CVS Flashcards
Heart faliure - def, types, Sy, Ix, Mx acute, Mx chronic
D - CO inadequate for bodies requirements.
Types - Systolic (EF <40%) vs diastolic (EF >50%). Right, left and CCF.
Sy - Left - SOB, poor ex tolerance, fatigue, orthopnoea, PND, nocturnal cough, pink frothy sputum, wheeze, cold peripheries.
Right - peripheral oedema, ascites, nausea, anorexia, facial engorgement, epistaxis.
Ix - ECG, BNP, CXR, if abnormal echo.
Mx acute - sit upright, O2 if required, diamorphine IV (vasodil), furosemide 40-80mg IV, consider GTN. CPAP.
Mx - chronic - stop smokin, less salt, weightloss. Furosemide, add spironolactone if hypokal. ACEi, b-blocker, digoxin. Palliate.
HTN - Types, Ix, Mx
Types - Vast majority essential HTN (isolated systolic), also malignant HTN (rapid rise - headache, retinal haemorrhage, papilloedema - furosemide and labetalol), secondary HTN (renal/endocrine disease).
Ix - If >140/90 offer ABPM, if >180/110 start Mx immediately. If ABPM >135/85 treat.
Mx - If <55 ACEi(ramipril)/ARB(candesartan) if >55/black start CCB (nifedipine). If not controlled combine with other not taking. ADD thiazide-like diuretic (chlortalidone/idapemide). Add spironolactone. If RF or diabetes start on ACEi irrelevant of age.
Mitral stenosis - Sy, IX, Mx
Sy - SOB, fatigue, palpitations, chest pain. Malar flush on cheeks. Rumbling mid diastolic murmur. Most common murmur following RheumHD.
Ix - ECF - AF, P-mitrale (biphasic P - LA hypertrophy), RVH. Echo diagnostic.
Mx - Rate control and anticoagulate if AF. Balloon valvuloplasty.
Mitral prolapse/regurg - cause, Sy, Ix, Mx
Cause - prolapse=congenital, regurg=calcification in elderly.
Sy - atypical CP, palpitations, SOB. Si regurg pan systolic murmur, prolapse=mid systolic click/murmur.
Ix - ECG - AF, P-mitrale. Echo.
Mx - Rate control AF. Surgery if severe.
Aortic stenosis - Cause, sy, Ix, Mx
C - Senile calcification, congenital/rheum fever.
Sy - Triad = angina, syncope, HF. SOB, dizzyness. Slow rising pulse, narrow pulse pressure, heave, ESM rad to carotids.
Ix - ECG - P-mitrale, LV strain, LBBB. Echo diagnostic. DDX HCM.
Mx - Prognosis poor without surgery - TAVI or percutaneous valvuloplasty.
Hyperlipidaemia - Types, Sy, Ix, Mx
Types - Common primary (most common, rise in LDL only). Familial primary hyperlipidaemia (multiple subtypes, suspect if FH or chol >7 <30yo and >9 if older). Secondary - cushings, hypothyroidism.
Sy - xanthomata on elbows/knees, palmar/tendons, eyelids (xanthelasma) or cornea (arcus).
Ix - Screen with lipid profile those at risk of hyperlipidaemia (FH, corneal arcus, xanthomata) or risk of CVD.
Mx - statin if QRISK >10%/10yrs, atorvastatin 20mg first line. Familial - add fibrates, ezetimibe (inhibits chol absorption), PCSK9 inhibitor - alirocumab.
Pericarditis - Def, Sy, Ix, Mx, Perocardial effusion
D - Imflammation of the pericardium, idiopathic or due to viral/bacterial infection, Dressler’s syndrome (Ab against heart 2wks post MI), autoimmune.
Sy - Central chest pain worse on inspiration or lying flat, releived by sitting forward. May show effusion or tamponade.
Ix - ECG - PR depression, saddle shaped ST elevation, may be everywhere (unlike MI).
Mx - Ibuprofen, treat cause, colchicine/steroids/immunosuppressants.
Pericardial effusion - fluid accumulation due to pericarditis.
Sy - SOB, raised JVP, bronchial breathing at left base.
Ix - echo.
Mx - treat cause, pericardiocentesis.
Cardiac tamponade - Def, Sy, Ix, Mx
Def - effusion prevents filling and reduces CO.
Sy - tachy, hypotension, pulsus paradoxus, JVP, Kussmaul’s sign (paradoxical rise in JVP with insp). Becks triad - falling BP, rising JVP, muffled HS.
Ix - Echo. Low QRS on ECG.
Mx - pericardiocentesis.
Angina - Types, Sy, Ix, Mx
Types - Stable - induced by effort. Unstable - increasing frequency or severity, occurring on minimal exertion or rest.
Sy - Central chest tightness/heavyness, brought on by exertion releived by rest. Radiating to arms and neck, with SOB, nausea, sweatiness, also ppt by emotion, cold, heavy meals.
Ix - If unstable - ECG, cardiac enzymes. Stable - angiography, or funtional imaging (stress echo/MRI).
