Cardiology Flashcards
1
Q
What is the aetiology of angina?
A
- mostly atheroma
- rare causes include anaemia, aortic stenosis, small vessel disease
2
Q
What is the pathophysiology of angina?
A
Atherosclerosis narrows the coronary arteries causing ischaemia which leads to pain
3
Q
What are the risk factors of angina?
A
- smoking
- hypertension
- diabetes mellitus
- obesity
- sedentary lifestyle
- age
- hypercholesteraemia
- family history (and genetic)
4
Q
What is the clinical presentation of angina?
A
- central chest tightness/ heaviness that may radiate, provoked by exertion, heavy meals of the cold (stops with rest/ GTN spray)
- dyspnoea, nausea, sweating, faintness
5
Q
What are the differential diagnoses of angina?
A
- pericarditis/ myocarditis
- pulmonary embolism
- chest infection
- aortic dissection
6
Q
How is angina diagnosed?
A
Exercise ECG
- often normal
- ST depression
- flat/ inverted T waves
- signs of a past MI
CT scan calcium scoring (more calcium = suggestive of angina)
7
Q
How is angina managed?
A
- modify risk factors
- medications: aspirin, BB, CCB, nitrates (GTN spray)
- surgical: PCI, CABG
8
Q
What is the aetiology of a STEMI?
A
Coronary artery disease
9
Q
What is the pathophysiology of a STEMI?
A
- complete occlusion of a major coronary artery previously affected by atherosclerosis, causing full thickness damage of heart muscle
- coronary plaque rupture resulting in thrombosis formation which occludes a coronary artery
10
Q
What are the risk factors of a STEMI?
A
- smoking
- hypertension
- diabetes
- obesity
11
Q
What is the clinical presentation of a STEMI?
A
- chest pain
- SOBOE
- pallor
- diaphoresis (unusual degree of sweating)
- dizziness
12
Q
What are the differential diagnoses of a STEMI?
A
- unstable angina
- NSTEMI
- aortic dissection
- pulmonary embolism
- pneumothorax
- pneumonia
- pericarditis
13
Q
How is a STEMI diagnosed?
A
- ECG (ST elevation, tall T waves, then pathological Q wave some time after → may also present as left bundle branch block)
- cardiac biomarkers (troponin)
- glucose
- electrolytes, urea, creatinine
14
Q
How is a STEMI managed?
A
- aspirin and P2Y12 inhibitors e.g. clopidogrel
- oxygen
- morphine
- GTN
- anticoagulation (unfractionated heparin)
- PCI/ CABG
15
Q
What is the aetiology of an NSTEMI?
A
- non-occlusive thrombus
- coronary embolism
- myocarditis
- pulmonary embolism
- aortic stenosis
16
Q
What is the pathophysiology of an NSTEMI?
A
- complete occlusion of a minor coronary artery or partial occlusion of a major coronary artery causes partial thickness damage of heart muscle
- oxygen demand of heart muscle can’t be met
17
Q
What is the clinical presentation of an NSTEMI?
A
- chest pain
- SOBOE
- weakness
- diaphoresis
- recent PCI/ CABG
18
Q
What are the differential diagnoses of an NSTEMI?
A
- aortic dissection
- pulmonary embolism
- peptic ulcer disease
- acute pericarditis
- oesophageal spasm
19
Q
How is an NSTEMI diagnosed?
A
- ECG (ST depression, T wave inversion)
- GTN trial
- cardiac troponin
20
Q
How is an NSTEMI managed?
A
- aspirin and P2Y12 inhibitors e.g. clopidogrel
- oxygen
- morphine
- GTN
- anticoagulation (unfractionated heparin)
- PCI/ CABG
21
Q
What is the aetiology of IHD?
A
Atheromatous plaque leading to obstruction of coronary blood flow
22
Q
What is the pathophysiology of IHD?
A
Imbalance between myocardial oxygen supply and demand
23
Q
What are the risk factors of IHD?
A
- advancing age
- tobacco smoking
- hypertension
- elevated LDL cholesterol
- obesity
- diabetes
- family history
24
Q
What is the clinical presentation of IHD?
A
- angina symptoms (chest pressure etc)
- jaw pain
- arm pain
- SOBOE
25
What are the differential diagnoses of IHD?
- aortic dissection
- pericarditis
- pulmonary embolism
- pneumothorax
- pneumonia
26
How is IHD diagnosed?
- resting ECG
- haemoglobin
- fasting lipid profile
- fasting blood glucose/ HbA1c
27
How is IHD managed?
- anti platelet therapy
- statins
- antihypertensives
- revascularisation
- GTN spray
28
What is the aetiology of heart failure?
IHD, hypertension, alcohol excess
Cardiomyopathy
- disease of heart muscles where the walls have become thickened, stiff or stretched
Valvular heart disease
- e.g. aortic stenosis, aortic and mitral regurgitation
Cor pulmonale
- abnormal enlargement of the right side of the heart as a result of disease of the lungs of the pulmonary blood vessels
Any factor that increases myocardial work
- e.g. anaemia, arrhythmias, hyperthyroidism, pregnancy, obesity
29
What is the pathophysiology of heart failure?
- physiological compensatory changes are initiated when the heart begins to fail to try and maintain cardiac output and peripheral effusion to negate the effects of HF
- as HF progresses, the mechanisms are overwhelmed and become pathophysiological (= decompensation)
- mechanisms = venous return (preload), outflow resistance, sympathetic system activation, RAAS
30
What are the risk factors of heart failure?
- >65y
- African descent
- men (due to lack of protective effect of oestrogen)
- obesity
- people who have had a previous MI
31
What is the clinical presentation of heart failure?
- SOB, FATIGUE, ANKLE SWELLING
- dyspnoea, especially when lying down
- raised jugular venous pressure
- cyanosis
- hypotension
- peripheral/ pulmonary oedema
- ascite
LEFT-SIDED = SOBOE
RIGHT-SIDED = OEDEMA
32
How is heart failure diagnosed?
Blood tests:
- brain natriuretic peptide, FBCs, U&E, liver biochemistry
CXR:
- alveolar oedema
- cardiomyopathy
- dilated upper lobe vessels of lungs
- pleural effusion
ECG:
- shows underlying causes e.g. ischaemia, left ventricular hypertrophy
Echocardiography:
- assess cardiac chamber dimension, look for regional wall motion abnormalities, valvular disease and cardiomyopathies
If ECG and BNP are both normal, HF is unlikely
33
How is heart failure managed?
| lifestyle changes, diuretics, surgeries, other drugs
Lifestyle changes:
- avoid large meals
- lose weight
- stop smoking
- exercise
- vaccinations
Diuretics:
- usually symptomatic relief (promote sodium and water loss so reduce ventricular filling pressure therefore reducing congestion)
- loop or thiazide diuretics
- aldosterone antagonists
Surgeries:
- mitral valve repair
- aortic/ mitral valve replacement
- heart transplant in young people
- ACEi, BB, digoxin, inotropes
- cardiac revascularisation and resynchronisation
34
What is the aetiology of primary hypertension?
- auto-regulation disturbance
- excess sodium intake
- renal sodium retention
- dysregulation of RAAS
- increased peripheral resistance
- endothelial dysfunction
35
What are the risk factors of primary hypertension?
- genetic susceptibility
- obesity
- high sodium
- low exercise
- low fruit and veg
- retinopathy
36
What is the clinical presentation of primary hypertension?
- headache
- visual changes
- SOBOE
- chest pain
- motor or sensory deficit
37
What are the differential diagnoses of primary hypertension?
- chronic kidney disease
- renal artery stenosis
- aortic coarctation
- obstructive sleep apnoea
- hyper/hypothyroidism
38
How is primary hypertension diagnosed?
- ECG (may show left ventricular hypertrophy)
- eGFR
- lipid panel
- urinalysis
39
How is primary hypertension managed?
- lifestyle modification
| - antihypertensive therapy (ACEi, ARB, CCB, BB, diuretics)
40
What is the aetiology of secondary hypertension?
- often renal disease or pregnancy (CKD is most common cause)
- endocrine causes (Cushing's, Conn's...)
- coarctation of the aorta
- drug therapy (some prescription drugs like corticosteroids and the contraceptive pill, alcohol, ecstasy, cocaine)
41
What is the pathophysiology of secondary hypertension?
- vascular changes (hypertension accelerates atherosclerosis)
- heart (major risk factor for IHD)
- nervous system (intracerebral haemorrhage is a frequent cause of death in 2o hypertension)
- kidneys (can be the cause or the result of renal disease)
- malignant hypertension (markedly raised diastolic BP and progressive renal disease)
42
What are the risk factors of secondary hypertension?
- increasing age
- race (more common in black people)
- family history
- overweight and obese
- little exercise
- smoking
- too much salt
- alcohol
- diabetes
- stress
43
What is the clinical presentation of secondary hypertension?
- often asymptomatic
| - found on screening
44
How is secondary hypertension diagnosed?
- look for end-organ damage e.g. LV hypertrophy, retinopathy and proteinuria
- urinalysis and albumin:creatinine ratio
- blood tests: serum creatinine, eGFR, glucose
- fundoscopy/ ophthamoscopy for retinal haemorrhage
- ECG and echo for LV hypertrophy
- 24h ambulatory BP monitoring
45
How is secondary hypertension managed?
- treatment goal is 140/90mmHg
- change diet: high consumption of fruits and veg, low fat, reduce salt and alcohol intake
- regular physical exercise
- lose weight
- stop smoking
ACD pathway:
A = ACEi
C = CCB
D = diuretic (thiazide or loop)
<55y = A → A+C or A+D → A+C+D → further diuretics, AB or BB
>55y or black of any age = C or D → A+C or A+D → A+C+D → further diuretics, AB or BB
