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Jonah's Med Notes > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Name 5 risk factors for CVD?

A
  1. Previous CAD (incl. angina, MI)
  2. High Cholesterol
  3. Diabetes
  4. HTN
  5. Smoking + alcohol
  6. Kidney disease
  7. Fam hx
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2
Q

What is cachexia?

A

Weakness and wasting of the body due to severe chronic illness.

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3
Q

Name three peripheral signs of Infective Endocarditis

A

Splinter haemorrhages in the nails

Osler’s nodes (red, raised, tender papules on fingers)

Janeway’s lesions (non-tender, maculo-papular lesions on palms)

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4
Q

What are these?

A

Roth’s spots seen on fundoscopy.

Retinal hemorrhages associated with Infective Endocarditis and others.

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5
Q

What is normal P wave duration and what does longer mean?

A

Normal = <2.5 sq

(longer → LA enlargement)

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6
Q

What is normal P wave amplitute and what does higher mean?

A

Normal = <2.5sq/0.25mV

(larger → RA enlargement)

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7
Q

What is the duration of the PR (start P wave to start of QRS) interval?

What does shorter/ longer mean?

A

3-5sq

(Shorter → abnormal tract of bypassing tissue,

Longer → AV block with disease)

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8
Q

What is the Cardiac Clock and how does it impact on axis?

A

Normal: between -30 and +90 degrees

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9
Q

What is normal QRS duration?

A

Normal QRS: <2.5 sq

Bundle branch blocks (give M shaped complexes); ventricular ectopic focus; anomalous atrio-ventricular pathway; non-specific intraventricular conduction defect.

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10
Q

How is LV hypertrophey calculated?

A

S-wave in lead V1 + R-wave in either lead V5 or V6 > 35 mm

Sokolaw-Lyon criteria

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11
Q

How can you tell RV hypertrophy?

A

Lead V1: positive deflection > negative deflection (in the presence of a normal QRS duration)

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12
Q

What leads on ECG reflect ischemia in the distribution of the RCA?

A

II, III, aVF

The inferior leads.

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13
Q

What chest leads reflect ischemia in the distribution of LAD?

A

V1-V4

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14
Q

What Lateral leads reflect ischemia in the distribution of the circumflex artery?

A

aVL, I, V5, V6

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15
Q

What test is used to:

  • Confirm dx of angina. Evaluate angina.
  • Assess prognosis following MI
  • Assess coronary revascularisation
  • Exercise induced arrhythmias?
A

Stress ECG

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16
Q

Where is BNP (B-type Natriuretic peptide) secreted from?

A

Secreted by LV w/ LV systolic dysfunction (stretch, fibrosis, etc)

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17
Q

Name 5 systems that can cause chest pain and ddxs:

A
  • Anxiety/emotion
  • Cardiac:
    • Acute coronary syndrome (angina, NSTEMI, STEMI)
    • Pericarditis
    • Mitral valve prolapse
  • Aortic dissection, aortic aneurysm
  • GI
    • Oesophagitis, oesophageal spasm, Mallory-Weiss tear
  • Lungs/pleura:
    • Bronchospasm, Pulm infarct, pneumonia, tracheitis, pneumothorax
    • PE, malignancy, TB, connective tissue disease
  • MSK:
    • Osteoarthritis, rib fracture, costochondritis, intercostal muscle injury
  • Neuro:
    • Prolapsed intervertebral disc, Herpes Zoster, thoracic outlet syndrome
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18
Q

How do you initially manage (Ix, Mx, Path) chest pain?

A

Chest pain or Sx of Myocardial Ischemia -> ECG + Vitals.

Basic Mx = O2, Aspirin, IV access, Pain relief, CXR

Pathology -> cardiac biomarkers, FBC, BGL, lipids, TSH

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19
Q

What are indications for reperfusion?

A

Chest pain >30min, <12hrs.

Persistent ST elevation or new LBBB

Myocardial infarct likely from hx

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20
Q

Name 5 systems that can cause dyspnoea and their ddxs?

A
  • Acute
    • Asthma, pneumonia, pulmonary oedema, pneumothorax, pulmonary embolus, metabolic acidosis, ARDS (acute respiratory distress syndrome), panic attack.
  • Pulmonary
    • Airflow obstruction (asthma, COPD, upper airway obstruction), restrictive lung disease (interstitial lung disease, pleural effusion, resp. muscle weakness), pneumonia, pneumothorax, PE, aspiration, ARDS
  • Cardiac
    • Myocardial ischaemia, congestive heart failure, valvular obstruction, arrhythmias, cardiac tamponade
  • Metabolic
    • Acidosis, hypercapnia, sepsis
  • Haeme
    • Anaemia
  • Psych
    • Anxiety/panic attack
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21
Q

What Ix do you want for dyspnea?

