6. CARDIOVASCULAR Flashcards
1
Q
what value is defined to be hypertension
A
140/90 or above
2
Q
what value defines malignant hypertension
A
180/110
3
Q
what is malignant hypertension (3)
A
very high blood pressure that develops quickly and causes organ damage
4
Q
what are the categories of hypertension and how many cases are in each category and describe the difference between the two
A
primary 90%
secondary 10%
primary has no known cause and secondary has known causes
5
Q
what is the most common cause of secondary hypertension
A
renal disease
6
Q
what are the causes of secondary hypertension (6)
3 Cs, 2Ps, 1R
A
renal disease
pregnancy
phaechromocytoma
cushings
conns
coarctation of the aorta (congenital narrowing of the aorta)
7
Q
why is primary hypertension not usually presented
A
its usually asymptomatic
8
Q
what are the 4 main areas that malignant hypertension has symptoms in
A
brain, eye, heart and kidneys
9
Q
how can end organ damage be assessed for hypertension (3)
A
fundoscopy= for papilloedema
urinalysis= for renal function
Echo/ECG= assesses left ventricular hypertrophy
10
Q
what can malignant hypertension cause in the brain (3)
A
cerebral oedema and haemorrhage and stroke
11
Q
what can malignant hypertension cause in the eye (2)
A
cotton wool spots
papilloedema
12
Q
what can malignant hypertension cause in the heart (2)
A
acute heart failure
aortic dissection
13
Q
what can malignant hypertension cause in the kidneys and what are the symptoms of this (1, 2)
A
acute kidney injury
proteinuria, haematuria
14
Q
what is the method that hypertension can be diagnosed with 1
A
ambulatory blood pressure
(home blood pressure monitoring)
15
Q
how is hypertension staged and what are the actions for each stage (3)
A
stage 1: 135/85 (assess risks- including assessing organ damage)
stage 2: 150/95 (medications)
stage 3: 180/110 (malignant- medications)
16
Q
what is the treatment approach for stage 1 hypertension 1
A
BP monitored every 5 years
17
Q
if the bp is measured at GP and is 140/90 then what is the next step
A
check ambulatory blood pressure at home
18
Q
what is always the first line of management for stage 2 hypertension 2
A
lifestyle changes and medication combined
19
Q
what is the treatment for a patient with malignant hypertension and signs of renal/ eye damage (2)
A
same day admission
start antihypertensive drug immediately
20
Q
what two things are offered to a person who has been diagnosed with hypertension
A
assessment of Cv risk
investigation for secondary hypertension
21
Q
what is the treatment for under 55s and not of African/ Caribbean origin (2)
A
ace inhibitor or angiotensin receptor blocker
22
Q
what is the treatment for over 55s and of African/ Caribbean origin (1)
A
calcium channel blocker
23
Q
what is the 2nd step if one drug is not controlling hypertension for the two categories of people to treat
A
<55 not A/C origin= CCB or thiazide like diuretic eg indapamide can be added
>55 of A/C origin= ACEi or ARB or thiazide like diuretic eg indapamide can be added
24
Q
if a patient is on ACEi and BB already but still symptomatic what should be given to them 1
A
spironolactone
25
give an example of an ARB, ACEI, beta blocker, calcium channel blocker
losartan, ramipril, bisoprolol, amlodipine
26
what is ACEi contradicted in 3
asthma and pregnancy and renal stenosis
27
what is a side effect of ACEi and what can be given instead
dry long term cough
ARB- losartan
28
side effect of beta blockers 1 and what can this cause 1
postural hypotension which cause cause loss of consciousness
29
what is the first line medication for diabetics with hypertension
ACEi
30
what happens when hypertension persists even when multiple medications are prescribed (2)
1. talk about adherence
2. add a beta blocker or spironolactone
31
what happens in ischaemic heart disease and what is the effect on cardiac myocytes
cardiac myocytes r damaged due to insufficient oxygenated blood supply
32
what are the two causes of ischaemic disease (2)
coronary artery occlusion caused by atherosclerosis
insufficient blood supply caused by valvular disease or anaemia
33
rate the severity of ischaemic heart disease (4)
stable angina-> unstable angina-> NSTEMI-> STEM
34
what are the investigations of ischaemic heart disease 3 (2, 3, 3)
1. resting ECG/ exercise ECG to induce ischaemia
2. blood tests: HBA1C, FBC, cholesterol profile
3. biological markers: troponin, creatine kinase and myoglobin
35
what is the treatment for unstable angina and NSTEMI (4)
BMOAN; beta blocker, morphine, oxygen, aspirin, nitrate
bmoaN for Nstemi and uNstable angina
36
what is the treatment for acute and for chronic ischaemic heart disease and what type of drug is it (1,1)
acute: clopidogrel (anti-platelet)
chronic: beta blocker eg atenolol
37
what is the treatment for acute STEMI (2)
PCI if available, otherwise fibrinolysis (alteplase/ streptokinase)
38
whata re the surgical interventions for ischaemic heart disease 2 and what does each stand for
PCI- percutaneous coronary intervention
or CABG- coronoary artery bypass graft
39
for what patients is CABG prefered over PCI 2
patents with diabetes over 65 years
40
what is acute coronary syndrome and what does it include
umbrella term including unstable angina, STEMI and NSTEMI
41
how is the diagnosis done for acute coronary syndromes
ECG to see if there is ST elevation
if there is ST elevation= STEMI
if no ST elevation, then a troponin test is done
if high troponin then its is a NSTEMI, if normal then it is unstable angina
42
what are the ECG changes shown for unstable angina, NSTEMI and STEMI (2, 2, 2)
unstable: normal/ ST depression and T wave inversion
NSTEMI: ST depresion and T wave inversion
STEMI: ST elevation in leads 2-3, pathological Q waves
43
what is the most common cause of reduced blood flow to the heart
coronary artery disease
44
what is angina
blood supply is less than the demand in the heart
45
what is stable angina induced by (3)
physical exertion, emotional stress or the cold
46
when does angina cause symptoms
when vessel is 70-80% occluded
47
how can stable angina be relieved (2)
rest or sublingual Glyceryl trinitrate spray
48
symptoms of stable angina (4)
central chest tightness/ discomfort
pain radiating to arms, neck or jaw
dyspnoae
sweating
49
what is the main investigation for stable angina and results (2)
ECG- ST interval can be normal or depressed and no T wave inversion
50
treatment for stable angina in order (4)
modify risk factors: stop smoking, exercise etc
GTN spray for relief
beta blocker
revascularisation (PCI/CABG)
51
how does a GTN spray work
PDE-5 inhibitor- causes coronary artery vasodilation
52
what is the first medicine treatment for stable angina 1 and what is after this 2 and names
GTN spray
beta blockers/ CCB
eg verapamil/ diltiazem
