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Year 3 GP > Cardiac > Flashcards

Cardiac Flashcards

(65 cards)

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1
Q

Aetiology of HTN

A 
95% essential 
Renal artery stenosis 
Hyperthyroidism 
PCKD
Chronic pyelonephritis 
Diabetic nephropathy 
RCC 
Cushing's 
Phaeochromocytoma 
Hyperaldosteronism
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2
Q

Symptoms

A

Asymptomatic

May get headaches

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3
Q

Stages of HTN

A

Stage 1 > 140/90 ABPM >135/85

Stage 2 > 160/100 ABPM > 150/95

Stage 4 >180/120

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4
Q

Signs

A

Retinal haemorrhage Papilloedema

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5
Q

Risk factors

A 
Age 
65 yo - men 
65 - 74 - female 
Black African and Asian 
FHx
Social deprivation 
Lifestyle - smoking and alcohol 
Anxiety and emotional stress
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6
Q

Complications

A 
Increased risk of:
Heart failure.
Coronary artery disease
Stroke
Chronic kidney disease
Peripheral arterial disease
Vascular dementia
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7
Q

Diagnosis

A

If blood pressure measured in the clinic is 140/90 - 180/120mmHg: ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension

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8
Q

Person’s blood pressure is 180/120 mmHg or higher

A

Refer for same-day specialist assessment if there are:

  • Signs of retinal haemorrhage and/or papilloedema
  • new onset confusion, chest pain, signs of HF or AKI

if not:

  • Ix for organ damage e.g. eGFR for kidney damage
  • tarting antihypertensive drug treatment immediately if organ damage

If no target organ damage is identified:
- repeat blood pressure measurement within 7 days

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9
Q

Assess for target organ damage

A

Urine dipstick:

  • haematuria
  • alb: Cr ratio

HbA1C
ECG
Serum LDL - QRISK

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10
Q

Mx

A

Lifestyle advice

  • diet and exercise
  • reduce caffeine
  • reduce salt
  • smoking and alcohol cessation

Antihypertensives

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11
Q

Antihypertensive procedure

A

Stage 1 - ACEi/ARB

  • if have T2DM
  • less than 55 yo

Stage 1 - CCB

  • over 55 yo
  • Afro-carribean

Stage 2 - ACEi/ARB +CCB

Stage 3 - ACEi/ARB +CCB + thiazide like diuretic

Stage 4 ACEi/ARB +CCB + thiazide like diuretic + beta blocker or alpha/beta blocker if K+ >4.5 mmol/l

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12
Q

Target BP for 80 years and over

A

< 150/90 mmHg.

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13
Q

Annual review

A

Adherence
BP
eGFR
QRISK

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14
Q

Pre - eclampsia

A

BP > 140/90 after 20 wks gestation

  • Proteinuria
  • Severe headache
  • Visual disturbances

Complications:

  • Renal insufficiency
  • Liver issue - ALT/AST
  • eclampsia
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15
Q

Risk factors for pre - eclampsia

A 
PMHx of pre - eclampsia 
CKD
T1/T2DM 
HTN 
SLE 
40+
Obese 
FHx
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16
Q

Mx of pre-eclampsia

A

Aspirin 75 - 150mg prescribed form 12 wks - if high risk

Labetalol

Urine dipstick

  • proteinuria 30mg
  • haematuria
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17
Q

When to suspect familial hypercholesterolaemia

A

Total cholesterol conc > 7.5 mmol/L

Personal or FHx of premature CHD < 60yo

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18
Q

Signs of hypercholesterolaemia

A

Xanthelasma
Corneal arcus
Tendon xanthoma

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19
Q

Secondary hyperlipidaemia

A 
Caused by:
T2DM 
Obesity 
Nephrotic syndrome 
Alcoholism 
Cushing's syndrome 
Hypothyroidism

Drugs:
Corticosteroids
Thiazide diuretic

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20
Q

Cardiovascular risk reduction

A

Primary reduction:
QRISK > 10%
Atorvastatin 20mg

Secondary reducation:
Atorvastatin 80mg

Contraindicated - ezetimibe 10mg

Follow up bloods 3 months and 12 months after starting statin

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21
Q

Familial hypercholesterolaemia diagnosis

A

Adults: LDL cholesterol 13+ mmol/L.

