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Core Conditions AJL (minus renal and respiratory) > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

How common is MI/ACS and who does it affect?

A

5/1000 per year

More common in males

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2
Q

What are the causes of MI/ACS?

A
  • A rupture to fibrous cap of a coronary artery plaque
  • Leads to platelet aggregation and adhesion, thrombosis, vasoconstriction and distal thrombus embolisation
  • Results in ischaemia due to reduction in coronary bloodflow
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3
Q

What are the risk factors for MI/ACS?

A 
Age
Gender
Family history
Smoking
Hypertension 
Diabetes
Obesity
Hyperlipidaemia
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4
Q

What are the symptoms of MI/ACS?

A 
Acute central chest pain (>20 mins)
Nausea
Sweatiness
Dyspnoea
Palpitations
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5
Q

What are the signs of MI/ACS on examination?

A 
Distress
Anxiety
Pallor
Sweatiness
⬆️ pulse/⬇️ pulse
BP ⬆️/⬇️ 
Signs of heart failure
4th heart sound
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6
Q

What are the possible differential diagnoses of MI/ACS?

A 
Angina
Pericarditis
Myocarditis
Aortic dissection
PE
Oesophageal reflux
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7
Q

What investigations are necessary to diagnose MI/ACS?

A

ECG
CXR
Bloods (FBC, U&Es, glucose, lipids)
Cardiac Enzymes (⬆️ Troponin, ⬆️ Creatine Kinase)

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8
Q

What are the treatments of MI/ACS?

A 
Anti-platelet agents
- aspirin
- Clopidogrel
Anti-thrombins
Anti-ischaemia agents
Coronary intervention
- Stenting
- Bypass
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9
Q

How common is Angina and who does it affect?

A

Men over 70 with atypical symptoms >90%

Women older than 70, 61-90%

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10
Q

What are the causes of angina?

A 
Mostly atheroma
Anaemia
Tachyarryhthmias
Arteritis
Small vessel disease
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11
Q

What are the risk factors for angina?

A 
Hypertension
Hypercholesterolaemia
Smoking
Type 2 diabetes
Age
Family History
Overweight
Stress
Gender
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12
Q

What are the symptoms of angina?

A 
acute central chest pain associated with;
Nausea and vomiting
Sweatiness
Dyspnoea
Palpitations
Syncope
Pulmonary oedema
Epigastric pain
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13
Q

What are the signs of angina on examination?

A 
Distress
Anxiety
Pallor
Sweatiness
⬆️/⬇️ in pulse
⬆️/⬇️ in BP 
4th heart sound
Signs of heart failure
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14
Q

What are the possible differential diagnosis of angina?

A 
Angina
Pericarditis
Myocarditis
Aortic dissection
PE
Oesophageal reflux/spasm
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15
Q

What investigations are necessary to diagnose angina?

A

ECG (ST elevation, T wave inversion)
Bloods - FBC, U&Es, glucose and lipids
Cardiac enzymes - cardiac Troponin, Creatine kinase, myoglobin

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16
Q

What are the treatments for angina?

A 
GTN spray
Beta blockers
Calcium channel blockers
Treating risk factors
Surgery
- coronary artery bypass graft
- percutaneous coronary intervention (coronary angioplasty)
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17
Q

How common is AF and who does it affect?

A

500,000 people in UK
More common as age ⬆️

More common in men
10% of people over 75

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18
Q

What causes AF?

A

Caused by atrial fibrosis and loss of atrial muscle mass
Fibrosis occurs as a result of ageing, inflammatory processes, genetic causes

  • High blood pressure
  • thyrotoxicosis
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19
Q

What are the risk factors for AF?

A 
Age
Heart disease
Hypertension
Family history
Hyperthyroidism
Alcohol consumption
Obesity
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20
Q

What are the symptoms of AF?

A 
Asymptomatic
Chest pain
Palpitations
Dyspnoea
Faintness
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21
Q

What are the signs of AF on examination?

A

Irregularly irregular pulse
Apical pulse rate greater than radial
1st heart sound of variable intensity
Signs of LVF

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22
Q

What are the possible differential diagnoses of AF?

A

Atrial flutter
Atrial extrasystoles
Supra ventricular tachyarrhythmias
Ventricular tachycardia

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23
Q

What investigations are necessary to diagnose AF?

A

ECG (absent P waves and irregular QRS complexes)
Bloods- U&Es, cardiac enzymes, TFTs, FBC
Echocardiogram
CXR to indicate cardiac structural causes of AF

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24
Q

What are the treatments for AF?

A

Rate control:
- Beta blocker (not calcium channel blockers due to bradycardia risk)
- digoxin
Rhythm control:
- pretreat for >4 weeks with sotalol or Amiodarone
- flecanide

Anticoagulation

  • warfarin
  • aspirin
  • Dabigatran- direct thrombin inhibitor
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25
Q

How common is essential hypertension and who does it affect?

A

20-30% of population
- 80-90% is essential/primary hypertension

Affects of 40-45% of black African adults

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26
Q

What causes essential hypertension?

A 
Genetic component
Low birth weight
Obesity
Excess alcohol intake
High salt intake
Metabolic syndrome
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27
Q

What are the risk factors for essential hypertension?

A

Family history
Personal history
Age

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28
Q

What are the symptoms of essential hypertension?

A

Generally Asymptomatic

In extremes:

  • headaches
  • fatigue/confusion
  • dizziness
  • nausea
  • vision problems
  • chest pains
29
Q

What are the signs of essential hypertension on examination?

A

High blood pressure

End organ signs:

  • loud second heard sound
  • left ventricular heave
  • fourth heart sound
  • retinal abnormalities
30
Q

What are the possible differential diagnoses of essential hypertension?

A

Secondary hypertension
Anaemia
Malignant hypertension

31
Q

What investigations are required to diagnose essential hypertension?

A

Need to exclude any end organ damage

  • U&Es, and renal ultrasound
  • urine dip
  • blood glucose
  • serum lipids
  • ECG
32
Q

What are the treatments of essential hypertension?

A 
Lifestyle modification
Drug therapy
- Diuretics (loop&thiazide)
- beta blockers
- ACE inhibitors
- Angiotensin 2 receptor blockers
- calcium channel blockers
32
Q

How common is DVT and who does it affect?

A

1/1000 people on UK develop DVT per year

More common as you get older >60yrs

More common in males

33
Q

What are the causes of DVT?

A

Thrombosis in the deep veins of the of the limbs/trunk, mainly in leg/pelvis

Usually originates from valves where thrombin made up of RBC and fibrin detach

Cause associated with risk factors

34
Q

What are the risk factors for DVT?

A 
Age >60 years
Severe medical co-morbidities
Obesity
Major abdo/pelvic surgery
Pregnancy
Immobility- surgery, illness/injury, travel
Vessel luminal damage - varicose veins
Oestrogen contraceptive pill, HRT 
- oestrogen causes blood to clot more easily
Family/personal history
35
Q

What are the symptoms of a DVT?

A

Often Asymptomatic

pain/tenderness

36
Q

What are the signs of DVT on examination?

A

Swollen leg
Warm leg
Calf tenderness
Superficial vein distension

37
Q

What are the possible differential diagnoses of a DVT?

A 
Ruptured Bakers cyst
Oedema from surrounding msk injuries
Cellulitis
Chronic oedema
Haematoma
Superficial thrombophlebitis
38
Q

What investigations are necessary to diagnose a DVT?

A

Serum D-dimer (good to rule out DVT but not confirm)

  • high levels of D-dimer (+ve result) indicates further investigation and high probability a DVT is present
  • normal levels of D-dimer (-ve result) confirm no DVT is present

Ultrasound

39
Q

What are the treatments of a DVT?

A
  • LMW heparin by subcutaneous injection every 24hrs for 5 days till oral Anticoagulation established
  • Warfarin for rapid Anticoagulation in VTE
  • maintenance dose warfarin
40
Q

How common is left ventricular failure and who does it affect?

A

1-3 of every 100 people will develop LVF

Prevalence increases with age

41
Q

What are the causes of Left Ventricular Failure?

A 
Myocardial ischaemia
Hypertension
Aortic stenosis/incompetence
Mitral incompetence
MI
Hypothyroidism
42
Q

What are the risk factors for left ventricular failure?

A 
Hypertension
Previous MI
Congenital heart defects
Diabetes
Excessive alcohol use
Irregular heart beat
43
Q

What are the symptoms of left ventricular failure?

A

Dominated by PULMONARY OEDEMA

Tachypnoea
Cough
Frothy/bloody mucus
Cyanosis
Dyspnoea on exertion and at rest
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue, Weakness
Exercise intolerance
Wheezing
44
Q

What are the signs of left ventricular failure on examination?

A 
Crackles on lung bases
Laterally displaced apex beat
Galloping rhythm
Increased BP/intra-cardiac pressure
Heart murmur (aortic stenosis, mitral regurgitation)
45
Q

What are the differential diagnoses of left ventricular failure?

A

PE
Lung cancer
Upper airway obstruction

46
Q

What investigations are necessary to diagnose left ventricular failure?

A 
CXR
Coronary angiography
ECG
Heart stress test
Cardiac Ultrasound
47
Q

How do you treat left ventricular failure?

A

Diuretics

48
Q

What is congestive cardiac failure?

A

Complex clinical syndrome resulting from structural or functional cardiac disorder that impairs the ability of the ventricles to fill or eject blood

Affects the ventricles

49
Q

How common is CCF?

A

Affects around 900,000 people in UK

50
Q

What causes CCF?

A 
Coronary artery disease
MI
Myocardial disease
Heart valve disease
Hyperthyroidism
Hypertension
51
Q

What are the symptoms of CCF?

A 
Dyspnoea
Cardiac asthma
Cough
Frothy bloody sputum
Orthopnoea
Paroxysmal nocturnal dyspnoea
Peripheral oedema
52
Q

What are the signs of CCF on examination?

A

Cyanosis

Pulmonary oedema

53
Q

What are the treatments for CCF?

A 
Diuretics
ACEi
Beta blockers
Spironolactone
Digoxin
Vasodilators
54
Q

When does mitral stenosis become symptomatic?

A

When the lumen is reduced to 1cm or less

55
Q

What causes mitral stenosis?

A

Long suffering rheumatic fever

56
Q

How does rheumatic fever cause mitral stenosis?

A

Rheumatic fever results in inflammation of all layers of the heart-pericardium, myocardium and endocardium
Causes pathological scarring of valve cusps and shortening and tightening of chordae tendinae

57
Q

What does mitral stenosis cause?

A

Causes poor emptying of the atrium

  • increasing pulmonary venous pressure
  • pulmonary hypertension
  • right ventricular Hypertrophy, dilation and failure
58
Q

What is the most common cause of mitral regurgitation?

A

Ischaemic Heart disease

59
Q

What is mitral prolapse?

A

Myxoid degeneration of cusps and chordae tendinae causing cusps to balloon into the atrium and chordae tendinae may rupture

60
Q

What are the symptoms of aortic stenosis?

A

Syncope
Angina
Left Ventricular failure

61
Q

What can cause aortic regurgitation?

A

Infective endocarditis

Aortic root dilation

62
Q

What are the signs and symptoms of Aortic regurgitation?

A

Systolic hypertension
Wide pulse pressure
Water hammer pulse

63
Q

What is right ventricular failure?

A

Failure of the ventricle to eject blood out of the ventricle to the lungs

Usually occurs as a result of left sided heart failure causing increased pressure through the lungs and to the right ventricle

Blood flow to the pulmonary arteries falls as blood begins to accumulate in the right ventricle, left atrium and systemic circulation

64
Q

What are the signs and symptoms of right ventricular failure?

A

Elevation of systemic venous pressure - JVP
Ascites & jaundice (liver and spleen congestion)
Peripheral pitting oedema
Parasternal heave (compensatory increase in contraction strength)
Nocturia - fluid retained in limbs re enter systemic circulation

65
Q

What is infective endocarditis?

A

Endovascular infection of cardiovascular structures including cardiac valves, atrial and ventricular endocardium large intrathoracic vessels and intracardiac foreign bodies (prosthetic valves)

66
Q

What is the pathology of infective endocarditis?

A

Vegetation which occur on valve leaflets and chordae tendinae
Vegetation a consist of fibrin, inflammatory cells and microbes on the endocardium

67
Q

What is the microbiology of infective endocarditis?

A

Acute: staph aureus

Sub-acute: strep viridans

68
Q

What are the signs of infective endocarditis?

A

Septic signs
Cardiac lesions (new murmur, changing murmur)
Immune complex deposition:
- Vasculitis
- Roth spots, splinter haemorrhages, oslers nodes
Embolic phenomena

Core Conditions AJL (minus renal and respiratory) (10 decks)

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