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Phase 2a > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is the principle cause of heart attack, stroke and gangrene of extremities?

A

atherosclerosis

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2
Q

What is the best-known risk factor for coronary artery disease?

A

age

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3
Q

What are the risk factors for atherosclerosis?

A

age
tobacco smoking
high serum cholesterol
obesity
diabetes
hypertension
family history

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4
Q

Where is atherosclerosis found?

A

peripheral and coronary arteries

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5
Q

Name the coronary arteries

A

left anterior descending
right
circumflex

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6
Q

What does an atherosclerotic plaque consist of?

A

lipids
necrotic core
connective tissue
fibrous cap

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7
Q

What eventually happens to an atherosclerotic plaque?

A

either occlude the vessel resulting in restriction of blood flow (angina), or rupture leading to thrombus formation and death

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8
Q

What starts atherosclerosis formation?

A

response to injury hypothesis
injury to endothelial cells leads to inflammation

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9
Q

What are some negative outcomes of inflammation?

A

myocardial repercussion injury
atherosclerosis
ischaemic heart disease IHD
rheumatoid arthritis
asthma
inflammatory bowl disease
shock
excessive wound healing

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10
Q

At what age do you begin getting fatty streaks?

A

younger than 10 years old

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11
Q

What is PCI?

A

percutaneous coronary intervention (stent)

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12
Q

What are coronary stents used in patients today made up?

A

stainless steel

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13
Q

Which drugs are on stents? Why?

A

sirolimus
stops cell proliferation which prevents significant stenosis

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14
Q

What does aspirin do pharmacologically?

A

irreversible inhibitor of platelet cyclo-oxygenase (anti-platelet)

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15
Q

How does statins affect cholesterol?

A

reduces cholesterol synthesis

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16
Q

What is angina?

A

mismatch of oxygen supply and demand

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17
Q

What are the risk factors of IHD?

A

age
cigarette smoking
family history
male
diabetes mellitus
hyperlipidemia
hypertension
kidney disease
obesity
physical inactivity
stress

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18
Q

What is ischaemic heart disease (IHD)?

A

heart problems caused by narrowing of the arteries

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19
Q

What is Ohm’s Law in medicine?

A

ΔP = QR

P= pressure
Q= flow
R= resistance

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20
Q

What is crescendo angina?

A

worsened angina over a series of months

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21
Q

What is unstable angina?

A

experiencing angina at rest

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22
Q

What is Prinzmetal’s angina

A

a coronary spasm that is very rare

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23
Q

What is microvascular angina?

A

angina with apparently normal main coronary arteries that mostly affects females

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24
Q

What kind of family history would be relevant for IHD?

A

first degree relative under the age of 60 years old

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25
Q

What is the differential diagnosis for chest pain?

A

MYOCARDIAL ISCHAEMIA
peri/myo carditis
pulmonary embolism/ pleurisy
chest infection
gastro-oesophageal (reflux, spasm, ulceration)
musculo-skeletal
psychological

dissection of the aorta

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26
Q

What are the side effects of beta blockers?

A

tiredness
nightmare
bradycardia
erectile dysfunction
cold hands and feet

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27
Q

Who should you never prescribe beta blockers to?

A

patients with severe asthma

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28
Q

What effect do nitrates have on the vessels?

A

venodilators

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29
Q

What do you need to be very careful with when prescribe aspirin?

A

gastric ulceration

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30
Q

What is CABG surgery?

A

coronary artery bypass graft surgery

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31
Q

What is syncope?

A

fainting

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32
Q

How can intake of digoxin show on an ECG?

A

QT prolonging

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33
Q

How many leads does a standard ECG have?

A

12 leads:
3 bipolar leads
3 augmented unipolar limb leans
6 unipolar precordial (chest) leads

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34
Q

What is the annulus fibrosis?

A

isolating barrier between atria and ventricles

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35
Q

What are the layers of the pericardium?

A

2 layers:
visceral single cell layer
fibrous parietal layer

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36
Q

What is acute pericarditis?

A

inflammatory pericardial syndrome with or without pericardial effusion

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37
Q

What is pericardial effusion?

A

build up of too much fluid in the pericardium

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38
Q

What percentage of incidences of pericarditis is idiopathic?

