Cardiology Flashcards

Flashcards about hypertension, stable angina, unstable angina, acute myocardial infarction, cardiogenic shock, atherosclerosis and ECG aspects

Hypertension

High blood pressure, SBP > 140mmHg and DBP > 90mmHg

Pre-hypertension

SBP (120-139mmHg), DBP (80-89mmHg)

Stage I Hypertension

SBP (140-159mmHg), DBP (90-99mmHg)

Stage II Hypertension

SBP > 160mmHg, DBP > 100mmHg

Secondary causes of hypertension

Renal disease, endocrine disorders, neurological disorders, medications, cirrhosis

Risk factors of hypertension

Age, gender, obesity, stress, family history, lifestyle (alcohol & smoking)

Formula for Blood Pressure

BP = CO x SVR

Clinical features of hypertension

Severe headache, blur vision, chest pain, dizziness, arrhythmia, diaphoresis, papilledema

Lifestyle changes for hypertension management

Weight loss, exercise, stress management, healthy food

Examples of CCB medications

Amlodipine, Nicardipine, Nifedipine

Examples of ARB medications

Losartan

Examples of ACEI medications

Captopril, Ramipril

Examples of Diuretic medications

Furosemide, chlorothiazide

Examples of Beta-blocker medications

Atenolol, propanolol

Examples of Alpha blocker medications

Prazosin

Examples of Vasodilators medications

Nitroglycerin, Sodium nitroprusside, Hydralazine

Angina pectoris

Chest pain or chest discomfort (Transient). Occurs during heart cell ischemic event related to mismatch of oxygen demand/supply to myocardium.

Most common Etiology of Angina pectoris

Coronary artery disease

Pathophysiology of Angina pectoris

Atherosclerosis à plaque in the heart artery à decrease Blood flow to myocardial à Ischemic/Hypoxia

Lifestyle changes for Stable Angina management

Diet, Exercise

Medication & Surgery to treat Stable Angina

Nitroglycerine , Coronary artery angiogram/PCI, Coronary artery bypass Graft

Complication of Stable Angina

Unstable angina, NSTEMI, STEMI, Sudden death

Unstable Angina Definition

Heart doesn’t get enough blood & Oxygen supply. Poor blood flow through coronary artery it called Coronary artery disease.

Most common cause of Unstable Angina

Atherosclerosis

Risk factors for Unstable Angina

Diabetes, High blood pressure, Increased LDL/Decreased HDL, Smoke, Obesity, Male sex

Clinical features of Unstable Angina

Chest pain occurs at rest (sleeping or sitting), shortness of breath, sweating, decreased BP, does not respond well with nitroglycerine

Blood Test used for diagnosis of Unstable Angina

Troponins I and T, Creatinine phosphokinase(CPK), Myoglobin

Medication used for Treatment of Unstable Angina

Heparin , Nitroglycerine , Control other associated disease

Non-medication Treatment for Unstable Angina

Angioplasty/Coronary Percutaneous Intervention

Complication of Unstable Angina

Arrhythmias, Heart attack, Heart failure

Acute Myocardial Infarction Definition

Sudden episodes of reduced or no blood flow to heart result of narrow or blockage of one or more coronary arteries

Causes of Acute Myocardial Infarction

Decreased BP, Obesity(Increased Cholesterol), Diabetes , Smoke, Age , Family history

Clinical feature of Acute Myocardial Infarction

Chest pain: Retrosternal or Left side duration > 30mn

First line Medication for Acute Myocardial Infarction

O2 supply, Anti-coagulant, Clopidogrel, Aspirin, Statin, PPIs

Complication of Acute Myocardial Infarction

Thrombosis, Heart arrhythmia, Heart failure, Cardiac arrest

Advice to patient after Acute Myocardial Infarction

Small salt diet, Take all the medication, Chest pain or tightness come back to hospital

Cardiogenic Shock Definition

Is the condition in which a suddenly weakened heart isn’t able to pump enough blood to the body

Cardiogenic Shock Epidemiology

Men>Woman

Risk factors of Cardiogenic Shock

Old age, History of heart failure/attack, Coronary artery disease(Blockage several heart’s main artery), DM/HTN Existing heart disease

Symptoms of Cardiogenic Shock

Clammy skin, decrease SBP, Tachycardia, Rapid respiration, Oliguria , Cyanosis , Mental confusion

Diagnosis of Cardiogenic Shock

Chest x-ray: Look for cardiomegaly, ECG, Echo-cardiogram: look for Endocarditis / Pericardial effusion Cardiac catheterization(Angiogram)

Treatment for Cardiogenic Shock

Inotropes, Thrombolytic drugs, Antiplatelet Angioplasty and stenting Balloon pump, Surgery

Prevention of Cardiogenic Shock

Avoid smoking & Alcohol, Maintain body weight, Limit added sugar Exercise regularly

Atherosclerosis Definition

Is a disease of arteries which is causes the formation of plaques in the artery’s wall. The plaque consists of fat, cholesterol , Calcium and macrophage.

Risk factors of Atherosclerosis

Smoking , HTN Increased LDL cholesterol, Diabetes à chronic hyperglycemia Family , Age, Lifestyle

Symptoms of Atherosclerosis

Heart arteries: Chest pain(Angina), Arteries leading to brain : sudden arm or leg numbness or weakness difficulty speaking drooping face

Medication Treatment for Atherosclerosis

STATINS(Decrease LDL) or Fenofibrates (Decrease TG), Antiplatelets, Anti coagulation drugs Anti-hypertensive Diabetic drugs

ECG of Angina

Unstable angina & NSTEMI have the same ECG (We look at ST segment & T wave)

ECG Definition

ECG is a graphic recording of electric potential generated by the heart

Use of ECG

Detecting arrhythmia Conduction disturbance Myocardial ischemia Metabolic disturbance(Hyper/Hypokalemia…)

Cardiac conduction system

ICS: specialized muscle cells, which can generate electricity and make the heart to pump.Electricity was made by: SA node , AV node , AV bundle Bundle branches Purkinje Fibers

ECG waves

P wave, QRS, ST segment, T wave

ECG Tracing

Usually speed: 25mm/s, Usually amplitude: 10mm/mV

ECG Analysis

Calculate: Rate (HR), Determine: Rhythm, Calculate: P wave, PR interval, QRS, T wave Determine AXIS Look for evidence of: ST depression, T wave inverted

Rhytm of ECG

Sinus: Normal P wave follows by normal QRST (Upright P in lead II)

ECG Aspect injury

ST elevation - ST elevated (J point included), Q wave - Dept > 1/3 QRS, or Width >1 mm (0.04 s)

STEMI caused by

Complete thrombus occlusion, LBBB