Cardio Conditions Flashcards
(57 cards)
1
Q
Features of Angina
A
- Constricting/heavy discomfort to the chest, jaw, neck, shoulders, or arms
- Symptoms brough on by exertion
- Symptoms relieved within 5min or GTN
3 ft = Typical angina
2 ft = atypical angina
0-1 = non-anginal chest pain
2
Q
Precipitants of angina
A
Emotion
Cold weather
Heavy meals
3
Q
Ass symptoms w/ Angina
A
Dyspnoea, nausea, sweatiness, faintness
4
Q
Causes of Angina
A
Atheroma Anaemia Coronary artery spasm AS Tachyarrhythmias HCM Arteritis/small vessel disease
5
Q
Name 4 types of angina
A
Stable angina: induced by effort, relieved by rest
Unstable angina: increasing in frequency or severity
Decubitus angina: pptated by lying flat
Variant (Prinzmetal) angina
6
Q
Specific tests to Angina
A
Lipids HbA1C Echo CXR ECG + Exercise ECG Angiography Functional imaging: MIBI scan
7
Q
Secondary prevention of cardiovascular disease to Angina
A
Stop smoking, exercise, dietary advice, optimise hypertension and diabetes
75mg aspirin daily if not contraindicated
Address hyperlipidaemia
Consider ACE inhibitors
8
Q
Acute Treatment to Angina
A
GTN spray, rpt dose after 5min + call an ambulance if pain doesn’t go away 300mg Aspirin 300mg Clopidogrel 10,000Units heparin B-blocker +/- Ca Channel Antagonist If not tolerated trial other agents
9
Q
Name Anti-anginal medications to Angina
A
B-blocker Ca Channel blocker Long-acting nitrates Ivabradine Ranolazine Nicorandil
10
Q
Name Surgical management to Angina
A
PCI and CABG
11
Q
Name the conditions that lead up to Acute Coronary Syndromes
A
Unstable Angina: no trop rise Myocardial Infarction Ischaemia STEMI NSTEMI
12
Q
What is STEMI
A
ACS which has ST-segment elevation or new-onset LBBB
13
Q
What is NSTEMI
A
ACS with trop +ve without ST-segment elevation
ECG: ST depression, T-wave inversion, non-specific changes
14
Q
Non-modifiable risk factors to ACS
A
Age
Male,
FH of IHD
15
Q
Modifiable risk factors to ACS
A
Smoking HT DM Hyperliipidaemia Obesity Sedentary lifestyle Cocaine use
16
Q
Symptoms of ACS
A
Acute central chest pain >20 mins Nausea Sweatiness Dyspnoea Palpitations
17
Q
Signs of ACS
A
Distress Anxiety Pallor Sweatiness Dec/inc pulse Dec/inc BP 4th heart sound
18
Q
Specific tests for ACS
A
ECG Glucose Lipids Toponins Echo
19
Q
Management of ACS
A
Antiplatelets: aspirin + clopidogrel (for 12mo)
Anticoagulate: fondaparinoux or alteplase
B-blocker: reduces myocardial demand
ACE-i: titrate up slowly, monitor renal fn
High dose statin
Echo to id LV function
Revascularisation
General advice: driving, work
20
Q
Complications of MI
A
Cardiac arrest Cardiogenic shock Left ventricular failure Bradyarrhythmias Tachyarrhythmias Right Ventricular failure/infarction Pericarditis Systemic embolism Cardiac tamponade Mitral regurg Ventricular septal defect Late malignant ventricular arrhythmias Dressler’s syndrome Left ventricular aneurysm
21
Q
Organic Cardiac causes of Arrhythmias
A
IHD Structural changes Cardiomyotpathy Pericarditis Myocarditis Aberrant conduction pathways
22
Q
Non-cardiac causes of Arrhythmias
A
Caffeine Smoking Alcohol Pneumonia Drugs: beta agonists, digoxin, L-dopa, tricyclics doxorubicin Metabolic imbalance incl thyroid disease Phaeochromocytoma
23
Q
Tests specific to Arrhythmias
A
Glucose Ca, Mg TSH ECG: 24h monitoring (halter) Echo: structural heart disease Provocation tests: exercise ECG, cardiac catheterisation +/- electrophysiological studies
24
Q
Name 5 types of Continuous ECG monitoring
A
Telemetry Exercise ECGs Holter Monitors Loop recorders Pacemakers and ICDs
25
Causes of Atrial fibrillation and flutter
```
PE, Pneumonia
Mitral valve disease
Hyperthyroidism
Post-op, Hypo K, Hypo Mg
Heart failure, HT, IHD, Caffeine, Alcohol
```
26
Symptoms of AF and flutter
```
Asymp
Chest pain
Palpitations
Dyspnoea
Faintness
```
27
Signs of AF and flutter
Irregularly irregular pulse
| Signs of LVF
28
Managing AF and flutter
ABCDE, get senior input
DC cardioversion +/- amiodarone
Heparin
Rhythm control: DC cardiovert or flecainide or amiodarone (<48h)
Rate control
Correct electrolyte imbalance, Rx ass illnesses
29
What medications allow for cardiac rate-control?
B-blocker or rate limiting Ca blocker
Add digoxin
Then consider amiodarone
Do not give b-blockers with verapamil
Amioderone, b-blocker, CCB, digoxin
30
How do you treat Paroxysmal AF?
