Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
88 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Angina sx |
Chest pain radiating to arm, neck, jaw Worse on exertion/exercise, after a heavy meal, in cold weather, emotional stress Relieved by rest or GTN after 5 minutes Also: Sob, nausea, CP not relieved by antacids |
3 main criteria |
|
|
Angina simple management |
Lifestyle Stop smoking stop drinking lose weight reduce salt and sat fats and exercise |
|
|
|
Medical mx of angina |
GTN spray -repeat dose after 5 mins. If not relieved 5 mins later call 999 BB or CCB. 2nd line isosorbide mononitrate, ivabradine or nicorandil (K+ channel opener) Consider statin, aspirin (BB), ACEi |
|
|
|
When to refer angina sx to hospital |
CP at rest CP with minimal exertion Angina sx despite treatment |
|
|
|
Diagnosis of stage 1 HTN |
Clinic >140/90 followed by ABPM >135/85 |
Also ABPM |
|
|
Diagnosis of stage 2 HTN |
Clinic BP >160/100 followed by ABPM >150/95 |
|
|
|
Diagnosis of severe/malignant HTN |
Clinic BP >180/110 |
|
|
|
What investigations need to be done for HTN |
ECG - LVH Fundoscopy - hypertensive retinopathy 1. Silver wiring 2. AV nipping 3. Dot and blot haemorrhages, cotton wool spots and hard exudates 4. Papilloedema Urine dip and analysis - proteinuria, ACR Bloods: FBC, cholesterol, electrolytes, eGFR |
Complications (3) Investigations (4) |
|
|
Secondary hypertension causes |
Renal: GN, renal artery stenosis, PKD Endocrine: Phaeochromocytoma, Conn's, cushing, acromegaly Also: the pill, coarctation of the aorta |
|
|
|
Hypertension BP targets |
Age <80 140/90 ABPM of 135/85 Age >80 150/90 ABPM of 145/85 Diabetes/end organ damage 130/80 |
Ages and diabetes |
|
|
When to medically treat stage 1 HTN |
If end organ damage Diabetes CV disease Renal disease |
|
|
|
Treatment of stage 2 HTN |
Medical regardless of age or sx |
|
|
|
Mx of severe/malignant HTN |
Same day referral to specialist/hospital Labetalol IV hydralazine Phentolamine GTN/sodium nitroprusside |
Action plus 4 drugs |
|
|
Step 1 drug mx |
If age <55 and not afro carribean ACEi / ARB SE: dry cough, hyperkalaemia, angioedema CI: bilateral renal artery stenosis If age >55 or afro carribean Dihudropyridine CCB SE: ankle oedema, gum hyperplasia |
Drug, side effects and CI |
|
|
Step 2 mx |
Add ACEi and CCB together |
|
|
|
Step 3 HTN mx |
Add ACEi plus CCB plus thiazide-like diuretic Chlorthalidone, indapamide Inhibit Na+/Cl- symporter in DCT which increases Ca2+ reabsorption. SE: increases uric acid causing GOUT, hypercalcaemia, hyponatraemia, diabetes |
|
|
|
Step 4 HTN mx |
Seek expert advice If K+<4.5 add spironolactone If K+>4.4 increase diuretic dose |
|
|
|
DDx Acute Chest Pain |
MI/ACS Stable angina Pulmonary embolism Pneumothorax Pneumonia GORD Pericarditis Tamponade |
Cardio 2+2 Resp 3 GI 1 |
|
|
MI sx |
Sudden onset CP radiating to neck arm jaw CP squeezing or crushing Not relieved by GTN SoB Sweating Cool clammy skin N+V |
|
|
|
MI initial management |
ABCDE then MONA Morphine O2 Nitrate(GTN) Aspirin 300mg |
|
|
|
Acute MI investigations |
ECG Troponin I |
2 key ix |
|
|
STEMI Mx |
Transfer for primary PCI if can reach within 120 mins +UF/LMWH Fibrinolysis within 12hrs if can't reach 1PCI centre within 120 mins |
|
|
|
NSTEMI mx |
Aspirin 300mg (lifelong 75mg) + Clopidogrel 300mg (12mo) GTN Morphine Beta Blocker Assess GRACE score and if intermediate to higher risk, coronary angiography +- PCI |
|
|
|
MI findings on examination |
Pallor Sweating (diaphoresis) HR updown BP updown HF signs (raised JVP, 3rd HS, bibasal creps, ankle oedema) Pansystolic murmur (papillary muscle rupture) |
5 signs |
|
|
3 findings on ECG suggesting ACS or ischaemia |
ST elevation New LBBB ST depression and T wave inversion |
STEMI NSTEMI AND WHAT ELSE |
|
|
Secondary mx of MI/ACS |
Statin Antiplatelets -lifelong aspirin, 12 month Clopidogrel then review Beta Blocker ACEi |
|
|
|
Heart Failure sx |
SoB on exertion or rest Orthopnoea (lying flat) PND Fatigue Peripheral oedema |
5 sx |
|
|
Causes of heart failure |
