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ICM Matrix > CVS > Flashcards

CVS Flashcards

1
Q

What are the shockable rhythms?

A

VF

pulseless VT

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2
Q

In ALS, when can (1mg) adrenaline be administered?

A

After chest compression have started ( 30:2)

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3
Q

What ESM is heard louder on expiration?

A

1) aortic stenosis

2) hypertrophic obstructive cardiomyopathy

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4
Q

What ESM is heard louder on inspiration?

A

1) pulmonary stenosis

2) atrial septal defect

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5
Q

What ECG abnormality is associated with hypercalcaemia?

A

Shortened QT interval

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6
Q

When a patient in cardiac arrest has organised electrical activity but there is still no pulse and there are no signs of life, what do you do?

A

1) continuing CPR at a rate of 30:2

2) IV adrenaline

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7
Q

What is stage 3 HTN defined as?

A

BP above 180/120

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8
Q

1st steps in stage 2 HTN

A

Assess target organ damage if <80yo. Give meds if >80yo

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9
Q

How to manage stage 3 HTN?

A

Specialist referral if <40yo

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10
Q

In stage 2 HTN (and above) which investigations would you carry out?

A

ECG, Fundoscopy, Urinalysis, BP, bloods

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11
Q

Which ECG changes would you see in hyperkalaemia?

A

Tall Tented T waves

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12
Q

Side effects of ARB

A

hyperkalaemia, hypotension, renal failure

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13
Q

What is orthostatic hypotension?

A

decrease in BP by > 20 systolic, 10 diastolic

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14
Q

how do you check for postural hypotension?

A

lying/standing BP for 3 mins

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15
Q

What might you see in an ECG in someone who has postural hypotension?

A

prolonged QT, bundle branch block

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16
Q

How do patients with HF present (specify left and right)?

A

Left : lung (confused, restless, orthopnoea, cyanosis, crackles)

Right : rest of the body (ascites, oedema, hepato/splenomegaly, weight gain)

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17
Q

What is BNP?

A

Measured in heart failure. Released in response to the heart stretching.

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18
Q

a specific sx of phlebitis

A

hardening of surrounding tissue due to lack of perfusion caused by inflammation

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19
Q

Sx of varicose veins

A

pains, itching, throbbing

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20
Q

what are the 6Ps and when do you look for them

A

arterial occlusion

Pallor
Paraesthesia
Pain
Poikilothermia (temperature)
Pulselessness
Paralysis
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21
Q

investigations for arterial occlusion

A

ABPI <0.5 is critical (refer to vascular MDT)
ABPI 0.6-0.9 is intermittent claudication (exercise management, angio or bypass)

Ultrasound of blood flow in peripheries

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22
Q

When would a patient with aortic aneurysm require surgery?

A

Aneurysm >5.5 / symptomatic / rupture

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23
Q

Which valvular disease is associated with rheumatic fever?

A

mitral stenosis

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24
Q

which criteria is used to rheumatic fever? Define the criteria.

A

Jones:

2 major criteria
1 major with 2 minor criteria

Evidence of recent streptococcal infection
raised or rising streptococci antibodies,
positive throat swab
positive rapid group A streptococcal antigen test

Major criteria
erythema marginatum
Sydenham’s chorea: this is often a late feature
polyarthritis
carditis and valvulitis (eg, pancarditis)
subcutaneous nodules

Minor criteria
raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval
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25
Q

Tx of acute rheumatic fever

A

Penicillin V and NSAIDs (aspirin or naproxen)

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26
Q

Giant cell arteritis buzzwords and sx!

A

Sx = Headache, visual disturbance, polymyalgia rheumatica

Ix = Temporal artery biopsy

Tx = Oral prednisolone

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27
Q

which valve is associated with endocarditis

A

mitral

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28
Q

Which criteria is used in endocarditis

A

Infective endocarditis diagnosed if
pathological criteria positive, or

2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria

Pathological criteria: Positive histology or microbiology

Major criteria
- Positive blood cultures
- Evidence of endocardial involvement
positive echocardiogram or
new valvular regurgitation

Minor criteria

  • predisposing heart condition or intravenous drug use
  • fever > 38ºC
  • vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
  • immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots
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29
Q

Endocarditis which causes HF requires what treatment ?

