CARDIOVASCULAR SYSTEM Flashcards
How many surgical patients get DVT?
a) 1-2%
b) 20-50%
c) 60-70%
d) 80-90%
b) 20-50%
name 3 symptoms presents on the calf of a DVT patient
tenderness
warmth
swelling
pitting oedema
give one systemic symptom which may be present for DVT
mild fever
What is Homan’s sign for DVT?
a) pain on knee flexion
b) pain on dorsiflexion
c) pain on knee extension
d) pain on plantarflexion
b) pain on dorsiflexion
why shouldn’t Homan’s sign be performed?
may dislodge clot
if pain is referred to the iliofemoral region, what does this mean in reference to motility of the clot?
more likely to dislodge
in complete occlusion due to DVT, what sign of peripheral hypoxia might you see in the leg?
cyanosis
what is post-phlebitis syndrome?
ulceration after complete occlusion following a DVT
give 2 iatrogenic risk factors for DVT
HRT
COCP
give two lifestyle risk factors for DVT
immobility
obesity
give 3 physiological risk factors for DVT
malignancy
pregnancy
thrombophilia
past DVT
what is a thrombus in contrast to a clot?
solid mass in circulation from living blood constituents in life (not dried, dead etc)
what are red thrombi made of?
a) red cell & fibrin
b) red cell & cholesterol
c) white cell & fibrin
d) white cell & cholesterol
a) red cell & fibrin
What is Well’s score used to calculate?
DVT risk
what would a Well’s score of 3 or more indicate?
high risk DVT
What are these criteria used to calculate? active cancer previous DVT recent immobilisation swollen superficial veins calf swelling >3cm entire leg swelling localised swelling
Well’s Score
DVT
what specific blood test would you use in the case of suspected DVT?
D-Dimer
what specific radiological test would you do in a suspected DVT?
compression ultrasound
give 2 differential diagnoses for DVT
ruptured baker’s cyst
cellulitis
what is the first drug you would give in treatment of DVT?
LMWH e.g. enoxaparin
when would INR indicate it would be safe to stop LMWH?
a) 2-3
b) 1-2
c) 4-5
d) 9-10
a) 2-3
name an anti-coagulant you might also give in the case of DVT
warfarin
name a factor Xa inhibitor that you might also give in the case of DVT
fondaparinux
give a complication of DVT
pulmonary embolism
how common is acute coronary syndrome?
a) 1/1000
b) 5/1000
c) 50/1000
d) 100/1000
b) 5/1000
name 2 rare causes of ACS
emboli
coronary spasm
coronary artery vasculitis
what differentiates between chest pain of unstable angina and of an MI?
unstable angina = 20mins
give two places that ACS chest pain radiate to?
left arm
neck
jaw
Give 4 symptoms of ACS
sweating
tachycardia
nausea
breathlessness
name 2 signs you might hear when listening to the heart on chest examination in ACS
4th heart sound
pan systolic murmur
pericardial friction rub
name a sign you might see when observing the neck of a patient with ACS
raised JVP
name a sign you might hear when listening to the lungs of someone with ACS
crepitation due to pulmonary oedema
how would you distinguish a silent MI from other ACSs?
no pain
which of these is NOT at risk of getting a silent MI?
a) old
b) diabetic
c) immobile
c) immobile
what is the difference between the tissue damage in a STEMI and a NSTEMI?
STEMI = infarction NSTEMI = ischaemia (reversible)
what are the three main causes of the arterial narrowing that can cause ACS?
rupture
thrombosis
inflammation
what is the end result of cells that are affected to artery narrowing of cells in ACS?
iscahemia
infarction
necrosis
what is the sinus rhythm in an inferior MI and why does this occur?
sinus bradycardia
vagal stimulation
what is a transmural MI?
necrosis through the thickness of the pericardium
name 7 risk factors for ACS
age male obesity smoking hypertension diabetes cholesterol sedentary lifestyle family history stress LVHF cocaine
why are ACS attacks more common in the morning?
blood pressure lower at night.
when it rises in the morning can dislodge a clot
what would high troponin and ACS symptoms indicate?
MI
what would normal troponin but ACS symptoms indicate?
unstable angina
what do the cardiac enzymes CK and CK-MB indicate in ACS?
myocyte death
when would you expect lactate dehydrogenase to rise after an MI?
a) minutes
b) hours
c) days
d) weeks
c) days
name 2 things you might see in a chest x-ray of someone with ACS
cardiomegaly
pulmonary oedema
widened mediastinum
give 4 differential diagnoses for ACS
pericarditis angina pulmonary embolism aortic dissection myocarditis pneumothorax GORD
what is the mortality for MIs within 2 hours of onset?
a) 5%
b) 25%
c) 50%
d) 75%
c) 50%
what is the 4-way treatment plan for acute STEMIs?
aspirin 300mg
nitrate GTN spray
clopidogrel 300mg
oxygen
what surgical treatment would you recommend for an acute STEMI?