VERAPAMIL
DILTIAZEM
53
differentials for stable angina (chest pain during exertion) 4- 3 r non heart related
pericarditis
Pulmonary E
mbolism
chest infection
Gastro Oesophageal Reflux Disease
54
what is unstable angina (2)
chest pain that occurs at rest, not relieved by GTN spray
55
compare unstable and stable angina chest pain in terms of duration and frequency
unstable lasts for longer and occurs more frequently
56
what is the first thing to do with unstable angina
immediate admission to hospital
57
what causes a STEMI vs NSTEMI
STEMI= complete occlusions of a major coronary artery
NSTEMI=partial occlusion of a major coronary artery or complete occlusion of a minor coronary artery
58
compare the heart damage in STEMI vs NSTEMI
STEMI=causes full thickness damage of heart muscle
NSTEMI=causes partial thickness damage of heart
59
after which results are STEMIs vs NSTEMIs diagnosed
STEMI= ecg results
NSTEMI= on troponin results (high)
60
what are the biological markers of STEMI and NSTEMI (3)
both have an increase in troponin, myoglobin and CK levels
61
what is prinzmetal's angina caused by and when does it happen
caused by coronary vasospasm
occur at rest/ night
62
what does the ECG show for prinzmental's angina and what are the characteristic of patients that have this
ST elevation
seen in cocaine users
63
compare an MI and angina in terms of occlusion level and permanent damage (2)
angina is usually due to narrowed coronary arteries but MI is due to blocked
angina has no permanent heart damage but MI has permanent heart damage
64
what are the 2 types of MI and their respected causes
type 1= due to ischaemic heart disease
type 2= due to increased demand or coronary artery vasospasm
65
risk factors for MI (4 non modifiable, 2 modifiable)
older age, male sex, family history of ischaemic heart disease, ethnicity (blacks and hispanics), smoking, sedendary lifestyle
66
symptoms of MI (6)
central pain, sweating, dyspnoea, palpitations, pallor, nausea
67
what is significant about diabetics that get MIs and what is the complication of this
MIs can be silent because no cardiac pain is felt from diabetic neuropathy
these patients can die form sudden collapse
68
what can STEMI show on an ECG a few days after the MI (3)
pathological Q waves, hyperacute T waves, LBBB
69
what is the treatment for MI 2
300mg loading dose of aspirin then maintenance dose of 75mg
70
differentials for MI (5)
pericarditis
myocarditis
pulmonary embolism
gastro oesophageal reflex disease
aortic dissection
71
complications of MI (10)- acronym
DARTHVADER
death
arrhythmia
rupture
tamponade
heart failure
valve disease
aneurysm
dressler syndrome (pericarditis due to injury to heart)
embolism
recurrence/ regurgitation
72
compare systolic and diastolic heart failure
systolic heart failure= inability of ventricle to contract properly
diastolic heart failure= inability of the ventricle to relax and fill
73
what are the ejection fraction values for diastolic and systolic heart failure
diastolic: EF > 40%
systolic: EF <40%
74
what r common causes of systolic failure 2
MI
poorly controlled HPT
75
what is cardiac failure
heart unable to pump enough blood to supply metabolising tissues in the body
76
compare left sided and right sided heart failure causes (3,3)
left causes: hypertension, coronary artery disease, valvular disease (divided into diastolic and systolic)
right
right causes: left ventricular failure, right MI or pulmonary hypertension
77
symptoms of left sided failure (8)
respiratory crackles
pink-tinged sputum
tachycardia
fatigue
CYANOSIS
EXERTION DYSPNOEA
cough
PULMONARY oedema due to vessel backflow
78
symptoms of right sided failure (5)
ASCITES
hepatosplenomegaly
WEIGHT GAIN
palpable JVP
PERIPHERAL OEDEMA due to systemic venous backflow
79
why is there increased jugular venous pulse? 1 and what condition is this indicative 1
due to increased pressure in right atrium
venous hypertension
80
what is myopathic heart failure
disease of the heart muscle that affects its size/ shape/ thickness and makes it harder for the heart to pump sufficient blood to the rest of the body
81
what is hypertensive heart failure
long term heart failure that develops over a long period of time in people who have hypertension
82
what is cor pulmonale heart failure and what does this lead to
enlargement of right ventricle which causes right side heart failure
83
what can cor pulmonale cause 3
venous overload, peripheral oedema and hepatic congestion
84
what can disease of lung/ pulmonary vessels cause 2 and what does this lead to 1, give an example of such a disease
pulmonary hypertension and right ventricular hypertrophy
leads to right side heart failure
COPD
85
what is congestive heart failure
failure on both sides of heart
86
what are the two methods the body uses to compensate for heart failure (2) and why is this only effective short term?
RAAS system activation (increased salt and water reabsorption to increase bp)
sympathetic system activation (increases inotrophy and chronotrophy)
short term as high RAAS and SNS activation exacerbates fluid overload
87
compare inotrophy and chronotrophy
inotrophy- force of heart contraction
chronotrophy- rate of heart contraction
88
what is the most common cause of heart failure
coronary artery occlusion
89
causes of cardiac failure (7- 4 heart and 3 non heart)
ischaemic heart disease, cardiomyopathy, valvular heart disease, arrythmias, anaemia, excess alcohol,
hyperthyroidism
90
risk factors for cardiac failure (5)
65+, african athnicity, male, obesity, history of MI
91
clinical signs of cardiac failure (7)- remember mneumonic
cyanosis, murmers, COUGH, oedema, displaced apex beat, orthopnoea, resp crackles
(many cardiac organs can omit deaths rhythm)
92
compare acute and chronic cardiac failure in terms of duration and emergency
chronic= occurs over time
acute= occurs suddenly, more of an emergency
93
acute cardiac failure treatment (4)
remember mneumonic
oxygen, morphine, furosemide, GTN spray
OMFG
94
explain chronic cardiac failure treatment- only lifestyle (3)
lifestyle: stop smoking, watch diet, avoid NSAIDs
95
explain chronic cardiac failure treatment- meds only (remember mneumonic) 4 lines
1st line- ACEi and Beta blocker
2nd- ARB and nitrate
3rd- cardiac resynchronisation or digoxin
4th-diuretics eg furosemide for symptoms relief
ABANCDD
96
how do diuretics work when treating heart failure
reduces blood volume which decrease blood pressure and reduces how hard the hear has to work
97
what four drugs can deal with reduced ejection fraction but what is a risk of these drugs
ACEi/ ARB/ beta blocker/CCB
increases likelihood of falls
98
what is the first line of treatment for oedema
diuretics
99
what is the marker for chronic heart failure but what is it not?
BNP
not diagnostic
100
what are the 2 types of murmurs and which is more common
systolic or diastolic
systolic is more common
101
what are the two types of systolic murmurs (remember mneumonic)
aortic stenosis
mitral regurgitation
ASMR
102
what are the two types of diastolic murmurs (remember mneumonic)
aortic regurgitation
mitral stenosis
ARMS
103
what is valve regurgitation and what does this lead to 2 and how does this affect the heart
floppy valve
= proximal chamber dilation and hypertrophy
which leads to heart becomes huge and rigid and poorly compliant
104
what is valve stenosis and what does this lead to 2 and how does this affect the heart
narrowed valve opening
=proximal chamber dilation and hypertrophy
which leads to heart becomes huge and rigid and poorly compliant
105
what are the three investigations done for valve disorders and what does each show
Echo- heart and valve function whilst beating
ECG- hypertrophy
CXR- calcifications/ masses of valves and aortic root
106
what is the GS diagnostic investigation for ALL valvular diseases and what does this look at
echocardiograms- looks at valve function during the cardiac cycle
107
what is the most common valve disorder
aortic stenosis
108
2 risk factors for aortic stenosis
calcified aortic value disease
congenital bicuspid aortic valve
109
pathophysiology of aortic stenosis- how does it cause ischaemia of heart 3
1. narrowed aortic valve opening causes reduced blood flow out of the left ventricle
2. the heart compensates to pump out more blood by undergoing left ventricular hypertrophy
3. this increases cardiac oxygen demand, leading to ischaemia
110
symptoms of aortic stenosis (2)
syncope on exertion
dyspnoea
111
what is the murmur for aortic stenosis 3
ejection systolic crescendo-decrescendo murmur at right sternal border 2nd ICS which radiates to carotids
112
what is the heart sound for aortic stenosis 1
prominant S4
113
investigations for aortic stenosis (3) and what would each show
GS: echocardiogram
ECG: ventricular hypertrophy
chest x-ray: calcified aortic valve
114
what is the treatment for aortic stenosis (2) and which is less invasive
surgical aortic valve replacement
or TAVI (transcutaneous aortic valve implantation) which is less invasive
115
differential for aortic stenosis
mitral regurgitation
116
causes of mitral regurgitation (4)
infective endocarditis
Post MI= papillary muscle dysfunction or ischaemic mitral valve
connective tissue disorders
117
what is the pathophysiology for mitral regurgitation and how it causes right ventricular dysfunction
1. leaky mitral valve= blood regurgitates into the left atrium
2. = left atrial enlargement
3. left ventricular hypertrophy as smaller volume of blood that can be pumped out
4. = pulmonary hypertension
5. = right ventricular dysfunction
118
symptoms of mitral regurgitation (2) and explain both
exertion dyspnoea- due to pulmonary hypertension
symptoms of heart failure- due to right side dysfunction
119
what is the mitral regurgitation murmur 3
pan systolic blowing murmur at apex radiating to axilla
120
what r the heart sounds for mitral regurgitation 2
soft S1, prominent S3 in heart failure
121
investigations for mitral regurgitation (2)
GS- echo
CXR and ECG
122
treatment for mitral regurgitation (3) and what r the 2 conditions for this surgery (mentioned in no. 3)
vasodialtors eg ACEi
rate control eg beta blockers
mitral valve surgery if ejection fraction is less than 60% or new onset atrial fib
123
causes of mitral stenosis (4) and what is the main cause
rheumatic heart disease
untreated streptococcal infections- MC
mitral valve calcification
infective endocarditis
124
pathophysiology of mitral stenosis- how does it cause right ventricular hypertrophy
more blood remains in left atrium so higher pressure in atria causes atrial hypertrophy
this causes pulmonary hypertension
this causes right ventricular hypertrophy
125
2 signs and 1 symptom of mitral stenosis and what is the characteristic of the symptom presentation
atrial fibrillation
malar cheek flush
dyspnoea
symptoms can appear years later
126
what is the murmur for mitral stenosis and how can this be heard best and how can u position the patient to hear this murmur
low pitched mid diastolic murmur, loudest at apex
best hear on expiration when patient lying on left
3Ls (Low pitched, Loudest at apex, Left side inspiration for patient)
127
investigations for mitral stenosis (3)
echocardiogram
ECG
CXR
128
treatment for mitral stenosis (4)
rate control- beta blockers
diuretics- furosemide
surgical mitral valve replacement or percutaneous balloon mitral valvotomy (less invasive)
129
what is aortic regurgitation
aortic valve doesnt close tightly (leaky aortic valves), allowing blood to leak into left ventricle from aorta during diastole
130
acute and chronic causes of aortic regurgitation (2,3)
acute:
aortic dissection
infective endocarditis
chronic:
congenital bicuspid aortic valve
rheumatic heart disease
connective tissue disorders (M/ED)
131
explain the pathophysiology of aortic regurgitation and how does this cause ischaemia of the heart
back flow is compensated for with left ventricular hypertrophy
this causes left ventricular hypertrophy and causes increased cardiac oxygen demand which causes ischaemia
132
1 symptom and 2 signs of aortic regurgitation
exertional dyspnoea
collapsing carrigon pulse with wide pulse pressure
133
what is the aortic regurgitation murmur
early diastolic blowing decrescendo murmur at right sternal border 2nd ICS
134
what is significant about the mitral stenosis murmur
longer the murmur means it is more severe
135
investigations for aortic regurgitation (3)
echocardiogram
ECG
CXR
136
treatment for aortic regurgitation 3
IE prophylaxis
vasodilators ie ACEi
monitor progression and do aortic valve replacement if symptoms r getting worse
137
what is a differential for aortic regurgitation
IE
138
what is infective endocarditis an infection of
infection of endocardium (inner lining of the heart) and valves
139
what are the two causes of IE
1. causative bacteria
2. colonising abnormal endothelium (vegetations)
140
what valve is affected in IE and what is the exception
mitral valve typically
tricuspid in IV drug users
141
risk factors for IE (6)
poor dental hygeine
prosthetic valve
intravenous drug use
rheumatic heart disease
male
elderly
2 lifestyle, 2 to do with heart, 2 non-modifiable risk factors
142
3 bacterial causes of IE, where from and which are the most common
most common= staphylococcus aureus (from intravenous drug use)
strep viridian’s due to mouth surgery/ dentists (common in developing countries)
staph epidermis due to prosthetic valve surgery
143
pathophysiology of IE vegetation formation
