Cardiovascular 1 Flashcards
(90 cards)
1
Q
ACS risk factors
A
Age Male Family history Smoking DM HTN Hypercholesterolaemia Obesity
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
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.
4
Q
STEMI - ECG findings
A
> 2mm ST elevation
New onset LBBB
Reciprocal ST depression
Secondary
- T-wave inversion
- Pathological Q waves
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
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
7
Q
NSTEMI management
A
DAPT
+ Fondaparinux
Grace score risk > 3
- Angiography within 4 days
+ CABG
8
Q
ACS secondary management
A
ACE-I
Statin - 1 year
BB - 1 year
DAPT - 1 year
Cardiac rehab
Smoking cessation
Diet/exercise
Education
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
10
Q
Angina criteria
A
- Sharp
- On exertion
- Relieved by GTN
3 = Angina 2 = Atypical angina 1 = Not angina
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
12
Q
Silent MI
A
Common exam question!
Patient is female or diabetic!
Atypical history
ECG shows obvious ischaemic changes
13
Q
Angina management
A
Aspirin
Nitrates
Statin
BB or CCB (Amlodipine)
Long-acting nitrate - Isosorbide mononitrate
+ CABG
14
Q
Infective endocarditis risk factors
A
CHIPS
CHD History of IE IVDU Prosthetic valve Structural heart defect
15
Q
Infective endocarditis aetiology
A
Staph Aureus
Staph Epidermidis - Recent surgery
Strep Bovis - Colorectal
Strep Viridans
Predisposing factors in paeds
- ASD
- VSD
- PDA
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
17
Q
Infective endocarditis investigations
A
Blood cultures
TTE
Duke’s criteria!
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
19
Q
Infective endocarditis management
A
Unknown bacterial cause - Amoxicillin
Known Staph Aureus - Flucloxacillin
(Known prosthetic valve) + Rifampicin + Gentamicin
Strep Viridans - Benzylpenicillin
20
Q
Rheumatic fever aetiology
A
Strep Pyogenes
Paeds
- Scarlet fever
- Strep pharyngitis
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
22
Q
Rheumatic fever criteria
A
JONES (FACE P) criteria
JONES = Major
FACE P = Minor
2 major
1 major + 2 minor
23
Q
Rheumatic fever investigations
A
Blood cultures
Throat swab
ASO titre
ECG - Prolonged PR
24
Q
Rheumatic fever management
A
Penicillin
IM Benzylpenicillin
25
Rheumatic fever complications
Mitral stenosis!
26
HTN aetiology
Primary - Essential HTN
Secondary
Renal
- RAS
- PKD
- Glomerular disease
Endocrine
- Conn's
- Cushing's
- Acromegaly
- Phaeochromocytoma
Other
- Pregnancy
- COCP
- NSAIDs
27
HTN thresholds
> 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
```
28
HTN management
< 55 or DM2
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
29
HTN management
> 55 or Afro-Caribbean
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
30
Heart failure aetiology
CHAVS
```
CHD
HTN
Age
Valvular disease
Structural heart defect
```
31
Heart failure pathophysiology
Decreased renal perfusion
= RAAS activated
= Fluid retention
= Systemic oedema
32
HF presentation
```
Orthopnoea
Dyspnoea
Paroxysmal noctural dyspnoea
Cough - Pink frothy sputum
Lethargy
Ankle oedema
```
33
HF signs
```
S3 + S4
Displaced apex beat
Crackles / Wheeze
Raised JVP
Hepatosplenomegaly
```
34
Breathlessness in HF - Pathophysiology
```
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
```
35
HF investigations
```
BNP
TTE
CXR - ABCDE
ECG - LVH
Baseline bloods
```
Depression screen
36
HF - CXR findings
ABCDE
```
Alveolar oedema
B - Kerly B lines - Interstitial oedema
Cardiomegaly
Dilated upper lobe vessels
Effusions
```
37
HF management - Pharmacological
ACE
BB
One of...
- Spironolactone
- ARB
- Hydralazine nitrate
Digoxin
Diuretic - Symptomatic relief only
38
HF management - Non-pharmacological
```
Cardiac rehab
Lifestyle modification
Fluid restriction - If overloaded
Pneumococcal vaccine
Flu vaccine
```
39
HF complications
```
Arrhythmias - AF
Sudden cardiac death
Depression
Cachexia
Death - 5-year survival is 5%
Impotence
CKD
```
40
HF classification
New York Heart Association
- Functional capacity (1-4)
- Objective assessment (A-D)
41
Acute HF - Clinical features
Acute pulmonary oedema
Cardiogenic shock
Right-sided HF
42
Acute HF - Management
Diuresis - Furosemide
O2 / CPAP
Clinical evaluation of systolic BP
> 100 - GTN
85-100 - Inotrope - Milrinone / Dobutamine
< 85 - Volume loading - NaCl
43
Pericarditis aetiology
MUMPs ITCH
Mumps/Coxsackie's
Uraemia
Malignancy
Post-MI - Dressler's
Infiltrative - TB
Trauma
Connective tissue disorder
Hypothyroid
44
Pericarditis clinical features
Chest pain - Relieved sitting forwards
| Pericardial rub - Scratchy sound on auscultation
45
Pericarditis investigations
ECG - Global changes
- PR depression
- Concave ST elevation - Saddle deformity
CRP ^
CXR - Rule out alternative diagnoses
Troponins - Rule out MI
46
Pericarditis management
NSAIDs
Colchicine
Steroids - If severe
Treat cause
47
Constrictive pericarditis
Most often caused by TB
Pericardial knock - Loud S3
CXR - Pericardial calcification
48
Cardiac tamponade aetiology
Pericardial effusion
| Usually due to trauma
49
Cardiac tamponade presentation
Beck's triad!
