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Year 3 > cardiovascular > Flashcards

cardiovascular Flashcards

1
Q

define arterial ulcer

A
  • localised area of damage and breakdown of skin
  • due to inadequate arterial blood supply
  • typically feet of patients with sever atheromatous narrowing of arteries supplying leg
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2
Q

aetiology of arterial ulcers

A
  • caused by lack of blood flow to capillary beds of lower extremities
  • prevalence increases with age and obesity

risk factors:

  • coronary heart disease
  • Hx of stroke/TIA
  • DM
  • peripheral arterial disease
  • immobility
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3
Q

symptoms + signs of of arterial ulcers

A
  • punched out appearance with clearly defined edges
  • eliptical shape
  • mainly on foot dorsum/toes
  • grey granulomatous tissue
  • ischaemic signs: hairlessness, pale skin, absent pulses, nail dystrophy, calf muscle wasting
  • night pain
  • pain is worse in supine because arterial blood flow is further reduced
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4
Q

investigations for arterial ulcers

A

1. doppler US of lower limbs

  • assess latency of arteries
  • assess potential for revascularisation/bypass surgery
  • ABPI - <0.9= PAD, <0.5- critical limb ischaemia
  • percutaneous angiography
  • ECG
  • fasting serum lipids
  • fasting blood glucose + HbA1c
  • FBC (anaemia can worsen ischaemia)
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5
Q

management of arterial ulcer

A

Immediate:

  • pain relief

surgery

  • angioplasty (balloon => widen arteries in atherosclerosis)
  • stenting
  • bypass grafts
  • amputate
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6
Q

define cardiac arrest

A

acute cessation of cardiac function

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7
Q

aetiology and risk factors of cardiac arrest

A

reversible:

  • hypothermia
  • hypoxia
  • hypovolaemia
  • hypo/hyperkalaemia
  • toxins
  • thromboembolic
  • tamponade
  • tension PTX
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8
Q

presenting symptoms of cardiac arrest

A

sudden; management precede/concurrent to Hx

preceding symptoms:

  • fatigue
  • fainting
  • blackouts
  • dizziness
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9
Q

physical examination findings of cardiac arrest

A

unconscious
absent breathing
absent carotid pulses

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10
Q

investigations for cardiac arrest case

A

cardiac monitor
- classification of rhythm

bloods:
- FBC
- ABG
- U&E
- cross match
- clotting screen
- toxicology screen
- blood glucose

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11
Q

management of cardiac arrest

A

approach arrest scene with caution
* cause of arrest may pose threat

BLS

  • if arrest is witnessed, consider precordial thump
  • clear and maintain airway
  • assess breathing, if absent, 2 rescue breaths
  • assess carotid pulse for 10 seconds, if absent, 30 chest compressions

advanced life support

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12
Q

advanced life support management of cardiac arrest with shockable rhythm

A

cardiac monitor + defibrillator

assess rhythm

shockable rhythms: pulseless VT/VF
- defibrillates once (150-360J biphasic, 360J monophasic)
- resume CPR for 2 mins
- reassess and shock again if no change
- 1mg IV adrenaline after 2nd defibrillation
- 1mg IV adrenaline every 3-5 mins
*persistant shockable rhythm after 3rd shock
- 300mg IV bolus amiodarone

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13
Q

advanced life support management of cardiac arrest with asystole/PEA

A

cardiac monitor + defibrillator

assess rhythm

pulseless electrical activity (PEA)/asystole:

  • CPR for 2 mins
  • reassess
  • 1mg IV adrenaline every 3-5 mins

*asystole or PEA + <60bpm, 3mg IV atropine once only

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14
Q

during CPR for cardiac arrest

A

check electrodes, paddle positions, and contacts

secure airway

consider magnesium, bicarbonate, and external pacing

stop CPR and check pulse ONLY IF change in rhythm or signs of life

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15
Q

treatment of reversible causes of cardiac arrest

A

hypothermia
- warm slowly

hypovolaemia

  • IV colloids
  • IV crystalloids
  • blood products

hypo/hyperkalaemia

  • give insulin (+dextrose) increase K+uptake

toxins
- toxin antidote

thromboembolic
- treat as PE/MI

tamponade
- pericardiocentesis

tension PTX
- aspiration/chest drain

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16
Q

complications of cardiac arrest

A

irreversible hypoxic brain damage
death

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17
Q

prognosis of cardiac arrest

A

resus less successful if cardiac arrest occurs outside hospital

increased duration of inadequate effective CO = poor prognosis

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18
Q

define DVT

A

thrombus formation within deep veins of usually calf or thigh

deep veins in leg more prone due to blood stasis (Virchow’s triad)

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19
Q

DVT risk factors

A
  • polycythaemia
  • thrombophilia
  • OCP
  • post surgery
  • prolonged immobility/ long flights
  • obesity
  • pregnancy
  • dehydration
  • smoking
  • malignancy
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20
Q

presenting symptoms of DVT

A
  • asymmetrical swollen leg
  • may be painless
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21
Q

examination findings of DVT

A
  • local erythema, warmth, and swelling
  • varicosities (dilated superficial veins)
  • skin colour changes
  • +/- unilateral leg pain
  • Homan’s sign
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22
Q

what is Homan’s sign

A

seen in patients with DVT

forced passive dorsiflexion of ankle causes deep calf pain

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23
Q

how to stratify risk of PE in case of DVT

A

stratified using Well’s PE criteria
2 or more = high risk

  • history: breathlessness, cough, haemoptysis
  • check RR, pulse oximetry, and pulse rate
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24
Q

investigations for DVT

A

Use Wells score for DVT (<2 = low risk)

doppler US - gold standard

bloods:

  • *- D dimer** (if low = unlikely to be DVT)
  • thrombophilia screen if indicated

impedance plethysmography
- changes in blood volume causes changes in electrical resistance

if suspected PE:

  • ECG
  • CXR
  • ABG
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25
Q

management plan for DVT

A

confirmed DVT + not pregnant

  • 3 months anticoagulation (DOACs- apixaban/ rivaroxiban) -LMWH as alternative
  • physical activity
  • compression stockings

Confirmed DVT + preganant

  • LMWH- anticoagulation
  • physical activity
  • compression stockings

*recurrent DVT = long term warfarin

if anticoagulation contraindicated (bleeding, haemorrhage, major trauma, aortic dissection) => IVC filter

* DVTs that DO extend above knee => anticoagulation for 6 months

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26
Q

prevention of DVT

A

graduated compression stockings

mobilisation

prophylactic heparin if high risk

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27
Q

possible complications of DVT

A
  • PE
  • venous infarction (death of tissue due to poor perfusion)
  • thrombophlebitis- inflammed vein due to clot (from recurrent DVTs)
  • chronic venous insufficiency
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28
Q

prognosis of DVT

A

depends on extent of DVT

below knee = good

proximal DVT = greater risk of embolisation

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29
Q

define vasovagal syncope

A

loss of consciousness from transient drop in blood flow to brain caused by excessive vagal discharge

