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2C Week 4,7 - heart failure and cardiomyopathy > C + D placement notes > Flashcards

C + D placement notes Flashcards

1
Q

fixed risk factors of stroke (7)

A

age; FH; previous stroke/TIA/MI/PVD; sickle cell anaemia; ehtnicity

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2
Q

modifiable risk factors of stroke (7)

A

drugs (blood thinners); cholesterol levels; diabetes; hypertension; high BMI; trauma; AF

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3
Q

examples of contraindications to thrombolysis (4)

A

recent major head trauma; INR >1.7; active bleeding; stroke/TIA in the last 6 months

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4
Q

Stroke/TIA driving rules

A

no driving for 4 weeks post event; inform DVLA if still have symptoms after 4 weeks for car and must inform DVLA regardless if HGVT liscence; no driving for 3 months if had multiple strokes/TIAs

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5
Q

how to distinguish stroke from bells palsy

A

bells - cant move entire half of face, complete droop (LMN lesion so affects innervation after they have been combined);
stroke - can move eyeybrows and up (stroke is UMN and top half of face is innervated by both sides of brain => still gets input from unaffected side)

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6
Q

what can cause bells palsy

A

dormant viral infection e.g. shingles (ramsey-hunt syndrome);

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7
Q

what is Todd’s palsy

A

a neurological condition experienced by individuals with epilepsy, in which a seizure is followed by a brief period of temporary paralysis. The paralysis may be partial or complete but usually occurs on just one side of the body; may also affect speech and vision

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8
Q

when should labetelol not be given in haemorragic stroke

A

if BP is already below 140/90 as lowering it further msy prevent adequate perfusion into the rest of the brain

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9
Q

what clotting factors does warfarin act on

A

2, 7, 9 10

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10
Q

INR formula

A

INR = prothrombin time of pt/standard prothrombin time

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11
Q

how is a high INR reversed

A

vit K (slow acting) and prothrombin CC (fast acting)

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12
Q

what is prothrombin time

A

a blood test that measures the time it takes for plasma to clot

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13
Q

in men, what associated symptom can be a warning sign for PVD

A

erectile dysfunction

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14
Q

what is iloprost

A

a vasodilator

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15
Q

where does temporal vision dessucate?

A

optic chasam

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16
Q

what thrombolytic agents can be used in limb ischaemia

A

Tissue plasminogen activator (e.g. alteplase); streptokinase

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17
Q

how to tell if ALI is caused by a thrombus or an embolism

A

thrombus - weak/no pulses in both limbs;
embolism - normal pulses in one limb but no pulse in the other (95% will be due to embolism from AF)

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18
Q

what sound form is normal on a doppler of blood vessels

A

triphasic

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19
Q

how long should you wait before giving antihypertensives to an ischaemic stroke patient

A

24-48 hrs

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20
Q

symptoms of AAA (3)

A

Abdominal pain
Back or loin pain
Distal embolisation producing limb ischaemia

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21
Q

other symptoms of AAA rupture

A

abdominal pain, back pain, syncope, or vomiting

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22
Q

most common type of AAA rupture

A

posteriorly into the retroperitoneal space

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23
Q

traid of AAA rupture

A
  1. flank or back pain
  2. hypotension
  3. pulsatile abdominal mass
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24
Q

when is surgury indicated for AAA

A

AAA >5.5cm in diameter, AAA expanding at >1cm/year, or a symptomatic AAA in a patient who is otherwise fit

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25
Q

how to calculate a pack year

A

packs of cigarettes a day (20 per pack) x number of years

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26
Q

how does T2DM affect aneurysms

A

causes calcification of bvs which protects from anueyrsms

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27
Q

symptoms of critical limb ischaemia

A

arises from chronic; rest pain, ulcers, gangrene, dry skin

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28
Q

symptoms of acute limb ischaemia

A

6 Ps - pain, pallor, pulselessness, parasthesia, poikilothermia; paralysis

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29
Q

treatment for acute limb ischaemia

A

emergency referal to vascular - Endovascular therapies: Percutaneous catheter-directed thrombolytic therapy; ercutaneous mechanical thrombus extraction
Surgical interventions:
Surgical thromboembolectomy;
Endarterectomy; Bypass surgery; Amputation if the limb is unsalvageable

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30
Q

management for moderate PAD

A

75mg clopi; 80mg atrovastatin

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31
Q

what changes to look for for signs of vascular disease

A

hair loss on limbs; symmetry; lipodermatosclerosis; spider veins; scars; ulcers; haemosiderin; oedema

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32
Q

what score is used to calculated DVT risk

A

well’s score; score of over 2 means DVT is likely

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33
Q

components of the wells score (9)

A

active cancer; paralysis; unilateral pitting oedema; previous DVT; bedridden for 3+ days or recent major surgery; calf swelling; whole leg swelling; dilated collaterals (not varicose veins); tenderness

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34
Q

features of varicose veins (9)

A

pain/ache; cramp; restless leg; fatigue; heaviness; itching; bleeding; phlebitis; discolouration

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35
Q

what causes ‘champagne bottle’ sign

A

localised chronic inflammation - acute phase proteins, break down of rbcs, fibristic scars, absent capillaries leading to hypoxia

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36
Q

what causes Hemosiderin

A

RBCs breaking down ad ferrous pigment leaking out of capillaries - due to blood pooling in legs bc it cant be pumped properly

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37
Q

chest pain differentials

A

STEMI; NSTEMI; stable angina; unstable angina (pain at rest); pneumonia; stomach ulcers; GORD; dissection

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38
Q

what factors affect the preload

A

venous return; gravity; muscle pump; pumping ability; volume; respiratory pump

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39
Q

what valve disease can cause AF?

A

MS + MR

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40
Q

cardio reasons for collapse

A

postural hypotension; MI; AS; bradycardia; tachycardia

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41
Q

non cardio reasons for collapse (6)

A

resp - PE;
neuro - vaso-vagal syncope; stroke/TIA
endo - diabetes (hypoglycaemia)
misc - Micturition syncope (while urinating), cough syncope

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42
Q

what does the coronary sinus do

A

drains the coronary arteries

43
Q

what does the right circumflex artery supply

A

conduction tissue; right side of heart - RA +RV

44
Q

what does the left circumflex arty supply

A

left atrium and the posterior-lateral aspect of the left ventricle

45
Q

what does the left anterior descending artery supply (4)

A

most of the interventricular septum; the anterior, lateral, and apical wall of the left ventricle; most of the right and left bundle branches; anterior papillary muscle of the mitral valve

46
Q

where is the SAN located

A

junction of the vena cava + RA

47
Q

what is the dicrotic notch

A

a prominent and distinctive feature of the pressure waveform in the central arteries. It is universally used to demarcate the end of systole and the beginning of diastole in these arteries

48
Q

high output cardiac failure CO and BP

A

vasodilation occurs meaning vasc resistance is low and so CO is high but BP is low

49
Q

3 neuro systems that regulate BP

A
  1. vasomotor centre in the medulla - incre symp stimulation -> smooth muscle contraction -> incr resistance -> incre afterload -> BP (e.g. when standing up);
  2. higher brain centres e.g. hypothal, cerebral cortex - stimulated by changes in temp, size, pH etc.;
  3. baroreceptors (in carotid sinus and aortic arch)/ chemo receptors (aortic/carotid bodies) - symp/parasymp stimulation when activated
50
Q

examples of vasodilators and how they work (2)

A

kinins - similar to histamine but acts only on visceral smooth muscle;
atria-natrietic peptide- increased release in resposne to atria stretch, decreases aldosterone release

51
Q

examples of vasoconstrictors

A

adrenaline, NA

52
Q

where are renin and angiotensin released from

A

renin - kidney
angiotensin - liver

53
Q

why is bloodflow autoregulation required

A

to make sure blood flow is constant and organ receive what they need

54
Q

what is an arrhythmia (electrically)

A

disorder of production/conduction of an impulse

55
Q

how to distinguish AF from AVRT/AVRNT

A

AF is has an irregularly irregular rythm; AVRNT/AVRT, regular and p waves may be visible

56
Q

what is a left anterior fasicular block

A

something interfering with your heartbeat’s signal when it gets to the left anterior fascicle of your heart’s left bundle branch - makes your heart’s left ventricle contract later than your heart’s right ventricle

57
Q

when may normal variant sinus arrhythmia occur

A

during breathing in

58
Q

how many large seconds are in a large ECG square

A

0.2 (200ms)

59
Q

for there to be 1 degree heart block, how many squares long must the PR interval be?

A

> 1 (0.2s)

60
Q

how many little squares wide is a wide complex QRS

A

6

61
Q

what does a carotid massage stimulate?

A

vagus nerve (via baroreceptros)

62
Q

what arrhythmias are irregularly irregular

A

mobitz II; 2:1/3:1 AV block

63
Q

RA enlargement ECG

A

peaked P wave (P pulmonale) with amplitude: > 2.5 mm in the inferior leads (II, III and AVF)

64
Q

what do bifid p waves indicate

A

result from slight asynchrony between right and left atrial depolarisation

65
Q

when is a Q wave pathological

A

depth is >25% the height of R

66
Q

digoxin toxicity ECG

A

downsloping, depressed ST segment

67
Q

hyperkalaemia ECG

A

tall T wave (>5mm in chest and >10mm in limb)