A

emergency valve replacement surgery

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30
Q

ECG findings for pericarditis

A

widespread saddle-shaped ST elevation in all leads

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31
Q

What is Becks triad?

A

cardiac tamponade
1. hypotension

  1. muffled heart sounds
  2. raised JVP
32
Q

which ECG finding is seen in cardiac tamponade

A

electric alternans

33
Q

ECG findings in an NSTEMI

A

pathological P waves

34
Q

what is Prinzemtal angina

A

sometimes relieved by medication but not by rest

35
Q

What is the most common causative organism for infective endocarditis?

A

Staphylococcus aureus

36
Q

What long-term medication should patient HF take?

A

ACEi =

BB = carvedilol and bisoprolol

37
Q

What medication is contraindicated with atenolol?

A

Verapamil = risk of heart block

38
Q

What is the most common complication of Hypertrophic obstructive cardiomyopathy?

A

Sudden death due to ventricular arrhythmia

39
Q

What is the gold-standard Tx for ST-elevation MI?

A

PCI

40
Q

What is hypertension?

A

a clinic reading persistently above >= 140/90 mmHg,
or:
a 24 hour blood pressure average reading >= 135/85 mmHg

41
Q

What are the 2 main types of hypertension?

A

Primary/essential: no single disease is identified as the cause of HTN, usually due to physiological changes as we age

Secondary: caused by a variety of endocrine, renal and other causes

42
Q

List some of the causes of secondary hypertension

A

Renal:

  • glomerulonephritis
  • renal artery stenosis
  • chronic pyelonephritis

Endocrine:

  • primary hyperaldosteronism
  • Cushings
  • congenital adrenal hyperplasia

Other:

  • glucocorticoids
  • NSAIDs
  • COCP
43
Q

Which symptoms may be seen in patients with severe hypertension?

A
  • headaches
  • visual disturbances
  • seizures
44
Q

How is end organ damage assessed?

A

Fundoscopy: check for retinopathy

Urine dipstick: renal disease as a cause or consequence of HTN

ECG: left ventricular hypertrophy or ischaemic heart disease

45
Q

What tests do patients typically have following a diagnosis of hypertension?

A
  • U&Es
  • HbA1c
  • Lipids
  • ECG
  • Urine dipstick
46
Q

What is end organ damage?

A

End organ damage usually refers to damage occurring in major organs fed by the circulatory system (heart, kidneys, brain, eyes)

47
Q

When is an ARB preferred over an ACEi?

A

patients of black African or African–Caribbean origin taking a CCB, if they require a second agent consider an ARB in preference to an ACEi

48
Q

Criteria for stage 1, stage 2 and severe hypertension?

A

Stage 1) Clinic BP >= 140/90 mmHg and subsequent ABPM average BP >= 135/85 mmHg

Stage 2) Clinic BP >= 160/100 mmHg and subsequent ABPM average BP >= 150/95 mmHg

Severe) Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg

49
Q

How does NICE recommend measuring BP when considering a diagnosis of Hypertension?

A

measure in both arms and if the difference is >20mmHg then repeat

if this remains the case then measure from the arm with higher readings and listen to heart sounds as there may be a pathological cause such as supravalvular aortic stenosis

50
Q

What should you do if BP >= 180/120mmHg?

A

specialist assessment

  • ?retinal haemorrhage or papilloedema
  • life-threatening sx
  • end organ damage assessment
51
Q

Which symptoms are life threatening in severe HTN?

A
  • new-onset confusion - chest pain
  • signs of heart failure
  • AKI
52
Q

When would a patient with stage 1 HTN be offered drug tx?

A

if <80yo AND:

  • end organ damage
  • established CVD
  • renal disease
  • diabetic
  • QRISK >10%
53
Q

Which algorithm can be used to estimate the risk of developing cardiovascular risk of the next 10 years and what is considered as high risk?

