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Finals!!! > Cardiovascular > Flashcards

Cardiovascular Flashcards

(48 cards)

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1
Q

Pericarditis presentation

A
  • Central chest pain worse lying flat
  • ?Fever
  • ?Pericardial rub
  • ECG- saddle shaped
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2
Q

Diastolic Murmurs

A
  1. Aortic Regurg
  2. Mitral Stenosis
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3
Q

Heart Failure Management

A
  • Acute- sit up, morphine, GTN, furosemide, NIV
  • ACEi/ ARB, Aspirin, Atorvastatin, Beta blocker, Diuretic
  • Avoid NSAIDs, CCB!
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4
Q

Features of Aortic Stenosis

A
  • Murmur- upper R sternal border –> carotids. Systolic crescendo-decrescendo
  • Sx Triad- Chest pain, SOB, syncope
  • Cause- esp senile calcification
  • Tx- valve replacement
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5
Q

Features of Mitral Regurgitation

A
  • Murmur- Apex –> axilla. Pansystolic rumble. S
  • x- palpitations, SOB
  • Causes- senile, infectiove endocarditis, marfans
  • Tx- valve replacement
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6
Q

Syncope differentials

A
  • Orthostatic BP- hypovolaemia, drug induced, PD, diabetic neuropathy
  • Neurally mediated- Carotid sinus sensitivity, situational
  • Neurocardiogenic- vasovagal
  • Cardiac- arrhythmias
  • Cardiac- structural
  • Cardiocascular- MI, PE, aortic dissection
  • Non-syncopal- CVA, metabolic, epilepsy, intoxication, falls
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7
Q

Heart Failure CXR findings

A
  • Alveolar oedema (bats wings)
  • kurley B lines
  • Cardiomegaly
  • Dilated upper lobe vessels
  • Effusion (pleural)
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8
Q

Management of ACS

A
  1. ABCDE
  2. Morphine + metoclopramide
  3. Aspirin 300 mg 1 dose –> 75mg
  4. GTN spray
  5. Clopidogrel/ ticagrelor
  6. LMWH- Fundoparineux
  7. Revascularisation- PCI/ CABG
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9
Q

Hypertensive Crisis and Tx

A
  • Hypertensive crisis= BP >200/120
  • Absence of end organ damage –> PO
  • End organ damage –> IV hydralazine/labetalol/nitroprusside/ GTN
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10
Q

Pericarditis treatment

A

NSAIDs, colchicine

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11
Q

Wolf-Parkinson-White ECG

A

Short PR interval and delta wave

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12
Q

Degrees of Heart Block and ECG features

A
  • 1st- Consistently prolonged PR
  • 2nd degree Mobitz 1- PR progressively lengthened –> dropped QRS
  • 2nd degree Mobitz 2- Prolonged PR, QRS regularly dropped
  • 3rd degree- no relation between p waves and QRS ==> Tx: pacemaker
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13
Q

Features of cardiac syncope

A
  • Sudden onset and recovery
  • No prodrome
  • Sx- palpitations, SOB, chest pain FHx????
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14
Q

Infective Endocarditis management

A
  • ABx- ampicillin + flucloxacillin + gentamicin IV
  • Surgical debridement/ valve replacement
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15
Q

Types fo ACS

A
  • Unstable Angina
  • NSTEMI
  • STEMI
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16
Q

Causes of sudden cardiac death

A
  • Coronary artery disease
  • Cardiomyopathies- Dilated, hypetrophic (children/athletes), restrictive, arrhythmogenic R ventricular cardiomyopathy
  • Inherited arrhythmia syndromes- long QT, CPVT
  • Valvular heart disease
  • Channelopathies eg Brugada syndrome
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17
Q

What is this ECG?

A

Atrial Fibrillation

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18
Q

Heart Failure Ix

A

ECG, BNP, ECHO

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19
Q

Symptoms of RHF

A

PeRipheral Oedema:

  • Ankle swelling
  • Ascites
  • Nausea
  • Anorexia
  • Facial engorgement
  • Epistaxis
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20
Q

Signs of familial hyperlipidaemia

Study These Flashcards
A
  • Tendon xanthoma
  • Corneal arcus
  • Xanthelasma
  • Palmar xanthoma
  • Tuberoeruptive xanthoma
  • Eruptive xanthoma
  • Lipaemia retinalis
21
Q

Narrow complex tachycardias + Tx

Study These Flashcards
A
  • AF –> beta blocker/ diltiazem –> digoxin –> amiodarone
  • SVT –> vagal manoevers –> adenosine 6mg –> 12mg –> 12mg Atrial flutter –> HELP! and beta blocker
22
Q

Treatment of bradycardia

Study These Flashcards
A
  • Atropine 500 micrograms IV (repeat max 3mg)
  • Isoprenaline
  • Adrenaline
  • Transcutaneous pacing
23
Q

What is the Cushing’s reflex?