A

CXR -> pneumonia, new onset HF, pneumothorax, etc.

CT -> PE, interstitial + alveolar lung disease

Modified Well’s criteria for PE

ABG, pulse oximetry, serum BNP in HF.

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22
Q

What are the cardiac causes of dyspnoea? (4)

A

Acute Left heart failure (MI, mitral regurg, AF)

Chronic Heart Failure

Arrhythmia

Angina

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23
Q

What is cardiogenic shock?

A

Impairment of tissue perfusion via acute circulatory failure, 2nd to a cardiac cause.

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24
Q

How does a massive PE cause Cardiogenic shock?

A

RV outflow obstruction -> no LV preload -> circ collapse

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25
What is syncope?
Sudden loss of consciousness, 2nd to decreased cerebral perfusion
26
What are 3 main cardiac causes of syncope?
* **Cardiac syncope** * Mechanical cardiac dysfunction, arrhythmia * **Neurocardiogenic syncope** * Abnormal autonomics (~vasovagal) * **Postural hypotension** * Vasoconstriction on standing impaired -\> low BP
27
What Ix would you like for syncope?
* Hx + collateral hx + exams (~Cardio + Neuro) * ECG * Cardiac -\> Holter monitor, echo, Electrophysiology study * Neuro -\> EEG, carotid Doppler, CT/MRI * Vasovagal -\> Tilt table test
28
Why does Postural Hypotension occur? (3)
* Relative hypovolaemia (dehydration, often 2nd to diuretics) * Autonomic (symp) degeneration -\> DM, Parkinson’s, aging * Drug therapy -\> anti-HTNs
29
What are the acute coronary syndromes?
Stable and unstable angina, NSTEMI, STEMI
30
Name 7 risk factors for Atherosclerosis:
*Remember endothelial activation is the initial cause - e.g. insult* * Age + Sex * Fam hx of prem disease * Smoking * HTN * Hypercholesterolaemia * DM * Haemostatic factors * Physical activity * Obesity * Alcohol
31
32
What is stable angina?
Ischemia 2nd to fixed atheromatous stenosis of coronary arteries Relieved with rest
33
What is unstable angina?
Ischemia via dynamic obstruction of a coronary artery due to plaque rupture or erosion w/ thrombosis Not relieved with rest.
34
What is the pathophy of MI?
**Almost all from atherosclerosis.** Pathophys based on **supply + demand balance.** Aetiology: CAD: atherosclerotic plaque rupture -\> thrombus/embolus formation -\> occlusion of vessels. Other: Trauma, vasculitis, coronary vessel spasm, coronary artery dissection, coronary embolus.
35
When do symtoms of MI occur?
Smaller epicardial vessels compensate well for large artery narrowing -\> **large arteries must be \>70% occluded** for Sx.
36
What is the socrates of MI?
Site - central chest, poorly localised Onset - gradual but acute Character - discomfort, tightness, crushing. Radiation - upper abdo, shoulders, arms, jaw, back Associated Sx - diaphoresis, N+V, clamminess, SOB Temporal Exacerbated w/ exercise. GTN + rest makes it better.
37
What might you expect to see on examination post MI?
Raised JVP, pulm crackles, tachycardia, S3 gallop, HR.
38
Where are reciprocal changes for MI seen?
Inferior \<-\> lateral None for anteroseptal. Posterior infarct -\> reciprocal ST depression in V1-4
39
What is immediate care for MI?
M - morphine -\> lower adrenergic stress + pain relief O - oxygen -\> relieve pulm oedema (where SaO2 \< 95%) A - aspirin -\> early N - nitroglycerin -\> sublingual or IV
40
What is the preferred intervention for MI?
PCI (percutaneous coronary intervention)
41
When is fibrinolytic therapy used?
PCI unavailable. Dx made \<120mins ago. Contra to PCI.
42
What is secondary prevention for MI?
* **Dual antiplatelets** - aspirin + clopidogrel 12mo * **B-blockers** - atenolol. Contra w/ brady, decompensated HF. * **ACEi** - captopril, Ramipril. All Pts. * Aldosterone antagonists - Spironolactone. In those w/ significant HF. * **Statins** in all pts. * Cardiac rehab
43
What is Dressler’s syndrome?
Pericarditis occurring 2–10 weeks post-MI without an infective cause Aspirin, acetaminophen
44
