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Year 3 > Core conditions CVD > Flashcards

Core conditions CVD Flashcards

1
Q

Common presenting CV conditions?

A 
ACS - MI/ Unstable angina
Stable Angina
1" HTN
AF
LVHF/RVHF/CHF
Valvular HD
Postural hypotension
DVT
Infective Endocarditis
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2
Q

A 65 y/o man walks into the GP with chest pain/sweating/nausea/SOB.

What are the diffrentials?

A

MI*
Angina*
Aortic dissection

PE
Pneumothorax

Oesephgeal reflex*
Peptic ulcer

MSK: costocondiritis*
Neuro: shingles

Anxiety*

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3
Q

What tests could you do to confirm if someone is having an MI?

A

Troponin (see in NSTEMMI)

ECG - ST elevation

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4
Q

Treatment of MI?

ROAM GB

A 
ROAM GB:
Reassurance
02
ASPIRIN
Morphine

GTN
B-blocker
(PCI)

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5
Q

What might a patient later suffer from after an MI?

A 
DARTH VADER:
Death/ Depression
Arrhythmias
Ruptured myocardium
Thrombus --> STROKE
Heart failure
Ventricular aneurysm
Angina
Dressler's syndrome
Emboli
Recurrence
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6
Q

A 70 y/o Diabetic man presents to A&E feeling SOB with chest pain on exertion and nausea. They feel better when they rest.

What is it likely to be?

A

Stable Angina

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7
Q

Angina = chest pain from heart ischaemia.

State 3 common causes.

A

ATHEROMA/CHD
Vasospasm
Aortic stenosis

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8
Q

Diffrentials of Angina?

A

Same as MI

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9
Q

Angina can be diagnosed by exclusion using an ECG. What would you give to relieve the man’s symptoms?

A

GTN spray
B-blockers/Ca2+ blocker

+ 2” prevention measures (Statins, Aspirin, ACE-In)

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10
Q

Complications of Angina?

A

MI

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11
Q

Define AF

A

AF = disordered electrical activity in the atria

1.5% of population

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12
Q

AF is associated with IHD*/HTN/Valvular HD/ Hyperthyroid/Congenital HD/Obesity.

T/F?

A

T

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13
Q

What lifestyle risk factor can lead to AF?

A

Alcohol

CV risk factors

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14
Q

State 4 symptoms that someone with AF may present with.

A

PALPITATIONS
SOB
Faint
Chest pain

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15
Q

What is the classic sign of AF?

A

Irregularly irregular pulse

often very fast pulse

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16
Q

Name 5 diffrentials of AF that the man could have.

A 
Atrial tachycardia
Ectopic beats
Wolf-Parkinson-White syndrome
Anxiety
Sinus Tachycardia
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17
Q

What investigative finding is diagnostic of AF?

A

ECG - No P waves

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18
Q

______ and _______ is a potential complication of AF.

Whats the treatment for AF?

A

STROKE, Heart Failure

ABCD:
Anti-coagulant
B-blocker
CCB (Rate-limitng)
Digoxin
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19
Q

Essential hypertension is present in > 30% of adults.

T/F?

A

T

Cause unknown

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20
Q

If you are ________ or have a _______ of HTN, you are more likely to get it.

A

Afro-Carribean

FH

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21
Q

List 7 diffrentials of essential HTN

A

WPW Syndrome
MI
Stroke

Hyperthyroid

Sleep apnoea
Anxiety

White coat HTN

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22
Q

How would you diagnose Essential HTN?

A

Sustained BP > 140/90 in home and clinic

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23
Q

State the 2 drugs most commonly prescribed for HTN.

A

ACE-In

Ca2+ blocker (>55ys/Afro-C)

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24
Q

What lifestyle changes would you encourage for someone with Essential HTN

A

Reduce Salt/Alcohol

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25
Q

Those with HTN are advised to have their _________ function checed annually

A

Kidney

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26
Q

What is the clinical definition of a sudden drop in blood pressure when someone stands up too quickly?

A

POSTURAL HYPOTENSION

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27
Q

Postural hypotension is common in the ________

A

Elderly

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28
Q

Which type of drug has a side effect of postural hypotension?

A

Diuretic

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29
Q

Risk factors for postural hypotension?

A

Elderly
Diuretics

Heart failure
Aortic stenosis
Diabetes

Parkinsons
Pernicious anaemia

Pregnancy

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30
Q

What would a patient say that made you think “postural hypotension”

A 
Light-headed/dizzy when stand
Blurred vision
Weakness
Headache
Nausea
Palpitations
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31
Q

The diffrentials of postural hypotension could be hypoglycaemia, vertigo, vasovagal syncope and psychogenic syncope.

What changes in the BP would make it diagnostic of PO?

A

Drop in BP when stand:
> 20mmHg systolic/

> 10mmHg dialstolic

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32
Q

DVTs affect ~1 in 1000 per year. List some risk factors

A 
Immobilisation
Recent surgey
Cancer
Obesity
Pregnancy
Dehydration
Factor V Leiden
Previous DVT
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33
Q

A 40 y/o come to the GP complaining of a red, hot, swollen leg.

What are the diffrentials?

A

DVT*

Skin:
Cellutitis*/Superficial thrombophlebitis/Cirrhosis

Trauma: sprain*/fracture

CV: Heart failure*, Acute Limb ischaemia

MSK: Baker’s cyst rupture*

Nephrotic syndrome*

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34
Q

Whats the 1st thing you would do if you suspect a DVT?

Other investigations?

A

Wells Score

Doppler
D-Dimer

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35
Q

The treatment for DVT is an anticoagulant. Give an example of one.

A

LMW heparin

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36
Q

State the main complication of DVT.

A

PE

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37
Q

LVHF is called by DYSFUNCTION or TOO MUCH PRESSURE.

What are the causes of LVHF?

A

MI

HTN
Valvular HD

(Also risk factors)

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38
Q

How would a person with LVHF present?

A

Cyanosed
SOB
Pulmonary oedema: Orthopnoea, PND
Blood in sputum

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39
Q

Diffrentials of LVHF can be anything Respiratory. What investigations would you do to exclude LVHF?

A

CXR - Cardiomegaly, pleural effusion, Kerley B lines, dilated hilum

ECHO - ejection fraction < 40%

BNP - if no previous MI

ECG - exclude

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40
Q

You order a CXR when you suspect LVHF from the signs. What signs did notice?

A 
Signs:  
High RR
High pulse
Low SATS
Dull to percuss
Bi-basal inspiratory crackles at
41
Q

What medication would you give to relieve LVHF?

A

BAD:
B-Blocker
Ace-In
Diuretic

42
Q

Complications of LVHF include (ROAD) Renal azotemia, Oedema, Arrythmias, Depression and ______

A

RVHF!

43
Q

Which condition is common in elderly and described as bacteria and debris colonising on the heart valve?

A

INFECTIVE ENDOCARDITIS (IE)

44
Q

State 5 risk factors of IE.

A

Dental work (Strep Viridans)
IVDU (Staph)
Defective valves
Congential heart defects

BOWEL CANCER (Strep Bovis)

45
Q

What pneumonic is used to remember the sign/symptoms of IE?

A

FROM JANE

Fever
Roth spots
Oslers nodes
Murmur

Janeway lesion
Anaemia
Nail haemorrhages
Emoboli

46
Q

The diffrential for IE are SLE, Cardiac tumours, Polymyalgia rheumatica.

How would you diagnose IE?

A

Blood culture

ECHO - vegetations

47
Q

Treatment of IE?

A

IV antibiotics

48
Q

Complications of IE?

A 
Septic embolic:
Stroke
Glomerulonephritis
AKI
MI
Congestive HF
49
Q

Unstable angina is AKA ________ ________?`

A

Crescendo angina

50
Q

How would you define unstable angina?

A

= angina of increasing freq OR with minimal exertion/at rest

51
Q

Unstable angina is a medical emergency. T/F?

How does it present?

A

T

Same signs, symptoms, diffrentials as MI.

52
Q

You investigate unstable angina the same way you would investigate an MI.
ECG and Troponin. What ECG findings may you see?

A

Normal ECG!

ST depression

Inverted T wave

53
Q

You are trying to avoid the unstable angina progressing to a MI. State the treatment you would give.

A

GTN spray
Analgesia
02

Other CV meds: Aspirin, B-blocker..

54
Q

A 65 y/o lady walks into the GP and wants to know what RVHF can be caused by what…?

A

LVHF
Cor pulmonale
Pulmonary stenosis
MI

55
Q

You explain that RVHF symptoms are less specific than for LVHF. What might a patient complain of?

A

CAW HEAD:
Constipation
Anorexia (nausea)
Weight loss

Hepatomegaly
Edema (bipedal, pulmonary)
Ascites
Distended neck vein

Urinary frequency

56
Q

Think of signs of RVHF after doing a CV exam. What are they?

A

Cold peripheries
High RR
Raised JVP

RV heave
Pleural/pericardial effusion
Hepatomegaly/Splenomegaly
Peripheral oedema

57
Q

Diffrentials for RVHF could be respiratory or renal. Name a few

A

Respiratory failure, CAP, COPD, ARDS

AKI, Nephrotic syndrome

58
Q

The investigations for RVHF are different to the LVHF. T/F?

A

F

The same!

59
Q

Treatment for RVHF?

A

B-A-D

60
Q

The complications of RVHF are _____ and _____

A

Arrhythmias

CCF

61
Q

What is the term for the condition where the heart is not abe to meet the body’s demands?

A

Congestive Cardiac Failure (CCF)

62
Q

State the criteria used to diagnose CCF.

A

Framingham Criteria

2 major/1 major + 2 minor

63
Q

Diffrentials for CCF are the same as for RVHF. T/F?

A

T

64
Q

What 2 investigations could you do to confirm CCF?

A

ECHO - chamber dilation, hypertrophy

CXR - cardiomegaly

65
Q

Treatment for CCF differs to that for LVHF and RVHF. How so?

A

LAD:
Lifestyle modifications
Ace-In
Diuretics

(No B-blockers!)

66
Q

70% of all Valvular Heart Disease (VHD) is due to ______/______ ______

A

Aortic/Mitral Stenosis

67
Q

State the most common VHD.

A

Aortic stenosis

10% of >80yrs

68
Q

Aortic stenosis has 2 principle causes…?

A
  1. Age-related calcification

2. Congenital 2 cusps (accelerates cusps)

69
Q

Aortic stenosis symptoms can be summarised using the mneumonic SATS.

What does it stand for?

A

S - Syncope
A - Angina
T - Tiredness
S - SOB (esp exertion)

70
Q

You perform a CV exam of someone who has symptoms of Aortic stenosis. What would you find?

A

Slow-rising pulse
Narrow systolic-diastolic pressure differences
LV heave
Ejection systolic murmur

71
Q

Diffrentials of Aortic stenosis can be made based on the murmurs. Name 2 diffrentials.

A

Aortic sclerosis
Aortic regurgitations
Subacute IE.

72
Q

If you suspect a patient has Aortic stenosis. What investigations would you do to confirm this?

A

ECHO
ECG - large QRS wave
CXR - cardiomegaly, AS calcification

73
Q

The standard treatment for Aortic stenosis is _____ _____ ________.

What if you are a child or unfit for surgery?

A

Aortic valve replacement (TAVI)

Balloon Valvuloplasty

74
Q

The main complication of Aortic stenosisis ____, which a patient can also present with.

State other complications.

A

ANGINA

Postural hypotension
CCF (LVH with no HTN)
Sudden death

75
Q

Which VHD is less common: mitral stenosis or mitral regurgitation?

A

Mitral regurgitiation

76
Q

Mitral stenosis occurs more commonly in males than females.T/F?

A

F

More common in females.

77
Q

State 5 causes of Mitral stenosis

A

Age-related calcification
Congenital
Rheumatic fever

Infective Endocarditis
SLE, AF

78
Q

How might a patient present with mitral stenosis? 4 P’s

think of anatomy

A 
Progressive SOB
Pulmonary oedema  (Orthopnoea, PND)

Palpitations (AF)
HaemoPtysis

79
Q

Signs of mitral stenosis?

A

Malar flush on cheeks
AF
Raised JVP
Mid-diastolic murmur

80
Q

The diffrentials of mitral stenosis may be…?

A

AF
Heart failure
SLE

81
Q

Mitral stenosis is closely related to ____.

A

AF!

LA dilataton can lead to AF
AF can loose some “atrial kick” –> stensosis

82
Q

You investigate to confirm a mitral stenosis diagnosis. What would you do?

A

CXR - enlarged LA
ECG - AF
ECHO

83
Q

The main treatment for Mitral stensosis is Percutanous Mitral Commisurectomy (PMC).
What medication would you give to treat the patient’s symptoms?

A

Diurectics (pulmonary oedema)
B-blockers/CCB (AF)
Anti-coagulant (AF)

84
Q

State 4 complications of mitral stenosis.

A

Dilated LA
AF
Pulmonary HTN –> RVHF
Infective Endocarditis (risk factors)

85
Q

Aortic regurgitation can present as SYNCOPE. What mneumonic is used to remember the causes of it?

A 
CREAM:
C- Congenital
R - RF
E - Endocarditis
A - Aortic root dilation
M - Marfan's   (RA, SLE, Syphilus)
86
Q

What signs would you expect to see in Aortic regurgitation?

A

Collapsing pulse

Diastolic murmur

87
Q

Diffrentials of Aortic regurgitation?

A

IE?

88
Q

You would investigate Aortic regurgitation using _____.

A

ECHO

89
Q

If symptomatic, how would you treat Aortic regurgitation?

A

Surgery

90
Q

When listening to heart sounds. When is systole and diastole in relation to the 1st and 2nd heart sounds?

A

Systole = between 1st and 2nd sound

Diastole = after 2nd sound

91
Q

Mitral regurgitation is more common in females than males. T/F?

A

T

92
Q

State causes of mitral regurgitation

A 
Mitral Valve Prolapse (MVP)*
Papillary muscle insufficiency (CHD)
IE
SLE
Calcification
Fen-Phen
93
Q

MVP is caused by myomatous degeneration from Conn Tissue disorder such as…?

A

Marfan’s

Enlos-Danlos

94
Q

The symptoms of mitral regurgitation are often ______?

A

ASYMPTOMATIC

95
Q

The signs of mitral regurgitation will be picked up in ausculation. What type of murmur would you hear?

A

Mid-systolic murmur

Holosystolic murmur

96
Q

You do an ECHO, CXR AND ECG to look for evidence of mitral regurgitation. What would you find?

A

ECHO - floppy valve
CXR - enlarged LA/LV
ECG - broad P wave

97
Q

Diffrentials of Mitral regurgitation?

A

?

98
Q

If severe you would treat mitral regurgitation by _____?

A

Valve repair

99
Q

Complications of mitral regurgitation?

A

AF –> Stroke
LV dysfunction
Pulmonary HTN –> RVHF

Year 3 (2 decks)

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