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30
Q

aetiology/risk factors of vasovagal syncope

A

common cause of fainting
precipitated by
- emotions
- orthostatic stress

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31
Q

presenting symptoms of vasovagal syncope

A

short loss of consciousness

vagal symptoms
- sweating
- dizziness
- light headedness
before episode

twitching during episode

quick recovery

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32
Q

signs on physical examination of vasovagal syncope

A

usually no signs

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33
Q

investigations for vasovagal syncope

A

checking for causes

ECG - arrhythmias
echocardiogram - outflow obstruction
lying/standing BP - orthostatic hypotension
fasting blood glucose - DM/hypoglycaemia

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34
Q

define venous ulcers

A
  • large, shallow, sometimes painful
  • usually superior to medial malleoli
  • caused by incompetent valves in lower limbs - leads to venous stasis and ulceration
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35
Q

aetiology and risk factors of venous ulcers

A

caused by incompetent valves in lower limbs
- leads to venous stasis and ulceration

risk factors:

  • obesity
  • immobility
  • recurrent DVT
  • varicose veins
  • previous injury/surgery to leg
  • age
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36
Q

presenting symptoms + signs of venous ulcers

A
  • large, shallow, sometimes painful ulcers
  • irregular margin
  • swelling, itching, aching
  • in gaiter region (superior to medial malleoli => mid calf)
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37
Q

associated signs of venous insuffiency with venous ulcers

A
  • stasis eczema
  • lipodermatosclerosis (champagne bottle)
  • haemosiderin deposition (dark colour)
  • atrophie blanche (blood deposits)
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38
Q

investigations for venous ulcers

A
  • ABPI (excuse arterial ulcer) - if ABPI <0.8, DO NOT apply pressure bandage
  • Duplex USS of lower legs (GOLD-STANDARD)
  • measure surface area of ulcer for monitoring of progression
  • microbiology swab samples
  • biopsy if suspected Marjolin’s ulcer
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39
Q

management of venous ulcers

A
  • graduated compression to reduce venous stasis- must exclude DM, neuropathy, and PVD before attempt
  • debridement and cleaning
  • Abx if infected
  • topical steroids to treat surrounding dermatitis
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40
Q

complications and prognosis of venous ulcers

A
  • recurrence
  • infection

good prognosis
- better results if mobile with few comorbidities

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41
Q

Define Ischaemic heart disease

A

Ischaemic heart disease is when myocardial demand exceeds oxygen supply resulting in chest pain (angina pectoris)
=> present as stable angina or ACS

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42
Q

Causes of IHD ( A VASE)

A

when myocardial demand exceeds oxygen supply

usually due to:

  • Atherosclerosis
  • Vasculitis
  • Arteritis
  • coronary artery Spasm (cocaine)
  • Embolism
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43
Q

Risk factors of IHD

A
  • male
  • Diabetes mellitus
  • FHx
  • Hypertension
  • Hyperlipidaemia
  • Smoking
  • older age
  • Obesity
  • sedentary lifestyle
  • cocaine
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44
Q

Pathophysiology of atherosclerosis

A
  1. endothelial damage causes monocytes/ LDLs to migrate into subendothelial space
  2. free LDLs bind to matrix proteoglycans
  3. monocytes differentiate => macrophages release free radicals that oxidise LDLs.
  4. macrophages engulf oxidised LDLs => foam cells
  5. foam cells release growth factors + cytokines => smooth muscle proliferation, collagen production, proteoglycan production
  6. forms atherosclerotic plaque
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45
Q

presenting symptoms of Stable angina

A
  • chest pain on exertion and relieved by rest
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46
Q

Examination findings of stable angina

A
  • mainly check for risk factors
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47
Q

Investigations for IHD (ACS)

A

Bloods:

  • FBC
  • U&Es, TFTs
  • CRP
  • glucose
  • lipid profile
  • amylase (exclude pancreatitis)
  • AST/ LDH (1-2 days post)
  • cardiac enzymes (troponins + Creatine Kinase-MB)
  • ECG (+ exercise ECG)
  • radionuclide scan
  • CT
  • MRI
  • Coronary angiography
  • CXR - check for HF signs (cardiomegaly, pulmonary oedema, widened mediastinum)
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48
Q

Prognosis of IHD

A
  • TIMI score (0-7 thrombolysis in MI)- high scores = high risk of cardiac events within 30 days of MI
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49
Q

define Acute coronary syndromes

A

type of IHD (atherosclerosis causing partial/total occlusion of coronary arteries)

  • unstable angina (RARE)
  • NSTEMI
  • STEMI
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50
Q

Pathophysiology of ACS

A
  1. unstable angina- unstable coronary plaque, disrupts fibrous cap => forms incomplete thrombus
  2. NSTEMI- incomplete thrombus forms => partial artery occlusion
  3. STEMI- coronary plaque ruptures => complete thrombus formation => complete artery occlusion, transmural infarction
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51
Q

presenting symptoms of ACS

A
  • acute-onset chest pain lasting >20mins
  • central, heavy, tight crushing chest pain
  • pain radiates to arm, neck, jaw, epigastrium

Associated symptoms:

  • breathlessness
  • sweating
  • palpitations
  • nausea
  • vomiting
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52
Q

Symptoms of silent infarcts in elderly/ diabetics

A
  • no chest pain
  • syncope
  • pulmonary oedema
  • epigastric pain
  • vomiting
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53
Q

Examination findings of ACS

A
  • may not be signs
  • pale, sweaty, restless, fever
  • high/low bp
  • arrhythmias
  • new heart murmurs
  • signs of heart failure (raised JVP, S3, basal crepitations)

*rule out aortic dissection (check radial pulses)

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54
Q

Investigations for ACS

A
  • bloods (FBC, U&Es, AST/LDH, lipid profile, glucose, amylase (exclude pancreatitis), CARDIAC ENZYMES (raised troponin/ myoglobin/ CK-MB)

*troponin not raised in unstable angina

  • ECG
  • radionuclide scans
  • CT coronary angiography
  • MRI
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55
Q

Investigations for stable angina

A
  • bloods (FBC, lipid profile, AST/LDH, cardiac enzymes: troponin, myoglobin, CK-MB, BNP)
  • ECG (usually normal)
  • CT coronary angiography (check for arterial stenosis)
  • exercise tolerance test
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56
Q

ECG findings for

  1. Unstable angina/ NSTEMI
  2. STEMI
A
  1. ST depression/ T wave inversion
  2. ST elevation, hyperacute T waves -tall (later T wave inversion), new-onset LBBB
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57
Q

