Cardio Flashcards
(25 cards)
What neurohormonal systems may be activated in heart failure?
Renin, Aldosterone, Angiotensin System
Catecholamines of the Sympathetic Nervous System
What changes are seen on X-ray in heart failure?
Kerley B lines
Dilated prominent upper lobe vessels
Cardiomegaly
Bilateral Pleural Effusions
Bat wing perihilar shadowing: alveolar oedema
What are the symptoms of left heart failure?
Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Breathelessness
Nocturnal cough productive of pink frothy sputum
How can blood pressure affect the administration of drugs?
Low BP delays absorption of oral and IM prescribed drugs
What are the complications to thrombolysis?
Any previous haemorrhagic stroke
Head trauma/ brain surgery within last 6 months
Known intracranial neoplasm
Recent major surgery
Active bleeding or known bleeding disorder
What is the mechanism of action of aspirin?
Surpresses production of prostaglandins and thromboxanes due to its reversible inactivation of cyclooxygenase
This inhibits platelet aggregation
What is the mechanism of action of statins?
Inhibit HMG-CoA, reducing liver synthesis of cholesterol. Also has protective endothelial effects
What is the mechanism of action of B-blockers?
Via B1-receptor they reduce force of contraction and speed of conduction in the heart.
This relieves myocardial ischaemia by reducing cardiac work and oxygen demand, and increasing myocardial perfusion
What is congestive heart failure?
Combination of both left and right heart failure
Will have symptoms of both
Why are loop diuretics best in heart failure?
Loop diuretics also have a direct effect on blood vessels, causing dilatation of capacitance veins. In acute heart failure, this reduces preload and improves contractile function of the “overstretched” heart muscle
This is probably this main benefit of loop diuretics in acute heart failure, as illistrated by the fact that the clinical response is usually evident before
What drugs are contraindicated in aortic stensosis?
Nitrates
Calcium channel blockers
ACEi
ARBs
Dipyridamole
Give causes of a systolic murmur
Aortic stenosis
Pulmonary stenosis
Mitral regurgitation
Tricuspid regurgitation
Give 4 non-modifiable risk factors of an MI
Age
Gender
Family history
Ethnicity
What 4 conditions predispose an individual to coronary heart disease?
Diabetes mellitus
Hypertension
Hyperlipidaemia
Obesity
Give 4 lifestyle factors which put patients at risk of CHD
Smoking
Obesity
Physical Inactivity
Cocaine use
What should be covered in 6 week consultation post MI?
Review symptoms: any dyspnoea, angina, palpitations
Consider coronary angiography: establish extent of residual coronary disease
What are the differentials for a systolic murmur in a post MI patient?
Post MI:
- Mitral regurgitation (papillary muscle dysfunction, acute left ventricular dilation)
- Ventricular septal defect (rupture of the interventricular septum)
General:
- Mitral regurgitation
- Ventricular septal defect
- Aortic stenosis
- Hypertrophic cardiomyopathy
- Tricuspid regurgitation
- Pulmonary stenosis
What are the investigations for renal artery stenosis?
Renal USS
CT/MRI angiography
Renal angiography
What is the management of renal artery stenosis?
Comprehensive antihypertensive regimen (stop ACEi for something else)
Transluminal angioplasty +/- stent placement
Revascularisation surgery
What are the side effects of B-blockers?
fatigue cold extremities headahce GI disturbance Sleep disturbance and nightmares Impotence
Side effects of thiazide diuretics?
Hyponatraemia
Hypokalaemia
Impotence
Gout
What are the side effects of CCBs?
Ankle swelling
Flushing
Headache
Palpitations
Verapamil
- Constipation
- Bradycardia
- Heart block
- Cardiac failure
What are the side effects of ACEi?
Hypotension
Dry cough
hyperkalaemia
Rarely
-angioedema and other anaphylactoid reactions
What are the causes of secondary hypertension?
Polycystic kidney disease
Cushing’s syndrome
Conn’s syndrome
Phaeochromocytoma
Hyperparathyroidism
Coarctation of the Aorta
Renal artery stenosis
