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Year 4 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Describe the CHA2Ds2VASc Score

A 
Congestive Cardiac Failure (1 Point)
Hypertension (1 Point)
Age > 75 (2 Points)
Diabetes (1 Point)
Stroke/TIA/TE (2 Points)
Vascular Disease (1 Point)
Sex (F) (1 Point)
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2
Q

What scale is used toa ssess risk of bleeding in AF

A

ORBIT screening tool

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3
Q

Signs of Atrial Fibrillation on an ECG

A

Absent p waves

Irregular QRS Complexes

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4
Q

What blood test is first line for Atrial Fibrilation

A

TFTs (hypethyroidism can cause Atrial Fibrilation)

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5
Q

How to manage acute Atrial Fibrilation (usually in young people or first presentation)

A

<48 Hours: Offer flecainide or amiodarone AS LONG AS THERE ARE NO STRUCTURAL or ISCHAEMIC HEART DISEASE

Or Just Amiodarone in the presence of structural or ischaemic heart disease

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6
Q

How is an acute stroke managed after 48 hours

A

Rate control: Beta Blockers or Dilitazem

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7
Q

Why is Dilitazem used instead of verapamil

A

Verapamil + Beta blocker can cause a heart block

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8
Q

Name two types of rhythm control

A

DC Cardioversion or Flecainide

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9
Q

If Cardioversion is chosen as the intended intervention, what must be done in advance

A

Anticoagulation fore 3 weeks first

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10
Q

If there is a risk of heart failure, what should be done prior to Cardioversion

A

4 Weeks of Amiodarone and 12 months after

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11
Q

If beta blockers or dilitazem are not working to control the rate, what can be given as an adjunct

A

Digoxin

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12
Q

First line management of paroxysmal AF

A

Sotalol or Flecainide

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13
Q

At what Chads2vasc score should anticoagulation be offered

A

2 or more

Considered at 1

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14
Q

What is Paroxysmal AF

A

Episode sof AF that come and go (last 48 hours)

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15
Q

What is Persistent AF

A

Lasts over 7 days but returns back to normal

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16
Q

What is Permenant AF

A

Episodes of AF that do not go back to normal, usually after unsuccessful treatment

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17
Q

What is the main cause of AF

A

High BP

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18
Q

What conditions in teh elderly can predispose them to AF

A

Infections

Pericarditis

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19
Q

What is the first line investigation for AF

A

ECG

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20
Q

When is a 24-hour ECG indicated

A

If AF comes and goes and was not detected in the ECG at time of recording

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21
Q

What is the main drug given for cardioversion

A

IV Adenosine

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22
Q

What is the criteria for cardioversion (more indicated in the following situations)

A
  • Recent AF
  • <65
  • Successful treatment of underlying cause for AF
  • No other heart abnormality
  • Acute HF or Unstable Angina being worsened by AF
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23
Q

What is Catheter Ablation

A

Where a catheter is passed into th eheart chambers via a large blood vessel in the leg

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24
Q

COmplications of AF

A
  1. HF
  2. Dilated Cardiomyopathy
  3. Angina
  4. Strokes/ Falls
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25
Q

If DOACs are contraindicated (first line for ChadsVasc/AF), what can be given

A

Vit K Antagonist

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26
Q

Under what circumstances are people under 65 contraindicated for DOAC use

A

Only has sex as a risk factor in Cha2ds2vasc

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27
Q

What criteria can be used to check risk of bleeding from anticoagulants in AF

A

ORBIT or HASBLED

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28
Q

When should patients with AF be referred to hospiatl or specialist referral

A

4 weeks after failed management

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29
Q

What scan should be done before someone goes through cardioversion

A

ECHO

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30
Q

What should be done to cardioversion if acute AF lasts over 48 hours

A

Be delayed

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31
Q

WHat should be done before DOACs are stopped?

