Cardio conditions Flashcards
What is an abdominal aortic aneurysm?
Pathological dilation of the abdominal aorta
What symptoms will someone with an unruptured AAA classically present with?
Centrally pulsatile mass
Generalised peritonitis
What symptoms will someone with a ruptured AAA classically present with?
New onset sudden abdominal or back pain (very severe, feels like a tearing)
Peritonitis- tenderness and rigidity
Abdominal distention
Sudden loss of conciousness
What are some risk factors for developing an AAA?
Family hx
Smoking
Increased age
Male sex
Who is more likely to get an AAA?
Older patients
Men in general, but if they present with rupture they are more likely to be a woman
What is the first line investigation for an AAA?
Bedside aortic ultrasound
What is the management for a ruptured AAA?
Immediate surgical repair
Post op abx, VTE prophylaxis
When should an AAA be operated on?
If its ruptured immediately
If its bigger than 5.5cm in diameter
If its bigger than 4cm in diameter and growing fast
What are the 2 ways an AAA will present?
Ruptured or unruptured
What are the 2 types of aortic aneurysm?
Abdominal and thoracic
When is screening for AAA available and who is eligible?
It is available for men over the age of 66
Also available for women over the age of 70 who have risk factors
What happens if someone is screened for an AAA and none is found, a small one is found, a medium one is found or a large one is found?
None= not invited back for screening Small= invited back once a year for screening Medium= invited back once every 3 months for screening Large= treated asap
What does acute coronary syndrome encompass?
Unstable angina
Posterior infarct
STEMI
NSTEMI
What symptoms will someone with ACS classically present with?
Central chest pain that they will describe as crushing
Pain that radiates to their left arm/shoulder and jaw
Pain that lasts for a few mins- half an hours (it will be continuous if they are having an MI
Who is more are risk of ACS?
Older patients Smokers Patients with diabetes mellitus Patients with dyslipidaemia (atherosclerosis etc) Those with significant family hx
When is family history significant for ACS?
First degree relative who had an MI/ ACS when they were young (under 50)
What are the first line investigations when someone presents with ACS? Explain why each one is done
ECG- to figure out what the issue is eg wheres the infarct, what is the arrhythmia etc
Bloods- troponin, ESR, CRP, can do CK-MB
U+Es- to check or imbalance as this can cause arrhythmia
Serum cholesterol
What do you need to remember about troponin when interpreting a patient’s results?
It may take a few hours to rise
What do you need to remember about cholesterol when interpreting a patient’s results?
It may fall after an MI and will take a while to restabilise and represent a patient’s usual cholesterol profile
What is the acute method of management when a patient has ACS?
Start them on a cocktail of drugs which you can remember by using the acronym MONABASH: Morphine/ analgesia Oxygen Nitrates ACE inhibitor Beta blocker Antiplatelets Statin Heparin
If someone has STEMI do an angioplasty immediately and if you can’t then start thrombolysis
What long term management is needed for someone with ACS?
Lifestyle modification- improve diet, try to do more exercise, smoking cessation, weight loss
Long term ACE inhibitor, statin, aspirin (or other blood thinner)
What are the complications of STEMI and how do you remember them?
DARTH VADER Death Arrhythmia Rupture (of septum or chamber wall) Tamponade Heart failure Valvular disease Aneurysm Dressler's syndrome (pericarditis a few days- week after MI) Reinfarction
Whats the first line treatment for STEMI?
Angiography
Whats the second line treatment for STEMI?
Thrombolysis
What is aortic dissection?
A tear in the inner layer of the aorta than causes bleeding into the aorta (or outside it completely)
What are the 2 types of aortic dissection and how do they differ?
Type A= only involves the ascending aorta
Type B= only involves the descending aorta
What symptoms will someone with an aortic dissection classically present with?
A sudden onset tearing chest pain that radiates to the back Pale Sweaty Clammy Hyper or hypotension
What happens to blood pressure when someone has an aortic dissection?
It can either reduce or increase
What will you find on examination of a patient with aortic dissection?
Pulse absent in one arm
Difference in pulses between arms >20 mmHg
New onset aortic regurgitation (early diastolic murmur)
Pleural effusion (left sided dull to percussion, reduced chest expansion, reduced breath sounds)
What are some risk factors for aortic dissection?
Increasing age Marfan's syndrome Family hx Hx of hypertension Atherosclerosis Recent valve replacement
What are the first line investigations for aortic dissection?
ECG Troponin CRP ESR U+Es FBC WCC Erect chest radiograph Cholesterol
How are aortic dissections managed?
If type A immediately refer them for emergency surgery
If type B they might be medically managed
Everyone should be given a beta blocker (or CCB if inappropriate) and opioid analgesia
You might want to consider a vasodilator
How do type A and type B aortic dissections differ in how they are managed?
