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Systems 1 Cardiology (ME2508) > Cardiac Diseases, Investigations and Treatments > Flashcards

Cardiac Diseases, Investigations and Treatments Flashcards

1
Q

Define hypertension.

A

The blood pressure above which the benefits of treatments outweigh the risks in terms of morbidity and mortality.

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2
Q

Define stage one hypertension.

A
  • BP of 140/90 or higher

- ABPM daytime average of 135/85 or higher

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3
Q

Define stage two hypertension.

A
  • BP of 160/100 or higher

- ABPM daytime average of 150/95 or higher

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4
Q

Define severe hypertension.

A
  • systolic BP of 180 or higher

- diastolic BP of 110 or higher

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5
Q

List the causes of secondary hypertension.

A
  • renal disease
  • drug induced (NSAIDs, oral contraceptive, corticosteroids)
  • pregnancy
  • endocrine
  • vascular
  • sleep apnoea
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6
Q

What are the risk factors for hypertension?

A
  • smoking
  • diabetes mellitus
  • renal disease
  • male
  • hyperlipidaemia
  • previous MI or stroke
  • left ventricular hypertrophy
  • family history - a closer correlation in siblings
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7
Q

Describe the treatment for hypertension in under 55’s (not afro-Caribbean or women of child-bearing age).

A
  • start on ACEinhibitor (Ramipril) or ARB (losartan)
  • add a thiazide-type diuretic (indapamide or clortalidone)
  • add CCB (amlodipine)
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8
Q

Describe the treatment for hypertension in over 55’s.

A
  • start CCB (amlodipine)
  • add thiazide-type diuretic (indapamide)
  • add ACEinhibitor (ramipril)
  • add a beta blocker
  • add one of the less commonly used agents
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9
Q

Describe the treatment for hypertension in Afro-Caribbean’s or women of child-bearing age.

A
  • start CCB (amlodipine)

- then follow the appropriate age pathway ( NO ACEI OR ARB)

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10
Q

Describe the treatment of preeclampsia.

A
  • CCB
  • thiazide-type diuretic
  • intravenous hydralazine, esmolol and labetalol
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11
Q

Which investigations would you carry out into a hypertensive person?

A
  • ECG
  • Echocardiograph
  • renal ultrasound
  • renal function
  • all to access end-organ damage
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12
Q

Define atheroma.

A

Formation of focal elevated lesions (plaques) in the intima of large and medium-sized arteries.

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13
Q

List the risk factors of atheroma.

A
  • hypercholesterolaemia
  • hyperlipidaemia
  • smoking
  • hypertension
  • diabetes mellitus
  • male
  • elderly
  • obesity
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14
Q

What are the preventative and therapeutic approaches for atheroma?

A
  • stop smoking
  • control of blood pressure
  • weight-loss
  • regular exercise
  • dietary modifications
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15
Q

What is the spectrum of Acute Coronary Syndrome?

A
  • unstable angina
  • non-ST elevation myocardial infarction
  • ST elevation myocardial infarction
  • sudden cardiac death
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16
Q

How would you treat a patient with a STEMI?

A
  • percutaneous coronary intervention

- if not available within two hours then thrombolysis is indicated

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17
Q

How would you treat a patient with ACS and no evidence of STEMI?

A
  • aspirin
  • ticagrelor
  • antiplatelet (clopidogrel)
  • Low molecular weight heparin
  • intravenous nitrate
  • beta blockers
  • statins
  • analgesia
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18
Q

What are the symptoms of cardiomyopathy?

A
  • progressive, slow onset dyspnoea
  • fatigue
  • orthopnoea
  • PND
  • Oedema
  • Cough
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19
Q

What is a true aneurysm?

A
  • all three tunica layers buldge
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20
Q

What is a false aneurysm?

A
  • the blood is contained by the thin adventitia layer
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21
Q

List the symptoms of an aneurysm.

A
  • often asymptomatic
  • dyspnoea
  • dysphagia
  • sharp chest pain radiating to back
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22
Q

Define an aortic dissection.

A

A tear in the inner wall of the aorta.

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23
Q

Describe Debakey’s classifications of aortic dissections.

