Rubgy cardio revision Flashcards
In an OSCE what is the most important first question?
Are you in pain just now?
Allows you to identify whether this is ample or a full history
In a history what would you want to know about palpitations?
When?
How long for?
Any other symptoms?
What is the positioning of the precordial ECG leads?
V1: 4th intercostal space at right border of sternum
V2: 4th intercostal space at left sternal edge
V4: 5th intercostal space midclavicular line
V3: between V2 and V4
V6: 5th intercostal space mid-axillary line
V5: between V4 and V6
Occlusion of which arteries affect which surfaces of the heart?
Lateral = circumflex Anterior = LAD Septal = LAD Inferior = RCA
Elevation of which leads indicates an MI on the septal, anterior, lateral and inferior surfaces?
Septal: V1 and V2
Anterior: V3 and V4
Lateral: V5, V6, I and aVL (L=lateral)
Inferior: II, III, aVF (F= foot - at the bottom)
What do ACE inhibitors do?
Prevent the conversion of angiotensin I to angiotensin II by blocking the angiotensin converting enzyme
Can cause a dry cough (25%)
How do ARBs work?
Block the angiotensin II receptor (so no effect on the levels on angiotensin II)
Name 2 calcium channel blockers and state which type of muscle they are effective against
Amlodipine + nifedipine
Smooth muscle channel blockers
What is the major side effect of Ca channel blockers?
Swollen ankles
Name and give an example fo the 2 types of diuretic
Thiazides: bendroflumethiazide
Loop: furosemide (not used for hypertension - good for HF)
What are B-blockers used to treat?
Angina (first line),
Hypertension (rarely),
Congestive cardiac failure (caution)
Post MI
Name 2 nitrates and explain what they are used to treat?
Glyceryltrinitrate (GTN) - short acting
=> used for angina/IV in MONA+T
Isosorbide mononitrate - long acting
=> acute coronary syndrome/prophylaxis of angina
What is the main symptom of digoxin toxicity?
Blurred yellow visioning headache
How is a murmur described?
- Systole or diastole?
- Type (ejection or pansystolic?)
- Where is it loudest?
- Where does it radiate to?
- What grade?
- Influenced by respiration?
What is the most common murmur?
Aortic stenosis
What is the grading of murmurs?
Grade 1: Very quiet - may not be audible
Grade 2: Quiet - audible
Grade 3: Moderately loud
Grade 4: Loud - palpable thrill
Grade 5: Very loud + thrill - audible with stethoscope partially of chest
Grade 6: Very loud + thrill - audible without stethoscope
What is the post MI treatment?
Dual antiplatelet therapy
ACEI
B-blocker
Statin
What is heart failure and what are it symptoms?
Inadequate cardiac output for the bodies needs
SOB, fatigue, poor exercise tolerance, ankle oedema, nocturnal cough, sleep on pillows (pulmonary oedema)
What are the main causes of congestive cardiac failure?
Coronary artery disease,
Hypertension,
Valvular disease,
Post MI
How is acute heart failure initially treated?
Sit upright O2 (high flow) Investigations Diamorphine IV Furosemide IV GTN (2 puffs)
How is the management of acute heart failure increased?
Increase furosemide
CPAP (continuous positive airway pressure)
How is chronic heart failure managed?
Furosemide, ACE inhibitor, B-blocker, Spironolactone, (increase to include digoxin and vasodilators - isosorbine mononitrate)
In cardiac arrest which rhythms are shockable and which are not?
SHOCKABLE: pulseless ventricular tachycardia, ventricular fibrillation
NOT SHOCKABLE: asystole, pulseless electrical activity
What are the signs of acute limb ischaemia?
6 Ps: Pain, Pulseless, Paraesthesia, Paralysis, Pallor, Perishingly cold
What is the difference and the difference in treatment between an arterial and a venous thrombus?
Arterial: white thrombus (PLT rich) - anti platelets (aspirin, clopidogrel, ticegralor)
Venous: red thrombus (RBC rich) - anticoagulants (heparin, warfarin, apixiban)
What are the important clotting factors?
2, 7, 9, 10
