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Phase 3b > Cardiology and Vascular Disease > Flashcards

Cardiology and Vascular Disease Flashcards

1
Q

what are some complications of a PE

A
  • Chronic thomboembolitic disease: ~5%

* CTEPH ~2%

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2
Q

what are symptoms of PE

A 
Unexplained acute breathlessness
chest pain
acute unexplained collapse
unexplained hypoxia 
haemoptysis 
signs of DVT
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3
Q

list 5 strong risk factors for PE

A
  • Fracture of lower limb
  • Hospitalisation for heart failure or atrial flutter/fibrillation within 3 months
  • Hip or knee replacement
  • Major trauma
  • MI within 3 months
  • Previous VTE
  • Spinal cord injury
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4
Q

list 5 moderate risk factors for PE

A
  • Arthroscopic knee injury
  • Autoimmune diseases
  • Blood transfusion
  • Central venous lines
  • Chemotherapy
  • Congestive heart or respiratory failure
  • Erythropoietin-stimulating agents
  • Hormone replacement therapy
  • IVF
  • Infection: pneumonia, UTI or HIV
  • Inflammatory bowel disease
  • (metastatic) Cancer
  • Oral contraceptive therapy
  • Paralytic stroke
  • Superficial vein thrombosis
  • Thrombophilia
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5
Q

list 5 weak risk factors for PE

A
  • Bed rest > 3 days
  • Diabetes mellitus
  • Hypertension
  • Immobility due to sitting (e.g. prolonged travel)
  • Increasing age
  • Laparoscopic surgery (e.g. cholecystectomy)
  • Obesity
  • Pregnancy
  • Varicose veins
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6
Q

what are the 3 components of PE ‘investigation’

A

clinical assessment and basic investigations
D-dimer
imaging

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7
Q

what is d-dimer

A

Fibrin degradation product

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8
Q

other than PE/DVT when might d-dimer be raised (or lowered)

A

• Liver, renal or cardiac failure; AF; aortic dissection, DIC, infection, pregnancy, malignancy, surgery and burns, snake bites etc.

falsely low: patients on anticoagulants

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9
Q

what features are needed to stratify risk of mortality in patients wit PE

A

blood pressure
imaging (looking for signs of RV dysfunction)
PESI score
cardiac laboratory biomarksers (looking for RV dysfunction or myocardial injury): BNP and troponin

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10
Q

management of PE patients based on their stratification

A

High risk: thrombolysis
intermediate risk: hospitalise + anti-coagulate
low risk: anti-coagulate + discharge

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11
Q

features that support using warfarin as an anticoagulant for PE

A 
	Already on warfarin + good INR control
	Antiphospholipid Syndrome
	Mechanical valve
	Extremes of weight
•	<40 or >130kg
	Creatinine Clearance <30 ml/min
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12
Q

features that support using DOACs as an anticoagulant for PE

A

 Patient convenience
 Ambulatory PE treatment
 Warfarin intolerance
 Malignancy

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13
Q

Features that support using LMWH as an anticoagulant for PE

A

 GI or GU malignancy
 Pregnancy
 Severe hepatic impairment

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14
Q

non modifiable risk factors for coronary artery disease

A
  • Family history
  • Age
  • Male sex
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15
Q

modifiable risk factors for coronary artery disease

A
  • Smoking
  • High cholesterol
  • High blood pressure
  • Overweight
  • Poor diet
  • Lack of physical activity
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16
Q

what is the gold standard investigation for coronary artery disease

A

angiography (CT or invasive)

17
Q

treatment for coronary artery disease

A

lifestyle modification: stop smoking, exercise, healthy diet etc.

statins

antiplatelets

medication to manage risk factors e.g. diabetes

medication to reduce angina attacks

18
Q

what medications can be used to reduce angina attacks

A 
	Nitrates (spray or long acting tablets)
	Beta-blockers 
	Calcium channel blockers 
	Nicorandil 
	Ivabradine 
	Ranolazine

o If medication not working or patient cannot tolerate side effects: stenting or coronary artery bypass grafting

19
Q

important investigations for MI

A

serial serum troponin

12 lead ECG

20
Q

immediate medical management of an MI

A

• Immediate dual antiplatelet therapy and pain relief
o DAPT: aspirin plus Ticagrelor, Prasugrel, or Clopidogrel

also give metoclopramide as prophylactic antiemetic for morphine

anticoagulation for 24-74hrs with Heparin, Fondaparinux or similar

21
Q

gold standard treatment for MI

A

• Both STEMI and NSTEMI should have angiography and if possible, stenting; STEMI immediately, NSTEMI within 72hrs or sooner if complications

22
Q

secondary prevention measured for an MI

A

o DAPT for a year, then aspirin alone
o Statin
o Beta blocker for a year
o ACE inhibitor
o Treatment for any complications (heart failure, arrhythmia etc.)
o Cardiac rehabilitation: exercise, education, diet, smoking cessation

23
Q

types of bradyarrythmias

A

sinus bradycardia

slow AF/atrial flutter

2nd degree heart block

3rd (complete) heart block

asystole

24
Q

causes of sinus bradycardia

A

Sinus bradycardia Drugs, fitness, conduction disease, hypothyroidism

25
Q

causes of heart block

A

Drugs, conduction disease (age), surgery, aortic endocarditis

26
Q

symptoms of bradyarrythmias

A

asymptomatic
tired/dizziness/breathlessness

complete heart block: + sudden death/syncope

asystole: sudden death

27
Q

management of bradyarrythmias

A

pacemaker (atropine short term)

28
Q

types of tachyarrythmias

A

AF/atrial flutter
superventricular tachycardia
VF/VT

29
Q

causes of AF/flutter

A 
Anything that causes atrial stretch 
Hypertension 
Heart failure 
Valve disease
Lung disease 
Obesity 
Age 
Hyperthyroid
30
Q

causes of SVT

A

Accessory pathways (WPW, etc.), tends not to have co-morbidity

31
Q

causes of VF/VT

A

Anything that affects the ventricles, esp. heart failure, cardiomyopathy, drugs, metabolic derangement, other severe disease, genetic

32
Q

symptoms of AF/flutter

A 
Asymptomatic 
Tiredness
Dizziness
Breathlessness
Palpitations 
Generally, “off”
33
Q

symptoms of SVT

A

Usually intermittent palpitation

Also: syncope/presyncope

34
Q

symptoms of VT/VF

A

Dizziness/breathlessness (both VT), sudden death/syncope (VT or VF)

Phase 3b (9 decks)

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