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Phase 2a Medicine - Riona > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is an aneurysm?

A

Dilated area of vasculature due to weakness of vessel walls

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2
Q

What is a true aneurysm?

A

Involves all layers of arterial wall

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3
Q

What is a false aneurysm?

A

Involves a collection of blood in the outer layer only

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4
Q

What is an AAA classified as?

A

> 50% dilation of aortic diameter

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5
Q

Name 3 risk factors for AAAs

A

Age

  • ) Male sex
  • ) Family history
  • ) Smoking
  • ) Hypertension
  • ) Hypercholesterolaemia
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6
Q

How are AAAs found?

A

Clinically silent, found on abdominal examination or plain XR

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7
Q

Name 4 things rapid expansion or rupture of an AAA may cause

A
  • ) Severe pain
  • ) Hypotension
  • ) Tachycardia
  • ) Profound anaemia
  • ) Hypovolaemic shock
  • ) Sudden death
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8
Q

What type of pain is there in an AAA rupture?

A

Severe, epigastric pain radiating to the back

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9
Q

Who is screened for an AAA?

A

All men >65

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10
Q

What is the treatment for an AAA?

A

Stent, graft, lifestyle changes

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11
Q

What size AAA should be operated on?

A

> 5.5cm or growing at >1cm/year

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12
Q

In who do ascending TAAs occur?

A

Marfan’s syndrome, hypertensives

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13
Q

In who do descending TAAs occur?

A

Atherosclerosis

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14
Q

Rapid expansion of a TAA causes what 4 symptoms?

A
  • ) Severe chest pain
  • ) Stridor
  • ) Haemoptysis
  • ) Hoarseness
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15
Q

What is an aortic dissection?

A

A tear in the intima of the aorta allows blood to be pumped under, creating a false lumen between the layers

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16
Q

What is the precursor to dissection?

A

Intramural haematoma

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17
Q

What occurs in IMH?

A

Rupture of vasa vasorum in aortic media

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18
Q

Who has a predisposition to aortic dissection?

A

Autoimmune rheumatic disease, Marfan syndrome, Ehlers-Danos syndrome

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19
Q

What are the 2 ways of classifying aortic dissection?

A

Length of time between onset of symptoms and diagnosis being made, anatomically

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20
Q

What are the 2 anatomical types of aortic dissection?

A

Type A (70%), type B (30%)

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21
Q

What does type A of aortic dissection involve?

A

Aortic arch and aortic valve proximal to L subclavian artery, includes De Bakey type 1 and 2

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22
Q

What does type B of aortic dissection involve?

A

Descending thoracic aorta distal to L subclavian artery, includes De Bakey 3

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23
Q

Name 4 symptoms of an aortic dissection

A
  • ) Sudden tearing chest pain and possible radiation to back
  • ) Hemiplegia
  • ) Unequal arm pulses
  • ) Unequal BP
  • ) Acute limb ischaemia
  • ) Paraplegia
  • ) Anuria
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24
Q

Name 3 other symptoms of an aortic dissection

A
  • ) Shock
  • ) Neurological
  • ) Aortic regurgitation
  • ) Inferior MI
  • ) Cardiac tamponade
  • ) Acute kidney failure
  • ) Acute lower limb ischaemia
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25
Q

What does a CXR of an aortic dissection show?

A

Widened mediastinum

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26
Q

Which type of aortic dissection should have surgery?

A

Type A

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27
Q

What medical treatment of aortic dissection is there?

A

Antihypertensives, IV beta blockers (metoprolol), vasodilators (GTN)

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28
Q

What is angina?

A

Condition of chest pain arising from the heart as a result of myocardial ischaemia

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29
Q

What is an example of an ischaemic metabolite?

A

Adenosine

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30
Q

What are the 3 main types of angina?

A

Stable/classic, unstable, Prinzmetal’s

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31
Q

Which angina is induced by effort and relieved by rest?

A

Stable/classic

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32
Q

Which angina is caused by coronary artery spasm, and when does it occur?

A

Prinzmetal’s, rest

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33
Q

What is unstable angina?

A

Angina of increasing frequency or severity, occurs on minimal exertion or at rest, associated with very increased MI risk

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34
Q

When do symptoms occur? (in relation to the lumen)

A

Diameter of the lumen below 75% of original

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35
Q

Name 3 causes for angina

A

Atherosclerosis, thrombosis, thromboembolism, artery spasm, collateral blood vessels, arteritis

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36
Q

What are the pathophysiological steps of angina? (5)

A

1) Resistance high due to sclerosis
2) Resistance tries to fall in exercise to increase the flow
3) Resistance cannot fall anymore, so flow cannot meet metabolic demand
4) Myocardium becomes ischaemic, pain
5) Resting reduces demand and thus pain

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37
Q

Name 5 risk factors for angina

A

DM, smoking, hyperlipidaemia, hypertension, family history, physical inactivity, stress, sex (male), increasing age, obesity

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38
Q

What is the presenting complaint of angina?

A

Central, crushing, tight/heavy chest pain that may radiate to arms, neck, jaw, teeth

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39
Q

What is angina bought on by?

A

Exertion

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40
Q

What is angina relieved by?

A

Rest

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41
Q

What is angina exacerbated by? (3)

A

Emotion, cold weather, heavy meals

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42
Q

What are other symptoms of angina?

A

Dyspnoea, nausea, sweating, faintness, dizziness

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43
Q

What are the criteria of chest pain for angina? (3)

A

1) Heavy, central chest pain radiating to arms, jaw, neck
2) Bought on by exertion/exercise
3) Relieved by rest/ sublingual GTN spray

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44
Q

What scores are given in the chest pain criteria for angina? (3)

A

3/3 - typical angina
2/3 - atypical angina
<1/3 - non-anginal pain

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45
Q

What is the medical treatment for angina?

A
  • ) Statins (if hyperlipidaemia)
  • ) Aspirin
  • ) GTN nitrate spray for pain
  • ) Beta blockers (atenolol, propranolol)
  • ) Calcium channel blockers (if b blockers CI)
  • ) Anti platelets (clopidogrel)
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46
Q

What is the surgical treatment for IHD?

A

CABG, PCI, PTCA

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47
Q

What does CABG stand for?

A

Coronary artery bypass graft/surgery

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48
Q

What does PCI stand for?

A

Percutaneous coronary intervention

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49
Q

What does PTCA stand for?

A

Percutaneous transluminal coronary angioplasty

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50
Q

What 3 conditions does ACS refer to?

A

STEMI (Q wave infarction), NSTEMI (non Q wave), unstable angina (UA)

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51
Q

What is the common pathology of ACS?

A

Plaque rupture, thrombosis and infarction

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52
Q

What are the 2 main differences between an MI and UA?

A

1) MI has myocardial damage

2) MI has rise in serum troponins

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53
Q

Name 3 non-modifiable risk factors for ACS

A

Age, male gender, family history of IHD

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54
Q

Name 3 modifiable risk factors for ACS

A

Smoking, hypertension, DM, hyperlipidaemia, obesity, sedentary lifestyle, cocaine use

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55
Q

What are 2 possible risk factors for ACS?

A

Stress, type A personality, LVH, raised fibrinogen

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56
Q

When does a MI occur?

