Cardiovascular Flashcards
(98 cards)
1
Q
what are clinical signs of unstable angina?
A
Chest pain with increasing frequency
Can occur at rest
Can have a fourth heart sound
2
Q
what are differentials of pleuritic chest pain?
A
- pleurisy
- pneumothorax
- pneumonia
- pericarditis
- PE
3
Q
what are risk factors of coronary artery disease?
A
- male over 60
- smoking
- hypertension
- high LDL/ low HDL
- diabetes
- inactivity
- obesity
- family history
- drug use
4
Q
what are symptoms of an acute MI?
A
- chest pain that can radiate to the left arm or jaw
- dyspnoea
- pallor
- hypotension
- tachycardia
- dizzy
5
Q
how can a MI be diagnosed?
A
- risk factors
- ECG
- troponin
- angiogram
6
Q
what is the immediate management for MI?
A
- pain relief (morphine and an anti emetic)
- oxygen
- aspirin
7
Q
what is the further management of a stemi?
A
- PCI if they present within 12 hours of onset and can get PCI within 120 minutes
- if PCI can’t be given within 120 minutes then fibrinolytic treatment/thrombolysis
8
Q
in MI when PCI can’t be offered what is often used for thrombolysis?
A
alteplase
reteplase
9
Q
what ECG leads are for the anterior section of the heart?
A
V1-V4
10
Q
what coronary artery supplies the anterior section of the heart?
A
left anterior descending
11
Q
what coronary artery supplies the inferior section of the heart?
A
right coronary artery
12
Q
what leads correspond to the inferior section of the heart?
A
- II,III, AVF
13
Q
what leads correspond to the lateral aspect of the heart?
A
- V5-V6
14
Q
what artery supplies the lateral aspect of the heart?
A
- left circumflex
15
Q
what leads correspond to the posterior heart?
A
V8,9
16
Q
What supplies the posterior heart?
A
right circumflex
17
Q
what long term primary care drug therapy can be given after MI?
A
ACE inhibitor
dual antiplatelet therapy: ticagrlor with aspirin
beta blocker
statin
18
Q
what is the P wave of an ECG?
A
- atrial depolarisation
19
Q
what is QRS of an ECG?
A
- depolarisation of the ventricles
20
Q
what is ST of an ECG?
A
- the plateu of an action potential
21
Q
what is the T wave of an ECG?
A
repolarisation
22
Q
what is the cause of a bifid P wave in lead II?
A
P.mitrale caused by mitral stenosis
23
Q
what is the ECG change in first degree heart block?
A
- a fixed PR interval over 0.2
24
Q
what is the ECG change in mobitz I?
A
a gradual increase in the PR interval then it drops
25
what is the ECG change in mobitz II?
PR interval is constant then drops at random
26
what change shows an ECG 'saw tooth' pattern?
Atrial flutter
27
what are delta waves a sign off?
wolff Parkinson white
28
what chest pain can be reported by someone with arrhythmias?
- palpitations
- chest pain
- syncope
- hypotension
- pulmonary oedema
29
what is AVNRT?
- a supraventricular tachycardia
| There is a re-entrant loop in the node itself that can send impulses up into the atria or down into the ventricles.
30
what can terminate AVNRT?
vagal discharge
31
what is AVRT?
- a supraventricular tachycardia
- an accessory pathway so two circuits are running.
Normal pathway via AVN and the accessory pathway.
32
what are clinical features of the supra-ventricular tachycardias? (AVNRT and AVRT)
```
rapid palpitations
anxiety
dizzy
central chest pain
weakness
polyuria
```
33
what are causes of atrial fibrillation?
- alcohol
- pneumonia
- hyperthyroidism
- PE
- mitral valve pathology
- pulmonary hypertension
34
what are extrinsic causes of sinus bradycardias?
- hypothermia
- hypothyroidism
- cholestatic jaundice
- raised intracranial pressure
- beta blockers
35
what are intrinsic causes of sinus bradycardias?
- acute ischaemia
| - chronic degenerative changes
36
what are causes of complete heart block?
