Cardiovascular Flashcards by Belle Storey

Give 4 risk factors for IHD

Modifiable: smoking, obesity, hypertension, sedentary lifestyle, diabetes, hypercholesterolaemia

Non-modifiable: Age, male, family history

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Other than exertion, give 2 possible triggers of angina

Cold/windy weather
Emotion (anger/excitement)
Lying down
Vivid dreams (nocturnal angina)

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Other than chest pain, give 2 symptoms a pt may experience during an episode of angina

SOB
Sweating
Feeling faint

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Name 2 blood tests requested for angina and why

FBC (anaemia)
TFTs (thyrotoxicosis)
lipid profile (hypercholesterolaemia)
glucose (T2DM)
U&Es (renal vessel disease if considering ACEi)

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Other than blood tests, name 3 tests used to investigate angina

Coronary angiogram (gold-standard)

ECG, exercise tolerance test, echocardiogram

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How does aspirin reduce the risk of coronary events

COX-1 inhibitor, inhibiting production of Thromboxine A2 from platelets (reduces the level of platelet aggregation)

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Which artery supplies the anterior territory of the myocardium?

Left anterior descending

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Give 3 aspects of your immediate management plan in a STEMI

PAIN:

Perform ABC assessment and ECG
Aspirin 300mg and Another antiplatelet (ticagrelor 180mg)
IV morphine if required (with an antiemetic e.g. metoclopromide)
Nitrate (GTN spray)

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What two management options are available to definitively treat a STEMI

Primary PCI
If PCI availability >120 min: thrombolysis with fibronlytic agent e.g. alteplase

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Give four medications that may be started prior to discharge after a STEMI

6 A’s:
Aspirin
Another antiplatelet (ticagrelor or clopidogrel)
Atorvastatin
ACEi
Atenolol (bisoprolol more commonly)
Aldosterone antagonist (e.g. eplerenone; for those with clinical HF)

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Give 3 signs of pulmonary oedema you would look for on examination

Tachycardia, tachypnoea, bilateral bibasal crackles on ausculatation, 3rd heart sound; if right-sided HF raised JVP and peripheral oedema

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4 pulmonary oedema investigations

CXR (ABCDEF)
ECG
ABG (T1RF?)
Echocardiogram (EF %)
Bloods (FBC, U&E, lipids, glucose)
Cardiac enzymes (e.g. troponin)

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Name 2 drugs that may be used in the treatment of acute pulmonary oedema

Oxygen
Furosemide
Morphine
Nitrates (GTN)

‘SODIUM’:
Sit up
Oxygen
Diuretics (Furosemide)
IV fluids need to be stopped
Underlying cause needs to be treated
Morphine + nitrate (severe cases)

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Name one drug that may have been used in the treatment of pulmonary oedema that can cause hypokalaemia

Furosemide

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Give 2 ways to raise potassium medically

Oral (sando-K)
IV (add KCI to IV fluids)

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Name the leads on a 12-lead ECG in which you would expect to see ST elevation on a lateral STEMI.

Which vessel is likely to be affected?

aVL, I, V5-V6

Left circumflex

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Give two abnormalities that may be seen on his ECG prior to discharge after a STEMI

T wave inversion
Pathological Q waves

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DVLA rules for driving after an MI

You don’t need to tellDVLAif you’ve had an MI or a heart, cardiac or coronary angioplasty

Stop driving after MI for:
* 1 week if you had successful angioplasty
* 4 weeks if you had angioplasty but it wasn’t successful or if you didn’t have angioplasty

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Give 3 possible complications of CT coronary angiogram

M-SAID
MI
Stroke (+ bleeding/haemorrhage)
Allergy to contrast
Infection
Damage to coronary vessels requiring intervention / Death

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Which territory of the myocardium do leads II, III and aVF represent?

Which vessel is responsible for this territory?

Inferior

Right coronary artery

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A patients pulse is no longer palpable and he’s stopped breathing, give 2 things you would do next?

Call for help / crash team
Start chest compressions

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What is the normal QRS interval?

< 120 ms

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What is a capture beat?

Sinus impulse conducts through the AV node producing a normal QRS complex between wide QRS complexes of ventricular tachycardia

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Regular, tachycardia, broad QRS complexes with an occasional capture beat, what is the rhythm disturbance?

Ventricular tachycardia

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Name the shockable rhythms

VF and pulseless VT

Give 2 drugs that may be used during cardiac arrest

Adrenaline Amiodorone Oxygen

What system is used to classify the severity of heart failure?

NYHA classification 1. no symptoms 2. mild / ordinary activity 3. symptoms occur with minimal activity / significant limitation 4. symptoms occur at rest/ severe limitations

Give 3 symptoms of left ventricular failure

SOB (3): Orthopnoea (exacerbated by lying flat) On exertion / reduced exercise tolerance Paroxysmal noctural dyspnoea Cough (2): Nocturnal Frothy white or pink sputum

Give 3 signs of heart failure on a CXR

ABCDEF of pulmonary oedema Alveolar oedema ('bat wings') Kerley B lines Cardiomegaly Diversion (upper lobe) Effusion (blunted costophrenic angles) Fluid in the fissures

How and where does furosemide act?

'LOOP diuretic' Inhibits the Na-K-2Cl co-transporter in the Loop of Henle (keeping Na in the urine) which therefore diminishes the osmotic gradient for water reabsorption (water follows salt)

Which drug used in AF and HF caused ST depression (reverse tick) and T wave inversion in V4-6 on ECG

Digoxin

BMI equation and classifications

weight in kg / height in m (sq) <18.5: underweight 18.5 to 24.9: healthy 25 to 29.9: overweight 30 to 39.9: obese >40: severely obese

3 pieces of lifestyle advice for overweight patient with hypertension

Aim to lose weight Increase exercise Stop smoking Reduce alcohol intake Low fat diet Low salt intake

Class of anti-hypertensive drug 1st line for 52 year old white pt with no co-morbidities

ACEi

Class of anti-hypertensive drug 1st line for 56 year old white pt with no co-morbidities

CCB

Class of anti-hypertensive drug 1st line for 52 year old patient with african-caribbean ethnicity

CCB

Class of anti-hypertensive drug 1st line for 58 year old patient with T2DM

ACEi

2 side effects to be aware of before starting an ACEi

Dry cough Hypotension Renal impairment Hyperkalaemia

2 signs that may be visible on the retina of someone with hypertensive retinopathy

CRASH: Cotton wool spots Retinal haemorrhages AV nipping Silver wiring Hard exudates

3 complications of essential hypertension

HF IHD Stroke CKD Hypertensive retinopathy PVD

Mechanism of action of simvastatin

Inhibits HMG-CoA reductase (rate-limiting step in cholesterol synthesis)

2 signs of hypercholesterolaemia on examination

Xanthelasma Tendon xanthoma Corneal arcus

One drug used to treat acute phase of gout

NSAID (ibuprofen, diclofenac, naproxen) Colchicine

3 common causes of AF

SMITH: Sepsis Mitral valve pathology IHD Thyrotoxicosis (hyperthyroidism) HTN

2 features of AF on ECG

Irregular QRS complexes Absent P waves

2 associated symptoms of AF

Syncope SOB Chest pain

2 methods of cardioversion in AF (rhythm control)

Electrical (DC cardioversion; on the R wave) Pharmacological (flecainide or amiodorone)

2 medications that may be used long term in AF

Beta-blocker CCB co-existing HF: Digoxin Amiodorone

2 complications of AF

Stroke TIA HF

Fever, night sweats, SOB, high-pitched early diastolic murmur, coarse crepitations at lung base → immediate management plan

(infective endocarditis) ABCDE approach

Organism most likely to be responsible for infective endocarditis

Staphylococcus aureus

Name of boat-shaped retinal haemorrhage with pale centre seen on fundoscopy of infective endocarditis patient

Roth spot

Criteria used for infective endocarditis diagnosis

Modified duke criteria Major: persistently positive blood cultures and vegetation on echo Minor (RF): IVDU, valve pathology, fever (>38), vascular features e.g. janeway lesions, immunological features e.g. oslers nodes, microbiological features e.g. positive culture

Other than early diastolic murmur, give 3 signs of aortic regurgitation

Collapsing pulse Corrigan's sign (carotid pulsation) Quinckes sign (nail bed pulsation) Austin flint murmur (mitral cusp fluttering from regurg causing mid-diastolic murmur)

Pan systolic murmur with RV heave - what valve disease has caused the infective endocarditis?

Tricuspid regurgitation

Most likely organism causing infective endocarditis in an IVDU

Staphylococcus aureus

How should blood cultures be taken in infective endocarditis

3 samples from different venepuncture sites 30 minutes apart from each other *All cultures should be collected prior to commencing antibiotics unless septic

Other than blood tests, what imaging investigations should be used in infective endocarditis?

Echocardiogram CXR (PE) ECG (AF from damaged valves) Urine dip (microscopic haematuria)

Other than IVDU, give 2 examples of pre-existing cardiac disease that increases risk of infective endocarditis?

Prosthetic valve Mitral valve disease Aortic valve disease (e.g. bicuspid aortic valve) PDA VSD Coarctation

4 medications used for secondary prevention in stable angina

Aspirin Atorvastatin ACE inhibitor Beta blocker

Medication and dose for bradycardia

Atropine 500 mcg (repeat if unsuccessful)

Non-pharmacological management option for bradycardia

Transcutaneous pacing

Name 2 reflexes you could check when verifying a death

Pupillary Corneal

3 components of Cushing's reflex

Hypertension Bradycardia Irregular breathing pattern

Describe 3 signs of expanding EDH as it enlarges and before it ultimately results in coning

Nausea and vomiting Brief lucid interval Rapid deterioration in consciousness (following lucid interval) CN III palsy / ‘down and out’ pupil Seizures Reduced GCS

What is 'coning'?

(Raised intracranial pressure causes) Herniation of the cerebellar tonsils through the foramen magnum Leads to compression to the brainstem (and respiratory arrest)

Name 4 clinical signs on examination of infective endocarditis

Roth spots Osler's nodes Splinter haemorrhages Splenomegaly Janeway'slesions Petechiae

Name 2 classes of drugs used first-line in HF which help to reduce mortality

ACEi Beta blockers

List 2 causes of distributive shock

*system wide vasodilation* Septic Anaphylactic Neurogenic

List 2 causes of hypovolaemic shock

*fluid loss* Haemorrhagic Burns

Causes of mediastinal widening

Aortic dissection Aortic aneurysm Lung mass

Murmur associated with aortic dissection

Early diastolic decrescendo Loudest at left sternal edge

Aortic dissection investigation in a) stable b) unstable

a) CT CAP (chest abdo pelvis) b) TOE

Classification system for aortic dissection

Stanford classification (Type A or B)

1st line medical management for aortic dissection

IV labetalol to control BP

2 clinical signs that would support coarctation of the aorta

Radio-femoral delay Ejection systolic murmur (i.e. aortic stenosis)

2 diagnostic tests for coarctation of the aorta

Echo CT aorta

2 ways you could exclude a renal cause of hypertension

U&E Renal USS

2 options for long term management of coarctation of aorta

Conventional open surgery Balloon angioplasty and stent insertion

Bedside investigation to confirm diagnosis of PVD

Ankle-brachial pressure index (ABPI)

3 definitive management options for proximal arterial occlusion in PVD

Bypass graft surgery Angioplasty Stent *leg MI*