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CV > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is cardiovascular disease?

A

General term for diseases of the heart and blood vessels

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2
Q

Give some examples of CVD.

A

Angina
MI
TIA, CVA
PVD
Chronic mesenteric ischaemia

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3
Q

Does severe mental illness increase risk of CVD?

A

Yes

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4
Q

What co-morbidities increase risk of CVD?

A

HTN
High or abnormal cholesterol
Irregular heartbeat (AF)
Hyperglycaemia
Diabetes
CKD
Inflammatory conditions e.g. RA

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5
Q

What statin is recommended for people with high risk of CVD initially?

A

Atorvastatin

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6
Q

Why is anticoagulation recommended in AF patients?

A

Reduce stroke risk

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7
Q

What increase in BP causes mortality risk to double?

A

20/10

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8
Q

If clinic BP is normal and ambulatory BP is high what type of HTN is this?

A

Masked HTN

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9
Q

What tests should be offered for all with HTN?

A

Urine for protein presence
Blood tests - Glucose, electrolytes, creatinine, estimated glomerular filtration rate, cholesterol
ECG
Fundi

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10
Q

What are the grades of hypertensive retinopathy?

A

I to IV

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11
Q

What are some common causes of secondary HTN?

A

Renal disease
Obstructive sleep apnoea
Aldosterinism
Reno-vascular disease

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12
Q

What are some uncommon causes of secondary HTN?

A

Cushing’s
Pheochromacytoma
Hyperparathyroidism
Intracranial tumour

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13
Q

What is fibromuscular dysplasia?

A

Corkscrew type dysplasia of the renal artery common in young women

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14
Q

When should lipids be measured?

A

MI
CVA
Other vascular disease
Acute pancreatitis
Family hx
Clinical signs

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15
Q

What are the clinical symptoms of hyperlipidemia?

A

Xanthomata
Xanthelasma
Corneal arcus
Milky blood/ serum

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16
Q

What should high HDL indicate?

A

Cardioprotection

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17
Q

Which lipid measurement is affected by fasting?

A

Triglycerides

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18
Q

What affect do statins have?

A

Stop cholesterol synthesis and have other impacts on atherosclerosis formation

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19
Q

Give some examples of statins.

A

Atorvastatin
Simvastatin
Rosuvastatin
Fluvastatin
Pravastatin

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20
Q

When does fluvastatin tend to be prescribed?

A

Safety grounds as least potent

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21
Q

Name some PCSK9 inhibitors

A

Alirocumab
Evolocumab
Inclisiran

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22
Q

What increases acute pancreatitis risk?

A

Triglyceride concentration

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23
Q

How much weight loss correlates to a BP reduction of 1mmHg?

A

1kg

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24
Q

What type of tablet can increase mortality in HTN?

A

Salty tablets

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25
Q

What diet is recommended for HTN?

A

DASH diet
Low or no salt diet

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26
Q

What drug groups can be used in HTN treatment?

A

Thiazide diuretics
ACEi/ARBs
Ca channel blockers
Beta blockers
Spironolactone

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27
Q

What HTN drugs are given to young women with caution?

A

ACEi or ARBs

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28
Q

What diet type can help in resistant HTN?

A

Low salt

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29
Q

What drug tends to be added to treatment in resistant HTN?

A

Spironolactone

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30
Q

In IHD what is a prolonged QT interval associated with?

A

Sudden cardiac death

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31
Q

What tools may be used to diagnose angina?

A

Exercise Testing
Perfusion Scanning
CT angiography
Angiography

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32
Q

What is a type 2 NSTEMI?

A

Troponin release during another illness, no evidence of recent plaque rupture

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33
Q

If a patient has raised troponin but a no MI symptoms and a normal ECG what is this likely to be classed as?

A

Myocardial injury

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34
Q

What patient group tend to have type 2 NSTEMIs?

A

Older patients with more comorbidities

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35
Q

What GI issues could lead to chest pain?

