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4MB Medicine (My version) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is angina?

A

Chest pain on exertion caused by myocardial ischaemia from coronary heart disease, usually atherothrombosis

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2
Q

What is the difference between stable and unstable angina?

A

Stable angina is induced by effort and relieved by rest/GTN spray
Unstable angina is an acute coronary syndrome with pain at rest/not relieved by GTN

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3
Q

List aetiology/risk factors for angina

A 
Atherosclerosis
Males
Smoking, excess alcohol
Poor diet, obesity
Arteritis
Low exercise
Hypertension
Diabetes
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4
Q

List clinical features of angina

A 
Central chest tightness on exertion
Pain may radiate to jaw/arm
Dyspnoea
Nausea
Sweating
Syncope
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5
Q

What investigations would you order for angina?

A

ECG may be normal
Exercise ECG, 24h ECG
CT catheter angiography

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6
Q

Outline medical treatment for angina

A

GTN spray when required
Secondary prevention (aspirin, statin, ACEi)
B-blockers unless contraindicated
Ivabradine/nicorandil if others not tolerated

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7
Q

Outline surgical treatment for angina

A

Coronary revascularisation (PCI, CABG) using balloon stent or graft bypass from internal mammary artery and greater saphenous vein

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8
Q

What are the acute coronary syndromes (ACS)?

A

Unstable angina
NSTEMI
STEMI

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9
Q

What is the pathophysiology of ACS?

A

Atherothrombotic plaque rupture leads to thrombosis and complete occlusion of coronary artery, causing ischaemia and potential necrosis

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10
Q

List risk factors/aetiology for ACS

A 
Males
Family history
Smoking, excess alcohol
Hypertension
Diabetes
High cholesterol
Obesity
Sedentary lifestyle
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11
Q

List clinical features of ACS

A 
New onset severe crushing chest pain, radiating to arm and/or jaw
Nausea, vomiting
Not relieve by rest or GTN
Breathlessness
Syncope
Confusion
Pallor, sweating
Palpitations, tachycardia
SENSE OF IMPENDING DOOM
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12
Q

What investigations would you do for ACS?

A

Bloods: cardiac enzymes (CK, troponin), electrolytes, glucose, lipids
ECG
CXR

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13
Q

What is the criteria for STEMI on ECG?

A

ST elevation of 1mm or more in 2 adjacent limb leads
or
ST elevation of 2mm or more in 2 contiguous chest leads

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14
Q

List ischaemic changes on ECG

A 
T wave inversion
Q waves
Tall T waves
ST depression
ST elevation
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15
Q

When do levels of troponin and CK peak in ACS?

A

Troponin: 3-12 h
CK: 24 h

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16
Q

Outline medical treatment for acute MI

A

Aspirin 300 mg
GTN sublingual
IV morphine
O2 if hypoxic

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17
Q

Outline definitive treatment for acute NSTEMI

A

B-blocker IV
LMW heparin
IV nitrate
Angiography if high risk

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18
Q

Outline definitive treatment for acute STEMI

A

PCI within 120 mins

Otherwise thrombolysis with streptokinase + aspirin, then reassess after 90 mins for need for PCI

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19
Q

What are the different stages of hypertension? (stage 1, stage 2 etc.)

A

Stage 1: 140-159/90-99
Stage 2: 160-179/100-109
Stage 3: 180/110 or higher

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20
Q

List risk factors/aetiology for hypertension

A

Renal disease (GN, polyarteritis, renal artery stenosis)
Endocrine disease (Cushing’s, Conn’s, phaeochromocytoma)
Pregnancy
Drugs
Alcohol excess
High salt intake
Essential hypertension (idiopathic)

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21
Q

List clinical features of hypertension

A 
Asymptomatic
Headache
Palpitations
Breathlessness
Advanced disease: blurred vision, palpable kidney, RF delay
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22
Q

What investigations would you do for hypertension?

A 
ECG, echo
Bloods: electrolytes, endocrine markers
Funduscopy
Urinalysis
Home/ambulatory BP monitoring
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23
Q

How is hypertensive retinopathy graded?

