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ICM - OBS > CVS > Flashcards

CVS Flashcards

1
Q

What is troponin?

A

component of the thin filaments in striated muscle.

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2
Q

What does raised troponin indicate?

A

Cardiac damage

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3
Q

Myocardial injury - Acute & chronic + troponin pattern

A
  • Acute : troponin is rising

- Chronic: troponin is elevated but doesn’t change over the course of 24 hours

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4
Q

Types of MI

A
  • T1 : athero-thrombosis in the artery supply

- T2: imbalance between myocardial O2 supply + demand unrelated to acute athero-thrombosis

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5
Q

When does troponin peak in STEMI & NSTEMI?

A
  • NSTEMI - Peak at 12 - 16 hours

- STEMI - Peak at 12-16 hours (higher value than NSTEMI)

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6
Q

Types of Natriuretic Peptides

A
  • ANP : atria of the heart
  • BNP : Ventricles of the heart
  • C-type NP: vascular endothelium
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7
Q

When is Natriuretic Peptides released?

A

Made in response to stretch of the heart - it is not stored

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8
Q

Lipid profile: HDL & LDL

A

HDL - good cholesterol

LDL - bad cholesterol

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9
Q

What specialist tests are carried out in lipid clinic?

A
  • Apolipoprotein a and b100
  • Lp (a)
  • Apo E genotyping & electrophoresis
  • Genetic Test
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10
Q

When do you treat abnormal lipid test?

A
  1. Familial hypercholesterolaemia
  2. Secondary prevention
    - -> Patients with establish vascular disease : angina, MI, PVD, CAS, CVA
  3. Primary prevention
    • T1DM
    • T2DM
    • CKD (eGFR <60)
  4. Primary prevention
    - depends on the risk not the cholesterol number
    - QRISK: age, gender, BP, total cholesterol
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11
Q

When do you refer for abnormal lipid results?

A
  1. If TC > 9.0 mmol/L or non -HDL > 7.5 mmol/L even if no FH
  2. If FH is suspected
    • FH + cholesterol > 7.5 depsite lifestyle intervention
    • proven FH in the family
  3. Urgent specialist reveiw if TG > 20 mmol/L
    • unless excess ETOH or poor gylcaemic control
  4. TG > 5 mmol/L and no SECONDARY CAUSE
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12
Q

Indication for BNP

A

Heart failure

increased levels may be seen in CKD

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13
Q

What drugs can affect BNP?

A

BB + diuretics

ACEi + ARB

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14
Q

Interpret troponin and when they elevate (hours/days)

A

Concentrations can increase within two or three hours and may remain high for 10 to 14 days.

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15
Q

Indications for Echocardiogram

A

Cardiomyopathy
heart failure
aneurysm
heart valve disease

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16
Q

What is a Tilt table test?

A

Diagnostic aid that helps clinicians determine if a patients symptoms are associated with a sudden drop in heart rate or blood pressure.

5 minutes supine
20 minutes passive tilt at 60-70 degrees
400mcg sublingual glyceryl trinitrate followed by further 15 minutes of Tilt

17
Q

Result of tilt table test

A

If you develop a drop in blood pressure/heart rate associated with symptoms your test will be classed as positive.

18
Q

Indication for exercise tolerance test

A 
Clinical history suggestive of:
vasovagal syncope / reflex syncope
Orthostatic Intolerance
Suspected autonomic dysfunction
Risk Stratification
19
Q

Contraindications for exercise tolerance test

A

Active endocarditis

Acute aortic dissection

Acute myocarditis/pericarditis

Decompensated heart failure

Inability to exercise

Myocardial infarction in previous two days

Ongoing unstable angina

Symptomatic severe aortic stenosis

Uncontrolled cardiac arrhythmia with hemodynamic compromise

20
Q

Indications for stress echo

A
  • patients who either cannot exercise or exercise submaximally (who should undergo pharmacologic stress)
  • patients with an uninterpretable ECG caused by repolarisation abnormalities
21
Q

What is stress echo

A

A stress echocardiography, also called an echocardiography stress test or stress echo, is a procedure that determines how well your heart and blood vessels are working.

During a stress echocardiography, you’ll exercise on a treadmill or stationary bike while your doctor monitors your blood pressure and heart rhythm.

When your heart rate reaches peak levels, your doctor will take ultrasound images of your heart to determine whether your heart muscles are getting enough blood and oxygen while you exercise.

