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Phase 2a medicine > Cardio > Flashcards

Cardio Flashcards

1
Q

What is the cause of ischaemic heart disease?

A

Atherosclerosis

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2
Q

Non modifiable risk factors for IHD?

A

Family history, Age, ethnicity (S.Asian)

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3
Q

Modifiable risk factors for IHD?

A

Smoking, Poor nutrition, sedentary lifestyle, alcohol, stress, HTN, obestiy, DM

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4
Q

How does IHD present?

A

With angina

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5
Q

What do patients describe with stable angina?

A

Constricting discomfort in front of chest, neck, shoulders, jaw or arms
Precipitated by physical exertion
Relieved by rest/GTN spray after 5 mins

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6
Q

What does an ECG show with stable angina?

A

Normal

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7
Q

Investigations for stable angina?

A

ECG, Lipid profile (increased LDL), FBC to exclude anaemia, HbA1c to exclude DM

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8
Q

Whats the gold standard investigation for stable angina>

A

CT coronary angiography

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9
Q

How to treat IHD?

A

ASPIRIN/Clopidogrel

STATINS

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10
Q

How to treat angina?

A

GTN spray, B blocker or CCB.

2nd: Aspirin, Atorvostatin, ACEi

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11
Q

What is unstable angina?

A

Pain not releived by rest or GTN spray. Comes on at rest

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12
Q

Which patients are most at risk of a silent MI?

A

Diabetics

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13
Q

What are the 3 conditions in acute coronary syndrome?

A

Unstable angina, STEMI, NSTEMI

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14
Q

Presentation of ACS?

A

Central constricting chest pain radiating to jaw or arms.
Sweatng
SOB
greater than 20mins

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15
Q

What does an ECG show in a STEMI?

A

ST segment elevation

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16
Q

What does troponin show in unstable angina?

A

Troponin normal as its ischaemia not infarction

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17
Q

What does an ECG show in Unstable angina and NSTEMI?

A

ST depression and deep T wave inversion

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18
Q

What is the immediate management for ACS?

A 
M - Morphine 
O - oxygen 
N - Nitrates (GTN spray)
A - Aspirin 
C - Clopidogrel
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19
Q

How to manage a STEMI>

A

PCI within 2 hours
Clopidogrel and aspirin
Fibrinolysis if PCI not possible, Alteplase

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20
Q

How to manage Unstable angina/NSTEMI?

A

GRACE score predicts 6 month risk
Low: ticagrelor and aspirin
Med: angiography and PCI, prasugrel and aspirin.

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21
Q

Secondary prevention for ACS.

A

ACAB

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22
Q

What does ACAB stand for?

A

ACEi
Clopidiogrel
Aspirin and atorvastatin
Beta blockers

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23
Q

Post MI complications?

A

DREAAD
Death, Rupture of heart septum/papillary muscles
Edema, Arrhythmias, Aneurysm, Dresslers syndrome

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24
Q

What is the most common cause of HTN?

A

Idiopathic (95%)

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25
Q

What are some of the underlying causes of hypertension?

A

Renal disease
Obestity
Pregnancy
Endocrine (conn’s syndrome)

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26
Q

What’s the definition of hypertension in clinic?

A

> 140/90 in clinic

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27
Q

Whats the definition of hypertension with ambulatory blood pressure monitoring?

A

> 135/85

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28
Q

Modifiable risk factors for HTN?

A

Alcohol intake, sedentary lifestyle, DM, sleep apnoea, smoking

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29
Q

What are the non-modifiable risk factors for HTN?

A

Age >65, FHx, ethnicity

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30
Q

Investigations for HTN?

A

Clinic BP and at home bp monitoring

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31
Q

What medication for HTN would you put a patient on who’s 45 and of northern European origin?

A

ACEi or ARB

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32
Q

What medication for HTN would you put a patient on who’s 50 and of black African origin?

A

CCB

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33
Q

What is the second step for HTN medication if the first didn’t work?

