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Year 3 GP > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Aetiology of HTN

A 
95% essential 
Renal artery stenosis 
Hyperthyroidism 
PCKD
Chronic pyelonephritis 
Diabetic nephropathy 
RCC 
Cushing's 
Phaeochromocytoma 
Hyperaldosteronism
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2
Q

Symptoms

A

Asymptomatic

May get headaches

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3
Q

Stages of HTN

A

Stage 1 > 140/90 ABPM >135/85

Stage 2 > 160/100 ABPM > 150/95

Stage 4 >180/120

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4
Q

Signs

A

Retinal haemorrhage Papilloedema

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5
Q

Risk factors

A 
Age 
65 yo - men 
65 - 74 - female 
Black African and Asian 
FHx
Social deprivation 
Lifestyle - smoking and alcohol 
Anxiety and emotional stress
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6
Q

Complications

A 
Increased risk of:
Heart failure.
Coronary artery disease
Stroke
Chronic kidney disease
Peripheral arterial disease
Vascular dementia
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7
Q

Diagnosis

A

If blood pressure measured in the clinic is 140/90 - 180/120mmHg: ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension

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8
Q

Person’s blood pressure is 180/120 mmHg or higher

A

Refer for same-day specialist assessment if there are:

  • Signs of retinal haemorrhage and/or papilloedema
  • new onset confusion, chest pain, signs of HF or AKI

if not:

  • Ix for organ damage e.g. eGFR for kidney damage
  • tarting antihypertensive drug treatment immediately if organ damage

If no target organ damage is identified:
- repeat blood pressure measurement within 7 days

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9
Q

Assess for target organ damage

A

Urine dipstick:

  • haematuria
  • alb: Cr ratio

HbA1C
ECG
Serum LDL - QRISK

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10
Q

Mx

A

Lifestyle advice

  • diet and exercise
  • reduce caffeine
  • reduce salt
  • smoking and alcohol cessation

Antihypertensives

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11
Q

Antihypertensive procedure

A

Stage 1 - ACEi/ARB

  • if have T2DM
  • less than 55 yo

Stage 1 - CCB

  • over 55 yo
  • Afro-carribean

Stage 2 - ACEi/ARB +CCB

Stage 3 - ACEi/ARB +CCB + thiazide like diuretic

Stage 4 ACEi/ARB +CCB + thiazide like diuretic + beta blocker or alpha/beta blocker if K+ >4.5 mmol/l

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12
Q

Target BP for 80 years and over

A

< 150/90 mmHg.

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13
Q

Annual review

A

Adherence
BP
eGFR
QRISK

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14
Q

Pre - eclampsia

A

BP > 140/90 after 20 wks gestation

  • Proteinuria
  • Severe headache
  • Visual disturbances

Complications:

  • Renal insufficiency
  • Liver issue - ALT/AST
  • eclampsia
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15
Q

Risk factors for pre - eclampsia

A 
PMHx of pre - eclampsia 
CKD
T1/T2DM 
HTN 
SLE 
40+
Obese 
FHx
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16
Q

Mx of pre-eclampsia

A

Aspirin 75 - 150mg prescribed form 12 wks - if high risk

Labetalol

Urine dipstick

  • proteinuria 30mg
  • haematuria
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17
Q

When to suspect familial hypercholesterolaemia

A

Total cholesterol conc > 7.5 mmol/L

Personal or FHx of premature CHD < 60yo

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18
Q

Signs of hypercholesterolaemia

A

Xanthelasma
Corneal arcus
Tendon xanthoma

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19
Q

Secondary hyperlipidaemia

A 
Caused by:
T2DM 
Obesity 
Nephrotic syndrome 
Alcoholism 
Cushing's syndrome 
Hypothyroidism

Drugs:
Corticosteroids
Thiazide diuretic

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20
Q

Cardiovascular risk reduction

A

Primary reduction:
QRISK > 10%
Atorvastatin 20mg

Secondary reducation:
Atorvastatin 80mg

Contraindicated - ezetimibe 10mg

Follow up bloods 3 months and 12 months after starting statin

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21
Q

Familial hypercholesterolaemia diagnosis

A

Adults: LDL cholesterol 13+ mmol/L.

Child: LDL cholesterol 11+ mmol/L

Use the Simon Broome criteria or the Dutch Lipid Clinic Network

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22
Q

Dutch Lipid Clinic Network

A

Definite’ FH > 8
‘Probable’ FH 6–8
‘Possible’ FH 3–5
‘Unlikely’ FH < 3

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23
Q

When is Qrisk not needed

A

TIDM and 40+
Has had diabetes for 10+ years
Has established nephropathy
Has other CVD risk factors

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24
Q

Causes of angina

A

Insufficient blood supply to the myocardium:

  • Previous MI
  • Atherosclerosis - coronary artery disease
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25
Q

Risk factors for angina

A 
Male 
Age 
FHx
Ethnicity - Black and asian 
Increased QRISK
Smoking 
High cholesterol and lipids 
HTN, DM, CKD
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26
Q

Symptoms of angina

A

Stable: Pain when exerting, relieved at rest

Relieved by GTN spray

Unstable angina: Pain at rest too

Atypical symptoms:

  • GI discomfort
  • Dyspnoea
  • Nausea
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27
Q

Angina impact on life

A

Reduced exercise tolerance

If severe, may not be able to leave home

28
Q

Investigations for angina

A

Bloods

  • FBC
  • Trop I
  • CRP
  • Lipids
  • HbA1c

ECG
QRISK

29
Q

Advice for angina

A

If experiencing chest pain:

  • rest and stop what you are doing
  • GTN spray
  • Second dose after 5 mins
  • If pain not relieved within 15 mins call 999
  • avoid cold, emotional stress and large meals
  • If occurs when driving, stop driving and recommence once pain has subsided
30
Q

Conservative mx of angina

A

Smoking cessation
Exercise
Reduce alcohol intake
Healthier diet - less salt and cholesterol

31
Q

Angina mx

A

GTN spray
Beta blocker or CCB

Secondary prevention of CVD

  • aspirin 75mg
  • ACEi - if DM
  • Statin - atorvastatin 20mg
32
Q

Angina follow up

A

4 week follow up - check response to treatment

Review every 6 months to 1 year

33
Q

Unstable angina Ix and mx

A

History
Cardiovascular examination
ECG
Bloods - trop I, HbA1c, lipids

GRACE score

Mx:
- Referral

34
Q

GRACE score

A

Predict 6-month mortality and risk of cardiovascular events.

35
Q

ACS

A

Acute coronary syndrome:

  • STEMI
  • NSTEMI
  • Unstable angina
36
Q

Causes

A

Coronary vascular disease

37
Q

Risk factors

A 
Previous MI 
Male 
Age 
Ethnicity - black or asian 
HTN, DM, CKD 
High cholesterol or lipids
High QRISK 
FHx
38
Q

Symptoms of MI

A 
Central dull crushing chest pain 
Gradual onset 
Radiates to arm, jaw and neck 
Sweating 
N+V
39
Q

Signs of MI

A

Bloods

  • increased troponin I
  • not increased with unstable angina

ECG:
STEMI - ST elevation
NSTEMI - ST depression
Unstable angina - ST depression

Previous MI

  • LBBB
  • Pathological Q wave
40
Q

ACS impact on lifestyle

A

Reduced exercise tolerance
HF - breathlessness and oedema
Increased risk of second MI

41
Q

Ix for ACS

A

Bloods:

  • FBC
  • Lipids
  • U+Es
  • LFTs
  • BM
  • TSH
  • Trop I

ECG

42
Q

Mx of ACS

A

Immediate referral

  • STEMI - PCI
43
Q

Conservative mx

A 
Weight loss 
Reduced salt and cholesterol intake 
Smoking cessation 
Reduce alcohol consumption 
Increase exercise
44
Q

Medication for ACS

A 
STEMI/NSTEMI:
Acute - morphine, oxygen, nitrates, aspirin 
Tripe therapy - warfarin, DOAC, aspirin 
Beta blocker/ CCB
ACEi
Statin - atorvastatin 80mg

Unstable angina:

  • Acute - morphine
  • GTN spray
  • Aspiring 300mg
45
Q

Atrial fibrillation

A

Supraventricular tachyarrhythmia resulting from irregular, disorganized electrical activity and ineffective contraction of the atria