Management for stable angina

A
  • reduce cardiac risk factors (lower bp/cholesterol, diabetes, stop smoking, exercise)

Immediate

  • 75mg/day aspirin
  • symptom relief: GTN spray

Long term

  • beta blockers (not for acute heart failure, cardiogenic shock, bradycardia, heart block, asthma)
  • CCBs
  • nitrates

Surgical:

  • PCI (if medication doesn’t work)
  • CABG
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58
Q

Mangement for unstable angina/ NSTEMI (MONABASH)

A
  • Morphine (give metoclopramide for nausea)
  • Oxygen (only if sats >95%)
  • Nitrates (GTN)
  • Antiplatelets (Aspirin, Clopidogrel)
  • Beta-blockers
  • ACE-inhibitors
  • Statins
  • Heparin

Surgery (no improvement) => angioplasty +/- revascularisation (PCI/ CABG)

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59
Q

Management for STEMI

A
  1. antiplatelet (ASPIRIN 300mg) + anticoagulants (heparin)
  2. primary PCI or thrombolysis
  3. Long term (beta-blockers, ACE-inhibitors, statins, antiplatelets (aspirin + clopidogrel), lifestyle changes, cardiac rehabilitation)
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60
Q

Complications of MI (DARTH VADER)

A
  • death
  • arrhythmias
  • rupture (septum/outer walls)
  • tamponade
  • heart failure
  • valve disease
  • aneurysm
  • Dressler’s syndrome (autoimmune pericarditis)
  • Embolism
  • Reinfarction
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61
Q

Pathophysiology of peripheral vascular disease

A

caused by atherosclerosis => stenosis of arteries => poor perfusion to limbs => ischaemia => pain

  • chronic limb ischaemia (intermittent claudication / critical limb ischaemia)
  • acute limb ischaemia
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62
Q

Risk factors for peripheral vascular disease

A
  • hypertension
  • smoker
  • FHx of CVD
  • diabetics
  • elderly
  • hyperlipidemia
  • sedentary lifestyle
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63
Q

Presenting symptoms of intermittent claudication

A
  • intermittent claudication (leg pain after exercise + relived on rest immediately
  • Calf claudication = femoral disease
  • Buttock claudication = iliac disease
  • erectile dysfunction
  • poor/ slow wound healing
  • gangrene
  • presecence of risk factors
  • reduced/ absent pulses
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64
Q

Presenting symptoms of critical limb ischaemia

A
  • gangrene
  • ulcers
  • pain at rest
  • night pain (relieved by dangling legs off the bed)
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65
Q

Investigations for peripheral vascular disease

A

Bedside:

  • ECG
  • ABPI (ankle brachial pressure index SBP of ankle/brachial)- <0.9 = abnormal, <0.5 = critical limb ischaemia

Bloods

  • FBC
  • U&E (check for renal disease)
  • fasting glucose (check in diabetics)
  • lipid levels
  • D-dimer (fibrin degradation product)
  • thrombophillia screen
  • troponins
  • CRP/ESR (raised indicates thrombophlebitis)

Imaging

  • Colour duplex ultrasound of pulses (check stenosis)
  • CT angiography/CTA(detetct location + stenosis)- need contrast
  • Magnetic resonance angiogaphy/MRA (detect stenosis)
  • Trancutaneous pressure of oxygen (perfusion to foot)
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66
Q

Why do diabetics/renal failure have a raised ABPI normally?

A

calcification of arteries result in high ankle pressures due to incompressible arteries

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67
Q

Management of peripheral arterial disease (intermittent claudication)

A

non-lifestyle limiting claudication

  • anti-platelets (aspirin, clopidogrel)
  • exercise
  • reduce risk factors (low fat/cholesterol diet, exercise, stop smoking/alcohol, optimise diabetes)

lifestyle limiting claudication

  • anti-platelets
  • exercise (supervised exercise therapy)
  • symptom relief VASOACTIVE drugs (naftidrofuril)- reduces pain on walking
  • adjunct revascularisation (PTA - percutaneous transluminal balloon angioplasty or BYPASS)
  • amputation
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68
Q

Define ischaemic limb

A
  • Can be acute or acute and chronic
  • thrombotic (absent/diminished pulses Hx of intermittent claudication)
  • embolic (suddent/more severe- no established collaterals)
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69
Q

Presenting symptoms of acute limb ischaemia (6Ps)

A
  • pale
  • pulselessness
  • perishingly cold
  • pain
  • paralysis
  • parasthesia

Other

  • hair loss
  • skin atrophy
  • punched out ulcers
  • leg colour change when raised to buerge’s angle
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70
Q

Management of acute limb ischaemia

A

Immediate

  • analgesia
  • anticoagulants (heparin)

Surgery

  • Revascularisation (within 4hrs)- endovascular revascularisation/ fasciotomy
  • Amputation
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71
Q

Define abdominal aortic aneurysm (AAA)

A

abnormal dilation of aorta (>50% normal size) across all layers of aorta wall

Screening progroamme for <65 males

  • >3mm => surveillance
  • >5.5mm => repair
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72
Q

risk factors for AAA

A
  • modifiable (smoking, hypertension, dyslipidemia)
  • non-modifiable (MALE, older, Family Hx)
  • connective tissue disorders (Marfan’s, Ehlers Danos)
  • Inflammatory disorders (Behcet’s disease-vessel inflammation)
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73
Q

Different types of aneurysms

A
  • true aneurysm= dilation across all layers of aorta wall
  • false/pseudoaneurysm = dilation only across part of aorta wall (adventitia)
  • location = aortic, iliac, popliteal
  • morphology = saccular / fusiform
  • aetiology = athelosclerosis, inflammatory, inherited, mycotic (infection by fungi/bacteria)
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74
Q
  1. Presenting symptoms of AAA
  2. Presenting symptoms of ruptured AAA
A

unruptured

  • usually asymptomatic
  • abdominal/groin/back pain (pressure related)

ruptured:

  • abdominal pain => radiates to back
  • syncope/ light headed (reduced cerebral perfusion)
  • cold, sweaty, nausea - activation of sympathetic response
  • pallor
  1. Pressure (back pain)
  2. Rupture (high mortality rate)
  3. Thrombosis (acute limb ischaemia)
  4. Embolisation (ischaemic symptoms)
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75
Q

Examination signs of AAA

A
  • pulsatile, expansile pulse in abdominal aorta palpation
  • shock signs (tachycardia, low bp) in RUPTURED AAA
  • +/- aortic bruits
  • pallor
  • abdominal distension
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76
Q

Investigations for AAA

A

Bedside

  • ECG (check for MI)

Bloods:

  • FBC (inflammatory AAA => anaemia)
  • CRP/ESR (raised)
  • clotting screen
  • U&Es
  • LFTs
  • Cardiac enzymes
  • blood cultures (+ve - inflammatory AAA)
  • Group and save- if surgery planned
  • amylase (exclude pancreatitis)

