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Phase II - Medicine Block > Cardiology Cases > Flashcards

Cardiology Cases Flashcards

1
Q

What are the key presenting symptoms of an acute myocardial infarction?

A

Chest pain; PSANS symptoms - nausea, feeling like they’re going to die; SANS - sweating, palpitations.

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2
Q

What is a silent MI?

A

ACS without chest pain.

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3
Q

What is the presentation of a silent MI?

A

Syncope, pulmonary oedema, epigastric pain and vomiting, post-operative hypotension or oliguria, acute confusional state, stroke, diabetic hyperglycaemic states.

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4
Q

Who is more likely to have a silent MI?

A

Elderly and diabetic patients.

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5
Q

Why might a diabetic person have no chest pain with MI?

A

Peripheral neuropathy of the nerves supplying the heart so no pain is felt.

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6
Q

What is the typical pain in acute MI? (SQITARPS)

A

Site - central chest; quality - crushing; intensity - bad; timing - acute; secondary symptoms - radiating pain to left arm, jaw, back.

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7
Q

What are the risk factors of AMI?

A

Non-modifiable - age, male gender, family history of IHD (MI in 1st degree relative <55). Modifiable - smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use. Others (debatable) - stress, type A personality, LVH, increased fibrinogen, hyperinsulinaemia, increased homocysteine levels, ACE genotype.

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8
Q

What are the signs of a patient presenting with AMI?

A

Distress, anxiety, pallor, sweatiness, pulse change, BP change, 4th heart sound, signs of heart failure, pansystolic murmur, low-grade fever.

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9
Q

What are the ECG test results from AMI?

A

STEMI - tall T waves, ST elevation, new LBBB wwithin hours –> Q waves and T wave inversion after a few hours-days. NSTEMI/unstable angina - ST depression, T wave inversion, non-specific changes.

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10
Q

What are the CXR signs from AMI?

A

Cardiomegaly, pulmonary oedema, widened mediastinum.

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11
Q

What investigations should be ordered for AMI?

A

ECG, CXR, bloods (FBC, U&E, glucose, lipids, cardiac enzymes).

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12
Q

What are the cardiac enzyme results from AMI?

A

Troponin T and I are sensitive and specific markers of myocardial necrosis.

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13
Q

How is AMI diagnosed?

A

Increased biomarkers + symptoms of ischaemia or ECG changes of new ischaemia or Q waves or new loss of myocardium or regional wall motion abnormalities on imaging.

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14
Q

What are the differential diagnoses of AMI?

A

Stable angina, pericarditis, myocarditis, Takotsubo cardiomyopathy, aortic dissection, PE, oesophageal reflux/spasm, pneumothorax, musculoskeletal pain, pancreatitis.

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15
Q

Why can AMI be ST elevated or not?

A

In full thickness infarction due to full vessel occlusion, there is ST elevation. In NSTEMIs, there isn’t full vessel occlusion so less infarction.

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16
Q

What is the brief pathophysiology of AMI?

A

Acute coronary syndrome has plaques in the arteries, these can fissure, releasing thrombogenic material. This blocks the artery so the heart tissue doesn’t have enough O2, therefore infarcts.

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17
Q

What is acute coronary syndrome?

A

Build up of atheromatous plaques occluding arteries. Pathology: plaque rupture, thrombosis, inflammation.

18
Q

What is the pneumonic for treatment of AMI?

A

MONA - morphine, oxygen, nitrates, and aspirin.

19
Q

How should symptoms be controlled in AMI?

A

PRN GTN and opiates. If insufficient - GTN infusion.

20
Q

How should risk factors be reduced to prevent future AMI?

A

Stop smoking; treat hypertension, diabetes mellitus, hyperlipidaemia; diet high in oily fish, fruit, vegetable, and fibre, and low in saturated fats; encourage daily exercise; mental health flag to GP.

21
Q

What are the cardioprotective medications that should be optimised after AMI?

A

Antiplatelets - aspiring and clopidogrel for 12 months with PPI for gastric protection; anticoagulate with fondaparinux until discharge; B-blockers (or verapamil or diltiazem if contraindicated); ACE-i if LV dysfunction, hypertension, diabetes (ARB if not tolerated); high-dose statin; eplerenone if heart failure.

22
Q

How should STEMI patients and very high-risk NSTEMI patients be managed surgically?

A

Immediate angiography ± PCI.

23
Q

Who should be considered for CABG in AMI patients?

A

Patients with multivessel disease.

24
Q

What are the complications of AMI?

A

Cardiac arrest, cardiogenic shock, LV failure, bradyarrhythmias, tachyarrhythmias, RV failure/infarction, pericarditis, systemic embolism, cardiac tamponade, mitral regurgitation, ventricular septal defect, late malignant ventricular arrhythmias, Dressler’s syndrome, LV aneurysm.

25
Q

What is the most common bradyarrhythmia seen in inferior MI patients?

A

First degree heart block.

26
Q

What are the bradyarrhythmias seen after AMI?

A

Sinus bradycardia, 1st degree heart block, Wenckebach phenomenon (Mobitz I 2nd degree heart block), Mobitz type II block, complete AV block, bundle branch block.

27
Q

What predisposes post AMI patients to tachyarrhythmias?

A

Hypokalaemia, hypoxia, and acidosis.

28
Q

What are the tachyarrhythmias seen after AMI?

A

Sinus tachycardia, SVT, AF or atrial flutter, freqent PVCs (premature ventricular complexes), non-sustained VT, sustained VT, ventricular fibrillation.

29
Q

How does RV failure/infarction post AMI present?

A

Low CO and increased JVP.

30
Q

How is RV failure/infarction post AMI treated?

A

Avoid vasodilators and diuretics. Inotropes needed in some cases.

31
Q

What is the presentation of pericarditis?

A

Central chest pain, relieved by sitting forwards.

32
Q

What is the ECG of pericarditis?

A

Saddle shaped ST elevation in all leads.

33
Q

How is pericarditis managed?

A

NSAIDs. Echo to check for effusion.

34
Q

How does cardiac tamponade post AMI present?

A

Low CO, pulses paradoxus, Kussmaul’s sign (JVP rises in inspiration), muffled heart sounds.

35
Q

How is cardiac tamponade diagnosed post AMI?

A

Echo.

36
Q

How is cardiac tamponade treated post AMI?

A

Pericardial aspiration and surgery.

37
Q

What is Dressler’s syndrome (complication of AMI)?

A

Recurrent pericarditis, pleural effusions, fever, anaemia, increased ESR 1-3 weeks post AMI.

38
Q

How is Dressler’s syndrome treat post AMI?

A

NSAIDs or steroids if severe.

39
Q

How does LV aneurysm post AMI present?

A

4-6 weeks post AMI, presents with - LVF, angina, recurrent VT, systemic embolism.

40
Q

NEXT IS CASE 2 - HEART FAILURE.

A

Pg 20 of workbook, find in clinical skills book.

Phase II - Medicine Block (2 decks)

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