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A

Raised ICP –> bradycardia and hypertension

24
Q

Features making SVT more likely than sinus tachycardia

Study These Flashcards
A
  • ++HR and drops suddenly
  • Rate doesn’t vary with respiration
  • Hard to see p waves
  • Responds to vagal manoevers
  • ++ Sx and palpitations
25
Broad complex tachycardias + Tx
* VT --\> amiodarone/ D/C cardioversion. PULSE? * AF with BBB * Torsades de Pointes --\> Magnesium 2g IV over 10mins
26
Presentation of Infective Endocarditis
* New heart murmur * Fever + signs of sepsis * Immune complex deposition- vasculitis, AKI, glomerulonephritidies, Roth spots, splinter haemorrhages, osler nodes * Embolic phenomena- Abscesses, janeway lesions
27
Infective Endocarditis diagnostic criteria
Dukes: * Major: +ve blood culture x2, + ECHO * Minor: Predisposed, Fever \>38, Vascular/ immunological signs, +ve blood culture/ ECHO that don't meet criteria. * Dx: 2x major OR 1x major and 3x minor OR 5x minor
28
What is QRISK2?
* 10 year CVD risk. \>10% --\> treat with statins. Involves: * Age * Sex * Ethnicity * Post-code * Smoking status * DM * MI * \<60y * CKD * BP * RA * BMI
29
MI Diagnostic criteria
Troponin 99th Percentile + rise or fall of 20% and 1 of the following: 1. Ischaemic Sx 2. ECG- ST elevation/ new LBBB 3. ECG- pathological Q wave 4. Imaging- loss of viable myocardium 5. Angiography- intracoronary thrombus
30
Hypertension Stages
1. \>140/90 (135/85) 2. \>160/100 (150/95) 3. \>180/110. EMERGENCY
31
Features of Aortic Regurgitation
* Murmur- LSE, ++ leaning forward. Early diastolic decrescendo. * Sx: SOB, collapsing pulse, palpitation, syncope * Causes: Infective endocarditis, Marfan's * Tx: ACEi, valve replacement
32
Symptoms of LHF
PuLmonary Oedema: * SOB, orthopnoea, PND * Poor exercise tolerance * Nocturnal cough +/- pink frothy sputum * Cold peripheries * Weight loss
33
Definition of Hypotension
SBP \<100 mmHg
34
Types of Hyperlipidaemia
* Common primary (70%) * Familial primary hyperlipidaemia * Secondary hyperlipidaemia- Cushing's, hypothyroid, nephrotic syndrome, renal failure, drugs eg corticosteroids
35
Systolic Murmus
* Aortic Stenosis * Mitral Regurg
36
Target BP
* \<80y= 140/90 * \>80y= 150/90 * Established CVD, DM + kidney/eye disease= 130/80
37
Secondary causes of hypertension and Ix
* Renal artery stenosis --\> urine dip * Phaeochromocytoma --\> urine catecholamines and plasma metanephrines * Conn's * Thyroid dysfunction --\> TFTs * Acromegaly --\> IGF-1 * Cushings --\> urinary free cortisol and dexamethasone suppression * Obstructive Sleep apnoea
38
Treatment of hyperlipidaemia
* 1st = lifestyle * 2nd= atorvastatin * 3rd= fibrates
39
ACS Post-Hospital discharge
* ACEi/ Aspirin * Beta blockers/ BP\<140 * Cholesterol (atorvastatin) * Diet/ Diabetes control/ Driving (stop 1-4w) * Education/ Exercise * Cardio rehab
40
Rheumatic Fever management
Bed rest, analgesia, Ben Pen
41
Definition of postural hypotension
BP drop \>20/10mmHg measured 1 min after standing from lying position
42
Features of Mitral Stenosis
* Murmur- Apex, ++ rolling patient to side. Mid-diastolic rumble. * Sx: SOB, malar flush, haemoptysis, chest pain, palpitations * Causes: Esp rheumatic fever * Tx: AF control, diuretics, valve replacement
43
Time course of Rheumatic fever
Pharyngeal infection with Strep --\> RF 2-4w later
44
AF management
* Rhythm control \<48h- D/C electrical shock or amiodarone/ flecainide * Rate control- beta blocker/ CCB (verapmil, diltizem) * Anticoagulation based on CHA2DS2VASc and HASBLED
45
Tachyarrhythmia + adverse features action
D/C shock x3 --\> Amiodarone 300mg --\> Repeat shock --\> Amiodarone 900mg over 24h
46
Treatment of Hypertension
1. \<55y= ACEi/ ARB \>55y or Afro-Caribbean= CCB eg amlodipine (hydralazine for Afro-Caribbean) 2. ACEi + CCB 3. ACEi + CCB + Thiazide diuretic 4. ACEi + CCB + Thiazide diuretic + Increase dose of diuretic/ switch diuretic, or add beta blocker
47
Management of angina pectoris
1. Stop CVS RF 2. 75mg aspirin 3. PRN GTN (2x --\> ambulance) 4. Antianginals: beta blocker/ CCB --\> isosorbide mononitrate 5. Revascularisation
48
Causes, features, Ix, Tx of cardiac tamponade
* Causes- trauma, lung/ breast Ca, MI, pericarditis * Signs: * Pulsus paradoxus * Beck's triad- falling BP, rising JVP, muffled HS * Raised JVP on inspiration * Ix: * ECG- electrical alternans * CXR- globular heart * ECHO diagnostic * Tx: pericardiocentesis ASAP!

Finals!!! (19 decks)

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