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3B > Cardiovascular 1 > Flashcards

Cardiovascular 1 Flashcards

1
Q

ACS risk factors

A 
Age
Male
Family history
Smoking
DM
HTN
Hypercholesterolaemia
Obesity
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2
Q

ACS initial management

A 
ABCDE + MONA + DAPT
Morphine
O2 if sats < 94%
Nitrates (GTN) - Useless in MI
Antiemetic - Metoclopramide?

DAPT - Clopidogrel/Ticagrelor + Aspirin 300mg

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3
Q

ACS investigations

A

ECG

Cardiac enzymes

  • Serial troponins (6 hours apart)
  • Cardiac myosin-binding protein C

Glucose
FBC, U&E, LFT
TFT!!!!
Lipid profile

Rule out differentials - CXR, D-dimer, etc.

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4
Q

STEMI - ECG findings

A

> 2mm ST elevation
New onset LBBB
Reciprocal ST depression

Secondary

  • T-wave inversion
  • Pathological Q waves
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5
Q

ACS - ECG regions

A

V1-V4 - Anterior - LAD
I, V5, V6, aVL - Lateral - Circumflex
II, III, aVF - Inferior - Right coronary
V7-V9, ST depression V3-V4 - Posterior - Right coronary

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6
Q

STEMI management

A

DAPT + Morphine
Heparin - Pre-PCI

PCI if…
< 12 hours since onset and PCI available within 2 hours
> 12 hours since onset, with evidence of ongoing ischaemia

PCI not available within 2 hours - Fibrinolysis - Alteplase

+ CABG

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7
Q

NSTEMI management

A

DAPT
+ Fondaparinux

Grace score risk > 3
- Angiography within 4 days

+ CABG

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8
Q

ACS secondary management

A

ACE-I
Statin - 1 year
BB - 1 year
DAPT - 1 year

Cardiac rehab
Smoking cessation
Diet/exercise
Education

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9
Q

ACS complications

A

Pro-Heart ADVERTS

Papillary muscle rupture - MR
HF - Chronic
Aneurysm - LV wall - Stroke risk
Dressler's - Pericarditis 2-5 weeks post-MI
VSD
Electrical - VF/VT/AF
Rupture - LV wall
Tamponade
Shock - Pulmonary oedema
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10
Q

Angina criteria

A
  1. Sharp
  2. On exertion
  3. Relieved by GTN
3 = Angina
2 = Atypical angina
1 = Not angina
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11
Q

Angina referral rules

A

CP < 12 hours + Abnormal ECG = Urgent
CP > 24 hours = Same day admission
CP > 72 hours = Check ECG and troponin

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12
Q

Silent MI

A

Common exam question!

Patient is female or diabetic!

Atypical history
ECG shows obvious ischaemic changes

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13
Q

Angina management

A

Aspirin
Nitrates
Statin

BB or CCB (Amlodipine)

Long-acting nitrate - Isosorbide mononitrate

+ CABG

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14
Q

Infective endocarditis risk factors

A

CHIPS

CHD
History of IE
IVDU
Prosthetic valve
Structural heart defect
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15
Q

Infective endocarditis aetiology

A

Staph Aureus
Staph Epidermidis - Recent surgery
Strep Bovis - Colorectal
Strep Viridans

Predisposing factors in paeds

  • ASD
  • VSD
  • PDA
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16
Q

Infective endocarditis symptoms

A

FROM JANE

Fever
Roth spots
Osler nodes - Painful - Hours/days
Murmur - MR - Pansystolic

Janeway lesions - Not painful - Days/weeks
Anaemia and anorexia
Nail haemorrhages
Emboli

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17
Q

Infective endocarditis investigations

A

Blood cultures
TTE

Duke’s criteria!

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18
Q

Infective endocarditis criteria

A

Duke’s criteria - BE TV MICE
2 major / 1 major + 3 minor / 5 minor

Major

  • Blood culture +ve
  • TTE - Evidence of endocardial involvement

Minor

  • Temp > 38
  • Vascular phenomenon
  • Microbiological evidence
  • Immunological phenomenon
  • Cardiac condition or IVDU
  • Echo findings
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19
Q

Infective endocarditis management

A

Unknown bacterial cause - Amoxicillin

Known Staph Aureus - Flucloxacillin

(Known prosthetic valve) + Rifampicin + Gentamicin

Strep Viridans - Benzylpenicillin

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20
Q

Rheumatic fever aetiology

A

Strep Pyogenes

Paeds

  • Scarlet fever
  • Strep pharyngitis
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21
Q

Rheumatic fever presentation

A

History of strep throat!

