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2a high tier > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the aetiology of angina?

A
  • mostly atheroma

- rare causes include anaemia, aortic stenosis, small vessel disease

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2
Q

What is the pathophysiology of angina?

A

Atherosclerosis narrows the coronary arteries causing ischaemia which leads to pain

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3
Q

What are the risk factors of angina?

A
  • smoking
  • hypertension
  • diabetes mellitus
  • obesity
  • sedentary lifestyle
  • age
  • hypercholesteraemia
  • family history (and genetic)
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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
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5
Q

What are the differential diagnoses of angina?

A
  • pericarditis/ myocarditis
  • pulmonary embolism
  • chest infection
  • aortic dissection
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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)

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7
Q

How is angina managed?

A
  • modify risk factors
  • medications: aspirin, BB, CCB, nitrates (GTN spray)
  • surgical: PCI, CABG
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8
Q

What is the aetiology of a STEMI?

A

Coronary artery disease

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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
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10
Q

What are the risk factors of a STEMI?

A
  • smoking
  • hypertension
  • diabetes
  • obesity
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11
Q

What is the clinical presentation of a STEMI?

A
  • chest pain
  • SOBOE
  • pallor
  • diaphoresis (unusual degree of sweating)
  • dizziness
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12
Q

What are the differential diagnoses of a STEMI?

A
  • unstable angina
  • NSTEMI
  • aortic dissection
  • pulmonary embolism
  • pneumothorax
  • pneumonia
  • pericarditis
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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
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14
Q

How is a STEMI managed?

A
  • aspirin and P2Y12 inhibitors e.g. clopidogrel
  • oxygen
  • morphine
  • GTN
  • anticoagulation (unfractionated heparin)
  • PCI/ CABG
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15
Q

What is the aetiology of an NSTEMI?

A
  • non-occlusive thrombus
  • coronary embolism
  • myocarditis
  • pulmonary embolism
  • aortic stenosis
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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
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17
Q

What is the clinical presentation of an NSTEMI?

A
  • chest pain
  • SOBOE
  • weakness
  • diaphoresis
  • recent PCI/ CABG
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18
Q

What are the differential diagnoses of an NSTEMI?

A
  • aortic dissection
  • pulmonary embolism
  • peptic ulcer disease
  • acute pericarditis
  • oesophageal spasm
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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
Q

What are the differential diagnoses of IHD?

A
  • aortic dissection
  • pericarditis
  • pulmonary embolism
  • pneumothorax
  • pneumonia
26
Q

How is IHD diagnosed?

A
  • resting ECG
  • haemoglobin
  • fasting lipid profile
  • fasting blood glucose/ HbA1c
27
Q

How is IHD managed?

A
  • anti platelet therapy
  • statins
  • antihypertensives
  • revascularisation
  • GTN spray
28
Q

What is the aetiology of heart failure?

A

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
Q

What is the pathophysiology of heart failure?

A
  • 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
Q

What are the risk factors of heart failure?

A
  • > 65y
  • African descent
  • men (due to lack of protective effect of oestrogen)
  • obesity
  • people who have had a previous MI
31
Q

What is the clinical presentation of heart failure?

A
  • 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
Q

How is heart failure diagnosed?

A

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
Q

How is heart failure managed?

lifestyle changes, diuretics, surgeries, other drugs

A

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
Q

What is the aetiology of primary hypertension?

A
  • auto-regulation disturbance
  • excess sodium intake
  • renal sodium retention
  • dysregulation of RAAS
  • increased peripheral resistance
  • endothelial dysfunction
35
Q

What are the risk factors of primary hypertension?

A
  • genetic susceptibility
  • obesity
  • high sodium
  • low exercise
  • low fruit and veg
  • retinopathy
36
Q

What is the clinical presentation of primary hypertension?

A
  • headache
  • visual changes
  • SOBOE
  • chest pain
  • motor or sensory deficit
37
Q

What are the differential diagnoses of primary hypertension?

A
  • chronic kidney disease
  • renal artery stenosis
  • aortic coarctation
  • obstructive sleep apnoea
  • hyper/hypothyroidism
38
Q

How is primary hypertension diagnosed?

A
  • ECG (may show left ventricular hypertrophy)
  • eGFR
  • lipid panel
  • urinalysis
39
Q

How is primary hypertension managed?

A
  • lifestyle modification

- antihypertensive therapy (ACEi, ARB, CCB, BB, diuretics)

40
Q

What is the aetiology of secondary hypertension?

A
  • 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
Q

What is the pathophysiology of secondary hypertension?

A
  • 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
Q

What are the risk factors of secondary hypertension?

A
  • increasing age
  • race (more common in black people)
  • family history
  • overweight and obese
  • little exercise
  • smoking
  • too much salt
  • alcohol
  • diabetes
  • stress
43
Q

What is the clinical presentation of secondary hypertension?

A
  • often asymptomatic

- found on screening

44
Q

How is secondary hypertension diagnosed?

A
  • 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
Q

How is secondary hypertension managed?

A
  • 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

2a high tier (10 decks)

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