Cardiovascular Flashcards
(119 cards)
1
Q
What is altherosclerosis?
A
A plaque blocking an artery - will form a thrombus is it ruptures
2
Q
Risk factors for atherosclerosis?
A
Smoking, ageing, high serum cholesterol, obesity, hypertension, DM, family history
3
Q
Where are atherosclerotic plaques usually located?
A
Peripheral and coronary arteries. Particularly form at locations with changes in flow, altered gene expression and wall thickness changes
4
Q
What is the structure of an atherosclerotic plaque?
A
Lipid laden macrophages, necrotic core, connective tissue and fibrous cap
5
Q
What inflammatory markers are found in plaque?
A
IL-2, IL-6, IL-8, IFN-gamma, TGF-beta, MCP-1 and C reactive protein
6
Q
Treatment of coronary artery disease?
A
Stent implantation, aspirin, clopidogrel/ticagrelor, statins
7
Q
What is angina?
A
Occurs due to a mismatch in the supply of oxygen and the demand of the myocardium
8
Q
What may cause unstable angina?
A
Rupture/erosion of a coronary artery atherosclerotic plaque
9
Q
S&S/Tests for unstable angina?
A
Chest pain at rest lasting for >20 mins, dysponea, sweating, nausea, anxiety.
ECG with ST depression, T wave inversion and normal troponin. Coronary angiography
10
Q
Treatment for unstable angina?
A
Aspirin and P2Y12 inhibitor (such as Clopidogrel), Beta Blockers, Nitrates, Statins, AECis, PCI (with GPIIb/IIIa)/CABG
11
Q
What causes an acute MI?
A
Thrombus formation in the coronary arteries due to atherosclerotic plaque rupture
12
Q
What will the ECG show in MI?
A
NSTEMI = Non-Q wave infarction with ST depression/T wave inversion STEMI = Q wave infarction with ST elevation/tall tented T waves or new LBBB
13
Q
S&S for MI
A
Unremitting severe chest pain occurs at rest and radiates to arms, neck, jaw and back, dysponea, vomiting, sweating, anxiety and elevated troponin
14
Q
Treatment for MI?
A
Pre-hospital = Aspirin and GTN
Hosptial = Morphine, Oxygen, Nitrates, Aspirin/clopidogrel (MONA) then consider PCI/thrombolysis
Subsequent management = Beta-blockers, ACEis, Clopidogrel, Aspirin, Statins (BACAS)
15
Q
What may cause stable angina?
A
Anaemia, polycythaemia, hypothermia, hypovolaemia = supply affected
Hypertension, hyperthyroidism, exercise, valvular heart disease = demand affected
16
Q
What will a stress ECG show in unstable angina?
A
ST depression and T-wave inversion (inversion if ischaemia)
17
Q
What is first line treatment of unstable angina?
A
Beta-blockers (atenolol or propanolol) OR CCBs (amlodopine, nifedipine). If intolerant SWITCH, if not controlled COMBINE.
18
Q
Risk factors for ischaemic heart disease?
A
Increasing age, being male, smoking, obesity, hypertension, hyperlipidaemia, diabetes
19
Q
What is heart failure?
A
The inability of the heart to deliver blood and therefore oxygen to the respiring tissues at a rate that is commensurate with the requirements of the metabolising tissues - depite normal or increased filling pressure.
20
Q
Main S&S of LV HF?
A
Extertional/nocturnal dysponea, fatigue and displaced apex beat
21
Q
Main S&S RV HF?
A
Peripheral oedema, raised JVP and hepatomegaly
22
Q
What are the main symptoms of HF?
A
Dysponea when lying flat, fatigue and ankle oedema - Cardinal triad
Displaced apex beat, 3rd/4th heart sounds and cyanosis
23
Q
Test for HF?
A
Increased NTproBNP (the higher this is the worse the HF) On CXR = Alveolar oedmea, B Kerley lines, Cardiomegaly, Dilated prominent upper lobes, Effusions (ABCDE)
24
Q
What are the NYHA classes of heart failure?
A
I = No-limitation II = Slight limitation - symptoms on normal activity III = Marked limitation - symptoms on light activity IV = Inability to carry out any physical activity without discomfort - symptoms at rest
25
Treatment for HF?
Symptomatic relief = frusomide
1st line = ACEis AND Beta-blockets
2nd line = spironolactone
3rd line = digoxin
26
What is a Hypertrophic Cardiomyopathy?
An autosomal dominant condition leading to thickening of the heart muscle walls = small ventricles and a powerful heart which is less compliant in diastole. Causes disarray of cardiac myocytes = conduction issues. Causes fibrotic tissues to run through heart muscles = arrhythmias
27
S&S of Hypertrophic CM?
Angina, palpatations, dysponea, syncope, SADS
28
Treatment of Hypertrophic CM?
IV amioderone, verapamil/Beta-blockers, ICD
29
What is a Dilated Cardiomyopathy?
An autosomal dominat condition causing dilation of the hear chambers and thinning of the muscles = contractility problems
30
S&S of Dilated CM?
HF symptoms, arrhythmia and embolism
31
What is Arrhythmogenic CM?
Myocytes die and are replaced with fat/fibrous tissues. The desmosomes are diseased so cells separate both physically and electrically - typically affects the RV
32
S&S of Arrhythmogenic CM?
Arrhythmias, oedema, dysponea, syncope, ventricular tachycardia, epsilon wave on ECG, Naxos disease
33
Treatment of Arrhythmogenic CM?
ICD, ACEi/beta-blockers, cardioversion
34
What is Primary Restrictive CM?
A group of diseases where amyloidosis causes the myocardium to become rigid, this restricts diastolic ventricular filling
35
S&S of Primary Restrictive CM?
Dysponea, exercise intoleracnce, palpatations, oedema and fatigue
36
Treatment of Dilated CM?
Diuretics and Beta-blockers
37
What is Brugada syndrome?
This causes disruption to the hearts normal rhythm - causes sudden death in the young.
38
What is tetralogy of fallot?
Ventricular septal defect, pulmonary stenosis, hypertrophy of RV, overriding aorta
39
S&S of tetralogy of fallot?
Cyanotic and squatting in toddlers, boot shaped heart
40
What is a ventricular septal defect?
An abnormal connection between the ventrciles - most close in childhood
41
S&S of ventricular septal defect?
Large = dyponea, poor feeding/failure to thrive, loud pansystolic murmur
42
What is an atrial septal defect?
An abnormal connection between the atria, often presents in adulthood
43
S&S of atrial septal defect?
Large = chest pain, palpatations and dysponea
44
What is an atrio-ventricular septal defect?
A whole in the very centre of the heart often seen in Down's syndrome. The whole septum is involved leading to one large malformed valve
THIS REQUIRES URGENT REPAIR
45
What is Coarctation of the Aorta?
Narrowing of the aorta at the site of the ductus arteriosus (distal to the left subclavian artery)
46
S&S of coarctation of the aorta?
Severe = complete obstruction of blood flow leading to heart failure and collapse, REQUIRES URGENT REPAIR
Right arm hypertension and bruits over the scapulae/back
47
S&S of Patent Ductus Arteriosus?
Continuous machinery murmur, cyanosed and clubbed toes but normal fingers
48
What is associated with a bicuspid aortic valve?
Coarctation/dilation of the ascending aorta as the valve degenerates quicker than normal valves
49
Which heart defects cause systolic murmurs?
```
Aortic stenosis (on ejection)
Mitral regurgitation (pansystolic blowing murmur)
```
50
Which heart defects cause diastolic murmurs?
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Aortic regurgitation (early diastolic)
Mitral stenosis (rumbling mid-diastolic murmur)
```
51
What is Eisenmenger's syndrome?
High pressure in the pulmonary circulation damages the pulmonary vasculature creating resistance through the lungs. RV pressure will then increase and the shunt reverses leading to cyanosis, clubbing and syncope
52
S&S of aortic stenosis?
Syncope/dysponea, angina and HF.
Slow rising carotid pulse and crescendo-decrescendo ejection systolic murmur
CAN BE CAUSED BY A BICUSPID AROTIC VALVE
53
What is the general investigation/treatment for all valvular heart diseases
ECHO
| Good dental hygiene (IE prophylaxis) and valve replacement
54
S&S of aortic regurgitiation?
Wide pulse pressure, decrescendo diastolic murmur, palpatations, angina and dysponea
55
What is the extra treatment of aortic regurgitation?
ACEis
56
S&S of mitral stenosis?
Dysponea, malar flush, low-pitched diastolic murmur/rumble. WILL SHOW AS AF ON ECG
57
What is the extra treatment of mitral stenosis?
Diuretics
58
S&S of mitral regurgitation?
Exercise intolerance/dysponea, fatigue, palpatations and pansystolic murmur
MAY BE CAUSED BY MITRAL VALVE RELAPSE OR AF
59
What may cause all valvular heart diseases?
Rheumatic heart disease (group A beta-haemolytic strep) and accquired calcification
60
What are the stages of hypertension?
Stage 1: >140/90mmHg or ABPM >135/85mmHg
Stage 2: >160/100mmHg or ABPM >155/95mmHg
Severe: Systolic >/= 180 and/or diastolic >/= 110
61
Essential vs secondary hypertension?
```
Essential = unknown cause/idiopathic
Secondary = commonly caused by renal disease, pregnancy, coarctation of the aorta, endocrine issues (such as Cushing's) and drugs such as NSAIDs
```
62
Risk factors for hypertension?
