Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2b deck > cardio 1 > Flashcards

cardio 1 Flashcards

1
Q

In which arteries would you be most likely to find atheromatous plaques?

A

In the peripheral and coronary arteries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the treatment for atherosclerosis?

A

Percutaneous coronary intervention (PCI).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can restenosis be avoided following PCI?

A

Drug eluting stents: anti-proliferative and drugs that inhibit healing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the key principle behind the pathogenesis of atherosclerosis?

A

It is an inflammatory process!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define angina.

A

Angina is a type of IHD. It is a symptom of O2 supply/demand mismatch to the heart experienced on exertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do blood vessels try and compensate for increased myocardial demand during exercise.

A

When myocardial demand increases e.g. during exercise, microvascular resistance drops and flow increases!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why are blood vessels unable to compensate for increased myocardial demand in someone with CV disease?

A

In CV disease, epicardial resistance is high meaning microvascular resistance has to fall at rest to supply myocardial demand at rest. When this person exercises, the microvascular resistance can’t drop anymore and flow can’t increase to meet metabolic demand = angina!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can angina be reversed?

A

Resting - reducing myocardial demand.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you describe the chest pain in angina?

A

Crushing central chest pain. Heavy and tight. The patient will often make a fist shape to describe the pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NICE definition of stable angina

A
  1. constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
  2. precipitated by physical exertion
  3. relieved by rest or GTN in about 5 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnostic tests for stable angina

A

1st line: CT coronary angiography
2nd line: non-invasive functional imaging (looking for reversible myocardial ischaemia)- e.g. stress echocardiography or MRI for stress-induced abnormalities
3rd line: invasive coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A young, healthy, female patient presents to you with what appears to be the signs and symptoms of angina. Would it be good to do CT angiography on this patient?

A

Yes. CT angiography has a high NPV and so is ideal for excluding CAD in
younger, low risk individuals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the primary prevention of angina.

A
  1. Risk factor modification.

2. Low dose aspirin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the secondary prevention of angina.

A
  1. Risk factor modification.
  2. Pharmacological therapies for symptom relief and to reduce the risk of CV events.
  3. Interventional therapies e.g. PCI.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Medication given to patients with angina

A
  1. aspirin and statin
  2. GTN spray
  3. beta blocker or CCB e.g.verapamil or diltiazem (one or the other but can give both if one does not work alone). If both BB and CCB given, use long acting dihydropiridine e.g. nifedipine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the action of beta blockers.

A

Beta blockers are beta 1 specific. They antagonise sympathetic activation and so are negatively chronotropic and inotropic. Myocardial work is reduced and so is myocardial demand = symptom relief.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give 4 side effects of beta blockers.

A
  1. Bradycardia.
  2. Tiredness.
  3. Erectile dysfunction.
  4. Cold peripheries.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When might beta blockers be contraindicated?

A

They might be contraindicated in someone with asthma or in someone who is bradycardic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the action of nitrates.

A

Nitrates e.g. GTN spray are venodilators. Venodilators -> reduced venous return -> reduced pre-load -> reduced myocardial work and myocardial demand.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the action of Ca2+ channel blockers.

A

Ca2+ blockers are arterodilators -> reduced BP -> reduced afterload -> reduced myocardial demand.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name 2 drugs that might be used in someone with angina or in someone at risk of angina to improve prognosis.

A
  1. Aspirin.

2. Statins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does aspirin work?

A

Aspirin irreversibly inhibits COX. You get reduced TXA2 synthesis and so platelet aggregation is reduced.
Caution: Gastric ulcers!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are statins used for?

A

They reduce the amount of LDL in the blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

management of ACS- drugs

A

MONA (Morphine, oxygen, nitrates, aspirin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe type 1 MI.

A

Spontaneous MI with ischaemia due to plaque rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe type 2 MI.

A

MI secondary to ischaemia due to increased O2 demand.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Give 3 signs of unstable angina.

A
  1. Cardiac chest pain at rest.
  2. Cardiac chest pain with crescendo patterns; pain becomes more frequent and easier provoked.
  3. No significant rise in troponin.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Patients presenting with acute chest pain:

a. Immediate management
b. Referral

A

a. GTN, aspirin 300mg, only give oxygen if stats <94%
ECG as soon as possible but do not delay transfer to hospital

b.
- current chest pain or chest pain in the last 12 hours with an abnormal ECG: emergency admission
- chest pain 12-72 hours ago: refer to hospital the same-day for assessment

  • chest pain > 72 hours ago: perform full assessment with ECG and troponin measurement before deciding upon further action
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What might the ECG of someone with unstable angina show?