A

Try the other so: ACEi or ARB or CCB, can also try thiazide like diuretic.

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34
Q

What is a AAA?

A

Abdominal aortic aneurysm, the weakening of the vessel wall of the abdominal aorta.

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35
Q

What is the pathogenesis of a AAA?

A 
Inflammation of smooth muscle cells 
Loss of structural integrity
Widening of the vessel
Mechanical stress (HTN) acts on weakened wall
Dilation and rupture may occur
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36
Q

What are the risk factors for AAA?

A

Smoking, family history, connective tissue disorders, age, atherosclerosis, male

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37
Q

What is the presentation of a AAA?

A

Asymptomatic, usually discovered on routine examination

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38
Q

Where are AAA’s commonly found?

A

Below the renal arteries

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39
Q

What symptoms can an AAA cause if expanding rapidly?

A

Lower back/abdominal pain

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40
Q

How to diagnose an AAA?

A

ultrasonography

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41
Q

When do you repair an AAA?

A

If ruptured, for a symptomatic AAA regardless of size.

For asymptomatic >5.5cm in men >5cm in women

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42
Q

What are the complications of AAA?

A

Rupture, thromboembolisms, fistula formation

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43
Q

What is the presentation of a ruptured AAA?

A

Acute onset of severe, tearing abdominal pain, radiation to the back, flank and groin
Painful pulsatile mass, hypovolemic shock, syncope, nausea and vomiting

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44
Q

What is the treatment for a ruptured AAA called?

A

EVAR (endovascular aneurysmal repair)

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45
Q

What is an aortic dissection?

A

A tear in the intimal layer, resulting in blood pooling between the intima and medial layers

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46
Q

What ages does an aortic dissection most commonly occur in?

A

Men 40-60

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47
Q

Which part of the aorta does an aortic dissection most commonly occur?

A

Ascending aorta (65%)

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48
Q

What is the consequence of an aortic dissection?

A

Flow through the false lumen can occlude flow through the branches of the aorta, including coronary, brachiocephalic, intercostal etc

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49
Q

What are the risk factors for aortic dissection?

A

Hypertension, trauma, vasculitis, cocaine use, connective tissue disorder

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50
Q

Clinical features of an aortic dissection?

A

Sudden and severe tearing pain in chest radiating to back, hypotension, asymmetrical blood pressure, syncope

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51
Q

How to diagnose an aortic dissection?

A

ECG, CXR, CT scanning

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52
Q

How to manage an aortic dissection?

A

Fluid resuscitation, inotropes, noradrenaline, opiods,
Endovascular stent graft repair
Antihypertensives after surgery

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53
Q

What is PVD?

A

Atherosclerosis of vessels, leading to poor circulation ad tissue ischaemia

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54
Q

What are the 6 p’s of end stage PVD?

A

Pain, paraesthesia, pulselessness, pallor, paralysis, perishingly cold

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55
Q

What are the risk factors for PVD?

A

Smoking, diabetes, HTN, sedentary lifestyle, hyperlipidaemia, history of CAD, over 40

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56
Q

What is the presentation of PVD?

A

Pain in lower limbs on exercise,
Intermittent claudication
Severe: unremitting pain in foot especially at night
Legs may be pale, cold, loss of hair and skin changes

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57
Q

What investigation do you do for PVD?

A

ABPI, ankle brachial pressure index.
Provides a measure of blood flow at the level of the ankle, this should be 1.
less than 0.9 indicates PVD

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58
Q

How to treat PVD?

A

Control risk factors:
Smoking cessation, exercise, weight reduction, BP and DM control, statins.
APIRIN/CLOPIDOGREL

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59
Q

What to do in critical limb ischaemia?

A

Revascularisation, (stenting, angioplasty, bypassing)

Amputation if unsuitable

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60
Q

Causes of mitral stenosis?

A

Rheumatic heart disease, infective endocarditis

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61
Q

Presentation of mitral stenosis?

