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Cardio Flashcards

1
Q

What are the risk factors for atherosclerosis (7)

A
  • Increasing age
  • Smoking
  • Diabetes
  • High cholesterol
  • Hypertension
  • Family history
  • Obesity
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2
Q

Describe the pathophysiology of atherosclerosis formation

A
  • 1st stage (fatty streaks) - Endothelial damage causes attraction and accumulation of lipid laden macrophages and T-lymphocytes in the vessel wall
  • 2nd stage (intermediate lesions) - Layers of lipid laden macrophages and T-lymphocytes in the vessel wall with platelet aggregation and adhesion
  • 3rd stage (fibrous plaques) - Dense fibrous cap formed on the lesions with fibrin filling of lesion. Prone to rupture and partially occlude arteries
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3
Q

What is stable angina

A
  • Chest pain or exercise that is a result of reversible myocardial ischaemia
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4
Q

What are the risk factors for stable angina (7)

A
  • Obesity/sedentary lifestyle
  • Smoking
  • Hypertension
  • High cholesterol
  • Diabetes
  • Family history
  • Increasing age
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5
Q

How might stable angina present (3)

A
  • 1) Central crushing chest pain radiates to jaw/right arm
  • 2) Brought on by exercise
  • 3) Relived by rest/GTN
  • 3/3 = typical angina, 2/3 = atypical angina, 1/3 = non-anginal pain
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6
Q

How do you diagnose stable angina (3)

A
  • ECG (may be normal or show ST depression)
  • CT Ca scoring (shows up as white)
  • Exercise ECG
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7
Q

How do you treat stable angina (7)

A
  • Lifestyle modification
  • Beta blockers (reduces HR and contractility by increased filling time hence sec. load on heart)
  • GTN spray (dec. afterload by arterial vasodilation and cornary artery vasodilation)
  • Aspirin
  • Statins (simvastatin)
  • CCB (verapamil)
  • PCI/revasc./CABG
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8
Q

What are the types of acute coronary syndrome (ACS) (3)

A
  • STEMI (complete major coronary artery blockage)
  • NSTEMI (partial major or complete minor coronary artery blockage)
  • Unstable angina (<24hrs onset, symptoms at rest, worsening of stable)
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9
Q

How might ACS present (6)

A
  • Acute severe central crushing chest pain, radiates to arm/neck/jaw
  • Sweating
  • Nausea and vomiting
  • Shortness of breath
  • Palpitations
  • Tachycardic and hypotensive
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10
Q

How do you diagnose ACS (3)

A
  • ECG (STE/STD/ tall T)
  • Raised troponin/CT-MB
  • Trans-thoracic echo
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11
Q

How do you treat ACS acutely (8)

A
  • MOANA
  • Morphine
  • Oxygen
  • Aspirin/clopidogrel
  • Nitrates
  • Atenolol
  • PCI (must be in 120 mins)
  • CABG
  • Fibrinolysis
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12
Q

How do you manage ACS (7)

A
  • Lifestyle modification
  • Statins
  • Beta blockers
  • ACE inhibitors
  • Aspirin
  • Warfarin
  • CCB
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13
Q

What are the potential complications of ACS (3)

A
  • Arrhythmia
  • Pericarditis
  • Heart failure
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14
Q

What is the definition of heart failure

A
  • Inability of the heart to deliver sufficient blood, hence oxygen to metabolising tissues
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15
Q

What are the main causes of heart failure (4)

A
  • Ischaemic heart disease (most common)
  • Valvular disease
  • Cardiomyopathy
  • Hypertension
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16
Q

What are the risk factors for heart failure (5)

A
  • Increasing age
  • Previous MI
  • Male
  • Obesity
  • African
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17
Q

Describe the pathophysiology of heart failure

A
  • As heart begins to fail various compensatory physiological changes occur
  • Sympathetic input increases HR and contractility
  • Renin-angiotensin system increases venous return hence increasing contractility
  • However as failure progresses the changes become pathophysiological eg. inc. HR and contractility means increased work load causing myocardial ischaemia
  • This is known as decompensation
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18
Q

How might heart failure present (5)

A
  • Triad of shortness of breath, fatigue and ankle oedema
  • Ascites
  • Cold peripheries/cyanosis
  • Hypotension/tachycardia
  • Bi-basal crackles
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19
Q

How do you classify heart failure symptoms

A
  • New york heart association classification
  • Class 1 - asymptomatic
  • Class 2 - symptoms on moderate exercise
  • Class 3 - symptoms on mild exercise
  • Class 4 - symptoms at rest
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20
Q