A

QRISK

> = 20% is considered high risk

54
Q

What is the clinic BP and ABPM for <80yo?

A

Clinic: 140/90 mmHg
ABPM: 135/85 mmHg

55
Q

What is the clinic BP and ABPM for >80yo?

A

Clinic: 150/90 mmHg
ABPM: 145/85 mmHg

56
Q

What is isolated systolic HTN?

A

systolic blood pressure 160 mmHg or more

57
Q

Examples of drugs which can cause hypertension

A
  • COCP
  • steroids
  • NSAIDs
  • SSNRI
  • recreational drugs
58
Q

What is malignant/accelerated hypertension?

A

EMERGENCY

rapid increase in BP >= 180/120mmHg resulting in end organ damage

59
Q

Define phlebitis and thrombophlebitis

A

Phlebitis means inflammation of a vein. Thrombophlebitis refers to a blood clot causing the inflammation.

60
Q

Patients with clinical signs of superficial thrombophlebitis affecting the proximal long saphenous vein should have which investigation?

A

ultrasound scan to exclude concurrent DVT

61
Q

What is a complication of arterial occlusion?

A

Gangrene

62
Q

Sx of peripheral vascular disease

A

may be sx free

  • sx of intermittent claudication (cramping with exercise, relieved by rest)
  • ulcers
  • hair loss
  • skin changes (thinning, brittle, shiny)
63
Q

Which investigations may be used in suspected PVD?

A
  • Doppler US
  • Angiogram
  • Ankle-brachial index
64
Q

Complications of PVD

A
  • stroke
  • restricted mobility
  • reduced wound healing
  • amputation
65
Q

What can cause cardiogenic shock?

A

Intrinsic:

  • MI
  • Arrhythmia

Extrinsic:

  • PE
  • Pneumothorax
66
Q

Why do symptoms occur in cadiogenic shock?

What are the symptoms?

A

Due to hypoperfusion or fluid overload

  • Chest pain
  • SOB
  • Palpitations
  • Syncope
  • Confusion
  • Sweating
  • Pale skin
67
Q

What are the signs of cardiogenic shock?

A
  • Tachycardia
  • Raised JVP
  • Cold peripheries
  • Hypotension
  • Peripheral oedema
  • Weak pulse
68
Q

What are the signs of hypovolaemic shock?

A
  • Tachycardia/tachypnoea
  • Reduced CRT
  • Cold peripheries
  • Hypotension
  • End organ dysfunction:
  • -> Oliguria/anuria
  • -> Confusion
  • -> irritability
  • -> Chest pain/ SOB
69
Q

How does rheumatic fever develop?

A

Following an immunological reaction to recent (2-6 weeks ago) streptococcus pyogenes infection (strep throat)

70
Q

What is the diagnostic criteria for rheumatic fever?

A

Jones:
Evidence of recent streptococcal infection accompanied by:
–> 2 major criteria
–> 1 major with 2 minor criteria

71
Q

What is the evidence of recent streptococcal infection in rheumatic fever?

A
  1. raised or rising streptococci antibodies,
  2. positive throat swab
  3. positive rapid group A streptococcal antigen test
72
Q

What is the major criteria in rheumatic fever?

A
  1. erythema marginatum
  2. Sydenham’s chorea: this is often a late feature
  3. polyarthritis
  4. carditis and valvulitis (eg, pancarditis)
  5. subcutaneous nodules
73
Q

What is the minor criteria in rheumatic fever?

A
  1. raised ESR or CRP
  2. pyrexia
  3. arthralgia (not if arthritis a major criteria)
  4. prolonged PR interval
74
Q

What is acute rheumatic fever?

A

Inflammation in the heart, joints, skin or CNS.

- can develop after strep throat

75
Q

Ix for suspected aortic dissection

A

CT angiography

TOE tends to be used to confirm the diagnosis if still unclear after CT angiography, or if the patient is unstable and is likely to deteriorate before getting to the CT scanner.

ICM Matrix (15 decks)

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