- autoimmune; SLE
- structural heart disease ; transposition of the great vessels
- levs disease
- lenegres disease
- acute MI
- ischaemic cardiomyopathy
- calcific aortic stenosis
- digoxin, beta blockers, calcium channel blockers
endocarditis, lyme disease
37
what are causes of general bradycardias?
D- drugs (aantiarrythmics, beta blockers, calcium channel blockers, digoxin
I- ischaemic/ infection
V- vagal hypertonia (athletes, vasovagal syncope, carotid sinus syndrome
I- infection: viral myocarditis, rheumatic fever, infective endocarditis
S- sick sinus syndrome
I- infiltration/ restrictive. autoimmune, sarcoid, haemochromatosis, amyloid, muscular dystrophy
O- hypothyroidism, Hypokalaemia, hypothermia
N- neuro; raised ICP
38
what is the pattern in an ECG of ventricular tachycardia?
Broad complex tachycardia (tomb stone)
39
what is the management of heart block?
asymptomatic and over 40bpm- no need for treatment
symptoms and below 40bpm- atropine
no response with atropine; pacing wire
40
what is the management of AVNRT?
- adenosine
- vagal discharge
symptom relief: beta blockers, calcium channel blockers.
last line: ablation
41
what is the treatment of AVRT?
- Adenosine
- atrial pacing
- catheter ablation
42
what is the management for wolf Parkinson white?
- procainamide
| - if hypotension cardiovert
43
what is the management of AF?
- coagulation
- rate control
- rhythm control
- cardioversion if unstable
44
what can be used in rhythm control in AF?
- amiodarone
- flecainide
- cardioversion
- ablation
45
what can be used for rate control in af?
- beta blocker
| - calcium channel blocker
46
what is given for ventricular tachycardia?
- NOT verapamil
| - amiodarone or lidocaeine
47
what is given for atrial flutter?
- vaso-vagal activity
| - adenosine
48
what bradycardias are recommended elective permanent pacing?
- mobitz II
third degree heart block
AF
sick sinus syndrome
49
what is the CHADSVASC score?
```
Congestive heart failure
Hypertension
Age over 75
Diabetes.M
Stroke/ TIA/ thromboembolism
Vascular disease
Age 65-74
Female
```
50
what is the CHADVASC score used for?
assessing need for anti coagulation
51
what are signs of left sided heart failure?
- shortness of breathe
- orthopnea
- pulmonary oedema
- displaced apex beat
- fine end inspiratory crackles
- dull lung bases
52
what are causes of left sided heart failure?
- coronary artery disease
- hypertension
- idiopathic
- valve disease
53
what valves can cause left sided heart disease?
mitral and aortic
54
what are signs of right ventricular failure?
- increased JVP
- oedema
- ascites
55
what are causes of right sided heart failure?
- left sided heart failure
- pulmonary hypertension
- right ventricular cardiac myopathy
- tricuspid valve disease
- cor pulmonale
- pulmonary valve disease
56
what valves are linked to right sided heart failure?
- mitral
| - pulmonary
57
what are the major criteria in the Framingham criteria?
- paroxysmal nocturnal dyspnoea
- neck vein distension
- cracles
- cardiomegaly
- acute pulmonary oedema
- S3 gallop
- increased CVP
- hepatojugular reflex
- weight loss
58
what are the minor criteria in the Framingham criteria?
- bilateral ankle oedema
- nocturnal cough
- dyspnoea on normal exertion
- hepatomegaly
- pleural effusion
- decrease in vital capacity by 1/3
- tachycardia
-
59
what is the Framingham criteria for?
the diagnosis of congestive heart failure. Need 2 major criteria of 1 major and 2 minors
60
what is the class of one of new York heart association classification of heart failure?
- Class one: no limitations. normal physical exercise doesn't cause fatigue, dyspnoea or palpitations
61
what is the class two of new York heart association?
Mild limitation. comfortable at rest but normal physical activity causes fatigue, dyspnoea or palpitation
62
what is the class three of the new York classification of heart failure?
Marked limitation. comfortable at rest but gentle physical activity produces marked symptoms of heart failure
63
what is the class four of the new York classification of heart failure?
symptoms of heart failure occur at rest and made work by physical activity
64
what drugs improve symptoms in heart failure?
