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Phase 2a > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Name 3 complications of hypertension

A
  • Aneursym
  • Vascular disease
  • Heart Disease
  • kidney failure
  • respiratory failure
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2
Q

Name three causes that could contribute to primary hypertension

A
  • genetic susceptibility
  • excessive sympathetic nervous system activity
  • abnormalities of Na/K membrane transport
  • high salt intake
    Abnormalities of RAAS
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3
Q

Name four causes of secondary hypertension.

A

C - coarctation of the aorta (narrowing)
R - renal disease and hypertension (chronic kidney disease, renal artery stenosis, glomerulonephritis)
E - endocrine causes (adrenal tumour, Cushing’s syndrome)
E - eclampsia (during pregnancy)
E - essential (primary - cause unknown)
P - pill (or other drugs eg. steroids, cocaine, amphetamines)

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4
Q

What clinical blood pressure requires acting upon?

A

> 140/90

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5
Q

At what clinical BP should anti-hypertensives be given immediately?

A

> 180/110

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6
Q

What is the name of the condition where BP is higher in clinical setting?

A

White coat hypertension

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7
Q

What actions should be carried out when a patient has clinical BP > 140/90?

A

Offer ambulatory BP monitoring (ABPM) and calculate risk of end organ damage

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8
Q

What actions should be carried out when a patient has clinical BP > 180/110?

A

Consider immediate anti-hypertensive drugs and referral. Offer Ambulatory BP monitoring and calculate risk of end organ damage.

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9
Q

Patient has ABPM of > 135/85 and end organ damage

A

Give anti-hypertensive

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10
Q

Patient has ABPM of > 150/95 but no end organ damage

A

Give anti-hypertensive

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11
Q

Patient has ABPM of > 135/85 but no end organ damage

A

Normotensive

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12
Q

Tests relating to hypertension

A
  • Ambulatory blood pressure monitoring or home BP
  • ECG or echo
  • Urinalysis
  • Eye exam
  • Fasting glucose
  • Serum cholesterol
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13
Q

Why would you do an ECG or echo on a patient with hypertension?

A

To detect left ventricular hypertrophy

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14
Q

Why would you do urinalysis on a patient with hypertension?

A

To detect proteinuria

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15
Q

Why would you do an eye exam on a patient with hypertension?

A

To detect retinopathy

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16
Q

What should be the goal BP in a patient with hypertension?

A

< 140/90 (or < 130/80 in diabetes)

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17
Q

Name three lifestyle changes for a patient with hypertension

A
  • stop smoking
  • low-fat diet
  • reduce alcohol intake
  • reduce salt intake
  • increase exercise
  • reduce weight (if overweight)
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18
Q

1st line drug for a white patient with hypertension aged under 55?

A

ACE-i (or ARB if not tolerant to ACE-i)

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19
Q

1st line drug for black patient with hypertension?

A

Calcium channel blocker OR Thiazide

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20
Q

1st line drug for white patient with hypertension aged over 55?

A

Calcium channel blocker OR Thiazide

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21
Q

Combination drug therapy for hypertension?

A
  • ACE-i AND calcium channel blocker OR diuretic.
  • ACE-i AND calcium channel blocker AND thiazide
  • Add spirolactone or high-dose thiazide. Check U+Es.
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22
Q

What is malignant hypertension?

A

A rapid rise in BP that leads to vascular damage

23
Q

What are the signs and symptoms of malignant hypertension?

A

Symptoms: headache, visual disturbance
Signs: severe hypertension (usually > 200/130), bilateral haemorrhages.

24
Q

Name 4 risk factors for atherosclerosis

A
  • age
  • smoking
  • high serum cholesterol
  • obesity
  • diabetes
  • hypertension
  • family history
25
Q

Describe the mechanism of atherosclerosis

A
  • initiated by injury to endothelium.
  • LDL passes into the cells, causing endothelial dysfunction
  • chemoattractants are released from the site of inflammation
  • Leukocytes accumulate and transmigrate into the vessel wall, leading to inflammation
  • these are fatty streaks (lipid laden macrophages, T cells)
  • progress to intermediate lesions (plus vascular smooth muscle, platelets, extracellular lipid)
  • progress to fibrous plaque which impede blood flow and are prone to rupture
  • rupture exposes collagen and necrotic material forms a thrombus
26
Q

What is the definition of ischaemic heart disease?

A

imbalance between oxygen supply and demand in the myocardium

27
Q

Causes of oxygen imbalance in ischaemic heart disease

A
  • blood supply is impaired
  • myocardium has greater demand for blood supply
  • there is increased distal resistance
  • reduced oxygen-carrying capacity of blood
28
Q

What is the most common cause of ischaemic heart disease?

A

Coronary atherosclerotic plaque that causes impairment of blood flow. Vessel diameter has to reduce by 75% before symptoms occur.

