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Priority 1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What do we need to know about a patient with hypertension?

A 
Any symptoms?
Age
Sex
Ethnicity
Family history
Weight/BMI
Diet (salt)
Smoking
Alcohol
Exercise
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2
Q

Examinations in hypertension

A

Obs (BP, pulse)
Cardio
Fundoscopy

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3
Q

Sings and symptoms of hypertension

A 
Headaches +/- blurred vision
Acute LVH
Acute renal failure/worsening CKD
Haemorrhagic stroke
Hypertensive encephalopathy 
Microangiopathic haemolytic anaemia
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4
Q

Define gestational hypertension

A

Elevated BP >20wks gestation without proteinuria

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5
Q

Causes of hypertension

A

95% essential
Genetics
Environment (stress, diet, intrauterine environment)

5% secondary causes (typically young pts)
Chronic renal diseases 
Renin release
Coarctation of aorta
Endocrine diseases 
Raised intracranial pressure
Toxaemia of pregnancy
Drugs (steroids, COCP, NSAIDs, lithium, cocaine, amphetamines)
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6
Q

Pathophysiology of hypertension

A

Atherosclerosis:
Plaque formation, intimal lipid deposition and resultant inflammation

Arteriosclerosis:
Hardening of artery/arteriole

Hyaline arteriosclerosis:
SMC in media replaced by collagen and deposition of plasma proteins

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7
Q

Investigations for hypertension

A 
BP
Pulse
Cardio exam
Fundoscopy
Home BP readings

Bloods:
U&Es, cholesterol, HbA1c, renin, aldosterone

Urine:
Dip, ACR, urinary free cortisol

ECG

Imaging:
Renal USS, MR aortogram

Retinal screening

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8
Q

Principles of hypertension management

A

Treat anyone with BP >150/100mmHg

Treat at risk with BP >140/90mmHg

At risk:
80yrs/CVS/DM/renal disease/20% QRISK2

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9
Q

Hypertension drugs

A

ACE inhibitors (ramipril)

Calcium channel blockers

Thiazide like diuretics

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10
Q

Indications for statins prescription

A 
Established CVS 10yr risk 10%
10yr history of DM
DM + renal disease
Raised LDL
DM aged 40-75
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11
Q

Define heart failure

A

Clinical syndrome characterised by typical symptoms that may be accompanied by signs

Caused by structural and/or functional cardiac abnormality

Resulting in reduced CO and/or elevated intracardiac pressures at rest or during stress

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12
Q

Signs and symptoms of heart failure

A

Symptoms:
Breathlessness, ankle swelling, fatigue

Signs:
Elevated JVP, pulmonary crackles, peripheral oedema

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13
Q

Pathophysiology of heart failure

A

Injury:
HTN, ischaemia, valve disease

Pump dysfunction:
Pressure overload (hypertrophy), volume overload (dilation of heart), RAAS activation and fluid overload
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14
Q

NYA classification of heart failure

A

Class I:
No SOB with normal activity

Class II:
Slight limitation with normal activity (comfortable at rest but physical activity produces symptoms)

Class III:
Marked limitation of normal activity - comfortable at rest but any activity produces symptoms

Class IV:
SOB with minimal exertion or at rest

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15
Q

Classifications of heart failure

A

L vs R

Systolic vs diastolic

Low vs high output

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16
Q

Define systolic heart failure and its causes

A

HF with reduced EF

Failure of contraction and pumping action of the ventricle during systole

Ventricle dilated

EF reduced <40% (normally 50-70%)

Causes:
IHD, MI, cardiomyopathy

17
Q

Define diastolic heart failure and its causes

A

HF normal EF

Failure of ventricle to relax and fill adequately due to increased wall stiffness

Seen in older pts, female with HTN.

Causes:
Age, HTN, constrictive pericarditis, tamponade, restrictive cardiomyopathy

18
Q

Define low output heart failure and its causes

A

Decreased CO and failure to increase normally with exertion

Causes:
Pump failure, decreased HR, (chronic) excessive overload

19
Q

Define high output heart failure and its causes

A

Normal or increased in face of increased needs, failure to occur when CO fails to meet these needs

Causes:
Anaemia, pregnancy, hyperthyroidism, Paget’s disease, AVM, beri-beri

20
Q

Right heart failure (acute) presentation + causes

A

Presents with circulatory collapse, shock/instant death

Causes:
Massive PE or MI involving RV but sparing LV

21
Q

Right heart failure (chronic) presentation + causes

A

Presents with peripheral oedema, raised JVP, hepatomegaly, ascites

Causes:
Lung pathology (cor pulmonale), COPD, pulmonary fibrosis, recurrent small PEs, LHF, LR shunting causing hypertrophy
22
Q

Define left heart failure

A

A syndrome which occurs when the pumping action of the heart is inadequate for the needs of the body