A

Re-assess using CHA2Ds2-Vasc first

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32
Q

What is an Abdominal Aortic Aneurysm

A

Irreversable dilation of a blood vessel by at least 50%

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33
Q

Two types of aorticaneurysms

A

Abdominal

Thoracic

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34
Q

What causes an abdominal aneurysm

A

Degradation of elastic lamellae from leukocytic infiltate. Cause dilatation of all three layers of the arterial wall

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35
Q

What is a pseudoaneurysm

A

Blood leakage through the arterial wall but contained within the adventitia

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36
Q

What is the normal diameter of the aorta

A

2cm

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37
Q

What size defines an aortic diameter

A

3cm +

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38
Q

Under what structure do most abominal aortic aneurysms arise from

A

Below the renal arteries

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39
Q

What is considered a threatening AAA

A

A growth of 1-6mm over a year on average (consistent growth)

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40
Q

What features on an aneurysm make it more prone to rupture

A 
The diameter (larger)
Growth Rate

Women

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41
Q

At what age are people screened for AAAs

A

Men over 65

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42
Q

Risk Factors for AAA

A
  1. FH
  2. Smoking
  3. Male
  4. Age
  5. HTN
  6. COPD
  7. Hyperlipidaemia
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43
Q

Symptoms of an upnruptured AAA

A

Asymptomatic

Rarely, back, abdominal, loin or groin pain
Signs of limb ischaemia

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44
Q

Symptoms of a ruptured AAA

A

HYPOTENSION:
Shock, syncope or collapse
Postural Hypotension

SUDDEN pain in the abdomen, back or loin

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45
Q

What examination is done to feel for AAA

A

Bimanual palpation of supraumbilical region

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46
Q

What makes palpation for AAA tricky

A

Hard with larger waist sizes

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47
Q

What condition other than acute pancreatitis can cause th grey turner sign

A

AAA

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48
Q

What causes the grey turner sign

A

Retroperitoneal haemorrhage

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49
Q

First line blood tests done for AAA

A

FBC, Clotting, renal and LFTs

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50
Q

First line investigation for AAA (scans)

A

Abdominal USS (can assess accuracy of dilation to up to 3mm)

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51
Q

Why is a CT angiography helpful in AAA

A

If >3mm and to check for the crescent isgn

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52
Q

What is the crescent isgn

A

Blood within the thrombus - predicts imminent rupture

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53
Q

What three AAA types should be considered for repair

A

SYmptomatic
Asymptomatic (>4.0 cm AND growing >1cm a year)
Asymptomatic (5.5cm or larger)

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54
Q

Management of an uncomplicated AAA

A

<5.5 cm:

general monitoring

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55
Q

HOw often shouldl a 3-4.4cm AAA be screened

A

Annual USS

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56
Q

How often should a 4.5-5.4cm AAA be screened

A

3 monthly USS

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57
Q

AT what point should we consider surgery for AAA

A

5.5cm or bigger

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58
Q

Name two types of surgical repair for AAA

A

Surgical (open) repair

Endovascular repair (stent graft through femoral arteries)

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59
Q

How often are med over 65 screened for AAA

A

Just once at that age

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60
Q

Name four contraindications to radio-ablation therapy for arrythmias

A
  1. Left atrial ablation for persistent AF with an atrial thrombus present
  2. Mobile left ventricular thrombus
  3. Mechanical heart valves
  4. Preganncy
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61
Q

Indications for radioactive frequency ablation

A
  1. Symptomatic SVT
  2. AVNRT
  3. WPW syndrome
  4. Atrial tachycardia
  5. Atrial Flutter
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62
Q

When is catheter ablation indicated fro AF

A

ONLY IF SYMPTOMATIC:

  • AF is refractory to at least one rhythm control medication (flecainide or amiodarone) - mainly paroxysmal is affected here
  • AF is symptomatic prior to starting rhythm control drugs
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63
Q

Which type of AF usually benefits from radiofrequency catheter ablation

A

Paroxysmal AF

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64
Q

First line management of Acute Coronary Syndrome

A

HOSPITAL ADMISSION - Medical Emergency

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65
Q

What is ACS

A

Acute myocardial ischaemic states:

