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Year 3 > Cardio > Flashcards

Cardio Flashcards

1
Q

Most common cause of hypertension

A

essential hypertension

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2
Q

Secondary causes for hypertension

A

ROPE
Renal disease (renal artery stenosis)
Obesity
Pregnancy induced (pre-eclampsia)
Endocrine (Conns syndrome - hyperaldosteronism)

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3
Q

Complications of hypertension

A

IHD
CVA
Hypertensive retinopathy
Hypertensive nephropathy
HF

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4
Q

When should you screen for HTN

A

Every 5 years but more for borderline patients and every year in patients with T2DM

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5
Q

Clinic readings for stage 1-3 of HTN

A

stage 1 - >140/90
stage 2 - >160/100
stage 3 - >180/120

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6
Q

Home readings for stage 1-2 of HTN

A

1 >135/88
2 >150/95

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7
Q

What screening tests should patients with HTN have for assessment of end organ damage

A

urine albumin:creatinine ratio for proteinuria and dipstick for NVH (non visible haematuria)
Bloods for HbA1c
Fundus examination for hypertensive retinopathy
ECG for cardiac abnormalities

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8
Q

Meds for HTN

A

ACE inhibitors -> ramipril
Beta blockers ->bisoprolol
Calcium channel blockers -.amlodipine
Thiazide like diuretics -> indapamide
ARB -> angiotensin II receptor blockers (candesartan)

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9
Q

treatment algorithm for HTN

A
  1. aged <55 and non black use A or if >55 or black use C
  2. A+C or A+D or C+D (if black use ARB instead of A)
  3. A+C+D
  4. A+C+D+Additional (low potassium use spironolactone, high potassium use doxazosin (alpha blocker) or atenolol)
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10
Q

Malignant hypertension

A

usually involves severe HTN and bilateral retinal haemorrhages and exudates

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11
Q

How to diagnose malignant hypertension

A

systolic BP >180 and diastolic >120
+
evidence of acute organ damage

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12
Q

Features of acute pericarditis

A
  • CP → may be pleuritic and often relieved by leaning forward
  • Non productive cough, dyspnoea and flu-like symptoms
  • Pericardial rub
  • Tachypnoea
  • Tachycardia
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13
Q

Causes of acute pericarditis

A
  • Viral infection (Coxsackie)
  • TB
  • Uraemia (causes fibrinous pericarditis)
  • Trauma
  • Post MI Dressler’s syndrome
  • Connective tissue disease
  • Hypothyroidism
  • Malignancy
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14
Q

Investigations for acute pericarditis

A

ECG: saddle shaped ST elevation, Pr depression
transthoracic echocardiography

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15
Q

Management for acute pericarditis

A

Treat underlying cause
Combination of NSAIDs and colchicine

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16
Q

Causes of constrictive pericarditis

A

any cause of pericarditis but particularly TB

17
Q

Features of constrictive pericarditis

A

dyspnoea
right sided heart failure: elevated JVP, ascites, oedema and hepatomegaly
JVP shows prominent X and Y descent
pericardial knock
positive kussmauls sign

18
Q

What would a CXR show in constrictive pericarditis

A

Pericardial calcification (Looks like the outer border of the heart is really well demarcated - almost outlined)

19
Q

Strongest risk factor for IE

A

having a previous episode

20
Q

Types of patients typically affected by IE

A

Mitral valve commonly affected
rheumatic valve disease
prosthetic valve
congenital heart defects
IV drug users - typically causes a tricuspid lesion
Recent piercings

21
Q

Most common organism to cause IE

A

Staphylococcus aureus

22
Q

Most common organism to cause IE that is found in the mouth/dental plaque

A

Streptococcus viridans

23
Q

Non infective causes of IE

A
  • Systemic lupus erythematosus
  • malignancy - marantic endocarditis
24
Q

Indications for surgery for IE

A
  • Severe valvular incompetence
  • Aortic abscess
  • infections resistant to antibiotics/fungal infections
  • cardiac failurerefractory to standard medical treatment
  • recurrent emboli after antibiotic therapy
25
Q

what criteria do you use for diagnosing IE

A

DUKES criteria

26
Q

Dukes criteria for IE

A

IE diagnosed if:

  • pathological criteria positive, or
  • 2 major criteria, or
  • 1 major and 3 minor criteria, or
  • 5 minor criteria

********Pathological criteria********

Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery

**Major criteria**

Positive blood cultures

  • two positive blood cultures showing typical organisms consistent with infective endocarditis, such asStreptococcus viridansand the HACEK group, or
  • persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific such asStaph aureusandStaph epidermidis, or
  • positive serology forCoxiella burnetii,Bartonellaspecies orChlamydia psittaci, or
  • positive molecular assays for specific gene targets

Evidence of endocardial involvement

  • positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
  • new valvular regurgitation

******Minor criteria******

  • predisposing heart condition or intravenous drug use
  • microbiological evidence does not meet major criteria
  • fever > 38ºC
  • vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
  • immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots
27
Q

Presentation of heart failure

A
  • SoB worsened on exertion
  • Cough. May produce frothy white/pink sputum
  • Orthopnoea (SoB when lying flat)
  • PND
  • Peripheral oedema
28
Q

How to diagnose heart failure

A
  • Clinical presentation
  • BNP blood test
  • Echocardiogram
  • ECG
29
Q

Causes of heart failure

A

IHD
Valvular heart disease (aortic stenosis)
essential/secondary hypertension
Arrhythmias

30
Q

Management for heart failure

A
  • Refer to specialist (NT-proBNP > 2,000 ng/litre warrants urgent referral)
  • Careful discussion and explanation of disease
  • Medical management
  • Surgical treatment in aortic stenosis or mitral regurgitation
  • Yearly flu and pneumococcal vaccination
  • Stop smoking
  • Optimise treatment co-morbidities
  • Exercise as tolerated
31
Q

First line treatment for heart failure

A

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 by A and B (spironolactone
oreplerenone)

Loop diuretics improves symptoms (e.g.furosemide 40mg once daily)

32
Q

What are nitrates contraindicated in

A

Hypotension

Year 3 (14 decks)

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