68
Q

what is sgarbossa’s criteria and what is it used for

A

used to identify an infarction on an ECG in someone with LBBB - Concordant ST elevation ≥ 1 mm in ≥ 1 lead;
Concordant ST depression ≥ 1 mm in ≥ 1 lead of V1-V3;
Proportionally excessive discordant ST elevation in ≥ 1 lead anywhere

69
Q

what can cause a fall in CO (with low preload)

A

hypotension; bleeding out; dehydration i.e. low blood volume

70
Q

what can cause a fall in CO (high preload)

A

heart failure

71
Q

what occurs in shock

A

metabolic demands are not met

72
Q

what are the shockable rhythms

A

pulseless VT; VF

73
Q

what rhythms are non-shockable

A

asystole; pulseless electrical activity (PEA)

74
Q

non-shockable rhythms management

A

asytole - CPR, adrenaline, other drugs;
PEA - check pulse, CPR -> continue this cycle

75
Q

VF ECG features

A

polymorphic QRS, features unidentifiable

76
Q

defib steps

A
  1. call for help;
  2. ABCDE - give O2, start CPR;
  3. place defib pads on (R mid clavicular, L mid-auxillary);
  4. stop CPR and remove O2 - check rythm;
  5. restart CPR and ask everyone else to stand clear - charge pads;
  6. stop CPR, make sure everyone is clear (no touching bed, no sudden movement etc.)
  7. deliver shock;
  8. immediately restart CPR + O2
77
Q

what is the main cause of pericarditis

A

Coxsackie B virus

78
Q

when is VT considered to be caused by an MI

A

if it occurs within 12hrs of MI

79
Q

ACS scorates

A

S- central
O- acute
C- crushing
R- neck, jaw, tongue, arms
A- SOB, diaphoresis (sweating), anxiety, nausea
T- depends on severity
E- possibly relieved w GTN
S- severe

80
Q

what scores are used to assess complexity and mortality risk in ACS

A

SYNTAX and GRACE score

81
Q

what is dressler’s syndrome

A

pericarditis

82
Q

what inflammatory markers indicate papillary muscle rupture

A

macrophages and granulation tissue

83
Q

what valve disease has a displaced apex sound

A

MR

84
Q

effect of squatting on ejection systolic murmurs

A

AS - murmur is worse
HOCM - murmur is improved (due to increased BP)

85
Q

with and NSTEMI what tool is used to decide what intervention should be done

A

GRACE score

86
Q

management for first time/unknown cause of AF

A

cardioversion (otherwise rate and rhythm)

87
Q

what may need to be done alongside rhythm control of AF

A

anticoagulation - as still in AF just not tachy

88
Q

at what point in the cardiac cycle should a CT angiogram be taken

A

diastole (low and stable HR)

89
Q

symptoms of HF (8)

A

SOB (exertional, PND, orthopnea); decreased exercise tolerance; syncope; fatigue; weight loss; cardiac wheeze (due to pulmonary oedema); sputum production (pink/frothy)

90
Q

signs of HF (9) on examination

A

raised JVP; gallop/tachycardia; pitting oedema; cyanosis; muffled heart sounds (pulmonary oedema); bibasal crackles (PO); valve disorders; HTN; ascites

91
Q

what can be given for pain in palliative HF pts (5)

A

diamorphine; oramorph; paracetamol; TENS machine; acupuncture

92
Q

examples of SSRIs

A

Citalopram; Fluoxetine

93
Q

what side effect can rosuvastatin cause

A

rhabdomyolysis (damaged muscle tissue releases its proteins and electrolytes into the blood which can damage brain, kidneys etc.)

94
Q

what are key differentiating symptoms for a SAH

A

thunderclap/smack to back of head headache; one eye non responsive to light

95
Q

what is Leriche syndrome

A

aortoiliac occlusive disease

96
Q

what is the leriche triad

A

erectile dysfunction; absent femoral pulses; buttock claudication

97
Q

why is atherosclerosis less common in veins and capillaries

A

blood is flowing at a much lower pressure - less damage = less inflammation and built up of plaque material

98
Q

what can be given for low BP in cardiogenic shock

A

IV GTN

99
Q

what is cardiogenic shock

A

inability of the heart of pump blood to meet the demands of the body

100
Q

what is Angioedema a side effect of

A

ACEi

101
Q

what drugs class if given for migraines

A

BBs

102
Q

symptoms of digoxin toxicity

A

nausea, vomiting, diarrhoea, abdominal pain, or anorexia; weakness, confusion; disturbances of colour vision with a tendency to perceive yellow halos around objects (xanthopsia)

103
Q

what is carcinoid syndrome

A

collection of symptoms some people with a neuroendocrine tumour may have - may affect the heart, especially the valves

2C Week 4,7 - heart failure and cardiomyopathy (6 decks)

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