(Cardiac output unable to meet needs of body)

23
Q

Left heart failure (acute) presentation + causes

A

Presents with acute pulmonary oedema

Causes:
Almost always complications of MI affecting LV
Extensive MI renders large volume of LV non-functional, rupture of mitral valve papillary muscle, development of arrhythmias

24
Q

Left heart failure (chronic) presentation + causes

A

Presents with dyspnoea/orthopnoea/PND, poor exercise tolerance & fatigue, nocturnal cough +/- pink frothy sputum, wheeze (cardiac asthma), nocturia, cold peripheries, weight loss, muscle wasting, hemosiderin laden macrophages

Causes:
Almost always chronic LVF
LV damaged slowly over time by chronic IHD due to atherosclerosis, systemic HTN, valvular heart disease

25
Q

What is the most common form of heart failure?

A

Chronic left sided heart failure

26
Q

Acute bi-ventricular (congestive) heart failure presentation

A

Severe pulmonary oedema

Chronic congestive heart failure patients may decompensate if heart is stressed - causing acute episodes

27
Q

Chronic bi-ventricular (congestive) heart failure

A

CO insufficiency for body’s requirements

Congestive cardiac failure = L+R HF, symptoms of both, breathlessness and fluid retention

28
Q

Risk factors for chronic bi-ventricular (congestive) heart failure

A 
MI
DM dyslipidaemia
Age
Male
HTN
LV dysfunction
Cocaine/toxins
Renal insufficiency
Valvular heart disease
Sleep apnoea
Elevated homocysteine
Elevated TNF-alpha
IL-6, CRF & natriuretic peptides
Decreased IGF-1
LVH
Family history HF
AF
Thyroid disorders
Low socioeconomic status
Tobacco
Excess alcohol & coffee
Tachycardia
Obesity
Depression/stress
Microalbuminuria
Anaemia & large AV fistula
29
Q

Complications of chronic bi-ventricular (congestive) heart failure

A 
Pleural effusion
Chronic renal insufficiency
Anaemia
Acute decompensation
Acute renal failure
Sudden cardiac death
30
Q

Causes of acute bi-ventricular (congestive) heart failure

A 
Concurrent illness
MI and consequences
Arrhythmias
Uncontrolled HTN
Valve disease
Non-compliance with fluid restriction
Diet or medication
Anaemia
Hyperthyroidism
Excessive fluid/salt intake
Medications causing fluid retention
31
Q

Define ischaemic heart disease

A

Spectrum of heart disease which results from coronary artery atherosclerosis

Includes stable angina, ACS and sudden cardiac death

32
Q

Modifiable risk factors for ischaemic heart disease

A 
BP
DM control
RA
Smoking
Diet
BMI
Exercise
LDL control
HDL control
TC/HDL cholesterol ratio
33
Q

Unmodifiable risk factors for ischaemic heart disease

A

Family history
Sex
Age
Ethnicity

34
Q

Pathophysiology of chronic ischaemic heart disease

A 
Low grade chronic ischaemia -> 
Fine diffuse fibrosis -> 
Decreased contraction -> 
Compensates by hypertrophy of remaining myocytes ->
Eventual decompensation
35
Q

Signs and symptoms of stable angina

A 
Induced by effort, relieved by rest
SOB
Pre-syncope
Nausea & vomiting
Non-pleuritic, positional, tender
Central pain
Tightness/heaviness
Radiates to one or both arms
Sweatiness, faintness
Lasts <20 mins (typically 1-2)
Relieved at rest / GTN
36
Q

Causes of stable angina

A

Gradually enlarging atherosclerotic plaque in a coronary artery causing gradually progressive stenosis

Rare causes: 
Anaemia
Tachyarrhythmias
Hypertrophic obstructive cardiomyopathy
Arteries/small vessel disease
37
Q

Investigations for stable angina

A

ECG
ST depression
Flat/inverted T waves
Signs of past MI

CT coronary angiogram,
Coronary angiogram
Stress testing
Myocardial perfusion imaging

Exclude precipitating factors:
Anaemia
Diabetes
Hyperlipidaemia
Thyrotoxicosis
Temporal arteries
38
Q

Management of stable angina

A

Modify risk factors:
Lifestyle
Exercise
Weight loss

First line:
Beta blockers/Ca channel blockers

Monotherapy:
Add 2nd agent e.g. atenolol, dilitiazem or verapamil

All to receive aspirin, statin, nitrates
Surgical revascularisation - CABG

39
Q

Stable angina triad of symptoms

Canadian Cardiovascular Society

A

3/3 typical angina,
2/3 atypical angina
1/3 non-angina - consider other diagnosis

Pain in retrosternal/neck/shoulders (T1-5 fibres)/jaw/arm

Provoked by exertion

Relieved by rest or GTN in 5 mins

Priority 1 (17 decks)

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