Cardiology Flashcards
MI NSTEMI:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - acute ischaemic event causing myocyte necrosis
Epidemiology - number 1 cause of death worldwide, mainly men
Pathogenesis - acute imbalance between myocardial oxygen demand and supply, coronary vascular obstruction
Presentation - chest pain, can radiate into arm and neck, diaphoresis, abdominal pain, nausea, vomiting, SOB
Investigations - cardiac examination, FBC, U&E, creatinine, LFT, blood glucose, troponin, creatinine kinases, CXR, ECG, GTN trial
Differential Diagnosis - STEMI, aortic dissection, PE, peptic ulcer disease
Risk Factors - atherosclerosis, diabetes, smoking, dyslipidaemia, age>65
Treatment - MONA. beta blockers, calcium channel blockers, GTN spray
1 year on: betablocker, ACEi, statin
MI STEMI:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - myocardial cell death occurring because of a prolonged mismatch between perfusion and demand demand
Epidemiology - 3 x more likely in men, CVD responsible for 30% of uk death
Pathogenesis - atherosclerotic plaque, abrupt and catastrophic disruption of cholesterol-laden plaque
Presentation - chest pain, dyspnoea, pallor, diaphoresis, nausea, vomiting, dizziness, weakness, tachycardia
Investigations - cardiac examination (audible S3 or S4 heart sounds), glucose, U&E, lipids, cardiac biomarkers, CXR, ECG, angiogram
Differential Diagnosis unstable angina, NSTEMI, aortic dissection, PE, pneumothorax, pneumonia
Risk Factors - hypertension, smoking, diabetes, obesity, metabolic syndrome, physical inactivity
Treatment - MONA, 1 year: CCB, ACEi, betablocker
Angina Stable vs unstable
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - attacks of chest pain caused by reduced blood flow to the heart
Epidemiology - higher in males than females
Pathogenesis - atherosclerotous plaque leading to obstruction of coronary blood flow is the most common cause, intense vasospasm
Stable - only on exertion
Unstale - at rest and on exertion
Presentation - chest pain radiating to arm and neck (not always)
Investigations - cardiac examination, FBC, CXR, angiogram
Differential Diagnosis - PE, pericarditis, aortic dissection, pneumothorax, STEMI/NSTEMI, CHF
Risk Factors - increased age, smoking, obesity, diabetes, hyperlipidaemia
Treatment - Stable: CCB, BB, lifestyle education, antiplatelet therapy, statin, GTN
Unstable: MONA, antiplatelet therapy, statin, BB, ACEi
Atrial Fibrillation
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - supraventricular tachyarrhythmia, uncoordinated atrial activity
Epidemiology - 0.5-1% prevalence, M1.5:F1
Pathogenesis - anatomically and histologically abnormal atria, dilation of atria with fibrosis and inflammation causes a difference in refractory periods within atrial tissue promoting electrical re-entry
Presentation - palpitations, tachycardia, irregular pulse, stroke
Investigations - cardiac examination, U&E, thyroid profile, ECG, echo
Differential Diagnosis - AF with variable AV conduction, multifocal atrial tachycardia
Risk Factors - hypertension, CHF, increased age, diabetes, rheumatic valvular disease
Treatment - anticoagulation or antiplatelet therapy: warfarin and rate control: bisopralol/propanalol
Essential Hypertension:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - BP>140/90 mmHg
Epidemiology - 1 billion people with hypertension, mainly men
Pathogenesis - affected by pre-load, contractility, vessel hypertrophy and peripheral constriction
Presentation - palpitations, retinopathy
Investigations - cardiac examination, urinalysis, fundoscopy, FBC, TSH, lipid panel, fasting metabolic with GFR, Hb, HbA1c, ECG
Differential Diagnosis - drug induced: NSAID, oral contraceptives, immunosuppressants, erythromycin, CKD, renal artery stenosis
Risk Factors - obesity, aerobic exercise<3 times a week, alcohol misuse, diabetes, black ancestry