PCI angioplasty
what three drugs would you give in the case of an NSTEMI?
beta blockers
LMWH
nitrates
fill in the blanks for ACS rehabilitation advice:
no __ for 1 month, no __ __ for 2 months
sex
air travel
what 4 drug groups would you give long term following an MI?
anti-coagulant
statin
ACE inhibitors
beta blockers
name 3 acute serious cardiac complications of ACS
cardiac arrest
heart block
cardiac tamponade
name 2 causes of sudden death following MI
ventricular fibrillation
asystole
name 2 peripheral complications of MI
DVT
PE
which of these is a cardiac enzyme that will rise within hours of an MI?
a) ALT
b) AST
c) ALP
d) AZT
b) AST
what is Dressler’s syndrome?
immune mediated pericarditis
what immune mediated, post-MI condition do these symptoms indicate?
post MI: fever, pericardial effusion, anaemia, cardiomegaly
a) Dressler’s
b) Robert’s
c) Mallory-Weiss
d) SLE
Dressler’s symdrome
how is dressler’s syndrome treated?
a) self limiting, NSAIDs & steroids
b) self limiting, antibiotics & DVT prophylaxis
c) emergency, anti-coagulants & statins
d) emergency, antibiotics and DVT prophylaxis
a) self limiting, NSAIDs & steroids
what is the prevalence of angina pectoris in the UK?
a) 2%
b) 10%
c) 40%
d) 60%
a) 2%
what causes the pain of angina pectoris?
insufficient oxygen supply to meet heart’s demand
what causes the insufficient oxygen to the heart in angina pectoris?
atherosclerosis & narrowing of vessels
name 2 other causes of angina pectoris
anaemia
thyrotoxicosis
hyperlipidaemia
what environmental factors can precipitate angina pectoris?
exercise
cold
heavy meals
name 3 risk factors for angina pectoris
smoking
exercise
hypertension
diabetes
what is classical angina?
exercise provoked
disappears w rest
what is decubitus angina?
when lying
what is nocturnal angina?
wakes patient
vivid dreams
what is prinzmetal’s angina
at rest
without trigger
what ECG abnormality would you see in prinzmetal’s angina?
ST elevation during pain
in which gender is Prinzmetal’s angina more common?
female
what is cardiac syndrome X?
abnormal stress response to exercise with no artery abnormality
which gender is cardiac syndrome more common in?
female
what cardiac imaging might you do in suspected angina?
echocardiography
CT coronary angiography
name 4 drugs given to treat angina
aspirin 75mg
beta blockers
calcium channel blockers
GTN spray
name 2 surgical interventions that you might consider if angina is severe or doesn’t respond to drugs
PCI
CABG
which of these facts is wrong about prevalence of AF?
a) 5% in over 65s
b) 10% in over 70s
c) 15% in stroke patients
d) 20% of hyperthyroid patients
d) 20% of hyperthyroid patients
which of these doesn’t cause AF?
a) heart failure
b) MI
c) hypertension
d) hypothyroidism
e) mitral valve disease
d) hypothyroidism
which of these doesn’t cause AF?
a) PE
b) pneumonia
c) pneumothorax
d) alcohol
e) surgery
f) sepsis
c) pneumothorax
what is the characteristic pulse pattern of someone with AF?
irregularly irregular
give 3 possible symptoms of AF
palpitations
chest pain
dyspnoea
syncope
name 3 risk factors for AF
rheumatic heart disease
alcohol intoxication
hypertension
thyrotoxicosis
what electrolyte imbalances can predispose to atrial fibrillation?
hypokalaemia
hypermagnaemia
what is the normal heart rate for someone with AF
a) 40-60bpm
b) 60-80bpm
c) 120-180bpm
d) 180-200bpm
c) 120-180bpm
what electrical fault results in AF?