A

80-90%

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39
Q

What is the leading cause of pericarditis in the UK?

A

viral infections

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40
Q

What is the most common non-infectious cause of pericarditis?

A

neoplasms

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40
Q

What is the most common non-infectious cause of pericarditis?

A

neoplasms

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41
Q

Describe pulsus paradoxus

A

when you breath in bp usually falls by <10mmHg but in moderate/ greater effusion the fall is >10mmHg. Due to greater drop in bp, cardiac output is reduced which reduces volume of peripheral pulse

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42
Q

What does acute STEMI mean?

A

acute ST elevation myocardial infarction (heart attack)

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43
Q

Why can it be difficult to distinguish between pericarditis and MI?

A

Both ECGs will have an ST elevation. In MI the elevation will be concave, in pericarditis the elevation will be saddle shaped.

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44
Q

What is cardiomyopathy?

A

primary heart muscle disease

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45
Q

What is HCM and what causes it?

A

hypertrophic cardiomyopathy

caused by sarcomeric protein gene mutations

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46
Q

How many people are affected by HCM?

A

1 in 500 people

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47
Q

What are the categories of cardiomyopathies?

A

hypertrophic
dilated
arrhythmogenic

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48
Q

What feature will you see in the histology of a heart with cardiomyopathy?

A

myofibrillar disarray

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49
Q

What is CPVT?

A

catecholaminergic polymorphic ventricular tachycardia

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50
Q

What is the major risk of atrial fibrillation?

A

stroke and/ or pulmonary embolism

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51
Q

What drugs are used to treat hypertension?

A

ACE inhibitors
ARBs
Calcium channel blockers
Beta blockers
Aldosterone antagonist
Alpha blockers
Renin inhibitors

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52
Q

What do ACE inhibitors treat?

A

hypertension
heart failure
diabetic nephropathy

53
Q

Give 4 examples of ACE inhibitors

A

ramipril
enalapril
perindopril
trandolapril

54
Q

What are the main adverse effects of ACE inhibitors?

A

DUE TO REDUCED ANGIOTENSIN II FORMATION:
hypotension
acute renal failure
hyperkalaemia
teratogenic effects in pregnancy

RELATED TO INCREASED KININS:
cough
rash
anaphylactoid reactions

55
Q

What does teratogenic mean?

A

refers to a substance that causes congenital disorders/ foetal abnormalities

56
Q

What are anaphylactoid reactions?

A

immediate systemic reactions that mimic anaphylaxis but are not caused by IgE-mediated immune responses

57
Q

What are Angiotensin II Receptor Blockers (ARBs) used to treat?

A

hypertension
diabetic nephropathy
heart failure (when ACEi contraindicated)

58
Q

Name 3 ARBs

A

candesartan
losartan
valsartan

59
Q

What are the main adverse effects of ARBs?

A

symptomatic hypotension
hyperkalaemia
potential renal dysfunction
rash
angio-oedema

Generally very well tolerated

60
Q

What are Calcium Channel Blockers used to treat?

A

hypertension
IHD - angina
arrhythmia (tachycardia)

61
Q

Name 3 common calcium channel blockers

A

amlodipine
nifedipine
felodipine

62
Q

What are the groups of calcium channel blockers?

A
  1. Dihydropyridines: nifedipine, amlodipine, felodipine, lacidipine
    preferentially affects vascular smooth muscle
  2. Phenylalkylamines: verapamil
    main effects on heart
  3. Benzothiazepines: diltiazem
    intermediate heart/ peripheral vascular effects
63
Q

What are the adverse effects of CCBs?

A

DUE TO PERIPHERAL VASODILATION (mainly dihydropyridines):
flushing
headache
oedema
palpitations

DUE TO NEGATIVE CHRONOTROPIC EFFECTS:
bradycardia
atrioventricular block

DUE TO INOTROPIC EFFECTS:
worsening of cardiac failure

verapamil causes constipation

64
Q

What are beta-adrenoceptor blockers used to treat?

A

IHD - angina
heart failure
arrhythmia
hypertension

65
Q

Name 3 beta blockers.

A

propranolol
bisoprolol
atenolol

66
Q

What is the difference between selective and non selective beta blockers?

