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Long Case > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Definition of unstable angina

A

Pain comes on at rest, negative troponins, no change on ecg

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2
Q

Definition of stable angina

A

Pain comes on by exercise/emotion, relieved by rest. negative troponins and no ecg changes

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3
Q

Things to ask about in chronic history

A 
OPTICPR
Onset
Presentation
Treatment
Investigations
Complications
Progression
Recovery
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4
Q

Associated symptoms of ischemic heart disease

A

Nausea, vomiting, dyspnoea,sweating, exercise tolerance, relieved by GTN

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5
Q

Background info with ischemic heart disease

A

Hospital admissions
Procedures-angioplasty, thrombolysis, stents (drug eluting/bare metal)
Medications started
Complications (arrhythmias/ heart failure/embolic events)
Participation in cardiac rehab program

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6
Q

Risk factors for ischemic heart disease

A 
Previous IHD
Hyperlipidemia
DM
Hypertension
Smoking
OCP
Family history
Obesity
Physical inactivity
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7
Q

Differentials for IHD

A

GORD
Oesophageal spasm
PE
MSK

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8
Q

Investigations for IHD

A 
ECG
Troponins (usually don't rise until 6 hours post so order a repeat. Remain elevated for 2 weeks)
Exercise tolerance test
ECHO
Angiogram
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9
Q

Immediate management of angina

A

Stable: GTN spray (caution with sildenafil) consider BBlockers
Unstable: Aspirin, GTN, consider BBlockers

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10
Q

Acute Management of STEMI

A

Morphine, GTN, O2 (if hypoxic), aspirin, ticagrelor, metoclopramide
Patients presenting within 12 hours consider for PCI
Otherwise thrombolysis with IV tenecteplase
Admit to CCU

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11
Q

Acute management of Non-stemi

A

Morphine, GTN, O2 (if hypoxic), aspirin, ticagrelor, metoclopramide
Admit to CCU

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12
Q

Secondary prevention of IHD

A

Pharmacological: consider BBlockers, Statins, ACE inhibitors, aspirin forever, ticagrelor for one year, nitrates

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13
Q

Indications for CABG?

A

Three vessel disease
Significant LAD stenosis
Significant left main coronary artery stenosis

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14
Q

Classic presentation of infective endocarditis

A

Fever, acute heart failure, new murmur

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15
Q

Risk factors for infective endocarditis

A

Recent dental, endoscopic, or operative procedure, valve disease, rheumatic fever, heart disease, IV drug use, immunosuppression

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16
Q

Most commonly affected valve in infective endocarditis

A

Mitral (mitral regurgitation) caused by strep viridans

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17
Q

How to diagnose infective endocarditis

A 
Duke's criteria
Major
1. Typical organism on 2x blood cultures
2.Evidence of endocardic involvement on echo
Minor
1. Predisposing cardiac condition/IV drug use
2. Fever >38
3. Vascular phenomena
4. Positive blood culture
5. Echo abnormality
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18
Q

Differentials for infective endocarditis

A

Rheumatic fever
Atrial myxoma (tumour)
SLE

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19
Q

Investigations for infective endocarditis

A

Bloods: Cultures for staph aureus and Step viridans
Check for inflammatory markers (FBC and ESR will be high)
Imaging: CXR (HF, cardiomegaly) ECHO
MSU (haematuria from emboli)

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20
Q

Management for infective endocarditis

A

IV antibiotics dependent on organism sensitivities
4 weeks but 6-8 weeks if prosthetic valves
Consider cardiac surgery
Consider antibiotic prophylaxis

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21
Q

What are the key formulae for the physiology of heart failure

A

Cardiac output= Stroke Volume x Heart Rate
Stroke Volume= diastolic volume-end systolic volume
Mean arterial pressure= diastolic pressure + 1/3pulse pressure

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22
Q

Difference in symptoms between left and right heart failure on history

A 
Left: dyspnoea and poor ETT
Orthopnea/PND
Wheeze
Nocturia
Cold peripheries
Pink frothy sputum
Right: peripheral oedema
ascites
nausea (biliary congestion)
facial engorgement
epistaxis
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23
Q

Cardiac precipitants of heart failure

Study These Flashcards
A 
Arrhythmia
MI
Valve injury
Hypertension
Cardiomyopathy/congenital
24
Q

