CVS Flashcards
What is troponin?
component of the thin filaments in striated muscle.
What does raised troponin indicate?
Cardiac damage
Myocardial injury - Acute & chronic + troponin pattern
- Acute : troponin is rising
- Chronic: troponin is elevated but doesn’t change over the course of 24 hours
Types of MI
- T1 : athero-thrombosis in the artery supply
- T2: imbalance between myocardial O2 supply + demand unrelated to acute athero-thrombosis
When does troponin peak in STEMI & NSTEMI?
- NSTEMI - Peak at 12 - 16 hours
- STEMI - Peak at 12-16 hours (higher value than NSTEMI)
Types of Natriuretic Peptides
- ANP : atria of the heart
- BNP : Ventricles of the heart
- C-type NP: vascular endothelium
When is Natriuretic Peptides released?
Made in response to stretch of the heart - it is not stored
Lipid profile: HDL & LDL
HDL - good cholesterol
LDL - bad cholesterol
What specialist tests are carried out in lipid clinic?
- Apolipoprotein a and b100
- Lp (a)
- Apo E genotyping & electrophoresis
- Genetic Test
When do you treat abnormal lipid test?
- Familial hypercholesterolaemia
- Secondary prevention
- -> Patients with establish vascular disease : angina, MI, PVD, CAS, CVA - Primary prevention
- T1DM
- T2DM
- CKD (eGFR <60)
- Primary prevention
- depends on the risk not the cholesterol number
- QRISK: age, gender, BP, total cholesterol
When do you refer for abnormal lipid results?
- If TC > 9.0 mmol/L or non -HDL > 7.5 mmol/L even if no FH
- If FH is suspected
- FH + cholesterol > 7.5 depsite lifestyle intervention
- proven FH in the family
- Urgent specialist reveiw if TG > 20 mmol/L
- unless excess ETOH or poor gylcaemic control
- TG > 5 mmol/L and no SECONDARY CAUSE
Indication for BNP
Heart failure
increased levels may be seen in CKD
What drugs can affect BNP?
BB + diuretics
ACEi + ARB
Interpret troponin and when they elevate (hours/days)
Concentrations can increase within two or three hours and may remain high for 10 to 14 days.
Indications for Echocardiogram
Cardiomyopathy
heart failure
aneurysm
heart valve disease
What is a Tilt table test?
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
Result of tilt table test
If you develop a drop in blood pressure/heart rate associated with symptoms your test will be classed as positive.
Indication for exercise tolerance test
Clinical history suggestive of: vasovagal syncope / reflex syncope Orthostatic Intolerance Suspected autonomic dysfunction Risk Stratification
Contraindications for exercise tolerance test
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
Indications for stress echo
- patients who either cannot exercise or exercise submaximally (who should undergo pharmacologic stress)
- patients with an uninterpretable ECG caused by repolarisation abnormalities
What is stress echo
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.
What is an exercise tolerance test?
- records the electrical activity of your heart whilst you exercise.
- It is most useful in patients who experience chest pain when they exert themselves.
- It is also used to detect whether heart rhythm abnormalities can be brought on by exercise
What is a transoesophageal echocardiogram?
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.
What is an electrophysiology of the heart study?
- During an EP study, your doctor inserts small, thin wire electrodes into a vein in the groin (or neck, in some cases).
- He or she will then thread the wire electrodes through the vein and into the heart.
- 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.
- Electrical signals are also sent through the electrodes to stimulate the heart tissue to try to cause the abnormal heart rhythm.