A

non selective act on beta 1 and beta 2 receptors
selective act just on beta 1 receptors

however none are 100% selective

67
Q

What are the adverse effects of beta blockers?

A

fatigue
headache
self disturbance/ nightmares

bradycardia
hypotension
cold peripheries

erectile dysfunction

68
Q

Which kind of patients must never been prescribed beta blockers?

A

patients with asthma- can trigger a severe asthma attack, potentially fatal

69
Q

What is bradycardia and tachycardia?

A

bradycardia: < 60bpm
tachycardia: > 100bpm

70
Q

What is PVD?

A

peripheral vascular disease

71
Q

Can you give beta blockers to patients in heart failure?

A

Yes- but you can’t give standard dose straight away, must start at low dose and rise slowly

72
Q

What do diuretics treat?

A

hypertension
heart failure

73
Q

What are the classes of diuretics?

A
  1. thiazides and related drugs (distal tubule)
  2. loop diuretics (loop of Henle)
  3. potassium-sparing diuretics
  4. aldosterone antagonists
74
Q

Name 3 thiazide diuretics.

A

bendoflumethiazide
hydrochlorothiazide
chlorothiazide

75
Q

Name 2 loop diuretics.

A

furosemide
bumetanide

76
Q

Name 2 potassium-sparing diuretics.

A

spironolactone
eplerenone

77
Q

What are the adverse effects of diuretics?

A

hypovolaemia
hypotension

low serum K+, Na+, Mg2+, Ca2+

raised uric acid (gout)
impaired glucose tolerance

erectile dysfunction

78
Q

Name an alpha 1 adrenoreceptor blocker.

A

doxazosin

79
Q

Name 2 centrally acting anti-hypertensives.

A

moxonidine
methyldopa

80
Q

Name a direct renin inhibitor.

A

aliskiren

81
Q

Why is methyldopa an important anti-hypertensive?

A

It can be used in pregnant women as it is not teratogenic, so women with preeclampsia (gestational high blood pressure) can be prescribed it

82
Q

What is LVSD?

A

left ventricular systolic dysfunction

83
Q

What is HFPEF?

A

heart failure with preserved ejection fraction (diastolic failure)

84
Q

What is the most common cause of heart failure?

A

coronary artery disease

85
Q

What is the first line treatment for heart failure?

A

ACE inhibitors and beta blockers
low dose and slow increase

86
Q

What is heart failure?

A

when the heart is unable to pump blood around the body properly

87
Q

What are ARNIs?

A

combination drug: aldosterone receptor antagonist and neprilysin inhibitor

88
Q

What are nitrates used to treat?

A

IHD - angina
heart failure

89
Q

Name 2 nitrate medications.

A

GTN spray/ infusion
isosorbide mononitrate

90
Q

What are the types of coronary artery disease?

A

chronic stable angina
unstable angina/ acute coronary syndrome (NSTEMI)
ST elevation myocardial infarction (STEMI)

91
Q

How do you treat chronic stable angina?

A
  1. anti platelet therapy- aspirin, clopidogrel
  2. lipid-lowering therapy- statins
  3. short acting nitrate- GTN spray for acute attack
  4. first line treatment: beta blockers or CCB
92
Q

Name 4 statins.

A

simvastatin
atorvastatin
rosuvastatin
pravastatin

93
Q

How do you treat acute coronary syndromes (NSTEMI and STEMI)

A
  1. pain relief: GTN spray and opiates (diamorphine)
  2. dual anti platelet therapy: aspirin plus tricagrelor/ prasugrel/ clopidogrel
  3. antithrombin therapy: fondaparinux
  4. consider glycoprotein IIb IIIa inhibitor for high risk cases: tirofiban
  5. background angina therapy: beta blocker, nitrate, CCB
  6. lipid lowering therapy: statins
  7. therapy for LVSD/ heart failure as required: ACEi, BB, aldosterone agonist

most patients will have invasive management of angioplasty or CABG

94
Q

What is another name for diamorphine?

A

heroin

95
Q

What are the classes of anti arrhythmic drugs?

A

sodium channel blockers
beta blockers

96
Q

What are the classes of anti arrhythmic drugs?

A

sodium channel blockers

beta blockers

amiodarone (prolong action potential)

calcium channel blockers (verapamil and diltiazem only)

digoxin

97
Q

List the main congenital heart defects.

