Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Cardiology > Hypertension & Acute Coronary Syndrome > Flashcards

Hypertension & Acute Coronary Syndrome Flashcards

1
Q

What are the big 3 causes of chest pain?

A

Acute coronary syndrome
Pulmonary embolism
Acute aortic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is acute aortic syndrome?

A

AAA
Dissection
Rupture
Penetrating ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is acute coronary syndrome?

A

STEMI, NSTEMI, unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the main types of hypertension?

A

Essential and secondary hypertension

Essential hypertension = cause unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What endocrine syndrome is a common cause of secondary hypertension?

A

Conn’s syndrome

Hyperaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is stage 1, 2 and 3 hypertension

-give the clinic and the ABPM/HBPM readings

A

1 clinic >140/90, home >130/85
2 clinic >160/100, home >150/95
3 clinic sBP >180 or dBP >120 = severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is masked hypertension?

A

Clinic less than 140/90 but home readings higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is accelerated AKA malignant hypertension?

A

> 180/20 plus hypertensive retinopathy or papilledema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the white coat effect?

A

> 20 systolic or 10 diastolic difference between clinic and average home readings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In basic terms, why does hypertension predispose heart failure?

A

Heart strain due to pumping against increased resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When do you offer ABPM?

A

If clinic >140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What test would you do if you suspected Conn’s syndrome?

A

Renin aldosterone ratio blood test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the 1st and 2nd line management of hypertension?

A

1st: If aged under 55 years ACEI or ARB
If aged over 55 years or black skin CCB

2nd: aged under 55: (ACEI or ARB) + (CCB or thiazide diuretic)
aged >55 or block skin: CCB + (ACEI or ARB or thiazide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the 3rd line management of hypertension?

A

ACEI/ARB + CCB + thiazide diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the 4th line management of hypertension?

A

Confirm elevated BP with ABPM
If K <4.5 add low dose spironolactone
If K >4.5 add alpha blocker or beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What stage of hypertension management is considered resistant hypertension?

A

4th line management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If blood pressure is uncontrolled on X number of drugs at optimal doses, seek expert help.. how many is X?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which antihypertensive causes angioedema as a SE?

A

ACEI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which antihypertensive causes urticaria as a SE?

A

ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which antihypertensive causes bronchospasm as a SE?

A

BB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which antihypertensive causes gout as a SE?

A

Diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which antihypertensive causes gingival hypertrophy as a SE?

A

CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which antihypertensive causes ankle edema as a SE?

A

CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which antihypertensive causes is also an antiandrogen?

A

Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which antihypertensive is contraindicated in bilateral renal artery stenosis?

A

ACEI

Also contraindicated in pregnancy and severe CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the mechanism of labetalol?

A

Alpha and beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the mechanism of prazosin?

A

A1 alpha blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the BP targets in hypertension?

A

Age under 80 clinic <140/90

Age over 80 clinic <150/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the effect of spironolactone and thiazide diuretics on potassium?

A

Thiazide diuretics case hypokalaemia

Spironolactone is potassium sparing - hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What group of antihypertensives should be used with caution in heart failure

A

BB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Out of LDL and HDL, which is the good and bad cholesterol

A

LDL bad, HDL good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is name of the scoring system for cardiovascular risk? At what cut off should you start primary prevention?

A

ASSIGN
>20

(Primary prevention is to prevent an event, secondary prevention is after an event to prevent recurrence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the mechanism of statins?

A

HMG Co-A reductase inhibitor

34
Q

Xanthomata, xanthelasma and xanthoma are all presentations of dyslipidaemia - which body parts do each refer to?

A

Xanthomata - fingers
Xanthelasma - eyes
Xanthoma - joints

35
Q

What sign can be seen in the iris of the eye in severe dyslipidaemia?

A

Corneal arcus

36
Q

What food interacts with statins?

A

Grapefruit juice

Also alcohol, St Johns wort, clarithromycin

37
Q

Name 4 side effects of statins

A

Myalgia
Rhabdomyolisis
Raised CK
Transient raise in ALT and AST

38
Q

What is the 1st line statin?

A

Atorvastatin
(second line simvastatin)
(statins are taken at night)

39
Q

What blood tests should you monitor when initiating statins? And when?

A

At 3 months check LFTs and lipids (total cholesterol, triglycerides, HDL)
Recheck at 1yr

40
Q

In high cholesterol, what percentage reduction are you aiming for in non-HDL? What do you do if not achieved?

A

40% reduction in non-HDL cholesterol

If not titrate dose up

41
Q

What is the second line management of high cholesterol?

A

Ezetimibe

42
Q

Put the stages of atherosclerosis in the correct order:

  • Atherosclerotic plaque
  • Normal
  • Fibrous plaque
  • Plaque rupture + thrombosis
  • Fatty streak
A 
Normal
Fatty steak
Fibrous plaque
Atherosclerotic plaque
Plaque rupture + thrombosis
43
Q

Here are the stages of atherosclerosis:
normal > fatty streak > fibrous plaque > atherosclerotic plaque > plaque rupture + thrombosis
Which stages are clinically silent? At which stages do you see stable angina or intermittent claudication? At which stages to do see ACS, CVAs or leg ischaemia?

A

Normal / fatty streak both clinically silent
Fibrous plaques and atherosclerotic plaques cause stable angina and intermittent claudication
Plaque rupture causes ACS, CVAs and leg ischaemia

44
Q

How would you clinically differentiate stable and unstable angina - in terms of triggers and relief

A

Stable angina is relieved by rest and GTN and provoked by exercise or the cold
Unstable angina occurs at rest and the pain is more intense

45
Q

What are troponins in unstable angina?

A

Normal

46
Q

How could you clinically differentiate an NSTEMI and unstable angina?

A

Unstable angina typically lasts under 15 minutes unlike a NSTEMI

47
Q

What test is diagnostic of stable angina?

A

None - it is a clinical diagnosis

Though perform an ECG, FBC, U+Es, LFTs, a lipid profile, HbA1C and fasting glucose for the work up

48
Q

GTN vasodilates or vasoconstricts

A

Vasodilates

49
Q

During angina symptoms, after how many minutes could you repeat a dose of GTN?

A

After 5 minutes repeat

If pain still present 5 minutes after the repeat dose, call an ambulance

50
Q

What is the basic pathology of unstable angina?

A

Plaque rupture - with a platelet rich clot on top

51
Q

What scar does a CABG leave? What scar does percutaneous coronary intervention with balloon angioplasty leave? What vein is harvested in a CABG?

A

CABG - median sternotomy scar
CABG harvest great saphenous vein in the leg
PCI - scar at site of entry at brachial/ femoral artery

52
Q

What 3 drugs comprise 1st line management of angina

A

GTN +
75mg aspirin +
BB eg bisoprolol 5mg

(2nd line switch BB to or add CCB eg amlodipine)
(3rd line nicorandil)
(Also a statin)

53
Q

What is the difference between an STEMI and NSTEMI in terms of basic pathophysiology?

A 
NSTEMI = artery open but severe narrowing
STEMI = lumen blocked causing ischemia 
(time = muscle)
54
Q

How long do symptoms last in an acute MI?

A

Longer than 20 mins

55
Q

What are the ECG features of an NSTEMI?

A

ST segment depression
T wave inversion
May be normal

56
Q

What are the ECG features of a STEMI?

A

> 1mm elevation in 2 adjacent limb leads or >2mm elevation in 1 chest lead
New LBBB
T wave inversion

57
Q

A lateral MI is due to occlusion of which vessel and where would it be seen on an ECG?

A

Lateral = left circumflex

aVL, I, v5, v6

58
Q

An inferior MI is due to occlusion of which vessel and where would it be seen on an ECG?

A

Inferior = right coronary

aVF, II, III

59
Q

An anterior MI is due to occlusion of which vessel and where would it be seen on an ECG? BIT CONFUSED IF LEFT CORONARY OR LAD

A

LEFT CORONARY OR LAD

60
Q

When to troponins peak? When should they be measured? Why do you need to interpret troponins with caution?

A

Peak 12-24hr
Measure at onset + repeat at 12hr
Non-specific myocardial damage
(also raised by PE, CKD, sepsis, myocarditis, aortic dissection)

61
Q

What is the biggest cause of death in acute MI?

A

Go into v-fib

62
Q

What is the 1st line Ix for an MI, how quickly should it be given?

A

12 lead ECG within 10 min of arrival

patients admitted to CCU, HDU or telemetry bed

63
Q

What is reperfusion therapy for a MI?

A

PCI or fibrinolysis

64
Q

If patients with an acute STEMI are not deemed eligible for reperfusion therapy (PCI or thrombolysis) what should they be given?

A

180mg ticagrelor antiplatelet + aspirin antiplatelet

65
Q

What are the indications for angiography with PCI (cath lab) for STEMI?

A

If under 12hr since symptom onset and PCI available within 120mins

66
Q

What are the indications for thrombolysis for STEMI?

A

If under 12hr since symptom onset and PCI not available within 120mins

67
Q

What drugs are given adjuvant to PCI?

A

Prasugrel and aspirin

68
Q

What 3 drugs is given for thrombolysis?

A

Streptokinase
300mg aspirin
180mg ticagrelor

69
Q

What is initial Mx of an NSTEMI?

A 
BATMAN
BB 
Aspirin 300mg ASAP
Ticagrelor
Morphine
Anticoagulant LMWH fondaparinux 2.5mg (not if going for angiograpy) 
Nitrate GTN
70
Q

How do you decide if NSTEMI patients get angiography?

A

Use scoring system eg GRACE to predict 6 month mortality. If risk >3% angiography (immediate if clinically unstable, within 72hr if stable)
If risk <3% conservative Mx without angiography unless younger patient

71
Q

What is the conservative management for NSTEMI without angiography?

A

Ticagrelor + aspirin + fondaparinux

72
Q

What is the long term management secondary prevention post heart attack?

A

Cardiac rehab + ACEI + dual antiplatlet therapy + statin
(ACEI rampipril continue indefinitely)
(Dual antiplatelet aspirin + another for 12mth)
(Statin 80mg atorvastatin)

73
Q

What are the exercise recommendations for cardiac rehab?

A

20-30 minutes a day to the point of slight breathlessness

74
Q

What is the mechanism of Dressler’s syndrome? How long post MI does it occur? How would it appear on an ECG?

A

Autoimmune
2-6wk
Global ST elevation

75
Q

Management of Dressler’s syndrome?

A

NSAIDs

76
Q

How soon after an MI does a VSD present? What murmur does it cause? How is it diagnosed? What is the management?

A

In 1st week
Pan-systolic murmur
Echo
Surgical

77
Q

3 wk after an MI a patient presents with fever, pleuritic chest pain and a pericardial rub - what is the diagnosis?

A

Dressler’s syndrome

with associated pericardial effusion

78
Q

How soon after an MI does LV free wall rupture present? What is the management

A

After 1-2 weeks

Urgent pericardiocentesis + thoracotomy

79
Q

Persistent ST elevation and left ventricular failure following an MI could be caused by what?

A

LV aneurysm

80
Q

An early-to-mid systolic murmur following an inferoposterior MI is caused by what?

A

Acute mitral regurgitation

Y4 Cardiology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions