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Toronto Notes x CC > Internal Med CC > Flashcards

Internal Med CC Flashcards

1
Q

Types of Angina

A

Stable Angina
Prinzmetal’s Angina (coronary artery vasospasm)
Unstable Angina

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2
Q

Management of Angina

A

Non-pharm: lifestyle modification (lose weight, exercise if tolerated)
Pharm: statins, antiplatelets/anticoags, nitrates
Interventional: revascularization

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3
Q

Investigations for Angina

A

ECG
Bloods - Troponins, Lipids, HbA1c, FBC(Hb)
Stress test
Coronary angiogram

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4
Q

Management of acute MI

A 
MONA (acute) BASH (chronic)
Morphine
Oxygen
Nitrates
Aspirin

B-block
ACE-I
Statin
Heparin

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5
Q

Types of MI

A

Type 1: from acute atherothrombotic coronary artery disease, precipitated by plaque rupture/erosion

Type 2: mismatch from oxygen supply and demand (coronary artery dissection, vasospasm, emboli)

Type 3: new ECG changes or VFib

Types 4&%

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6
Q

Management of Aortic Regurgitation

A

Medical: vasodilators (reduce systolic HTN and improve EF) - ACE-I, Hydralazine, Ca-Channel Block
Surgical: Aortic Valve Replacement (TAVI) - indicated by symptoms or impaired/dilated LV or aortic dilatation >50mm
Monitoring - ECHO every 6-12 months

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7
Q

What does a collapsing pulse indicate?

A

Aortic regurgitation

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8
Q

What condition is characterized by wide pulse pressure, displaced apex beat, and a high-pitched decrescendo diastolic murmur?

A

Aortic Regurgitation

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9
Q

Investigations for Aortic Regurgitation

A 
ECG
CXR
ECHO
CT-angio
contras aortography
coronary angiography
cardiac MRI
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10
Q

What are the 3 hallmark signs of Aortic Stenosis?

A

1 Angina
2 Syncope
3 Heart failure

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11
Q

Investigations of Aortic Stenosis

A 
ECG
CXR
ECHO
Cardiac MRI
Cardiac CT angio
BNP
Coronary angiography
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12
Q

Management of Aortic Stenosis

A

Symptom relief
Valve replacement -
1 prosthetic: mechanical prosthesis (req Warfarin lifelong) or bio-prosthesis
2 TAVI

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13
Q

What is an important factor to consider in mitral stenosis for Aboriginal Australians?

A

Rheumatic Fever Hx

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14
Q

Pathophysiology of Mitral Stenosis

A

thickening/fusion and calcification of the mitral leaflets, resulting in shortening of the chordae tendinae

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15
Q

Sequelae of Mitral Stenosis

A

Pulmonary vasculature issues (pulmonary arterial HTN, interstitial edema, pulmonary regurgitation)
Right Heart Failure

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16
Q

Associations of Mitral Stenosis

A

Rheumatic Fever
Dialysis (causes severe mitral annular calcification in elderly patients)
Fabry’s Disease (alpha 1-galactosidase deficiency)
SLE/RA
Radiotherapy - Hodgkin’s Lymphoma survivors

17
Q

Management of Mitral Regurgitation

A

Acute: Nitrates, Diuretics, Sodium Nitroprusside (reduces afterload and regurg)

Chronic: 
Ace-I
B-Block
Spironolactone
Surgical replacement/repair
18
Q

Causes of Primary Mitral Regurgitation

A

Acute: Ischemia (MI), rupture of chordae tendinae/papillary muscle, endocarditis with leaflet destruction

Chronic: degeneration (prolapse, flail leaflet)

19
Q

Causes of Secondary Mitral Regurgitation

A

Dilated cardiomyopathies
IHD
myocarditis

20
Q

Causes of Tricuspid Stenosis

A

Rheumatic Fever
Infective Endocarditis
Carcinoid Syndrome

21
Q

Diagnostic Features of Acute Coronary Syndromes

A 
1 Chest pain
2 ECG changes
3 increased (then decrease) of cardiac biomarkers, ex Troponin
22
Q

Causes of Microcytic Anaemia

A 
IDA
Copper deficiency
Lead poisoning
Chronic disease
Haemoglobinopathy
23
Q

Causes of Normocytic Anaemia

A

Haemorrhage
Renal failure
Cancer
Marrow disorder

24
Q

Causes of Macrocytic Anaemia

A 
B12 deficiency
Folate deficiency
Alcohol
Liver disease
Thyroid
Marrow disorders
Drugs
25
Q

Causes of Atrial Fibrillation

A 
PIRATES
PE
IDH
Rheumatic Valvular Disease (MS/MR)
Anaemia/Alcohol/Age/Autonomic tone
Thyroid disease (Hyperthyroidism)
Elevated BP (HTN)/Electrolyte Disturbance
Sleep apnea, Sepsis/infection, Surgery
26
Q

Criteria of Stroke Risk Stratification

A 
CHADS-2-VASC
CCF - 1
HTN - 1
Age >75 - 2
DM - 1
Stroke/TIA - 2
Vascular disease - 1
Age 65-74 - 1
Sex (F) - 1
27
Q

Risk of Bleeding Assessment

A 
HAS-BLED
HTN - 1
Abnormal RFTs/LFTs - 1 each
Stroke - 1
Bleeding - 1
Labile INR - 1
Elderly >65yo - 1
Drugs/alcohol - 1
28
Q

Management of Atrial Fibrillation

A 
Anticoagulation + Rate or Rhythm:
RATE:
1 B-Block (Metoprolol)
2 Ca Channel Block (Amlodipine)
3 Glycosides (Digoxin)

RHYTHM:
1 Cardiac ablation (create scar tissue to block abnormal signals)
2 Cardioversion (chemical [Flecainide, Amiodarone] or DC [electrical])

29
Q

Contraindications of Flecainide

A

possible bradycardia or heart block
elderly
no AV slowing
*always give AV-blocking drug with Flecainide

30
Q

Causes of Long QT Syndrome:

A

Antipsychotics
Antibiotics
Antifungals

31
Q

Symptoms of Left Heart Failure

A

Cough/frothy sputum (pulmonary edema)
Orthopnea
Paroxysmal noctural dyspnea (PND)
Dyspnea (exertional)

32
Q

Aetiologies of Heart Failure:

A

Diseased Myocardium: IHD, toxicity (drugs, radiation), autoimmune/inflammation, infiltration (malignancy, amyloidosis, sarcoidosis)
metabolic derangements
genetic abnormalities

Abnormal Loading: HTN, high-output states, volume overload, myocardial structural defects

Arrhythmias (tachy, brady)

33
Q

Causes of systolic dysfunction:

A

arrhythmias
dilated CM
myocarditis/infection

34
Q

Causes of diastolic dysfunction:

A

constrictive pericarditis
restrictive or hypertrophic cardiomyopathy
pericardial tamponade

Toronto Notes x CC (2 decks)

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