Chapter 2- Cardiovascular Flashcards
What is heart failure?
A complex syndrome that can occur from any structural or functional cardiac disorder that impairs the ability of the heart to fill with and eject blood and therefore function efficiently as a pump to support physiological circulation
Name two types of heart failure
1) systolic heart failure (reduced ejection fraction ventricles can’t pump it fully)
2) diastolic heart failure (preserved ejection fraction heart can’t fill with blood properly
-biventricular –> both sides
What ejection fraction signifies systolic heart failure?
<40%
Why is the ejection fraction in diastolic heart failure normal?
Because although you have a low stroke volume you also have a reduced ‘preload’ (low total volume entering ventricle)
With left sided heart failure blood gets backed up to where?
The lungs
With right sided heart failure blood gets backed up to where?
The body
What’s JVP and what’s it often a sign of?
Jugular venous pressure (often in right sided heart failure)
Why can patients with heart failure get enlarged livers and spleens and what can this lead to?
Fluid leaks out into interstitial space and they enlarge, can lead to e.g liver cirrhosis
True or false: very little fluid can build up in the peritoneal space
False a LOT of fluid can = ascites
What is pitting oedema?
E.g fluid build up in legs when you press it it leaves a ‘pit’ and takes a while to come back
How many classes are on the New York heart association classification?
Four
Tnt (troponin) above what levels indicates a probable MI?
> 30 ng/L
What is troponin?
Specific cardiac structural proteins- if there is myocyte injury troponin will be released
Name two cardioselective beta blockers used in heart failure
Bisoprolol
Carvedilol
Name a new combination treatment used in heart failure
Sacubitril/valsartan
What type of drug is sacubitril?
Neprilysin inhibitor
How does sacubitril work?
Reduces the breakdown of natriuretic proteins, increasing salt and water excretion via kidneys
What is an ICD?
Intra cardiac defirbrillator: implanted device to terminate or shock patients who develop life threatening heart rhythms, often combined with CRT device
What is a CRT device?
Cardiac resynchronisation therapy: special pace maker device to improve efficiency of existing pump function
Acute coronary syndrome can be split into three clinical presentations- what are these?
STEMI
NSTEMI
unstable angina (UA)
Name three things that can damage the endothelium of artery walls
Low density lipoprotein
Smoking
High blood pressure
What’s a foam cell
Dead macrophages containing excess low density lipoproteins
Name two cardiac troponins and when should they be measured?
TnT and Tnl : levels taken on arrival, at 6 hours and 12hours if required (levels peak within 12 hours)
How long does it take troponin levels to fall after their initial rise?
They fall slowly for up to 2 weeks
Name two cardiac markers used in ACS
Cardiac troponins
Creatinine kinase
Describe how creatinine kinase rises and fall post infarction?
Rises 6 hours post infarction and falls >36 hours
Why is creatinine kinase levels not as good as troponin levels?
Creatinine kinase is not cardioselective - also found in skeletal muscle so may be higher in e.g athletes
What does the GRACE score calculate?
% risk of mortality from ACS
What GRACE score signifies high risk?
> 3%
What GRACE score signifies intermediate risk?
1.5-3%
What GRACE score signifies low risk?
<1.5%
The GRACE score tells you the % risk of death at 4 different intervals, what are these
1) in hospital
2) 6months
3) 1 year
4) 3 years
During an acute NSTEMI the anticoagulant fondaparinux is used–> when would you use IV UFH instead?
When GFR <20ml/min
When would you use tirofiban in acute treatment of NSTEMI?
If GRACE >6% or significant ECG changes –> NICE says it prevents thrombus extension
List the medication expected for Intermediate risk NSTEMI
Aspirin 300mg Clopidogrel 600mg (or ticagrelor) Fondaparinux (or UFH) IV nitrates Morphine & metoclopramide Beta blocker ACEi Statin
Name one extra medication use for high risk NSTEMI not used in intermediate risk NSTEMI
Tirofiban
What heart rate do you aim for post NSTEMI?
50-60bpm
When using aldosterone antagonists such as spironolactone or eplerenone what should you be cautious of
Hyperkalaemia
If patients have evidence of heart failure post MI (ejection fraction <40%) what should they be started on within 3-14 days of the event?
Aldosterone antagonist such as eplereone (if already on spironolactone then remain on this)
What is PCI
Percutaneous coronary intervention–> balloon stent to prevent stenosis
When should thrombolysis be used?
When can’t get to angioplasty for STEMI
What is tirofiban?
Glycoprotein 2B/3A inhibitors –> reversible inhibition of platelets whilst bound
