CVS Disease Flashcards
Coronary Heart Disease causes include
increased LDL smoking bad diet family history increased BP stress anaemia hyperthyroid
Coronary Heart Disease can cause
endothelial injury fatty streaks fibrous cap foam cells atherosclerosis
Coronary Heart Disease (CHD) signs include
anaemia tar staining bruits reduced pulses lipid arcus
Symptoms of CHD could be
(un)stable angina
raised JP
pre-syncope
dyspnoea
How can CHD be investigated?
angiography echo ECG U&Es liver enzymes FBC CXR
What are the treatments for CHD?
NSAIDS Statins Treat underlying problem (smoking, diet etc) Bypass GTN CCBs Stenting
What are the causes of an NSTEMI and STEMI?
Unstable angina
ACS (acute coronary syndrome)
What can an NSTEMI cause?
atheroma
rupture
necrosis
On an ECG, what can show an NSTEMI?
path Q waves
ST depression
also increases troponin
What are the symptoms of an NSTEMI?
(un)stable angina
What investigations should be done for an NSTEMI?
ECG
increased troponin and myoglobin tests
angio
echo
What can treat an NSTEMI?
Aspirin Clopidogrel Heparin Statins B-blockers CABG ACE inhibitors Pain meds
What can a STEMI cause?
Atheroma
Rupture (=thrombosis)
Necrosis
Ischaemia
What signs show a STEMI?
ST elevation
increased troponin
increased CK-MB
What physical symptoms can show a STEMI?
severe chest pain dyspnoea fatigue, sweaty syncope pale skin, clammy decreased BP brady/tachycardia
What investigations should be done for a STEMI?
ECG increased troponin and CK-MB tests FBC Glucose Lipid profile Echo
What can treat a STEMI?
Aspirin GTN Oxygen IV pain meds ACE inhibitors Beta Blockers Streptokinase Lifestyle changes
In Ischaemic Heart Disease (IHD), what can cause it?
atheroma smoking increase lipids thrombosis or embolus anaemia
What does IHD cause?
decreased oxygen decreased lung function tachycardia increased lactate myocardial necrosis
What signs may show IHD?
pallor
oedema
yellow infarct
What are the symptoms of IHD?
angina
dyspnoea
sweating
nausea/vomiting
What investigations should be done for IHD?
ECG
increased troponin
ST depression/flat
How do you treat IHD?
decrease the risk factors
angina meds
CHD treatments
control BP well
What causes aortic valve disease (stenosis)?
rheumatic fever
congenital causes
fusion of cusps
calcification
What does aortic stenosis cause?
decreased ventricular emptying
ischaemia (then left ventricle failure)
arrhythmia
What are the signs of aortic stenosis?
ejection systolic murmur
slow rising pulse
carotid pulse with small volume
What are the symptoms of aortic stenosis?
angina dyspnoea heart failure palpitations syncope
What investigations should be done for aortic stenosis?
ECG CXR Echo ETT LV function Doppler
What is the solution for a stenosed aortic valve?
Insertion of prosthetic valve
What are the causes of aortic regurgitation?
rheumatic fever infective endocarditis syphilis spondylitis increase BP
What can aortic regurg. cause?
increase left ventricle size
decreased coronary perfusion
What are the signs of aortic regurg?
collapsing pulse
dilated LV
early diastolic murmur
What are the symptoms of aortic regurg?
asymptomatic
dyspnoea
angina
pounding heart
How is aortic (and mitral) regurgitation and mitral stenosis investigated?
ECG
CXR
Echo
Cardiac catheter
How is aortic regurg. treated?
Diuretics
Antibiotics
Prosthetic valve
What can cause mitral regurgitation?
rheumatic fever prolapse myocarditis increase BP IHD infective endocarditis
What does mitral regurg. cause?
atrial dilation
increased LV size
increased atrial pressure
What are the signs of mitral regurgitation?
pulmonary oedema
lateral apex beat
PS murmur (regurg during systole)
S3 sound
The symptoms of mitral regurg are:
palpitations dyspnoea orthopnea fatigue (less CO2) forceful heart beat
Mitral regurgitation is treated by:
prophylaxis (infective endocarditis) surgical repair prosthetic valve ACE inhibitors diuretics
Hypertrophic cardiomyopathy is
familial
Hypertrophic cardiomyopathy causes
increased atrial pressure, size and dilatation
Hypertrophic cardiomyopathy signs include
asymmetric septal hypertrophy
jerky carotid pulse
ejection systolic murmur
PS murmur, S4
Symptoms of Hypertrophic cardiomyopathy include
syncope asymptomatic dyspnoea pain palpitations
Hypertrophic cardiomyopathy may be looked into with
CXR ECG Echo Pedigree analysis ETT
Hypertrophic cardiomyopathy can by treated by
Beta blockers
CCBs
diuretics
ablation
Mitral stenosis is caused by
rheumatic fever
Mitral stenosis causes
increased atrial pressure, size, dilatation
Mitral stenosis is characterised by
tapping apex beat pulmonary oedema increased RV size mitral facies flush raised JVP (in right heart failure)
Dilated cardiomyopathy causes include
idiopathic causes
autoimmune
inflammation
metabolic
Dilated cardiomyopathy can cause
decreased systolic function heart failure (congestive)
Signs of dilated cardiomyopathy include
congestive heart failure raised JVP ankle oedema Creps gallop rhythm
Symptoms of dilated cardiomyopathy are
dyspnoea
fatigue
palpitations
syncope
Investigations for dilated cardiomyopathy are
CXR
ECG
Echo
Angiography
The treatment for dilated cardiomyopathy are
antiarrhythms anticoagulants diuretics ACE inhibitors ARBs BBs
The causes of myocarditis are
toxins
drugs
allergies
HIV
Myocarditis causes
inflammation
In myocarditis there are what signs (if any)?
