Cardiology Flashcards

Question

When do the different cardiac enzymes rise after an ACS?

Answer 1

Trop - rises within 3-12hrs with a peak at 24-48hrs, falls back to baseline over 5-14 days CK -MB (cardiac specific) - rises withing 3-12hrs, peaks at 24hrs and falls again after 48-72hrs Myoglobin - rises within 1-4 hrs of the pain very sensitive but not specific LDH rises at day 2 and peals at day 3

Answer 2

Cardiac arrest Cardiogenic shock Unstable angina Bradycardia/ heart block: 1st degree most commonly after inf MI complete AV block usually resolved after a few days Tachyarrhthmias: keep K an Oxygen levels within normal range Heart failure Pericarditis DVT/ PE Systemic embolism: from LV mural thrombus Cardiac tamponade Mitral regurgation: 1. severe LV dysfunction causing annular dilation of valve 2.MI in inf wall leading to papillary muscle dysfunction 3. MI in papillary muscles Ventricular septal defect: Pansystolic murmur, high JVP, cardiac failure caused by rupture of the myocardium due to remodeling of the tissue. Left ventricular aneurysms Dressler's syndrome recurrent pericarditis, pleural effusions, fever and anaemia

Answer 3

``` Heart failure/ ischemia Hypertension MI PE Mitral valve disease pneumonia Hyperthyroidism Caffeine, alcohol Post op Low potassium, low magnesium ``` ``` RARE: cardiomyopathy constrictive pericarditis sick sinus syndrome lung ca atrial myxoma endocarditis haemochromatosis sarcoid ``` LONE AF = no cause found

Answer 4

Electrical cardioversion = using defib Drug cardioversion = amioderone IVI 5mg/kg over 1hr via central line or flecanide if there is no structural cardiac disease, or WPW (it is a strong negative inoptrope) Do not cardiovert until fully anticoagulated if the AF has been going on for >48hrs

Answer 5

RATE CONTROL: usually used first line in patients with AF unless the AF had a reversible cause, a patients heart failure is thought to be primarily caused by their AF, it is new onset AF, the AF is thought to be suitable for ablation B blocker is first line or a rate limiting Ca blocker, can add digoxin or diltiazem if doesn't respond. Aim is to get HR <100 so they can carry out physical activity. RHYTHM CONTROL: If cardioversion is chosen should anticoagulate and use amioderone for 4 week beforehand, and continue up to 12 weeks.

Answer 6

``` CHA2DS2 Vasc score Congestive heart failure = 1 Hypertension = 1 Age 65-74 = 1 >75yrs = 2 Diabetes = 1 Prior TIA/ stroke = 2 Vascular disease history ``` Need to anticoagulate is score >2 (taking into account bleeding risk HAS BLED score

Answer 7

Senile calcification Congenital bicuspid valve Rheumatic heart disease

Answer 8

Triad of: angina, syncope and heart failure Slow rising pulse, narrow pulse pressure, ejection systolic murmur radiating to the carotids, quiet second heart sound (as the aortic valve cannot close) ECG - LVH, can have left anterior hemiblock or LBBB

Answer 9

Aortic sclerosis is just degeneration of the valve. There is a murmur but no carotid radiation and the pulse is normal character and volume, with a normal second heart sound.

Answer 10

Acute- Infective endocarditis, ascending aortic dissection, chest trauma Chronic - connective tissue disorders, rheumatic fever, Takayasu arteritis, RA, SLE, seronegative arthritides, hypertension, osteogenesis imperfecta, syphilis

Answer 11

Exertional dyspnoea, orthopnoea, PND. Collapsing, water hammer pulse, early diastolic murmur, best heard in expiration with patient sat forward Corrigan's sign - carotid pulsation de Musset's sign - head nodding with each heart beat Quicke's sign - capillary pulsation in nail bed Duroziez's sign - in the groin, a finger compressing the femoral artery 2cm proximal to the stethoscope gives a systolic murmur, and 2cm distal to the stethoscope gives a diastolic murmur. Traube's sign - pistol shot sound over femoral arteries Austin flint murmur - mid diastolic murmur, denotes severe AR