Treatment -
1st line:
<55 - ACEi
>55 - CCB or thiazide type diuretic
2nd line:
ACEi + CCB + thiazide type diuretic
3rd line:
ACEi + CCB + thiazide type diuretic
4th line:
further diuretic therapy or alpha blocker or beta blocker
DVT:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - development of blood clot in major deep vein in leg, thigh, pelvis or abdomen
Epidemiology - 1 in 1000 adults, black heritage
Pathogenesis - begin to form just above venous valve, clot may occlude entire lumen
Presentation - calf swelling, localised pain, asymmetric oedema, prominent superficial veins, worsening pain when bending foot, leg cramping at night
Investigations - peripheral vascular examination, FBC, U&E, LFT, whole leg ultrasound, proximal duplex ultrasound, D-dimer
Differential Diagnosis - cellulitis, calf muscle tear, haematoma in muscle, popliteal cyst
Risk Factors - medical hospitalisation in past 2 months, major surgery within 3 months, increased age, pregnancy, factor 5 leiden, protein C+S deficiency, frequent flying
Treatment - low molecular weight heparin and anticoagulant treatment (DOAC)
Left Ventricular Failure:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - heart unable to generate cardiac output sufficient to meet demands of body without increase of diastolic pressure
Epidemiology - 1-2%, mainly adults
Pathogenesis - heart failure represents complex syndrome
Presentation - dyspnoea, JVP, S3 gallop, cardiomegaly, hepatojugular reflux, orthopnoea, PND, nocturia, night cough, pleural effusion, oedema
Investigations - cardiac examination, FBC, U&E, creatine, glucose, LFT, TFT, CXR, ECG, transthorasic echocardiogram
Differential Diagnosis - ageing, physical inactivity, pneumonia, PE, cirrhosis, DVT
Risk Factors - MI, diabetes, old age, male, hypertension
Treatment - ACEi, BB, diuretic
Mitral Stenosis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - narrowing of mitral orifice caused by rheumatic valvulitis producing fusion of valve commissures and thickening of valve leaflets
Epidemiology - most caused by rheumatic fever, 2 per 100,000
Pathogenesis - flow between left atrium and ventricle is reduced
Presentation - dyspnoea, orthopnoea, opening snap on auscultation, diastolic murmur, haemoptysis, hoarseness
Investigations - cardiac examination, CXR, ECG, transthoracic echo
Differential Diagnosis - left atrial myxoma, unexpected AF
Risk Factors - streptococcal infection, female, serogenic medications, SLE, amyloidosis, bronchial carcinoid syndrome
Treatment -
Balloon valvotomy
Pregnant: diuretics
Mitral Regurgitation:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - commonest valve lesion
Epidemiology - 5 million + worldwide
Pathogenesis - ischaemic papillary muscular dysfunction or rupture, acute RF, acute dilation of left ventricle due to myocarditis or ischaemia
Presentation - dyspnoea on exertion, decreased exercise tolerance, lower extremity oedema, holocystic murmur, fatigue, displaced point of maximal impulse
Investigations - cardiac examination, transthoracic echo, ECG
Differential Diagnosis - ACS, IE, mitral stenosis, aortic stenosis, aortic or pulmonary valve disease, atrial myxoma
Risk Factors - mitral valve prolapse, rheumatic disease history, IE, cardiac trauma, MI, congenital heart disease
Treatment - acute/severe/chronic: annuloplasty or mechani8cal valve and anticoagulation or bioprosthesis
if asymptomatic: ACEi and beta blockers
Aortic Stenosis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - obstruction of blood flow across the aortic valve due to pathological narrowing
Epidemiology - most common valvular heart disease, increased with age
Pathogenesis - calcification of normal trileaflet valves
Presentation - dyspnoea, chest pain, ejection systolic murmur, S2 diminished and single, carotid parvus et tardus
Investigations - cardiac examination, ECG, transthoracic echo