damaged endocardium has increased platelet deposition and bacteria adheres to this, causing vegetation to be formed
144
signs of IE 4
splinter haemorrhages
Janesway lesions
Osler nodes
Roth spots
145
symptoms of IE (4
fever
confusion
night sweats
finger clubbing
146
what are the specific signs of IE caused by
vasculitis (inflammation of small blood vessels)
147
when should you suspect IE
if someone comes in with a fever and a new murmur, suspect IE
148
investigations for IE (3 plus diagnostic)
1. blood cultures (3 separate from different sites over 24 hours, before antibiotics)
2. TOE for diagnosis
3. FBC- high CRP, ESR and neutrophillia
4. ECG if long PR interval= aortic root abscess
149
how is IE diagnosed (criteria)
duke's criteria= either of these:
1. 2 separate blood cultures are positive with typical pathogens that cause IE
2. new valvular regurgitation OR echocardiogram positive for IE (shows vegetations)
150
what is the advantage of TOE over TTE and what they stand for
trans-oesophageal echocardiogram
Transthoracic echocardiogram
TOE is more sensitive and diagnostic
151
treatment for IE 3
prolonged course of antibiotics (6 weeks)
2 weeks IV then switch to oral
if valve is incompetent, replace valve with a different prosthetic
152
what antibiotics should be prescribed for IE (Staph, non staph, MRSA, prosthetic valve, unknown)
staph= flucloxacillin and rifampicin (replace flucloxacillin with vancomycin if MRSA)
strep= benzylpenicillin and gentamicin
MRSA= vancomycin and rifampicin
gentamicin for prosthetic valve
1st line when the organism is unknown= ampicillin and gentamicin
153
differentials for IE 3
SLE
antiphsopholipid syndrome
meningitis
154
what is pericarditis and what can accompany it
acute inflammation of pericardium
with or without effusion
155
who does pericarditis usually affect (2)
typically affects males 20-50 years old
156
causes of pericarditis (in order of how common) (5)
mostly idiopathic
viral infections
trauma eg MI
bacterial infections (mycobacterium tuberculosis)
fungal infections
157
pathophysiology of pericarditis (3)
1. acute inflammation of pericardium
2. the inflated pericardial layers rub against each other and exacerbate further inflammation
3. this can lead to exudate building up in the pericardial space
158
what are the two types of effusion that can occur in pericarditis
serous or haemorrhagic effusion can occur
159
symptoms of pericarditis (4)
chest pain which extends to the left shoulder tip that is worse on inspiration and lying down
fever, dyspnoea, cough
160
what is formed in constrictive pericarditis and what does it impair
this is a late complication of acute pericarditis where
granulation tissue formation in pericardium means impaired diastolic filling
161
what is pericardial friction rub and when is it present (2 things to mention about what it sounds like)
high pitched scratchy sound heart loudest on the midline during inspiration
pericarditis
162
investigations for pericarditis and results (3) and which one is diagnostic
CXR: cardiomegaly due to effusion
ECG: saddle shaped ST elevation and PR depression (diagnostic)
FBC: high ESR and WCC
163
treatment for pericarditis (3)
NSAIDs (ibuprofen)
and colchicine for 3 weeks
antibiotics if bacterial TB infection
164
treatment for TB (remember mneumonic)
RIPE
rifampin
isoniazid
pyrazinamide (pirate names zinna then mide)
ethambutol
165
complication of pericarditis 3
cardiac tamponade
myocarditis
constrictive pericarditis
166
what condition causes pericardial effusion
acute pericarditis
167
explain at what point pericardial effusion becomes a medical emergency and what is another name for this
when it compromises ventricular filling
cardiac tamponade
168
1 symptom and 3 signs of pericardial effusion
soft and distant heart sounds
muffled apex beat
raised JVP (jugular vein pulse)
dyspnoea
169
investigations for pericardial effusion (3)
CXR: large globular heart
ECG: low voltage QRD complexes
Echocardiogram (diagnostic)
170
management for treating pericardial effusion (2)
treat the underlying cause eg pericarditis
most resolved spontaneously
171
what is cardiac tamponade and how does it affect the ventricles
ventricles unable to fill because of accumulation of fluid in pericardial space due to pericardial effusion
172
how is cardiac output reduced in cardiac tamponade
accumulation of fluid in pericardial space causes compression of heart chambers which decreases venous return (pressure gradient)
this decreases the filling of the heart and reduces the cardiac output
173
SIGNS not symptoms of cardiac tamponade (4)
Beck’s triad:
muffled heart sounds
raised jugular venous pulse
hypotension
pulses paradoxus (large decrease in stroke volume so the systolic blood pressure drops by more than 10mmHg on inspiration)
174
investigations for cardiac tamponade 3 and results of each
CXR: large globular heart
ECG: low voltage QRS complexes
Echocardiogram: late diastolic collapse of right atrium
175
treatment for cardiac tamponade
pericardiocentesis (drainage of fluids from pericardial space)
176
differential diagnosis for cardiac tamponade
Kaussmal’s
also causes a paradoxical increase JVP with inspiration
177
what is medically classed as an abdominal aortic aneurysm 2
1. permanent aortic dilation
2. diameter over 3cm
178
where does AA occur (1,1) and what is it associated with (1,1)
typically infrarenal (below renal arteries) - associated with elderly men
can occur in thoracic aorta- typically associated with Marfans and Ehlers Danlos syndromes
179
risk factors for AAA (4)
smoking, obesity, family history, age
180
what is the pathophysiology for AAA (1) and what risk does this increase (1)
dilation of all 3 layers of the artery
increased risk of rupture
181
symptoms of AAA (4) and when do these symptoms occur (1)
sudden epigastric pain radiating to flank
pulsatile mass in abdomen
hypotension
tachycardia
asymptomatic until rupture
182
investigations for AAA (1st line/ diagnostic) 1 ONLY
abdominal ultrasound to look at aorta
183
treatment for AAA if not ruptured yet (2 classifications for different treatment pathways)
for asymptomatic and under 5.5cm monitor
for symptomatic and/or over 5.5cm then open surgery/ EVAR- extravascular aneurysm repair
184
treatment for AAA if ruptured (4)- step by step pathway
stabilise: ABCDE, fluids, transfusion
AAA graft surgery
185
differential diagnosis for AAA
acute pancreatitis
186
what is aortic dissection and what is it due to
tear in intima causing blood to ‘dissect’ through the media and the layers
due to mechanical wall stress
187
risk factors for aortic dissection (main, 4)
hypertension (main)
family history
trauma
smoking
connective tissue disorder eg Marfans/ Ehlers Danlos sydnrome
188
2 locations of aortic dissection and their classification
1. Sinotubular junction (where aortic root become ‘tubular’ aorta near aortic valve)-most common (location is classed as A)
2. distal to left subclavian artery in descending aorta (location is classed as B)
189
pathophysiology of aortic dissection and how can it cause organ failure
blood dissects through the media and intima and pools in the false lumen
this causes decreased perfusion to end organs which can cause organ shock/ failure
190
symptoms of aortic dissection (6)
sudden onset of ripping/tearing chest pain
hypotension
NEW AORTIC REGURGITATION MURMUR
neurological deficit eg fainting
CARDIAC TAMPONADE
DECREASE IN LEFT ARM PERIPHERAL PULSE
A in Aortic= aortic regurgitation murmur
D in dissection= decrease in left peripheral pulse
SS in dissection= syncope (fainting) and sudden onset of ripping/ tearing chest pain
C in dissection= cardiac tamponade
ion in dissection= hypotension
then hypotension
191
investigations and results for aortic dissection (2, gold standard)
chest x-ray: widened mediastinum
gold standard is TOE- more sensitive and specific for aortic dissection- shows intimal flap and false lumen
CT angiogram- shows intimal flap and false lumen (for more stable patients)
192
differential diagnosis for aortic dissection (1)
MI
193
treatment for aortic dissection (2)
prevention for aortic dissection (2)
open surgical repair (for location A) or endovascular aneurysm repair (for location B)
prevention: beta blocker eg labetolol to prevent reflex tachycardia
and sodium nitroprusside vasodilator
194
complications of aortic dissection (4)
cardiac tamponade
aortic regurgitation
pre-renal AKI
stroke
A in aortic= aortic regurgitation
R in aortic= (pre) renal AKI
i in aortic= ischaemic stroke
c in arotic= cardiac tamponade
195
what are the two main types of venous thromboemboli
DVT and PE
196
risk factors for venous thromboembolism (think about virchows triad)- 4 1 2
hypercoagulability (due to pregnancy, obesity, sepsis, malignancy)
venous stasis (due to immobility-causes aggregation of clotting factors)
endothelial injury (smoking, trauma)
197
what is DVT
thrombus in deep leg vein
198
compare concern of a DVT above and below the calf
if below calf, less concerning as there r many minor veins there
if above calf, this can be life threatening so there r more major veins and occlusion can impede distal flow
199
symptoms of DVT (3)
unilateral swollen calf
warm and oedematous veins
blue leg if occlusion of a large vein
200
diagnosis criteria 1 and 2 investigations for DVT. What is the GS
diagnosis based on Wells score being 2 or above:
diagnostic test: raised D-dimer and duplex ultrasound (GS)
201
treatment for DVT (2 med and 2 non pharmological) and what is this treatment plan the same as
1. DOAC (LMWH if renally impaired)
2. utilise mobilisation and compression stockings
small PE
202
differential for DVT
cellulitis
203
what is PE
DVT embolisms and lodges in the pulmonary artery circulation
204
how does PE cause right sided failure and what is the medical term for this
right ventricle strains to overcome PE
=pulmonary hypertension
=right sided heart failure
cor pulmonale
205
symptoms of PE (7)
sudden onset pleuritis chest pain
dyspnoea
tachycardia
hypotension
increase JVP
ankle oedema
206
investigations for PE (4)- 1st line, diagnostic, 1 other and diagnosis criteria
first line: high D-dimer
diagnostic: CT pulmonary angiogram (key!)
ECG: sinus tachycardia, new RBBB, S1Q3T3 (large S wave in lead 1, Q wave in lead 3, inverted T wave in lead 3)
Diagnosis based on Well’s score being 4 or above
207
treatment for large PE and how common is this
thrombolytic eg alteplase
uncommon
208
treatment for small PE (2) and how common is this (what is the contraindication and what can be given instead)
1) heparin given as it works faster, is more potent and has reduced risks of coagulation
2) anticoagulants given ie DOACs like apixiban/ rivaroxiban
contraindication for renal impairment- give LMWH eg dalteparin
more common
209
what is peripheral vascular disease
ischaemia of lower limb arteries
210
risk factors for PVD (6)
smoking
hypertension
ageing
obesity
chronic kidney disease
type 2 DM
211
what is the classification for acute PVD, when is there pain, how occluded is the lumen and what is the cause of the occlusion
intermittent claudification
pain on exertion
partial lumen occlusion
atherosclerotic
212
what is the classification for chronic PVD, when is there pain, and what is there a risk of getting 2
critical limb ischaemia
pain at rest
gangrene and infection
213
what occurs when blood supply is occluded (3)
irreversible nerve and muscle damage within 6 hours and skin changes r the last to appear, mostly likely gangrenous changes
214
symptoms of PVD (4) and test and positive result for it 1
skin changes: colour, cooler and ulcerations
pulsatile regions (due to turbulent blood flow)
burger test positive: elevate leg 45 degrees for 1 min= pallor then reactive hyperaemia
215
why does chronic ischaemic pain occur at night (2) and what can this lead to (2)
due to elevation of limb which can further reduce blood supply to the distal part of the limb which can cause tissue loss (ulcers and gangrene)
216
what does ABPI stand for, what is it what is classed as normal and explain what the value for results means
ankle brachial pressure index
compares blood pressure in upper and lower limbs as a ratio
0.5-0.9= intermittent claudication
less than 0.5= critical chronic limb ischaemia
absent/0= risk of acute limb threatening ischaemia
217
what are the investigations for PVD (3)
1. ABPI
2. colour duplex ultrasound imaging- assesses degree of stenosis
3. CT angiography if surgery is considered
218
treatment for intermittent claudification (2)
1. reduce risk factors eg stop smoking
2. exercise programme for intermittent which trains through the pain to stimulate collateral blood supply growth
219
treatment for chronic limb ischaemia (1)
revascularisation surgery (PCI if small, bypass if longer)
220
treatment for acute limb-threatening ischaemia (1)
surgical emergency requires revascularisation within 4-6 hours otherwise there is an increase amputation risk
221
complications of PVD (3)
amputation
permanent limb weakness
rhabdomyolysis
222
what usually happens to healthy patients with acute limb ischaemia
their body develops collaterals (extra vessels to alternatively vascularise the limb around the faulty blood vessels)
223
what are the 6 Ps and how can they assess the severity of the acute limb ischaemia
6 Ps: pulselessness, pallor, pain, persistently cold, paralysis, parasthesia
->the more of these 6 Ps that you have, the more deadly the ischaemia
224
what is tachycardia
bpm over 100
225
what are the conditions with tachycardia (5)
A fib
atrial flutter
Wolff parkinson white
supraventricular tachycardia
ventricular tachycardia
226
what is bradycardia
bpm under 60
227
what are the conditions with bradycardia (6)
RBBB
LBBB
primary, secondary and tertiary heart block
sinus bradycardia
228
what 6 arrythmias are there
atrial fibrillation
atrial flutter
wolff-parkinson white (AVRT)
long QT syndrome
AV blocks
Bundle branch blocks
229
what is the atrial firing rhythm of atrial fibrillation
irregular irregular atrial firing rhythm
230
what is the most common cardiac arrythmia
atrial fibrillation
231
causes of atrial fibrillation (4)
heart failure
hypertension
secondary to mitral stenosis
sometimes idiopathic
232
risk factors of atrial fibrillation (5)
60+
T2DM
hypertension
valve defects eg mitral stenosis
past history of MI
233
explain the pathophysiology of atrial fibrillation and how it increases the risk of thromboembolic events (3)
1. rapid firing rate 300-600 bpm causes atrial spasm (not co-ordinated contraction like normal)
2. blood is not efficiently pumped to ventricles
3. this decreases cardiac output and increases the risk of thromboembolic events
234
symptoms of A fib (6)
palpitations
irregularly irregular pulse
thromboemboli eg ischaemic stroke
chest pain
SYNCOPE
HYPOTENSION
6 Ps- palpitations, pulse, pain in chest, (hy)potension, (P)FAINTING and thromPoemboli
235
what are the 3 types of atrial fibrillation and what are their patterns
paroxysmal (episodic)
persistant (longer than 7 days)
permanent (sinus rhythm unrestorable)
236
diagnostic investigation for atrial fibrillation (1, 3)
ECG is diagnostic:
irregularly irregular pulse
narrow QRS (less than 120ms
no p waves (fibrillatory squiggles instead)
acronym= PIQ
237
acute treatment for atrial fibrillation
synchronised cardioversion DC (shock heart back into normal rhythm)
238
long term treatment for atrial fibrillation (2 management approaches)
medical approach: beta blocker/ CCB eg verapamil and anticoagulation
surgical approach
239
surgical treatment for atrial fibrillation, what is it for
radio frequency ablation
intends to prevent future episodes
240
complications of atrial fibrillation (3)
heart failure
ischaemic stroke
mesenteric ischaemia
241
what is atrial flutter firing rhythm (2) and compare it for atrial fibrillation (2)
irregular organised atrial firing
less common and less severe than atrial fibrillation
242
pathophysiology of atrial flutter 2
1. fast atrial ectopic firing 120-350 bpm
2. this causes atrial spasm
243
symptoms of atrial flutter (2)
dyspnoea
palpitations
244
investigation for atrial flutter (1) and results (2)
ECG diagnostic: f wave ‘saw tooth’ pattern, often with a 2:1 blocker (2 p waves for every QRS)
245
treatment for atrial flutter that is acutely unstable
DC synchronised cardioversion
246
treatment for atrial flutter that is stable (2) and what is the purpose of these treatments
1. rhythm/ rate control with beta blocker and oral anticoagulation
2. radio frequency ablation
to prevent future episodes
247
what is the wolff parkinson white AVRT
accessory pathways for conduction= bundle of Kent
248
what is an AVRT
means an accessory pathway exist for impulse conduction
249
explain the pathophysiology of the wolff parkinson white arrythmia (syndrome)
pre-excitation syndrome (excite ventricle faster than typical pathwa)
250
what is the cause of wolff parkinson white (1)
often hereditary
251
what are the symptoms of wolff parkinson white (3)
palpitations
dizziness
dyspnoea
252
what are the ECG changes seen in Wolff parkinson white (3)
slurred delta waves
short PR interval
wide QRS complex
acronym= QuPiD
253
what is the treatment for wolff parkinson white (3)
1. valsalva manoeuvre and carotid massage
2. IV adrenaline (temporarily ceases conduction- warn patient it feels like dying)- 6mg then 12mg, then 12 mg and additional doses if unsuccessful
3. radiofrequency ablation of bundle of Kent
254
what is long QT syndrome and what type of arrythmia does this lead to?
congenital channelopathy disorder where mutation affects cardiac ion channels
=ventricular taachycardia
255
what is a typical long QT interval in long QT syndrome
QT interval is 480ms +
256
what are the 4 causes of long QT syndrome
1. Romano Ward syndrome (autosomal dominant)
2. Jerrell Lange Nelson syndrom (autosomal recessive)
3. hypokalaemia and hypocalcaemia (not inherited)
4. drugs eg amiodarone and magnesium
257
what are two examples of long QT syndrome
torsades de pointes
ventricular fibrillation
258
what is torsades de pointes, what does this look like on an ECG
polymorphic ventricular tachycardia in patients with prolong QT
rapid irregular QRS completes which ‘twist’ around baseline
259
what does ventricular fibrillation look like on ECG and what can happen with ventricular fibrillation
shapeless rapid oscillations on ECG
patient becomes pulseless and goes into cardiac arrest (no effective cardiac output)
260
what can torsades de pointes do? (2)
cease spontaneously
develop into ventricular fibrillation
261
what is the first line of treatment for ventricular fibrillation
electrical defibrillation
262
what is primary AV block
PR interval prolongation (200ms +) and every P followed by QRS
263
what is the treatment for asymptomatic and symptomatic primary AV block (1, 3)
if asymptotic then no treatment
symptomatic treatment= beta blocker eg atenolol, CCB eg verapamil, digoxin to block AVN conduction
264
what are the two types of secondary AV block
Mobitz type 1 and 2
265
what is mobitz 1 AV block
PR prolongation until a QRS is dropped (PR progressively elongates)
266
what are the causes and treatment of mobitz 1 AV block (4,1)
causes: inferior MI, beta blockers/ CCB/ digoxin
treatment only for symptomatic= pacemaker
267
what is mobitz 2 AV block
PR interval is consistently prolonged at the same length
with random dropped QRS
268
what are the causes, symptoms and treatment of mobitz 1 AV block (5,3, 1)
causes: inferior MI, beta blockers/ CCB/ digoxin, rheumatic fever
symptoms: SOB, chest pain, syncope (triad)
treatment= pacemaker
269
what is a tertiary AV block
AV dissociation (complete heart block so atria and ventricles beat independantly of each other
270
what sustains the heartbeat in a tertiary AV block, what is their firing rate and why is this bad
ventricular escape rhythm is sustaining the heartbeat
(ventricle pacemakers take over which is bad (firing rate= 20-40bpm))
271
causes of tertiary AV block (3) and treatment (2)
acute MI, hypertension, structural heart disease
treatment: IV atropine and permanent pacemaker
272
what is a bundle branch block and what are the two types
blocked bundles of His
can either be RBBB or LBBB (right/ left bundle branch block)
273
what happens in a RBBB and in a LBBB
RBBB: right ventricle is activated later than left ventricle
LBBB: left ventricle is activated later than right ventricle
274
what are the causes of RBBB (3) and LBBB (2)
RBBB: pulmonary emboli, ischaemic heart disease, ventricular septic defect
LBBB: ishcaemic heart disease, valvular disease
275
what is the heart sound and ECG pattern in RBBB
wide physiological S2 splitting heart sound
MARROW: M in V1 (R wave), W in V6 (S wave)
276
what is the heart sound and ECG pattern in LBBB
reversed S2 splitting heart sound
WILLIAM: W in V1 (r wave), M in V6 (s wave)
277
what is cardiomyopathy and what are the 3 types
disease of the myocardium (muscular/ conduction defects)
hypertrophic, restrictive and dilated
278
why is hypertrophic cardiomyopathy significant
most common cause of death in young people
279
cause of hypertrophic cardiomyopathy 3
cause: familial inherited auto s mutation of sarcomere proteins (troponin T and myosin B), exercise and aortic stenosis
280
pathophysiology of hypertrophic cardiomyopathy
thick noncompliant heart causes impaired diastolic filling which decreases cardiac output
281
symptoms of hypertrophic cardiomyopathy (5)
chest pain, palpitations, SOB, syncope, may present with sudden death
282
investigations for hypertrophic cardiomyopathy (2 + diagnostic)
abnormal ECG, genetic testing, echocardiogram (diagnostic)
283
treatment for hypertrophic cardiomyopathy (3)
beta blocker, calcium channel blocker, amiodarone (anti-arrhythmic)
284
how common is restrictive cardiomyopathy
rare
285
causes of restrictive cardiomyopathy (3)
granulamatous disease (sarcoidosis, amyloidosis), idiopathic, post MI
286
pathophysiology of restrictive cardiomyopathy
Rigid fibrotic myocardium fills poorly and contracts poorly= low CO
287
symptoms of restrictive cardiomyopathy (4)
dyspnoea, oedema, congestive heart failure, narrow pulse pressure eg 105/95
288
investigations for restrictive cardiomyopathy (2 + diagnostic)
ECG, echocardiogram (diagnostic), cardiac atherterisation (definitive)
289
treatment for restrictive cardiomyopathy (1)
none
can consider transplant but most patients die within 1 year
290
how common is dilated cardiomyopathy
most common cardiomyopathy
291
causes of dilated cardiomyopathy (3)
autosomal dominant familial cytoskeletal gene mutation, ischaemic heart disease and alcohol
292
pathophysiology of dilated cardiomyopathy
thin cardiac walls do not contract well= decreased cardiac output
293
symptoms of dilated cardiomyopathy (4)
dyspnoea, heart failure, atrial fibrillation and thromboemboli
DiLATed
D= dyspnoea
L= heart faiLure
A= atrial fibrillation
T= thromboemboli
294
investigations for dilated cardiomyopathy (1 + diagnostic)
ECG, echocardiogram (diagnostic)
295
treatment for dilated cardiomyopathy (1)
treat underlying conditions eg AFib and heart failure
296
what can shock be medically classed as?
a medical emergency
297
what occurs during shock and what is the risk 3
hypoperfusion of tissues which causes tissue hypoxia and risks organ dysfunction
298
what are the 3 types of shock and explain what causes failure in each
cardiogenic: heart pump failure, issue with LV
hypovolemic: issue with venous return to heart, reduced preload
distributive: issue with arterial supply to tissues (includes septic, neurogenic and anaphylactic shock)
299
presenting symptoms of shock 6
confusion
weak and rapid pulse
REDUCED GLASGOW COMA SCALE
DECREASED URINE OUTPUT
pale, cold skin
hypotension
300
what is the earliest and more accurate indicator of shock
increased capillary refill time
301
what are the 4 main organs at risk of failing due to shock
kidney
lung
heart
brain
302
what is hypovolemic shock due to
due to blood loss (trauma or GI bleed) or fluid loss (dehydration)
303
symptoms of hypovolemic shock (4)
clammy pale skin, confusion, hypotension, tachycardia
304
treatment for hypovolemic shock (3)
ABCDE, give oxygen and fluids
305
what is septic shock due to
due to uncontrolled bacterial infection
306
symptoms of septic shock (4)
pyrexic, warm peripheries, bounding pulse, tachycardia
307
treatment for septic shock
ABCDE, broad spectrum antibiotic
308
what is cardiogenic shock due to (4)
due to heart pump failure, MI, cardiac tamponade and pulmonary emboli
309
symptoms of cardiogenic shock (2)
heart failure signs (oedema), increased JVP
310
treatment for cardiogenic shock (2)
ABCDE and treat underlying cause
311
what is anaphylactic shock due to
IgE mediated type 1 hypersensitivity against an allergen
312
treatment for anaphylactic shock (2)
ABCDE and IM adrenaline
313
what is neurogenic shock due to, give an example and what nervous system does it impair
due to spinal cord trauma eg road traffic injury
disrupts sympathetic nervous system but the parasympathetic remains intact
314
symptoms of neurogenic shock (4)
hypotension, bradycardia, confusion, hypothermia
315
treatment for neurogenic shock (2) and how does it work
ABCDE and IV atropine (blocks vagal tone and causes more PNS inhibition and gives more chance for SNS to work)
316
where is rheumatic fever normally found
mostly in developing countries in young people
317
what is rheumatic fever
systemic response to beta haemolytic group A strep
eg pyogenes
318
what is rheumatic heart disease and how common is this
where rheumatic fever affects the heart. 50% of those with rheumatic fever and likely to have rheumatic heart disease
319
what is the pathophysiology of rheumatic fever
1. M protein from S pyogene reach within the valve tissue of the heart
2. antibodies and cross linking occurs in response to this= autoantibody mediation destruction and inflammation
3. this typically thickens leaflets causing valve stenosis
320
what valves are affected in rheumatic fever
mostly affects mitral valve (70% mitral only, 25% mitral and aortic)
321
3 symptoms, 2 signs of rheumatic fever
SYMPTOMS
new murmur (particular mitral stenosis)
pyrexia
athritis
SIGNS:
Sydenham's chorea (uncoordinated jerky movements)
arthritis
erythema nodosum (swollen fat under skin causing bumps/ patches to look darker/redder than surrounding skin)
322
investigations for rheumatic fever (2) and what would be seen on each
chest x ray: cardiomegaly / heart failure (mitral stenosis signs)
echocardiogram: shows extent of valvular damage
323
diagnosis criteria for rheumatic fever
diagnosis: Jones criteria
recent S progenies infection
need 2 major/ 1 major and 2 minor symptoms
major= new murmur, arthritis, erythema nodosum, Sydenham's chorea
minor= pyrexia, increase in ESR/CRP, arthralgia
324
treatment for rheumatic fever 2
antibiotics: IV benzyloenecillin immediately then phenoxypenecillin for 10 days
325
what can be given for Sydenham's chorea that occurs due to rheumatic fever
give haloperidol
doll holding peri peri chicken with a halo on top
326
how are structural heart defects diagnosed
echocardiogram
327
how common is bicuspid aortic valve defect and what valve does it usually affect
most common inherited heart defect
aortic
328
what happens in the bicuspid aortic valve defect
bicuspid degenerates faster than normal and will become regurgatative earlier- leads to arotic stenosis/ regurgitation
329
what is atrial septal defect 2 and how does it affect oxygen levels
open foramen ovale so blood shunts from left to right, it doesnt- it is non cyanotic
330
compare older and younger people with atrial septal defect
older patient have more shunting, causing dyspnoea compared to younger with more compliant hearts
331
what can atrial septal defect lead to 4
overloads right hand side circulation= right ventricular hypertrophy
this leads to eisenmenger syndrome (pulmonary hypertension which reversal of shunt which goes from right to left and non oxygen blood is pumped to the body)
332
treatment for atrial septal defect
if it doesn't spontaneously close then use surgical methods
333
what is ventricular septal defect and is this cyanotic
left to right shunt in ventricle
non cyanotic (doesn't affect oxygen levels)
334
what is there a risk of in ventricular septal defect
risk of eisenmengers and right ventricular hypertrophy (similar to atrial septal defect)
335
what are the symptoms for a small and large ventricular septal defect (1,3)
small VSD= asymptomatic, large= exercise intolerance, failure to thrive, harsh pan systolic murmur
336
treatment for ventricular septal defect
spontaneous closure or surgical closure
337
what is an atrioventricular septal defect and what is this assocaited with
hole down middle of heart (no atrial or interventricular septum)
with Downs syndrome
338
treatment for atrioventricular septal defect
hard to treat
339
what is a patent ductus arteriosus
ductus arterioles fails to close post birth causing blood to shunt from aorta to pulmonary trunk
340
what is the risk for a patent ductus arteriosus 1
risk of pulmonary overload and eisenmengers
341
symptoms for patent ductus arteriosus (3)
dsypnoea, failure to thrive, machine like murmur
342
investigations for patent ductus arteriosus (3)
chest x-ray, ECG, echocardiogram
343
treatment for patent ductus arteriosus (2)
prostaglandin inhibitor (eg methacin) which may induce closure, otherwise consider surgery
344
what is the tetralogy of fallots pathophysiology and is it cyanotic
ventricular systolic defect causes right ventricle outflow obstruction (deoxygenated blood is shunted to the systemic circulation), making it cyanotic
345
investigations for tetralogy of fallot and what do they show (2,1)
echo, chest x-ray shows a boot shaped heart
346
what is a behavior of infants with tetralogy of fallot and why do they do this
infants often seen in knee to chest squatting position which increases preload and after load and improves cyanosis
347
treatment for tetralogy of fallot
treatment: full surgical repair within 2 years of life (this gives a good prognosis if done)
348
what is coarctation of the aorta 1 and what is the pathophysiology of this
narrowing of aorta
blood is diverted through proximal aortic arch branches= increased perfusion to upper body vs lower body
349
symptoms of coarctation of aorta (2)
scapular bruits (hypertension in collaterals), upper body hypertension
350
investigations for coarctation of aorta and what is seen (2,1)
CT angiogram, chest x-ray= ‘notched ribs’= dilated intercostal vessels
351
treatment for coarctation of the aorta (2)
surgical repair or stenting
352
what are non-pharmalogical treatments to prevent falls in the future 3
compression stockings
sitting-standing slowly, increase oral salt/ fluid intake
353
what is the pharmacological treatment for postural hypotension
oral fludrocortisone
354
acute treatment of acute coronary syndrome 5
MONAC
morphine
oxygen IF sats under 94
nitrates
aspirin
clopidogrel
355
risk factors for aortic dissection 3
cocaine users
connective tissue disorders
smoking
356
what is an alternative to beta blockers that are contraindicated in severe asthma 1
verapamil (CCB)
357
what valve is usually affected in IVDU
tricuspid
358
what two medications are given to heart failure patients to slow the progression of their heart failure
ACEi
beta blockers
359
what are the cardinal signs of heart failure 3
orthopnea (difficulty breathing whilst lying down)
ankle oedema
fatigue
360
what is becks triad 3 and what condition is it associated with
increased JVP
hypotension
muffled heart sounds
cardiac tamponade
361
what is the 2nd step if one drug is not controlling hypertension for the two categories of people to treat
<55 not A/C origin= CCB or thiazide like diuretic eg indapamide can be added
>55 of A/C origin= ACEi or ARB or thiazide like diuretic eg indapamide can be added
362
if a patient is on ACEi and BB already but still symptomatic what should be given to them 1
spironolactone
363
what ecg leads look at the lateral aspect of the heart
I, aVL, V5, V6
364
what ecg leads look at the anterior aspect of the heart
V3-4
365
what ecg leads look at the inferior aspect of the heart
II, III, aVF
366
what ecg leads look at the septal aspect of the heart
V1-2
367
what ecg leads looks at the LAD
V1-4
368
what ecg leads look at the RCA
II, III, aVF
369
what ecg leads look at the LCx/ diagonal of LAD
I, aVL, V5-6
370
what CHA2DS2VASK score requires anticoagulation for males and females
males- 1 or more
females- 2 or more
371
what is the specific treatment for heart failure with reduced ejection fraction and preserved ejection fraction
reduced EF (less than 40%): spironolactone
preserved EF (over 40%): furosemide
372
what valve disorder can present several days after an MI
acute mitral regurgitation
373
what is the 1st line treatment for IE and what is the GS
1- TTE
2- TOE
374
what is dresslers syndrome
pericarditis caused by injury to the heart
375
what is a side effect of amlodipine and what alternative can be given to prevent this side effect 2
peripheral/ ankle oedema
ace inhibitor (if not already given) and indapamide
376
what is the triad of rheumatic fever presentation
polyarthritis, athralgia, erythema marginatum
377
rheumatic fever treatment 2
1. IV benzylpenecillin
2. phenoxymethylpenecillin for 10 days
378
what is the diagnosis criteria for rheumatic fever called
Jones
379
what is the function of furosemide in heart failure
symptomatic releif
