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Disease summaries > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

3 classical features of stbale angina

A

Chest pain - radiation to left arm/jaw/neck
Brought on by exertion
Relieved by rest / GTN spray

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2
Q

Causes of angina

A

IHD
Coronary artery vasospasm
Decubitus

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3
Q

Stable angina sx

A

Dyspnoea
Nausea
Sweatiness
Faintness

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4
Q

Precipitating factors for angina

A

Emotion
cold weather
heavy meals

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5
Q

Stable angina Investigations

A

Bloods
ECG
- ST depression
- T wave inversion

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6
Q

Stable angina diagnostic investigations

A

CT coronary angiogram
Stress echocardiography
Cardiac MR

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7
Q

Stable angina management

- Lifestyle

A

Smoking cessation
Excercise
Dietary advice
Weight loss

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8
Q

Stable angina management

- Pharmacological

A

RF modification

  • Asprin
  • Statin

Symptomatic releif
- GTN spray

Antianginal medications

  • Bisoprolol or Amlodopine
  • Switch
  • combine
  • 3rd drug - Isosorbide dinitrate
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9
Q

Stable angina management

- surgical

A

PCI

  • DAPT
  • Risk of thrombosis and restenosis

CABG

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10
Q

What is unstable angina

A

Sudden new onset angina
Significant deterioration in angina
Pain with increasing frequency
Occurs on minimal exertion or rest

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11
Q

Unstable angina investigations

A

ECG - ST depression
Cardiac enzymes
FBC
Coronary angiogram

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12
Q

Unstable angina management

A

RF modification

  • Statin
  • ACEi

Reduce CV events

  • Aspirin + Clopidogrel
  • Fondaparinux / LMWH

Symptomatic
- GTN spray

Anti-anginal medications

  • Bisorpolol
  • Amlodopine
  • Nitrates
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13
Q

Differences in Investigations

  • Unstable angina
  • NSTEMI
  • STEMI
A

Unstable -
Normal ECG / ST depression
Normal troponins

NSTEMI -
ST depression / T wave inversion
Raised troponins

STEMI
ST elevation
New onset LBBB
Raised troponins

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14
Q

Myocardial infarction presentation

A 
Chest pain - radiation 
Occurs at rest 
Nausea 
dyspnoea
palpitations 
sweatiness 
pallor
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15
Q

Silent MIs presentation

A

Pulmonary oedema
epigastric pain
vomitting
syncope

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16
Q

STEMI Investigations

A

ECG

  • Hyperacute t waves
  • ST elevation
  • New LBBB
  • T wave inversion - days
  • Pathological Q waves - days

Bloods

  • Troponin
  • creatnine kinase

CXR

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17
Q

MI Acute management

A

Pre hospital

  • Aspirin
  • GTN
Hospital 
M - Morphine 
O - O2
N - GTN 
A - Aspirin + clopidogrel
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18
Q

STEMI acute management

A

Reperfusion therapy
- Angiography + PCI
Within 12hrs of STEMI onset

  • Thrombolysis
    PCI unavailble within 2hrs
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19
Q

PCI

- Medications given prior

A

DAPT

  • Aspirin
  • Ticagrelor

Tirofiban - GPIIb/IIa

LMWH

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20
Q

MI Complications

A 
Death 
Arrhythmias
Tamponade 
HF 
Valve disease 
Dresslers syndrome 
Embolism
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21
Q

Chest pain differential dx

A 
MI
Angina 
Pericarditis 
Rib fracture 
Anxiety 
PE
Pneumonia 
GORD 
Cholecystisis
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22
Q

NSTEMI/UA risk stratification

A

GRACE - Global registry of acute coronary events
- 6m mortality risk

TIMI - Thrombolysis in MI
- 14 day all cause mortality risk

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23
Q

Other causes of increased troponins

A 
HF 
Tachyarrhytmias 
sepsis 
myocarditis 
PE
Aortic dissection 
Chronic renal failure
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24
Q

Secondary prevention following MI

A 
Beta blocker
ACEi
Clopidogrel 
Aspirin 
Statin
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25
AAA Presentation
Asymptomatic | Pain - lower back
26
AAA Examination findings
Pulsatile abdominal mass Auscultation - Bruit Tachycardia
27
AAA Investigations
Abdominal IS CT scan - IV Contrast X - Ray
28
AAA complications
Aortic dissection
29
TAA Risk factors
``` Arterial HTN CTD - Ehlers danlos - Marfans Bicuspid aortic valve Trauma Smoking ```
30
TAA presentation
``` Thoracic back pain chest pressure Dysphagia cough Upper venous congestion - Mediastinal compression ```
31
TAA Investigations
CXR TOE echo CT angiogram chest
32
TAA Complications
Embolism Aortic valve regurgitation TAA rupture Aortic dissection
33
What classification is used for heart failure
NYHA
34
Causes of systolic HF
HTN MI IHD Cardiomyopathy
35
Causes of diastolic HF
Constrictive pericarditis Obesity Restrictive cardiomyopathy
36
HF Compensatory mechanisms
Increase HR RAAS Activation - Increases afterload + preload SNS Activation - Afterload - Vasoconstriction - Increased HR - Increased preload - Increase contractability
37
HF cardiac changes
Ventriuclar dilatation | Myocyte hypertrophy
38
HF presentation - Sx
``` SOB Fatigue Ankle swelling Orthopnea - PND Cough - Sputum - Pink/frothy (PO) Weight loss ```
39
HF Examiantion findings
Palpation - Displaced apex beat - Raised JVP - Oedema - Tachycardia Auscultation - 3rd + 4th heart sounds - Narrow pulse pressure - Bibasal lung crackles
40
HF investigations
Bloods - BNP - Cardiac enzymes - FBC - LFTs (Heaptomegaly) CXR ECG - L.V hypetrophy - Ischaemia Echo - Gold standard - Conducted if BNP too high
41
HF CXR findings
``` A - Alveolar oedema B - Kerely B lines C - Cardiomegaly D - Dilated prominent lobe vessels E - Pleural effusion ```
42
HF Management - Pharmacolgical
Symptomatic relief - Furosemide Disease - altering 1st = Ramipril + Bisoprolol 2nd= Spirinolactone 3rd = Digoxin
43
Causes of increased BNP
``` DM Sepsis Old age HF PE COPD Kidney disease Liver cirrhosis ```
44
Acute HF management
100% O2 Diamorphine Furosemide Nitrates
45
Causes of Cor pulmonale
COPD Bronchiectasis Pulmonary fibrosis Sever chronic asthma
46
HTN presentation - Sx
Asymptomatic Headache visual disturbance Chest pain
47
HTN presentation - signs
Bilateral retinal haemorrhages | Papilloedema
48
HTN complications - eyes - cardiac - renal - neurological - Gu
Retinopathy LVH HF IHD PVD Renal failure Proteinuria Headache nausea vomitting stroke/TIA Impotnece
49
Malignant HTN - Retinal changes
Flame shaped haemorrhages Cotton wool spots Hard exudates Papilloedema
50
HTN investigations
Clinical spygmammoter 24hrs ABPM Test for end organ damage: - ECG/Echo - Urinalysis - Fundoscopy - Retinopathy
51
Stage 1 HTN
Clinical BP = 140/90 ABPM = 135/85
52
Stage 2 HTN
Clinical BP = 160/100 ABPM = 150/95
53
Stage 3 HTN
Clinical BP = 180/120 IMMEDIATE TX
54
When is treatment given in HTN
ABPM < 135/85 - No tx ABPM > 135/85 Tx - If QRisk2 is >20% ABPM >150/95 - Tx
55
HTN Management - lifestyle
Weigh tloss reduce alcohol intake reduce salt intake smoking cessation
56
Causes of a systolic murmur
Aortic stenosis - Ejection systolic Mitral regurgitation - Pansystolic
57
Causes of diastolic murmur
Aortic regurgitation - Early diastolic murmur Mitral stenosis - Mid diastolic murmur
58
What does S1 represent
Mitral and tricuspid valve closure
59
What does S2 represent
Aortic and pulmonary valve closure
60
What is S3 common in
MR | HF
61
Causes of aortic stenosis
Calcification RHD Bicuspid valve
62
