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Y1 Cardiovascular > Conditions - HF / Atherosclerosis / Syncope / stroke / shock > Flashcards

Conditions - HF / Atherosclerosis / Syncope / stroke / shock Flashcards

1
Q

What is congestive heart failure

A

inability of the heart to maintain adequate cardiac output

Often the end stage of cardiac conditions

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2
Q

Categories of HF

A

Acute vs Chronic
Right vs Left
Systolic vs Diastolic
High vs Low output

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3
Q

What is chronic heart failure

A

Progressive dysfunction

Can have acute attacks

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4
Q

Common causes of acute heart failure

A

Acute MI
Acute cardiac tamponade
Acute valvular tamponade
Acute infective endocarditis

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5
Q

Common causes of chronic HF

A

Aortic stenosis
Ischaemic diseases
Cardiomyopathy
arrhythmias

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6
Q

Which side HF causes pulmonary congestion and systemic hypotension

A

Left HF (left ventricular failure)

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7
Q

What does right Ventricular failure cause

A

Pulmonary hypoperfusion

Systemic congestion

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8
Q

Common causes of right sided heart failure

A

secondary to left sided HF
cor pulmonale
congenital disease
pulmonary valve disease

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9
Q

What is cor pulmonale

A

Pulmonary hypertension -> increases SVR -> harder for right ventricle to pump blood -> right ventricular hypertrophy and eventually RVF

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10
Q

Common causes of Left sided HF

A

cardiomyopathy
valvular disease
congenital diseases

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11
Q

What is it called when there is both right and left side heart failure

A

Congestive cardiac failure

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12
Q

What does high output HF mean

A

There is sufficient cardiac output but not enough for the body due to increased metabolic demands / reduced SVR / shunting

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13
Q

What does systolic HF mean

A

impaired contraction during systole

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14
Q

Ejection fraction formula

A

SV / EDV

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15
Q

What does ejection fraction measure

A

The proportion of EDV ejected

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16
Q

What causes preserved ejection fraction heart failure

A

Diastolic heart failure

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17
Q

What causes diastolic HF

A

Cardiomyopathy - stiffness of the heart (cannot stretch to fill)
Cardiac tamponade
Constrictive pericarditis

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18
Q

What type of cardiomyopathy cause systolic HF

A

thin, weak heart muscle

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19
Q

What conditions cause increase in metabolic demands which in turn causes high output HF

A

Pregnancy

Hyperthyroidism

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20
Q

What conditions cause very low SVR which in turn causes high output HF

A

Sepsis - causes vasodilation
Anaemia
thiamine deficiency

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21
Q

What are the consequences of left sided heart failure

A

Pulmonary congestion because blood cannot be pumped out so it backs up in pulmonary vessels

Systemic hypotension because blood not pumped out

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22
Q

Symptoms of LVF pulmonary congestion

A

Exertional dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea
nocturnal cough

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23
Q

Clinical features of LVF pulmonary congestion

A

Pulmonary oedema - fluid in alveoli due to high blood pressure forcing fluid out
Tachycardia
3rd heart sound
Crackles on auscultation

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24
Q

Clinical Signs of systemic hypoperfusion

A

Prolonged capillary refill time
cyanosis
Pulsus alterans

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25
Q

What is the word for alternating strong and weak pulses

A

Pulsus alternans

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26
Q

How does LVF cause RVF

A

Pulmonary congestion -> pulmonary hypertension -> cor pulmonale

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27
Q

Symptoms of RVF (systemic congestion)

A

Oedema
weight gain
abdominal distention

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28
Q

Clinical signs of RVF

A 
Elevated JVP 
Ankle / sacral oedema
Ascites 
Hepatomegaly 
Tricuspid regurgitation - pansystolic murmur
Pleural effusion
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29
Q

Diagnosis of HF

A

Blood tests
ECG
Imaging - echocardiogram / CXR

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30
Q

What do blood tests for HF measure

A

FBC - to exclude anaemia
U&Es - to exclude renal failure causing oedema
LFT - to check for hepatomegaly and exclude liver failure causing oedema
TFT - to exclude hyperthyoridism
BNP

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31
Q

What does elevated BNP indicate

A

Highly likely it is heart failure hence refer the patient to get echocardiogram

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32
Q

What does echocardiogram see

A

Any valvular abnormalities / contraction dysfunction

Measures ejection fraction - to see if EF is preserved or reduced

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33
Q

Normal ejection fraction value

A

50 - 70%

Below 40% + elevated BNP = HFrEF

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34
Q

Features of CXR that may be seen in HF

A

Cardiomegaly (due to hypertrophy)
Pulmonary oedema
Pleural effusion
Kerley B line

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35
Q

What is Kerley b line

A

It is a line normally at lung bases, extending transversely to touch the pleural margin.
It indicates pulmonary oedema

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36
Q

First line drug therapy for LVF

A 
Diuretics - for relief oedema
- loop (furosemide) is used 
- add thiazide if oedema is resistant 
ACEi + Beta Blockers 
AT inhibitor if ACE is not tolerated
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37
Q

