cardio Flashcards
(157 cards)
1
Q
what is prinzmetals angina
A
non exertional chest pain due to coronary artery vasospasm
seen w brief st elevation and no raised biomarkers
seen in younger px esp w cocaine use
2
Q
what is decubitus angina
A
chest pain brought on by lying flat
3
Q
what is stable angina
A
central crushing chest pain (or to jaw, neck, l shoulder) brought on by exertion and relieved by rest <5min ir glyceryl trinitrate spray (GTN spray) mostly due to atheromous plaque
4
Q
modifyable risk factors stable angina
A
obesity
smoking
poor diet
t2dm
hyperlipidaemia
sedentary lifestyle
htn
5
Q
non-modifiable risk factors stable angina
A
FHX
male
ethnicity - south asian, afro-caribbean
incr age
6
Q
signs and symptoms stable angina
A
central crushing chest pain due to exertion- relieved by stress
exertional dyspnoea
incr sweating
nausea
7
Q
diagnosis stable angia
A
ecg- normal, may show st depression
normal biomarkers/ troponin
ct angiogram to show luminal narrowing
8
Q
symptomatic treatment stable angina
A
glyceryl trinirate spray
9
Q
long term treatment stable angina 1-3rd line
A
CCB or BB
ccb + bb
ccb+bb+ antianginal med eg long acting nitrate
10
Q
non-pharmacological management stable angina
A
lose wt, incr exercise, stop smoking, better diet, control other co-morbidities
11
Q
ddx for stable angina
A
acute coronary syndrom, heart failure pericarditis
12
Q
ccb needed for stable angina + example
A
non rate limiting eg amylodipine not verapamil
can cause excessive brdycardia
13
Q
tx if medicine isnt successful for stable agina
A
revascularisation
- pci (percutaneous intervention)
- cabg (coronary artery bypass grafting)
14
Q
+/- cabg
A
- more invasive, incr risk of stroke, long recovery time
+ better outcome/ prognosis
15
Q
-/+ pci
A
+ less invasive, short recovery time
- risk of stent thrombosis
16
Q
what is pci
A
percutaneous intervention
- inflating a ballon in an atheromous vessel to dilate to help blood flow
17
Q
what is cabg
A
coronary artery bypass grafting
- left internal mammary artery used to bypass left anterior descending artery to bypass occlusion/ atheroma
18
Q
conditions of acute coronary syndrome
A
unstable angina
non stemi
stemi
19
Q
general pathogenesis of acs
A
- atheroma formation
endothelial damage causes the entery of LDL into intima layer of artery - this oxidises causing inflam response -> macrophages
1. FATTY streak- 10yrs <
- lipid laden marcophages and t cells
- INTERMEDIATE LESIONS
- layers of smooth muscle, foam cells and t cells
- FIBROUS ADVANCED LESIONS
- lipid core w necrotic debis
- fibrous cap w smooth muscle, collagen and elastin
- tough fibrous cap - more stable - less chance of rupture
- protrudes into lumen -> stenosis can cause ischaemia and reduced perfusion
- PLAQUE RUPTURE
- cap needs to be maintained by reabsorption and redeposition of smooth muscle
- thins with damage eg enzymic activity causing it to haemorrhage and rupture
- contrnts released into lumen causing thrombus formation , which can cause ischaemia and infarction
- cap needs to be maintained by reabsorption and redeposition of smooth muscle
- INTERMEDIATE LESIONS
20
Q
what % vessel occlusion does sx start to occur in stable angina
A
approx 70%
21
Q
what is unstable angina
A
crushing central chest pain occurs spontanteously/ not due to exertion and not relieved by rest or gtn spray
due to partial occlusion of vessel
22
Q
what is nonstemi
A
partial occlusion of a vessel leading to tissue necrosis and release of biomarkers eg troponin but not seen w st elevation
23
Q
what is a stemi
A
st elevation myocardial infarct
complete occlusion of a coronary vessel causing cardiac tissue necrosis with raised biomarkers and ecg changes
24
Q
are ecg changes seen in unstable angina
A
not commonly
- may see t wave inversion or st depression
25
what are the ecg changes seen in a nonstemi
st depression
