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Year 3 core conditions > cardiovascular > Flashcards

cardiovascular Flashcards

1
Q

causes of MI

A

erosion or rupture of fibrous cap of coronary artery atheromatous plaque

subsequent formation of platelet rich cot and vasoconstriction produced by platelet release of serotonin a nd thromboxane A

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2
Q

types of MI and their causes

A

STEMI = complete blockage of coronary artery

NSTEMI +unstable angina
= partial/intermittent blockage to artery
ST depression and T inversion

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3
Q

risk factors for MI

A 
age
male
fmaily history (first degree <50yo)
hyperlipidaemia
cigarette moking 
hypertension
metabolic factors/diabetes
diet/exercise
psychological factors
elevated CRP
alcohol 
coagulation factors
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4
Q

presentation of MI

A

central crushing chest pain
radiating to arms, shoulder , neck
no longer than 15min
new onset or deterioration of stable angina

Nausea and vomiting, sweating, breathlessness, haemodynamic instbility, collapse, arrhythmia, new onset heart failure

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5
Q

signs on examination of MI

A

no physical signs unless complications develop

patient = pale, sweaty, grey

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6
Q

investigations of MI

A

ECG

bloods - cardiac markers (troponin, creatine kinase), FBC, creatinine, electrolytes glucose, lipids

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7
Q

signs of MI on ECG

A

STEMI - ST elevation within hours, followed by T wave flattening or inversion

NSTEMI - ST depression and T inversion

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8
Q

treament of MI

A 
GTN spray + IV morphine
antiemetic such as metoclopramide
oxygen if needed
insulin if hypo
aspirin nad second antiplatelet
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9
Q

when to do reperfusion therapy in STEMI

A

if present within 12hrs of onset

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10
Q

types of coronary reperfusion

A

PCI (percutaneous coronary intervention) or fibrinolysis

CABG (coronary aryery bypass graft)

dependent on time after symptom onset - PCI if <12hrs

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11
Q

secondary prevention of MI

A 
lifestyle changes
ACE inhibitor
beta blocker
dual antiplatelet therapy
statin
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12
Q

who gets angina?

A

55-64 yo
8% men, 3% women
Men>Women

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13
Q

causes of angina

A

insufficient blood supply to the heart muscle

due to coronary artery disease - atherosclerosis narrows lumen. symptoms when oxygen demand increases

can also be caused by valve disease, hypertrophic obstructive cardiomyopathy or hypertensive heart disease

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14
Q

risk facors fo ischaemic heart disease/angina

A 
age
male
familyhistory
hyperlipidaemia
cigarrette smoking
hypertension
diabetes
diet and exercise
psychosocial factors
elevated CRO
high alcohol intake
high level of coagulationfactors
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15
Q

presentation of angin

A

stable - consticting discomfort in front of chest spreadig to neck, shoulders, jaw or arms
precipitated by phsycial exertion
releived by rest or GTH within 5 mins

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16
Q

what pain features make angina more unlikely?

A 
continuous or prolonged pain
unrelated to activity
brought on by breathing
associated with dizziness
palpitations
tingling
difficulty swallowing
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17
Q

signs on exmaination of angina

A

examine CAD risk via history and BMI

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18
Q

investigations for angina

A

ECG - look for changes consistent with CAD that may indicade ischaemia or prev infarct

normal ECG does not confirm or exclude angina

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19
Q

ECG consistent with CAD that may indicate ischaemia or prev infarct

A

pathological Q waves
left bundle branch block
st-segment and T wave abnromalities

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20
Q

treatment of angina

A

GTN before activies that may bring on and when stop

long term prevention:

  • beta blcoker or calcium channel blocker as first line
  • if cant - long acting nitrate, nicorandil, ivabradine,

secondary prevention of Cardiovasccular event s - management of CVS risk factors, psychological support, drug treatment, atherosclerotic disease treamtent (low dose aspirin, statin, ACEi)

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21
Q

AF, men or women?