What conditions contraindicate the use of beta blockers

A

Asthma
COPD
Bradycardia

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38
Q

Second line treatment for LVF

A

Spironolactone (aldosterone inhibitor)
Digoxin
Ivabradine
Vasodilators - hydralazine + nitrates

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39
Q

When can digoxin be used

A

Second line treatment of HF if patient has atrial fibrillation

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40
Q

Third line treatment of HF

A

Cardiac resynchronisation therapy

Transplantation

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41
Q

When is cardiac resynchronisation therapy used

A

Last line treatment for HF in patients with prolonged QRS

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42
Q

Treatment for acute HF

A

IV furosemide
IV dopamine
IV diamorphine

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43
Q

Drugs to treat angina

A 
CCB
Beta blockers
Nitrates
aspirin
statin
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44
Q

Formation of atherosclerotic plaque

A

1) initial endothelial injury, increasing permeability of the vessel
2) LDL move into the intima layer. Monocytes move into the intima layer
3) Monocytes become macrophages and release free radicals that oxidise LDL -> OXLDL
4) Macrophage engulf OXLDL -> foam cell -> forms fatty streak
5) OXLDL also amplifies this inflammation process by attracting more macrophages
6) Release of inflammatory mediators causes proliferation of smooth muscle into intima layer
7) Recurrent injury and healing -> fibrosis -> collagen deposit in intima layer
8) Atherosclerotic plaque with fibrous cap and fatty core forms

45
Q

Complications of atherosclerosis (STADEI)

A 
Arteriole Stenosis 
Arteriole Thrombosis 
Aneurysm 
Dissection
Embolism
Ischaemia
46
Q

Why do aneurysms form

A

Weakened tunica media layer, causing persistant dilation

47
Q

List the different consequences of atherosclerosis in different arteries

A

Carotid artery - stroke / TIA
Renal artery - renal hypertension / renal failure
Coronary artery - MI / heart failure
Periphery artery - leg ischaemia / claudication

48
Q

What increases risk of thrombosis

A

Virchow’s triad

  • abnormal blood flow
  • increased coagulability of blood
  • injury to the vessel
49
Q

Consequences of arterial thrombosis

A

MI
renal infarction
cerebral infarction
Gut infarction

50
Q

What is dissection

A

Splitting of media layer by flowing blood, creating a false lumen

51
Q

pregnancy and Marfan’s syndrome causes an increase in risk of which complication of atherosclerosis

A

Dissection

52
Q

What are the risk factors for atherosclerosis

A 
Obesity 
High cholesterol
Smoking  
Type 1 diabetes 
Physical inactivity
Hypertension
53
Q

What is considered as hypertension

A

Anything above 140/90

54
Q

What is considered as stage I hypertension

A

above 140/90 or

Ambulatory BP 135/85

55
Q

What is considered as stage II hypertension

A

Above 160/100 or

>150/95 ambulatory BP

56
Q

What is considered as stage III hypertension

A

Above 180/110 or

Ambulatory diastolic pressure 110

57
Q

Normal range of pulse pressure

A

30 - 50

58
Q

Formula for pulse pressure

A

Systolic BP - Diastolic BP

59
Q

What conditions do hypertension increase the risk for

A

MI
stroke
Chronic kidney disease

60
Q

What are the classifications of hypertension

A

primary vs secondary

benign vs malignant

61
Q

What is defined as a malignant hypertension

A

When diastolic BP is > 130-140

Life threatening

62
Q

Why is it important to still treat benign hypertension

A

Because it can eventually case

  • Left ventricular hypertrophy
  • HF
  • atherosclerosis
  • thickening of tunica media
  • hypertensive arteriosclerosis
  • hypertensive retinopathy
63
Q

What can malignant hypertension cause

A

acute HF
cerebral haemorrhage (haemorrhagic stroke)
acute renal failure
fibrinoid necrosis in blood vessels

64
Q

What drugs can cause hypertension

A

NSAID
Glucocorticoids
Oral contraceptives

65
Q

Risk factors for hypertension

A 
Age
Family history of hypertension
Obesity
Alcohol
Diabetes
66
Q

What are the conditions that can cause secondary hypertension

A

Excess renin
hyperaldosteronism
Cushing’s syndrome

67
Q

How would you diagnose hypertension

A

Blood tests to exclude secondary causes
Measure BP
Average of 2 ambulatory BP to confirm
Measure ASSIGN risk score

68
Q

Management of hypertension

A

Stage I - lifestyle advice

Stage II and III - lifestyle advice + drug therapy

69
Q

When is CCB used in hypertension management

A

First line if the patient does not have type 2

diabetes

70
Q

What is the drug therapy for hypertension

A

First line - ACE inhibitors / CCB
Second line - ACEi + CCB/Diuretics or CCB + ACEi/Diuretics
Third line - ACEi + CCB + Diuretics

