Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA Content > Cardiovascular - Level 3 > Flashcards

Cardiovascular - Level 3 Flashcards

1
Q

Definition of accelerated hypertension?

A
  • Severe increase in blood pressure to 180/120 mmHg or higher with signs of retinal haemorrhage and/or papilledema (swelling of the optic nerve);
  • Also known as malignant hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Epidemiology of accelerated hypertension?

A
  • Average age is 40 years
  • Men more commonly
  • Black ethnicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of accelerated hypertension?

A 
o	Renovascular disease – renal artery stenosis
o	Renin-secreting neoplasms
o	Renal vasculitis – scleroderma, polyarteritis, SLE
o	Phaeochromocytoma
o	Cocaine abuse
o	MAOIs, COCP
o	Glomerulonephritis
o	Pre-eclampsia/Eclampsia
o	Hyperthyroidism/Hypothyroidism
o	Cushing’s syndrome
o	Acromegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of accelerated hypertension?

A
  • May be asymptomatic
  • Symptoms
    o Headache
    o Fits
    o N&V
    o Visual disturbances
    o Chest pain
    o Neurological changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Initial investigations to perform in accelerated hypertension?

A
  • Blood pressure – lying and standing and in both arms
  • Fundoscopy
  • Bloods
    o FBC, clotting, U&E, LFTs, TFTs, glucose, troponin
  • Urine dipstick
  • CXR – cardiac size, cardiac failure
  • ECG – LVH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations to find cause of accelerated hypertension?

A 
o	CT/MRI of head/kidneys
o	Plasma renin
o	Plasma aldosterone
o	24-hour urine VMA and metanephrin levels
o	ANA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Referral in people with accelerated hypertension?

A
  • Refer for same-day specialist assessment if >180/120 and:
    o Signs of retinal haemorrhage or papilloedema OR
    o Signs of new onset confusion, CP, HF, AKI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of accelerated hypertension?

A
  • Reduce BP over 24-48 hours
    o IV labetalol (alternatives nitroprusside /nicardipine)
     Every 10 minutes according to response
    o If LV failure – IV furosemide, GTN and nifedipine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Definition of pericarditis?

A
  • Acute inflammation of pericardium (membranous sac surrounding heart) and can co-exist with myocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PAthology of pericarditis?

A

o Pericardial vascularisation and infiltration with leukocytes
o Exudate and adhesion within pericardial sac and serous effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Epidemiology of pericarditis?

A

o 5% of ED visits with chest pain
o Usually post-viral or idiopathic
o Can become recurrent if >1 episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of pericarditis?

A

o Myocardial infarction (including Dressler’s syndrome)
o Viral - Coxsackie, Echovirus, EBV
o Bacterial - Pneumococcus, meningococcus, haemophilus, staphylococcus, TB
o Neoplasms, Uraemia, SLE, rheumatoid arthritis
o Drug - Hydralazine, procainamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms of pericarditis?

A

o Chest pain
 Sharp, central or retrosternal
 Radiates to neck, trapezius ridge or shoulders
 Worse on deep inspiration, exercise, swallowing and lying flat
 Relieved by sitting up and leaning forward
o May have cough, chills, weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Signs of pericarditis?

A

Pericardial friction rub
 Often intermittent, positional and elusive
 Louder during inspiration and may be heard on systole and diastole
 Scratchy superficial sound, loudest in midline and lower left parasternal edge
Low grade fever
Tachycardia
Tachypnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations of pericarditis?

A

ECG
o Concave-upward ST segment elevation
o PR depression in limb and pre-cordial leads
o Reciprocal PR elevation and ST depression in aVR

CXR
o Flask-shaped cardiac silhouette sign of large pericardial effusion

Bloods
o FBC, U&Es, CRP, ESR and troponin

Blood cultures if evidence of sepsis

Echocardiogram
o If pericardia effusion or cardiac tamponade suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of pericarditis?

A

o Benign or self-limiting
o Rest
o High dose NSAIDs (naproxen 250mg TDS/QDS) +/- PPI cover
 Give 7-14 days then taper off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of pericardial effusion in pericarditis?

A

o Senior help, immediate echocardiogram

o Pericardiocentesis under US and then drainage or open thoracotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of constrictive pericarditis in pericarditis?

A

o Pericardial resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Prognosis of pericarditis?

A
  • Most improve over days to weeks

- Recurrence in around 1 in 3 patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Definition of pericardial effusion?

A
  • Accumulation of fluid in pericardial sac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of pericardial effusion?

A

o Viruses (Coxsackie, flu, EBV, mumps, varicella, HIV)
o Bacteria (pneumonia, rheumatic fever, TB, staphs)
o Fungi
o MI and Dressler’s syndrome
o Drugs – Procainamide, hydralazine, penicillin
o Others – uraemia, RA, SLE, trauma, surgery, malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Symptoms of pericardial effusion?

A

o SOB
o Symptoms of pericarditis – sharp chest pain, radiating to scapular ridge, relieved by sitting up and worsening with inspiration
o Syncope
o Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Signs of pericardial effusion?

A

o Raised JVP (prominent X descent)
o Bronchial breathing at left base (Ewart’s sign)
o Look for signs of cardiac tamponade
 Tachycardia, pulsus paradoxus, hypotension, raised JVP, muffled S1 and S2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Investigations of pericardial effusion?

A
  • Bloods
    o FBC, U&Es, CRP, cardiac enzymes
    o Blood cultures if needed
  • CXR
    o Enlarged, globular heart
  • ECG
    o Low voltage QRS complexes and alternating QRS morphologies
  • Echocardiogram
    o Echo-free zone surrounding heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management of pericardial effusion?

A
  • Treat cause
  • Oxygen if needed
  • Pericardiocentesis
    o Therapeutic in cardiac tamponade
    o Pericardial fluid sent for culture, ZN stain/TB culture and cytology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Complications of pericardial effusion?

A

o Pericardial tamponade

o Chronic pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Definition of cardiomyopathy?

A

myocardial disorder in which myocardium is structurally or functionally abnormal without coronary artery disease, hypertension, valvular or congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of cardiomyopathy?

A

o Primary – idiopathic and not attributed to a cause

o Secondary – associated with:
 CKD, cirrhosis, obesity, stress
 SLE/sarcoidosis/amyloidosis
 Diabetes, thyroid, acromegaly, haemochromatosis
 Cocaine, alcohol, chemotherapy
 Trypanosomiasis, viruses
 Malnutrition, deficient Vit B, calcium, magnesium
 Hypertension, IHD, valvular disease
 Duchenne
 Peripartum cardiomyopathy – between last month and 5-6 months after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Definition of dilated cardiomyopathy?

A

o Ventricular chamber enlargement and contractile dysfunction with normal LV wall thickness
o RV may be dilated and dysfunctional too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Epidemiology of dilated cardiomyopathy?

A
  • Most frequent indication for heart transplant
  • Prevalence – 0.2%
  • More common in males
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Associations of dilated cardiomyopathy?

A 
o	Ischaemia
o	Genetic (Barth syndrome)
o	Alcohol
o	Thyrotoxicosis
o	RA, SLE
o	Drugs – cocaine, amphetamines, heroin
o	Peri/Post-partum
o	Haemochromatosis, sarcoidosis, amyloidosis
o	Virus – adenovirus, CMV, coxsackie, Lyme, toxoplasmosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Symptoms of dilated cardiomyopathy?

A

o Asymptomatic
o Heart failure symptoms – exertional SOB, orthopnoea, PND, weakness, fatigue, oedema
o AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Signs of dilated cardiomyopathy?

A 
o	Tachycardia
o	AF
o	Low BP
o	Raised JVP
o	Displaced, diffuse apex beat
o	Loud 3rd and/or 4th HS
o	Mitral/Tricuspid regurgitation
o	Signs of heart failure – pleural effusion, oedema, hepatomegaly, ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Investigations of dilated cardiomyopathy?

A
  • ECG
    o Tachycardia, non-specific T wave changes, LBBB
  • Bloods
    o FBC, U&E, LFT, TFTs, BNP, troponins
  • CXR
    o Cardiomegaly, pulmonary oedema
  • Echocardiogram
    o Globally dilated hypokinetic heart with low EF, may have MR/TR, LV mural thrombus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Diagnostic investigations of dilated cardiomyopathy?

A
  • Cardiac Catheterisation
  • Cardiac MRI
  • Endomyocardial biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Investigations to find cause of dilated cardiomyopathy?

A

o Genetics, serologies, electrophysiology, exercise testing, iron levels, vitamin levels, ANA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of dilated cardiomyopathy - pharmacological management?

A
  • Bed rest

o Diuretics
 Furosemide - if symptomatic with fluid overload
 Spironolactone if low K with furosemide

o ACEi

o Beta-blockers

o Digoxin
 Inadequate response to ACE inhibitors and diuretics if AF or tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Management of dilated cardiomyopathy - surgical management?

A
  • Pacing Support
    o Biventricular pacing (CRT)
     If NYHA class 3 or 4 with QRS prolongation
     With ICD
  • Surgical
    o Heart transplant
     80% one-year survival
    o LV assist devices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Complications of dilated cardiomyopathy?

A

o Progressive heart failure

o Sudden cardiac death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Definition of hypertrophic cardiomyopathy?

A

o Autosomal dominant genetic disorder
o Disorganised cardiac myocytes due to mutations in genes of sarcomeric proteins (cardiac B-myosin, troponin, A-tropomyosin)
o LV hypertrophy, impaired diastolic filling and abnormalities of mitral valve
o Can cause obstruction of LVOT (HOCM), diastolic dysfunction, myocardial ischaemia and risk of tachyarrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Epidemiology of hypertrophic cardiomyopathy?

A
  • Most common CV genetic disease
  • Prevalence 0.2%
  • Men, 20-30 years old, Black people
  • Most common cause of SCD in young people and athletes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Symptoms of hypertrophic cardiomyopathy?

A
  • Mostly asymptomatic
    o SOB, chest pain, palpitations, syncope
    o Sudden death – due to arrhythmias or obstruction of LVOT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Signs of hypertrophic cardiomyopathy?

A

o Forceful apex beat
 Double impulse if LVOT obstructed
o Late ejection systolic murmur (augmented by standings or Valsalva)
 Left sternal edge, radiating to aortic and mitral areas
o JVP ‘a’ wave prominent
o AF
o BP changes during upright exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ECG findings in hypertrophic cardiomyopathy?

A

o LVH
o Deep, narrow (“dagger-like”) Q waves in the lateral (V5-6, I, aVL) and inferior (II, III, aVF) leads
o T-wave inversion
o AF, VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Echo findings in hypertrophic cardiomyopathy?

A

o Asymmetrical septal hypertrophy (>15mm) with ratio of septal to posterior of >1.4:1
o Small LV cavity
o Hypercontractile posterior wall
o Mid-systolic closure of aortic valve
o Systolic anterior motion of mitral valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

CXR findings in hypertrophic cardiomyopathy?

A

o Heart size normal or enlarged

o LA enlargement seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Further testing needed in hypertrophic cardiomyopathy?

A

o Exercise ECG + Holter monitor
 Risk stratification – increased if blunted systolic BP to exercise, ventricular arrhythmias, progressive ST depression and symptoms
o Nuclear tests and cardiac catheterisation
o Cardiac MRI
 If poor visualisation on Echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Screening in hypertrophic cardiomyopathy?