A

I: tortuous arteries, narrowing/sclerosis
II: AV nipping, marked sclerosis
III: haemorrhages, cotton wool spots, hard exudates
IV: III + papilloedema

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24
Q

Outline medical management of hypertension

A 
If under 55yo, start with ACEi
If over 55yo or black, start with Ca ch blocker
If uncontrolled on these,
ACEi + Ca ch blocker
then
add thiazide diuretic
then
add alpha/beta blocker
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25
Q

What is the BP target for diabetic patients with hypertension?

A

Less than 130/80

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26
Q

What is an arrhythmia?

A

Disturbance in the cardiac rhythm generated by abnormal conduction

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27
Q

List risk factors/aetiology for arrhythmias

A 
Heart conditions
Congenital heart disease
Smoking, alcohol
High caffeine intake
Pneumonia
Thyrotoxicosis
Metabolic imbalance
Drugs (amiodarone, B agonists, digoxin, levodopa, illicit drugs)
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28
Q

List clinical features of arrhythmias

A 
Palpitations
Abnormal pulse
Chest pain
Syncope
Dizziness
Dyspnoea
Altered consciousness
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29
Q

What investigations would you order for arrhythmias?

A

ECG, 24 h ECG, event recording
Electrophysiology
FBC, U+E, glucose, Ca, Mg, thyroid function
Echocardiogram

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30
Q

Which drug can be used to treat bradycardia?

A

Atropine

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31
Q

Outline treatment of supraventricular tachycardias

A

Vagal maneuvres (breath-hold, Valsalva, ice, carotid massage)
IV adenosine/verapamil
DC shock

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32
Q

List class I anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

Na channel blockers (rhythm control)
Lignocaine
Disopyramide
Flecanaide

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33
Q

List class II anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

B blockers (rate control)
Atenolol
Propranolol

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34
Q

List class III anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

K channel blockers (rhythm control)
Amiodarone
Sotalol

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35
Q

List class IV anti-arrhythmic drugs and whether they are rhythm or rate controlling

A

Ca ch blockers (rate control)
Verapamil
Diltiazem

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36
Q

List the main narrow-complex tachycardias

A 
Sinus tachycardia
Supra-ventricular tachycardia
Atrial fibrillation/flutter
Atrial tachycardia
Junctional tachycardia (AVNRT, AVRT, BBB)
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37
Q

List the main broad-complex tachycardias

A

Ventricular tachycardia
Torsades de Pointes
SVT with aberrancy
Ventricular fibrillation

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38
Q

Outline treatment of narrow-complex tachycardias (except AF)

A

SVT: vagal maneuvres, IV adenosine/verapamil, DC shock
Junctional: ablation of accessory pathways, rhythm control

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39
Q

Outline treatment of ventricular tachycardia

A

Amiodarone/lignocaine + dextrose if stable
Correct K with calcium chloride
DC shock if pulseless or unstable

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40
Q

Outline treatment of ventricular fibrillation

A

DC shock
Mg chloride
Implantable defibrillator

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41
Q

Outline treatment of torsades de Pointes

A

Mg sulfate IV

Overdrive pacing

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42
Q

List aetiology/risk factors for AF

A 
Heart failure
Ischaemia, MI
Hypertension
Mitral valve disease
Pneumonia
Hyperthyroidism
Caffeine, alcohol
Hypokalaemia
Cardiomyopathy
Pericarditis
Sick sinus syndrome
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43
Q

Outline treatment of acute AF

A

O2 + emergency cardioversion/amiodarone if unstable
Anticoagulation with LMW heparin
Rate control: diltiazem/verapamol/metoprolol/digoxin
AV node ablation or pacing

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44
Q

What is the aim for INR with warfarin on AF?

A

2-3

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45
Q

Describe 1’ heart block

A

Prolonged PR interval (greater than 0.22s)

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46
Q

Describe 2’ type 1 heart block

A

Progressive prolonging of PR interval with dropped QRS complex

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47
Q

Describe 2’ type 2 heart block

A

Normal PR interval with some dropped QRS complexes

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48
Q

Describe 3’ heart block

A

Dissociation of P-wave and QRS complexes

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49
Q

What would an ECG show in right bundle branch block?

