IHD, Angina + MI Flashcards
(71 cards)
1
Q
Stable angina?
A
Onset on exertion, relief with rest/GTN
2
Q
Unstable angina?
A
Onset at rest, some relief from GTN
3
Q
NSTEMI?
A
No egg changes, rise in troponin
4
Q
STEMI?
A
ST elevation + troponin rise
5
Q
New onset bundle branch block?
A
MI until proven otherwise - treat as STEMI
6
Q
Causes of troponin elevation?
A
MI Heart failure Myocarditis/pericarditis LVH CKD Diabetes CPR/cardioversion
7
Q
Syndrome X?
A
Angina triggered by emotion/anxiety, no abnormalities of arteriography
8
Q
Prinzmetal’s variant angina?
A
Vasospasm of coronary arteries, at rest with ST segment elevation
9
Q
ACS treatment?
A
Oxygen Morphine Aspirin Nitrates Beta blockers Clopidogrel Reperfusion
10
Q
Thrombolysis drugs?
A
Alteplase,
Reteplase
Streptokinase
Tenecteplase
11
Q
Post MI cocktail?
A
ACE
Beta blocker
Statin
Dual antiplatelet
12
Q
When can second antiplatelet be stopped?
A
12 months post MI
13
Q
ST elevation V1-V6?
A
Anterior MI - LAD
14
Q
ST elevation II, III, aVf?
A
Inferior MI - RCA
15
Q
What does RCA supply?
A
NODES - SAN + AVN
16
Q
ST elevation - I, aVL, V5, V6?
A
Lateral MI - left circumflex
17
Q
Common causes of chest pain?
A
Angina ACD Oesophagitis PE Pneumothorax dissecting AA chest wall pain
18
Q
What is troponin I bound to?
A
Myosin
19
Q
Consequences of MI?
A
Death Arrhythmia Rupture Tamponade Heart failure Valve disease Aneurysm Dressler's syndrome Embolism Recurrence
20
Q
What is cardiac tamponade?
A
Reduced ventricular filling due to accumulation of blood/pus/clots in pericardial space
21
Q
Triad of acute cardiac tamponade?
A
Distant heart sound
Decreased arterial blood pressure
Distended neck veins
(also pulses paradoxus present)
22
Q
What is dressler’s syndrome?
A
Late onset pericarditis - 6 weeks post MI Fever Pleuritic pain Pericardial effusion Raised ESR
23
Q
What is pulsus paradoxus?
A
Large drop in BP on inspiration
24
Q
What is pericarditis?
A
Inflammation of pericardium - protective covering of the heart
25
Viral causes of pericarditis?
Coxsackie B echovirus
26
Bacterial causes of pericarditis?
Rare - staph - fatal, strep, pneumococcal, meningococcal
27
Where to listen for pericardial friction rub?
Lower left sternal edge, expiration, patient leaning forwards
28
Symptoms of pericarditis?
Pain
Fever
Dyspnoea
Pericardial friction rub
29
ECG of pericarditis?
Diagnostic - saddle snapped ST elevation
| PR segment depression
30
Treatment of pericarditis?
Bed rest and NSAIDs
31
Constrictive pericarditis?
Thickened pericardium due to chronic inflammation - bacteria, TB, rheumatic heart disease - affects ventricular filling
32
Decubitus angina?
Triggered by lying flat
33
Most common cardiac tumour?
Myxoma - benign
34
Secondary hypertension?
```
Renal conditions
Thyroid
Cushing's
Preeclampsia
Hyperaldosteronism
Obstructive sleep apnoea
Malignancy
Acromegaly
Coarction
Conn's
Pheochromocytoma,
```
35
Signs of hypercholesterolemia?
Xanthelasmas
Corneal arcus
Xanthomas on elbows, knees, and buttocks
36
Mild hypertension?
140/90
37
Moderate hypertension?
160/100
38
Severe hypertension?
180/110
39
Other investigations when diagnosing hypertension?
Urinalysis - renal disease
Blood glucose - diabetes
Lipid profile - cardiovascular risk
ECG - LVH
40
What is coarctation of the aorta?
Congenital narrowing of the aorta, usually distal to the ligamentum arteriosum
41
Finding in coarctation?
Hypertension in upper limb, absent/weak pulses in lower limb
42
Isolated systolic hypertension?
Rise in systolic but not diastolic - hyperthyroidism, artery stiffness, diabetes or valvular disease
43
White collar syndrome?
Raise in blood pressure when taken by a medical professional but normal at home
44
Consequences of hypertension?
```
Cardiovascular disease
Renal disease
Heart failure
Retinopathy
Acute dissection
```
45
How does hyperthyroidism cause hypertension?
Thyroxine exacerbates the effect of sympathetic nervous system = increased vascular resistance + cardiac output
46
How does hypothyroidism cause hypertension?
slows heart rate, vascular resistance increases to compensate
47
Conn's syndrome?
Hyperaldosteronism due to adrenal adenoma
48
Most common cause of hyperaldosteronism?
Adrenal hyperplasia
49
Cushing's syndrome?
Excess cortisol secretion - pituitary or adrenal tumour or use of exogenous steroids
50
Initial antihypertensive for <55 non-black
Ace inhibitor, beta blocker if not tolerated
51
Initial antihypertensive >55 black
Calcium channel blocker or thiazide like diuretic if not suitable
52
Step 2 hypertension treatment?
ACE + CCB or ACE + diuretic - use ARB in black patients
53
Step 3 hypertension treatment?
ACE/ARB + CCB + thiazide like diuretics
54
Step 4 hypertension treatment?
Spironolactone, consider alpha blocker or beta blocker
55
What is pheochromocytoma?
Rare tumour derived from chromaffin cells that secretes catecholamines, usually in the adrenal medulla
56
Symptoms of pheochromocytoma?
```
Headache
Sweating
Palpitations
Tremor
Nausea
Weakness
Anxiety
Sense of doom
Tremo
Hypertensive retinopathy
```
57
How to treat dressler's syndrome?
NSAIDs
58
Most common cause of death post-MI?
Ventricular fibrillation
59
When do patients get heart block post MI?
Inferior MIs (most commonly)
60
Presentation of aneurysm post MI?
Left ventricular aneurysm
Persistent ST elevation in anterior leads
Left ventricular failure
61
How does a ventricular septal defect present?
Rupture of intraventricular septum
Acute heart failure
Pansystolic murmur
62
Who gets acute mitral regurgitation post MI?
Infero-posterior infarction
Papillary muscle rupture
Early - mid systolic murmur
63
What is Kussmaul's sign?
Increased JVP on inspiration
| Sign of constrictive pericarditis
64
Features of constrictive pericarditis?
```
Dyspnoea
Right heart failure
JVP - prominent x and y descent
Pericardial knock - loud S3
Kussmaul's sign
Pericardial calcification
```
65
Cardiac tamponade vs constrictive pericarditis?
CT - absence Y descent
CP - X+Y present
Pulsus paradoxus - CT
Kussmaul's - CP
66
Causes of angina
```
Atheroma
Anaemia
Coronary artery spasm
Tachyarrhythmias
Aortic stenosis
```
67
Precipitants of angina
Exertion
Emotion
Cold weather
Heavy meals
68
Symptoms of angina
Pain - central into jaw + neck
Dyspnoea
Nausea
Sweatiness
69
Management of angina
GTN spray
1st - B-blocker or CCB. ACEi if diabetes. Low dose aspirin
2nd - long acting nitrate, Nicorandil or Ivabradine
3rd - PCI or CABG
70
What is troponin?
Proteins involved with cardiac and skeletal muscle contraction. Released in myocardial cell damage.
Trop I + T are most cardiac specific
71
How can you differentiate between rises of troponin?
MI / acute damage - likely to continue rising
| Other insults - unlikely to change hour to hour