A

Malar flush, AF

62
Q

Sound on auscultation with mitral stenosis?

A

Mid diastolic, low pitches rumbling murmur.

63
Q

Causes of mitral regurgitation?

A

Idiopathic, IHD, infective endocarditis, rheumatic heart disease, EDS, marfans

64
Q

whats the murmur for mitral regurgitation?

A

Pan systolic, high pitched whistling murmur

65
Q

What are the consequences of mitral regurgitation?

A

Congesitve heart failure

66
Q

Waht are the causes of aortic regurgitation

A

Idiopathic, EDS, MArfans

67
Q

What does the murmus sound like for aortic regurgitation?

A

early diastolic soft rumbling murmur and austin flint murmur at the apex, collapsing pulse

68
Q

Causes of aortic stenosis?

A

Idiopathic, rheumatic heart disease,

69
Q

Presnetation of aortic stenosis?

A

Exertional syncope, slow rising pulse, narrow pulse pressure

70
Q

What does the murmur sound like for aortic stenosis>

A

Crescendo-decrescendo murmur radiating to carotids

71
Q

What is BNP>

A

A hormone secreted by the cardiac cells in response to pressure in the heart

72
Q

What is the function of BNP>

A

Helps to regulate the fluid levels in the body, by monitoring salt and pressure.

73
Q

What is the definition of heart failure?

A

Cardiac output is inadequate for the body’s requirements

74
Q

What is systolic heart failure?

A

Inability of the ventricle to contract normally

75
Q

What is diastolic heart failure?

A

Inability of the ventricle to relax and fill normally

76
Q

What is chronic heart failure?

A

Develops and progresses slowly arterial pressure is well maintained until late

77
Q

What are the causes of left sided heart failure?

A

CAD, myocardial infarction, cardiomyopathy, congenital heart defects

78
Q

What are the causes of right sided heart failure?

A

Right ventricular infarct, pulmonary hypertension, pulmonary emobolism, COPD, cor pulmonale

79
Q

Causes of diastolic HF?

A

Aortic stenosis, chronic hyertension

80
Q

Causes of systolic HF?

A

IHD, Cardiomyopathy, myocardial infection

81
Q

Why is there hypertrophy of the myocardium in HF?

A

Due to increased preload. As the myocardium fails there is less blood ejected and so the preload increases.
to compensate there is hypertrophy of the myocardium

82
Q

Why does hypertrophy of the myocardium lead to ischaemia?

A

An increased number and size of cells leads to an increased demand for oxygen which the heart cannot sustain, this leads to ischaemia and reduced contractility of the myocardium

83
Q

Why do the ventricles become dilated in HF?

A

There is a decreased contractility, but increased workload for the amount for blood remaining, this leads to stretching and dilation of the ventricles.
The cells then become tired and this is pathological

84
Q

What are the common symptoms of HF?

A

SOB, fatigue, peripheral oedema

85
Q

Signs of HF

A

Tachycardia, ascites, elevated jugular venous pressure, cardiomegaly

86
Q

What investigations can you do for HF?

A

ECG, may indicate cause such as MI or ventricular hypertrophy
BNP (released when the ventricular walls are under stress.

87
Q

WHat would you see on a CXR in HF?

A 
A - alveolar oedema (bat wings)
B - Kerley B lines
C - Cardiomegaly 
D - Dilated upper lobe vessels of lungs 
E - effusions pleural
88
Q

How do diuretics work in HF?

A

Reduces preload and pressure on the ventricles

89
Q

Name an aldosterone antagonist?

A

Spironolactone

90
Q

Heart failure treatment

A

Dieuretics, ACEi, B-blocker, aldosterone antagonist, digoxin

91
Q

What is cor pulmonale?

A

Right sided HF caused by chronic pulmonary hypertension

92
Q

Symptoms of cor pulmonale?

