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Cardiology Flashcards

1
Q

What is the typical lesion seen in atherosclerosis?

A

Fatty streak

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2
Q

What are the cellular components of atherosclerosis?

A

Macrophages, smooth muscle cells, lymphocytes

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3
Q

What are the risk factors for atherosclerosis?

A 
Age
Hypercholesterolaemia
Family history of diabetes
Male
Obesity
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4
Q

What are the risk factors for angina?

A 
Age
Hypercholesterolaemia 
Diabetes
Male
Obesity
Smoking
Drinking
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5
Q

What is the clinical presentation of angina?

A

Constricting chest pain
Chest pain on exertion
Pain relieved by rest or GTN

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6
Q

What investigations would you do for a patient with ?angina?

A

ECG - t wave changes or ST changes, pathological Q wave changes
Bloods - FBC, LFTs, RBG, TFTs, cholesterol, troponins

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7
Q

What is the management for angina?

A

Lifestyle modification to modify risk factors
GTN spray on attack
Aspirin daily
Statins
Calcium channel blocker or beta blocker
Long-acting nitrate
Revascularisation if patient is high risk of persistent

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8
Q

What is acute coronary syndrome?

A

ST-elevation ACS (STEMI)
Non-ST elevation ACS (NSTEMI)
Unstable angina

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9
Q

What are the risk factors for ACS?

A 
Age
Hypercholesterolaemia 
Diabetes
Male
Obesity
Smoking
Drinking
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10
Q

What is the clinical presentation of ACS?

A 
Fatigue
Nausea and vomiting
Impending sense of doom
Chest pain
Breathlessness
Clammy
Pale
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11
Q

What investigations would you do for a patient with ?ACS?

A

ECG - ST changes with a STEMI

Bloods - FBC, LFTs, RBG, TFTs, cholesterol, troponins

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12
Q

What is the management of ACS?

A 
ABCDE
MONA - morphine, oxygen (if hypoxic), nitrates, aspirin
Aspirin and ticagrelor
LMWH or fondaparinux 
Revascularisation 
Statins
Calcium channel blocker or beta blocker
Long-acting nitrate
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13
Q

What are the possible complications of ACS?

A

Arrhythmia
Shock
Death
AF

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14
Q

Where do mitral valve murmurs radiate to?

A

The axilla

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15
Q

Where do aortic valve murmurs radiate to?

A

The carotid arteries

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16
Q

What investigations would to do for a mitral stenosis?

A

CXR - small heart but big LA, possible calcification
ECG - sinus rhythm or AF
Echo - LA enlargement, assess mitral valve mobility, gradient and mitral valve area

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17
Q

What is the management of mitral stenosis?

A 
Medical: beta-blockers, calcium channel blockers, digoxin, diuretics
Valvotomy to widen the valve
Valve replacement
Treat AF
Treat dyspnoea with low dose diuretics
?Infective endocarditis prophylaxis
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18
Q

What are the causes of mitral regurgitation?

A 
Degenerative
IHD
Infective endocarditis
Ehlers-Danlos syndrome
Marfan's syndrome
Rheumatic heart disease
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19
Q

What are the symptoms of mitral regurgitation?

A 
Palpitation
Dyspnoea
Orthopnoea- difficult in breathing when lying flat
Fatigue
Lethargy
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20
Q

What murmur does mitral regurgitation have?

A

Pansystolic murmur

Palpable thrill if the regurgitation is severe

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21
Q

What murmur does aortic stenosis have?

A

Systolic, low pitched ejection murmur that radiates to the carotids
Ejection click
Palpable thrill

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22
Q

What are the symptoms of aortic stenosis?

A

Exercise induced syncope
Dyspnoea
Angina

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23
Q

What murmur does aortic regurgitation have?

A

High pitched, early diastolic
Ejection systolic
Mid-diastolic rumble

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24
Q

What BP is stage 1 hypertension?

