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Prep for Phase 3A > Cardio > Flashcards

Cardio Flashcards

1
Q

Stroke volume eqn

A

EDV- ESV

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2
Q

CO eqn

A

HR xSV

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3
Q

BP eqn

A

CO x TPR

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4
Q

PP eqn

A

SP - DP

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5
Q

MAP eqn

A

DP + 1/3PP

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6
Q

Ejection fraction eqn

A

SV/EDV

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7
Q

Ohm’s Law

A

F = Pressure difference/R

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8
Q

Poiseuille law

A

Q = Pi(Pressure difference) r^4 /8nl

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9
Q

Preload

A

Volume of blood in ventricles before they contract

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10
Q

Afterload

A

Force against which the ventricles must contract to expel blood out of ventricles

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11
Q

Contractility

A

Inherent strength and vigor of the heart’s contraction during systole

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12
Q

Elasticity

A

Ability of heart to return to its normal shape after stretching by recoiling once the force is removed

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13
Q

Compliance

A

How easily the heart will stretch when filled with a volume of blood

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14
Q

Resistance

A

Force that must be overcome to push blood through the circulatory system

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15
Q

Atherosclerosis

A

Deposition of fatty deposits in the artery walls and hardening/stiffening of blood vessel walls

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16
Q

Where does atherosclerosis affect

A

Medium and large arteries

,mainly affecting Cx, LAD, RCA

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17
Q

Structure of atherosclerotic plaque

A

Lipid
Necrotic Core
Connective tissue
Fibrous Cap

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18
Q

Atherosclerosis formation

A
  1. Endothelial dysfunction
  2. High levels of LDL in blood
  3. Inflammation
  4. Macrophages take up oxidised LDLs, to form foam cells
  5. Foam cells promote migration of SMC from tunica media to intima. When they die, lipid content released causing plaque growth
  6. Formation of fatty streak in intimal layer
  7. Activated macrophages release cytokines and growth factors
  8. Smooth muscle proliferation around lipid core, leading to formation of fibrous cap
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19
Q

Three main things atherosclerosis causes

A

Stiffening -> HTN
Stenosis -> Ischaemia -> angina
Plaque rupture -> thrombus -> ischaemia -> ACS

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20
Q

Hypertrophic Cardiomyopathy?

A

Marked ventricular hypertrophy in the absence of abnormal loading conditions such as hypertension and valvular disease

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21
Q

Hypertrophic Cardiomyopathy

A

Second most common cardiomyopathy after dilated

Most common cause of sudden cardiac death in young

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22
Q

Inheritance pattern Hypertrophic Cardiomyopathy

A

Autosomal dominant

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23
Q

Pathophysiology hypertrophic cardiomyopathy

A

Caused by sarcomeric gene mutations

They hypertrophic, non compliant ventricles impair diastolic filling causing reduced SV and CO

Disarray of cardiomyocytes so conduction is affected

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24
Q

Hypertrophic Cardiomyopathy presentation

A

Asymptomatic

SOB, Angina, Syncope

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25
Q

Hypertrophic Cardiomyopathy investigation

A

ECG (LVH hypertrophy- Progressive T wave inversion and deep Q waves)
ECHO and MRI show ventricular hypertrophy, MRI shows fibrosis
Genetic Analysis

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26
Q

Hypertrophic Cardiomyopathy management

A

Amiodarone (risk of arrhythmia)

B blockers, verapamil (Chestpain dyspnoea)

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27
Q

Hypertrophic Cardiomyopathy complications

A

Sudden death, cardiac arrhythmias, thromboembolisms, infective endocarditis, heart failure

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28
Q

Dilated Cardiomyopathy

A

Dilated left ventricle that contracts poorly

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29
Q

Dilated Cardiomyopathy epidemiology

A

Most common cardiomyopathy

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30
Q

Inheritance pattern dilated cardiomyopathy

A

Autosomal dominant

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31
Q

Dilated Cardiomyopathy causes

A

Genetic
Alcohol
Ischaemia
Thyroid Disorder

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32
Q

Dilated Cardiomyopathy pathophysiology

A

Cytoskeleton gene mutations

Poorly generated contractile force leads to progressive dilation of heart with some diffuse interstitial fibrosis

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33
Q

Dilated Cardiomyopathy presentation

A

SOB
Fatigue
Heart Failure
Embolism from mural thrombus

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34
Q

Dilated Cardiomyopathy investigations

A

CXR - Cardiac enlargement
ECG - Arrhythmia, t wave flattening
Echo - Dilated ventricles

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35
Q

Dilated Cardiomyopathy management

A

HF and AF treated in conventional way

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36
Q

Restricted Cardiomyopathy

A

condition where the chambers of the heart become stiff over time.