A

1 - originates in ascending aorta and propagates
2 - originates and is confined to ascending aorta
3 - originates in descending aorta and can move

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24
Q

Describe the Stanford classifications of aortic dissections.

A

A - involves the ascending aorta

B - excludes the ascending aorta

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25
Q

Define a stroke.

A

Sudden localised loss of brain function due to ischaemia or haemorrhage, and lasting more than 24hrs.

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26
Q

List the four sub-types of strokes.

A

Total Anterior Circulation Stroke - 20% (worst mortality rate)
Partial Anterior Circulation Stroke - 35%
Lacunar Stroke - 20%
Posterior Circulation Stroke - 25% (highest recurrence rate)

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27
Q

Define atherothrombosis.

A

An unpredictable process caused by unstable plaques.

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28
Q

What are the four subtypes of acute coronary syndromes?

A
  • unstable angina
  • NSTEMI
  • STEMI
  • sudden cardiac death
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29
Q

When are ACS symptoms present?

A

Almost always, including at rest.

in contrast to stable angina which is only on exertion

30
Q

What changes may be seen in an ECG of a patient with ACS?

A
  • ST-segment depression
  • ST-segment elevation
  • T-wave inversion
31
Q

List the immediate treatment for ACS, after ABCDE.

A

M - morphine (or diamorphine)
O - oxygen
N - Nitroglycerine (GTN)
A - Aspirin 300mg orally

32
Q

What is the long term treatment for ACS?

A 
- dual anti-platelet therapy 
(both aspirin and ADP receptor blocker)
- Heparin - anti-thrombotic
- beta blockers
- statins
- ACEi
33
Q

In which circumstances would thrombolysis be the optimal reperfusion strategy for STEMI?

A
  • if door-balloon >90mins
  • if (door-balloon) minus (door-needle) >1-2hrs
  • if <3hrs since symptoms onset
34
Q

In which circumstances would primary PCI be the optimal reperfusion strategy for STEMI?

A
  • if door-balloon <90mins
  • if >3hrs since symptoms onset
  • if cardiogenic shock
  • if there is a high bleeding risk
  • if a diagnosis is uncertain
35
Q

What is Virchow’s triad?

A

Factors causing thrombosis

  • changes in blood constituents - coagulability
  • changes in the pattern of blood flow - stasis/turbulence
  • changes in blood vessel wall - atheroma
36
Q

Define dilated cardiomyopathy.

A 
Left ventricle (perhaps more) is enlarged and weakened, and function is impaired. 
May be a primary problem or arise as an end-result to pathological insult to the myocardium.
37
Q

Define heart failure.

A

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction.

38
Q

List the signs of chronic heart failure.

A
  • oedema
  • tachycardia
  • raised JVP
  • chest crepitations
  • 3rd heart sounds
  • displaced or abnormal apex beat
39
Q

What are the European soc Cardiology guidelines for diagnosing heart failure?

A
  1. Symptoms or signs of HF
  2. Objective evidence of cardiac dysfunction
  3. Response to therapy (diuretics)
40
Q

What pharmacological therapies would be effective to relieve symptoms of heart failure?

A

improve symptoms - diuretics and digoxin
improve symptoms and survival - ACEi and ARB’s
improve survival - beta blockers

41
Q

In which condition do 15% of those affected have AV septal defects?

A

Down Syndrome

42
Q

List characteristics of Turner’s syndrome.

A
  • affecting only women
  • heart defects - coarctation of the aorta
  • short stature
  • infertility
  • absences of periods
43
Q

List characteristics of Noonan’s syndrome.

A
  • autosomal dominant
  • affects males who have all or some of the physical features of Turner’s syndrome, but normal sex chromosomes.
  • low testosterone
  • reduced sperm count
  • short stature
  • mild learning difficulties
  • neck webbing
  • heart defects - pulmonary stenosis
44
Q

Name and describe the acronym used for 22q11 Deletion Syndrome.

A 
CATCH22
C - Cardiac malformation
A - abnormal faces 
T - thymic hypoplasia
C - cleft palate
H - hypoparathyroidism
22 - 22q11 Deletion Syndrome
45
Q

List the characteristics of William’s syndrome.