A

Reflux
Peptic ulcer pain
Oesophageal spasm
Biliary colic

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36
Q

How might pericarditis be differentiated from an MI?

A

Posture related pain

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37
Q

How is stable angina likely to present?

A

Visceral pain, hard to describe
Risk factors present
Radiating to arm(s), back, neck, jaw
Pain brough on by exertion, stress, cold, after meals
Relieved by rest within 5 minutes or GTN

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38
Q

What are the components of drug management in angina?

A

Antiplatelet - Usually aspirin
Beta blockers - Slow HR and reduce oxygen demand
Statins
ACEi
Nitrates

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39
Q

What are the main drugs used for secondary prevention in PVD?

A

Antiplatelet
High dose statin

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40
Q

What conditions are seen within PVD?

A

Intermittent Claudication
Chronic Limb Threatening Ischaemia

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41
Q

What is intermittent claudication and how will it present?

A

Muscle ischaemia on exercise
Pain on walking in muscle groups distal to occlusion
No pain at night/ rest

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42
Q

Does treatment of intermittent claudication prevent development of chronic limb threatening ischaemia?

A

No

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43
Q

What is chronic limb threatening ischaemia?

A

Insufficient blood reaching a limb or part of a limb to maintain limb viability

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44
Q

How might chronic limb threatening ischaemia present?

A

Pain at rest
Ulcers
Gangrene
Usually wake at night
Cool to touch, absence of peripheral pulses, colour change, venous guttering

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45
Q

What investigations may be carried out in chronic limb threatening ischaemia?

A

Pulses
ABPI
Duplex
Angiography - MR, CT

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46
Q

What is ABPI and what are the normal values?

A

Ankle Brachial Pressure Index
Ankle/brachial pressure
>1.0 are normal
<0.9 confirms PAD

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47
Q

What should happen to ABPI after exercise?

A

Increase

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48
Q

What surgical options are there for PVD?

A

Angioplasty +/- stent
Open surgery grafting
Amputation

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49
Q

What is an aneurysm?

A

Permanent, localised dilation of an artery of more than 50% of the normal arterial diameter

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50
Q

What is the normal aortic diameter?

A

1.2 -2cm

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51
Q

What are the 2 aneurysm types?

A

True
False

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52
Q

Describe a true aneurysm.

A

All 3 layers are involved and intact

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53
Q

Describe a false aneurysm.

A

Defect in the wall of the artery and the surrounding structure (skin, fat, fascia) keep the aneurysm restrained

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54
Q

What are the 2 aneurysm shapes?

A

Saccular
Fusiform

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55
Q

How are AAAs screened?

A

Ultrasound

56
Q

What investigation gives the morphology of an AAA?

A

Contrast CT

57
Q

When an AAA ruptures what structure may contain it?

A

Retroperitoneal

58
Q

What is the recommended size for asymptomatic AAA repair?

A

5.5cm diameter
Rapid expansion >1cm/year

59
Q

What is trashing?

A

Clot within an aneurysm and bits break off affecting the lower limbs

60
Q

What are the 2 surgical options for AAA elective repair?

A

EVAR
Open repair

61
Q

What occurs in aortic dissection?

A

Blood propagates within medial layer, creating a flap, true lumen and false lumen

62
Q

What is a type A aortic dissection?

A

Always involves aortic arch

63
Q

What is a type B aortic dissection?

A

Involves descending aorta distal to left subclavian artery

64
Q

What type of aortic dissection is an emergency?

A

Type A

65
Q

What are the common signs and symptoms of aortic dissection?

A

Acute excruciating chest or interscapular pain
Chest pain
Back pain
Abdominal pain
Renal ischaemia
Recurrent pain, refractory pain

66
Q

Name some rare symptoms of aortic aneurysm.

A

Syncope
Pulse deficits
Hypotension/ shock
Visceral ischaemia
Limb ischaemia
Spinal cord ischaemia

67
Q

What are the time periods for acute, sub acute and chronic aortic dissection?

