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Flashcards in Cardiology Deck (48)
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1

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

2

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

3

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

4

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)

5

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

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

7

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

8

Describe the acute management of ACS

Reassurance / A–E
O2 (if sats <94)
Morphine (5mg+) + Metoclopramide (10mg)
Aspirin 300mg
Nitrates (unless hypo)

9

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)

10

What Ix should be done in suspected pulm oedema

ABG
FBC / UEs / Glucose
CRP
D-dimer
CXR
ECG
ECHO

11

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

12

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

13

List direct + indirect causes of ARDS (4+6)

Direct:
Aspiration / inhalation / near-drown
Pneumonia

Indirect:
Sepsis
Anaphylaxis
Tranfusion reaction / ADR
Multiple trauma
Pancreatitis

14

List direct + indirect causes of ARDS (4+6)

Direct:
Aspiration / inhalation / near-drown
Pneumonia

Indirect:
Sepsis
Anaphylaxis
Tranfusion reaction / ADR
Multiple trauma
Pancreatitis

15

How is ARDS managed?

Treat as acute pulm oedema
But use CPAP as initial
± Aminophylline if bronchospasm

16

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

17

How is ARDS managed?

Treat as acute pulm oedema
But use CPAP as initial
± Aminophylline if bronchospasm

18

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

19

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

20

What Ix should be done if suspecting endocarditis

FBC
UEs
CRP/ESR
Blood cultures X3
Urinalysis
CXR
ECG regularly
Transthoracic ECHO

21

What Ix should be done if suspecting endocarditis

FBC
UEs
CRP/ESR
Blood cultures X3
Urinalysis
CXR
ECG regularly
Transthoracic ECHO

22

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

23

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

24

What Empirical Abx are given in acute management of endocarditis (3)

Fluclox
Ben-Pen
Genta

(Consult micro)

25

What Empirical Abx are given in acute management of endocarditis (3)

Fluclox
Ben-Pen
Genta
IV 4wks

(Consult micro)

26

What Empirical Abx are given in acute management of endocarditis (3)

Fluclox
Ben-Pen
Genta
IV 4wks

(Consult micro)

27

List some causes for 1st degree heart block

CAD
Electrolyte disurbances
Digoxin toxicity
Acute rhematic fever

28

List some causes for 1st degree heart block

CAD
Electrolyte disurbances
Digoxin toxicity
Acute rhematic fever

29

Outline the management of Bradycardias

A–E / Treat reversible causes

Assess for any adverse features:
• Syncope
• Shock
• Heart failure
• Myocardial ischaemia
If so; Atropine 500mcg IV / transcutaneous pacing

If none; Assess risk of systole (prev asystole / 2nd II / 3rd)
If no risk; transcutaneous pacing

30

Outline the management of Bradycardias

A–E / Treat reversible causes

Assess for any adverse features:
• Syncope
• Shock
• Heart failure
• Myocardial ischaemia
If so; Atropine 500mcg IV / transcutaneous pacing

If none; Assess risk of systole (prev asystole / 2nd II / 3rd)
If no risk; transcutaneous pacing