A

o Echocardiogram
 First-degree family members of affected patients
• Repeat every 12-24 months throughout adolescence

o ECG
 Athletes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Management of asymptomatic hypertrophic cardiomyopathy?

A

 ICD
• If 1st degree relative with SCD, LV wall thickness >30mm, unexplained syncope
 Restrict from high-intensity athletics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Management of symptomatic hypertrophic cardiomyopathy - drug management?

A 
•	Beta-blockers (atenolol)
•	Verapamil
•	Disopyramide
o	To reduce LVOT gradient and diastolic dysfunction
•	Amiodarone
o	To suppress arrhythmias
•	Anticoagulation – NOAC/Warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Management of symptomatic hypertrophic cardiomyopathy - surgical?

A

 Surgical
• Catheter ablation for AF if drug refractory
• Septal myomectomy (surgical or alcohol ablation)
o If refractory symptoms or elevated resting outflow gradients
• Heart Transplant if refractile

 Pacing
• ICD implantation if risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Prognosis of hypertrophic cardiomyopathy?

A

o Variable – can remain asymptomatic or progress with heart failure
o Competitive sport increases risk of sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Definition of restrictive cardiomyopathy?

A

o Normal LV cavity size and systolic function but increased myocardial stiffness
o Ventricle incompliant and fills predominantly in early diastole
o Associated with raised LA pressure, atrial dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Epidemiology of restrictive cardiomyopathy?

A
  • Least common cardiomyopathy
  • 5% of all cardiomyopathies
  • Elderly
  • Tropical Africans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Causes of restrictive cardiomyopathy?

A 
o	Idiopathic
o	Loffler’s syndrome (endomyocardial fibrosis)
o	Infiltrative myocardial disease
o	Amyloidosis (MC in West)
o	Sarcoidosis
o	Haemochromatosis
o	Fabry’s disease
56
Q

Symptoms of restrictive cardiomyopathy?

A

o Heart Failure – SOB, fatigue, oedema

o Similar to constrictive pericarditis

57
Q

Signs of restrictive cardiomyopathy?

A 
o	Loud 3rd HS
o	RVF predominate
	Raised JVP (prominent x and y descents)
	Hepatomegaly
	Oedema
	Ascites
o	AF
58
Q

Investigations and findings of restrictive cardiomyopathy?

A
  • ECG
    o Tachycardia, non-specific T wave changes, LBBB
  • Bloods
    o FBC, U&E, LFT, TFTs, BNP, troponins
  • CXR
    o Cardiomegaly, pulmonary oedema
  • Echocardiogram
    o Thickened ventricular walls, valves and atrial septum with small cavities
59
Q

Diagnostic imaging in restrictive cardiomyopathy?

A
  • Cardiac Catheterisation
  • Cardiac MRI – distinguish restrictive CM and constrictive pericarditis
  • Cardiac biopsy
60
Q

Management of restrictive cardiomyopathy?

A
  • Treat cause
  • Management of Heart Failure
    o Diuretics
     Furosemide
     Spironolactone
    o ACEi
-	Other managements
o	Amiodarone
o	Anticoagulation if AF – NOACs/Warfarin
o	Pacemakers/ICD
o	Transplantation
61
Q

Definition of arrhythmogenic right ventricular cardiomyopathy?

A

o Fibro-fatty replacement of RV myocytes due to apoptosis, inflammation or genetics

62
Q

Epidemiology of ARVC?

A
  • Prevalence – 1 in 2000
  • Presents in adolescence or early childhood
  • Males
  • Autosomal dominant (more common), also recessive
  • Common cause of SCD in young people
63
Q

Symptoms of ARVC?

A
  • Men aged 15-35

o Palpitations
o Presyncope
o Syncope
o SCD

64
Q

Signs of ARVC?

A

o Atrial arrhythmias

65
Q

Phases of ARVC?

