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Phase 2a - conditions > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

What is atherosclerosis?

A

Build up of fatty deposits within arteries.

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2
Q

What are the risk factors for atherosclerosis?

A 
Age 
Smoking 
High cholesterol 
Obesity 
Diabetes
Hypertension 
Family history
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3
Q

What are the components of an atherosclerotic plaque?

A 
Lipid 
Necrotic core 
Connective tissue 
Fibrous cap 
Lymphocytes and macrophages
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4
Q

Describe the pathogenesis of atherosclerotic plaques.

A

Injury occurs to the endothelium, inflammation occurs and a plaque progresses.

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5
Q

What is the first stage of an atherosclerotic plaque?

A

Fatty streak

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6
Q

What are the risks of an atherosclerotic plaque?

A

It will rupture and form thrombi which will occlude vessels.
Plaque erosion may occur and a platelet clot will form above the plaque and occlude a vessel.

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7
Q

What is ischaemic heart disease?

A

Heart problems caused by vessel obstruction where blood supply does not meet metabolic demand.

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8
Q

What are the risk factors for ischaemic heart disease?

A 
Smoking 
Obesity 
Sedentary lifestyle 
Hypertension 
Diabetes 
Older age 
Male
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9
Q

Describe the pathophysiology of stable angina.

A

There is increased resistance in the blood vessels of the heart so microvascular blood vessels are dilated at rest. On exercise they cannot dilate further so myocardial ischaemia occurs with the increased demand.

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10
Q

Which two vessel types determine coronary blood flow?

A

Epicardial vessels - minimal resistance

Microvascular vessels - the major determinate of resistance.

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11
Q

What are the clinical features of stable angina?

A

Heavy, central, tight chest pain
Radiate to arms, jaw and neck
Precipitated by exercise
Relieved rapidly by rest

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12
Q

What are the differential diagnoses of stable angina?

A 
GORD 
Pericarditis 
Aortic dissection 
Musculoskeletal injury - ie. broken rib 
Psychological - ie. anxiety
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13
Q

What investigations are carried out in angina?

A

Blood tests - risk of anaemia causing angina.
ECG
Chest X-Ray
Echocardiography - if a high risk is indicated
Angiography - if risk indicates so

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14
Q

What are the results of an ECG in stage angina?

A

Usually normal

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15
Q

What are the causes of stable angina?

A

Atherosclerosis - usually
Anaemia
Tachyarrhythmias

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16
Q

How do you stratify risk in a patient with angina?

A

Calculating the likelihood of CAD

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17
Q

How do you calculate the likelihood of CAD?

A

Patients age, gender and type of angina.

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18
Q

What is the initial management of angina?

A

Modify risk factors - stop smoking, exercise, weight loss, control hypertension and diabetes.

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19
Q

What can be used for symptomatic relief in angina?

A

GTN spray (causes vasodilation)

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20
Q

What other pharmacological therapies can be used?

A

Beta-blockers (ie. propranolol)
Calcium channel antagonists (ie. amlodipine)
Long acting nitrates

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21
Q

When may surgery be indicated in angina?

A

When symptoms persist on two anti - anginals.

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22
Q

What are the rarer forms of angina?

A

Prinzmetal angina - coronary artery spasm

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23
Q

What are the three forms of acute coronary syndrome?

A

Unstable angina
NSTEMI
STEMI

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24
Q

What are the causes of acute coronary syndrome?

A

Arterial thrombosis - most common
Coronary spasm
Emboli

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25
What investigations should be carried out in acute coronary syndrome?
ECG Bloods - FBC, U&E, glucose, lipids Cardiac enzymes
26
What cardiac enzymes can you test for in ACS?
Troponin Creatinine kinase Myoglobin
27
What are the differential diagnoses of ACS?
Angina Pericarditis Myocarditis Pulmonary embolism
28
How do you interpret troponin results?
Measure levels >6 hours after symptoms, if raised repear 3 hours later. If there has been a fall in troponin then an MI is indicated (STEMI or NSTEMI)
29
What other conditions can troponin be indicative for?
Pulmonary embolism Myocarditis Congestive heart failure
30
What is unstable angina?
Angina of increasing severity or frequency, occurs with minimal exercise. High risk of developing to an MI.
31
What are the ECG changes in unstable angina?
Usually normal | Or ST depression and T wave flattening.
32
What is an NSTEMI?
This is a myocardial infarct diagnosis made retrospectively after troponin results and other investigations.
33
What are the symptoms of a STEMI?
``` Acute central chest pain Radiating to jaw, arms and shoulder >20 minutes Nausea Dyspnoea Sweating Palpitations ```
34
Can a STEMI preset silently?
YES. This is most common in the elderly of diabetics.
35
What are the signs of a STEMI?
Distress, anxiety, pallor, sweatiness, raised pulse.
36
What are the ECG changes of a STEMI?
ST elevation, tall T waves, Q waves can develop later.
37
What are the ECG changes in a NSTEMI?
ST depression, Q waves can develop later.
38
What is the initial management of a STEMI?
``` M - morphine O - oxygen as needed N - nitrates A - aspirin 300mg Restore coronary perfusion - PCI or thrombolysis ```
39
What are further pharmacological options offered to patients who have had a STEMI?
Beta blocker ACE inhibitor Aspirin 75mg daily Statin
40
What lifestyle changes can be recommended following an MI?
Smoking cessation Exercise Healthy diet Weight loss
41
What is heart failure?
An inability of the heart to deliver blood at a rate commensurate with the requirement of the metabolising tissues.
42
What are the types of heart failure?
HF with preserved ejection fraction (diastolic) | HF with reduced ejection fraction <40% (systolic)
43
What is the cause of systolic heart failure?
Myocyte death - IHD, MI, cardiacmyopathy
44
What is the cause of diastolic heart failure?
Muscle hypertrophy, cardiac tamponade, hypertension, constrictive pericarditis.
45
What is the body's compensatory mechanisms when the heart begins to fail?
Sympathetic stimulation RAAS activation Myocardial remodelling - ventricular dilation and myocyte hypertrophy.
46
Describe the pathophysiology of sympathetic activation in heart failure.
In the short term this increases HR to maintain the required CO. In the long term it reduced myocardial reserve and increases dysfunction. Indication for beta blocker therapy.
47
Describe the pathophysiology of RAAS activation in heart failure.
It increases water and salt retention. This increases afterload and preload, the demand on the heart is increased and dysfunction is increased.
48
What are the causes of right sided heart failure?
Pulmonary stenosis Left sided heart failure Any lung disease that increases vascular resistance.
49
What are the symptoms of right sided heart failure?
``` Peripheral oedema Ascites Nausea Anorexia Facial engorgement ```
50
What are the causes of left sided heart failure?
Ischaemic heart disease Hypertension Aortic/mitral valve disease
51
What are the symptoms of left sided heart failure?
``` Dyspnoea Poor exercise tolerance Fatigue Wheeze Nocturia Cold peripheries ```
52
What is the term for both sides of the heart failing?
Congestive heart failure.
53
What are the signs of heart failure?
``` Cardiomegaly Cool peripheries Cyanosis Tachycardia Displaced apex beat Weight loss ```
54
What investigations should be carried out in heart failure?
Blood tests - b-type natriuretic peptide ECG Chest X-Ray Echocardiography
55
What are the signs of heart failure on X-Ray?
``` Alveolar oedema Kerley B lines Cardiomegaly Dilated prominant upper lobe vessels Pleural effusion ABCDE ```
56
What are the result of b-type natriuretic peptide in heart failure?
Raised. Released on myocyte stretch.
57
What is the classification system for heart failure?
New York Heart Association Classification
58
What are the categories in the NYHA Classification of HF?
I - no limitation, asymptomatic II - mild limitation, comfortable at rest III - marked limitation, gentle activity produced marked symptoms. IV - significant limitation, symptoms at rest
59
Lifestyle advice for someone with heart failure?
Stop smoking Dietary modification - less salt Weight loss Avoid exacerbating factors - NSAIDs
60
What drugs can be offered in heart failure and give an example?
``` Diuretics - frusomide ACE inhibitors - lisinopril Beta blockers - proranolol Spironolactone Digoxin ```
61
What diuretics are used in heart failure?
Loop diuretics - frusomide
62
What are the side effect of diuretics?
Can cause hypokalaemia
63
What diuretics can be used if hypokalaemia occurs?
Spironolactone is a potassium sparing diuretic.
64
What are the possible side effects of ACE inhibitors?
Cough
65
How do ACE inhibitors work?
Inhibit the conversion of angiotensin I - angiotensin II. less vasoconstriction, less water retention, less sympathetic activity
66
In what condition are beta blockers contraindicated?
Asthma
67
How do beta blockers work?
Inhibit sympathetic activation - less vasoconstriction and lower HR.
68
What is the function of digoxin?
It is a rate control medication.
69
How do you treat acute heart failure?
Oxygen Nitrates - GTN Analgesia IV frusomide
70
What are the possible complications of heart failure?
Renal dysfunction Arrhythmias Thromboembolism
71
What are the four main valvular problems in the heart?
``` Aortic stenosis Mitral regurgitation Aortic regurgitation Mitral stenosis ALL ON THE LEFT SIDE. ```
72
At what point in aortic stenosis are symptoms felt?
When the valve area is 1/4 of its normal.
73
What are the causes of aortic stenosis?
Degenerative calcification Congenital bicuspid valve Rheumatic heart disease
74
What is the most common valvular disease?
Aortic stenosis
75
What are the pressure changes in the heart for aortic stenosis?
Increased pressure gradient between LV and A. LV pressure increases A pressure decreases
76
What is the compensatory mechanism of the heart in aortic stenosis?
LV hypertrophy
77
What are the symptoms of aortic stenosis?
Exertional syncope Angina Exertional dyspnoea
78
What are the signs of aortic stenosis?
Slow rising carotid pulse - pulsus tardus Decreased pulse amplitude - pulsus parvus Ejectional systolic murmur - crescendo/decrescendo Soft/absent second heart sound Prominent 4th heart sound
79
What investigations to carry out in aortic stenosis?
Echocardiography - diagnostic test ECG Chest X-Ray - LVH and calcification visible
80
How do you diagnose aortic stenosis?
Severe - valve area <1.0cm2
81
What is the general management for aortic stenosis?
Dental hygiene/consider antibiotic prophylaxis | ANY symptom is an indication for surgical intervention
82
What is mitral regurgitation?
Backflow of blood from the LV->LA during systole.
83
What are the causes of mitral regurgitation?
Degenerative change Ischaemic heart disease Rheumatic heart disease Infective endocarditis
84
What are the compensatory changes of the heart in mitral regurgitation?
``` LA dilation (due to volume overload in systole) LV hypertrophy ```
85
What are the pressure changes in mitral stenosis?
Rise in LA pressure during systole.
86
What are the symptoms of mitral stenosis?
Exertional dyspnoea Fatigue Palpitations
87
What are the signs of mitral stenosis?
Soft first heart sounds (incomplete closure) Pansystolic mumur at apex, radiating to axilla. Displaced apex beat.
88
What investigations to carry out in mitral regurgitation?
Echocardiography - diagnostic test ECG Chest X-Ray - Enlarged LA + LV
89
What is the pharmacological management for mitral regurgitation?
ACE inhibitors Rate control for AF - BBs CCBs digoxin Anticoagulant for AF Diuretics can help symptomatically
90
What are the indication for surgery in mitral regurgitation?
Any symptoms | EF <60%
91
What is aortic regurgitation?
Leakage of blood into the LV during diastole.
92
What are the causes of aortic regurgitation?
Bicuspid aortic valve Rheumatic heart disease Infective endocarditis
93
What are the compensatory heart changes seen in aortic regurgitation?
LV dilation and LV hypertrophy
94
What are the pressure changes seen in aortic regurgitation?
