CVS Flashcards
What are the shockable rhythms?
VF
pulseless VT
In ALS, when can (1mg) adrenaline be administered?
After chest compression have started ( 30:2)
What ESM is heard louder on expiration?
1) aortic stenosis
2) hypertrophic obstructive cardiomyopathy
What ESM is heard louder on inspiration?
1) pulmonary stenosis
2) atrial septal defect
What ECG abnormality is associated with hypercalcaemia?
Shortened QT interval
When a patient in cardiac arrest has organised electrical activity but there is still no pulse and there are no signs of life, what do you do?
1) continuing CPR at a rate of 30:2
2) IV adrenaline
What is stage 3 HTN defined as?
BP above 180/120
1st steps in stage 2 HTN
Assess target organ damage if <80yo. Give meds if >80yo
How to manage stage 3 HTN?
Specialist referral if <40yo
In stage 2 HTN (and above) which investigations would you carry out?
ECG, Fundoscopy, Urinalysis, BP, bloods
Which ECG changes would you see in hyperkalaemia?
Tall Tented T waves
Side effects of ARB
hyperkalaemia, hypotension, renal failure
What is orthostatic hypotension?
decrease in BP by > 20 systolic, 10 diastolic
how do you check for postural hypotension?
lying/standing BP for 3 mins
What might you see in an ECG in someone who has postural hypotension?
prolonged QT, bundle branch block
How do patients with HF present (specify left and right)?
Left : lung (confused, restless, orthopnoea, cyanosis, crackles)
Right : rest of the body (ascites, oedema, hepato/splenomegaly, weight gain)
What is BNP?
Measured in heart failure. Released in response to the heart stretching.
a specific sx of phlebitis
hardening of surrounding tissue due to lack of perfusion caused by inflammation
Sx of varicose veins
pains, itching, throbbing
what are the 6Ps and when do you look for them
arterial occlusion
Pallor Paraesthesia Pain Poikilothermia (temperature) Pulselessness Paralysis
investigations for arterial occlusion
ABPI <0.5 is critical (refer to vascular MDT)
ABPI 0.6-0.9 is intermittent claudication (exercise management, angio or bypass)
Ultrasound of blood flow in peripheries
When would a patient with aortic aneurysm require surgery?
Aneurysm >5.5 / symptomatic / rupture
Which valvular disease is associated with rheumatic fever?
mitral stenosis
which criteria is used to rheumatic fever? Define the criteria.
Jones:
2 major criteria
1 major with 2 minor criteria
Evidence of recent streptococcal infection
raised or rising streptococci antibodies,
positive throat swab
positive rapid group A streptococcal antigen test
Major criteria
erythema marginatum
Sydenham’s chorea: this is often a late feature
polyarthritis
carditis and valvulitis (eg, pancarditis)
subcutaneous nodules
Minor criteria raised ESR or CRP pyrexia arthralgia (not if arthritis a major criteria) prolonged PR interval
Tx of acute rheumatic fever
Penicillin V and NSAIDs (aspirin or naproxen)
Giant cell arteritis buzzwords and sx!
Sx = Headache, visual disturbance, polymyalgia rheumatica
Ix = Temporal artery biopsy
Tx = Oral prednisolone
which valve is associated with endocarditis
mitral
Which criteria is used in endocarditis
Infective endocarditis diagnosed if
pathological criteria positive, or
2 major criteria, or
1 major and 3 minor criteria, or
5 minor criteria
Pathological criteria: Positive histology or microbiology
Major criteria - Positive blood cultures - Evidence of endocardial involvement positive echocardiogram or new valvular regurgitation
Minor criteria
- predisposing heart condition or intravenous drug use
- fever > 38ºC
- vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura
- immunological phenomena: glomerulonephritis, Osler’s nodes, Roth spots
Endocarditis which causes HF requires what treatment ?
emergency valve replacement surgery
ECG findings for pericarditis
widespread saddle-shaped ST elevation in all leads
What is Becks triad?
cardiac tamponade
1. hypotension
- muffled heart sounds
- raised JVP
which ECG finding is seen in cardiac tamponade
electric alternans
ECG findings in an NSTEMI
pathological P waves
what is Prinzemtal angina
sometimes relieved by medication but not by rest
What is the most common causative organism for infective endocarditis?
Staphylococcus aureus
What long-term medication should patient HF take?
ACEi =
BB = carvedilol and bisoprolol
What medication is contraindicated with atenolol?
Verapamil = risk of heart block
What is the most common complication of Hypertrophic obstructive cardiomyopathy?
Sudden death due to ventricular arrhythmia
What is the gold-standard Tx for ST-elevation MI?
PCI
What is hypertension?
a clinic reading persistently above >= 140/90 mmHg,
or:
a 24 hour blood pressure average reading >= 135/85 mmHg
What are the 2 main types of hypertension?
Primary/essential: no single disease is identified as the cause of HTN, usually due to physiological changes as we age
Secondary: caused by a variety of endocrine, renal and other causes
List some of the causes of secondary hypertension
Renal:
- glomerulonephritis
- renal artery stenosis
- chronic pyelonephritis
Endocrine:
- primary hyperaldosteronism
- Cushings
- congenital adrenal hyperplasia
Other:
- glucocorticoids
- NSAIDs
- COCP
Which symptoms may be seen in patients with severe hypertension?
