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5th year CC ACT + Level 1 > CARDIOLOGY > Flashcards

CARDIOLOGY Flashcards

1
Q

**Cardiac Arrest

Treatment

Adrenaline dose

A
  • Most commonly occurs due to patients developing VF & is the most common cause of death following a MI. Patients are managed as per the ALS protocol with defibrillation

1) CPR 30:2 + 02, adrenaline every 3-5 mins
2) Assess Rhythm
- Shockable –> Shock (amidarone after 3 shocks)
1 in 10,000 adrenaline every 3-5 mins

  • Return of spontaneous circulation –> A-E
  • Non-Shockable (PEA/systole) Repeat CPR
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2
Q

**Myocardial Infarction
STEMI

Syx

ECG changes

IVX

Management

A

STEMI –> MMONACH
- CF: Chest pain radiating to arms, back or jaw – not relieved by GTN
Nausea + Vomiting +. Sweating, Acute Dyspnoea
Extreme distress

Atypical: epigastric or back pain (silent in elderly or diabetic)

ECG:
. ECG (confirms Dx)
- First sign = peaked T wave then…
- ST elevation ≥1 mm (limb leads) ≥ 2mm (chest leads) – onset mins, lasts 2wks
1. Left anterior descending (LAD) – supplies anterior, left ventricle (V1-4)
2. Circumflex artery – supplies lateral of heart (I, AVL, V5-6)
3. Right coronary artery – supplies inferior of heart (II, III, AVF) → high risk of heart block

Blood: Troponin peaks at 12 hrs, CK increased

Management:
a) Coronary angiography + primary PCI
⇒ If presentation within 12 hrs of Sx onset and
⇒ If PCI can be delivered within 2hrs of when fibrinolysis could be given

OR if PCI not available = Fibrinolysis: Alteplase (or reteplase, streptokinase)

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3
Q

**Acute Coronary Syndrome

SYX

Treatment

A
  • A set of symptoms resulting from acute myocardial ischaemia. There are two groups:
    Unstable angina and NSTEMI – not treated w/ thrombolysis
    STEMI – must undergo reperfusion therapy on presentation
Common symptoms:
Chest pain radiating to arms, back or jaw > 15 mins 
Acute dyspnoea 
Nausea, vomiting and sweating 
Haemodynamic instability

IMMEDIATE treatment for suspected ACS (MONA)
Morphine, Oxygen, GTN, Aspirin 300mg PO
ECG + blood markers (Trop T+I, CK)

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4
Q

**Acute Left Ventricular Failure

SYx

A

SYX: SOB (blood buildds into lungs)

Causes: infections, LV aneurysms & Left ventricular free wall rupture –>

Seen in 3% of MIs - occurs 1-2 weeks after. Present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, ↓BP, Ejection fraction, diminished heart sounds). Urgent pericardiocentesis and thoracotomy are required.

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5
Q

**Hypertension
stages

Ivx algorithm,

A

Stage 1: 140/90
Stage 2: 160/100
Stage 3: >180/110
Malignant: >200/120

RF: DM, obesity, salt, stress, conns, phaemochromocytoma

IVX: Ambulatory or home Bpm.
URGENT referral if BP >180/110 + pappiloedema, retinal haemorrage or suspected phaemochromocytoma
ECG

QRISK2

TX: Lifestype
Offer dx if level 1 and tried lifestyle

Under 55
1) A 2) A + C/D 3) A + C + D

Over 55 + afro carribean
1) C 2) C + A/D 3) C + A + D

4) = add a blocker or further diuretetic eg spironolactone

D = thiazide diuretic

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6
Q

**Chronic Cardiac Failure

A

Pump failure of L, R or Both sides of heart resulting in characteristic symptoms

Cause: Low output, increased pre-load or pump failure

SYSTOLIC: EF < 40%, ventricles cannot contract fully

DIASTOLIC: EF> 50% - ventricles cannt relax fully

LVF –> DYSPNOEA, orthopnoea, PND, nocturnal cough (pink frothy), weight loss, fatigue, basal creps, displaced apex. LEFT LOOP LUNG

RVF -> PERIPHERAL OEDEMA, calf swelling, ascites, N+Vm JVP, weight

CF: Poor exercise tolerance 
Confusion, Dizzy – cerebral Sx from ↓blood supply PMH – MI, AF, IHD, HTN, ascites 
Lungs - ↑RR, Cyanosis 
Heart - ↑HR, 3rd heart sound 
Limbs – Cachexia, muscle waste

IVX: ECG: axis deviation
BNP, CXR, bloods, urine dip

Treatment:
- Pneumococcal vaccine
- LOOP DIURETIC furosemide
- B BLOCKER = bisoprolol 
(+ thiazaide diuretic)
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7
Q

**Deep Vein Thrombosis

Score?

