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CP1 revision > Deck 1 > Flashcards

Deck 1 Flashcards

1
Q

Angina grading

A

Canadian cardiovascular society 1-4

1 is on strenuous, 2 is on mod exertion, 3 is on mild exertion and 4 is at rest

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2
Q

Angina causes

A

Reduced perfusion (atheroma, embolus, iflammation, hypotension, spasm, thrombosis), reduced oxygenation (anaemia, carboxyhaemoglobinaemia) or increased tissue demands (LVH)

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3
Q

CTCA

A

First choice in new onset angina pain. Looks at whole vessel, not just lumen (can adequately assess plaque burden)
Use in NICE probability 61-90%

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4
Q

CT-FFR

A

Computer modelling to assess functional impact (if <0.8 then haemodynamically significant)
Use in NICE probability 31-60%

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5
Q

Clinical diagnosis of angina

A

At NICE probability >90%

Looks at age and symptom type

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6
Q

Angina Tx

A

Address RF
GTN spray, BB (or rate limiting CCB)
Can add nicorandil for refractory disease (vasodilator)
Give statin and low dose aspirin
Surgery required if large area at risk (>10%) or left main stem, or 2-3 vessel disease.
CABG good for diffuse disease, reduced LV function, recurrent stent stenosis and in diabetes.
PCI good for 1 or 2 vessel, frailty, advanced age or varicose veins.

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7
Q

Acute MI

A

Can be regional (90%) or circumferential (10%)
See trop rise (if ECG change only then unstable angina)
If Trop rise + ST elevation/LBBB then STEMI (full thickness)
If trop rise and no ST elevation then NSTEMI (partial thickness)

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8
Q

RCA supplies
Type of MI
Which leads

A

RA, RV, posterior septum - often AVN and SAN
Gives posterior/inferior MI
Leads II, III, avF

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9
Q

LCA (main stem) MI

A

Massive anteriolateral MI

Seen on I, aVL, V1-V6

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10
Q

LAD supplies

Which leads

A

LV and anterior septum

V1-V4

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11
Q

Circumflex supplies?
Type of MI
Leads?

A

LA and LV
Lateral MI
I, aVL and V5/6

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12
Q

DDX for acute coronary syndrome

A

Coronary artery spasm, pericarditis/myocarditis, aortic dissection, PE, pneumothorax, oesophageal disease (worse on leaning forwards), mediastinitis, costochondritis, trauma

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13
Q

Troponin peak

A

24h

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14
Q

ECG MI progression

A 
Tall T waves at 5 mins
ST elevation at 30 minutes
T wave inversion, Q waves (2h)
ST segment normal (days)
T wave may return to normal, Q wave remains (WEEKS)
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15
Q

ACS management

A

Morphine (5mg + antiemetic), GTN/IV nitrates (unless hypotensive), 300mg aspirin, oxygen if <94%
PCI within 90 minutes if STEMI
If NSTEMI then GRACE score

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16
Q

AMI complications

A

Short term:
Arrythmias, Pulmonary oedema (LVF), cardiogenic shock, thromboembolism, ventriculoseptal defect (due to intracardiac rupture), ruptured cordae tendinae (mitral valve incompetence), ventricular wall rupture (leads to haemopericadium, cardiac tamponade and death)
Long term: HF, dressler (immune mediated pericarditis wit raised ESR and myocardial antibodies), ventricular aneurysm formation (distended scar)

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17
Q

IE risks

A

Damaged endocardium (valve disease, prostetic valves, congenital disease), sustained bacteraemias (IVDU, infected intravascular device, untreated abscess/collection)

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18
Q

Vascular IE phenomenom

A

Splinter haemorrahage, janeway lesion

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19
Q

Immunological IE phenomenon

A

Osler node, Roth spot, glomerulonephritis (microscopic haematuria)

