Cardiology Flashcards
(43 cards)
Name 5 causes of HF
Ischaemic Heart Disease Hypertension Dilated Cardiomyopathy Valvular Heart Disease RHF (Cor Pulmonale, RV infarct, PHTN, PE, COPD) Congenital Heart Disease Alcohol Pericarditis
What 4 things occur pathophysiologically in HF?
Activation of SNS - Raised HR and Contractility, Vasoconstriction resulting in increased preload to try and improve contractility, but this also increased afterload
Renin-Angiotensin System - reduced CO results in reduced renal perfusion, resulting in renin release. This raises water and Na retention, increasing venous return, to help maintain SV. As retention increases, can get P oedema and causes dyspnoea.
ANP and BNP released
Ventricular Dilatation and remodelling - when compensatory mechanisms become limited.
What x-ray findings are there in HF?
Cardiomegaly Kerley 'B' lines - interstitial oedema Peri-hilar shadowing (Bat's wing) - alveolar oedema Pleural Effusion Dilated vessels in upper lobe
What is the normal level of BNP?
< 100pg/ml
What investigations would you order for initial suspicion of HF? If any are abnormal what would you do next?
CXR, Bloods (BNP), ECG (if normal, unlikely HF)
Echo -TTE (if normal, unlikely HF)
How do you treat HF?
Vasodilator Therapy : Ace-Inhibitors* (ARAs if intolerable), Isosorbide Mononitrate (reduces preload) with Hydralazine (reduces afterload)
Ivabradine (alternative to ISMN)
Beta-Blockers* - helps block chronically activated SNS
Diuretics - used in pts with fluid overload
Loop (Furosemide, Bumetanide 20-40mg daily)
Thiazide (Bendroflumethiazide 2.5mg daily)
Aldosterone antagonists (Spironolactone)
How do ACE-i work?
Inhibit Angiontensin II (which usually causes vasoconstriction)
Increase levels of bradykinin, which causes vasodilation
Enhance salt and water excretion
Summarise the management of HF. (General, Pharmacological, Non-Pharmacological)
General: Educate, light exercise, diet, vaccine against influenza and pneumococcal, social changes
Pharmacological: ACE-i, BB, Diuretics, Digoxin, Inotropes
Non-pharmacological: CABG/PCI, cardiac resynchronisation therapy, implantable defibrillator, repair underlying cardiac problems (valve, congenital), cardiac transplant
What is the emergency management of Acute HF (caused by hypertensive HF/acute pulmonary oedema/cardiogenic shock/RHF)?
Same investigations as chronic HF
High flow oxygen, sometimes CPAP
Diuretic - Furosemide iv 50mg
Measure SBP
Give vasodilator if <100
Give vasodilator and/or inotrope if 85-100
Give inotrope and/or dopamine and/or noradrenaline if <85
If no response, try mechanical assist devices
Give some examples of Vasodilators
GTN
Isosorbide Mononitrate
Nitroprusside
ACE-i
What does an artheroma consist of?
Fatty streak, macrophages, lipids, smooth muscle cells (usually in the intima of the artery)
Name 6 RFs for IHD
Reversible: High cholesterol, high fat diet, Sedentary lifestyle, smoking, HTN,
Irreversible: Age, Gender, FH
What assessment tool do NICE recommend for estimated CVD risk?
QRISK2 - gives the 10-year risk of CVD
Use in high-risk people
Takes into account DM, BP, lipid profile, age, gender, fH
What is prinzmetal’s / variant angina?
Coronary artery spasm
What is decubitus angina?
Angina on lying down
What is cardiac syndrome X?
Pt has symptoms of angina, a positive exercise test, but on investigation has normal coronary arteries
What investigations would you perform in suspected angina?
Usually diagnosis is clinical
Resting ECG - normal between attacks, ST depression or T-wave flattening during attack
Exercise ECG - Positive in most people with CAD, ST depression at a low workload or a paradoxical fall in BP with exercise indicate CAD
Angiography - Only really used if intervention is planned, so exact coronary pathology can be found out
What is the long term management of angina?
Modify lifestyle factors
Aspirin - 75mg daily - inhibits COX2 and thus thromboxane A2
Clopidogrel - 75mg daily - if aspirin intolerable
Statin - aim for cholesterol <5.0 mmol/L
If persistent despite oral treatment, consider revascularisation therapy:
PCI - Try if 2 anti-anginals and still not improving, preferred in pts with isolated disease, complications are death, acute MI, need for restenosis, give aspirin and clopidogrel for 6-12 months after
CABG - use mammary artery to bypass stenosis, recommended in pts with triple artery disease, impaired LVF
What is the symptomatic treatment of angina?
GTN - tablet or spray
Encourage to use before exertion rather than waiting for pain to develop
S/E is severe headache
What prophylaxis is given to angina patients?
Nitrates - reduce the pressures in the heart by dilating coronary arteries (ISM,ISD)
BBs - reduce HR and contractility thus reducing myocardial oxygen demand
Ca+ Antagonists - Relax the coronary arteries and reduce contractility thereby reducing oxygen demand
What is most common cause of an ACS?
Rupture of a fibrous cap of a coronary plaque
How is Unstable Angina different to NSTEMI?
In an NSTEMI, the occluding thrombus is large enough to cause myocardial damage, and thus a rise in troponin and creatine kinase.
What are the similarities of NSTEMI and UA?
ECG may be normal / show ischemia with T-Wave inversion and ST depression
Troponin may be 0 on arrival to hospital (measure 12h later, if still normal it suggests UA)
Both can be complicated by a STEMI if not treated
Name some risk stratification scoring systems for MI
TIMI, GRACE
Looks at age, cardiac markers, ECG results to see if there is a risk of a STEMI/death in patients with either NSTEMI or UA