Aortic stenosis presentation
``` DASH D - Dyspnoea A - Angina S - Syncope H - HF (LVH) ```
63
Aortic stenosis signs
Slow rising carotid pulse Narrow pulse pressure Carotid radiation Ejection systolic murmur
64
Aortic stenosis investigations
Echo ECG - LVH with strain - P mitrale - LAD CXR
65
What is aortic sclerosis
Senile degeneration of valve - Ejection systolic murmur but no carotid radiation
66
Causes of mitral regurgitation
``` IHD Annular calcification RHD Pappilary muscle failure - MI Mitral valve prolapse - Ehlers danlos + Marfans ```
67
Mitral regurgitation presentation
Exertional dyspnoea fatigue palpitations
68
Mitral regurugitation signs
Auscultation - Pansystolic murmur - Apex radiates to axilla Soft S1 Palpation Displaced apex beat
69
What causes tall peaked P waves in lead II
Right atrial enlargement
70
What causes bifid P waves
Left atrial enlargement
71
Mitral regurgitation investigations
Echo ECG - AF / LVH CXR - Larger L.A
72
Causes of aortic regurgitation
IE Ascending aortic dissection Trauma
73
Aortic regurgitation presentation
PAD P - Palpitations A - Angina D - Dyspnoea
74
Aortic regurgitation signs
Auscultation - wide pulse pressure - early diastolic murmur Palpation - Collapsing pulse - Displaced apex beat
75
Causes of mitral stenosis
RF IE Mitral annular calcification
76
Mitral stenosis presentation
``` Dyspnoea fatigue palpitations chest pain haemoptysis R. Heart failure sx ```
77
Mitral stenosis signs
Malar flush Palaption - Raised JVP Low volume pulse Auscultation Mid - diastolic murmur
78
When can a Mitral stenosis mumrur be heard the best
Patient laid in L- side + Expiration
79
Charecteristics of Mitral regurgitation murmur
At apex and spreads to axilla
80
When can a Aortic regurgitation mumrur be heard the best
Sitting foward
81
What classifies a narrow complex tachycardia
QRS < 120ms
82
Causes of sinus tachycardia
``` Anaemia infection fever Thyrotoxicosis Acute PE Hypovolaemia Atropine ```
83
What si the 1st line management of SVT
Adenosine
84
Causes of AF
``` SMITH S- Sepsis M - Mitral pathology I - IHD T - Thyrotoxicosis H - HTN ```
85
AF - sx and sign
sx - - chest pain - palpitations - dyspnoea signs - - Irregularly irregular pulse
86
AF Investigations
ECG - Rapid and irregualr QRS complexes - no p waves - Irregualrly irregualr pulse
87
Acute AF management
Rate control Beta blockers - Atenolol CCB - Diltiazem Rhythm control - Time of onset established <48hrs - Cardioversion >48hrs - Anticoagualtion - Warfarin - Rivaroxiban
88
CHA2-DS2-VASc score
``` C - CCF H - HTN A - Age > 75 D - DM S - Stroke V - Vascualr disease A - Age (65-74) S - Sex - female ```
89
What is used to assess bleeding score when considering anticoagualtion
``` HASBLED H - HTN A - Abnormal liver/renal fucntion B - Bleeding L - Liable INRs E - Elderly D - Drugs / alcohol ```
90
Atrial flutter management
Beta blockers DC cardioversion Anti-coagualtion - warfarin Radiofrequency catheter ablation
91
Cause of AV re entrant tachycardia
Incomplete seperation atria and ventricles leads to accessory pathyway - Prone to AF
92
Accessory pathway in Wolff parkinson white syndrome
Bundle of kent
93
WPWS investigations
Short PR Interval Wide QRS complex Delta wave
94
WPWS Tx
Haemodynamic instability --> Cardioversion Haemodynamically stable --> 1 - Carotid massage 2- Valsalva manoevere 3- Adenosine Surgical Catheter ablation - AVRT
95
Most common post - MI arrhythmia
Ventricualr ectopics
96
Causes of ventricular tachycardia
Long QT Digoxin toxicity Ischaemia Scarring
97
VT treatment
Unstbale - Electrical cardioversion + Amiodarone Stable - Beta blockers + Amiodarone