A

more in men

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22
Q

causes of AF

A 
IHD
hypetension
valvar heart disease
hyperthyroidism
cardiac diseases
non cardiac - drugs, infection, electrolyte issues, lung cancer, PE, thyrotoxicosis, DM
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23
Q

presentation of AF

A

irregular pulse

+ SOB, palpitations, chest discomfort, syncope or dizziness, reduced exercise tolerance, malaise or polyuria

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24
Q

complications of AF

A

stroke, TIA, heart failure

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25
Q

signs on examination of AF

A

irregularly irregular pulse

suspect paroxysmal AF if symptoms are episodic and last <48hr

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26
Q

investigations of AF

A

ECG - no P waves, chaotic baseline, irregular ventricular rate, ventricular compleses unless conduction defect

24 hr tape if paxosymal AF suspected

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27
Q

treatment of AF

A

when caused by acute precipitating event, treat underlying cause

rate control - reduce HR at rest and: beta blocker, calcium antagonist, sedentary people = digoxin

rhythm control: electrical DC cardioversion then beta blockers, catheter ablation techniques

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28
Q

define essential hypertension

A

BP > 140/90

major risk factor for stroke and heart disease

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29
Q

who gets essential hypertension

A

20-30% of pop

more common in africans and old ppl

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30
Q

risk factors for essential hypertension

A

non-modifiable - fmaily history, older age, ethnicity, gender, metabolic syndrome

modifiable - obesity, smoking, alcohol, stress, sodium/salt - diet, physical activity

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31
Q

causes of secodnary hypertension

A

congenital

acquired - renal disease, endocrine disease, pregnancy, drugs, white coat syndrome

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32
Q

presentation of essential hypertension

A

usually asymtpomatic
headache/visual disturbance
sweating, palpitations, headaches, episodic feeling of ‘about to die’
epistaxis, nocturia, SOB due to LVH or HF

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33
Q

stage 1 hypertension

A

140/90mmHg in surgeyr

135/85 at home

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34
Q

stage 2 hypertension

A

160/100mmHg in surgery

150/95 at home

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35
Q

stage 3 hypertension

A

> 180/129 in surgery

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36
Q

masked hypertensuon

A

lower on measuring in surgery than at home

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37
Q

white coat effect

A

> 20/10mmHg between clinic and ABPM/HBPM

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38
Q

malignant hypertension

A

> 200/130,mHg + end organ failure
short onset
urgent same day assessment

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39
Q

investigations for essential hypertension

A

look for organ damage - fundoscopy, ECG, blood tests, urinalysis, renal ultrasound, echo, fasting glucose, investigations for suspected secondary cuases

Q risk = provides risk of MI/stoke in next 10 years

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40
Q

management of essential hypertension

A

referral to specialist if:

  • urgent treatment needed, malignant hyeprtension severe, suspected pahechromocytoma, impending complications
  • possible underlying cause conns, onset worsening, resistnent, young age
  • herapeutic probllems
  • hypertension in pregnancy

lifestle changes

41
Q

treatment goal of essential hypertension

A

reduce to 140/85 - slowly as rapid reduction cna be fatal esp in storke

reudce risk of complciations

42
Q

treatmnet of essential hypertension <55 yo

A

ACE inhibitor (or ARB)

then,

ACEi + Ca antagonist or thiazide diuretic

then,

ACEi + Ca antagonist + thiazide diuretic

if Qrisk > 20, give statin

43
Q

treatment of essential hypertension >55yo

A

Ca antagonist or thiazide diuretic

then,

ACEi +Ca antagonist or thiazide diuretic

then,

ACEi + Ca antagonist + thiazide diuretic

statin if Q risk >20

44
Q

causes of DVT

A

provoked by risk facros

unprovoked - DVT w/o transient risk factor

45
Q

risk factors of DVT

A

intrinsic - prev., cancer, age, overwight, male, heart fialure, severe infection, thombophilia, injury to vascular wall, varicose veins, soking

temporary - immobility, trauma, hormone treatment, pregnancy, dehydration

46
Q

presentation of DVT

A

often asymptomatic

leg - warm, swollen, calf tenderness, superficial venous distension, changes to skin colour