Type a= refer for immediate surgery
Type b= can be medically managed
Who do you give beta blockers to and who do you give CCBs to?
Beta blockers= patients who are under 55 or white
CCB= patients who are over 55 or not white
What condition does the management of posterior infarcts follow?
STEMI
What is the grace scale?
It is used to stratify the risk of someone with NSTEMI so you can see if they would benefit from an angioplasty
What medication will ACS respond well to?
GTN spray
How can you differentiate MI from Boerhaave’s perforation if there is chest pain and vomiting present in both?
Boerhaave's= pain will follow an episode of vomiting MI= if vomiting is present it will only start after the pain has started
What is aortic stenosis?
Narrowing of the aortic valve that reduces blood flow from the left ventricle into the aorta
What are some risk factors for developing aortic stenosis?
Bicuspid aortic valve
Increasing age
CKD
Rheumatic fever
What murmur does aortic stenosis result in?
Ejection systolic murmur (mid systole)
What is the pathophysiology underlying aortic stenosis?
It can arise due to calcification or sclerosis
What is the first line investigation for aortic stenosis?
Echocardiogram
What does ECG stand for?
Electrocardiogram
How is aortic stenosis managed?
TAVI= transthoracic aortic valve implantation
Post surgery give lifelong blood thinners- aspirin and if contraindicated then clopidogrel
Also give abx to prevent infective endocarditis
What are some complications of aortic stenosis?
Heart failure
Sudden death
Left ventricular hypertrophy
What is aortic regurgitation?
Backflow of blood from the aorta into the left ventricle due to intrinsic valve disease or widening of the aortic root
What symptoms will someone with aortic regurgitation present with classically?
They usually won’t present unless its acute
Diastolic murmur
They may have shortness of breath, chest pain, fatigue etc
What are some risk factors for aortic regurgitation?
Increasing age Bicuspid valve Marfan's syndrome Rheumatic fever CKD
What are the first line investigations for aortic regurgitation?
ECG
Echocardiogram
Erect CXR (may show cardiomegaly)
How is aortic regurgitation managed?
TAVI if they present acutely (before surgery give ionotropes and vasodilators to stabilise the patient)
If its mild or moderate assess whether TAVI is beneficial and if not vasodilator therapy
What are some complications of aortic regurg?
Chronic heart failure
Left ventricular hypertrophy
Cardiomegaly
What murmur is heard with aortic regurgitation? How will it differ if regurgitation is mild vs severe?
Diastolic murmur
If mild= early diastolic murmur
If more severe= the murmur will last longer, but note that it will NOT be more intense (only the duration increases)
What happens to an aortic regurgitation murmur as the regurgitation increases in severity?
It becomes longer
What is arterial thrombosis?
The formation of a blood clot in an artery
What are some ways arterial thrombosis may present?
Heart attack Angina Stroke TIA Peripheral vascular disease Limb ischaemia
What are some symptoms patients may experience as a result of arterial thrombosis?
Chest pain/ angina
Stroke
Pain in limbs
What is the cause of arterial thrombosis?
Atherosclerosis (the build up of fats in arteries)
What are the stages of atherosclerosis?
Fatty streak
Atheroma
Fibroatheroma
Complicated lesion
What are some risk factors for developing arterial thrombosis?
Smoking Hypertension Alcohol misuse Diet high in fat and salt Sedentary lifestyle Diabetes mellitus
How is arterial thrombosis managed
Medications- blood thinners like warfarin, antiplatelets like aspirin or clopidogrel, ACE inhibitors to reduce blood pressure
Surgery- coronary angiography, CABG, carotid endartectomy
Lifestyle advice- good diet low in sat fats and salt, adequate exercise, stop smoking, reduce alcohol intake etc
What is coronary angiography?
When a tube is placed inside one of the coronary vessels to hold it open
What are some investigations you might do when you suspect arterial thrombosis?
ECG, troponin etc if you suspect MI/ angina
Non contrast head CT for stroke/ TIA
What is an arterial ulcer?
An area of the skin that has broken down (often after minor injury) and is slow to heal due to inadequate blood supply
What symptoms will someone with an arterial ulcer classically present with?
Ulcer that looks like skin thats been punched out
Often located in the lower legs or feet
Episode of previous minor trauma to the area
Painful, pain worse at night
Minimal bleeding even when knocked or touched
Borders well defined
What is the first line investigation for an arterial ulcer?
Nothing, diagnosis is usually clinical
Capillary refill can be done
Foot pulses may be checked
Why do arterial ulcers arise?
Due to atherosclerosis leading to poor blood supply to an area which means when there is trauma blood supply is inadequate for healing