Antiemetic
| loop diuretics
65
what drugs improve survival in heart failure?
ACE inhibitor
BETA blockers
spironolactone
vasodilators: hydralazine isosorbide dinitrate
66
what is the emergency management of a patient with heart failure?
- IV access
- sit up
- oxygen
- diuretics
- morphine to reduce preload
- anti emetics
- nitrates
- ionotropes
67
what are the xray signs of congestive heart failure?
- alveolour shadowing
- kerley b lines
- cardiomegaly
- upper lobe diversion
- effusion
- fluid in the fissures
68
what are indications for ACE inhibitors?
- first/ second line treatment for hypertension
| - first line for heart failure
69
how do ACE inhibitors work?
- prevent formation of angiotensin II (a vasoconstrictor)
- no AG II means no aldosterone
- sodium and water excretion
70
what are side effects of ACE inhibitors?
hypotension
persistant dry cough
hyperkalaemia
71
what are indications for beta blockers?
- first line in ischaemic heart disease
- first line in chronic heart failure
- first line if AF
- first line in supraventricular tachycardia
72
where are beta 1 receptors found?
the heart
73
what patients shouldn't be given beta blockers?
ASHTMA
74
what are the lub dub heart sounds?
S1- closure of mitral and tricuspid
| S2- closure of aortic and pulmonary valves
75
what are the systolic murmurs?
```
Aortic stenosis (late in systole)
Mitral regurgitations
```
76
what are the diastolic murmurs?
aortic regurgitation
| mitral stenosis
77
what are signs of aortic stenosis?
- ejection systolic murmur
- crescendo decrescendo murmur
- narrow pulse pressure
- S4
- systolic thrill
78
what are signs of an aortic sclerosis?
- valve thickening
- doesn't radiate to the carotids
- ejection systolic murmur
- slow rising pulse
- no thrill heard
79
what are signs of mitral regurgitation?
- pan systolic murmur
- pulmonary oedema
-
80
what are signs of tricuspid regurgitation?
- same symptoms as right sided heart failure
- palpable liver
- blowing pansystolic murmur
81
what is S3?
normal under 30 years
| also in left ventricular failure, constrictive pericarditis, mitral regurgitation.
82
what is S4?
atrial contraction against a stiff ventricle. heard in aortic stenosis
83
what is the pathology in anaphylaxis?
An IgE mediated activation of mast cells leading to release of multiple factors.
84
what are the main mediators in anaphylaxis?
- histamine
| - prostaglandin D2
85
what causes the later reaction in anaphylaxis?
IL5
86
what is the most common cause of obstructive shock?
PE leading to RV failure.
87
what are features of hypovolaemic shock?
- decreased skin turgor
- dry skin
- dry tongue
- oral mucosa
- postural hypotension
- decreased JVP
- increased vascular resistance
- cold peripheries
- slow cap refill
88
what are features of septic shock?
- hypotension even after fluid resuscitation
| - decreased vascular resistance
89
what are features of anaphylactic shock?
- facial, tongue or throat swelling
- stridor
- wheeze
- syncope
- high mast cell tryptase
- decreased vascular resistance
90
what types of shock have decreased vascular resistance?
- septic shock
| - anaphylaxis shock
91
what types of shock have high CVP?
- cardiogenic shock
92
what types of shock cause low central venous pressure?
- hypovoelamic shock
- anaphylactic shock
- septic shock
93
what are complications of a massive blood transfusion?
- temperature change causing hypothermia, vasoconstriction and arrhythmia
- coagulopathy as it has no platelets or clotting factors
- hypocalcaemia as the citrate binds calcium
- increased oxygen affinity due to reduced 2,3DBG content
- hyperkalaemia
- microemboli
94
large blood transfusions can cause coagulopathy what can be given?
fresh frozen plasma
| platelet concentrates
95
what is given in fluid resuscitation?
0.9% sodium chloride 500ml over 15 minutes
96
what are properties of crystalloids?
- made up of smaller molecules
- good for volume expansion
- leave the vascular space
97
what does ventricular fibrillation look like on an ECG?
- no p wave
- highly irregular
- no qrs clear complexes
98
what are two shockable rhythms?
- VT
| - VF