22
Q

What is an exercise tolerance test?

A
  1. records the electrical activity of your heart whilst you exercise.
  2. It is most useful in patients who experience chest pain when they exert themselves.
  3. It is also used to detect whether heart rhythm abnormalities can be brought on by exercise
23
Q

What is a transoesophageal echocardiogram?

A

Check how well your heart’s valves and chambers are working.

place the ultrasound probe into your mouth and ask you to swallow so they can pass it into your oesophagus.

24
Q

What is an electrophysiology of the heart study?

A
  1. During an EP study, your doctor inserts small, thin wire electrodes into a vein in the groin (or neck, in some cases).
  2. He or she will then thread the wire electrodes through the vein and into the heart.
  3. To do this, he or she uses a special type of X-ray “movie,” called fluoroscopy. Once in the heart, the electrodes measures the heart’s electrical signals.
  4. Electrical signals are also sent through the electrodes to stimulate the heart tissue to try to cause the abnormal heart rhythm.
25
Q

Indications of electrophysiology study of the heart

A

dizziness, fainting, weakness, palpitation, or others to see if they might be caused by a rhythm problem.

26
Q

What is a PCI?

A

The procedure is usually performed through blood vessels in the wrist or groin.

A small cut is then made either in the wrist or groin

A sheath (long thin plastic tube) is inserted into the blood vessel.

A fine wire is then passed through the narrowed part of the artery and over this wire a balloon is passed over and inflated in the narrowing.

27
Q

Pacemaker or ICD procedure - transvenous implantation

A

During transvenous implantation, the cardiologist will make a 5 to 6cm (about 2 inch) cut just below your collarbone, usually on the left side of the chest, and insert the wires of the pacemaker (pacing leads) into a vein.

The pacing leads are guided along the vein into the correct chamber of your heart using X-ray scans. They then become lodged in the tissue of your heart.

The other ends of the leads are connected to the pacemaker, which is fitted into a small pocket created by the cardiologist between the skin of your upper chest and your chest muscle.

28
Q

Indications for ambulatory BP

A 
primary hypertension (~ 90%) 
no identifiable cause
  • secondary hypertension
  • sleep apnoea
  • renal disease (adult polycystic disease, tumours, …)
  • endocrine (phaeochromocytoma,
  • Cushing’s syndrome, …)
  • vascular (co-arctation of the aorta, renal artery stenosis, …)
    drugs (alcohol , contraceptive pill, non-steroidal anti-inflammatory, cocaine, …)
29
Q

Examples of Vascular Ultrasound Examinations

A
  • Carotid
  • Arterial: Upper/Lower Limb
  • Venous: DVT/ VVs
  • AAA
  • EVAR (Endovascular Aortic Repair)
  • AVF/Fistula
  • TCD
30
Q

Indications for carotid USS

A
  • Stroke/TIA
  • ENT
  • Cardiac Intervention
  • > 70% stenosis
  • Symptomatic
  • 2-week window
31
Q

Indications for arterial USS

A
  • Claudication/ PAD
  • Ischaemia/Necrosis
  • Diabetic ulcers

-ABPIs often performed initially to rule out disease

32
Q

Indications for vein USS

A
  • Incompetence/ Varicose Veins
  • DVT
  • Lymphoedema
  • Pre Surgery Mapping
33
Q

USS - Aneurysm screening

A
  • To rule out/ monitor AAA
  • > 3.0cm - Monitoring
  • > 5.5cm –Intervention
  • AAA rupture = 80% mortality risk
  • AAA screening programme
34
Q

Indications for EVAR

A
  • Treatment of AAA via stents
  • Previously Open Repair
  • Post-Op/ Surveillance monitoring for Endoleaks, Stent migration, Stent occlusion
35
Q

Ix in anaphylaxis

A
  1. ECG:
    Anaphylaxis can cause myocardial ischaemia
  2. Mast cell tryptase:
    - In anaphylaxis, mast cell degranulation leads to increased tryptase levels.
    - Useful in the follow-up of suspected anaphylactic reactions, not in the initial recognition and treatment
  3. ABG: Important if airway/breathing issues
  4. FBC: Especially to check for eosinophilia
  5. CXR: Check for foreign body, consolidation, pneumothorax
36
Q

What falsely raises affects BNP?

A

ACE inhibitors
angiotensin-2 receptor blockers
diuretics.

ICM - OBS (18 decks)

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