A

When there is the death of cardiac myocytes due to prolonged myocardial ischaemia

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57
Q

What is troponin?

A

Protein complex that regulates actin and myosin contraction, highly sensitive marker for cardiac muscle injury, can be positive in other conditions

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58
Q

What is the pathophysiology of an MI?

A

Rupture/erosin of a coronary artery atheromatous plaque can lead to the prolonged occlusion of the coronary artery

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59
Q

Name 4 symptoms of an MI

A
  • ) Central crushing chest pain >20 minutes
  • ) Sweatin
  • ) Breathlessness
  • ) Nausea
  • ) Vomiting
  • ) Restlessness
  • ) Pale &grey
  • ) Syncope
  • ) Pulmonary oedema
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60
Q

Name 4 signs of an MI

A
  • ) Distress
  • ) Anxiety
  • ) Pallor
  • ) Raised/lowered pulse
  • ) Raised/lowered BP
  • ) 4th heart sound
  • ) Signs of HF
  • ) Pan systolic murmur
  • ) Low grade fever
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61
Q

What will be seen on an ECG in an MI?

A

ST elevation (STEMI only), tall peaked T waves, T wave inversion after few hours, pathological Q waves (not always)

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62
Q

What does a CXR show in an MI?

A

Cardiomegaly, pulmonary oedema, wide mediastinum

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63
Q

What are the 2 biochemical cardiac markers, and when do they peak in an MI?

A

1) Cardiac troponin - peaks at 24-48

2) Creatinine kinase - peaks at 24

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64
Q

Name 3 differential diagnoses of an MI

A

Angina, pericarditis, myocarditis, PE, aortic dissection

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65
Q

What are the 5 mainstays of MI treatment?

A

1) Symptom control (pain)
2) Modify risk factors
3) Optimise cardioprotective medications
4) Revascularisation
5) Manage complications

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66
Q

What 2 drugs do we manage chest pain with?

A

GTN nitrate PRN and opiates

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67
Q

What are the 5 main drugs given in an MI?

A

1) Antiplatelets (aspirin and clopidogrel)
2) Anticoagulate (fondaparinux)
3) Beta blockers (start low and increase slowly)
4) ACEI or ARB (in LV dysfunction, hypertension, DM)
5) Statin (atorvastatin)

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68
Q

What may be given with anti platelets?

A

PPI for gastric protection

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69
Q

What drug may we give if a beta blocker is contraindicated?

A

Calcium blocker (verapamil or diltiazem)

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70
Q

What is the surgical treatment for an MI?

A

STEMI and high risk NSTEMI - angiography and PCI

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71
Q

What should patients with multi vessel disease have in an MI?

A

CABG

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72
Q

Name 5 complications of an MI

A

Cardiac arrest, cariogenic shock, LV failure, bradyarrhythmias, tachyrrhythmias, RV failure/infarction, percicarditis, systemic embolism, cardiac tamponade, mitral regurgitation, ventricular septal defect, late malignant ventricular arrhythmias, Dressel’s syndrome, LV aneurysm

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73
Q

Define cardiac failure

A

The failure of the heart to transport blood out

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74
Q

What is cardiogenic shock?

A

Severe failre

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75
Q

What is HFREF and HFPEF?

A

HFREF - redused ejection fraction HF <40%

HFPEF - preserved ejection fraction HF >50%

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76
Q

What is the most common cause of HF?

A

Myocardial dysfunction from IHD

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77
Q

Name 3 other causes of HF

A

Hypertension, alcohol excess, cardiomyopathy, valvular disease, anaemia, endocardial disease, pericardial disease

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78
Q

What is the pathophysiology of HF?

A

1) Compensatory mechanisms become overwhelmed
2) CO increases as venous return increases
3) Stretch capability of sarcomeres exceeded
4) Cardiac contraction force diminishes
5) Limit to pericardial contraction

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79
Q

Name 4 symptoms of HF

A

Breathlessness, tiredness, cold peripheries, leg swelling, increased weight

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80
Q

Name 4 signs of HF

A
  • ) Tachycardia
  • ) Displaced apex beat
  • ) Added heart sounds and murmurs
  • ) Raised JVP (when R side affected)
  • ) Hepatomegaly
  • ) Ascites
  • ) Oedemas
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81
Q

What are the 8 types of HF?

A

1) Systolic HF
2) Diastolic HF
3) LV failure
4) RV failure
5) Acute HF
6) Chronic HF
7) Low-output HF
8) High-output HF

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82
Q

What occurs in systolic HF?

A

Ventricle is unable to contract properly, reduced CO and EF <40%

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83
Q

What occurs in diastolic HF?

A

Ventricles unable to relax and fill properly, increase in filling pressure, stiffer heart, EF >50%

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84
Q

What occurs in LV failure?

A

LV unable to pump out sufficient blood

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85
Q

What occurs in RV failure?

A

RV unable to pump blood out properly

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86
Q

What is congestive cardiac failure?

A

LV and RV failure together

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87
Q

What occurs in acute HF?

A

New onset acute or decompensation of chronic characterised by pulmonary and/or peripheral oedema +/- peripheral hypoperfusion

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88
Q

What occurs in chronic HF?

A

Progresses slowly, venous congestion common

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89
Q

What occurs in low output HF?

A

CO is decreased and fails to increase normally with exertion

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90
Q

What occurs in high output HF

A

Output is normal or increased in the face of significantly increased demands, normal or somewhat raised CO fails to meet these needs

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91
Q

Name 5 symptoms of LV failure

A

Dyspnoea, nocturnal cough, wheeze, nocturne, cold peripheries, muscle wasting, weight loss

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92
Q

Name 5 symptoms of RV failure

A

Peripheral oedema, ascites, nausea, anorexia, facial engorgement, neck and face pulsation, epistaxis

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93
Q

Name 3 causes of RV failure

A

LVF, pulmonary stenosis, lung disease

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94
Q

What are the 4 classes of HF?

A

Class I - no limitation, asymptomatic
Class II - slight limitation, mild
Class III - marked limitation, moderate
Class IV - inability to carry out any physical activity without discomfort, severe

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95
Q

What are the 4 stages of HF?

A

A - high risk of HF
B - asymptomatic HF
C - symptomatic HF
D - end stage HF

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96
Q

What are the major Framingham criteria for the diagnosis of HF? (8)

A 
SAW PANIC
S3 heart sound
Acute pulmonary oedema
Weight loss
Paroxysmal nocturnal dyspnoea
Abdominojugular reflux
Neck vein distension
Increased cardiac shadow on XR
Crepitation
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97
Q

What are the minor Framingham criteria for the diagnosis of HF? (7)

A 
HEART ViNo
Hepatomegaly
Effusion
Ankle oedema, bilateral
Exceptional dyspnoea
Tachycardia
Vital capacity decreased by 1/3
Nocturnal cough
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98
Q

What shows on a CXR of HF?

A 
ABCDE
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
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99
Q

What do we look for in bloods in HF?

A

B type natriuretic peptide, BNP

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100
Q

If ECG and BNP are normal, is HF likely?

A

No

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101
Q

What further test should be done with abnormal ECG and BNP?

A

Echo

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102
Q

What are the 4 parts of non medical treatment of HF?

