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Cardiovascular system > Pathology > Flashcards

Pathology Flashcards

1
Q

Pernicious anaemia

A
  • Auto immune condition affection stomach, B12 can’t bind to intrinsic factor (allowing B12 to be absorbed) and parietal cells affected ***

Sx - Tired all the time, confused, pins and needles often in feet

Ix - Anti intrinsic factor - moat specific and so first line (IFA) and anti parietal cell antibodies (PCA)
- microcytic anaemia

Mx - Intramuscular B12 and oral B12

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2
Q

Familial hypercholestrolaemia

A

**Autosomal dominant condition

Increased LDL In the blood, leading to cardiovascular disease

Due to:
- Faulty LDL receptor and so LDL can’t enter cell form the blood

  • Faulty Apo B-100 (name badge) - LDL cells can’t interact with the receptor, increasing in the blood
  • Increased PCSK9 function - Destroys LDL receptors, LDL increases in the blood
  • Leads to atherosclerosis
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3
Q

Dysbetalipoproteinaemia

A
  • Genetic defect leading to an increase in APO B containing lipoproteins

Cx - mutation in APO E gene

  • Triggered by diabetes, hypothyroidism, obesity

Sx- Increased triglycerides and LDL, lipid deposits on skin, premature cardiovascular disease

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4
Q

Familial chylomicronaeima

A
  • Too many chylomicrons in the blood leading to pancreatitis
  • Chylomicrons take fat from food
  • Due to deficiency in lipoprotein lipase enzyme which normally promotes uptake of chylomicrons in cells, leading to increased triglyceride levels
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5
Q

Abdominal aortic aneurysm + rupture

A
  • Swelling in aorta running to stomach and and chest, usually just before bifurcation at L4 - loss of elastic fibres in tunica media

Complications - Infarction/ischemia in bowels, kidneys, lower limbs

Sx - Sudden severe pain in tummy (central), radiating to lower back or legs, dizziness, sweating, palpitations, nausea and vomiting

Ix - Abdominal ultrasound
- CTA
- Screening offered to all men aged >65

Mx - surgery for grafting

Rupture - extreme central abdominal pain, massive internal bleeding, 80% don’t survive

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6
Q

Dissecting aortic aneurysm

A
  • Most common in thoracic aorta
  • Wall of the aorta (tunica intima) splits into 2 layers creating a cavity
  • more common in men in 60s

Cx - hypertension, atherosclerosis, Marfan syndorme, aneurysms

Sx - sudden serve chest pain that can move to the back, loss of consciousness, SOB, weak pulse in a limb, leg pain, widened mediastinum
- weak carotid, brachial or femoral pulse
- variation in arm BP

Ix - CXR, ECG, FBC, BP of both arms
- CT thoracic aorta

Mx - ascending - labetalol and surgery (aortic root replacement) (if murmur = AR)
- aortic root replacement as surg
Mx - descending - lebatalol non surgery unless complications

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7
Q

Stable angina

A
  • Chest pain caused by artery stenosis
  • Stable - brought on during exercise
  • Unstable - brought on at rest

Sx - Chest pain that is tight or crushing and either central or left sided, shortness of breath, fatigue, sweating, dizziness

Ix - ECG and coronary angiography

Mx - GTN acutely, aspirin and statin
- long term relief - CCB (non rate limiting) and BB
- lifestyle and secondary prevention

  • BB or amplodapine 1st line to prevent attacks
  • Isosorbide mononitrate if not fixed^
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8
Q

Unstable angina

A

Ix - ECG, angio, echo

  • Sx of ACS, tropnons normal, ECG normal or ST depression or T wave inversion

Mx - Lifestyle, dual platelet, other BP meds

*BB or Verapamil 1st line to prevent attack

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9
Q

MI

A
  • Complete blockage of blood flow to heart leading to tissue necrosis

Sx - Starts off mild then gets worse (most common)
- sudden chest pain radiating from left arm to neck
- shortness of breath, sweating, nausea, vomiting, abnormal heart rhythm (DULL HEAVY CHEST PAIN)

Ix - positive torponin, ST elevation in ECG, increased resp rate (pain),
- RCA MI can cause arrhythmias
*Tropnin elevated for 10 days post
* CK MB elevated for 3-4 days post

Mx - Morphine, oxygen, nitroglycerin, aspirin (MONA)

  • If first attender - Give aspirin, place in W position and give nitrate if prescribed
  • Post MI - dual platelet, ACEi, BB and CCB
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10
Q