Aortic pressure drops during diastole.
95
What is the presentation of aortic regurgitation?
Exertional dyspnoea | Angina
96
What are the signs of aortic regurgitation?
Collapsing pulse Wide pulse pressure Displaced apex beat Diastolic blowing murmur
97
What are the investigation is aortic regurgitation?
Echocardiogram ECH Chest X-Ray - LV dilation and hypertrophy
98
When is surgeyr indicated in aortic stenosis?
Any symptom | EF <50%
99
What is mitral stenosis?
Obstruction of flow from LA to LV that prevents proper filling during diastole.
100
What are the causes of mitral stenosis?
Rheumatic heart disease Infective endocarditis Mitral calcification
101
What compensatory changes are made in mitral stenosis?
LA hypertrophy and dilation
102
What are the pressure changes seen in mitral stenosis?
Increases LA pressure, can have a build up of back pressure onto the pulmonary circulation. LA pressure decreases during diastole.
103
What are the symptoms of mitral stenosis?
Progressive dyspnoea Right heart failure symptoms eventually AF
104
What are the signs of mitral stenosis?
Low volume pulse Malar flush on cheeks Loud first heart sound Rumbling diastolic murmur
105
What are the indications for surgery in mitral stenosis?
Any symptoms
106
What percentage of births have a cardia defect?
1%
107
What are the defects in the tetralogy of Fallot?
Ventricular septal defect Overriding aorta Hypertrophy of the right ventricle Right ventricular outflow tract obstruction/pulmonary stenosis.
108
In what syndrome is tetralogy of Fallot very common?
DiGeorge syndorme
109
Why do patients present cyanosed with tetralogy of Fallot?
Pulmonary stenosis leads to RV pressure increase. RvV pressure greater that LV and blood moves across via the VSD. Deoxygenated blood circulates.
110
What intervention is needed in tetralogy of Fallot?
Blalock-taussing shunt - connects subclavian to pulmonary artery for further blood oxygenation. VSD closure Relief of pulmonary stenosis.
111
What is the most common congenital heart defect?
Ventricular septal defect
112
Is there cyanosis in a VSD.
No. The shunt is L-R as LV has a high pressure.
113
What is the physiological consequence of a small VSD?
Small increase in pulmonary blood flow
114
What are the symptoms of a small VSD?
Asymptomatic usually. Most close by 10 years old.
115
What is the clinical sign of a VSD?
Large pansystolic murmur.
116
What is the physiological consequence of a large VSD?
High pulmonary blood flow - can lead to Eisenmenger;s complex. Significant LA and LV dilation.
117
What is Eisenmenger's complex?
Pulmonary hypertension - damages pulmonary vasculature - pulmonary resistance increases - RV pressure increases - eventually RV pressure>LV pressure - shunt reverses - CYANOSIS
118
What is the treatment of a VSD?
Closure
119
What is an atrial septal defect?
An abnormal connection between the two atria.
120
Does the patient present cyanosed?
No. the shunt is from the L-R as the LA has a higher pressure.
121
What are the clinical effects of a large ASD?
There is significant overload to the right heart. Dyspnoea and exercise tolerance.
122
What are the clinical signs of an ASD?
Pulmonary flow murmur Large pulmonary arteries on X-Ray Possible cardiomegaly
123
What are the heart changes as a result of a significant ASD?
Right sided dilation and hypertrophy.
124
What is the treatment of an ASD?
Closure.
125
What is an atrio-ventricular septal defect?
There is a large septal defect and one large atrioventricular valve.
126
What is a patent ductus arteriosus?
The ductus arteriosus is a bypass from the pulmonary artery to aorta in order to bypass the lungs in a neonate.
127
Where is the shunt is a patent ductus arteriosus?
From the aorta to the pulmonary artery.
128
What is the effect of a patent ductus arteriosus?
Pulmonary hypertension Left heart volume overload overload and hypertrophy Possible Eisenmenger's syndrome
129
What the treatment of patent ductus arteriosus?
Closure.
130
What is coarctation of the aorta?
Narrowing of the aorta at the site of the ductus arteriosus.
131
What are the effects of coarctation of the aorta?
Hypertension Murmur Claudication Headaches
132
What is a bicuspid aortic valve?
A bicuspid valve made of two instead of three valves.
133
What is the effect of a bicuspid aortic valve?
Is prone to becoming stetotic and regurgitant.
