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CMS > Week 2 - Cardiovascular Medicine 2 > Flashcards

Week 2 - Cardiovascular Medicine 2 Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

structural heart disease: 2 examples?

A

heart failure

valvular heart disease

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2
Q

structural heart disease: investigations?

A

ECG - electrocardiogram
chest xray
echocardiogram

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3
Q

heart failure: causes? x5

A
  • ischaemic heart disease
  • hypertension
  • valvular heart disease
  • alcohol excess
  • numerous other causes
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4
Q

heart failure: symptoms?

A

pump failure, due to:
- fluid accumulation: oedema
lungs -> breathlessness. could occur on exertion or lying flat
- swelling of peripheries: pitting oedema

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5
Q

heart failure: presentation?

A
  • gradual onset

- can present acutely to hospital shortness of breath, often during night time while lying flat

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6
Q

heart failure: treatment?

A
  1. address underlying cause, e.g:
    - ischaemic heart disease
    - hypertension
    - valvular heart disease
    - alcohol excess + other causes
  2. medication
    - diuretics
    - ACE inhibitors
    - angiotensin II antagonists
    - b-blockers
    - digoxin
  3. surgical
    - CABG/PTCA for coexisting angina
  4. pacemaker
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7
Q

heart failure: dental aspects

  • polypharmacy?
  • NSAIDs?
  • patient lying flat?
  • what to do when heart failure presenting?
A
  • due to drug side effects, risk of interactions
  • cause fluid retention. avoid them
  • caution when lying patient flat
  • ABCDE approach, potential cardiac arrest, use AED
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8
Q

valvular heart disease: which side commonly affected? which valves?

A
  • left side of heart

- aortic and mitral valve

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9
Q

valvular heart disease: causes?

A
  • congenital
  • infective endocarditis
  • rheumatic fever: complication of streptococcus infection), rare
  • age-related: most common
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10
Q

valvular heart disease:

describe pathophysiology

A
  1. regurgitation
    - loss of valve integrity
    - becomes floppy
    - results in leakage
    - lead to heart failure
  2. stenosis
    - narrowing of valve
    - obstruction of flow
    - leads to inadequate output and pump failure
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11
Q

valvular heart disease: treatment?

A
  1. medication: treat heart failure
  2. surgery: valve replacement
    - porcine (animal tissue)
    - metallic (anticoagulation critical) requires warfarin
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12
Q

why is warfarin required when doing valve replacement?

A

valve is recognized as foreign body, will trigger coagulation, leading to thrombosis (bad). warfarin thins blood and prevents clotting

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13
Q

what is INR?

what is the normal INR + INR for metal valves?

A
  • international normalised ratio: test used to monitor the effects of warfarin. blood test that checks how long it takes for blood to clot
  • normal INR: 1.1
  • for metal valves: 3
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14
Q

infective endocarditis: how is it induced?

how can it occur?

A
  • induced by invasive procedures: dental procedures including tooth brushing
  • can occur spontaneously: dental caries and gingivitis
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15
Q

valvular heart disease: infective endocarditis

  • occurs on what type of valves?
  • aetiology/due to?
A
  • usually occurs on diseased or prosthetic valves
  • trivial bacteraemia:
    strep viridans
    strep faecalis
    staph aureus
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16
Q

valvular heart disease: infective endocarditis

- clinical features?

A
  • prolonged febrile illness
  • valve degeneration and failure
  • embolic disease: brain, skin, anywhere
  • immune complex formation: kidney failure
17
Q

valvular heart disease: infective endocarditis

  • how to investigate
  • treatment?
A
  • blood cultures, echocardiogram

- prolonged course of intravenous antibiotics, surgery may be necessary

18
Q

valvular heart disease: dental aspects

  • OH?
  • prophylaxis?
  • pts at risk of heart failure/collapse?
  • pts at risk of endocarditis?
A
  • maintain high standard of OH: avoid surgery if possible, avoid spontaneous bacteraemia
  • prophylaxis no longer routinely given
  • identify by taking good history, avoid treatment if unstable, caution with pt lying flat
  • encourage good OH, practice good preventive dentistry
19
Q

what is sinus rhythm?