Answer 12

``` Sinus Brady: -ve chronotropes - B blockers, calcium channel blockers, digoxin, amiodarone, clonidine, Hypoxia, Hypothermia, Hypothyroidism Cushing's reflex MI - right sided Sick sinus syndrome ``` ``` Sinoatrial block - no pwaves on ECG Ischemia Hyperkalaemia Excessive vagal tone -ve chronotopes ``` Sick sinus syndrome: Fibrosis of the sinus node Hyperkalaemia, hypoxia, hypothermia, hypothyroidism, hyperthyroidism, drugs and toxins AV block - rule out MI, lymes disease, myocarditis/ endocarditis, SLE

Answer 13

A drop of >15mmHg when standing for 3 mins

Answer 14

Autonomic neuropathy (diabetes) Antihypertensive medications Over diuresis Multisystem atrophy - a parkinsons plus syndrome

Answer 15

Patients with normal valves get acute infective endocarditis - present with acute heart failure and emboli. S aureus the most common pathogen. Patients with abnormal valves get sub acute infective endocarditis. Strep viridans most common pathogen

Answer 16

Septic signs: Fever, rigors, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing Cardiac lesions: Any new murmur or changing pre-existing murmur. Immune complex deposition: Vasculitis - microscopic haematuria is common Roth spots - boat shaped retinal haemorrhage with pale centre. Splinter haemorrhages Osler's nodes - painful pulp infarcts in fingers or toes Janeway lesions - painful palmar and plantar macules Embolic phenomena: emboli may cause abscessed in brain, heat, kidney, spleen or gut.

Answer 17

Duke criteria 2 major, or 1 major and 3 minor or 5 minor. Major: Positive blood cultures - in 2 separate cultures, or +ve in 3 >12hr apart Endocardium involved - +ve Echo, or new valvular regurg ``` Minor: Predisposition (cardiac lesion or IVDU) Fever >38 Vascular/ immunological signs +ve blood culture that doesn't meet major criteria Positive echo does doesn't meet major ```

Answer 18

They inhibit the enzyme HMG-COA reductase (responsible for de novo synthesis of cholesterol in the liver). The inhibition of it leads to increased LDL receptor expression by hepatocytes which leads to a decrease of circulating LDL.

Answer 19

Chol 7.5 - 16, with increased LDL and decreased HDL | Tri glycerides

Answer 20

Left heart failure symptoms = lung symptoms as the blood is backing up in the pulmonary system. Dyspnoea, poor exercise tolerance, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough Right heart failure symptoms = fluid in the rest of the body, as it is backing up there. Peripheral oedema, ascites, nausea, anorexia, raised JVP,

Answer 21

If a person has symptoms of heart failure and a high BNP then it is likely they have heart failure. Pts who have not had previous MI should have their BNP measured prior to referral to cardiology. BNP can be high in: left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia, GFR 70yrs and cirrhosis.

Answer 22

``` Cardiomegaly Dilated prominent upper lobe vessels Alveolar oedema (bats wings) Kerley B lines (interstitial oedema) Pleural effusion ```

Answer 23

All types of heart failure: Diuretics Calcium channel blockers - amlodipine if the patients have hypertension, must avoid verapamil, diltiazem etc. Aspirin - if patients have atherosclerotic disease Left sided heart failure: B blocker - deceases the mortality of patients Ace inhibitor - improves symptoms and increases life expectancy Spironalactone - only after specialised advice Digoxin - can be used for worsening heart failure

Answer 24

I - heart failure present but no undue dyspnoea from ordinary activity II - comfortable at rest, dyspnoea on ordinary activities III - less than ordinary activity causes dyspnoea, which is limiting IV - dyspnoea present at rest, activity causes discomfort.

Answer 25

When there is a decrease in renal blood flow (low BP) the kidney converts prorenin to RENIN RENIN converts angiotensinogen to angiotensin I Angiotensin I is converted to ANGIOTENSIN II by ACE. ANGIOTENSIN II does many things: Increases sympathetic activity - vasoconstriction Increases tubular reabsoprtion of Na and Cl, and excretion of K, leading to water retention Stimulates aldosterone secretion from the adrenal cortex Stimulates ADH secretion from the posteior lobe of the pituitary gland. ALDOSTERONE - Increases tubular reabsoprtion of Na and Cl, and excretion of K, leading to water retention ADH - increases water absorption in the collecting duct

Answer 26

Evidence of group A strep + 2 major or 1 major and 2 minor Major: Carditis - tachycardia + murmur Arthritis - migratory polyarthritis, affecting the larger joints. Subcutaneous nodules - small mobile painless nodules on extensor surfaces Erythema marginatum - geographical type rash with red raised edges and clear centre Sydenham's chorea ``` Minor: Fever Raised ESR or CRP Arthralgia Prolonged PR Previous rheumatic fever ```

Answer 27

Causes: Rheumatic fever and congenital Symptoms: Dyspnoea, fatigue, palpitations, chest pain. The left atrium pressure has to increase to maintain CO so the pulmonary pressure increases, and AF occurs Signs: Malar flush on cheeks, low volume pulse, AF, tapping non displaced apex beat. Loud S1, rumbling mid diastolic murmur, heard best on expiration with patient on the left side.

Answer 28

Causes: Functional - LV dilatation, annular calcification, rheumatic fever, infective endocarditis, MV prolapse, ruptured chordae tendinae, connective tissue disorders, Symptoms: Dyspnoea, fatigue, palpitations LV will enlarge as the stroke volume needs to increase to maintain forward CO Signs: AF, hyperdynamic apex beat, RV heave, soft S1, split S2, pansystolic murmur as apex, radiating to axilla

Cardiology Flashcards

(53 cards)