Cardio Flashcards
(28 cards)
A pt presents to A+E with motor weakness (loss of power), loss of sensation and difficulty speaking. On examination they have loss of visual fields on the left side of their left eye and right side of their right eye.
You think this patient has had a stroke. What are the 2 types of stroke? From the history where do you think this stroke is? List the risk factors, investigations and treatment of this disease
RF: Age, Hypertensions, Smoking, FH, Race
1. Ischaemic clot stops blood to area of brain
2. Hemorrhagic- blood leaks into brain tissue
NOTE: Lancular (LACS) small, hypertension
Bitemporal hemianopia lesion at chiasma
Management-
Protect Airways
Pulse (AF?), BP + ECG
Stop Antihypertensives + HRT- affect cerebroperfusion
Bloods- FBC, Platelets, RBC, Glucose, Lipids
Urgent CT/MRI
Thrombolysis (onset <4.5hrs ago) + alteplase
Antiplatelets- 300mg Asprin
Prophylaxis-
Exercise, Better diet
Control RF: cardiac, DM, hypertension, obesity
If previous stroke
+ antiplatelets- clopidogrel / warfrin if AF stroke
If TIA (<24hr occlusion)
Antiplatelets- clopidogrel + warfrin (AF, mitral stenosis, emboli) + Carotid Endarterectomy (carotid stenosis) + 1 month off driving
A pt with a recent heart valve replacement is discovered to have a new murmur when reviewed in clinic. What diagnosis must you rule out? What signs would you expect to find on examination? Describe the organisms possibly responsible and the management of this condition
Infective Endocarditis- Emboli cause- Splinter Haemorrhages (peripheries) , Vasculitis Rash, Oslers Nodes (soles), Janeway Lesions (dark hands,soles), Roth Spots (retinal haemorrhage)
Organisms- S.Aureus, Strep.Viridans, Enterococci (Comorbities, elderly), STIs, Candida
Management-
Blood Cultures- 3 sets, 3 sites 6 hrs between. If septic 2 sets, 2 sites, 1hr apart.
Bloods- Normochromic, Normocytic Anaemia, Neutrophilia, high ESR/CRP, urinalysis (microscopic haematuria)
CxR (cardiomeagly), Echo (vegetations), ECG
Native Valves- Blind (amoxicillin + genamicin)
Staph- (flucoxacillin)
Strep- (Benzylpenecillin)
Prosthetic- Blind (vancomycin + gentamicin + rifampicin)
Staph- (flucloxacillin + gentamicin + rifampicin)
Strep- (Benzylpenecillin + gentamicin)
A 65 year old male is presented to A+E with severe hypotension and back pain. What is the immediate diagnosis you must rule out? How is this managed and prevented?
Abdominal Aortic Aneurysm Rupture- EMERGENCY
Saccular, Fusiform, False Aneurysms- grow- dissection
If Ascending AA- dysphagia + hoarseness
If descending AA- Sharp chest pain
RF- Male, Age, Smoking, Hypertension. So AAA Screening for men >65 (US)
Operate (80% mortality)
A pt presents to A+E with unilateral swelling of the right leg. On examination the leg is erythematous will loss of dorsal pedis and posterior tibial limb pulses.
The pt is a smoker and diabetic.
What is your most likely diagnosis? How would you manage this?
Deep Venous Thrombosis
Management-
D-Dimer Bloods, Compression US
+ Low molecular Weight Heparin + Compression Stockings
+ stop oral contraceptive if on
Risk of PE (SOB, chest tightness, haemoptysis)- CT Pulmonary Angiography
A pt presents with severe oedema of the ankles and signs of a lack of peripheral perfusion. On examination they have Atrial Fibrillation. What is your working diagnosis? Describe the peripheral signs seen and the management of this condition
Congestive Heart Failure- Inability of the heart muscle to pump properly.
Peripheral Perfusion- Dysnopea, Fatigue, Lower ETT, Wheeze, Weight Loss, Tachycardia, Displaced Apex Beat
Manage-
ECG (LV Systolic Dysfunction), Echo (ejection fraction), B Naturetic Peptide (increased), CxR (cardiomegaly)
+ loop diuretics eg./ frusemide, + ACE-I/ARB if cough + B-Blockers
If no improvement add digoxin
A pt presents to A+E with central, crushing chest pain which radiates to the left arm accompanied by breathless and nausea. What is the most likely diagnosis? What can this lead to? How is it investigated and treated?
Unstable angina with potential to progress to Myocardial Infarction (ischaemic necrosis)
Manage- Cardiac Troponin (sensitive measure of necrosis should be normal if angina), ECG (tall T waves/ ST elevation)
Bloods- FBC, Glucose, Lipids
O2, GTN, Anitplatelets, Morphine
+ Angioplasty and stent or thromboylsis + B-Blocker eg./ atenolol + Ace-I
Identify the parameters for hypertension, the risk factors involved, associated treatment and complications.
Normal 120/80 mmHg
S1- 140/90 mmHg
S2- 160/100 mmHg
Severe- 180/110 mmHg
RF: Age, Weight Race, FH, Diet (NaCl), Low birth weight, DM, LV Hypertrophy.
Management- Aim to get to 135/85 sphygmomanometer (ambulatory/ home), ECG (end organ damage), Renal USS
+ ACE-I eg./ Ramipril - If <55
OR ARB (cough, teratogenic so >55) eg./ Valsartan OR CCB (>55, black) eg./ Amlodipine
+ TTD eg./ thiazine
+ spirolactone/ B Blocker
Complications- Stroke, Retinopathy, CHF, Renal Failure
Describe the formation of an atheroma and what groups of people are at risk
- Fatty Streak (kids, lipids + macrophages, may disappear)
- Early Plaque (young adults, patchy lipid laden macrophages)
- Fully Developed- Central Lipid Core (necrotic) + fibrous tissue cap
Injury- INC LDL- Monocyte Adhesion- Platelet Adhesion
RF: Hypercholestrolemia, Smoking, Hypertension, Male, Elderly, DM, Hyperthyrodism, Low birth weight.
IF plaque ruptures and contents into blood stream can cause infarction at any site
eg./ Coronary Arteries- MI
Carotid/ Cerebrals- Stroke
Illeal/Femoral/Popiteal- Gangrene
Arterial Bed- organ infarct eg./ AAA
Describe Virkows Triad. What is it used to depict the risk factors for?
Virkows Triad- Presdisposition to thrombus/ Embolism
- Hypercoagulation
- Endothelial Injury
- Stasis of blood flow
A patient presents with central, crushing chest pain. What are you differential cardiac causes? How would you rule these out/in?
Hx, ECG + Troponin
ACS’s
1. Unstable Angina- inc frequency, unpredictable, rest normal ECG (can show ST depression/ T wave changes) + normal Troponin
2. NSTEMI- >20min chest pain, sustained, ST depression/ T wave changes, normal/ slightly elevated Troponin
3. STEMI- >20 min chest pain, sustained, ST elevation, significantly elevated Troponin
A Pt presents to A+E with central, crushing chest pain. Upon questioning, the pain seems to be increasing in frequency, spontaneously and at rest. You give the patient an ECG and find a slight depression of T waves. You measure the patients bloods and troponin is normal.
What is your most likely diagnosis? What would your management be?
Unstable Angina (can have ST depression/ T wave changes/ normal ECG) Reassure Oxygen (high flow) Morphine Aspirin Nitroglycerine Clopidogrel Enoxaparin
A Pt presents to A+E with central, crushing chest pain. Upon questioning, the pain has lasted >20mins and is constant. You give the patient an ECG and find a depression of T waves. You measure the patients bloods and troponin is elevated.
What is your most likely diagnosis? What would your management be?
NSTEMI Reassure Oxygen (high flow) Morphine Aspirin Nitroglycerine Clopidogrel Enoxaparin
A Pt presents to A+E with central, crushing chest pain. Upon questioning, the pain has lasted >20mins and is constant. You give the patient an ECG and find an elevation of T waves. You measure the patients bloods and troponin is markedly elevated.
What is your most likely diagnosis? What would your management be?
STEMI A- patent B- O2 (high flow), RR, sats C- pulses, BP (both arms), JVP, murmurs, ECG, IV access, ABG Aspirin Morphine Fibrinolysis (+angio)
How does HF look on a CXR?
Alveolar Bat Winging Kerly B Lines (interstitial oedema) Cardiomeagly Dilated upper lobe vessels Pleural Effusion
What is the difference in fluid shift between right and left heart failure?
Left HF- fluid backs up in lungs- SOB, dysnopea, wheeze, pulmonary oedema, cold peripheries
Right HF- fluid backs in in abdo + peripheries- peripheral oedema, ascites, epistaxis
What sided heart failure occurs first?
Left Sided Heart Failure
Broadly, what causes RHF?
LVH, lung disease, pulmonary stenosis
What are the 4 types of Heart Failure? Briefly describe each
- LSHF- pulmonary oedema
- RSHF- peripheral oedema
- Systolic HF- LV can’t contract properly
- Diastolic HF-LV cant relax/ fill properly
What can cause cardiac failure?
Hypertension Valvular Disease Coronary Disease Cardiomyopathy Myocarditis Congenital Arrythmias Other: HIV, DM, Haemochromotosis, hypo/hypethyroid, amyloidosis
You see a patient in clinic with dizziness and chest pain. On ECG you see-
Rate- 350bpm
Rhythm- Irregularly irregular
Narrow QRS complexes
No P waves
Which is your diagnosis? Can you name a few common causes? How do you treat this?
Atrial Fibrillation due to tachycardia rate, irregular rhythm, narrow QRS and no p waves
Cause: HF, hypertension, MI, PE, mitral disease, pneumonia, hyperthyroid, caffeine
Treat:
Rate Control- B Blockers/ CCB
Rhythm- Cardioversion
+ Anticoagulation- heparin (acute) then move to warfarin
A patient presents with an irregular pulse. What investigation must you do? Why?
ECG
Rule out AF due to risk of embolic stroke
AF- Tachy, irregularly irregular, narrow QRS, missing P waves
What is Acute Atrial Fibrillation? How is management changed?
AF in <48hr period O2 U+E Emergency cardio version/ IV amiodarone CCB/ B Blocker LMWH
In what time limit of presentation can cardio version be preformed?
48 hours
You see a patient in clinic with an ECG- Rate- 300bpm Rhythm- regular Narrow QRS complexes No P waves 2:1 block Complexes have a 'saw toothed' appearance What is your most likely diagnosis? How would you treat?
Atrial Flutter
Carotid sinus massage + IV adenosine- unmask flutter
Cardioversion (+anticoag before)
+amiodrone to restore and maintain sinus rhythm
