Cardiology and Vascular Disease Flashcards
what are some complications of a PE
- Chronic thomboembolitic disease: ~5%
* CTEPH ~2%
what are symptoms of PE
Unexplained acute breathlessness chest pain acute unexplained collapse unexplained hypoxia haemoptysis signs of DVT
list 5 strong risk factors for PE
- 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
list 5 moderate risk factors for PE
- 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
list 5 weak risk factors for PE
- 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
what are the 3 components of PE ‘investigation’
clinical assessment and basic investigations
D-dimer
imaging
what is d-dimer
Fibrin degradation product
other than PE/DVT when might d-dimer be raised (or lowered)
• Liver, renal or cardiac failure; AF; aortic dissection, DIC, infection, pregnancy, malignancy, surgery and burns, snake bites etc.
falsely low: patients on anticoagulants
what features are needed to stratify risk of mortality in patients wit PE
blood pressure
imaging (looking for signs of RV dysfunction)
PESI score
cardiac laboratory biomarksers (looking for RV dysfunction or myocardial injury): BNP and troponin
management of PE patients based on their stratification
High risk: thrombolysis
intermediate risk: hospitalise + anti-coagulate
low risk: anti-coagulate + discharge
features that support using warfarin as an anticoagulant for PE
Already on warfarin + good INR control Antiphospholipid Syndrome Mechanical valve Extremes of weight • <40 or >130kg Creatinine Clearance <30 ml/min
features that support using DOACs as an anticoagulant for PE
Patient convenience
Ambulatory PE treatment
Warfarin intolerance
Malignancy
Features that support using LMWH as an anticoagulant for PE
GI or GU malignancy
Pregnancy
Severe hepatic impairment
non modifiable risk factors for coronary artery disease
- Family history
- Age
- Male sex
modifiable risk factors for coronary artery disease
- Smoking
- High cholesterol
- High blood pressure
- Overweight
- Poor diet
- Lack of physical activity
what is the gold standard investigation for coronary artery disease
angiography (CT or invasive)
treatment for coronary artery disease
lifestyle modification: stop smoking, exercise, healthy diet etc.
statins
antiplatelets
medication to manage risk factors e.g. diabetes
medication to reduce angina attacks
what medications can be used to reduce angina attacks
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
important investigations for MI
serial serum troponin
12 lead ECG
immediate medical management of an MI
• 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
gold standard treatment for MI
• Both STEMI and NSTEMI should have angiography and if possible, stenting; STEMI immediately, NSTEMI within 72hrs or sooner if complications
secondary prevention measured for an MI
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
types of bradyarrythmias
sinus bradycardia
slow AF/atrial flutter
2nd degree heart block
3rd (complete) heart block
asystole
causes of sinus bradycardia
Sinus bradycardia Drugs, fitness, conduction disease, hypothyroidism
causes of heart block
Drugs, conduction disease (age), surgery, aortic endocarditis
symptoms of bradyarrythmias
asymptomatic
tired/dizziness/breathlessness
complete heart block: + sudden death/syncope
asystole: sudden death
management of bradyarrythmias
pacemaker (atropine short term)
types of tachyarrythmias
AF/atrial flutter
superventricular tachycardia
VF/VT
causes of AF/flutter
Anything that causes atrial stretch Hypertension Heart failure Valve disease Lung disease Obesity Age Hyperthyroid
causes of SVT
Accessory pathways (WPW, etc.), tends not to have co-morbidity
causes of VF/VT
Anything that affects the ventricles, esp. heart failure, cardiomyopathy, drugs, metabolic derangement, other severe disease, genetic
symptoms of AF/flutter
Asymptomatic Tiredness Dizziness Breathlessness Palpitations Generally, “off”
symptoms of SVT
Usually intermittent palpitation
Also: syncope/presyncope
symptoms of VT/VF
Dizziness/breathlessness (both VT), sudden death/syncope (VT or VF)