ST- Elevated ACS

Non-ST Elevated ACS

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66
Q

What is Non STEMI signs on an ECG

A

ST-segment depression
T wave inversion
Flat T Waves

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67
Q

Lab Results in unstable Angina

A

Troponin levels are normal

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68
Q

Lab results seen in NSTEMI

A

A rise in troponin levels

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69
Q

Risk Factors for ACS in younger people

A
  1. Endocarditis
  2. Vasculitis
  3. Cocaine and durg use
  4. Increased oxygen requirement (hyperthyroidism)
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70
Q

Presentation of NST-ACS

A
  1. Anginal pain at rest
  2. New onset angina
  3. Sweating, nausea, vomtiing, fatigue, shortness of breath, palpitations (nervousness)
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71
Q

What type of patients are less likely to present with chest pain from MIs

A

Elderly and patients with diabetes

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72
Q

How long does angina last for

A

20 mins

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73
Q

Where can angina spread

A

Arms, back and jaw

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74
Q

Should response to GTN be considered to make diagnosis for ACS

A

No

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75
Q

First line investigation for suspected ACS

A

12-Lead ECG

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76
Q

Why is troponin measured first in ACS rather than CKMB

A

Troponin sensitivity is superior in the first 6 HOURS

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77
Q

How long can troponin remain in the blood after an MI

A

14 Days

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78
Q

When do troponin I and T become detectable in th eblood

A

3-6 hours after infarction

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79
Q

If a patient presenting with unstable angina or NSTEMI is clincially unstable, what should be done after ECG and troponin test

A

CT Angiography

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80
Q

What happens to glucose levels inACS

A

Hyperglycaemia

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81
Q

What does hyperglycaemia in ACS predict about the prognosis

A

Poor

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82
Q

What would an ECHO demonstrate in ACS (what’s its use?)

A

Demonstrates wall motion abnormalities ude to ischaemia

83
Q

What is the gold standard for detecting th epresence and severity of ACS

A

CT Angiography

84
Q

What is the first line management of a suspected ACS (ECG changes, elevated troponin levels)

A

300 mg Aspirin + 180mg Ticagrelor

85
Q

If Aspirin is contraindicated for use in ACS, what shoudl be given instead

A

Clopidogrel monotherapy

86
Q

What artery supplies the right atrium and right ventricle

A

Right Coronary Artery

87
Q

What artery supplies the left atrium

A

Circumflex Artery

88
Q

What artery supplies the Anterior Left Ventricle and Anterior aspect of the septum

A

Left Anterior Descending

89
Q

If there is no ST elevation seen on an ECG, what should be done as second line investigation

A

Serum Troponin tests

90
Q

What are other causes for raised troponin levels

A
  1. CKD
  2. Sepsis
  3. Myocarditis
  4. Aortic Dissection
  5. PE
91
Q

When should a Primary PCI be given for a STEMI

A

Within 12 hours of onset

92
Q

When should thrombolysis be done for an acute STEMI

A

If PCI is not available within 2 hours

93
Q

What is PCI

A

Catheter up femoral artery that identifies the blocked area + widens it

94
Q

Name two type of thrombolysis agents

A

Streptokinase

Aletplase

95
Q

Treatment of an acute NSTEMI

A

BATMAN

B - Beta Blockers
A - Aspirin 300mg
T - Ticagrelor
M - Morphine
A - Anticoagulant (Fondaparinux)
N - Nitrates (GTN)
96
Q

What score is used to assess the risk of death or repeat MI after an NSTEMI

A

Grace Score

97
Q

If GRACE score is 5%+, what should be done

A

PCI

98
Q

Complications of an MI

A

DREAD

D- Death
R - Rupture of septum 
E - Oedema (Heart Failure)
A - Arrythmia and Aneurysm 
D - Dressler's Syndrome
99
Q

What is Dressler’s Syndrome

A

A type of pericarditis that occurs after an MI

100
Q

Symptoms of Dressler’s Syndrome

A

Low grade fever, pleuritic chest pain and pericardial rub on auscultation

101
Q

ECG changes in Dressler’s Syndrome

A

ST Elevation

T Wave Inversion

102
Q

How is Dressler’s Syndrome managed

A

NSAIDs (Aspirin/Ibuprofen)

103
Q

Secondary Prevention Medical Management of ACS

A

AAAAAA (6As)

