CVS conditions - general Flashcards
What is the pathology of heart failure?
Heart can’t pump at the required rate
What are the causes of heart failure?
Ischaemia Hypertension Valvular disease Pulmonary embolism Myocarditis Endocarditis
What are the signs of left sided heart failure?
Dyspnoea Orthopnoea Fatigue Lung crepitations Pleural effusion
What are the signs of right sided heart failure?
Peripheral oedema
Abdominal distension
Increased JVP
Hepatomegaly
What investigations would be done if heart failure was suspected?
ECG
ECHO - diagnostic
Blood - BNP, FBC, U&Es, LFT, TFT
CXR
How is heart failure managed?
Reduce risk factors GTN spray - symptomatic ACEi - ramipril B-blocker - bisoprolol Loop diuretic - furosemide K sparing diuretic - spironolactone
What is involved in acute coronary syndrome?
Unstable angina
STEMI
NSTEMI
What is the pathology of acute coronary syndrome?
Thrombus from atherosclerosic plaque blocking a coronary artery
What is the cause of acute coronary syndrome?
Atherosclerosis
What are the symptoms of acute coronary syndrome?
Central crushing chest pain Potential radiation to neck/left arm Sweating Dyspnoea Palpitations
What investigations would be done if acute coronary syndrome was suspected?
ECG - if ST elevation then STEMI, if ST depression/T wave inversion then NSTEMI/unstable angina
Troponin - increased in STEMI and NSTEMI
How is acute coronary syndrome treated?
Angina - reduce risk factors, GTN spray, B-blocker
STEMI - percutaneous coronary intervention (PCI if within 2hrs), thrombolysis (if after 2 hours)
NSTEMI - batman, b-blocker, aspirin, tricagrelor, morphine, anticoagulant, nitrates
What are the complications of acute coronary syndrome?
Death Rupture of heart septum Oedema - heart failure Arrhythmia Aneurysm
What are the causes of hypertension?
Can be essential, secondary or malignant
Risk factors - obesity, smoking, alcohol, high salt diet, DM
Secondary causes - cushing’s, acromegaly, chronic renal failure
What is classified as essential hypertension?
140/90
What are the signs of hypertension?
Normally asymptomatic
What are the symptoms of malignant hypertension?
Severe hypertension
Headaches
Bilateral retinal haemorrhages and exudates
Papilloedema
How is hypertension investigated?
Ambulatory blood pressure monitoring (ABPM)
How is hypertension treated?
Confirm - ABPM
Address risk factors
<55 step 1 – ACEi/ARB (ramipril / candesartan)
>55 African step 1 – CCB (amlodipine)
Both step 2 – ACEi/ARB + CCB
Step 3 – ACEi/ARB + CCB + thiazide diuretic (indapamide)
Step 4 – resistant hypertension, refer to specialist
What are the complications of hypertension?
IHD
Stroke
Haemorrhage
Heart failure
What is the pathology of atrial fibrillation?
Disorganised atrial activity resulting in ventricular irregularities
What are the causes of atrial fibrillation?
AF affects Mrs SMITH Sepsis Mitral valve pathology IHD Thyrotoxicosis Hypertension
What are the symptoms of atrial fibrillation?
Can be asymptomatic Palpitations SOB Dizziness Heart failure Irregularly irregular pulse Tachycardia
How is atrial fibrillation investigated?
ECG - absent P waves, narrow QRS complexes, irregularly irregular ventricular rhythm
Bloods - FBC, U&Es, TFT, LFT
Cardiac enzymes
How is atrial fibrillation treated?
Rate control - B-blocker (bisoprolol), Ca blocker (amlodipine)
If symptoms <48hrs cardioversion
Anticoagulant - warfarin
What score is used to assess the risk of embolic stroke and the need for coagulation?
CHA2DAS2-VASc
What are the causes of ventricular tachycardia?
IHD
MI
Cardiomyopathy
Drug toxicity
What are the symptoms of ventricular tachycardia?
Palpitations
Chest pain
Syncope
How is ventricular tachycardia investigated?
ECG - broad complexes
How is ventricular tachycardia treated?
Amiodarone
What system is used to classify heat failure?
New York classification of heart failure
New York classification of heart failure
1 – heart disease present but no breathless from normal activities
2 – comfortable at rest, dyspnoea during normal activities
3 – less than ordinary activities causes dyspnoea
4 – dyspnoea at rest
What are some side effects of ACEi?
Cough
Who can’t have b-blockers?
Asthmatic - risk of bronchospasm
What would be seen on an x-ray if the person had heart failure?
ABCDE: Alveolar oedema Kerley B lines – interstitial oedema Cardiomegaly Dilated prominent upper lobe vessels Pleural effusion
What are other causes of ST elevation?
Coronary vasospasm Pericarditis Left bundle branch block Left ventricular hypertrophy Ventricular aneurysm
What is stable angina?
Symptomatic reversible myocardial ischaemia – narrowing of coronary artery
What causes stable angina?
Atheroma
What are the signs of stable angina?
Constricting heavy pain to chest radiation to left arm and jaw – brought on by exertion Relieved by 5 mins rest with GTN spray 3 – typical angina 2 – atypical angina 0/1 – not angina
What investigations would be done if stable angina was suspected?
ECG – normal
CT coronary angiography
Bloods – FBC, U&Es, TFTs, lipids, HbA1c
Consider ECHO and CXR
How is stable angina treated?
Address exacerbating factors
Secondary prevention – reduce risk factors, aspirin
Symptomatic – GTN spray
B-blocker or CCB
If medical fails – PCI, angioplasty, CABG
