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2B - GRIND > Cardio > Flashcards

Cardio Flashcards

1
Q

Sx of shock?

A

Pallor, cold peripheries, tachycardia, slow capillary refill, tachypnoea, hypotension and oliguria

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2
Q

Name the different types of shock?

A 
Hypovolaemic shock (bleeding/fluid loss)
Cardiogenic shock (ACS, arrhythmias)
Septic shock (infection)
Anaphylactic shock (allergy)
Neurogenic (spinal cord injury)
Endocrine failure (Addison's or hypothyroidism)
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3
Q

What casues sepsis?

A

Infection with any organism can cause acute vasodilation from inflammatory cytokines. Gram negative bacteria produce endotoxins which can casue a sudden spetic shock without signs of infection (fever or raised WCC)

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4
Q

Sx of sepsis?

A 
Shiver/fever/very cold
Extreme pain/discomfort
Pale/discoloured skin
Sleepy/difficult to rouse/confused
"I feel like I might die"
Short of breath
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5
Q

Tx of sepsis?

A

Sepsis 6 - complete within 1 hour

Administer oxygen, Take blood cultures, Give IV antibiotics, Give IV fluids, Check serial lactate, Measure urine output

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6
Q

What type of hypersensitivity reaction is anaphylaxis?

A

Type I (IgE mediated). Occurs in response to allergens

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7
Q

Sx of anaphylaxis?

A

Itching, sweating, D&V, erythema, urticaria, oedema, wheeze, cyanosis, tachycardia and hypotension

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8
Q

What is the primary treatment of anaphylaxis?

A

IM adrenaline 0.5mg (i.e. 0.5ml of 1:1000). Repeate every 5 mins if needed

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9
Q

Sx of peripheral arterial disease?

A

Cramping pain in the calf, thigh or buttock after walking a certain distance that is relieved by rest = intermittent claudication
This can develop into critical ischaemia = ulceration, gangrene and foot pain at rest (e.g. at night relieved by hanging the leg over the bed)

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10
Q

What would you find on examination for PAD?

A

Absent femoral, popliteal or foot pulses, cold white legs, atrophic (thin) skin, hairless, punched out ulcers and postural dependant colour change

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11
Q

Sx of acute ischaemia?

A

Pale, Pulseless, Painful, Paralysed, Paraesthetic and Perishingly cold limb

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12
Q

How can you asssess critical ischaemia?

A

Buerger’s test. Lie the patient flat and elevate both legs to 45 degrees and hold for 1-2 mins (pallor of the feet indicates ischaemia). Ask pt. to sit up and swing their legs over the bed - observe the time it takes for them to go pink red (Buerger’s time and indicated disease severity)

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13
Q

Tx of PAD?

A

Antihypertensives, statins, clopidogrel (reduce CV risk), exercise programmes, vasoactive drugs or surgical revascularisation. Amputation in extreme disease

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14
Q

How can you measure the severity of PAD?

A

Buerger’s angle (angle at which feet become pale) and time (time which feet take to get their colour back).
ABPI - 0.5-0.9 = PAD, <0.5 = critical ischaemia
Do a colour duplex US!

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15
Q

Sx of ruptured AAA?

A

Severe abdominal pain radiating to the back, collapse, expansile abdominal mass and shock.
If it ruptures anteriorly in the peritoneal cavity patient will die within minutes

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16
Q

When should you treat AAA?

A

When it is >5.5cm, if it is rapidly growing or if it is symptomatic (causing back pain)

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17
Q

Sx of aortic dissection?

A

Type A = in the ascending aorta. Type B = tears in the descending aorta.
Will cause sudden tearing chest pain which radiates to the back, unequal arm pulses

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18
Q

Sx of varicose veins?

A

Patients most often present complaining of ugly legs.

There may also be pain, cramping, tingling, restless leg, oedema, eczema and ulcers

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19
Q

How do you check for SFJ valve incompetence?

A

Place a finger on the SFJ and a finger on the end of a varicose vein. Tap the SFJ - if you feel a percussion wave in the varicose vein the valve is incompetent.

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20
Q

How does AF show on ECG?

How does atrial flutter show on ECG?

A

Tachycardic, irregularly irregular QRS complex and no P waves
Tachycardic with a sawtooth pattern

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21
Q

Briefly describe how heart block appears on ECG?

A

ALL HAVE PROLOGED PR INTERVAL
1st degree = prolonged PRi but 1:1 conduction (P:QRS)
2nd degree: MT1 = PRi becomes increasingly prolonged until a QRS wave is dropped
MT2 = PRi is constant but a QRS wave is dropped at a regular rate
3rd degree = P and QRS waves have no relation - complete heart block (patient will be very bradycardic)

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22
Q

What are the alternative names for the 2nd degree heart blocks?

A

Type 1 = Wenckebach phenomenom

Type 2 = Hay phenomeneom

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23
Q

When might you see ST elevation?

A

STEMI, acute pericarditis (saddle shaped)

24
Q

When might you see ST depression?

A

NSTEMI, angina

25
Q

When might you see T wave inversion?

A

NSTEMI, V1-V3 = RBBB, V4-V6 = LBBB and sometimes in hypokalaemia (may just be small)

26
Q

What are the ECG changes seen in hypercalcaemia/hypocalacemia?

A 
Hyper = short QT interval
Hypo = long QT interval and small T waves
27
Q

What are the ECG changes seen in hyperkalaemia?

A

Tall tented T waves, wide QRS wave, absent P waves

28
Q

What is the significance of QRS width? (<0.12 or >0.12 secs)

A 
Narrow = ventricles are being depolarized by the normal pathway e.g. AF or atrial flutter
Wide = ventricular depolarization is slowed e.g. VF, VT, BBB
29
Q

Sx of coarctation of the aorta?

