Flashcards in Cardiology Deck (171)
What is angina?
Chest pain on exertion caused by myocardial ischaemia from coronary heart disease, usually atherothrombosis
What is the difference between stable and unstable angina?
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
List aetiology/risk factors for angina
Smoking, excess alcohol
Poor diet, obesity
List clinical features of angina
Central chest tightness on exertion
Pain may radiate to jaw/arm
What investigations would you order for angina?
ECG may be normal
Exercise ECG, 24h ECG
CT catheter angiography
Outline medical treatment for angina
GTN spray when required
Secondary prevention (aspirin, statin, ACEi)
B-blockers unless contraindicated
Ivabradine/nicorandil if others not tolerated
Outline surgical treatment for angina
Coronary revascularisation (PCI, CABG) using balloon stent or graft bypass from internal mammary artery and greater saphenous vein
What are the acute coronary syndromes (ACS)?
What is the pathophysiology of ACS?
Atherothrombotic plaque rupture leads to thrombosis and complete occlusion of coronary artery, causing ischaemia and potential necrosis
List risk factors/aetiology for ACS
Smoking, excess alcohol
List clinical features of ACS
New onset severe crushing chest pain, radiating to arm and/or jaw
Not relieve by rest or GTN
SENSE OF IMPENDING DOOM
What investigations would you do for ACS?
Bloods: cardiac enzymes (CK, troponin), electrolytes, glucose, lipids
What is the criteria for STEMI on ECG?
ST elevation of 1mm or more in 2 adjacent limb leads
ST elevation of 2mm or more in 2 contiguous chest leads
List ischaemic changes on ECG
T wave inversion
Tall T waves
When do levels of troponin and CK peak in ACS?
Troponin: 3-12 h
CK: 24 h
Outline medical treatment for acute MI
Aspirin 300 mg
O2 if hypoxic
Outline definitive treatment for acute NSTEMI
Angiography if high risk
Outline definitive treatment for acute STEMI
PCI within 120 mins
Otherwise thrombolysis with streptokinase + aspirin, then reassess after 90 mins for need for PCI
What are the different stages of hypertension? (stage 1, stage 2 etc.)
Stage 1: 140-159/90-99
Stage 2: 160-179/100-109
Stage 3: 180/110 or higher
List risk factors/aetiology for hypertension
Renal disease (GN, polyarteritis, renal artery stenosis)
Endocrine disease (Cushing's, Conn's, phaeochromocytoma)
High salt intake
Essential hypertension (idiopathic)
List clinical features of hypertension
Advanced disease: blurred vision, palpable kidney, RF delay
What investigations would you do for hypertension?
Bloods: electrolytes, endocrine markers
Home/ambulatory BP monitoring
How is hypertensive retinopathy graded?
I: tortuous arteries, narrowing/sclerosis
II: AV nipping, marked sclerosis
III: haemorrhages, cotton wool spots, hard exudates
IV: III + papilloedema
Outline medical management of hypertension
If under 55yo, start with ACEi
If over 55yo or black, start with Ca ch blocker
If uncontrolled on these,
ACEi + Ca ch blocker
add thiazide diuretic
add alpha/beta blocker
What is the BP target for diabetic patients with hypertension?
Less than 130/80
What is an arrhythmia?
Disturbance in the cardiac rhythm generated by abnormal conduction
List risk factors/aetiology for arrhythmias
Congenital heart disease
High caffeine intake
Drugs (amiodarone, B agonists, digoxin, levodopa, illicit drugs)
List clinical features of arrhythmias
What investigations would you order for arrhythmias?
ECG, 24 h ECG, event recording
FBC, U+E, glucose, Ca, Mg, thyroid function