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20
Q

Native valve IE causes

A

Streptococcus viridans, Streptococcus mitis

S. aureus in IVDU

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21
Q

Prosthetic valve IE causes

A

coagulase negative staphylococcus (e.g. s epidermidis for first 2 month)

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22
Q 
IE causes:
- Bowel malignany
-GI/GU disease
If culture negative
If non infectious
A

Streptococcus bovis in bowel malignancy
Enterococcus in GI/GU tract
Coxiella burnetii, bartonella, brucella, HACEK (haemophilus, actinobacilus, cardiobacterium, eikenella, kingella)
Non infectious cause is libman sacks lesions (SLE)

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23
Q

IE investigations

A

Echo (ideally TOE)

FBC, CRP, ESR, BCx3, Urinalysis, ECG, CXR

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24
Q

Dukes IE criteria

A

Major is: atypical organism on 2 separate BCs, echo findings or new valvular regurgitation (worsening of existing not enough)
Minor is predisposition, pyrexia, vascular phenomena, immunological phenomena, positive BC

Can diagnose if 2 major 1 minor, 1 major 3 minor or 5 minor

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25
Q

IE complications and managment

A

HF (sudden onset valve disease), perivascular abscess (aotic root abscess), septic emboli (stroke, discitis, splenic/renal infatct), metastatic abscess (lung) and mycotic aneurysm.

Manage with ABx, may need surgical involvement for valves or abscess. Prophylaxis is not routine.

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26
Q 
Aortic stenosis
Causes
Features
O/E
O/I
Management
A

Most common valvular disease.
Bicuspid valve, rheumatic fever, age related calcification.
Angina, arrythmias from remodelling, exertional syncope and LVF
O/E: small volume, slow rising, narrow pulse, chest wall heave, crescendo/decrescendo EJ murmur (?carotid radiation). Accentuate by sitting forward on expiration.
ECG shows LVH/arrythmia, cXR cardiomegaly, echo shows thickened valves/calcifications, cardiac catheterisation shows pressure gradient across valve
Management: balloon valvuloplasty or valve replacement

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27
Q 
Aortic regurgitation
Causes
Features
O/E
O/I
Management
A

HTN, aortic dissection tracking back, CT disorder, IE, Rh fever, bicuspid valve
SOB, fatigue, palpitations, angina
O/E: wide pulse volume, collapsing pulse, displaced apex, early diastolic (decrescendo) murmur. Quinke’s sign (nail bed pulse), De Musset’s sign (nod with heart beat), Duroziez’s sign (murmur on femoral with distal pressure)
O/I: ECG (LV hypertrophy), Echo (regurgitation), cardiac catheter shows wide pressure
Needs valve replacement as progresses to heart failure

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28
Q

Mitral stenosis causes
Features
O/E
O/I

A

Rheumatic fever (mainly), but congenital, degenerative and SLE
SOB, fatigue, AF, haemoptysis (pul. backflow)
Malar flush, small volume pulse, left parasternal heave (RVH), mid diastolic murmur at apex (rad lat), JVP distension, AF
ECG, CXR, Echo, cardiac catheter
Haemodynamic support, diuretic, PBV

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29
Q 
Mitral regurgitation
Causes
Features
o/e
O/I
Management
A

left ventricular dilatation, cardiomyopathy, degeneration, infection Rh, IE, CT disoders, autoimmune
SOB, fatigue, oedema, syncope,
AF (less common than MS), parasternal heay, PS murmur, displaced apex
ECG, CXR, echo, cardiac catheter
Haemodynamic support, ACEi, BB, surgical valve replacement

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30
Q

Infected valves

A

Tend to be mitral, bu IVDU tricuspid

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31
Q

Tricuspid/pulmonary mutmur

A

TS: mid diastolic murmur with RHF signs
TR: PS murmur and RHF signs (cor pulmonale)
PS: ES murmur, RV heave, RHF
PR: diastolic murmur, often asymptomatic

