Cardiovascular diseases Flashcards
how is MI diagnosis made
troponin above 99th percentile plus one of
symptoms of ischaemia
ecg changes indicating ischaemia
ecg changes of necrosis
imaging showing mycrodial damage
how can diabetics present different in MI
sometimes no chest pain
how to differentiate MSK chest pain
ask patient to press on it themselves and see if it gets worse
is ACI pain more likely to be pin point or regionalised
regionalised, sometimes radiates
where is ACS pain likely to radiate to
jaw arms neck back
symptoms of ACS
angina nausea vomiting sweating abdo pain SoB tachycardia
how to go about investigating ACS
troponin at admission ECG CXR hx and exam BM
how to investigate troponin in ACS
if Trop at admission is above 99th centile, then do 2nd one after 3 hours, if its more than 10ng/L and rising more than 20%, possible ACS
if below 99th centile at admission and more than 6 hrs since symptoms, not likely ACS, if less than 6 hours, repeat in 3 hours.
acute medical management of ACS
GTN, oxygen, antiemetic, analgesia,
long term management after ACS
aspirin, ACEI, beta blockers, antithrombin e..g clopidog or ticagrelor
if ECG shows ST elev what is the management
PCI or CBAG
what is the TIMI risk score
risk of cardiac event in 14 days after NSTE ACS
what is the GRACE score
risk of death or MI after 6 months
differentials of chest pain
cardiac - angina, aortic dissection, pericarditis,
pulmonary - PE, pneumothorax, pneumonia, pleurisy
GI - gastritis, esgitis, pancreatitis, gallstones
msk - costochondritis, trauma
anxiety
how does high lipid levels lead to atherosclerosis?
lipids usually dissolve through endothelium but come out, in a lipid rich environment, they stay inside and contribute to foam cell development
explain the process of lipid metabolism
ingested lipids are packaged as chylomicrons in the intestines and then processed in the liver to become LDL, these are then sent around the body. they then return to the liver as HDL
which is the most common primary hyperlipidaemia condition
polygenic familial hypercholesterolaemia
which cholesterols are associated with increasd risk?
triglycerides, LDLs, VLDLs
what does total cholesterol measure
all the lipids, HDL LDL, VLDL, but not triglycerides
high tryglyceride levels are associated with atherosclerosis T or F
F
what is required to measure LDL-C?
fasting
what is the alternative to measuring LDL-C
non-HDL-C
what are some physical signs of hypercholesterolaemia
tendon xanthomas
corneal arcus
cutaenous xanthomas
what lipid is raised in familial hypercholesterolaemia
LDL-C
what lipid is raised in familial combined hypercholesterolaemia
high ldlc, high TG, low hdlc
what is apolipoprotein used for
better marker of lipids, but expensive.
which apolipoprotein is associated with ldl and hdl?
ldl is apoB
hdl is apoA
what is raised in remnant (type III) hyperlipidaemia
TC raised, trig raised,
investigations in someone with hyperlipidaemia?
rule out secondary causes - kidney, liver, look for cardiovascular complications, look for signs of hyperlipidaemia
history to ask for in investigating hyperlipidaemia
cardiovascular history diabetes, pmhx drug history family history life style - smoking diet
what is a sinister sounding type of syncope
sudden collapse with no prodrome and rapid recovery
what syndrome is associated with fainting on startling
catecholinergic polymorphic VT
what are some ways to monitor heart conduction
ecg
holter ecg
zio patch
implantable loop recorder
what are ecg signs of Long qt syndrome
long qt interval, T waves end more than half way past T-T interval
what are ecg signs of brugada syndrome
st elevation in v1-v3 described as cove lik
how does torsade de point look like
wavy ribbon like ventricular tachycardia
what causes sudden death in channeloppathies
mutations in ion channels causing disruption of flow in electrical conductions
what is arryhthmogenic right ventricular cardiomyopathy and how does it kill
mutation in desmosomes, cause tearing of heart muscle when stretched, causing scaring and fibrosis, leading to conduction disturbance
what channels are affected in LQTSd
sodium and potassium
when is a Q wave pathologic?
> 1 box wide or if is 1/3 of entire QRS amplitude in at least 2 contiguous leads
under what circumstances in someone presenting with non-ST elevation chest pain, do you repeat a Troponin T at 6 hours?
more than 99th centile trop T at admission, but <10ng/L increase or <20% increase after 3 hours.
what imaging should be done after a PCI in post-MI patient?
coronary angiogram
complications after MI?
DARTH VADER
death arrythmia rupture tamponade heart failure
Valve disease aneurysm dressler's syndrome (pericardial rub) embolism (thromboembolism) recurrence/mitral regurgitation
complications of hypertension?
stroke heart failure peripheral vascular disease AF hypertensive nephrosclerosis hypertensive retinopathy
what is high triglycerides associated with
pancreatitis, metabolic syndrome, DM
what is apoB and apoA associated with?
apoB is associated with atherogenic molecules
apoA is associated with HDL (neutral/protective lipoproteins)
what are tendon xanthomas associated with?
familial hypercholesteroalaemia, more xanthomas, more likely to be homozygous
what is the inheritance pattern of familial hypercholesteroalaemia,
co-dominant
what is the patient profile/presentation of familial combined hypercholesterolaemia?
no other specific signs of hypercholesterolaemia, older age of presentaiton.
what is tubero-eruptive xanthelasma associated with?
familial remant hyperlipidaemia
when can a qrisk score not be used?
already on treatment, HIV medication, autoimmune conditions, severe obesity
what is a possible cause of dyslipidaemia in someone presenting also with frothy urine?
nephrotic syndrome
secondary causes of hyperlipidaemia?
nephrotic syndrome hypothyroidism diabetes renal failure alcohol consumption