A

Lifestyle changes, treatment of underlying cause, treatment of exacerbating factors, avoidance of exacerbating factors

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103
Q

What are the 6 drugs that should be given in HF?

A

1) Diuretics (loop, furosemide)
2) ACE-I or ARB
3) Beta-blockers (start low and go slow, carvedilol)
4) Mineralocorticoid receptor antagonists (still symptomatic, spironolactone)
5) Digoxin
6) Vasodilators (if intolerant to ACE-I and ARBs, hydrazine and isorbide dinatrate)

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104
Q

Give an example of a K+ sparing diuretic

A

Spironolactone

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105
Q

Give an example of a thiazide diuretic

A

Metolazone

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106
Q

What is the Fontan procedure?

A

Palliative surgical procedure for hearts with only one useable ventricle

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107
Q

What is a bicuspid aortic valve associated with? (2)

A

Coarctation and dilation of the ascending aorta, predisposition to IE

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108
Q

What is an atrial septal defect?

A

A hole in the septum that connects the artia

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109
Q

What are the 3 main types of atrial septal defect?

A

Primum, secundum, sinus venosus

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110
Q

What are secundum defects?

A

Most common, high up in septum

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111
Q

Which direction is the shunt in secundum defects?

A

L to R (not blue!) because pressure in LA is higher than in RA

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112
Q

Name 4 symptoms for atrial septal defects

A
  • ) Dyspnoea
  • ) Hypertension
  • ) Cyanosis
  • ) Arrhythmia
  • ) Haemoptysis
  • ) Chest pain
  • ) Pulmonary flow murmur
  • ) Fixed split-second heart sound (lub dub dub)
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113
Q

What 3 things are seen on a CXR for atrial septal defects?

A

Big pulmonary arteries, big heart, small aortic knuckle

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114
Q

What does the ECG for atrial septal defects show? (primum and secundum)

A

Primum - RBBB with L axis deviation and prolonged PR interval
Secundum - R atrial deviation

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115
Q

What symptoms does a large hole have (atrial septal defect) that a small hole doesn’t?

A

SOBOE, increased chest infections

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116
Q

What is a complication of atrial septal defects?

A

Eisenmenger’s complex

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117
Q

What is a ventricular septal defect?

A

A hole in the septum that connects the ventricles

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118
Q

What are the symptoms of a small ventricular septal defect?

A

Asymptomatic, signs of loud systolic murmur and thrill

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119
Q

What are the symptoms of a large ventricular septal defect?

A

Very high pulmonary blood flow, breathlessness, poor feeding, failure to thrive, increased resp rate, tachycardia, big heart on CXR

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120
Q

Which direction is the shunt in ventricular septal defects?

A

L to R

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121
Q

What are atrio-ventricular septal defects?

A

Holes in the centre of the heart, involving ventricular and atrial septum and mitral and tricuspid valves

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122
Q

What are the 2 types of atrio-ventricular septal defects?

A

1) Complete

2) Partial

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123
Q

What are the symptoms of a complete atrio-ventricular septal defect?

A

Breathlessness, poor weight gain, poor feeding

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124
Q

When does a partial atrio-ventricular septal defect present?

A

Late adulthood

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125
Q

What are the 3 locations for an atrio-ventricular septal defect to be?

A

1) Interatrial
2) Interatrial and interventricular
3) Interventricular

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126
Q

In what syndrome do atrio-ventricular septal defects often occur?

A

Down’s syndrome

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127
Q

What is coarctation of the aorta?

A

Congenital narrowing of the descending aorta

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128
Q

Where does a coarctation of the aorta usually occur?

A

Just distal to the origin of the L subclavian artery (at the site of insertion of the ductus arteriosus)

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129
Q

What is coarctation of the aorta associated with? (2)

A

Bicuspid aortic valve and Turner’s syndrome

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130
Q

What does severe coarctation of the aorta present with?

A

Collapse with HF

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131
Q

What does mild coarctation of the aorta present with?

A

Hypertension, incidental murmur

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132
Q

How do we repair coarctation of the aorta?

A

Surgery or balloon and stenting

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133
Q

Name 3 clinical signs of coarctation of the aorta

A

1) R arm hypertension
2) Bruits (buzzes) over scapulae and back
3) Murmur
4) Radiofemoral delay and weak femoral pulse

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134
Q

Name 3 long term problems of coarctation of the aorta

A

1) Hypertension (CAD, strokes, sub arachnoid haemorrhage)
2) Re-coarctation
3) Aneurysm formation at site of repair

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135
Q

What is tetralogy of Fallot?

A

Most common cyanotic congenital heart disorder, due to abnormalities in separation of truncus arteriosis into the aorta and pulmonary arteries

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136
Q

What are the 4 features of tetralogy of Fallot?

A

1) Ventricular septal defect
2) Pulmonary stenosis
3) RVH
4) Aorta overriding the septal defect

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137
Q

Which way is the shunt in tetralogy of Fallot?

A

R to L

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138
Q

Is tetralogy of Fallot cyanotic (blue?)

A

YES

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139
Q

Name 4 symptoms of tetralogy of Fallot

A

Child - restless, agitated, squatting, difficulty feeling, clubbing, failure to thrive

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140
Q

What does an ECG show in tetralogy of Fallot?

A

RVH with RBBB

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141
Q

What is the classic sign of tetralogy of Fallot on a CXR/echo?

A

Boot shaped heart

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142
Q

How do we treat tetralogy of Fallot? (5)

A

1) Oxygen
2) Place patient in knee to chest position (increases peripheral vascular resistance and decreases shunt)
3) Morphine (relaxes pulmonary outflow)
4) Long term beta blockers
5) Surgical repair with Blalock-Taussig shunt

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143
Q

What is Eisenmenger’s syndrome?

A

Reversal of shunt direction to R to L

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144
Q

Why does Eisenmenger’s syndrome occur?

A

High pressure pulmonary blood flow, resistance to blood flow to lung increases, RV pressure increases

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145
Q

What colour is the patient in Eisenmenger’s syndrome?

A

Blue

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146
Q

What is a patent ductus arteriosus?

A

Ductus arteriosus (between aortic arch and pulmonary artery) doesn’t close

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147
Q

What are 2 clinical signs of a patent ductus arteriosus?

A

Continuous ‘machinery’ murmur, Eisenmenger’s syndrome

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148
Q

What is pulmonary stenosis?

A

Narrowing of the outflow of the R ventricle

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149
Q

What are the 4 types of pulmonary stenosis?

A

1) Valvar
2) Sub valvar
3) Supra valvar
4) Branch

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150
Q

What are the symptoms and signs of a severe pulmonary stenosis?

A

RV failure as neonate, collapse, poor pulmonary blood flow, RVH, tricuspid regurgitation

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151
Q

What are 2 methods of treating pulmonary stenosis?

A

Balloon valvuloplasty, shunt

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152
Q

What is Marfan’s syndrome?

A

Connective tissue disorder with a decrease in extracellular microfibril formation and poor elastic fibres

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153
Q

What are the 4 major diagnostic criteria for Marfan’s syndrome?

A

1) Lens dislocation
2) Aortic dissection or dilatation
3) Dural ectasia
4) Skeletal features (arachnodactyly, arm span > height, pectus deformity, scoliosis)

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154
Q

How many major criteria are needed for a diagnosis of Marfan’s?

A

2

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155
Q

What are 3 minor signs of Marfan’s syndrome?

A

1) Mitral valve prolapse
2) Joint hypermobility
3) High arched palate

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156
Q

What is the treatment of Marfan’s syndrome?

A

Beta blockers to slow dilatation, annual echos, elective surgical repair when aorta >5cm

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157
Q

What gene causes Marfan’s syndrome?

A

Autosomal dominant fibrillin gene FBN1

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158
Q

Name 4 causes of mitral stenosis

A
  • ) Rheumatic fever
  • ) Infection with group A beta-haemolytic streptococcus
  • ) Congenital
  • ) Prosthetic valve
  • ) Mucopolysaccharidoses
  • ) Endocardial fibroelastosis
  • ) Malignant carcinoid tumours
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159
Q

What are the steps of pathogenesis in mitral stenosis? (6)

A

1) Inflammation
2) Mitral thickening
3) Cusp fusion
4) Calcium deposition
5) Severely narrowed valve orifice
6) Progressive immobility of valve cusps

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160
Q

What do compensatory mechanisms in mitral stenosis lead to?

A

Compensatory mechanisms of increased LA pressure leads to LA hypertrophy and dilatation, thus pulmonary venous, pulmonary arterial, and right heart pressures also increase

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161
Q

What can the increase in pulmonary capillary pressure in mitral stenosis lead to?

A

Pulmonary oedema, particularly when there is AF with tachycardia

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162
Q

What does pulmonary hypertension lead to in mitral stenosis?

A

RVH, dilatation and failure with subsequent tricuspid regurgitation

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163
Q

When do symptoms begin in mitral valve stenosis? (size)

A

<2cm^2

164
Q

Name 5 symptoms of mitral valve stenosis

A

Dyspnoea, fatigue, palpitations, chest pain, systemic emboli, haemoptysis, cough, chronic bronchitis like picture

165
Q

Name 4 signs of mitral stenosis

A

1) Malar flush on cheeks
2) Low volume pulse
3) Palpable S1, opening snap, mid diastolic murmur
4) Right HF

166
Q

What may a CXR in mitral stenosis show?

A
  • ) LA enlargement
  • ) Pulmonary oedema
  • ) Calcification of valve
167
Q

What does an ECG show in mitral stenosis?

A

P-mitrale (bifid P wave) if sinus rhythm, features of RVH, right axis deviation and tall R waves, AF common

168
Q

What is the diagnostic test for mitral stenosis?

A

Echocardiography

169
Q

What are the medical treatments of mitral stenosis? (4)

A

1) Management of rate control in AF
2) Anticoagulation with warfarin
3) Diuretics (to decrease preload)
4) Penicillin as prophylaxis against rheumatic fever

170
Q

What are the surgical treatment of mitral stenosis?

A

1) Cardiac catheterisation
2) Balloon valvuloplasty
3) Open mitral valvotomy/valve replacement

171
Q

What is mitral regurgitation?

A

Mitral valve doesn’t close properly

172
Q

Name 4 causes of mitral regurgitation

A
  • ) Degenerative diseases
  • ) IHD
  • ) Rheumatic heart disease
  • ) IE
  • ) Diseases of the myocardium (DCM and HCM)
  • ) Rheumatic autoimmune diseases (SLE)
  • ) Collagen diseases (Marfan’s, Ehlers-Danos)
  • ) Drug disorders
173
Q

How is mitral regurgitation accommodated for over time?

A

Large LA

174
Q

Why is there an enlarged LV in mitral regurgitation?

A

1) Proportion of stroke volume being regurgitated

2) SV increases to maintain CO

175
Q

What are 4 symptoms of mitral regurgitation?

A
  • ) Dyspnoea
  • ) Orthopnoea
  • ) Fatigue and lethargy
  • ) Palpitations
176
Q

What are 4 signs of mitral regurgitation?

A
  • ) IE
  • ) AF
  • ) Displaced apex beat
  • ) RV heave
  • ) Soft S1
  • ) Cardiac cachexia
177
Q

What are 3 signs of mitral regurgitation on a CXR?

A

1) Big LA and LV
2) Mitral valve calcification
3) Pulmonary oedema

178
Q

What 2 other tests are used in mitral regurgitation?

A
  • ) Echocardiogram (LV function and aetiology)

- ) Doppler echo (size and site of regurgitant jet)

179
Q

What is used to confirm diagnosis in mitral regurgitation?

A

Cardiac catheterisation

180
Q

What are 4 options of treatment for mitral regurgitation?

A
  • ) Rate control if AF
  • ) Anticoagulants
  • ) Diuretics
  • ) Surgery - repair/replace valve
181
Q

What is aortic stenosis?

A

Narrowing of orifice from LV to aorta

182
Q

What does aortic stenosis include?

A
  • ) Calcific stenosis of a tricuspid aortic valve
  • ) Stenosis of a congenitally defected bicuspid valve
  • ) Rheumatic stenosis
183
Q

What are the 3 most common causes of aortic stenosis?

A

1) Calcific aortic valve disease (CAVD)
2) Bicuspid aortic valve (BAD)
3) Rheumatic fever

184
Q

Name 2 other causes of aortic stenosis

A
  • ) CKD
  • ) Paget’s disease of bone
  • ) Previous radiation exposure
  • ) SLE
185
Q

Why does compensatory LVH occur in aortic stenosis?

A

Obstruction to LV emptying causes an increase in LV pressure

186
Q

Name 4 symptoms of aortic stenosis

A

1) Exercise induced syncope
2) Angina
3) Dyspnoea
4) Chest pain

187
Q

Name 4 signs of aortic stenosis

A

1) HF
2) Systemic emboli (if IE)
3) Slow rising pulse
4) Narrow pulse pressure
5) Heaving, non-displaced apex beat
6) LV heave
7) Aortic thrill
8) Ejection systolic murmur

188
Q

What does an ECG show in aortic stenosis? (5)

A

P-mitrale, LVH, poor R wave progression, LBBB, complete AV block

189
Q

What does a CXR show in aortic stenosis? (3)

A

LVH, calcified aortic valve, post-stenotic dilatation of ascending aorta

190
Q

What test is used for diagnosis in aortic stenosis?

A

Echocardiogram

191
Q

What is the treatment for aortic stenosis?

A

Valve replacement

192
Q

What is acute aortic regurgitation caused by?

A

IE, ascending aortic dissection, chest trauma

193
Q

What is chronic aortic regurgitation caused by?

A

Congenital, connective tissue disorders, rheumatic fever/arthritis, Takayasu arteritis, SLE, hypertension

194
Q

Name 2 symptoms of aortic regurgitation

A

Exertional dyspnoea, orthopoena, palpitations, angina, syncope

195
Q

Name 3 signs of aortic regurgitation

A

Collapsing pusle, wide pulse pressure, displaced hyper dynamic apex beat, high pitched early diastolic murmur

196
Q

What does an ECG show in aortic regurgitation?

A

LVH

197
Q

What does CXR show in aortic regurgitation?

A

Dilated ascending aorta, pulmonary oedema

198
Q

Which test is diagnostic in aortic regurgitation?

A

Echocardiography

199
Q

What is the medical treatment of aortic regurgitation?

A

ACEI, echo to monitor

200
Q

What is the surgical treatment of aortic regurgitation?

A

Replace valve before significant LV dysfunction

201
Q

What is a cardiomyopathy?

A

A disease that affects the heart’s mechanical and electrical function

202
Q

What are the 3 types of cardiomyopathy?

A

1) Hypertrophic cardiomyopathy (HCM)
2) Arrhythmogenic cardiomyopathies (ACMs)
3) Dilated cardiomyopathy (DCM)

203
Q

What is the genetic cause of HCM?

A

Sarcometric protein gene mutations

204
Q

Which part of the heart does HCM generally affect?

A

Septum

205
Q

Which cardiomyopathy is the most common cause of sudden cardiac death in young people?

A

HCM

206
Q

Name 4 symptoms of HCM

A
  • ) Many asymptomatic
  • ) Angina
  • ) Dyspnoea
  • ) Palpitations
  • ) Dizzy spells
  • ) Syncope
  • ) Jerky carotid pulse sign and ejection systolic murmur in LVOT obstruction
  • ) Temporary tachycardia
207
Q

What does an ECG show in HCM?

A

LVH, ST and T wave changes, abnormal Q waves in inferolateral leads

208
Q

What does an echo show in HCM?

A

Classically asymmetrical LVH involving septum more than posterior wall, systolic anterior motion of mitral valve, vigorously contacting ventricle

209
Q

If a patient has 2 or more risk factors for sudden cardiac death, what should they be given in HCM?

A

Implantable cardiverter defibrillator (ICD)

210
Q

If a patient has 1 or no risk factors for sudden cardiac death, what should they be given in HCM?

A

Amiodarone

211
Q

What 3 drugs should be given in HCM?

A

1) Beta-blockers
2) Verapamil
3) Anticoagulants

212
Q

What is ACM?

A

Rare inherited condition that predominantly affects the RV with fatty/fibro-fatty replacement of the myocytes, resulting in dilatation

213
Q

75% of cases of ACM also involve which part of the heart?

A

LV

214
Q

What is the genetic cause of ACM?

A

Desmosome protein gene mutations

215
Q

Name 4 symptoms of ACM

A
  • ) Asymptomatic
  • ) Ventricular arrhythmia
  • ) Syncope
  • ) Sudden death
  • ) Symptoms and signs of right HF
216
Q

What does an ECG and ECHO show in ACM?

A

ECG - usually normal, may show T wave inversion of small amplitude waves at end of QRS complex
ECHO - usually normal, more advanced cases may show RV dilatation and aneurysm formation

217
Q

Clinical diagnosis is made with which 5 criteria for ACM?

A

1) Structural abnormalities of RB and RVOT
2) Fibro-fatty replacement of myocytes on tissue biopsy
3) Repolarisation and conduction abnormalities on ECG
4) Ventricular tachycardia
5) FHx of ACM/sudden premature death due to ACM

218
Q

What are the 2 medical treatment for ACM?

A

Betablockers and amiodarone (for symptomatic)

219
Q

What are the 2 surgical treatments for ACM?

A

ICD, heart transplant

220
Q

What is DCM characterised by?

A

Dilatation of ventricular chambers and systolic dysfunction with preserved wall thickness

221
Q

What is the heart like in DCM? (2)

A

1) Contractibility impaired

2) Enlarged, heavy, dilated heart

222
Q

Is HCM autosomal dominant or recessive?

A

Dominant

223
Q

Is DCM autosomal dominant or recessive?

A

Dominant

224
Q

What is the genetic cause of DCM?

A

Cytoskeletal gene mutations

225
Q

Name 4 symptoms DCM can present with

A
  • ) Fatigue
  • ) Dyspnoea
  • ) Pulmonary oedema
  • ) RVF
  • ) Emboli
  • ) AF
226
Q

What does an ECG show in DCM?

A

Tachycardia, non-specific T wave changes, poor R wave progression

227
Q

What does a CXR show in DCM?

A

Generalised cardiac enlargement

228
Q

Name 5 signs of DCM

A
  • ) Increased pulse
  • ) Decreased BP
  • ) Increased JVP
  • ) Diffuse and displaced apex
  • ) S3 gallop
  • ) Mitral/tricuspid regurgitation
  • ) Pleural effusion
  • ) Oedema
  • ) Jaundice
  • ) Hepatomegaly
  • ) Ascites
229
Q

What is the treatment in DCM?

A

Diuretics, ACEI, anticoagulants, pacemakers, ICDs, transplantation

230
Q

What is acute pericarditis?

A

Inflammation of the pericardium

231
Q

Name 4 secondary causes of acute pericarditis

A
  • ) Viruses (coxsackie, echovirus, EBV, adenovirus, HIV)
  • ) Bacteria (TB, staph aureus)
  • ) Fungi and parastitis
  • ) Autoimmune (SLE, RA)
  • ) Drugs (chemo, penicillin)
  • ) Metabolic
  • ) Other (trauma, surgery, malignancy, radio, chronic HF, MI)
232
Q

What does acute pericarditis present as?

A

Central chest pain worse on inspiration or lying flat and relief by sitting forwards

233
Q

What is the classic clinical sign of acute pericarditis?

A

Pericardial friction rub

234
Q

What does an ECG show in acute pericarditis?

A

Concave ST segment and PR depression

235
Q

What may a CXR show in acute pericarditis?

A

Cardiomegaly, indicates pleural effusion

236
Q

A diagnosis for acute pericarditis is made from 2/3 of

A

1) Chest pain
2) Friction rub
3) ECG changes

237
Q

What is the treatment for acute pericarditis?

A

NSAIDs/aspirin with PPI, steroids if not effective

238
Q

What is a pericardial effusion?

A

Accumulation f fluid in the pericardial sac

239
Q

What is cardiac tamponade?

A

A pericardial effusion that raises intrapericardial pressure, reducing ventricular filling and thus dropping CO

240
Q

What are 3 causes of pericardial effusions?

A
  • ) Pericarditis
  • ) Myocardial rupture
  • ) Aortic dissection
  • ) Pericardium filling with pus
  • ) Malignancy
241
Q

What are 3 clinical features of a pericardial effusion?

A
  • ) Dyspnoea
  • ) Chest pain
  • ) Compression symptoms (hiccoughs, nausea)
242
Q

What are 4 signs of cardiac tamponade?

A
  • ) Increased pulse
  • ) Decreased BP
  • ) Pulsus paradoxus
  • ) Increased JVP
  • ) Kussmaul’s sign (rise in JVP/neck distension on inspiration)
  • ) Muffled S1 and S2
243
Q

What does a CXR show in a pleural effusion?

A

Enlarged globular heart

244
Q

What does an ECG show in a pleural effusion?

A

Low voltage QRS complexes, possibly electrical alternans/alternating QRS morphologies

245
Q

What is a diagnostic test for a pleural effusion?

A

Pericardiocentesis (removal of fluid)

246
Q

What is the treatment for a pleural effusion?

A

Treat cause

247
Q

What is the treatment for cardiac tamponade?

A

Periardiocentesis

248
Q

What is constrictive pericarditis?

A

The heart is encased in a rigid pericardium

249
Q

What are the causes of constrictive pericarditis?