A

o Concealed – subtle RV changes, minor arrhythmias – asymptomatic or SCD

o Overt electrical disorder – symptomatic RV arrhythmias with abnormal RV wall – palpitations and syncope – arrhythmias and SCD common

o RV failure – extension of disease to whole RV causes dysfunction

o Biventricular pump failure – LV involved leads to HF

66
Q

Investigations of ARVC?

A 
-	ECG
o	Ventricular arrhythmias, LBBB
-	Bloods
o	FBC, U&E, LFT, TFTs, BNP, troponins
-	CXR
-	Echocardiogram
67
Q

Diagnostic imaging of ARVC?

A
  • Cardiac Catheterisation
  • Cardiac MRI
    o RV enlargement, fatty infiltration, fibrosis and wall motion abnormalities
  • Cardiac biopsy
68
Q

Management of non-threatening ventricular arrhythmias?

A

o Beta-blockers (sotalol)

o Amiodarone

69
Q

Management of sustained VT/VF?

A

o Serial therapeutic drug trials using programmed ventricular stimulation
o ICD
 If inducible or present with syncope/cardiac arrest
o Radio-frequency ablation (if localised disease)

70
Q

Prognosis of ARVC?

A

o Progressive deterioration of RV function

o Mortality rate 1-3% per year

71
Q

Pathology of aortic dissection?

A

o Longitudinal splitting of muscular aortic media by column of blood
o Dissection may spread proximally, distally, rupture internally back into aortic lumen or externally

Lead to:
o Aortic incompetence, coronary artery blockage, cardiac tamponade
o Rapid exsanguination

72
Q

Classification of aortic dissection?

A

o Stanford Type A (70%)
 Ascending aorta involved

o Stanford Type B (30%)
 Ascending aorta not involved

73
Q

Risk factors of aortic dissection?

A 
o	Hypertension (70%)
o	Bicuspid aortic valve
o	Marfan’s syndrome
o	Ehlers-Danlos syndrome
o	Recent cardiac surgery or angiography/angioplasty
74
Q

Symptoms of aortic dissection?

A

o Abrupt onset sharp, tearing or ripping pain (maximal at onset) in anterior and posterior chest
o Syncope
o Hemiplegia (occlusion of carotid artery)
o Anuria (occlusion of renal arteries)
o Paraplegia (occlusion of spinal artery)

75
Q

Signs of aortic dissection?

A

o Aortic regurgitation murmur (30%)
o Asymmetrical peripheral pulses or pulse deficit
o Hypertension
o Hypotension – features of tamponade or neurological signs

76
Q

Investigations of aortic dissection?

A 
-	Bloods
o	FBC, U&E, coagulation, glucose and cross-matching
-	ECG
o	MI, LVH, ischaemia
-	CXR
o	Widened mediastinum 
o	Double knuckle aorta
o	Deviation of trachea 
o	Calcium sign – separation of two parts of wall of calcified aorta
-	CT Angiography
o	Definitive diagnosis
77
Q

Management of aortic dissection?

A

o High flow O2 using face mask
o Insert 2 wide-bore IV cannulas and cross-match 10U of blood (inform blood bank of suspected diagnosis)
o IV morphine + Antiemetic
o Call cardiothoracic team and cardiologist early
 All Type A dissections treated surgically
 Type B managed medically or surgically (if leaking, ruptured, compromising vital organs)
o Insert arterial line (right radial artery) and discuss how to control BP (Aim 100-110mmHh using labetalol infusion)

78
Q

Epidemiology of acute mesenteric ischaemia?

A

o >50 years old

o Mostly small bowel

79
Q

Causes of acute mesenteric ischaemia?

A

Arterial (thrombotic, embolic)
 AF, MI, mitral stenosis, endocarditis, arterial catheterisation
 Atherosclerosis, aortic aneurysm, heart failure, dehydration

Non-occlusive (low-flow states – poor cardiac output)
 Hypotension, cocaine, digitalis

Venous thrombosis
 Hypercoagulability (protein C and S deficiency, tumours, infection)

Trauma, Vasculitis, Radiotherapy

80
Q

Symptoms of acute mesenteric ischaemia?

A

 Acute severe abdominal pain
• Constant, central or around RIF
 No abdominal signs
 Rapid hypovolaemia – then shock

81
Q

Investigations of acute mesenteric ischaemia?

A 
o	Bloods
	Raised Hb, WCC, amylase
	Metabolic acidosis
o	AXR
o	CT angiography – gold standard
o	MR oximetric measurement of superior mesenteric vein flow
82
Q

Medical management of acute mesenteric ischaemia?

A

 Fluid resuscitation
 NG tube
 IV gentamicin + metronidazole
 IV UFH

83
Q

Surgical management of acute mesenteric ischaemia?

A

 Prompt laparotomy if peritonitis
 Arteriography and thrombolytics/Revascularisation
 Resection of dead bowel

84
Q

Prognosis of acute mesenteric ischaemia?

A

o Poor – mortality 50-90% in arterial and non-occlusive disease

85
Q

Complications of acute mesenteric ischaemia?

A

o Septic peritonitis

o SIRS into multi-organ dysfunction syndrome

86
Q

Definition of chronic mesenteric ischaemia?

A
  • Chronic atherosclerotic disease of vessels supplying intestine
  • Known as intestinal angina – usually all three major mesenteric arteries involved
87
Q

Epidemiology of chronic mesenteric ischaemia?

A

o Low incidence – mainly females 50-70 tears old

88
Q

Risk factors of chronic mesenteric ischaemia?

A

o Hx of CVD

o Smoking, hypertension, diabetes, hyperlipidaemia

89
Q

Symptoms of chronic mesenteric ischaemia?

A 
o	Abdominal Pain
	Moderate-to-severe colicky or constant pain
	Often post-prandial
o	Eating hurts
o	Weight loss and fear of eating
90
Q

Signs of chronic mesenteric ischaemia?

A

o Vague abdominal tenderness
o Abdominal bruit
o PR bleeding
o N&V

91
Q

Investigations of chronic mesenteric ischaemia?

A

o Bloods – FBC, LFT, U&Es – dehydration and malnutrition
o CXR
o ECG
o CT angiography – gold standard

92
Q

Management of chronic mesenteric ischaemia - asymptomatic?

A

 Smoking cessation and antiplatelet therapy

93
Q

Management of chronic mesenteric ischaemia - symptomatic?

A

 Surgery- Percutaneous transluminal angioplasty and stent insertion (option for open)
 May need TPN

94
Q

Definition of ischaemic colitis?

A
  • Compromised blood circulation supplying the colon
95
Q

Epidemiology of ischaemic colitis?

A

o Disease of the elderly mostly – average age 70

96
Q

Risk factors of ischaemic colitis?

A

o Thrombosis – IMA thrombosis
o Emboli – mesenteric arterial emboli, cholesterol emboli
o Decreased CO
o Shock
o Trauma
o Strangulation
o Drugs – digitalis, oestrogens, antihypertensives, cocaine, COCP
o Surgery – cardiac bypass, aortic dissection repair
o Vasculitis – SLE, polyarteritis nodosa, SCC
o Hypercoagulability – Protein C&S deficiency, PNH, antithrombin 3 deficiency
o Long-distance running

97
Q

Symptoms of ischaemic colitis?

A

o Acute onset LIF abdominal pain
o N&V
o Bloody diarrhoea

98
Q

Investigations of ischaemic colitis?

A

o Colonoscopy and biopsy – gold standard

o Barium enema – thumbprinting of submucosal swelling

99
Q

Management of ischaemic colitis?

A

o Fluid replacement
o Broad-spectrum antibiotics
o Surgery – laparotomy and removal of necrotic colon

100
Q

Path of SVC? Definition of SVC obstruction?

