Advanced Cardiovascular Disease & Endocrine Disorders Flashcards
(18 cards)
What are the 3 types of Heart Faliure?
Left Sided
Right Sided
Congestive
State 3 clinical features of heart faliure
Symptoms of reduced oxygen perfusion
Symptoms of fluid overload
Third heart sound
In heart faliure, why is the RAAS system activated?
And why is this bad?
It’s activated due to the drop in BP/venous return
The problem with this is it makes the heart work harder when it’s broken…so it just makes everything worse over time!
In heart faliure why do we want to stimulate the natriuretic peptide system?
How could this be done?
As this inhibits RAAS activation
Could be done by using Neprilysin Inhibitors, which prevent Neprilysin from breaking down natriuetic peptides
When would Ivabradine be used in Heart Faliure?
In replace of a beta-blocker if the patient cannot take them
Acts as an SA node blocker, and does so without affecting contractility and blood pressure (is metabolised by CYP however)
What is Heparin Induced Thrombocytopenia (HIT)?
And how is it diagnosed?
The formation of IgG antibodies by the body that target platelet factors and heparin due to heparin being derived from pigs (so an immune response)
Causes the clot risk to increase considerably
Hit is less likely with LMWHs than UFH, but cant still occur
Diagnosed via ELISA –> Score of 0.8 is diagnostic
What are the 2 licenced types of anticoagulation for somebody that’s been diagnosed with HIT?
Fondaparinux –> Indirect inhibitor of Xa
Argatroban –> Direct thrombin inhibitor
Short duration of action so good if a ‘test’ is needed
Monitored using APTT
No dose adjustment is needed in renal impairment
What is Anti-Phospholipid Syndrome (APS)?
An autoimmune disease that causes thrombotic effects, major bleeding and possibly death
Worse outcomes associate with being diagnosed with all 3 APS antibodies –> These tests must be done in un-anticoagulated patients
Most common in pregnant women and assocaited co-morbidities
What is the only DOAC that needs to be dose adjusted due to weight?
Edoxaban
For people under 60kg
What are the 2 categories of risk for complications of diabetes?
Macrovascular –> MI, Stroke and Peripheral artery disease
Microvascular –> Nephropathy, Neuropathy and Retinopathy
What are the 3 types of Diabetic Retinopathy?
Macular Oedema (M0-1) –> Nerve fibres in the retina begin to swell
Background Retinopathy (R0-R1)/NPDR –> Walls of the blood vessels in the retina weaken, allowing microaneurysms to protrude, making the retina become fluid and bloody
Larger retina vessles also begin to dilate and become irregular in diameter
Proliferative Diabetic Retinopathy (R2-R3) –> Damaged blood vessles close off, allowing new ones to be made that are leaky, and promote scar tissue formation.
This can cause a detatched retina and raise intraocular pressure, damaging the optic nerve and causing glaucoma
This is the stage at which people will become blind!
What are the 2 types of Diabetic Neuropathy?
Peripheral Neuropathy –> Affects any peripheral limb, with symptoms being worse at night
The most common type of neuropathy
Autonomic Neuropathy –> When the automomic nervous system is effected (heart, bladder, stomach, intestines, sex organs and eyes)
If this occurs, the risk of heart attacks goes through the roof!
What is Diabetic Kidney Disease (DKD)?
What annual check should be done to ensure people don’t get this?
Defined as an increased albuminuria excretion (over 30mg/g) and a gradual reduction in GFR
Should check the Urinary Albumin:Creatinine ratio (ACR)
What does insulin do?
Promotes the following….
Peripheral utilisation of glucose
Suppresses hepatic glucose production
Limits postprandial glucose elevation
What type of insulin regimen would a type 1 diabetic be on?
Basal Bolus Regime
BD Levimir (long acting)
TDS rapid acting insulin with each meal
In terms of insulin dose changes, what are the 3 golden rules?
Make 1 adjustment at a time
Make small adjustments –> 10-20% change
Review blood glucose levels 2-3 days post change –> If no effect then you can make another adjustment
What is the 15g:15min rule?
During hypoglycaemic episodes, they should take 15g of a fast acting CHO, followed by 15g of slow acting CHO
Then should re-test glucose levels 15mins after this
At what weight/BMI are DOACs contraindicated?
Over 120kg
BMI of 40 or over