A

M-wave in V1, W-wave in V6

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50
Q

What would an ECG show in left bundle branch block?

A

W-wave in V1, M-wave in V6

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51
Q

List risk factors/aetiology for heart blockWhat is

A 
Normal variants
Athletes
Sick sinus syndrome
Ischaemic heart disease
Drugs (digoxin, B blockers)
Congenital heart disease
Calcified valves
Trauma
Surgery
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52
Q

Outline treatment of heart block

A

IV atropine

Pacing

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53
Q

How does the body try to compensate for low cardiac output in heart failure?

A

Retains fluid which increases preload and causes further stress on the heart, causing congestive heart failure

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54
Q

What is “systolic” heart failure? Give causes

A

Ventricles unable to contract normally, causing reduced cardiac output (ejection fraction less than 40%)
Causes: IHD, MI, cardiomyopathy

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55
Q

What is “diastolic” heart failure? Give causes

A

Ventricles unable to relax normally, causing increased preload (ejection fraction greater than 50%)
Causes: constrictive pericarditis, restrictive CM, tamponade, hypertension

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56
Q

List causes of right heart failure

A

Left ventricular failure
Pulmonary stenosis
Lung disease, cor pulmonale

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57
Q

List causes of left heart failure

A

Valve disease
Arrhythmia
Hypertension
Congenital defects

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58
Q

List clinical features of right heart failure

A 
Raised JVP
Peripheral oedema
Epistaxis
Organomegaly
Ascites
Nausea
Anorexia
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59
Q

List clinical features of left heart failure

A 
Dyspnoea
Fatigue, poor exercise tolerance
Pulmonary oedema
Orthopnoea
PND
Pink frothy sputum
Cold peropheries
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60
Q

What are major symptoms/signs of heart failure according to Framingham criteria?

A 
PND
Crepitations
S3
Cardiomegaly
Raised JVP
Pulmonary oedema
Weight loss
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61
Q

What are minor symptoms/signs of heart failure according to Framingham criteria?

A 
Ankle oedema
Dyspnoea
Tachycardia
Nocturnal cough
Pleural effusion
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62
Q

What would you see on an XR in heart failure?

A 
Alveolar shadowing (bat's wings)
Kerley B lines
Cardiomegaly
Dilated upper vessels
Effusion
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63
Q

Outline treatment of acute heart failure

A 
Sit up
High flow O2
IV diamorphine
IV furosemide
GTN/nitrate
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64
Q

Outline medical treatment of heart failure

A

Diuretics (furosemide, spironolactone)
ACEi if LV dysfunction
Digoxin if LV impairment
B-blocker reduces mortality long-term

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65
Q

What is a cardiac murmur?

A

Sound made due to turbulent blood flow against diseased/damaged heart valves

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66
Q

Systolic murmurs are in time with the carotid pulse. True/False?

A

True

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67
Q

List aetiology of mitral stenosis

A

Rheumatic fever
Congenital anomaly
Prosthesis
Carcinoid tumour

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68
Q

List notable clinical features of mitral stenosis

A 
Mid-diastolic "rumbling" with loud opening snap
Tapping apex
Malar flush
Low-volume pulse
Atrial fibrillation
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69
Q

List aetiology of mitral regurgitation

A 
Rheumatic fever
LV dilation
Calcification
Endocarditis
Connective tissues disease
Chordae rupture
70
Q

List notable clinical features of mitral regurgitation

A

Pansystolic with radiation to axillar
RV heave
Atrial fibrillation
Ankle swelling

71
Q

List aetiology of mitral valve prolapse

A 
WPW
Atrial septal defect
Patent ductus
Cardiomyopath
Connective tissue disease
72
Q

List notable clinical features of mitral valve prolapse

A

Mid-systolic click +/- late systolic murmur

Autonomic dysfunction

73
Q

Outline general treatment of mitral valve disease

A

Control AF, anticoagulation
Balloon valvoplasty in stenosis
Valve replacement
B blocker may help symptoms

74
Q

List aetiology of atrial stenosis

A

Calcification
Congenital bicuspid valve
Kidney disease
Hypertrophic cardiomyopathy

75
Q

List notable clinical features of aortic stenosis

A

Ejection systolic with radiation to carotids
Slow-rising pulse
Heaving apex
Exertional dyspnoea

76
Q

List aetiology of aortic regurgitation

A

Connective tissue disease
Rheumatic fever
Endocarditis
Vasculitis

77
Q

List notable clinical features of aortic regurgitation

A 
Early-diastolic
Displaced apex
Collapsing pulse
Corrigan's sign (carotid pulsation)
De Musset sign (head nod with beat)
78
Q

Outline general treatment for aortic valve disease

A 
Valve replacement (valvotomy, TAVI)
ACEi, diuretics
79
Q

List aetiology of tricuspid regurgitation

A 
RV dilation
Pulmonary hypertension
Rheumatic fever
Endocarditis
IV drug use
Carcinoid tumour
Ebstein's anomaly
80
Q

List notable clinical features of tricuspid regurgitation

A 
Pansystolic
RV heave
Hugely raised JVP
Pulsatile hepatomegaly
Hepatic pain on exertion
Ascites
81
Q

List aetiology of pulmonary stenosis

A

Congenital
Turner’s, Noonan’s, Falot’s
Rheumatic fever
Carcinoid tumour

82
Q

List notable clinical features of pulmonary stenosis

A

Ejection systolic with radiation to left shoulder
Split S2
Dyspnoa
Ascites

83
Q

If someone presents with a fever and new cardiac murmur, what’s the diagnosis until proven otherwise?

A

Infective endocarditis

84
Q

List non-bacterial aetiology/risk factors for endocarditis

A 
IVDU
Diabetes
Valve disease
Congenital heart conditions
Low dental hygiene, dental procedures
85
Q

List bacterial aetiology for endocarditis

A

Strep viridans
Staph aureus, Enterococci, Staph epidermidis (prosthesis)
Rare: Haemophilus, Actinobacillus, Cardiobacter, Eikenella, Kingella (HACEK)

86
Q

List clinical features of endocarditis

A 
Signs of sepsis - fever, rigors, night sweats, malaise, weight loss
New murmur
Breathless
Fatigue
Clubbing
Roth spots (retinal haemorrhage)
Splinter haemorrhages
Janeway lesions (painless palmar nodes)
Osler nodes (painful pulps on fingers/toes)
87
Q

What investigations would you do for endocarditis?

A 
3 sets of blood cultures at peak of fever PRIOR to antibiotics
Bloods
Urinalysis
CXR
ECG
Echocardiograph
88
Q

Outline Duke’s major criteria for endocarditis

A 
\+ve blood culture
Endocardium involvement (+ve echo, new valve regurg)
89
Q

Outline Duke’s minor criteria for endocarditis

A 
Risk factor present
Fever above 38'C
Immune/vascular signs
\+ve blood culture
\+ve echocardiograph
90
Q

What is required from Duke’s criteria to diagnose endocarditis?

A

2 majors
1 major + 3 minors
5 minors

91
Q

What empirical therapy is used for endocarditis?

A

Benzylpenicillin + gentamicin

+/- flucloxacillin

92
Q

What antibiotics would you give for Staph endocarditis?

A

Flucloxacillin
Gentamicin
Vancomycin if MRSA +/- rifampicin

93
Q

What antibiotics would you give for Strep endocarditis?

A

Benzylpenicillin

Gentamicin

94
Q

What antibiotics would you give for Enterococcus endocarditis?

A

Amoxicillin

Gentamicin

95
Q

What antibiotics would you give for atypical endocarditis?

A

Doxycycline
Cotrimoxazole
Fluconazole/amphoterecin

96
Q

List aetiology/risk factors for myocarditis

A

Viral infection (Coxsackie, CMV, adenovirus, HIV)
Drugs (cyclophosphamide, penicillin, chloramphenicol, phenyotin, radiation)
Idiopathic

97
Q

List clinical features of myocarditis

A 
Fatigue
Dyspnoea
Palpitations
Chest pain
Fever
Tachycardia
Soft S1, S4 gallop rhythm
98
Q

What investigations would you do for myocarditis?