Imaging

  • Hameodynamically unstable => Aortic USS
  • Hameodynamically stable => CT with contrast Angiography, MRI angiography
77
Q

Management for AAA

A

Hameodynamically unstable + ruptured/symptomatic AAA

  • RESUS (B- oxygen, C- 2 large bore IV cannulae, take bloods, measure bp. IV fluids -for shock)
  • analgesia
  • Prophylaxis antibiotics
  • Surgery (endovascular aneurysm repair, open repair)
  • VTE prophylaxis

Asymptomatic AAA

  • Surveillance
  • modify risk factors (stop smoking, exercise, low fat diet)
78
Q

Indications for surgery for AAA

A
  • women >5cm, men >5.5 cm size
  • growing >1cm/yr
  • symptomatic
  • repair aorta-iliac disease
79
Q

define aortic dissection

A

tear in the tunica intima=> between the inner (interna) /outer wall (media) creating a false lumen in the aorta

80
Q

classification of aortic dissection

A

Stanford

  • Type A- affects ascending aorta (MORE SEVERE)
  • Type B- affects descending aorta

Debakey

  1. Type I- ascending aorta + aortic arch affected
  2. Type II- ascending aorta
  3. Type III- descending aorta
81
Q

Causes of aortic dissection

A
  • uncontrolled Hypertension
  • connective tissue disorders (Marfan’s, Erhlers Danos, Loeys-dietz)
  • Aortic atherosclerosis
  • vasculitis
  • iatrogenic (angioplasty)
  • pregnancy
  • Congenital => Coarctation (? x2 arches)
  • Aortitis (inflammation of aorta)
  • Trauma
  • Cocaine
82
Q

Presenting symptoms of aortic dissection

A
  • sharp, tearing pain radiating to back
  • +/- loss of consciousness
  • poor perfusion of end organs
  • carotid artery => blackout, dysphagia, hemiparesis
  • coronary artery => chest pain
  • subclavian artery => ataxia, loss of consciousness
  • anteria spinal artery=> paraplegia
  • coeliac axis artery => abdominal pain (ischaemia)
  • renal artery => renal failure, anuria
83
Q

Examination findings of aortic dissection

A
  • hypertension, bp difference >20mmHg between arms

aortic insufficiency

  • murmur on back (below scapula) => abdomen
  • unequal arm pulses
  • signs of aortic regurg (collapsing pulse, diastolic murmur)
  • +/- abdominal mass
84
Q

Investigations for aortic dissection

A

Bedside

  • ECG (usually normal but could see inferior ST elevation/ LVH if coronary arteries affected)

Bloods

  • FBC
  • U&E- check renal function
  • Cardiac enzymes (exclude MI)
  • clotting screen
  • group and save

Imaging

  • CXR - widened mediastinum
  • CT angiogram aorta - can see false lumen (DIAGNOSTIC)
  • Transoesophageal Echo- look at valves (for patients unsuitable for CT)
85
Q

Management for aortic dissection

A

Haemodynamically unstable

  • RESUS => oxygen, IV fluids, cannula, take bloods
  • Analgesia (opioids-morphine)

Type A

  • SURGERY

Type B

  • UNCOMPLICATED: control bp- (IV labetolol- beat-blocker), HR, pain
  • COMPLICATED: surgery (Thoracic endovascular aortic repair/ open surgery)
86
Q

Differentials for aortic dissection

A
  • chest pain radiating to back => MI
  • hypotension => tamponade
  • pulsus paradoxus (bp change on inspiration) => pericarditis, tamponade, COPD, Obstructive sleep apnoea
87
Q

define arrythmias

A

due to conduction abdnormality at SAN/ AVN => abnormal heart rhythm

88
Q

Conduction pathway of heart

A
  1. SAN generates impulses across atria walls
  2. Conducted by AVN
  3. Signalds travel down bundle of His
  4. Electrical impulse goes down left / right bundle branches
  5. Down into purkynje fibres => ventricles
89
Q

Types of arrythmias

A

Bradyarrythmia (<60bpm)

  • heart block (1st, Mobitz I, Mobitz II, 2nd degree 2:1, 3rd degree )
  • sinus bradycardia - treat with atropine

Tachyarrythmia (>100bpm)

  • supraventricular tachycardia (narrow QRS)- Atrial flutter, AF, Wolff-parkinson
  • ventricular tachycardia (prolonged QRS)
  • ventricular fibrillation (no pulse, irregular rhythm)
  • RBBB/LBBB block => prolongs QRS complex
90
Q

Causes of bradyarrythmias

A
  • age-related conductive tissue fibrosis
  • drugs (beta-blockers + CCBs)
  • previous MI
  • hypothermia
  • electrolyte imbalance
  • increased vasovagal tone (head injury, pain)
91
Q

presenting symptoms of heart block

A
  • usually asymptomatic
  • dizziness
  • palpitations
  • chest pain

Mobitz II/ Type 3:

  • syncope
92
Q

examination findings of heart block

A
  • usually normal
  • large volume pulse
  • cannon waves in JVP

Mobitz II/ Type 3 heart block:

  • hypotension
  • heart failure (raised JVP, peripheral oedema)
93
Q

investigations for heart block

A
  • ECG (GOLD-STANDARD)
  • Bloods: FBC, U&Es, TFTs, digoxin, troponin
  • CXR: cardiomegaly, pulmonary oedema
  • ECHO - exclude valve disease
94
Q

ECG features for heart block

A
  • 1st degree - long PR interval (>3-5 small squares)
  • Mobitz I/ Wenckebach- lengthening PR interval, drop QRS
  • Mobitz II - missing QRS complexes (normal PR interval)
  • 2nd degree AV block (2:1/3:1)
  • 3rd degree - atria/ventricles out of sync
95
Q

Management of heart block

A
  • cardiac monitoring
  • Treat cause (hypothermia, STOP drugs, correct electrolytes)
  • => PERMENANT PACEMAKER

Haemodynamically unstable:

  • CPR
  • external pacemaker (de-fibrillator)
  • Temporary pacing wire inserted via femoral vein
96
Q

Causes of tachyarrythmias

A
  • MI
97
Q

presenting features of tachyarrythmias

A
  • chest pain
  • palpitations
  • dyspnoea (SOB)
  • syncope
98
Q

investigations for tachyarrythmias

A
  • ECG

Bloods:

  • U&Es- electrolyte imbalance => arrythmias
  • drug toxicology screen
  • Cardiac enzymes - troponins (check for recent MI/ischaemia)
99
Q