134
What is pulmonary stenosis?
Narrowing of the pulmonary artery.
135
What is the effect of pulmonary stenosis?
Right ventricular failure Right ventricular hypertrophy Poor pulmonary blood flow Tricuspid regurgitation
136
What are the cardiac causes of an arrhythmia?
``` MI Coronary artery disease Mitral valve disease Cardiomyopathy Pericarditis Myocarditis ```
137
What are the non-cardiac causes of arrhythmia?
``` Caffeine Smoking Pneumonia Drugs Metabolic imbalance ie. potassium ```
138
What is the typical presentation of arrhythmias?
``` Palpitations Chest pain Syncope Hypotension Some are symptomatic ```
139
Investigations to carry out in someone with an arrhythmia?
Blood - FBC, U&E ECG Echocardiogram Provocation tests
140
What are the two types of bradycardia?
Sinus - failure of impulse formation | AV block - failure of impulse conduction
141
What are the causes of sinus bradycardia?
Hypothyroidism Hypothermia Drugs - beta blockers, digoxin Acute ischaemia to SAN
142
What is first degree heart block?
PR interval >0.22s | Every atrial depolarisation followed by ventricular depolarisation (just with delay)
143
What is second degree heart block?
Occurs when some atrial depolarisation trigger ventricle depolarisation but not all.
144
What scale are the various forms of second degree heart block judged on?
Mobitz scale
145
What is Mobitz type I?
Progressive increase in PR interval until a missed ventricular depolarisation and it is 'reset.'
146
What is Mobitz type II?
A dropped ventricular depolarisation is not followed by a prolongation of PR again.
147
What is third degree heart block?
All atrial activity fails to conduct to the ventricles.
148
What is bundle branch block?
Delay/blockage of signal from one of the bundles to stimulate ventricular contraction.
149
What is the overarching ECG sign of a bundle branch block?
QRS >0.12s
150
What is the ECG finding in right BBB?
M in V1 and W in V6 - MaRRoW
151
What is the ECG finding in left BBB?
W in V1 and M in V6 - WiLLiaM
152
What two groups can tachycardias be split into?
Ventricular and supraventricular
153
What are examples of supraventricular tachycardias?
Atrial fibrillation Atrial flutter AV nodal re-entry tachycardia
154
What is atrial fibrillation?
Irregular, continuous, rapid activation of the atria with irregular ventricular conduction. 300-600 bpm.
155
What are the causes of AF?
``` Hypertension Heart failure Rheumatic heart disease Caffeine Alcohol ```
156
What are the signs of AF?
Irregularly irregular pulse
157
What are the symptoms of AF?
Asymptomatic Chest pain Palpitations Dyspnoea
158
What does an ECG show in AF?
Absent P waves | Irregular QRS complexes
159
What is the risk with AF?
The formation of emboli
160
What is the treatment for acute AF?
Cardioversion - drugs (amiodarone) or electrical. Rate control with beta blockers/CCB of digoxin. Anticoagulation with LMWH
161
What are the drugs used for rate control?
First line - beta blockers/CCB Second line - Digoxin Third line - amiodarone
162
What is the method for rhythm control?
Cardioversion
163
What is atrial flutter?
Regular, rapid atrial depolarisation (approx 300bpm).
164
What are the ECG changes in normal tachycardia?
Normal P wave followed by normal QRS
165
What rate is required for a sinus tachycardia?
>100bpm
166
What are the causes of sinus tachycardia?
Anaemia, anxiety, exercise, pain, heart failure.
167
What is ventricular tachycardia?
Wide QRS complexes independent of P waves.
168
What are the effects of ventricular tachycardia?
Syncope, arrest.
169
What is ventricular fibrillation?
Rapid, irregular QRS complexes.
170
What is present in Wolff-Parkinson-White Syndrome?
Accessory pathways between atria and ventricles.
171
What are the risk factors for hypertension?
``` Family history Male Sedentary lifestyle Unhealthy diet Obesity ```
172
What are the causes of hypertension?
``` Unknown primary cause Conn's syndrome - hyperalderosteonism Renal failure Drugs Pregnancy ```
173
What are the symptoms of hypertension?
None usually.
174
What is malignant hypertension?
An acute rise in BP leading to vascular damage. Systolic >200, diastolic <130.
175
What are the symptoms of malignant hypertension?
Headache | Visual disturbances
176
What blood pressure measurement is classed as stage 1 hypertension?
>140/90
177
What tests can be carried out to confirm a diagnosis of hypertension?
24 hour ambulatory BP monitor | Multiple home BP measurements
178
What measurement is classed as stage 2 hypertension?
>160/100
179
What measurement is classes as stage 3 hypertension?
>180 and/or >110
180
What other investigation should be carried out in a person with hypertension?
Eye exam - hypertensive retinopathy Urine tests - kidney damage ECG Cardiovascular risk test - QRISK
181
At what ABPM do you treat?
>135/85 with a QRISK >20% | >150/95
182
What lifestyle changes are recommended is a hypertensive patient?
``` Smoking cessation Low fat diet Reduce alcohol and salt intake Weight loss Exercise ```
183
What is the treatment pathway for <55 year old with hypertension?
``` ACE inhibitor (or ARB if intolerant) ACE inhibitor + calcium channel blocker ACE inhibitor + calcium channel blocker + thiazide diuretic ACE inhibitor + calcium channel blocker + thiazide diuretic + diuretic/alpha/beta blocker. ```
184
Give an example of a ACE inhibitor.
Lisinopril
185
Give an example of a ARB.
Candesartan
186
Give an example of a CCB.
Amlodipine
187
Give an example of a thiazide diuretic?
Chlortalidone
188
What is the treatment pathway for a patient >55 or afro-caribbean with hypertension.
Start with a CCB first | Then add ACEi and follow pathway as normal.
189
What is the BP treatment goal for a standard hypertensive patient?
<140/90 (or ABPM 135/85)
190
What is the BP treatment goal for a diabetic hypertensive patient?
<130/80
191
What is the BP treatment goal for a >80 year old hypertensive patient?
<150/90
192
What are the risks associated with hypertension?
Stroke Ischaemic heart disease Renal failure Heart failure
193
What are the three main subsets of cardiomyopathy?
Hypertrophic, dilated and arrhythmogenic.
194
What is the physiological effect of hypertrophic cardiomyopathy?
Muscle hypertrophy -> decreased chamber volume. Myocyte disarray - arrhythmias Fibrosis - arrhythmias Arterial hypertrophy - blocks arteries and causes ischaemia
195
What are the symptoms of hypertrophic cardiomyopathy?
``` Mostly asymptomatic Chest pain Dyspnoea Syncope Arrhythmias Sudden arrhythmic death syndrome ```
196
What investigations should be carried out in the case of cardiomyopathies?
ECG Echocardiography Chest X-Ray
197
What is seen on ECG in hypertrophic cardiomyopathy?
Very large voltages
198
What is seen on echocardiography in hypertrophic cardiomyopathy?
asymmetric LV hypertrophy
199
What is dilated cardiomyopathy?
Dilation of the heart chamber with preserved wall thickness.
200
What is the physiological effects of dilated cardiomyopathy?
Blood cannot be pumped out of the heart effectively --> heart failure
201
What is the cause of arrhythmogenic cardiomyopathy?
Desmosome gene mutations - cause cells to separate and myocytes are replaced by fat or fibrous tissue.
202
What disease is associated with arrhythmogenic cardiomyopathy?
Naxos Disease
203
What are the other features of naxos disease?
Woolly hair Palmar and plantar keratoderma.
204
What is a channelopathy?
Inherited arrhythmia caused by a channel protein gene mutation.
205
What is an example of a channelopathy?
Long QT syndrome
206
What is the cause of Marfan's disease?
Autosomal dominant mutation of the fibrillin gene.
207
What is the effect of Marfan's disease on the heart?
Lots of fibrillin at the base of the aorta so - enlargeed root with aneurysm/rupture.
208
What are the skeletal effects of Marfan's disease?
High arch palette Tall Long limbs.
209
What is the primary cause of peripheral vascular disease?
Atherosclerosis
210
What is the first symptom felt in peripheral vascular disease?
Intermittent claudication
211
What is intermittent claudication?
On exercise the demand for oxygen of the tissues rises and this cannot be met my the blood supply - ischaemia occurs.
212
What are the symptoms of intermittent claudication?
Cramping and pain on movement | Relieved by rest
213
What is critical limb ischaemia?
The oxygen supply to tissues is barely met at rest.
214
What are the symptoms of critical limb ishcaemia?
Rest pain, can be relieved on movement 'hanging leg out the bed.' Ulceration can occur.
215
What are the differences between intermittent claudication and critical limb ischaemia?
In intermittent claudication the oxygen demand is met at rest in CLI it is not. In IC pain is relieved by rest in CLI it is relieved by movement.