A

ECG (STE/STD, T inversion, arrhythmia, AV block)
Tropnonin I or T confirms diagnosis
CK

99
Q

Outline treatment of myocarditis

A

Supportive, rest, treat cause
Avoid sports
ACEi/B-blocker/spironolactone where heart failure

100
Q

List aetiology/risk factors for pericarditis

A

Viruses (EBV, Coxsackie, flu, mumps, varicella, HIV)
Bacteria (pneumonia, rheumatic fever, TB)
Post-MI (Dressler’s syndrome)
Drugs
Inflammatory/chronic disease

101
Q

List clinical features of pericarditis

A

Chest pain, worse on inspiration/lying flat, relieved sitting forward
Friction rub
Evidence of effusion/tamponade

102
Q

What investigations would you order for pericarditis?

A 
ECG shows widespread saddle-shaped STE
CXR
Echo
Cardiac enzymes (troponin may be raised)
Blood cultures/serology
103
Q

Outline treatment of pericarditis

A

Rest, analgesia
Treat cause
Steroid or immunosuppression

104
Q

What are cardiomyopathies?

A

Diseases that affect the mechanical/electrical function of the heart

105
Q

What is hypertrophic cardiomyopathy?

A

LV outflow obstruction from asymmetrical septal hypetrophy

106
Q

What is the genetic abnormality in hypertrophic cardiomyopathy?

A

Autosomal dominant mutation in sarcomeric genes, resulting in reduced myosin and troponin

107
Q

List clinical features of hypertrophic cardiomyopathy

A 
Asymptomatic or sudden death
Syncope
Chest pain
Dyspnoea
Jerky pulse
Double apex pulsation
Systolic thrill, ejection murmur
108
Q

What investigations would you order for hypertrophic cardiomyopathy?

A

ECG shows LVH, inferolateral Q waves
May be in AF/WPW
Echo shoes asymmetrical septal hypertrophy, midsystolic aortic valve closure

109
Q

Outline treatment of hypertrophic cardiomyopathy

A

B-blocker/verapamil for symptoms
Amiodarone control arrhythmia
Septal myomectomy if severe
Implantable defib

110
Q

What is dilated cardiomyopathy?

A

Dilated ventricles with systolic dysfunction but preserved wall thickness
Essentially a flabby heart

111
Q

What genetic abnormality causes dilated cardiomyopathy?

A

Mutation in cytoskeletal/myocyte genes causing contractile insufficiency

112
Q

What risk factors is dilated cardiomyopathy associated with?

A 
Alcohol
Hypertension
Haemochromatosis
Viral infections
Autoimmunity
113
Q

List clinical features of dilated cardiomyopathy

A 
Fatigue
Dyspnoea
Po oedema
RV failure, emboli
Raised JVP
Arrhythmia, tachycardia
Hypotension
Displaced apex
Jaundice, ascites, hepatomegaly
114
Q

What investigations would you do for dilated cardiomyopathy?

A

CXR shows cardiomegaly, po oedema
ECG
Echo shows dilated chambers, low ejection fraction

115
Q

Outline treatment of dilated cardiomyopathy

A

Manage heart failure (digoxin, furosemide, ACEi)
Pacing
Heart transplant

116
Q

What is restrictive cardiomyopathy?

A

Reduced volume of both ventricles with atrial enlargement and impaired filling

117
Q

What conditions are associated with restrictive cardiomyopathy?

A

Amyloidosis
Haemochromatosis
Sarcoidosis
Scleroderma

118
Q

List clinical features of restrictive cardiomyopathy

A

Similar to pericarditis
RHF signs
Hepatomegaly, ascites

119
Q

What investigations would you do for restrictive cardiomyopathy?

A

CXR shoes po venous congestion
ECG low-voltage QRS
Echo shows impaired filling
Cardiac catheterisation

120
Q

What is arrhythmogenic right ventricular cardiomyopathy (ARVC)?

A

Fibro-fatty replacement of myocytes, causing RV dilation

121
Q

What is the genetic abnormality that causes ARVC?

A

Mutation in desmosomal genes affecting the ryanodine receptor

122
Q

What is atrial myxoma?

A

Rare benign cardiac tumour, usually found in right atrium

123
Q

List clinical features of atrial myxoma

A

May mimic endocarditis
Mitral stenosis
Tumour plop on auscultation

124
Q

What is the difference between ostium secundum and primum atrial septal defect?

A

Secundum: high in septum, presents in adulthood
Primum: opposite endocardial cushions, presents early

125
Q

List clinical features of atrial septal defect

A 
Cyanosis
Po hypertension
Arrhythmia
Haemoptysis
Chest pain
Raised JVP
Wide split S2 heart sound
Ejection systolic murmur
Migraines
126
Q

What investigations would you do for atrial septal defect?

A

Echo shows left-right shunt
ECG shows RBBB with LAD and prolonged PR interval
CXR shows small aortic knuckle, po plethora

127
Q

Outline treatment of atrial septal defect

A

Usually closes before age of 10

Transcatheter closure

128
Q

What is the most common congenital cardiac anomaly?

A

Ventricular septal defect

129
Q

List clinical features of ventricular septal defect

A

Severe heart failure
Loud murmur, thrill
Harsh pansystolic murmur at left sternal edge

130
Q

What investigations would you do for ventricular septal defect?

A

Echo shows left-right shunt
Eisenmenger complex (right-left shunt)
ECG shows LAD and LVH or PVH
CXR shows normal or cardiomegaly

131
Q

Outline treatment of ventricular septal defect

A

May close spontaneously
Endovascular or medical closure
Treat heart failure

132
Q

What is patent ductus arteriosus?

A

Persistent communication between po. artery and desc. aorta

133
Q

List clinical features of patent ductus arteriosus

A

Bounding pulse

Machine-gun murmur

134
Q

What is coarctation of aorta?

A

Narrowing of desc. aorta just distal to insertion of ductus arteriosus

135
Q

List risk factors/aetiology of coarctation of aorta

A 
Boys
Bicuspid aortic valve
Ventricular septal defect
Mitral valve disease
CTD's
136
Q

List clinical features of coarctation of aorta

A

Headaches
Nosebleeds
Radio-femoral delay
Scapular bruit

137
Q

What would a CXR of coarctation of aorta show?

A

Rib-notching

138
Q

Outline treatment of coarctation of aorta

A

Surgery

Balloon dilation +/- stent

139
Q

What makes up tetralogy of Fallot?

A

Ventricular septal defect
Pulmonary stenosis
RV hypertrophy
Overriding aorta

140
Q

List clinical features of tetralogy of Fallot

A 
Cyanosis (right-left shunt)
Restless, agitated
Toddler squat to increase peripheral resistance
Difficulty feeding
Failure to thrive
Clubbing
Exertional dyspnoea
Palpitations
RV failure
Syncope
141
Q

What investigations would you do for tetralogy of Fallot?

A

CXR boot-shaped heart

Echo assesses degree of stenosis

142
Q

Outline treatment of tetralogy of Fallot

A 
Oxygen
Positioning
Morphine if irritated
Long-term B-blocker
Endocarditis prophylaxis
Surgery to close VSD, correct po stenosis
143
Q

What is intermittent claudication?

A

Chronic lower limb ischaemia relieved by rest

144
Q

List aetiology/risk factors for intermitted claudication

A

Smoking
Diabetes
High cholesterol
Hypertension

145
Q

List clinical features of intermittent claudication

A 
Exertional/cramping pain usually in calves relieved by rest
Ulceration
Dry skin
Hair loss
Diminished/absent pulses
Cold legs
Atrophy
Cap refill less than 2s
146
Q

What investigations would you do for intermittent claudication?

A 
Bloods
ECG
Catheterisation
Duplex US scan
ABPI of 0.4-0.9
147
Q

Outline treatment of intermittent claudication

A

Lifestyle improvement (smoking, exercise, weight)
Antiplatelets (aspirin)
Surgery (angioplasty +/- stent, bypass graft)
Amputation

148
Q

Acute limb ischaemia is a surgical emergency. True/False?

