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Cardiology > Cardiology Conditions > Flashcards

Cardiology Conditions Flashcards

1
Q

What is required for making a diagnosis of Congestive Cardiac Failure?

A

Framingham Criteria - at least 2 major, or 2 minor + 1 major criteria

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2
Q

Give the ‘major’ and ‘minor’ components of the Framingham Criteria of Congestive Cardiac Failure

A

Major: PND, crepitations, S3 gallop, cardiomegaly, Raised central venous pressure, weight loss >4.5kg in 5 days unresponsive to treatment, neck vein distention, acute pulmonary oedema, hepatojugular reflex

Minor: Bilateral ankle oedema, dyspnoea on exertion, tachycardia (>120bpm), nocturnal cough, hepatomegaly, pleural effusion, decrease in vital capacity by 1/3 maximum recorded

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3
Q

What are the characteristic appearances of a chest x-ray in a patient with left ventricular failure?

A

ABCDE:

A - Alveolar oedema (Bat's wings)
B - Kerley B lines
C - Cardiomegaly
D - Dilated prominent upper lobe vessels
E - Effusion (pleural)
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4
Q

How is heart failure classified?

A

New York Classification

I - Heart disease present, no undue dyspnoea on ordinary activities
II - Comfortable at rest, dyspnoea on ordinary activity
III - Less than ordinary activity causes dyspnoea, which is limiting
IV - Dyspnoea present at rest; all activities causes discomfort

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5
Q

What is cor pulmonale?

A

Right sided heart failure caused by chronic right pulmonary arterial hypertension

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6
Q

Describe the management approaches to chronic heart failure.

A
  • Manage lifestyle factors e.g. stop smoking, reduce salt intake, lose weight, manage diet
  • Treat underlying cause e.g. dysrhythmia
  • Treat precipitating causes e.g. anaemia
  • Remove exacerbating drugs e.g. NSAIDS (Fluid retention), Verapamil (negative inotrope)
  • Drug therapy (see separate card)
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7
Q

Describe the drug therapy approaches to chronic heart failure.

A
  • ACE Inhibitors (or ARB if side effects with ACE-I)
  • Beta blockers e.g. carvedilol
  • Diuretics e.g. furosemide, bumetanide
  • Spironolactone
  • Digoxin
  • Vasodilators e.g. hydralazine, isosorbide dinitrate
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8
Q

What are the main risk factors for coronary artery disease?

A

Sex (Male), Age, Smoking, Diabetes, High cholesterol, Obesity, Hypertension, Family History

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9
Q

What is the blood pressure definition of hypertension?

A

140/90

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10
Q

Why is it important to monitor and treat a patient’s blood pressure?

A

Hypertension contributes to a wide range of cardiovascular complications e.g. MI, stroke, renal disease

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11
Q

List some key features of malignant hypertension

A

Severe raised BP, hypertensive retinopathy with bilateral retinal haemorrhages, exudates and papilloedema

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12
Q

Define the stages of hypertensive retinopathy

A 
I = Tortuous vessels with shiny edges (silvery wiring)
II = A-V nipping
III = Flame haemorrhages and cotton-wool spots
IV = Papilloedema
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13
Q

List some causes of secondary hypertension

A

Drugs e.g. NSAIDs, steroids, COCP
Coarctation of the aorta
Endocrine causes e.g. phaeochromocytoma, acromegaly, Cushing’s, Conn’s
Renal causes e.g. glomerulonephritis

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14
Q

How is malignant hypertension treated?

A

Hospital admission, oral atenolol, bendroflumethiazide, amlodipine, nifedipine

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15
Q

What are 4 medical emergencies caused by hypertension?

A

Malignant hypertension
Hypertensive heart failure
Aortic dissection
Hypertensive encephalopathy

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16
Q

How is hypertensive encephalopathy and aortic dissection managed?

A

In ITU with arterial line and IV labetalol

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17
Q

In a black, 58 year old male patient with a BP of 165/95, what would be your medical management?

A

Start with calcium channel blocker OR thiazide diuretic…then switch to ACE Inhibitor plus diuretic…then use triple therapy i.e. ACE Inhibitor, calcium channel blocker, thiazide diuretic. Consider further diuretic, alpha blocker or beta blocker if BP still raised.

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18
Q

In a white, 52 year old patient with a BP of 165/95, what would be your medical management?

A

Start with ACE Inhibitor…then add thiazide diuretic OR calcium channel blocker…then use triple therapy i.e. ACE Inhibitor, calcium channel blocker, thiazide diuretic. Consider further diuretic, alpha blocker or beta blocker if BP still raised.

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19
Q

What is Stage 2 hypertension? Would you treat it?

A

BP >160/100 in clinic, and 150/95 in ambulatory setting. Treat all these patients.

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20
Q

What does a VLDL molecule consist of?

