Term
| characteristic features of MI |
|
Definition
heavy central chest pain
radiate to neck and left arm
nausea, sweating, vomiting
elderly and diabetics may experience no pain
the pt may have risk factors for CVS disease |
|
|
Term
|
Definition
they may have a history of asthma, Marfan's etc
there will be sudden dyspnoea and pleuritic chest pain |
|
|
Term
|
Definition
sudden dyspnoea and pleuritic chest pain
calf pain/swelling
pt may be current COC user or have an ongoing malignancy |
|
|
Term
|
Definition
sharp pain that may be pleuritic in nature
it is relieved by sitting forwards |
|
|
Term
| features of dissecting aneurysm |
|
Definition
'tearing' chest pain, radiating through to the back.
there may be unequal upper limb BP |
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|
Term
|
Definition
burning retrosternal pain
other symptoms: regurg and dysphagia |
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|
Term
|
Definition
pain often worse on movement or palpation
may be made worse with trauma or coughing.
could be due to shingles where pain often precedes the rash. |
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|
Term
| if there is a filling defect within the aortic intima what condition could occur? |
|
Definition
aortic dissection.
blood tracks into the medial layer causing a false lumen.
most common in afro carribean males aged 50-70 |
|
|
Term
| what is the Stanford classification of Aortic dissection? |
|
Definition
Type A - proximal origin
Type B - distal to left subclavian
A type managed surgically
B type managed non operatively. |
|
|
Term
| how is aortic dissection diagnosed and confirmed? |
|
Definition
diagnosis can be made with CXR showing a widened mediastinum.
confirmation is with CT angiography |
|
|
Term
| sudden onset chest pain, haemoptysis, hypoxia and small pleural effusions. what are you thinking? how will you diagnose it. what underlying thing might the pt have? |
|
Definition
PE
CT pulmonary angiography for definitive diagnoses
pt may have underlying DVT
rx: anticoagulation |
|
|
Term
features of perforate peptic ulcer
rx for perf? |
|
Definition
sudden onset epigastric abdo pain followed by generalised abdo pain.
pain of gastric ulcer is typically worst after eating
erect CXR may show small amounts of free air beneath diaphragm. Large amounts of free air associated with colonic perforation.
rx: laparotomy. small tears are covered with a piece of omentum. large tears managed with partial gastrectomy. |
|
|
Term
| which spontaneous rupture of the lower oesophagus occurs as a result of repeated episodes of vomiting? |
|
Definition
Boerhaaves syndrome.
rupture usually distally sited and on the left hand side.
HX: pts say sudden onset severe chest pain that may complicate severe vomiting.
complication: severe sepsis secondary to mediastinitis. |
|
|
Term
diagnosis of Boerhaave syndrome?
rx? |
|
Definition
CT contrast swallow
rx: thoracotomy and lavage
if presentation < 12 hours repair is possible
if > 12 h> insert T tube to create a controlled fistula between oesophagus and skin
if > 24 hours associated with very high mortality. |
|
|
Term
| in pt presenting with ?ACS when should you offer oxygen? what level? |
|
Definition
|
|
Term
| define Anginal pain according to NICE |
|
Definition
constricting discomfort in front of chest, neck, shoulders, jaws or arms
this is precipitated by exertion
relieved by GTN of 5 mins rest
if pts have all 3 = typical angina
2 features? atypical angina
1 or none: non anginal chest pain. |
|
|
Term
| if a pt with typical angina and a CAD score of 10-29% what test would you do? |
|
Definition
| CT calcium scoring: extent of calcified plaques in coronary arteries. |
|
|
Term
| if a pt with typical angina and a CAD score of 30-60% what test would you do? |
|
Definition
functional imaging e.g.
myocardial perfusion scan with SPECT
stress echo
MR imaging for stress induced wall changes. |
|
|
Term
| pt with typical angina symptoms and 61-90% of CAD what test would you do? |
|
Definition
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|
Term
| list unmodifiable risk factors for IHD |
|
Definition
|
|
Term
| list modifiable risks for IHD |
|
Definition
smoking
obesity
DM
HTN
hypercholesterolemia |
|
|
Term
| in IHD what are foam cells? |
|
Definition
| monocytes that have turned into macrophages and engulfed oxidised LDL. as foam cells die, they further propagate the inflammatory response. |
|
|
Term
| which stain is used to differentiate between collagen and smooth muscle? |
|
Definition
|
|
Term
ECG changes in V1 to V4. what time of MI?
which artery is affected? |
|
Definition
|
|
Term
ECG changes in II, III and AVF.
where is the MI?
which artery is affected? |
|
Definition
inferior MI
right coronary artery |
|
|
Term
ECG changes is I, V5-6
where is the MI?
which artery is affected? |
|
Definition
Later MI
artery affected is circumflex. |
|
|
Term
what drugs are involved in secondary prevention of ACS?
what lifestyle changes? |
|
Definition
aspirin
second anti platelet e.g. clopidogrel
statin
ACE-i
beta blocker
lifestyle: lose weight, exercise more, eat less salt, more oily fish, fruit and vegetable. |
|
|
Term
|
Definition
initial: LMWH or fandaparineux.
then warfarin or NOAC
unprovoked PE 6 months
provoked PE 3 months
recurrent PE : lifelong anticoagulation |
|
|
Term
| in massive PE where there is circulatory failure, what is the 1st line of rx? |
|
Definition
|
|
Term
| management of aortic dissection |
|
Definition
Type A: surgical endovascular repair, keep BP within 100-120 whilst awaiting intervention
Type B: conservative mx
bed rest
lV laebtolol to prevent progression of high BP |
|
|
Term
|
Definition
| it is a protein released from myocytes when irreversible myocardial damage occurs. |
|
|
Term
| when does serum troponin levels increase ein ACS? |
|
Definition
3-12 hours from onset of pain.
They peak at 24-48 hours and return to baseline over 5-14 days. |
|
|
Term
| what is the most sensitive early marker for myocardial death? |
|
Definition
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