A
  • SVC extends from the junction of the right and left innominate veins to the right atrium
  • SVC provides venous drainage for the head, the neck, the upper extremities and the upper thorax
  • Caused by extrinsic compression, thrombosis, or invasion of the wall of the superior vena cava
  • Most commonly by extensive lymphadenopathy in the upper mediastinum (often in patients with lung cancer or lymphoma)
  • Can occur with any solid tumour (rarer causes include germ cell, breast or oesophageal cancer)
  • EMERGENCY
101
Q

Epidemiology of SVC obstruction?

A
  • Males > Females

- Malignant causes common when older

102
Q

Aetiology of SVC obstruction - malignant?

A 
	Lung Cancers
	Lymphoma
	Mediastinal Lymphadenopathy
	Germ cell tumours
	Thymoma
	Oesophageal
103
Q

Aetiology of SVC obstruction - non malignant?

A 
	Non-malignant tumours
	Mediastinal fibrosis
	Infection (TB)
	Aortic aneurysm
	Thrombus
104
Q

Symptoms of SVC obstruction?

A 
o	Headache/“feeling of fullness” in the head
o	Facial swelling
o	Dyspnoea (often worse on lying flat) 
o	Cough
o	Hoarse voice
105
Q

Signs of SVC obstruction?

A

o Facial/upper limb oedema
o Prominent blood vessels on the neck, trunk and arms
o Cyanosis

106
Q

Investigations of SVC obstruction?

A
  • Chest X-ray

- CT chest

107
Q

Management of SVC obstruction?

A
  • Corticosteroids (dexamethasone 16mg daily) with PPI cover
  • Urgent vascular stenting
  • Followed by radiotherapy or chemotherapy depending on primary tumour type
  • May need LMWH (if thrombus confirmed)
108
Q

Management of SVC obstruction - if cause unknown?

A

o Bloods: tumour markers
o CT chest, abdomen, pelvis
o Bronchoscopy/OGD
o Biopsy urgently

109
Q

Definition of Raynaud’s syndrome?

A
  • Episodic vasospasm that causes digits to change colour to white (pallor) from lack of blood flow
  • Brought on by cold temperatures
  • Affected areas subsequently turn blue due to de-oxygenation and/or red perfusion
110
Q

Types of Raynaud’s syndrome?

A

o Primary (idiopathic) RP – no underlying cause

o Secondary RP – associated underlying cause (usually connective tissue disorders – scleroderma, systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome or polymyositis)

111
Q

Epidemiology of Raynaud’s syndrome?

A
  • Affects 1-3% of population
  • Women > Men
  • Occurs in 20-30s most commonly
112
Q

Causes of secondary Raynaud’s syndrome?

A 
o	Scleroderma
	Includes ‘limited cutaneous systemic sclerosis’ – CREST (calcinosis, Raynaud’s phenomenon, oesophageal dysfunction, sclerodactyly, telangiectasia)
o	SLE
o	Rheumatoid arthritis
o	Sjogren’s syndrome
o	Dermatomyositis and polymyositis
o	Drugs
113
Q

Causes of digital vasospasm - drugs?

A 
	Amphetamines and cocaine
	Beta-blockers
	Chemotherapy
	Ciclosporin
	Interferon-alpha/beta
	COCP
	Clonidine
114
Q

Causes of digital vasospasm - vascular occlusive disease?

A

 Buerger’s disease
 Ateriosclerosis
 Thromboembolic disease

115
Q

Causes of digital vasospasm - haematological?

A

 Polycythaemia
 Paraproteinaemia
 Leukaemia

116
Q

Causes of digital vasospasm - occupation/environmental?

A

 Vibration injury
 Exposure to vinyl polychloride
 Frostbite/Cold injury

117
Q

Causes of digital vasospasm - infections?

A

 Hep B and C

 Mycoplasma infections

118
Q

Causes of digital vasospasm - endocrine?

