Cardiology Flashcards
Definition of Severe Aortic Stenosis?
Aortic valve area (AVA) <1cm^2, Mean Pressure Gradient >40mmHg, Peak Aortic Jet Velocity of >4m/s (remembered as the 1, 4, 4)
Syptoms and signs of PE?
Dyspnoea (73%)
Chest pain (66%) - this implies infarction and occurs 3-7 days after embolism.
Cough (37%)
Haemoptysis (13%)
Few signs - only tachypnoea, tachycardia, hypoxia which is often mild.
Components of a Thrombophilia Screen?
Antithrombin 3
Protein C and S
Factor 5 Leiden
Plasminogen
Fibrinogen
Activated Protein C Resistance
Wells Score for PE Components?
There are 7 components:
Clinical DVT (3)
Alternative Diagnosis is less likely than PE (3)
Tachycardia (1.5)
Immobilisation or Surgery in last 4 weeks (1.5)
Previous VTE (1.5
Haemoptysis (1)
Active Cancer (1)
Score of 4 or lower indicates PE is unlikely –> proceed to PERC.
PERC Score Components?
8 components:
Age <50y
Pulse < 100
Sp02 > 94%
No haemoptysis
No exogenous oestrogen
No previous DVT or PE
No surgery of trauma with in 4 months
No unilateral leg swelling.
What are the 5 groups of pulmonary hypertension?
Group 1 - isolated precapillary pulmonary hypertension (PAH)
Group 2 - Pulmonary Hypertension due to Left heart disease
Group 3 - Pulmonary hypertneion due to lung disease and hypoxia
Group 4 - Pulomary artery obstruction (CTEPH)
Group 5 - Pulmonary hypertneion with unclear/multifactorial mechanisms
How is probability of Pulmonary Hypertension determined on initial testing?
Echocardiogram - Peak tricuspid regurgitation velocity. >3.4 m/2 indicates high probability.
Other features include enlargement of the pulmonary artery, RV, RA and inferior vena cava
Haemodynamic definition of Pre-capillary hypertension on right heart catheterisation?
mPAP is high (>20mmHg)
PAWP is low <15mmHg (surrogate marker of left ventricular pressure)
PVR high >3 WU (pulmonary vascular resistance)
Haemodynamic definition of isolated post-capillary hypertension on right heart catheterisation?
mPAP >20
PAWP high >15 mmHg
PVR low <3
PAH treatment targeting the Endothelin pathway?
Endothelin Recepter Antagonists:
Ambriesantan, Bosentan, Macitentan.
PAH treatments targeting the Nitric oxide pathway?
PDE5 - posphodiesterase type 5 inhibitors - which increase endogenous nitric oxide levels. Sildenafil, Tadalafil, Riociguat
PAH treatments targeting the prostacyclin pathway?
Epoprostenol (intravenous), iloprost (nebulised), Seleipag (oral prostenoid).
What are the heart failure beta-blockers?
BC-MN
Bisoprolol
Carvedilol
Metoprolol CR
Nebivolol
Sokolow-Lyon criteria for LVH
S wave V1 + R wave in V5 >35mm (7 large sqares).
OR R wave in aVL > 11mm
Testing in stable coronary artery disease?
CTCA
Echo
Nuclear medicine
FFR
Angiography with fractional flow reserve has
FFR = distal pressure / proximal pressure
FFR <0.8 indicates haemodynamically significant stenosis that will benefit from stenting.
LDL goal for Ischaemic Heart Disease
< 1.8 with statin
If not meeting goal, add with ezetimibe
If not meeting goal add PCSK9i
Indications for aspirin
Only secondary prevention
Consider if no MI but evidence of CVD on imaging
No role for primary prevention
COMPASS Study
Low dose rivaroxaban + aspirin improved outcomes compared to aspirin alone (for secondary prevention)
Low dose Colchicine
IIb - can be considered for secondary prevention for CAD
Diabetes and CAD
Aim HbA1c < 7 %
Empagliflozen
Liraglutide
Indications for revascularisation in patients with STABLE or silent ischaemic heart disease?
2 reasons:
1) for prognosis:
Left main disease with >50% stenosis
Proximal LAD disease with >50% stenosis
2 or 3 vessel disease with >50 stenosis and LVEF <35%
Large areas of ischaemia on functional testing (>10% of LV)
Single remaining patent CA with stenosis >50%
or 2) for symptoms:
- significant stenosis in the presence of limiting angina or angina equivalent that has persisted with maximal medical therapy.
Medical therapy vs PCI for STABLE CAD?
No difference in outcome
Improved symptoms with PCI.
CABG vs PCI
STITCHES Trial - multi vessel disease with LV < 35%, CABG is better.
FREEDOM Trial - DM with multi-vessel disease - CABG better.
Difference between CABG and PCR
High need for repeat procedure for PCI
