CVS and Cancer Flashcards
Abdominal aortic aneurysm
Abnormal, persistent, localised dilatation of the aorta (>3 cm across)
RF: Male, over 60, smoking, atherosclerosis, hypertension, genetic
Clinical presentation: majority asymptomatic (detected incidentally), worsening abdominal or back pain, hypotension, and/or expansile abdominal mass, collapse(ruptured)
Tests: USS, abdominal CT/MRI
Aortic dissection
Tear in the tunica intima of the aorta forms, and the high-pressured blood flowing through the aorta begins to tunnel between the tunica intima and tunica media creating a false lumen.
Causes: Chronic hypertension, blood vessel coarctation, marfans, ehlers danlos, aneurysm
Symptoms: Sudden tearing chest pain radiating to the beack, limb ischemia and kidney ischemia, cardiac temponande
Aortic regurgitation (insufficiency)
Causes:
<50yrs: Post-inflammatory: Rheumatic heart disease, infective endocarditis, syphilis, SLE, ankylosing spondylitis
> 50yrs: Aortic root/ascending aorta dilatation: Systemic hypertension, aortic dissection, Marfans, arthritis,
Signs: wide pulse pressure, collapsing pulse, displaced hyperdynamic apex beat, ,high-pitched early diastolic murmur (heard best in expiration, with patient sitting forward)
Doppler Echocardiography is diagnostic.
ECG (signs of LVH)
Chest xray (cardiomegaly)
Aneurysm
An artery with a dilatation >50% of its original diameter
True aneurysm - all layers
False aneurysm - collection of blood in the outer layer only which communicates with the lumen
Bladder Cancer
More common in men
Most are TCC
Presentation: Painless haematuria, recurrent UTIs, voiding irritability
Associations: smoking, aromatic amines (rubber industry), chronic cystitis, schistosomiasis (increased risk of SCC), pelvic irradiation
Tests: Cystoscopy with biopsy is diagnostic
Urine: MCS (sterile pyuria)
CT urogram is both diagnostic and provides staging
Breast Cancer
Affects 1 in 9 women
RF: FH, age, uninterrupted estrogen exposure (not have given birth, not breast feeding, early menarche, late menopause, HRT), obesity, BRCA gene, past breast cancer
Invasive ductal carcinoma (70%)
Invasive lobular carcinoma (10-15%)
60-70% are estrogen receptor positive (better prognosis)
30% overespress HER2 and are associated with
Aortic Regurgitation Pathophysiology
Aortic valve becomes leaky and blood flows back into the left ventricle in diastole.
Diastolic murmur
LV increases in size -> Left ventricular hypertrophy
Syncope
Aortic Regurgitation Symptoms
Chronic AR: initially asymptomatic. Later, symptoms of heart failure (exertional dyspnoea, orthopnoea, fatigue, angina)
Severe acute AR: sudden cardiovascular collapse
symptoms related to aetiology
Aortic Regurgitation Signs
Collapsing Pulse
Wide pulse pressure
Hyperdynamic displaced apex beat
Early diastolic murmur: lower left sternal edge, better heard with patient sitting forward and with breath held at expiration.
Austin Flint mid-diastolic murmur: Over the apex, from turbulent reflux hitting mitral valve causing a physiological mitral stenosis
Aortic Stenosis
Causes:
- Stenosis secondary to rheumatic heart disease (commonest worldwide)
- Calcification of congenital bicuspid aortic valve
- Degeneration/calcification of tricuspid valve due to age
Aortic stenosis epi.
Prevalence in >75yrs
if congenital bicuspid instead of tri may present earlier
Aortic Stenosis symptoms
Angina (Increased oxygen demand of hypertrophied ventricles)
Syncope or dizziness on exercise
Symptoms of heart failure
Aortic Stenosis exam
narrow pulse pressure
slow rising pulse
Harsh ejection systolic murmur at aortic area, radiating to the carotids and apex
Second heart sound may be softer or absent
Ejection click: bicuspid
Aortic Stenosis Investigation
ECG (LVH)
CXR (calcification of valve)
Echocardiogram ( visualises stenosis)
Cardiac angiography (check for CAD)
Arterial Ulcers
Caused by insufficient arterial blood supply to the lower limb, either in the major arteries or in the small distal capillaries leading to ischaemia or necrosis.
Reduced arterial flow starves the tissue of oxygen and nutrients, making them vulnerable to trauma and breakdown.
Diabetes, RA, vasculitis, peripheral vascular disease, IHD, cerebrovascular event (stroke and TIA) can lead to vascular insufficiency.
Arterial Ulcers
Usually foot, toes, ankle and back of the calf
rapid progression -> especially if infection is present
Minimal oedema
Foot pulses may be diminished or absent. Doppler USS or duplex scan necessary. Monophasic
Skin: Pale, shiny, cold to touch. Skin may be dark pink when hung down and white on elevation. Nails rough and hair loss due to lack of oxygenation to the hair follicles.
Low exudate levels.
Deep punched out ulcer. Presence of sloughy, necrotic tissue. Underlying bone, tendon or muscle may be present.
Contributing factors: smoking, hyperlipidaemia
Atrial fibrillation
Characterised by rapid, chaotic, and ineffective atrial electrical conduction.
- No cause
- Secondary causes lead to abnormal atrial electrical pathways that result in AF
Systemic causes: Thyrotoxicosis, hypertension, pneumonia, alcohol
Heart: Mitral valve disease, IHD, rheumatic heart disease, cardiomyopathy, pericarditis, sick sinus syndrome, atrial myxoedema
Lungs: Pulmonary embolus, bronchial carcinoma
Atrial Flutter
Characterised by atrial rate of 300 bpm and ventricular rate of 150 bpm
Sawtoothed appearance on ECG
Reversed with vagal manoeuvres, IV adenosine, or chemical cardioversion.
