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Flashcards in Cardiology Deck (171)
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1

What is angina?

Chest pain on exertion caused by myocardial ischaemia from coronary heart disease, usually atherothrombosis

2

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

3

List aetiology/risk factors for angina

Atherosclerosis
Males
Smoking, excess alcohol
Poor diet, obesity
Arteritis
Low exercise
Hypertension
Diabetes

4

List clinical features of angina

Central chest tightness on exertion
Pain may radiate to jaw/arm
Dyspnoea
Nausea
Sweating
Syncope

5

What investigations would you order for angina?

ECG may be normal
Exercise ECG, 24h ECG
CT catheter angiography

6

Outline medical treatment for angina

GTN spray when required
Secondary prevention (aspirin, statin, ACEi)
B-blockers unless contraindicated
Ivabradine/nicorandil if others not tolerated

7

Outline surgical treatment for angina

Coronary revascularisation (PCI, CABG) using balloon stent or graft bypass from internal mammary artery and greater saphenous vein

8

What are the acute coronary syndromes (ACS)?

Unstable angina
NSTEMI
STEMI

9

What is the pathophysiology of ACS?

Atherothrombotic plaque rupture leads to thrombosis and complete occlusion of coronary artery, causing ischaemia and potential necrosis

10

List risk factors/aetiology for ACS

Males
Family history
Smoking, excess alcohol
Hypertension
Diabetes
High cholesterol
Obesity
Sedentary lifestyle

11

List clinical features of ACS

New onset severe crushing chest pain, radiating to arm and/or jaw
Nausea, vomiting
Not relieve by rest or GTN
Breathlessness
Syncope
Confusion
Pallor, sweating
Palpitations, tachycardia
SENSE OF IMPENDING DOOM

12

What investigations would you do for ACS?

Bloods: cardiac enzymes (CK, troponin), electrolytes, glucose, lipids
ECG
CXR

13

What is the criteria for STEMI on ECG?

ST elevation of 1mm or more in 2 adjacent limb leads
or
ST elevation of 2mm or more in 2 contiguous chest leads

14

List ischaemic changes on ECG

T wave inversion
Q waves
Tall T waves
ST depression
ST elevation

15

When do levels of troponin and CK peak in ACS?

Troponin: 3-12 h
CK: 24 h

16

Outline medical treatment for acute MI

Aspirin 300 mg
GTN sublingual
IV morphine
O2 if hypoxic

17

Outline definitive treatment for acute NSTEMI

B-blocker IV
LMW heparin
IV nitrate
Angiography if high risk

18

Outline definitive treatment for acute STEMI

PCI within 120 mins
Otherwise thrombolysis with streptokinase + aspirin, then reassess after 90 mins for need for PCI

19

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

20

List risk factors/aetiology for hypertension

Renal disease (GN, polyarteritis, renal artery stenosis)
Endocrine disease (Cushing's, Conn's, phaeochromocytoma)
Pregnancy
Drugs
Alcohol excess
High salt intake
Essential hypertension (idiopathic)

21

List clinical features of hypertension

Asymptomatic
Headache
Palpitations
Breathlessness
Advanced disease: blurred vision, palpable kidney, RF delay

22

What investigations would you do for hypertension?

ECG, echo
Bloods: electrolytes, endocrine markers
Funduscopy
Urinalysis
Home/ambulatory BP monitoring

23

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

24

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
then
add thiazide diuretic
then
add alpha/beta blocker

25

What is the BP target for diabetic patients with hypertension?

Less than 130/80

26

What is an arrhythmia?

Disturbance in the cardiac rhythm generated by abnormal conduction

27

List risk factors/aetiology for arrhythmias

Heart conditions
Congenital heart disease
Smoking, alcohol
High caffeine intake
Pneumonia
Thyrotoxicosis
Metabolic imbalance
Drugs (amiodarone, B agonists, digoxin, levodopa, illicit drugs)

28

List clinical features of arrhythmias

Palpitations
Abnormal pulse
Chest pain
Syncope
Dizziness
Dyspnoea
Altered consciousness

29

What investigations would you order for arrhythmias?

ECG, 24 h ECG, event recording
Electrophysiology
FBC, U+E, glucose, Ca, Mg, thyroid function
Echocardiogram

30

Which drug can be used to treat bradycardia?

Atropine