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Cardioresp > IHD, Angina + MI > Flashcards

IHD, Angina + MI Flashcards

1
Q

Stable angina?

A

Onset on exertion, relief with rest/GTN

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2
Q

Unstable angina?

A

Onset at rest, some relief from GTN

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3
Q

NSTEMI?

A

No egg changes, rise in troponin

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4
Q

STEMI?

A

ST elevation + troponin rise

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5
Q

New onset bundle branch block?

A

MI until proven otherwise - treat as STEMI

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6
Q

Causes of troponin elevation?

A 
MI
Heart failure
Myocarditis/pericarditis
LVH
CKD
Diabetes
CPR/cardioversion
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7
Q

Syndrome X?

A

Angina triggered by emotion/anxiety, no abnormalities of arteriography

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8
Q

Prinzmetal’s variant angina?

A

Vasospasm of coronary arteries, at rest with ST segment elevation

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9
Q

ACS treatment?

A 
Oxygen
Morphine
Aspirin
Nitrates
Beta blockers
Clopidogrel
Reperfusion
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10
Q

Thrombolysis drugs?

A

Alteplase,
Reteplase
Streptokinase
Tenecteplase

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11
Q

Post MI cocktail?

A

ACE
Beta blocker
Statin
Dual antiplatelet

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12
Q

When can second antiplatelet be stopped?

A

12 months post MI

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13
Q

ST elevation V1-V6?

A

Anterior MI - LAD

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14
Q

ST elevation II, III, aVf?

A

Inferior MI - RCA

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15
Q

What does RCA supply?

A

NODES - SAN + AVN

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16
Q

ST elevation - I, aVL, V5, V6?

A

Lateral MI - left circumflex

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17
Q

Common causes of chest pain?

A 
Angina
ACD
Oesophagitis
PE
Pneumothorax
dissecting AA
chest wall pain
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18
Q

What is troponin I bound to?

A

Myosin

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19
Q

Consequences of MI?

A 
Death
Arrhythmia
Rupture
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler's syndrome
Embolism
Recurrence
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20
Q

What is cardiac tamponade?

A

Reduced ventricular filling due to accumulation of blood/pus/clots in pericardial space

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21
Q

Triad of acute cardiac tamponade?

A

Distant heart sound
Decreased arterial blood pressure
Distended neck veins
(also pulses paradoxus present)

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22
Q

What is dressler’s syndrome?

A 
Late onset pericarditis - 6 weeks post MI
Fever
Pleuritic pain
Pericardial effusion
Raised ESR
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23
Q

What is pulsus paradoxus?

A

Large drop in BP on inspiration

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24
Q

What is pericarditis?

A

Inflammation of pericardium - protective covering of the heart

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25
Q

Viral causes of pericarditis?

A

Coxsackie B echovirus

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26
Q

Bacterial causes of pericarditis?

A

Rare - staph - fatal, strep, pneumococcal, meningococcal

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27
Q

Where to listen for pericardial friction rub?

A

Lower left sternal edge, expiration, patient leaning forwards

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28
Q

Symptoms of pericarditis?

A

Pain
Fever
Dyspnoea
Pericardial friction rub

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29
Q

ECG of pericarditis?

A

Diagnostic - saddle snapped ST elevation

PR segment depression

30
Q

Treatment of pericarditis?

A

Bed rest and NSAIDs

31
Q

Constrictive pericarditis?

A

Thickened pericardium due to chronic inflammation - bacteria, TB, rheumatic heart disease - affects ventricular filling

32
Q

Decubitus angina?

A

Triggered by lying flat

33
Q

Most common cardiac tumour?

A

Myxoma - benign

34
Q

Secondary hypertension?

A 
Renal conditions
Thyroid
Cushing's
Preeclampsia
Hyperaldosteronism
Obstructive sleep apnoea 
Malignancy
Acromegaly
Coarction
Conn's
Pheochromocytoma,
35
Q

Signs of hypercholesterolemia?

A

Xanthelasmas
Corneal arcus
Xanthomas on elbows, knees, and buttocks

36
Q

Mild hypertension?

A

140/90

37
Q

Moderate hypertension?

A

160/100

38
Q

Severe hypertension?

A

180/110

39
Q

Other investigations when diagnosing hypertension?

A

Urinalysis - renal disease
Blood glucose - diabetes
Lipid profile - cardiovascular risk
ECG - LVH

40
Q

What is coarctation of the aorta?

A

Congenital narrowing of the aorta, usually distal to the ligamentum arteriosum

41
Q

Finding in coarctation?

A

Hypertension in upper limb, absent/weak pulses in lower limb

42
Q

Isolated systolic hypertension?

A

Rise in systolic but not diastolic - hyperthyroidism, artery stiffness, diabetes or valvular disease

43
Q

White collar syndrome?

A

Raise in blood pressure when taken by a medical professional but normal at home

44
Q

Consequences of hypertension?

A 
Cardiovascular disease
Renal disease
Heart failure
Retinopathy
Acute dissection
45
Q

How does hyperthyroidism cause hypertension?

A

Thyroxine exacerbates the effect of sympathetic nervous system = increased vascular resistance + cardiac output

46
Q

How does hypothyroidism cause hypertension?

A

slows heart rate, vascular resistance increases to compensate

47
Q

Conn’s syndrome?

A

Hyperaldosteronism due to adrenal adenoma

48
Q

Most common cause of hyperaldosteronism?

A

Adrenal hyperplasia

49
Q

Cushing’s syndrome?

A

Excess cortisol secretion - pituitary or adrenal tumour or use of exogenous steroids

50
Q

Initial antihypertensive for <55 non-black

A

Ace inhibitor, beta blocker if not tolerated

51
Q

Initial antihypertensive >55 black

A

Calcium channel blocker or thiazide like diuretic if not suitable

52
Q

Step 2 hypertension treatment?

A

ACE + CCB or ACE + diuretic - use ARB in black patients

53
Q

Step 3 hypertension treatment?

A

ACE/ARB + CCB + thiazide like diuretics

54
Q

Step 4 hypertension treatment?

A

Spironolactone, consider alpha blocker or beta blocker

55
Q

What is pheochromocytoma?

A

Rare tumour derived from chromaffin cells that secretes catecholamines, usually in the adrenal medulla

56
Q

Symptoms of pheochromocytoma?

A 
Headache
Sweating
Palpitations
Tremor
Nausea
Weakness
Anxiety
Sense of doom
Tremo
Hypertensive retinopathy
57
Q

How to treat dressler’s syndrome?

A

NSAIDs

58
Q

Most common cause of death post-MI?

A

Ventricular fibrillation

59
Q

When do patients get heart block post MI?

A

Inferior MIs (most commonly)

60
Q

Presentation of aneurysm post MI?

A

Left ventricular aneurysm
Persistent ST elevation in anterior leads
Left ventricular failure

61
Q

How does a ventricular septal defect present?

A

Rupture of intraventricular septum
Acute heart failure
Pansystolic murmur

62
Q

Who gets acute mitral regurgitation post MI?

A

Infero-posterior infarction
Papillary muscle rupture
Early - mid systolic murmur

63
Q

What is Kussmaul’s sign?

A

Increased JVP on inspiration

Sign of constrictive pericarditis

64
Q

Features of constrictive pericarditis?

A 
Dyspnoea
Right heart failure
JVP - prominent x and y descent
Pericardial knock - loud S3
Kussmaul's sign
Pericardial calcification
65
Q

Cardiac tamponade vs constrictive pericarditis?

A

CT - absence Y descent
CP - X+Y present

Pulsus paradoxus - CT
Kussmaul’s - CP

66
Q

Causes of angina

A 
Atheroma
Anaemia
Coronary artery spasm
Tachyarrhythmias
Aortic stenosis
67
Q

Precipitants of angina

A

Exertion
Emotion
Cold weather
Heavy meals

68
Q

Symptoms of angina

A

Pain - central into jaw + neck
Dyspnoea
Nausea
Sweatiness

69
Q

Management of angina

A

GTN spray
1st - B-blocker or CCB. ACEi if diabetes. Low dose aspirin
2nd - long acting nitrate, Nicorandil or Ivabradine
3rd - PCI or CABG

70
Q

What is troponin?

A

Proteins involved with cardiac and skeletal muscle contraction. Released in myocardial cell damage.
Trop I + T are most cardiac specific

71
Q

How can you differentiate between rises of troponin?

A

MI / acute damage - likely to continue rising

Other insults - unlikely to change hour to hour

Cardioresp (8 decks)

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