RW Year 6 > Cardiovascular > Flashcards

Cardiovascular Flashcards

(70 cards)

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1
Q

CHADSVASc Score

A
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2
Q

HASBLED Score

A
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3
Q

Tx for undifferentiated SVT

A

IV Adenosine

Slows the HR to see the underlying cause

Brings heart back to sinus rhythm

Warn patient it’ll feel like they are about to die

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4
Q

Causes of AF

A

PIRATES

  • Pulmonary embolism
  • Ischaemia (myocardial)
  • Respiratory disease
    • Pneumonia
    • Lung cancer
  • Alcohol or atrial enlargement or myxoma
  • Thyrotoxicosis
  • Ethanol
  • Sepsis / Sleep apnoea

+ Valvular heart disease (esp Mitral)

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5
Q

ECG signs of AF

A

Absent P waves

Fibrillatory waves

Irregularly irregular rhythm

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6
Q

Tx of AF

A

Onset < 48 hours

  • If unstable –> DC cardioversion
  • If stable
    • Rate control
      • (1) Beta blockers or CCB
      • (2) Digoxin
      • (3) Amiodarone
    • Anticoagulation
      • LMWH
    • Rhythm control
      • TOE + Cardioversion (DC or chemical)
        • Flecainide or Amiodarone or Propafenone

Onset > 48 hours

  • Rate control (as above)
  • Anticoagulation
    • Heparin + Warfarin (INR 2-3 for 3-4 weeks)
  • After 3-4 weeks –> Rhythm control ==> Cardioversion (DC or chemical)

If paroxysmal –> Pill in pocket (Flecainide PRN)

If refractory to cardioversion

  • Rate control + Anticoagulation
  • Catheter radiofrequency ablation
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7
Q

ECG signs of Atrial flutter

A

Narrow complex tachycardia

Fixed AV block (150bpm, 100bpm, 75bpm) or Variable

Saw-tooth pattern (flutter waves)

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8
Q

Tx of Atrial Flutter

A

If diagnostic uncertainty –> Carotid massage or IV Adenosine

Treat underlying cause

Rate control (B blockers, CCB, Amiodarone)

Anticoagulation

Rhythm control (TOE + Cardioversion)

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9
Q

Tx of WPW

A

If unstable –> Cardioversion

If stable

  • If tachycardia
    • Carotid sinus massage + Valsalva manoeuvre
    • IV Adenosine
    • DC Cardioversion
  • If symptomatic –> Catheter ablation of accessory pathway
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10
Q

ECG features of VT

A

Broad QRS + tachycardia

Capture beats (pathognomonic)

Fusion beats

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11
Q

Tx of VT

A

Unstable

  • (1) DC Cardioversion
  • (2) Correct electrolytes
  • (3) Amiodarone

Stable

  • (1) Correct electrolytes
  • (2) Amiodarone
  • If refractory –> DC Cardioversion

If Torsades de Points –> Magnesium sulphate

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12
Q

Tx of sinus bradycardia

A

Atropine

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13
Q

Systolic vs Diastolic HF

A
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14
Q

L vs R heart failure vs CCF

A
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15
Q

New York Heart Association (NYHA) Classification

A

NYHA 1 : disease present, no limitation

NYHA 2 : slight limitation, improves with rest

NYHA 3 : marked limitation on exertion, improves with rest

NYHA 4 : SOB at rest

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16
Q

Ix for heart failiure

A

Screening –> BNP (sensitive but not specific)

If high BNP or abnormal ECG or Hx of MI –> Doppler Echo (diagnostic)

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17
Q

Tx for acute pulmonary oedema

A

FOGDC

IV Furosemide

+/- Oxygen

+/- IV Diamorphine

+/- IV GTN

+/- CPAP

+/- Intubation + Ventilation

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18
Q

Tx of heart failure

A

ALL HF

  • Loop diuretics (symptomatic)
  • +/- Anti-platelet
  • +/- Statin

If EF < 55% (systolic heart failure) ==> ABCD HI DICD

  • (1) ABCD
    • ACE inhibitor + B blocker (​only start one at a time)
    • If EF < 35% –> +/- Spironolactone
  • (2) +/- Hydralazine + Isosorbide dinitrate combination
  • (3) If Heart failure + AF –> +/- Digoxin
  • (4) If EF < 35% –> +/- ICD or CRT (if LBBB)
  • (5) Heart transplant
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19
Q

Recurrent chest infections

Ejection systolic murmur (LUSE)

Fixed, widely split S2

Diagnosis?

A

ASD

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20
Q

Hypertension in R arm

ESM

Radio-femoral delay

Diagnosis

A

Coarction of the Aorta

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21
Q

HOCM

Cause

Sx

Ix

Tx

Cx

A

HOCM

Autosomal dominant

Sx

  • Syncope, Angina, Dyspnoea
  • Bifid carotid pulse (jerky)
  • Double apex beat
  • ESM
  • S4

Ix

  • Echo
    • Assymetrical hypertrophy
    • Mitral regurgitation

Tx

  • If symptomatic
    • Beta blockers
    • Septal myotomy
  • Treat arrhthmia
    • +/- ICD
    • +/- Heart transplant

Cx

  • VT/VF –> Sudden death
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22
Q

Diliated cardiomyopathy

Causes

Sx

Ix

Tx

Cx

A

Dilated cardiomyopathy

  • Cause
    • Post-viral myocarditis
    • Alcohol
  • Symptoms
    • Congestive heart failure
  • Ix: Echo
    • Mitral regurgitation
    • Tricuspid regurgitation
    • Dilated ventricles
    • Global hypokinesia
  • Tx
    • Manage heart failure
    • Treat arrhythmia
    • ICD or CRT
    • +/- Heart transplant
  • Cx
    • Heart failure
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23
Q

Types of heart block

A

1st degree: fixed prolonged PR

2nd degree (Mobitz 1): progressively prolonged PR , then drop beats

2nd degree (Mobitz 2): fixed PR with drop beats

3rd degree: P-QRS dissociation

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24
Q

Tx for heart block

A

1st degree and 2nd degree (Type 1)

  • If asymptomatic –> monitoring
  • If symptomatic –> Elective pacemaker

2nd degree (Type 2) and 3rd degree

  • Unstable
    • Transcutaneous (external) pacing
    • +/- Atropine
    • Elective Pacemaker
  • Stable
    • Elective Pacemaker
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25
**Viral prodrome: Fever, respiratory symptoms or gastroenteritis** **New-onset congestive cardiac failure** **Chest pain** **High CK** **High Troponin** Diagnosis? Tx?
Myocarditis * **Prednisolone** * +/- Nitroprusside * +/- Nitroglycerin * +/- Dobutamine * **Manage hearttt failure**
26
Triad of pericarditis
* **Chest pain** (pleuritic, worse lying down, relieved leaning forward) * **Pericardial rub** (walking on snow) * **Serial ECG changes**
27
Signs of constrictive pericarditis
Kussmaul's sign (rise in JVP with inspiration) Pulsus paradoxus (drop in sBP with inspiration) R heart failure
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Signs of cardiac tamponade
↑ JVP ↓ BP Muffed heart sounds
29
Tx of pericarditis
Treat underlying cause (1) **NSAIDs** (2) **Corticosteroids + Colchicine** +/- **Pericardiocentesis** (if cardiac tamponade or pericardial effusion)
30
Infective endocarditis is most commonly associated with which murmur
Mitral regurgitation
31
Dukes criteria for IE
IF **BER** (**Major**, Minor) * **Blood culture** (2 cultures from 2 sites \> 12 hours apart) * **Echo** * **Regurgitation** * Immunological / Vascular signs * Fever
32
Tx for IE
**Antibiotics** (Amoxicillin/Flucloxacillin + Gentamicin) **Surgical removal of infected valves** **+/- Replace valves**
33
Rheumatic fever Cause Criteria
Group A β-haemolytic streptococcus pyogenes JONES criteria MAJOR (at least 2) + Evidence of Group A strep infection (ASO titre, PCR) * Joint involvement * O: Carditis * Nodules (subcutaneous) * Erythema marginatum * Sydenham's chorea
34
Tx of acute rheumatic fever
* **Aspirin** +/- Corticosteroids * **Antibiotics** (IV Benzylpenicillin, then oral Penicillin V) * ABx prophylaxis (until 18 years old)
35
Ix for ACS
**Serial Troponins** If UA or NSTEM ==\> **CTPA** (non-invasive) If STEMI ==\> **Angiography +/- PCI** (invasive)
36
Unstable angina vs NSTEMI vs STEMI
Unstable angina * Chest pain at rest * Normal Troponin * *_ECG_*: ST depression or T wave inversion or normal NSTEMI * Troponin: +ve (rising) * *_ECG_*: ST depression or T wave inversion or normal STEMI * Troponin: +ve (rising) * *_ECG_*: ST elevation or new onset LBBB
37
Treatment for STEMI
Initial --\> MONAC * **Morphine** + Metaclopramide * **Oxygen** (if hypoxic) * **Nitrates** (sublingual GTN) * **Aspirin + Clopidogrel** * + PPI Then * *_If access to PCI \< 90min_* * **Angiopathy + PCI** (or CABG) * + Anticoagulation (Heparin) * Continue Aspirin + Clopidogrel * *_If no access to PCI within 90 min_* AND *_symptom onset \< 12 hours_* * **Thrombolysis** (IV Alteplase) * Then, **PCI**
38
Treatment of NSTEMI
Initial --\> MONAC * **Morphine** + Metaclopramide * **Oxygen** (if hypoxic) * **Nitrates** (sublingual GTN) * **Aspirin + Clopidogrel** * + PPI * **_+ Anticoagulation_** ==\> stabilise the clot * **Fondaparinux** or **LMWH** or **Unfractionated Heparin** Then --\> **GRACE score** * High risk ==\> **Angiography + PCI** * Low risk * Admit to Ward * + Anticoagulation * + **Elective PCI or CABG**
39
Post-MI care
* Modify cardiovascular risk factors * Drugs (**ABCD**) * **ACE inhibitors** * **Beta blockers** * _Cholesterol control_ (**Statin**) * _Dual antiplatelet_ * **Aspirin** (lifelong) **+ Ticagrelor** (12 months) * Echo: look for heart failure
40
Tx of Unstable angina
Tx for Unstable Angina is the same as Post-MI care * Modify cardiovascular risk factors * Drugs (ABCD) * **ACE inhibitors** * **Beta blockers** * Cholesterol control (**Statin**) * Dual antiplatelet * **Aspirin** (lifelong) + **Ticagrelor** (12 months)
41
Tx for stable angina
GTN + CBAS * **Sublingual GTN** * **CCB** *_or_* **Beta blocker** * Rate control to improve symptoms * Not both! * Modify risk factors * **Aspirin** * **Statin**
42
Causes of Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis
Aortic regurgitation * **Rheumatic heart disease** (most common in developing countries) * **Infective endocarditis** * **Type A aortic dissection** * **Connective tissue disorders (Marfans)** ==\> aortic root dilatation * **Congenital bicuspid aortic valve** Aortic stenosis * **Age-related calcification** * **Congenital bicuspid aortic valve** Mitral regurgitation * **Rheumatic heart disease** * **Infective endocarditis** * **Left ventricular dilatation** (Functional MR) * **Papillary muscle rupture** * **Post MI** * **Connective tissue disordres** Mitral stenosis * **Rheumatic heart disease** * **Infective endocarditis**
43
Aortic regurgitation - Sx
**Symptoms of Heart failure** **Wide pulse pressure** **Collpasing pulse** **Displaced apex beat** (volume overloaded --\> cardiomegaly) **Early diastolic murmur** (loudest sitting forward + expiration) **+/- Austin flint murmur** (diastolic murmur) Quincke's sign | Corrigan's sign | Pistol shot femorals
44
Sx of Aortic stenosis
**Syncope, Angina, Dyspnoea** **Slow rising pulse** **Narrow pulse pressure** **Heaving apex beat** (LVH) **ESM** - radiating to carotids, loudest on expiration
45
Sx of Mitral regurgitation
**Sx of heart failure** **AF** **Displaced apex heart** **Pan-systolic murmur** (apex, radites to axilla)
46
Sx of Mitral stenosis
**Malar flush** (back pressure in pulmonary system --\> rise in CO2 --\> vasodilation) **AF** **Undisplaced, _tapping_ apex beat** (due to loud S1) **Mid-diastolic murmur** (louder when lying on left, opening snap) **Loud S1**
47
Treatment of ## Footnote **Aortic regurgitation** **Aortic stenosis** **Mitral regurgitation** **Mitral stenosis**
Aortic regurgitation * Manage CVD risk factors + Treat HF * **Aortic valve replacement** Aortic stenosis * Manage CVD risk factors + Treat HF * Treat angina * **Aortic valve replacement** * **Transcatheter aortic valve implantation** (TAVI) * **Balloon aortic valvuloplasty** (BAV) Mitral regurgitation * Manage CVD risk factors + Treat HF * Treat AF * **Mitral valve repair with annuloplasty ring** * **Mitral valve replacement** (prosthetic or mechanical) Mitral stenosis * Manage CVD risk factors + Treat HF * Treat AF * **Percutaneous mitral commissurotomy** (PMC) * **Mitral valve replacement** (prosthetic or mechanical)
48
Most common location for AAA
**Infrarenal** (90%) Remaining for juxtarenal or suprarenal
49
Definition of AAA
Aortic dilatation **\> 1.5x expected AP diameter**, given patient's gender and body size
50
UK screening for AAA
**Abdo USS** All **men \> 65 years old** One time screening If **\> 5.5cm** ==\> 2 week referral for surgery If **3 - 5.4 cm** ==\> USS follow-up (every 3-12 months) If **\< 3.0 cm** ==\> Discharge
51
**Surgical Tx for AAA** Indications? Types?
Indications for repair * Symptomatic AAA * Asymptomatic AAA \> 5.5cm * Asymptomatic AAA growing \> 1cm/year **Open repair** * Indications: * Younger patients * Ruptured AAA **Endovascular aneurysm repair** (EVAR) * Indications: unfit for surgery
52
Sx of Aortic dissection
53
Diagnosis?
1.
54
Tx of Aortic dissection
ABCDE Medical (preferred for Type B) * Lower BP --\> **Beta blockers** Surgical (preferred for Type A) * **Open surgery** * **Endovascular stent-graft repair**
55
Indications for Carotid endarterectomy
* **Stroke/TIA _AND_ Stenosis \> 50%** * Carotid stenosis \> 50% or \>70% (depends on guidelines) * Symptomatic
56
Ix for DVT
If likely --\> **Proximal leg USS** If unlikely --\> **D-dimer** * If +ve --\> **Leg USS** * If -ve ==\> excludes DVT
57
Types of Gangrene
**Wet gangrene** ==\> Infectious (Staph, Strep, Clostridium perfringes) **Dry gangrene** ==\> Arterial obstruction or Venous obstruction
58
Tx for hypertension Targets
59
Define postural hypotension
drop in sBP \> 20mmHg (or \> 30 mmHg if hypertensive) and/or dBP \> 10mmHg after standing for 3 minutes vs lying
60
signs of chronic venous insufficiency
HASLEGS * **Haemosiderin deposition** = RBC breakdown * **Atrophie blanche** = smooth, white stellate scars due to fibrinolytic disruption * **Swelling (Ankles)** * **Lipodermatosclerosis** = inflammation of s.c. fat * **Eczema** = Varicose eczema * **Gaiter ulcers** * **Stars venous** = venous stars * Red/blue/purple vessels radiating from central point * Blood flows from periphery to centre * Not obliterated by pressure
61
6Ps of acute limb ischaemia
**Pain** **Pallor** **Pulselessness** **Perishingly cold limb** **Paraesthesia**\* ==\> Misnomer --\> actually anaesthesia (= loss of sensation) **Paralysis\***
62
Ix for acute limb ischaemia
URGENT **DSA scan** (diagnostic + therapeutic) URGENT **CT angiogram**
63
Tx for acute limb ischaemia
* Initial * **Unfractionated Heparin** (5000 Units Bolus + Infusion) * Definitive * If requiring immediate Tx ==\> Surgical revascularisation * *_Embolus_* **--\> Embolectomy** * *_Small thrombus_* **--\> Thrombolysis (tPA)** * *_Large thrombus_* **--\> Arterial bypass or Angioplasty** * If irreversible * **Amputation** Treatment similar to NSTEMI
64
Spectrum of chronic limb ischaemia
* **Intermittent claudication** * **Leg pain on extertion** * **No rest pain** * **Critical limb ischaemia** * Requires 1 of the following * **Rest pain** * **Arterial ulcers** * **Gangrene**
65
Ix for chronic limb ischaemia
**ABPI \< 0.9** ==\> peripheral arterial disease **Colour Duplex USS scan** (1st line imaging)
66
Tx for chronic limb ischaemia
Conservative * **Modify cardiovascular risk factors** Medical * **Anti-platelets** (Aspirin or Clopidogrel or Ticagrelor) Surgical (rarely required) * **Percutaneous transluminal angioplasty** (PTA) **+ stenting** * **Bypass grafting** * Saphenous vein * Dacron or PTFE * **Endarterctomy** * **Amputation**
67
Classification for chronic venous insufficiency
CEAP classification ## Footnote TV OS WW C0 = normal C1 = telangiectasia C2 = varicose veins C3 = oedema C4 = skin changes (pigmentation or eczema or lipodermatosclerosis) C5 = healed wound C6 = open wound
68
Causes and origins of varicose veins
69
Tx of varicose veins
**Lifestyle changes** **Graduated compression stockings** Minimally invasive treatment * **Sclerotherapy** * **Radiofrequency ablation** * **Endovenous laser therapy** Surgical * **Phlebectomy** (stab avulsions along vein)
70
Tx for superficial thrombophlebitis
NSAIDs
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