Pill in pocket (sotalol or fleicanamide PRN)
Anticoagulation
Consider ablation if symptomatic
31
Treatment of Atrial flutter
```
B-blocker and Ca blocker
Add digoxin
Then consider amiodarone
Pill in pocket (sotalol or fleicanamide PRN) + anticoagulated
DC cardioversion + amiodarone IV
```
32
What are the indications for a temporary cardiac pacing
Symptomatic bradycardia which is unresponsive to atropine
After acute anterior MI
After inferior MI
Suppression of drug-resistant tachyarrhythmias
General anaesthesia, cardiac surgery, electrophysiological studies, drug OD
33
Indications for permanent pacemaker
```
Complete AV block
Mobitz type II AV block
Persistent AV block after anterior MI
Symptomatic bradycardias
HF
Drug resistant tachyarrhythmias
```
34
Pacemaker letter codes
1st letter the chamber being paced
2nd letter the chamber sensed
3rd letter the pacemaker response
4th letter: rate modulation, programmable, multiprogrammable
5th letter P = pace, S = shock, D = dual, 0 = neither
35
What are the classifications of heart failure
```
Systolic
Diastolic
Left ventricular failure
Right ventricular failure
Acute heart failure
Low-output heart failure
High-output heart failure
```
36
Signs of HF
```
Cyanosis
Low BP
Narrow pulse pressure
Pulsus alternans
Displaced apex (LV dilatation)
RV heave (pulmonary HT)
```
37
Specific tests to HF
BNP, CXR, ECG
ECHO
Rarely: endomyocardial biopsy
38
For HF, what do u see on CXR
```
A – alveolar odema (Bat’s wings)
B – Kerley B lines (interstitial oedema)
C – Cardiomegaly
D – dilated prominent upper lobe vessels
E – pleural effusion
```
39
Symptoms of Left ventricular failure
```
Dyspnoea
Poor exercise tolerance
Fatigue
Orthopnea
Paroxysmal nocturnal dyspnoea
Nocturnal cough – nocturia
Cold peripheries
Wt loss
```
40
Causes of RVF
LVF
Pulmonary stenosis
Lung disease
41
Symptoms of RVF
Peripheral oedema, Ascites, Facial engorgement
Nausea, anorexia
Epistaxis
42
Acute HF means….
New onset acute or decompensation of chronic heart failure
43
Causes of Low-output HF
Excessive preload
Excessive afterload
Chronic excessive afterload
Pump failure
44
Causes for High-output HF
Anaemia, pregnancy, hyperthyroidism
Paget’s disease
Arteriovenous malformation
Beriberi
45
Treatment of HF
```
ACE-i
B-blockers
Diuretics
Digoxin
Mineralocorticoid receptor antagonists
Vasodilators
```
46
Inpatient management of HF
Minimal exertion, Na+ and fluid restriction
Opiates and IV nitrates may relieve symptoms
Give DVT prophylaxis: heparin + TED stockings
Metolazone and IV furosemide
Weigh daily – freq U+E
Consider: cardiac resynchronisation, LV assist device, transplantation
47
Name the four classes of HT
Primary or essential HT
Secondary HT
Malignant or accelerated phase HT: rapid rise in BP, vascular dmg – slowly decrease it over time
White coat HT: elevated clinic pressure
48
Symptoms of HT
```
Asymptomatic
Headache +/- visual disturbance
Signs of renal disease
Radiofemoral delay
End-organ dmg: proteinuria, LVH, retinopathy
Palpable kidneys
```
49
Specific tests to HT
```
ABPM or home BP monitoring
ECG or echo
Urine analysis (protein and blood, K+ and Ca)
Renal US
24h urinary meta-adrenaline
Urinary free cortisol
Renin aldosterone
MR aorta (coarctation)
```
50
Causes for secondary HT
Renal disease: glomerulonephritis, polyarteritis nodosa (PAN), systemic sclerosis, chronic pyelonephritis, polycystic kidneys
Endocrine disease: Cushing’s, Conn’s, hyperparathyroidism
Other: coarctation, pregnancy, liquorice
Drugs: steroids, MAOI, OCP, cocaine, amphetamines
51
Management of HT
Lifestyle changes
Drugs: monotherapy, dual therapy, triple therapy
ACE-I or ARB
B-blocker
Ca Ch blocker
Dual therapy: add thiazide
Quad therapy: add spironolactone + monitor U+E
52
Rheumatic fever is diagnosed using which criteria
Jones criteria
- Evidence of Group A b-haemolytic strep infection
- Major criteria
Carditis, arthritis, subcutaneous nodules, erythema marginatum, sydenham’s chorea
- Minor criteria
Fever, raised esr/crp, athralgia, prolonged PR interval, previous rheumatic
53
How do u manage rheumatic fever
```
Bed rest for 2w
Benzylpenicillin
Analgesia for carditis/arthritis
Immobilise joints in severe arthritis
Haloperidol or diazepam for the chorea
Secondary prophylaxis: Penicillin 250mg/12h PO
```
54
What causes Infective endocarditis?
Bacteraemia (HACEK – haemophilus, actinobacillus, cardiobacterium, eikenella, kingella) and chlamydia
Fungi
SLE
Malignancy
55
Signs of IE
Septic signs: fever, rigors, night sweats, malaise
Cardiac lesions: new murmur
Immune complex deposition: vasculitis
Embolic phenomenon
56
How do u diagnose IE
Modified Duke criteria
- Blood cultures
- Blood tests
- Urinalysis: haematuria
- CXR: cardiomegaly, pulmonary oedema
- Regular ECGs
- Echo
- CT
57
Risk factors for IE
Skin breaches (dermatitis, IV lines, wounds)
Renal failure
Immunosuppression
DM
