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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
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
21
surgical interventions for angina?
PCI coronary artery bypass graft
22
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
23
CABG
midline sternotomy incision graft vessel attached to affected artery bypassing it great saphenous vein internal thoracic artery radial artery
24
ACS
unstable angina STEMI NSTEMI thrombus > blockage > platelets mainstay - antiplatelets
25
left anterior descending > LAD supplies
anterior aspect of left ventricle anterior aspect of septum
26
Presentation of ACS?
central, constricting chest pain radiation to jaw /arms nausea/ vomiting sweating feeling impending doom SOB palpitations
27
ECG changes ACS
ST elevation LBBB new ST depression t wave inversions pathological q waves 6 hours after
28
Left anterior descending shown by which ECG leads?
V1-v4 anterior aspect of heart
29
Right coronary artery
inferior II,III, aVF
30
lateral aspect of heart?
circumflex leads I, aVL, V5-6
31
role of troponin in ACS
protein in cardiac muscle and skeletal muscle released by ischaemic tissue rising, high is bad suggestive of nstemi
32
unstable angina from an nstemi
symptoms of ACS but normal troponin normal ECG and /or st depression or t wave inversion
33
Mx of ACS
Call ambulance Perform ECG Aspirin 300mg IV morphine /antiemetic (metoclopromide) Nitrate (GTN)
34
STEMI within 12 hours
PCI has to be in next 2 hours or thrombolysis - alteplase
35
NSTEMI mx batman
Base decision on GRACE score aspirin 300mg stat ticagrelor 180mg morphine antithrombin (fondaparinus) nitrate
36
what does GRACE score calculate?
6 month probability death after having a nstemi 3% or less is low risk 3% is medium or high
37
what is pleuritic pain?
worse with breathing in so worse on inspiration
38
Pericardial friction rub on ausculatation
rubbing scratching sound
39
Ix which suggest pericarditis?
WBC, CRP, ESR raised ECG changes > saddle shaped ST elevation
40
Mx of pericarditis
NSAIDs Colchicine
41
Colchicine?
anti inflammatory tubulin polymerization is inhibited - interferes with migration and phagocytosis and reduces inflammatory cycle
42
what us a pericardial effusion?
fluid in the percardial cavity inward pressure on heart = more difficult to expand during diastole
43
Cardiac tamponade?
effusion large enough to raise intra- pericardial pressure affected heart filling in diastole = decreased CO in systole
44
presentation of pericarditis?
chest pain low grade fever
45
HTN - cut offs?
140/90 135/85 in Home readings
46
causes
primary / essential Secondary HTN
47
Secondary HTN roped
renal disease obesity pregnancy endocrine drugs
48
Renal disease - 2^ HTN
renal artery stenosis > duplex USS MR / CT angiogram
49
endocrine causes of HTN
Conn's Phaechromocytoma Cushings disease
50
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
51
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
52
QRISK estimates?
% risk of patient having a stroke or MI in next 10 years >10% offer a statin low dose 20mg
53
Mx of HTN?
acei beta block- bisoprolol CCB thiazide like diuretic ARB
54
what medication is better for type 2 diabetics? HTN step 1?
ACEi
55
whats better for black african and African caribbean family origin
calcium channel blocker
56
Potassium and HTN
ACEi and Sprinolocatone increase risk of hyperkalaemia thiazide like diuretics cause hypokalaemia
57
how does spironolactone work?
Blocks action of aldosterone in kidneys results in sodium excretion and potassium reabsorption
58
IV options in hypertensive emergencies
Sodium nitroprusside Labetalol Glyceryl trinitrate Nicardipine
59

Final Year (24 decks)

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