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2 - CVS > deck_862050 > Flashcards

deck_862050 Flashcards

1
Q

Name three organs/systems other CVS which can cause chest pain

A

Lungs and pleura GI systemChest wall

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2
Q

What can be used to distinguish between different types of pain?

A

Character and type of pain, other special symptoms.

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3
Q

What conditions of lungs and pleura cause chest pain? (3)

A

PneumoniaPulmonary EmbolismPneumothorax

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4
Q

What conditions of the GI system cause chest pain?

A

Oesophagus – RefluxPeptic ulcer diseaseGall Bladder – Biliary colic, cholecystitis

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5
Q

What conditions of the chest wall cause chest pain?

A

Ribs – fractures, bone metastasesMusclesSkin (herpes zoster) Costo-chondral joints

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6
Q

What conditions of the CVS cause chest pain?

A

Myocardium – Angina, MIPericardium – PericarditisAorta – Aortic dissection

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7
Q

What are the two types of risk factors for coronary atheroma?

A

ModifiableNon-modifiable

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8
Q

Give three non-modifiable risk factors for coronary artheroma

A

Increasing AgeMale gender (females catch up after menopause)Family history

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9
Q

Give seven modifiable risk factors for coronary atheroma

A

HyperlipidaemiaSmoking HypertensionDiabetes mellitus – Doubles IHD riskExerciseObesityStress

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10
Q

What are the four main risk factors for coronary artheroma?

A

HyperlipidaemiaSmokingHypertensionDiabetes mellitus (doubles IHD)

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11
Q

What type of pain can IHD cause?

A

Central, retrosternal or left sided

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12
Q

Describe the course of the pain from IHD

A

Pain my radiate to shoulder and arms, with left side more common that the right- May radiate along the neck, jaw, epigastrium and back.

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13
Q

Describe the character of the pain from IHD

A

Crushing, occasionally described as burning epigastric pain (inferior MI)

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14
Q

How does pain from IHD vary?

A

In intensity, duration, onset and precipitation. Aggravating and relieving factors and associated symptoms

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15
Q

How does pain from IHD get worse?

A

Stable angina –> Unstable angina –> MI

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16
Q

Describe the structure of atheromas in stable angina

A

Atheromatous plaques with a necrotic centre and fibrous cap

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17
Q

What is the effect of atheroma in IHD?

A

Occlude more and more of the lumen as they build up in coronary vessels. This leaves less space for passage of blood and ischaemia in myocardium

18
Q

What area is most at risk of ischaemia?

A

Subendocardial surface, myocardial wall pressure greatest

19
Q

How does coronary arteries increase O2 uptake?

A

Increase flow, via vasodilator metabolites (adenosine, K+, H+)Collateral circulationO2 uptake already maximum!

20
Q

What increases myocardial demand?

A

Heart rateWall tension - preload, afterloadContractility

21
Q

What does myocardial O2 supply depend on?

A

Coronary blood flow- perfusion pressure- coronary artery resistance O2 carrying capacity

22
Q

What is the usual presentation of a STEMI?

A
  • Chest pain not relieved by GTN - N&V- May be painless +/- atypical - Acute pulmonary oedema, SOB, syncope, cardiogenic shock
23
Q

What are four ECG findings you will see in STEMI?

A
  • ST elevation (see above)- New LBBB - +/- T wave inersion- Pathological Q waves
24
Q

Give 4 steps in initial management of STEMI

A
  • Airway, Breathing, Circulation- IV access - 12-lead ECG- MONA
25
Q

What is MONA?

A

o Morphine (2.5 – 10mg + antiemetic)o Oxygeno Nitrates (GTN spray 2 puffs sublingually) o Aspirin (300mg chewed)

26
Q

What are three investigations you should do in STEMI?

A
  • Bloods o FBC, U&E, LFTs, glucose, lipids, CK, Troponin I - Portable CXR - ECG
27
Q

What are two main treatments in STEMI?

A

Thrombolysis or PCI

28
Q

When is PCI used?

A

 PCI is the gold standard for acute coronary syndrome and should only be used if primary PCI programme available within 120 minutes of first medical contact Indications are the same as thrombolysis

29
Q

What are the ECG changes which indicate thrombolysis or PCI?

A

• ST elevation >1mm in 2+consecutive leads• ST elevation >2mm in 2+consecutive leads• New onset LBBB

30
Q

Give four contraindication for thrombolysis

A

• Haemorrhagic sroke or ischaemic stroke

31
Q

What do you give along with PCI or thrombolysis?

A

B blockerACE inhibitor Clopidogrel

32
Q

What complications can you develop as a result of a STEMI?

A

SPREADS – Sudden DeathP – Pump failure/pericarditisR – Rupture papillary muscle or septumE – EmbolismA – Aneurysm/arrhytmias D – Dresslers syndrome ( pleuritic chest pain, pericarditis and low grade fever which develops post-MI and is thought to be immune mediated.

33
Q

What do you prescribe on discharge post-MI

A

Aspirin, clopidogrel, ACE inhibitor, B blocker, Statin, Risk factor modification, 1 month off work.

34
Q

What are the two main ECG changes in an NSTEMI?

A

1) T wave inversion 2) ST depression

35
Q

How do you differentiate between STEMI and NSTEMI?

A

NSTEMI will have a positive troponin I and unstable angina will be negative.

36
Q

What are the management steps for an NSTEMI/

A

1) Analgesia a. Morphine2) Anti-ischaemica. Nitrates b. ACE inhibitor c. B blockersd. Calcium channel antagonistse. Statins3) Anti-platelets a. Aspirinb. Clopidogrel 4) Anti-thrombotic a. LMWH

37
Q

When is PCI considered in an NSTEMI?

A

PCI can be considered if Troponin is persistently raised, the angina persists despite best medical therapy or there are features of- Heart failure- Poor LV function- Haemodynamic instability - PCI

38
Q

What is the SA Node suppliedby?

A

RCA

39
Q

What is the AV node supplied by?

A

RCA

40
Q

What is the bundle of HIS supplied by?

A

LAD

41
Q

WHAT is the RBBB supplied by?

A

Proximal portion by LADDistal Portion by RCA

42
Q

What is the LBBB suppied by?

A

LADLAD and PDA

2 - CVS (28 decks)

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