Cardiovascular Disease Cards Flashcards
(124 cards)
1
Q
What is angina
A
A form of stable ischaemic heart disease - a mismatch of oxygen demand and supply
2
Q
What is the main cause of angina
A
Atheroma
3
Q
Name a few predisposing factors to ischaemic heart disease
A
Cigarette smoking Diabetes mellitus Hyperlipidaemia Hypertension Family history
4
Q
What is the incidence of angina for men
A
35 per 100,000 per year
5
Q
What is the incidence of angina for women
A
20 per 100,000 per year
6
Q
What are the main symptoms of angina
A
Chest pain
Breathlessness
7
Q
What are two managements/treatments of angina that dont involve drugs
A
Alteration of lifestyle
Modification of risk factors
8
Q
Name some common types of drugs used to treat angina
A
Aspirin Beta-blockers Calcium channel blockers Statins ACE-inhibitors Nitrates
9
Q
When medication fails what two other options are there to treat angina
A
Percutaneous coronary intervention (PCI) = stents
Coronary artery bypass graft (CABG) = graft from vein in chest or leg replaces blocked coronary artery
10
Q
What is the clinical classification of unstable angina (3 things)
A
Cardiac chest pain at rest
Cardiac chest pain with crescendo pattern
New onset angina
11
Q
What diseases does ‘acute coronary syndromes’ include
A
Unstable angina and evolving MI
12
Q
What troponin levels suggests unstable angina
A
No significant rise in troponin levels
13
Q
What is a myocardial infarction
A
Cell death of myocardial cells due to lack of oxygen
14
Q
What are the common symptoms of an MI
A
Acute central chest pain>20mins Nausea Sweatiness Dyspnoea Palpitations
15
Q
What are the common signs of an MI
A
Distress Pallor Change in pulse rate Change in BP 4th heart sound
16
Q
Name 3 non-modifiable risk factors for MI
A
Age
Sex
FH of IHD
17
Q
Name 3 modifiable risk factors for MI
A
Smoking Hypertension Diabetes Hyperlipidaemia Obesity Inactive lifestyle
18
Q
What is the incidence of MI
A
5 per 1000 per year
19
Q
What is the mortality of MIs
A
50% die within 2 hours of symptoms
20
Q
What is commonly seen on an ECG if MI has occurred
A
ST segment elevation
21
Q
What tests are done in hospital before giving any drugs if MI suspected
A
ECG
High flow oxygen mask if hypoxic
IV access for bloods
Brief assessment
22
Q
What drugs are given after a brief assessment of an MI (5 things)
A
Aspirin 300mg chewed Morphine 5-10mg + antiemetic GTN sublingually 2 puffs Beta-blocker e.g. Atenolol 5mg IV Thrombolysis
23
Q
What are complications of MI
A
Cardiac arrest - cardiogenic shock Unstable angina Bradycardia or heart block LV/RV heart failure DVT and PE
24
Q
What is cardiomyopathy
A
Primary heart muscle disease
25
Types of cardiomyopathy include
```
Hypertrophic
Dilated
Restrictive
Arrhythmogenic RV dysplasia
Takotsubo
```
26
What is hypertrophic cardiomyopathy
Portion of the heart muscle becomes thickened with no obvious cause
27
What is hypertrophic cardiomyopathy caused by
Sarcomeric protein gene mutations
28
What are the symptoms of hypertrophic cardiomyopathy
```
Angina
Dyspnoea
Palpitations
Dizzy spells
Syncope
```
29
What is the management of hypertrophic cardiomyopathy
Beta-blockers for symptoms
| Consider implantable defibrillator
30
What is dilated cardiomyopathy
The heart becomes enlarged and cant pump blood effectively
31
What is dilated cardiomyopathy often caused by
Cytoskeletal gene mutations
32
What symptoms does dilated cardiomyopathy present with
Heart failure symptoms: SOB, fatigue, pulmonary oedema
33
What is the main feature of atthymogenic cardiomyopathy (ARVD/ALVD)
Arrhythmia
34
What is arrhythmogenic cardiomyopathy caused by
Desmosome gene mutations
35
What is cardiac failure
Cardiac output and BP are inadequate for the body's requirements
36
What are the 3 cardinal symptoms of heart failure that are non-specific
SOB
Fatigue
Ankle swelling
37
What are the causes of low output heart failure
Ischaemia
Hypertension
Valve disorders
Increased alcohol use
38
What are symptoms specific to LV heart failure
Dyspnoea, poor exercise tolerance, fatigue, muscle wasting, cold peripheries
39
What are symptoms specific to RV heart failure
Peripheral oedema, abdominal distension (ascites), pulsation in neck and face, facial engorgement
40
What are the heart failure stages: ABCD
A: high risk developing HF
B: asymptomatic HF
C: symptomatic HF
D: end-stage HF
41
Name 5 medications given to manage HF
```
Diuretics (reduce oedema)
ACE-inhibitors
Beta-blockers (start low and go slow)
Hydralazine and nitrates (dilators)
Digoxin
```
42
What is acute decompensated congested heart failure
Sudden worsening of the signs and symptoms of heart failure
43
What are common causes of acute decompensated congested heart failure
```
Acute MI
Uncontrolled increase in BP
Obesity
AF and arrhythmias
NSAIDS
```
44
What are the symptoms of DVT
Pain
| Swelling
45
What are the signs of DVT
Tenderness
Swelling
Warmth
Discolouration
46
What are the risk factors for DVT
Surgery, immobility, leg fracture
OC pill, HRT, pregnancy
Long haul flights
Inherited thrombophilia
47
What are 2 investigations for DVT
1. D-dimer (normal excludes diagnosis)
| 2. Ultrasound compression - test proximal veins
48
What are the treatments for DVT and PE
LMW heparin minimum 5 days
Oral warfarin 6 months
Compression stockings
Treat/seek underlying cause
49
What are the mechanical preventions of DVT and PE
Hydration and early mobilisation, compression stockings, foot pumps
50
What are the chemical preventions of DVT and PE
LMW heparin
51
What are the symptoms of PE
Breathlessness
Pleuritic chest pain
Signs/symptoms of DVT
Risk factors
52
What are the signs of PE
Tachycardia
Tachypnoea
Pleural rub
Precipitating cause
53
What does the CXR look like for PE
Normal
54
What are the blood gases like for PE
Decreased oxygen and carbon dioxide
55
Define shock
When the cardiovascular system is unable to provide adequate substrate for aerobic cellular respiration
56
Describe what someone in shock looks like
Skin is pale, sweaty, cold and vasoconstricted
May be confused, weak, collapsed, coma
Pulse is weak and rapid
Urine output reduced
57
Organs are at risk if hypotension occurs for too long during shock, what could happen to the kidneys, lungs, heart and brain?