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37
Q

Restricted Cardiomyopathy causes

A

Amyloidosis
Idiopathic
Sarcoidosis
End-myocardial fibrosis

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38
Q

Restricted Cardiomyopathy pathophysiology

A

Normal/decreased ventricular volume with bi-atrial enlargement, normal wall thickness, normal cardiac valves and impaired ventricular filling

Restrictive physiology

Poor dilation of the heart restricts the ability of the heart to pump blood to the rest of the body

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39
Q

Restricted Cardiomyopathy presentation

A

SOB
Fatigue
Embolic symptoms

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40
Q

Restricted Cardiomyopathy investigations

A

CXR
Echo (abnormal but non-specific)
Cardiac Catheterisation

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41
Q

Restricted Cardiomyopathy management

A

None, poor prognosis

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42
Q

Arrhythmogenic right ventricular cardiomyopathy

A

progressive fatty and fibrous replacement of ventricular myocardium

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43
Q

Arrhythmogenic right ventricular cardiomyopathy inheritance pattern

A

Autosomal dominant with incomplete penetrance but can be recessive

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44
Q

Arrhythmogenic right ventricular cardiomyopathy presentations

A

Arrhythmia
Syncope
RHF

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45
Q

Arrhythmogenic right ventricular cardiomyopathy investigation

A

ECG (T wave inversion)
Echo (normal/right ventricular dilation)
Genetic testing

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46
Q

Arrhythmogenic right ventricular cardiomyopathy management

A

Beta blockers
Amiodarone
Cardiac transplant

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47
Q

Atherosclerosis Risk factors

A

Older age
FHx
Male

Smoking
Alcohol
poor diet (reduced veg, omega 3, high salt)
Low exercise
obesity
Poor sleep
Stress
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48
Q

Medical co-morbidities increasing risk of atherosclerosis

A 
Diabetes
HTN
CKD
Inflammatory conditions i.e. RA
Atypical antipsychotics
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49
Q

End results of Atherosclerosis

A 
Angina
MI
TIA
Stroke
PVD
MI
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50
Q

Primary Prevention Cardiovascular disease

A

Do a Q risk score

If more than 10%, offer a statin, 20mg at night

All patients with CKD/T1DM for >10 years should be offered too

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51
Q

Secondary prevention Cardiovascular disease

A

Aspirin (and second antiplatelet (clopidogrel)
Atorvastatin (80mg)
Atenolol (100mg once daily) /other B-blockers (5-10mg once daily)
ACE inhibitor (Ramipril 1.25mg once daily)

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52
Q

Side effects of statin

A

myopathy
T2DM
Haemorrhagic strokes

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53
Q

Primary cause of IHD

A

atherosclerosis

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54
Q

IHD epidemiology

A

Largest cause of death in UK

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55
Q

IHD RF

A

Age, Gender, FHx

Smoking, HTN, Obesity, DM, Sedentary lifestyle, High Fat, low antioxidant, stress, alcohol, high coagulation factors

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56
Q

Angina presentation and classifications

A
  1. Constricting discomfort in chest, neck, shoulder, jaw
  2. Precipitated by exertion
  3. Relieved by rest/GTN

all 3= typical angina
2 = atypical angina
1/0 = non-anginal pain

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57
Q

IHD investigations

A 
ECG (normal-
Lipid profile (may be increased)
FBC (exclude anaemia)
HBA1C (exclude DM)
CT coronary angiography (may show narrowed/blocked areas on vessel)
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58
Q

IHD treatment

A

Antiplatelet (aspirin/clopidogrel)
Statin
HTN control

Angina control
GTN spray
Beta blockers

Secondary
Aspirin
Atorvastatin
ACEi
PCI/CABG if extensive
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59
Q

Angina DDx

A 
Pericarditis
PE
Chest Infection
Dissection of aorta
GORD
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60
Q

Angina features

A 
Central, retrosternal pain
Crushing
Radiates to arms and neck
Exacerbated by cold, exertion, large meal
Relieved with rest
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61
Q

Causes of Prinzmetal’s angina

A

Coronary artery spasm

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62
Q

Cardiac syndrome X?

A

patients with symptoms of angina, positive exercise test but normal coronary arteries

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63
Q

Angina investigations

A 
ECG (possible ST depression, T wave flattening/incersion)
Exercise ECG positive
FBC (exclude anaemia)
U+E (prior to ACEi)
LFT (prior to statin)
Lipid profile
TFT (check hypo/hyper)
HBA1C (exclude diabetes)
CT coronary angiography
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64
Q

Angina Management

A

RAMP

Refer to cardiology if unstable
Advise about diagnosis, management and when to call ambulance
Medical treatment
Procedural/surgical intervention

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65
Q

Medical management Angina

A

GTN (immediate symptomatic relief)

Beta blocker (long term symptomatic relief)
CCB
Secondary prevention
Aspirin
Atorvastatin
ACEi
Already on Beta blocker
66
Q

Surgical interventions Angina

A

PIC

CABG

67
Q

ACS DDx

A 
Angina
Pericarditis
Aortic Dissection
Pulmonary Embolism
GORD
68
Q

RCA supply

A

Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior septal area

69
Q

Cx supply

A

Left atrium

Posterior aspect of left ventricle

70
Q

LAD supply

A

Anterior aspect of left ventricle

Anterior aspect of septum

71
Q

Types of ACS

A

Unstable angina
STEMI
NSTEMI

72
Q

If there is a new left bundle branch block and suspected ACS diagnosis?

A

STEMI

73
Q

If ST elevated suspected ACS dx?

A

STEMI

74
Q

Raised Troponin with ST depression/T wave inversion/ pathological Q wave dx?

A

NSTEMI

75
Q

Troponin levels normal, normal ECG ddxs?

A

Unstable angina, MSK chest pain

76
Q

ACS symptoms

A 
Central constricting chest pain
Nausea vomiting
Sweaty, clammy
Feeling of impending doom
SOB
>20 mins
Palpitation
Radiation to jaws, arms
77
Q

ACS investigations

A

ECG
Troponin
CXR (look for oedema)

FBC
U+E
LFT
Lipid
TFT
HBA1C
Echo (functional damage assessment)
CT coronary angiogram
78
Q

ECG changes in STEMI

A

ST segment elevation

New Left Bundle Branch Block

79
Q

ECG changes NSTEMI

A

ST segment depression
Deep T wave inversion
Pathological Q waves

80
Q

heart area, ECG leads for LCA

A

Anterolateral

I, aVL, V3-6

81
Q

heart area, ECG leads for LAD

A

Anterior V1-4

82
Q

heart area, ECG leads for LCx

A

Lateral

I, aVL, V5-6

83
Q

heart area, ECG leads for RCA

A

Inferior

II, III, aVF

84
Q

What does a rise in troponin mean and when can it be raised

A

Proteins released from ischemic muscle

Chronic Renal Failure
Sepsis
Myocarditis
Aortic Dissection
Pulmonary Embolism
85
Q

ACUTE STEMI treatment

A

PCI if <2hrs of presentation
Thrombolysis if PCI not available within 2hrs

Advice on aspirin and ticagrelor

86
Q

Acute NSTEMI management

A 
Betablockers
Aspirin (300mg stat)
Ticagrelor (180mg stat)
Morphine 
Anticoagulant (Fondaparinux unless high risk bleeding)
Nitrates
87
Q

How to assess PCI in NSTEMI

A

GRACE Score

88
Q

GRACE score for NSTEMI

A

5% low risk
5-10& medium
>10% high

Low = ticagrelor aspirin
Medium/high = angiography + PCI + Prasugrel and aspirin
89
Q

Complications of MI

A 
Death
Rupture of heart septum and papillary muscles
Edema (HF)
Arrhythmia and Aneurysm
Dressler's Syndrome
90
Q

Dressler’s Syndrome onset

A

Usually 2-3 weeks after MI

91
Q

What is the cause of Dressler’s and what does it cause

A

Localised immune response, causes pericarditis

92
Q

Dressler’s syndrome presentation

A

Pleuritic chest pain
Low grade fever
Pericardial rub on auscultation

Possibly Pericardial effusion
Rarely Pericardial tamponade

93
Q

Dressler’s syndrome diagnosis?

A

ECG (ST elevation, T wave inversion)
Echo (pericardial effusion)
Raised ESR, CRP

94
Q

Dressler’s syndrome management

A

NSAIDs

SEVERE: Steroids,

May need pericardiocentesis

95
Q

ACS Secondary prevention

A

Aspirin (75mg OD)
Another antiplatelet (clopidogrel,ticagrelor)
Atorvastatin (80mg)
ACEi
Atenolol/other BB
Aldosterone antagonist (for those with clinical heart failure)

96
Q

Differential diagnosis MI (4)

A

Angina
Pneumonia
Pneumothorax
GORD

97
Q

MI pathophysiology

A

Rupture of vulnerable fibrous plaque cap. Results in arterial occlusion resulting in myocardial necrosis.

98
Q

MI presentation (7)

A 
Pale, Grey, Sweaty
Nausea, vomiting
Brady/tachycardia
Central Chest pain (radiates to arm, jaw, neck)
Hypotension
Pulmonary oedema
Arrythmias
SOB
99
Q

MI investigations (5)

A

Clinical history
STEMI on ECG (ST elevation, Tall T waves, LBBB, T wave inversion and pathological Q waves follows)
NSTEMI - ST depression

Troponin
CXR
Bloods (FBC, U+E, Glucose, Lipids)

100
Q

Management MI acute (5)

A

MONAC

101
Q

LVF triggers (4)

A

Iatrogenic (aggressive IV fluids in frail elderly)
Sepsis
MI
Arrythmia

102
Q

Presentation LVF (9)

A

SOB
Cough (frothy white/ pink sputum)
Tachycardia
Tachypneic

Chest pain in ACS
Fever in Sepsis
Palpitations in arrhythmias

If with RHF
Peripheral oedema
Raised JVP

103
Q

Clinical signs LVF (8)

A 
Tachypneic 
Tachycardia
Reduced O2 sats
3rd Heart Sound
Bilateral basal crackles
Hypotension in severe cases

IF with RHF
Raised JVP
Peripheral oedema

104
Q

LVF investigations (8)

A 
History
Clinical examination
ECG (look for ischemia, arrhythmia)
ABG 
CXR (ABCDE)
Bloods
BNP
Echocardiography ( ejection fraction should be >50% in normal)
105
Q

Cardiomegaly definition

A

Cardiothoracic ration of > 0.5

106
Q

LVF management

A

POUR SOD

Pour/remove IV fluids
Sit Up
Oxygen (if falling <95%)
Diuretics (IV 40 mg stat)

Monitor fluid balance

107
Q

Why sit patients up if LVF

A

When lying flat the fluid in the lungs spreads to a larger area. When upright gravity takes it to the bases leaving the upper lungs clear for better gas exchange

108
Q

Cor pulmonale?

A

R sided HF caused by respiratory disease. The increased pressure and resistance in the pulmonary arteries results in the right ventricle being unable to effectively pump blood out.

109
Q

Respiratory causes of Cor pulmonale (5)

A 
COPD
Pulmonary Embolism
Interstitial lung disease
Cystic fibrosis
Primary pulmonary hypertension
110
Q

Usual PCs RHF (4)

A

SOB
Chest pain
Peripheral oedema
Syncope

111
Q

RHF management

A

Treat symptoms and underlying cause

LTOT usually used

112
Q

HF?

A

Inability of heart to deliver blood and 02 at a rate that is commensurate with the requirement of metabolizing tissue of the body

113
Q

HF epidemiology

A

Annual incidence of 10% >65 years

50% die in 5 years

114
Q

RF HF (5)

A 
>65
African
Obesity
Male
History of MI
115
Q

Main Causes of HF (3)

A

IHD
Cardiomyopathy (dilated)
HTN

116
Q

HF pathophysiology

A

Activation of sympathetic nervous system: Increased contractility and HR, Constriction of venous capacitance vessels redistribute flow centrally and increase preload, also leads to increase of afterload by arteriolar constriction

Outflow resistance: When there is an increase in afterload there is an increase in EDV and decreased SV and hence CO

RAAS: Reduced CO and increased sympathetic tone leads to diminished renal perfusion thereby activating RAAS and fluid retention.

117
Q

HF presentation (5)

A 
Fatigue
SOB
Peripheral oedema
Orthopnoea
Paroxysmal nocturnal dyspnoea
118
Q

HF clinical signs (8)

A
  • Tachycardia
  • Elevated JVP
  • Tender hepatomegaly
  • Cardiomegaly
  • Displaced Apex beat
  • Third & Fourth heart sounds
  • Pleural Effusion
  • Hypotension
119
Q

HF investigations

A

Bloods (BNP)
ECG (for underlying cause MI)
CXR (ABDCE)
Echocardiogram (Assess ventricular and systolic functioning)

120
Q

Causes of PND (3)

A

Firstly, fluid settling across a large surface area of their lungs as they sleep lying flat. As they stand up the fluid sinks to the lung bases and their upper lungs clear and can be used more effectively.

Secondly, during sleep the respiratory centre in the brain becomes less responsive so their respiratory rate and effort does not increase in response to reduced oxygen saturation like it normally would when awake. This allows the person to develop more significant pulmonary congestion and hypoxia before waking up and feeling very unwell.

Thirdly, there is less adrenalin circulating during sleep. Less adrenalin means the myocardium is more relaxed and this worsens reduces the cardiac output.

121
Q

Chronic HF causes (4)

A
  • Ischaemic Heart Disease
  • Valvular Heart Disease (commonly aortic stenosis)
  • Hypertension
  • Arrhythmias (commonly atrial fibrillation)
122
Q

Chronic HF management

A

Based on NICE guidelines 2018.

Refer to specialist (NT-proBNP > 2000ng/L warrants urgent referral)
Medical management
Surgical treatment (aortic stenosis/mitral regurgitation)

Additional management:
•	Yearly flu and pneumococcal vaccine
•	Stop smoking
•	Optimise treatment of co-morbidities
•	Exercise at tolerated

First Line Medical Treatment (ABAL)
ACE inhibitor (e.g. ramipril titrated as tolerated up to 10mg once daily)
Beta Blocker (e.g. bisoprolol titrated as tolerated up to 10mg once daily)
Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone)
Loop diuretics improves symptoms (e.g. furosemide 40mg once daily)

123
Q

HF management considerations

A

Aldosterone antagonists are used when there is a reduced ejection fraction and symptoms are not controlled with an ACEi and beta blocker.

Patients should have their U&Es monitored closely whilst on diuretics, ACE inhibitors and aldosterone antagonists as all three medications can cause electrolyte disturbances.

124
Q

HTN?

A

High blood pressure

125
Q

Causes of HTN

A

Renal disease
Obesity disease
Pregnancy induced HTN/ pre-eclampsia
Endocrine *Conns

126
Q

Complications of HTN

A

IHD
Cerebrovascular accident *stroke/haemorrhage
HTN retinopathy, nephropathy
HF

127
Q

HTN stages

A

S1: >140/90 - >135/85
S2: >160/100 - >150/95
S3: >180/120

128
Q

HTN investigations

A

Clinical blood pressure , ambulatory blood pressure

End organ damage
Urine albumin creatinine ration (proteinuria)
Dipstick (haematuria)
Bloods (GFR, Hb)

ECG (LVH/MI)
Echocardiography

Fundus examination
Bloods (HBA1c, renal function, lipids)

129
Q

Which patients receive ACEi/ARB for HTN as first step

A

HTN with T2DM

HTN without T2DM but <55 and not of african carribean/black origin

130
Q

What is U+E S/E of thiazide

A

Causes hypokalaemia

131
Q

BP Target for those < and > 80 years

A

140/90 and 150/90

132
Q

What causes first heart sound

A

Closure of AV valves at the start of ventricular systole

133
Q

What causes second heart sound

A

Closure of SLV once systolic contraction is complete

134
Q

When is the 3rd heart sound heard?

A

0.1s after 2nd heart sound

135
Q

Causes of 3rd heart sound

A

Rapid Ventricular filling causing chordae tendinae to pull to their full length

136
Q

What is a 3rd heart sound an indication of?

A

In young 15-40 normal

In older patients indicates HF as ventricles and chordae are stiff and weak

137
Q

4th Heart sound?

A

heard directly before s1, indicates a stiff/hypertrophic ventricle caused by turbulent flow from atria contracting against non-compliant ventricle

138
Q

Where to listen for heart murmurs

A

Pulmonary: 2nd ICS LSB
Aortic: 2nd ICS RSB
Tricuspid: 5th ICS LSB
Mitral: 5th ICS mid clavicular line

139
Q

Where to listen to S1 and S2

A

Erb’s point, third intercostal space on LSB

140
Q

What does mitral stenosis cause

A

Left atrial hypertrophy

141
Q

What does Aortic stenosis cause

A

Left ventricular hypertrophy

142
Q

What does mitral regurgitation and aortic regurgitation cause

A

Left atrial and ventricular dilatations

143
Q

Mitral stenosis RF

A

Rheumatic fever

Untreated Strep infections

144
Q

Murmur for mitral stenosis

A

Mid-diastolic, low pitched “rumbling” murmur due to low velocity blood

145
Q

Mitral stenosis presentation (6)

A 
Progressive SOB
Cough
Haemoptysis
Malar flush
Atrial fibrillation
Pulmonary HTN leading to RHF causing fatigue and lower limb oedema
146
Q

Why does mitral stenosis cause AF

A

struggles in pushing blood through stenotic valve causes strain, electrical disruption resulting in fibrilaltion

147
Q

Mitral stenosis investigations

A

CXR: enlarged LA, pulmonary oedema
ECG: AF, LA hypertrophy resulting in bidid P wave
Echo: diagnostic, assess severity

148
Q

Mitral stenosis treatment

A

B blockers HR control
Diuretics for fluid overload
Percutaneous balloon valvotomy to increase size of mitral valve opening
Mitral valve replacement

149
Q

Mitral regurgitation sound

A

Pan-systolic, high pitched murmur due to high velocity blood flow

150
Q

Mitral regurgitation signs

A

Pan systolic high pitched murmur
Radiates to left axilla
May hear a third heart sound

151
Q

Mitral regurgitation causes

A 
Idiopathic
IHD
IE
RHD
Connective tissue: EDS, MS
152
Q

Mitral regurgitation investigations

A

CXR, ECG (signs of enlarged LA /and LV
Echo
Doppler and colour flow doppler

153
Q

Mitral regurgitation management

A

Diuretics and ACEi

Surgical intervention if severe/symptomatic

154
Q

Aortic stenosis sound

A

Ejection-systolic, high pitched murmur with crescendo-decrescendo character due to speed of blood flow across the valve

155
Q

Aortic stenosis signs

A

Ejection systolic, high pitched murmur with crescendo-decrescendo character
Murmur radiates to carotids
Slow rising pulse and narrow pulse pressure

156
Q

Aortic stenosis causes

A

Idiopathic age related calcification

RHD

157
Q

Aortic stenosis investigations

A

CXR
ECG
Echo

158
Q

Aortic stenosis management

A

Aortic valve replacement if symptomatic

TAVI

159
Q

Aortic regurgitation sound

A

Early diastolic, soft murmur
Associated with Corrigan’s pulse (collapsing pulse)
Austin flint murmur (early diastolic “rumbling” murmur)

160
Q

Aortic regurgitation causes

A

Idiopathic age related weakness

Connective tissue disorder (EHS/MS)

161
Q

Atrial fibrillation DDx

A

Atrial flutter

Supraventricular tachyarythmias

162
Q

AF pathophysiology

A

SAN

Prep for Phase 3A (6 decks)

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