Respiratory precipitants of heart failure

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A

Chronic lung disease/cor pulmonale

Pulmonary embolism

25
Non cardiac/resp precipitants of heart failure
``` Discontinuation of diuretic Drugs which cause salt and water retention Anemia Thyrotoxicosis Infection Anaesthesia ```
26
HF risk factors
``` Hypertension Hyperlipidemia DM Smoking Obesity Physical inactivity Coronary artery disease Family history ```
27
Dilated cardiomyopathy risk factors
Alcohol intake Family history Haemochromatosis
28
Difference in signs between right and left heart failure on exam
Left: cool peripheries, bibasal crackles, stony dullness, cyanosis Right: peripheral pitting oedema, raised JVP, ascites, hepatomegaly Both: murmur, AF, parasternal heave, displaced apex beat, S3, palmar crease/conjunctival pallor
29
Describe the Framingham Major criteria for congestive cardiac failure
``` PND Crepitations S3 gallop cardiomegaly elevated JVP weight loss >4.5kg in 5 days in response to treatment Neck vein distension Acute pulmonary oedema Hepatojugular reflex ```
30
Describe the Framingham Minor criteria for CCF
``` bilateral ankle oedema Dyspnoea on ordinary exertion tachycardia decrease in vital capacity by 1/3 nocturnal cough hepatomegaly pleural effusion ```
31
Differentials for heart failure
Nephrotic syndrome Liver disease Pneumonia COPD
32
Which bloods for investigating heart failure?
``` Hb -exclude anemia as precipitant Electrolytes and creatinine (hyperkalemia for arrhythmias and hyponatremia may mean long standing HF) BNP eGFR (renal cause or consequence) TFTs (thyrotoxicosis) ```
33
Signs of HF on chest xray?
``` A: alveolar oedema B: kurley b lines C: cardiomegaly D: distended superior pulmonary vessels E: effusion ```
34
Other investigations for HF
ECG(LVH/LBBB) Echo (infarct/dilation/estimate EF) Coronary angiography (exclude coronary artery disease) Endomyocardial biopsy if cause elusive
35
Management acute heart failure
``` Sit patient upright High flow O2 Morphine Furosemide GTN CONTRAINDICATED=BBLOCKERS ```
36
Management non-pharmacological chronic heart failure
Treat underlying cause( CABG/thyroid disease/valve replacement) Flu vaccine Control risk factors Low salt diet
37
Management pharmacological chronic heart failure
1. Furosemide 40mg OD 2. Cilazapril 1-2.5 mg/ Metoprolol 23.75mg 3. add other 4. Spironolactone 5. ARB/digoxin/anticoag 6. Entresto (neprolysin and ARB) Avoid calcium channel blockers (-ve inotropes) and NSAIDs (fluid retention)
38
Grades of hypertension
Grade 1: 140-159 Grade 2: 160-179 Grade 3: 180
39
Key things in hypertension history
When diagnosis was made readings before and after treatment how blood pressure is measured treatments (past/present/side effects) any complications (stroke/HF/renal failure) any potential secondary cause Check for symptoms of malignant hypertension (severe headache)
40
Key things to check in hypertension exam
Fundoscopy BP in both arms Check radiofemoral delay Signs of cushings
41
Investigations for hypertension
``` U/E/creatinine: check for renal issues ECG CXR Urine analysis HbA1c Lipids Aldosterone/renin ratio (Conns) 24 hour catecholamines (phaeo) 9am serum cortisol (cushings) Renal artery doppler (renal artery stenosis) Ambulatory BP ```
42
How do we diagnose hypertension?
BP of over 140/90 on three separate occasions, preferably ambulatory to prevent white coat HTN
43
Treatment ladder of HTN
Depends on cardiovascular risk profile if <10%: primarily lifestyle advice 10-20%: begin BP lowering med and statin 20%+: BP lowering, statin and anticoag
44
Pharmacological treatment HTN
1. if age <55 begin with ACEi if >55 begin with CCB 2. add other 3. thiazide 4. add bblocker or spironolactone Dont give ACEi to females of reproductive age Swap ACEi for ARB if cough
45
List the precipitants for AF
``` ATMISHAP Age Thyrotoxicosis Mitral valve disease Ischaemic heart disease Surgery/sleep apnoea/smoking Hypertension Alcohol/caffeine PE ```
46
Differential diagnosis for irregularly irregular beat
AF Ventricular ectopic Atrial flutter Complete heart block with variable ventricular escape
47
Investigations for arrhythmia
``` ECG-either resting or 24 halter monitor Electrophysiological studies (assess inducibility of arrhythmias) ETT (if IHD) Echo U+E, TFTs, serial trops ```
48
Management symptomatic bradycardia
Consider permanent pacemaker if complete heart block, second degree AV block or sinus node dysfunction
49
Management ventricular tachycardia
Consider implanted cardioverter-defibrillator if VF/VT with instability, contraindications to drug treatment or symptomatic long QT
50
Management of acute AF (<48 hrs)
DC cardioversion if unstable | Medical cardioversion with 5mg/kg amiodarone over an hour with subsequent infusion if necessary
51
Management of acute AF (>48 hrs)
Do not cardiovert unless have been shown to be free of a thrombus Rate control: With calcium channel blockers (diltiazem) or bbblockers (metoprolol). Digoxin as 3rd choice Thromboprophylaxis: LMWH then warfarin/dabigatran
52
Management of AF chronic
Begin with rate control: bblockers, ccb, digoxin 3rd line Consider rhythm control: 3 weeks anticoagulation before cardioversion (flecainide or amiodarone), AF ablation Anticoagulation based on CHADSVSc score >1 (male) or >2
53
CHA2DSVS
``` Congestive HF HTN Age Diabetes Stroke/TiA Vascular disease Sex F ```
54
How many seconds are little and big squares on an ECG?
Big: 0.2seconds Little: 0.04 seconds
55
What is the new york heart association classification for heart failure
1 No limitation of physical exertion 2 Angina/dyspnoea on moderate activity 3 Angina/dyspnoea on mild activity 4 Angina/dyspnoea at rest

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