Heart Disease Flashcards
What is the mechanism of ischaemic heart disease?
Atherosclerosis of the coronary.a
↓O2 supply to myocardium
Leads to ischaemia
Stable angina caused by exertion, relieved by rest
What are risk factors for ischaemic heart disease?
Smoking DM HTN ↑Chol ↓Exercise Obesity Stress FHx
What symptoms would make a diagnosis of angina unlikely?
Continuous/prolonged Unrelated to activity Pleuritic pain Dizziness Palpitations Tingling
How is ischaemic heart disease/angina investigated?
1) 64 slice CT coronary angiography IF INCONCLUSIVE 2) Non-invasive functional testing: MPS w/SPECT /Stress ECHO 3) Invasive coronary angio Other) Bloods: BNP, Trop ECG
What is the QRisk2 score?
Screening to calculate % risk of MI or stroke over next 10 years
How can variant angina be differentiated from decubitus angina?
V = Coronary artery spasm D = Precipitated by lying flat
How is Ischaemic heart disease/angina managed?
0) GTN: 1-2 puffs after angina or before activity
1) Regular meds: Beta blocker (Atenolol/Bisoprolol) /Rate limiting CCB (Diltiazem/Verapamil)
2) Monotherapy of long acting nitrate: Isosorbide Mononitrate- can then combine with BB/CCB
ALL: Aspirin 75mg + Statin
ACEi = Stable angina + DM
What is ischaemic heart disease also known as?
Angina
What should be covered at annual review?
Fasting bloods Urine test BP QRisk2 Medication review Flu vaccine Lifestyle advice
What are the complications of ischaemic heart disease and how do they occur?
MI – thrombus/emboli blocks coronary artery → infarction
IHD → HF – ischaemic myocardium dies from hypoxia → fibrous tissue develops → low CO + SV → high HR
What is essential HTN?
Primary HTN without an identifiable cause
What are the different grades of HTN?
Pre-HTN: 130/90 1: 140/90 2: 160/100 3: 180/110 Malignant: 200/120
How is HTN investigated?
1) BP in clinic: >180/110 start Tx straight away >140/90 → ABPM 2) ABPM 3) HBPM Assess CV risk: QRisk2 Score Assess CKD risk Opthalmoscope: Hypertensive retinopathy
What ABPM values require treating?
> 80yo: 145/85
<80yo: 135/85
How is someone counselled for ABPM?
2 measures per hour during waking hours
Average value from 14values
When is an urgent referral required for someone with HTN?
Accelerated HTN = >180/110 with any of:
Papilloedema
Retinal haemorrhage
Suspected phaeochromocytoma
In HTN how is CKD risk assessed?
Bloods: eGFR (89-60 = mild CKD), Glucose, Urea (>7.8), ↑creatinine
Urine: ACR >1 = early renal disease >3 = significant
How is HTN treated?
1) <55yo = ACEi/ARB
1) >55yo = CCB
2) ACEi + CCB
3) ACEi + CCB + Thiazide
4) Add a-blocker/ Spironolactone/ Beta blocker
When on anti-HTN treatment what are the blood pressure targets?
<80yo = 140/90 in clinic 5 less at home >80yo = 150/90 in clinic 5 less at home
What are the signs of malignant HTN?
BP >180/110 Headache Papilloedema Retinal haemorrhage Epistaxis Nocturia Dyspnoea (LVF)
How is malignant HTN treated?
GTN
OR
IV Labetalol
What are the SE of ACEi?
Postural hypoT Dry cough Dyspnoea ↑K+ Angioedema
What are the SE of ARBs?
Dizziness
What are the SE of CCBs?
Ankle oedema
Headache
Palpitations
Dizziness
What are the SE of Thiazides?
HypoK
Headache
Postural hypoT
Dizziness
What are the SE of K+ sparing diuretics?
Gynaecomastia
Impotence
Menstrual irregularities
What is postural hypotension?
Fall in sBP of >20mmHg
AND/OR
Fall in dBP of >10mmHg
WITHIN 3mins of standing
What are triggers for postural hypotension?
Drugs: A-blockers, diuretics, TCAs, Antihypertensives Vol depletion Physical reconditioning Prolonged bed rest Peripheral neuropathy Parkinson's/Lewy body dementia
How is postural hypotension managed?
1) Eliminate aggravating factors
+/-) Fludrocortisone + NaCl
CORRECT: Any anaemia