98
Ventricualr fibrillation Investigations
ECG - Shapeless rapid oscillations - No organised complexes
99
VF causes
Ventricualr ectopic beats
100
Shockable hearth rhythms
VF | VT
101
Causes of long QT syndrome
``` Hyponatraemia Hypocalcaemia Hypomagneasemia Amiodarone Tricyclics ```
102
Tx of sinus bradycardia
Atropine
103
Causes of 1st and 2nd degree HB
``` Athletes Inferior MI AVN vlocking drugs Myocarditis Hypokalemia ```
104
Cause of 3rd degree HB
``` Congenital heart disease IHD Infection HTN Drug - induced ```
105
Causes of LBBB
IHD Aortic valve disease HTN Cardiomyopathy
106
Causes of RBBB
``` PE IHD ASD VSD Cor pulmonale ```
107
Acute limb ischaemia defenition
End stage of PAD | Inadequate blood supply to the limg to allow it to fucntion normally at rest
108
What is intermittent claudication
Ischaemia in a limb during exertion | - Relieved by rest
109
Examiantion signs of PVD
- Buergers angle < 20 degrees - Absent femoral/popliteal/foot pulses - Punched out ulcers - CRT > 15s
110
Chronic limb ischaemia stages
Asymptomatic IC Ischaemic rest pain Ulceration / gangrene
111
IC presentation
Cramping pain Induced by excercise Relieved by rest
112
Critial ischaemia presentation
Ulceration gangrene foot pain - NOCTURAL + at rest Relieved by hanging foot over bed
113
Critical limb ischaemia investigations
1st - Colour duplex US 2nd - ABPI - PAD (0.5-0.9) - Critical limb (<0.5) Bloods CT angiography
114
Critical limb ischaemia management
Treat HTN Atorvastatin Quit smoking Clopidogrel
115
Acute limb ischaemia presentation
``` 6P's Pain pulseless parasthesia perishigly cold paralysis pale ```
116
Acute limb ischaemia management
Emboli - Surgical embelectomy Heparin
117
Sepsis 6?
``` BUFALO Blood cultures Urine output Fluids Abx Lactate O2 ```
118
Teratology of fallot charecteristic features
Over riding aorta VSD Patent ductus arteriosis Pulmonary stenosis
119
Teratology of fallot presentation - sx + signs
Cyanotic (R-->L shunt) Squatting Pulmonary stenosis murmur
120
Teratology of fallot investigations
CXR - Boot shaped heart Echo
121
VSD - Presentation - Signs
SOB Poor feeding failure to thrive Pan-systolic murmur
122
Signs of co-arctation of aorta on exmaination
Radiofemoral delay R.arm HTN Scapular bruit
123
Causes of pericarditis
``` Coxsackie B EBV TB Rheumatoid arhtiritis Kidney failure - uraemia Post - MI ```
124
Pericarditis presentation
Chest pain - Pleuritic - Worse on lying down - Relieved by sitting foward Fever Dyspnoea
125
Pericarditis investigations
Auscultation - Pericardial friction rub Bloods ECG - Saddle shaped ST elevation - PR depression - Flattened t waves - T wave depression ECG - Pericardial effusion
126
Pericarditis management
NSAIDs Aspirin Colichine
127
What decreases the recurrence of pericarditis
Colchicine
128
What is given for recurrent pericarditis
Prednisolone
129
complications of pericarditis
Pericardial effusion --> Cardiac tamponade | Constrictive pericarditis
130
What is beck's triad
Muffled heart sounds increased JVP Falling BP
131
Most affected valves in IE
Tricuspid
132
IE most common cause
Streptococcus viridans - new cardiac murmur
133
Cause of IE in: - IVDU - Dermatitis - DM
Staphylococcus aureus
134
Cause of IE in: | Metallic valve replacement
Staphylococcus epidermitis
135
Describe staph.Aueus
Gram +ve staphylococcus coagulase +ve Gold clumping
136
Describe staph.Epidermididtis
Gram +ve Staphlococcus | coagulase -ve
137
Describe Viridans streptococci
Gram +ve streptococci Alpha - haemolytic Optocjin resistnat
138
IE presentation