AVN intermittently responds causing irregular ventricular contraction
which of these isn’t a result of AF?
a) stasis of blood in heart chambers
b) neovascularisation
c) cardiac output drops
b) neovascularisation
how long does acute AF last?
less than 48 hours
what is paroxysmal AF?
recurrent sudden episodes
what is the difference between persistent and permanent AF?
persistant = rhythm treatable permanent = rhythm non-treatable
what ECG sign shows AF?
absent P waves
name 3 possible drugs given to control ventricular rate in acute AF
diltiazem
verapamil
digoxin
amoidarone
why would you give warfarin in chronic AF?
reduce risk of stroke (anticoagulation)
name 2 drugs used for first line treatment in chronic AF
beta blocker
calcium channel blocker
name a complication of AF
stroke
in what race is hypertension most common?
black africans
in what gender is hypertension most common?
men
what is the percentage of hypertension in the general population?
a) 5-10%
b) 20-30%
c) 50-60%
d) 75-85%
b) 20-30%
what is the main cause of essential hypertension?
no underlying cause
what is another element in the cause of essential hypertension?
genetics
what happens to blood pressure in hypertension?
elevated
name 2 non-circulatory symptoms of hypertension
headaches
sweating
shortness of breath
what would radio-femoral delay in hypertension indicate?
aortic coarctation
what would renal bruit in hypertension indicate?
renovascular disease
name 4 lifestyle risk factors for hypertension
obesity
alcohol
salt intake
stress
name 3 endocrine diseases which may predispose to hypertension
conn's cushion's acromegaly pheochromocytoma diabetes
name 2 physiological risk factors for hypertension
pregnancy
diabetes
which of these describes hypertension
a) increase in peripheral vascular resistance
b) increase in coronary vascular resistance
c) increase in coronary vascular lumen width
d) increase in peripheral vascular lumen width
a) increase in peripheral vascular resistance
how is hypertension graded?
1-3
3 is most severe
what aldosterone disorder can cause hypertension?
primary aldosteronism
what condition would hypokalaemia in hypertension indicate?
Conn’s
what heart changes might be seen in an ECG for hypertension
left ventricular hypertrophy
why is it important for the blood pressure not to be reduced too fast in treatment of hypertension?
baroreceptors in brain adapt to high pressure so reduction speedily may cause cerebral ischaemia
what would be first line treatment for essential hypertension?
ace inhibitor
or angiotensin 2 receptor antagonist
what would be first line treatment for someone over 55 or afro-carribean with hypertension?
thiazide diuretic and calcium channel blocker
what defines cardiac failure?
heart not able to pump blood at rate required for normal metabolism
disease of what arteries can cause cardiac failure?
coronary arteries
what is the prevalence of under 85s and over 85s for heart failure in the UK?
a) 7/1000, 90/1000
b) 50/1000, 150/1000
c) 100/1000, 200/1000
d) 1/1000, 5/1000
a) 7/1000, 90/1000
where would you get oedema in left ventricular failure in contrast with right ventricular failure
left = pulmonary oedema right = ankle/sacral
what sided heart failure would be characterised by orthopnoea and paroxysmal nocturnal dyspnoea?
left
in which sided heart failure would you find a displaced apex beat?
left
in which sided heart failure might you find ascites?
right
in which sided heart failure might you find a right ventricular parasternal heave?
right
what is the name of the classification system for heart failure?
new york heart association
name 5 things you might see on a chest X-ray for heart failure
Alevolar oedema (bats wing) Interstitial oedema (kerley B lines) Cardiomegaly Upper lobe Deviation Pleural effusions
what might an echocardiogram show for heart failure?
chamber distension
what is forward heart failure in relation to the kidneys?
ventricle can’t maintain normal renal circulation
Which system causes sodium and water retention in forward heart failure?
renin-angiotensin system
what occurs to the atria in backwards heart failure?
ventricles can’t prevent atria from overfilling
what occurs to the pulmonary system in backwards heart failure
back pressure on system
when is the onset of acute heart failure?
sudden within minutes of MI or valvular collapse
what 2 things cause onset of chronic heart failure
mitral stenosis which leads to RHF
chronic ischaemia
which sided heart failure is most common?
left
how would you define the circulating volume in congestive cardiac failure?
hypervolaemic
what occurs to the lungs with congestive cardiac failure
pulmonary oedema
what is cor pulmonale and what causes it?
right sided heart failure due to COPD
what two words would you use to describe greater circulating fluid before and after entering the heart?
preload
afterload
what happens to the ventricles during heart failure
dilation
what 2 things happen to myocytes during heart failure?
hypertrophy & remodelling
name 2 diuretics you could give in treatment for heart failure
furosemide
bendroflumethiazide
bumetanide
name an ace inhibitor you could give in treatment of heart failure
ramipril
name an angiotensin 2 receptor antagonist you could give in treatment of heart failure
losartan
when would you use angiotensin two receptor antagonists in heart failure?
intolerance to ace inhibitors
why are ace inhibitors used in the treatment of heart failure?
Relax blood vessels and lower blood pressure.
This improves blood flow.
Your heart is then able to pump more blood to the rest of your body without working harder.
why are beta blockers used in heart failure?
to improve cardiac function
when would you give a cardiac glycoside in heart failure? give an example
if AF present
digoxin
why are vasodilators and nitrates used to treat heart failure?
to reduce preload and afterload
intolerance to what 2 drugs would justify giving vasodilators and nitrates?
ace inhibitors
angiotensin 2 receptor antagonists
when would you consider anticoagulation/antiplatelets in a heart failure patient?
risk of stroke
what is mortality at 5 years for heart failure?
a) 5%
b) 25%
c) 50%
d) 75%
c) 50%
risk of what other cardiac condition is increase by four times following heart failure?
stroke
what two red flags would make you worry about infective endocarditis?
fever
new murmur
what 4 hand and nail signs might you expect to see in infective endocarditis?
clubbing
laneway lesions
osler’s nodes
splinter haemorrhages
what organ may be enlarged in septic infective endocarditis?
spleen
which of these is not a results of immune-complex deposition in infective endocarditis?
a) haematuria
b) non-viral hepatitis
c) glomerulonephritis
b) non-viral hepatitis
name 2 lifestyle risk factors for infective endocarditis
IVDU
poor dental hygiene
name 2 physiological risk factors for infective endocarditis
new arrhythmias
congestive heart failure
name an iatrogenic risk factor for infective endocarditis
prosthetic material in heart
what is the most common causative organism for infective endocarditis?
Staph A
name 2 other causative organisms for infective endocarditis
Coagulase negative Staph A
Streptoccous= Most common Strep Viridans
what is Duke’s criteria?
diagnosis of infective endocarditis
which of these is not a feature of Duke’s criteria
a) positive blood culture
b) fever
c) positive echo
d) new murmur
e) heart diameter
f) predisposing factors
e) heart diameter
what is mortality rate for infective endocarditis without treatment?
100%
what 2 antibiotics would you give for infective endocarditis
penicillin & gentamicin
what 2 antibiotics would you give for MRSA infective endocarditis?
vancomycin & gentamicin
name 2 complications of infective endocarditis
sepsis
infective emboli
abscess
what hearing distortions are common with postural hypotension?
tinnitus
what kind of syncope is present with postural hypotension?
vasovagal
what occur to the blood pressure that is abnormal in postural hypotension?
suddenly falls on standing
what condition is defined by a fall in the systolic by 20mmHg and diastolic by 10mmHg?
postural hypotension
where does blood pool upon a change in body position in postural hypotension?
lower extremities
how does pooling of blood in postural hypotension affect venous return? how does this affect cardiac output?
compromises venous return
decreases cardiac output and arterial pressure
which group does postural hypotension NOT commonly affect?
a) elderly
b) those with low blood pressure
c) young children
c) young children
what are the causes of postural hypotension?
4A’s, 2D’s, 2P’s
anorexia addison's atherosclerosis antidepressants diabetes ehler's Danklos Parkinson's phaechromocytoma
what change to diet is encouraged in postural hypotension?
high salt
what drug would you give in the case of anaemic postural hypotension?
erythropoietin
name a common heart irregularity in a young person
supra ventricular tachycardia (SVT)
name 3 symptoms associated with SVT
rapid
regular heart beat
chest pain
improves with rest
how would you treat SVT?
beta blocker
ca-ch blocker
What is congested heart failure?
It is both right and left heart failure. Blood returning to the heart get trapped in the IVC and SVC causing oedema.
What affect does congested heart failure have on the kidney?
Causes them to retain water and sodium which causes further oedema.
What are the condition that cause restrictive blood flow and therefore CHF?
Cardiac temponade
Constrictive pericarditis
What conditions cause inadequate heart rate and therefore CHF?
Beta blockers
Post MI
heart block
What is the New York heart Classification of heart failure?
Class I (no symptoms) – you don’t have any symptoms during normal physical activity
Cass II (mild) – you’re comfortable at rest, but normal physical activity triggers symptoms
Class III(moderate) – you’re comfortable at rest, but minor physical x triggers symptoms
Class IV (severe) – you’re unable to carry out any physical activity without discomfort and you may have symptoms even when resting ( symptomatically severe HF)
What conditions causes increase pre-load in low output heart failure?
Mitral regurgitation and fluid overload
What conditions causes increase after-load in low output heart failure?
Aortic stenosis and hypertension
What are the two main causes of HF?
CAD and hypertension
What is high output HF?
It is when the heart has a normal cardiac output however the demand of the body is greater than normal and therefore cannot meat the bodies demand
What conditions cause high output HF?