A

140/90 in clinic

135/85 at home or ambulatory

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25
What BP is stage 2 hypertension?
160/100 in clinic | 150/95 at home or ambulatory
26
What BP is severe hypertension?
180/110 - NEEDS TREATING ASAP!!
27
At what point do you treat hypertension?
Stage 2 or 3 | Stage 1 if the patient has DM, kidney disease
28
What is the management of hypertension?
>55 or not caucasian? Calcium channel blocker <55 and caucasian? ACEi/ARB Then combination treatments Then add a thiazide diuretic
29
What compensatory changes are seen in heart failure?
``` Ventricular dilatation Myocyte hypertrophy Increased collagen synthesis Salt and water retention Peripheral vasoconstriction Increased sympathetic stimulation ```
30
What are the symptoms of heart failure?
``` Exertional dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Cold peripheries ```
31
What are the signs of heart failure?
``` Cardiomegaly Added heart sounds and murmurs Elevated JVP Tachycardia Hypotension Bibasal crackles Ascites Oedema - peripheral and sacral Displaced apex beat Hepatomegaly ```
32
What is the management for heart failure?
``` Lifestyle modification: Education Obesity control Diet Smoking cessation Vaccines Cardiac rehab ``` ``` Drugs: Diuretics e.g. furosemide ACE inhibitors e.g. lisinopril Beta blockers e.g. bisoprolol ARB e.g. candesartan Calcium glycosides e.g. digoxin ``` Other: Revascularisation Valvular replacement
33
What is shock?
Failure of the circulatory system to maintain an adequate organ perfusion
34
What are the causes of shock?
``` Haemorrhagic Anaphylaxis Septic Cardiogenic Hypovolaemic ```
35
What is the management of anaphylaxis?
ABCDE Oxygen Adrenaline Anti-histamines
36
What is the management for septic shock?
``` Sepsis six: Blood cultures Urine output Fluids Antibiotics IV Lactate Oxygen ```
37
In an acute MI, which drug should you give for thrombolysis?
Streptokinase
38
What is the downside to streptokinase?
It is derived from a bacteria so resistance is an issue therefore if a patient has had it once then they can't have it again.
39
What are the clinical features of infective endocarditis?
``` Fever Splinter haemorrhages Janeway lesions Osler's nodes Roth spots New murmur Malaise Symptoms of septic emboli e.g. stroke, PE, pneumonia ```
40
What investigations would you do for infective endocarditis?
Echo CXR Blood cultures
41
What is Duke's criteria?
The diagnostic criteria for infective endocarditis
42
What are the signs for MI?
Levigne's sign, loss of consciousness, pallor, clammy
43
What are the diagnostic tests for MI?
12 lead ECG - ST elevation in STEMI or LBBB, may show pre-existing coronary artery disease e.g. Q waves Bloods: FBC, glucose, renal function, U&Es, TFTs and cardiac enzymes Echo CXR Coronary angiography
44
What is unstable angina?
An acute coronary syndrome - angina symptoms that come on at rest
45
What are the complications of an MI?
Heart failure, myocardial rupture and aneurysmal dilatation, ventricular septal defect, mitral regurgitation, arrhythmias, conduction disturbances, post-MI pericarditis
46
What tests would you do to diagnose heart failure?
History and physical examination CXR - cardiomegaly Bloods: FBC, U&Es, LFTs, cardiac enzymes, BNP, TFTs ECG - ischaemic changes or arrhythmia Echo - chamber dimensions, systolic and diastolic function, wall abnormalities, valvular heart disease, cardiomyopathies Myocardial perfusion imaging
47
What are the causes of mitral stenosis?
Rheumatic heart disease Congenital Calcification Infective endocarditis
48
What is the pathophysiology involved in mitral stenosis?
Obstruction of LV inflow prevents proper filling during diastole, LA pressure increases and LA hypertrophy and dilatation occur
49
What are the symptoms of mitral stenosis?
Severe dyspnoea, pink frothy sputum, haemoptysis, palpitations
50
What are the signs of mitral stenosis?
Mitral facies - ducky pink discolouration of the cheeks Atrial fibrillation Prominent "a" wave in jugular pulsations HEART SOUNDS: loud S1, loud P2, opening snap
51
What murmur does mitral stenosis have?
Mid-diastolic rumble at the apex
52
What is the pathophysiology involved in mitral regurgitation?
LA dilatation, LV hypertrophy and increased contractility
53
What are the signs of mitral regurgitation?
Laterally displaced diffuse apex beat Systolic thrill HEART SOUNDS: soft S1, prominent third heart sound
54
What investigations should be performed to confirm mitral regurgitation?
ECG - LA enlargement, AF, LV hypertrophy CXR - LA enlargement, central pulmonary artery enlargement Echo - Estimation of LA and LV size and function, valve structure assessment
55
What is the management of mitral regurgitation?
Medical: ACE inhibitors, rate control for AF, anticoagulation for AF, diuretics, serial echos, prophylaxis for infective endocarditis Surgery: Mitral valve replacement or repair
56
What are the causes of aortic stenosis?
Congenital - aortic stenosis or a bicuspid valve | Acquired - degenerative calcification, rheumatic heart disease
57
What is the pathophysiology involved in aortic stenosis?
A pressure gradient develops between the LV and the aorta (increased afterload), LV function is initially maintained by compensatory pressure hypertrophy, when compensatory mechanisms fail, LV function declines
58
What are the signs of aortic stenosis?
Slow rising carotid pulse (pulsus tardus) Decreased pulse amplitude (pulsus parvus) Systolic thrill HEART SOUNDS: soft or absent second heart sound, S4 gallop due to LVH, ejection click
59
What tests are used to diagnose aortic stenosis?
CXR - relatively small heart with prominent, dilated, ascending aorta, aortic valve may be calcified ECG - LV hypertrophy and LA delay Echo - thickened, calcified and immobile aortic valve cusps, LV hypertrophy Cardiac catheterisation - used to assess pressure gradient but rare
60
What is the treatment for aortic stenosis?
Surgical replacement - TAVI (transcatheter aortic valve implantation), valvotomy ?Prophylaxis for infective endocarditis
61
What are the causes of aortic regurgitation?
Rheumatic heart disease, infective endocarditis, severe hypertension and a bicuspid valve
62
What is the pathophysiology involved in aortic regurgitation?
There is reflux of blood from the aorta into the LV during diastole, to maintain cardiac output the LV enlarges. Diastolic BP falls and coronary perfusion decreases. The longer the LV is mechanically less efficient, the oxygen demand increases resulting in ischaemia
63
What are the symptoms of aortic regurgitation?
Angina, dyspnoea, orthopnoea, palpitations
64
What are the signs of aortic regurgitation?
Wide pulse pressure Hyperdynamic and displaced apical impulse Collapsing or bounding pulse Head nodding with each heartbeat Quincke's sign - capillary pulsation in the nail beds
65
What tests are used to diagnose aortic regurgitation?
CXR - LV enlargement and dilatation of the ascending aorta ECG - LV hypertrophy - tall R waves, inverted T waves in left sided chest leads and deep S waves in right-sided leads Echo - vigorous cardiac contraction, dilated LV, regurgitant jet on doppler Cardiac catheterisation - rare
66
What is the treatment for aortic regurgitation?
Medical: Consider IE prophylaxis Vasodilators (e.g. ACE inhibitors) Surgery: aortic valve replacement
67
What is the aetiology of infective endocarditis?
Bacteraemia and abnormal cardiac endothelium result in infective endocarditis. Bacteraemia normally occurs from poor dental hygiene, IVDUs and soft tissue infections
68
What are some common organisms that cause infective endocarditis?
Streptococcus viridans - prosthetic valves, dental disease Staphylococcus aureus - IVDUs, prolonged vascular access e.g. central lines, valve surgery Staphylococcus epidermidis - IVDUs, valve surgery
69
What are the symptoms of infective endocarditis?
Fever, malaise, night sweats, rigors, joint pain
70
