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High Yield > CVD > Flashcards

CVD Flashcards

1
Q

What are the risk factors for hypertension?

A 
Obesity
Alcohol
Smoking
High sodium intake
Age >65
Medications (OCP, NSAIDs)
Co-morbidities (renal disease, diabetes)
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2
Q

What is defined as hypertension?

A

Clinical reading >140/90 mmHg

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3
Q

Why would you treat hypertension?

A

Could lead to organ damage:
blood vessels (atherosclerosis, aneurysm)
cardiac (LVH, increased afterload, IHD)
brain (ischemic, hemorrhagic stroke, vascular stroke, dementia)
kidneys (glomerulosclerosis, renal artery stenosis or aneurysm)
eyes (retinopathy)
sleep apnoea
sexual dysfunction

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4
Q

What is the treatment algorithm for CVD?

A

< 55 years old or diabetic, then ACE inhibitors

> 55 years old or afro-carribean, then calcium channel blockers

After first step, ACE + CCB
Then ACE + CCB + thiazide diuretic
Then, add spironolactone or increase thiazide

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5
Q

What groups should you specifically consider when treating hypertension?

A
  1. Patients over 80 years (only treat stage 2 hypertension)
  2. Patients with diabetes (in type 1, only treat if BP >135/85. In type 2, treat if > 140/80)
  3. Patients under 40 years of age (secondary investigation)
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6
Q

What are the side effects of ACE-inhibitors?

A

Dry cough, angioedema, hyperkalaemia

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7
Q

What are the side effects of CCB?

A

Ankle oedema, flushing, headache

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8
Q

What are the side effects of thiazide diuretic?

A

Hyponatraemia, hypokalaemia

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9
Q

What are the underlying causes of hypertension?

A

Primary hyperaldosteronism
Structural renal disease
Endocrinological disorders

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10
Q

What happens to the blood pressure in pregnancy?

A

Falls in first trimester, continues to fall until 20-24 weeks. Then increases by term

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11
Q

How is hypertension in pregnancy defined?

A

Systolic > 140 mmHg or diastolic > 90 mmHg

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12
Q

What are risk factors for pregnancy hypertension?

A

Hypertension during previous pregnancies
Chronic kidney disease
Autoimmune disorders
Type I or II diabetes

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13
Q

What is malignant hypertension?

A

High BP with symptoms and signs indicative of acute impairment of one or more organ system (BP often > 180mmHg)

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14
Q

How would you treat malignant hypertension?

A

IV sodium nitroprusside

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15
Q

What are causes of malignant hypertension?

A

Discontinuation of medication, drug use, head trauma, eclampsia

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16
Q

What are symptoms of malignant hypertension?

A

Chest pain, headache, dyspnoea, anxiety, palpitations

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17
Q

What is a silent MI related to?

A

Diabetes, sometimes presents with epigastric pain

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18
Q

What are the symptoms, troponin and ECG for angina?

A

Precipitated by activity, minimal symptoms at rest or after GTN

Normal T

Normal ECG

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19
Q

What are the symptoms, troponin and ECG for unstable angina?

A

Symptoms occur at rest and often persist more than 10 minutes

Normal T

Normal or abnormal ECG

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20
Q

What are the symptoms, troponin and ECG for NSTEMI?

A

Long-lasting symptoms, even at rest

Raised T

ST depression and T wave flattening/inversion

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21
Q

What are the symptoms, troponin and ECG for STEMI?

A

Long-lasting symptoms, even at rest

Raised T

ST segment elevation and hyperacute T waves

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22
Q

If there is an abnormality in the anterior or septal leads, where would the occlusion be?

A

Left anterior descending artery

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23
Q

If there is an abnormality in the lateral leads, where would the occlusion be?

A

Left circumflex artery

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24
Q

If there is an abnormality in the inferior leads, where would the occlusion be?

A

Right coronary artery

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25
Q

What is the management of a STEMI or NSTEMI?

A
  1. Cardiac chest pain
  2. If SaO2 < 94%, give O2
  3. Analgesia, anti-emetics, nitrates
  4. Dual antiplatelet therapy -> aspirin 300mg + ticagrelor
  5. Test for troponin and look at ECH

If STEMI -> percutaneous coronary intervention
If NSTEMI -> fondaparinux

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26
Q

What does the secondary prevention of acute coronary syndrome entail?

A

Lifestyle changes and drug therapy

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27
Q

What are common drugs given to acute coronary syndrome patients?

A

ACE inhibitors (ramapril)
Dual antiplatelet (aspirin + ticagrelor)
Beta-blocker (bisoprolol)
Statin (atorvastatin)

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28
Q

What does ramapril do?

A

Decrease BP

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29
Q

What does aspirin/ticagrelor do?

A

Reduce clotting risk

30
Q

What does bisoprolol do?

A

Reduce HR

31
Q

What does atorvastatin do?

A

Reduce cholesterol

32
Q

What are the short term complications of MI?

A

Within 24h: Arrhythmia, pulmonary oedema, cardiogenic shock

1-10 days: Ventricular septal defect, mitral regurgitation, free wall rupture, pericarditis

33
Q

What are the longer-term complications of MI?

A

7-10 days: embolism

Late: heart failure, arrhythmias, LV aneurysm, Dressler’s syndrome

34
Q

What are the three main symptoms of left ventricular failure?

A

Dyspnoea, poor exercise tolerance, fatigue

35
Q

What are the two main symptoms of right ventricular failure?

A

Peripheral oedema, ascites

36
Q

What are the two types of left ventricular failure?

A

Preserved EF

Reduced EF

37
Q

What is the consequence of preserved ventricular failure?

A

Heart can’t fill due to stiff and thick walls

38
Q

What is the consequence of reduced ventricular failure?

A

Heart can’t pump due to stretched and thin walls

39
Q

What are the causes of heart failure?

A
  1. Pressure overload (regurgitation)
  2. Volume overload (hypertension, stenosis)
  3. Contractile dysfunction
40
Q

How does heart failure typically present?

A 
Pulmonary oedema - will hear lung crackles
Cardiomegaly - on CXR
Exertional dyspnoea
Paroxysma nocturnal dyspnoea 
Peripheral oedema
Clubbing
RaisedJ VP
41
Q

What are CXR findings in heart failure?

A

Cardiomegaly
Small pleural effusion
Pulmonary oedema

42
Q

What are lifestyle changes to manage heart failure?

A

Exercise-based rehabilitation programme
Stop smoking
Reduce alcohol
Annual influenza jab and one-off pneumococcal jab

43
Q

What is the pharmacological management of heart failure?

A

First line: ACE + beta-blocker

Second line: angiotensin blockers, digoxin, diuretics

44
Q

What does “lub” mark?

A

Start of ventricular systole
Closure of AV valves
Synchronised with radial pulse

45
Q

What does “dub” mark?

A

Start of ventricular diastole

Closure of semilunar valves

46
Q

What are the main causes of heart murmurs?

A

Regurgitation or stenosis

47
Q

What are the 4 categories of murmurs?

A
  1. Obstruction of outflow tracts
  2. Regurgitation
  3. Continuous murmur (shnuts)
  4. Flow murmur (increased haemodynamic flow; no harm)
48
Q

What are the two types of murmurs in S1?

A
  1. Pan-systolic - during S1 (AV valve regurgitation)

2. Ejection systolic - after S1 (aortic stenosis)

49
Q

What are the two types of murmurs in S2?

A
  1. Early diastolic - start of S2 (aortic regurgitation)

2. Late diastolic - later on in diastole (AV valve stenosis)

50
Q

What is Carvallo’s sign?

A

Murmurs louder upon inspiration

51
Q

When are ride sided murmurs louder?

A

Inspirations

52
Q

When are left-sided murmurs louder?

A

Expiration

53
Q

What is S3?

A

Early diastole; early ventricular filling bc of high volume (normal in athletes)

54
Q

What is S4?

A

Occurs late in diastole; atrial contraction against stiff ventricle (may be heard in stenosis and hypertension)

55
Q

What are symptoms of supraventricular tachycardias?

A

Palpitations, light-headed, chest pain, SoB

56
Q

What types of supraventricular tachycardias exist?

A
  1. AF (irregular)

2. Atrial flutter (regular)

57
Q

What are risk factors for supraventricular tachycardias?

A

Age

Pre-existing CVD

58
Q

What are symptoms of ventricular tachycardia?

A

Palpitations, light-headed, chest pain, SoB

WITH regular rhythm

59
Q

What is the result of ventricular tachycardias?

A

Haemodynamic compromise

60
Q

What are symptoms of heart block?

A

Palpitations, light-headed, chest pain, SoB

WITH regular rhythm

Bradycardia

61
Q

How would you recognise AFib on an ECG?

A
  1. Lack of P waves
  2. Narrow QRS complex
  3. Small fibrillatory waves
  4. Irregular
62
Q

How would you recognise AFlut on an ECG?

A
  1. Regular atrial activity
  2. Flutter waves
  3. Narrow QRS complex
  4. Often present with AV block
63
Q

How would you recognise ventricular tachycardia on an ECG?

A
  1. Mono or polymorphic QRS
  2. Indeterminate axis
  3. Broad QRS complex
  4. Rapid heart rate
64
Q

How would you recognise ventricular fibrillation on an ECG?

A
  1. Chaotic irregular deflections
  2. Varying amplitude
  3. No discernable P, QRS, T waves
  4. Rate 150-500 bmp
65
Q

How would you treat ventricular tachycardia?

A

Haemodynamically stable –> IV amiodarone (300 mg)

Haemodynamically unstable –> DC cardiovesion

Pulseless VT –> defibrillation

66
Q

How would you treat ventricular fibrillations?

A

Defibrillation

67
Q

How would you treat atrial flutter?

A

Haemodynamically compromised –> DC cardioversion

Haemodynamically stable –> vagal maneuvers; cough, cold stimulus. Otherwise IV adenosine 6/12/12 mg

68
Q

How would you treat atrial fibrillation?

A

Haemodynamically compromised –> DC cardioversion

Haemodynamically stable:

  1. New onset –> BBs + IV flecainide or amiodarone
  2. Chronic onset –> anticoagulants
69
Q

What are class 1 antiarrhythmics?

A

Sodium channel blockers

70
Q

What are class 2 antiarrhythmics?

A

Beta-blockers

71
Q

What are class 3 antiarrhythmics?

A

Potassium channel blockers

72
Q

What are class 4 antiarrhythmics?

A

Calcium channel blockers

High Yield (3 decks)

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