71
Q

What is stroke

A

Acute onset of neurological symptoms and signs due to disruption of blood supply to the brain

72
Q

Difference between TIA and stroke

A

TIA is a brief disruption, usually due to small blood clots and will resolve by itself

73
Q

2 types of stroke

A

Ischaemic stroke

Haemorrhagic stroke

74
Q

What is ischaemic stroke

A

Due to blood clot occluding the vessels that supply the brain
Can be due to thrombosis or embolism

75
Q

Which part of the heart most commonly produce blood clots

A

Left atrium (atrial fibrillation usually occurs here)

76
Q

What are the causes for ischaemic stroke

A

Thrombosis / atherothrombotic
Embolism
Hypoperfusion due to stenosed artery

77
Q

What is haemorrhagic stroke

A

Stroke due to bleeding inside or around brain tissue, causing damage

78
Q

Unmodifiable risk factors for stroke

A 
Age 
family history of stroke
previous history of stroke or TIA
gender
race
79
Q

Modifiable risk factors of stroke

A 
Hypertension
Hyperlipidaemia 
AF
Smoking 
Alcohol
Diabetes
HF
80
Q

What is FAST score

A 
Facial drooping
Arm weakness
Speech difficulties
Time 
This helps identify those that need urgent referral to stroke center
81
Q

Imaging for stroke

A

CT is better than MRI because CT is quicker

82
Q

What should not be given to a person with haemorrhagic stroke

A

Antiplatelets and anticoagulants

83
Q

What is the management of ischaemic stroke

A

Thrombolysis ror thrombolectomy

Treat underlying cause

84
Q

4 types of shock

A

Hypovolaemic
Distributive
Obstructive
Cardiogenic

85
Q

What is defined as shock

A

Abnormal circulatory system resulting in inadequate tissue perfusion due to low BP and CO

86
Q

What is hypovolaemic shock

A

Shock due to loss in blood volume which can be haemorrhagic or non-haemorrhagic

87
Q

How does loss in blood volume lead to hypovolaemic shock

A

Loss in blood volume -> decrease in venous return -> decrease in preload -> decrease in EDV -> decrease in SV hence CO

Loss in blood volume -> decrease in BP -> baroreceptor reflex + RAAS system -> vasoconstriction + tachycardia

88
Q

Why are patients in hypovolaemic shock tachycardic and peripherally cool

A

Due to sustained decrease in blood volume activating baroreceptor reflex and RAAS

Baroreceptor reflex -> increase in sympathetic stimulation -> vasoconstriciton and increase in heart rate
RAAS -> vasoconstriction

89
Q

Under what circumstances will the compensatory mechanisms fail to maintain BP

A

When the loss in blood is > 30% of total blood volume

90
Q

What is cardiogenic shock

A

Shock due to cardiac dysfunction

91
Q

What causes cardiogenic shock

A

Arrhythmias
Valvular pathologies
MI

92
Q

What is obstructive shock

A

Shock due to pressure pressing against the heart or occlusion of vessels

93
Q

What causes obstructive shock

A

Pneumothorax - air pressure pressing against the heart -> decrease in venous return

Cardiac tamponade - fluid pressing against the heart -> decrease in venous return

94
Q

What is distributive shock

A

Shock due to peripheral vasodilation leading to abnormal distribution

95
Q

What causes distributive shock

A

Septic shock
Anaphylactic shock
Neurogenic shock - excess parasympathetic stimulation causing vasodilation

96
Q

How to manage septic shock

A

Septic 6 bundle - start within an hour
3 in - IV fluids / oxygen / antibiotics
3 out - blood culture / serum lactate / urine output

97
Q

What is syncope

A

Transient loss of consciousness characterized by short duration due to hypotension causing short inadequate cerebral perfusion

98
Q

What is the difference between syncope and stroke

A

Inadequate perfusion in syncope is only for a short duration
Hypotension in syncope is not sustained
Syncope is self-resolving

99
Q

3 types of syncope

A

Postural hypotension
Reflex syncope
Cardiac syncope

100
Q

3 types of reflex syncope

A

Vasovagal
Situational
Carotid sinus

101
Q

What is reflex syncope

A

Syncope due to reflex response leading to cardioinhibition and vasodepression

102
Q

What triggers vasovagal syncope

A

Prolonged standing
Heat
Stress

103
Q

Prodromal symptoms + no signficant history is a typical example of

A

Vasovagal syncope

104
Q

What triggers situational syncope

A

Coughing
Urination
Swallowing

105
Q

What is carotid sinus syncope

A

Exaggerated response to carotid baroreceptors due to neck manipulation

106
Q

What is cardiac syncope

A

An acute cardiac event causing sudden drop in CO and BP

107
Q

What kind of cardiac events can cause cardiac syncope

A

Arrhythmias

Structural diseases - aortic stenosis / cardiomyopathy limiting blood flow

108
Q

Why shouldn’t aspirin be used in asthmatics

A

Most people with asthma are allergic to aspirin

Y1 Cardiovascular (6 decks)

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