A

Acute < 2 weeks
Sub acute 2 weeks to 90 days
Chronic >3 months

68
Q

What are the goals of medical management of aortic dissection?

A

Lower BP
Reduce aortic wall stress
Reduce force of left ventricular ejection
Aim BP 100-120, HR <60

69
Q

What medication groups are used in medical treatment of aortic dissection?

A

IV beta blocker
Calcium channel blockers
ACEi

70
Q

What are the 2 surgical options for aortic dissection repair?

A

Stent graft
Open thoracic aortic repair

71
Q

Why is cognitive impairment a potential complication of a CABG?

A

Cardio-pulmonary bypass used during procedure so can be reduced oxygen supply to the brain

72
Q

What is PCI

A

Percutaneous Coronary Intervention
Coronary angioplasty with stenting

73
Q

What artery tends to be accessed for PCI?

A

Radial artery

74
Q

What is the recommended time limit for a STEMI to have PCI?

A

<30 minutes after arrival

75
Q

Why is the radial artery used for PCI access?

A

Hand has dual supply
Superficial
Compressible
No adjacent nerve/ vein

76
Q

What is the main treatment for 3 vessel or left main coronary artery disease?

A

CABG

77
Q

What is VTE?

A

Venous Thromboembolic Disease
Covers DVT and PE

78
Q

What are the 2 types of DVT?

A

Distal: Calves
Proximal: Popliteal or femoral

79
Q

What syndrome occurs in nearly a third of proximal DVT patients?

A

Post thrombotic syndrome

80
Q

How is a DVT diagnosed?

A

Ultrasound or doppler ultrasound

81
Q

How is a DVT treated?

A

Oral anticoagulation

82
Q

How would a PE present?

A

Pleuritic pain
Collapse
Haemoptysis
Hypoxia
Tachycardia

83
Q

What is the gold standard for PE diagnosis?

A

CTPA

84
Q

What score can be used in identifying PE likelihood?

A

WELLS

85
Q

What can help to identify PE severity?

A

PESI score
Presentation

86
Q

How are high risk PE patients treated?

A

Thrombolysis then oral anticoagulation

87
Q

How are intermediate or low risk PEs treated?

A

Oral anticoagulation

88
Q

What is Virchow’s triad?

A

Endothelial injury
Circulatory status
Hypercoagulable state

89
Q

What does a D-Dimer measure?

A

Breakdown product of cross linked fibrin

90
Q

What does a D-Dimer help screen for?

A

VTE

91
Q

What are the first line anticoagulants for VTE?

A

Apixaban
Rivaroxoban

92
Q

What is the reversal treatment for a warfarin overdose?

A

Vitamin K

93
Q

What treatment is used in patients with a PE and active cancer?

A

Low weight molecular heparin

94
Q

What treatment durations are recommended in VTE?

A

Provoked with reversible factor: 3-6 months
Provoked with irreversible factor: 3-6 months or lifelong
Unprovoked: All men lifelong, women patient based

95
Q

What scoring tool can help decide treatment duration in women with a VTE?

A

HERDOO2

96
Q

What characterises post thrombotic syndrome?

A

Pain
Oedema
Hyperpigmentation
Eczema
Varicose veins
Venous ulceration

97
Q

What are thought to be associated with post thrombotic syndrome?

A

DVT induced damage to valves in the deep vein
Valvular reflex leading to venous HTN

98
Q

How will thromboembolic pulmonary HTN present?

A

Progressive dyspnoea and hypoxaemia
Right heart failure frequently occurs

99
Q

What are the sections of the mediastinum?

A

Superior
Inferior: Anterior, middle, posterior

100
Q

What can be found in the anterior mediastinum of a child?

A

Thymus gland

101
Q

What is the anterior mediastinum normally full of in an adult?

A

Fat

102
Q

What is found in the middle mediastinum?