ECGs of tachyarrhythmias

  1. Atrial flutter (SVT)
  2. Atrial fibrillation (SVT)
  3. Ventricular tachycardia
  4. Ventricular fibrillation
A
  1. Atrial flutter (saw tooth)
  2. Atrial fibrillation (no P waves)
  3. VF- no identifiable P waves/QRS complexes
  4. VT- wide QRS (>3 boxes), HR >100bpm
100
Q

management of tachyarrythmias

A

adverse signs (SHOCK, syncope, MI, HF)

  1. synchronised DC shock (for shockable rhythm-VF/VT) X3
  2. IV amiodarone (anti-arrhythmic)
  3. long term - implantable cardio defibrillator (ICD)

no adverse signs + broad QRS (ventricular)

  • regular = VT (amiodarone)
  • irregular = VF (seek HELP)

no adverse signs + narrow QRS (SVT)

  • regular= 1. adenosine = Atrial flutter (b-blocker)
  • irregular = AF (B-blockers, amiodarone/digoxin if HF signs)
101
Q

define infective endocarditis

A

infection of endocardium (lining of heart chambers) due to vegetation (platelets, fibrin, bacteria deposits) destroy valve leaflets and invade myocardium

102
Q

common microorganisms that cause infective endocarditis

A
  • staph aureus (IV drug users) MOST COMMON
  • streptococcus viridans (dental hygiene related)
  • streptoccous bovis (colorectal cancer related)
  • Staphylococcus epidermidis (prosthetic valves)
103
Q

risk factors for infective endocarditis

A
  • recent dental work/ poor dental hygiene (S. viridans)
  • IV Drug users
  • valve defects (congenital, rheumatic fever)
  • prosthetic heart valves
  • post-op wounds
  • DM
  • organ transplants
104
Q

presenting symptoms of infective endocarditis

A
  • FEVER
  • chills
  • malaise
105
Q

examination findings of infective endocarditis (FROM JANE C)

A
  • Fever
  • Roth spots on retina
  • Osler’s nodes (painful)
  • new heart Murmur
  • Janeway lesions (painless)
  • Anaemia (pallor)
  • Nail-splinter haemorrages
  • Emboli
  • Clubbing
106
Q

investigations for infective endocarditis

A
  • Urinalysis
  • Bloods: FBC-low Hb, high WCC, high CRP, U&Es, LFTs, +ve rheumatoid factor
  • Blood cultures (x3)
  • CXR- cardiomegaly
  • ECHO - check for vegetation (>2mm)
107
Q

Management of Infective endocarditis

A
108
Q

What’s the diagnostic tool for infective endocarditis

A

Duke’s criteria

  • 2 major (+ve blood cultures, new murmur)
  • 1 major + 2 minor
  • 5 minor (temp, IV drug user, pre-existing heart disease, R/O/J/S)
109
Q

Management of infective endocarditis

A
  • 4-6 week ANTIBIOTICs (empirical =benzylpenicillin/amoxicillin)
  • if not surgery
110
Q

Complications of infective endocarditis

A
  • aneurysm
  • heart failure
  • valve incompetence
111
Q

define hypertension

A

peristently raised high blood pressure >140/90

  1. essential (idiopathic/unknown)- 90%
  2. secondary (medical cause)
112
Q

Risk factors for primary (essential) hypertension

A
  • older age
  • males (<65), females (>65)
  • high salt diet
  • poor exercise
  • obesity
  • high alcohol intake
  • black afro-carribean ethnicity
  • stress/ anxiety
113
Q

Causes of secondary hypertension (medical)

A

renal

  • diabetic nephropathy (proteinurea, microalbuminuria)
  • polycystic kidney disease
  • glomerulonephritis (microscopic haematuria)
  • pyelonephritits
  • RCC (haematuria, loin mass/pain)

endocrine

  • primary hyperaldosteronism (hypokalemia, alkalosis/XS bicarbonate)
  • phaechromocytoma (XS adrenaline- intermittent high bp/sweating/headaches/postural hypotension)
  • Cushing’s (XS cortisol=> moon face, striae, central obesity)
  • acromegaly (XS GH => enlarged hands/feet, macroglossia, sweating)
  • hypothyroidism
  • hyperthyroidism

vascular

  • coarcation of aorta (radio-femoral delay)
  • renal artery stenosis (abdominal bruit + peripheral vascular disease)

drugs

  • ALCOHOL
  • OCP
  • corticosteroids
  • cocaine
114
Q

How to classify hypertension?

A
  1. stage 1 - 140/90 in clinic or 135/85 ABPM/home
  2. stage 2- 160/100 in clinic or 150/90 ABPM/home
  3. stage 3/ severe- 180/120
115
Q

Why does Ambulatory blood pressure monitoring (ABPM) have a lower threshold for hypertension diagnosis?

A
  • avoids blood pressure rise due to white coat syndrome (anxious in clinic can increase bp)
116
Q

Presenting symptoms of hypertension

A
  • severe:
  • headaches
  • bleeding nose
117
Q

examination signs for hypertension

A
  • signs of heart failure (raised JVP, pitting oedema)

end organ damage (fundoscopy)

  • retinal haemorrhages
  • papilloedema
  • proteinuria (AKI)
118
Q

Investigations for hypertension

A
  1. ABPM/HBPM

Check for secondary cause

  • ECG (check for left ventricular hypertrophy)
  • Urine dipstick- haematuria, proteinurea (AKI), microalbuminuria (nephropathy)

Bloods:

  • FBC
  • U&Es
  • urine albumin:creatine ratio
  • eGFR - CKD
  • TFTs (hypo/perthyroidism)
  • lipid profile (check CV risk)
  • HbA1c- diabetes (check CV risk)

Calculate Q-risk

Imaging

  • renal USS + CT
119
Q

Management of hypertension

A
  • lifestyle (low salt diet, exercise, stop smoking, reduce alcohol)
  • medical (A=ACE-inhibitor rampiril, C= CCB amlodipine, D= thiazide-diuretics indapamide)

<55 / T2DM

  1. A
  2. A+C/ A+D
  3. A+C+D

>55/ afro-carribean descent

  1. C
  2. C+A/ C+D
  3. A+C+D
  4. Still uncontrolled bp
  • repeat bp=> ABPM, check for postural hypertension
  • add low dose loop diuretic (spiranolactone)/ alpha or beta-blocker if they have hyperkalemia (>4.5mmol/L)
  • if bp still not controlled refer to specialist
120
Q

complications of hypertension

A
  • heart (coronary artery disease, heart failure)
  • vascular (vascula dementia, peripheral artery disease, stroke)
  • renal (CKD)
121
Q

What score should be calculated for hypertensive patients?