How do you diagnose heart failure (3)

A
  • CXR (cardiomegaly)
  • Brain natriuretic peptide (released by ventricles in response to strain)
  • Echo
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21
Q

How do you treat heart failure (6)

A
  • Lifestyle change
  • Diuretics (spironalactone (k+ sparing)/ furosemide)
  • ACE inhibitors/ angiotensin 2 R.B (canderstan)
  • Beta blockers (atenolol)
  • Revascularisation
  • Transplant in young
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22
Q

What is the epidemiology of hypertension (3)

A
  • More common in men
  • Increases with age
  • More common in black people
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23
Q

What are the stages of hypertension (3)

A
  • Stage 1 - >140/90 in clinic or >135/85 at home
  • Stage 2 - >160/100 in clinic or >150/95 at home
  • Severe - >180 syst. and/or >110 dias.
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24
Q

What are the risk factors for hypertension (6)

A
  • Black
  • Increasing age
  • Male
  • Diabetes
  • Smoking
  • High salt diet
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25
How do you diagnose hypertension (2)
- Clinical examination | - 24 hour ambulatory monitoring
26
How do you treat hypertension
- Aim for 140/90 - <55 1st line ACE-i or ARB - >55 or afro-Caribbean 1st line CCB - 2nd line ACI-i and CCB - 3rd line ACE-i and CCB and thiazide diuretic - 4th line add Beta blocker or spironalactone
27
What is atrial fibrillation (AF)
- A chaotic irregular atrial rhythm of 300-600 bpm with irregular ventricular response and hence rhythm
28
What is the epidemiology of AF
- Most common arrhythmia | - More common in males
29
What are the causes of AF
- CAD - Cardiomyopathy - Cardiac surgery - Hypertension - Heart failure - Idiopathic
30
Describe the pathophysiology of AF
- Rapid irregular depolarisation of the atria with poor contractile response leading to atrial spasm - Irregular ventricular response - CO decreases due to poor ventricular filling - Blood pools in atria and clots causing increased risk of embolism
31
How might AF present (5)
- Palpitations - Chest pain - Shortness of breath - Fatigue - Syncope
32
How do you diagnose AF
- ECG (absent P waves, irregular, rapid QRS)
33
How do you treat AF (5)
- Cardioversion (LMW heparin - enoxaparin) - Warfarin - Anti-arrhythmic (amoidarone) - CCB (verapamil) - Blocks AV node - Beta blockers (atenolol) - Controls HR
34
What is atrial flutter
- A rapid regular organised atrial rate 250-350 bpm
35
What is the epidemiology of atrial flutter (3)
- Often associated with AF - More common in males - Increases with age
36
How might atrial flutter present (5)
- Palpitations - Syncope - Fatigue - Chest pain - Shortness of breath
37
How do you diagnose atrial flutter
- ECG (sawtooth)
38
How do you treat atrial flutter (4)
- Cardioversion (LMW heparin - enoxaparin) - Warfarin - Anti-arrhythmic (amoidarone) - Beta blockers (atenolol) - Controls HR
39
Describe 1st degree AV block
- P-R enlongation without QRS drop - Caused by AV blocking drugs (CCB/BB) and inferior MI - Asymptomatic and no treatment
40
What are the two types of type 2 AV block
- Mobitz I and II
41
Describe Mobitz I AV block
- Progressive Q-R elongation then QRS drop then reset - Caused by inferior MI and AVN blocking drugs (CCB/BB) - Syncope, dizziness, fatigue - Pacemaker if poorly tolerated
42
Describe Mobitz II AV block
- P-R interval constant with QRS dropping - Caused by inferior MI and AVN blocking drugs (CCB/BB) - Syncope, chest pain, SOB and hypotension - Pacemaker
43
Describe type 3 AV block
- No conduction of atrial depolarisation to ventricles - Complete block at AV node - Ventricular rhythm sustained by spontaneous depolarisation below AV node - Syncope, chest pain, SOB and hypotension - P completely independent of QRS - Pacemaker insertion
44
What is the epidemiology of mitral valve stenosis (3)
- Normal = 4-6cm symptoms start at <2cm - More common in men - Usually secondary to rheumatic HD
45
Describe the pathophysiology of mitral valve stenosis
