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S&P - Cardiovascular > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Give some differential diagnoses for chest pain. Which two of these are associated with pleuritic pain?

A

Acute Coronary Syndromes (presenting with crushing chest pain), Myocarditis (sharp but variable pain) Aortic dissection (tearing sudden onset chest pain radiating to the back) Pulmonary embolism (pleuritic chest pain worse on inspiration and movement)
Pneumothorax (pleuritic sudden onset pain)
Reflux (pain mimicking MI)

Both Pneumothorax and PE are associated with pleuritic pain

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2
Q

What can a Chest X-ray show for Aortic dissection?

A

Widened mediastinum

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3
Q

Briefly describe the utility of the D-dimer assay.

A

Useful in ruling out (when result is negative) PE in patients whose clinical history shows a low pre-test probability of PE. However, the test is has a low PPV D-diner can also be raised in sepsis and stroke

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4
Q

What is the first line investigation in Acute Coronary Syndromes?

A

ECG

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5
Q

If there is no ST elevation, what can be used to distinguish NSTEMI from Unstable Angina Pectoris?

A

Troponin, positive in NSTEMI and negative in Unstable Angina Pectoris

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6
Q

Give 3 indicators of high risk in NSTEMI patients

A

ST depression
Haemodynamic/rhythm instability
Diabetes mellitus

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7
Q

How is ST elevation defined?

A

> 0.1mV (2mm) in 2 adjacent limb leads

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8
Q

Give 5 risk factors for PE

A 
Recent surgery 
Thrombophilia
Long haul flight/immobility
Previous PE
Active cancer
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9
Q

What is the definitive treatment in ACS, and what are the two main methods?

A

Revascularisation (surgery)

  • Coronary Angioplasty
  • Coronary Artery Bypass Graft (CABG)
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10
Q

Rank the 3 common Achte Coronary Syndromes in terms of severity

A

STEMI>NSTEMI>UAP

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11
Q

How is Aortic dissection classified? What is the gold standard test?

A

Type A: dissection of ascending aorta
Type B: dissection of descending aorta.

Gold standard test is CT aortogram

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12
Q

Describe the pathophysiology of Aortic dissection and give 3 risk factors.

A

The tunica intima tears due to a pre-existing abnormality, causing blood to accumulate in the false lumen. In Type A, blood supply to the head and neck is compromised, increasing stroke risk. In Type B, kidney perfusion is impaired. Risk factors include Hypertension, trauma and Marfan’s syndrome

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13
Q

What heart sound is diagnostic of pericarditis?

A

Pericardial rub

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14
Q

What ECG change do you get in pericarditis?

A

ST segments are saddle shaped

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15
Q

Why is troponin elevated in myocarditis?

A

Inflammation (as well as infarction) can increase troponin.

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16
Q

State the main regular narrow complex tachycardias and irregular narrow complex tachycardias

A

Regular:
AVRT
AVNRT

Irregular:
AF

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17
Q

A patient has a broad complex tachycardia. Which part of the heart is likely affected? (Top/bottom)

A

Bottom

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18
Q

What is given in the short-term management of all regular narrow complex tachycardias?

A

Adenosine

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19
Q

A patient was found to be tachycardic and unstable. What is the immediate management? Soon after they present with an acute onset of AF. Under what two circumstances will the patient require the same treatment as above?

A

Electrical cardioversion.

First circumstance: acute onset <24 hours allows cardioversion

Second circumstance: If AF persists despite more than 3 weeks of pharmacological treatment including anticoagulation, cardioversion can also be used.

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20
Q

For Atrial flutter, what is the key ECG feature?

A

Saw-tooth pattern

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21
Q

Describe the rhythm control treatment in irregular narrow complex tachycardias in harmodynamically stable patients

A

If underlying structural heart disease -> Amiodarone.

If no structural heart disease -> Flecainide

22
Q

Briefly describe the utility of the CHA2DS2-VASc score. What do the H, A and D stand for?

A

A score used to estimate the risk of someone in Atrial Fibrillation of having a stroke. Anyone with a score>1 should be anti-coagulated.
H - Hypertension
A - Age
D - Diabetes

23
Q

A patient has 3rd degree complete heart block. What is the emergency treatment, and what is the definitive treatment?

A

Emergency: atropine and transcutaneous pacing

Definitive: pacemaker

24
Q

What is the main cause of mortality in AF patients?

A

Stroke

25
Q

In 10% of people, the ______________ artery is dominant in the inferior wall of the heart, but in most there is a dominant ___________ artery. The largest artery is the __________ artery which supplies the ___________.