29
Q

What percentage does a vessel have to be reduced by to cause symptoms in Ischaemic heart disease?

A

75%

30
Q

What are the effects of ischaemia on the myocardium?

A
  • reduced contractility

- damage the myocardial cells

31
Q

What are the three features a patient has to have to be classed as typical angina?

A
  • chest pain and discomfort (typically heavy central that can radiate up the arms, jaw and neck)
  • symptoms brought on by exertion
  • symptoms relieved by 5mins rest or using GTN spray
32
Q

What is decubitus angina?

A

Angina that is precipitated by lying flat.

33
Q

What is the difference between stable and unstable angina?

A

stable angina - induced by effort relieved by rest, good prognosis
unstable angina - increasing frequency or severity, occurs on minimal exertion or at rest, increased risk of MI

34
Q

What is variant angina?

A

Angina caused by coronary artery spasm, can occur in normal arteries

35
Q

What tests would you do to assess someone with query angina?

A

ECG - usually normal, may show signs of past MI
Examination - usually normal
Blood tests - FBC, U+Es, lipids, HbA1c, thyroid function tests
Consider Chest X-ray and echo

36
Q

What secondary prevention measures should be used in patients with ACS?

A
  • stop smoking
  • 75mg aspirin daily
  • address hyperlipidaemia
  • consider ACE-i
37
Q

What is PRN symptom relief?

A

Pro re nata. When necessary symptom relief. e.g. GTN spray

38
Q

Anti-anginal drugs?

A

1st line: B-blocker or Ca channel blocker

Other drugs: long-acting nitrates, ivabradine, ranolazine, nicorandil

39
Q

What revascularisation should be given to patients with Ishcaemic heart disease?

A
  • Percutaneous coronary intervention (PCI)

- Coronary Artery Bypass Graft (CABG)

40
Q

What are the main management steps for patients with ischaemic heart disease?

A
  • address exacerbating factors eg anaemia
  • secondary prevention
  • PRN symptom relief
  • Anti-anginal drugs
  • revascularisation
41
Q

What is Acute Coronary Syndromes?

A

Unstable angina and myocardial infarctions. They share a common pathology of plaque rupture, thrombosis and inflammation.

42
Q

Name 5 risk factors for ACS

A

Non-modifiable - age, gender, family history
Modifiable - smoking, hypertension, diabetes mellitus, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use
Controversial - stress, type A personality, left ventricular hypertrophy, increased fibrinogen, hyperinsulinaemia

43
Q

What are the symptoms of ACS?

A

Acute central chest pain lasting >20 mins, often associated with nausea, sweatiness, dyspnoea, palpitations
Can have MI that is silent.

44
Q

Name 4 signs of ACS?

A
  • distress
  • anxiety
  • pallor
  • sweatiness
  • pulse change
  • blood pressure change
  • 4th heart sound
  • signs of heart failure
45
Q

What tests should be done on a patient to confirm ACS?

A
  • ECG - STEMI or NSTEMI
  • chest X-ray
  • Blood tests - FBC, U+Es, glucose, lipids, cardiac enzymes
  • Echo - regional wall abnormalities
46
Q

What is the urgent non-hospital management for ACS (NSTEMI or STEMI)?

A

M - morphine
O - oxygen if sats <95% or breathless
A - aspirin 300mg immediately
N - nitrates (long-lasting)

47
Q

What is the urgent hospital management of ACS?

A
  • make diagnosis
  • bed rest
  • morphine
  • aspirin
  • oxygen therapy
  • restore coronary perfusion
  • anti-coagulation
  • B-blockers
48
Q

What is the non-urgent management for ACS?

A
  • symptom control
  • modify risk factors
  • optimise cardioprotective medications
  • revascularisation
  • manage complications
  • discharge
49
Q

Should a patient who drives a lorry go back to driving immediately after discharge?

A

No. They should not continue driving, but they may be able to start again after functional tests.

50
Q

What is the definition of heart failure?

A

When cardiac output is inadequate for the body’s requirements

51
Q

Name 4 causes of heart failure

A
  • Ischaemic heart disease
  • hypertension
  • alcohol excess
  • cardiomyopathy
  • valvular heart disease
  • endocardial or pericardial causes
52
Q

What are the two main types of heart failure?

A
  • Heart failure with reduced ejection fraction (systolic failure)
  • Heart failure with maintained ejection fraction (diastolic failure)
53
Q

Describe heart failure with reduced ejection fraction (systolic failure)

A

The ventricles do not contract normally, resulting in reduced cardiac output

54
Q

Describe heart failure with maintained ejection fraction (diastolic failure)

A

The ventricles do not relax and fill normally, resulting in increased filling pressures

Phase 2a (2 decks)

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