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P2 CARDIO > Pathology > Flashcards

Pathology Flashcards

1
Q

Define Ischaemic Heart Disease (IHD)

A

Myocardial demand for oxygen/ nutrients greater than delivery via coronary arteries

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2
Q

What are the causes of IHD?

A
  • Occlusive: atherosclerosis
  • Reduced O2 delivery: anaemia, hypotension
  • Increased O2 requirements: LVH
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3
Q

Non-modifiable risk factors for IHD (4)

A

Age
Gender (M>F)
Family history
Genetics

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4
Q

Modifiable factors for IHD (5)

A 
Smoking
Alcohol
Poor diet
Obesity
Lack of exercise
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5
Q

Clinical risk factors for IHD (3)

A

Hypertension
Diabetes
Hyperlipidaemia

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6
Q

Psychosocial risk factors for IHD (3)

A

Low control jobs = high stress
Lack of social support/ interaction
Depression

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7
Q

What causes angina?

A

Reduced blood flow –> reversible myocardial ischaemia –> chest pain

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8
Q

What is stable angina?

A

Cardiac chest pain on EXERTION, relieved by rest

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9
Q

What is unstable angina?

A

Crescendo (gets worse) cardiac chest pain at MINIMAL EXERTION, NOT relieved by rest
No cardiac biomarkers/ enzymes

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10
Q

What is Prinzmetal’s/ vasospastic angina?

A

Pain at REST, caused by coronary artery spasm

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11
Q

What is decubitus angina?

A

Pain when LYING FLAT

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12
Q

What are the clinical manifestations of angina? (6)

A 
Heavy/ constricting pain to chest, jaw, neck, arms
Nausea
Dyspnoea
Nausea
Faintness
Sweatiness
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13
Q

What is the first line treatment for angina?

A
  • GTN spray

- Beta-blockers (bisoprolol)

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14
Q

How would you manage angina? (7)

A
  • Lifestyle changes
  • GTN spray
  • Antiplatelet: aspirin
  • Beta-blockers: bisporolol
  • CCB: amlodipine
  • Statin: atorvastatin
  • ACEi: ramipril
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15
Q

What do antiplatelets do? (give examples)

A

Inhibits platelet aggregation (aspirin, clopidogrel [P2Y12 inhibitor])

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16
Q

What do beta-blockers do? (give examples)

A

Prevents stimulation of beta-adrenoreceptors at nerve endings of sympathetic NS.
Causes dec in HR (inc diastole for coronary artery filling) + dec contractility (dec O2 demand of the heart)
(bisoprolol, atenolol)

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17
Q

What do nitrates do?

A

Dilate systemic veins to decrease venous return to the heart.
Decreased preload –> decreased contractility –> decreased O2 demand.
Also dilate coronary arteries

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18
Q

What do CCB do?

A

Dilate systemic arteries –> decreased afterload on heart –> decreased contractility of the heart –> decreased O2 demand.
Also dilate coronary arteries
(amlodipine)

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19
Q

What so statins do?

A

Lower blood cholesterol

atorvastatin

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20
Q

What is a STEMI?

A

Obstruction of a major CA causing infarct of the heart muscle

21
Q

How can you detect a STEMI?

A

ECG - ST elevation

Raised serum troponin I & T

22
Q

What are the symptoms of a STEMI? (4)

A
  • Severe chest pain lasting > 20mins
  • Pain not relieved by GTN spray
  • Pain radiation: L arm, neck, jaw
  • Pale, clammy, sweating
23
Q

What is an NSTEMI?

A

Lesser degree of obstruction of a CA than a STEMI causing infarct of the heart muscle

24
Q

How can you detect an NSTEMI?

A

ECG - ST depression, T wave inversion

Raised serum troponin I & T levels

25
Q

What are the symptoms of an NSTEMI? (3)

A
  • Pressure, tightness/ discomfort of chest
  • Radiation to jaw, neck, neck, stomach
  • Dizziness, lightheadedness, nasuea, sweating, SOB
26
Q

What are the treatments for ACS (STEMI, NSTEMI)? (6)

A

M - morphine (diamorphine)
O* - oxygen if hypoxia present
N* - nitrates (GTN spray)
A* - antiplatelet dual therapy (aspirin 300mg + clopidogrel)
IV antiemetic (metoclopramide)
Emergency PCI/ CABG or thrombolysis (streptokinase/ alteplase)

27
Q

What are the long-term treatments for ACS?

A
  • Managing risk factors
  • Aspirin 75mg daily
  • Statin
  • B-Blocker
  • ACEi
  • No driving for 1 month
28
Q

What are the complications for MI?

A
  • Recurrent infarction
  • Angina post infarction
  • Heart failure
  • Pericarditis
  • Arrhythmias
29
Q

Define stage 1 hypertension

A

Blood pressure > 140/90 (clinic)

30
Q

Define stage 2 hypertension

A

Blood pressure > 160/100 (clinic)

31
Q

Define stage 3 hypertension

A

Blood pressure > 180/ 110 (clinic)

32
Q

How would you tackle stage 1 HT?

A

Advise lifestyle changes (if under 80 + no target organ damage or 10y CVD risk)

33
Q

How would you tackle stage 2 HT?

A

Give medication regardless of age

34
Q

How would you tackle stage 3 HT?

A

SEVERE - give medication

35
Q

What is primary HT?

A

HT due to unknown cause

36
Q

What is secondary HT?

A

HT caused by another condition eg kidney disease, diabetes, obstructive sleep apnoea

37
Q

What are the symptoms of HT? (9)

A
  • Asymptomatic
  • Dyspnoea/ difficulty breathing
  • Fatigue
  • Severe headache
  • Dizzy –> syncope
  • Nosebleeds
  • Vision problems
  • Chest pain
  • Signs of kidney problems
38
Q

How would you treat HT non-pharmacologically?

A
  • Treat underlying cause

- Lifestyle changes: weight loss, stop smoking, educed salt/ alcohol intake

39
Q

What is step 1 treatment for hypertensive pt under 55?

A

ACEi (if not tolerated, ARB and last resport B-blocker)

40
Q

What is step 1 treatment of black AC/ over 55yo hypertensive pt?

A

CCB (if not tolerated, thiazide-related diuretic)

41
Q

What is step 2 treatment for hypertensive pt?

A

ACEi/ ARB + CCB

42
Q

What is step 3 treatment for hypertensive pt?

A

ACEi/ ARB + CCB + D (thiazide-like diuretic)

43
Q

What is step 4 treatment for hypertensive pt?

A

ACEi/ ARB + B + CCB + D + further diuretic

Consider specialist advice

44
Q

What is heart failure?

A

Inadequate cardiac output for body requirements

45
Q

What are the signs of right heart failure? (4)

A
  • Peripheral oedema
  • Raised JVP
  • Ascites
  • Liver & spleen enlargement
46
Q

What are the signs of left heart failure? (5)

A
  • Pulmonary oedema (crackles on chest exam)
  • Dyspnoea
  • Tachypnea (INC resp rate)
  • Cyanosis (turnng blue due to lack of O2)
  • PINK FROTHY SPUTUM
47
Q

What are the symptoms of heart failure? (4)

A
  • SOB on exertion, at rest, when lying flat
  • Fatigue
  • Wheezing
  • Tachycardia
48
Q

How would you investigate for heart failure? (4)

A
  • ECG for underlying causes
  • CXR: A - Alveolar oedema (bat wing), B - B-line Kerley, C - Cardiomegaly, D - dilated vessels, E - effusion (pleural)
  • Serum BNP (if normal excludes HF)
  • ECHO

P2 CARDIO (11 decks)

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