What is the general approach to stable angina management?
Decrease myocardial O2 demand, increase O2 delivery. Control RF - Control HTN, DM, CKD, smoking, dyslipidaemia, obesity.
45
How does AF lead to CVA?
Decreased atrial contraction -\> stasis -\> thrombus -\> stroke + systemic embolism.
46
How is Atrial Fibrillation Stroke Risk calculated?
CHA₂DS₂-VASc Score
47
How is a CHA₂DS₂-VASc calculated?
* Congestive Heart Failure 1 point * HTN hx 1 point * Age \> 75yrs 2 points * DM 1 point * Stroke of TIA hx 2 points * Vascular disease 1 point * Age 65-74 yrs 1 point * Sex Category female 1 point
48
What are the implications of a CHA₂DS₂-VASc Score?
0 points total = no prophylaxis 1 point = consider oral anti-coag or aspirin 2 points = oral anti-coag
49
How is SVT managed?
Carotid sinus massage or Valsalva. IV adenosine. ~verapamil. Recurrent -\> catheter ablation OR B-blocker prophylaxis.
50
How is Torsades de Pointes managed?
Correct underlying cause. Give IV Mg Atrial pacing
51
How do B-Blockers work?
Reduce SA node depol + relative block of AV node. Useful for rate control.
52
Why does Renal Failure occur in Advanced Cardiac Failure?
Via poor renal perfusion. Exacerbated by ACEi.
53
Why can Hypokalaemia occur in Advanced Cardiac Failure?
Diuretics + hyperaldosteronism (RAAS activation)
54
Why can Hyperkalaemia occur in Advanced Cardiac Failure?
Potassium sparing diuretics (spironolactone) + renal dysfunction.
55
Why can Hyponatremia occur in Advanced Cardiac Failure?
Diuretics
56
How can Impaired Liver Function result in Advanced Cardiac Failure?
Hepatic venous congestion, poor arterial perfusion -\> mild jaundice, abnormal LFTs, coagulation changes.
57
Why does Thromboembolism occur in Advanced Cardiac Failure?
Stasis (low CO + forced immobility), emboli from AF.
58
What signs are found on X-ray of Heart Failure?
A -Alveolar oedema B - Kerley B lines (interstitial oedema) C -Cardiomegaly D- Dilated prominent upper lobe vessels E - Pleural Effusion
59
How is Bacterial Endocarditis investigated?
* Blood culture * Echo -\> vegetations + inflame changes * Non-specific: * FBC -\> normocytic + normochromic anaemia, leucocytosis. * CRP, ESR * Urinalysis -\> protein + haematuria * ECG + CXR ~\> normal
60
What is the criteria used for Bacterial Endocarditis?
Modified Duke’s Criteria
61
What are the two Major Criteria for Bacterial Endocarditis in Duke's Criteria?
1. +ve Blood culture 2. Echo changes -\> vegetations, new valvular regurg.
62
Name 3 minor criteria of Duke's Criteria?
* Predisposing valvular/cardiac anomaly * IV drug use * Fever \>38 * Embolic phenomenon -\> petechiae, peripheral, splinter haemorrhages, CVA * Vasculitic phenomenon -\> janeway/oslers, clubbing, Roth’s spots * Inconclusive blood cultures * Suggestive echo
63
Name 5 causes of Secondary Hypertension
Renal - glomerulonephritis, reflux nephropathy, renal artery stenosis, diabetes. Endocrine - Conn’s syndrome, Cushing’s, phaeochromocytoma, etc. Other - Drugs, pregnancy, etc
64
What 3 drugs cause the triple whammy?
ACEi + diuretic + NSAID
65
What are the 3 adverse effects of ACEis?
Cough (bradykinin build up) Postural hypotension Decreased GFR
66
How do Dihydropyridine CCBs work?
Predominantly vasodilators
67
How do non-hydropyridine CCB’s work?
Negative cardiac inotropic/chronotropic effects + moderate vasodilation
68
What causes an S3 Murmur?
Early diastolic murmur. Ken-tucky Passive left ventricle filling when blood stikes a compliant left ventricle.
69
70
Quinke's sign (nailbed pulsation) is a clinical sign of:
Aortic Regurgitation
71
72
How is the cardiac membrane stabilised is Hyperkalaemia?
Intravenous calcium gluconate
73
What is Dresslers Syndrome?
It is a condition characterised by an autoimmune response mounted by the body after injury to myocardium or pericardium, in the case of this gentleman - a myocardial infarction. The condition comprises of fever, pericarditis, pleuritic pain +/- pericardial effusion.
74

Jonah's Med Notes (8 decks)

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