47
Q

investigations of DVT

A

d-dimer test if low clinical probability score - sensitive but not specific

venous compression ultrasonography for iliofemoral thrombosis

wells score

coagulation screen to exclude pre existing thormbotic tendancy

48
Q

treatment of DVT

A

LMWH where feasible

warfarin start at same time

49
Q

congestive heart failure

A

left and right sided heart failure

50
Q

causes of heart failure

A

ischaemic heart disease
cardiomyopathy (dilated)
hypertension

many other causes

51
Q

HF with reduced ejection fraction AKA systolic failrue

A

left ventricle loses ability to contract normally

heart cant pump with enough force to push enough blood into cirucaltion

52
Q

HF with preserved ejection fraction AKA diastolic failure

A

left ventricle loses ability to relax normally - muscle has become stiff

the heart cannot properly fill with blood during the rest period between each beat

53
Q

risk factors for HF

A

AF, diabetes, family hsitory of heart fialure or sudden cardiac death

54
Q

presentation fo HF

A

breathlessness - on exertion, rest, kying flat, nocturnal cough, waking up from sleep

fluid rentention - ankle swleling, bloated, weight gain

fatigue

lightheadedness or history of syncope

55
Q

signs of HF

A 
tachycardic
laterally discplaced apex beat
heart murmurs
3rd and 4th heart sonds
hypertension
raised JVP
enlarged liver 
tachypnoea, basal crepitatios, pleural effysions

dependent oedema
ascites
obesity

56
Q

investgiations of HF

A

ECG
if no prev MI - naturitic peptide level
tests for aggravating facorrs and exclude other conditions - CXR, urine dipstick, lung function tests

blood tests - U+Es, eGFR, FBC, thyroid, LTs, HbA1c, fasting lipids

57
Q

treatment of HF with reduced ejection fraction

A

heart fialure with reduced ejection fraction:

  • loop diuretic
  • ACEi and Bblocker
  • antiplatelet or statin?
  • manage causes
  • screen for depression and anxiety
  • lifestyle improvements
58
Q

treatment of HF with preserved ejection fraction

A

loop diuretic
consider antiplatelet and statin
lifestyle
screen for depression and anxiety

59
Q

commonest valvular issue

A

mitral regurge

60
Q

mitral regurge

A

pansystolic
apex + diaphragm + left side
radiates to axilla

61
Q

mitral stenosis

A

mid diastolic murmur

apex

62
Q

aortic stenosis

A

ejection systolic murmur

aortic area + radiate to carotids

63
Q

aortic regurgitation

A

diastolic murmur

64
Q

4 main valvular heart disease

A

mitral regurgitation
mitral stenosis
aortic stenosis
aortic regurgitation

65
Q

what causes mitral regurgitation

A

MV prolapse - either congenital or rupture of chordae/papillary muscles

rheumatic disease

endocarditis

connective tissue disorder

66
Q

what causes mitral stenosis

A

rheumatic heart disease

67
Q

what causes aortic stenosis

A

calcific degeneration
bicuspid valve
rheumatic disease

68
Q

what causes aortic regurgitation

A 
rheumatoid 
endocarditis
aortic dissection
marfans + connective tissue disorders
calcific degeneration
trauma
69
Q

signs of mitral regurge

A

acute - signs of congestive cardiac failure

chronic - exertional dyspnoea, orthopnoea

displaced apex beat, AF in 80%

70
Q

signs of mitral stenosis

A 
dyspnoea
bronchitis
haemoptysis
AF
left  parasternal heave 
tapping apex beat
71
Q

