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65 Cards in this Set
- Front
- Back
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Define cardiovascular shock |
It is a situation, when the cardiovascular system is unable to provide adequate substrate for aerobic cellular respiration |
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Criteria for circulatory shock diagnosis |
• sys <90 mmHg • MAP <65 mmHg • urine output <0.5 ml/kg/hr • serum lactate >2 mmol/L |
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Define mean arterial pressure (MAP) |
MAP = CO x TPR Shock occurs when CO (cardiac output) is inadequate Shock occurs when the TPR (total peripheral resistance) decreases (distributive hypovolaemia) |
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Causes of low cardiac output (CO) shock (3) |
1) Hypovolaemic (haemorrhage, fluid loss, D+V, burns, heat, pancreatitis) 2) Cardiogenic shock (ACS, arrhythmia, Ao dissection, acute valve failure) 3) Secondary Cardiogenic (PE, tension pneumothorax, tamponade) |
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Causes of peripheral resistance failure (distributive shock) (at least 3) |
1) Septic shock (Gram negative infection > endotoxins) 2) Anaphylactic shock 3) Neurogenic shock 4) Endocrine failure (Addison's, anaemia, hypothyroidism) 5) Cytotoxic shock (e.g. cyanide poisoning) |
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Cardiac tamponade: BECK'S TRIAD |
1) BP drop 2) Elevated JVP 3) Can't hear: muffled heart sounds >> decreased HS due to pericardial effusion >> pulsus paradoxus (lost on inspiration) >> treat with PERICARDIOCENTESIS (aspiration) |
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SEPSIS PATHWAY (4 STAGES) |
SIRS - systemic inflammatory response syndrome SEPSIS - SIRS + infection SEVERE SEPSIS - sepsis + end organ damage SEPTIC SHOCK - severe sepsis + hypotension |
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SIRS criteria |
• temperature >38ºC or <36ºC • HR >90 bpm • RR >20 breaths/min • WBC >12,000 or <4,000 >12,000 = leukocytosis <4,000 = leukopenia |
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SEPSIS TREATMENT |
IV ANTIBIOTICS: > TAZOCIN > GENTAMICIN > VANCOMYCIN |
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ANAPHYLACTIC SHOCK PATHOGENESIS > WHAT MEDIATES IT? > WHAT IS RELEASED? > WHAT TYPE OF SHOCK OCCURS? |
> MEDIATED BY IgE > ++ RELEASE OF HISTAMINE > DISTRIBUTION SHOCK ~ CAPILLARY LEAKAGE |
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ANAPHYLACTIC SHOCK PRESENTATION (S&S) |
> cyanosis, oedema > breathlessness, wheeze, stridor > urticarial rash (aka hives) > erythema > angioedema (airways, tongue, eyes) > D&V > tachycardia > hypotension > sweating |
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ANAPHYLACTIC SHOCK Rx > 3 things to do? |
1) Secure the airway (intubate?) 2) Give Adrenaline IM, 0.5 ml (EpiPen) 3) IV Hydrocortisone |
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ARDS: ACUTE RESPIRATORY DISTRESS SYNDROME Name at least 3 pulmonary causes: |
1) Pneumonia 2) Chemical pneumonitis 3) Smoke inhalation (burns) 4) Near-drowning |
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ARDS: ACUTE RESPIRATORY DISTRESS SYNDROME Name at least 3 extra-pulmonary causes: |
1) Shock 2) head injury 3) drug reaction (AMIODARONE!!) 4) Sepsis |
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ARDS NAME 3 DIAGNOSTIC CRITERIA |
1) CXR >> bilateral pulmonary infiltrates 2) normal PCWP (Pulmonary capillary wedge pressure) + associated pulmonary oedema 3) refractory hypoxaemia (PaO2/FiO2 = <200) |
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What should be remembered regarding oxygen therapy for ARDS? |
Give mechanical ventilation with LOW TIDAL VOLUME > to avoid pneumothorax > lungs are heavy and non-compliant |
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SINUS BRADYCARDIA > NAME INTRINSIC CAUSES (3) |
> MYOCARDIAL INFARCTION > CHRONIC DEGENERATIVE FIBROTIC CHANGES > SICK SINUS SYNDROME >>> tachy/brady >>> sinus arrest |
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SINUS BRADYCARDIA > NAME EXTRINSIC CAUSES (3) |
> HYPOTHERMIA > HYPOTHYROIDISM > CHOLESTATIC JAUNDICE > RAISED INTRACRANIAL PRESSURE > DRUGS • Beta blockers • digoxin • anti-arrhythmic drugs |
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DEFINE PR INTERVAL |
> A conduction time it takes for the wave of polarisation to spread from the atria to the ventricles > [0.12 - 0.20s] |
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PEA Pulseless Electrical activity > define! |
PEA = electro-mechanical dissociation > clinical diagnosis of cardiac arrest > no pulse produced > ECG showing (semi)organised electrical activity > there is no asystole, just the CO is not sufficient to produce pulse peripherally |
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PEA Pulseless Electrical activity > the main causes (6H/6T) |
6H - hypovolaemia - hypoxia - hydrogen (acidosis) - hypo/hyperkalaemia - hypoglycaemia - hypothermia 6T - tablets & toxins - tamponade - tension pneumothorax - thrombosis - tachycardia - trauma |
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PEA Pulseless Electrical activity > Rx |
CPR Adrenaline injection > You can't use defibrillator |
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Name 6 risk factors for atherosclerosis |
1 hypertension 2 smoking 3 obesity, diet 4 hypercholesterolanaemia 5 age 6 sedentary lifestyle 7 diabetes mellitus |
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Name 2 ECG changes in ischaemia |
ST depression T-wave inversion |
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Name 2 options for stenotic coronary vessel treatment |
PCI: percutaneous coronary intervention CABG: Coronary artery bypass graft |
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PRIMARY PREVENTION FOR ASYMPTOMATIC INDIVIDUALS > name at least 3 indications |
1) total cholesterol >8mmol/L (or LDL >6mmol/L) 2) BP >180/110 mmHg (stage III / severe HTN) 3) all diabetes mellitus patients 4) close relatives with early onset CAD |
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Angina > name at least 4 types |
1) angina pectoris (exertional) 2) unstable angina (crescendo) 3) refractory angina (resistant) 4) Prinzmetal (variant) angina 5) Cardiac syndrome X 6) Decubitus angina (in HF) |
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Prinzmetal's angina > when does it occur? > aetiology > patient profile? > ECG changes? > RX? |
> occurs usually at rest, without provocation, usually early mornings > VASOSPASTIC: coronary vasomotor tone increases (these arteries are healthy) > relatively young women ~40yo, not many RF > ST elevation on ECG (mimicking MI) > CCB ± long-acting nitrates (isosorbide mononitrate) >>> avoid aspirin and BB (can aggravate ischaemia) |
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Cardiac syndrome X > aetiology & pathophysiology > patient profile |
> aka MICROVASCULAR ANGINA > increased downstream resistance > abnormal dilator regulation of coronary microvasculature > usually women > good prognosis but highly symptomatic |
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Presentation: PERICARDITIS TAMPONADE |
- sharp pain - associated with breathing - relieved when sitting forward (less strain on the pericardial sac attached to the diaphragm) - in pericarditis: ECG: a global saddle-shaped ST-elevation |
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Presentation: PULMONARY EMBOLISM |
- chest pain - haemoptysis - coughing out phlegm > frothy, pink mucous - decreased oxygen saturation - recent history of calf/ leg pain (DVT origin) - recent history of immobility (surgery, flight) |
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Presentation: AORTIC DISSECTION |
- severe tearing chest pain radiating to the back |
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Presentation: MSK PAIN pointers |
- associated with breathing and movement - recent Hx of unusual exertion, movement - certain movements always provoke the pain - some positions can relieve the pain |
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HYPERLIPIDAEMIA > name at least 2 peripheral signs |
- lipid arcus (arcus senilis round iris) - xanthelasma (round eye-lids) - xanthoma tendinosum (round tendons) |
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THYROTOXICOSIS > name at least 3 cardiovascular symptoms/complications |
- tachycardia ± AF - fast pulse - warm vasodilated peripheries, pyrexia - palmar erythema - high-output heart failure |
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What protein attaches G-actin to Tropomyosin? |
Troponins - troponin I (attached to actin) - troponin T (attached to tropomyosin) - troponin C (attache to Ca2+) |
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Which troponins are commonly monitored in MI? |
- troponin I - troponin T |
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CHANGES IN THE LEADS: ANTERIOR MI |
V1-V3 elevation (anterior/septal leads) (LAD: left anterior descending) |
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CHANGES IN THE LEADS: MASSIVE ANTERO-LATERAL MI |
V1-V4 elevation (anterior and lateral leads) (LCA: Left coronary artery) |
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CHANGES IN THE LEADS: LATERAL MI |
V5-V6, I, aVL elevation (LCA: left circumflex artery) |
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CHANGES IN THE LEADS: INFERIOR MI |
II, III, aVF elevation (right coronary artery) |
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CHANGES IN THE LEADS: POSTERIOR MI |
V1-V3 depression (right coronary artery) |
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Killip Classification > what is it? |
Killip classification for post-MI heart failure (HF) assessment Killip I (no crackles, no S3) Killip II (crackles <50% of lung fields/or S3) Killip III (crackles in >50% of lung fields) Killip IV (cardiogenic shock) >> Rx: revascularisation ± intra-oartic balloon pump (IABP) |
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RIGHT CORONARY ARTERY INFARCTION (sequelae) |
RCA: inferior MI > II, III, AVF >> papillary muscle infarction > mitral regurgitation >> SAN & AVN in most people > heart block & AV block |
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PULSUS PARADOXUS - what is it? - in which condition does it occur? |
> exaggeration of normal phenomenon, where the pulse/ CO decreases on inspiration > when we inspire: thoracic volume increases and the pressure drops increasing the systemic cardiac return > more blood in the RV means there will be less space for LV-filling > seen in CARDIAC TAMPONADE (Beck's triad) |
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DRESSLER'S SYNDROME > what is it? > what causes it? > presentation? > treatment Rx? |
- a recurrent post MI pericarditis (2-10wks) - autoimmune response to cardiac damage: anti-myocardial antibodies & elevated ESR - presents with angina, fever, pleural effusions and anaemia - Rx: NSAIDs, steroids |
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What conditions are associated with aortic coarctation? |
> Turner's syndrome > Berry aneurysms > Bicuspid aortic valve |
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What could be found on examination of someone with aortic coarctation? |
Discrepant BP in upper and lower part of the body |
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What infective agents typically cause rheumatic fever? |
Group A beta haemolytic streptococci > streptococcus pyogenes (antigen similarity with myocytes) > immunity to streptococcal pharyngitis can produce antibodies that cross-react with cardiac myocytes & valvular glycoproteins |
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What are the diagnostic criteria for Rheumatic Fever? > name? > list 5 criteria |
JONES' CRITERIA J: joints > polyarthritis O: heart > cardiomegaly, murmurs, pericarditis N: nodules, subcutaneous E: erythema marginatum S: Sydenham's chorea (St Vitus dance) |
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What is the most common cause of myocarditis? |
Viral myocarditis > coxsackie, adenovirus, echovirus, influenza Non-infectious > SLE, scleroderma, drugs, RA, sarcoidosis |
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Name the 6 P of acute lower limb ischaemia |
1 pain 2 pallor 3 pulseless 4 perishing cold 5 paraesthesia 6 paralysis |
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Aneurysm: definition |
A permanent dilatation of an artery to >50% of its original diameter > in a true aneurysm: all the tunicae involved > in a false aneurysm: only the adventitia involved |
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Aneurysms: name 4 causes for aneurysm formation |
- atheroma (advanced plaque > media thinning) - trauma - infection (mycotic aneurysms: IE, syphilis, E coli) - CTD (Marfan's, Ehler's-Danlos) - inflammation (Takayasu's aortitis) |
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AAA screening - who? - what test? |
- all men >65yo - USS abdomen |
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Ruptured AAA symptoms (name all 4) |
- severe epigastric pain, radiating to the back & to the groin - hypovolaemic shock symptoms - pulsatile abdo mass (unless v obese) - thrash feet (from 2ry emboli lodged in feet) |
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If AAA suspected, the presence of what can be checked to further support the diagnosis? |
> popliteal aneurysms: look behind patients' knees |
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Unruptured AAA >> name 3 indications for surgery |
1) diameter >5.5 cm 2) expansion >1cm/yr 3) symptomatic: abdo/back pain |
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AAA differentials (epigastric pain shooting into the groin and lower back) |
> LBP: IV disc disease? vertebral body erosion? > renal colic: mimics AAA > diverticulitis > testicular pain |
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TAA: thoraco-abdominal aneurysms > describe the presentation |
> sudden severe chest pain radiating to the upper back > hypovolaemic shock (hypotension, tachy, pale) > chest symptoms: >> stridor (compressed bronchial tree) >> haemoptysis (aorto-bronchial fistula) >> haematemesis (aorto-oesophageal fistula) >> hoarseness (recurrent laryngeal nerve compression) |
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AORTIC DISSECTION > which layers of the vessel get separated |
Tear in tunica intima > blood enters the media and cleaves the intimal/medial plain: dissection |
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Classification based on proximal/distal aortic dissection |
Stanford A (proximal) > aortic arch + ao valve + prox. to L subclavian origin > De Bakey t1 (extends to abdo aorta) > De Bakey t2 (only ascending aorta) Stanford B (distal) > distal to L subclavian origin > De Bakey t3 (only descending & abdo aorta) |
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Aortic dissection Rx > for type A > for type B |
Stanford A > surgery! >> arch replacement, high mortality > antihypertensives (BB) Stanford B > pharmacotherapy only > BB: labetalol |
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Takayasu's disease > epidemiology > pathophysiology > S+S > Rx |
> rare, mostly in Japan, females > vasculitis involving the aortic arch & other major arteries: aortic arch syndrome > systemic illness, pain & tenderness over affected arteries, absent peripheral pulses, HTN > Rx: corticosteroids (± surgical bypass might be needed) |
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Buerger's disease (thromboangiitis obliterans) > epidemiology > aetiology > pathophysiology > S+S > Rx |
> young-ish, male, smokers > smoking related inflammation > inflammation & thrombosis of middle-sized arteries and veins: causing ischaemia in peripheries > claudication, ulcers, gangrenes > Rx: STOP SMOKING |