A

Dyspnoea, fatigue and syncope

93
Q

Investigations for cor pulmonale?

A

ABG - hypoxia and hypercapnia

94
Q

Management of cor pulmonale?

A

Treat underlying cause, give O2, treat cardiac failure, heart lung transplant

95
Q

A patient with recently diagnosed heart failure comes to your GP practice for a check-up and medication review. He tells you that he has felt a little weaker and more tired than usual recently. His current medications include: Furosemide, Ramipril, Bisoprolol
His blood results show: Sodium: 142 (135-145) Potassium: 2.4 (3.5-5.5)
Which of the following drugs is the most likely cause of the electrolyte abnormality?
A. Furosemide
B. Ramipril
C. Bisoprolol
D. None of the above

A

Furosemide, give spironolactone instead as this avoids hypokalaemia

96
Q

What is the heart rate for tachycarida?

A

> 100bpm

97
Q

What heart rate is bradycardia?

A

<60bpm

98
Q

What is atrial fibrillation?

A

Chaotic irregular rhythm with an irregular ventricular rate

99
Q

What is seen on an ECG with AF?

A

No P waves, irregularly irregular QRS

100
Q

What are the causes of AF?

A

Idiopathic, HTN, HF, CAD, valvular heart disease

101
Q

What is the pathophysiology of AF?

A

Continuous rapid activation of the artira with no organised mechanical action

102
Q

Risk factors for AF?

A

60+, DM, high BP, CAD, past MI, structural heart disease.

103
Q

What is the presentation of AF?

A

Asymptomatic, palpitations, dyspnoea, chest pains, fatigue

104
Q

How to treat AF?

A

Shock with a defibrillator, give LMWH

105
Q

What is atrial flutter?

A

Organised atrial rhythm at a rate of 250-350bpm

106
Q

Causes of atrial flutter?

A

Idiopathic, CHD, obesity, hypertension, HF, COPD, pericarditis

107
Q

Presentation of Atrial flutter?

A

Palpitations, breathlessness, chest pain, dizziness, syncope, fatigue

108
Q

Treatment for atrial flutter

A

LMWH, shock with defibrillator, catheter ablation, IV amiodarone

109
Q

What is a bundle branch block?

A

A block in conduction of one of the bundle branches so the ventricles don’t receive impulses at the same time

110
Q

What pattern is seen in leads V1 and V6 in RBB?

A

MarroW

111
Q

What is the pathophysiology of RBB?

A

RBB doesnt conduct
Impulse spreads from left to right ventricle
Late activation of RV

112
Q

What are the causes of RBB?

A

PE, IHD, atrial ventricular septal defect

113
Q

Treatment of RBB?

A

Pacemaker, cardiac resynchronisation therapy, reduce blood pressure

114
Q

What pattern is seen on V1 and V6 in LBB?

A

WilliaM

115
Q

What are the causes of RBB?

A

IHD and Aortic valve disease

116
Q

Presentation of long QT syndrome?

A

Syncope, palpitations, may progress to VF

117
Q

What is Wolff parkinson white syndrome?

A

Accessory pathway for conduction, impulses can travel quicker to the AVN and ventricle.

118
Q

Causes of WPW?

A

Congenital, hypokalaemia/calcaemia, amiodarone,

119
Q

What is pericarditis?

A

Inflammation of the pericardium with or without effusion

120
Q

Infection causes of pericarditis?

A

Enteroviruses, adenoviruses, mycobacterium tuberculosis, histoplasma

121
Q

Autoimmune causes of pericarditis?

A

RA, sjogrens, SLE

122
Q

Pathophysiology of pericarditis?

A

Inflammation of the pericardium causes narrowing of pericardial space.
If untreated this causes a friction and a build up of exudate and adhesions in the pericardial space
This can put pressure on cardiac myocytes and lead to dysfunction

123
Q

Symptoms of pericarditis?

