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Yr1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is atherosclerosis?

A
  • plaque build-up in the arteries

- main issue is when the plaque RUPTURES, leading to thrombus formation and ultimately death

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2
Q

What are 3 risk factors for atherosclerosis?

A
  • age
  • smoking
  • high-serum cholesterol
  • obesity
  • diabetes
  • hypertension
  • family history
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3
Q

Where can atherosclerotic plaques be found?

A
  • in peripheral and coronary arteries
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4
Q

What is the structure of an atherosclerotic plaque?

A
  • lipid
  • necrotic core
  • connective tissue
  • fibrous cap
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5
Q

What can cause inflammation in the arterial wall?

A
  • LDLs - can accumulate

- endothelial dysfunction (response to injury hypothesis)

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6
Q

How do leukocytes recruit to vessel walls?

A
  • They are captured and roll along the surface (mediated by selectins
  • Adhere to surface
  • Transmigration occurs
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7
Q

Describe fatty streaks of atherosclerosis

A
  • earlest lesion
  • appear v early age
  • cannot cause much destruction
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8
Q

Describe intermediate lesions of atherosclerosis

A
  • have foam cells, vascular smooth muscle cells and T-lymphocytes
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9
Q

Describe fibrous plaques of atherosclerosis

A
  • impede the blood flow
  • prone to rupture
  • covered by fibrous cap and has necrotic debris
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10
Q

Which stage of atherosclerosis is a patient likely to start showing symptoms?

A
  • Between 2 and 3

- between intermediate and advanced lesions

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11
Q

What happens with plaque rupture in atherosclerosis?

A
  • the fibrous cap has to be resorted and redeposited
  • the cap can become weak and rupture
  • thrombus formation and vessel occlusion
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12
Q

What is the main treatment for atherosclerosis?

A
  • Percutaneous coronary intervention (PCI)

- drug eluting stent

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13
Q

What are some limitations of PCI?

A
  • Can lead to restenosis
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14
Q

How does a drug-eluting stent work?

A
  • reduce the smooth muscle cell proliferation

- this reduces growth after placement of stent

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15
Q

What medication can be used in atherosclerosis?

A
  • Aspirin
  • Clopidogrel
  • Statins
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16
Q

What are the contra-indications for aspirin and clopidogrel?

A
  • Excessive bleeding
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17
Q

What is patent foramen ovale?

A
  • Hole in the heart that did not close as it should have done after birth
  • eventually produces arrhythmias, pulmonary hypertension and cardiac failure
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18
Q

How can we reduce disease incidence effectively?

A
  • Modify risk facts for an individual and on a population basis
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19
Q

What are the unmodifiable risk factors in CHD?

A
  • age
  • sex
  • ethnicity
  • genetics
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20
Q

What are the psychosocial risk factors in CHD?

A
  • behavioural patterns/traits
  • depression/anxiety
  • work
  • social support
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21
Q

How is angina related to atherosclerosis?

A
  • It is a symptom, which occurs as a consequence of resisted coronary blood flow
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22
Q

What are the modifiable risk factors for angina?

A
  • smoking
  • diabetes
  • hypertension
  • hypercholesterolaemia
  • sedentary lifestyle
  • stress
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23
Q

How would a patient with angina present?

A
  • chest pain and discomfort
  • heavy, central tight pain radiating to arms, jaw and neck
  • worse on exertion
  • relieved by rest/ GTN spray
  • often normal on presentation
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24
Q

What conditions can show similar symptoms to angina?

A
  • pericarditis
  • pulmonary embolism
  • chest infection
  • dissection of the aorta
  • GORD
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25
Q

What basic investigations would you perform on a patient with angina?

A
  • 12 lead ECG = would show Q waves, T-wave inverson
  • echo
  • pre-test probability of CAD
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26
Q

What is the problem with a 12 lead ECG, echo and angina?

A
  • Often normal - no direct markers are present
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27
Q

What are two examples of diagnostic investigations for angina?

A
  • CT angiography
  • invasive angiography
  • exercise stress treadmill
  • stress echo
  • perfusion MRI
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28
Q

What are the diagnostic tests for angina looking for?

A
  • Evidence of impaired blood flow
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29
Q

What is the treadmill test?

A
  • induce ischaemia whilst walking
  • looking for ST segment depression
  • not used as regularly anymore
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30
Q

What is a CT angiogram?

A
  • ideal for excluding CAD in younger, lower risk individuals
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31
Q

What is the best investigation for CAD and angina?

A
  • Pre-test probability of CAD
  • History most useful for angina
  • choice depends on many factors
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32
Q

What is the primary management for CAD and angina?

A
  • primary prevention
  • 10 year risk is calculated
  • diet, exercise, smoking cessation, etc.
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33
Q

What is the secondary management for CAD and angina?

A
  • Lifestyle changes
  • Pharmacological - beta blockers and nitrates
  • Interventional (PCI and surgery)
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34
Q

What is the pharmacological treatment for CAD and angina?

A
  • beta-blockers (bisoprolol and atenolol)

- these reduce HR and contractility to reduce work of heart and oxygen demand

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35
Q

What are the side effects of beta blockers?

A
  • tiredness, nightmares
  • erectile dysfunction
  • bradycardia
  • cold hands and feet
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36
Q

What are contra-indications of beta blockers?

A
  • severe bronchospasm (asthma)
  • excess bradycardia
  • severe heart block
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37
Q

How do nitrates work?

A
  • primarily venodilators
  • reduce preload on the heart
  • reduce work on heart and oxygen demand
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38
Q

How do calcium channel antagonists work?

A
  • reduce afterload on heart to reduce work of heart and oxygen demand
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39
Q

How does revascularisation work?

A
  • To restore coronary artery and increase flow reserve
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40
Q

What are acute coronary syndromes?

A
  • a spectrum of acute cardiac conditions
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41
Q

How does a myocardial infarction present?

A
  • cardiac chest pain which is severe and unremitting
  • occurs at rest
  • associated with sweating, breathlessness, nausea and/or vomiting
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42
Q

What is the management of MI?

A
  • call 999, give aspirin
  • pain relief
  • consider urgent coronary angiography
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43
Q

What are P2Y inhibitors (anti-platelet drugs)?

A
  • Used in combination with aspirin as a management of ACS

- examples are clopidogrel and ticagrelor

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44
Q

What types of factors can affect the response to clopidogrel?

A
  • dose
  • age
  • weight
  • disease states e.g. diabetes
  • drug-drug interactions
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45
Q

What are adverse side effects of clopidogrel and ticagrelor?

A
  • bleeding
  • rash
  • GI disturbance
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46
Q

How would you diagnose deep vein thrombosis?

A
  • symptoms and signs are non-specific
  • symptoms are pain and swelling
  • signs include tenderness, swelling, warmth and discolouration
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47
Q

How would you investigate DVT?

A
  • D-dimer

- ultrasound compression test

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48
Q

What is the treatment for DVT?

A
  • LMW heparin
  • oral warfarin
  • compression stocking
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49
Q

What are two examples of risk factors for DVT?

A
  • surgery
  • OC pill, pregnancy
  • long haul flights (rare)
  • inherited thrombophilia
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50
Q

How does pulmonary embolism present?

A
  • chest pain and sob
  • breathlessness, may have signs of DVT,
  • no other diagnosis more likely
  • likely to be tachycardic and have pleural rub
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51
Q

How would you investigate PE?

A
  • x-ray usually normal
  • ECG shows sinus tachy
  • ABG - decreased O2 and CO2
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52
Q

How would you treat PE?

A
  • LMW heparin
  • oral warfarin
  • DOAC
53
Q

What is DOAC?

A
  • used for treatment of AF and DVT/PE

- cannot be used in pregnancy

54
Q

What is the clinical diagnosis for stage 1 and stage 2 hypertension?

A
  • BP 140/90mmHg = stage 1

- BP 160/100mmHg = stage 2

55
Q

What is the primary treatment for stage 1 hypertension?

A
  • lifestyle modification

- then pharmacological medication

56
Q

What are the different types of diuretics which can be given in hypertension?

A
  • thiazides e.g. bendroflumethiazide
  • loop diuretics e.g. furosemide
  • potassium-sparing e.g. amiloride
  • aldosterone antogonists
57
Q

What are side-effects of diuretics?

A
  • hypovolaemia

- hypotension

58
Q

Name two beta-blockers

A
  • bisoprolol
  • propanolol
  • atenolol
59
Q

Name two calcium channel blockers

A
  • amlodipine
  • nifedipine
  • verapamil
60
Q

What are CCBs used in?

A
  • hypertension
  • angina
  • tachycardia
61
Q

What is another example of a type of anti-hypertensive medication?

A
  • alpha-1 adrenoreceptor blockers

- prazosin, doxazosin

62
Q

How is chronic stable angina defined (5)?

A
  • anginal chest pain
  • predictable
  • exertional
  • infrequent
  • stable
63
Q

How is unstable angina/NSTEMI defined (4)?

A
  • unpredictable
  • may be at rest
  • frequent
  • unstable
64
Q

How is ST-elevation MI (STEMI) defined (4)?

A
  • unpredictable
  • rest pain
  • persistent
  • unstable
65
Q

What is hypertrophic cardiomyopathy (HCM) caused by and what can it cause?

A
  • sarcomeric protein gene mutations

- symptoms include angina, dyspnoea, palpitations or syncope

66
Q

What is dilated cardiomyopathy (DCM)?