Differential Diagnosis - aortic stenosis, IHD, hypertrophic cardiomegaly
Risk Factors - >60, congenital aortic valve, rheumatic heart disease CKD, radiotherapy, high LDL
Treatment - Unstable: balloon valvuloplasty, betablockers/vasopressors
Stable: surgical aortic valve replacement
Aortic Regurgitation:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - diastolic leakage of blood from aorta to LV
Epidemiology - 13% in men, 8.5% in women
Pathogenesis - acute: end diastolic pressure in LV reses sharply, heart tried to compensate by increase in HR
Chronic: both LV volume and pressure overload, increase in wall tension
Presentation - dyspnoea, fatigue, weakness, orthopnoea, soft S1, soft or absent S2, cyanosis
Investigations - cardiac examination, CXR, echo, ECG
Differential Diagnosis - MR, mitral stenosis, aortic stenosis, pulmonary regurgitation
Risk Factors - bicuspid aortic valve, RF, endocarditis, marfan’s syndrome, aortitis
Treatment - Acute: inotropes, vasodilators and urgent aortic valve replacement/repair: dopamine, nirtoprusside
Chronic: aortic valve replacement, transcatheter aortic valve implantation
Right Ventricular Failure:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - complex syndrome in which ability of the heart to maintain the circulation of blood is impaired because of structural or functional impairment
Epidemiology - 1/35 people, increased risk in males
Pathogenesis - RHF RV infant, pulmonary hypertension, PE, cor pulmonale, COPD, severe bradycardia
Presentation - dyspnoea, orthopnoea, nocturnal cough, fluid retention, fatigue, syncope
Investigations - cardiac examination, FBC, U&E. HbA1c, TFT, LFT, fasting lipid, CXR, 12 lead ECG, echo
Differential Diagnosis - COPD, asthma, PE, lung cancer, anxiety, nephrotic syndromes, thyroid disease, bilateral renal artery stenosis
Risk Factors - AF, diabetes, history of AF
Treatment - HF with reduced EF; loop diuretic, ACEi, betablocker, antiplatelet or statin therapy
HF with preserved EF: loop diuretic, antiplatelet/statin therapy
Infective Endocarditis:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - infection involving endocardial surface, including valvular structures
Epidemiology - 10-15K cases each year, 1/2 patients over 60
Pathogenesis - typically develops on valvular heart surfaces
Presentation - fever, chills, night sweats, weakness, SOB, arrhythmias, headache
Investigations - cardiac examination, urinalysis, FBC, chemistry panel with glucose, blood cultures, echo, ECG
Differential Diagnosis - RF, atrial myxoma, libman-sacks endocarditis, non-bacterial thrombotic endocarditis
Risk Factors - IE history, presence of artificial prosthetic heart valves, certain types of congenital heart disease, post heart transplant
Treatment - beta lactam + gentamicin or vancomycin: benzyl penicillin
Postural Hypotension:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differential Diagnosis
Risk Factors
Treatment
Definition - fall in systolic blood pressure of 20mmHg or 30mmHg in those with hypertension
Epidemiology - 11-16%, increase in older people
Pathogenesis - 700ml blood pools in leg, venous return to the heart decreases resulting in decreased cardiac output, baroreflex: mediated sympathetic activation
Presentation - postural lightheadedness, parkinsonian features, cerebellar ataxia, weight loss, abnormal GI motility, erectile dysfunction, heat intolerance, dry skin
Investigations - cardiac examination, posture test, lying and standing BP
Differential Diagnosis - neurally mediated syncope, vertigo, non-specific falls in older people, psychogenic syncope
Risk Factors - frailty, medication impairing sympathetic tone, volumedepletion, autonomic neuropathy, lewy-body dementia, parkinsons
Treatment - eliminating aggrevatiung factors and lifestyle changes e.g. antidepressants, diuretics, antihypertensive agents, alpha blockers, sildenafil