Fever + new murmur ``` FROM JANE F - Fever R - Roth spots O - Osler nodes M - Murmur ``` J - Janeway lesions A - Anaemia N - Nails SH E - Emboli Clubbing
139
IE investigations
Blood cultures Echo - vegitations Bloods Urinalysis ECG - HB - Long PR interval
140
IE diagnostic criteria
Duke modified criteria
141
IE management - Emperical tx
Ampicillin + flucloxacillin + gentamicin
142
IE Management - Step
Benzylpenicillin + gentamicin
143
IE Management - Staph
Vancomycin + Rifampicin
144
IE Prophylactic therpay
Amoxicillin | Clindamycin
145
How long should the PR interval last
120 - 200ms
146
Which is the most effect Beta-blocker post MI
Propanolol | Blocks Na+ channels
147
Why is Verapamil more effective than amlodopine
No effect on Ca2+ at rest
148
Indication of adenosine
1st line - SVT
149
Adenosine S/E
Bradycardia | Impending doom
150
Indication od amioderone
Last line Tachyarrhythmias
151
Amiodarone S/E
``` QT prolongation Grey skin Hypo/hyper thyroidism Hepatitis Sun sensitivity ```
152
Tx for Bradyarhytmias
Atropine
153
Atropine S/E
Tachycardia dry mouth constipation
154
MOA - - Thiazides - Loop - Aldosterone antagonist
DCT - Na+/Cl- Asceding loop - Na+/k+/Cl DCT
155
Loop diuretics S/E
Hypotension Low electrolyte state Hearing loss tinitus
156
Thiazide diuretics S/E
Hyponatraemia Hypokalaemia Impotence IGT
157
CYP450 inhibitors
Macrolides - erythromycin Diltiazem Amiodarone
158
CYP450 Inducers
Carbamezepine Phenytoin Rifampicin
159
Causes of radio-radial delay
Sublavian artery stenosis Aortic dissection Aortic co-arctation
160
Slow rising pulse
Aortic stenosis
161
Thready pulse
Intravascualr hypovolaemia - Sepsis
162
Collapsing pusle
``` Fever Pregnancy Aortic regurgitation Patent ductus arteriosus Anaemia Thyrotoxicosis ```
163
What is a corneal arcus
Yellow/grey ring around iris - Hypercholesterolaemia
164
What is Buerger's test
Ischaemia severity indicator | - Positive = Legs turn Red/Purple
165
What is lipodermatosclerosis
Hardening of the skin distally and swelling of the calf
166
Where is the SFJ located
4cm lateral and 4cm inferior to the pubic tubercle
167
What does the tap test indicate
Thrill felt by finger at SFJ | Continuity of the vein secondary to valve incompetancy
168
What does the Trendelenburg test Indicate
Tourniquet at SFJ Veins refill - Problem below torniquet level Veins don't fill back up - Problem above torniquet level
169
Bounding pulse
Aortic regurgitation | CO2 retention
170
Narow BP
Aortic stenosis CCF Cardiac tamponade
171
Wide BP
Aortic reguritation | Aortic dissection
172
Positive hepatojugular reflux test
Constricitve pericarditis RVF LVF Restrictive cardiomyopathy
173
Parasternal heave
RVH
174
Pulsating hepatomegaly
Tricuspid regurgitation
175
Function of calcium gluconate in hyperkalaemia
stabalises cardiac membrane
176
Function of insulin in hyperkalaemia
Drives extracellular K+ into the cell
177
Mobitz type 1 presentation
Lightheaded dizzy syncope
178
Mobitz type 2 presentation
SOB Chest pain Postural HTN
179
Post MI medications
``` DABS DAPT - Asprin + Ticagleror A - Ramipril B - Bisoprolol S - Atorvastatin ```
180
Acute NSTEMI Management
BATMAN
181
Tachyarrhythmias management
Unstable - 3 shocks - Amiodarone Narrow complex - AF - Flutter --> Rate control - SVT --> Vasovasal / Adenosine Broad - VT --> Amiodarone
182
Drawbacks of mechanical heart valves
Thrombus formation IE Haemolysis Lifelong anticoagulation - warfarin
183
Causes of an irregualrly irregualr pulse
AF | Ventricualr ectopics

Disease summaries (9 decks)

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