A

Pericardium
Heart
Parts of the great vessels that connect with the heart

103
Q

Where does the trachea bifurcate?

A

Level of the sternal angle

104
Q

What is found in the posterior mediastinum?

A

Trachea
Oesophagus
Vagal trunks
Thoracic aorta
Thoracic duct
Azygous vein
Sympathetic chains and trunks
Sympathetic ganglia

105
Q

Where does the azygous vein pass?

A

Up posterior mediastinum then crosses over the root of the lung to superior vena cava

106
Q

When does the thoracic aorta become the abdominal aorta?

A

As it passes through the diaphragm

107
Q

Where do the coronary arteries originate?

A

At aortic valve

108
Q

What are the 3 branches of the arch of the aorta?

A

Brachiocephalic trunk
Left common carotid
Left subclavian

109
Q

Where does the brachiocephalic trunk supply?

A

Right side of head and neck and right upper limb

110
Q

Where does the left common carotid artery supply?

A

Left side of the head and neck

111
Q

Where does the left subclavian artery supply?

A

Left upper limb

112
Q

How many paired costal arteries are there?

A

11

113
Q

What branch from the thoracic aortas anterior surface?

A

Bronchial arteries
Oesophageal arteries
Mediastinal arteries
Pericardial arteries
Phrenic arteries

114
Q

Where does the thoracic duct drain lymph into?

A

Left venous angle

115
Q

Where is the left venous angle formed?

A

Between the internal jugular vein and subclavian vein

116
Q

Where does the right lymphatic duct drain into?

A

Right venous angle

117
Q

What lymph nodes are found around the root of the lung?

A

Bronchopulmonary lymph nodes

118
Q

What lymph nodes are found at the bifurcation of the trachea?

A

Tracheobronchial lymph nodes

119
Q

Where does the thoracic duct originate?

A

In the abdomen at the cisterna chyli (swollen start)

120
Q

Where does the thoracic duct travel?

A

Up posterior mediastinum between the azygous vein and oesophagus

121
Q

What is CN X?

A

Vagus nerves

122
Q

Where does the right vagus nerve travel?

A

Right lateral border of the trachea
Travels down the side
Passes posterior to the root of the lung
Forms a plexus on the oesophagus

123
Q

Where does the left vagus nerve travel?

A

Passes over the surface of the aorta
Posterior to the root of the lung
Forms a plexus on the oesophagus

124
Q

What is the ligamentous arteriosum?

A

Connective tissue structure between pulmonary trunk and arch of the aorta

125
Q

What nerve supplies the larynx?

A

Recurrent laryngeal branch

126
Q

Where do the recurrent laryngeal nerves branch from?

A

Vagus nerves

127
Q

Which recurrent laryngeal nerve enters the chest?

A

Left

128
Q

What are central veins?

A

Large veins close enough to the heart that the pressure within them is said to approximately reflect the pressure in the right atrium

129
Q

What are the central veins?

A

Internal jugular veins
Subclavian veins
Brachiocephalic veins
Superior vena cava
Inferior vena cava
Iliac veins
Femoral veins

130
Q

Where in the spine do phrenic nerves originate?

A

C3,4,5

131
Q

Where do the phrenic nerves supply somatic motor to?

A

Diaphragm

132
Q

Where do the phrenic nerves supply somatic sensory to?

A

Mediastinal parietal pleura
Fibrous pericardium
Diaphragmatic parietal pleura
Diaphragmatic parietal peritoneum

133
Q

What could refer pain to the diaphragm?

A

Liver abscess
Inflammation of gall bladder

134
Q

What is the somatic sensory supplied by CN X?

A

Palate, laryngopharynx, larynx

135
Q

What is the somatic motor supplied by CN X?

A

Pharynx and larynx

136
Q

What type of nerves does CN X contain for the thoracic and abdominal organs?

A

Autonomic parasympathetic

137
Q
A

CV (5 decks)

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