A

QRISK - risk of developing CVD in 10yrs

122
Q

define pericardial disease

A

pericarditis = inflammation of pericardium

constrictive pericarditis = chronic inflammation of pericardium (rigid/thickened so heart is restricted)

123
Q

causes of pericarditis

A
  • mainly viral (coxsacchie virus, echovirus,mumps)
  • bacterial (streptococci, staph.)
  • POST-MI
  • Dressler’s syndrome
124
Q

presenting symptoms of pericarditis

A
  • central chest pain
  • may radiate to shoulder/arm
  • pleuitic chest pain relieved by leaning forward
  • nausea
125
Q

examination findings of pericarditis

A
  • fever
  • friction rub (like leather rubbing together)
  • faint heart sounds
126
Q

Signs of constrictive pericarditis

A

Right heart failure signs:

  • pulsus paradoxus (>10mmHg drop in SBP on inspiration)
  • Kussmaul’s sign (paradoxical raise in JVP on inspiration)
  • hepatomegaly
  • ascities
  • pericardial knock (early diastolic knock)
  • peripheral oedema
  • AF
127
Q

investigations for pericarditis

A
  • ECG - widespread saddle-shaped ST elevation
  • Echo - pericardial effusion
  • Bloods: FBC, CRP, troponins, U&Es,
  • CXR - cardiomegaly
128
Q

Management for pericarditis

A

acute:

  • treat underlying cause
  • NSAIDs for pain/fever
  • aspirin

recurrent

  • low-dose steroids
  • immunosuppressants

surgical (if constricitve pericarditis) => pericardiectomy (cut part of pericardium)

129
Q

complications of pericarditis

A
  1. pericardial effusion (fluid in pericardium)
  2. cardiac tamponade (fluid build up compresses heart)
  3. cardiac arrythmias
130
Q

symptoms + signs of cardiac tamponade

A

symptoms:

signs: (BECK’S TRIAD)

  • raised JVP
  • hypotension
  • muffled heart sounds
131
Q

define cardiac failure

A

inability of cardiac output to meet body’s demands despite normal venous pressures

132
Q

how to classify heart failure

A
  • acute/chronic
  • LHF/ RHF or congestive heart failure (LHF +RHF)
  • low cardiac output or high cardiac output
133
Q

Causes of LHF (low cardiac output)

A

Valvular

  • aortic stenosis
  • aortic regurgitaiton
  • mitral regurgitation

Muscular

  • ischaemic heart disease (IHD)- most common
  • arrythmias
  • myocarditis

Systemic:

  • sarcoidosis
  • amyloidosis
134
Q

Causes of RHF

A

Secondary to LH failure (congestive cardiac failure)

Lungs:

  • Pulmonary hypertension (cor pulmonale)
  • Pulmonary embolism
  • Chronic lung disease (Cystic fibrosis, ILD)

Valvular disease:

  • tricuspid regurgitation
  • pulmonar valve disease
135
Q

Causes of high output failure (NAPMEALS)

*higher CO demand than normal

A
  • Nutritional (thiamine/ B1 deficiency)
  • Anaemia
  • Pregnancy
  • Malignancy
  • Endocrine (hyperthyroidism)
  • AV malformation
  • Liver cirrhosis
  • Sepsis
136
Q

symptoms + signs of left heart failure

A

Symptoms:

  • dyspnoea/ SOB- paroxysmal nocturnal dyspnoea, exertional dyspnoea, orthopnoea

1 - none
2 - on ordinary activities
3 - less than ordinary activities
4 - at rest

  • nocturnal cough (+ pink frothy sputum)
  • fatigue

Signs:

  • raised RR/HR
  • S3 gallop- rapid ventricular filling, S4
  • displaced apex beat
  • pluses alternans- arterial pulse waveforms with alternating strong and weak beats
  • bilateral basal crackles (pulmonary oedema)
  • wheeze
137
Q

symptoms + signs of right heart failure

A

symptoms:

  • swollen ankles
  • fatigue
  • reduced exercise tolerance
  • anorexia
  • nausea

signs:

  • face swelling
  • raised JVP
  • pan-systolic murmur (tricuspid regurgitation)
  • ascites, hepatomegaly
  • pitting oedema
138
Q

explain why pulsus alternans occurs

A

LV dysfunction
= significant decrease in EF
= reduced SV
= increased EDV
= LV stretched more for next contraction

starling’s law: increased stretch = increased strength of myocardial contraction
= stronger systolic pulse

139
Q

Investigations for cardiac failure

A

Bedside: ECG

Bloods:

  • BNP (specific)
  • FBC (exclude anaemia)
  • U&E
  • LFT
  • TFT (exclude hypothyroidism)

Imaging:

  1. CXR (ABCDE)
  • Alveolar shadowing
  • kerley B lines
  • Cardiomegaly
  • upper lobe Diversion
  • Effusion
  1. Transthoracic echocardiogram (DIAGNOSTIC)
  • assess ventricular contraction
  • systolic dysfunction (LV EF < 40%)
  • diastolic dysfunction (due to decreased compliance which causes restrictive filling defect)
140
Q

Management of acute heart failure

A
  1. upright position
  2. 60-100% oxygen (consider CPAP)
  3. IV diamorphine (venodilator + anxiolytic)
  4. GTN infusion (venodilator- reduces preload)
  5. IV furosemide (venodilator- reduces preload)
141
Q

Management of chronic heart failure

A
  1. treat cause and exacerbating factors
  2. Lifestyle- low salt diet, exercise
  3. Drugs (ABD)
  • ACE inhibitors or angiotensin receptor blockers (if intolerant/ cough)
  • Beta blockers
  • loop Diuretics -furosemide
  • aldosterone antagonists (monitor K+)
  • hydralazine and nitrate- for afro-carribeans
  • digoxin
  1. cardiac resynchronisation therapy
142
Q

complications of cardiac failure

A
  • respiratory failure
  • renal failure
  • cardiogenic shock
  • death

prognosis= 50% die within 2 yrs

143
Q

define myocarditis

A

inflammation of the myocardium (heart muscle)

144
Q

causes of myocarditis

A
  • Coxsaccie virus
  • infection
  • drugs- cocaine
  • radiation
  • metal
145
Q

presenting symptoms of myocarditis

A
  • flu-like
  • SOB
  • chest pain (worse on lying down)
  • palpitations
146
Q

investigations for myocarditis

A
  • ECG - ST/T wave changes
  • cardiac biomarkers: CK, troponin
  • endomyocardial biopsy (diagnostic but very invasive so rarely done)
147
Q

management of myocarditis

A
  • supportive care
  • conventional heart failure therapy
148
Q

define pulmonary hypertension

A

increase in pulmonary arterial pressure (PAP)