t wave inversion
26
ecg changes in stemi
st elevation
pathological q waves after a few days (indicated previous MI)
new left bundle branch block
t wave inversion
27
what are 2 biomarkers raised in MI
troponin - specific - rise seen after 3 hrs of MI
creatinine kinase MB - non specific also seen in bone pathology
28
signs and symptoms of acs
- severe crushing central chest pain radiating to neck, jaw, shoulder
- dyspnoea
- sweating
- palpitations
- anxiety - feeling of impending doom
- nausea
- hypotension and tachycardia
29
1st line investigations of acs
ecg withing 10 min/ immediately
troponin bloodtest
30
2nd line investigations of acs
ct angiogram - identify occluded vessel
31
what leads of an ecg show a lad occluson
V1-4
32
which leads shows a left circumflex occlusion
I, aVL, V5, V6
33
which leads show a right coronary artery occlusion
II, III, aVF
34
which leads show a septal view of LAD
V1-2
35
which leads show and anterior view of LAD
V3-4
36
what is acute management for acs
MONAC
Morphine
Oxygen (if low oxy sat)
Nitrates (short acting)
Aspirin (300mg)
Clopidgrel (75mg)
37
secondary acute management for unstable angina and nonstemi
after MONAC
- GRACE score - 6mmth mortality risk
- if low risk - monitor
- if high risk - urgent angiogram and consider pci
38
what is the management of stemi
after MONAC
- urgert pci within 2hrs of sx
- thrombolysis w allopase after 12 hrs sx
39
long term prevention of acs
aspirin 75mg daily
bb eg propanolol
clopidogrel - 12mnth
acei
atrovstatin
40
complications of MI
DARTHVADER
death
aneurysms
rupture
tamponade
heart failure
valvular disease
arrhythmias
dresslers syndrome
embolism
recurrance regurgitation
41
what is dresslers syndrome
autoimmune pericarditis occuring 2 wks after MI
42
what is htn
clinical bp reading >=140/90mmHg
ambulatory bp >=135/85mmHg
43
what are the 2 types of htn
primary 'essential' htn
secondary htn
44
what is essential htn
primary htn that has no underlying cause
95% cases
45
what are causes of secondary htn
renal: ckd, glomerulonephropathy
endo: cushings, phaeochromocytoma, hypertension
46
risk facctors htn -non/modifiable
non:
- ethnicity- afro-caribbean
- incr age
- fhx
- men
modifiable:
- high salt intake
- obesity
- sedentary lifestyle
- smoking
47
symptoms htn
ASx may have pulsatile headache
secondary condition sx
48
what is malignant htn
stage 3 htn classed as >= 180/120 mmHg
start immediate treatment
49
symptoms of maligant htn
hypertensive retinopathy - papilloedema, blurred vision
cardiac signs eg chest pain
polyuria , oligouria
50
investigations for htn
1st. clincal bp reading on each arm - record lowest value
2nd. if >140/90 do ambulatory bp for 24 hrs or home bp monitoring
(should have an average of 135/85mmHg)
51
what secondary investigations should bedone for htn
secondary organ damage
- fundoscopy for retinopathy
- urinalysis for kidney function
- Hba1c`
52
htn tx for afro-caribbean woman age 60 (1st-3rd line)
>= 55yrs or afro-caribbean
1st CCB
2nd CCB + ACEi (or ARB if CI) or thiazide like diuretic
3rd CCB + ACEi (or ARB) + thiazide like diuretic
53
htn tx for 30yr old w t2dm
<55 or w t2dm
1st ACEi (or ARB)
2nd ACEi (or ARB) + CCB
3rd ACE (or ARB) + CCB + thiazide like diuretic
54
htn tx for 58yr old afro-caribbean w t2dm
with DM follow ACEi path but use ARB instead
If not afro caribbean >55 w t2dm follow ACE i path
55
what is stage 1 htn
home/ ambulatory bp >135/85mmHg
clincal bp >140/90mmHg
56
what is stage 2 htn
ambulatory bp 150/95mmHg
clinical bp 160/100mmHg
57
what is pericarditis
inflammation of the pericardium- mostly acute
can either be dry (fibrinous) or effusive (purulent, haemorrhagic or serous)
- effusion is secondary to inflammation + can cause further complications
58
2 main causes of percarditis
idiopathic
viral - coxsakkie
59
name 5 other causes of pericarditis
idiopathic
viral: coxsakkie, EBV, VZV, HIV