A

Endogenous triglycerides produced in the liver

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21
Q

Which enzyme releases triglycerides from chylomicrons and VLDL molecules?

A

Lipoprotein lipase

22
Q

Describe the pattern of inheritance of primary familial hyperlipidaemia

A

Autosomal dominant

23
Q

What is the worst prognostic factor for a patient in heart failure?

A

Hyponatraemia

Mechanism unclear

24
Q

Why is furosemide given in acute pulmonary oedema?

A

It has a vasodilator effect and not a diuretic effect in acute pulmonary oedema

25
Q

What is the ejection fraction and how is it calculated?

A

Ejection fraction is the proportion of blood entering the heart in diastole which is pushed out in systole

SV / EDV = Ejection fraction

26
Q

Which of these does not produce prognostic improvement in heart failure:

Bisoprolol
Atenolol
Carvedilol
Metoprolol

A

Atenolol

27
Q

What is high output cardiac failure?

A

Normal or high output as a response to incredibly high demands. Failure occurs when the heart is unable to meet these demands.

28
Q

List some causes of high output cardiac failure

A 
Anaemia
Pregnancy
Beriberi
Hyperthyroidism
Paget's disease
29
Q

What vitamin is deficient in Beriberi?

A

B1 (thiamine)

30
Q

ST elevation in leads II, III, aVF indicates infarction of which territory (artery) in the heart?

A

This is an inferior infarction and indicates damage to the right coronary artery

31
Q

ST elevation in leads V1-4 indicates infarction of which territory (artery) in the heart?

A

This is an anterolateral infarction and indicates damage to the left anterior descending artery

32
Q

ST elevation in leads I, aVL, V4-6 indicates infarction of which territory (artery) in the heart?

A

This is an anterolateral infarction and indicates damage to the left anterior descending and left circumflex arteries

33
Q

ST elevation in leads I, aVL, V5-6 indicates infarction of which territory (artery) in the heart?

A

This is a lateral infarction and indicates damage to the left circumflex artery

34
Q

Tall R waves in leads V1-2 indicates infarction of which territory (artery) in the heart?

A

This is a posterior infarction and indicates damage to the right coronary artery / left circumflex

35
Q

What is the character of the pain in a patient suffering with acute pericarditis?

A

Central chest pain, worst on inspiration, worst on leaning backwards, relieved by leaning forward

36
Q

What does an ECG show in acute pericarditis?

A

Concave ‘saddle shaped’ ST elevation across all leads

37
Q

What is the management for acute pericarditis?

A

Treat the underlying cause

Analgesia - NSAIDs

38
Q

What is constrictive pericarditis?

A

The heart is contained within a rigid pericardium so it is unable to fill effectively during diastole. May be idiopathic or caused by haemorrhage into the pericardium during surgery.

39
Q

What is Kussmaul’s sign?

A

JVP rises paradoxically on inspiration

40
Q

What are the clinical features of a patient with constrictive pericarditis?

A

Those of right sided heart failure: Raised JVP, Kussmaul’s sign (JVP rises on inspiration), S3, quiet heart sounds, soft apex beat, ascites, hepatosplenomegaly, oedema

41
Q

What is the management of constrictive pericarditis?

A

Surgical excision of the pericardium

42
Q

What is a pericardial effusion?

A

Accumulation of fluid in the pericardial sac

43
Q

What are the clinical signs of a patient with cardiac tamponade?

A 
Tachycardia
Hypotension
Pulsus paradoxus
Raised JVP
Kussmaul's sign
Quite heart sounds
44
Q

What is pulsus paradoxus and how might you detect it?

A

Abnormally large decrease in systolic blood pressure during inspiration. Detection is by auscultating heart sounds during inspiration that cannot be felt at the radial pulse.

45
Q

What is Beck’s triad?

A

Diagnostic of cardiac tamponade

Falling BP
Rising JVP
Muffled heart sounds

46
Q

Which type of angina is precipitated by lying flat?

A

Decubitus angina

47
Q

What are the two most significant viral cause of acute pericarditis?

A

Coxsackie virus

Echovirus

48
Q

Which lipid molecule is raised in common primary hyperlipidaemia?

A

LDL only

49
Q

List 3 causes of hypertension in childhood

A

Congenital heart disease - coarctation of the aorta
Pheochromocytoma
Renal disease - glomerulonephritis

50
Q

What is takotsubo cardiomyopathy?

A

A stress-related cardiomyopathy, precipitated by emotional or physical stress (sometimes known as ‘broken heart syndrome’) and presenting in the same way as acute coronary syndrome

51
Q

What is Prinzmetal’s angina also known as?

A

Variant angina

52
Q

What is Prinzmetal’s angina?

A

Also known as ‘variant angina’, it is chest pain which occurs without exertion, and is caused by coronary artery spasm

Cardiology (4 decks)

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