- headaches
- visual disturbances
- seizures
How is end organ damage assessed?
Fundoscopy: check for retinopathy
Urine dipstick: renal disease as a cause or consequence of HTN
ECG: left ventricular hypertrophy or ischaemic heart disease
What tests do patients typically have following a diagnosis of hypertension?
- U&Es
- HbA1c
- Lipids
- ECG
- Urine dipstick
What is end organ damage?
End organ damage usually refers to damage occurring in major organs fed by the circulatory system (heart, kidneys, brain, eyes)
When is an ARB preferred over an ACEi?
patients of black African or African–Caribbean origin taking a CCB, if they require a second agent consider an ARB in preference to an ACEi
Criteria for stage 1, stage 2 and severe hypertension?
Stage 1) Clinic BP >= 140/90 mmHg and subsequent ABPM average BP >= 135/85 mmHg
Stage 2) Clinic BP >= 160/100 mmHg and subsequent ABPM average BP >= 150/95 mmHg
Severe) Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg
How does NICE recommend measuring BP when considering a diagnosis of Hypertension?
measure in both arms and if the difference is >20mmHg then repeat
if this remains the case then measure from the arm with higher readings and listen to heart sounds as there may be a pathological cause such as supravalvular aortic stenosis
What should you do if BP >= 180/120mmHg?
specialist assessment
- ?retinal haemorrhage or papilloedema
- life-threatening sx
- end organ damage assessment
Which symptoms are life threatening in severe HTN?
- new-onset confusion - chest pain
- signs of heart failure
- AKI
When would a patient with stage 1 HTN be offered drug tx?
if <80yo AND:
- end organ damage
- established CVD
- renal disease
- diabetic
- QRISK >10%
Which algorithm can be used to estimate the risk of developing cardiovascular risk of the next 10 years and what is considered as high risk?
QRISK
> = 20% is considered high risk
What is the clinic BP and ABPM for <80yo?
Clinic: 140/90 mmHg
ABPM: 135/85 mmHg
What is the clinic BP and ABPM for >80yo?
Clinic: 150/90 mmHg
ABPM: 145/85 mmHg
What is isolated systolic HTN?
systolic blood pressure 160 mmHg or more
Examples of drugs which can cause hypertension
- COCP
- steroids
- NSAIDs
- SSNRI
- recreational drugs
What is malignant/accelerated hypertension?
EMERGENCY
rapid increase in BP >= 180/120mmHg resulting in end organ damage
Define phlebitis and thrombophlebitis
Phlebitis means inflammation of a vein. Thrombophlebitis refers to a blood clot causing the inflammation.
Patients with clinical signs of superficial thrombophlebitis affecting the proximal long saphenous vein should have which investigation?
ultrasound scan to exclude concurrent DVT
What is a complication of arterial occlusion?
Gangrene
Sx of peripheral vascular disease
may be sx free
- sx of intermittent claudication (cramping with exercise, relieved by rest)
- ulcers
- hair loss
- skin changes (thinning, brittle, shiny)
Which investigations may be used in suspected PVD?
- Doppler US
- Angiogram
- Ankle-brachial index
Complications of PVD
- stroke
- restricted mobility
- reduced wound healing
- amputation
What can cause cardiogenic shock?
Intrinsic:
- MI
- Arrhythmia
Extrinsic:
- PE
- Pneumothorax
Why do symptoms occur in cadiogenic shock?
What are the symptoms?
Due to hypoperfusion or fluid overload
- Chest pain
- SOB
- Palpitations
- Syncope
- Confusion
- Sweating
- Pale skin
What are the signs of cardiogenic shock?
- Tachycardia
- Raised JVP
- Cold peripheries
- Hypotension
- Peripheral oedema
- Weak pulse
What are the signs of hypovolaemic shock?
- Tachycardia/tachypnoea
- Reduced CRT
- Cold peripheries
- Hypotension
- End organ dysfunction:
- -> Oliguria/anuria
- -> Confusion
- -> irritability
- -> Chest pain/ SOB
How does rheumatic fever develop?
Following an immunological reaction to recent (2-6 weeks ago) streptococcus pyogenes infection (strep throat)
What is the diagnostic criteria for rheumatic fever?
Jones:
Evidence of recent streptococcal infection accompanied by:
–> 2 major criteria
–> 1 major with 2 minor criteria
What is the evidence of recent streptococcal infection in rheumatic fever?
- raised or rising streptococci antibodies,
- positive throat swab
- positive rapid group A streptococcal antigen test
What is the major criteria in rheumatic fever?
- erythema marginatum
- Sydenham’s chorea: this is often a late feature
- polyarthritis
- carditis and valvulitis (eg, pancarditis)
- subcutaneous nodules
What is the minor criteria in rheumatic fever?
- raised ESR or CRP
- pyrexia
- arthralgia (not if arthritis a major criteria)
- prolonged PR interval
What is acute rheumatic fever?
Inflammation in the heart, joints, skin or CNS.
- can develop after strep throat
Ix for suspected aortic dissection
CT angiography
TOE tends to be used to confirm the diagnosis if still unclear after CT angiography, or if the patient is unstable and is likely to deteriorate before getting to the CT scanner.