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MS4 - CVS > HTN + Endocarditis > Flashcards

HTN + Endocarditis Flashcards

1
Q

Stages of HTN

A

Stage 1: Clinic BP > 140/90, ABP/HBP 135/85
Stage 2: Clinic BP > 160/100, ABP/HBP 150/95
Severe: Clinic BP > 180/110
Malignant HTN

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2
Q

Malignant HTN definition

A

BP > 200/130

+ bilateral retinal haemorrhage / papilloedema

+/- Sx

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3
Q

Sx of malignant HTN

A

Headache

Visual disturbance

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4
Q

Hypertensive emergencies

A

Acute renal failure

Heart failure

Encephalopathy

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5
Q

HTN investigations

A

24h ambulatory BP

Home BP

QRISK2

Urine: haematuria, Alb:Cr ratio

Bloods: FBC, U+Es, eGFR, glucose, fasting lipids

12 lead ECG

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6
Q

When to Rx HTN

A

Severe HTN

Stage 2 after ABP/HBP

Stage 1 if QRISK2 10 yr risk > 20%

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7
Q

Mx of HTN

A

1) ACEi or ARB if <55yrs, Calcium channel blocker(CCB) if >55 or black
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + Thiazide like Diuretic
4) (resistant hypertension) Add further diuretic or a/B blocker

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8
Q

Treatment of malignant HTN

A

Controlled reduction in BP to avoid watershed stroke
Atenolol or long acting calcium channel blocker

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9
Q

Causes of HTN

A

Primary

Renal

Endocrine

Drugs

ICP↑

Aortic coarctation

Fluid overload

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10
Q

Renal causes of HTN

A

Renal artery stenosis

Glomerulonephritis

Autosomal dominant polycystic kidney disease

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11
Q

Endocrine causes of HTN

A

Hyperthyroid

Cushing’s

Phaeochromocytoma

Acromegaly

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12
Q

Drugs causing HTN

A

Cocaine

NSAIDs

OCP

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13
Q

End organ damage in HTN (CANER)

A

1) Cardiac - IHD, L ventricular hypertrophy, Aortic/mitral regurg
2) Aortic - Aneurysm, Dissection
3) Neuro - Stroke, Encephalopathy
4) Eyes - hypertensive retinopathy
5) Renal - Proteinuria, CKD

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14
Q

Fever + new murmur

A

Endocarditis until proven otherwise

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15
Q

RFs for infective endocarditis

A

Dermatitis

IV injections

Renal failure

DM

Prosthetic valves

Dental hygiene

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16
Q

Causes of endocarditis

A

Bacteraemia

Fungi

SLE

Malignancy

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17
Q

Libman-Sacks endocarditis

A

SLE associated endocarditis

18
Q

Bacterial causes of infective endocarditis

A

Strep viridans

Staph aureus

Staph epidermis

Diphtheroids

HACEK

19
Q

HACEK definition

A

Gram negative bacteria

Rare causes of endocarditis

20
Q

HACEK bacteria

A

Haemophilus

Actinobacillus

Cardiobacterium

Eikenella

Kingella

21
Q

Fungal causes of infective endocarditis

A

Candida

Aspergillus

Histoplasma

22
Q

Septic signs of infective endocarditis

A

Fever

Sweats

Weight loss

Splenomegaly

Anaemia

23
Q

Hand signs of infective endocarditis

A

Clubbing

Splinter haemorrhages

Osler’s nodes

Janeway lesions

24
Q

Cardiac signs of infective endocarditis

A

New / changing murmur

Vegetations

Long PR

Emboli

25
Q

Immune complex deposition signs of infective endocarditis

A

Vasculitis

Glomerulonephritis

Roth spots

Splinter haemorrhages

26
Q

Roth spots

A

Boat shaped retinal haemorrhages

Pale centre

27
Q

Diagnosis of infective endocarditis

A

Duke criteria:

  • 2 major or
  • 1 major + 3 minor
  • 5 minor
28
Q

Major Duke criteria

A

Positive blood cultures

Endocardium involvement:

  • Positive echo
  • or new valve regurgitation
29
Q

Minor Duke criteria

A

Fever

Predisposition

Vascular / immunological signs

Positive blood culture (doesn’t meet major criteria)

Positive echo (doesn’t meet major criteria)

30
Q

Predisposition to infective endocarditis

A

Cardiac lesion

IVDU

31
Q

Positive blood cultures for major Duke criteria

A

Typical organism

2 separate cultures

32
Q

Mx of infective endocarditis

A

Abx - liaise with microbiologists and cardiologists

Surgery

33
Q

When to consider surgery for infective endocarditis

A

Heart failure

Valvular obstruction

Repeated emboli

Myocardial abscess

Unstable infected prosthetic valve

34
Q

Prevention of infective endocarditis

A

Good oral hygiene

Risks of tattoos / piercing

NOT abx

35
Q

Sx of aortic dissection

A

Tearing chest pain

+/- Radiation to back

May lead to reduced brain perfusion or acute limb ischaemia

36
Q

Types of thoracic aortic dissection

A

Type A (70%)

Type B (30%)

37
Q

Type A aortic dissection definition

A

Involves ascending aorta

38
Q

Type B aortic dissection definition

A

Does NOT involve ascending aorta

39
Q

Mx of type A aortic dissection

A

Crossmatch 10 units blood

Surgery

40
Q

Mx of type B aortic dissection

A

Crossmatch 10 units blood

Medical

Hypotensives - keep systolic BP 100-110

Surgery

MS4 - CVS (8 decks)

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