TB
Autoimmune: SLE, RA, sjogren
dresslers syndroms: autoimmune following after mi
Hypothyroidism
60
typical px of pericarditis
male, 20-50s w recent viral infection
61
describe pericardial chest pain
severe sharp pleuritic chest pain that radiates to trapezius, neck, jaw
worse when lying down and relieved by sitting foward
62
signs and symptoms for pericarditis
severe sharp pleurtic chest pain
-worse lying down
- better sitting foward
pericardial friction rub on ascultation
- to and fro high pitch/ leathery extra heart beat
63
innervation of pericardium
phrenic nerve- so paiin refers to shoulder, neck and jaw
64
investigations for pericarditis
ECG - diagnostic
- wide saddle shaped ST elevation
- PR depression
CXR: if effusion will show cardiomegaly
troponin- exclude MI
ESR
CRP
65
main important differential with pericarditis
MI - central chest pain - but not pleuritic or worse lying down
66
treatment for pericarditis
NSAIDs eg aspirin
Colchicine
67
complications pericarditis
constrictive pericarditis (chronic) granulmous tissue formation of pericardium causing reduced cardiac output and congestiev heart failure
effusion may occur - pericardial effusion and this may result in cardiac tamponade if it affects heart function due to compression
68
what is cardiac tamponade
complication of pericardial effusion
where excessive collection of pericardial fluid results in inability of heart to maintain CO and contract-> chamber collapse
69
what are the signs and symptoms of cardiac tamponade
becks triad- incr jugular venous pressure, hypotension and muffled heart sounds
pulsus paradoxus - during inspiration, systolic pressure drops by >10mmHg
tachy cardia
70
investigations for cardiac tamponade
ECG- tachycardia and different qrs amplitudes (electrical altercans)
CXR- cardiomegaly with pleural effusions
ECHO - diagnostic
71
treatment for pericarditis
urgent pericardiocentesis
72
what is infective endocarditis
infection of the endocardium usually due to bacteria
73
risk factors infective endocarditis
men
congential heart disease (young px)
prosthetic valves (older px)
rheumatic heart diesase
poor dental hygeine/ rectent dental proceedue
IVDU
74
what is typically affected in infective endocarditis
valves - typically left (aortic and mitral) but righ (tricuspid in ivdu)
75
pathophysiology fo infective endocarditis
- abnormal endocardium have increased platelet and fibrin deposition, esp near the valves
- this incr likelihood of bacteria colonising there and infecting endocardium formign bacteria vegetatitons causing valvular damage
can cause regurgitation
76
signs for infective endocarditis (5)
janeway lesions - red marks on hands
oslers nodes - nodules on fingers
roth spots - white centered retinal haemorrhages
splinter haemorrhages - under fingernails
new heart murmer - due to regurgitation
77
symptoms for infective endocarditis
non-specific
- fever
- headache
- wt loss, malaise, night sweats
- arthalgia due to septic emboli
78
causes of infective endocarditis
mc s. aureus
s. viridans - poor dental hygine associated
79
common bacteria causing infective endocarditis w poor dental hygine
s. viridans
80
ivdu is associated w infective endocarditis on which side of the heart
right
81
ddx of fever and new heart murmur
infective endocarditis- important to rule out
82
1st line investigations for infective endocarditis -
- blood cultures - 3 done w a 1 hour internal - must be done before AB tx starts
83
diagnostic investigation for infective endocarditis
TOE
- transoesophageal echogram - more invasive than transthoracic echocardiogram but better imagine
- endocardial vegitations
- valvular regurgitations
84
criteria used for diagnosing infective endocarditis and its composition
dukes criteria
- 2 major
- 5 minor
85
major points of dukes criteria
what is dukes criteria
for diagnosign infective endocarditis
- 2/3 positve blood cultures
- echogram - vegetations/ regurgitations
86
5 minor points of dukes criteria
vascular abnormalities eg septic emboli
pyrexia
immunological manifestations eg roth spots
predespositing heart conditon / ivdu
1 positve blood culture
87
treatment for infective endocarditis
6 wk ABs
2 wk IV then 4 wk oral
88
tx for infective endocarditis due to s. aureus
vancomycin and rifampicin
89
complications of infective endocarditis
sepsis
valvular regurgitation
congestive heart failure
90
what are the 3 types of AV heart blocks
1st, 2nd, 3rd heart block
91
describe 1st heart block
consistent prolonged PR interval >0.2sec with no missed AV conductance (no dropped qrs complexes)- slow conduction
92
causes of 1st degree heart block
hypokalaemia
drugs: BB, CCB, digoxin, amiodarone
Inferior MI
cardiomyopathies
93
symptoms and treatment of 1st degree heart block
ASx so no tx- pretty common
94
what are the 2 types of 2nd degree heart block
Mobitz type 1 and 2
95
describe mobitz type 1 heart block
2nd degree heart block
- progressive prolongation of PR interval until failure of AV conduction causing 1 dropped QRS
- pr interval is normal following then progressively prolongs again
96
causes of mobitz 1 heart block
inferior MI
drugs: ccb, bb, digoxin, amiodarone
cardiomyopathies
97
treatment of mobitz 1 heart block
if symptomatic -> pacemaker
eg chest pain
98
describe mobitz ii heart block
2nd degree heart block
- consistent prolonged PR interval w occasional failure of AV conductance (occasional dropped qrs complexes)
99
treatment of mobitz ii heart block
- pacemaker
100
symptoms of mobitz ii heart block
- chest pain, dyspnoea, syncope if severe
101
causes of mobitz type ii heart block
ant MI
SLE
rheumatic fever
102
what are the ratios for mobitz i, ii
MI = ratio of p waves to qrs complexes of full cycle (until qrs is dropped) eg 4:3
MII = ratio of how many qrs complexes conducted before a dropped one X:1
103
what is a 3rd degree heart block
AVN dissociation. Failure of conductance between atria and ventricles. P and qrs wave independent of eachother
104
how do ventricles contract in 3rd heart block
escaped rhythm giving a narrow qrs complex or broard depending on where block originated
105
causes of 3rd heart block
lyme disease
acute MI
endocarditis
HTN
106
treatment 3rd heart block
IV atropine
107
what is afib
irregularly irregular contraction of the atria 300-600bpm causing rapid and ireg ventricle contraction
108
causes of afib
PIRATE
Pulmonary- PE/COPD
Idipathic/ IHD
Rheumatic heart disease/ mitral valve disease
Alcohol
Thyroid- hyperthyroidism
Electrolyte imbalance - low Mg, high/low K
109
risk factors for afib
htn , t2dm , incr age, male
110
symptoms and signs of afib
palpitations
dyspnoea
chest pain
ASx
hypotension
signs of heart failure
irreg pulse
111
ecg findings of afib
absent p waves
irregular qrs complex
tachycardia
112
types of afib
paroxysmal: <7 days
persistent: >7days and reseolves
permenant: unresolving
113
acute managment for afib
- DC cardioversion - defibrillation
114
chronic managment for afib, once stable 1
1. rate control: BB (bisoprolol), CCB (verapamil), or digoxin if have heart failure + anticoagulants for all
2. rhythm control: amiodarone or electrical
115
what is atrial flutter
regular fast contractions of the atria 250-320bpm characterised by saw tooth waves due to reentry waves
116
signs and symptoms of atrial flutter
syncope
dyspnoea
palpitations
fatigue
117
ecg findings of atrial flutter
sawtooth atrial flutters between narrow qrs complexes
118
causes of atrial flutter
idiopathic, IHD, alcohol, htn
119
treatment of atrial flutter
acute- dc cardioversion
after stable - rate control
120
what does avrt stand for
atrioventricular re entrent tachyarrhythmia
121
give an example fo avrt
wolff parkinison white syndrome
122
pathophysiology of WPWS
accessory pathway - bundle of kent - which causes pre-excitement of the ventricles
as SAN impulse is conducted via BoK and atria to the AVN
123
ecg findings of WPWS
short pr interval
wide qrs complex
delta wave- inital sloping of qrs interval
124
1st, 2nd, 3rd line treatment of WPWS
1st. carotid massage/ valsalva manouver
2nd. IV adenosine - causes complete heart block so px feels like they are dyign
3rd. radiotherapy of ablation of bundle of ken
125
what is IV adenosin used for and how does it work
for wolff parkinson white syndrome
- causes complete heart block and restarts the heart
126
what is heart failure
inability of the heart to pump enough blood, therefore O2 to supply the metabolic demands of tissue, causing a syndrome of signs and symptoms
127
what is AAA
permenent dilation of aorta more than 50% (>3cm typically) mc infrarenal
128
where is the most common place for aaa to occur
infra renal
129
2 types of aaa
true aaa- 3 layers of the blood vessel
false aaa - 1/2 layers of the blood vessel
130
whos more at risk of an inflammatory aaa
younger pxs w atherosclerosis
131
additionl feature of px w inflammatory aaa
fever
132
risk factors aaa
smoking - mainly
incr age
men
connective tissue diseases eg ellos danlos and marfans
htn
133
what is the main risk factor of aaa
smoking
134
what is the signs and symptoms of an unruptured aaa
mostly asx
135
signs and symptoms of ruptured aaa
- pulsatile abdo mass
- sudden severe epigastric pain
- tachycardic and hypotensive
136
investigations of aaa
abdo ultrasound `
137
managment of unruptured aaa <5.5cm
monitor and conservative management eg stop smoking, better diet, exercise
138
conditions of surgical management for unruptured aaa
>5.5cm
4cm and fast progression - dilates more than 1cm annualy
139
managment for high risk unruptured aaa
surgical repair- endovascular aortic repair or open repair
140
managment for ruptured aaa
urgent endovascular aortic repair
141
heart murmur for aortic regurgitation
early diastolic blowing murumur, heard best on expiration and when sitting up
142
heart murmur for aortic stenosis
ejection systolic crescendo decrescendo murmur radiating to apex and carotids
143
heart murmur for mitral regurgitation
pansystolic blowing murmur radiating to left axilla
144
heart murmur for mitral stenosis
rumbling mid diastolic murmur with opening snap, best hear on expiration when lying on lhs
145
causes for aortic stenosis
- ageing calcification
- congenital bicuspid valve
- rheumatic heart disease
146
causes for aortic regurgitation
- rhuematic heart disease
- infective endocarditis
- ED / M
- congenital bicuspid valve
147
causes for mitral stenosis
- rhemuatic heart disease
148
causes of mitral regurgitation
- rheumatic heart disease
- ED/ M
- infective endocarditis
- post MI
149
symptoms and signs of aortic stenosis
- SAD
- syncope, angina, dyspnoea
- narrow pulse pressure
- slow rising pulse
-
150
signs and symptoms for aortic regurgitation
- PAD
- palpitatins, angina, dysnpoea
- collapsing carrigan pulse
- austin flint murmur
- widened pulse pressure
151
signs and symptoms for mitral stenosis
- Afib, palpitations, malar flush, dyspnoea
- loud first heart sounf
152
signs and symptoms for mitral regurgitaiton
- palpitations, dyspnoea, weakness, fatigues
- soft 1st heart sound
153
investigations for valvular heart disease
- ecg, cxr
- gold: echocardiogram - look for chamber and valve abnormality and size
154
general tx for valvular heart disease
- valve repair. replacement
155
treatment for high risk aortic stenosis
TAVI
transmembrane aortic valve implant
156
what does valve stenosis cause (pathophysiology)
valves are unable to open properly as are stiff causing poor blood flow to next chamber/ blood vessel.
this causes proximal vessl to contract more to maintain cardiac output causing hypertrophy
157
what does valve regirgitation cause
- backflow of blood
