Cardiovascular Flashcards
(155 cards)
1
Q
Anteroseptal, inferior, lateral leads and which coronary artery they cover?
A
Anteroseptal = V1-V4 (LAD)
Inferior = II, III and aVF (RCA)
Lateral = I, aVL, V5, V6 (LCx)
2
Q
Normal P, PR and QRS duration?
A
P = 0.08-0.1 secs
PR = 0.12-0.2 secs
QRS = < 0.1 secs
3
Q
What does a small vs large box on a standard ECG represent?
A
Small = 0.04 seconds
Large = 0.2 seconds
4
Q
Calculating heart rate using the rhythm strip?
A
Regular = 300 ÷ large squares between QRS complexes
Irregular = QRS complexes in 6 seconds (30 large squares) x 10
5
Q
ECG feature of right vs left axis deviation and causes?
A
Right = lead I + III point to each other
→ RVH, RBB, cor pulmonale, anterolateral MI, left posterior hemiblock
Left axis = lead I + II point away from each other
→ LVH, LBBB, inferior MI, left anterior hemiblock
6
Q
ECG features of RBBB vs LBBB?
A
WiLLiaM MaRRoW:
→ RBBB = M in V1, W in V6
→ LBBB = W in V1, M in V6
7
Q
Bifascicular vs trifascicular block?
A
Bifascicular = RBBB + left hemiblock
Trifascicular = above + 1st degree heart block
8
Q
Outline the sinoatrial (SA) node action potential.
A
- Slow Na influx (HCN “pacemaker” channel)
- Rapid Ca influx
- K efflux
9
Q
Outline the atrial/ventricular myocyte action potential.
A
- Rapid Na influx
- K efflux vs Ca influx (plateau phase)
- K efflux exceeds Ca influx
10
Q
Virchow’s triad?
A
Stasis of blood
Endothelial damage
Hyper-coagulability
11
Q
Heart attack vs cardiac arrest?
A
Heart attack = vascular occlusion or ischaemia leads to tissue death
Cardiac arrest = electrical disturbance stops heart beat
12
Q
Acute coronary syndromes and ECG/troponin findings?
A
Unstable angina = abnormal/normal ECG + normal troponin
NSTEMI = abnormal/normal ECG + raised troponin
STEMI = ST-elevation/new LBBB + raised troponin (not required)
13
Q
Patient groups more likely to have an atypical ACS presentation?
A
Elderly
Diabetics
Women
14
Q
ECG features of ischaemia?
A
ST elevation or depression
T wave elevation or inversion or flattening
New LBBB
Pathological Q waves
15
Q
ECG criteria for STEMI diagnosis?
A
≥ 1mm ST elevation in any 2 contiguous leads except V2 and V3 where these criteria apply:
→ ≥ 2.5mm in men < 40
→ ≥ 2mm in men > 40
→ ≥ 1.5mm in women
16
Q
ECG feature of posterior MI?
A
Reciprocal changes in leads V1-V3 (e.g. ST depression)
17
Q
Which coronary artery supplies the atrioventricular (AV) node and significance?
A
Right coronary artery
RCA infarcts (e.g. inferior MI) can cause arrhythmias
18
Q
Management of a STEMI?
A
Morphine (severe pain)
Oxygen (SaO2 < 94%)
GTN (not if hypotensive)
Aspirin 300mg
Ticagrelor or prasugrel or clopidogrel
PCI < 120 mins = PCI + UFH and GPI (radial access) or bivalirudin and GPI (femoral access)
PCI > 120 mins = thrombolysis + fondaparinux
19
Q
Preferred antiplatelet for patient getting PCI vs high bleeding risk?
A
PCI = prasugrel
High bleeding risk = clopidogrel
20
Q
ECG monitoring post-thrombolysis?
A
ECG after 60-90 mins
Consider PCI if ongoing ischaemia
21
Q
List some contrindications to thrombolysis?
A
Bleeding/coagulation disorder
Active internal bleeding
Recent bleed, trauma or surgery
Stroke < 3 months ago
Severe hypertension
Intracranial neoplasm
22
Q
First enzyme to be released in MI and enzyme used to assess re-infarction?
A
First to be released = myoglobin
Assessing for re-infarction = CK-MB
23
Q
Most sensitive enzyme in MI, time of elevation, peak levels and when it return to normal?
A
Troponin
→ elevates in 4-6 hours
→ peaks at 12-24 hours
→ returns to normal at 7-10 days
24
Q
Post-MI persistent ST-elevation and ventricular failure?
A
Left ventricular aneurysm
25
Post-MI cardiac tamponade?
Left ventricular free wall rupture
26
Features and management of cardiac tamponade?
Beck's triad:
→ hypotension
→ raised JVP
→ muffled heart sounds
Management = pericardiocentesis
27
Post-MI pericarditis classification and management?
< 48 hours = acute pericarditis
2-6 weeks = Dressler's syndrome
Management = NSAID + colchicine
28
Most common cause of death post-MI?
Ventricular fibrillation (VF)
29
Post-MI DVLA guidance?
4 weeks off driving
→ 1 week if successful angioplasty
30
Management of NSTEMI and unstable angina?
Morphine (severe pain)
Oxygen (SaO2 < 94%)
GTN (not if hypotensive)
Aspirin 300mg
Fondaparinux (if urgent PCI not planned)
Unstable = angiography +/- PCI (urgent)
GRACE score > 3% = angiography +/- PCI (within 72 hours)
GRACE score ≤ 3% = ticagrelor or clopidogrel
31
Secondary drug prevention of ACS?
Block an ACS:
→ beta-blocker
→ aspirin (lifelong)
→ ACEi
→ ticagrelor or prasugrel or clopidogrel (12 months)
→ statin
32
Statin examples, mechanism of action and side effects?
Examples = atorvastatin, simvastatin
Mechanism of action = inhibits HMG-CoA reductase
Side effects = myalgia, myositis, rhabdomyolysis, deranged LFTs
33
Statin monitoring requirements?
Baseline LFTs
→ LFTs at 3 months
→ LFTs at 12 months
34
Investigation for stable angina?
CT coronary angiogram
35
Management of stable angina?
GTN for all then:
1st line = beta-blocker or non-dihydropyridine CCB
2nd line = beta-blocker + dihydropyridine CCB
3rd line = beta-blocker + isosorbide mononitrate or ivabradine or nicorandil or ranazoline
4th line = PCI or CABG
36
Technique for preventing tolerance to standard-release isosorbide mononitrate?
Asymmetric dosing intervals e.g. 7 hours apart
37
Examples of antiplatelets vs anticoagulants?
Antiplatelets = aspirin, clopidogrel, prasugrel, ticagrelor
Anticoagulants = warfarin, heparin, rivaroxaban, edoxaban, dabigatran, fondaparinux, apixaban, bivalirudin
38
Mechanism of action of aspirin, clopidogrel, prasugrel and ticagrelor?
Aspirin = COX-1 and COX-2 inhibitor
Clopidogrel/prasugrel/ticagrelor = P2Y12 ADP receptor inhibitor
39
Mechanism of action of warfarin, heparin, rivaroxaban, apixaban, edoxaban, dabigatran, fondaparinux and bivalirudin?
Warfarin = vitamin K antagonist
Heparin/fondaparinux = activates antithrombin III
Rivaroxaban/apixaban/edoxaban = direct factor Xa inhibitor
Dabigatran/bivalirudin = direct thrombin inhibitor
40
Reversal agent for dabigatran vs apixaban vs rivaroxaban?
Dabigatran = idarucizamab
Apixaban/rivaroxaban = andexanet alfa
41
How is INR calculated?
INR = (patient PT ÷ normal PT) x ISI
42
Key factors which may potentiate warfarin?
Liver disease
P450 enzyme inhibitors
43
List some P450 inducers vs inhibitors?
Inducers = phenytoin, carbamazepine, rifampicin, St John's wort, phenobarbitone, chronic alcohol use
Inhibitors = ciprofloxacin, erythromycin, isoniazid, amiodarone, ketoconazole, acute alcohol use
44
Management of INR 5.0-8.0 (no bleed vs bleed), INR > 8 (no bleed vs bleed) and major haemorrhage?
INR 5.0-8.0 (no bleed) = withhold 1 or 2 doses, reduce maintenance dose
INR 5.0-8.0 (bleed) = stop warfarin, IV vitamin K, restart warfarin when INR < 5.0
INR > 8 (no bleed) = stop warfarin, oral vitamin K, restart warfarin when INR < 5.0
INR > 8 (bleed) = stop warfarin, IV vitamin K, restart warfarin when INR < 5.0
Major haemorrhage = stop warfarin, IV vitamin K, prothrombin complex (1st line) or FFP (2nd line)
45
Examples of tachycardia?
Sinus tachycardia
Atrial fibrillation
Atril flutter
Re-entrant pathways
Ectopic beats
46
Classification of tachycardias?
Narrow, regular
Narrow, irregular
Wide, regular
Wide, irregular
47
Management of REGULAR narrow complex tachycardia?
Unstable = synchronised DC cardioversion!
Stable = vagal manoeuvres e.g. carotid sinus massage or Valsalva manoeuvre (1st line), adenosine 6mg → 12mg → 18mg (2nd line)
48
Management of REGULAR broad complex tachycardia?
Unstable = synchronised DC cardioversion!
Stable = amiodarone or lidocaine
49
Management of torsades de pointes?
Unstable = synchronised DC cardioversion!
Stable = IV magnesium sulphate
50
Outline the types of AF?
Acute (< 48 hours)
Paroxysmal AF (< 7 days, episodic)
Persistent AF (> 7 days, responds to cardioversion)
Permanent AF (> 7 days, no response to cardioversion)
51
Overview of acute AF management?
< 48 hours = rate OR rhythm control
> 48 hours or uncertain = rate control
52
Rate control management of AF?
1st line = beta-blocker or non-dihydropyridine CCB
2nd line = dual therapy of beta-blocker, diltiazem or digoxin
53
Rhythm control management of AF?
DC cardioversion
Pharmacological cardioversion
→ structural heart disease = amiodarone
→ no structural heart disease = flecainide
54
Advice for cardioversion management of AF?
< 48 hours = DC or pharmacological cardioversion
> 48 hours or uncertain = 3 weeks anticoagulation then DC cardioversion or TOE to exclude thrombus in the left atrial appendage then immediate DC cardioversion
55
Score to assess stroke vs bleeding risk of AF patients?
Stroke = CHA2DS2VASC
Bleeding risk = ORBIT
56
CHA2DS2VASC criteria and recommendation based on score?
CHF, HTN, > 75, DM, stroke/TIA/VTE, vascular disease, 65-74, female
0 = no treatment
1 = consider anticoagulation (male), no treatment (female)
≥ 2 = anticoagulation
57
Drug options for AF anticoagulation?
Non-valvular AF = DOAC
Valvular AF/prosthetic valve = warfarin
58
Management of atrial flutter?
Initially the same as AF e.g. rate/rhythm control
Radiofrequency ablation is curative
59
Examples of bradycardia?
Sinus bradycardia
Sick sinus syndrome
Heart block
60
Outline the types of heart block?
1st degree = PR > 0.2, regular
2nd degree (Mobitz I) = PR prolongs until dropped beat
2nd degree (Mobitz II) = PR interval constant but beat sometimes dropped
3rd degree = no association between P wave and QRS
61
Management of bradycardia?
1st line = atropine 500mcg (repeat up to 3mg)
2nd line = transcutaneous pacing
3rd line = transvenous pacing or permanent pacemaker
62
Which types of heart block require a permanent pacemaker?
Mobitz type II
3rd degree (complete) heart block
63
Shockable vs non-shockable cardiac arrest rhythms?
Shockable = VF and pulseless VT
Non-shockable = PEA and asystole
64
4 Hs and 4 Ts of reversible cardiac arrest?
Hs = hypoxia, hypothermia, hyper/hypo and hypovolaemia
Ts = thrombosis, toxins, tamponade and tension pneumothorax
65
Defibrillation management of shockable rhythm?
Arrest witnessed = 3 successive shocks then 2 mins CPR
Arrest unwitnessed = 1 shock then 2 mins CPR
66
Drug management of non-shockable vs shockable cardiac arrest?
Non-shockable = adrenaline 1mg STAT
→ adrenaline every 3-5 mins
Shockable = adrenaline 1mg + amiodarone 300mg after 3 shocks
→ adrenaline every 3-5 mins
67
How should drugs be given during cardiac arrest?
1st line = intravenous (IV)
2nd line = intraosseous (IO)
68
ECG feature of hypothermia?
J waves (upward deflection after QRS)
69
ECG features of hypokalaemia vs hyperkalaemia?
Hypo = flat/absent T waves, U waves, ST depression
Hyper = tall T waves, flat P waves, wide QRS
70
Antiarrhythmic drug classes and examples?
Class I (Na) = lignocaine, lidocaine, flecainide
Class II (beta) = propanolol, metoprolol, atenolol
Class III (K) = amiodarone, sotalol
Class IV (Ca) = verapamil, diltiazem
Misc = atropine, adenosine, ivabradine, digoxin
71
Atropine mechanism of action and side effects?
Mechanism of action = muscarinic antagonist
Side effects = anticholinergic (e.g. dry eyes/mouth, urinary retention)
72
Adenosine mechanism of action and side effects?
Mechanism of action = causes transient AVN block
Side effects = bronchospasm, chest pain, flushing
73
Ivabradine mechanism of action and side effects?
Mechanism of action = blocks the pacemaker channel
Side effects = heart block, bradycardia, luminous phenomena
74
Digoxin mechanism of action and side effects?
Mechanism of action = blocks the Na+/K+ ATPase
Side effects = GI upset, anorexia, yellow-green vision, arrhythmias, gynaecomastia
75
ECG feature of digoxin use?
ST "scooped out" or "reverse tick sign"
76
Classic cause of digoxin toxicity and management?