A
  • dilation of ventricles where walls are normal or thinner
  • patients present with HF symptoms
  • generally go to have transplants
67
Q

What are inherited arrhythmias (channelopathy)?

A
  • caused by ion channel protein gene mutations

- includes long and short QT and brugada

68
Q

What are the common viral causes of pericarditis?

A
  • enteroviruses
  • herpesviruses
  • adenoviruses
    parvovirus B19
69
Q

What are some non-infectious aetiologies of pericarditis?

A
  • Sjogren syndrome
  • rheumatoid arthritis
  • scleroderma
  • neoplastic - tumours
  • myxoedema
70
Q

What are some traumatic and iatrogenic reasons for pericarditis?

A
  • direct injury (e.g. oesophageal performation)
  • indirect injury (non-penetrating thoracic injury
  • delayed onset - iatrogenic trauma e.g. PCI
71
Q

What is the diagnosis for acute pericarditis?

A
  • inflammatory syndrome with or without effusion

- Need 2/4 of: chest pain, friction rub, ECG changes and pericardial effusion

72
Q

What type of chest pain would a patient present with if they had acute pericarditis?

A
  • severe
  • sharp and pleuritic
  • rapid onset
  • positional, less pressure of pericardium
  • worse on coughing/deep inspiration
73
Q

Other than chest pain, what are the symptoms of acute pericarditis?

A
  • dyspnea
  • cough
  • systemic disturbance e.g. rash, joint pain
74
Q

What past medical history can lead to pericarditis?

A
  • cancer
  • rheumatological diagnosis
  • pneumonia
  • cardiac procedure (PCI)
  • MI
75
Q

Name 3 differential diagnosis of pericarditis.

A
  • pneumonia
  • pleurisy
  • PE
  • MI
  • Aortic dissection
  • pancreatits
76
Q

What are the examination and investigations of pericarditis?

A
  • Examination - pericardial rub, sinus tachycardia, fever, Beck’s triad
  • Investigations - ECG, bloods, echo
77
Q

What is Beck’s triad?

A
  • hypotension
  • elevated jugular venous pressure (JVP)
  • quiet heart sounds
78
Q

How would pericarditis present on an ECG?

A
  • diffuse ST segment elevation, ST segment not on isoelectric line
  • No reciprocal ST depression
  • saddle shaped
79
Q

How would blood tests show pericarditis?

A
  • increase in WCC
  • increased troponin suggests myopericarditis
  • CXR shows pneumonia common with bacterial causes
80
Q

How do you manage a patient with pericarditis?

A
  • sedentary activity until resolution of symptoms
  • NSAID (ibuprofen or aspirin)
  • colchicine (has nausea and diarrhoea as side effects)
81
Q

What are two examples of heart failure?

A
  • myocardial dysfunction
  • hypertension
  • alcohol excess
  • cardiomyopathy
  • valvular
82
Q

What are the symptoms of heart disease (both specific and non-specific)

A
  • SOB
  • fatigue
  • ankle swelling
  • orthopnoea (SOB when flat)
  • PND (SOB at night)
83
Q

What signs would be present in a HF patient?

A
  • peripheral oedema
  • crackles and tachycardia are non-specific
  • murmurs
  • Raised JVP and displaced apex beat
84
Q

How does the NYHA classify HF?

A
  • Class 1 = no limitation
  • Class 2 - slight limitation
  • Class 3 - marked limitation
  • Class 4 - inability to carry out physical activity without discomfort
85
Q

What is the treatment for a HF patient with preserved left ventricular ejection fraction?

A
  • give diuretics to deal with the congestion

- treat any CVD problem

86
Q

What are some complications of HF?

A
  • renal dysfunction
  • rhythm disturbances
  • systemic thromboembolism
  • DVT and PE
87
Q

What are the main treatments for HF?

A
  • Diuretics (thiazides)
  • ACEI
  • aldosterone antagonism
  • beta blockers
88
Q

What is the 1st line treatment for HF?

A
  • ACE inhibitors (ramipril or enalapril)

- Beta-blockers (isosorbide)

89
Q

What is heart failure?

A
  • The heart is not pumping blood around your body very efficiently
90
Q

What is congenital heart disease?

A
  • general term for a range of birth defects that affect the normal way the heart works
91
Q

What is tetralogy of Fallot?

A
  • stenosis of RV outflow

- RV is higher pressure than LV - so de-oxygenated blood passes to LV

92
Q

What is the treatment for Tetralogy of Fallot?

A
  • Surgical repair before age of 2

- most do very well

93
Q

What are ventricular septal defects (VSD)?

A
  • abnormal connection between two ventricles
  • blood flows to RV, increased blood flow through lungs
  • Associated with Eisenmenger syndrome
94
Q

How would an infant patient with a large VSD present?