216
What are the causes of acute limb ischaemia?
Thrombi | Emboli
217
What are the symptoms of acute limb ischaemia?
``` Pain Palor Perishing cold Pulseless Paralysis Paraesthesia - 6 Ps. ```
218
What are the investigations that can be carried out in peripheral vascular disease?
Ankle-brachial pressure index - 0.5-0.9 Ultrasound scan Angiography
219
What are lifestyle changes that can be made in peripheral vascular disease?
``` Smoking cessation Blood pressure control Weight loss Exercise Lower fat diet ```
220
What is the treatment option in acute limb ischaemia?
Revascularisation | Amputation
221
What are the causes of shock?
``` Blood loss Myocardial failure Pulmonary embolus Vasodilation AV shunt ```
222
What are the types of shock?
``` Anaphylactic Neurogenic Hypovolaemic Haemorrhagic Septic ```
223
What is the mechanism of anaphylactic shock?
Type 1 IgE mediated hypersensitivity causes profound vasodilation
224
What are the causes of hypovoleimic shock?
Bleeding Trauma Rupture
225
What is shock?
Circulatory failure resulting in inadequate organ perfusion.
226
What is an aneurysm?
Permanent dilation of an artery to twice its normal diameter
227
What are the possible causes of aneurysm?
Atheroma - inflammation weakens the wall Infection Trauma Genetic
228
Name two locations of aneurysm.
Abdominal aortic | Berry aneurysm - circle of Willis
229
What are the symptoms of an abdominal aortic aneurysm?
Asymptomatic | Epigastric/back pain
230
What are the signs of an abdominal aortic aneurysm?
Pulsatile mass
231
What as the signs of a ruptured AAA?
Hypotension Tachycardia Profound anaemia Sudden death
232
What is an aortic dissection?
A tear in the intima of the aorta leads to blood moving in and splitting the vessel wall in two.
233
What is pericarditis?
Inflammation of the pericardium
234
What is the anatomy of the pericardium?
Visceral layer sits on the surface of the heart Parietal is a fibrous layer Between the two is 50ml of serous fluid.
235
What are the causes of pericarditis?
Infection Malignancy Trauma
236
What is the presentation of pericarditis
``` Severe and sharp chest pain worse on inspiration/lying flat Relieved sitting forwards Dyspnoea Cough ```
237
What are the investigations for pericarditis?
ECG | Blood
238
What are the signs of pericarditis?
Pericardial friction rub
239
What are the ECG signs of pericarditis?
Saddle shaped ST elevation | PR depression
240
What is the management of pericarditis?
Treat cause Analgesia - NSAIDs Colchicine - reduces chance of recurrence.
241
What are the complications of pericarditis?
Recurrence Pericardial effusion Tamponade Constrictive pericarditis
242
What is the effect of a pericardial effusion?
If it is slow then the pericardium has time to expand and adapt. If it rapid then there is no time to adapt, pressure increases and cardiac tamponade occurs.
243
What is cardiac tamponade?
Compression of the heart caused by pericardial effusion.
244
What is constrictive pericarditis?
Thick, fibrous, calcified pericardium restricts diastolic filling.
245
What is the most common organism to cause endocarditis?
Staphylococcus aureus
246
What are the symptoms of endocarditis?
Fever Night sweats Malaise Weight loss
247
What are the signs of endocarditis?
``` Any new murmur/change in pre-existing murmur Pyrexia Splinter haemorrhages (in nails) Effect of emboli elsewhere Clubbing ```
248
What criteria is used to diagnose endocarditis?
Duke criteria
249
What tests should be carried out in suspected endocarditis?
Blood cultures (3+!!) - can still be culture negative Blood tests - neutrophillia, raised ESR and CRP CXR ECG Echocardiogram
250
What are possible complications of infective endocarditis?
Heart failure Valvular obstruction Emboli formation
251
What are the major Duke criteria?
``` Positive blood culture Endocardium involved (on echo or new regurgitation) ```
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What are the minor Duke criteria?
Predisposition Fever Vascular/immunological signs Positive blood culture but doe not fulfil major criteria Positive echo but does not fulfil major criteria
253
What are the risk factors for endocarditis?
Cardiac lesion IC drug use Open wounds Organ transplant

Phase 2a - conditions (11 decks)

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