fatigue abnormal heart beat (fainting) SOB (exercise + lying down at night) sharp stabbing pain (radiates to neck/shoulders) light-headedness
What are the symptoms of myocarditis?
fatigue
palpitations
pain
What investigations should be done in suspected myocarditis?
CXR
ECG
Viral RNA/Ab titre
Enzymes
What is the treatment for myocarditis?
Rest ACE inhibitors (in heart failure)
What can cause acute pericarditis (and pericardial effusion)?
viral TB bacteria an MI autoimmune neoplastic
What does acute pericarditis cause?
inflammation
infection
What are the signs of acute pericarditis?
raised JVP muffles heart sounds a rub fever lymphocytosis
What are the symptoms of acute pericarditis?
sharp pain when moving/respiring
sit forward for relief
What investigations should be done in acute pericarditis?
ECG T wave flat enzymes CXR Echo
What treats acute pericarditis?
Rest (self limiting)
NSAIDS (non acute phase)
steroids
Pericardial Effusion is also known as
Pericardial Tamponade
What does pericardial effusion cause?
right ventricle compression
tamponade
The signs of pericardial effusion are:
muffled heart sounds raised JVP on inspiration tachycardia decreased BP paradoxical pulse
The symptoms of pericardial effusion are:
Rub
Decreased heart sounds
Investigations for pericardial effusion are
ECG
CXR
Echo
MRI
Causes of constrictive pericarditis are
TB
Bacteria
Rheumatic fever
Constrictive pericarditis causes
late stage cardiac filling
thick fibrous & calcified
loss of elasticity
Signs of constrictive pericarditis are
venous congestion
oedema
raised JVP on inspiration
irregular pulse with regular heart beat
Symptoms of constrictive pericarditis are
decreased ventricle filling dysponea cough paroxysmal nocturnal dysponea (PND) orthopnea fatigue atrial dilation
Investigations for constrictive pericarditis include
CXR ECG Echo CT MRI Catheter
Treatment for constrictive pericarditis is
resection
Infective endocarditis is caused by
malignancy
strep. virus
staph. a
group d strep
Infective endocarditis causes
abnormal structure that leads to:
- turbulence
- decreased pressure (Venturi effect)
- thrombi
and bacteraemia
Signs of infective endocarditis include
a new murmur Ruth spots (retina) January lesions Olsers nodes Clubbing
Symptoms of infective endocarditis include
malaise anorexia fever headache myalgia dyspnoea/orthopnea stroke
Investigations for infective endocarditis include
echo for endo ebscess oscillating intra cardiac mass new valve regurg increased CRP ECG U&Es CXR
The treatment for infective endocarditis includes
prophylaxis
IV antibiotics
surgery
What can be used in combo with gentamicin to treat infective endocarditis?
gentamicin with one of these three:
- benzylpenicillin
- vancomycin
- flucloxacillin
Heart failure is caused by
LV dysfunction valve disease restrictive cardiomyopathy constrictive pericarditis arrhythmia MI
Heart failure (L and R) causes:
LV dysfunction increased preload & afterload increased myocyte necrosis decreased CO2 fibrosis
Signs of heart failure include:
Creps Oedema Tachycardia Raised JVP S3
Symptoms of heart failure are:
dyspnoea
orthopnea
fatigue
PND
Investigations done in heart failure (LHF and RHF) are:
Echo
MRI
Increased BNP (brain natriuretic peptide)
The treatment of heart failure (LHF and RHF) is
ACE inhibitors BBs ARBs transplant diuretics digoxin
Left heart failure (LHF) is caused by
IHD
Raised BP
Mitral/Aortic valve disease
cardiomyopathy
Signs of left heart failure are
S3
S4 gallop
apex disposition
tachycarida
Symptoms of left heart failure are
fatigue
dyspnoea
orthopnea
PND
Right heart failure (RHF) is caused by
LHF
cor pulmonale
tricuspid/pulmonary valve disease
left to right shunt
Signs of RHF are
raised JVP
hepatomegaly
pitting oedema
pleural trans
Symptoms of RHF include
fatigue
dyspnoea
anorexia
nausea
An abdominal aortic aneurysm (AAA) can cause
tachycardia
decreased BP (rupture)
Bruit
Signs of an AAA are:
epigats –> backpain
Investigations for an AAA include
CT Ultrasound CXR FBC U&Es
Treatment of an AAA includes
surgery (>5.5cm)
endovascular repair
What can the following events cause? Cerebral infarct Embolus CHD AF Dilated Myopathy
A stroke
What does a stroke cause?
haemorrhage or thromboembolism
Symptoms of a stroke are
FAST abbreviation
hemiparesis
aphasia
What does FAST stand for?
