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Final Year > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what is artherosclerosis?

A

atheroma (fatty deposit)

sclerosis (hardening / stiffening)

> chronic inflammation and activation of the immune system

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2
Q

atherosclerosis leads to?

A

stiffening
hypertension
> pumping blood against extra resistance

stenosis
reduced blood flow

plaque rupture
thrombus > ischaemia > ACS - coronary artery becomes blocked

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3
Q

RF modifiable atherosclerosis

A

raised cholesterol
smoking
alcohol consumption
diet
exercise
obesity
stress

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4
Q

RF atherosclerosis non modifiable

A

age
fhx
male gender

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5
Q

end results of atherosclerosis?

A

angina
MI
TIA
strokes
PAD
chronic mesenteric artery

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6
Q

diet & exercise NICE

A

<30% total fat in total calories
sat fat less than 7%
wholegrain
5 fruit and veg
2x fish
4 a week legumes etc

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7
Q

Exercise NICE

A

3 hours minutes a week moderate
75 mins vigorous intensity
strength 2x a week

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7
Q

what is QRISK3?

A

% risk pt will have a stroke or MI in next 10 years

if above 10% offer statin low dose (20mg)

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7
Q

when are statins given in primary prevention?

A

qrisk3 of 10% or more
CKD
T1DM

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8
Q

moa of statin?

A

inhibits enzyme
= reduced cholesterol production in liver

LDL cholesterol is BAD
HDL is good

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8
Q

Statins

A

check lipids 3 months after start
again at 12 months

<40% reduction in bad cholesterol (non HDL)

mild rise in AST / ALT (<3x upper limit of normal)

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9
Q

S/E of statins?

A

myopathy
rhabdomyolysis - CK
t2dm
haemorrhagic stroke

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9
Q

interaction of statins

A

many drugs
macrolide abx - clari

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10
Q

PCSK9 inhibitors

A

lower cholesterol monoclonal antibodies

subcut injection

EVOLOCUMAB

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10
Q

Ezetimibe

A

cholesterol lowering drug
inhibits absorption of cholesterol in intestine

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11
Q

2 prevention of CVD

A

antiplatelet
atorvastatin 80mg
atenolol - beta block

ACEi

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12
Q

________is the antiplatelet of choice in peripheral arterial disease and following an ______ stroke.

A

Clopidogrel

ischaemic

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13
Q

what is the criteria for clinically diagnosing familial hypercholesterolaemia?

A

simon boome criteria

dutch lipid netwrok

> Fhx
very high cholesterol >7.5mmol/l
tendon xanthomata

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14
Q

angina

A

stable - at rest ‘ relieved by GTN
unstable - when you are at rest
> Unstable angina is a form of ACS needs management IMMEDIATELY

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15
Q

what is angina?

A

chest pain w/wo radiation to jaw or arms

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16
Q

Angina Ix?

A

physical exam > heart sounds, signs of HF, BP, BMI

ECG
FBC (anaemia)
U&Es
LFTs (statin therapy)
lipid
TFT
hba1c / fast glucose

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17
Q

CT coronary angiography

A

inject contrast
take CT images timed with heart contractions to give detailed view of coronary arteries

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18
Q

Invasive coronary angiography

A

catheter into pt brachial or femoral artery

> aorta and coronary arteries
Xray guidance
contrast helps visualise and xray images the stenosis

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19
Q

stable angina management?
RAMPS

A

stable is when you have angina with exertion

refer to cardio
advise
medical treatment (GTN)
procedure
secondary prevention

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20
Q

medical management of stable angina

A

sublingual GTN
> vasodilates > improves blood flow
1) GTN when symptoms start
2)second dose after 5 mins
3) third after another 5
4) call ambulance

long term symptom relief
1) beta block (bisoprolol)
2)CCB - verapamil

long-acting
1) nitrate - isosorbide mononitrate
2)ivabradine - acts on sinoatrial node

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21
Q

surgical interventions for angina?

A

PCI
coronary artery bypass graft

22
Q

PCI

A

percutaneous coronary intervention

insert catheter into brachial / femoral artery
use of xray through arterial system to coronary arteries

area of stenosis identified (via x-ray imaging)

angioplasty (balloon to widen lumen)

insert stent to keep it open

23
Q

CABG

A

midline sternotomy incision

graft vessel attached to affected artery bypassing it

great saphenous vein
internal thoracic artery
radial artery

24
Q

ACS

A

unstable angina
STEMI
NSTEMI

thrombus > blockage > platelets

mainstay - antiplatelets

25
Q

left anterior descending
> LAD

supplies

A

anterior aspect of left ventricle

anterior aspect of septum

26
Q

Presentation of ACS?

