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Phase 2a LM > Cardiovascular Disease Cards > Flashcards

Cardiovascular Disease Cards Flashcards

1
Q

What is angina

A

A form of stable ischaemic heart disease - a mismatch of oxygen demand and supply

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2
Q

What is the main cause of angina

A

Atheroma

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3
Q

Name a few predisposing factors to ischaemic heart disease

A 
Cigarette smoking
Diabetes mellitus 
Hyperlipidaemia 
Hypertension 
Family history
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4
Q

What is the incidence of angina for men

A

35 per 100,000 per year

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5
Q

What is the incidence of angina for women

A

20 per 100,000 per year

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6
Q

What are the main symptoms of angina

A

Chest pain

Breathlessness

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7
Q

What are two managements/treatments of angina that dont involve drugs

A

Alteration of lifestyle

Modification of risk factors

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8
Q

Name some common types of drugs used to treat angina

A 
Aspirin
Beta-blockers
Calcium channel blockers
Statins
ACE-inhibitors
Nitrates
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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

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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

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11
Q

What diseases does ‘acute coronary syndromes’ include

A

Unstable angina and evolving MI

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12
Q

What troponin levels suggests unstable angina

A

No significant rise in troponin levels

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13
Q

What is a myocardial infarction

A

Cell death of myocardial cells due to lack of oxygen

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14
Q

What are the common symptoms of an MI

A 
Acute central chest pain>20mins
Nausea
Sweatiness
Dyspnoea 
Palpitations
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15
Q

What are the common signs of an MI

A 
Distress
Pallor 
Change in pulse rate 
Change in BP
4th heart sound
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16
Q

Name 3 non-modifiable risk factors for MI

A

Age
Sex
FH of IHD

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17
Q

Name 3 modifiable risk factors for MI

A 
Smoking
Hypertension
Diabetes
Hyperlipidaemia 
Obesity 
Inactive lifestyle
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18
Q

What is the incidence of MI

A

5 per 1000 per year

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19
Q

What is the mortality of MIs

A

50% die within 2 hours of symptoms

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20
Q

What is commonly seen on an ECG if MI has occurred

A

ST segment elevation

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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

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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
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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
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24
Q

What is cardiomyopathy

A

Primary heart muscle disease

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25
Q

Types of cardiomyopathy include

A 
Hypertrophic 
Dilated
Restrictive
Arrhythmogenic RV dysplasia
Takotsubo
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26
Q

What is hypertrophic cardiomyopathy

A

Portion of the heart muscle becomes thickened with no obvious cause

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27
Q

What is hypertrophic cardiomyopathy caused by

A

Sarcomeric protein gene mutations

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28
Q

What are the symptoms of hypertrophic cardiomyopathy

A 
Angina
Dyspnoea 
Palpitations 
Dizzy spells
Syncope
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29
Q

What is the management of hypertrophic cardiomyopathy

A

Beta-blockers for symptoms

Consider implantable defibrillator

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30
Q

What is dilated cardiomyopathy

A

The heart becomes enlarged and cant pump blood effectively

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31
Q

What is dilated cardiomyopathy often caused by

A

Cytoskeletal gene mutations

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32
Q

What symptoms does dilated cardiomyopathy present with

A

Heart failure symptoms: SOB, fatigue, pulmonary oedema

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33
Q

What is the main feature of atthymogenic cardiomyopathy (ARVD/ALVD)

A

Arrhythmia

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34
Q

What is arrhythmogenic cardiomyopathy caused by

A

Desmosome gene mutations

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35
Q

What is cardiac failure

A

Cardiac output and BP are inadequate for the body’s requirements

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36
Q

What are the 3 cardinal symptoms of heart failure that are non-specific

A

SOB
Fatigue
Ankle swelling

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37
Q

What are the causes of low output heart failure

A

Ischaemia
Hypertension
Valve disorders
Increased alcohol use

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38
Q

What are symptoms specific to LV heart failure

A

Dyspnoea, poor exercise tolerance, fatigue, muscle wasting, cold peripheries

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39
Q

What are symptoms specific to RV heart failure

A

Peripheral oedema, abdominal distension (ascites), pulsation in neck and face, facial engorgement

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40
Q

What are the heart failure stages: ABCD

A

A: high risk developing HF
B: asymptomatic HF
C: symptomatic HF
D: end-stage HF

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41
Q

Name 5 medications given to manage HF

A 
Diuretics (reduce oedema)
ACE-inhibitors
Beta-blockers (start low and go slow)
Hydralazine and nitrates (dilators)
Digoxin
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42
Q

What is acute decompensated congested heart failure

A

Sudden worsening of the signs and symptoms of heart failure

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43
Q

What are common causes of acute decompensated congested heart failure

A 
Acute MI
Uncontrolled increase in BP
Obesity 
AF and arrhythmias 
NSAIDS
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44
Q

What are the symptoms of DVT

A

Pain

Swelling

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45
Q

What are the signs of DVT

A

Tenderness
Swelling
Warmth
Discolouration

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46
Q

What are the risk factors for DVT

A

Surgery, immobility, leg fracture
OC pill, HRT, pregnancy
Long haul flights
Inherited thrombophilia

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47
Q

What are 2 investigations for DVT

A
  1. D-dimer (normal excludes diagnosis)

2. Ultrasound compression - test proximal veins

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48
Q

What are the treatments for DVT and PE

A

LMW heparin minimum 5 days
Oral warfarin 6 months
Compression stockings
Treat/seek underlying cause

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49
Q

What are the mechanical preventions of DVT and PE

A

Hydration and early mobilisation, compression stockings, foot pumps

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50
Q

What are the chemical preventions of DVT and PE

A

LMW heparin

51
Q

What are the symptoms of PE

A

Breathlessness
Pleuritic chest pain
Signs/symptoms of DVT
Risk factors

52
Q

What are the signs of PE

A

Tachycardia
Tachypnoea
Pleural rub
Precipitating cause

53
Q

What does the CXR look like for PE

A

Normal

54
Q

What are the blood gases like for PE

A

Decreased oxygen and carbon dioxide

55
Q

Define shock

A

When the cardiovascular system is unable to provide adequate substrate for aerobic cellular respiration

56
Q

Describe what someone in shock looks like

A

Skin is pale, sweaty, cold and vasoconstricted
May be confused, weak, collapsed, coma
Pulse is weak and rapid
Urine output reduced

57
Q

Organs are at risk if hypotension occurs for too long during shock, what could happen to the kidneys, lungs, heart and brain?

A 
Kidneys = acute tubular necrosis 
Lungs = ARDS 
Heart = ischaemia or MI
Brain = confusion, irritability, coma
58
Q

What therapies in practice do you need to carry out when someone is in shock

A

A,B,C

Airways
Breathing (give 100% oxygen)
Circulation (IV access, give fluid or blood if blood loss)

59
Q

In shock, what is the triad that patients normally die from

A

Coagulopathy
Hypothermia
Metabolic acidosis

60
Q

Define cardiogenic shock

A

Failure of the heart to maintain the circulation

61
Q

What can cause cardiogenic shock

A 
Cardiac tamponade
PE 
Acute MI 
Fluid overload
Myocarditis
Arrhythmias
62
Q

What is the management of cardiogenic shock

A
  1. Oxygen
  2. Diamorphine for pain and anxiety
  3. Investigations
63
Q

Define septic shock

A

When sepsis is complicated by persistent hypotension that’s unresponsive to fluid resuscitation

64
Q

Define anaphylactic shock

A

Intense allergic reaction with massive release of histamine and other vasoactive mediators causing haemodynamic collapse

65
Q

Give 2 causes of hypovolaemic shock

A

Loss of blood

Loss of fluid

66
Q

Describe class 1 of the haemorrhagic shock classification

A 
Blood loss 15%
Pulse <100
Normal BP and PP and RR 
Slightly anxious 
Urine output <30ml/hr
67
Q

Describe class 2 of the haemorrhagic classification system

A 
Blood loss 15-30%
Pulse >100
BP normal 
Pulse pressure decreased
RR 20-30
Urine 20-30 ml/hr 
Mildly anxious
68
Q

Describe class 3 of the haemorrhagic classification system

A 
Blood loss 30-40%
Pulse >120
BP decreased
PP decreased 
RR 30-40
Urine 5-15 ml/hr 
Confused
69
Q

Why is arterial BP not a good indication of shock in young people

A

They compensate very well then only decrease BP when shock is really advanced

70
Q

What should you test instead in a young person suspected to be in shock

A

Capillary refill time (CFT)

71
Q

What 3 things are required for an acute respiratory distress syndrome (ARDS) diagnosis

A

Impaired oxygenation
Bilateral pulmonary infiltrates (blood, pus, protein…not air)
No cardiac failure

72
Q

Define pericarditis

A

An inflammatory pericardial syndrome with or without effusion

73
Q

The clinical diagnosis of pericarditis is made from 2 out of 4:

A
  1. Chest pain 85-90%
  2. Friction rub 33%
  3. ECG changes 60%
  4. Pericardial effusion up to 60% , usually mild
74
Q

What is the most common cause of pericarditis

A

Viral infection

75
Q

What are the non-infectious causes of pericarditis

A

Autoimmune - sjorgens syndrome, rheumatoid arthritis
Neoplastic - secondary tumours e.g.lung and breast
Metabolic - uraemia, myxoedema
Trauma - direct and indirect

76
Q

What is the clinical presentation of pericarditis

A

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
Q

What does the ECG look like for someone who’s got pericarditis

A

Concave ST segment
No reciprocal ST depression
Saddle shaped
PR depression

78
Q

What is the management of pericarditis

A

NSAID or aspirin for pain

Treat the cause

79
Q

Define infective endocarditis

A

Infection of the heart valve/s

80
Q

How do you catch IE

A 
Abnormal valve (regurgitant or prosthetic)
Introduce infection into blood or heart during surgery 
Previously had IE
81
Q

How does IE present clinically

A

New regurgitant heart murmur
Embolic events of unknown origin
Sepsis of unknown origin
Fever

82
Q

Who most commonly gets IE

A

Elderly
Young IV drug abusers
Young with congenital heart disease
Prosthetic heart valves

83
Q

Name some typical MOs that can cause IE

A

Strep viridans, strep bovis, staph aureus, community acquired enterococci

84
Q

What is the treatment for oral strep or group D strep that has caused IE

A

Penicillin
Amoxicillin
Ceftriaxone

85
Q

What is the treatment for staph that has caused IE

A

(Flu) cloxacillin

Oxacillin

86
Q

Describe the two type of echocardiography that can be performed if IE is suspected

A 
Transthoracic echo (TTE) - non invasive, safe, poor images so lower sensitivity
Transoesophageal each (TOE) - tube down throat, risk of aspiration/perforation, better images
87
Q

What are the 4 peripheral stigmata seen in IE

A

Macular petechial and embolic skin lesions
Splinter haemorrhages
Osler nodes
Janeway lesions

88
Q

Describe what splinter haemorrhages look like

A

Tiny red lines on the tips of fingernails

89
Q

Describe what Osler nodes look like

A

Small red dots under the skin at the tips of the fingers

90
Q

Describe what janeway lesions look like

A

Pink/red slightly larger patches all over hands and fingers

91
Q

Describe what macular petechial and embolic skin lesions look like

A

Darker red/brown patches around hand and fingernails

92
Q

What is the management of IE

A

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
Q

What is the HFREF type of heart failure

A

Heart failure with reduced ejection fraction

94
Q

What is the ejection fraction in HFREF

A

<40%

95
Q

What is HFPEF

A

Hear failure with preserved ejection fraction (>50%)

96
Q

What is the main cause of heart failure

A

Myocardial dysfunction caused by IHD

97
Q

What are some common symptoms of heart failure

A

SOB
Tiredness
Leg swelling
Cold peripheries

98
Q

What sign is only seen in HF and mitral valve disease

A

Paroxysmal nocturnal dyspnoea

99
Q

Name some types of drugs used to treat HFREF

A

ACE-inhibitors
Hydralazine and nitrates
Aldosterone agonists
Beta-blockers

100
Q

What type of drug doesnt work as well in Afro-Caribbean race and what is given as well to people of that race

A

ACE-inhibitors dont work as well, hydralazine and nitrates work really well, so given in addition to ACE-i

101
Q

Name an aldosterone agonist

A

Spironolactone (side effect of diuretic)

102
Q

What is given to HFREF patients when ACE-i arent working

A

Sacubitril-Valsartan

103
Q

What is aortic stenosis

A

Narrowing of the aortic valve

104
Q

What are the 3 main things people with aortic stenosis present with

A

Syncope, angina, dyspnoea on exertion

105
Q

What are the congenital causes and acquired causes of aortic stenosis

A

Congenital - bicuspid valve

Acquired - degenerative calcification, rheumatic heart disease

106
Q

What is the Tx for aortic stenosis

A

ECG assess severity
If asymptomatic then just surveillance
If symptomatic then aortic valve replacement

107
Q

What is aortic regurgitation

A

Leakage of blood into the LV during diastole due to ineffective coaptation of the aortic cusps

108
Q

What is the main cause of aortic regurgitation

A

Bicuspid aortic valve

109
Q

What do you see on an X ray if there’s aortic regurgitation

A

Enlarged cardiac silhouette and aortic root

110
Q

What are the main symptoms of aortic regurgitation

A

Dyspnoea
Palpitations
Cardiac failure

111
Q

What is mitral stenosis

A

Obstruction of LV inflow that prevents proper filling during diastole

112
Q

What is the gold standard test for the diagnosis of mitral stenosis

A

ECHO

113
Q

What is the predominant cause of mitral stenosis and is the incidence and prevalence increasing or decreasing

A

Rheumatic carditis

Incidence and prevalence are decreasing due to a reduction in rheumatic heart disease

114
Q

What is the pathophysiology of mitral stenosis

A

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
Q

What is mitral regurgitation

A

A backflow of blood from the LV into the LA during systole

116
Q

What are the common causes of mitral regurgitation

A

Myxomatous degeneration (mitral valve prolapse)
Ischaemic MR
Rheumatic heart disease
Infective endocarditis

117
Q

What is the first line treatment for someone who has HTN and is <55years old

A

ACE-inhibitor

118
Q

What symptom occurs if someone is ACE-i intolerant and why

A

Cough due to increased bradykinin

119
Q

What treatment is given in HTN if someone is ACE-i intolerant

A

Angiotensin receptor blocker e.g. Candesartan

120
Q

What is the first line treatment for HTN for someone who is >55 years or Afro-Caribbean

A

Calcium channel blocker

121
Q

What are the type subtypes of calcium channel blockers

A

Dihydropyridines - smooth muscle of vessels - Amlodipine

Non-dihydropirines - heart - verapamil

122
Q

What is step 2 in HTN treatment if ACE-i/ARB or CCB havent worked

A

ACE-i/ARB and CCB

123
Q

What is the 3rd step of HTN treatment

A

Ace-i/ARB and CCB and Thiazide-like diuretics

124
Q

Give an example of a thiazide, loop diuretic, potassium sparing diuretics

A

Thiazide - bendroflumethiazide
Loop diuretics - furosemide
Potassium sparing - spironolactone

Phase 2a LM (7 decks)

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