A

The ECG from someone with unstable angina may be normal or might show T wave inversion and ST depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What might the ECG of someone with NSTEMI show?

A

The ECG from someone with NSTEMI may be normal or might show T wave inversion and ST depression. There also might be R wave regression, ST elevation and biphasic T wave in lead V3.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What might the ECG of someone with STEMI show?

A

The ECG from someone with STEMI will show ST elevation in the anterolateral leads. After a few hours, T waves invert and deep, broad, pathological Q waves develop.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

A raised troponin is not specific for ACS. In what other conditions might you see a raised troponin?

A
  1. Gram negative sepsis.
  2. Pulmonary embolism.
  3. Myocarditis.
  4. Heart failure.
  5. Arrhythmias.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the treatment of choice for STEMI?

A

PCI.

34
Q

What is the function of P2Y12?

A

It amplifies platelet activation.

35
Q

Give 3 potential side effects of P2Y12 inhibitors.

A
  1. Bleeding.
  2. Rash.
  3. GI disturbances.
36
Q

Describe the secondary prevention therapy for people after having a STEMI.

A
  1. Aspirin.
  2. Clopidogrel (P2Y12 inhibitor).
  3. Statins.
  4. Metoprolol (beta blocker).
  5. ACE inhibitor.
  6. Modification of risk factors.
37
Q

ECG: what does the P wave represent?

A

Atrial depolarisation.

38
Q

ECG: what might a long PR interval indicate?

A

Heart block.

39
Q

ECG: what does the QRS complex represent?

A

Ventricular depolarisation.

40
Q

ECG: what does the T wave represent?

A

Ventricular repolarisation.

41
Q

What might tall pointed P waves on an ECG suggest?

A

Right atrial enlargement.

42
Q

What might notched, ‘m shaped’ P waves on an ECG suggest?

A

Left atrial enlargement.

43
Q

What part of the ECG does the plateau phase of the cardiac action potential coincide with?

A

QT interval.

44
Q

What is the dominant pacemaker of the heart?

A

The SA node. 60-100 beats/min.

45
Q

What are the symptoms of DVT?

A

Non-specific symptoms, pain and swelling. Tenderness, warmth and slight discolouration.

46
Q

What is the diagnostic scoring system for DVT? What score makes a DVT likely?

A

Well’s score, 2 points or more means DVT likely

47
Q

Well’s criteria (each one point)

A
  • active cancer (1)
  • Paralysis/immobilisation (1)
  • bedridden for 3+ days/major surgery within last 12 weeks (1)
  • localised tenderness along deep venous system (1)
  • entire leg swollen (1)
  • calf swelling at least 3cm bigger than asymptomatic side (1)
  • pitting oedema (1)
  • collateral superficial veins (1)
  • previously documented DVT (1)
    alternative diagnosis equally likely (-2)
48
Q

what should be done if well’s score= 2+?

A
  • US compression scan

- If US negative, do D dimer

49
Q

What is the treatment for DVT?

A
  1. LMWH
  2. Apixaban/rivaroxaban (DOAC)s, warfarin if it is contraindicated
  3. Compression stockings.
  4. Treat the underlying cause e.g. malignancy or thrombophilia.
50
Q

How can DVT’s be prevented?

A
  1. Hydration.
  2. Mobilisation.
  3. Compression stockings.
  4. Low does LMWH.
51
Q

What might be the consequence of a dislodged DVT?

A

Pulmonary embolism.

52
Q

What are the potential consequences of arterial thrombosis?

A
  1. MI.
  2. Stroke.
  3. Peripheral vascular disease e.g. gangrene
53
Q

How does warfarin work?

A

It produces NON-functional clotting factors 2, 7, 9 and 10.

54
Q

What is warfarin the antagonist of?

A

Vitamin K.

55
Q

What is infective endocarditis?

A

Infection of the heart valves.

56
Q

What is the clinical diagnosis of hypertension?

A

BP ≥ 140/90mmHg.