Ischaemic heart disease Valvular disease Dilated cardiomyopathy Hypertensive heart disease Anaemia Arrhythmia Thyrotoxicosis Infection and alcohol |
4 plus 4 |
|
|
Acute HF management |
O2 + GTN Morphine IV frusemide Beta Blocker bisprolol |
4 treatments |
|
|
Heart Failure chronic mx |
ACEi + BB Frusemide Spironolactone Avoid NSAIDs and verapamil |
4 drugs |
|
|
Describe how SVT looks like and how do you treat it? |
Narrow QRS complex < 0.12s Regular Vagal manoueuvres 1. Valasalva manoeuvre 2. Carotid sinus massage 3. Breath holding IV Adenosine 6mg, 12mg, 12mg bolus CI: asthma, decompensated heart failure, 2nd/3rd degree heart block |
2 ECG features 2 types of treatment Contraindications to the 2nd drug treatment |
|
|
Describe bifascicular block |
RBBB + LAD |
|
|
|
Describe trifascicular block |
Bifascicular (RBBB + LAD) + 1st degree AV block |
|
|
|
Mx of Torsades de pointes |
MgSO4 Defibrillate |
|
|
|
Management of VT |
DC shock if unstable Amiodarone if time |
Wide QRS complex regular rhythm |
|
|
Acute mx of AF |
If unstable DC cardioversion Rate control using BB or CCB (bisoprolol or verapamil) CI: heart failure) If pharmacological cardioversion then amiodarone or flecainide Assess thrombosis risk using CHA2DS2VASC and bleeding risk using HASBLED. Give warfarin or a NOAC. |
Initial plus anticoagulation |
|
|
3 causes of AF |
Ischaemic heart disesease Thyrotoxicosis Hypertension |
|
|
|
Heart Failure ix |
ECG CXR Bloods: BNP ECHO |
3 imaging plus 1 blood |
|
|
What would you see on a heart failure CXR |
Alveolar oedema Kerley B lines Cardiomegaly Dilated upper lobe vessels Pleural effusion |
ABCDE |
|
|
Treatment of bradyarrhythmia |
Atropine 500mcg IV Temporary pacing wire |
|
|
|
Anterior MI ECG leads |
V3 V4 |
|
|
|
Septal MI ECG leads |
V1 V2 |
|
|
|
Lateral MI ECG leads |
V5 V6 I aVLateral |
|
|
|
Inferior MI ECG leads |
II, III aVF |
|
|
|
For inferior MI, which artery is occluded? |
Right coronary artery |
|
|
|
For anterior MI, which artery is occluded? |
Left anterior descending |
|
|
|
For lateral MI, which artery is occluded? |
Left circumflex |
|
|
|
Complications of MI |
Arrhythmia - tachy (SVT) - AF - brady (heart block) CHF - SoB, orthopnoea, PND, peripheral oedema, fatigue Cardiac arrest/cardiogenic shock Mitral regurg Myocardial rupture 3-5 days post MI Pericarditis - CP relieved by sitting forwards. ECG: saddle shaped STE Rx: NSAIDs, ECHO to check for effusion (tamponade) |
6 |
|
|
PCI complications |
Bleeding Infection Pain around catheter insertion site MI/stoke during procedure |
|
|
|
Coronary angiography complications |
Bleeding Infection Pain around catheter insertion site MI/stoke during procedure Allergic reaction to contrast dye |
|
|
|
Arrival to ECG time Door to needle time for thrombolytics |
10 mins 30 mins |
|
|
|
Cardiological + other causes of collapse |
Vasovagal (neurocardio) Postural hypotension (drop of 20mmHg+ from sitting to standing) MI Arrhythmia - VF, VT, heart block Aortic stenosis (angina, syncope, SoB on exertion- ASS) GI bleed (anaemia) Hypoglycaemia Seizure (tongue biting, incontinence, post-ictal phase) Pulmonary embolism Aortic dissection |
10 (8 key) |
|
|
Causes of arrhythmia |
MI CAD Myocarditis Pericarditis Valve disease Caffeine Alcohol Drugs (B2 agonists, digoxin) Metabolic imbalance (K+, Ca2+) |
5 cardiac 4 non-cardiac |
|
|
DDx for SoB |
Shock, sepsis Cardiac: MI Arrhythmia CHF PE Resp: COPD Asthma Pneumonia Pneumothorax Cancer Haematological: Anaemia |
2 immediate emergencies Cardiac (4) Resp (5) Haem (1) |
|
|
Investigations for cardiac conditions |
Bedside: ECG Imaging: CXR ECHO CT angiography Coronary angiography Bloods: FBC, TFTs, Troponin I, BNP |
Bedside (1) Imaging (4) Bloods (4) |
|
|
Drug class that decreases preload |
Diuretics |
|
|
|
Drug classes which decrease afterload |
ACEi/ARB CCB - dyhydropyridines |
|
|
|
Drug class affecting heart contractability |
BB CCB - nondihydropyridines Do NOT give verapamil with BB |
|
|
|
Drug contraindication to verapamil |
Beta blockers |
|
|
|
Contraindications to beta blockers |
Asthma and verapamil |