Hyperthyriodism
Paget disease
Heart disease with anaemia or pregnancy
What are the two types of LHF?
Systolic and diastolic heart failure
What is systolic LHF?
There is a reduced ejection fraction and the cardiac output of the left heart cannot meat the demand of the body. Abnormal left ventricular contraction
EF = <40%
What is diastolic LHF?
It is when the left side of the heart has a thickened heart muscle and cannot relax properly and therefore fill up normally. Increased filling pressure
EF= >50%
What causes systolic LHF?
MI CAD Hypertension Aortic stenosis Mitral regurgitation IHD Arrhythmia
What causes diastolic LHF?
Cardiac tamponade Constrictive pericarditis Pericarditis disease Hypertension Aortic stenosis that leads to hypertrophy Hypertension can lead to hypertrophy CAD
What are signs and symptoms of RHF?
Increase JVP Hepato congestion leading to ascites Peripheral oedema ( ankle and sacral) Right ventricle parasternal heaves Pitting oedema Fatigue
In which side heart failure would cause Haemoptysis and coughing up sputum that is frothy and pink?
Left
What are the symptoms of LHF?
Haemoptysis Coughing up pink and frothy sputum Fatigue PND Orthoponea
What are the signs of LHF?
S3 gallop Tachycardia Tachypnoea Pleural effusion Pleural oedema Displaced apex beat
What is the main cause of RHF?
Main cause of RHF is caused by LHF which causes increase in pressure in the lungs and then back to the right hand side of the heart increasing the work load
What lung diseases causes RHF?
PE, Pulmonary hypertension and emphysema
What type of stenosis causes RHF?
Mitral stenosis causes hypertrophy of atria and also increase in preload
What type of regurgitation causes RHF?
Tricuspid regurgitation as it causes volume overload and dilation of the right ventricle.
What birth defect leads to RHF?
Left to right shunt
What type of stenosis is there in Fallots Tetralogy?
Pulmonary stenosis
What is Ebstein’s anomaly?
Abnormality in tricuspid valves
What is Rheumatic heart disease?
Valvular disease due to rheumatic fever
What causes Rheumatic fever?
Untreated throat infection caused by Group A Streptoccocus
What is the cause of mitral stenosis?
Mainly due to Rheumatic heart disease
Can be due to calfication
Who is mitral stenosis commonly seen in?
Pregnancy
What are the symptoms of mitral stenosis?
Chest pain Fatigue Dyspnoea palpitations Haemoptysis
Signs of mitral stenosis
Mid late diastolic murmur
Radiates to axillia
Malar flush
What are the complications of Mitral stenosis?
AF Pulmonary Hypertension HF Left atrial dilation Thromboembolism
How do you diagnose mitral stenosis?
CXR = L atrial enlargement Echo = L atrial enlargement, thick+calcified mitral valve
What is the most common valvular disease in western world?
Aortic stenosis
What is the cause of aortic stenosis?
Calcification by age but made worse by dm and hypertension
Symptoms of aortic stenosis?
HF, angina and syncope
What are the signs of aortic stenosis?
Ejection systolic murmur that radiates from aortic area to carotid
Slow rising pulse
Narrow BP
Left ventricular heaves
What are the complications of aortic stenosis?
Left ventricular hypertrophy and dilation
HF
Thromboembolism
How is aortic stenosis diagnosed?
Cardiac chamber catheterisation –> definitive
ECG
Echo–> thickened valves and LV hypertrophy
Cxray–> cardiomegaly
What is the most common valvular disease?
Mitral regurgitation
What are the causes of mitral valve regurgitation?
Infective endocarditis
Mitral valve prolapse
Connective tissue disorder (marfans)
Rheumatic fever
What type of murmur in mitral regurgitation?
Pan systolic murmur
Where does mitral regurgitation radiate to?
Axilia
What is mitral regurgitation complications?
Heart failure
Pulmonary oedema
LV hypertrophy
AF
What is the main diagnosis of mitral regurgitation?
Echo which shows prolapsed valve
What is treatment for mital regurgitation?
- Vasodilators to reduce afterload
- Treat HTN
- Treat AF
- Intra-aortic balloon pump if acute until surgery
- Valve repair or replacement
What is the cause of aortic regurgitation?
- Idiopathic aortic root dilatation
- Dilatation due to ageing, infection, HTN or inflammatory disease
- Congenital bicuspid valve
- Infective endocarditis
- Aortic dissection
- Trauma
What sort of murmur is aortic regurgitation?
Early dialstolic murmur
What is the characteristic of BP in aortic regurgitation?
Wide BP
