Cardiovascular Flashcards
1
Q
Normal systolic ejection fraction? %
A
60
2
Q
Plaque
A
endophytic mass of distorted endothelial surfaces containing lymphocytes, macrophages, smooth muscle cells
3
Q
Foam cells
A
macrophages + oxidised LDLs
4
Q
Aneurysm
A
enlargement of an artery caused by a weakness in an arterial wall
5
Q
Complications of plaque rupture
A
occlusion due to thrombus, chronic narrowing of vessel lumen, aneurysm change, embolism of thrombus
6
Q
Ischaemic heart disease
A
Angina, MI, chronic congestive cardiac failure, sudden death
7
Q
Pathological complications of MI
A
arrhythmias, L ventricular failure, extension of infarction, rupture of the myocardium
8
Q
aneurysm
A
dilation of part of the myocardial wall, usually associated with fibrosis and atrophy of myocytes, risk of subsequent embolism
9
Q
Acute rheumatic fever
A
group A beta-haemolytic streptococcus infection, major factor with heart disease in the developing world
10
Q
Clinical significance of acute rheumatic fever
A
chronically scarring and deformity produces contracture of the valve and chordae tendinae, may subsequently calcify and distort blood flow
11
Q
Infective endocarditis
A
infective process involving the cardiac valves
12
Q
Causes of infective endocarditis
A
rheumatic valvular heart, mitral valve prolapse, elderly pregnancy, diabetes
13
Q
Characteristic microorganisms causing infective endocarditis
A
streptococci, staphylococci, fungi and atypical bacteria also
14
Q
aortic stenosis increases the risk of ?
A
MI and infective endocarditis
15
Q
Mitral stenosis is commonly associated with what disorders?
A
Connective tissue
16
Q
Myocarditis
A
reflects inflammation of the myocardium, usually associated with muscle cell necrosis and degeneration, multiple causes but most common is viral myocarditis
17
Q
Key types of cardiomyopathy
A
DCM (dilated), HCM (hypertrophic CM) , ARVCM (arrhythmogenic right ventricular CM)
18
Q
cardiomyopathy
A
primary cardiac disease with contractile dysfunction and atypical morphology
19
Q
DCM - dilated cardiomyopathy
A
most common type of CM, many causes, chronic ischaemia, MI, often end in cardiac failure
20
Q
Pathological presentation of dilated cardiomyopathy
A
enlarged, heavy and dilated heart
21
Q
HCM - hypertrophic cardiomyopathy
A
due to mutations of proteins in muscle cells, leads to progressive sarcomeric dysfunction, accounts for 5-10% of sudden deaths in young adults
22
Q
ARVCM - arrhythmogenic right ventricular CM
A
thinning and fatty infiltration of right ventricular outflow tract with fibrosis and inflammation
23
Q
Abdominal aortic aneurysm
A
almost always caused by atheroma, majority below renal arteries
24
Q
Haemangioendothelioma
A
vascular tumour of endothelial cells of low grade malignancy
25
Rheumatic fever
Systemic infection common in developing countries from a Lancefield group A B-haemolytic streptococci, common cause of structural heart disease
26
Pathophysiology of rheumatic fever?
An antibody from the bacterial cell wall cross reacts with valve tissue, which can cause permanent damage to the heart valves
27
Rheumatic fever presentation
Fever, arthritis, chorea, fatigue, tachycardia, murmur, erythema marginatum (red rash with raised edges and clear centre on trunk)
28
Ix for rheumatic fever
Jones criteria - recent streptococcus infection + 2 major/1 major + 2 minor criteria
Major - carditis, arthritis, erythema marginatum
Minor - fever, raised ESR/CRP
29
Tx for rheumatic fever?
IV ABx, aspirin for analgesia, diazepam for chorea
30
Medications causing iatrogenic hyperkalaemia?
ACE-i, ARBs, potassium sparing diuretics, NSAIDs, digoxin
31
Renal causes of hyperkalaemia?
AKI, CKD - kidneys are responsible for 90% of the potassium excretion, therefore impaired renal function = hyperkalaemia
32
DKA and Addisons disease both cause
hyperkalaemia
DKA - lack of insulin, K+ moves out of the cell
Addisons - lack of aldosterone, therefore less K+ excretion
33
Typical ECG findings for hyperkalaemia?
Tall-tented T waves, flattened P waves, broad QRS complexes
34
Angina is caused by?
Narrowing of the coronary arteries - ischaemia
35
Sx of angina?
Constricting chest pain, may radiate to jaw/arms, worse after activity, relieved by rest or GTN within 5 minutes
36
Unstable angina
Part of acute coronary syndrome, symptoms of chest pain come on at rest, symptoms of angina acutely get worse
37
Why are plaques commonly formed in the coronary arteries?
Turbulent follow
38
GS investigation for assessing coronary arteries for px with angina?
CT coronary angiography (contrast to show narrowing in arteries)
39
Foam cells?
Injured endothelial cells attract macrophages, which engulf the LDLs that have accumulated, forming foam cells
40
Baseline tests for angina?
Bloods, ECG, echocardiography, CXR
41
Mx for angina
1. Lifestyle - diet, limit alcohol/smoking, exercise, weight loss
2. GTN spray
3. Beta-blocker or CCB
4. Revascularisation surgery
42
How does GTN spray work?
Stimulates endothelial cells to release NO which triggers vasoconstriction
43
ACS refers to 3 states of myocardial ischaemia:
unstable angina, NSTEMI, STEMI
44
How to make a dx in ACS?
1. ECG - ST elevation = STEMI, no ST elevation = NSTEMI or unstable angina
2. Troponin level - raised = NSTEMI, normal = unstable angina
45
Sx of ACS?
Central, constricting chest pain with...
- Nausea/vomiting
- Sweating
- SOB
- Palpitations
- Pain radiating --> arm/jaw
46
What px might experience a silent MI?
diabetics
47
Why are troponins indicative of MI?
Released by myocytes after ischaemia
48
How to treat an acute STEMI?
Primary percutaneous coronary intervention, thrombolysis - should be treated within 12hrs
49
Example of thrombolytic agents?
Streptokinase
50
Complications of MI? DREAD
```
Death
Rupture of heart septum
Edema (heart failure)
Arrhythmia, aneurysm
Dressler's syndrome
```
51
What is Dressler's syndrome?
Post-myocardial infarction syndrome (2-3 weeks after MI) - localised immune response that causes pericarditis (presents with pleuritic chest pain, fever)
52
Most common cause of mitral stenosis?
rheumatic heart disease
53
sx of mitral stenosis
dyspnoea, reduced exercise tolerance, haemoptysis
54
What is rheumatic heart disease?
Infection by group A streptococcus pharyngitis
55
How might mitral stenosis --> AF? R heart failure?
Raised pressures in the L atrium --> atrial enlargement + increased pressure predisposes to AF and atrial thrombosis. Raised atrial pressures --> raised pulmonary HTN --> R sided heart failure
56
What is the Q risk score?
Lifetime risk of cardiovascular disease development
57
Who with HTN is offered treatment?
1. Everyone with stage 2 (160/100mmHg)
| 2. Stage 1 (140/90) <80 and Q risk score >10%
58
How does HTN mx differ for afro-caribbeans?
Similar to >55, 1st tx = CCBs
59
Biggest rf for cardiac failure?
IHD
60
Normal systolic ejection fraction? In systolic heart failure?
60-65%, <40%
61
Categories of heart failure
Systolic/diastolic (impaired ejection/filling)
Left/right
Acute/chronic
62
Px of heart failure
3 cardinal symptoms - SOB, fatigue, ankle swelling (peripheral oedema)
Fatigue, dyspnoea, orthopnoea, pulmonary oedema, raised JVP
63
What are you looking for in a blood test with a patient with heart failure?
B-type NP - released due to myocardial wall stress --> systemic vasodilation --> less effort for heart
64
MX of chronic heart failure - ABCD other
```
ACE-I/ARBs - ramipril
Beta-blockers - bisprolol
CCBs- amlopidine
Diuretics - Indamapide
Other - Digoxin
```
65
1st line test for cardiac failure
Blood test for BNP
66
shockable cardiac arrest rhythms?
ventricular tachycardia and ventricular fibrillation (use defibrillation)
67
Tx for tachycardia unstable arrhythmia?