JONES FACE P

Joints - Arthralgia
O - Heart - Murmur - Late diastolic MS
Nodules
Erythema marginatum
Sydenham's chorea
Fever 
Anaemia / Anorexia
CRP ^ 
ECG - Prolonged PR
Previous rheumatic fever
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22
Q

Rheumatic fever criteria

A

JONES (FACE P) criteria

JONES = Major
FACE P = Minor

2 major
1 major + 2 minor

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23
Q

Rheumatic fever investigations

A

Blood cultures
Throat swab
ASO titre
ECG - Prolonged PR

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24
Q

Rheumatic fever management

A

Penicillin

IM Benzylpenicillin

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25
Q

Rheumatic fever complications

A

Mitral stenosis!

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26
Q

HTN aetiology

A

Primary - Essential HTN

Secondary

Renal

  • RAS
  • PKD
  • Glomerular disease

Endocrine

  • Conn’s
  • Cushing’s
  • Acromegaly
  • Phaeochromocytoma

Other

  • Pregnancy
  • COCP
  • NSAIDs
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27
Q

HTN thresholds

A

> 140/90 - Perform ABPM
150/95 - Start anti-HTN medication

Age < 80 + Systolic > 135 + One of the following...
- QRISK2 > 10
- End organ damage
- Renal failure
- HF
- Diabetes
= Start anti-HTN medication
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28
Q

HTN management

< 55 or DM2

A
  1. ACE-I or ARB
  2. A + Diuretic / CCB
  3. A + D + C
  4. K < 4.5 = Add spironolactone
    K > 4.5 = Add AB or BB
  5. Specialist review
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29
Q

HTN management

> 55 or Afro-Caribbean

A
  1. CCB
  2. C + ACE-I or ARB
  3. C + A + Diuretic
  4. K < 4.5 = Add spironolactone
    K > 4.5 = Add AB or BB
  5. Specialist review
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30
Q

Heart failure aetiology

A

CHAVS

CHD
HTN
Age
Valvular disease
Structural heart defect
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31
Q

Heart failure pathophysiology

A

Decreased renal perfusion
= RAAS activated
= Fluid retention
= Systemic oedema

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32
Q

HF presentation

A 
Orthopnoea
Dyspnoea
Paroxysmal noctural dyspnoea
Cough - Pink frothy sputum
Lethargy
Ankle oedema
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33
Q

HF signs

A 
S3 + S4
Displaced apex beat
Crackles / Wheeze 
Raised JVP
Hepatosplenomegaly
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34
Q

Breathlessness in HF - Pathophysiology

A 
Poor cardiac output from LV
Left side of the heart becomes congested
Poor blood flow in pulmonary vessels
Increased hydrostatic pressure
Fluid moves from vascular to tissue compartment
Poor gaseous exchange
= Breathlessness
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35
Q

HF investigations

A 
BNP
TTE
CXR - ABCDE
ECG - LVH
Baseline bloods

Depression screen

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36
Q

HF - CXR findings

A

ABCDE

Alveolar oedema
B - Kerly B lines - Interstitial oedema
Cardiomegaly
Dilated upper lobe vessels
Effusions
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37
Q

HF management - Pharmacological

A

ACE
BB

One of…

  • Spironolactone
  • ARB
  • Hydralazine nitrate

Digoxin
Diuretic - Symptomatic relief only

38
Q

HF management - Non-pharmacological

A 
Cardiac rehab
Lifestyle modification
Fluid restriction - If overloaded
Pneumococcal vaccine
Flu vaccine
39
Q

HF complications

A 
Arrhythmias - AF
Sudden cardiac death
Depression
Cachexia
Death - 5-year survival is 5%
Impotence
CKD
40
Q

