Cardiology 1 (IHD - Hypertension) Flashcards
What are the diagnostic criteria for infective endocarditis and rheumatic fever/heart disease?
IE: Modified Duke’s criteria
Rheumatic fever: Modified Jone’s criteria
Why might someone have a normal blood pressure if they are experiencing heart failure or shock?
Compensatory mechanisms (RAAS, Sympathetic NS, ANP…etc)
How do you prevent heart failure (ischaemic/IHD/MI cause)?
Smoking cessation, treat DM/HTN, statin, exercise, weight loss, reduce alcohol…etc
How do you treat asymptomatic HF patients?
ACE-I (ramipril) or ARB (losartan)
How do you treat Symptomatic HF patients?
ACE-I (or ARB) + Beta blocker (propranolol), reduce sodium intake, diuretics (oedema), digoxin, treat cause (revascularisation and valve replacement), spironolacton
How do you treat end stage HF?
inotropes (Dobutamine), biventricular pacemaker, heart Tx,, palliative care
How does Digoxin work?
Inhibits Na+/K+ ATPase –> increasing intracellular sodium
What is the classification system used to assess the severity of HF and whether the treatment is working?
New York association of HF
Give an example of an inotrope and an ARB?
Inotrope (dobutamine) and ARB (Losartan)
Why should you never prescribe a loop diuretic and thiazide diuretic?
Risk of hypokalaemia
What is a big complication of spironolactone and ACE-Is?
Hyperkalaemia
What can acute heart failure cause?
(Cardiogenic) shock
How does COPD lead to cor pulmonale (R HF)?
2 ways:
Firstly, hypoxia causes vasoconstriction of pulmonary vessels –> pulmonary hypertension –> RVH (COMPENSATION) –> R HF
Secondly, destruction of the capillary beds –> pulmonary HTN
How does acute pericarditis differ from a STEMI on an ECG?
2 things:
- pericarditis changes in ALL leads
- saddle shaped ST elevation for pericarditis (concave for STEMI)
What revascularisation technique isn’t used for a STEMI?
CABG
Is thrombolytic therapy used in an NSTEMI?
No
What is the score used to assess risk in an NSTEMI patient?
Grace score
What do UA and NSTEMI show on ECG? How do you distinguish them?
The same thing (ST segment depression and inverted T waves) - therefore do cardiac protein markers to distinguish (CK-MB and troponins T and I are raised in NSTEMI
What is seen on CXR in HF?
Alveolar oedema, kerley B lines, Cardiomegaly, dilated upper vessels, pleural Effusion (ABCDE)
What marker can you measure in the blood for heart failure?
BNP (produced by the ventricles)
Which organism causes rheumatic fever?
Beta haemolytic group A streptococci (strep pyogenes)
What is the classic triad of symptoms for aortic stenosis?
SAD (syncope on exertion, angina, dyspnoe)
What are the signs of aortic stenosis?
Slow rising carotid pulse, murmur (early ejection systolic murmur - crescendo-decrescendo), ejection click, split S2 and there is an S4, murmur radiates to the carotids
What is the treatment for SYMPTOMATIC Aortic stenosis?
Ao valve replacement (TAVI or surgical) - NO DRUGS
