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PAR2021 Cardiology > Week 11 > Flashcards

Week 11 Flashcards

1
Q

What are two causes of non-ischaemic chest pain?

A
  • Aortic aneurysms

- Pericarditis

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2
Q

What is an aortic aneurysm

A
  • dilation or enlargement of the aorta

- >3cm diameter of >150% of normal

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3
Q

what percentage of aneurysms present as AAA?

A

90%

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4
Q

What are the layers of the Aorta?

A

Tunica adventitia - strong made of collagen and elastic fibres
Tunica Media - smooth muscle
Tunica Intima

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5
Q

What are the three categories of aneurysms?

A

True aneurysm - involves all 3 layers

False aneurysm - blood leaks through intima but contained by media and adventitia

Dissecting aneurysm - blood penetrates intima and creates secondary lumen between layers of vessel wall

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6
Q

What could it be if you feel a palpable abdominal mass?

A

AAA

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7
Q

What are the two types of aneurysms?

ON EXAM

A
  • Fusifrom - buldges on all sides of aorta

- Saccular - buldges on one side only

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8
Q

What are risk factors for aortic aneurysms?

A
  • SMoking
  • Hypertension
  • High Cholesterol
  • Male
  • Older age
  • Family history
  • Female <40 - Pregnancy
  • Bicuspid aortic valve - 7-14%
  • Marfan syndroms - 5-9%
  • Turner syndrome
  • Trauma
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9
Q

What is marfans syndrome?

A

genetic disorder of connective tissue

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10
Q

How would your patient present with a dissecting ruptured AA?

A
  • Pain
  • Agitated
  • Diaphoretic/Palour
  • Hypotension
  • High HR (compensation)
  • Feeling of impending doom

Abdominal AA:

  • Abdominal distension (AAA)
  • Femoral pulses
  • Cold foot: Clots in lower limb

Thoracic:

  • Unequal BP in arms (thoracic AA)
  • ACS
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11
Q

What is the patient reported pain associated with AA?

A

Often asymptomatic until rupture:

Abdominal:

  • Pain in chest, abdomen, back or flank or tearing pain
  • Not changed with movement
  • Deep aching, throbbing and gnawing pain
  • Pulsating sensation in abdomen

Thoracic:

  • Chest pain - deep aching and throbbing or tearing
  • Radiating to back
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12
Q

How do you manage AA in pre-hospital?

A
  • IV access - bilateral large bore - Fluid
  • Pain relief
  • Oxygen
  • MICA/HEMS
  • Hypotensive resuscitation - agressive fluids
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13
Q

What is the systolic BP cutoff for giving fluid?

A

Give fluid below 70SBP

for organ perfusion - which shuts down below 70…

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14
Q

How do you treat someone with Haemorrahgic hypovolaemia with a SBP below 70?

A

Normal saline 250ml IV bolus

  • repeat as required - titrate to > or equal to 70SPB

Max dose 2000mL

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15
Q

What is pericarditis?

A

Inflammation and swelling of the pericardial sac (around the heart)

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16
Q

What is the cause of pericarditis?

A
  • Viral - 85%
  • Bacterial
  • Fungal
  • Idiopathic
  • Autoimmune
  • Post surgical
17
Q

How does pericarditis present?

A

Chest pain:
- Sharp and pleuritic, improved bu sitting up and leaning forward. Worse lying down. Described as retrosternal

Pericardial friction rub:
a superfiscially scratchy or squeaky sound best heard with the stethoscope over left sternal border.

ECG Changes:
- New widespread ST elevation or PR depression

Pericardial effusion

Infective cause:
- Fever, flu like symptoms

18
Q

What are the ECG changes associated with pericarditis?

A
  • Concave ST Elevation

- PR depression

19
Q

What are the 4 stages of ECG changes associated with Pericarditis?

A

stage 1 - widespread STE and PR depression with reciprocal changes in aVR (first 2 weeks)

Stage 2 - normalisation of ST segment, generalised T wave flattening (1-3 weeks)

Stage 3 - flattened T waves become inverted (3 - several weeks)

Stage 4 - ECG returns to normal

20
Q

What are 3 STEMI mimics?

A
  • Pericarditis
  • Pinzmetal’s angina
  • Takotsubo
21
Q

What is Prinzmetal’s angina?

A

Vagospastic angina

Vasospasm of coronary arteries leading to intermittent occlusion

Self resolved

22
Q

What is Takosubo?

NOT ON EXAM

A

Vast majority of cases are women and most pre-menopausal

Often occurs after bad news

Constant anxiety

  • Spasm of heart changes shape
23
Q

Explain the 4 stages of the cardiac cell action potential graph?

A

4 - Slow depolarisation - Sodium and calcium channels open

0 - Rapid depolarisation - Voltage gated sodium channels open

1 - voltage gated Potassium channels open and sodium channels close

2- Plateau - Calcium channels open

3 - Repolarisation - calcium channels close, potassium channels remain open

24
Q

What are CLASS 1 cardiac drugs?

A

Sodium channel blockers

25
Q

What do CLASS 1 cardiac drugs do?

A
  • Prolong AP
  • Shorten AP (ligocaine)

Slows down phase 0 in both atrial and ventricular arrhythmias

  • Helps to treat arrythmias such as AF
26
Q

What are some CLASS 1 cardiac drugs?

A
  • Procainamide
  • Quinidine
  • Disopyramide
27
Q

What are CLASS II cardiac drugs?

A

Beta blockers

28
Q

What do CLASS II cardiac drugs do?

“OLOLs”

A

Blocking B1 receptors decreases responsiveness of SA and AV node

  • slows heart rate
29
Q

What are effects of class 2 overdose?

A
  • Brady
  • Hypotension
  • Wide QRS
  • VT
30
Q

What are CLASS III cardiac drugs?

A

Potassium channel blockers

  • Effects phase 3
31
Q

What do CLASS III cardiac drugs do?

A

Prolongs non refractory period

slows AP in ventricular cells

Can break reentrant circuits allow SA node to take over.

32
Q

What are CLASS IV cardiac drugs?

A

Calcium channel blockers

33
Q

What are Cardiac Glycosides?

A
  • For AF
  • inhibit enzyme ATPase associated with Na/K pump
  • decreased HR
  • Increased contraction force
  • Slows condusction through AV node
34
Q

What are Cardiac Glycosides?

A

Digoxin

  • For AF
  • inhibit enzyme ATPase associated with Na/K pump
  • decreased HR
  • Increased contraction force
  • Slows condusction through AV node
35
Q

What are vitamin K inhibitors?

A

Warfarin

  • stops clotting

Vitamin K used in synthesis of prothrombin

36
Q

Where do Class 1, 2, 3 & 4 cardiac drugs work on the AP

A

1 - Phase 0 and phase 4 - sodium blockers

2 - Phase 2 - beta blockers

3 - Phase 3 - Potassium blockers

4 - Phase 2 - Calcium channel blockers

37
Q

What are some drugs listed as class 1, 2, 3, 4 cardiac drugs and what do they do?

A 
Class I :
Ligocaine, Procainamide
- Decrease conduction rate
- decrease contractility
- extend AP duration
- Increase effective refractory period
Class II:
Beta blockers 'OLOLs'
- Decrease conduction
- Decrease contractility
- Decrease rate
Class III:
Amiordarone, Sotalol
- Decrease AV conduction
- Decrease contractility
- Increase AP duration
- Increase effective refractory period
Class IV:
Verapamil, Diltiazem
- Decrease AV conduction
- Decrease contractility
- Decrease AP duration

PAR2021 Cardiology (12 decks)

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