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4MB Medicine Aaron > Cardiology 1 > Flashcards

Cardiology 1 Flashcards

1
Q

What is angina?

A

Chest pain on exertion caused by myocardial ischaemia from coronary heart disease, usually atherothrombosis

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2
Q

What is the difference between stable and unstable angina?

A

Stable angina is induced by effort and relieved by rest/GTN spray Unstable angina is an acute coronary syndrome with pain at rest/not relieved by GTN

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3
Q

List aetiology/risk factors for angina

A

Atherosclerosis Males Smoking, excess alcohol Poor diet, obesity Arteritis Low exercise Hypertension Diabetes

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4
Q

List clinical features of angina

A

Central chest tightness on exertion Pain may radiate to jaw/arm Dyspnoea Nausea Sweating Syncope

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5
Q

What investigations would you order for angina?

A

ECG may be normal Exercise ECG, 24h ECG CT catheter angiography

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6
Q

Outline medical treatment for angina

A

GTN spray when required Secondary prevention (aspirin, statin, ACEi) B-blockers unless contraindicated Ivabradine/nicorandil if others not tolerated

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7
Q

Outline surgical treatment for angina

A

Coronary revascularisation (PCI, CABG) using balloon stent or graft bypass from internal mammary artery and greater saphenous vein

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8
Q

What are the acute coronary syndromes (ACS)?

A

Unstable angina NSTEMI STEMI

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9
Q

What is the pathophysiology of ACS?

A

Atherothrombotic plaque rupture leads to thrombosis and complete occlusion of coronary artery, causing ischaemia and potential necrosis

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10
Q

List risk factors/aetiology for ACS

A

Males Family history Smoking, excess alcohol Hypertension Diabetes High cholesterol Obesity Sedentary lifestyle

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11
Q

List clinical features of ACS

A

New onset severe crushing chest pain, radiating to arm and/or jaw Nausea, vomiting Not relieve by rest or GTN Breathlessness Syncope Confusion Pallor, sweating Palpitations, tachycardia SENSE OF IMPENDING DOOM

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12
Q

What investigations would you do for ACS?

A

Bloods: cardiac enzymes (CK, troponin), electrolytes, glucose, lipids ECG CXR

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13
Q

What is the criteria for STEMI on ECG?

A

ST elevation of 1mm or more in 2 adjacent limb leads or ST elevation of 2mm or more in 2 contiguous chest leads

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14
Q

List ischaemic changes on ECG

A

T wave inversion Q waves Tall T waves ST depression ST elevation

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15
Q

When do levels of troponin and CK peak in ACS?

A

Troponin: 3-12 h CK: 24 h

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16
Q

Outline medical treatment for acute MI

A

Aspirin 300 mg GTN sublingual IV morphine O2 if hypoxic

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17
Q

Outline definitive treatment for acute NSTEMI

A

B-blocker IV LMW heparin IV nitrate Angiography if high risk

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18
Q

Outline definitive treatment for acute STEMI

A

PCI within 120 mins Otherwise thrombolysis with streptokinase + aspirin, then reassess after 90 mins for need for PCI

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19
Q

What are the different stages of hypertension? (stage 1, stage 2 etc.)

A

Stage 1: 140-159/90-99 Stage 2: 160-179/100-109 Stage 3: 180/110 or higher

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20
Q

List risk factors/aetiology for hypertension

A

Renal disease (GN, polyarteritis, renal artery stenosis) Endocrine disease (Cushing’s, Conn’s, phaeochromocytoma) Pregnancy Drugs Alcohol excess High salt intake Essential hypertension (idiopathic)

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21
Q

List clinical features of hypertension

A

Asymptomatic Headache Palpitations Breathlessness Advanced disease: blurred vision, palpable kidney, RF delay

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22
Q

What investigations would you do for hypertension?

A

ECG, echo Bloods: electrolytes, endocrine markers Funduscopy Urinalysis Home/ambulatory BP monitoring

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23
Q

How is hypertensive retinopathy graded?

A

I: tortuous arteries, narrowing/sclerosis II: AV nipping, marked sclerosis III: haemorrhages, cotton wool spots, hard exudates IV: III + papilloedema

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24
Q

Outline medical management of hypertension

A

If under 55yo, start with ACEi If over 55yo or black, start with Ca ch blocker If uncontrolled on these, ACEi + Ca ch blocker then add thiazide diuretic then add alpha/beta blocker

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25
Q

What is the BP target for diabetic patients with hypertension?

A

Less than 130/80

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26
Q

What is an arrhythmia?

A

Disturbance in the cardiac rhythm generated by abnormal conduction

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27
Q

List risk factors/aetiology for arrhythmias

A

Heart conditions Congenital heart disease Smoking, alcohol High caffeine intake Pneumonia Thyrotoxicosis Metabolic imbalance Drugs (amiodarone, B agonists, digoxin, levodopa, illicit drugs)

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28
Q

List clinical features of arrhythmias

A

Palpitations Abnormal pulse Chest pain Syncope Dizziness Dyspnoea Altered consciousness

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29
Q

What investigations would you order for arrhythmias?