conditions plus drug |
|
|
Chronic mx of AF |
1st BB or rate-limiting CCB 2nd digoxin (do not give verapamil and BB) |
|
|
|
Paroxysmal AF mx |
Pill in the pocket: Sotalol or flecainide |
2 options |
|
|
Rheumatic fever -causative organisms -duckett-jones criteria (evidence of recent GAS infection) -sx (major criteria) -mx -main valve complictions |
GAS (S. pyogenes) =ve throat culture, +ve rapid strep antigen test, rising/elevated strep antibody titre, scarlet fever Carditis, subcut nodules, arthritis, erythema marginatum, sydenhams chorea Benzylpenicillin + Pen V Mitral stenosis |
|
|
|
Shock definition and MAP |
Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion resulting in cellular hypoxia Shock likely if MAP <60mmHg MAP = diastolic + (1/3 pulse pressure) |
Definition and MAP diagnosis |
|
|
Anaphylaxis sx |
Itch, sweat N+V+D Urticaria and Oedema Wheeze/laryngeal obstruction |
|
|
|
Anaphylaxis tx/mx |
O2 IM adrenaline 1:1000 0.5mg (repeat every 5 mins) IV Hydrocortisone 200mg IV Chlorphenamine If wheeze then 5mg neb salbutamol |
5 |
|
|
What type of shock is anaphylaxis |
Distributive |
|
|
|
Types of distributive shock |
Sepsis Anaphylaxis |
|
|
|
Treatment of sepsis (6) |
Give O2 Give IV fluids Take blood cultures Give abx Measure lactate Measure urine output |
|
|
|
Causes of cardiogenic/obstructive shock |
Cardiogenic: MI, CHF, Arrhythmia, valvular disease, ischemic cardiomyopathy Obstructive shock - PE, pneumothorax, tamponade (Beck's triad muffled heart sounds, raised JVP, hypotension) |
|
|
|
When dealing with shock, if BP is unrecordable.... |
Call the cardiac arrest team |
|
|
|
Reversible causes of cardiac arrest (H) |
Hypoxia Hypothermia Hypovolaemia Hypokalaemia/hyperkalemia |
hypo...x4 |
|
|
Reversible causes of cardiac arrest (T) |
Tamponade Tension pneumothorax Thrombosis Toxins |
|
|
|
BLS: If PEA/asystole...mx |
Non-shockable so give 1mg adrenaline IV 1:10,000 Resume CPR for 2 mins, reassess then repeat |
|
|
|
BLS: If VF or pulseless VT....mx |
Shock Give 1mg IV adrenaline 1:10,000 continue CPR GIve adrenaline every 3-5 mins Give IV amiodarone 300mg IV after 3 shocks |
|
|
|
What may suggest renal artery stenosis? What drug is contraindicated if bilateral? |
Hypertension that is non-responsive to medication ACEi |
|
|
|
How to diagnose renal artery stenosis? (1 o/e, 2 ix) |
Auscultate renal bruits Renal USS + doppler Renal angiography is the gold standard but is invasive |
|
|
|
Carotid stenosis sx, o/e (1), ix (1), mx (1 drug + 1 procedure) |
TIA sx: facial droop, unilateral limb weakness, slurred speech sudden loss of vision balance and coordination problems lasting <24hrs Carotid doppler US Aspirin 300mg + carotid endarterectomy |
|
|
|
Risk factors for mesenteric ischemia (3) |
AF CHF Previous MI |
|
|
|
Sx of mesenteric ischemia |
usually Sup Mesenteric Vein/Artery Acute severe abdo pain, constant, central/ RIF Bloody stool Rapid hypovolaemia and shock |
|
|
|
Ix for mesenteric ischemia (3) |
ABG - lactate - metabolic acidosis Bloods: FBC (raisedWCC) AXR CT/MR angiography |
|
|
|
Mx of mesenteric ischemia |
IV fluids Abx - gentamicin and metronidazole Heparin/thrombolytic Exploratory laparotomy and removal of dead bowel |
|
|
|
Ischaemic colitis sx, ix (2), mx (2) |
Low, left sided abdo pain + bloody stool Colonscopy + biopsy, barium enema showing thumbprinting of submucosal swelling IV fluids Abx |
|
|
|
RFs for infective endocarditis (3) |
Valve disease Valve replacement IV drug use |
|
|
|
What 2 sx suggest IE? Other sx? |
Fever + NEW MURMUR Clubbing Wx loss, night sweats Splenomegaly Anaemia Fatigue/malaise |
|
|
|
Immune complex deposition signs of IE |
Roth spots on fundoscopy (haemorrhagic spots with pale centre) Splinter haemorrhages Osler's nodes on fingers/toes - painful infarcts Vasculitis, microscopic haematuria, GN |
|
|
|
Embolic phenomemon of IE |
Janeway lesions - painless palmar/plantar macules, non-tender, erythematous |
|
|
|
Ix for Inf Endo |
3x blood cultures FBC: normochromic normocytic anaemia Raised WCC Rasied CRP ECG, CXR, ECHO |
|
