Cardiology Flashcards
(29 cards)
What is an atrial myxoma?
A benign tumour which is usually found in the left atrium of the heart, it is found in 30-40 year old women
What are the symptoms of atrial myxoma?
Intermittent syncope SOB Fever Malaise Cachexia
How do you treat atrial myxoma?
Minimally invasive right thoracotomy
What are the symptoms of constrictive pericarditis?
Progressive dyspnoea
Fatigue/ weakness
Peripheral oedema
How do you manage constrictive pericarditis?
Pericardiectomy via. Sternotomy incision
What are the causes of constrictive pericarditis?
Post MI
Cardiac surgery
TB
What are the symptoms of acute pericarditis?
Pleuritic chest pain which is relieved by sitting forward Pericardial rub Tachypnoea Tachycardia Non productive cough SOB Flu symptoms
What are the causes?
Post MI- dresslers Viral Hypothyroidism CTD Trauma
How do you investigate acute pericarditis?
Bedside ECG showing widespread ST elevation
Bloods
Transthoracic echo
How do you treat acute pericarditis?
Ibuprofen and colchicine
What does acute coronary syndrome consist of?
Unstable angina, NSTEMI,STEMI
What is the pathogenesis of ACS?
Atherosclerosis
Plaque fissure becomes thrombosis which causes vasoconstriction and ultimately ischaemia.
What is the clinical presentation of ACS?
Severe crushing chest pain which is present at rest (whereas angina is <20 mins and relievable)
The pain is retrosternal radiating to arm/neck/jaw
Sweating, palpitations, dyspnoea, nausea, sense of impeding doom
How long does ACS pain last?
Usually>20 mins and it isn’t relieved by 3xGTN sprays
What are the findings of ACS on examination?
Pallor, sweating, tachycardia- sympathetic sx
Myocardial impairement- hypotension, increased JVP, basal creps, 3rd heart sound, pulmonary and peripheral oedema
What are the risk factors for ACS?
HT Increased cholesterol Smoking Alcohol FHx Previous IHD DM Increased BMI Male Age
What IX should be carried out for ACS?
Bloods- lipids, glucose, cholesterol, clottimg
Troponin’s on admission and again 6-12 hours later
ECG should be done within ten minutes
Others= ECHO, CXR, CT angiogram
What are the differentials for ACS?
Aortic dissection Coronary spasm Pericarditis/myocarditis MSK (costochondritis) PE PT x GORD PUD
What is the acute management of NSTEMI/UA?
Morphine + metaclopramide
Oxygen (if sats less than 94%)
Nitrates (GTN)
Antiplatelets (300mg chewable aspirin + ticagrelor/clopidogrel)
Anticoagulant (fondaparinux, 2.5mg for 72 hrs)
Grace score (mortality) , DAPT score (assess bleeding risk), angiographic assessment, revascularisation options (PCI, CABG)
What is the acute management of STEMI?
Morphine and metaclopramide
Oxygen
Nitrates
Antiplatelets (300mg aspirin + ticagrelor+clopidogrel)
Anticoagulant (fondaparinux 2.5mg for 72 hours)
PCI if <120 mins, target 150mins call- balloon time
Second line = thrombolysis if >120 mins
How do you treat ACS in the lifelong?
Lifelong aspirin- 75mg OD
Continue a 2nd anti platelet for 1 year- ticagrelor/clopidogrel
ACE-I
Beta blocker (lifelong) bisoprolol 2.5mg OD
Lifelong atorvastatin 80mg OD
Treat underlying problema- HF/HT
What are the complications of ACS?
Darth Vader Death Arrythmia Rupture Tamponade Heart failure Valve problem Aneurysm of ventricle Dressler syndrome Emboli Recurrence
What is becks triad?
It signifies tamponade, low BP, increased jVP, quiet heart sounds
What are the sx of dresslers syndrome?
Fever
Chest pain
Pericardial effusion
Exertional dyspnoea
