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GP > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What’s the management of hypertension for a Caucasian 45 year old man?

A

Lifestyle changes

1st: ACEi or ARB
2nd: Add Ca-channel blocker
3rd: Add thiazide-like diuretic
4th: Add further diuretic or A or B-blocker

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2
Q

What’s the management of hypertension for a Black Afro-Caribbean 60 year old lady?

A

Lifestyle changes

1st: Ca-channel blocker
2nd: Add ACEi or ARB
3rd: Add thiazide-like diuretic
4th: Add another diuretic, A or B-blocker

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3
Q

What’s the management of hypertension for a Caucasian 75 year old lady?

A

1st: Ca-channel blocker
2nd: Add ACEi or ARB
3rd: Add thiazide-like diuretic
4th: Add another diuretic, A or B-blocker

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4
Q

Name some:

  • ACEi
  • ARB
  • B-blockers
  • A-blockers
  • Ca channel blockers?
A

ACEi: Lisinopril, ramipril

ARB: Candesartan, losartan

B-Blocker: Bisoprolol

A-blocker: Doxazosin

CCB: amlodipine

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5
Q

What are the 3 types of diuretics? Give an example of each type.

A

Thiazide-like
- indapamide

Loop
- furosemide

K sparing
- spironolactone

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6
Q

How do thiazide-like diuretics work?

A

Act on proximal part of distal tubule

Increase sodium excretion from blood to urine

Increase water excretion from blood to urine

This reduces the blood volume and therefore BP

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7
Q

How do loop diuretics work?

A

Act on the loop of Henle

Causing loss of water from blood to urine

Reducing blood volume and BP

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8
Q

How do K sparing diuretics work?

A

Inhibit sodium/potassium exchange by blocking aldosterone

So loss of water from blood to urine but no loss of K

Not very effective diuretics

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9
Q

Briefly describe the RAAS pathway.

A

Liver produces angiotensinogen

Renin, an enzyme, is released by kidney due to low fluid volume in nephron

Renin converts angiotensinogen –> angiotensin 1

In lungs, ACE converts ang-1 –> ang-2

Ang-2 causes adrenal gland to release aldosterone

Aldosterone acts on collecting ducts to retain water

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10
Q

How do CCBs work?

A

When calcium enters the cells of blood vessels, the blood vessels constrict.

CCBs block Ca entering the cells, so blood vessels don’t constrict and even dilate, so BP doesn’t rise

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11
Q

What’s the management of heart failure?

A

Lifestyle changes

Drugs:

  1. diuretics, loop and if required K sparing
  2. ACEi or ARB
  3. B blocker
  4. Spironolactone
  5. Digoxin
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12
Q

How does digoxin work?

A

It slows down the heart and allows proper filling of ventricles

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13
Q

List some symptoms of R and L sided heart failure? Explain.

A

Right:
RV can’t pump blood to lungs quick enough, blood backs up into VC, so there’s peripheral and sacral oedema, ascites

Left:
LV can’t pump blood to aorta very well, blood backs up into lungs causing pulmonary hypertension and oedema, SOB, cough. Also body is hypoperfused: cold peripheries, wasting

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14
Q

What respiratory symptoms are seen in heart failure?

A

SOB

Cough:

  • paroxysmal nocturnal dyspnoea
  • orthopnea
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15
Q

Investigations of heart failure?

A

ECG

Bloods: B natriuretic peptide

CXR

Echo

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16
Q

What would you see on the CXR of a patient in heart failure?

A

A: Alveolar oedema

B: Kerley B lines

C: Cardiomegaly

D: Dilated prominent upper lobe vessels

E: Pleural effusion

17
Q

How is hypertension staged?

A
  1. Over 135/85
  2. Over 150/95

Severe: systolic > 180, diastolic > 110

18
Q

How are stages 1 + 2 hypertension managed?

A

Stage 1: lifestyle modification, smoking, alcohol, exercise, diet, relaxation

Stage 2: drugs

19
Q

What is AF?

A

Abnormal heart rhythm caused by rapid and irregular atrial contraction

Atrial stagnation, blood clots as it’s stagnant in artia

Clots are pumped around body

20
Q

What are the risk factors for AF?

A 
Hypertension
Coronary artery disease
Valvular heart disease
Sepsis
Alcohol
PE
Thyrotoxicosis
21
Q

Clinical features of AF?

A

Palpitations
SOB
Chest pain
Dizziness

22
Q

Investigations of AF?

A

ECG

Echo

23
Q

Management of AF?

A

Rate control: B blockers, or Ca channel blockers

Rhythm control: cardioversion, amiodarone

Anti-coagulation: warfarin, aspirin, NOAC

24
Q

When would you use cardioversion to treat AF?

A

In younger patients with new AF

25
Q

How would you assess a patient with AF’s risk of having a stroke?

How would you manage depending on risk?

A

CHA2DS2Vasc

CCF
Hypertension
Age over 70 (2)
Diabetes
Stroke/TIA (2)
Vascular disease
Age 65-74
Sex female
C
0 = low risk, no intervention
1 = moderate, consider intervention
2 = high risk, intervene
26
Q

What’s a NOAC?

A

Novel anti-coagulant

Apixiban
Rivaroxiban

27
Q

In a patient taking an anti-coagulant? How could you asses the risk of them having a bleed?

A

HAS BLED score

Hypertension
Abnormal renal or liver function
Stroke

Bleeding
Labile INR
Elderly (over 65)
Drugs and alcohol

28
Q

What anti-coagulants can we give? Briefly describe how they work.

A

NOAC: apixaban, rivaroxiban
They inhibit clot formation

Warfarin: vitamin K antagonist, reducing synthesis of coagulation factors

Aspirin: inhibits platelet aggregation

29
Q

How is heart failure classified?

A

New York heart association

  1. no symptoms or limitation to ADLs
  2. mild symptoms, slight limitation to ADLs
  3. marked symptoms, limitation to ADLs, only comfortable at rest
  4. severe symptoms, uncomfortable at rest
30
Q

What community support is available to patients with heart failure?

A 
Named GP
Advanced nurse practitioners
District nurses
Charities (BHF)
Counselling
Palliative services
Community mental health teams
31
Q

What is angina?

A

Chest pain caused by insufficient blood flow to heart muscles

Often caused by coronary artery disease, arrhythmias, vasospasm

32
Q

Clinical features of stable angina?

A

Constricting discomfort in front of chest, neck, shoulders, jaw, arms

Precipitated by physical exertion

Relieved by rest or GTN spray

33
Q

What’s the difference between stable and unstable angina?

A

Stable is pain on exertion

Unstable is pain at rest as well

34
Q

Investigations of angina?

A

Angiography

Stress echo

35
Q

Management of angina?

A
  1. symptom control: GTN spray
2. prevention of acute coronary syndrome (unstable angina, MI)
Aspirin
beta-blocker
Statin
Ca channel blocker
ACEi

More severe: ivabradine, nicorandil etc.

36
Q

What is ivabradine?

A

Drug that slows down heart rate

GP (13 decks)

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