A

Unknown, TB, after any pericarditis

250
Q

Name 4 signs of constrictive pericarditis

A
  • ) Right HF with increased JVP
  • ) Kussmaul’s sign
  • ) Soft, diffuse apex beat
  • ) Quiet heart sounds
  • ) S3
  • ) Hepatsplenomegaly
  • ) Ascites
  • ) Oedema
  • ) Diastolic pericardial knock
251
Q

What does a CXR show in constrictive pericarditis?

A

Small heart +/- pericardial calcification

252
Q

What is the treatment for constrictive pericarditis?

A

Surgical excision of pericardium

253
Q

What is the most important risk factor for premature death and CVD?

A

Hypertension

254
Q

What is the diagnostic definition of hypertension?

A

BP >140/90mmHg on >2 readings on separate occasions

255
Q

What % of cases are primary/essential hypertension, and what is their cause?

A

95%, unknown

256
Q

What are the main causes of secondary hypertension? (3)

A
  • ) Renal disease (glomeruloneprhtis, poly arthritis nods, sclerosis, PKD)
  • ) Endocrine disease (Cushing’s, Conn’s, hyperPTH)
  • ) Coartation, pregnancy, liquorice, drugs (steroids, pill, cocaine)
257
Q

Name 5 risk factors for hypertension

A
  • ) Older age
  • ) FHx
  • ) Male sex
  • ) Afro-Caribbean origin
  • ) High salt
  • ) Sedentary lifestyle
  • ) Obesity
  • ) Smoking
  • ) Excess alcohol
258
Q

What are the symptoms of hypertension?

A

Asymptomatic! Except in malignant hypertension

259
Q

How do we find hypertension?

A

Signs of underlying cause, look for end organ damage and retinopathy

260
Q

What is malignant/accelerated phase hypertension?

A

A rapid rise in BP leading to vascular damage (pathological hallmark is fibrinoid necrosis)

261
Q

What 2 things can confirm diagnosis of hypertension?

A

Ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM)

262
Q

What are the clinic BPs at stage 1, 2 and severe hypertension?

A

Stage 1 - >140/90
Stage 2 - >160/100
Severe - systolic >180 and/or diastolic >110

263
Q

What are the ABPMs at stage 1, 2 and severe hypertension?

A

Stage 1 - >135/85
Stage 2 - >150/95
Severe - >180/110

264
Q

What other tests are there for hypertension?

A
  • ) Fasting glucose and cholesterol (overall risk)
  • ) ECG (organ damage)
  • ) U&Es (cause)
265
Q

What clinic BP should a patient have to be treated for hypertension?

A

> 160/100 or >140/90 with other risk factors

266
Q

What is our treatment BP goal in hypertension?

A

<140/90mmHg

267
Q

What is the treatment for hypertension in >55s or Afro-Caribbeans?

A

Calcium channel blockers (amlopidine, nifedipine)

268
Q

What is the treatment for hypertension in <55s?

A

ACE-I (lisinopril) or ARB (candesartan)

269
Q

If intolerance or CI to ACEI/ARB, what do we give to treat hypertension?

A

Beta blockers (bisoprolol)

270
Q

What do we give if BP is uncontrolled in hypertension treatment?

A

ACEI and calcium channel blocker/diuretic (cholartalidone)

271
Q

What is peripheral vascular disease caused by?

A

Atherosclerosis

272
Q

What are the 4 stages of the Fontine classification system for peripheral artery disease?

A

I - asymptomatic
II - intermittent claudication
III - ischaemic rest pain
IV- ulceration/necrosis/gangrene (critical)

273
Q

What are 4 symptoms and signs of chronic lower limb ischaemia?

A
  • ) Exertional discomfort relieved by rest
  • ) Pain in calf, bottom, thigh
  • ) Possible erectile dysfunction
  • ) Severe pain in foot that stops from sleeping
  • ) Cold lower limbs
  • ) Dry skin, no hair
  • ) Diminished/absent pulses
274
Q

What is the treatment of chronic lower limb ischaemia?

A
  • ) Lifestyle modification
  • ) Cilostazol (phosphodiesterase III inhibitor increases cAMP levels, causes vasodilation, inhibits platelet aggregation)
  • ) PCTA in severe disease
  • ) Amputation
275
Q

What is acute lower limb ischaemia often due to?

A

Thrombus in situ or an embolus

276
Q

What are the symptoms of acute lower limb ischaemia?

A 
6Ps!!!!
Pale
Pulseless
Pain
Paralysed
Paraesthesia
Perishingly cold
277
Q

What is the treatment for acute lower limb ischaemia? (2)

A

Surgery - angioplasty, embolectomy, local thrombolysis

Medical - anticoagulant with heparin

278
Q

Is acute lower limb ischaemia a medical emergency?

A

Yes

279
Q

What is shock?

A

Circulatory failure resulting in inadequate organ perfusion

280
Q

What is shock often defined as?

A

Systolic BP <90mmHg or MAP <65mmHg

281
Q

What can shock result from, using an equation?

A

MAP = CO x SVR (systemic vascular resistance)

1) Reduction in CO
2) Loss of SVR
3) Both

282
Q

What 2 things can cause a reduction in CO?

A

1) Hypovolaemia (bleeding/fluid loss)

2) Pump failure (cariogenic shock/secondary causes)

283
Q

What can cause a loss of SVR? (5)

A

1) Sepsis
2) Anaphylaxis
3) Neurogenic
4) Endocrine failure
5) Drugs (anaesthetics, antihypertensives, cyanide poisoning)

284
Q

How do we assess shock?

A

ABCDE

285
Q

What type of shock does cold and clammy suggest?

A

Cardiogenic

286
Q

What type of shock does warm and well perfused with bounding pulse points suggest?

A

Septic

287
Q

What typeof shock does a wheeze suggest?

A

Anaphylactic

288
Q

What is sepsis?

A

Life threatening organ dysfunction caused by a dysregulated host response to infection

289
Q

What is the key to treating sepsis?

A

Early recognition!

290
Q

What is the management of septic shock?

A
  • ) Broad spectrum antibiotics within 1hr (tazocin with gentamicin)
  • ) Fluids within 1hr
  • ) Give fluid boluses of crystalloids
  • ) Oxygen as required
291
Q

What is anaphylactic shock?

A

A type 1 IgE-mediated hypersensitivity reaction

292
Q

What does the release of histamine and other agents cause in anaphylactic shock?

A

Capillary leak, wheeze, cyanosis, oedema (lips, tongue, eyelids, larynx) and urticarial (rash)

293
Q

Give 3 examples of precipitants of anaphylactic shock

A
  • ) Drugs (penicillin)
  • ) Latex
  • ) Stings
  • ) Eggs
  • ) Fish
  • ) Peanuts
  • ) Strawberries
  • ) Semen (rare)
294
Q

Give 5 signs and symptoms of anaphylactic shock

A
  • ) Itching
  • ) Sweating
  • ) Diarrhoea and vomiting
  • ) Erythema
  • ) Urticaria
  • ) Oedema
  • ) Wheeze
  • ) Laryngeal obstruction
  • ) Cyanosis
  • ) Tachycardia
  • ) Hypotension
295
Q

What are the management steps of anaphylactic shock? (8)

A

1) Secure airway and give 100% O2
2) Remove cause and raise feet to improve circulation
3) Give adrenaline IM and repeat every 5 mins as needed (resp and BP guided)
4) Secure IV access
5) Chlorphenamine and hydrocortisone (antihist and steroid)
6) IV fluid if needed
7) Salbutamol if asthma
8) Admission if still hypotensive

296
Q

What does neurogenic shock result from?