HF classification

A

New York Heart Association

  • Functional capacity (1-4)
  • Objective assessment (A-D)
41
Q

Acute HF - Clinical features

A

Acute pulmonary oedema
Cardiogenic shock
Right-sided HF

42
Q

Acute HF - Management

A

Diuresis - Furosemide
O2 / CPAP

Clinical evaluation of systolic BP
> 100 - GTN
85-100 - Inotrope - Milrinone / Dobutamine
< 85 - Volume loading - NaCl

43
Q

Pericarditis aetiology

A

MUMPs ITCH

Mumps/Coxsackie’s
Uraemia
Malignancy
Post-MI - Dressler’s

Infiltrative - TB
Trauma
Connective tissue disorder
Hypothyroid

44
Q

Pericarditis clinical features

A

Chest pain - Relieved sitting forwards

Pericardial rub - Scratchy sound on auscultation

45
Q

Pericarditis investigations

A

ECG - Global changes

  • PR depression
  • Concave ST elevation - Saddle deformity

CRP ^
CXR - Rule out alternative diagnoses
Troponins - Rule out MI

46
Q

Pericarditis management

A

NSAIDs
Colchicine

Steroids - If severe

Treat cause

47
Q

Constrictive pericarditis

A

Most often caused by TB
Pericardial knock - Loud S3
CXR - Pericardial calcification

48
Q

Cardiac tamponade aetiology

A

Pericardial effusion

Usually due to trauma

49
Q

Cardiac tamponade presentation

A

Beck’s triad!

  1. Fixed raised JVP
  2. Hypotension
  3. Muffled heart sounds

Dyspnoea
Tachycardia

50
Q

Cardiac tamponade investigations and examination findings

A

ECG - Electrical alternans - QRS complexes alternate in amplitude

On examination…

  • Pulsus paradoxus - BP drop > 10 during inspiration
  • Kussmaul sign - JVP unchanged throughout inspiration
  • Absent Y descent in JVP
51
Q

Cardiac tamponade management

A

Pericardiocentesis

52
Q

Aortic stenosis aetiology

A

Calcification
Bicuspid valve
Rheumatic heart disease

53
Q

Aortic stenosis presentation

A

SADD

Syncope
Angina
Dyspnoea
Death

54
Q

Aortic stenosis examination findings

A

Ejection systolic murmur - Radiating to the carotids
- 2nd intercostal space

Ejection click
Narrow PP
Slow rising pulse
S4
Thrill
55
Q

Aortic stenosis investigations

A

TTE

ECG

  • LVH
  • Downward T wave in V6
56
Q

Aortic stenosis management

A

Symptomatic or valvular gradient > 40

TAVI - Transcatheter aortic valve replacement
+ Angiography

57
Q

Aortic regurgitation aetiology

A

Acute

  • Aortic dissection - Dilatation effect
  • IE
  • Rheumatic fever

Chronic

  • Ehlers-Danlos / Marfan’s
  • Ankylosing spondylitis
  • RA
58
Q

Aortic regurgitation presentation

A

Orthopnoea

Fatigue

59
Q

Aortic regurgitation clinical findings

A

Diastolic murmur - On held expiration
- Left 3rd intercostal space

Austin-Flint murmur - Mid-late

  • Low pitched rumbling
  • Best heard at cardiac apex

Wide PP
Slow rising pulse

Quincke’s sign - Systolic pulsations on light compression of nailbed
DeMusset’s sign - Rhythmic head nodding in line with heartbeat

60
Q

Aortic regurgitation investigations

A

TTE

61
Q

Aortic regurgitation management

A

Diuretics - Furosemide
Valve replacement
Treat cause

62
Q

Mitral regurgitation aetiology

A

Post-MI - Papillary muscle rupture
Rheumatic fever
IE
Ehlers-Danlos

63
Q

Mitral regurgitation clinical findings

A

Pansystolic murmur
Best heard at cardiac apex
Left lateral position

64
Q

Mitral regurgitation investigations and management

A

TTE
ECG

Valve replacement

65
Q

Mitral stenosis aetiology

A

Rheumatic fever

66
Q

Mitral stenosis examination findings

A

Mid-late diastolic murmur - Radiating to axilla
Opening snap
Malar flush
AF

67
Q

Mitral stenosis investigations

A

TTE
ECG - AF
CXR - Left atrial enlargement

68
Q

Mitral stenosis management

A

Vasodilators - GTN
Diuretics - Furosemide
Replacement

69
Q

Bradycardia aetiology

A

Sinus bradycardia

  • Athletes
  • Hypothyroid
  • Hypothermia
  • Sick sinus syndrome
  • Infarction