```
Kidneys = acute tubular necrosis
Lungs = ARDS
Heart = ischaemia or MI
Brain = confusion, irritability, coma
```
58
What therapies in practice do you need to carry out when someone is in shock
A,B,C
Airways
Breathing (give 100% oxygen)
Circulation (IV access, give fluid or blood if blood loss)
59
In shock, what is the triad that patients normally die from
Coagulopathy
Hypothermia
Metabolic acidosis
60
Define cardiogenic shock
Failure of the heart to maintain the circulation
61
What can cause cardiogenic shock
```
Cardiac tamponade
PE
Acute MI
Fluid overload
Myocarditis
Arrhythmias
```
62
What is the management of cardiogenic shock
1. Oxygen
2. Diamorphine for pain and anxiety
3. Investigations
63
Define septic shock
When sepsis is complicated by persistent hypotension that's unresponsive to fluid resuscitation
64
Define anaphylactic shock
Intense allergic reaction with massive release of histamine and other vasoactive mediators causing haemodynamic collapse
65
Give 2 causes of hypovolaemic shock
Loss of blood
| Loss of fluid
66
Describe class 1 of the haemorrhagic shock classification
```
Blood loss 15%
Pulse <100
Normal BP and PP and RR
Slightly anxious
Urine output <30ml/hr
```
67
Describe class 2 of the haemorrhagic classification system
```
Blood loss 15-30%
Pulse >100
BP normal
Pulse pressure decreased
RR 20-30
Urine 20-30 ml/hr
Mildly anxious
```
68
Describe class 3 of the haemorrhagic classification system
```
Blood loss 30-40%
Pulse >120
BP decreased
PP decreased
RR 30-40
Urine 5-15 ml/hr
Confused
```
69
Why is arterial BP not a good indication of shock in young people
They compensate very well then only decrease BP when shock is really advanced
70
What should you test instead in a young person suspected to be in shock
Capillary refill time (CFT)
71
What 3 things are required for an acute respiratory distress syndrome (ARDS) diagnosis
Impaired oxygenation
Bilateral pulmonary infiltrates (blood, pus, protein...not air)
No cardiac failure
72
Define pericarditis
An inflammatory pericardial syndrome with or without effusion
73
The clinical diagnosis of pericarditis is made from 2 out of 4:
1. Chest pain 85-90%
2. Friction rub 33%
3. ECG changes 60%
4. Pericardial effusion up to 60% , usually mild
74
What is the most common cause of pericarditis
Viral infection
75
What are the non-infectious causes of pericarditis
Autoimmune - sjorgens syndrome, rheumatoid arthritis
Neoplastic - secondary tumours e.g.lung and breast
Metabolic - uraemia, myxoedema
Trauma - direct and indirect
76
What is the clinical presentation of pericarditis
Severe, sharp and pleuritic pain
Radiating to arm and trapezius ridge (phrenic)
Relieved by sitting forward and worse lying down
Dyspnoea
Cough
Hiccups (phrenic)
77
What does the ECG look like for someone who's got pericarditis
Concave ST segment
No reciprocal ST depression
Saddle shaped
PR depression
78
What is the management of pericarditis
NSAID or aspirin for pain
| Treat the cause
79
Define infective endocarditis
Infection of the heart valve/s
80
How do you catch IE
```
Abnormal valve (regurgitant or prosthetic)
Introduce infection into blood or heart during surgery
Previously had IE
```
81
How does IE present clinically
New regurgitant heart murmur
Embolic events of unknown origin
Sepsis of unknown origin
Fever
82
Who most commonly gets IE
Elderly
Young IV drug abusers
Young with congenital heart disease
Prosthetic heart valves
83
Name some typical MOs that can cause IE
Strep viridans, strep bovis, staph aureus, community acquired enterococci
84
What is the treatment for oral strep or group D strep that has caused IE
Penicillin
Amoxicillin
Ceftriaxone
85
What is the treatment for staph that has caused IE
(Flu) cloxacillin
| Oxacillin
86
Describe the two type of echocardiography that can be performed if IE is suspected
```
Transthoracic echo (TTE) - non invasive, safe, poor images so lower sensitivity
Transoesophageal each (TOE) - tube down throat, risk of aspiration/perforation, better images
```
87
What are the 4 peripheral stigmata seen in IE
Macular petechial and embolic skin lesions
Splinter haemorrhages
Osler nodes
Janeway lesions
88
Describe what splinter haemorrhages look like
Tiny red lines on the tips of fingernails