1. 3 synchronised shocks
| 2. amiodarone infusion
68
Tx for stable tachycardia arrhythmia px --> narrow complex (QRS <0.12s)
AF - rate control with BB
Atrial flutter - "
Supraventricular tachycardias - treat with vagal manoeuvres and adenosine
69
Tx for stable tachycardia arrhythmia px --> broad complex (QRS >0.12s)
Ventricular tachycardia - amiodarone infusion
| SVT with bundle branch block - tx as normal SVT
70
Atrial flutter
Re-entrant rhythm in either atria (electrical signals re-circulates due to extra electrical pathway) --> signal goes round and round the atria, atrial contraction at 300bpm. Each signal enters the ventricles every second lap (150bpm ventricular contraction) - ECG sawtooth appearance, P wave after P wave
71
Supraventricular tachycardia
Caused by the signal from the ventricles, re-entering the atria, thus travelling through the AVN --> another ventricular contraction
72
2 main types of SVT (based on source of signals)?
1. Atrioventricular nodal re-entrant tachycardia (re-entry through AVN)
2. Atrioventricular re-entrant tachycardia (extra accessory circuit)
73
What does a SVT look like on an ECG?
- Narrow QRS <0.12s
| - QRS followed immediately by a T wave
74
What is Wolff-Parkinson White syndrome?
Atrioventricular re-entrant tachycardia
75
Px of AFib (PIS)?
1. Palpitations, racing heart
2. Irregularly irregular pulse
3. SOB, lightheadedness
76
ECG AF
Absent P waves
| Irregular, rapid QRS complex
77
TX for SVT
1. Continuous ECG monitoring
2. Valsalva manoeuvre
3. Carotid sinus massage
4. Adenosine/ verapamil
5. Current cardioversion
78
What is the valsalva manoeuvre?
Blowing really hard into a syringe in attempt to reset heart to sinus rhythm
79
1st line drug for SVT?
Adenosine
80
Wolf-Parkinson White syndrome
= arrhythmia that has an accessory electrical pathway that connects the atria and the ventricles
81
tx for Wolf-Parkinson White syndrome
Radiofrequency ablation of the extra circuit
82
ECG changes for Wolf-Parkinson White syndrome
- Short PR interval
- Wide QRS
- Delta wave
83
Causes of prolonged QT interval syndrome?
Idiopathic, drugs e.g. antipsychotics
84
Prolonged QT interval
ECG finding of prolonged repolarisation, therefore in this period, random depolarisations occur called "afterdepolarisations"
85
Prognosis of prolonged QT interval
Self-limiting, or will progress to ventricular tachycardia (can lead to cardiac arrest)
86
Ventricular ectopics
Premature ventricular beats caused by random electrical discharges outside the area, often present of random brief palpitations
87
Tx for ventricular ectopics?
In healthy people, no tx
| In other heart conditions - expert advice
88
ECG presentation for 1st AVN heart block
PR interval prolonged, >0.22s
89
2nd degree AV heart block
SOME atrial impulses do not make it through
| Mobitz type I (wenkebach) and type II
90
Mobitz type I/Wenkebach block
Longer PR interval --> QRS dropped, repeat
91
Mobitz type II
Constant prolonged PR --> drop
92
3rd degree AV heart block
No impulses pass from atria --> ventricle, ventricular contractions are completely independent, risk of asystole
93
Tx for bradycardias/stable AV block?
Observation
94
Tx for unstable AV block
IV atropine (increase heart rate)
95
AF
Contraction of atria is uncoordinated, rapid and irregular, due to disorganised electrical activity
96
AF increases risk of?
Embolic stroke
97
Differentials for irregularly irregular pulse?
AF, ventricular ectopics
98
Tx for rate control in AF
1. Beta-blockers
2. CCBs
3. Digoxin (if sedentary)
99
When can rhythm control be offered to AF patients?
When the cause is reversible, is of new-onset, AF is causing heart failure - electrical or pharmacological cardioversion
100
Anticoagulation for AF
1. Warfarin
| 2. DOACs - apixaban, rivaroxaban
101
How does acute LVF present?
Rapid onset breathlessness, worse lying down (orthopnoea), better sitting up
102
Why might you have an enlarged vein in your neck with R sided heart failure?
raised jugular venous pressure
103
Mx for L sided heart failure (Pour SOD)
1. Pour away (stop) any IV fluids
2. Sit up
3. Oxygen
4. Diuretics
104
Risk factors for Infective endocarditis
Prosthetic valves, congenital cardiac defect, damage to valves from rheumatic heart disease, IV drug abuse, poor dental hygiene
105
Pathophysiology of Infective endocarditis
characterised by formation of infected vegetations of heart valves, px has underlying cardiac disease allowing for the adherence of bacteria
106
What is Infective endocarditis
Infection of the endocardial surface of the heart
107
Infective endocarditis px
Fever, cardiac murmur, Janeway lesion, Oslers nodes, Splinter haemorrhages
108
Ix for Infective endocarditis
Blood cultures and echocardiography
109
Modified Dukes Criteria?
diagnostic tool for infective endocarditis
110
Dx infective endocarditis?
Blood cultures, echocardiogram
111
Tx infective endocarditis?
Antibiotics, cardiac surgery
112
Pericarditis? late complication of PC?
inflammation of the pericardium, idiopathic, acute pericarditis can complicate into constrictive pericarditis (heart encased in rigid pericardium)
113
Px of pericarditis?
Chest pain, better sitting up, fever, dyspnoea, pericardial rub
114
ECG of pericarditis?
saddle shaped ST elevations
115
Mx of pericarditis?
NSAIDs, colchicine
116
Constrictive pericarditis
Complication of pericarditis, rigid pericardium, impedes diastolic filling, Kussmaul's sign, ascites, oedema, R heart failure. Mx by pericardium resection
117
All cardiomyopathies carry risk of?
arrhythmia
118
What can pericardial effusion become?
cardiac tamponade - when fluid becomes so much it affects the filling
119
Rheumatic fever
Systemic infection by streptococcal pharyngitis (throat inflammation), the antibodies produced by to the carbohydrate cell wall of the streptococcus cross-react with the valve tissue in the heart --> permanent valve disease
Px - tachycardia, murmurs, fever
120
Px with abdominal or thoracic aneurysms need rigorous control of?
Blood pressure
121
How does aortic dissection occur?
Tear in the intima, blood penetrates layers, forces the layers apart - medical emergency
122
Px of aortic dissection
Sudden onset crushing chest pain (may radiate, mimicking an MI), HTN, shock, aortic regurgitation
123
Mx of aortic dissection
1. HTN drugs to reduce BP
2. Analgesia
3. Surgery to replace
124
What defines aortic aneurysm?
Dilatation of the aortic to twice the normal diameter
125
Dilated CM
dilated ventricles, genetic mutation, cardiac myocytes = weak, impairs contractility, reduces systolic function
126
Hypertrophic CM
Interventricular septum in particular has hypertrophied --> filling issues, diastolic dysfunction (cause of sudden cardiac death in young people)
127
Restrictive CM
Heart muscles --> stiff, infiltrative diseases cause stiffness
128
Tx for CM
Same for cardiac failure (CCBs, Beta blockers) + AF, amiodarone - anti-arrhythmatic agents
129
Px of dilated CM
SOB, fatigue, dyspnoea, (like heart failure), arrhythmias
130
Dx for valvular disease?
echocardiogram
131
examples of CCBs
Amlopidine, verapamil
132
X-ray findings in heart failure - ABCDE
```
A - alveolar oedema
B - Kerley B lines
C - cardiomegaly
D - dilation of upper lobe vessels
E - pleural effusions
```
133
What would show an ST elevation on an ECG?
STEMI, prinzmetal angina, pericarditis
134
Prinzmetal angina
spasm in the coronary artery recurrent angina at rest, transient ST elevations on ECG
135
Difference between BNP and ANP
both indicative of HF, ANP released mainly from the atria in response to stretch, and BNP from ventricles