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32
Q

Valve replacement

A

Tissue replaced 10-15 years, but decreased clot risk (anticoag in weeks - months post surgery, but needs immunosuppression)
Mechanical last longer, but need lifelong anticoag.
If older, clot risk, or high bleed risk on warfarin/can’t take warfarin/limited life expectancy then tissue

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33
Q

Warfarin INRs

A

2-3 in AF

3-4 in mechanical heart valve

34
Q

HF causes

A

IHD (most common), dilated cardiomyopathy, HTN, valvular, congenital, cor pulmonale, alcohol, drugs

35
Q

EF HF classes

A

40-70% normal
40-50 is borderline
<40 is systolic HF
<35% is severe

36
Q

HFrEF

A

Generally ischaemic heart disease, HTN, dilated cardiomyopathy, myocarditis. Systolic dysfunction, reduced EF

37
Q

HEpEF

A

Insuffiicient filling of ventricle, reduced compliance.
Generally age, HTN, left ventricular hypertophy, restrictive cardiomyopathy, hypertrophic cardiomyopathy, fibrosis, amyloidosis, sarcoidosis, constrictive pericarditis, haemochromatosis, aging

38
Q

left sided HF

A

Fatigue, restlessness, confusion, orthopnoea, tachycardia, exertional dyspnoea, paroxysmal noctural dyspnoea, elevated pulmonary capillary wedge pressure - can track back to give pulmonary HTN (cough, crackles, wheeze, blood tinged sputum, tachypnoea)
Can get crackles, gallop rhythm (3rd heart sound), displaced apex

39
Q

RHF causes and signs

A

Can be via lung problem.
Fatigue, increased peripheral venous pressure, ascites, hepatosplenomegaly, JVP distention, anorexia, GI distress, weight gain, oedema

40
Q

HF class

A

NYHA

1 is no limitations, 2 is slight, 3 is comfortable at rest but sig on activity, 4 is symptoms at rest

41
Q

Pulmonary Oedema

A

Fluid in alveolar wall
Most common cause is LVF with backpressure (red cell leaks digested by macrophages - heart failure cells)
Generally increased capillary pressure (heart failure/fluid overload/pulmonary venous obstruction), can be increased capillary permeability (ARDS, infection, sepsis, DIC, inhaled toxin, protein loss, lymphatic obstruction (tumour)
Causes dyspnoea, paroxysmal noctural dyspnoea, orthopnoea. May get cheyne stokes on acute
CXR : batwing oedema, kerley B lines, upper vessel enlargement

42
Q

HF management

A

In acute, sit patient up, give high flow oxygen and IV diuretics (consider IB nitrates, opiates, CPAP, ianotropic support, dervice therapy, assist device, transplant)
Cardiac resynch can be useful
In chronic: diuretic (symptom), ACEi (or ARB) + BB (not in acute decompensation or with asthma). Can add on others.
Digoxin in refractory HF.

43
Q

Atheroma

A

Fatty streak (due to initial insult allowing LDL deposits)
Lipid plaque (damages media)
Fibrolipid plauqe
Complicated atheroma

44
Q

Cardiac marker timeline

A

Initial rise is CK-MB, then myoglobin, then troponin. Peaks at 24h then has second peak at 4 days

45
Q

ACS types1

A

Angina is demand ischaemia (no infarct)
Unstable angina is rupture of unstable plaque (ischaemia, no infarct - can get ECG change)
NSTEMI is plaque rupture. Top rise +/- ECG change
STEMI is trop and ST elevation

46
Q

Histological infarct timeline

A

0-12h has limited evidence
12-24h has necrotic fibres and oedema
24-72h has acute inflammation (pale macroscopically)
3-14 days is macrophage removal and granulation occurs
14-21 days is fibrous granulation tissue
21-56 is scaring

47
Q

MI sequalae

A

PE (thrombus in heard), stroke, arrythmia, cardiac tamponade, valvular problem, haemopericardium (myocardial rupture), fibrinous pericardium