A
  • deletion of elastin on chromosome seven
  • ‘elfin’ appearance
  • hypercalcaemia
  • short stature
  • learning difficulties
  • heart defects - aortic stenosis
46
Q

List the characteristics of foetal alcohol syndrome.

A
  • hearing loss
  • visuomotor difficulties
  • fine motor difficulties
  • low birth weight
  • facial abnormalities
47
Q

Define Marfan’s syndrome.

A

An autosomal dominant connective tissue disorder caused by a fibrillin 1 gene mutation.

48
Q

What is used for the clinical diagnosis of Marfan’s syndrome?

A

Ghent 2010 Criteria

49
Q

List characteristics of Marfan’s syndrome.

A
  • excessive tallness
  • abnormally long and slender fingers and toes
  • partial dislocation of eye lenses
  • heart defects - aortic dissection/mitral valve prolapse
  • pneumothorax
  • dural ectasia
50
Q

List some signs and symptoms of deep vein thrombosis.

A
  • unilateral limb swelling
  • calf tenderness
  • calor of affected area
  • erythema
  • ulceration (if severe)

Often asymptomatic

51
Q

What score is used to assess deep vein thrombosis and pulmonary embolism?

A

Wells score

52
Q

List some signs and symptoms of pulmonary embolism.

A
  • pleuritic chest pain
  • dyspnoea
  • haemoptysis
  • tachycardia
  • pleural rub

If severe;

  • sudden onset severe dyspnoea
  • syncope
  • cyanosis
  • tachycardia
  • low BP
  • raised JVP
  • sudden death
53
Q

How would you test for a potential blood clot?

A

D-dimer

54
Q

How would you treat DVT or PE?

A
  • anticoagulants

heparin or warfarin

55
Q

How would you treat a massive pulmonary embolism?

A
  • thrombolysis
56
Q

Define infective endocarditis.

A

An infection of the endocardium, heart valves, IV septum, chordae tendinae and intra-cardiac devices.

57
Q

Describe the prognosis and mortality associated with infective endocarditis.

A
  • Poor prognosis

- High mortality

58
Q

Infective endocarditis is most commonly seen in patients with which morbidities?

A
  • prosthetic heart valves
  • mitral valve prolapse
  • bicuspid aortic valve
  • congenital heart disease
  • any immunocompromised patients
59
Q

List three of the most common bacterial agents causing infective endocarditis, and state which is most common.

A
  • streptococci
  • enterococci
  • staphylococcus

Most common is Strep. viridans

60
Q

Describe the Modified Duke Criteria.

A

The major criteria - identifies organism and provides evidence of infection anywhere within the heart
The minor criteria - focuses on the endocarditis complex of clinical findings

61
Q

What would be the treatment for infective endocarditis before a causative agent has been identified?

A
  • IV gentamicin and IV amoxicillin
62
Q

What does SIHD stand for?

A

Stable Ischemic Heart Disease

63
Q

What is the most common cause of angina?

A

Coronary atheroma

64
Q

Describe the Canadian Classification of angina severity.

A

I - symptoms only on significant exertion
II - slight limitation of ordinary activity (>1 flight of stairs)
III - marked limitation (1 flight of stairs)
IV - symptoms on any activity (getting washed/dressed)

65
Q

What does PCI stand for?

A

Percutaneous Coronary Injection

66
Q

What does CABG stand for?

A

Coronary Artery Bypass Graft

67
Q

List the key symptoms of stroke.

A
  • loss of power
  • loss of sensation
  • loss of speech
  • loss of vision
  • loss of coordination
68
Q

Which key symptom would suggest a haemorrhagic stroke?

A
  • photophobia
69
Q

What is the importance of localisation when a stroke has occurred?

A
  • confirms diagnosis
  • allows better selection of imaging
  • gives an indication of the cause
  • gives an indication of prognosis
70
Q

What are the differences between transudates and exudates?

A

Transudates - low protein/albumin and low specific gravity

Exudates - high protein/albumin and high specific gravity

Systems 1 Cardiology (ME2508) (8 decks)

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