Face
Arms
Speech
Time to call 999
To investigate a stroke you would do a:
CT
MRI
Doppler/Duplex or carotid
Angiography
Treatment of a stroke =
Statins Anticoags Thrombolysis Aspirin Chlopidogrel Surgery
Raynauds is more common in
females
Raynauds causes
vasoconstriction/spasm of digital arteries
Signs of raynauds include
cyanosis
cole/pale digits
red (after reperfusion)
Symptoms of raynauds are
numbness
To treat raynauds one should
stop smoking
keep warm
Atrial Fibrillation is caused by
rheumatic fever heart failure alcoholism infection valvular disease dilated myopathy hypertension
Atrial fibrillation leads to
stroke
Sign of atrial fibrillation are
irregular pulse
tachycardia
increased S1 waves
absent a waves
Investigations for atrial fibrillation are
ECG TFTs FBC Echo Doppler
Treatment for atrial fibrillation is
treat underlying cause
ablation
antiarrhythms
implantable cardiovert defib
Chronic peripheral arterial disease (PAD) is caused by
smoking
dilated myopathy
increased lipids
hypertension
PAD can cause
atherosclerosis
vasculitis
buergers
dilated myopathy
Signs of PAD are
cold dry skin
no hair on limbs
decreased pulses
A symptoms of PAD is
cramp
Investigations for PAD include
ankle-brachial pressure index
angiogram
Treatment of PAD (and acute limb ischaemia) =
surgery angioplasty amputate decrease blood glucose statins ACE inhibitors clopidogrel
Embolus and Thrombi can cause what CVS disease?
Acute Limb Ischaemia
Signs of acute limb ischaemia are
surgery
thrombolysis
The 5Ps of acute limb ischaemia are
pin pulseless pallor parathesia paralysis
(and perishing cold)
Investigating acute limb ischaemia involves
ECG
CXR
routine bloods
angiogram
Sinus Bradycardia is caused EXTRINSICALLY by
hypothermia hypothyroid cholestasis drugs (BBs) digitalis
Sinus bradycardia is cause INTRINSICALLY by
SA node disease
atrial fibrosis
Sinus bradycardia causes less
CO2
Signs of sinus bradycardia are
PR interval 0.12 - 0.2 seconds
QRS
Symptoms of sinus bradycardia are
light headedness dizzy hypotension vertigo syncope
Sinus bradycardia is looked into using an
ECG
Heart rate in sinus bradycardia =
> 100bpm
Primary AV block is caused by
Av node disease increased vagal tone myocarditis post MI CCBs / BBs digitalis
Describe the PR interval in a primary AV block
0.22secs
every atrial deploy followed by ventricle contraction
A primary AV block is ______ and has ______ signs.
It requires _______ treatment.
asymptomatic
no signs
no treatment
Primary AV block investigations =
ECG
drug screen
electrolytes
Secondary AV block is caused by
post MI
some P waves conduct, some do not
Secondary AV block symptoms include
light headedness
dizziness
syncope
Factors affecting oxygen level supply are
inspired oxygen pulmonary function blood constituents blood flow vasculature integrity tissues mechanisms
Factors affecting oxygen demand are
tissues (all have different needs)
activity of tissue above baseline tissue
IHD supply issues are
coronary artery atheroma cardiac failure pulmonary disease/oedema/function anaemia previous MI
Hepatic cirrhosis =
regenerative nodules with intervening fibrosis
Hepatic cirrhosis results from
liver damage i.e. HBV, alcohol
Hepatic cirrhosis causes
loss of normal architecture
portal blood flow blocked
local chronic congestion
Congestive Cardiac Failure (CCF) is when the heart is unable to
clear blood from right and left ventricles
CCF causes
decreased CO increased fluid in body and veins RHF pulmonary oedema (LHF) both ventricles fail
Peripheral Oedema is when the heart
cannot empty the RV in systole
Bacteraemia causes:
brushing teeth, bowel movements
invasive procedures
extra-cardiac infections
gingival disease
Marfan’s Syndrome is a weakness in
connective tissues
Marfan’s Syndrome can cause _____ in the eyes?
cataracts lens dislocation retinal detachment glaucoma myopia
Characteristics of Marfan’s include
tall, slim
long legs/arms/hands
small lower jaw
loose/flexy joints
Other issues caused my Marfan’s include
scoliosis aortic aneurysm mitral/tricuspid issues stretch marks dural ectasia spondylolisthesis
Treatment of Arrhythmias includes
warfarin
dabigatran
rivaroxaban
apixaban
Type 1A anti arrhythmic agents are ____ and affect ____ wave
fast K+ and Na+ channel blockers
QRS complex
Type 1B anti arrhythmic agents are and ______ to the QRS?
fast Na+ channel blockers
prolong QRS in overdose