A

 Hypothyroidism
 Pheochromocytoma
 Carcinoid syndrome

119
Q

Symptoms of Raynaud’s syndrome?

A

o Digits turn white (pallor) then blue with deoxygenation and/or red with reperfusion
o Digital pain, paraesthesia

120
Q

Diagnosis of Raynaud’s syndrome?

A
  • Clinical Diagnosis

o Diagnose primary Raynaud’s if no features of secondary Raynaud’s present

121
Q

Assessment and testing for secondary Raynaud’s syndrome?

A
  • Assess for secondary Raynaud’s
    o Connective tissue disease
     Morning joint stiffness, swollen joints, rash, photosensitivity, hairloss, dry eyes/mouth, FHx
    o Drugs and Medications
  • Testing for secondary Raynaud’s
    o Abnormal nail-fold capillaries (red pen marks, often seen in cuticles) using otoscope, ophthalmoscope or dermatoscope
    o Digital ulcers
    o Bloods – FBC, ESR, ANA, creatinine
122
Q

When to suspect secondary Raynaud’s syndrome?

A 
o	Onset >30 years
o	Episodes intense, painful and asymmetrical
o	Positive ANA
o	Abnormal nail beds
o	Ulcers
123
Q

Management of severe ischaemia in Raynaud’s syndrome?

A

Admission

124
Q

Referral to secondary of Raynaud’s syndrome?

A

o All secondary Raynaud’s syndrome

o Children 12 years or less

125
Q

General advice in Raynaud’s syndrome?

A 
o	Keeping whole body warm (gloves/warm socks)
o	Smoking cessation
o	Regular exercise
o	Avoiding stress
o	Stop drug exacerbating Raynaud’s
126
Q

Drug management of Raynaud’s syndrome?

A

If lifestyle advice fails
o Medication
 Nifedipine 5mg TDS and titrate up to 20mg TDS
o Refer if that fails

127
Q

Complications of Raynaud’s syndrome?

A

o Digital ischaemia
o Gangrene
o Digital Ulcers
o Infection

128
Q

Definition of lymphoedema?

A
  • Atypical collection of lymph fluid within body tissues

- Due to failure to clear fluid and macromolecules by lymphatic system

129
Q

Types of lymphoedema?

A

o Primary lymphoedema – congenital insufficiency of lymphatic system
 Milroy’s disease
 Turner’s syndrome

o Secondary lymphoedema – damage to lymphatic system or removal of lymph nodes by surgery/radiotherapy/infection or injury
 Malignancy (most commonly arms in breast cancer) (or its treatments)
 Recurrent lymphangitis (erysipelas, chronic venous ulceration)
 Lymph obstruction (tumour, TB, filariasis)

130
Q

Causes of lymphoedema?

A

o Malignancy (or its treatment)

131
Q

Symptoms of lymphoedema?

A 
o	Progressive swollen, firm limbs
	Arms and legs affected more often   
	Poorly pitting
o	Heaviness or fullness of limb
o	Tight sensation in skin
132
Q

Signs of lymphoedema?

A

o Kaposi-Stemmer sign – inability to pinch fold of skin on dorsal surface of foot at base of second toe
o Poorly pitting oedema
o Recurrent infections of limbs

133
Q

Diagnosis and investigations of lymphoedema?

A
  • Clinical diagnosis
  • Lymphangosyntigraphy
    o Diagnostic
  • Lymphangiography
    o Shows lymph hypoplasia, hyperplasia or retrograde obliteration
134
Q

Management of lymphoedema - general advice?

A

o Skin and nail care – reduce infection risk
o Elevation of limbs above level of heart when possible
o Regular exercise

135
Q

Management of lymphoedema - conservative management?

A

o Compression stockings
o Manual lymph drainage
o Intermittent pneumatic compression

136
Q

Management of lymphoedema - surgical management?

A

o If non-surgical methods have failed

o Liposuction, debulking and bypass operations

MSRA Content (87 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions