cardiovascular Flashcards
(98 cards)
1
Q
causes of MI
A
erosion or rupture of fibrous cap of coronary artery atheromatous plaque
subsequent formation of platelet rich cot and vasoconstriction produced by platelet release of serotonin a nd thromboxane A
2
Q
types of MI and their causes
A
STEMI = complete blockage of coronary artery
NSTEMI +unstable angina
= partial/intermittent blockage to artery
ST depression and T inversion
3
Q
risk factors for MI
A
age male fmaily history (first degree <50yo) hyperlipidaemia cigarette moking hypertension metabolic factors/diabetes diet/exercise psychological factors elevated CRP alcohol coagulation factors
4
Q
presentation of MI
A
central crushing chest pain
radiating to arms, shoulder , neck
no longer than 15min
new onset or deterioration of stable angina
Nausea and vomiting, sweating, breathlessness, haemodynamic instbility, collapse, arrhythmia, new onset heart failure
5
Q
signs on examination of MI
A
no physical signs unless complications develop
patient = pale, sweaty, grey
6
Q
investigations of MI
A
ECG
bloods - cardiac markers (troponin, creatine kinase), FBC, creatinine, electrolytes glucose, lipids
7
Q
signs of MI on ECG
A
STEMI - ST elevation within hours, followed by T wave flattening or inversion
NSTEMI - ST depression and T inversion
8
Q
treament of MI
A
GTN spray + IV morphine antiemetic such as metoclopramide oxygen if needed insulin if hypo aspirin nad second antiplatelet
9
Q
when to do reperfusion therapy in STEMI
A
if present within 12hrs of onset
10
Q
types of coronary reperfusion
A
PCI (percutaneous coronary intervention) or fibrinolysis
CABG (coronary aryery bypass graft)
dependent on time after symptom onset - PCI if <12hrs
11
Q
secondary prevention of MI
A
lifestyle changes ACE inhibitor beta blocker dual antiplatelet therapy statin
12
Q
who gets angina?
A
55-64 yo
8% men, 3% women
Men>Women
13
Q
causes of angina
A
insufficient blood supply to the heart muscle
due to coronary artery disease - atherosclerosis narrows lumen. symptoms when oxygen demand increases
can also be caused by valve disease, hypertrophic obstructive cardiomyopathy or hypertensive heart disease
14
Q
risk facors fo ischaemic heart disease/angina
A
age male familyhistory hyperlipidaemia cigarrette smoking hypertension diabetes diet and exercise psychosocial factors elevated CRO high alcohol intake high level of coagulationfactors
15
Q
presentation of angin
A
stable - consticting discomfort in front of chest spreadig to neck, shoulders, jaw or arms
precipitated by phsycial exertion
releived by rest or GTH within 5 mins
16
Q
what pain features make angina more unlikely?
A
continuous or prolonged pain unrelated to activity brought on by breathing associated with dizziness palpitations tingling difficulty swallowing
17
Q
signs on exmaination of angina
A
examine CAD risk via history and BMI
18
Q
investigations for angina
A
ECG - look for changes consistent with CAD that may indicade ischaemia or prev infarct
normal ECG does not confirm or exclude angina
19
Q
ECG consistent with CAD that may indicate ischaemia or prev infarct
A
pathological Q waves
left bundle branch block
st-segment and T wave abnromalities
20
Q
treatment of angina
A
GTN before activies that may bring on and when stop
long term prevention:
- beta blcoker or calcium channel blocker as first line
- if cant - long acting nitrate, nicorandil, ivabradine,
secondary prevention of Cardiovasccular event s - management of CVS risk factors, psychological support, drug treatment, atherosclerotic disease treamtent (low dose aspirin, statin, ACEi)
21
Q
AF, men or women?
A
more in men
22
Q
causes of AF
A
IHD hypetension valvar heart disease hyperthyroidism cardiac diseases non cardiac - drugs, infection, electrolyte issues, lung cancer, PE, thyrotoxicosis, DM
23
Q
presentation of AF
A
irregular pulse
+ SOB, palpitations, chest discomfort, syncope or dizziness, reduced exercise tolerance, malaise or polyuria
24
Q
complications of AF
A
stroke, TIA, heart failure
25
signs on examination of AF
irregularly irregular pulse
| suspect paroxysmal AF if symptoms are episodic and last <48hr
26
investigations of AF
ECG - no P waves, chaotic baseline, irregular ventricular rate, ventricular compleses unless conduction defect
24 hr tape if paxosymal AF suspected
27
treatment of AF
when caused by acute precipitating event, treat underlying cause
rate control - reduce HR at rest and: beta blocker, calcium antagonist, sedentary people = digoxin
rhythm control: electrical DC cardioversion then beta blockers, catheter ablation techniques
28
define essential hypertension
BP > 140/90
major risk factor for stroke and heart disease
29
who gets essential hypertension
20-30% of pop
more common in africans and old ppl
30
risk factors for essential hypertension
non-modifiable - fmaily history, older age, ethnicity, gender, metabolic syndrome
modifiable - obesity, smoking, alcohol, stress, sodium/salt - diet, physical activity
31
causes of secodnary hypertension
congenital
| acquired - renal disease, endocrine disease, pregnancy, drugs, white coat syndrome
32
presentation of essential hypertension
usually asymtpomatic
headache/visual disturbance
sweating, palpitations, headaches, episodic feeling of 'about to die'
epistaxis, nocturia, SOB due to LVH or HF
33
stage 1 hypertension
140/90mmHg in surgeyr
| 135/85 at home
34
stage 2 hypertension
160/100mmHg in surgery
| 150/95 at home
35
stage 3 hypertension
>180/129 in surgery
36
masked hypertensuon
lower on measuring in surgery than at home
37
white coat effect
>20/10mmHg between clinic and ABPM/HBPM
38
malignant hypertension
>200/130,mHg + end organ failure
short onset
urgent same day assessment
39
investigations for essential hypertension
look for organ damage - fundoscopy, ECG, blood tests, urinalysis, renal ultrasound, echo, fasting glucose, investigations for suspected secondary cuases
Q risk = provides risk of MI/stoke in next 10 years
40
management of essential hypertension
referral to specialist if:
- urgent treatment needed, malignant hyeprtension severe, suspected pahechromocytoma, impending complications
- possible underlying cause conns, onset worsening, resistnent, young age
- herapeutic probllems
- hypertension in pregnancy
lifestle changes
41
treatment goal of essential hypertension
reduce to 140/85 - slowly as rapid reduction cna be fatal esp in storke
reudce risk of complciations
42
treatmnet of essential hypertension <55 yo
ACE inhibitor (or ARB)
then,
ACEi + Ca antagonist or thiazide diuretic
then,
ACEi + Ca antagonist + thiazide diuretic
if Qrisk > 20, give statin
43
treatment of essential hypertension >55yo
Ca antagonist or thiazide diuretic
then,
ACEi +Ca antagonist or thiazide diuretic
then,
ACEi + Ca antagonist + thiazide diuretic
statin if Q risk >20
44
causes of DVT
provoked by risk facros
| unprovoked - DVT w/o transient risk factor
45
risk factors of DVT
intrinsic - prev., cancer, age, overwight, male, heart fialure, severe infection, thombophilia, injury to vascular wall, varicose veins, soking
temporary - immobility, trauma, hormone treatment, pregnancy, dehydration
46
presentation of DVT
often asymptomatic
| leg - warm, swollen, calf tenderness, superficial venous distension, changes to skin colour
47
investigations of DVT
d-dimer test if low clinical probability score - sensitive but not specific
venous compression ultrasonography for iliofemoral thrombosis
wells score
coagulation screen to exclude pre existing thormbotic tendancy
48
treatment of DVT
LMWH where feasible
warfarin start at same time
49
congestive heart failure
left and right sided heart failure
50
causes of heart failure
ischaemic heart disease
cardiomyopathy (dilated)
hypertension
many other causes
51
HF with reduced ejection fraction AKA systolic failrue
left ventricle loses ability to contract normally
| heart cant pump with enough force to push enough blood into cirucaltion
52
HF with preserved ejection fraction AKA diastolic failure
left ventricle loses ability to relax normally - muscle has become stiff
the heart cannot properly fill with blood during the rest period between each beat
53
risk factors for HF
AF, diabetes, family hsitory of heart fialure or sudden cardiac death
54
presentation fo HF
breathlessness - on exertion, rest, kying flat, nocturnal cough, waking up from sleep
fluid rentention - ankle swleling, bloated, weight gain
fatigue
lightheadedness or history of syncope
55
signs of HF
```
tachycardic
laterally discplaced apex beat
heart murmurs
3rd and 4th heart sonds
hypertension
raised JVP
enlarged liver
tachypnoea, basal crepitatios, pleural effysions
```
dependent oedema
ascites
obesity
56
investgiations of HF
ECG
if no prev MI - naturitic peptide level
tests for aggravating facorrs and exclude other conditions - CXR, urine dipstick, lung function tests
blood tests - U+Es, eGFR, FBC, thyroid, LTs, HbA1c, fasting lipids
57
treatment of HF with reduced ejection fraction
heart fialure with reduced ejection fraction:
- loop diuretic
- ACEi and Bblocker
- antiplatelet or statin?
- manage causes
- screen for depression and anxiety
- lifestyle improvements
58
treatment of HF with preserved ejection fraction
loop diuretic
consider antiplatelet and statin
lifestyle
screen for depression and anxiety
59
commonest valvular issue
mitral regurge
60
mitral regurge
pansystolic
apex + diaphragm + left side
radiates to axilla
61
mitral stenosis
mid diastolic murmur
| apex
62
aortic stenosis
ejection systolic murmur
| aortic area + radiate to carotids
63
aortic regurgitation
diastolic murmur
64
4 main valvular heart disease
mitral regurgitation
mitral stenosis
aortic stenosis
aortic regurgitation
65
what causes mitral regurgitation
MV prolapse - either congenital or rupture of chordae/papillary muscles
rheumatic disease
endocarditis
connective tissue disorder
66
what causes mitral stenosis
rheumatic heart disease
67
what causes aortic stenosis
calcific degeneration
bicuspid valve
rheumatic disease
68
what causes aortic regurgitation
```
rheumatoid
endocarditis
aortic dissection
marfans + connective tissue disorders
calcific degeneration
trauma
```
69
signs of mitral regurge
acute - signs of congestive cardiac failure
chronic - exertional dyspnoea, orthopnoea
displaced apex beat, AF in 80%
70
signs of mitral stenosis
```
dyspnoea
bronchitis
haemoptysis
AF
left parasternal heave
tapping apex beat
```
71
aortic stenosis triad
angina
syncope
dyspnoea
72
signs of aortic stenosis
angina, syncope, dyspnoea
sudden death
slow rising, low vol pulse
heaving apex beat
73
signs of aortic regurge
```
acute = endocarditis, signs of LVF
chronic = asymptomatic
```
later - orthopnoea, fatigue, dyspnoea
collapsing water hammer pulse
74
investigations of valvular heart disease
CXR
transthoracic ECHO - diagnostic
ECG
75
diagnosis of mitral regurge
CXR cardiomegaly
| transthoracic ECHO diagnostic
76
diagnosis of mitral stenosis
CXR shows enlarged LA
| echo diagnostic
77
aortic stenosis diagnosis
ECG shows LV hypertrophy
| echo diagnostic
78
aortic regurge diagnosis
CXR cardiomegaly
| echo diagnostic
79
treatment of mitral regurge
surgery if acute or severe chronic
80
treatment of mitral stenosis
surgery if MC area <1cm (normal = 3-4)
81
treatment of aortic stenosis
surgery if symptomatic
82
treatment of aortic regurgitation
acute AR is a surgical emergency
| chronic is operated on before ejection fraction <55% or LV dilates >5.5 cm
83
right ventricular failure AKA
cor pulmonale
84
systolic vs diastolic heart failure
systolic = cant pump hard enough during systole
diastolic = not enough bood fills during diastole
85
causes of right ventricular failure
pulmonary hypertension due to: damage to lung tissue, damage to pulmonary vessels, affecting spine or ribcage , or left heart dysfunction + failure
primary right sided heart failure due to right ventricular MI or pulmonary valve stenosis
86
symptoms of right ventricular failure
```
SOB
fatigue
fainting
raised JVP
hepatomegaly
oedema
```
= all due to backup of blood
87
signs on examination of right ventricular failure
```
tachycardia
laterally displaced apex beat
raised JVP
respiratory signs
liver enlargement
```
88
investigations of right ventricular failure
ECHO
ECG
exclusion tests - CXR, urine dipstickm bloods, spirometry, eGFR, thyroid function, HbA1c etc
89
treatment of right ventricular failure
treat underlying lung condition - e.g. oxygen etc
confirmed heart failure with reduced ejection fraction: loop diuretic, ACEi, b blocker, consider antiplatelet or statin, manage causes, life style improvement, screen for depression and anxiety
confirmed heart failure with preserved ejection fraction: loop diuretic, antiplatelet/statin, lifestyle, anxiety and depression screen
90
causes of infective endocarditits
infections occur on valves:
- congenital or defected valves (usually on left side of heart, right side if IVDU)
- normal valves with virulent organisms
- prosthetic valves
- associated with VSD or persistent ductus arteriosis
strep viridans, enterooccci are common causes
91
symptoms and signs of infective endocarditis
systemic features of infection - malaise, fever, night sweats, weight loss, anaemia, splenomegaly
valve destruction - lead to heart failure or heart murmurs
vascular phenomena - abscesses in brain, spleen, kidney, embolisation to lung = infarct or pneumonia
immune complex deposition in blood vessels = vasculitits, petechial haemorrhage in skin, nails and retinae, oslers nodes, janeway lesins,
92
investigations of infective endocarditis
```
blood cultures
ECHO
serology
CXR - septic emboli
ECG to show MI
anaemia with raised ESR and lecocytosis
diagnosis - dukes criteria
```
93
treatment of infective endocarditis
empirical ABX until sensitivity performed
surgery to replace valves if severe heart failure, extensive damage or getting worse
94
who gets postural hypotension
elderly and polypharmacy
95
causes of postural hypotension
blood pressure lowering meds - beta blockers, ACEi, AIIRAs, diuretics, calcium channel blockers
96
define postural hypotension
drop in at least 20mmHg systolic and 10mmHg diastolic within 3 minutes of standing upright
97
presentation of postural hypotension
light headedness or syncope when standing up, e.g. going to toilet at night
98
treatment of postural hypotension
adjust medication doses