aortic stenosis triad

A

angina
syncope
dyspnoea

72
Q

signs of aortic stenosis

A

angina, syncope, dyspnoea

sudden death

slow rising, low vol pulse
heaving apex beat

73
Q

signs of aortic regurge

A 
acute = endocarditis, signs of LVF
chronic = asymptomatic

later - orthopnoea, fatigue, dyspnoea
collapsing water hammer pulse

74
Q

investigations of valvular heart disease

A

CXR
transthoracic ECHO - diagnostic
ECG

75
Q

diagnosis of mitral regurge

A

CXR cardiomegaly

transthoracic ECHO diagnostic

76
Q

diagnosis of mitral stenosis

A

CXR shows enlarged LA

echo diagnostic

77
Q

aortic stenosis diagnosis

A

ECG shows LV hypertrophy

echo diagnostic

78
Q

aortic regurge diagnosis

A

CXR cardiomegaly

echo diagnostic

79
Q

treatment of mitral regurge

A

surgery if acute or severe chronic

80
Q

treatment of mitral stenosis

A

surgery if MC area <1cm (normal = 3-4)

81
Q

treatment of aortic stenosis

A

surgery if symptomatic

82
Q

treatment of aortic regurgitation

A

acute AR is a surgical emergency

chronic is operated on before ejection fraction <55% or LV dilates >5.5 cm

83
Q

right ventricular failure AKA

A

cor pulmonale

84
Q

systolic vs diastolic heart failure

A

systolic = cant pump hard enough during systole

diastolic = not enough bood fills during diastole

85
Q

causes of right ventricular failure

A

pulmonary hypertension due to: damage to lung tissue, damage to pulmonary vessels, affecting spine or ribcage , or left heart dysfunction + failure

primary right sided heart failure due to right ventricular MI or pulmonary valve stenosis

86
Q

symptoms of right ventricular failure

A 
SOB
fatigue
fainting
raised JVP
hepatomegaly
oedema

= all due to backup of blood

87
Q

signs on examination of right ventricular failure

A 
tachycardia
laterally displaced apex beat
raised JVP
respiratory signs 
liver enlargement
88
Q

investigations of right ventricular failure

A

ECHO
ECG
exclusion tests - CXR, urine dipstickm bloods, spirometry, eGFR, thyroid function, HbA1c etc

89
Q

treatment of right ventricular failure

A

treat underlying lung condition - e.g. oxygen etc

confirmed heart failure with reduced ejection fraction: loop diuretic, ACEi, b blocker, consider antiplatelet or statin, manage causes, life style improvement, screen for depression and anxiety

confirmed heart failure with preserved ejection fraction: loop diuretic, antiplatelet/statin, lifestyle, anxiety and depression screen

90
Q

causes of infective endocarditits

A

infections occur on valves:

  • congenital or defected valves (usually on left side of heart, right side if IVDU)
  • normal valves with virulent organisms
  • prosthetic valves
  • associated with VSD or persistent ductus arteriosis

strep viridans, enterooccci are common causes

91
Q

symptoms and signs of infective endocarditis

A

systemic features of infection - malaise, fever, night sweats, weight loss, anaemia, splenomegaly

valve destruction - lead to heart failure or heart murmurs

vascular phenomena - abscesses in brain, spleen, kidney, embolisation to lung = infarct or pneumonia

immune complex deposition in blood vessels = vasculitits, petechial haemorrhage in skin, nails and retinae, oslers nodes, janeway lesins,

92
Q

investigations of infective endocarditis

A 
blood cultures
ECHO
serology
CXR - septic emboli
ECG to show MI
anaemia with raised ESR and lecocytosis
diagnosis - dukes criteria
93
Q

treatment of infective endocarditis

A

empirical ABX until sensitivity performed

surgery to replace valves if severe heart failure, extensive damage or getting worse

94
Q

who gets postural hypotension

A

elderly and polypharmacy

95
Q

causes of postural hypotension

A

blood pressure lowering meds - beta blockers, ACEi, AIIRAs, diuretics, calcium channel blockers

96
Q

define postural hypotension

A

drop in at least 20mmHg systolic and 10mmHg diastolic within 3 minutes of standing upright

97
Q

presentation of postural hypotension

A

light headedness or syncope when standing up, e.g. going to toilet at night

98
Q

treatment of postural hypotension

A

adjust medication doses

Year 3 core conditions (15 decks)

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