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Phase 2b > Cardiovascular revision > Flashcards

Cardiovascular revision Flashcards

(56 cards)

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1
Q

what ECG leads show the right coronary artery

A

aVF, 2, 3

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2
Q

what side of the heart do leads aVF, 2, and 3 represent

A

inferior

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3
Q

what ECG leads represent the left anterior descending artery

A

V1-V4

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4
Q

what side of the heart do leads V1-V4 show

A

anterior and septal

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5
Q

what ECG leads represent the left circumflex artery

A

V5, V6, aVL, 1

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6
Q

what side of the heart do leads V5, V6, aVL and 1 show

A

lateral

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7
Q

what makes the S1 heart sound

A

mitral and tricuspid closure

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8
Q

what makes the second heart sound

A

aortic and pulmonary valve closure

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9
Q

What does S3 heart sound show

A

rapid ventricular filling in early diastole

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10
Q

when is the S3 heart sound normal

A

young/pregnant people

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11
Q

What pathology does the S3 heart sound mean

A

mitral regurg and heart failure

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12
Q

What is the S4 heart sound

A

pathological gallop

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13
Q

what causes the pathological gallop (S4)

A

due to blood forced into stiff hypertrophic ventricle (LVH + aortic stenosis)

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14
Q

what are the two broad categories of ischaemic heart disease

A

angina and MI

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15
Q

what causes central crushing chest pain

A

myocardial ischaemia as a result of reduced flow in the coronary arteries

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16
Q

what are the three categories of angina pain

A

1) central crushing chest pain +/- radiating to neck/jaw
2) brought on by exertion
3) relieved with 5 mins rest or GTN spray

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17
Q

what are the three acute coronary syndromes

A

unstable
NSTEMI
STEMI

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18
Q

what are the levels of ischaemia/infarction in the three types of ACS

A

unstable - severe ischaemia
NSTEMI - partial infarction
STEMI - transmural infarct

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19
Q

what is the QRISK score

A

predicts risk of CVD in 10 upcoming years
(score of 10+ = 10% + risk in next 10 years)

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20
Q

what should be started with a 10+ score in QRISK

A

lipid lowering therapy - statins = primary prevention

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21
Q

what are the 4 types of angina

A

stable
unstable
prinzmetals
decubitus

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22
Q

what is stable and unstable angina

A

stable - normal 3 part definition
unstable - pain at rest, not relieved with GTN or inactivity

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23
Q

what is prinzmetals angina

Study These Flashcards
A

due to coronary vasospasm (not CV vessel atherogenesis)

24
Q

who might have prinzmetals angina

Study These Flashcards
A

cocaine users

25
what would an ECG show in prinzmetals angina
ST elevation
26
what is decubitus angina
induced when patient lies flat
27
risk factors for ischaemic heart disease
obesity T2DM HTN smoking age (older) male FHx cocaine use
28
what are the three steps of atherogenesis
fatty streaks intermediate lesions fibrous plaques (advanced)
29
where does the fatty streak form and in what age group and how does it occur
appears in internal wall less than 10 y/o T-cells and lipid laden macrophages (foam cells)
30
what occurs in the intermediate lesions
foam cells (bigger, taken up lipids), T-cells + vascular smooth muscle cells platelets also aggregate and adhere to site, inside vessel lumen
31
what occurs in the fibrous plaques
large lesions (foam cells, T-cells, smooth muscle, fibroblasts, lipids with a necrotic core) develop fibrosis cap over top of lesion
32
at what percent of lumen occlusion does symptoms of stable angina begin to occur
70-80%
33
symptoms of ischaemic heart disease
central crushing chest pain +/- radiate to jaw/neck nausea sweating fatigue dyspnoeic weak breathing
34
diagnosis for stable angina
1st line -ECG - resting = normal, exercise induced (ischaemic) results in change GS - CT angiography = stenosed atherosclerotic arteries
35
treatment for symptoms of stable angina
GTN sublingual spray
36
lifestyle modifications to treat stable angina
decrease weight stop smoking healthy diet
37
pharmacological treatment for angina
1) CCB (amlodipine) (heart failure = CI) or beta-blocker (bisoprolol)(astham = CI) 2)CCB + Beta-blocker 3) CCB + BB + antianginal - ivabradine or long-acting nitrates
38
what CCB are not appropriate for angina and why
non-rate limiting; can cause excessive bradycardia -not verapamil or diltiazem
39
surgical options for angina (ischaemic heart disease)
revascularisation PCI - balloon stent coronary artery CABG - bypass graft (LAD bypassed by LMA)
40
pros and cons of PCI and CABG
PCI + less invasive, - risk of stenosis CABG + better prognosis, - more invasive
41
what are the two types of MI and what causes them
type 1 - IHD type 2 - increase demand or cavasospasm
42
what are the three categories for ACS
unstable angina NSTEMI STEMI
43
what are the ECG changes seen after an MI
hyperacute T waves pathologically deep Q waves LBBB
44
What is the occlusion, infarction, ECG and trop and creatine kinase status in unstable angina
partial occlusion of minor coronary artery no infarction, ischaemia only normal ECG - maybe some ST depression / T wave inversion No trop/CK change
45
What is the occlusion, infarction, ECG and trop and creatine kinase status in NSTEMI
major / partial occlusion of total minor coronary artery sub-endothelial infarction (area far away from CA occlusion dies) ECG shows ST depression and T wave inversion and no Q waves Elevated trop
46
What is the occlusion, infarction, ECG and trop and creatine kinase status in STEMI
total occlusion of major CA there is transmural infarction ST segment elevation in local leads + Q waves elevated trop and CK due to infarction
47
is trop or CK a better marker for ACS
trop has a shorter half-life and may be better a few days after event
48
symptoms of ACS
same as stable angina, but pain is at rest and not relievable palpitations and may be more severe
49
diagnosis of ACS
ECG biomarkers CT angiogram - shows extent of occlusion
50
acute treatment of ACS episode
morphine O2 (if sats <94%) GTN aspirin (300mg) clopidogrel (75mg)
51
what is the GRACE score
mortality risk of patients with ACS from MI (w/in 6 months-3years)
52
what to do in a NSTEMI/unstable angina with a high risk GRACE score
immediate angiogram + consider PCI
53
STEMI treatment
PCI - w/in 12 hours of symptom onset / <2 hours of first medical contact thrombolysis if >12hours with alteplase
54
what can be used in long term prevention for ACS
beta-blocker (life) aspirin (300mg, then 75mg for life) atorvastatin (80mg life) ACE-i (life) clopidogrel (75mg for 12mnths)
55
complications of ACS
short term - HF due to vent fibrillation, mitral incompetence, LV free wall rupture, cardiogenic shock longer than 2 wks - dressler syndrome (autoimmune pericarditis), HF, LV aneurysm, heart literally becomes saggy
56

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