1. Fixed raised JVP
2. Hypotension
3. Muffled heart sounds
Dyspnoea
Tachycardia
50
Cardiac tamponade investigations and examination findings
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
Cardiac tamponade management
Pericardiocentesis
52
Aortic stenosis aetiology
Calcification
Bicuspid valve
Rheumatic heart disease
53
Aortic stenosis presentation
SADD
Syncope
Angina
Dyspnoea
Death
54
Aortic stenosis examination findings
Ejection systolic murmur - Radiating to the carotids
- 2nd intercostal space
```
Ejection click
Narrow PP
Slow rising pulse
S4
Thrill
```
55
Aortic stenosis investigations
TTE
ECG
- LVH
- Downward T wave in V6
56
Aortic stenosis management
Symptomatic or valvular gradient > 40
TAVI - Transcatheter aortic valve replacement
+ Angiography
57
Aortic regurgitation aetiology
Acute
- Aortic dissection - Dilatation effect
- IE
- Rheumatic fever
Chronic
- Ehlers-Danlos / Marfan's
- Ankylosing spondylitis
- RA
58
Aortic regurgitation presentation
Orthopnoea
| Fatigue
59
Aortic regurgitation clinical findings
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
Aortic regurgitation investigations
TTE
61
Aortic regurgitation management
Diuretics - Furosemide
Valve replacement
Treat cause
62
Mitral regurgitation aetiology
Post-MI - Papillary muscle rupture
Rheumatic fever
IE
Ehlers-Danlos
63
Mitral regurgitation clinical findings
Pansystolic murmur
Best heard at cardiac apex
Left lateral position
64
Mitral regurgitation investigations and management
TTE
ECG
Valve replacement
65
Mitral stenosis aetiology
Rheumatic fever
66
Mitral stenosis examination findings
Mid-late diastolic murmur - Radiating to axilla
Opening snap
Malar flush
AF
67
Mitral stenosis investigations
TTE
ECG - AF
CXR - Left atrial enlargement
68
Mitral stenosis management
Vasodilators - GTN
Diuretics - Furosemide
Replacement
69
Bradycardia aetiology
Sinus bradycardia
- Athletes
- Hypothyroid
- Hypothermia
- Sick sinus syndrome
- Infarction
Extrinsic factors
- BBs
- Alcohol
AV block
BBB
70
Sinus bradycardia management
When symptomatic or < 40bpm
IV atropine
Temporary pacing wire
IV adrenaline
71
AV node block aetiology
PR > 0.2
Coronary artery disease
Cardiomyopathy
Fibrosis - Elderly patients
Abscess
72
AV node block symptoms
Syncope
| Heart failure
73
AV node block management
If symptomatic or broad QRS
Pacemaker
IV atropine
74
AV node block types
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
LBBB
Aetiology - Post MI / Aortic stenosis
WiLLiaM
W in V1
M in V6
76
RBBB
Aetiology
- Physiological
- PE
- RVH
- CAD
- ASD
MaRRoW
M in V1
W in V6
77
Bifascicular block
| Trifascicular block
```
Bifascicular = RBBB + LAD
Trifascicular = RBBB + LAD + 1st degree block
```
78
Sinus tachycardia aetiology
```
Alcohol
Stress
Hyperthyroid
HF
PE
Anaemia
Caffeine
Infection
```
79
SVT aetiology
AAAAAAAAAAAAAAAAAAA
AF
Atrial flutter
Atrioventricular re-entry tachycardia - AVRT
Atrioventricular nodal re-entry tachycardia - AVNRT
80
AF aetiology
Paroxysmal
- PE
- Infection
- Alcohol - Holiday heart syndrome
Prolonged / permanent
- HF
- Age
- Post-MI
- Cardiomyopathy
- Mitral stenosis
- Hyperthyroid
81
AF investigations
ECG
- Irregularly irregular
- Absent P waves
TFTs
82
AF management
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
CHA2DS2-VaSc
```
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
HASBLED
```
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
AVNRT
Atrioventricular nodal re-entry tachycardia
Teens / 20s
ECG - Absent P waves + Narrow QRS
86
WPW pathophysiology
Congenital accessory pathway between atria and ventricles
Atrioventricular re-entry tachycardia
Accessory pathway does not slow conduction
AF can lead to VF
87
WPW ECG findings
```
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
WPW associated conditions
```
Hypertrophic cardiomyopathy
Mitral valve prolapse
Ebstein's anomaly
Thyrotoxicosis
Secundum ASD
```
89
WPW management
Radiofrequency ablation of accessory pathway
Sotalol
Amiodarone
Flecainide
90
SVT management
Vasovagal manoeuvres
IV adenosine
DC cardioversion
Long-term
- Radiofrequency ablation
- BB