A FIB
Very common in the elderly
Symptoms: often asymptomatic. Some patients experience palpitations or syncope. Symptoms of the cause of A fib.
Exam: Irregularly irregular pulse. Difference in apical beat and radial beat.
Investigation:
ECG: uneven baseline (fibrillations) with absent p waves. Irregular QRS.
Blood: Cardiac enzymes
ECHO: Valvular disease
Management of AFIB
Treat any reversible cause (pneumonia, thyrotoxicosis)
- Rhythm control
- If <48 hours cardioversion (IV Flecainide or DC cardioversion)
- If >48hrs anticoagulate for a few weeks before attempting cardioversion - Rate control (aim-90)
- Digoxin, Beta-blocker, CCB (verapamil) - Stroke risk
Calculate risk using CHADS2 and CHADS2VASc
AFIb complications and prognosis
Thromboembolism
Worsens heart failure
Chronic AF in diseased heart does not usually return to sinus rhythm.
Cardiac Arrest
Acute cessation of cardiac function
Causes of cardiac arrest
4 Hs
4Ts
Hypoxia
hypothermia
hypovolaemia
Hypo- or hyperkalaemia
Tamponade
Tension pneumothorax
Thromboembolism
Toxins and metabolic diorders
Patient unconscious not breathing absent carotid pulse
cardiac arrest
Cardiac arrest investigations
Cardiac monitor: Classification of rhythm directs management
Bloods: ABG, U&E, FBC, cross-match, toxicology screen
Management cardiac arrest
BLS
ALS
Treatment of reversible causes
Complications: irreversible hypoxic brain damage
Cardiac failure
Inability of cardiac output to meet the bodies demand despite normal venous pressures
10% of >65
Cardiac Failure cause
Low output (decreased cardiac output)
left heart failure: IHD, hypertension
right heart disease: secondary to left heart failure, infarction, pulmonary hypertension/ embolus/ valve disease, chronic lung disease
Biventricular failure: cardimyopathy, arrhytmias
High output ( increased demand) anaemia, beriberi, pregnancy, pagets disease, hyperthyroidism
Left Heart failure
Tachycardia displaced apex beat bilateral basal crackles (fluid overload) third heart sound gallop rhythm pan-systolic murmur
orthopnea, PND, fatigue, wheeze, pink frothy sputum, fatigue, decreased perfusion of body
Right heart failure
Increased JVP
hepatomegaly
ascites
ankle/sacral oedema
swollen ankles, fatigue, anorexia nausea, increased weight due to oedema, decreased exercise tolerance
Heart failure invest
Bloods
CXR: cardiomegaly, pleural effusion, kerley b lines, perihilar shadowing, fluid in the fissures
ECHO
Management acute HF
ACUTE LVF: cardiogenic shock (dopamine) sit up patient 60-100 % oxygen consider CPAP diamorphine GTN infusion IV furosemide
Management chronic HF
treat the cause Ace inhibitors Beta blockers Furosemide ARB Aldosterone antagonist Hydralazine and nitrate digoxin Cardiac resynchronisation therapy
HF
Respiratory failure
cariogenic shock death
50 % of patients with severe hf die in 2 years
Cardiomyopathy
Primary disease of the myocardium (heart muscle)
May be dilated -muscle walls stretched and thin (post-viral, alcohol, drugs, thyrotoxicosis), restrictive - stiff and and rigid (amyloidosis, sarcoidosis, haemachromatosis), or hyperpertrophic- muscle enlarged and walls of heart chamber have thickened (genetic)
Dilated symptoms: HF symptoms, arrhythmia, embolism, FH sudden death
Hypertrophic: Usually none. same as above
Pericarditis
Inflammation of the pericardium
idiopathic, infective, connective tissue disease (SLE, sarcoid), Post MI, dresslers syndrome
uncommon
Sharp central chest pain, which may radiate to the neck and shoulder. Made worse by coughing, deep inspiration, and lying flat
relieved by leaning forward
Dyspnoea and nausea
Exam: fever, pericardial friction rub - heard best left sternal lower border leaning forward , heart sounds may be faint due to effusion Cardiac tamponade (becks triad) Constrictive pericarditis
ECG - saddle shaped st segment
Coronary angiography
Xray imaging to see heart blood vessels
angiogram can proceed into angioplasty ( open up clogged arteries)
Indications: coronary artery disease, angina, aortic stenosis, heart failure
Complications: radiation, heart attack, stroke, injury to artery and bleeding, infection
Coronary artery bipass graft
Treat coronary artery disease
Healthy blood vessels from elsewhere in the body are used to bipass the blocked or narrowed arteries
Risk of stroke heart attack, bleeding, infection
DC cardioversion
Convert abnormal heart rhythm to normal one using electrical shock
Most common arrhythmias: AF
Risk of blood clots
Complications: irritation around pad area, doesn’t work need pacemaker or ICD
2 coronary artery revascularisation techniques
PCI
and coronary artery bipass grafting
Implanted cardiac defibrillator
Monitors heart rhythm. If it senses dangerous rhythms, it delivers a shock.
Defibrillation.
Small device placed in your chest or abdomen if you have an irregular heartbeat or are at risk for sudden cardiac arrest.
Needed in life threatening abnormal heart rhythm
ICD continually monitors heart rhythm and can send low-or high-energy electrical pulses to correct an abnormal heart rhythm. Will initially send low and then high energy electrical pulses when low ineffective.
Pacemakers only give low energy impulses to restore heart rhythm.
ICD more effective in patients with high risk for sudden cardiac arrest.
PCI vs. CABG
PCI less invasive and shorter time to recover.
CABG if multiple arteries are involved or structure of blood vessel near your heart is abnormal.
