More Big Resp/Cardio diseases Flashcards
What is hypertension?
High blood pressure
What are some causes of hypertension?
Primary hypertension - idiopathic
Secondary hypertension - has a known cause.
Chronic renal infection Polycystic kidney disease Renal artery stenosis Cushing's preeclampsia Drug induced by NSAIDs/oral contraceptive Sleep apnoea Coarctation of the aorta.
What are the risk factors for hypertension?
Genetics Diet Diabetes Obesity Exercise Contraceptives Stress Afro-carribean Age Low birth weight
What are the symptoms for hypertension?
Often there are no symptoms - incidental finding to another condition.
Diet Diabetes Medications Stress Family history Exercise
Upon examination of an individual with suspected hypertension what would be found?
Tar staining Hypercholesterolaemia Xanthalasma Corneal arcus End organ damage Retinopathy Proteinuria Left ventricular hypertrophy Radiofemoral delay Palpable kidneys
What investigations aid the diagnosis of hypertension?
Measure blood pressure using a sphygmomanometer.
ABPM or HBPM
ECG- to look fo cause of hypertension
Urine analysis - to check kidney function
What are the values of stage 1 hypertension?
Clinical = 140/90
ABPM=135/85
What are the values of stage 2 hypertension?
Clinical = 160/100 ABPM= 150/95
What are the values of severe hypertension?
Systolic= >180 OR Diastolic= >110
What is the available treatment for hypertension?
<55yrs old:
1- ACE inhibitor or ARB
2- Add thiazide like diuretic
> 55yrs, Afro-carribean, women of child bearing age:
1- Ca2+ channel blocker
2- Add thiazide like diuretic
All:
3- CCB + ACEI/ARB + Thiazide like diuretic
4- <4.5mmol/L give spironolactone
>4.5mmol/L give higher dose Thiazide like diuretic.
Specialist drugs: Alpha adrenoreceptor agonist
Centrally acting agents
Vasoldilators
What are some examples of ACEIs?
Ramipril
What are some examples of Thiazide like diuretics?
Indapamide
Clortalidone
What are some examples of CCBs?
Felodipine
Diltiazem
Verapamil
What are some examples of angiotensin II antagonists (ARBs)?
Losartan
Valsartan
What are some complications of hypertension?
Atheroma Stroke Haemorrhage MI Left ventricular failure Retinopathy
Puts more strain on organs.
What is Marfan’s syndrome?
A genetic disorder that affects the body’s connective tissue.
What causes Marfan’s syndrome?
Autosomal dominant inheritance.
Mutation to 15q21 in fibrillin-1 gene causing abnormal or absent fibrin in connective tissue.
What are the symptoms of Marfan’s disease?
Cardiac - chest pain murmur palpitations Aortic dilation Mitral valve prolapse
Pulmonary - Pneumothorax
Dyspnoea
Eyes- Ectopia lentis
Bad vision
Skeletal - Tall stature Long thin limbs Scoliosis Kyphosis Funnel or pigeon chest Flat feet Roll in on their ankles High palate Thumb sticks out when they make a fist. Stretch marks Fatigue
What would be seen on the examination of an individual with suspected Marfan’s?
12 systemic features each given a score
If patient score 7 or above then it is Marfan’s.
Systemic features are: Face Mitral valve prolapse Pneumothorax Dural ectasia Scoliosis/kyphosis Pectus deformity Striae Myopia Ankle deformity Flat feet Upper limbs exceed height Thumb Wrist Reduced elbow extension.
What investigations are used to aid the diagnosis of Marfan’s?
ECHO - assess cardiac involvement MRI - assess lumbar spine Pelvic x-ray Chets x-ray Genetic test for fibrillin-1 mutation.
What is the treatment available for Marfan’s?
Annual ECHO to monitor heart.
Prophyllactive aortic surgery
Beta Blockers
ARBs.
What is Stroke?
Temporary occlusion of the blood supply to the brain causing loss of function. It last longer than 24hours.
TIA (transient ischaemic attack) lasts less than 24hours.
What are the causes of stroke?
Haemorrhage - 15%
Ischaemia - 85%
What are the risk factors for stroke?
Male Increasing age Atrial fibrillation Diabetes Smoking Hypertension Hypercholesterolaemia
What are the symptoms of stroke?
Loss of feeling Clumsy/weak limbs Loss of vision Dysarthia - motorspeech disorder Dysphasia - language disorder Involuntary eye movement Headache Vomiting
Upon examination of a patient suspected of having a stroke what would you find?
Tachycardia
Irregular heart rhythm
Murmur/galloping heart
Carotid bruit if carotid disease is cause.
What are the investigations for stroke?
Full blood count Lipid profile Carotid doppler ultrasound ECG ECHO CT/MRI
What is the available treatment for stroke?
Thrombolysis - alteplase
Thrombolectomy - IV retrieval
Secondary prevention - Aspirin/Clopidogrel
Statins
Antihypersensitives
Diabetic control
Carotid endarterectomy - removes plaque build up in carotid.
What are the different types of stroke?
TACs (Total Anterior Circulation) - usually due to occlusion of proximal middle cerebral artery. Only 1 symptom of loss of function.
PACs (Partial Anterior Circulation) - 2/3 symptoms of loss of function. Occlusion of branches of middle cerebral artery.
Lacunar - weakness of 1 side involving 2/3 body areas. Often silent.
POCs (Posterior Circulation) - affects brainstem, cerebellar or occipital lobes.
What is COPD?
Chronic Obstructive Pulmonary Disease
Group of lung conditions that contribute to the narrowing of airway, making it difficult to empty air out of lungs.
Chronic bronchitis + Emphysema
What is chronic bronchitis?
Chronic inflammation of the bronchi that causes a build up of sputum. There is less pull on airways so elastic lining flops and becomes inflamed.
What is emphysema?
Dilation of alveoli, breakdown of walls causing a decrease in surface area and making them baggy.
What are the risk factors for COPD?
Smoking Occupation Increasing age Family history Alpha-1-antitrypsin deficiency
What are the symptoms of COPD?
Progressive dyspnoea - starts on exertion but then becomes more severe. Chest pain Fatigue Cough Sputum - green Ankle oedema Weight loss Loss of appetite Wheeze Fever
What are the characteristics of COPD symptoms that distinguish it from other lung conditions?
Progressive
Irreversible
Non variable
Permanent
What are the investigations that aid the diagnosis of COPD?
Spirometry Peak Flow Full blood tests Chest x-ray Sputum culture
What is the available treatment for COPD?
1- SABA - salbutamol
2- LAMA or LABA - salmeterol/ tioptropium
3- LAMA and LABA
4- ICS + LAMA + LABA - fostair/flutiform/symbicort
If symptoms exacerbate - hospitalisation.
Nebulisers if can’t use inhalers
Prednisolone steroid 5-7days
Oxygen
Lung reduction surgery for severe emphysema.
Stop smoking/ change lifestyle
Lung transplant - last resort!
What is Atherosclerosis?
Accumulation of fat/scar tissue on the endothelial walls of arteries forming atheromas.
What is an atheroma?
Central lipid core with fibrous tissue cap, filled with inflammatory cells.
What are the causes of atheroma?
Hypercholesterolaemia
Endothelial injury
Haemodynamic disturbance
What are the risk factors atherosclerosis?
Hypercholesterolaemia Smoking Hypertension Male Age Sedentary lifestyle Low birth weight
What are the symptoms of atherosclerosis?
Angina Claudication Tissue atrophy MI Stroke Lower limb gangrene
What is the available treatment of atherosclerosis?
Angioplasty - stenting Bypass grafting Thrombolysis Thrombolectomy Endarectomy Control of BP Statins
What are the complications of atherosclerosis?
Rupture
Embolism
Stenosis
What are the stages of plaque formation?
1- fatty streak
2- early atheromatous plaque
3- fully developed atheromatous plaque
What is aortic dissection?
A tear in the inner wall of the aorta caused by blood forcing the wall apart.
What are the causes of aortic dissection?
Trauma Cardiac surgery Marfan's Bicuspid AV Atherosclerosis Hypertension
What are the risk factors of aortic dissection?
Trauma Smoking Cocaine Pregnancy Arteritis Hypertension Hypercholesterolaemia
What are the symptoms of aortic dissection?
Severe tearing chest pain Radiation to back Syncope Atrial fibrillation Externa rupture Pericardial tamponade Pleuritic chest pain
What would be found on the examination of a patient with suspected aortic dissection?
Reduced peripheral pulses BP mismatch in upper limbs Murmur of aortic regurgitation hypo/hypertension Pulmonary oedema Inferior ST elevation
What are the investigations of aortic dissection?
CXR- mediastinal widening, loss of aortic knob, tracheal deviation, pleural effusion
CT/MRI
Transoesophageal ECHO
What is Cystic fibrosis?
Genetic condition (autosomal recessive) that affects the body’s ability to control the movement of salt and water between cells. This causes sticky mucus to build up in the lung sand digestive system.
What causes cystic fibrosis?
A mutation in the CFTR gene so that it no longer codes for the protein channel that aids the movement of water and salt between cells.
What are the symptoms of CF?
Lungs: Recurring chest infections Cough Wheeze Dyspnoea Purulent sputum
Digestive system: Pale, greasy poo Difficulty putting weight and growing Constipation Physical weakness Hunger and thirst Severe constipation in first few days of life.
What investigations aid the diagnosis of CF?
PKU heel prick test at 5 days old.
Sweat test - sample is taken to see how much salt is in it.
Genetic test - to look for abnormalities
Family testing - any brothers/sisters tested for carrier gene. Can be salvia or blood.
What is the treatment available for CF?
No cure for CF so treatment is to relieve symptoms.
Multidisciplinary team required.
Antibiotics to treat chest infections
Hypertonic saline to thin mucus
Ivacaftor - new drug that reduces mucus levels.
Bronchodilators and Steroids - to help with narrowed airways.
Routine vaccinations Enzyme supplements Exercise Airway clearance techniques Dietary advice Lung transplant - last resort!
What is pneumonia?
Inflammation lung tissue caused by a bacterial infection.
What are some of the organisms that cause pneumonia?
Streptococcus pneumoniae Staph. aureus Mycoplasma pneumonia Chlamydia psittaci Haemophilus influenza
What are the different types of pneumonia?
Community acquired Hospital acquired Aspiration Recurrent Broncho Lobar Atypical
What are the symptoms of pneumonia?
Cough Sputum - thick green/yellow /brown Possible haemoptysis Dyspnoea Tachycardia Fever Malaise Sweating/chills Loss of appetite Chest pain - pleuritic
What are the investigations that aid the diagnosis of pneumonia?
CXR Sputum culture Full Blood count Mycoplasma IgM Atypical serology Pneumococcal urinary antigen.
What is the treatment available for pneumonia?
Antibiotics - beta-lactams and macrolides
Fluids
Analgesia
Supplemental oxygen
What are the possible complications of pneumonia?
Pleurisy Pleural effusion Empyema Organisation to form mass lesion Lung Abscess Bronchiectasis Recurrent pneumonia
What is bronchiectasis?
Pathological dilation of the bronchi due to severe infection, recurrent infections, proximal bronchial obstruction or lung parenchymal destruction.
Chronic condition that causes a build up of mucus and makes individual more prone to infection.
What are the symptoms of bronchiectasis?
Persistant cough
Dyspnoea
Gets worse if develop aa lung infection.
What is the treatment available for bronchiectasis?
Antibiotics to treat infections.
Airway exercises to aid clearance of mucus.
Nebulisers or bronchodilators to aid breathing
Hypertonic saline to thin mucus.
What is an arrhythmia?
An abnormal heart rhythm.
What are the symptoms of arrhythmias?
Asymptomatic Palpitations Dyspnoea Chest pain Fatigue Embolism
What are the investigations that aid the diagnosis of arrhythmias?
ECG- 12 lead 24hr recording
Blood tests - especially thyroid function
ECHO - to look for cause.
What is supreventrivcular tachycardia?
AV nodal re-enterant tachycardia.
Episodes of abnormally high heart rate at rest.
What is atrial fibrillation?
Heart beats irregularly and faster than normal.
What is atrial flutter?
Abnormally rapid but regular contraction of the atria.
What is ventricular fibrillation?
Heart quivers instead of pumping due to disorganisation in ventricles. Basically cardiac arrest.
What is ventricular tachycardia?
Regular fast heart rate from improper electrical activity in the heart.
What is first degree heart block?
PR interval is >0.2secs.
What are the causes of first degree heart block?
Increased vagal tone Electrolyte disturbance Myocarditis Mitral valve surgery Inferior MI AV node blocking drugs
What is second degree heart block?
Mobitz type 1 - progressive prolongation of PR interval, culminating in a non-conducted p wave.
Mobitz type 2- intermittent non conducted p waves without PR interval prolongation.
What is third degree heart block?
No correlation between P wave and QRS complex. Complete AV block
What is the treatment for heart block?
Atropine
Temporary pacemaker
Permanent pacemaker
What is endocarditis?
Infection of the endocardium, valves, septa, chordae tendinae or intra-cardiac devices.
What are the causes of endocarditis?
Bacterial or fungal infection Rheumatic fever Valvular disease Invasive surgery Congenital heart disease Gingivitis
What are the risk factors for endocarditis?
Age Male Invasive procedures Prosthetic valves IV drug abuse Immunocompromised Diabetes AIDs Burns
What are the symptoms of endocarditis?
Fever Malaise Fatigue Chills Arthralgia Weight loss Headache
What would be seen on examination of a patient with suspected endocarditis?
Fever Roth spots Osler's nodes Malaise Janeway lesions Anaemia Nepthritis Emboli
What investigations aid the diagnosis of endocarditis?
Full Blood count C-reactive protein Erythrocyte sedimentation Urea and electrolytes Blood culture - 3 sets from different sites 6hrs in-between. Urinalysis ECG - wide QRS complex CXR Transthoracic ECHO
What is the treatment available for endocarditis?
IV antibiotics or 2 oral at once.
