Studydroid is shutting down on January 1st, 2019

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What is the common cause of angina pectoris?
What are the less common causes of angina pectoris? [5]
Anaemia, aortic stenosis, tachyarrythmias, hypertrophic obstructive cardiomyopathy, arteritis/small vessel disease
Name the types of angina [4]
Stable angina, unstable (crescendo) angina, decubitus angina, variant (Prinzmetal\\\'s) angina
How is stable angina induced?
Effort (relieved by rest)
What are the characteristics of unstable (crescendo) angina? [3]
Increasing frequency or severity, occurs in minimal exertion or rest, associated with ^^ risk of MI
What precipitates decubitus angina?
Lying flat
What is the cause of variant (Prinzmetal\\\'s angina)?
Coronary artery spasm
Angina - tests [2]
ECG, exercise ECG
How may angina present on ECG? [4]
May be normal, ST depession, flat/inverted T waves, signs of past MI
What precipitating factors may need to be excluded when investigating angina? [5]
Anaemia, diabetes, hyperlipidaemia, thyrotoxicosis, giant cell arteritis
What is the lifestyle management of angina? [3]
Stop smoking, encourage exercise, weight loss
Describe the drug management of stable angina [6]
Aspirin (75-150mg/24h), B-blockers (e.g. atenolol 50-100mg/24h po), nitrates (symptomatic spray, prophylaxis po), calcium antagonists (amlodipine 10mg/24h; diltiazem-MR 90-180mg/12h po), statin, K+ channel activator
List the treatment steps for acute coronary syndrome without ST-elevation (e.g. unstable angina, evolving MI [4]
MONA - morphine, oxygen, nitrate, aspirin
What is percutaneous transluminal coronary angioplasty (PTCA)?
Balloon dilation of a stenotic vessel
What are the indications for CABG? [8]
Left main stem disease, multi-vessel disease, multiple severe stenoses, distal vessel disease, failed/unsuitable for angioplasty, refractory angina, MI, pre-operative (valve/vascular surgery)
Acute coronary syndromes (unstable angina, evolving MI) - P [4]
Plaque rupture, thrombosis, and inflammation (rarely emboli, coronary spasm, or vasculitis)
What are the risk factors for ACS? [9]
Non-modifiable: age, male sex, family history of IHD; modifiable: smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary lifestyle
What is the incidence of ACS?
5/1000 per annum (UK) for ST-segment elevation
What ECG changes are seen in ACS without ST-segment elevation? [4]
May show ST-depression, T-wave inversion, non-specific changes, or be normal
How is ACS diagnosed?
2/3 from: i) typical history, ii)ECG changes, iii) cardiac enzyme rise
What are the symptoms of ACS? [5]
Acute central chest pain lasting > 20 mins, sweatiness, dyspnoea, palpitations (elderly or diabetics may suffer \\\'silent\\\' infarct)
List the signs of ACS [6]
Distress and anxiety, pallor, sweatiness, pulse/BP high or low, 4th heart sound, may be signs of HF
What investigations are useful in ACS? [3]
ECG, CXR, bloods (FBC, U&E, ^glucose, low lipids, ^cardiac enzymes - CK, AST, LDH, troponin)
What are the differential diagnoses, for suspected ACS? [6]
Angina, pericarditis, myocarditis, aortic dissection, pulmonary embolism, oesophageal reflux/spasm
In ACS, what proportion of deaths occur in the first 2 hours?
What are the CXR findings in ACS?
Cardiomegaly, pulmonary oedema, widened mediastinum (NB do not delay Rx waiting for CXR)
What are the classical ECG findings in ACS? [6]
Hyperacute T-waves, ST elevation or new LBBB occur within hours of acute Q-wave. T-wave inversion and pathological Q-waves follow after hours or days. (ECG initially normal in 20%)
Describe post-ACS management [8]
48h bed rest, daily 12-lead ECG U&E cardiac enzymes for 2-3d, prophylaxis for thromboembolism, oral B-blockers, continue ACE-i, statin, exercise ECG, modify risk factors
List the complications of MI [13]
Cardiac arrest, cardiogenic shock, unstable angina, bradycardias/heart block, tachyarrythmias, LVF, RVF/infarction, pericarditis, DVT/PE/systemic embolism, cardiac tamponade, mitral regurgitation, ventricular septal defect, Dressler\\\'s syndrome
List the cardiac causes of arrhythmia [8]
MI, coronary artery disease, LV aneurysm, MV disease, cardiomyopathy, pericarditis, myocarditis, aberrant conduction pathways
List the non-cardiac causes of arrhythmia [7]
Caffeine, smoking, alcohol, pneumonia, drugs, metabolic imbalance (K+, Ca2+, Mg2+, hypoxia, etc), phaeochromocytoma
How does arrhythmia present? [5]
Palpitation, chest pain, (pre)syncope, hypotension, or pulmonary oedema. (May be unsymptomatic)
What tests are indicated in arrhythmias? [8]
FBC, U&E, glucose, Ca2+, Mg2+, TSH, ECG (24h/exercise), echo
Bradycardia (<40 bpm or symptomatic) - Rx [4]
Treat cause (e.g. drugs, hypothyroidism), atropine 0.6 - 1.2 mg iv, temporary/permanent pacing wire, isoprenaline
How does sick sinus syndrome arise?
Sinus node dysfunction causes bradycardia +/- arrest, SA block, or tachy-brady syndrome (AF and thromboembolism may occur)
How is sick sinus syndrome treated? [1]
What is SVT?
Narrow complex tachycardia (>100 bpm, QRS width <120 ms)
What is the acute management of SVT? [4]
Vagotonic manoeuvres, iv adenosine or verapamil (if not on B-blocker), DC shock if compromised
What is the maintenance management of SVT? [2]
B-blockers or verapamil
How is AF/flutter treated?
Digoxin loading dose (500 micrograms/12h x 2) then maintenance dose (0.125-0.25mg/24h)
How is VT defined?
Broad complex tachycardia (rate >100 bpm, QRS duration >120ms)
What is the acute management of VT?
iv lignocaine or amiodarone
Which drug is used in the maintenance management of VT?
What is narrow complex tachycardia?
ECG shows rate of >100bpm and QRS complex duration of <120ms
What is the differential diagnosis of narrow complex tachycardia? [7]
Sinus tachycardia, SVT, AF, atrial flutter, atrial tachycardia, multifocal atrial tachycardia, junctional tachycardia
How does sinus tachycardia present on ECG?
Normal P wave followed by normal QRS
How does SVT present on ECG?
P wave absent or inverted after QRS
How does AF present on ECG?
Absent P wave, irregular QRS complexes
How does atrial flutter present on ECG?
Atrial rate usually 300 bpm (sawtooth baseline), ventricular rate often 150 bpm
How does atrial tachycardia present on ECG?
>100 bpm/QRS <120ms, abnormally shaped P waves, may outnumber QRS
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