Increasing age, race (being black), alcohol, diabetes, obesity, stress, excess salt
63
S&S of hypertension?
Asymptomatic,
Malignant hypertension = acute optic haemorrhage, papilloedema, renal vascular changes
Complications = LV hypertrophy, proteinuria, retinopathy, headache, nausea, vomiting and imptoence
64
Treatment of hypertension if under 55?
ACEis/ARBs -> add CCBs -> add bendroflumethiazide -> add furosemide
65
Treatment of hypertension in over 55s/Afro-Carribeans?
CCBs -> ACEis/ARBs AND CCBs -> add bendroflumethiazide -> add furosemide
ACEis are less effective in Afro-Carribeans so treat in combination with CCBs
66
Name the differnt types of shock?
```
Hypovolaemic = decreased blood volume
Cardiogenic = heart not pumping
Septic = organ damage due to widespread infection
Alaphylactic = severe allergic reaction to an antigen (type 1)
Neurogenic = spinal cord injury
Anaemic = not enough capactiy to carry oxygen
Cytotoxic = cells are poisoned
```
67
S&S of hypovolaemic shock?
Cold/pale/clammy/grey skin, drowsiness, confusion and increased sympathetic tone
68
S&S of cardiogenic shock?
Increased JVP, gallop rhythm, pulmonary oedema, HF signs
69
S&S of septic shock?
Nausea/vomiting, vasodilation, warm peripharies, pyrexia/rigours, bounding pulse
70
S&S of anaphylactic shock?
Profound vasodilation, warm peripheries, decreased BP, tachycardia, pulmonary oedema and bronchospam
71
Name the organs most at risk in shock?
Kidneys, lungs, heart and brain
72
Name some infective and non-infective causes of acute pericarditis?
Viral = enteroviruses and adeniviruses
Bacterial = mycobacterium TB
Fungal = histoplasma spp.
SLE, Rheumatoid Arthritis, trauma and secondary metastatic tumours.
73
S&S of pericarditis?
Severe pleuritic chest pain worse on lying flat/relieved by sitting forward, dysponea, pericardial friction rub, tachycardia and fever
74
What would an ECG show in acute pericarditis?
Saddle shaped ST elevation and PR depression
75
Treatment for pericarditis?
Restrict physical activity until symptoms improve, NSAIDs for 2 weeks and colchicine for 3 weeks
76
What is pericardial effusion and cardiac tamponade?
A collection of fluid within the pericardial sac which occurs due to acute pericarditis. If a large volume of fluid fills the ventricular space filling will be compromised leading to cardiac tamponade
77
S&S of pericardial effusion?
Soft and distant heart sounds, apex beat is obscured, raised JVP and dysponea
78
S&S of tamponade?
High pulse but low pulse pressure, riased JVP, Kussmaul's sign, pulsus paradoxus and decreased cardiac output
79
What is Beck's triad
Falling blood pressure, rising JVP and muffled heart sounds as the 3 main signs of cardiac tamponade
80
What is constrictive pericarditis?
When the pericardium becomes thick, fibrous and calcifeid as a result of pericarditis. This measn the pericardium becomes inelastic and so diastolic filling is restricted
81
What are the most common causes of infective endocarditis?
Strep. viridans (new cardiac murmur), Staph. aureus (VDU/DM), staph, epidermitis (metallic valves) and fungal infection
82
What are the types of infective endocarditis?
Left sided native, left sided prosthetic, right sided and device related
83
S&S of infective endocarditis?
Fever, new onset murmur, Osler's nodes/Janeway lesions, splinter haemorrhages, Petechiae haemorrhages/Roth spots, emboli
84
Treatment for infective endocarditis?
Antimicrobials IV for 6 weeks, surgery and treat the complications
85
What is bradycardia?
A heart rate of less than 60bpm
86
What is tachycardia and what are the two types?
A heart rate of more than 100bpm.
Supraventricular = arises from the atrium/AV junction (narrow QRS and hidden P waves)
Ventricular = arised from the ventricles (broad QRS)
87
How does first degree heart block appear on ECG?
PR interval >200ms but 1:1 conduction (this is due to delayed AV conduction)
88
How does second degree heart block appear on ECG?
Not 1:1 conduction but still some relation.
Mobitz type I = progressive PR wave prolongation until P wave fails to conduct so QRS disappears
Mobitz type II = no progressive PR wave prolongation - QRS is lost predictably (in a ratio)
89
How does third degree heart block appear on ECG?
There is no association between atrial and ventricular contraction - P and QRS waves occur independantly.
90
S&S and treatment of thrid degree heart block?
Diziness and black outs - requires a permanent pacemaker
91
How can you tell between a right and a left bundle branch block?
Both are associated with wiced QRS complexs.
RBBB = M in V1, W in V6
LBBB = W in V1, M in V6
92
When do RBBB/LBBBs occur?
```
RBBB = occurs in health individuals and those with PE, RV hypertrophy, ischaemia or congenital heart diseases
LBBB = associtated with underlying cardiac pathology e.g. ischaemic heart disease, LV hypertrophy and aortic valve disease
```
93
How does Wolff-Parkinson White Syndrome appear on ECG?
Short PR interval and wide QRS complex due to a congenital acessory conduction pathway
94
Treatment for Prolonged QT syndrome?
Arrhythmia prevention such as beta blockers and potassium supplements and arrhythmia termination (ICD)
95
What is atrial fibrillation? And what causes it
A chaotic persistent irregualry irregular atrial rhythhm with a HR of 120-180 bpm
Caused by HF/ischaemia, hypotension, pneumonia, PE or hyperthyroidism
96
S&S of Atrial FIbrillation?
Chest pain, palpatations, irregular pulse, dysponea and syncope
On ECG = absent P waves and irregular QRS wave
97
Treatment of AF?
Rate control = Beta-blockers or CCBs
Rhytmn control = cardioversion (electrical or amioderone)
Anticoagulation = LMWH until risk assed then if high risk Warfarin (INR 2-3)
98
What is an atrial flutter? How is it treated?
Occurs in those with CV disease/DM. Produces a saw tooth line on the ECG
Treat with anticoagulation and cardioversion as in AF
99
What is an Ectopic beat?
It is a disturbance in the beat and electrical conduction of the heart (may be atrial or ventricular)
100
What may cause sinus tachycardia?
Anaemia, anxiety, exercise, pain, sepsis and hypovolaemia etc.
101
S&S of stable angina?
Constricting central tight chest pain radiating to the jaw/neck, precipitated by exertion and relieved by GTN and rest
102
Treatment for stable angina?
Sympton relief = GTN
RF modification = aspirin and statins
Anti-anginal = Beta-blockers and/or CCBs
Interventional = PCI/CABG
103
After a patient has had a PCI what medications do they need?
Dual platelet therapy for 12 months (aspirin and clopidogrel)
104
What is the physiological difference between a STEMI and an NSTEMI?
```
STEMI = complete and sudden occlusion of the coronary artery
NSTEMI = partial occlusion of the coronary artery
```
105
What are teh main cuases of heart failure?
IHD, hypertension an dilated CM
106
What are the ejection fractions seen in the different types of HF?
Reduced EF HF <40%
Mid-range EF HF 40-49%
Preserved EF HF >50%
107
What is cor pulmonale?
```
RV enlargement (may be due to RV HF)
Presents are dysponea, syncope, fatigue, tachycardia, cyanosis and raised JVP
```
108
What is broad complex tachycardia? Give examples?
QRS >120ms, ventricular fibrilation and ventricular tachycardia
109
What is a narrow complex tachycarida? Give examples?
QRS <120ms, supraventricular tachycardias e.g. sinus tachycarida, AF and atrial flutter
110
How is stroke risk assed in AF patients?
CHA2DS2VASc = Congestive cardiac failure (1), Hypertension (1), Age (65-74 = 1, >75 = 2), Diabetes (1), Stroke/TIA (2), Vascular disease (1) Sex category (female = 1)
111
What is a ventricular flutter?
A chaotic rhythm with no pattern, requires urgent defibrillation and IV amioderone
112
How do you treat ventricular tachycardia?
Cardioversion (electrical or chemical)
113
What are the two types of aortic aneurysm?
True = all three layers are involved/dialted
False = blood collects between the media and adventitia (only the adventita will expand)
Both can rupture leading to sudden severe abdo pain, expanding abdo mass and rapid death
114
What is an aortic dissection, what are the types?
Tear in the intima leading to sudden severe tearing chest pain radiating to the back
A = in the ascending aorta (70%)
B = not in the ascending aorta
115
What is the classificsation for chronic peripheral vascular disease?
```
Fontaine classification:
1 = asymptomatic
2 = intermittent claudication (induced by exercise and relieved by rest)
3 = ischaemic pain at rest
4 = ulceration and gangrene
```
116
What is critical limb ischaemia?
A serious kind of PAD (ankle-brachial pressure index <0.5), pain of limb at rest, particularly at nigh - pain relieved by hanging the leg over the bed and shaking
117
What is first line treatment for peripheral arterial disease?
Clopidogrel
118
S&S of acute PVD?
Pulseless, Pale, Perisihingly cold, Parasthesisa, Paralysis and Pain in limb
Revascularise within 4-6 hours and give LMW Heparin
119
What are the sepsis interventions?
Blood cultures, Urine output levels, Fluids, Anitbiotics, Lactate levels, Oxygen
