disabling tachycardia
Pt awaiting stents or bypass or valve surgery = if stable, can do treatment

40
Q

How to investigate MIs?

A

Troponin count
ECG
Chest pain

41
Q

What ECG and troponin features are present with different types of MI?

A

NSTEMI and STEMI = raised troponin

STEMI
- Elevated S-T

NSTEMI
- Normal ST or depressed ST or T wave inversion

42
Q

How to manage MIs?

A

Both = Immediate dual anticoagulation therapy (aspirin and clopidogrel) and pain relief (aspirin and opiates)
- Avoid O2 and nitrates
Anticoagulation for 24-72hrs (heparin)
STEMI = Angiography and stenting (but thrombolyse preferred if available) immediately
NSTEMI = Angiography and PCI (stenting) within 72hrs or sooner if complications - takes longer to diagnose due to troponin non-sensitive test taking 6-12hrs)

43
Q

Secondary prevention of MI?

A

Dual antiplatelet therapy for a yr, then aspirin alone, statin, beta blocker, ACE inhibitor
Clopidogrel 1 month after STEMI, 1 yr after NSTEMI

Cardiac rehab, exercise, education, smoking cessation, diet

VASCULAR SYSTEM AND MEDICAL EMERGENCIES 303 (3 decks)

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