Child: LDL cholesterol 11+ mmol/L

Use the Simon Broome criteria or the Dutch Lipid Clinic Network

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22
Q

Dutch Lipid Clinic Network

A

Definite’ FH > 8
‘Probable’ FH 6–8
‘Possible’ FH 3–5
‘Unlikely’ FH < 3

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23
Q

When is Qrisk not needed

A

TIDM and 40+
Has had diabetes for 10+ years
Has established nephropathy
Has other CVD risk factors

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24
Q

Causes of angina

A

Insufficient blood supply to the myocardium:

  • Previous MI
  • Atherosclerosis - coronary artery disease
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25
Risk factors for angina
``` Male Age FHx Ethnicity - Black and asian Increased QRISK Smoking High cholesterol and lipids HTN, DM, CKD ```
26
Symptoms of angina
Stable: Pain when exerting, relieved at rest Relieved by GTN spray Unstable angina: Pain at rest too Atypical symptoms: - GI discomfort - Dyspnoea - Nausea
27
Angina impact on life
Reduced exercise tolerance | If severe, may not be able to leave home
28
Investigations for angina
Bloods - FBC - Trop I - CRP - Lipids - HbA1c ECG QRISK
29
Advice for angina
If experiencing chest pain: - rest and stop what you are doing - GTN spray - Second dose after 5 mins - If pain not relieved within 15 mins call 999 - avoid cold, emotional stress and large meals - If occurs when driving, stop driving and recommence once pain has subsided
30
Conservative mx of angina
Smoking cessation Exercise Reduce alcohol intake Healthier diet - less salt and cholesterol
31
Angina mx
GTN spray Beta blocker or CCB Secondary prevention of CVD - aspirin 75mg - ACEi - if DM - Statin - atorvastatin 20mg
32
Angina follow up
4 week follow up - check response to treatment | Review every 6 months to 1 year
33
Unstable angina Ix and mx
History Cardiovascular examination ECG Bloods - trop I, HbA1c, lipids GRACE score Mx: - Referral
34
GRACE score
Predict 6-month mortality and risk of cardiovascular events.
35
ACS
Acute coronary syndrome: - STEMI - NSTEMI - Unstable angina
36
Causes
Coronary vascular disease
37
Risk factors
``` Previous MI Male Age Ethnicity - black or asian HTN, DM, CKD High cholesterol or lipids High QRISK FHx ```
38
Symptoms of MI
``` Central dull crushing chest pain Gradual onset Radiates to arm, jaw and neck Sweating N+V ```
39
Signs of MI
Bloods - increased troponin I - not increased with unstable angina ECG: STEMI - ST elevation NSTEMI - ST depression Unstable angina - ST depression Previous MI - LBBB - Pathological Q wave
40
ACS impact on lifestyle
Reduced exercise tolerance HF - breathlessness and oedema Increased risk of second MI
41
Ix for ACS
Bloods: - FBC - Lipids - U+Es - LFTs - BM - TSH - Trop I ECG
42
Mx of ACS
Immediate referral - STEMI - PCI
43
Conservative mx
``` Weight loss Reduced salt and cholesterol intake Smoking cessation Reduce alcohol consumption Increase exercise ```
44
Medication for ACS
``` STEMI/NSTEMI: Acute - morphine, oxygen, nitrates, aspirin Tripe therapy - warfarin, DOAC, aspirin Beta blocker/ CCB ACEi Statin - atorvastatin 80mg ``` Unstable angina: - Acute - morphine - GTN spray - Aspiring 300mg
45
Atrial fibrillation
Supraventricular tachyarrhythmia resulting from irregular, disorganized electrical activity and ineffective contraction of the atria
46
Types of AF
Paroxysmal AF — episodes lasting longer than 30 seconds but less than 7 days. - Self terminating Persistent AF — episodes lasting longer than 7 days - or less than seven days but requiring pharmacological or electrical cardioversion Permanent AF — AF that fails to terminate using cardioversion, AF that is terminated but relapses within 24 hours, or longstanding AF (usually longer than 1 year)
