Cardiology Flashcards
(48 cards)
List the cardiac DDx for chest pain (3) + non-cardiac causes (6)
Cardiac:
ACS (UA/NSTEMI/STEMI)
Peri/myocarditis
Aortic dissection
Non-cardiac: Oesophageal Pneumothorax PE Costrochondritis (MSk) Trauma Mediastinitis
How are the 3 different types of ACS diagnosed?
UA = T inversion + no troponin rise
STEMI = troponin rise + ST elevation/new LBBB NSTEMI = troponin rise + new LBBB/no ST
What are the 3 diff presentations of ACS that may be seen O/E?
Symp:
Tachy / HTN / Pallor / Sweaty
Vagal:
Brady / Vomiting
Myocardial impairment:
Hypotension / Narrow PP / JVP rise / Basal creps / HS3
Which areas does the R coronary aa supply? An occlusion (MI) in this aa would cause changes in which leads?
RA / RV / Posterior Septum
AVN (80%) / SAN (60%)
II, III, aVF (posterior/inferior)
Which areas does the L circumflex aa supply? An occlusion (MI) in this aa would cause changes in which leads?
LA / LV
I, aVL, V5-6
Which areas does the LAD aa supply? An occlusion (MI) in this aa would cause changes in which leads?
LV / Anterior Septum
V1–4
What Ix must be done in ?ACS (5)
ECG (every 15mins whilst pain / continuous if ACS Dx) Cardiac troponin I (4-8hrs/peak 24hrs) Bloods: FBC / UEs / Glucose / Lipids CXR (megaly / oedema / wide mediastinum) Transthoracic ECHO - if in doubt / DDx
Describe the acute management of ACS
Reassurance / A–E O2 (if sats <94) Morphine (5mg+) + Metoclopramide (10mg) Aspirin 300mg Nitrates (unless hypo)
Outline the long term management after an MI
48hrs admit + continuous ECG + daily UEs/Trop Start ABC Aspirin 75mg od life Bisoprolol life Clopidogrel 75mg od 1yr
After 48hrs, RAN:
Ramipril (2.5mg bd)
Atorvastatin (80mg on)
± Nitrate oral (isosorbide - if angina)
What Ix should be done in suspected pulm oedema
ABG FBC / UEs / Glucose CRP D-dimer CXR ECG ECHO
Outline acute management of acute pulm oedema
Upright 15L O2 IV furosemide / IV diamorphine SBP >100 = GTN/IV nitrate SBP <100 = ICU/Ventilate (cardiogenic shock) Hx/Ex/Ix
Outline acute management of acute pulm oedema
Upright 15L O2 IV furosemide / IV diamorphine SBP >100 = GTN/IV nitrate SBP <100 = ICU/Ventilate (cardiogenic shock) Hx/Ex/Ix
List direct + indirect causes of ARDS (4+6)
Direct:
Aspiration / inhalation / near-drown
Pneumonia
Indirect: Sepsis Anaphylaxis Tranfusion reaction / ADR Multiple trauma Pancreatitis
List direct + indirect causes of ARDS (4+6)
Direct:
Aspiration / inhalation / near-drown
Pneumonia
Indirect: Sepsis Anaphylaxis Tranfusion reaction / ADR Multiple trauma Pancreatitis
How is ARDS managed?
Treat as acute pulm oedema
But use CPAP as initial
± Aminophylline if bronchospasm
List direct + indirect causes of ARDS (5+7)
Direct: Aspiration Smoke inhalation / near-drown Pneumonia Lung contusion
Indirect: Sepsis Anaphylaxis Tranfusion reaction / ADR Multiple trauma DIC Pancreatitis
How is ARDS managed?
Treat as acute pulm oedema
But use CPAP as initial
± Aminophylline if bronchospasm
List some signs O/E that may be seen in infective endocarditis (2+7)
Fever**
Changing/new murmur**
Microscopic haematuria (70%) Splenomegaly (40%) Osler's nodes Clubbing Roth spots (retina) Petechial rash Digital infarcts / splinter haemorrhages
List some signs O/E that may be seen in infective endocarditis (2+7)
Fever**
Changing/new murmur**
Microscopic haematuria (70%) Splenomegaly (40%) Osler's nodes Clubbing Roth spots (retina) Petechial rash Digital infarcts / splinter haemorrhages
What Ix should be done if suspecting endocarditis
FBC UEs CRP/ESR Blood cultures X3 Urinalysis CXR ECG regularly Transthoracic ECHO
What Ix should be done if suspecting endocarditis
FBC UEs CRP/ESR Blood cultures X3 Urinalysis CXR ECG regularly Transthoracic ECHO
List the Duke Major / Minor criteria for endocarditis
How is a Dx made from these criteria
Major:
+ve cultures
+ve ECHO
Minor: Fever >38 Clinical signs (imm/vasc) Predisposition Cultures/ECHO insufficient for Major
2 Major // 1 Major + 3 Minor
List the Duke Major / Minor criteria for endocarditis
How is a Dx made from these criteria
Major:
+ve cultures
+ve ECHO
Minor: Fever >38 Clinical signs (imm/vasc) Predisposition Cultures/ECHO insufficient for Major
2 Major // 1 Major + 3 Minor
What Empirical Abx are given in acute management of endocarditis (3)
Fluclox
Ben-Pen
Genta
(Consult micro)