A

Spinal cord injury, epidural or spinal anaesthesia

297
Q

Give 4 symptoms/signs of neurogenic shock

A
  • ) Hypotension
  • ) Warm flushed skin
  • ) Low BP
  • ) Priapism
  • ) Bradycardia
  • ) Diaphragmatic breathing if below C5
  • ) Respiratory arrest if above C3
298
Q

What are the 4 drugs given for neurogenic shock?

A

1) Dopamine
2) Vasopressin
3) Noradrenaline
4) Atropine (bradycardia)

299
Q

What is cardiogenic shock?

A

A stat of inadequate tissue perfusion primarily due to cardiac dysfunction

300
Q

Give 5 causes of cardiogenic shock

A
  • ) MI
  • ) Arrhythmias
  • ) Pulmonary embolus
  • ) Tension pneumothorax
  • ) Cardiac tamponade
  • ) Myocarditis
  • ) Valve destruction
  • ) Aortic dissection
301
Q

What are the management steps for cardiogenic shock? (8)

A

1) MI treatment
2) Oxygen
3) Dimorphine IV
4) Investigations and monitoring
5) Correct arrhythmias, U&E abnormalities
6) Optimise filling pressure
7a) If underfilled, use a plasma expander
7b) If overfilled, give inotropic support
8) Look for and treat cause

302
Q

What is haemorrhagic shock?

A

Type of hypovolaemic shock that occurs from bleeding

303
Q

What are the management steps for haemorrhagic shock? (4)

A

1) Stop bleeding if possible
2) Give fluid bolus and repeat if needed
3) If still in shock, crossmatch blood
4) Give fresh frozen plasma with red cells

304
Q

What is infective endocarditis?

A

Infection of endocardial lined cardiovascular structures

305
Q

Give 3 examples of endocardial lined cardiovascular structures

A
  • ) Cardiac valves
  • ) Atrial and ventricular endocardium
  • ) Large intrathoracic vessels
  • ) Intracardiac foreign bodies (prosthetic valves, pacemaker leads)
306
Q

What is the most common organism in acute IE?

A

Staph. aureus

307
Q

Name 4 risk factors for acute IE

A

Skin breaches, renal failure, immunosuppression, DM

308
Q

Name 4 risk factors for subacute IE

A

Aortic/mitral valve disease, tricuspid valves in IVDU, coarctation, patent ductus arteriosus, VSD, prosthetic valves

309
Q

Which type of valves are in acute/subacute IE?

A

Acute - normal

Subacute - abnormal

310
Q

What is the most common organism in subacute IE?

A

Strep. viridans

311
Q

Give an example of a fungi in IE

A

Candida

312
Q

Why is there an increased risk of IE with abnormal valves or previous IE?

A

Damaged endocardium promotes platelet and fibrin deposition

313
Q

Give 4 symptoms/signs of IE

A
  • ) Septic signs
  • ) New murmer/change in murmur
  • ) Roth spots, splinter haemorrhages, Osler’s nodes
  • ) Janeway lesions
  • ) Embolic events
  • ) Neurological dysfunction
  • ) Splenomegaly, petechiae, clubbing
314
Q

Give 5 septic signs

A

Fever, riggers, night sweats, malaise, weight loss, anaemia, splenomegaly, clubbing

315
Q

Whose criteria do we use to diagnose IE?

A

Duke’s

316
Q

What are the 2 Duke’s major criteria to diagnose IE?

A

1) Positive blood culture (2 separate cultures)

2) Endocardium involvement (positive echocardiogram etc)

317
Q

What are the 5 Duke’s minor criteria to diagnose IE?

A

1) Predisposition
2) Fever >38’C
3) Vascular phenomena
4) Immunological phenomena
5) Positive blood culture (not major)

318
Q

How many of each Duke’s criteria do we need to diagnose IE?

A
  • ) 2 major
  • ) 1 major and 3 minor
  • ) 5 minor
319
Q

Is TTE or TOE more sensitive and thus better for diagnosing IE?

A

TOE

320
Q

What does TTE stand for?

A

Transthoracic echo

321
Q

What does TOE stand for?

A

Transoesophageal echo

322
Q

What do blood tests show in IE?

A

Anaemia, neutrophilic, high ESR?CRP, RH

323
Q

What drug do we give to treat IE?

A

Antibiotics

1) Native/old prosthetic valve - ampicillin, flucloxacillin and gentamicin
2) Prosthetic valve - vancomycin, gentamicin, rifampicin

324
Q

Give 4 reasons a patient may need surgery to treat IE

A
  • ) HF
  • ) Valvular obstruction
  • ) Repeated emboli
  • ) Fungal IE
  • ) Persistent bacteraemia
  • ) Myocardial abscess
  • ) Unstable infected prosthetic valve
325
Q

What is the organism in rheumatic fever?

A

Lancefield group A beta haemolytic streptococci

326
Q

What is the pathogenesis of rheumatic fever?

A

An antibody to the carbohydrate cell wall of he streptococcus cross-reacts with valve tissue

327
Q

How do we diagnose rheumatic fever?

A

With evidence of a recent strep infection plus 2 major criteria/1 major and 2 minor

328
Q

What is rheumatic fever a risk factor for/predisposer to?

A

IE

329
Q

What is myocarditis?

A

Inflammation of the myocardium

330
Q

What is myocarditis often associated with?

A

Pericardial inflammation (myopericarditis)

331
Q

Give 3 causes of myocarditis

A
  • ) Idiopathic
  • ) Viral
  • ) Bacteria
  • ) Spirochaetes
  • ) Protozoa
  • ) Drugs
  • ) Toxins
  • ) Immunological
332
Q

Give 2 symptoms of myocarditis

A

ACS-like symptoms, HF symptoms, palpitations, tachycardia, soft S1, S3 gallop

333
Q

What does an ECG show in myocarditis?

A

ST changes and T wave inversion, atrial arrhythmias, transient AV block, QT prolongation

334
Q

What is the gold standard for diagnosis of myocarditis?

A

Endomyocardial biopsy

335
Q

What is a channelopathy?

A

An inherited arrhythmia caused by ion channel protein gene mutations (K, Na, Ca)

336
Q

What are channelopathies associated with? (2)

A

1) Long QT syndrome

2) Brugada syndrome

337
Q

Which is the most common cardiac tumour?

A

Cardiac myxoma

338
Q

What sort of symptoms does a cardiac myxoma usually produce?

A

Obstructive

339
Q

Where does a cardiac myxoma show bias towards?

A

Atria

340
Q

What is atheroma?

A

Degeneration of the walls of arteries caused by accumulated fatty deposits and scar tissue

341
Q

What is atherosclerosis?

A

Disease where there is hardening and narrowing of the artery due to plaques

342
Q

What are 2 ways a plaque can cause damage?

A

1) Angina - occludes vessel lumen resulting in restriction of blood flow
2) Thrombus formation - rupture

343
Q

What is an atheromatous plaque characterised by?

A

Distorted endothelial surface containing lymphocytes, macrophages, smooth muscle cells and a variably complete endothelial surface

344
Q

What are the 3 things the distribution of plaques is governed by?

A

1) Changes in flow turbulence
2) Wall thickness changes
3) Altered gene expression in the key cell types

345
Q

What are the steps of the progression of atherosclerosis? (5)

A

1) Fatty streaks
2) Intermediate lesions
3) Fibrous plaques/advanced lesions
4) Plaque rupture
5) Plaque erosion

346
Q

Give 3 complications of a plaque rupture

A

Acute occlusion, chronic narrowing, aneurysm change, embolism of thrombus

347
Q

What is vasculitis?

A

An inflammatory and variably necrotic progress centred on blood vessels

348
Q

What is vasculitis initiated by?

A

Viral infection

349
Q

What 2 features of vasculitis are immune related?

A

1) Deposition of immune complexes

2) Direct attack on vessels by antibodies

350
Q

What is an arrhythmia?

A

Disturbance of cardiac rhythm

351
Q

Give 4 common presentations of arrhythmias

A
  • ) Palpitations
  • ) Chest pain
  • ) Presyncope/syncope
  • ) Hypotension
  • ) Pulmonary oedema
  • ) Asymptomatic (AF)
352
Q

Give 4 cardiac causes of arrhythmias

A
  • ) IHD
  • ) Structural changes
  • ) Cardiomyopathy
  • ) Pericarditis
  • ) Myocarditis
  • ) Aberrant conduction pathways
353
Q

Give 4 non cardiac causes of arrhythmias

A
  • ) Caffeine
  • ) Smoking
  • ) Alcohol
  • ) Pneumonia
  • ) Drugs
  • ) Metabolic imbalance
354
Q

Give 2 tests we do for arrhythmias

A

1) 24 hour ECG monitoring

2) Echo - structural heart disease

355
Q

What can we look for on an ECG for arrhythmias?

A

Signs of IHD, AF, short PR interval, long QT interval, U waves

356
Q

What is a narrow complex tachycardia?

A

Rate of >100bpm and QRS complex duration of <120ms

357
Q

What can be given to slow the ventricular rate so we can see the ECG more clearly?

A

Adenosine

358
Q

What is a broad complex tachycardia?

A

Rate of >100 and QRS complexes >120ms

359
Q

What is atrial fibrillation?

A

A chaiotic, irregular atrial rhythm at 300-600bpm

360
Q

Give 3 causes of AF

A

HF, hypertension, IHD, PE, mitral valve disease, pneumonia, hyperthyroidism, caffeine, alcohol, post op, decreased K, decreased Mg

361
Q

What type of pulse does AF have?

A

Irregularly irregular

362
Q

What does an ECG show in AF?

A

Absent P waves, irregular QRS complexes

363
Q

What do we use to rate control chronic AF?

A

Beta blocker or rate limiting calcium blocker

364
Q

Which artery does lead I lateral relate to?

A

Circumflex artery

365
Q

Which artery does lead V1 septal relate to?

A

Left anterior descending artery

366
Q

Which artery does lead V4 anterior relate to?

A

Right coronary artery

367
Q

Which artery does lead II inferior relate to?

A

Right coronary artery

368
Q

Which artery does lead aVL lateral relate to?

A

Circumflex artery

369
Q

Which artery does lead V2 septal relate to?

A

Left anterior descending artery

370
Q

Which artery does lead V5 lateral relate to?

A

Circumflex artery

371
Q

Which artery does lead III inferior relate to?

A

Right coronary artery

372
Q

Which artery does lead aVF inferior relate to?

A

Right coronary artery

373
Q

Which artery does lead V3 anterior relate to?

A

Right coronary artery

374
Q

Which artery does lead V6 lateral relate to?

A

Circumflex artery

375
Q

What is a tachycardia’s rate?

A

> 100bpm

376
Q

What is a bradycardia’s rate?

A

<60bpm

377
Q

What is heart block?

A

Disrupted passage of electrical impulses through AVN

378
Q

What are the 4 types of heart block?

A

1) 1st degree
2) 2nd degree (Mobitz I)
3) 2nd degree (Mobitz II)
4) 3rd degree (complete HB)

379
Q

What is 1st degree HB?

A

The PR interval is prolonged and unchanging, no missed beats

If the R is far from the P, then you have a first degree!

380
Q

What is 2nd degree Mobitz I HB?

A

PR interval becomes longer and longer until a QRS is misses, then resets, Wenckebach phenomenon
Longer, longer, longer drop! Then you have a Wenckebach

381
Q

What is a 2nd degree Mobitz II HB?

A

QRS regularly missed, may progress to complete HB, due to loss of conduction in bundle of His and Purkinje fibres
If some Ps don’t get through, then you have Mobitz II!

382
Q

What is a 3rd degree HB?

A

No impulses are passed from the atria to the ventricle, P waves and QRSs appear independently of each other
If Ps and Qs don’t agree, then you have a 3rd degree!

383
Q

What type of rhythm is there in 3rd degree HB?

A

Bradycardic

384
Q

What pattern is in a LBBB?

A

wiLLiam

W and M pattern

385
Q

What is LBBB caused by?

A

IHD, hypertension, cardiomyopathy, idiopathic fibrosis

386
Q

What pattern is RBBB?

A

maRRow

M and W pattern

387
Q

What is RBBB caused by?

A

Normal variants, pulmonary embolisms, cor pulmonale

388
Q

What are ectopic beats?

A

Most common arrhythmia, types of palpitations, generally benign

389
Q

What can high burden ventricular ectopics cause?

A

HF

390
Q

What can high burden atrial ectopics progress to?

A

AF

391
Q

Is atrial or ventricular mechanical contraction lost in AF?

A

Atrial

392
Q

How do we restore sinus rhythm in acute AF?

A

Electrical cardioversion

393
Q

What does an ECG show in pericarditis at rest?

A

Saddle shaped ST and PR depression

394
Q

What does an ECG show in hyperkalaemia at rest?

A

Tall tented T waves and pathological Q waves

395
Q

What does an ECG show in STEMI at rest?

A

ST elevation

396
Q

What does an ECG show in angina in a stress test?

A

ST depression

397
Q

What does an ECG show in AF at rest?

A

Absent P wave

398
Q

What does a early diastolic murmur indicate? (2)

A

Mitral stenosis, aortic regurgitation

399
Q

What does an early systolic click indicate? (2)

A

Mitral valve replacement, pulmonary stenosis

400
Q

What does an ejection systolic crescendo-decrescendo indicate?

A

Aortic stenosis

401
Q

What does a pan systolic murmur indicate? (2)

A

Mitral regurgitation, tricuspid regurgitation

402
Q

How does heparin work?

A

Inhibits thrombin and factor Xa

403
Q

How do CCBs work?

A

Increases cGMP and reduces intracellular Ca2+

404
Q

How do NSAIDs work?

A

Inhibits cyclooxygenase (COX) reducing production of thromboxane A2

405
Q

How does warfarin work?

A

Inhibits production of vitamin-K dependent clotting factors

406
Q

Where are roth spots found?

A

Eyes

407
Q

What is the definition of blood pressure?

A

Cardiac output x total vascular resistance

Phase 2a Medicine - Riona (17 decks)

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