Management

A

Legs or Pelvis and can –> PE

RF: smoking, BMI > 30, cancer, VTE hx

CF: Limb pain and tenderness along line of DV
Swelling of calf or thigh, pitting oedema

IVX: WELLS SCORE
Score >2 = likely –> D dimer test and proximal leg vein USS

Management: LMWH / fondaparinux 5 days at least (discuss long term) or warfarin

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8
Q

**Acute Limb Ishcaemia

A
  • Due to embolus or thrombosis
Rapid onsent Syx
•	6Ps
o	Pale
o	Pulseless
o	Painful
o	Paralysed
o	Paraesthetic
o	Perishinglycold 
•	Onset of fixed mottling of skin implies irreversible changes

IVX: hand held doppler
bloods and ecg/echo/uss

Management: urgent admission, check for compartment syndrome, surgical emboletomy fogarty catheter, anticoag

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9
Q

**Superficial Thrombophlebitis

A
  • Superficial vein (often long saphenous of leg) becomes inflamed and forms a clot within = Virchow’s triad = damage to blood vessel wall, stasis of blood flow; HYPERCOAGULABILITY of blood

RF: Obesity, Thrombophilia, Smoking, COCP, Preg, IVDU or IV infusion

CF: Erythema, swelling, tenderness. Septic = hard lump and fever

IVX: clinical (venography could aggravate conditon)

Mx: Elastic support, exericse, analgesia and LMWH + surgery if recurrent

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10
Q

**Cannula Related Phlebitis

A
  • Septic phlebitis often with long term IV cannula or IVDU
  • Local irritation at site
  • Hard lump
  • Fever, tachycardia, nausea + vomiting, ↓BP
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11
Q

**Complete heart block

aka 3rd degree

A
  • Complete absence of AV conduction – none of the supraventricular impulses are conducted to the ventricles
  • • Perfusing rhythm maintained by a junctional or ventricular escape rhythm
    • Typically the patient will have severe bradycardia with independent atrial and ventricular rates ie AV disccociation

Cause: underlying ischaemic damage / drug induced

CF: dizziness, palpitations, sob, chest pain

IVx: ecg = complete dissociation of p waves from qrs

Acute: a-e, 02, Atropine
Chronic: pacemakers

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12
Q

**Postural Hypotension

drop 20 systolic

A
  • Common in elderly
    Cause: medications, hypovolaemia, autonomic neuropathy

CF: dizziness, blurred vision, syncope, palpitations

IVX: lying and standing BP

TX: review meds, lifestyle changes e.g stand slowly, stockings for legs, increase salt intake
mineralocoricodis e.g fludrocortisone !!!!

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13
Q

Stabile Angina

A
  • Induced by effort, relieved by rest
  • Radiate to arms, neck, jaw, teeth & N +V
    Cause: atheroma

IVX: ECG- ST Depression + inverted T waves
stress echo

Management: GTN (Se flushing and headache)

  • Ca channel blocker
  • Aspirin
  • Statins

CABG for revascularisation

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14
Q

Atrial Flutter

- (less common than AF)

A
  • Re-entrant rhythm in L or R atrium causing endless loop (by over-riding SA node) →atria contract at high rate in flutter like rhythm (>300bpm often)
CF: Palpitations + chest pain 
Regularly irregular heart beat
●	Can be regular, but always rapid 
●	Usually 150bpm (2:1 AV conduction) 
Dyspnoea, fatigue + dizzy 
Syncope 
HF – L or R

IVX: ECG - saw tooth, no p waves
CXR for HF and echo for structural

ACUTE Management: DC shock –> amiodarone, repeat shock –> amiodarone, vagal manouvres and adenosine to reduce tachy.

CHRONIC management: ablation, anticoagulate and amiodarone, atenolol for rate and pacemaker.

