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Leila PACES > Collapse/Chest pain consultation > Flashcards

Collapse/Chest pain consultation Flashcards

(46 cards)

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1
Q

DDx collapse/ black out

A

Cardiac: arrhythmnia, sarcoid, lyme disease, post-op SAVR (complete heart block), obstructive cardiac lesion: AS, MS, HCM

Neuro: epilepsy, stroke, EtOH, Hypoglycaemia, vertebrobasilar insufficiency, SAH

Orthostatic/postural Hypo

Vasovagal (neurocardiogenic/ neurally mediated)

Psychogenic non-epileptic spells, anxiety, FND

ANAEMia

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2
Q

which conditions can cause heart block

A

Sarcoid
Lyme disease

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3
Q

What is important to ask about in social history

A

driving
Job (swimming pools/ heavy machinery etc)
If they have baths

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4
Q

Which systems would you examine

A

Focussed cardio - arrhythmia? valvular disease? Pacemaker/ICD scars? LSBP

Focussed neuro - fundoscopy, pronator drift, UMN signs, parkinsonian features

Signs of diabetes

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5
Q

what is considered a postural drop

A

> 20/10mmhg difference

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6
Q

what could help distinguish if vasovagal

A

precipitating factor like stress, cough, micturation, defecation

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7
Q

3 P’s in collapse history

A

Provocation

Posture

Prodrome

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8
Q

collapse after sudden head turning/ looking up

A

vertebrobasilar insufficiency

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9
Q

if syncope occured whist lying/sitting, what does this point more towardsd?

A

cardio cause

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10
Q

associated symptoms to ask for in collapse

A

chest pain, SOB, palpitations
headache, tongue biting and incontinence
aua/ deja vu, anxiety, olfactory sx, paraesthesia

light headedness/dizziness, tunnel vision, tinnitus (vasovagal/orthostatic)

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11
Q

why is alcohol history important in patients with syncope

A

alcohol withdrawal can cause seizures

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12
Q

Ix in collapse case

A

Bedside
Obs, LSBP, BM
12-lead ECG +/- holter

Bloods: FBC, UE, LFT, TFT, Hba1c, bone profile and electrolytes

Special
Echo
Implantable loop recorder
EEG if neuro and /or CT/MRI brain

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13
Q

Management if cardiac cause

A

Pacemaker, ICD, revascularisation and valvular surgery

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14
Q

VAsovagal mx

A

Patient education on avoidance of precipitants

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15
Q

Orthostatic hypotension mx

A

salt and fluid intake
support stockings
medication re iew with GP
Occasionally would be suitable for fludrocortisone or midodrine

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16
Q

cardio red flag features

A

syncope during exercise
FH sudden cardiac death

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17
Q

why may you get collapse with diabetes

A

hypo
autonomic neuropathy in advanced disease

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18
Q

meds history

A

any drugs which prolong QTc
any diuretics
any anti hypertensives

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19
Q

important q in a young female with collapse

20
Q

MODES OF CHEKCING RHYTHM

Study These Flashcards
A

ECG/telemetry/24hour tape/72hour/7 day tape/reveal device (implantable loop recorder)

21
Q

syndromic facies + collapse

Study These Flashcards
A

?MD with complete heart block

22
Q

causes of chest pain per system

Study These Flashcards
A

Cardio:
ACS
Stable angina
Pericarditis
Aortic dissection
Heart failure

Resp
PE
PTX
Pneumonia
cOPD/Asthma
Lung cancer

Gastro
GORD
PUD
Pancreatitis
Oesophageal rupture

Other
Costochondritis
RhA
Ankylosing spondylitis
Substance misuse
Shingles

23
Q

abstain from driving for how long post MI?

Study These Flashcards
A

4 weeks if no treatment
1 weeks if treated with PCI

24
Q

abstain for how long post TIA?

25
group 2 post MI/TIA
6 weeks
26
chest pain, difference in BP, new EDM, neurology
aortic dissection
27
trop in unstable angina vs NSTEMI/STEMI
Not raised in UA
28
initial investigations in suspected cardiac sounding chest pain
Obs and BM 12 lead ECG CXR Troponin FBC UE LFT Coag fasting lipids and glucose
29
Mortality scores used to risk stratify patients with ACS
GRACE and TIMI
30
secondary prevention in ACS
Statins Angiotensin-converting enzyme inhibitor Beta blocker Control of cardiovascular risk factors: smoking, diabetes, hypertension, dyslipidaemia
31
Special tests in angina investigation
CTCA Cardiac catheterisation Functional imaging
32
treatment of stable angina
conservative: lifestyle measures like smoking cessation, stop alcohol, exercise, weight loss medical GTN spray (one dose and can repeat 5 mins later) Aspirin 75mg OD High dose statin ACEi Anti-anginals: BB/CCB If refractory can try long acting nitrates/ nicorandil/ivabradine surgical coronary revascularisation (CABG or percutaneous angioplasty)
33
angina and sexual activity
okay as long as they can go up 2 flights of stairs without getting breathless/chest pain, can take GNT spray 10 mins before Avoid drugs like sildefanil within 12 hours of taking nitrate Any pain during sex to stop
34
how would you explain angina to a patient?
inadequate oxygen supply to heart muscle causing pain /mismatch between oxygen delivery and demand to heart muscle due to ischaemia - caused by atherosclerosis
35
should you give aspirin to patient who has stable angina and peripheral vascular disease
no not needed if already taking clopidogrel
36
STEMI management
1) 300mg aspirin (morphine, metoclopramide, GTN) 2) check eligibility for reperfusion therapy (PCI or fibrinolysis) 3) if eligible -> PCI if < 120 mins or fibrinolysis > 120 mins 4) If PCI, also give prasugrel/ticagrelor, Clopi if already on OAC. 5) If fibrinolysis give ticagrelor. If ongoing MI/ ECG changes following this for consideration of PCI
37
STEMI management if not eligible for reperfusion therapy
Aspirin + ticagrelor/clopi Cardio review Secondary prevention and cardiac rehab
38
what timings have to be met to be offered reperfusion therapy in SETMI
<12hours of sx onset and PCI can be delivered in <120 mins -> PCI <12hours of sx onset but PCI cannot be delivered <120 mins -> fibrinolysis (Streptokinase/alteplase)
39
ACS more chronic mx
Cardiac rehab programme (lifestyle/sex/travel/healthy eating/exercise etc) Drugs: Continue DAPT 12 months then aspirin lifelong ACEi BB/CCB Statin
40
NSTEMI mx
1) risk stratify using GRACE/TIMI 2) Low risk: conservative management with ticagrelor and aspirin (can consider angiography+/- stent later date) 3) High risk: offer immediate angio (With follow on pCI), ticagrelor + aspirin 4) cardiac rehabilitation and secondary prevention
41
long covid heart symptopms
palpitations chest pain tachycardia myocarditis/pericarditis
42
who to refer patients with long covid symptoms
long covid clinic / physio/ psychotherapist
43
how long does long covid last
reports of 3 months - 3 years
44
beck's triad of tamponade
Hypotension/ drop in BP on inspiration Raised JVP Muffled heart sounds
45
what is pulsus paradoxus
SBP drop > 10mmhg on inspiration
46
causes of pericarditis
post-viral HIV/TB Rheumatological: SLE, RhA Cancer Uraemia Post cardiac surgery Dressler's (post MI)

Leila PACES (15 decks)

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