Heart failure

A
  • More in, less out
  • Affects hearts ability to pump blood to systemic circulation - Most commonly systolic failure of the left ventricle

Ix - Reduced LVEF - normally between 50-70% (stroke volume/end diastolic volume) - HR needs to be low enough to calculate
- ANP and BNP levels increased due to high ventricular filling pressure
- ECG and echo

Sx - Oedema, dyspnoea, fatigue, tahcycardia

Mx - ACEi/ARB or entresto (valsartan), beta blocker, spironolactone, SGLT2i
Acute pulmonary oedema - furosemide

  • medications not working use CPAP (continuous positive airway pressure)
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11
Q

LVF

A
  • Increased pulmonary venous pressure causing pulmonary oedema (complaining of orthopnea)
  • Left ventricle can’t pump blood to rest of the body, too much blood in the LA, pulmonary veins and lungs - fluid begins to leak into the surrounding tissues and lungs

Sx - SOB, looking and feeling unwell, cough with frothy sputum

Ix - increased resp rate, reduced O2 levels, tachycardia, displaced apex beat, crackles sounding wet on auscultation, increased BNP (overfilled heart)

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12
Q

Right sided HF

A
  • Increased systemic venous pressure

Sx - Pleural effusions (fluid in lungs), ankle/peripheral oedema, enlarger liver, elevated JVP, ascites, SOB
*Enlargement of organs due to increased systemic pressure

Ix - ECG and Echo

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13
Q

Mitral stenosis

A

Cx - rheumatic heart disease (Most common), infective endocarditis, calcification,

Sx- Malar flush and atrial fibrillation

Ix - mid diastolic, low pitched rumbling murmur due to low velocity of blood flow
* Loudest during expiration

** Enlargement of the LA can compress the oesophagus causing difficulty swallowing

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14
Q

Mitral regurgitation

A

Cx - weakening of the valve with age, rheumatic heart disease, infective endocarditis, CT tissue disorders such as Marfan’s syndrome

Ix - Pan/holosystolic high pitched whistling murmur due to high velocity of blood,
* loudest with expiration
* Atrial fibrillation

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15
Q

Aortic stenosis

A

Cx - Age related calcification, rheumatic heart disease, infective endocarditis

  • Leads to left ventricular hypertrophy

Ix - Ejection systolic high pitched murmur (due to high velocity of systole) with a crescendo - decrescendo character

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16
Q

Aortic regurgitation

A

Cx - Age related weakness, CT tissue disorders such as Marfan’s syndrome, rheumatic heart disease, endocarditis
- Causes left ventricular dilation

Ix - Early diastolic soft/blowing murmur
- decrescendo
- collapsing pulse

  • Can be heard over mitral area
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17
Q

Infective endocarditis

A
  • Infection in the inner lining of the heart (endocardium) caused by bacteria travelling in the blood - Strep viridisans by mouth most common (strep sanguinis) staph aureus from Injections.
  • staph viridian post valave surgery

Sx - High temperature, chills, headache, joint and muscle pain, possible chest pain when you breathe, SOB, night sweats…

RF - valve replacement surgery, a prosthetic valve, congenital heart disease, hypertrophic cardio myopathy, previous damaged valves, IV drug user

Ix - Blood cultured x3 , ESR, CRP
- echo 1st line , ECG, ultrasound for spleen
- splinter haemorrhages (association)

Mx - IV antibiotics
- surgery to repair valves of heart if affected

** Damages heart valves due to endocarditis can increase stroke risk by embolism
*New piercing of nipples is risk factor

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18
Q

Pericarditis/Dressler’s syndrome

A
  • Swelling and irritation of the pericardium that surrounds the heart (pericarditis) - can be viral (few weeks post upper resp infection)
  • 2 weeks to few months after MI = Dressler’s syndrome

Sx - Sharp or stabbing chest paiN, a cough, fatigue, shortness of breath, cardiac tamponade , fever
- Spreads to left shoulder, gets worse when lying down, coughing or breathing in, alleviated when sitting forward

Ix - Bloods: Bacteria cultured, ESR and CRP, troponin
- ECG - widespread saddle shaped ST elevation, PR depression
- transthoracic echo given to all

Mx - anti inflammatory drugs, steroids and reduce activity,
- antibiotics if caused by bacteria

  • SLE a risk factor
  • In constrictive pericarditis, JVP can rise on inspiration Kassumals sign
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19
Q

