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Cardiology Flashcards

1
Q

What is the best known risk factor for coronary artery disease?

A

Age

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2
Q

State 7 risk factors for coronary artery disease.

A
  1. Age
  2. Tobacco smoking
  3. High serum cholesterol
  4. Obesity
  5. Diabetes
  6. Hypertension
  7. Family history
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3
Q

True or False: the artery walls contain epithelium cells.

A

False - epithelial cells are found in the endothelium

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4
Q

What is the location of the sinoatrial node?

A

Cristae terminalis

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5
Q

What is the primary cause of ischaemic heart disease?

A

Atherosclerosis

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6
Q

What is the most common presentation of ischaemic heart disease?

A

Angina and normal examination

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7
Q

State 3 non-modifiable risk factors for ischaemic heart disease.

A
  1. Family history
  2. Age
  3. Ethnicity
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8
Q

State 8 modifiable risk factors of ischaemic heart disease.

A
  1. Smoking
  2. Poor nutrition
  3. Sedentary lifestyle
  4. Alcohol
  5. Stress
  6. Hypertension
  7. Obesity
  8. Diabetes
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9
Q

How does angina present in ischaemic heart disease?

A
  1. Constricting discomfort in front of chest, neck, shoulders, jaws or arms
  2. Brought on by physical exertion
  3. Relieved by rest or GTN spray in under 5 minutes
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10
Q

What 4 investigations would you do to diagnose ischaemic heart disease?

A
  1. ECG
  2. Lipid profile
  3. FBC
  4. HbA1c
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11
Q

What would the result of an ECG be in ischaemic heart disease?

A

Usually normal

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12
Q

What would a lipid profile show in ischaemic heart disease?

A

High LDL, low HDL

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13
Q

Why would you perform a FBC for suspected ischaemic heart disease?

A

To exlude anaemia

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14
Q

Why would you perform a HbA1c for suspected ischaemic heart disease?

A

To exclude diabetes

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15
Q

What is the gold standard investigation for angina?

A

CT coronary angiography

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16
Q

State 3 secondary prevention measures recommended for ischaemic heart disease?

A
  1. Antiplatelet therapy
  2. Lipid lowering therapy
  3. Good hypertensive and glycaemic control
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17
Q

State 2 examples of antiplatelet therapy.

A
  1. Aspirin

2. Clopidogrel

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18
Q

How does antiplatelet therapy prevent ischeamic heart disease?

A

They stop platelets agregating on plaques, therefore preventing further occlusion of vessels and iscaemia.

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19
Q

What drugs are used as lipid lowering therapy in iscaemic heart disease?

A

Statins

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20
Q

What is given to angina patients for short term symptomatic relief?

A

GTN spray

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21
Q

What is GTN spray, and how is it administered?

A

Glyceryl trinitrate spray is sprayed under the tongue for fast absorption.

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22
Q

What 2 things may be given to angina patients for long term symptomatic relief?

A

Beta blockers or calcium channel blockers.

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23
Q

What is a very typical side effect of calcium channel blockers?

A

Ankle swelling

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24
Q

What 3 things are given to patients as secondary prevention of angina?

A
  1. Aspirin (low-dose)
  2. Atorvastatin
  3. ACE inhibitors
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25
What is the main complication of ischaemic heart disease?
Acute coronary syndrome
26
What does STEMI and NSTEMI mean?
``` STEMI = ST elevation myocardial infarction NSTEMI = Non-ST elevation myocardial infarction ```
27
Why do calcium channel blockers cause ankle swelling?
They increase capillary pressure leading to leakage of fluids into surrounding tissues.
28
Acute coronary syndrome is an umbrella term for what 3 conditions?
1. Unstable angina 2. STEMI (complete occlusion) 3. NSTEMI (partial occlusion)
29
What is unstable angina?
Myocardial ischaemia at rest or on minimal exertion in the abscence of acute cardiomyocyte injury.
30
What is the difference between stable and unstable angina?
Stable angina is brought on by exertion, whereas unstable angina comes on at rest and is caused by arteries being more stenosed.
31
State 4 ways in which unstable angina presents.
1. Central, constricting, chest pain radiating to jaws and arms 2. Sweating 3. Shortness of breath 4. Episoded lasting longer than 20 minutes
32
True or False: unstable angina is relieved by rest or GTN spray.
False - unstable angina is NOT relieved by rest or GTN spray
33
Why may diabetics patients have a silent MI?
Diabetic neuropathy causes loss of sensation, so diabetic patients may not feel that they have had a heart attack.
34
What would you find on an ECG of a patient with stable angina?
Normal EGC
35
How would you use troponin levels to differentiate between angina and STEMI?
Troponin levels are normal in stable and unstable angina, byt are elevated in NSTEMI and STEMI.
36
Why are troponin levels elevated in STEMI and NSTEMI?
In STEMI and NSTEMI, heart muscle cells die. As the cells die they release troponin.
37
If a patient presents with acute coronary syndrome, what will you look for to diagnose STEMI?
1. ECG showing ST elevation | 2. Elevated troponin.
38
If a patient presents with acute coronary syndrome, what will you look for to diagnose unstable angina?
1. ECG showing ST depression and/or deep T wave inversion | 2. Normal troponin level
39
If a patient presents with acute coronary syndrome, what will you look for to diagnose NSTEMI?
1. ECG showing ST depression and/or deep T wave inversion | 2. Abnormal troponin level
40
What is the immediate management of acute coronary syndrome?
Think MONAC ``` Morphine Oxygen (if saturation < 92%) Nitrate Aspirin (300 mg) Clopidogrel ```
41
If STEMI is identified within 120 minutes of its onset, how do you manage it?
1. Percutaneous coronary intervention (PCI) | 2. Clopidogrel and aspirin as prophylactic drugs to prevent clots
42
If STEMI is identified after 120 minutes from its onset, how do you manage it?
1. Alteplase for secondary fibrinolysis | 2. Ticagrelor and aspirin
43
What are 2 major contra-indications for fibrinolysis?
1. Warfarin | 2. History of ischaemic stroke, or previous haemorrhagic stoke
44
What is the immediate management for unstable angina and NSTEMI?
1. Risk stratification using GRACE score, followed by appropriate management 2. Fondaparinux for thrombus prevention
45
If a patient with NSTEMI or unstable angina is high risk for developing STEMI how do you manage them?
1. Urgent PCI or fibrinolysis | 2. Prasugrel and aspirin
46
If a patient with NSTEMI or unstable angina is medium risk for developing STEMI how do you manage them?
1. Early angiography and non-urgent PCI | 2. Prasugrel and aspirin
47
If a patient with NSTEMI or unstable angina is low risk for developing STEMI how do you manage them?
1. Tricagrelor and aspirin | 2. Annual check-ups
48
What is the secondary prevention for patients with acute coronary syndrome?
Think ACAB ACE inhibitors Clopidogrel Aspirin and atorvastatin Beta blocker
49
What are the complications of MI?
Think DREAAD ``` Death Rupture of heart septum or papillary muscles Edema (heart failure) Arrhythmia Aneurysm Dressler’s syndrome ```
50
What is meant by essential hypertension?
Hypertension with no underlying cause.
51
What conditions can be an underlying cause of hypertension?
Think ROPE Renal disease Obesity Pregnancy (pre-eclampsia) Endocrine (Conn’s syndrome)
52
Define hypertension.
BP > 140/90 in clinic (account for white coat syndrome) | BP > 135/85 with ABPM or at home readings
53
Why does Conn’s syndrome cause hypertension?
⬆️ aldosterone = ⬆️ sodium reabsorption = ⬆️ water reabsorption = ⬆️ blood volume = higher BP
54
State 5 modifiable risk factors for hypertension.
1. Exessive alcohol intake 2. Sedentary lifestyle 3. Diabetes 4. Sleep apnoea 5. Smoking
55
State 3 non-modifiable risk factors for hypertension.
1. Increasing age 2. Family history 3. Ethnicity (afro-caribbean)
56
What BP values define stage 1 Hypertension?
Clinic BP > 140/90 | ABPM BP > 135/85
57
What BP values define stage 2 hypertension?
Clinic BP > 160/90 | ABPM BP > 150/90
58
What BP values define stage 3 hypertension?
Clinic and ABPM BP > 180/120 (with organ damage) = malignant hypertension = medical emergency
59
In a patient with hypertension, what 7 investigations would you do to rule out other complications?
Renal complications 1. Urine ACR (albumin:creatine ratio) looking for proteinuria 2. Dipstick looking for microscopic haematuria 3. Blood looking for renal function (GFR) and Hb Cardiovascular complications 4. ECG lookig for previous infarction or left ventricular hypertrophy Hypertensive retinopathy 5. Fundus examination Other 6. HbA1c looking for diabetes 7. Lipids (LDL:HDL)
60
What is the first step in treating a hypertensive 49-year-old male, without diabetes, and not of black African or African-Caribbean descent?
ACE inhibitor (e.g. ramipril). If bad side effects occur an angiotensin II receptor blocker (ARB) (e.g. candesartan) can be used.
61
What is the first step in treating a hypertensive 60-year-old female, without diabetes, of black African family origin?
Calcium Channel Blocker (e.g. amlodipine)
62
What is a common, troublesome side effect of ACE inhibitors?
Dry Cough
63
What would the second step be in treating a hypertensive 46-year-old female, without diabetes, and not of black African or African-Caribbean family origin?
ACE inhibitor (e.g. ramipril) or angiotensin II receptor blocker (ARB) (e.g. candesartan) AND calcium channel blocker (e.g. amlodipine) or thiazide-like diuretic
64
What would the second step be in treating a hypertensive 77-year-old male, without diabetes, and of African-Caribbean descent?
Calcium channel blocker (e.g. amlodipine) AND ACE inhibitor (e.g. ramipril) or angiotensin II receptor blocker (e.g. candesartan) or thiazide-like diuretic
65
What is the third step in treating a patient with hypertension?
ACE inhibitor (e.g. ramipril) or angiotensin II receptor blocker (ARB) (e.g. candesartan) AND calcium channel blockers (e.g. amlodipine) AND thiazide-like diuretic
66
Where is the most likely place for an aneurysm to occur?
Abdominal aorta
67
What is an aneurysm?
Weakening of a vessel wall floowed by dilation die to increased wall stress.

Phase 2A (4 decks)

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