89
Describe what Osler nodes look like
Small red dots under the skin at the tips of the fingers
90
Describe what janeway lesions look like
Pink/red slightly larger patches all over hands and fingers
91
Describe what macular petechial and embolic skin lesions look like
Darker red/brown patches around hand and fingernails
92
What is the management of IE
Treat the infection based on blood culture results
Treat complications like arrhythmia, embolisms, stroke rehab
Surgery - if infection not cleared, replace infected devices, remove valve after infection cured
93
What is the HFREF type of heart failure
Heart failure with reduced ejection fraction
94
What is the ejection fraction in HFREF
<40%
95
What is HFPEF
Hear failure with preserved ejection fraction (>50%)
96
What is the main cause of heart failure
Myocardial dysfunction caused by IHD
97
What are some common symptoms of heart failure
SOB
Tiredness
Leg swelling
Cold peripheries
98
What sign is only seen in HF and mitral valve disease
Paroxysmal nocturnal dyspnoea
99
Name some types of drugs used to treat HFREF
ACE-inhibitors
Hydralazine and nitrates
Aldosterone agonists
Beta-blockers
100
What type of drug doesnt work as well in Afro-Caribbean race and what is given as well to people of that race
ACE-inhibitors dont work as well, hydralazine and nitrates work really well, so given in addition to ACE-i
101
Name an aldosterone agonist
Spironolactone (side effect of diuretic)
102
What is given to HFREF patients when ACE-i arent working
Sacubitril-Valsartan
103
What is aortic stenosis
Narrowing of the aortic valve
104
What are the 3 main things people with aortic stenosis present with
Syncope, angina, dyspnoea on exertion
105
What are the congenital causes and acquired causes of aortic stenosis
Congenital - bicuspid valve
| Acquired - degenerative calcification, rheumatic heart disease
106
What is the Tx for aortic stenosis
ECG assess severity
If asymptomatic then just surveillance
If symptomatic then aortic valve replacement
107
What is aortic regurgitation
Leakage of blood into the LV during diastole due to ineffective coaptation of the aortic cusps
108
What is the main cause of aortic regurgitation
Bicuspid aortic valve
109
What do you see on an X ray if there's aortic regurgitation
Enlarged cardiac silhouette and aortic root
110
What are the main symptoms of aortic regurgitation
Dyspnoea
Palpitations
Cardiac failure
111
What is mitral stenosis
Obstruction of LV inflow that prevents proper filling during diastole
112
What is the gold standard test for the diagnosis of mitral stenosis
ECHO
113
What is the predominant cause of mitral stenosis and is the incidence and prevalence increasing or decreasing
Rheumatic carditis
| Incidence and prevalence are decreasing due to a reduction in rheumatic heart disease
114
What is the pathophysiology of mitral stenosis
LA dilation due to reduced emptying into the LV leads to pulmonary congestion
Right heart failure symptoms due to pulmonary venous HTN
Haemoptysis due to rupture of bronchial vessels due to pulmonary HTN
115
What is mitral regurgitation
A backflow of blood from the LV into the LA during systole
116
What are the common causes of mitral regurgitation
Myxomatous degeneration (mitral valve prolapse)
Ischaemic MR
Rheumatic heart disease
Infective endocarditis
117
What is the first line treatment for someone who has HTN and is <55years old
ACE-inhibitor
118
What symptom occurs if someone is ACE-i intolerant and why
Cough due to increased bradykinin
119
What treatment is given in HTN if someone is ACE-i intolerant
Angiotensin receptor blocker e.g. Candesartan
120
What is the first line treatment for HTN for someone who is >55 years or Afro-Caribbean
Calcium channel blocker
121
What are the type subtypes of calcium channel blockers
Dihydropyridines - smooth muscle of vessels - Amlodipine
| Non-dihydropirines - heart - verapamil
122
What is step 2 in HTN treatment if ACE-i/ARB or CCB havent worked
ACE-i/ARB and CCB
123
What is the 3rd step of HTN treatment
Ace-i/ARB and CCB and Thiazide-like diuretics
124
Give an example of a thiazide, loop diuretic, potassium sparing diuretics
Thiazide - bendroflumethiazide
Loop diuretics - furosemide
Potassium sparing - spironolactone