A

normal cardiac rhythm

20
Q

what is abnormal cardiac rhythm?

values for too fast/slow rates?

A
  • arrhythmia: irregular heartbeat
  • too fast: > 100/minute
  • too slow: < 60/minute
  • abnormal beat conduction
21
Q

cardiac arrhythmia: symptoms?

A
  • can be nil
  • palpitations
  • chest pain
  • heart failure
  • syncope: loss of consciousness due to fall in BP
22
Q

cardiac arrhythmia: list of conditions?

A
  • atrial fibrillation: irregular
  • supraventricular tachycardia: too fast
  • bradyarrhythmia: too slow
  • ventricular arrhythmia: abnormal conduction
23
Q 
cardiac arrhythmia: atrial fibrillation
incidence?
symptoms?
associated with?
managed by what drugs?
increased risk of?
A
  • common: 10% of elderly
  • often asymptomatic
  • associated with cardiovascular disease: heart failure, angina, HBP
  • digoxin, amiodarone, b-blockers, calcium antagonists
  • increased risk of stroke: pt should be on anticoagulant
24
Q 
tachyarrhythmia:
supraventricular tachycardia (SVT)
- incidence?
- benign? exception in?
- precipitated by?
- symptoms?
A
  • common. often in otherwise healthy people
  • usually benign, except in wolf-parkinson white syndrome
  • precipitated by caffeine, infections and maybe anxiety
  • unpleasant feeling, palpitations, chest pain, breathlessness
25
Q

tachyarrhythmia:
supraventricular tachycardia (SVT)
- treatment?
- prevention?

A
  • vagal manoeuvres e.g. valsava manoeuvre
  • carotid sinus massage
  • drugs e.g. adenosine

prevention:

  • drugs
  • surgery
26
Q

bradyarrhythimia:

  • heart rate of?
  • what happens if rate < 40/minute?
  • causes? x4
  • treatment?
A
  • < 60/minute
  • dizziness and blackout
  • age, ischaemia, drugs, may be physiological (athletes)
  • remove underlying cause, usually drugs. pt may require pacemaker
27
Q

cardiac arrhythmia: ventricular arrhythmia

  • emergency? why?
  • causes?
A
  • a medical emergency, because it is peri-arrest rhythm

- usually ischaemic heart disease, drugs, congenital, electrolyte disturbance

28
Q

ventricular arrhythmias:

  1. ventricular tachycardia: symptoms?
  2. ventricular fibrillation?
A
  1. breathlessness, dizziness, chest pain, palpitations, cardiorespiratory arrest
  2. always cardiorespiratory arrest
29
Q

ventricular arrhythmias: treatment for both conditions?

A
  • ventricular tachycardia:
    immediate: hospitalization for defibrillation/drugs
    long term: drugs, ICD (implantable cardiac defibrillator)
  • ventricular fibrillation:
    immediate: defibrillation
    long term: drugs, sometimes ICD
30
Q

cardiac arrhythmia: dental aspects
recognize those at risk via?
if unstable?
how to recognize unwell patients?

A
  • medical/drug history
  • avoid treating
  • light-headed, collapse
    chest pain
    breathlessness
    sweaty, distressed
    particular concerns; e.g. heart rate <40, >150, history of collapse, hypotension
31
Q

cardiac arrhythmia: dental aspects

management of emergencies?

A
  • ABC: remember oxygen
  • hospitalization
  • prepare to manage cardiac arrest: apply AED pads, switch on
32
Q

cardiac arrhythmia: dental aspects
pacemakers: what to note?
LA?

A
  • identify pts with pacemaker, do not require antibiotic cover, theoretical risk of electric interference
  • avoid adrenaline containing LA; seek advice

CMS (16 decks)

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