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Phase 3 > Cardio Pathology > Flashcards

Cardio Pathology Flashcards

1
Q

Define Atrial Fibrillation:

A

Tachycardia

  • lack of P waves
  • Narrow QRS
  • Variable QRS rate
  • regularly irregular
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2
Q

What are the three isoforms of AF?

A

Paraoxysmal

  • <48hrs
  • usually spontaneously stops

Persistent

Permanent

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3
Q

Signs and symptoms of AF?

A

Palpitations

Dyspnoea
Chest pain
Reduced ejection fracture

  • *usually due to tachycardiomyopathy
  • increased metabolic demand that can’t be sustained
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4
Q

Investigations into AF:

A

ECG

Echocardiogram

Thyroid function
- hyperthyroidism

LFTs

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5
Q

Whats the management of AF?

A
  • Prevention of symptoms
  • rate control
  • Correction of rhythm
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6
Q

What is the management of AF rate control?

A

1st line:

  • beta blockers
  • Ca2+ antagonists (verapamil)

**verapamil not okay for heart failure

2nd line:
- Digoxin

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7
Q

What is the management of Rhythm control?

A

<48hours then:

Class I: Na2+ blockers

  • Flecainide 100mg
  • Propafenone 150-300mg
  • *not in Coronary heart disease

Class III: K+ channel blockers

  • Amiodarone
  • *only option for heart failure patients

> 48hours then:

Anti-coagulation treatment first for 4-6 weeks.

  • Dabigatran
  • Rivaroxaban
  • Apixaban
  • Edoaxban

*warfarin only when mitral stenosis or replaced valve.

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8
Q

What is the scoring system used to work out coagulation use in AF?

A

CHA2DS2VASC

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9
Q

Define heart failure:

A

Abnormal Cardiac function/ structure, leading to failure of deliver of oxygen and metabolic demands of tissue, despite normal filling pressures.

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10
Q

What are the key symptoms in heart failure?

A

Breathlessness
Fatigue
Ankle Swelling

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11
Q

What are the two main sub-stypes of heart failure?

A

Reduced Ejection fraction HF.
- impaired myocardial contraction

  • males
  • younger patients
  • Coronary aetiologies

Preserved ejection fraction:

  • poor ventricular filling due to poor compliance of the ventricles
  • LVH
  • Hypertension
  • Amyloid depositions
  • elderly
  • females
  • diabetics
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12
Q

What is associated with left sided heart failure?

A

Dyspnoea

Paraoxysmal nocturnal dyspnoea

Sputum red cough

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13
Q

What is associated with right sided heart failure?

A
  • Raised JVP
  • Hepatomegaly
  • Nut meg liver
  • pitting oedema
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14
Q

In investigations, what is a major Lab finding, which without basically rules out Heart failure?

A

BNP

Pro- BNF

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15
Q

Investigations for heart failure?

A

ECG

  • hypertrophy
  • QRS duration

Bloods

  • BNP
  • pro-BNP
  • full blood count
  • LFTs (damaged liver)
  • Urea (renal damage)

Chest x-ray

  • Pulmonary oedema
  • Cardiomegaly
  • Kerley B lines

Echocardiogram

Haemotology

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16
Q

Outline the pharmacological management of heart failure:

A
  1. Beta blocker + ACE inhibitors (or ARB)
  2. Mineralcorticoid Receptor antagonist + ACE (or ARB)
    (Plus diuretic if fluid overloaded)
  3. Sacubitril/ Valsartan
    + MRA + Beta blocker
    (this is level of specialist)
  4. ICD or CRT -P + Ivabradine
    (ICD and CRT given if ejection fraction is low)
    (Ivabradine given if >75bpm in sinus)
    • digoxin
  6. Heart transplant
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17
Q

Define M.I

A

Any elevation of Troponin with clinical presentation suggesting M.I

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18
Q

What are the types of M.I?

A

Type I:
- coronary event (classical)

Type II: 
Failure of demand - no blood clots.  
increased demand, or decreased supply 
- sepsis 
- arrhythmia

Type III:
Sudden Cardiac Arrest

Type IVa:
- PCI

Type IVb:
M.I stent

Type V:
Cardiovascular surgery

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19
Q

What is the term where there is ballooning of the heart due to emotional stress?

A

Takosubo cardiomyopathy

sudden weakening of the heart due to emotional distress

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20
Q

How long till there is irreversible death of cardio cells in ischemia of the heart?

A

40mins

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21
Q

Outline the changes in the heart tissue after M.I

A

12-24 hours:

  • neutrophil infiltration
  • hyper eosinophilic necrosis

1-3 days
- loss of stiations

3-7 days
- macrophages involvement

7-10 days
- granulation tissue

> 2 months
- dense collagen scar formation

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22
Q

M.I in the inferior of the heart is caused by blockage to?

A

RCA

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23
Q

M.I in the posterior of the heart is caused by blockage to?

A

RCA

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24
Q

M.I in the anterior of left ventricle of the heart is caused by blockage to?

A

LAD

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25
Q

M.I in the lateral part of left ventricle of the heart is caused by blockage to?

A

Left circumflexed artery

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26
Q

M.I in the anteroseptal of the heart is caused by blockage to?

A

LAD

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27
Q

M.I in the right ventricle of the heart is caused by blockage to?

A

RCA

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28
Q

Investigations of M.I?

A

ECG

Chest X-ray

Troponin

Full blood count

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29
Q

Immediate management of M.I?

A

**emergancy transfer to heart centre

**defibrillator placed on

Morphine - 10mg IV
Metoclopramide - 10mg

Oxygen

Nitrates

Aspirin

Clopidogrel
*changed to Ticagrelor when in hospital

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30
Q

Whats the time line for PCI?

A

90mins

40mins driving to centre

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31
Q

What is the alternative to PCI?

A

Thrombolysis

Tenecteplase
- bolus

Heparin

  • un fractioned
  • bolus
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32
Q

What the post M.I pharmacological treatment?

A 
ACE inhibitors 
Beta blockers 
Statins 
Aspirin 
Ticagrelor

Eplerenone (diabetics, LV dysfunction and heart failure)

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33
Q

What are the treatments post M.I?

A

90 minute ECG

Pharmcology

Bloods

Echo

Cardiac rehabilitation

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34
Q

What are some complications of M.I?

A

Arrhythmias

  • VT/ VF
  • AF

Heart failure

  • damaged wall
  • damaged valves

Cardiogenic shock

Myocardial Rupture
- 3-5days

Pyschological

35
Q

What is the treatment of NSTEMI?

A

Aspirin
Clopidogrel/ Ticagrelor
Heparin

Secondary:
ACE inhibitors 
Beta blockers 
Statins 
Eplerenone (subjective)

Echo

Cardiac rehabilitation

36
Q

What valve is most commonly associated with endocarditis?

A

Mitral

37
Q

Which drug is mainly cleared by the renal system and may be implicated in renal failure?

A

Dabigatran

38
Q

Preserved ejection fracture is also known as? and why is this?

A

Diastolic heart failure:

due o the fact the heart is literally not filling up much i.e. LVH

thus the ejection fracture is normal, but the overall volume is not!

39
Q

Who typically gets Reduced ejection fracture heart failure?

A
  • young
  • male
  • Coronary heart disease associated
40
Q

What type of heart block is characterised by continually increasing lengths of the P-Q interval until it stops, then repeats?

A

Second Degree Heart block, Type I (Mobitz type I)

41
Q

In third degree heart block, what occurs?

A

Widden of the QRS complex.

42
Q

If a home monitoring kit is used to analyse blood pressure, what does there need to be for diagnosis of high blood pressure?

A

2 readings

twice a day

taken over 4-7 days

43
Q

What is the cut off level for home readings for hypertension?

A

135/ 85

44
Q

What are the cut offs for nighttime hypertension?

A

> 120/ >70

45
Q

In patients with grade 1 hypertension who are low risk for systemic disease, when do you treat them with medication?

A

after 3-6 months of life style changes

46
Q

Which stage do you treat all patients with medication?

A

Grade 2

> 160-179/ 100-109

47
Q

What is high output heart failure?

A

This is where the cardiac output is increased well past that of normal valves for that setting. Results in massive stress to the heart.

for example severe anaemia reduces the viscosity of the blood - increasing pre-load - massively impacting the stress on the heart

48
Q

List some common causes of heart failure:

A

Coronary heart disease

Hypertension

Toxins

  • chemotherapy
  • alcohol

Idiopathic

49
Q

What is acute heart failure?

A

Worsening of chronic
or
New in de novo cause

50
Q

What are the stages of heart failure?

A

I: no symptoms

II: symptoms, shortness of breath when doing certain activities

III: Marked symptoms when doing certain activities. Comfortable at rest

IV: Severe symptoms, uncomfortable when at rest. bed bound

51
Q

What investigations need to be done for HF?

A 
ECG
Chest x-ray
Bloods 
U&amp;Es 
BNPs and Pro BNPs
Echo
52
Q

What is a ICD?

A

Implantable cardioverter defibrillator

Many patients with heart failure can go into VT - which this senses and stops via a shock

53
Q

What is valsartan?

A

Angiotensin II blocker

54
Q

What does a CRT device do?

A

Enable the heart to pump more efficiently by co-ordinating the ventricles and helping time them

Used for Left bundle branch - which is often associated with HF.

55
Q

At which stage of the management of HF, do you seek expert advice?

A

After Mineral-corticosteroid diuretic therapy has been used.

56
Q

In the setting of acute/ decompensated HF, what needs to be given?

A

Furosemide

Nitrates
- dilates V&As

CPAP

  • increases O2
  • reduces preload by increasing intrathoracic pressure

Morphine

  • pain
  • dilates venous - reduces preload

Dobutamine
- inotropic stimulation

57
Q

What is BNP?

A

Bodies natural diuretic

  • dilates
  • promotes diuresis
58
Q

What is Pro-BNP?

A

a cleaved part of the BNP

59
Q

What investigations are done in the setting of acute heart failure?

A 
ECG 
Chest x-ray
Echo 
Thyroid functions 
Troponin 
BNP
60
Q

What are the two presentations of infective endocarditis? and what pathogens are most associated with them?

A

Acute
- staph aureus

Sub - acute
- strep viridans

61
Q

What are the symptoms of infective endocarditis?

A
  • fever
  • heart murmur
  • Fatigue malasia
  • embolic events
  • splinter haemorrahges
62
Q

What investigations need to be done when there is suspected endocarditis?

A
  • echo
  • transthoracic
  • transesophageal
  • Blood cultures
  • 3 samples
  • peripheral locations
  • pre-antibiotics
  • 10mls in each
  • sterile technique
  • FBC
  • ESR
  • U&Es
  • ECG
  • Sputum
  • heart failure
63
Q

What is the duke criteria? and what is needed for diagnosis?

A

Major:

  • typical 2 organisms
  • positive echo

Minor:

  • risk factor - IV user, prosthetic valve
  • Fever
  • Vascular phenomena
  • Immunological phenomena
  • positive cultures (but outwith major)
  • Echo (but outwith major)
2 Majors 
or 
1 Major + 3 minors 
or 
5 minors
64
Q

What is the treatment of Infective endocarditis?

A 
Native valves:
*Amoxicillin 
\+
*Flucloxacillin
\+
Gentamicin

Prosthetic valves:
*Vancomycin
+
*gentamicin

65
Q

What is the most significant factor for diagnosis of endocarditis?

A

Volume of blood

66
Q

If you have a diagnosis of Streptococcal for endocarditis, what antibiotics should be used?

A

Benzylpenicillin
+
Gentamicin

for 4 weeks

67
Q

How do the bacteria in endocarditis cause vegetations?

A

Through quorum sensing

68
Q

What are the main types of endocarditis?

A

IVDU - Staph Aureus

Native valve - Strep Viridans

Prosthetic Valve - Staph Epidermis/ MRSA

69
Q

Name some causes that are not STEMI but increase troponin levels:

A

P.E

Sepsis

Tachyarrhythmias

Renal Failure

70
Q

What can cause saddle shape of the ST segement on most of the leads?

A

Pericarditis

71
Q

What are the inferior leads of the ECG? what vessel do they correlate with?

A

II, III and aVF

- right coronary artery

72
Q

What are the anteroseptal leads, and what ones specifically look at the septum?

A

V1, V2, V3, V4
- Left atrioventricular descending

V1 and V2 look specifically at septum
- Circumflex

73
Q

What leads look at the left lateral leads?

A

I, aVL, V5, V6

- Left circumflex

74
Q

What things outwith the valves themselves can lead to valvular disease?

A

Valvular annular stretching open

Valve apparatus being damaged

75
Q

What type of hypersensitivity is rheumatic fever, what is the pathogen and what is the antibodies produced?

A

type II

Pyogenes

Antistreptolysin antibodies

76
Q

What murmur causes head popping? and why?

A

Aortic regurgitation

- due to the changes in pressures as systolic is high, but diastolic is low

77
Q

Which leaflet of the mitral stenosis is more prone to damage?

A

Anterior

- because its larger

78
Q

What are the space changes that occur in mitral stenosis?

A

5cm2 > 1cm2

- symptomatic

79
Q

What murmur gets quieter as it gets worse, and what is this called?

A

aortic stenosis

- low flow gradient

80
Q

What is the 6ps of critical limb ischemia?

What is a good diagnostic factor for differentiated between poor limb ischemia and potential limb loss?

A 
Pallor 
Painful 
Paraesthesia 
Pulseless 
Paralysis/ paretic  
Perishingly cold

Muscle tenderness is good at differentiating between really bad ischemia and potential limb loss.
- with muscle tenderness being likely to loose limb

81
Q

What are the investigations done into limb threatening ischemia?

A

ABPI

CT Angiogram

Pulses

Arteriogram

  • embolectomy
  • thrombolysis

**good thing about arteriogram is that whilst there you can carry invasive surgery such as angioplasty and stenting

82
Q

What are the treatments for critical limb ischemia?

A

The limb must be assessed to see if it is able to be saved, if not it will be amputated.

if viable limb then:
*thrombolysis 
- alteplase 
- PCI 
(depending on patient)

Heparin - Low molecular weight

Analgesics

83
Q

What is the long term management of PVD:

A

Statins

Fibrates
- reduce tricycles in liver

Aspirin

Anti-hypertensives - not Beta blockers

life style changes

84
Q

In order to get renal failure from renal stenosis, what must be present?

A

Stenosis of both arteries

Phase 3 (50 decks)

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