- Narrowing and stiffening of mitral valve causes decreased blood flow from LA-LV - To maintain CO, LA hypertrophy and dilatation occurs - This causes secondary PH and PO and PH causes RV hypertrophy/dilatation
46
How might mitral valve stenosis present (6)
- Progressive shortness of breath/dyspnoea - RH failure (ankle oedema/fatigue/SOB) - Haemoptysis due to PH - Palpitations (AF can occur) - Malar flush (pink/purple cheek discolouration) - Heart sounds
47
How do you diagnose mitral valve stenosis (3)
- CXR (stenosed mv and RV/LA hypertrophy) - ECG (AF and RV/LA hypertrophy) - Echo (gold standard)
48
How do you treat mitral valve stenosis (4)
- Beta blockers - Diuretics for oedema - Percutaneous mitral balloon valvotomy - Mitral valve replacement
49
What is the epidemiology of mitral regurgitation (2)
- Due to abnormality in chordae tendinae, LV, leaflets of valve or papillary muscles - Most commonly due to myxomatous degeneration (weakening of chordae tendinae)
50
Describe the pathophysiology of mitral regurgitation
- Systolic leak of blood from LV to LA - Leads to LA dialtation and LV hypertrophy/dilatation in an attempt to maintain CO - LA dilatation causes PH and RV hypertrophy/dilatation
51
How might mitral regurgitation present (4)
- Shortness of breath/dyspnoea - RV failure (oedema/fatigue/SOB) - Raised SV felt as palpitation - Heart sounds
52
How do you diagnose mitral regurgitation (3)
- CXR (LV/LA/RH enlargement) - ECG (LV/RV hypertrophy) - Echo.
53
How do you treat mitral regurgitation (3)
- Beta blockers - Diuretics - Surgery
54
What is the epidemiology of aortic stenosis (3)
- Normal area is 3-4cm symptoms at less than 1 - Mostly disease of ageing, but also congenital - Most common valve disease
55
What are the types of aortic stenosis (3)
- Supravalvular - Valvular (most common) - Subvalvular
56
Describe the pathophysiology of aortic stenosis
- Decreased blood flow from LV to aorta leads to LV hypertrophy and dilatation in an attempt to maintain CO against increased afterload - This also causes relative LV ischaemia causing angina, arrhythmia and failure
57
How might aortic stenosis present (5)
- TRIAD - Angina - Shortness of breath - Syncope - Slow rising carotid pulse and decreased pulse amplitude - Heart sounds
58
How do you diagnose aortic stenosis (3)
- CXR (LV enlargement + calcified aortic valve) - ECG (LV hypertrophy + arrhythmia) - Echo.
59
How do you treat aortic stenosis (2)
- Aortic valve replacement | - Transcutaneous aortic valve implantation
60
What is the epidemiology of aortic regurgitation (3)
- Mostly caused by congenital bicuspid aortic valve - Also infective endocarditis and rheumatic HD - May be associated with aortic stenosis
61
Describe the pathophysiology of aortic regurgitation
- Reflux of blood form aorta to LV - LV hypertrophy occurs to maintain CO - Due to hypertrophy and decreased perfusion of coronary arteries LV ischaemia and angina occurs
62
How might aortic regurgitation present (6)
- Angina - Shortness of breath/dyspnoea - Wide pulse pressure - Palpitations - Syncope - Heart sounds
63
How do you diagnose aortic regurgitation (3)
- CXR (LV hypertrophy and aortic root dilation) - ECG (LV hypertrophy) - Echo
64
How do you treat aortic regurgitation (2)
- ACE-inhibitors | - Valve replacement
65
What are the risk factors for infective endocarditis (5)
- Elderly - Congenital heart disease - Poor dental hygiene - IV drug use/iv cannula - Heart surgery/pacemaker
66
What organisms cause infective endocarditis (3)
- Staph. areus (most common) - Strep. viridans - Pseudomonas aeruginosa
67
Describe the pathophysiology of infective endocarditis
- Combination of organisms in blood and abnormal cardiac endothelium allowing adherence and growth - Vegetation grows on valves, most commonly on mitral/aortic (except in iv drug use affects RH) - Causes valvular destruction and hence worsening HF
68
How might infective endocarditis present (8)
- Headache/fever/myalgia/sweats - Splinter haemorrhage - Embolic skin lesions - Finger clubbing - Osler nodes - tender nodules in the digits - Janeway lesions - haemorrhages and nodules in the fingers - Roth spots - retinal haemorrhages - Petechiae
69
How do you diagnose infective endocarditis (3)
- Transoesophageal echo - Blood cultures (3 different sites in 24 hours) - FBC (raised ESR/CRP/anaemia)
70
How do you treat infective endocarditis (3)
- Staph. areus vancomycin + Rifampicin - Step. viridans Gentamycin + benzylpenicillin - Surgery to replace infected valve
71
What is the epidemiology of hypertrophic cardiomyopathy (3)
- 2nd most common cardiomyopathy - Autosomal dominant - Most common cause of sudden cardiac death in young
72
Describe the pathophysiology of hypertrophic cardiomyopathy
- Ventricular hypertrophy of no other cause - Caused by sarcomeric protein gene mutation - Ventricles become less compliant leading to decreased filling and hence decreased CO
73
How might hypertrophic cardiomyopathy present (5)
- Angina/chest pain - Shortness of breath/dyspnoea - Syncope - Palpitation/arrhythmia - Jerky carotid pulse
74
How do you diagnose hypertrophic cardiomyopathy (3)
- ECG (LV hypertrophy) - Echo - Genetic testing
75
How do you treat hypertrophic cardiomyopathy (3)
- Anti arrythmic (amoidarone) - Beta blocker - CCB
76
What is the epidemiology of dilated cardiomyopathy (3)
- Most common cardiomyopathy - Autosomal dominant - May also be caused by alcohol, ischaemia and thyroid issues
77
Describe the pathophysiology of dilated cardiomyopathy
- Cytoskeletal gene mutations - Dilatation of ventricles or all 4 cardiac chambers - Thin muscle layer means poor contractility and hence CO is low
78
How might dilated cardiomyopathy present (5)
- Chest pain/angina - Shortness of breath/dyspnoea - HF (oedema, fatigue, SOB) - Palpitations/arrhythmia - Raised jugular venous pressure
79
How do you diagnose dilated cardiomyopathy (2)
- CXR (cardiomegaly) | - Echo
80
How do you treat dilated cardiomyopathy
- Treat HF and arrhythmia
81
Describe eisenmengers syndrome
- Initial L to R shunt as left pressure > right pressure - This causes increase in pulmonary blood flow, resulting in increased pulmonary artery vascular resistance - This initiates an increase in RH pressure above LH pressure - This causes the shunt to reverse, so now is R to L - This causes cyanosis
82
What is the epidemiology of atrial septal defects (ASD) (3)
- 1/3 of congenital HD - Often presents in adulthood - More common in women
83
Describe pathophysiology of ASD
- Hole in atrial septum (wall) - Shunt from L to R - Can reverse with PH (eisenmengers)
84
How might ASD present (4)
- Shortness of breath/dyspnoea - Cyanosis - Palpitation/arrhythmia - Murmur
85
How do you diagnose ASD (3)
- CXR (cardiomegaly/large PA) - Echo. - ECG (RBBB)
86
How do you treat ASD
- Surgical or percutaneous closure
87
What is the epidemiology of ventricular septal defects (VSD) (2)
- 20% of congenital HD | - Many close spontaneously during childhood
88
Describe the pathophysiology of VSD
- Shunt R to L | - May reverse/ PH (eisenmengers)
89
How might VSD present (5)
- Cyanosis - Small skinny baby - Raised resp. rate - Tachycardia - Murmur
90
How do you diagnose VSD (2)
- Echo | - CXR (cardiomegaly)
91
How do you treat VSD (3)
- Small = none - Medium = ACE-i and diuretics - Surgical closure
92
What is the epidemiology of AVSD (2)
- Associated with downs syndrome | - Instead of two AV valves one large leaky malformed one
93
How might AVSD present (3)
- Cyantic, breathless baby - Tachycardia/ raised resp. rate - Poor weight gain/feeding
94
How do you treat AVSD
- Surgical repair/PA banding
95
Describe the epidemiology of peripheral vascular disease (2)
- More common in men | - Mostly caused by atherosclerosis
96
Describe Chronic lower limb ischaemia (4)
- Exercise induced - Partial blockage causes decreased oxygen delivery caused increased lactic acid production - Crampy pains on exercise, relived by rest - Cold limbs
97
Describe critical limb ischaemia (4)
- Symptoms at rest, usually nocturnal - Relieved by hanging limb out of bed - Blood supply barely adequate for normal metabolism - May lead to infarct/gangrene
98
Describe acute limb ischaemia (6)
- 6ps - Perishing cold - Pallor - Pain - Paralysis - Paraesthesiae - Pulseless
99
