Week 5 Flashcards
What is chronic, stable angina?
Fixed stenosis
Demand led ischaemia
Predictable
Safe
What is an acute coronary syndrome?
Any acute presentation of coronary artery disease
Dynamic stenosis
Supply led ischaemia
Unpredictable
Dangerous
In the platelet cascade, how are activators such as ADP released?
Degranulation
What is the first line investigation ordered in a patient with a suspected heart attack?
ECG
Check for ST elevation, T wave inversion and Q waves
What leads show an inferior MI?
II
III
AVF
What leads show an anterior MI?
V1-V6
What leads show an anteroseptal MI?
V1-V4
What leads show an anterolateral MI?
I
AVL
V1-V6
What investigations should be ordered in a suspected MI?
ECG
Cardiac enzymes - Creatinine kinase
Protein marker - troponin
What is the treatment for a STEMI?
Analgesia (diamorphine IV)
Anti-emetic IV
Aspirin
Clopidogrel
GTN
Oxygen if hypoxic
Primary angioplasty
What does troponin do?
Binds calcium and actin
It facilitates contraction
What do capillaries do?
Deliver O2 and nutrients to tissues
Remove metabolites from cells
What are the forces favouring capillary filtration?
Capillary hydrostatic pressure
Interstitial fluid osmotic pressure
What are the forces opposing capillary filtration?
Capillary osmotic pressure
Interstitial fluid hydrostatic pressure
What does heart failure do to the Frank Starling curve?
Shift it to the right
What are the 4 causes of oedema?
Raised capillary pressure
Reduced plasma osmotic pressure
Lymphatic insufficiency
Changes in capillary permeability
What does ivabradine do to heart rate?
Slows it
Is bradycardia an SVT or a ventricular arrhythmia?
SVT
What are ectopic beats?
Beats or rhythms that originate in places other than the SA node
What is syncope?
Loss of consciousness
What investigations should be done in a person with a cardiac arrhythmia?
ECG CXR Echocardiogram Stress ECG 24hr ECG Ectrophysiological study
What on an ECG shows that the patient could have had a previous MI?
Presence of Q waves
What is the treatment for sinus bradycardia?
Atropine (if acute)
Pacing if haemodynamic compromise
What is the treatment for sinus tachycardia?
Treat underlying cause
Beta-adrenergic blockers
What is the treatment for atrial ectopic beats?
Generally no treatment
B-adrenic blockers may help
Avoid stimulants e.g. caffeine
What is the acute mangement of supraventricular tachycardia?
Valsalva manouvres
IV adenosine
IV verapamil
What is verapamil?
Calcium channel blocker
What is the chronic management of SVT?
Avoid stimulants
Electrophysiologic study and ablation (first line in young/symptomatic patients)
Beta blockers
Antiarrhythmic drugs
What is first degree heart block?
Each P wave takes longer
P-R interval longer than normal (>0.2 sec)
No treatment
What is Mobitz type I heart block?
2nd degree HB
Progressive lengthening of the PR interval, eventually resulting in a dropped beat
What is Mobitz type II HB?
2nd degree HB
usually 2:1/3:1 but may be variable
Dropped beats just whenever
Permanent pacemaker indicated
What is 3rd degree HB?
How is it treated?
Complete heart block
Ventricular pacing
What is atrial fibrillation that lasts less than 48hrs?
Paroxysmal
What is atrial fibrillation that lasts more than 48hrs?
Persistent