149
Q

Causes of pulmonary hypertension

A
  1. Pulmonary arterial hypertension - changes to pulmonary arteries (thick/stiff)
  • connective tissue disorders (scleroderma)
  • liver disease
  • congenital heart defects
  • HIV
  • Idiopathic
  1. PH associated with Left ventricular failure
  2. PH associated with Lung disease (less oxygen)
  • COPD
  • interstitial lung disease- pulmonary fibrosis
  • Obstructive sleep apnoea
  • obesity hyperventillation syndrome
  1. PH associated with blood clots Thromboses/emboli in lungs
  • HIV
  • Liver disease/ portal hypertension
  • congenital heart defects
  1. PH associated with other rare causes
  • sarcoidosis
  • tumours (compression of pulmonary vessels)
150
Q

Presenting symptoms of pulmonary hypertension

A
  • progressive breathlessness
  • weakness/tiredness
  • exertional dizziness and syncope

Late stage:

  • angina
  • oedema
  • ascites
  • tachyarrhythmias
151
Q

Examination findings of pulmonary hypertension

A

Inspection:

  • raised JVP
  • peripheral oedema
  • ascites

Palpation:

  • right ventricular heave

Auscultation:

  • loud pulmonary second heart sound
  • pulmonary regurgitation murmur (early diastolic)
  • tricuspid regurg
152
Q

Investigations for pulmonary hypertension

A

Bedside:

  • ECG- right ventricular hypertophy + strain

Bloods:

  • LFTs - liver disease/portal hypertension

Imaging:

  • CXR- exclude other lung problems
  • ECHO- check right ventricular function

Other:

  • Right heart catheteristion (directly measures pulmonary pressures) - DIAGNOSTIC
  • Pulmonary function tests
  • Lung biopsy - interstitial lung disease
153
Q

Management of pulmonary hypertension

A

Supportive treatment

  • diuretics- removes excess fluid (treat ankle swelling)
  • oxygen (reduce breathlessness)
  • pulmonary rehabilitiation (exercise to help with breathlessness)

Specialist treatment varies on type of PH

  1. Pulmonary arterial hypertension (group 1) =>pulmonary vasodilators
  2. caused by left heart disease/lung conditions(group 2/3) => as PH is secondary treat the primary condition
  3. caused by blood clots (group 4) => anticoagulants(warfarin, DOACS)
154
Q

Complications of pulmonary hypertension

A
  • Cor pulmonale - right ventricle enlargement => failure
  • Blood clots
  • Arrythmias (palpitations, dizziness, fainting)
  • Bleeding in lungs (haemoptysis)
  • Pregnancy complications
155
Q

types of aortic valve disease

A
  1. aortic stenosis- aortic valve becomes thick and fuses together, narrowing the opening causing reduced blood flow to body
  2. aortic regurgitation- dilation of aortic valve causing backflow of blood back into left ventricle
156
Q

causes/risk factors for aortic valve disease

A

aortic stenosis

  • calcified aortic valve (elderly/CKD) most common
  • congenital bicuspid aortic valve
  • inflammation after rheumatic fever (Strep. A causes inflammation + calcification to valve endothelium)
  • Others: SLE/paget’s

aortic regurgitation

  • rheumatic heart disease (valves damaged after rheumatic fever)
  • congenital bicupsid aortic valve
  • endocarditis
  • connective tissue disorder -MARFAN’S, aortitis
157
Q

symptoms + signs of aortic stenosis

A

Symptoms:

  • exertional SOB
  • exertional syncope
  • angina (chest pain)
  • RISK FACTORS

Signs:

  • A: ejection-systolic murmur (loudest over aortic valve and radiates to carotid)
  • narrow pulse pressure
158
Q

symptoms + signs of aortic regurgitation

A

symptoms:

  • usually asymptomatic until they develop heart failure
  • palpitations
  • fatigue/ dyspnoea/ chest pain

signs:

  • diastolic murmur
159
Q

investigations for aortic valve disease

A
  • Transthoracic Echocardiogram (DIAGNOSTIC)
  • ECG- aortic stenosis =>LVH (high S voltage V1-V3, high R voltage V4-V6)
  • CXR
160
Q

Management of aortic valve disease

A
  • unstable - balloon valvuloplasty (valve repair)- aortic stenosis
  • stable
  1. surgical aortic valve replacement (TAVI)
  2. warfarin + antibiotics (prevent infective endocarditis)

*transcatheter aortic valve replacement (for high risk patients)

161
Q

complications of aortic valve disease

A
  • heart failure
  • infective endocarditis
  • sudden death
  • arrythmias
162
Q

Types of mitral valve disease

A
  • mitral stenosis - thick mitral valve fuses together causing narrowed opening => reduced blood flow from left atrium to left ventricle
  • mitral regurgitation- dilated mitral valve so blood leaks back into left atrium
163
Q

causes of mitral valve disease

A

mitral stenosis:

  • rheumatic heart disease (most common)
  • congenital
  • endocarditis

mitral regurgitation: (anything damages valves)

  • rheumatic heart disease (most common)
  • infective endocarditis
  • mitral valve prolapse
  • Hx of MI, heart trauma, IHD, Hypertrophic cardiomyopathy
164
Q

symptoms + signs of mitral stenosis

A

symptoms:

  • dyspnoea
  • fatigue
  • orthopnoea
  • risk factors (FEMALE, Rheumatic fever)

signs:

  • diastolic murmur (loudest over mitral valve)
  • Loud S1
  • opening snap on auscultation
  • signs of pulmonary hypertension/ right heart failure (raised JVP, oedema, ascites)
165
Q

symptoms + signs of mitral regurgitation

A

symptoms:

  • dyspnoea on exertion
  • reduced exercise tolerance
  • fatigue
  • risk factors

signs:

  • pansystolic murmur loudest over mitral valve that radiates to axilla
166
Q

investigations for mitral valve disease

A
  • Transthoracic echocardiogram (diagnostic)
  • ECG- could have AF/ LVH
  • CXR- kerly B lines (mitral stenosis -pulmonary hypertension)
167
Q

management for mitral valve disease

A

mitral stenosis

  • usually do nothing

severe disease:

  1. diuretic (reduce atrial pressure)
  2. balloon valvotomy (open valve)
  3. OR surgical valve replacement
    • beta blockers (reduce symptoms)

mitral regurg

  • mitral valve repair (balloon vavluloplasty/ annuloplasty)
  • mitral valve replacement
  • ACE-inhibitor + beta-blockers
168
Q

Complications of mitral valve disease

A
  • AF
  • stroke
  • infective endocarditis
169
Q

types of right sided valve disease

A
  • tricuspid regurgitation- backflow of blood from RV => RA during systole
  • tricuspid stenosis- reduced blood flow from RA => RV during diastole
  • pulmonary stenosis- narrowing of valve between RV and pulmonary atery => blocked blood flow
  • pulomonary regurgitation- valve flaps don’t close properly so blood leaks back into right ventricle
170
Q

causes of right valve diseases

A

tricuspid regurg:

  • Infective endocarditis-IV drug user (most common)
  • congenital (Ebstein’s anomaly - malpositioned TV)
  • right ventricle dilation due to pulmonary hypertension
  • Rheumatic heart disease

tricuspid stenosis:

  • Hx of rheumatic fever (most common)
  • carcinoid tumours
  • IV drug use

pulmonary stenosis:

  • congenital heart defect (most common)
  • rubella
  • rheumatic fever
  • carcinoid syndrome (rare tumour)

pulmonary regurgitation:

  • pulmonary hypertension => RV dilation
  • endocarditis
  • left-sided heart disease
  • surgical repair of tetralogy of Fallot (pulmonary stenosis, VSD , RVH, misplaced aorta)
171
Q

Symptoms + signs of tricuspid regurgitation

A

Symptoms:

  • dyspnoea
  • fatigue
  • palpitations
  • headaches
  • nausea
  • epigastric pain worse on exercise

Signs:

  • Inspection: RHF signs (raised JVP, ascites, oedema)
  • Palpation: parasternal heave
  • Auscultation: pan-systolic murmur louder on inspiration, loud P2 of second heart sound
  • Chest exam: signs of pleural effusion/ causes of pulmonary hypertension
  • Abdo exam: palpable liver,ascites, jaundice
  • Limbs: pitting oedema
172
Q

Symptoms + signs of tricuspid stenosis

A

Symptoms:

  • dyspnoea (SOB)
  • reduced exercise tolerance
  • fatigue

Signs:

  • diastolic murmur at lower left sternal border
  • RHF signs (raised JVP (with A wave), ascites, oedema )
173
Q

Symptoms + signs of pulmonary valve stenosis

A

Symptoms

  • fatigue
  • SOB on activity
  • chest pain
  • fainting (loss of consciusness)

Signs:

  • systollic murmur
174
Q

Symptoms + signs of pulmonary regurgitation

A

Symptoms:

  • dyspnoea (SOB)
  • decreased exercise tolerance
  • orthopnoea (painful breathing)
  • fatigue
  • palpitations

Signs:

  • diastolic murmur
175
Q

Investigations for right sided heart murmurs

A

Bloods:

  • FBC
  • LFTs
  • Cardiac enzymes
  • blood cultures

Imaging

  • CXR- right side enlargment
  • ECHO- show ventricle dilation/ valve proplapse

Other:

  • ECG
176
Q

Management for right sided heart valves

A

Stenosis: (surgical)

  • TV: balloon valvuloplasty (repair valves) / valvotomy
  • PV: vavuloplasty (balloon to pulmonary valve) or pulmonary valve replacement (open heart surgery/catheter)

Regurgitation: (surgical)

  • TV: open-heart surgery to patch holes/tears, separating valve flaps
  • PV: valve replacement, placing a tube with a valve between right ventricle and pulmonary artery
177
Q

complications of right valve diseases

A

PV stenosis:

  • infective endocarditis
  • arrhythmias
  • thickened heart muscle (RV needs to pump harder to force blood into pulmonary artery => RVH)
  • heart failure
178
Q

define gangrene

A

poor vascular supply => tissue necrosis

  • dry gangrene- necrosis without infection
  • wet gangrene - tissue death and infection

Rarer:

  • gas gangrene - type of necrotising myositis (Clostridia perfringens)
  • necrotising fasciitis- life-threatening infection of deep fasciaa causing necrosis of subcutaneous tissue
179
Q

causes and risk factors for gangrene

A

gangrene:

  • acute limb ischaemia
  • trauma
  • thermal injury

Necrotising fasciitis

  • microbial infection (strep. , stap. , bacteriodes)

Risk factors:

  • diabetes
  • peripheral vascular disease
  • leg ulcers
  • malignancy
  • immunosuppression
  • steroid use
  • surgical wounds
180
Q

Symptoms + signs of gangrene

A

Symptoms:

  • VERY painful
  • gas gangrene- rapid onset, muscle swelling, gas production, severe pain

Signs:

  • redness around gangrenous tissue
  • gangrenous tissue = black (Hb breakdwn products)
  • wet gangrene - swelling, blistering + pus discharge and strong odour
  • gas gangrene - oedema, discoluration, crepitus (clicking joint)
181
Q

symptoms + signs of necrotising fasciitis

A

Symptoms:

  • redness and oedema

Signs:

  • haemorrhagic blisters
  • sepsis (high/low temp, tachypnoea, hypotension)
182
Q

Investigations for gangrene

A

Bloods:

  • FBC
  • U&Es
  • glucose (diabetes)
  • CRP (inflammation)
  • blood culture (check for microbes)

Wound swab, pus/fluid aspirate

X-ray (could show gas produced in gas gangrene)

183
Q

management of gangrene

A
  • remove affected/ dead tissue (debridement)
  • To speed up recovery: IV fluids, nutrients/blood transfusions
  • Amputation (if very severe)

Treat cause:

  • Teat infection with antibiotics
  • restore blood flow to affected area (bypass surgery/ angioplasty- balloon or stent opens up vessel)
184
Q

define hyperlipidemia

A
  • high levels of cholesterol +/- triglycerides
  • total cholesterol (>200mg/dL = abnormal)
185
Q

causes/risk factors for hyperlipidemia

A
  • high fat diet
  • low exercise
  • older age - higher cholesterol
  • Familial hypercholesterelmia
  • Secondary hyperlipdemia - cushing’s, hypothyroidism, nephrotic syndrome
  • Mixed hyperlipedima (high TG + cholesterol)- T2DM, metabolic syndrome, chronic renal failure,
186
Q

symptoms + signs of hyperlipidemia

A
  • usually asymptomatic until complications develop
  • HYPERTENSION
  • corneal arcus, xanthelesmas, xanthoma’s
187
Q

investigations for hyperlipidemia

A

Lipid profile

  • LDL - bad cholesterol
  • HDL - good cholesterol that protect from CVD
  • triglycerides
  • total cholesterol (>200mg/dL = abnormal)

Fundoscopy

Test for secondary causes:

  • HbA1c- diabetes
  • TFTs- hypothyroidism
  • U&Es/creatinie - kidney disease
  • LFTs - check liver function
188
Q

management of hyperlipidemia

A
  • Lifestyle modification - less fatty diets, more exercise, weight loss, stop smoking
  • Medicaiton
  1. Statins - stops liver making cholesterol
  2. cholesterol absorption inibitors- ezetimibe
  3. nicotinic acids- affect liver and raise HDL, lower LDL
  4. resins - binds to bile, so liver uses cholesterol to make more bile

*triglyceridemia => fibrates, nicotinic acid, fish oil

189
Q

complications of hyperlipidema

A
  • CVD/ ACS (athersclerosis causing artery narrowing)
  • hypertension
  • stroke
  • peripheral vascular disease
  • high TGs => pancreatitis

Year 3 (27 decks)

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