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PHASE 2 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Give 7 risk factors for atherogenesis

A
  1. Age
  2. Smoking
  3. Diabetes
  4. High cholesterol (LDLs)`
  5. Family history
  6. Obesity
  7. Hypertension
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2
Q

How does atherogenesis begin

A

Endothelial damage due to irritants. Attracts monocytes and build up of cholesterol

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3
Q

What are the 4 stages of atherogenesis/atherosclerosis

A
  1. Fatty streaks
  2. Intermediate lesions
  3. Fibrous plaques
  4. Plaque rupture
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4
Q

Describe the first part of atherogenesis

A

Fatty streaks are lipid laden, full of T cells and macrophages

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5
Q

What are 3 stages of the second stage of atherogenesis

A

Foam cells, smooth muscle proliferation to the intima, and platelet adhesion

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6
Q

What covers the edge of a plaque

A

Fibrous cap of collagen, elastin and calcium secreted by smooth muscle cells (stimulated by presence of foam cells)

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7
Q

What causes plaque rupture in atherogenesis

A

Increased inflammation -> rupture and heal over and over, occluding more of the lumen each time -> ischaemia due to reduced blood flow -> angina

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8
Q

What causes MI (at the most basic level)

A

Imbalance between myocardial oxygen demand and supply

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9
Q

What is the most common cause of MI and give 2 other causes

A

Coronary artery atheroma

Hypertension and vasculitis

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10
Q

Give non-modifiable risks for myocardial ischaemia (3)

A
  • Family history
  • Age
  • Gender
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11
Q

Give modifiable risks for myocardial ischaemia (7)

A
  • Obesity
  • Hypertension
  • High cholesterol diet
  • Diabetes
  • Smoking
  • Alcohol
  • High saturated fats diet
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12
Q

How is cardiovascular risk estimated and what is the threshold for primary prevention

A

QRISK3

>10% risk over the next 10 years indicates primary prevention

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13
Q

Def: angina

A

Crushing chest pain due to myocardial ischaemia

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14
Q

What is the criteria for diagnosing angina

A
  • Central crushing chest pain radiating to jaw/right arm
  • Worse on exercise
  • Relieved by rest or GTN spray

Must be more than 1 symptom

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15
Q

Levine’s sign

A

Putting clenched fist over chest to cope with pain

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16
Q

Give 5 variants of angina

A
  1. Unstable
  2. Nocturnal
  3. Decubitis
  4. Cardiac syndrome
  5. Variant angina
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17
Q

4 investigations for suspected angina

A
  1. CT coronary angiogram
  2. Resting ECG
  3. Exercise ECG
  4. Stress echocardiography
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18
Q

2 principles of angina management

A
  1. Modifiable risk factor management

2. Symptom control

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19
Q

Pharmacological steps for treatment of angina

A

Control of risk factors: aspirin + clopidogrel + statin
Symptomatic:
- First line - GTN spray and beta blocker/ calcium channel blocker
- Second line - add beta blocker/ calcium channel blocker
- Third line - isosorbide mononitrate/nicorandil

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20
Q

2 interventional measures for uncontrolled angina

A

Percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)

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21
Q

Common mechanism to all acute coronary syndromes

A

Rupture of atherosclerotic plaque

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22
Q

Difference between unstable angina, NSTEMI and STEMI

A

STEMI: ST elevation and raised cardiac markers
NSTEMI: no ST elevation (could be depression) and cardiac markers
Unstable angina: neither change

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23
Q

Clinical features of ACS

A

Central crushing chest pain at rest radiating to arm/jaw, sweating, cold, clammy, not relieved with GTN spray

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24
Q

Immediate management of suspected ACS (8)

A
  • ECG and bloods - cardiac markers, creatinine, electrolyte, glucose
  • GTN/morphine, aspirin and clopidogrel, fondaparinux, tirobifan/abciximab, oxygen
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25
Q

If NSTEMI or unstable angina what is the immediate management

A

Assess risk factors using TIMI.
Low risk = ECG stress test
Medium/high risk = PCI (percutaneous coronary intervention)

26
Q

Drugs used in prolonged management of a patient with ACS

A

Aspirin + clopidogrel (1 year only), GTN for 24-48 hrs, statins + ACE inhibitors, GPIIb/IIIA inhibitor (abciximab/tirobifan) in high risk

27
Q

What is the TIMI score

A

Thrombosis in MI score. Assesses the risk of a subsequent MI from ACS

28
Q

Clinical features of a STEMI

A

Central crushing chest pain that may radiate to the arm/jaw at rest for hours. Associated with sweating, clamminess, vomiting, greyness

29
Q

ECG changes over time in STEMI

A

Minutes: ST elevation
Hours: T wave inversion and broad and deep Q waves
Days: ST returns to normal
Weeks: T wave returns, Q waves remain

30
Q

Give likely cardiac markers elevated in STEMI

A

Troponin (most sensitive) Myocardial bound creatinine kinase also used but not as good

31
Q

After immediate management of ACS, confirmed STEMI. What are the next steps

A 
Immediate PCI (optimal) or thrombolysis
If HR > 100 give IV metoprolol and titrate to match HR
32
Q

What does heart failure result from

A

Heart failing to pump blood and maintain CO

33
Q

3 most common causes of heart failure

A
  • Ischaemic heart disease
  • Dilated cardiomyopathy
  • Hypertension
34
Q

5 rarer causes of heart failure

A
  • Valvular heart disease
  • Congenital heart disease
  • Pericardial heart disease
  • Hyperdynamic circulation (pregnancy, hyperthyroidism, obesity)
  • Other cardiomyopathies
35
Q

Sympathetic nervous system contribution to heart failure

A

Increases HR and myocardial contractility. Contracts veins leading to increased preload (starling mechanism) and causes arterial constriction leading to increased afterload

36
Q

RAAS contribution to heart failure

A
  1. Cardiac output fall and sympathetic tone leads to RAAS activation
  2. Increases fluid and salt retention
  3. Preload increased causing oedema
  4. Angiotensin II potent vasoconstrictor, increasing afterload
37
Q

Ventricular dilatation contribution to heart failrue

A

Myocardial failure -> decrease in stroke volume so increased afterload. Increased volume stretches myocardium for stronger contraction.
Stretching becomes detrimental. Bigger ventricles also need more O2

38
Q

4 clinical syndromes of heart failure

A
  1. Left ventricular systolic dysfunction
  2. Right ventricular systolic dysfunction
  3. Congestive heart failure
  4. Heart failure with preserved ejection fraction
39
Q

6 symptoms of left heart failure

A
  1. Exertional dysponoea
  2. Fatigue
  3. Orthopnoea
  4. Paroxymal nocturnal
  5. Cyanosis
  6. Pulmonary oedema
40
Q

4 symptoms of right heart failure

A
  1. Peripheral oedema
  2. Dyspnoea
  3. Fatigue
  4. Increased weight (potential cor pulmonale so lung problems)

cor pulmonale = abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

41
Q

8 signs of heart failure

A
  1. Ascites
  2. Hepatomegaly
  3. Ankle oedema
  4. Lung crackles
  5. Cardiomegaly
  6. Increased JVP (jugular venous pressure)
  7. 3rd and 4th heart sounds
  8. Tachycardia
42
Q

How is heart failure classified

A

Class I: no symptoms and no limitations of normal activities
Class II: mild symptoms and slight limitation in ordinary activity (e.g. shortness of breath when climbing stairs)
Class III: Marked limitation in normal activities. Comfortable only at rest
Class IV: Severe limitations. Dyspnoea at rest

43
Q

Algorithm for investigating suspected heart failure

A
  1. Bloods (FBC for anaemia, LFTs for hepatomegaly, glucose for diabetes, U+Es, thyroid tests)
  2. Measure BNP (b type natriuretic peptide) >100 then do an echo
44
Q

5 non-pharmacological management steps

A
  1. Stop smoking
  2. Lower salt intake
  3. Moderate exercise + lose weight
  4. No alcohol
  5. Vaccine for pneumococcus and flu
45
Q

3 drugs given in heart failure

A
  1. Loop diuretics
  2. ACE inhibitors/ ARBs (angiotensin receptor blockers)
  3. Beta blockers
46
Q

2 drugs given in heart failure following initial 3 drugs

A
  1. Spironolactone (treats fluid build up)

2. Digoxin (increases force of heart contraction)

47
Q

Def: hypertension

A

Blood pressure > 140/90

must be measured on 2 separate occasions

48
Q

6 contributing factors to hypertension

A
  1. Obesity
  2. High salt intake
  3. Alcohol
  4. Diabetes
  5. Genetics
  6. Low birthweight
49
Q

Initial investigations for someone with high BP

A

24 hour ambulatory BP monitoring

50
Q

4 further investigations for high BP

A
  1. Urine dipstick
  2. U+Es
  3. Blood glucose
  4. Serum lipids
51
Q

What is target blood pressure in:

  1. Normal people
  2. > 80s
  3. Diabetics
A
  1. 140/90
  2. 150/90
  3. 130/80
52
Q

7 examples of end organ damage

A
  1. Retinopathy (most important to check)
  2. Renal failure
  3. Stroke/TIA
  4. MI/angina
  5. LV hypertrophy
  6. Peripheral vascular disease
  7. Heart failure
53
Q

5 non-pharmacological treatments for hypertension

A
  1. Stop smoking
  2. Reduce salt intake
  3. Reduce saturated fats
  4. Increase exercise
  5. Increase fruit and veg
54
Q

Outline drug treatment pathway for hypertension

A 
Step - 
Under 55: ACE inhibitors or ARB
Over 55: calcium channel blocker
Step 2 - 
Combine ACE-i/ARB and calcium blocker
Step 3 - 
Thiazide diuretic 
Step 4 - 
alpha/beta blocker, spironolactone
Pregnancy use methydopa
55
Q

5 symptoms of arrhythmias

A
  1. Palpitations
  2. Dyspnoea
  3. Syncope
  4. Dizziness
  5. Asymptomatic
56
Q

How can arrhythmias get diagnosed

A

ECG, 24 ambulatory ECG, loop recorder

57
Q

3 causes of heart block

A
  • Coronary artery disease
  • Cardiomyopathies
  • Fibrosis of conducting pathways (particularly in older people)
58
Q

Describe the 3 degrees of AV block and ECG changes

A

1st degree: >0.2s PR interval no Rx needed

2nd degree: Mobitz 1 - progressively longer PR

59
Q

How are the 3 degrees of AV block

A

1st degree - no Rx needed
2nd degree - mobitz 1 just monitor, mobitz 2 and 2:1 give pacemaker
3rd degree - pacemaker

60
Q

Describe RBBB (right bundle branch block) and 3 causes

A

Right bundle branch no longer conducts. ????????

61
Q

Describe LBBB (left bundle branch block) and 3 causes

A

Left bundle branch no longer conducts ???????

PHASE 2 (6 decks)

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