Cardiology 2 Flashcards
Drug class and mechanism of Digoxin?
Class: Cardiac glycoside Inhibits Na/K pump and causes: - bradycardia - slows AVN conduction - increased ectopic activity - increased force of contraction
Side effects of digoxin?
Narrow therapeutic range Nausea Vomiting Diarrhoea Confusion
Main clinical indication of Digoxin?
Atrial fibrillation to reduce ventricular rate response Severe heart failure as +vly ionotropic
Eisenmenger’s syndrome?
High pressure pulmonary flow Damages to delicate pulmonary vasculature The resistance to blood flow through lungs increases RV pressure increases Shunt direction reverses Patient becomes BLUE
Clinical signs of atrial septal defects
Pulmonary flow murmur Big pulmonary arteries on CXR Big heart on chest x ray Risk of infective endocarditis
Long term problems of coarction
-Re coarction requiring repeat intervention -Aneurysm formation at the site of repair Hypertension leads to: - early coronary artery disease/stroke - sun arachnoid haemorrhage
What is pulmonary stenosis?
Narrowing of the outflow of the right ventricle can occur in different locations: - Valvar - Sub valvar - Supra valvar - in branches
Severe pulmonary stenosis?
Right ventricular failure as a neonate -collapse -poor pulmonary blood flow -RV hypertrophy -tricuspid regurgitation
Moderate/mild pulmonary stenosis?
well tolerated for many years -Right ventricular hypertrophy
Treatment of pulmonary stenosis?
Balloon valvuloplasty Open valvotomy Open trans-annular patch Shunt (to bypass blockage)
What reduction do you expect with a full dose of any single drug?
Systolic: 8-10mmHg Diastolic: 4-6mmHg
Thresholds for treatment for hypertension?
Low CVD risk 160/100mmHg High CVD risk 140/90mmHg (Clinic thresholds)
Targets for blood pressure after treatment?
- Routine <140/90 mmHg - Previous stroke < 130/80mmHg - Heavy proteinuria <130/80mmHg - CKD and Diabetes <130/80mmHg - older patients <150/90mmHg
How many drugs are generally needed to control blood pressure?
Mostly one or two
Can you lower blood pressure with lifestyle changes?
Yes: -Weight loss -Salt restriction -Exercise -Alcohol
Why would blood pressure treatment be withheld?
During general anaesthesia hypotension can be a problem and anyihypertensives block attempts to increase BP ==> ACEi + ARBs temporarily stopped
Pathophysiology of aortic stenosis
a pressure gradient develops between left ventricle and aorta - LV function initially maintained by compensatory pressure hypertrophy - when compensatory mechanism exhausted, LV function declines
Main phenotypes of heart failure
HF with reduced ejection fraction (HFrEF) HF with preserved ejection fraction (HFpEF) HF due to severe valvular heart disease (HF-VHD) HF with pulmonary hypertension (HF-PH) HF due to right ventricular systolic dysfunction (HF-RVSD)
Side effect of GTN spray?
Excruciating headache
Systolic murmurs?
ASMR Aortic Stenosis Mitral Regurgitation
Diastolic Murmer?
ARMS Aortic regurgitation Mitral stenosis
What is coarction of the aorta associated with?
Turner’s syndrome and Berry aneurysms of the brain
Reasons for imperfect blood supply to the heart?
Atherosclerosis - thrombosis - thromboemboli - artery spasm - collateral blood vessels - blood pressure/ cardiac output/ heart rate - Arteritis
Another name for pericarditis?
Dressler syndrome
What investigations need to be done as part of a hypertension screening?
Urine dipstick (kidneys = end organ damage) ECG (LVH) HBA1c Renal function Fundosocopy (eyes) Lipid profile Qrisk Only check cortisol if there’s a secondary cause of hypertension
What do you need to calculate Qrisk?
Lipid profile
What changes in the arteries are likely to be seen due to angina?
Smooth muscle proliferation and migration from the tunica media to the intima -decreased release of nitric oxide - infiltration of Subendothelial space by Low-density lipoprotein (LDL) particles - formation of foam cells from macrophages
Which blood test is the most accurate marker for acute cardiac damage?
Troponin T - short term, released by cardiac myocytes
Blood marker for heart failure?
Brain natriuretic peptide
Inflammatory blood marker?
C reactive protein
Which investigation is diagnostic for heart failure?
Echocardiogram- allows you to see ventricles and valves (valves cause murmurs)
Which medication can be prescribed to relieve symptoms (swollen ankles) of heart failure?
Oral digoxin (cardiac glycoside)
Which two medications can cause postural hypertension?
Bisproplol Amlodipine
Non pharmacological treatment to help with postural hypertension?
Increase salt intake Increase oral fluid intake Compression stockings Sit + stand slowly
What is postural hypertension?
Sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within 3 minutes of standing
Causes of postural hypersensitivity?
Disorders affecting autonomic nervous system (eg. Parkinson’s disease) reduced blood volume, or iatrogenic causes eg. Antihypertensives
Pharmovological treatment options of postural hypertension?
Oral fludrocortisone
Prevalence of postural hypertension?
Affects 5% to 30% of people aged over 65 years and up to 60% of people with Parkinson’s disease
5 investigations to assess for infective endocarditis?
Bedside- ECG, urinalysis Bloods - FBC, CRP, blood cultures Imaging - Echo
Low amplitude p wave possible causes?
Atrial fibrosis Obesity Hyperkalemia
High amplitude p waves possible cause?
Right atrial enlargement
Broad notched ‘bifid’ p wave possible causes?
Left atrial enlargement
Broad QRS possible causes?
Ventricular conduction delay/ branch bundle block Pre-excitation
Small QRS complex possible causes?
Obese patient Pericardial effusion Infiltrative cardiac disease
What can T wave changes indicate?
ischeamia/infarction - myocardial strain (hypertrophy) - myocardial disease (cardiomyopathy)
Ecg for ischeamia?
T wave flattening inversion ST segment depression