57
Q

Name 2 systems that are targeted pharmacologically in the treatment of hypertension.

A
  1. RAAS.

2. Sympathetic nervous system (NAd).

58
Q

Name 3 ACE inhibitors. In what diseases are ACE inhibitors clinically indicated?

A 
Ramipril, enalapril, perindopril
indicated in: 
1. Hypertension.
2. Heart failure.
3. Diabetic nephropathy
59
Q

Give 5 potential side effects of ACE inhibitors.

A
  1. Hypotension.
  2. Hyperkalaemia.
  3. Acute renal failure.
  4. Teratogenic.
  5. Dry cough
60
Q

What are ARBs? At which receptor do ARB’s work? Name some?

A

Angiotensin 2 receptor blockers. AT-1 receptor. candesartan, losartan, valsartan

61
Q

A patient with hypertension has come to see you about their medication. You see in their notes that ACE inhibitors are contraindicated. What might you prescribe them instead?

A

An ARB e.g. candesartan.

62
Q

Give 4 potential side effects of ARBs.

A

ARBs have similar side effects to ACEi:

  1. Hypotension.
  2. Hyperkalaemia.
  3. Renal dysfunction.
  4. Rash.

Contraindicated in pregnancy.

63
Q

Name 4 Calcium channel blockers.

A
  1. Amlodipine.
  2. Felodipine.
  3. Diltiazem.
  4. Verapamil.
64
Q

Name 2 dihydropyridines and briefly explain how they work.

A

Dihydropyridines are a class of calcium channel blockers. Amlodipine and felodipine are examples of dihydropyridines. They are arterial vasodilators.

65
Q

Name a calcium channel blocker that acts primarily on the heart.

A

Verapamil - it is negatively chronotropic and inotropic.

66
Q

Name a calcium channel blocker that acts on the heart and on blood vessels.

A

Diltiazem - acts on the heart and the vasculature.

67
Q

Give 3 potential side effects that are due to the vasodilatory ability of calcium channel blockers.

A
  1. Flushing.
  2. Headache.
  3. Oedema.
68
Q

Give a potential side effect that is due to the negatively inotropic ability of calcium channel blockers.

A

Worsening cardiac failure.

69
Q

Give 4 potential side effects of verapamil.

A
  1. Worsening cardiac failure (-ve inotrope).
  2. Bradycardia (-ve chronotrope).
  3. Atrioventricular block (-ve chronotrope).
  4. Constipation!
70
Q

A patient comes to see you who has recently started taking calcium channel blockers for their hypertension. They complain of constipation. What calcium channel blocker might they be taking?

A

Verapamil.

71
Q

Give 5 potential side effects of beta blockers.

A
  1. Fatigue.
  2. Headache.
  3. Nightmares.
  4. Bradycardia.
  5. Hypotension.
  6. Cold peripheries.
  7. Erectile dysfunction.
  8. Bronchospasm.
72
Q

Diuretics: where do in the kidney do thiazides work?

A

The distal tubule.

73
Q

Name a thiazide.

A

Bendroflumethiazide.

74
Q

Name 2 loop diuretics.

A
  1. Furosemide.

2. Bumetanide.

75
Q

Name a potassium sparing diuretic.

A

Spironolactone.

76
Q

Why are potassium sparing diuretics especially effective?

A

They have anti-aldosterone effects too.

77
Q

Give 5 potential side effects of diuretics.

A
  1. Hypovolemia.
  2. Hypotension.
  3. Reduced serum Na+/K+/Mg+/Ca2+.
  4. Increased uric acid -> gout.
  5. Erectile dysfunction.
  6. Impaired glucose tolerance.
78
Q

You see a 45 y/o patient who has been taking ACE inhibitors and calcium channel blockers for their hypertension. Following several tests you notice that their blood pressure is still high. What would you do next for this patient?

A

You would combine the ACEi/ARB and calcium channel blockers with a thiazide diuretic e.g. bendroflumethiazide.

79
Q

You see a 45 y/o patient who has recently been diagnosed with hypertension. What is the first line treatment?

A

ACE inhibitors e.g. ramapril or ARB e.g. candesartan.

80
Q

You see a 65 y/o patient who has recently been diagnosed with hypertension. What is the first line treatment?

A

Calcium channel blockers (as this patient is over 55) e.g. amlodipine.

2b deck (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions