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Phase 2A > Cardiology > Flashcards

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
Q

What BP is stage 2 hypertension?

A

160/100 in clinic

150/95 at home or ambulatory

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26
Q

What BP is severe hypertension?

A

180/110 - NEEDS TREATING ASAP!!

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27
Q

At what point do you treat hypertension?

A

Stage 2 or 3

Stage 1 if the patient has DM, kidney disease

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28
Q

What is the management of hypertension?

A

> 55 or not caucasian? Calcium channel blocker
<55 and caucasian? ACEi/ARB
Then combination treatments
Then add a thiazide diuretic

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29
Q

What compensatory changes are seen in heart failure?

A 
Ventricular dilatation
Myocyte hypertrophy
Increased collagen synthesis
Salt and water retention
Peripheral vasoconstriction
Increased sympathetic stimulation
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30
Q

What are the symptoms of heart failure?

A 
Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue
Cold peripheries
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31
Q

What are the signs of heart failure?

A 
Cardiomegaly
Added heart sounds and murmurs
Elevated JVP
Tachycardia
Hypotension
Bibasal crackles
Ascites
Oedema - peripheral and sacral
Displaced apex beat
Hepatomegaly
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32
Q

What is the management for heart failure?

A 
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

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33
Q

What is shock?

A

Failure of the circulatory system to maintain an adequate organ perfusion

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34
Q

What are the causes of shock?

A 
Haemorrhagic
Anaphylaxis
Septic
Cardiogenic
Hypovolaemic
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35
Q

What is the management of anaphylaxis?

A

ABCDE
Oxygen
Adrenaline
Anti-histamines

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36
Q

What is the management for septic shock?

A 
Sepsis six:
Blood cultures
Urine output
Fluids
Antibiotics IV
Lactate
Oxygen
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37
Q

In an acute MI, which drug should you give for thrombolysis?

A

Streptokinase

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38
Q

What is the downside to streptokinase?

A

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.

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39
Q

What are the clinical features of infective endocarditis?

A 
Fever
Splinter haemorrhages
Janeway lesions
Osler's nodes
Roth spots
New murmur
Malaise
Symptoms of septic emboli e.g. stroke, PE, pneumonia
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40
Q

What investigations would you do for infective endocarditis?

A

Echo
CXR
Blood cultures

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41
Q

What is Duke’s criteria?

A

The diagnostic criteria for infective endocarditis

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42
Q

What are the signs for MI?

A

Levigne’s sign, loss of consciousness, pallor, clammy

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43
Q

What are the diagnostic tests for MI?

A

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

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44
Q

What is unstable angina?

A

An acute coronary syndrome - angina symptoms that come on at rest

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45
Q

What are the complications of an MI?

A

Heart failure, myocardial rupture and aneurysmal dilatation, ventricular septal defect, mitral regurgitation, arrhythmias, conduction disturbances, post-MI pericarditis

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46
Q

What tests would you do to diagnose heart failure?

A

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

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47
Q

What are the causes of mitral stenosis?

A

Rheumatic heart disease
Congenital
Calcification
Infective endocarditis

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48
Q

What is the pathophysiology involved in mitral stenosis?

A

Obstruction of LV inflow prevents proper filling during diastole, LA pressure increases and LA hypertrophy and dilatation occur

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49
Q

What are the symptoms of mitral stenosis?

A

Severe dyspnoea, pink frothy sputum, haemoptysis, palpitations

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50
Q

What are the signs of mitral stenosis?

A

Mitral facies - ducky pink discolouration of the cheeks
Atrial fibrillation
Prominent “a” wave in jugular pulsations
HEART SOUNDS: loud S1, loud P2, opening snap

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51
Q

What murmur does mitral stenosis have?

A

Mid-diastolic rumble at the apex

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52
Q

What is the pathophysiology involved in mitral regurgitation?

A

LA dilatation, LV hypertrophy and increased contractility

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53
Q

What are the signs of mitral regurgitation?

A

Laterally displaced diffuse apex beat
Systolic thrill
HEART SOUNDS: soft S1, prominent third heart sound

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54
Q

What investigations should be performed to confirm mitral regurgitation?

A

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

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55
Q

What is the management of mitral regurgitation?

A

Medical: ACE inhibitors, rate control for AF, anticoagulation for AF, diuretics, serial echos, prophylaxis for infective endocarditis
Surgery: Mitral valve replacement or repair

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56
Q

What are the causes of aortic stenosis?

A

Congenital - aortic stenosis or a bicuspid valve

Acquired - degenerative calcification, rheumatic heart disease

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57
Q

What is the pathophysiology involved in aortic stenosis?

A

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

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58
Q

What are the signs of aortic stenosis?

A

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

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59
Q

What tests are used to diagnose aortic stenosis?

A

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

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60
Q

What is the treatment for aortic stenosis?

A

Surgical replacement - TAVI (transcatheter aortic valve implantation), valvotomy
?Prophylaxis for infective endocarditis

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61
Q

What are the causes of aortic regurgitation?

A

Rheumatic heart disease, infective endocarditis, severe hypertension and a bicuspid valve

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62
Q

What is the pathophysiology involved in aortic regurgitation?

A

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

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63
Q

What are the symptoms of aortic regurgitation?

A

Angina, dyspnoea, orthopnoea, palpitations

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64
Q

What are the signs of aortic regurgitation?

A

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

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65
Q

What tests are used to diagnose aortic regurgitation?

A

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

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66
Q

What is the treatment for aortic regurgitation?

A

Medical: Consider IE prophylaxis
Vasodilators (e.g. ACE inhibitors)
Surgery: aortic valve replacement

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67
Q

What is the aetiology of infective endocarditis?

A

Bacteraemia and abnormal cardiac endothelium result in infective endocarditis.
Bacteraemia normally occurs from poor dental hygiene, IVDUs and soft tissue infections

68
Q

What are some common organisms that cause infective endocarditis?

A

Streptococcus viridans - prosthetic valves, dental disease
Staphylococcus aureus - IVDUs, prolonged vascular access e.g. central lines, valve surgery
Staphylococcus epidermidis - IVDUs, valve surgery

69
Q

What are the symptoms of infective endocarditis?

A

Fever, malaise, night sweats, rigors, joint pain

70
Q

What are the signs of infective endocarditis?

A 
Finger clubbing
Cardiac murmurs
Skin lesions - Osler's nodes, splinter haemorrhages, Janeway lesions, petechiae
Roth's spots - seen on the retina
Septic emboli
71
Q

What are the diagnostic tests for infective endocarditis?

A

Duke’s criteria
Blood cultures (3 separate sets from different sites)
ECG
CXR
Echo - visualisation of vegetations on valve leafllets

72
Q

What is the treatment for infective endocarditis?

A

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
Q

What are some causes of hypertrophic cardiomyopathy?

A

Aortic stenosis, hypertension, mutations in sarcomeric proteins

74
Q

What is the pathophysiology of hypertrophic cardiomyopathy?

A

The heart hypertrophies to try and improve contractility and force; this can be due to stenosis or mutated proteins

75
Q

What are the symptoms of hypertrophic cardiomyopathy?

A

Chest pain, dyspnoea, syncope or pre-syncope, cardiac arrhythmias, sudden death

76
Q

What are the signs of hypertrophic cardiomyopathy?

A 
Double apical pulsation
Jerky carotid pulse
Ejection systolic murmur
Pan-systolic murmur (due to mitral regurgitation)
4th heart sound
77
Q

What tests are used to diagnose hypertrophic cardiomyopathy?

A

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
Q

What is the treatment for hypertrophic cardiomyopathy?

A

Prevention of sudden cardiac death e.g. ICD

Surgery - septal myectomy, cardiac transplant

79
Q

What are some causes of dilated cardiomyopathy?

A

Mutations in proteins such as dystrophin, myocarditis, autoimmune disorders, endocrine disorders, neuromuscular diseases, toxins e.g. alcohol or chemotherapy

80
Q

What is the pathophysiology of dilated cardiomyopathy?

A

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
Q

What are the symptoms of dilated cardiomyopathy?

A

Dyspnoea, syncope and angina

82
Q

What are the signs of dilated cardiomyopathy?

A

Pulmonary oedema, elevated JVP, low pulse pressure, arrhythmias, conduction defects

83
Q

What tests are used to diagnose dilated cardiomyopathy?

A

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
Q

What is the treatment for dilated cardiomyopathy?

A

Conventional management of heart failure
Cardiac resynchronisation therapy
ICDs
Surgery - transplantation

85
Q

What are the causes of a ventricular septal defect?

A

Post-MI

Congenital - incomplete looping of the heart during days 24-28 of development

86
Q

What is the pathophysiology involved in ventricular septal defects?

A

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
Q

What is the epidemiology of a ventricular septal defect?

A

30-60% of newborns with a congenital heart defect

Frequently associated with other congenital conditions e.g. Down’s syndrome

88
Q

What are the symptoms of a ventricular septal defect?

A

Failure to thrive (if VSD is large), dyspnoea, sweaty

89
Q

What are the signs of a ventricular septal defect?

A

Pansystolic murmur along the lower left sternal border, tachycardia, palpable thrill. Parasternal heave and a displaced apex beat if the VSD is large

90
Q

What tests are used to diagnose a ventricular septal defect?

A

Cardiac auscultation
Echo
Cardiac catheterisation to measure pressures

91
Q

What is the treatment for a ventricular septal defect?

A

Monitor - most cases heal within the first years of life

Surgery - transcatheter closure, open surgery

92
Q

What complication can arise from a ventricular septal defect?

A

Eisenmenger’s syndrome

93
Q

What is Eisenmenger’s syndrome?

A

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
Q

What are some causes of an atrial septal defect?

A

Down’s syndrome, foetal alcohol syndrome, Ebstein’s anomaly, patent foramen ovale

95
Q

What is the pathophysiology involved in an atrial septal defect?

A

There is a left to right shunt which can increase pulmonary blood flow and therefore cause pulmonary hypertension

96
Q

What are the symptoms of an atrial septal defect?

A

Dyspnoea, chest pain

97
Q

What are the signs of an atrial septal defect?

A

AF, raised JVP, wide fixed split S2

98
Q

What tests are used to diagnose an atrial septal defect?

A

Significant ASDs can be detected using in utero USS
Auscultation
Echo - diagnostic
CXR - large heart, dilated pulmonary vasculature
ECG - AF

99
Q

What are the complications of an atrial septal defect?

A

Pulmonary hypertension and Eisenmenger’s syndrome

100
Q

What is the treatment of an atrial septal defect?

A

Monitoring/conservative management if the ASD is asymptomatic
Closure - surgical closure or percutaneous closure

101
Q

What are the causes of Tetralogy of Fallot?

A

Unknown, it is thought to be due to environmental factors, genetic factors or both

102
Q

What is the pathophysiology involved in Tetralogy of Fallot?

A

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
Q

What are the symptoms of Tetralogy of Fallot?

A

Dyspnoea on exertion, failure to gain weight, retarded growth and physical development, syncope, difficulty feeding

104
Q

What are the signs of Tetralogy of Fallot?

A

Cyanosis, finger and toe clubbing, heart murmur, polycythaemia

105
Q

What tests are used to diagnose Tetralogy of Fallot?

A

Auscultation - murmur
CXR - boot shaped heart
ECG - RBBB, RV hypertrophy
Echo - diagnostic

106
Q

What is the treatment of Tetralogy of Fallot?

A

Surgical repair of the defects

107
Q

What are the four right to left heart shunts?

A 
4 T's:
Truncus arteriosus
Transposition of great vessels
Tricuspid atresia
Tetralogy of Fallot
108
Q

What are the left to right heart shunts?

A

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus

109
Q

What tests can be used to diagnose structural heart defects?

A

CXR, echo, ECG, auscultation

110
Q

What are some causes of pericarditis?

A

Infectious - viral (enterovirus, herpes virus, adenovirus), bacterial (M. tuberculosis)
Autoimmune - Sjogren’s syndrome, rheumatoid arthritis
Neoplastic
Metabolic - uraemic
Traumatic

111
Q

What is the pathophysiology of pericarditis?

A

Inflammation of the pericardium, with or without effusion

112
Q

What are the symptoms of pericarditis?

A

Sudden onset chest pain, fever, weakness, palpitation, dyspnoea, cough, hiccups

113
Q

What are the signs of pericarditis?

A

Pericardial rub, positional chest pain, sweating, signs of effusion - pulsus parodoxus

114
Q

What tests are used to diagnose pericarditis?

A

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
Q

What is the treatment for pericarditis?

A

Sedentary activity until resolution of symptoms, monitor with ECG and CRP
Treat with NSAIDs
Colchicine reduces the rate of recurrence

116
Q

What are some causes of hypertension?

A

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
Q

What is the pathophysiology involved in hypertension?

A

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
Q

Which group does hypertension affect more?

A

Men

119
Q

What are the symptoms of hypertension?

A

Usually it is asymptomatic but they can be headaches, lightheadedness, vertigo and tinnitus

120
Q

What are some signs of hypertension?

A

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
Q

How is hypertension diagnosed?

A

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
Q

What are some causes of atrial fibrillation?

A 
Ischaemic heart disease
Hypertension
Pulmonary embolism
Hyperthyroidism
Mitral valve disease
123
Q

What is the pathophysiology involved in atrial fibrillation?

A

The AV node is bombarded with depolarisation waves of varying strength and it only conducts in an “all or nothing” fashion

124
Q

What is the epidemiology of atrial fibrillation?

A

It is the most common arrhythmia

125
Q

What are the symptoms of atrial fibrillation?

A

Palpitations, anginal chest pain, dyspnoea, orthopnoea, dizziness, paroxysmal nocturnal dyspnoea, light headedness

126
Q

What are the signs of atrial fibrillation?

A

An irregular pulse

127
Q

What tests are used to diagnose atrial fibrillation?

A

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
Q

What is the treatment for atrial fibrillation?

A

Rate control: beta-blockers, calcium channel blockers, digoxin
Restore sinus rhythm: electrical cardioversion, pharmacological cardioversion (amiodarone, flecainide)
Anticoagulation - Warfarin

129
Q

What is a complication of atrial fibrillation?

A

A cerebro-vascular event

130
Q

Which scoring system predicts the possibility of a cerebrovascular event?

A

CHAD-VASC score

131
Q

What are some causes of atrial flutter?

A

Idiopathic
Ischaemic heart disease
Atrial depletion (septal defect, PE, mitral/tricuspid disease)

132
Q

What is the pathophysiology involved in atrial flutter?

A

It is a type of supraventricular tachycardia caused by a re-entrant loop circuit within the right atrium

133
Q

What are the symptoms of atrial flutter?

A

Palpitations, dyspnoea, chest pain, dizziness, nausea, nervousness

134
Q

What are some signs of atrial flutter?

A

Oedema of the legs or abdomen

135
Q

What tests are used to diagnose atrial flutter?

A

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
Q

What is the treatment of atrial flutter?

A

Rate control: beta-blockers, calcium channel blockers, digoxin
Restore sinus rhythm: electrical cardioversion, pharmacological cardioversion (amiodarone, flecainide)
Anticoagulation - Warfarin

137
Q

What is a complication of atrial flutter?

A

A cerebrovascular event

138
Q

What are some causes of an aortic aneurysm?

A

Atherosclerosis
Infection e.g. Syphilis
Trauma
Genetic diseases e.g. Marfan’s or Ehlers-Danlos

139
Q

What is the pathophysiology involved in an aortic aneurysm?

A

A weakness in the arterial wall causes it to expand over time as the blood is under such high pressure within the aorta

140
Q

What is the epidemiology of aortic aneurysms?

A

Men > women
Incidence increases with age
AAA is the most common
Infrarenal AAA is the most common AAA location

141
Q

What are the symptoms of an aortic aneurysm?

A

Most are asymptomatic but rapid expansion or rupture can cause severe epigastric pain that radiates to the back

142
Q

What are the signs of an aortic aneurysm?

A

A pulsatile, expansile mass (in the abdomen)

143
Q

What tests are used to diagnose an aortic aneurysm?

A

USS abdomen/thorax
CT abdomen/thorax
Angiography - MRI or CT
Bloods - FBC, U&Es, CRP, group and save

144
Q

What is the treatment for an aortic aneurysm?

A

Watch and wait with lipid and BP control

Surgical repair - EVAR, open repair with a Dacron or Gore-Tex graft

145
Q

What are some causes of an aortic dissection?

A 
Hypertension
Connective tissue disorders
Marfan's syndrome
Cardiac surgery
Chest trauma
Infection e.g. syphilis
146
Q

What is the pathophysiology involved in aortic dissection?

A

Blood penetrates the intima and enters the media layer, the high pressure rips the tissue of the media apart along the laminated plane

147
Q

What is the epidemiology of aortic dissection?

A

Men > women

Mean age is 63

148
Q

What are the symptoms of an aortic dissection?

A

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
Q

What are the signs of an aortic dissection?

A

Hypotension, shock, murmur - aortic insufficiency, MI, pleural effusion

150
Q

What tests are used to diagnose an aortic dissection?

A

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
Q

What is the treatment of an aortic dissection?

A

Medical management - strict BP control (beta-blockers, calcium channel blockers)
Surgery

152
Q

What are some causes of critical limb ischaemia?

A

Smoking, DM, hypertension, hyperlipidaemia, physical inactivity

153
Q

What is the pathophysiology involved in critical limb ischaemia?

A

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
Q

What is the epidemiology of critical limb ischaemia?

A

Men > women

Incidence increases with age

155
Q

What are the symptoms of critical limb ischaemia?

A

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
Q

What are the signs of critical limb ischaemia?

A

Cold limbs, dry skin on the limb, lack of hair, pulses diminished or absent

157
Q

What tests are used to diagnose critical limb ischaemia?

A

Ankle/brachial pressure index (ABPI)
Doppler
CT angiography or MRI angiography
History and examination

158
Q

What is the treatment for critical limb ischaemia?

A

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
Q

What are some causes of intermittent claudication?

A

Smoking, DM, hypertension, hyperlipidaemia, physical inactivity

160
Q

What is the pathophysiology involved in intermittent claudication?

A

Moderate ischaemia.

The cells undergo anaerobic metabolism when oxygen demand exceeds supply and lactic acid is formed, resulting in pain

161
Q

What is the epidemiology of intermittent claudication?

A

Men > women

Incidence increases with age

162
Q

What are the symptoms of intermittent claudication?

A

Pain on exertion (distal to the site of atheroma), resolves on resting

163
Q

What are the signs of intermittent claudication?

A 
Cyanosis, atrophic changes e.g. shiny skin, lack of hair, 
All the P's:
Pallor increase
Pulse decreased
Perishing cold
Pain
Paraesthesia
Paralysis
164
Q

What tests are used to diagnose intermittent claudication?

A

History and examination
Bloods: FBC, U&Es, lipid profile, glucose
USS doppler of the limb
MR angiography

165
Q

What is the treatment for intermittent claudication?

A

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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