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4 CSIM2 > Cardiovascular diseases > Flashcards

Cardiovascular diseases Flashcards

1
Q

how is MI diagnosis made

A

troponin above 99th percentile plus one of

symptoms of ischaemia
ecg changes indicating ischaemia
ecg changes of necrosis
imaging showing mycrodial damage

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2
Q

how can diabetics present different in MI

A

sometimes no chest pain

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3
Q

how to differentiate MSK chest pain

A

ask patient to press on it themselves and see if it gets worse

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4
Q

is ACI pain more likely to be pin point or regionalised

A

regionalised, sometimes radiates

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5
Q

where is ACS pain likely to radiate to

A

jaw arms neck back

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6
Q

symptoms of ACS

A 
angina
nausea vomiting
sweating
abdo pain
SoB
tachycardia
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7
Q

how to go about investigating ACS

A 
troponin at admission
ECG 
CXR
hx and exam
BM
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8
Q

how to investigate troponin in ACS

A

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.

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9
Q

acute medical management of ACS

A

GTN, oxygen, antiemetic, analgesia,

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10
Q

long term management after ACS

A

aspirin, ACEI, beta blockers, antithrombin e..g clopidog or ticagrelor

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11
Q

if ECG shows ST elev what is the management

A

PCI or CBAG

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12
Q

what is the TIMI risk score

A

risk of cardiac event in 14 days after NSTE ACS

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13
Q

what is the GRACE score

A

risk of death or MI after 6 months

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14
Q

differentials of chest pain

A

cardiac - angina, aortic dissection, pericarditis,

pulmonary - PE, pneumothorax, pneumonia, pleurisy

GI - gastritis, esgitis, pancreatitis, gallstones

msk - costochondritis, trauma

anxiety

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15
Q

how does high lipid levels lead to atherosclerosis?

A

lipids usually dissolve through endothelium but come out, in a lipid rich environment, they stay inside and contribute to foam cell development

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16
Q

explain the process of lipid metabolism

A

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

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17
Q

which is the most common primary hyperlipidaemia condition

A

polygenic familial hypercholesterolaemia

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18
Q

which cholesterols are associated with increasd risk?

A

triglycerides, LDLs, VLDLs

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19
Q

what does total cholesterol measure

A

all the lipids, HDL LDL, VLDL, but not triglycerides

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20
Q

high tryglyceride levels are associated with atherosclerosis T or F

A

F

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21
Q

what is required to measure LDL-C?

A

fasting

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22
Q

what is the alternative to measuring LDL-C

A

non-HDL-C

23
Q

what are some physical signs of hypercholesterolaemia

A

tendon xanthomas
corneal arcus
cutaenous xanthomas

24
Q

what lipid is raised in familial hypercholesterolaemia

A

LDL-C

25
Q

what lipid is raised in familial combined hypercholesterolaemia

A

high ldlc, high TG, low hdlc

26
Q

what is apolipoprotein used for

A

better marker of lipids, but expensive.

27
Q

which apolipoprotein is associated with ldl and hdl?

A

ldl is apoB

hdl is apoA

28
Q

what is raised in remnant (type III) hyperlipidaemia

A

TC raised, trig raised,

29
Q

investigations in someone with hyperlipidaemia?

A

rule out secondary causes - kidney, liver, look for cardiovascular complications, look for signs of hyperlipidaemia

30
Q

history to ask for in investigating hyperlipidaemia

A 
cardiovascular history
diabetes, pmhx
drug history
family history
life style - smoking diet
31
Q

what is a sinister sounding type of syncope

A

sudden collapse with no prodrome and rapid recovery

32
Q

what syndrome is associated with fainting on startling

A

catecholinergic polymorphic VT

33
Q

what are some ways to monitor heart conduction

A

ecg
holter ecg
zio patch
implantable loop recorder

34
Q

what are ecg signs of Long qt syndrome

A

long qt interval, T waves end more than half way past T-T interval

35
Q

what are ecg signs of brugada syndrome

A

st elevation in v1-v3 described as cove lik

36
Q

how does torsade de point look like

A

wavy ribbon like ventricular tachycardia

37
Q

what causes sudden death in channeloppathies

A

mutations in ion channels causing disruption of flow in electrical conductions

38
Q

what is arryhthmogenic right ventricular cardiomyopathy and how does it kill

A

mutation in desmosomes, cause tearing of heart muscle when stretched, causing scaring and fibrosis, leading to conduction disturbance

39
Q

what channels are affected in LQTSd

A

sodium and potassium

40
Q

when is a Q wave pathologic?

A

> 1 box wide or if is 1/3 of entire QRS amplitude in at least 2 contiguous leads

41
Q

under what circumstances in someone presenting with non-ST elevation chest pain, do you repeat a Troponin T at 6 hours?

A

more than 99th centile trop T at admission, but <10ng/L increase or <20% increase after 3 hours.

42
Q

what imaging should be done after a PCI in post-MI patient?

A

coronary angiogram

43
Q

complications after MI?

A

DARTH VADER

death
arrythmia
rupture
tamponade
heart failure
Valve disease
aneurysm
dressler's syndrome (pericardial rub)
embolism (thromboembolism)
recurrence/mitral regurgitation
44
Q

complications of hypertension?

A 
stroke
heart failure
peripheral vascular disease
AF
hypertensive nephrosclerosis
hypertensive retinopathy
45
Q

what is high triglycerides associated with

A

pancreatitis, metabolic syndrome, DM

46
Q

what is apoB and apoA associated with?

A

apoB is associated with atherogenic molecules

apoA is associated with HDL (neutral/protective lipoproteins)

47
Q

what are tendon xanthomas associated with?

A

familial hypercholesteroalaemia, more xanthomas, more likely to be homozygous

48
Q

what is the inheritance pattern of familial hypercholesteroalaemia,

A

co-dominant

49
Q

what is the patient profile/presentation of familial combined hypercholesterolaemia?

A

no other specific signs of hypercholesterolaemia, older age of presentaiton.

50
Q

what is tubero-eruptive xanthelasma associated with?

A

familial remant hyperlipidaemia

51
Q

when can a qrisk score not be used?

A

already on treatment, HIV medication, autoimmune conditions, severe obesity

52
Q

what is a possible cause of dyslipidaemia in someone presenting also with frothy urine?

A

nephrotic syndrome

53
Q

secondary causes of hyperlipidaemia?

A 
nephrotic syndrome
hypothyroidism
diabetes
renal failure
alcohol consumption

4 CSIM2 (11 decks)

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