Cardiology Flashcards
Define malignant hypertension. What are some symptoms?
BP >180/120, associated with signs of retinal haemorrhages and/or papilloedema on fundoscopy.
- Red flag symptoms of malignant HTN:
- Headache
- Visual disturbances
- Seizures
- Nausea & vomiting
- Chest pain
What are blood pressure targets in those under & over 80 years old with hypertension?
- <80 years old → clinic BP < 140/90
- > 80 years old → clinic BP <150/90
What medication is given in any patient with diabetes for their hypertension?
ACE inhibitor
What are the two main types of HF?
- HF with reduced ejection fraction (HFrEF)
- Weakness of heart muscle, resulting in impaired ventricular emptying.
- Ejection fraction <50%
- HF with preserved ejection fraction (HFpEF)
- Poor contractility of myocardium, resulting in impaired ventricular filling.
- Ejection fraction >50%
- Diastolic dysfunction
- Poor contractility of myocardium, resulting in impaired ventricular filling.
What is the key blood test used in suspected heart failure? What do the results mean?
- N-terminal pro-B-type natriuretic peptide (NT-proBNP)
- Should be measured in all patients presenting with symptoms & clinical signs of HF to inform type & urgency of further investigations
- <400 ng/L → HF unlikely
- 400-2000 → refer routinely for specialist assessment & echo within 6 weeks
- > 2000 → refer urgently for specialist assessment & echo within 2 weeks.
What medications are started in someone with Chronic Heart Failure? What is added if symptoms fail to be controlled?
- Furosemide if fluid overloaded.
- ACEi + BB
- Aldosterone antagonist if symptoms are still bothersome (spironolactone, eplerenone)
What classification system is used to determine the severity of Chronic Heart Failure?
New York Heart Association’s Classification System:
- Class 1 → no symptoms during ordinary PA
- Class 2 → slight limitation of PA by symptoms
- Class 3 → less than ordinary PA leads to symptoms
- Class 4 → inability to carry out any activity without symptoms.
What are the difference between arterial & venous leg ulcers?
- Arterial → due to ischaemia secondary to inadequate blood supply
- Smaller & deeper than venous ulcers
- Well defined borders → punched-out appearance
- Occur peripherally → eg, on the toes
- Have reduced bleeding
- Are painful
- Venous → due to impaired drainage & pooling of blood in the legs
- Occur after minor injury
- Larger & more superficial than arterial ulcers
- Irregular, gently sloping borders
- Affect the gaiter area of the leg → mid-calf down the ankle
- Less painful
- Occur with other signs of chronic venous insufficiency → haemosiderin staining & venous eczema
What is the key investigation for peripheral arterial disease? What is a normal vs PAD result?
- Ankle-brachial pressure index
- Ratio of systolic BP in the ankle compared with the arm → readings are taken manually using a doppler probe
- Ankle:arm ratio
1-1.4: normal
<0.9: PAD
<0.5L severe & limb-threatening ischaemia
How is intermittent claudication managed?
- Lifestyle changes → stop smoking, more PA
- Medical treatments
- Atorvastatin 80mg
- Clopidogrel 75mg OD
- Naftidrofuryl oxalate → peripheral vasodilator
- Surgical
- Endovascular angioplasty & stenting
- Endarterectomy
- Bypass surgery
How often is a AAA screened for?
Start age 65 - if normal (<2cm) then discontinue
If 3-4.4cm: screen annually
If 4.5-5.4cm: screen every 3 months
When is an AAA surgically repaired?
If:
- symptomatic
- >5.5cm
- >4cm & rapidly growing >1cm per year
What are the causes of AF?
SMITH:
- Sepsis
- Mitral valve pathology
- Ischaemic heart disease
- Thyrotoxicosis
- Hypertension
- Also, alcohol & caffeine are lifestyle causes.
When is rate control offered to people with atrial fibrillation?
1st line in all apart from the following:
- A reversible cause of AF
- New onset AF → <48hrs
- Heart failure caused by AF
- Symptoms persistent despite being effectively rate controlled
What are the rate control options for AF?
- 1st line → Beta-blocker (eg, atenolol, bisoprolol)
- 2nd line → calcium-channel blocker (diltiazem, verapamil)
- 3rd line → digoxin (only in sedentary people with persistent AF, as requires monitoring & there is a risk of toxicity)