A - Aspirin 75mg
A - Antiplatlete (clopidogrel or ticagrelor)
A - Atorvastatin
A - Ace Inhibitors
A - Atenolol
A - Aldosterone Antagonist (eplenerone)
104
Q

What is a Type 1 MI

A

Traditional MI due to ACS

105
Q

What is a Type 2 MI

A

Ischaemia secondary to reduced oxygen (anaemia, tachycardia)

106
Q

What is a Type 3 MI

A

Sudden cardiac arrest suggestibe of an ischaemic issue

107
Q

What is a Type 4 MI

A

PCI/CABG or stunting causes

108
Q

Threshold to treat hyperglycaemia

A

Keep blood glucose below 11.0 mmol/l using insulin bolus

109
Q

What causes pulmonary oedema

A

Where fluid leaks from the pulmonary

110
Q

What is Cardiogenic pulmonary oedema

A

Left sided heart failure (increased pressure)

111
Q

Causes of Non-cardiogenic Pulmonary Oedema

A

ARDS
Lymphatic Insufficiency (lung transplant)
Narcotic overdose
High Altitude

112
Q

What renal conditions can cause acute pulmonary oedema

A

AKI
CKD
Renal Artery Stenosis

113
Q

How does high altitude and ARDS contribute to pulmonary oedema

A

Increases pulmonary capillary permeability

114
Q

Presentation of pulmonary oedema

A

INITIIAL DRY or PINK PRODUCTIVE COUGH

Severe breathlessness
Sweaty
Neasua
Anxiety 
Paroxysmal nocturnal dyspnoea or orthopnoea
115
Q

Name two conditions that result in a gallop rhythm

A

Valve stenosis or regurgitation

116
Q

What is the triad of cardiogenic shock

A

Hypotension, oliguria and low CO

117
Q

How should pulmonary oedema be treated first line in a pre-hospital setting

A

FIRST LINE: NItrates (e.g., GTN) to solve orthostatic hypotension

IV Furosemide (vasodilation)

Opioids if in distress

118
Q

Treratment of pulmonary congested HF

A
  1. IV Furosemide (loop diuretic)
  2. High Flow Oxygen
  3. LMWH to reduce risk of PE
  4. IV NItrates if systolic BP > 110 mmHg
119
Q

What is the only circumstance in where opioids should be given tor elieve anxiety from HF

A

If we’re still in the compensated phase of HF

120
Q

What are inotropes

A

These change the force of heart contractions

121
Q

What ar epositive and negative inotropes

A

Positive increase force, negative weaken force

122
Q

Nmae two negative inotropes

A

Beta blockers

CCB

123
Q

Name a positive inotrope

A

Digoxin

124
Q

Pharmacology of digoxin

A

INcreases amount of calcium in teh heart, by blocking calcium channels from where they normally leave

125
Q

When are inotropes indicated in acute pulmonary oedema

A

Only when patient is hypotensive (<85 mmHg)

126
Q

Why should inotropes be avoided in pulmonary oedema or HF

A

They cause sinus tachycardia = arrythmias

127
Q

What inotrope can be given to counteract bet ablockers in people with acute HF

A

Levosimendan (calcium sensitiser)

128
Q

After stabilising someone with acute pulmonary oedema, what should be done

A

ACEi or ARB if not already being given ASAP

Beta blockers

Aldosterone

Digoxin to control ventricular rate in AF

129
Q

How does digoxin function to control rate rhythm

A

Controls ventricular rate

130
Q

Lifestyle advice for someone with acute pulmonary oedema

A

Restrict sodium intake to <2g a day and fluid to 1.5L a day

131
Q

If people with acute pulmonary oedema still struggle to breathe following medical intervention, what should be done

A

CPAP

132
Q

When should someone with acut epulmonary oedema be intubated

A

Respiratory failure leading to hypoxia, hypercapnia and acidosis

133
Q

Who should be referred for ABPM monitoring

A

140/90mmHg or higher to confirm diagnosis of hypertension

134
Q

Under what condition should an ABPM be done

A

First line before HBPM always.