47
Causes of AF
Congestive heart failure Rheumatic valvular disease Atrial or ventricular dilation or hypertrophy Pre-excitation syndromes (such as Wolff–Parkinson–White syndrome) Sick sinus syndrome Congenital heart disease Inflammatory or infiltrative disease (such as pericarditis, amyloidosis, or myocarditis).
48
Risk factors for AF
``` Excessive caffeine intake Alcohol abuse Obesity Smoking Medication - thyroxine or bronchodilators ```
49
Complications of AF
Stroke and thromboembolism | Heart failure
50
Diagnosis AF
Clinical history Cardiovascular examination - pulse irregularly irregular ECG
51
Presentation of AF
``` Breathlessness. Palpitations. Chest discomfort. Syncope or dizziness. Reduced exercise tolerance ```
52
Mx of AF
Onset within 48 hours and haemodynamically - urgently admit for electric cardioversion Onset within 48 hours and stable - urgently admit for cardioversion (may be drug) If symptomatic - urgent referral CHADVASC - 2+ - anticoag HAS-BLED - risk of major bleed
53
Medication
Rate control: - beta blocker or CCB - digoxin - non‑paroxysmal atrial fibrillation who are sedentary Rhythm control: - Flecainide - Amiodarone Anticoagulants: - apixaban, dabigatran or rivaroxaban `
54
AF follow up
Within 1 week of starting rate-control treatment Review the person at least annually once symptoms are controlled
55
Heart failure
Ability of the heart to maintain the circulation of blood is impaired as a result of a structural or functional impairment of ventricular filling or ejection
56
New York Heart Association (NYHA)
Class I — no limitation of physical activity. Class II — slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in undue breathlessness, fatigue, or palpitations. Class III — marked limitation of physical activity. Comfortable at rest but less than ordinary physical activity results in undue breathlessness, fatigue, or palpitations. Class IV — unable to carry out any physical activity without discomfort. Symptoms at rest can be present.
57
Causes of HF
``` IHD - most Coronary artery disease HTN Pregnancy. Infiltrative - sarcoidosis, amyloidosis, haemochromatosis Aortic stenosis Pericarditis AF Nephrotic syndrome ```
58
Risk factors
Alcohol Cocaine Obesity Smoking
59
Presentation of HF
``` Breathlessness on exertion Orthopnoea Paroxysmal nocturnal dyspnoea Fluid retention Fatigue, decreased exercise tolerance Light headedness or history of syncope ```
60
Signs of HF
``` Tachycardia Laterally displaced apex beat Hypertension Raised jugular venous pressure Enlarged liver Basal crepitations Oedema ```
61
Diagnosis
``` History Cardiac examination Bloods - BNP - HbA1C ECG Urine dipstick QRISK ```
62
Mx of heart failure with reduced ejection fraction
Furosemide ACEi + Beta blocker Statin - QRISK Supervised exercise-based group rehabilitation programme
63
Mx of heart failure with preserved ejection fraction
Furosemide Statin Supervised exercise-based group rehabilitation programme Consider if an antiplatelet drug is indicated
64
End-stage heart failure mx
At high risk of dying within the next 6–12 months 1. Set realistic goals of care with the person and their family/carers. 2. MDT 3. Review medication 4. Advance care plan
65
HF follow up
Frequency of follow up individualized to the severity and stability of symptoms, treatment, and comorbidities Person's clinical condition or drugs have changed - 2 weeks Stable - at least every 6 months

Year 3 GP (20 decks)

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