Cardio Flashcards by Chloe Cooke

Most common cause of hypertension

essential hypertension

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Secondary causes for hypertension

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

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Complications of hypertension

IHD
CVA
Hypertensive retinopathy
Hypertensive nephropathy
HF

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When should you screen for HTN

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

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Clinic readings for stage 1-3 of HTN

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

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Home readings for stage 1-2 of HTN

1 >135/88
2 >150/95

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

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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Meds for HTN

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

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treatment algorithm for HTN

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

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Malignant hypertension

usually involves severe HTN and bilateral retinal haemorrhages and exudates

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How to diagnose malignant hypertension

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

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Features of acute pericarditis

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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Causes of acute pericarditis

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

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Investigations for acute pericarditis

ECG: saddle shaped ST elevation, Pr depression
transthoracic echocardiography

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Management for acute pericarditis

Treat underlying cause
Combination of NSAIDs and colchicine

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Causes of constrictive pericarditis

any cause of pericarditis but particularly TB

Features of constrictive pericarditis

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

What would a CXR show in constrictive pericarditis

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

Strongest risk factor for IE

having a previous episode

Types of patients typically affected by IE

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

Most common organism to cause IE

Staphylococcus aureus

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

Streptococcus viridans

Non infective causes of IE

Systemic lupus erythematosus
malignancy - marantic endocarditis

Indications for surgery for IE

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

what criteria do you use for diagnosing IE

DUKES criteria

Dukes criteria for IE

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 as *Streptococcus viridans* and 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 as *Staph aureus* and *Staph epidermidis*, or - positive serology for *Coxiella burnetii*, *Bartonella* species or *Chlamydia 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

Presentation of heart failure

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

How to diagnose heart failure

- Clinical presentation - BNP blood test - Echocardiogram - ECG

Causes of heart failure

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

Management for heart failure

- 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

First line treatment for heart failure

**ACE** inhibitor (e.g. ***ramipril*** titrated as tolerated up to 10mg once daily) **B**eta blocker (e.g. ***bisoprolol*** titrated as tolerated up to 10mg once daily) **A**ldosterone antagonist when symptoms not controlled by A and B (***spironolactone*** or ***eplerenone)*** **L**oop diuretics improves symptoms (e.g. ***furosemide*** 40mg once daily)

What are nitrates contraindicated in

Hypotension