46
Q

Types of AF

A

Paroxysmal AF — episodes lasting longer than 30 seconds but less than 7 days.
- Self terminating

Persistent AF — episodes lasting longer than 7 days
- or less than seven days but requiring pharmacological or electrical cardioversion

Permanent AF — AF that fails to terminate using cardioversion, AF that is terminated but relapses within 24 hours, or longstanding AF (usually longer than 1 year)

47
Q

Causes of AF

A

Congestive heart failure
Rheumatic valvular disease
Atrial or ventricular dilation or hypertrophy
Pre-excitation syndromes (such as Wolff–Parkinson–White syndrome)
Sick sinus syndrome
Congenital heart disease
Inflammatory or infiltrative disease (such as pericarditis, amyloidosis, or myocarditis).

48
Q

Risk factors for AF

A 
Excessive caffeine intake
Alcohol abuse
Obesity 
Smoking
Medication - thyroxine or bronchodilators
49
Q

Complications of AF

A

Stroke and thromboembolism

Heart failure

50
Q

Diagnosis AF

A

Clinical history
Cardiovascular examination
- pulse irregularly irregular
ECG

51
Q

Presentation of AF

A 
Breathlessness.
Palpitations.
Chest discomfort.
Syncope or dizziness.
Reduced exercise tolerance
52
Q

Mx of AF

A

Onset within 48 hours and haemodynamically - urgently admit for electric cardioversion

Onset within 48 hours and stable - urgently admit for cardioversion (may be drug)

If symptomatic - urgent referral

CHADVASC - 2+ - anticoag
HAS-BLED - risk of major bleed

53
Q

Medication

A

Rate control:

  • beta blocker or CCB
  • digoxin - non‑paroxysmal atrial fibrillation who are sedentary

Rhythm control:

  • Flecainide
  • Amiodarone

Anticoagulants:
- apixaban, dabigatran or rivaroxaban `

54
Q

AF follow up

A

Within 1 week of starting rate-control treatment

Review the person at least annually once symptoms are controlled

55
Q

Heart failure

A

Ability of the heart to maintain the circulation of blood is impaired as a result of a structural or functional impairment of ventricular filling or ejection

56
Q

New York Heart Association (NYHA)

A

Class I — no limitation of physical activity.

Class II — slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

Class III — marked limitation of physical activity. Comfortable at rest but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations.

Class IV — unable to carry out any physical activity without discomfort. Symptoms at rest can be present.

57
Q

Causes of HF

A 
IHD - most 
Coronary artery disease
HTN
Pregnancy.
Infiltrative -  sarcoidosis, amyloidosis, haemochromatosis
Aortic stenosis 
Pericarditis 
AF
Nephrotic syndrome
58
Q

Risk factors

A

Alcohol
Cocaine
Obesity
Smoking

59
Q

Presentation of HF

A 
Breathlessness on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fluid retention
Fatigue, decreased exercise tolerance
Light headedness or history of syncope
60
Q

Signs of HF

A 
Tachycardia
Laterally displaced apex beat
Hypertension
Raised jugular venous pressure
Enlarged liver
Basal crepitations
Oedema
61
Q

Diagnosis

A 
History 
Cardiac examination
Bloods - BNP 
- HbA1C
ECG 
Urine dipstick 
QRISK
62
Q

Mx of heart failure with reduced ejection fraction

A

Furosemide
ACEi + Beta blocker
Statin - QRISK
Supervised exercise-based group rehabilitation programme

63
Q

Mx of heart failure with preserved ejection fraction

A

Furosemide
Statin
Supervised exercise-based group rehabilitation programme
Consider if an antiplatelet drug is indicated

64
Q

End-stage heart failure mx

A

At high risk of dying within the next 6–12 months

  1. Set realistic goals of care with the person and their family/carers.
  2. MDT
  3. Review medication
  4. Advance care plan
65
Q

HF follow up

A

Frequency of follow up individualized to the severity and stability of symptoms, treatment, and comorbidities

Person’s clinical condition or drugs have changed - 2 weeks

Stable - at least every 6 months

Year 3 GP (20 decks)

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