48
Q

Aortic dissection RF

A

CT disorder, vascular inflammation (inc. giant cell arteritis), trauma, surgery, HTN, age, smoking atheromas

49
Q

Aortic dissection classes

A

De Bakey 1 is intimal tear on ascending that continues to descending
De bakey 2 is ascending only
De bakey 3 is descending only
Standard A is 1 and 2, B is 3

50
Q

Dissection sequalae

A

Can occlude branches, can track back along and cause abscesses, valvular problems and haemopericardium
Can compress nearby structures
Can rupture into the vessel, or around the vessel

51
Q

Left ventricle on CXR?

A

Not visible

52
Q

Causes of hemidiaphragn elevation on CXR

A

Can be loss of lung volume pulling it up.
Also applies to hila
Can also be ipsilateral phrenic nerve palsy (malignancy invading/compressing nerve or C3, C4, C5 root.

53
Q

Carina >90 on CXR

A

Atrial enlargement

54
Q

Peaked P waves

A

RAH

55
Q

Notched/broad P waves

A

LAH

56
Q

PR interval

A

Start of P to start of QRS
AVN delay
3-5 squares
Longer is 1dHB
Increases then drops is wenckebach/mobitz 1
Intermittent drpo then mobitz 2 (pacing needed)
If p and QRS have no relationship then 3rd degree

57
Q

QRS>120

A

ventricular origin or BBB

58
Q

RV hypertrophy

A

R and S transition point (R and S equal) shifts from V3/4 to V5/6

59
Q

LVHypertrophy

A

R in V5, or S depth in V1 and V5 <25mm

60
Q

ST elevation

A

If all leads then ?pericarditis
>2mm chest
>1mm limb

61
Q

ST depression

A

Ischaemia/digoxin

62
Q

T wave inversion

A

aVR, III, V1/V2 (? V3 in black people)

Otherwise, ischaemia, ventricular hypertrophy, BBB, digoxin

63
Q

Q waves are normal in

A

I, aVL, V5/V6

Can indicate old infarction elsewhere

64
Q

Prolonged QT

A

Start of QRS to end of T
Should be <0.45s (2 large squares)
Can lead to VT

65
Q

RBBB

A

M shape in V1
W in V6 with deep S
Consider underlying ASD/PE

66
Q

LBBB

A

W in V1, M in V6. No further interpretation
If asymptomatic then ?aortic stenosis
If chest pain then ? MI

67
Q

RAD

A

Can indicate PE

68
Q

LAD

A

Can indicate conduction defect

69
Q

aVR, V1, V2

A

Look at right ventricle

70
Q

aVL, I

A

Left surface

71
Q

V5/V6

A

Left ventricle

72
Q

V3/V4

A

Septum

73
Q

II, III and aVF

A

Inferior surface

74
Q

WPW

A

Short PR interval
Slurred upstroke delta
RAD
Can cause paroxysmal tachycardia (re-entry circuit with no tachycardia)

75
Q

Hypocalcaemia on ECG

A

Prolonged QT

76
Q

Hypercalcaemia on ECG

A

QT shortening

77
Q

Atrial flutter

A

> 250, no baseline between p waves. Tx as pre AF

78
Q

AF causes

A

HTN, valvular heart disease, HF, IHD, chest infection, PE lung cancer, alcohol excess, thyrotoxicosis, electrolyte depletion, infection, DM
Tx with BB or rate limiting CCB. May use cardioversion if unstable

79
Q

CHAD2DS2VASC

A

Assess stroke risk. Intervene is 1+ in men, 2+ in women

80
Q

Ventricular tachycardia

A

Wide QRS in all leads. Can become VF so tx urgently (cardioversion if <90 systolic, chest pain, HF or rate >150. Otherwise amiodarone).

CP1 revision (16 decks)

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