A

central, constricting chest pain

radiation to jaw /arms
nausea/ vomiting

sweating
feeling impending doom
SOB
palpitations

27
Q

ECG changes
ACS

A

ST elevation
LBBB new

ST depression
t wave inversions

pathological q waves
6 hours after

28
Q

Left anterior descending

shown by which ECG leads?

A

V1-v4

anterior aspect of heart

29
Q

Right coronary artery

A

inferior
II,III, aVF

30
Q

lateral aspect of heart?

A

circumflex
leads
I, aVL, V5-6

31
Q

role of troponin in ACS

A

protein in cardiac muscle and skeletal muscle

released by ischaemic tissue
rising, high is bad suggestive of nstemi

32
Q

unstable angina from an nstemi

A

symptoms of ACS but normal troponin

normal ECG and /or st depression or t wave inversion

33
Q

Mx of ACS

A

Call ambulance
Perform ECG
Aspirin 300mg
IV morphine /antiemetic (metoclopromide)
Nitrate (GTN)

34
Q

STEMI within 12 hours

A

PCI has to be in next 2 hours
or thrombolysis - alteplase

35
Q

NSTEMI
mx
batman

A

Base decision on GRACE score
aspirin 300mg stat
ticagrelor 180mg
morphine
antithrombin (fondaparinus)
nitrate

36
Q

what does GRACE score calculate?

A

6 month probability death after having a nstemi

3% or less is low risk
3% is medium or high

37
Q

what is pleuritic pain?

A

worse with breathing in

so worse on inspiration

38
Q

Pericardial friction rub on ausculatation

A

rubbing
scratching sound

39
Q

Ix which suggest pericarditis?

A

WBC, CRP, ESR raised
ECG changes > saddle shaped ST elevation

40
Q

Mx of pericarditis

A

NSAIDs
Colchicine

41
Q

Colchicine?

A

anti inflammatory
tubulin polymerization is inhibited -

interferes with migration and phagocytosis and reduces inflammatory cycle

42
Q

what us a pericardial effusion?

A

fluid in the percardial cavity

inward pressure on heart = more difficult to expand during diastole

43
Q

Cardiac tamponade?

A

effusion large enough to raise intra- pericardial pressure

affected heart filling in diastole = decreased CO in systole

44
Q

presentation of pericarditis?

A

chest pain
low grade fever

45
Q

HTN - cut offs?

A

140/90
135/85 in Home readings

46
Q

causes

A

primary / essential

Secondary HTN

47
Q

Secondary HTN

roped

A

renal disease
obesity
pregnancy
endocrine
drugs

48
Q

Renal disease - 2^ HTN

A

renal artery stenosis >

duplex USS
MR / CT angiogram

49
Q

endocrine causes of HTN

A

Conn’s
Phaechromocytoma
Cushings disease

50
Q

HTN affects on heart?

A

left ventricle straining against increased resistance in the arterial system

muscle becomes thicker

sustained / forceful apex beat

ECH - voltage criteria
echo

51
Q

HTN and end organ damage assessment

A

urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria

bloods for hbA1c renal function and lipids

eye / fundus examination
ECG for abnormality

52
Q

QRISK estimates?

A

% risk of patient having a stroke or MI
in next 10 years

> 10% offer a statin low dose 20mg

53
Q

Mx of HTN?

A

acei

beta block- bisoprolol
CCB
thiazide like diuretic
ARB

54
Q

what medication is better for type 2 diabetics? HTN step 1?

A

ACEi

55
Q

whats better for black african and African caribbean family origin

A

calcium channel blocker

56
Q

Potassium and HTN

A

ACEi and Sprinolocatone increase risk of hyperkalaemia

thiazide like diuretics cause hypokalaemia

57
Q

how does spironolactone work?

A

Blocks action of aldosterone in kidneys
results in sodium excretion
and potassium reabsorption

58
Q

IV options in hypertensive emergencies

A

Sodium nitroprusside
Labetalol
Glyceryl trinitrate
Nicardipine

59
Q
A

Final Year (23 decks)

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