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Cardiovascular Conditions Flashcards

1
Q

What are the three main conditions that comprise Acute Coronary Syndrome?

A

Unstable Angina
NSTEMI
STEMI

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2
Q

What are the main differences between stable and unstable angina?

A

In STABLE angina, pain is experienced on exertion with relief from GTN
In UNSTABLE angina, pain is experienced at rest and is not necessarily relieved by nitrate use.

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3
Q

Who is most likely to be affected by angina?

A

Those over the age of 55- prevalence increases with age

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4
Q

What are the main causes of angina?

A

CORONARY ARTERY DISEASE

VALVULAR DISEASE- e.g. aortic stenosis, hypertrophic obstructive cardiomyopathy, hypertensive disease)

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5
Q

What are the main risk factors of angina?

A

NON-MODIFIABLE- ethnicity (south asian origin), gender (male), family history
MODIFIABLE- smoking, obesity, lack of exercise
PMH- diabetes, hypertension, hyperlipidaemia, metabollic syndrome.

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6
Q

What is the main presentation of angina?

A

CONSRICTING CHEST PAIN- found in the front of the chest, in the neck, shoulders, jaw or arms.
Precipitated by physical exertion (stable)
Relieved by rest or GTN (stable)

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7
Q

What are the clinical signs associated with angina?

A

On ECG, pathological Q waves, st- segment and t wave abnormalities.

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8
Q

What are some of the differentials for angina?

A 
MI
Unstable angina
Dissecting thoracic aneurysm
Pericardial pain
Acute congestive heart failure
Arrhythmias
Other causes: GI, MSK, Psych., Respiratory
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9
Q

What investigations would be most appropriate for suspected angina?

A

IMAGING: ECG, ECHO
BLOODS: FBC, LFTS, TFTS, glucose, troponin (<14ng/l is normal), cardiac enzymes.

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10
Q

What is the best mode of treatment for stable angina?

A 
GTN spray
Rest
Beta-Blockers- Bisoprolol
Calcium Channel Blockers- Amlodipine
Lifestyle changes for the modifiable risk factors as diet, smoking cessation.
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11
Q

What is the immediate treatment in unstable angina?

A

Use of aspirin and fondaparinux.

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12
Q

In the event of first line treatment not working for angina, what is the next step (following nitrates and aspirin etc)?

A

Coronary revascularization- PCI, coronary bypass.

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13
Q

Who is most likely to be affected by atrial fibrilation?

A

Those with increasing age tend to experience AF

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14
Q

What is AF?

A

It is an arrhythmia wherein there is an irregularly irregular beating of the heart. It leads to inefficient ventricular filling and therefore reduced cardiac output.

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15
Q

What are the main causes of atrial fibriliation?

A

Valvular heart disease
Ischaemic heart disease
Hypertension
Hyperthyroidism

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16
Q

What are the main risk factors associated with atrial fibrilation?

A

NON-MODIFIABLE- gender (male), family history
MODIFIABLE- obesity, caffeine intake, excessive alcohol intake, smoking
PMH- diabetes, ckd, valvular conditions (rheumatic heart disease, sick sinus syndrome, Wolff-Parkinson-White syndrome).

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17
Q

What are the main symptoms associated with atrial fibrilation?

A 
Dyspnoea
Palpitations
Syncope
Chest discomfort
Stroke/TIA
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18
Q

Clinical signs of atrial fibrilation?

A

ABSENT P WAVES

irregularly irregular waves.

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19
Q

Some of the differential diagnoses for atrial fibrilation include:

A

Atrial flutter, atrial extrasystoles, ventricular ectopic beats, sinus tachycardia, SVT, multifocal atrial tachycardia, Wolff-Parkinson-Syndrome

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20
Q

Which investigations are appropriate for suspected atrial fibrilation?

A

IMAGING: ECG, ECHO
BLOODS: FBC, LFTs, TFTs, glucose, cardiac enzymes.

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21
Q

What are the treatment options for atrial fibrilation?

A

RATE + RHYTHM CONTROL- standard beta-blocker (bisoprolol/atenolol) and a calcium channel blocker- amlodipine)
cardioversion/ablation
THROMBOPHYLAXIS
ANTICOAGULATION

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22
Q

What are the complications associated with atrial fibrilation?

A

Increased risk of stroke

Acute heart failure

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23
Q

What constitutes heart failure?

A

It is the inability of the heart to pump efficiently. This means that there can either be systolic dysfunction (affecting cardiac output), or diastolic dysfunction (improper filling of the atria or ventricles).

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24
Q

Who is more likely to be affected by congestive heart failure?

A

It is frequent in MEN and in the ELDERLY

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25
What are some of the causes of heart failure?
Coronary heart disease Hypertension Valvular heart disease Cardiomyopathies Arrhythmias IATROGENIC- beta-blockers, calcium antagonists, anti-arrhytmics, cytotoxics TOXINS- alcohol, cocaine, mecury cobalt, arsenic ENDOCRINE- diabetes, hyper/hypothyroidism, Cushing's, phaeochromocytoma, excessive growth hormone, adrenal insufficiency NUTRITIONAL- deficiencies of thiamine, selenium, carnitine, obesity, cachexia INFILTRATIVE- sarcoidosis, amyloidosis, haemochromatosis, Löffler's eosinophilia, connective tissue disease) INFECTIVE- Chaga's disease, HIV, beriberi
26
What are some risk factors associated with Congestive heart failure?
sleep apnoea excessive alcohol intake smoking
27
What are the key presentations stated in heart failure?
``` Dyspnoea Fatigue Fluid retention Peripheral oedema in the legs and sacrum Orthopnoea Paroxysmal Nocturnal dyspnoea Nocturia, cold peripheries, weight loss, muscle wasting Right ventricular failure ```
28
What are the clinical signs of heart failure?
``` Tachycardia at rest Low systolic BP RV heave raised JVP Gallop rhythm Bilateral basal inspiratory crackles Pleural effusion Tender hepatomegaly Framingham criteria New York scoring system ```
29
What are some differential diagnoses associated with heart failure?
DYSPNOEA-COPD, Asthma, PE, lung cancer, Anxiety | PERIPHERAL OEDEMA- nephrotic syndrome, hypoalbuminaemia.
30
Which investigations are useful in suspected heart failure?
BLOODS: BNP (beta natriuretic peptide- hormone released with the stretch of ventricles e.g. in fluid overload). Quite good indicator. IMAGING: ECHO, ECG, CXR, cardiac MRI, angiography, CT.
31
What is the best treatment for heart failure?
ACEi- these improve ventricular function (-pril) IV-DIURETIC- for combating fluid retention, (spironolactone =k+sparing) BETA-BLOCKER- (bisoprolol, atenolol) ARBs- (-artans) DIGOXIN VASODILATORS- isosorbide mononitrate
32
How often does deep vein thrombosis occur and who is most likely to be affected by it?
It happens to 25-50% pf surgical patients and mostly in MALES over the age of 60
33
What is the cause of DVT?
Reduced blood flow causing unnecessary clotting.
34
What are the risk factors associated with DVT?
NON-MODIFIABLE- acquired/familial thrombophilia MODIFIABLE- obesity, dehydration, smoking, immobilisation PMH- cancer, previous VT, heart failure, varicose veins, pregnancy
35
What are the clinical presentations of DVT?
CALF WARMTH, TENDERNESS, SWELLING Pitting oedema Distention of superficial veins Mild fever
36
What are the clinical signs of DVT?
Above 2 on the Well's score | Raised D-dimer
37
What are some differential diagnoses associated with DVT?
``` Physical trauma Cardiovascular disorders Ruptured Baker's cyst Cellulitis Septic arthritis Cirrhosis Nephrotic syndrome ```
38
What are the investigations used for suspected deep vein thrombosis?
BLOODS: FBC, LFTs, d-dimer IMAGING: CXR, CT abdomen/pelvis, USS
39
What is the treatment necessary for DVT?
ANTICOAGULATION- LWMH (heparin), fondaparinux, NOACs. | Prevention- graduated compression stockings
40
What is involved in the Wells assessment?
One point for any of these: - active cancer - bedridden for 3 or more days - localised tenderness of deep venous system - paralysus, paresis, recent immobilisation of leg - swelling of the entire leg - calf swelling by more than 3cm - pitting oedema in symptomatic leg - previous DVT - collateral superficial veins.
41
Who is most likely to be affected by essential/primary hypertension?
Those of Afro-Caribbean descent
42
What are the risk factors associated with primary hypertension?
NON-MODIFIABLE- Age, ethnicity, family history | MODIFIABLE- obesity, inactivity, smoking, alcohol, stress, high salt/ low potassium/ low vitamin D
43
What are the clinical signs of essential hypertension?
Blood pressure measuring >140/90mmHg should be watched | >160/100mmHg counts as stage 2 hypertension
44
What investigations should be done in essential hypertension?
Urine dipstick for protein and blood Serum creatinine, electrolytes and eGFR IMAGING: Renal USS, 12 lead ECG, ECHO
45
What treatments should be issued for hypertension?
ANTI-HYPERTENSIVES- ACEi (-prils), CCB (-dipines), ARB (-artans), BETA-BLOCKERS (-olols), A-BLOCKERS (doxazosin) Lifestyle changes
46
Who is affected by left ventricular failure?
those over 65 years
47
What is the main cause of left ventricular failure?
``` Arrhythmias Cardiomyopathies High output states Volume overload Hypertension CHD MI ```
48
What are the risk factors associated with left ventricular failure?
NON-MODIFIABLE- family history MODIFIABLE- obesity, smoking, alcohol PMH- diabetes
49
What are the symptoms associated with left ventricular failure?
``` Breathlessness PND Fluid retention Fatigue Light headedness/syncope ```
50
What are some of the clinical signs associated with left ventricular failure?
``` Tachycardia laterally displaced apex beat raised JVP hepatomegaly tachypnoea, basal creps, pleural effusion dependent oedema ```
51
What are the differential diagnoses associated with left ventricular failure?
DYSPNOEA-COPD, Asthma, PE, lung cancer, Anxiety | PERIPHERAL OEDEMA- nephrotic syndrome, hypoalbuminaemia, pelvic tumour
52
Which investigations are appropriate in left ventricular failure?
BLOODS: BNP (beta natriuretic peptide- hormone released with the stretch of ventricles e.g. in fluid overload). Quite good indicator. IMAGING: ECG, CXR (cardiomegaly, blunt costophrenic angles, septal Kerley B lines)
53
What is the best treatment for left ventricular failure?
ACEi- these improve ventricular function (-prils) IV-DIURETIC- Furosemide, Spironolactone (k+sparing) BETA-BLOCKER- (bisoprolol, atenolol) ARBs- (-artans) ALPHA-BLOCKER- doxazosin
54
What is the main cause of myocardial infarction?
Coronary heart disease
55
What are the risk factors in myocardial infarction?
NON-MODIFIABLE- family history, gender (male) MODIFIABLE- obesity, smoking, alcohol PMH- diabetes, hypertension
56
What are the symptoms associated with myocardial infarction?
``` Breathlessness Chest pain - CENTRAL/EPIGASTRIC - RADIATING TO ARMS, SHOULDERS, NECK - SUBSTERNAL PRESSURE - RADIATION TO THE LEFT SIDE ```
57
Clinical signs of myocardial infarction include:
``` Low grade fever Hypo/hypertension 3rd and 4th heart sounds Raised JVP Peripheral oedema ```
58
What are some differential diagnoses associated with myocardial infarction?
CVD- angina, acute pericarditis, myocarditis aortic stenosis, aortic dissection RESP.- PE, pneumonia, pneumothorax GI- oesophageal spasm, GORD, cholecystitis, acute pancreatitis MSK
59
What investigations are appropriate for suspected MI?
BLOODS: troponin, CRP, IMAGING: ECG, ECHO, CXR, angiography
60
What can be signs of MI can be seen on ECG?
- ST elevation - reciprocal ST depression - pathological Q wave depression
61
What is the difference between NSTEMI and STEMI?
STEMI is worse and invloves TRANSMURAL infarcation | NSTEMI has less infarction and covers a smaller region
62
What is the primary treatment for an acute MI?
MONAT Morphine (pain relief) Oxygen in reduced sats and heart failure Nitrates (GTN, IV Nitrate, sublingial, buccle) Aspirin (cox inhibitor and antiplatelet) Ticagrelor (antiplatelet, better than clopidogrel) Streptokinase (thrombolytic) then PCI ALSO GIVE ANTIEMETIC (metaclopramide)
63
What treatment is used in secondary prevention of MI?
ATORVASTATIN 80mg, helps with plaque stabilization BETA BLOCKER- bisoprolol, propanolol, lowers heart rate ACEi- ramipril

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