A

Holes:
Ventricular septal defect
Atrial septal defect
Atrio-ventricular septal defect
Patent ductus arteriosus

Narrowings:
Coarctaction of the aorta
Bicuspid aortic valve and aortopathy
Pulmonary stenosis

Holes and Narrowings:
Tetralogy of fallot
Eisenmenger syndrome
Univentricular hearts

98
Q

What percentage of patients with congenital heart defects have an intellectual disability?

A

10%

99
Q

How many babies are born with tetralogy of fallot?

A

1 in 1000

100
Q

What are the 4 features of tetralogy of fallot?

A

ventricular septal defect
pulmonary stenosis
hypertrophy of right ventricle
overriding aorta

101
Q

How do newborns with tetralogy of fallot look?

A

patients are blue- these are called ‘fallot spells’

102
Q

How is tetralogy of fallot treated?

A

complete surgical repair at 3-6 months (repair of VSD and incise pulmonary valve to increase size of pulmonary artery)

103
Q

How does ToF affect patients that have undergone surgery?

A

often get pulmonary valve regurgitation later in life- 40% of ToF patients eventually need a pulmonary valve replacement

104
Q

What is VSD?

A

ventricular septal defect
abnormal connection between the two ventricles

105
Q

Are babies with VSD a normal colour?

A

yes- they are not blue as blood flows from high pressure chamber to low pressure chamber

106
Q

How do you treat a small VSD?

A

leave it alone- as child grows the small hole will be less and less important

107
Q

How does Eisenmengers syndrome present?

A

blue lips
clubbed blue fingers

108
Q

What causes Eisenmengers syndrome?

A

Irregular blood flow in the heart and lungs causing pulmonary arterial hypertension. It is irreversible and causes early mortality.

109
Q

How do you close an ASD?

A

surgically
percutaneous (key hole technique)

110
Q

What is an ASD?

A

atrial septal defect

111
Q

What is an AVSD?

A

atrio-ventricular septal defect

112
Q

What condition is AVSD associated with?

A

trisomy 21 (Down’s syndrome)

113
Q

What is an ASVD anatomically?

A

instead of 2 separate AV valves, there is one big malformed one

114
Q

What is a patent ductus arteriosus?

A

connection between the pulmonary artery and aorta

115
Q

How does a patent ductus arteriosus occur?

A

everyone has a ductus arteriosus that spasms and closes in the first few days of life, PDA occurs when this doesn’t happen

116
Q

What is coarctation of the aorta?

A

narrowing of the aorta at the site of insertion of the ductus arteriosus

117
Q

What are the ways to repair coarctation of the aorta?

A

subclavian flap repair
end to end repair

118
Q

What is a bicuspid aortic valve?

A

a normal aortic valve has three cusps, but bicuspid AVs you only have two cusps

119
Q

What the occurrence of bicuspid aortic valves?

A

very common: 1-2% of population

120
Q

What is a BAV in cardiology?

A

bicuspid aortic valve

121
Q

What is pulmonary stenosis?

A

narrowing of outflow of the right ventricle, can be valvular, sub-valver or supra-valvar

122
Q

What is the pathway of electrical conduction in the heart?

A

SA node
atria
AV node
bundle of His
purkinje fibres

123
Q

How do you find the heart rate from an ECG?

A

300/number of squares

124
Q

What is a normal QRS axis?

A

-30 to +90 degree

125
Q

What do the waves on an ECG mean?

A

P wave - atrial depolarisation
QRS complex - ventricular depolarisation
T wave - ventricular repolarisation

126
Q

What is the PR interval?

A

atrial depolarisation and conduction from atria to ventricles

127
Q

How does Wolf Parkinson’s White syndrome show on an ECG?

A

short PR interval
prolonged QRS complex

128
Q

What does an abnormal ST segment indicate?

A

can be elevated in early repolarisation, peri/myocarditis, MI

129
Q

What is a ‘normal heart rate’?

A

60-100 bpm

130
Q

What are the causes of heart failure?

A

myocardial dysfunction
IHD
hypertension
alcohol excess
cardiomyopathy
valvular/ endocardial/ pericardial causes

Phase 2a (18 decks)

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