A

True

Requires revascularisation within 4-6 hours

149
Q

List aetiology/risk factors for acute limb ischaemia

A

Thrombosis in situ
Emboli
Graft, angioplasty occlusion
Trauma

150
Q

List clinical features of acute limb ischaemia

A 
Pale
Pulseless
Painful
Paralysis
Paraesthesiae
Perishing cold
151
Q

Outline treatment of acute limb ischaemia

A 
Urgent arteriography
Surgical embolectomy
Local thrombolysis (tPA)
Anticoagulate (heparin)
Angioplasty
152
Q

What are varicose veins?

A

Incompetent valves prevent blood progressing from deep to superficial veins, causing long tortuous dilated veins

153
Q

List aetiology/risk factors for varicose veins

A 
Obstruction
DVT
Ovarian tumour
Valve disease
AV malformation
Prolonged standing
Pregnancy
OCP use
154
Q

List clinical features of varicose veins

A 
Pain
Crampy legs
Tingling
Ugly legs
Oedema
Varicose eczema
Ulcers
Haemosiderin staining
Atrophie blanche
Lipidodermatosclerosis
Phlebitis
155
Q

What investigations would you do for varicose veins?

A

Doppler USS
Trendelenberg test
Buerger test

156
Q

Outline treatment for varicose veins

A 
Treat cause, education
Elevation, stock, lose weight
Injection sclerotherapy
Laser coagulation
Endovenous ablation
157
Q

List aetiology/risk factors for DVT

A 
Post-surgery
Immobility
Increasing age
Pregnancy
Oestrogen therapy
Trauma
Malignancy
Thrombophilia
Previous DVT
158
Q

List clinical features of DVT

A 
Calf warmth
Tenderness
Swelling
Erythema
Mild fever
Pitting oedema
PE-like features
159
Q

What investigations would you do for DVT?

A

Bloods: d-dimers, thrombophilia tests
Compression Doppler USS
PTP score
Well’s score

160
Q

Outline treatment of DVT

A 
Stop OCP
Mobilisation
TED stockings
Anticoagulate (LMWH, warfarin)
IVC filters if active bleeding
161
Q

What is an aneurysm?

A

Greater than 50% dilation of an artery’s original diameter involving all layers of the vessel

162
Q

What are the common sites for an aneurysm?

A

Aorta
Iliac artery
Femoral artery
Popliteal artery

163
Q

List aetiology/risk factors abdominal aortic aneurysm

A 
Defect in collagen-elastase regulation
Atherosclerosis
Trauma
Infection
CTD's
Vasculitis
Genetics
164
Q

List clinical features of abdominal aortic aneurysm

A 
May be asymptomatic until rupture
Intermittent/continuous abdo pain radiating to back
Collapse
Hypotension
Expansile abdo mass
Discoloured peripheries
Tachycardia
Pallor
165
Q

What investigations would you do for abdominal aortic aneurysm?

A

Regular USS monitoring for men over 65

166
Q

Outline treatment of abdominal aortic aneurysm

A

Less than 5.5 cm - monitoring
Reserve surgery unless expanding more than 1cm a year
Lifestyle advice, exercise tests
Surgery (EVAR, open)

167
Q

Outline acute treatment of rupture of abdominal aortic aneurysm?

A

Blood amylase, ECG, crossmatch blood
Catheterise
Large IV access, give O Rh blood
Prompt surgery and antibiotic

168
Q

What is aortic dissection?

A

Splitting of aortic tunica media

Either type A (involving ascending aorta) and type B (not involving ascending aorta)

169
Q

List clinical features of aortic dissection

A

Sudden tearing chest pain radiating to back
Hemiplegia
Radio-radio delay
Hypotension

170
Q

What investigations would you do for aortic dissection?

A 
Crossmatch blood
ECG
CXR
CT/MRI
Trans-oesophageal echo
171
Q

Outline treatment of aortic dissection

A

Hypotensives (keep systolic 100-110) (labetolol)

Urgent surgery

4MB Medicine (My version) (19 decks)

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