How do you diagnose limb ischaemia (2)
- Colour duplex ultrasound | - CT/MR angiography
100
How do you treat limb ischaemia (6)
- Acute - Revasc./thrombolysis - Chronic/critical - Warfarin/clopidogrel - ACE-i/statins - Risk factor modification
101
What is patent ductus arteriosus (PDA)
- A persistent connection between the pulmonary artery and the descending aorta - Leads to R-L reverse shunt (eisenmengers)
102
How might PDA present (4)
- Breathlessness/dyspnoea - Cyanosis - Tachycardia - Bounding pulse
103
What are the key features of tetralogy of fallot (4)
- Most common cyanotic congenital HD - VSD - Overriding aorta - Pulmonary stenosis - RH hypertrophy (R-L shunt due to RV pressure increase due to pulmonary stenosis)
104
How might tetralogy of fallot present (4)
- Cyanosis - Small baby, slow growth - SOB/dyspnoea - Murmur
105
How do you treat tetralogy of fallot
- Surgery | - Often pulmonary regurgitation, requiring follow up surgery in adulthood
106
What is the epidemiology of pericarditis (2)
- More common in males | - Usually seen in adults
107
What can cause pericarditis (5)
- Viral - Adeno/enteroviruses - Bacterial - Mycobacterium tuberculosis - Trauma - Iatrogenic - Autoimmune
108
How might pericarditis present (5)
- Sudden onset severe pleuritic chest pain - Worse on inspiration/lying relieved by sitting forward - Shortness of breath/dyspnoea - Fever - Pericardial friction rub
109
How do you diagnose pericarditis (2)
- ECG (saddle STE) | - CXR may show effusion
110
How do you treat pericarditis (3)
- Rest - NSAIDs - Colchicine
111
What is pericardial effusion/cardiac tamponade
- A collection of fluid in the potential space of the pericardial space - Often associated with acute pericarditis - When a large amount accumulates it decreases ventricular filling - this is cardiac tamponade
112
How might pericardial effusion/cardiac tamponade present (4)
- High pulse with low BP - High JVP - Pulsus paradoxus - Decreased CO
113
How do you diagnose pericardial effusion/cardiac tamponade (2)
- CXR (large globular heart) | - Echo
114
How do you treat pericardial effusion/cardiac tamponade
- Mild resolve | - Pericardial drainage via. pericardiocentesis
115
What is an aneurysm
- A permanent dilatation of an artery to 2x its normal diameter
116
What are the types of aneurysm (2)
- True = all layers | - False = Outer layer only (adventitia)
117
What is the epidemiology of aortic aneurysm (2)
- Increases with age | - More common in males
118
How might an abdominal aortic aneurysm present (5)
- Abdominal/back/groin pain - Pulsatile abdominal swelling - Hypotension - Tachycardia - Collapse
119
How do you diagnose abdominal aortic aneurysm
- Abdominal ultrasound
120
How do you treat abdominal aortic aneurysm (3)
- Monitor/treat risk factors (hypertension etc.) - Endovascular stent - Surgical clipping
121
How might a thoracic aortic aneurysm present (5)
- Neck/back/chest/epigastric sudden onset severe pain - Hypotension - Collapse - Tachycardia - Haemoptysis
122
How do you diagnose thoracic aortic aneurysm (2)
- CT/MRI | - Transoesophageal echo
123
How do you treat thoracic aortic aneurysm (2)
- Monitor/treat risk factors (hypertension) | - Surgical clipping
124
What is the epidemiology of aortic dissection (3)
- Elderly - More common in males - Most common aortic emergency
125
How might aortic dissection present (4)
- Sudden onset severe central chest pain - Tearing sensation - Hypertension - Shock
126
How do you diagnose aortic dissection (2)
- CXR (widened mediastinum) | - Urgent CT/MRI/TOE
127
How do you treat aortic dissection (3)
- Rapid B.P control (iv Beta blocker/GTN) - Morphine - Surgery/endovascular stent
128
What is shock
- Acute circulatory failure with inadequate perfusion of tissues resulting in generalised hypoxia
129
How might shock present (7)
- Pale - Cold/shivering - Sweaty - Weak/fast pulse - Confusion - Collapse - Increased capillary refill time
130
What can cause shock (4)
- Hypovolaemic - Cardiogenic - Anaphylactic - Septic
131
How do you treat shock
- ABC

Finals (11 decks)

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