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1st Year > Cardio > Flashcards

Cardio Flashcards

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1
Q

MAP =

A

CO x TPR

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2
Q

short term control of BP is by..

A

arterial baroreflex

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3
Q

long term control of BP (3 hormone systems)

A

renin-angiotensin-aldosterone system ADH ANP (atrial natriuretic peptide)

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4
Q

renin-angiotensin-aldosterone system

A

modulating Na+ transport affects how big the osmotic gradient is outside the CD can control CD permeability

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5
Q

complications of hypertension (give examples)

A

end-organ damage: retinopathy, peripheral vascular disease, stroke, coronary heart disease, heart failure, cardiac disease, renal failure, and proteinuria.

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6
Q

stage 1 and 2 hypertension are? severe?

A

1: 140/90 2: 160/100 severe: 180/110

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7
Q

causes of secondary hypertension

A

Chronic renal disease (Renal artery stenosis, chronic pyelonephritis, fibromuscular dysplasia, polycystic kidneys)

drugs (NSAIDS, oral contraceptives, corticosteroids)

pregnancy

Endocrine disease, (Cushings, Conn’s, Phaeochromocytoma, acromegaly, hypo and hyperthyroidism)

vascular (Coartaction of aorta)

sleep apnoea

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8
Q

pathophysiology of hypertension

A

sodium and fluid retention

or increase in peripheral resistance

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9
Q

6 factors influencing blood pressure

A

age

genetics

eenvironment

weight

alcohol

race

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10
Q

risk factors for hypertension complications (8)

A

smoking , Diabetes mellitus, Hyperlipidaemia, Previous MI or stroke, FH

Renal disease

Male

Left ventricular hypertrophy

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11
Q

score for predicting cardiovascular risk

A

Q Risk score

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12
Q

first line treatment hypertension

A

black or over 55 or woman of child bearing age: CCB or thiazide like diuretic

young: ACEI/ARB

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13
Q

for treatment resistance hypertension (Rx?)

A

spirinolactone (potassium sparing diuretic)

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14
Q

example of ACEI

A

ramipril

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15
Q

most common cause of stable angina

A

reduced blood flow to heart due to coronary atheroma

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16
Q

Sx of stable angina

A

Chest Tightness - which can radiate to the arm(s), neck, jaw, and teeth.

Exertional Breathlessness

Exertional Fatigue

Exertional (near) Syncope

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17
Q

signs of stable angina

A

tar stained fingers

corneal arcus

obesity

diabetic retinopathy

xanthelasma

signs of HF = basal crackles, raised JVP, peripheral oedema

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18
Q

what type of murmur do u hear in mitral regurg

A

pansystolic murmur

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19
Q

what type of murmur do u hear in aortic stenosis

A

ejection systolic murmur

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20
Q

Ix for stable angina

A

CXR

Coronary Angiography

Cardiac Catheterisation

CT

ECG (usually normal, but maybe ST depression, flat or inverted T waves, signs of MI)

Exercise Tolerance Test (ETT)

FBC

Myocardial Perfusion Imaging

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21
Q

Rx for stable angina

A
  1. B-Blockers (Relief)
  2. Calcium Channel Blockers (Relief)
  3. Nitrates/Ivabradine (Nitrates is for symptom relief, and Ivabradine reduces heart rate)
  4. ACE Inhibitors (Prevention)
  5. Aspirin/Statins (Prevention) (Aspirin, 75-150mg/24h, reduced mortality by 34%)

Other treatments:

  • Coronary Artery Bypass (CABG) Surgery
  • Long-acting Calcium Antagonists (If you can’t use B-Blockers, then these are very useful)
  • Potassium Channel Activator
  • Percutaneous Transluminal Coronary Angioplasty (PTCA)
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22
Q

first line Rx for stable angina for relief of Sx

A

beta blocker

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23
Q

risk factors for MI (modifiable and nonmodifiable)

A

Non-modifiable = Age, Gender, Family History.

Modifiable = Smoking, Hypertension, Diabetes, Obesity, Hyperlipidaemia.

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24
Q

Sx of MI

A

Acute Central Chest Pain (lasting >20 min)

Palpitations

Breathlessness

Pain in one or both arms, the jaw, neck, back, or stomach

Sweating

Nausea

Dizziness

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25
Ix for MI
ECG, bloods, cardiac enzymes (troponin)
26
Immediate Rx for MI
MONARCH morphine, oxygen, nitrates, aspirin (300mg PO), reperfusion (thrombolysis, or PCI), clopidogrel, heparin BASIC beta blocker, anticoagulants, statin, inhibitor of angiotensin 2, correct risk factors
27
which vein usually used for CABG
long saphenous vein, reversed
28
ACS symptoms will almost always give symptoms ____ in contrast to stable angina which is only on exertion.
ACS symptoms will almost always give symptoms **_at rest_** in contrast to stable angina which is only on exertion.
29
difference in presentation between unstable angina and NSTEMI?
Unstable Angina pectoris (UAP), angina on effort, but of progressive increasing frequency and severity, often provoked by less exertion and/or then at rest. NSTEMI will much more often start with myocardial ischaemic symptoms occurring at rest.
30
ECG changes in UA and NSTEMI?
ST-segment depression, transient ST-segment elevation and/or T-wave inversion
31
Atypical ACS presentation (women, elderly, diabetic) involves..
SOB, NV, epigastric pain
32
immediate Rx of UA and NSTEMI
MONA (morphine, oxygen, nitrate, aspirin 300mg)
33
what should be given for 1 year after ACS event?
dual anti-platelet therapy
34
what anti-thrombotic therapy given in ACS?
LMWH (now replaced by fondaparinaux s/c)
35
Most important determinants of MI survival
age & LV ejection fraction.
36
where is the occlusion most commonly in sudden cardiac death in young
proximal LAD
37
complications of MI 2 life threatening 1 later
mechanical complications, ventricular arrhythmic complications later: LV thrombus
38
Mechanical Complications of MI
Free Wall Rupture Papillary Muscle Rupture Rupture of IVS (VSD)
39
where is free wall rupture most common
LAD territory
40
free wall rupture common in...
Elderly, females, HBP & anterior MI.
41
septal wall rupture common in
nElderly, females, HBP, those not thrombolysed, anterior MI
42
Symptoms of papillary muscle rupture signs?
Sudden severe breathlessness (MVR) Autonomic activation eg sweating, nausea & vomiting Chest pain signs: Shock, tachycardia, pulmonary oedema **New harsh systolic murmur** VSD - LSE right chest (always) MV rupture - apex back (can be absent) Right parasternal heave Palpable thrill, elevated JVP
43
Rx for papillary muscle rupture
MV replacement VSD repair with pericardial or synthetic patch CABG if needed
44
difference in ECG in ventricular tachycardia vs ventricular fibrillation
ventricular tachycardia= wide rapid QRS, P waves not visible ventricular fibrillation = no p or QRS complexes
45
VF tends to rapidly deteriorate into \_\_\_\_\_.
VF tends to rapidly deteriorate into **_asystole_**.
46
LV thrombus Seen typically in ______ MI and resulting significant LV dysfunction. Seen after 48 hours- early ____ done in CCU should be repeated if above infarct pattern.
LV thrombus Seen typically in **_apical/antero-apical_** MI and resulting significant LV dysfunction. Seen after 48 hours- early **_echos_** done in CCU should be repeated if above infarct pattern.
47
Rx for LV thrombus
Anticoagulation for 6/12 with warfarin and repeat echo
48
•Patients with STEMI have a high likelihood of a ______ occluding the infarct artery.
•Patients with STEMI have a high likelihood of a **_coronary thrombus_** occluding the infarct artery.
49
Goal of therapy of ACS is •Increase \_\_\_\_\_\_\_ –T\_\_\_\_\_ –C\_\_\_\_\_\_ •Decrease \_\_\_\_\_ –Decrease in \_\_\_, –Decrease \_\_\_\_\_ –Decrease ____ or \_\_\_\_\_\_
* Goal of therapy of ACS is * Increase **_myocardial oxygen supply_** –**_Thrombolysis_** –C**_oronary vasodilation._** •Decrease **_myocardial oxygen demand_** –Decrease in **_heart rate,_** –Decrease **_blood pressure,_** –Decrease **_preload_** or **_myocardial contractility_**
50
how does fondaparinaux work and why is it liked?
selective inhibitor of factor Xa no need for platelet monitoring
51
Systolic Heart Failure = Inability of the ____ to contract normally, therefore Cardiac Output decreases. Ejection Fraction (EF) is \_\_\_
Systolic Heart Failure = Inability of the **_Ventricle_** to contract normally, therefore Cardiac Output decreases. Ejection Fraction (EF) is **_\<40%._**
52
causes of systolic HF
MI, IHD, cardiomyopathy
53
Diastolic Heart Failure = Inability of the \_\_\_\_\_. EF \_\_\_\_
Diastolic Heart Failure = Inability **_of the Ventricle to relax, and fill normally_**. EF **_\>50%_**
54
causes of diastolic HF
Constrictive Pericarditis, Tamponade, Restrictive Cardiomyopathy, Hypertension.
55
Sx of right ventricular failure
Peripheral Oedema (up to thighs, sacrum, abdominal wall), Ascites, Anorexia, Nausea, Neck and Face Pulsation, increased JVP Epistaxis, Facial Engorgement.
56
Sx of left ventricular failure
orthopnea, paroxysmal nocturnal dyspneoa, noctunral cough, fatigue, weight loss, nocturia, muscle wasting, cold peripheries
57
general Sx of Heart failure
SOB (orthopnea, PND) cough, wheeze peripheral oedema fatigue
58
signs of HF (O, P, A)
Obs and O: reduced BP, cool peripheries, cyanosis, tachycardia, pulsus alternans, raised JVP P: right ventricular heave, displaced apex A: crepitiations, heart murmers, 3rd heart sound
59
2 key Ix in HF
ECHO (for valvular heart disease) BNP
60
diagnosis of HF is based on ______ criteria
diagnosis of HF is based on **_Framingham_** criteria
61
Rx for HF (5) | (pharmacological)
diuretics ACEI spirinolactone (potassium sparing diuretic/aldosterone antagonist) sacubitril valsartan (ARB) digoxin
62
Rx for HF (5) (non-pharmacological)
implants= pacemaker, Cardiac resynchonisation therapy, implantable cardioverter defibrillators surgery = CABG, heart valve surgery, heart transplant

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