A

Radiofemoral delay, weak femoral pulses, hypertension, bruits over the scapula and systolic murmur

30
Q

Sx of Atrial septal defect?

A

Chest pain and palpitations. L-R shunt leads to pulmonary hypertension = dyspnoea, haemoptysis
Ostium primum presents in childhood (downs syndrome) - near the AV valve
Ostium secundum presents 40-60 as HF

31
Q

Sx of Ventricular septal defect?

A

Harsh pansystolic murmur, dyspnoea, haemoptysis.

Large holes present as severe HF in infancy

32
Q

What is Eisenmenger’s sydnrome?

A

A complication of ASD/VSD where pulmonary hypertension (due to L-R shunt) causes the shunt to shift (R-L). This leads to cyanosis

33
Q

What is Tetralogy of Fallot?

A

MOST COMMON CYONOTIC CONGENITAL HD

Ventricular spetal defect, pulmonary stenosis, RV hypertrophy and an overriding aorta

34
Q

Sx and Dx for Tetralogy of Fallot?

A

Causes cyanosis, dypnoea, palpitations and clubbing. Toddlers will squat
RBBB on ECG, boot shaped heart on x-ray

35
Q

How do the 4 main valvular heart diseases sound on auscultation?

A

Mitral regurg = pansystolic murmur and displaced apex beat
Mitral stenosis = rumbling mid-diastolic murmur and a non-displaced apex beat
Aortic stenosis = ejection systolic murmur and a non-displaced apex beat
Aortic regurg = high pitched early diastolic murmur and a displaced apex beat

36
Q

What are the commonest causes of IE?

A

Staph. aureus or Strep. viridans

37
Q

Sx of IE?

A

FROM JANE

Fever, Roth spots, Oslers nodes, Murmur, Janeway lesions, Anaemia, Nail spliter haemorrhages, Emboli

38
Q

Sx of dilated cardiomyopathy?

A

Fatigue, dyspnoea, pulmonary oedema/ankle swelling, hypotension, tachycardia, displaced apex beat

39
Q

Sx of hypertrophic cardiomyopathy?

A

Sudden death, angina, dyspnoea, palpitations, syncope, CCF

40
Q

What is the commonest cause of pericarditis? How do you treat?

A

TB

Rifampicin, isoniazib, pyrazinamide and ethambutol

41
Q

Sx of pericarditis?

A

Central chest pain which is worse on inspiration/lying flat and relieved by sitting forward. Fever and pericardial friction rub heard on auscultation

42
Q

Dx and Tx for pericarditis?

A

Pericardial friction rub is heard, ECG = saddle shaped ST elevation and PR depression
NSAIDs with PPI, colchicine. Rest until symptoms resolve

43
Q

Sx of pericardial effusion?

A

Dyspnoea, chest pain, phrenic hiccupps, muffled heart sounds and Ewart’s sign (bronchial breathing at the left base)

44
Q

Causes of pericardial effusion?

A

Pericarditis, myocardial rupture e.g. penetrating stab wound, and aortic dissection

45
Q

Sx of cardiac tamponade?

A

Tacycardia, hypotension, pulsus paradoxus, kussmauls sign, increased JVP and muffled heart sounds.
Becks triad = falling BP, Kussmaul’s sign and rising JVP

46
Q

Describe Pulsus Paradoxus and Kussmaul’s sign

A

Pulsus paradoxus = abnormally large decrease in systolic blood pressure on inspiration
Kussmaul’s sign = abnormally large increase in JVP on inpiration

47
Q

Sx of heart failure?

A

Fatigue, dyspnoea and oedema = cardinal.
LVHF = poor exercise tolerance, orthopnoea, PND, wheeze, nocturnal cough with pink frothy sputum and nocturia
RVHF = ascites, nausea, facial engorgement and epistaxis
Also hypotension and cyanosis

48
Q

Dx and Tx for HF?

A

BNP and ECHO

Diuretics, ACEi, Beta-blockers

49
Q

What do you see on x-ray in HF?

A

ABCDE: Alveolar oedema, keryl B lines, Cardiomegaly, Dilated upper lobe veins, pleural Effusions

50
Q

Describe the NYHA classification of HF?

A 
I = Heart disease but no dyspnoea from ordianry activity
II = Comfortable at rest, dyspnoea on ordinary activity
III = Dyspnoea on light activity - limits acitvity
IV = Dyspnoea at rest - all activity causes discomfort
51
Q

How can you differentiate between stable and unstable angina?

A 
Stable = chest pain and dyspnoea brought on by exercise and relieved by rest
Unstable = chest pain and dyspnoea of increasing frequency and severity - occurs at rest
52
Q

How does angina appear on ECG?

A

ST depression, T wave inversion - may appear normal!

53
Q

Tx of angina?

A 
GTN spray for acute flare ups. Beta-blocker or CCB, 75mg aspirin, statin, hypertensive treatment
Consider revascularisation (PCI with dual anti-platelet therapy of aspirin and clopidogrel or CABG)
54
Q

Tx of MI?

A

MONAC = Morphine, Oxygen, Nitrates (GTN), Aspirin (300mg) and Clopidogrel/Tricagrelor
Beta-blockers, Anti-hypertensives, statins.
Tirofiban if undergoing PCI or streptokinase if not

55
Q

Dx of STEMI and NSTEMI?

A 
Both = raised troponin
STEMI = ST elevation, pathological Q waves and new LBBB
NSTEMI = ST depression and T wave inversion

2B - GRIND (11 decks)

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