What are the signs of infective endocarditis?
``` Finger clubbing Cardiac murmurs Skin lesions - Osler's nodes, splinter haemorrhages, Janeway lesions, petechiae Roth's spots - seen on the retina Septic emboli ```
71
What are the diagnostic tests for infective endocarditis?
Duke's criteria Blood cultures (3 separate sets from different sites) ECG CXR Echo - visualisation of vegetations on valve leafllets
72
What is the treatment for infective endocarditis?
Empirically: penicillin and gentamicin Staphylococcal: vancomycin or flucloxacillin or benzylpenicillin and gentamicin Streptococcal: penicillin and gentamicin All antibiotics should be given IV and should be given for a long course e.g. 6 weeks
73
What are some causes of hypertrophic cardiomyopathy?
Aortic stenosis, hypertension, mutations in sarcomeric proteins
74
What is the pathophysiology of hypertrophic cardiomyopathy?
The heart hypertrophies to try and improve contractility and force; this can be due to stenosis or mutated proteins
75
What are the symptoms of hypertrophic cardiomyopathy?
Chest pain, dyspnoea, syncope or pre-syncope, cardiac arrhythmias, sudden death
76
What are the signs of hypertrophic cardiomyopathy?
``` Double apical pulsation Jerky carotid pulse Ejection systolic murmur Pan-systolic murmur (due to mitral regurgitation) 4th heart sound ```
77
What tests are used to diagnose hypertrophic cardiomyopathy?
ECG - LV hypertrophy, ST and T wave changes, abnormal Q waves Echo - hypertrophy of the heart, vigorously contracting ventricle Cardiac MR - detects hypertrophy and fibrosis Genetic analysis
78
What is the treatment for hypertrophic cardiomyopathy?
Prevention of sudden cardiac death e.g. ICD | Surgery - septal myectomy, cardiac transplant
79
What are some causes of dilated cardiomyopathy?
Mutations in proteins such as dystrophin, myocarditis, autoimmune disorders, endocrine disorders, neuromuscular diseases, toxins e.g. alcohol or chemotherapy
80
What is the pathophysiology of dilated cardiomyopathy?
Progression of heart failure is associated with LV remodelling which results in gradual increases in the LV end-diastolic and end-systolic volume, wall thinning and a change in chamber geometry
81
What are the symptoms of dilated cardiomyopathy?
Dyspnoea, syncope and angina
82
What are the signs of dilated cardiomyopathy?
Pulmonary oedema, elevated JVP, low pulse pressure, arrhythmias, conduction defects
83
What tests are used to diagnose dilated cardiomyopathy?
CXR - cardiac enlargement ECG - non-specific ST segment and T wave changes, arrhythmias Echo - ventricular dilatation Cardiac MR - ventricular dilatation and myocardial thrombus Coronary angiography
84
What is the treatment for dilated cardiomyopathy?
Conventional management of heart failure Cardiac resynchronisation therapy ICDs Surgery - transplantation
85
What are the causes of a ventricular septal defect?
Post-MI | Congenital - incomplete looping of the heart during days 24-28 of development
86
What is the pathophysiology involved in ventricular septal defects?
During systole, some blood from the LV leaks into the RV which passes through the lungs and re-enters the LV vie the pulmonary veins and LA. There is volume overload on the LV and increased pulmonary blood flow leading to pulmonary hypertension
87
What is the epidemiology of a ventricular septal defect?
30-60% of newborns with a congenital heart defect | Frequently associated with other congenital conditions e.g. Down's syndrome
88
What are the symptoms of a ventricular septal defect?
Failure to thrive (if VSD is large), dyspnoea, sweaty
89
What are the signs of a ventricular septal defect?
Pansystolic murmur along the lower left sternal border, tachycardia, palpable thrill. Parasternal heave and a displaced apex beat if the VSD is large
90
What tests are used to diagnose a ventricular septal defect?
Cardiac auscultation Echo Cardiac catheterisation to measure pressures
91
What is the treatment for a ventricular septal defect?
Monitor - most cases heal within the first years of life | Surgery - transcatheter closure, open surgery
92
What complication can arise from a ventricular septal defect?
Eisenmenger's syndrome
93
What is Eisenmenger's syndrome?
The process in which a long standing left to right shunt causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic right to left shunt
94
What are some causes of an atrial septal defect?
Down's syndrome, foetal alcohol syndrome, Ebstein's anomaly, patent foramen ovale
95
What is the pathophysiology involved in an atrial septal defect?
There is a left to right shunt which can increase pulmonary blood flow and therefore cause pulmonary hypertension
96
What are the symptoms of an atrial septal defect?
Dyspnoea, chest pain
97
What are the signs of an atrial septal defect?
AF, raised JVP, wide fixed split S2
98
What tests are used to diagnose an atrial septal defect?
Significant ASDs can be detected using in utero USS Auscultation Echo - diagnostic CXR - large heart, dilated pulmonary vasculature ECG - AF
99
What are the complications of an atrial septal defect?
Pulmonary hypertension and Eisenmenger's syndrome
100
What is the treatment of an atrial septal defect?
Monitoring/conservative management if the ASD is asymptomatic Closure - surgical closure or percutaneous closure
101
What are the causes of Tetralogy of Fallot?
Unknown, it is thought to be due to environmental factors, genetic factors or both
102
What is the pathophysiology involved in Tetralogy of Fallot?
Pulmonary infundibular stenosis, overriding aorta, ventricular septal defect and right ventricular hypertrophy. Thought to be due to unequal growth of the aorticopulmonary septum causing an overriding aorta. This causes stenosis of the pulmonary artery resulting in hypertrophy of the RV.
103
What are the symptoms of Tetralogy of Fallot?
Dyspnoea on exertion, failure to gain weight, retarded growth and physical development, syncope, difficulty feeding
104
What are the signs of Tetralogy of Fallot?
Cyanosis, finger and toe clubbing, heart murmur, polycythaemia
105
What tests are used to diagnose Tetralogy of Fallot?
Auscultation - murmur CXR - boot shaped heart ECG - RBBB, RV hypertrophy Echo - diagnostic
106
What is the treatment of Tetralogy of Fallot?
Surgical repair of the defects
107
What are the four right to left heart shunts?
``` 4 T's: Truncus arteriosus Transposition of great vessels Tricuspid atresia Tetralogy of Fallot ```
108
What are the left to right heart shunts?
Ventricular septal defect Atrial septal defect Patent ductus arteriosus
109
What tests can be used to diagnose structural heart defects?
CXR, echo, ECG, auscultation
110
What are some causes of pericarditis?
Infectious - viral (enterovirus, herpes virus, adenovirus), bacterial (M. tuberculosis) Autoimmune - Sjogren's syndrome, rheumatoid arthritis Neoplastic Metabolic - uraemic Traumatic
111
What is the pathophysiology of pericarditis?
Inflammation of the pericardium, with or without effusion
112
What are the symptoms of pericarditis?
Sudden onset chest pain, fever, weakness, palpitation, dyspnoea, cough, hiccups
113
What are the signs of pericarditis?
Pericardial rub, positional chest pain, sweating, signs of effusion - pulsus parodoxus
114
What tests are used to diagnose pericarditis?
Clinical examination ECG - PR depression in all territories, diffuse ST elevation, concave ST segment Bloods: FBC, EXR & CRP (high ESR might suggest aetiology), ANA (young females - ?SLE), troponins CXR - rule out effusion (>300ml) Echo
115
What is the treatment for pericarditis?
Sedentary activity until resolution of symptoms, monitor with ECG and CRP Treat with NSAIDs Colchicine reduces the rate of recurrence
116
What are some causes of hypertension?
Primary - high salt diet, obesity, lack of exercise, increase in age, insulin resistance Secondary - kidney disease, Cushing's syndrome, hyperthyroidism, hypothyroidism, pheochromocytoma, hyperaldosteronism, renal artery stenosis
117
What is the pathophysiology involved in hypertension?
Cardiac output and peripheral resistance are two determinants of arterial pressure CO = SV x HR Peripheral resistance is determined by functional and anatomic changes in small arteries and arterioles e.g. atherosclerosis
118
Which group does hypertension affect more?
Men
119
What are the symptoms of hypertension?
Usually it is asymptomatic but they can be headaches, lightheadedness, vertigo and tinnitus
120
What are some signs of hypertension?
Changes in the optic fundus seen on opthalmoscopy | Signs for a cause of secondary hypertension e.g. moon face in Cushing's or weight loss in hyperthyroidism
121
How is hypertension diagnosed?
3 separate high BP readings >140/90 or >135/85 if at home Ambulatory monitoring to confirm diagnosis Bloods to check for other causes and organ damage
122
What are some causes of atrial fibrillation?
``` Ischaemic heart disease Hypertension Pulmonary embolism Hyperthyroidism Mitral valve disease ```
123
What is the pathophysiology involved in atrial fibrillation?
The AV node is bombarded with depolarisation waves of varying strength and it only conducts in an "all or nothing" fashion
124
What is the epidemiology of atrial fibrillation?
It is the most common arrhythmia
125
What are the symptoms of atrial fibrillation?
Palpitations, anginal chest pain, dyspnoea, orthopnoea, dizziness, paroxysmal nocturnal dyspnoea, light headedness
126
What are the signs of atrial fibrillation?
An irregular pulse
127
What tests are used to diagnose atrial fibrillation?
ECG - absence of p waves with disorganised electrical activity in their place, irregular R-R intervals Echo - identifies valvular heart disease, size and function of the chambers of the heart
128
What is the treatment for atrial fibrillation?
Rate control: beta-blockers, calcium channel blockers, digoxin Restore sinus rhythm: electrical cardioversion, pharmacological cardioversion (amiodarone, flecainide) Anticoagulation - Warfarin
129
What is a complication of atrial fibrillation?
A cerebro-vascular event
130
Which scoring system predicts the possibility of a cerebrovascular event?
CHAD-VASC score
131
What are some causes of atrial flutter?
Idiopathic Ischaemic heart disease Atrial depletion (septal defect, PE, mitral/tricuspid disease)
132
What is the pathophysiology involved in atrial flutter?
It is a type of supraventricular tachycardia caused by a re-entrant loop circuit within the right atrium
133
What are the symptoms of atrial flutter?
Palpitations, dyspnoea, chest pain, dizziness, nausea, nervousness
134
What are some signs of atrial flutter?
Oedema of the legs or abdomen
135
What tests are used to diagnose atrial flutter?
ECG - regular atrial rate of 20-400 bpm (depends on the size of the RA), sawtooth pattern best seen in II, III and VF, narrow complex QRS. The ventricular rate is determined by the AV conduction ratio (2:1 is the commonest)
136
What is the treatment of atrial flutter?
Rate control: beta-blockers, calcium channel blockers, digoxin Restore sinus rhythm: electrical cardioversion, pharmacological cardioversion (amiodarone, flecainide) Anticoagulation - Warfarin
137
What is a complication of atrial flutter?
A cerebrovascular event
138
What are some causes of an aortic aneurysm?
Atherosclerosis Infection e.g. Syphilis Trauma Genetic diseases e.g. Marfan's or Ehlers-Danlos
139
What is the pathophysiology involved in an aortic aneurysm?
A weakness in the arterial wall causes it to expand over time as the blood is under such high pressure within the aorta
140
What is the epidemiology of aortic aneurysms?
Men > women Incidence increases with age AAA is the most common Infrarenal AAA is the most common AAA location
141
What are the symptoms of an aortic aneurysm?
Most are asymptomatic but rapid expansion or rupture can cause severe epigastric pain that radiates to the back
142
What are the signs of an aortic aneurysm?
A pulsatile, expansile mass (in the abdomen)