Mx - Lifestyle, all get aspirin, GTN and statin. Start CCB or b-blocker. If no response do both. Then add long acting nitrate and ref for PCI?CABG.
ACS - Def, Sy, Ix, Mx, complications
D - Syndrome of unstable angina, NSTEMI, STEMI.
Sy - Acute chest pain lasting 20m, nausea, sweatiness, SOB, palpitations. May present without pain - silent esp in diabetes/elderly.
Ix - ECG - tall T waves, ST elevation, new LBBB. V1-4 is LAD as anterior. V5-5, I AVL circumflex (also supply inferior if left dominant). II, III, AVL are inferior RCA. Also ST depression, T wave inversion. T wave inversion and path Q waves (>1/4 QRS) follow after days. Bloods - cardiac troponin.
Mx - 300mg aspirin and GTN, morphine and metaclopromide.
If STEMI PCI within 2hrs.
NSTEMI/UA - b-blocker, fondaparinux, ticagrelol/clopidogrel(if AF), GRACE score if moderate/high risk angiography/PCI within 72hrs.
CABG if left main stem disease, triple vessel disease.
Comp - Cardiac arrest, cardiogenic shock, bradycardia/heart block, tachyarrhythmias, HF, DVT?PE, pericarditis/tamponade - N.B Dresslers sy (recurrent pericarditis wks post MI).
Bradyarrhythmias - Cause, heart block types, Mx
Cause - drugs (b-blocker, digoxin), sick sinus syndrome (tachy and brady), hypothyroidism, heart block (AV node dysfunction).
First degree - long PR >5squares. No Mx/pace.
Second degree - Mobitz 1 (wenckebach) - PR increases at each QRS until there is a skipped P. Mx - pace if Sy.
Second degree - Mobitz 2 - ratio of P to QRS either 2:1 or 3:1. Mx - pace externally then lab.
Third degree - no relation between P and QRS. Mx - pace externally then lab.
Sick sinus syndrome - varying brady/arrest, heart block, SVT, AF. Mx - pace.
Mx - If asy and >40BPM nothing required. If rate <40 or sy give atropine up to 3mg and insert pacing wire. If no response to atropine transcutaneously pace until op.
AF - def, Cause, Sy, Ix, Acute Mx, Chronic Mx, Paroxysmal Mx
Def - Irregularly irregular atrial rhythm caused by rapid depolarisation. Flutter is constant depolarisation with sawtooth baseline on ECG, rate often 150BPM.
Cause - HF, MI, HTN, any major illness, hyperthyroid, caffeine, alcohol, post-op, hypokalaemia.
Sy - Asy or CP, palpitations, SOB, syncope. Irreg irreg pulse.
Ix - ECG - absent P waves, irregular QRS.
Acute Mx (if <48hrs onset) - If unstable emergency cardioversion (200J) or flecainide/amiodarone (if VHD), then anticoagulate for 4wks. If not treat cause, rate control with verapamil/bisoprolol, or digoxin/amiodarone. Anticoagulate with LMWH.
Chronic Mx (>48hrs) - Usually rate control and anticoag - b-blocker/verapamil, digoxin if sedentary. Start warfarin/NOAC based on CHADVASC and HASBLED. Rhythm control - if young, symptomatic/CCF, first presentation. Do echo, pretreat with sotalol/amiodarone, cardiovert with flecainide, anticoagulate for 4wks.
Paroxysmal AF - pill in the pocket flecainide. Consider anticoagulating.
SVT - Def, Sy, Ix, Mx
Narrow complex tachy. Due to AF, atrial flutter, paroxysmal and WPW (congenital accessory pathways).
Sy - palpitations, SOB, CP, pre-syncope.
Ix - ECG - paroxysmal - absent P waves or inverted after QRS. WPW - delta wave (slurred upstroke of QRS).
Mx - Vagal manouvres (20ml syringe/carotid massage), IV adenosine 6,12,12. If nil improvement cardiovert. WPW refer to cardio for electrophysiology (invasive catheter do electrophysiology - locates pathways) and ablation.
Broad complex tachycardia - VF, VT, Torsade de pointes, Capture beats, Fusion beats
VT - broad complex tachy, no P waves. If pulseless or unstable defib. If stable emergency Mx - amiodarone and if fails defib. To diagnose you need to see:
- Capture beats - normal beat gets through.
- Fusion beats - VT and normal beat at the same time.
VF - Broad complex tachy with random squigles. DC cardiovert (360J).
Torsade de pointes - looks like VF but is a VF with a varying axis, if stable give magnesium sulphate, if not cardiovert
Hypertensive crisis - Def, Sy, Mx
Def - BP >180/110 with acute damage to target organs.
Sy - papilloedema or retinal haemorrhage, stroke, aortic dissection, pulmonary oedema, hypertensive encephalopathy, stroke, intracerebral or subarachnoid haemorrhage, eclampsia, RF.
Mx - promptly reduce BP e.g. labetalol/GTN. Severe HTN urgency (without end organ damage) should be managed more slowly with reduction over 1-2dys with labetalol/amlodipine.