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15
Q

Atrial Fibrillation

A
  • Disorganised electrical impulses
    Causes: HF or IHD (common mid-early), MI (22%), HTN, PE, mitral valve disease, hyperthyroidism (thyrotoxicosis)
  • Alcohol or caffeine induced
  • Abnormal impulses typically originate at pulmonary veins

Types: Acute, Recurrent, Paroxysmal, persistent, permanent

CF: Dyspnoea Dizzy/syncope, Palpitations Fast, irregular pulse, Apex pulse is faster > radial pulse, Signs of LVF → Pulmonary oedema

Refer: HR > 150bpm ± ↓BP < 90
Severe symptoms: chest pain, syncope
PMHx of Stroke, MI, TIA

IVX: ECG (irregularly ireegular R-R and narrow QRS complexes, absent p waves)

Echo- atrial enlargement

Management:
Acute: Life threatening –> DC cardioversion or Chemical - Flecanide or Amiodarone if structureal abnormalities.

Acute: not threatening –> BB or digoxin if HF

Chronic: Rate control, Digoxin for sedentry patients or Diltiazem
+ rhythm control is still syx after rate controlled via amiodarone +felcanine + anticoagulant

  • LA ablatation if drugs failed + consider LA appendage occulusion

CHA2DSVaSc stroke risk

Rx: stroke, bleed, mesenteric ischameia

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16
Q

Heart Block - all degrees

A

–> FIRST degree: Slow AV node conduction
- PR interval >200ms PROLONGED INTERVAL
-All atrial impulses conducted to ventricles
- Benign
–> SECOND
Mobitz I: AV node conduction defect
Mobitz II: Conduction defect below AV node
- Degenerative: Lev’s disease = acquired complete heart block due to idiopathic fibrosis and calcification of the electrical conduction system
- Risk of progression to 3rd degree block

IVX: ECG + echo

Management: mobitz II atropine and pacing

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17
Q

Re-entrant supra- ventricular tachycardia

A
  • SVT is usually paroxysmal and episodes may occur regularly or infrequently. They may last minutes or several months
    Re-entrant tachycardias are due to abnormalities of impulse conduction

Cause: previous MI, mitral valve prolapse, congential heart disease, pericardiits

CF: Minimal symptoms or may present with syncope
Palpitations and light headedness which start and end abruptly
ECG –> pre excitation

Management: if haem unstable

1) valsalva and IV ADENOSINE
2) IV BETA BLOCKER
3) Synchronised Cardioversion

Example Wolf Parkinson White- delta wave (leading up)

18
Q

Ventricular Tachycardia

A

CF: Palpitations, dizzy, SoB Tachycardia, Pallor
Worrying signs – hypotension, HF, MI, syncope, pulseless, chest pain

ECG: regular rhythm, broad complex tachy, absent p waves

IVX: bloods, U+E and CXR for HF

Management:
- Pulseless VT or VF = defibrillation
- With pulse: synchronised cardioversion and amiodarone
A-E
Implant cardioverter defirbillation

Complication: Torsades de points (QTc elongation, broad tachy- give IV mg)

19
Q

Mitral regurgitation

A

Abnormal regurgitation of blood from left ventricle, into left atrium during systole
–> Primary
Degenerative – LV dilatation, annular calcification
Acute – papillary muscle rupture (MI), Inf endocarditis, trauma
Mitral valve prolapse (weakened chordae tendenae – mid systolic click, systolic murmur), ASD
Rheumatic fever (→leaflet fibrosis)
–> Secondary (functional)
LVF enlargement and remodelling (→abnormal valve function)
Cardiomyopathy, CAD

CF: SOBOE, cough, palpitations

Signs: displaced apex beat, RV heave, PANSYSTOLIC murmur at apex –> radiates to L axilla

Soft S1

IVX: Ecg broad P wave (left atrial enlargement)
CXR: enlarged left A +V

Management: control rate if fast AF + Anticoagulate. Repair or replace valve. Abx to prevent I endocarditis.

20
Q

Aortic regurgitation

A 
- •	Caused by either problems with the aortic valve or aortic root, incl:
o	Bicuspid aortic valve
o	Rheumatic fever
o	Infective endocarditis
o	Collagen vascular diseases
o	Degenerative aortic valve disease

CF: exertional dyspnoea, orthopnoea, paroxysmal nocturan dyspnoea, angina, collapsing pulse

IVX: ECG –> LVH, CXR

TX: anticoagulate

21
Q

Infective endocarditis

aortic now most affected above mitral

A
  • Intracardiac and systemic effects
    Sterile fibril platelet vegetation is prerequisite
    Acute IE - e.g invading organism or trauma
    Subacute: bacterial clumps

Cause: S. viridens, S aureus

CF: FEVER + NEW MURMER ie until proven otherwise

Immune complex deposition: vasculitis, roth spots (retinal haemorrhage), splinter haemorrhage, oslers nodes, janeway lesions, arthritis

IVX: bloods, blood CULTURES
2 sets at different times 1 hour before abx. Urine dip, ECG and Echo

DUKE CRITERIA
Major criteria:
o Positive blood culture:
- Typical organism in 2 separate cultures or
- Persistently +ve blood cultures eg 3, 12hrs apart
o A +ve serological tests for Q fever
o Endocardium involved:
- +ve echo (vegetations, abscess, new partial dehiscence of prosthetic valve)
- New valvular regurgitation (change in murmur not sufficient)

Minor criteria:
o Predisposition (cardiac lesions, IVDU)
o Fever >38°C
o Vascular/immunological signs
o +ve blood culture that do not meet major criteria
o +ve echo that does not meet major criteria

Diagnosis = 2 major + 1 minor; 1 major + 3 minor; all 5 minor

Management: 4-6 week course of iv ABX
maintain food oral health

22
Q

Pulmonary Embolism

Syx

Score+ what number >

A

Fat, thrombosis, amniotic fluid or air embolus in pulmonary artery tree

RF: surgery, immobility, varicose veins, malignancy

CF: dyspnoea, pleuritic chest pain, dizziness, syncope, hypotension, pyrexia, tachy, raised JVP, dvt

IVX: bloods, d-dimer, ABG, CXR, ECG, CTPA !!!

Wells Score
- if likely (4+) to CTPA

Management: Large PE = o2, morphine, thrombolysis, heparin, compression stockings

Prevention: lmwh, stockings

23
Q

Aneurysms

true = all 3 layers wall

A

Localised abnormal dilatation of an artery due to weakness in the arterial wall

Cause: syphillis, infective, atheroclorosis, vasculitits

  • Cerebral anurysms
24
Q

Varicose Veins

A
  • Long, torturous and dilated vein of superficial venous system. Due to incompetent valves – venous hypertension - dilatation

RF: pregnancy, FH, prolonged standing

CF: pain, cramps, oedema

IVX: auscultate for bruits, examine for ulcers, doppler US probes

Management: refer to specialist if pain or bleeding or thrombophlebitis, can have laser or endothelial ablation

Lose weight, walk, stockings

25
Q

Chronic lower limb ischaemia

when is the pain?

CF:

IVX

Management

A

Presence of ischaemic rest pain, and ischaemic lesions or gangrene objectively attributable to arterial occlusive disease

CF: Cramping - claudication distance relieved by rest, pain at rest (critical limb ischaemia), ulceration, absent pulses, 6 Ps

Ivx: exclude DM
CARDIO risk assessment
ABPI and duplex imaging

Management: stop smoking, exercise, antiplatelets, surgican reconstruction or amputation

26
Q

Abdominal aortic aneuysm

Syx

A

Abdominal aortica aneurysms (50% bigger diameter)

Syx pain radiates to back, collapse, shock

IVX: fbc, ecg, exr, US, CT

  • driving rules important

TX ruptured: VAsc surgeon and anaesthetist

Unruptured: monitor and elective if >5cm

27
Q

2- Pericarditis

A

Inflammation of pericardium

Cause: Vrial (coxshachievirus), bacterial, rheumatological e.g sarcoidosis,

SYX: Chest pain, radiates to neck, aggravated by lying flat
- non-productive cough
chills, weakness, tachypnoea, fever

IVX: ECG
stage 1: concave st-segment elevation and t waves. As progress to stage 3: t wave inversion

CXR and FBC

Management; tx underlying cause, NSAIDS for 2 weeks and if recurrent then Colchine too

28
Q

2- Pericardial effusions

Syx

Tx

A

Collection of fluid in the pericardial space- transudates or exudate.
Cause: infection, malignancy

SYX: chest pain, pericardial pain relieved by sitting, syncope, palpitation, SOB, cough
--> Triad of pericardial tamponade
o	Hypotension
o	Muffled heart sounds
o	Jugular venous distention

IVX: bloods, troponin, echo, CXR, ECG, MRI, pericardial fluid aspiration for analysis

TX: pericardiocentesis

29
Q

2- mesenteric ischamia

A
  • Impaired blood transfusion to the intestine, bacterial translocation and systemic inflammatory response
  • Caused by conditions causing arterial emboli

Syx: colicky poorly localised pain

IVX: abdo to rule out other causes
- angiograpphy gold standard

Management: resus with fluids and 02

  • Thrombolytics and surgical angioplasty
  • Bypass and resection of bowel if gangrene develop
30
Q

2- Superior Vena Cava Thrombosis

A
  • Malignant causes common and goitre, mediastrinal fibrosis, infection

SYX: dyspnoea, cough, chest pain at rest, dizziness, syncope

IVX: CXR, CT scan, doppler

TX: Corticosteroids dexamethasone 16mg with PPI cover

31
Q

2- Cardiomyopathy

A

Heart muscle is structurally and functionally abnormal

1) Dialated
2) Hypertrophic
3) Restrictive
4) arrythmogenic

IVX: bloods, CXR, ECG

TX: implantable cardioverter defibrillates and ? heart transplant

32
Q

CHADSVASC

A
  • CHF (1)
  • HTN controlled or uncontrolled (1)
  • Age: > 65 (1) ≥ 75 (2)
  • Diabetes mellitus (1)
  • Stroke, TIA or thromboembolism (2)
  • Vascular disease (1)
  • Sex: Male (0) Female (1)
  • Score ≥ 7 = 10% stroke risk (only add female gender as risk if there is at least another RF)

Give: NOAC, warfarin or aspirin

33
Q

HAS-BLED

A

Bleed risk when on anticoagulant

HTN > 160 (1),
Abn renal + liver func (1-2), Stroke (1),
Bleeding (1),
Labile INRS (1),
Elderly >65 (1),
Drugs (anti-coag/plat, NSAIDs) or alcohol (1-2)

–> Calculates risk of bleeding with A/C treatment

34
Q

Ventricular Fibrillation

A

MEDICAL EMERGENCY

RF: IHD, MI, hypoxia,

CF: chest pain, faigue, palpiations then sudden loss of responsiveness absent breathing and pulse

IVX: ECG- NO P, QRS OR T WAVE

Management
ALS
- adrenaline 1:10,000
- amiodarone  300mg IV
 - CPR
- shock if shockable
35
Q

** Myocardial infarction
NSTEMI

syx

treatment

A

3 distinctive features:

  • Resting angina
  • New-onset severe angina
  • Increasing angina – prev diagnosed angina, but more frequent, longer in duration, lower in threshold

ECG: T inversion, ST depression, Q waves
Bloods: raised trop and CK

TX: Coronary reperfusion therapy PCI if within 12 hrs, LBB or on going pain or
- CABG

MMONACH
Metoclopramide, morphine, 02, gtn, aspirin, clopdigrel, heparin

36
Q

Aftercare for STEMI OR NSTEMI

A 
ABC'S
Ace inhibitor
Beta Blocker
anti-Coagulant: aspirin and clopidogrel
Statin
37
Q

MI Complications:

what syndrome?

A 
Cardiac arrest, Cardiogenic shock, CHF
Tachyarrhythmias/ Bradyarrhtymias
Pericarditis in first 48 hrs
Mitrial regurg
VSD, LV aneurysm , LV free wall rupture

-> Dresslers sydnrome (2-6 weeks post MI; autoimmune= fever, pericarditis, pleuritic pain and pericardial effusion)

38
Q

Drugs side effects
Ace

ARB

CCB

Thiazide

K sparing

A

Ace: Postural hypotension, drug cough, dyspnoea, rash, increased K

ARB: Dizzy

CCB: Ankle oedema, headache, palpitaitions, nausea, dizzy

Thiazides: Hypokalaemia, headache, postural hypo

K sparing: = spironolactone Gynaecomastia, impotence, mesntrual irregulatirity

39
Q

Mitral Stenosis

A

– Obstruction of mitral valve –> left atrial hypertrophy —> pulmonary congestion (LVF) → RVF

Cause: Calcification, rheumatic fever (infective endocarditis)

Signs: Dyspnoea, PND, malar flush on cheeks due to increase C02, RV HEAVE, AF common,

CXR: Left atrial enlargement, mitral valve calcification

Acute AF: GTN, BB or rate limiting CCB, mitral valve replacement, warfarin
PO penicillin if recurrent rheumatic fever

40
Q

Aortic stenosis

Most frequent valvular heart disease

A

Tight valve - advanced from sclerosis

Cause: rheumatic heart disease, aging, congenital

CF: anginal, syncope, heart failure Triad
dizziness, LV heave, aortic thrill

IVX: ECG, CXR and see LVH, calcified aortic value,
Cardiac MRI

Management: early surgical intervetion and avoid exertion
TAVI - transcatheter aortic valve implantation

41
Q

Heart Failure Treatment

Acronym

A

ABAL - not abal with heart failure

ACE INHIBITOR
B BLOCKER
ALDOSTERONE AGONSIT- Spironolactone
LOOP DIURETIC - Furosemide

5th year CC ACT + Level 1 (20 decks)

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