143
What tests are used to diagnose an aortic aneurysm?
USS abdomen/thorax CT abdomen/thorax Angiography - MRI or CT Bloods - FBC, U&Es, CRP, group and save
144
What is the treatment for an aortic aneurysm?
Watch and wait with lipid and BP control | Surgical repair - EVAR, open repair with a Dacron or Gore-Tex graft
145
What are some causes of an aortic dissection?
``` Hypertension Connective tissue disorders Marfan's syndrome Cardiac surgery Chest trauma Infection e.g. syphilis ```
146
What is the pathophysiology involved in aortic dissection?
Blood penetrates the intima and enters the media layer, the high pressure rips the tissue of the media apart along the laminated plane
147
What is the epidemiology of aortic dissection?
Men > women | Mean age is 63
148
What are the symptoms of an aortic dissection?
Severe pain - location of the pain is the location of the dissection, radiating to the back Syncope Neurological symptoms (secondary to lack of blood supply to the spine
149
What are the signs of an aortic dissection?
Hypotension, shock, murmur - aortic insufficiency, MI, pleural effusion
150
What tests are used to diagnose an aortic dissection?
Bloods: FBC, U&E, cardiac enzymes, D-dimer, group and save CT - tennis ball sign (visualisation of the intimal flap) CXR - wide mediastinum in ascending aortic dissection MRI TOE
151
What is the treatment of an aortic dissection?
Medical management - strict BP control (beta-blockers, calcium channel blockers) Surgery
152
What are some causes of critical limb ischaemia?
Smoking, DM, hypertension, hyperlipidaemia, physical inactivity
153
What is the pathophysiology involved in critical limb ischaemia?
The blood supply to the limb is barely adequate to allow basal metabolism so there is no reserve available for increased demand such as exercise
154
What is the epidemiology of critical limb ischaemia?
Men > women | Incidence increases with age
155
What are the symptoms of critical limb ischaemia?
Pain at rest, ulceration of the limb, gangrene of the limb, pain at night relieved by hanging the foot over the edge of the bed
156
What are the signs of critical limb ischaemia?
Cold limbs, dry skin on the limb, lack of hair, pulses diminished or absent
157
What tests are used to diagnose critical limb ischaemia?
Ankle/brachial pressure index (ABPI) Doppler CT angiography or MRI angiography History and examination
158
What is the treatment for critical limb ischaemia?
Risk factor modification: smoking cessation; control of hypertension, hyperlipidaemia and diabetes; antiplatelet therapy, exercise and weight reduction Revascularisation - stent, balloon angioplasty, carotid endarterectomy Amputation if the tissue has died
159
What are some causes of intermittent claudication?
Smoking, DM, hypertension, hyperlipidaemia, physical inactivity
160
What is the pathophysiology involved in intermittent claudication?
Moderate ischaemia. | The cells undergo anaerobic metabolism when oxygen demand exceeds supply and lactic acid is formed, resulting in pain
161
What is the epidemiology of intermittent claudication?
Men > women | Incidence increases with age
162
What are the symptoms of intermittent claudication?
Pain on exertion (distal to the site of atheroma), resolves on resting
163
What are the signs of intermittent claudication?
``` Cyanosis, atrophic changes e.g. shiny skin, lack of hair, All the P's: Pallor increase Pulse decreased Perishing cold Pain Paraesthesia Paralysis ```
164
What tests are used to diagnose intermittent claudication?
History and examination Bloods: FBC, U&Es, lipid profile, glucose USS doppler of the limb MR angiography
165
What is the treatment for intermittent claudication?
Risk factor modification: smoking cessation; control of hypertension, hyperlipidaemia and diabetes; antiplatelet therapy, exercise and weight reduction Revascularisation - stent, balloon angioplasty

Phase 2A (11 decks)

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