Internal Med CC Flashcards
Types of Angina
Stable Angina
Prinzmetal’s Angina (coronary artery vasospasm)
Unstable Angina
Management of Angina
Non-pharm: lifestyle modification (lose weight, exercise if tolerated)
Pharm: statins, antiplatelets/anticoags, nitrates
Interventional: revascularization
Investigations for Angina
ECG
Bloods - Troponins, Lipids, HbA1c, FBC(Hb)
Stress test
Coronary angiogram
Management of acute MI
MONA (acute) BASH (chronic) Morphine Oxygen Nitrates Aspirin
B-block
ACE-I
Statin
Heparin
Types of MI
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&%
Management of Aortic Regurgitation
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
What does a collapsing pulse indicate?
Aortic regurgitation
What condition is characterized by wide pulse pressure, displaced apex beat, and a high-pitched decrescendo diastolic murmur?
Aortic Regurgitation
Investigations for Aortic Regurgitation
ECG CXR ECHO CT-angio contras aortography coronary angiography cardiac MRI
What are the 3 hallmark signs of Aortic Stenosis?
1 Angina
2 Syncope
3 Heart failure
Investigations of Aortic Stenosis
ECG CXR ECHO Cardiac MRI Cardiac CT angio BNP Coronary angiography
Management of Aortic Stenosis
Symptom relief
Valve replacement -
1 prosthetic: mechanical prosthesis (req Warfarin lifelong) or bio-prosthesis
2 TAVI
What is an important factor to consider in mitral stenosis for Aboriginal Australians?
Rheumatic Fever Hx
Pathophysiology of Mitral Stenosis
thickening/fusion and calcification of the mitral leaflets, resulting in shortening of the chordae tendinae
Sequelae of Mitral Stenosis
Pulmonary vasculature issues (pulmonary arterial HTN, interstitial edema, pulmonary regurgitation)
Right Heart Failure
Associations of Mitral Stenosis
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
Management of Mitral Regurgitation
Acute: Nitrates, Diuretics, Sodium Nitroprusside (reduces afterload and regurg)
Chronic: Ace-I B-Block Spironolactone Surgical replacement/repair
Causes of Primary Mitral Regurgitation
Acute: Ischemia (MI), rupture of chordae tendinae/papillary muscle, endocarditis with leaflet destruction
Chronic: degeneration (prolapse, flail leaflet)
Causes of Secondary Mitral Regurgitation
Dilated cardiomyopathies
IHD
myocarditis
Causes of Tricuspid Stenosis
Rheumatic Fever
Infective Endocarditis
Carcinoid Syndrome
Diagnostic Features of Acute Coronary Syndromes
1 Chest pain 2 ECG changes 3 increased (then decrease) of cardiac biomarkers, ex Troponin
Causes of Microcytic Anaemia
IDA Copper deficiency Lead poisoning Chronic disease Haemoglobinopathy
Causes of Normocytic Anaemia
Haemorrhage
Renal failure
Cancer
Marrow disorder
Causes of Macrocytic Anaemia
B12 deficiency Folate deficiency Alcohol Liver disease Thyroid Marrow disorders Drugs
Causes of Atrial Fibrillation
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
Criteria of Stroke Risk Stratification
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
Risk of Bleeding Assessment
HAS-BLED HTN - 1 Abnormal RFTs/LFTs - 1 each Stroke - 1 Bleeding - 1 Labile INR - 1 Elderly >65yo - 1 Drugs/alcohol - 1
Management of Atrial Fibrillation
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])
Contraindications of Flecainide
possible bradycardia or heart block
elderly
no AV slowing
*always give AV-blocking drug with Flecainide
Causes of Long QT Syndrome:
Antipsychotics
Antibiotics
Antifungals
Symptoms of Left Heart Failure
Cough/frothy sputum (pulmonary edema)
Orthopnea
Paroxysmal noctural dyspnea (PND)
Dyspnea (exertional)
Aetiologies of Heart Failure:
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)
Causes of systolic dysfunction:
arrhythmias
dilated CM
myocarditis/infection
Causes of diastolic dysfunction:
constrictive pericarditis
restrictive or hypertrophic cardiomyopathy
pericardial tamponade