Hypertrophic obstructive cardio myopathy

A

Cx - Post MI, infection, injury, heart valve problems, high BNP

  • Septum between ventricles can become thick, preventing the blood from exiting the heart - Obstructive cardio myopathy
  • ejection systolic murmur heard loudest after valsalva Manoeurvre
  • Autosomal dominant

Sx - Chest pain (during exercise), fainting, palpitations, shortness of breath

Complications - Sudden death due to arrhythmia , HF, mitral valve problems, blocked BF, atrial fibrillation

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20
Q

Atrial fibrillation

A
  • Disordered electrical activity leads to rapid and uncoordinated atria contraction > leading to uncoordinated ventricular contractions

Cx - Sepsis, mitral valve problems, ischemic heart disease, hyperthyroidism, hypertension

Sx - Shortness of breath, palpations, syncope,

Ix - Irregularly irregular ventricular contractions, absence of p waves on ECG (due to lack of coordinated electrical activity)

Mx - DOAC
- , beta blocker,Digoxin, CCB
- pace maker, ablation,
- If acute: Begin anticoagulation and DC cardio

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21
Q

Atrial flutter

A

Short circuit in the heart causes the atria to contract rapidly

Sx - Stroke, palpitations, dizziness, short of breath, fatigue

Caused by - prior cardiac surgery or prior ablation

Ix - sawtooth baseline on ECG

Mx - CCB, beta blocker
- electrical cardio version (if unstable)

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22
Q

patent ductus arteriosus

A
  • Connection between the arch of the aorta and the pulmonary arteries that is open for a foetus but should close shortly after brith
  • If it doesn’t close, too much blood can flow into the lungs and pressure can increase in the baby’s lungs, causing pulmonary hypertension and so a large heart
  • Should close due to reduced level of prostaglandins

Sx - SOB

Ix - machine like murmur

Mx - indomethacin

  • Fibrous remnant of this is the ligamentum arteriousum
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23
Q

Hypocoagulation

A
  • Reduced ability to clot (turn blood to gel)

Cx - thrombocytopenia, vonwilebrand disease, deficient in vitamin K, deficient in clotting factors

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24
Q

Acute coronary syndrome

A

3 types: unstable angina, STEMI or NSTEMI

Sx - nausea and vomiting, sweating, palpitations, SOB, pain radiation to jaw or arms

prevention - Dual paletlet, ACEi, Beta blcoker, statin

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25
Q

Cor pulmonale/RHF

A

Right sided HF caused by respiratory disease

  • Increased pressure in pulmonary arteries results in the right ventricle being unable to pump blood to the pulmonary arteries, causing a back pressure of blood to the right atrium, vena cava and systemic system

Cx - (respiratory) COPD, PE, interstitial lung disease, cystic fibrosis, pulmonary hypertension

Sx - Main is SOB, peripheral oedema, syncope, cyanosis, raised JVP, hepatomegaly

Ix - Echo, ECG, BNP,

26
Q

Prosthetic valves

A
  • Scar right down the midline of chest indicates a mitral or aortic valve replacement (also a CABG)

Bioprosthetic - limited lifespan of around 10 years

Mechanical - long lifespan of >20 years but require lifelong anticoagulation with warfarin and aspirin

complications - thrombus, infective endocarditis, haemolytic (blood gets churned up in valve)

27
Q

Rheumatic fever and heart disease

A

RF - Inflammatory disease that can develop when strep throat or scarlet fever isn’t properly managed - molecular mimicry of bacterial M protein from strep pyrogens
- most often in kids
- often effects connective tissues
- most often with mitral valve

Sx - fever, painful, hot joints, chest pain, chorea, erythema margintum, murmur, SOB

Ix - Bloods: CRP and ESR
ECG and echo - showing vegitations/scarring of valve

Mx - Antibiotics (usually penicillin for strep), anti inflammatory drugs,

  • Strep throat will have been diagnosed 2-4 weeks prior to symptoms
28
Q

vasovagal attack

A

*Most common cause of fainting usually In older adults

Sx - nausea, dizziness, pale skin, sweating, tinnitus, lightheaded (all prior to fainting)

Mechanism - reduced contractility, reduced HR, reduced CO, peripheral vasodilation and venous pooling

Ix - ECG, echo, stress test, bloods,

Mx - unnecessary unless repeat event

29
Q

Tricuspid regurgitation

A

Cx - rheumatic heart disease, right ventricular failure, pulmonary hypertension (COPD)

Sx - pulsatile hepatomegaly -back flow of blood into liver during cardiac cycle

Ix - pan systolic murmur

-

30
Q

Idiopathic intracranial hypetension

A
  • Obese pregnant females

Sx - Papillodema and abducens nerve palsy

31
Q

Cardiac tamponade

A
  • Pericardial fluid accumulation, heart put under pressure, preventing heart pumping

Sx - Becks triad: Hypotension, increased JVP, muffled heart sounds
** 7 days post MI complication

Ix - echo

32
Q

Major bleeding

A
  • Stop warfarin, give IV vit K 5mg, prothrombin complex concentrate
33
Q

Malignant hyperthermia

A

Sx - muscle rigidity, high bp, high HR,

*Dominant inheritance

Cx - analgesia reaction
- suxamethonium - releases lots of calcium

Mx - Dantrolene

34
Q

STEMI

A

Ix - ECG, echo angiogram
- troponin may not may not be raised

**ECG showing ST election or new bundle branch block

Mx - Morphine, oxygen, nitrate, aspirin 300mg - initial
- Thrombolysis - alteplase…
- PCI with dual platelet

35
Q

NSTEMI

A

Ix - ECG, echo, angiogram

**Troponins will be raised, ECG may be normal or showing ST depression or T wave inversion
* CK MB - remains elevated for 3-4 days post MI, troponin for 10

Mx - Morphine, oxygen, nitrate, aspirin 300mg - initial

*Base PCI and angioplasty on grace score, aspirin 300mg, ticagrelor or clopidogrel (low risk or high risk of bleeding respectively) 180mg, morphine, antithrombin with fondaparinux, nitrate
*Grace score>3% offer coronary angiography within 72hrs

36
Q

Non shockable rhythms

A
  • asystole/pulseless

Mx - IV adrenaline ASAP

37
Q

SVT - Arrhythmias

A

*Narrow complex tachycardia (QRS less than 3 small squares/120ms)
*Shockable

Sx - SOB, palpitations, fainting, sweating…

Mx - Acute - vagal manœuvres (carotid massage, valsalva), IV adenosine 6mg, then 12mg, then 18mg, (if asthmatic give verapamil), DC cardio version

Prevention - BB and ablation

38
Q

V tach - arrhythmias

A
  • Broad complex tachycardia - potential to become V fibb
    *Shockable

Sx - SOB, palpitations, fainting, sweating

Mx - If unstable (systolic <90, chest pain, HF) DC cardio version
- if stable give amiodarone
**If amiodarone not available, lidocaine can be used

39
Q

V Fibb

A
  • If witness arrest give 1 shock then 2 mins CPR

*If not witness, give 3 shocks then 300mg amiodarone

40
Q

Torsades de pointes

A
  • V tach with long QT interval that can become v fibb

Mx - IV magnesium sulphate

41
Q

A FIbb

A
  • No p waves, irregularly irregular

Sx - SOB, fatigue…

Mx - Anti coagulation with DOAC
- BB (metoprolol) CCB then digoxin for rate control
- if patient unstable give DC cardio version

42
Q

Dabigatran antidote

A
  • Idirucizumab
43
Q

INR range

A

<1.1 for healthy people

  • Taking warfarin between 2-3

** If INR is high, skip 1/2 doses, then reduce warfarin dose

44
Q

Bradycardia

A

Mx - Atropine 3mg, transcutaneous pacing, adrenaline, transvenous pacing

Signs of shock - 500ug IV - up to 3mg^^

45
Q

Primary hyperaldosteronism

A
  • Most common 2nd cause of hypertension

Ix - aldosterone:renin

46
Q

Hypertension

A

*If <55 or T2DM
ACE
ACE+CCB or ACE+thiazide like diuretic
ACE+CCB+thiazide like diuretic

If >55 and non T2DM or black
CCB
CCB+ACE or CCB+thiazide like diuretic
CCB, ACE, thiazide like diuretic

*Both - spironolactone
Beta blocker or alpha blocker

47
Q

Bleeding protocol

A

Minor bleeding with warfarin
- stop warfarin, give 3mg vitamin K

Major bleeding
- stop warfarin, give 5mg vitamin K, give prothrombin concentrate

48
Q

Takayasu’s arteritis

A
  • Large vessels vasculitis associated with occlusion of the aorta
  • usually younger females and asians

Sx - systemic features, absent limb pulse, different BP in upper limbs, aortic regurgitation,

Ix - MRA or CTA

Mx - Steroids

49
Q

Atrial myxoma

A
  • Most common cardiac tumour
  • 75% LA attached to the fossa ovallis, usually females

Sx - mitral valve obstruction, systemic embolism, and systemic symptoms
- Mid diastolic murmur

Ix - Echo - pendunctulated heterogenous mass usually in septal area of LA

50
Q

DC cardio version

A
  • Tachy + signs of shock, syncope, myocardial ischaemia or heart failure - given ups to 3 shocks
51
Q

Pulmonary embolism

A
  • Clot travels to the heart and into the pulmonary arteries - affecting transportation of blood to the lungs to become oxygenated

Sx - sudden onset SOB, chest pain, calf pain
- Atypcial sx - lung crackles, fever…

RF - period of inactivity, surgery, combined pill, malignancy, steroids, pregnancy…

Ix - CTPA
- if not showing up, proximal venous US

Mx - DOAC
- If unprovoked treat for at least 3 months (usually 6)
- If DOAC not tolerated give heparin

52
Q

Atrial septal defect

A
  • Goes undetected I’m childhood usually, only detected in adulthood

Sx - Fatigue, breathless, palpitations…
- Ejection systolic murmur louder on inspiration (Opposite from aortic stenosis)
- RBBB

53
Q

Ventricular septal defect

A
  • Congenital defects are axs with chromosomal disorders
  • close in 50% spontaneously

Sx - Pansystolic murmur

54
Q

Tetralogy of fallot

A
  • Most common cause of congenital cyanotic disease
  • Malformation of the sort-pulmonary septum

Sx - VSD, RVH, pulmonary stenosis, overriding aorta
- R-L shunt
- ejection systolic murmur

  • aorta+septum pushed to the anteriorly to the right, obstructing pulmonary arteries causing stenosis and RVH - affects level of cyanosis

Mx - surgical repair
- BB to help with episodes

55
Q

Post MI complications

A
  • Cardiogenic shock - LV wall can be damaged and reduced ejection fraction
  • Cardiac arrest - usually due to V Fibb
  • Chronic HF - Damage to LV
  • Tachy and Brady - V fibb (most common) and V tach plus AV block if inferior MI
  • Pericarditis and Dressler’s syndrome - 2 hours weeks post MI or 2-6 weeks is Dressler’s

*LV aneurysm - Damage to LV can weakened wall causing aneurysm - present with persistent ST elevation and LVF - at risk of thrombus so anti coagulated

  • LV free wall rupture - 3% - Presents with acute HF 2nd to cardiac tamponade 1 week post - urgent pericardiocentesis and Thoracotomy
  • Ventricular septal defect - Rupture of ventricular septum showing acute HF, pan systolic murmur
  • Mitral regurgitation - Inferior-posterior MI - rupture of papillary muscle
56
Q

Hypertension

A
  • 180/120 - same day treatment

Ix - 24 ambulatory monitory to aid diagnosis
- if >180/120 - urine dip for end organ damage first line

Mx -

57
Q

Acute management of STEMI

A

STEMI identified and symptoms present for less than 12 hrs

1st - 300mg Aspirin

*If PCI available within 2 hrs -
Prior to PCI - Dual platelet, if not on Anti coagulant - give praugrel, if on anticoagulant give clopidogrel
* During PCI - Unfraxtioned heparin with glycoprotein IIbi
* Drug eluting stents used

  • If PCI unavailable within 2 hrs - Fibrinolysis - Give an antithrombin at the same time
  • post procedure give ticagrelor
  • For ongoing ischaemia, consider PCI
58
Q

Acute management of NSTEMI

A
  • NSTEMI/UNSTABLE ANGINA IDENTIFIED

1st - 300mg aspirin
- fondaparinux if no immediate PCI planned

Grace score<3% - Give ticagrelor

Grace score >3% - PCI immediately or within 72hrs, give praugrel or ticagrelor, give unfractioned heparin, Drug eluting stents used
*Clopidogrel if high bleeding risk

59
Q

Constrictive pericarditis

A
  • Kassumauls sign - JVP saying fixed on inspiration
  • Favours constrictive pericarditis over cardiac tamponade
60
Q

Takosubo cardiomyopathy

A
  • Transiet apical ballooning in times of stress
  • Chest sx in periods of stress

Sx - SOB, CP, dizzy..

Ix - ECG showing ST elevation
- Troponin raised
- Angiogram - showing no vessel narrowing

61
Q

VF/PULSLESS VT Mx

A
  • 1 SHOCK ASAP

Cardiovascular system (3 decks)

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