Cardiology Flashcards
what is artherosclerosis?
atheroma (fatty deposit)
sclerosis (hardening / stiffening)
> chronic inflammation and activation of the immune system
atherosclerosis leads to?
stiffening
hypertension
> pumping blood against extra resistance
stenosis
reduced blood flow
plaque rupture
thrombus > ischaemia > ACS - coronary artery becomes blocked
RF modifiable atherosclerosis
raised cholesterol
smoking
alcohol consumption
diet
exercise
obesity
stress
RF atherosclerosis non modifiable
age
fhx
male gender
end results of atherosclerosis?
angina
MI
TIA
strokes
PAD
chronic mesenteric artery
diet & exercise NICE
<30% total fat in total calories
sat fat less than 7%
wholegrain
5 fruit and veg
2x fish
4 a week legumes etc
Exercise NICE
3 hours minutes a week moderate
75 mins vigorous intensity
strength 2x a week
what is QRISK3?
% risk pt will have a stroke or MI in next 10 years
if above 10% offer statin low dose (20mg)
when are statins given in primary prevention?
qrisk3 of 10% or more
CKD
T1DM
moa of statin?
inhibits enzyme
= reduced cholesterol production in liver
LDL cholesterol is BAD
HDL is good
Statins
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)
S/E of statins?
myopathy
rhabdomyolysis - CK
t2dm
haemorrhagic stroke
interaction of statins
many drugs
macrolide abx - clari
PCSK9 inhibitors
lower cholesterol monoclonal antibodies
subcut injection
EVOLOCUMAB
Ezetimibe
cholesterol lowering drug
inhibits absorption of cholesterol in intestine
2 prevention of CVD
antiplatelet
atorvastatin 80mg
atenolol - beta block
ACEi
________is the antiplatelet of choice in peripheral arterial disease and following an ______ stroke.
Clopidogrel
ischaemic
what is the criteria for clinically diagnosing familial hypercholesterolaemia?
simon boome criteria
dutch lipid netwrok
> Fhx
very high cholesterol >7.5mmol/l
tendon xanthomata
angina
stable - at rest ‘ relieved by GTN
unstable - when you are at rest
> Unstable angina is a form of ACS needs management IMMEDIATELY
what is angina?
chest pain w/wo radiation to jaw or arms
Angina Ix?
physical exam > heart sounds, signs of HF, BP, BMI
ECG
FBC (anaemia)
U&Es
LFTs (statin therapy)
lipid
TFT
hba1c / fast glucose
CT coronary angiography
inject contrast
take CT images timed with heart contractions to give detailed view of coronary arteries
Invasive coronary angiography
catheter into pt brachial or femoral artery
> aorta and coronary arteries
Xray guidance
contrast helps visualise and xray images the stenosis
stable angina management?
RAMPS
stable is when you have angina with exertion
refer to cardio
advise
medical treatment (GTN)
procedure
secondary prevention
medical management of stable angina
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
surgical interventions for angina?
PCI
coronary artery bypass graft
PCI
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
CABG
midline sternotomy incision
graft vessel attached to affected artery bypassing it
great saphenous vein
internal thoracic artery
radial artery
ACS
unstable angina
STEMI
NSTEMI
thrombus > blockage > platelets
mainstay - antiplatelets
left anterior descending
> LAD
supplies
anterior aspect of left ventricle
anterior aspect of septum
Presentation of ACS?
central, constricting chest pain
radiation to jaw /arms
nausea/ vomiting
sweating
feeling impending doom
SOB
palpitations
ECG changes
ACS
ST elevation
LBBB new
ST depression
t wave inversions
pathological q waves
6 hours after
Left anterior descending
shown by which ECG leads?
V1-v4
anterior aspect of heart
Right coronary artery
inferior
II,III, aVF
lateral aspect of heart?
circumflex
leads
I, aVL, V5-6
role of troponin in ACS
protein in cardiac muscle and skeletal muscle
released by ischaemic tissue
rising, high is bad suggestive of nstemi
unstable angina from an nstemi
symptoms of ACS but normal troponin
normal ECG and /or st depression or t wave inversion
Mx of ACS
Call ambulance
Perform ECG
Aspirin 300mg
IV morphine /antiemetic (metoclopromide)
Nitrate (GTN)
STEMI within 12 hours
PCI has to be in next 2 hours
or thrombolysis - alteplase
NSTEMI
mx
batman
Base decision on GRACE score
aspirin 300mg stat
ticagrelor 180mg
morphine
antithrombin (fondaparinus)
nitrate
what does GRACE score calculate?
6 month probability death after having a nstemi
3% or less is low risk
3% is medium or high
what is pleuritic pain?
worse with breathing in
so worse on inspiration
Pericardial friction rub on ausculatation
rubbing
scratching sound
Ix which suggest pericarditis?
WBC, CRP, ESR raised
ECG changes > saddle shaped ST elevation
Mx of pericarditis
NSAIDs
Colchicine
Colchicine?
anti inflammatory
tubulin polymerization is inhibited -
interferes with migration and phagocytosis and reduces inflammatory cycle
what us a pericardial effusion?
fluid in the percardial cavity
inward pressure on heart = more difficult to expand during diastole
Cardiac tamponade?
effusion large enough to raise intra- pericardial pressure
affected heart filling in diastole = decreased CO in systole
presentation of pericarditis?
chest pain
low grade fever
HTN - cut offs?
140/90
135/85 in Home readings
causes
primary / essential
Secondary HTN
Secondary HTN
roped
renal disease
obesity
pregnancy
endocrine
drugs
Renal disease - 2^ HTN
renal artery stenosis >
duplex USS
MR / CT angiogram
endocrine causes of HTN
Conn’s
Phaechromocytoma
Cushings disease
HTN affects on heart?
left ventricle straining against increased resistance in the arterial system
muscle becomes thicker
sustained / forceful apex beat
ECH - voltage criteria
echo
HTN and end organ damage assessment
urine albumin:creatinine ratio for proteinuria and dipstick for microscopic haematuria
bloods for hbA1c renal function and lipids
eye / fundus examination
ECG for abnormality
QRISK estimates?
% risk of patient having a stroke or MI
in next 10 years
> 10% offer a statin low dose 20mg
Mx of HTN?
acei
beta block- bisoprolol
CCB
thiazide like diuretic
ARB
what medication is better for type 2 diabetics? HTN step 1?
ACEi
whats better for black african and African caribbean family origin
calcium channel blocker
Potassium and HTN
ACEi and Sprinolocatone increase risk of hyperkalaemia
thiazide like diuretics cause hypokalaemia
how does spironolactone work?
Blocks action of aldosterone in kidneys
results in sodium excretion
and potassium reabsorption
IV options in hypertensive emergencies
Sodium nitroprusside
Labetalol
Glyceryl trinitrate
Nicardipine