A

Circumflex coronary artery
Right coronary artery
Left Anterior Descending (LAD)
Anterior wall

26
Q

Summarise the criteria for diagnosis of STEMI

A

ST elevation by 0.1mV in 2 adjacent leads V1-3 and LBBB with QRS > 130ms absent W waves in I, V5 and V6

27
Q

How can a posterior infarct be localised?

A

ST elevation in V7-9 (additional leads formed by pleading V4-6 on the back) and ST depression in V1-3 (mirroring V7-9)

28
Q

Briefly describe the epidemiology of normal variant infarct mimics, in terms of age and ethnicity

A

Decrease in prevalence with age.

Found in Afro-Caribbeans

29
Q

How does normal variant ST elevation differ from true infarct ST elevation?

A

Normal Variant ST elevation tends to be concave on ECG, whereas pathological ST elevation tends to be convex

30
Q

In immediate management of acute MI, what intervention had replaced fibrinolysis?

A

PCI (Primary Coronary Intervention)

31
Q

Give 3 situations when Coronary angiography is contraindicated

A

In patients with unexplained fever, severe anaemia or severe coagulopathy

32
Q

Summarise the Ischaemic cascade, giving details of the ECG changes

A

Initially perfusion abnormality, then diastolic dysfunction, then systolic dysfunction, then ECG changes, then Angina.

ECG changes: Hyperacute T-waves, then ST elevation (convex) then Pathological Q-waves, then loss of R waves, then T-wave inversion

33
Q

In which differential for chest pain is contrast MRI especially useful?

A

Myocarditis, because this can cause chest pain, ECG changes and troponin rise, but the coronary arteries will crucially be normal on MRI

34
Q

In Type II MI the aim is to treat the underlying cause. What could cause a) decreased supply, or b) increased demand, in Type II MI?

A

a) Blood loss

b) Tachycardia due to sepsis

35
Q

In severe Aortic stenosis, valve area is greater than _____ and peak velocity is greater than _____ .

A

1cm3

4m/s

36
Q

Give 2 common causes of Aortic stenosis and regurgitation. Give 1 distinguishing cause for each.

A

Bicuspid and infective endocarditis can cause both stenosise and regurgitation.

Calcification causes stenosis, whereas Rheumatic Heart Disease causes regurgitation.

37
Q

What is the definitive treatment for Aortic valve defects?

A

Percutaneous intervention with Transcatheter Aortic Valve Implantation (TAVI)

38
Q

What scoring system is used to decide which patients will receive surgical intervention for TAVI?

A

The Euroscore

39
Q

Mitral valve defects are more/less common than Aortic valve defects

A

Less

40
Q

A patient has Aortic regurgitation. What do you expect to find on examination? What about if they had mitral regurgitation?

A

High volume pulse, diastolic murmur, signs of heart failure.

Mitral: pansystolic murmur, diastolic apex beat, atrial fibrillation.

41
Q

What are the symptoms and signs of mitral stenosis? Give 3 of each.

A

Symptoms:
Breathlessness, palpitations, haemoptysis.

Signs:
Diastolic murmur, loud first heart sound, atrial fibrillation

42
Q

Mitral stenosis and regurgitation share which sign? How do their murmurs differ?

A

Both share atrial fibrillation. Regurgitation murmurs are pansystolic whereas stenosis murmurs are diastolic

43
Q

Briefly describe the epidemiology of heart failure

A

Prevalence and incidence increases with age, and there is a poor prognosis of 50% 5 year mortality

44
Q

Which type of chronic heart failure has better outcomes with treatment?

A

Systolic HF (HFrEF)

45
Q

What is the main cause of heart failure?

A

Ischaemic heart disease

46
Q

What is the most specific a) sign, and b) symptom, of heart failure?

A

a) third heart sound

b) oedema

47
Q

What is the most effective treatment for end-stage (IV) heart failure?

A

Heart transplant

48
Q

A patient has heart failure. What 3 features would you expect to find on a chest X-ray?

A

Cardiothoracic ratio>50%
Pleural effusion
Upper love diversion (increased size of upper love vessels)

49
Q

In heart failure patients, what do pathological W waves indicate?

A

That the cause of their heart failure is likely Ischaemic heart disease with previous MI

50
Q

What is the stimulus for BNP release? What does BNP stand for?

A

Ventricular stretch

B-type Natriuretic Peptide

S&P - Cardiovascular (1 decks)

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