cardio shiiiiite Flashcards by a forbes

2 for each: modifiable, clinical, non-mod RF for ischaemic heart disease

Modifiable:
Smoking
Obesity
Sedentary lifestyle
Diet

clinical:
Hypertension
Diabetes
Hyperlipidaemia
Depression

Non-modifiable
Age
Genetics/Family history
Gender (M>F risk)

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stable angina?

induced by effort, relieved by rest

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unstable angina?

can occur on minimal/no exertion

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decubitus angina?

precipitated by lying flat

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prinzmetal angina?

caused by coronary artery spasm

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angina pathology

restricted coronary blood flow, secondary to atherosclerosis

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stable angina ECG

ST depression and T wave inversion

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STEMI & ECG

Sudden complete (100%) occlusion of a coronary artery
transmural

ST elevation
new LBBB

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NSTEMI & ECG

Severely narrowed artery but the artery is not fully occluded
subendocardial

ST depression, T wave inversion
non-transmural subendocardial ischemia

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NSTEMI test to differentiate from angina

troponin posi in NSTEMI

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ACS path

plaque rupture > thrombosis > inflammation

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unstable angina ECG

(when pain occurs) ST depression

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list some diff diag for chest pain

acute MI
angina
pericarditis
myocarditis
rib fracture
chest trauma
muscular
anxiety
PE
pneumonia
tension pneumothorax
lung cancer
GORD
oesophageal rupture

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RF for cardiac failure

65 and older
African descent
Men
Obesity
Previous MI

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blood in right side of heart comes from…? goes to..?

from: body
to: lungs

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blood in left side of heart comes from…? goes to..?

from: lungs
to: body

(hence thicc muscular wall)

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symtoms of left ventricular failure

LUNGS
Exertional dyspnoea 
Fatigue 
Paroxysmal nocturnal dyspnoea (PND)
Nocturnal cough – (+/-) pink frothy sputum 
Cyanosis 
Orthopnoea 
Wheeze (cardiac ‘asthma’)

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heart signs for left ventricular failure

Cardiomegaly (displaced apex beat)
3rd and 4th heart sounds 
↓BP
Narrow pulse pressure 
Pulsus alternans (alternating strong and weak beats)
Crepitations in lung bases

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symptoms of right ventricular failure

Peripheral oedema 
Ascites
Nausea 
Anorexia 
Facial engorgement

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heart signs of right ventricular failure

Raised JVP
Hepatomegaly 
Pitting oedema
Ascites 
Weight gain (fluid)

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gold standard test for cardiac failure

echocardiography

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3 signs, 3 symp of cor pumonale

Symptoms:
Dyspnoea
Fatigue 
Syncope
Signs:
Cyanosis 
Tachycardia
Raised JVP 
Hypoxia
3rd heart sound

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cor pulmonale

right sided heart failure caused by respiratory disease

pulmonary hypertension = back pressure of blood in right atrium, vena cava and systemic venous system

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treat cor pulmonale

treat underlying cause, o2 24%, diuretic - furosemide

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complications of hypertension

``` retinopathy LVH HF renal failure proteinuria headache nausea vomiting impotence ```

investigate hypertension

24hr ambulatory BP monitoring (ABPM) - at least 2 measurements per hour during the person's usual waking hours OR... Multiple home BP monitoring (if patient can’t tolerate ABPM) - BP recorded twice daily look for organ damage (urinalysis, ecg, fundoscopy)

hypertension lifestyle advice

``` Weight loss Reduce alcohol intake Reduce salt intake Stop smoking Regular exercise Stress reduction ```

meds for hypertension if under 55

``` ACE-I/angiotensin 2 receptor blocker add CCB add Diuretic - thiazide - add spironolactone if <4.5 K+ add alpha or beta blocker if >4.5 ```

meds for hypertension if over 55 or black of any age

``` CCB add ACE-I/angiotensin 2 receptor blocker add Diuretic - thiazide - add spironolactone if <4.5 K+ add alpha or beta blocker if >4.5 ```

when and what should be used instead of ABCD in hypertension

if encephalopathy use sodium nitroprusside infusion

causes of aortic stenosis - acquired and congenital

``` acquired = calcification, rheumatic heart disease congenital = bicuspid valve, william's syndrome ```

path of aortic stenosis

obstructed LVOT = increase ventricular pressure = LVH = blood stays

signs describe which valvular disease? Slow rising carotid pulse Narrow pulse pressure Carotid radiation

aortic stenosis

investigation for valvular disease

echocardiography

treat aortic stenosis/mitral regurgitation

valve repair/replacement

causes of mitral regurgitation

mitral valve prolapse, IHD, rheumatic heart disease

path of mitral regurg

Back flow of blood leading to pure volume overload | Regurgitation → LA dilatation → LVH as ventricle swells to maintain BP

signs describe which valvular disease? | Soft S1, Displaced hyperdynamic apex beat

mitral regurgitation

prophylactic antib in aortic stenosis bc..?

prevent risk of IE

signs describe which valvular disease? | Collapsing pulse, Wide pulse pressure, Displaced apex beat

aortic regurgitation

rheumatic fever bacteria/reaction

Group A Beta-haemolytic Streptococcus (GABHS) - strep pyogenes infection type 2 hypersens

3 things caused by rheumatic fever

leaflet thickening commissural fusion shortening and thickening of the tendinous cords

sinus rhythym

cardiac rhythm that starts with depolarization at the sinus node with correctly orientated p waves on an ECG

sinus tachycardia

>100bpm + sinus rhythm Physiological response to exercise and excitement anaemia, infection, fever treat with atenolol

sinus tachycardia on ecg

P waves piggyback onto the T waves = camel hump T waves

1st line management in SVT

adenosine

Irregularly irregular rhythm | Absent P waves

atrial fib

treat acute atrial fib

acute: cardioversion (electrical/amiodarone) correct electrolytes, rate control, anticoagulate

treat chronic atrial fib (baso same for atrial flutter)

rate control - beta blockers eg. atenolol, or CCB verapamil rhythm control - electrical cardioversion or amiodarone anticoag- warfarin

atrial flutter ecg

sawtooth pattern, regular atrial rate

surgery for AF

Radiofrequency catheter ablation – curative for most patients

AVNRT ECG

absent p waves

wolff parkinson white syndrome ecg

short pr interval qide qrs delta wave

Sinus Bradycardia

normally athletes caused by: beta blockers, vasovagal attacks, hypothermia, hypothyroidism, raised ICP treat intrinsic with atropine/temporary pacing

3rd degree heart block treat

IV atropine

LBBB

IHD, aortic valve disease, htn WiLLiaM slurred wave in V1 R wave in V6

RBBB

PE, IHD, Cor pulmonale MaRRoW R wave in V1 Slurred wave in V6

unruptured aortic aneurysm pres

Asymptomatic (usually), Pulsatile on palpation

ruptured aortic aneurysm

Intermittent or continuous abdominal/epigastric pain (radiates to back, iliac fossae or groins) Collapse/Shock Expansive abdominal mass

investigate aortic aneurysm and treat

CT angiography | Surgery (if ruptured IMMEDIATE) or Stenting (unruptured)

screen for aortic aneurysm?

All males at age 65 years Via Aortic Ultrasound High risk if: symptomatic, aortic diameter >5.5cm or rapidly enlarging (>1cm/year)

tetralogy of fallot

Ventricular Septal Defect (VSD) Pulmonary Stenosis Right Ventricular Hypertrophy (RVH) Overriding Aorta

cardio shiiiiite Flashcards

(62 cards)