Extrinsic factors

  • BBs
  • Alcohol

AV block
BBB

70
Q

Sinus bradycardia management

A

When symptomatic or < 40bpm
IV atropine
Temporary pacing wire

IV adrenaline

71
Q

AV node block aetiology

A

PR > 0.2

Coronary artery disease
Cardiomyopathy
Fibrosis - Elderly patients
Abscess

72
Q

AV node block symptoms

A

Syncope

Heart failure

73
Q

AV node block management

A

If symptomatic or broad QRS

Pacemaker
IV atropine

74
Q

AV node block types

A

1st degree - Prolonged PR

2nd degree

  • Mobitz 1 - Increasingly long PR + Dropped QRS
  • Mobitz 2 - Prolonged PR + Dropped QRS (specific ratio)

3rd degree - P waves have no relationship to QRS

75
Q

LBBB

A

Aetiology - Post MI / Aortic stenosis

WiLLiaM
W in V1
M in V6

76
Q

RBBB

A

Aetiology

  • Physiological
  • PE
  • RVH
  • CAD
  • ASD

MaRRoW
M in V1
W in V6

77
Q

Bifascicular block

Trifascicular block

A 
Bifascicular = RBBB + LAD
Trifascicular = RBBB + LAD + 1st degree block
78
Q

Sinus tachycardia aetiology

A 
Alcohol
Stress
Hyperthyroid
HF
PE
Anaemia
Caffeine
Infection
79
Q

SVT aetiology

A

AAAAAAAAAAAAAAAAAAA

AF
Atrial flutter
Atrioventricular re-entry tachycardia - AVRT
Atrioventricular nodal re-entry tachycardia - AVNRT

80
Q

AF aetiology

A

Paroxysmal

  • PE
  • Infection
  • Alcohol - Holiday heart syndrome

Prolonged / permanent

  • HF
  • Age
  • Post-MI
  • Cardiomyopathy
  • Mitral stenosis
  • Hyperthyroid
81
Q

AF investigations

A

ECG

  • Irregularly irregular
  • Absent P waves

TFTs

82
Q

AF management

A

Onset < 48 hours - Rate or rhythm control
Onset > 48 hours - Rate control

Rate control

  • BB
  • CCB - Rate limiting - Verapamil
  • Digoxin

Rhythm control

  • Flecainide - No structural heart abnormality
  • Amiodarone
  • DC cardioversion - If acutely unwell and < 48 hours since onset
  • Ablation

CHADSVASC - Anticoagulate - Warfarin

83
Q

CHA2DS2-VaSc

A 
Female = 2 
Male = 1
CHF - 1
HTN - 1
Age 65-75 - 1
Age > 75 - 2
DM - 1
Stroke/TIA/VTE - 2
Vascular disease - 1
Sex - Female - 1
84
Q

HASBLED

A 
HTN - 1
Abnormal renal and/or liver function - 1 or 2
Stroke - 1
Bleeding disorder - 1
Labile INRs - 1
Elderly > 65 - 1
Drugs - NSAIDs and/or alcohol - 1 or 2
85
Q

AVNRT

A

Atrioventricular nodal re-entry tachycardia

Teens / 20s
ECG - Absent P waves + Narrow QRS

86
Q

WPW pathophysiology

A

Congenital accessory pathway between atria and ventricles
Atrioventricular re-entry tachycardia
Accessory pathway does not slow conduction
AF can lead to VF

87
Q

WPW ECG findings

A 
Short PR
Wide QRS - Slurred upstroke - Delta wave
Left or right axis deviation
Type A - Dominant R wave in V1
Type B - No dominant R wave in V1
88
Q

WPW associated conditions

A 
Hypertrophic cardiomyopathy 
Mitral valve prolapse
Ebstein's anomaly
Thyrotoxicosis
Secundum ASD
89
Q

WPW management

A

Radiofrequency ablation of accessory pathway
Sotalol
Amiodarone
Flecainide

90
Q

SVT management

A

Vasovagal manoeuvres
IV adenosine
DC cardioversion

Long-term

  • Radiofrequency ablation
  • BB

3B (23 decks)

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