HTN poorly controlled
Signs of pereclampsia
High risk patients
White coat hypertension 
Reverse white coat hypertension 
Postural hypotension
135
Q

What is the upper limit of normal for an ABPM

A

135/85 mmHg

136
Q

Some disadvantage sto ABPM

A
  1. Sleep disturbances
  2. Training required
  3. Brusing from cuff
  4. Poor Technique
137
Q

When does BP normally fall when doing an ABPM

A

Normally at night as a physiological hing

If rises at night = concerning

138
Q

What are true aneurysms

A

Involve all three of the layers of the artery wall (intima, media and adventitia)

139
Q

What are pseudo aneurysms

A

These are collections of blood held around the vessel wall by connective tissue which can end up reputuring and lead to thrombosis

140
Q

Signs of a false aneurysm

A

Pulsatile mass

141
Q

What can cause an aneurysm

A

Atherosclerosis
Vasculitis
Syphilis
Congenital (Berry Aneurysm)

142
Q

Risk Factors for aneurysms

A
  1. Anomalous vessels
  2. Coarctation of aorta
  3. PCKD
  4. Fibromuscular dysplasia
  5. Connective tissue disorders
143
Q

Where are cerebral aneurysms typically found

A

At the bifurcation of the middle cerebral artery at the circle of willis

144
Q

Most common type of peripheral aneurysm

A

Popliteal

145
Q

What causes an aortic dissection

A

When a tear in the tunica intima causes blood to spill in the tunica media which spreads

146
Q

Signs of a carotid dissection

A
  1. Headache
  2. Neck and facial pain
  3. Stroke symptoms and transient blindness and syncope
147
Q

What artery is usually involved in a carotid dissection

A

Internal carotid artery

148
Q

Investigations for a carotid dissection

A

Duplex Carotid USS

Then an MRI scan of the brain with/without angiography

149
Q

Contraindications to ACEi

A
  1. Pregnancy
  2. Hypersensitivity to ACE
  3. Angiooedema
  4. Breast-feeding
150
Q

What drugs do ACEi interact with

A

NSAIDs
Heparin
Lithium

151
Q

Side-effects of ACEi

A
  1. Impaired renal function
  2. Hyperkalaemia
  3. Persistent dry cough
152
Q

How should a persistent dry cough be corrected

A

Switch to ARBs

153
Q

What two things should be done before giving someone an ACEi

A

Check serum U+E and Creatinine before starting

Reduce furosemide if >80 mg a day

154
Q

When should ACEi be stopped

A
  1. Worsening renal function
  2. Persistent dry cough
  3. Hypotension
  4. Hyperkalaemia
155
Q

Function of Class I anti-arrythmic drugs (procainamide, dispyramide, lidocaine and flecanide)

A

Membrane stabilising

156
Q

Why are beta blockers given in AF

A

Reduce adrenergic input to the heart

157
Q

How does amiodarone and sotalol work to regulate heart

A

Potassium blockers

158
Q

How does verapamil regulate the heart

A

Blocks influx of calcium ions

159
Q

First line management of Haemophilia and vWD

A

Desmopressin (boosts factor VIII concentration)

160
Q

Role of aspirin

A

Irreversible inhibitor of COX-2, reducing Thromboxane A2

161
Q

Pharmacology of clopidogrel

A

ADP receptor antagonist

162
Q

Presentation of Aortic Dissection

A
  1. Chest Pain
  2. Aortic Regurgitation
  3. MI
  4. Congestive HF
  5. Syncope
  6. Stroke symptoms
  7. Mesenteric Ischaemia
  8. Kidney Injury

FIRST PHASE: Severe pain and pulse loss, bleeding then stops

SECOND PHASE: Pressure erupts and causes bleeding into the mediastium and elsewhere = cardiac tamponade

163
Q

Onset of aortic dissection

A

Male in 60s with hypertension and SUDDEN ONSET

164
Q

What happens to the pain felt in an aortic dissection as the dissetcion progresses

A

Migrates retrosternally (proximal dissection) or between scapula and the back (distal)

