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Yr 5 Cardiology > Heart Disease > Flashcards

Heart Disease Flashcards

1
Q

What is the mechanism of ischaemic heart disease?

A

Atherosclerosis of the coronary.a
↓O2 supply to myocardium
Leads to ischaemia
Stable angina caused by exertion, relieved by rest

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2
Q

What are risk factors for ischaemic heart disease?

A 
Smoking
DM
HTN
↑Chol
↓Exercise
Obesity
Stress
FHx
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3
Q

What symptoms would make a diagnosis of angina unlikely?

A 
Continuous/prolonged
Unrelated to activity
Pleuritic pain
Dizziness
Palpitations
Tingling
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4
Q

How is ischaemic heart disease/angina investigated?

A 
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
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5
Q

What is the QRisk2 score?

A

Screening to calculate % risk of MI or stroke over next 10 years

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6
Q

How can variant angina be differentiated from decubitus angina?

A 
V = Coronary artery spasm
D = Precipitated by lying flat
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7
Q

How is Ischaemic heart disease/angina managed?

A

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

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8
Q

What is ischaemic heart disease also known as?

A

Angina

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9
Q

What should be covered at annual review?

A 
Fasting bloods
Urine test
BP
QRisk2
Medication review
Flu vaccine
Lifestyle advice
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10
Q

What are the complications of ischaemic heart disease and how do they occur?

A

MI – thrombus/emboli blocks coronary artery → infarction

IHD → HF – ischaemic myocardium dies from hypoxia → fibrous tissue develops → low CO + SV → high HR

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11
Q

What is essential HTN?

A

Primary HTN without an identifiable cause

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12
Q

What are the different grades of HTN?

A 
Pre-HTN: 130/90
1: 140/90
2: 160/100
3: 180/110
Malignant: 200/120
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13
Q

How is HTN investigated?

A 
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
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14
Q

What ABPM values require treating?

A

> 80yo: 145/85

<80yo: 135/85

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15
Q

How is someone counselled for ABPM?

A

2 measures per hour during waking hours

Average value from 14values

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16
Q

When is an urgent referral required for someone with HTN?

A

Accelerated HTN = >180/110 with any of:
Papilloedema
Retinal haemorrhage
Suspected phaeochromocytoma

17
Q

In HTN how is CKD risk assessed?

A

Bloods: eGFR (89-60 = mild CKD), Glucose, Urea (>7.8), ↑creatinine
Urine: ACR >1 = early renal disease >3 = significant

18
Q

How is HTN treated?

A

1) <55yo = ACEi/ARB
1) >55yo = CCB
2) ACEi + CCB
3) ACEi + CCB + Thiazide
4) Add a-blocker/ Spironolactone/ Beta blocker

19
Q

When on anti-HTN treatment what are the blood pressure targets?

A 
<80yo = 140/90 in clinic 5 less at home
>80yo = 150/90 in clinic 5 less at home
20
Q

What are the signs of malignant HTN?

A 
BP >180/110
Headache
Papilloedema
Retinal haemorrhage
Epistaxis
Nocturia
Dyspnoea (LVF)
21
Q

How is malignant HTN treated?

A

GTN
OR
IV Labetalol

22
Q

What are the SE of ACEi?

A 
Postural hypoT
Dry cough
Dyspnoea
↑K+
Angioedema
23
Q

What are the SE of ARBs?

A

Dizziness

24
Q

What are the SE of CCBs?

A

Ankle oedema
Headache
Palpitations
Dizziness

25
Q

What are the SE of Thiazides?

A

HypoK
Headache
Postural hypoT
Dizziness

26
Q

What are the SE of K+ sparing diuretics?

A

Gynaecomastia
Impotence
Menstrual irregularities

27
Q

What is postural hypotension?

A

Fall in sBP of >20mmHg
AND/OR
Fall in dBP of >10mmHg
WITHIN 3mins of standing

28
Q

What are triggers for postural hypotension?

A 
Drugs: A-blockers, diuretics, TCAs, Antihypertensives
Vol depletion
Physical reconditioning
Prolonged bed rest
Peripheral neuropathy 
Parkinson's/Lewy body dementia
29
Q

How is postural hypotension managed?

A

1) Eliminate aggravating factors
+/-) Fludrocortisone + NaCl
CORRECT: Any anaemia

Yr 5 Cardiology (8 decks)

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