Cardiology Flashcards
(212 cards)
Define coronary artery disease
Narrowing/blockage of the coronary arteries caused by atheroscleoris leading to angina
What are the modifiable and non-modifiable risk factors for CAD?
Modifiable - smoking, alcohol excess, obesity, inactivity, hyperlipidaemia, hypertension, OCP
Non-modifiable - male sex, increasing age, family history, genetics
What features of a history would make you suspect CAD?
Central pain/tightness in the chest which may radiate to the jaw/arm and is brought on by exertion (exercise, emotional stress)
PMH/FH of heart disease
What features on examination would make you suspect CAD?
Examination may be normal
Xanthelasma/corneal arcus - hyperlipidaemia
High BP - hypertension
Ejection systolic murmur/slow-rising pulse - aortic stenosis
What investigations would you do if you suspected CAD?
Bloods - FBC, TFTs, glucose, HbA1c, lipids, U&Es, troponin
ECG
Imaging - CXR, echo
How is CAD managed?
First line - lifestyle modifications, GTN, beta blocker, verapamil
Second line - beta blocker and dihydropyridine, isosorbide mononitrate
What further interventions are available for CAD and when would they be used?
PCI revascularisation - single vessel disease or multi-vessel disease <65 years with suitable anatomy
CABG - multi-vessel disease >65 years or diabetic
Pain management if patient is not suitable for either
What are the complications of PCI?
Bleeding MI Dissection Haematoma Stroke Death
What are the differential diagnoses to consider for CAD?
MI Aortic dissection PE GORD Angina
What are the complications of CAD?
MI
AV block
Arrhythmia
Sudden cardiac death
What is the prognosis of CAD?
Cardiovascular risk can be lowered with lifestyle modifications and treatment
How can CAD be prevented?
QRISK score in primary care can identify risk early
Healthy lifestyle
Secondary prevention drugs - ACEi, statin, BB, DAPT
Define myocardial infarction
Acute coronary syndrome in which cardiac myocytes die because of myocardial ischaemia, most commonly caused by atherosclerotic embolus
What are the modifiable and non-modifiable risk factors for MI?
Modifiable - smoking, alcohol excess, obesity, inactivity, hyperlipidaemia, hypertension, OCP
Non-modifiable - male sex, increasing age, family history, genetics
What features of a history would make you suspect MI?
Severe, crushing, central chest pain radiating to the jaw/arm which does not settle with GTN
How might an MI present differently in an elderly or diabetic patient?
Fatigue
Syncope
Dyspnoea
What features on examination would make you suspect MI?
Pale
Sweaty/clammy
Hypotensive
What investigations would you do if you suspected MI?
Bloods - FBC, troponin, glucose, U&Es
ECG - ST depression and T wave inversion or persistent ST elevation
Cardiac monitoring - arrhythmia
When should a troponin be repeated in a patient with suspected MI?
4-6 hours after initial sample
12 hours after pain settles
What is the immediate management for a MI?
Oxygen GTN Morphine Metoclopramide Aspirin Clopidogrel/ticagrelor
What are the 2 main treatments for MI and when would they be carried out?
PCI - presenting within 12 hours of symptom onset, able to transfer within 120 minutes of attending
Thrombolysis - transfer time >120 minutes
What is the process for a patient undergoing thrombolysis?
Tenecteplase given and transferred for rescue PCI (if unsuccessful) or angiography (if successful)
What are the contra-indications of thrombolysis?
Previous intracranial haemorrhage Ischaemic stroke in past 6 months Major trauma/surgery in past 3 weeks Puncture GI bleeding Cerebral malignancy AVM Dissection
What additional drug should be given to patients undergoing PCI for myocardial infarction?
Heparin/enoxaparin