A 
Severe chest pain, sharp, pleuritic, rapid onset. relieved by sitting forward
Dyspnoea,
cough
hiccups
fever 
myalgia
124
Q

Signs of pericarditis?

A

Pericardial rub on auscultation, tachycardia, peripheral oedema, increased JVP

125
Q

What is the diagnostic test for pericarditis?

A

ECG

126
Q

What does pericarditis show on ECG?

A

Saddle shaped ST elevation, diffuse ST elevation in all leads, PR depression

127
Q

How to treat pericarditis?

A

Reduce phyisical activity
NSAIDS with gastric protection
Cochicine for 3 months
treat the cause

128
Q

What is dilated cardiomyopathy?

A

Left ventricle is dilated with thin muscle and so contracts poorly

129
Q

What are the causes of dilated cardiomyopathy?

A

Ischaemia, alcohol, thyroid disorder, genetic

130
Q

What do investigations show for dilated cardiomyopathy?

A

CXR: cardiac enlargment
ECG: tachycardia, arrhythmia, T-wave changes

131
Q

What is hypertrophic cardiac myopathy?

A

Ventricular hypertrophy causing obstruction of the outflow tract

132
Q

What are the signs of hypertrophic cardiomyopathy?

A

Ejection systolic murmur, jerky carotic pulse, left ventricular outflow obstruction

133
Q

What is restrictive cardiomyopathy?

A

Scar tissue replaces the normal heart muscle and the ventricles become rigid so they don’t contract properly

134
Q 
Which of the following differential diagnoses is the most common cause of sudden cardiac death in young people (and the most likely differential)? 
Restrictive cardiomyopathy	
Dilated cardiomyopathy	
Hypertrophic cardiomyopathy
Pericarditis
A

Hypertrophic cardiomyopathy

135
Q

A patient has a fever and new murmur, what diagnosis is this until proven otherwise?

A

Infective endocarditis

136
Q

What is infective endocarditis?

A

An infection of the endocardium or vascular endothelium of the heart

137
Q

What is the pathophysiology of infective endocarditis?

A

Platelet and fibrin deposition onto heart valves.
Organisms in the bloodstream adhere and grow on the valves.
Organisms destroy the valve causing regurgitation and worsening heart failure

138
Q

Which valves are most commonly affected in IE?

A

Aortic and mitral

139
Q

Risk factors of IE?

A

Prosthetic valve, valve disease

140
Q

Symptoms of IE?

A

Fever, rigors, night sweats, malaise, weight loss

141
Q

Signs of IE

A

Embolic skin lesions (fun little dots on the foot)
Splinter haemorrhages
Oslers nodes and janeway lesions on hands
Roth spots on eyes
Petechiae on skin (red rash)

142
Q

What is the dukes criteria for IE?

A

Positive blood culture from 3 different spots at peak points of fever
Echocardiogram showing vegetation, transoesophageal echo

143
Q

Which antibiotics to trwat IE?

A

Staph: vancomycin

144
Q

What to do if valve cant be treated with antibiotics?

A

Replace the valve if infection can’t be treated

145
Q

How to prevent IE?

A

Good oral health, no IV drug use, educcate surgery patients on symptoms

146
Q

What is rheumatic fever?

A

A systemic infection common in developing countries, from streptococci
Can cause permenant damage to heart valves

147
Q

Symptoms of rheumatic fever?

A

Fever, arthrits, chest pain, SOB, fatigue, Chorea (jerky movements)

148
Q

Signs of rheumatic fever/

A

Tachycardia, murmur, pericardial rub, red rash on trunk, thigh or arms, prolonged PR interval.

149
Q

Investigations for rheumatic fever?

A

Recent strep infection plus some of the signs and symptoms

150
Q

Treatment for rheumatic fever?

A

Bed rest until CRP is normal for 2 weks consistently
IV benzylpenicilin
Aspirin

151
Q

Findings on CXR in aortic dissection?

A

Wide mediastinum

Phase 2a medicine (14 decks)

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