165
Q

What causes paraplegia in an aortic dissection

A

Blocking spinal arteries

166
Q

First line investigation for a suspected aortic dissection

A

ECG to discard an MI

167
Q

What should be used to check the extent and site of an aortic dissection

A

Transthoracic or oesophageal USS

168
Q

What is the definitive diagnostic for an aortic dissection

A

MRI scanning

169
Q

Management of an aortic dissection

A
  1. IV MORPHINE

2. Manage Hypertension with beta blockers

170
Q

What are the three types of Aortic Dissections

A

Type I; Aorta, arch and descending aorta

Type II; Ascending Aorta only

Type III: Descending aorta distal to left subclavian

DeBakey Classification

171
Q

Surgical intervention for Type III aortic dissections

A

TEVAR

172
Q

Management of chronic aortic dissections

A

Medical treatment only

173
Q

What heart murmur may be heard in aortic dissections

A

A diastolic murmur from aortic regurgitation

174
Q

What is a poor prognosis of an aortic dissection

A

Hypotension

175
Q

Lifelong prophylaxis of aortic dissections

A

Beta BLockers and USS screens

176
Q

Name three conditions that may cause aortic regurgitation

A
  1. Bicuspid aortic valve
  2. Rheumatic Fever
  3. Infective Endocarditis
177
Q

Most common cause ofAortic regurgitation

A

Rheumatic heart disease

178
Q

Onset of Aortic Regurgitation

A

40-60

179
Q

What chronic conditions can cause aortic regurgitation

A

SLE
Marfan’s
Ehler-Danlos
Turner

180
Q

Characteristic of pulse heard in aortic regurgitation

A

Bounding and collapsing peripheral pulses (water hammer)

181
Q

Describe the pulse pressure found in Aortic Regurgitation

A

Wide with a sudden collapse of the pulse at the end

182
Q

Signs of Aortic Reguratation

A

Head Bopping

Pulsus Bisferiens

183
Q

What is Pulsus Bisferiens

A

single central pulse wave with two peaks and a dip

184
Q

How does the patient need to sit in order to hear the aortic regurgitation murmur

A

Sitting forward and breathing out

185
Q

What murmur is heard in AR

A

S1 is soft + Early diastolic murmur

186
Q

Definitive diagnosis of AR

A

ECHO with doppler

187
Q

How often do patients with AR need to be monitored for

A
  1. Yearly review and ECHo every 2 years
188
Q

Medical Management of AR

A
  1. Vasodilators and inotropic agents
189
Q

Indications for surgery for AR

A
  1. Symptomatic

2. Asymptomatic when left ventricular function is deteriorating

190
Q

Presentation of aortic stenosis

A

Shortness of breath
Angina
Dizziness or syncope
HF

191
Q

Sounds heard in AS

A

PULSUS PRAVUS et Tardus (slow rising and flat)

Disappearance of second aortic sound or softening

Harsh systolic murmur

192
Q

Pulse pressure characteristic of Aortic Stenosis

A

Narrow pulse pressure

193
Q

Where does teh systolic murmur in AS transmit to in AS and how does this differ from AR

A

AS transmits to the carotids unlike in AR

194
Q

Describe the nature of the systolic ejection murmur in AS

A

Crescendo-Decrescendo

195
Q

Where is the AS murmur typically found

A

Second right intercostal space

196
Q

Investigation of AS

A
  1. ECG for LVH

2. ECHO (transoeosphageal)

197
Q

Should excercise testing be used to check for As

A

NO unless symptoms are being masked

198
Q

What serum level dictates prognosis in AS

A

Natriuretic peptides

199
Q

Role of Cardiac Catheterisation

A

Measures pressure across valves and chambers

200
Q

Main complication of symptomatic AS

A

Left ventricular ejection fraction deteriorates (left sided heart failure)

201
Q

Surgical intervention for AS

A

Transcatheter aortic valve implantation or Aortic Valve replacement

202
Q

At what K+ level should blood tests be repeated within a day

A

Over 6 mmol

203
Q

Over what serum K+ level should a patient be admitted to hospital

A

Over 6.5mmol/mol

204
Q

Side Effects of CCB

A

Pitting Oedema

Low BP

Year 4 (16 decks)

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