A

ECG, 24 h ECG, event recording Electrophysiology FBC, U+E, glucose, Ca, Mg, thyroid function Echocardiogram

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30
Q

Which drug can be used to treat bradycardia?

A

Atropine

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31
Q

Outline treatment of supraventricular tachycardias

A

Vagal maneuvres (breath-hold, Valsalva, ice, carotid massage) IV adenosine/verapamil DC shock

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32
Q

List class I anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

Na channel blockers (rhythm control) Lignocaine Disopyramide Flecanaide

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33
Q

List class II anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

B blockers (rate control) Atenolol Propranolol

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34
Q

List class III anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

K channel blockers (rhythm control) Amiodarone Sotalol

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35
Q

List class IV anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

Ca ch blockers (rate control) Verapamil Diltiazem

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36
Q

List the main narrow-complex tachycardias

A

Sinus tachycardia Supra-ventricular tachycardia Atrial fibrillation/flutter Atrial tachycardia Junctional tachycardia (AVNRT, AVRT, BBB)

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37
Q

List the main broad-complex tachycardias

A

Ventricular tachycardia Torsades de Pointes SVT with aberrancy Ventricular fibrillation

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38
Q

Outline treatment of narrow-complex tachycardias (except AF)

A

SVT: vagal maneuvres, IV adenosine/verapamil, DC shock Junctional: ablation of accessory pathways, rhythm control

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39
Q

Outline treatment of ventricular tachycardia

A

Amiodarone/lignocaine + dextrose if stable Correct K with calcium chloride DC shock if pulseless or unstable

40
Q

Outline treatment of ventricular fibrillation

A

DC shock Mg chloride Implantable defibrillator

41
Q

Outline treatment of torsades de Pointes

A

Mg sulfate IV Overdrive pacing

42
Q

List aetiology/risk factors for AF

A

Heart failure Ischaemia, MI Hypertension Mitral valve disease Pneumonia Hyperthyroidism Caffeine, alcohol Hypokalaemia Cardiomyopathy Pericarditis Sick sinus syndrome

43
Q

Outline treatment of acute AF

A

O2 + emergency cardioversion/amiodarone if unstable Anticoagulation with LMW heparin Rate control: diltiazem/verapamol/metoprolol/digoxin AV node ablation or pacing

44
Q

What is the aim for INR with warfarin on AF?

A

2-3

45
Q

Describe 1’ heart block

A

Prolonged PR interval (greater than 0.22s)

46
Q

Describe 2’ type 1 heart block

A

Progressive prolonging of PR interval with dropped QRS complex

47
Q

Describe 2’ type 2 heart block

A

Normal PR interval with some dropped QRS complexes

48
Q

Describe 3’ heart block

A

Dissociation of P-wave and QRS complexes

49
Q

What would an ECG show in right bundle branch block?

A

M-wave in V1, W-wave in V6

50
Q

What would an ECG show in left bundle branch block?

A

W-wave in V1, M-wave in V6

51
Q

List risk factors/aetiology for heart blockWhat is

A

Normal variants Athletes Sick sinus syndrome Ischaemic heart disease Drugs (digoxin, B blockers) Congenital heart disease Calcified valves Trauma Surgery

52
Q

Outline treatment of heart block

A

IV atropine Pacing

53
Q

How does the body try to compensate for low cardiac output in heart failure?

A

Retains fluid which increases preload and causes further stress on the heart, causing congestive heart failure

54
Q

What is “systolic” heart failure? Give causes

A

Ventricles unable to contract normally, causing reduced cardiac output (ejection fraction less than 40%) Causes: IHD, MI, cardiomyopathy

55
Q

What is “diastolic” heart failure? Give causes

A

Ventricles unable to relax normally, causing increased preload (ejection fraction greater than 50%) Causes: constrictive pericarditis, restrictive CM, tamponade, hypertension

56
Q

List causes of right heart failure

A

Left ventricular failure Pulmonary stenosis Lung disease, cor pulmonale

57
Q

List causes of left heart failure

A

Valve disease Arrhythmia Hypertension Congenital defects

58
Q

List clinical features of right heart failure

A

Raised JVP Peripheral oedema Epistaxis Organomegaly Ascites Nausea Anorexia

59
Q

List clinical features of left heart failure

A

Dyspnoea Fatigue, poor exercise tolerance Pulmonary oedema Orthopnoea PND Pink frothy sputum Cold peropheries

60
Q

What are major symptoms/signs of heart failure according to Framingham criteria?

A

PND Crepitations S3 Cardiomegaly Raised JVP Pulmonary oedema Weight loss

61
Q

What are minor symptoms/signs of heart failure according to Framingham criteria?

A

Ankle oedema Dyspnoea Tachycardia Nocturnal cough Pleural effusion

62
Q

What would you see on an XR in heart failure?

A

Alveolar shadowing (bat’s wings) Kerley B lines Cardiomegaly Dilated upper vessels Effusion

63
Q

Outline treatment of acute heart failure

A

Sit up High flow O2 IV diamorphine IV furosemide GTN/nitrate

64
Q

Outline medical treatment of heart failure

A

Diuretics (furosemide, spironolactone) ACEi if LV dysfunction Digoxin if LV impairment B-blocker reduces mortality long-term

65
Q

What is a cardiac murmur?

A

Sound made due to turbulent blood flow against diseased/damaged heart valves

66
Q

Systolic murmurs are in time with the carotid pulse. True/False?

A

True

67
Q

List aetiology of mitral stenosis

A

Rheumatic fever Congenital anomaly Prosthesis Carcinoid tumour

68
Q

List notable clinical features of mitral stenosis

A

Mid-diastolic “rumbling” with loud opening snap Tapping apex Malar flush Low-volume pulse Atrial fibrillation

69
Q

List aetiology of mitral regurgitation

A

Rheumatic fever LV dilation Calcification Endocarditis Connective tissues disease Chordae rupture

70
Q

List notable clinical features of mitral regurgitation

A

Pansystolic with radiation to axillar RV heave Atrial fibrillation Ankle swelling

71
Q

List aetiology of mitral valve prolapse

A

WPW Atrial septal defect Patent ductus Cardiomyopath Connective tissue disease

72
Q

List notable clinical features of mitral valve prolapse

A

Mid-systolic click +/- late systolic murmur Autonomic dysfunction

73
Q

Outline general treatment of mitral valve disease

A

Control AF, anticoagulation Balloon valvoplasty in stenosis Valve replacement B blocker may help symptoms

74
Q

List aetiology of atrial stenosis

A

Calcification Congenital bicuspid valve Kidney disease Hypertrophic cardiomyopathy

75
Q

List notable clinical features of aortic stenosis

A

Ejection systolic with radiation to carotids Slow-rising pulse Heaving apex Exertional dyspnoea

76
Q

List aetiology of aortic regurgitation

A

Connective tissue disease Rheumatic fever Endocarditis Vasculitis

77
Q

List notable clinical features of aortic regurgitation

A

Early-diastolic Displaced apex Collapsing pulse Corrigan’s sign (carotid pulsation) De Musset sign (head nod with beat)

78
Q

Outline general treatment for aortic valve disease

A

Valve replacement (valvotomy, TAVI) ACEi, diuretics

79
Q

List aetiology of tricuspid regurgitation

A

RV dilation Pulmonary hypertension Rheumatic fever Endocarditis IV drug use Carcinoid tumour Ebstein’s anomaly

80
Q

List notable clinical features of tricuspid regurgitation

A

Pansystolic RV heave Hugely raised JVP Pulsatile hepatomegaly Hepatic pain on exertion Ascites

81
Q

List aetiology of pulmonary stenosis

A

Congenital Turner’s, Noonan’s, Falot’s Rheumatic fever Carcinoid tumour

82
Q

List notable clinical features of pulmonary stenosis

A

Ejection systolic with radiation to left shoulder Split S2 Dyspnoa Ascites

83
Q

If someone presents with a fever and new cardiac murmur, what’s the diagnosis until proven otherwise?

A

Infective endocarditis

84
Q

List non-bacterial aetiology/risk factors for endocarditis

A

IVDU Diabetes Valve disease Congenital heart conditions Low dental hygiene, dental procedures

85
Q

List bacterial aetiology for endocarditis

A

Strep viridans Staph aureus, Enterococci, Staph epidermidis (prosthesis) Rare: Haemophilus, Actinobacillus, Cardiobacter, Eikenella, Kingella (HACEK)

86
Q

List clinical features of endocarditis

A

Signs of sepsis - fever, rigors, night sweats, malaise, weight loss New murmur Breathless Fatigue Clubbing Roth spots (retinal haemorrhage) Splinter haemorrhages Janeway lesions (painless palmar nodes) Osler nodes (painful pulps on fingers/toes)

87
Q

What investigations would you do for endocarditis?

A

3 sets of blood cultures at peak of fever PRIOR to antibiotics Bloods Urinalysis CXR ECG Echocardiograph

88
Q

Outline Duke’s major criteria for endocarditis

A

+ve blood culture Endocardium involvement (+ve echo, new valve regurg)

89
Q

Outline Duke’s minor criteria for endocarditis

A

Risk factor present Fever above 38’C Immune/vascular signs +ve blood culture +ve echocardiograph

90
Q

What is required from Duke’s criteria to diagnose endocarditis?

A

2 majors 1 major + 3 minors 5 minors

91
Q

What empirical therapy is used for endocarditis?

A

Benzylpenicillin + gentamicin +/- flucloxacillin

92
Q

What antibiotics would you give for Staph endocarditis?

A

Flucloxacillin Gentamicin Vancomycin if MRSA +/- rifampicin

93
Q

What antibiotics would you give for Strep endocarditis?

A

Benzylpenicillin Gentamicin

94
Q

What antibiotics would you give for Enterococcus endocarditis?

A

Amoxicillin Gentamicin

95
Q

What antibiotics would you give for atypical endocarditis?

A

Doxycycline Cotrimoxazole Fluconazole/amphoterecin

4MB Medicine Aaron (4 decks)

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