Cardio Flashcards
hypertension variants
masked
white coat
isolated systolic
clinical features of hypertension
asymptomatic
headaches
dizziness, tinnitus, blurred vision
strong bounding pulse
flushed
underlying cause
hypertension IX
history and physical exam
look for signs of target organ damage
electrolytes (HTN meds can alter these so collect baseline stats)
renal function tests
TSH - screen for hyperthyroidism
urinalysis - albumin or blood in urine
BP - 2 readings on 2 occasions
causes of secondary HTN
thyroid disease
fibromuscular dysplasia
renal parenchymal disease
coarctation of the aorta
obstructive sleep apnoea
hyperaldosteronism
renal artery stenosis
HTN mx
lifestyle
meds:
1 - age < 55 - ACE inhibitor, age >55 or black - CCB
2 - ACE inhibitor + CCB
3 - ACEi + CCB + thiazide-like diuretic
4 - consider further diuretic or beta blockade or alpha blocker
nephroprotective HTN meds
good for pts with DM or renal problems
ACEi - pril drugs like lisinopril, captopril, enalapril
ARBs - artan drugs like lorsartan or valsartan
examples of thiazide diuretics
hydrochlorothiazide
chlorthalidoine
examples of CCBs
dihydropyridine
amlodipine
nifedipine
pulmonary HTN signs and symptoms
exertional dyspnoea/syncope
exertional chest pain
cyanosis
fatigue
hoarseness
cough, haemoptysis
jugular vein distention
loud second heart sound
signs of RHF - palpitation, hepatojugular reflex
nail clubbing
pulmonary HTN Ix
transthoracic echocardiography:
- tricuspid regurg, underfilling of left heart chambers, look for RV pressure overload (hypertrophy)
right heart catheterisation
ECG:
- right ventricular hypertrophy
- right axis deviation
- p pulmonale - big tall peaked p waves
pulmonary HTN Mx
acute: oxygen and diuretics
cause dependent: pulmonary vasodilators, pulmonary endarterectomy, anti-coagulants, fix cardiac valves, treat underlying lung pathology
pulmonary vasodilators examples
endothelin receptor antagonist (bosentan)
PDE 5 inhibitor - sildenafil
prostaglandin analogs - iloprost
orthostatic hypotension causes
hypovolemia
autonomic dysfunction
drugs + alcohol
diuretics, anti-hypertensives, anti-depressants, sedatives
old ppl
diabetes, parkinsons
management of hypotension
fluid and sodium intake
remove offending drugs
compression stockings
med:
short acting pressors like midodrine (alpha agonist) or volume expanders like fludrocortisone
hyperlipidaemia signs and symptoms
xanthoma
xanthelasma
hepatic steatosis, pancreatitis
premature atherosclerosis
diagnosis of hyperlipidaemia
fasting lipid profiles
hyperlipidaemia mx
lifestyle (low fat, alcohol avoidance)
statins (+/- other lipid lowering agents)
omega 3 fatty acids
fibrates
clinical and serum findings in familial hyperchylomicronaemia
pancreatitis
hepatosplenomegaly
xanthoma
high chylomicrons
elevated TG
findings for familial hypercholesterolaemia
early atherosclerosis
tendon xanthoma
high lLDL
familial dysbetalipoproteinaemia findings
early atherosclerosis
palmar xanthoma
high LDL, chyomicrons, triglycerides
familial hypertriglyceridemia findings
pancreatitis
high VLDL and TG
abetalipoproteinemia findings
steatorrhoea
fat soluble vit deficiencies
no chylomicrons
no VLDL
peripheral vascular disease summary
acute limb ischaemia
- sudden decrease in limb perfusion
intermittent claudication
- pain on exertion
critical limb ischaemia
- pain at rest
acute limb ischaemia symptoms
6 Ps
pain
pale
pulseless
paralysis
paraesthesia
perishingly cold
chronic peripheral vascular disease symptoms
hair loss
numbness in feet/legs
brittle, slow growing toenails
ulcers
absent pulses
atrophic skin
PVD Ix
Beurger’s test. <20 degrees indicates severe limb ischaemia
Ankle-Brachial pressure index (ABPI)
normal range 0.9-1.2
< 0.5 indicates CLI
full cardio risk assessment (BP, HR, bloods (GBC, fasting glucose, lipids)
ECG
colour duplex ultrasound
magnetic resonance angiogram
Leriche syndrome sx
buttock claudication
impotence
absent/weak distal pulses
arterial ulcer sx
appearance:
punched out
distal
well defined
pale base (grey granulation tissue)
hair loss, shiny pale skin
calf muscle wasting
absent pulses
night pain
venous ulcer sx
appearance
large and shallow
less well-defined
gaiter region
swelling
itching
aching
stasis eczema
atrophie blanche
hemosiderin deposition
lipodermatosclerosis
arterial ulcer ix
dupler USS of lower limbs
ABPI
percutaneous angiography
ECG
bloods:
- fasting serum lipids
- HbA1c
- blood glucose
- FBC
venous ulcer ix
duplex USS of lower limbs
measure SA of ulcer to monitor progression
ABPI
swab for microbiology if indicated
biopsy if possibility of Marjolin’s ulcer
venous ulcer treatment
graded compression stockings
debridement and cleaning
abx if needed
moisturising cream
AAA definition
localised enlargement of the abdominal aorta where the diameter is >3cm or >50% larger than normal diameter
most occur below renal arteries
AAA RFs
smoking, male, connective tissue diseases, old age, HTN, inflammatory disorders
screening population = males >65 yrs old
AAA Sx
unruptured:
usually asymptomatic
may have pain in back, abdo or groin
ruptured:
sudden severe pain in back, abdo, groin
syncope
shock
signs:
pulsatile and expansile mass on palpation
abdominal bruit
Grey-Turner’s sign (ruptured)
AAA Ix
g.s: abdo US (can’t tell if ruptured)
bloods
CT angiogram (can detect rupture)
MR angiogram (can detect rupture. contrast allergy or renal impairment)
aortic dissection classification
Debakey - type I to type IIIb
Stanford - type A and type B
ascending + descending aorta = type I/ type A
ascending aorta only = type II/ type A
descending only above diaphragm = type IIIa/ type B
descending only below diaphragm = type IIIb/ type B
aortic dissection RFs
smoking
male
connective tissue disorders
HTN
congenital abnormalities eg aortic coarctation
crack cocaine
aortic dissection symptoms and signs
sudden central tearing pain can radiate to back
symptoms caused by blockages to branches
carotid - blackout, dysphasia
coronary - angina
subclavian - LOC
renal - anuria, renal failure
hypertension
blood pressure difference between two arms (>50%)
murmur on the back
signs of aortic regurgitation
signs of connective tissue disease
aortic dissection Ix
bloods
ECG (normal) to rule out MI
CXR
g.s. = CT angiogram
varicose veins RFs
age
female
obesity
FHx
caucasian
varicose veins causes
idiopathic valvular incompetence (mostly this)
DVT
AV malformations
venous outflow obstruction
varicose veins Sx
visible dilation of veins
leg aching
swelling and itching
bleeding
veins feel tender or hard
tap test
auscultation of bruits
Trendelenburg test
varicose veins Ix
g.s. = duplex USS
- locates incompetent valve and excludes DVT
varicose veins Mx
conservative:
- compression stockings
- lifestyle changes
endovascular treatment:
- radiofrequency ablation
- endovenous laser ablation
- liquid or foam microinjection scleropathy
surgery:
- stripping of the long saphenous vein
- saphenofemoral ligation
- avulsion of varicosities
varicose veins complications
venous ulcer
stasis eczema
lipodermatosclerosis
hemosiderin deposition
sclerotherapy:
skin staining, local scarring
surgery:
haemorrhage, infection, recurrence, paraesthesia, peroneal nerve injury
gangrene causes
tissue ischaemia and infarction
physical trauma
gas gangrene caused by Clostridium Perfringens
gangrene RFs
DM
immunosuppression
steroid use
PVD
ulcers
gangrene Ix
Bloods: FBC, U&Es, glucose, CRP, blood culture
MC&S
x-ray of affected area may show gas produced in gas gangrene
DVT Sx
erythema
warmth
painless
varicosities
swollen limb
may be asymptomatic
Homan’s sign
DVT Ix
RR, O2 sats, HR
g.s: doppler US
impedance plethysmography
D-dimer
ECG, CXR, ABG (if PE suspected)
risk stratified using Well’s criteria (different to PE Well’s score)
DVT Mx
DOACs (apixaban, rivaroxaban)
LMWH
3 months both for maintenance
10 days for initiation
warfarin for maintenance if contraindications
prevention:
compression stocking
advise physical activity and mobilisation