A
  • breathless
  • poor feeding (skinny)
  • increased resp. rate
  • tachycardia
  • large heart
95
Q

What is Eisenmengers Syndrome?

A
  • high pressure pulmonary blood flow with damage to vasculature
  • RV pressure increases and shunt direction reverses
  • patient becomes blue
96
Q

What are atrial septal defects (ASD)?

A
  • abnormal connection between two atria

- causes increased circulation through the lungs

97
Q

What are the clinical signs of an ASD patient?

A
  • pulmonary flow murmur
  • fixed split second heart sound
  • big heart and pulmonary arteries
98
Q

How would you treat an ASD?

A
  • surgically

- percutaneous

99
Q

What is an atrio-ventricular septal defect?

A
  • hole in centre of heart
  • can be complete or partial
  • generally one large malformed valve
100
Q

How would a patient with AVSD present?

A
  • Generally have Down’s Syndrome
  • breathless as neonate
  • poor weight gain and feeding
  • will need surgical repair
101
Q

How would a patient with patent ductus arteriosus present?

A
  • continuous murmur
  • large, big heart, breathless
  • will need to be closed within first few weeks of life
102
Q

What is coarctation of the aorta?

A
  • Narrowing of aorta at site of insertion of ductus arteriosus
103
Q

How would a patient present with coarctation of aorta?

A
  • right arm hypertension

- murmur

104
Q

What is aortic stenosis?

A

It is the narrowing of the aortic valve opening

- Symptoms only occur once the valve is 1/4 of normal

105
Q

What are the signs of aortic stenosis?

A
  • syncope on exertion
  • cannot keep BP high
  • difficulty breathing
106
Q

How would you investigate aortic stenosis?

A
  • echo
107
Q

What is the management of aortic stenosis?

A
  • dental hygiene/care

- surgical replacement or TAVI

108
Q

Why is medication not used in aortic stenosis?

A
  • It is a mechanical problem

- vasodilators are CONTRAINDICATED in severe AS

109
Q

What is TAVI?

A
  • transcatheter aortic valve implantation

- used in aortic stenosis

110
Q

What is mitral regurgitation?

A
  • Backflow of blood from the LV to LA during systole
111
Q

What are the signs and symptoms of mitral regurgitation?

A
  • Exertion dyspnoea (exercise intolerance)
  • displaced hyperdynamic apex beat
  • heart failure
112
Q

What investigations would you use for mitral regurgitation?

A
  • ECG
  • CXR
  • echo
113
Q

How would you manage mitral regurgitation?

A
  • Vasodilators (ACEI)
  • beta blockers for rate control
  • diuretics for fluid overload
114
Q

What is aortic regurgitation?

A
  • Leakage of blood into LV during diastole

- due to ineffective aortic cusps

115
Q

What are the symptoms of aortic regurgitation?

A
  • Asymptomatic until 4/5th decade
  • dypsnoea
  • palpitations
116
Q

How would you investigate aortic regurgitation?

A
  • CXR

- echo

117
Q

What is the management of aortic regurgitation?

A
  • use vasodilators but only if patient is symptomatic
  • serial echo to monitor
  • surgical treatment
118
Q

What is mitral stenosis?

A
  • the obstruction of LV inflow that prevents proper filling

- always associated with rheumatic heart disease

119
Q

What are the signs and symptoms of mitral stenosis?

A
  • pulmonary hypertension
  • signs of right-sided HF
  • mitral facies (pink/purple patches on the cheeks)
120
Q

How would you investigate mitral stenosis?

A
  • ECG
  • CXR (LA enlargement)
  • echo - MOST USED
121
Q

How do you manage mitral stenosis?

A
  • echo for monitoring
  • medical therapy does not prevent progression
  • surgery - mitral balloon valvotomy
122
Q

What is infective endocarditis?

A
  • infection of heart valve or other structures e.g. septal defects
123
Q

How does a patient get infective endocarditis?

A
  • have an abnormal valve
  • infectious material is introduced via surgery
  • had IE previously
124
Q

What are the symptoms of IE?

A
  • depends on site
  • systemic infection by fever and sweats
  • embolisation via stroke, PE, kidney dysfunction, MI
  • valve dysfunction with HF
125
Q

Which microorganisms are consistent with IE?

A
  • Streptococci viridans

- Staphylococcus aureus

126
Q

How would you diagnose IE?

A
  • ECG
  • TTE (transthoracic echo)
  • blood cultures
127
Q

What is the treatment for IE?

A
  • Antimicrobials (IV)

- treat complications - HF, embolisation, abscess drainage, surgery

128
Q

What anti-biotics would you give for a patient with IE?

A
  • For strep - penicillin or amoxicillin

- For staph - flucloxacillin with gentamicin

Yr1 (13 decks)

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