Hypokalaemia
→ digoxin binds to K site on the N+/K+ ATPase so less K means more digoxin binding
Management = digibind (digoxin antibody)
77
Monitoring requirements of amiodarone?
6 monthly TFTs and LFTs
78
Features, investigation and management of pericarditis?
Generally unwell (e.g. fever)
Pleuritic chest pain (worse lying down)
Pericardial rub
Investigation = transthoracic echo
Management = NSAID + colchicine
79
ECG features of pericarditis?
PR depression (most specific)
Widespread "saddle" ST elevation
80
JVP feature of constrictive pericarditis?
Kussmaul's sign (JVP rises on inspiration)
81
Features, investigation and management of myocarditis?
Generally unwell (e.g. fever)
Chest pain
Typically young patient
Commonly seen with pericarditis
Investigation = endomycocardial biopsy
Management = supportive management
82
Modified Duke's criteria scores for infective endocarditis diagnosis?
2 major criteria OR
1 major + 3 minor criteria OR
5 minor criteria
83
What are the 2 major and 5 minor Duke's criteria?
Major = positive blood cultures, endocardial involvement
Minor = predisposition, fever > 38 °C, negative microbiology, vascular phenomena, immunological phenomena
84
Most common valve affected in infective endocarditis in IVDUs vs non-IVDUs?
IVDUs = tricuspid valve
Non-IVDUs = mitral valve
85
Pathogen associated with infective endocarditis in IVDUs, poor dental hygiene, prosthetic valves and GI pathology?
IVDUs = staphylococcus aureus
Poor dental hygiene = streptococcus viridans
Prosthetic valves = staphylococcus epidermidis
GI pathology = streptococcus bovis
86
Antibiotic management of infective endocarditis?
Native valve = amoxicillin + gentamicin
Prosthetic valve = vancomycin + gentamicin + rifampicin
Staph aureus = flucloxacillin
87
Stanford classification of aortic dissection?
Type A (most common) = ascending aorta
Type B = descending aorta
88
Features, investigations and management of aortic dissection?
Tearing chest pain (may radiate to back)
Radio-radial or radio-femoral delay
Pulse deficit
BP different between arms
Investigations = CT angiography (stable) or TOE (unstable)
Management = manage BP e.g. IV metoprolol + surgery (type A) OR conservative management (type B)
89
Cause of S1, S2, S3 and S4 heart sounds?
S1 = mitral and tricuspid closure
S2 = pulmonary and aortic closure
S3 = diastolic ventricular filling
S4 = atria contracting against stiff ventricle
90
Rule for hearing murmurs best?
RILE:
→ right-sided on inspiration
→ left-sided on expiration
91
Ejection systolic murmur causes?
Aortic stenosis
Pulmonary stenosis
Atrial septal defect (ASD)
Tetralogy of Fallot
HOCM
92
Pansystolic murmur causes?
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect (VSD)
93
Early diastolic murmur causes?
Aortic regurgitation
Pulmonary regurgitation
94
Mid-late diastolic murmur cause?
Mitral stenosis
95
Murmur associated with AF, wide PP, narrow PP, collapsing pulse, slow rising pulse, large JVP V wave and malar flush?
AF = mitral stenosis
Wide PP = aortic regurgitation
Narrow PP = aortic stenosis
Collapsing pulse = aortic regurgitation
Slow rising pulse = aortic stenosis
Large JVP V wave = tricuspid regurgitation
Malar flush = mitral stenosis
96
Most common cause of aortic vs mitral murmurs?
Aortic stenosis = calcification
Aortic regurgitation = infective endocarditis
Mitral stenosis = rheumatic fever
Mitral regurgitation = valve prolapse
97
Management of valve disease?
Asymptomatic = monitor
Symptomatic = surgery e.g. replacement, vavuloplasty
98
Indication for aortic valve surgery in an asymptomatic patient?
Valvular gradient > 40mmHg + LVD
99
Features of right-sided vs left-sided heart failure?
Right-sided = peripheral oedema, raised JVP, hepatomegaly, anorexia
Left-sided = dyspnoea, orthopnoea, PND, pulmonary oedema
100
CXR features of heart failure?
Alveolar oedema
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated upper lobe vessels
Effusion
Fluid in the horizontal fissure
101
Investigations for heart failure?
NT-proBNP (1st line)
Tranthoracic echocardiogram
102
Management of patients with raised NT-proBNP?
> 2000ng/L = 2 week referral for assessment + echo
400-2000ng/L = 6 week referral for assessment + echo
103
NYHA classification of heart failure?
Class I = no symptoms
Class II = mild
Class III = moderate
Class IV = severe (e.g. symptoms at rest)
104
What is ejection fraction and value for heart failure diagnosis?
Percentage of ventricular diastolic volume ejected during ventricular systole
→ < 40% = HFrEF
→ ≥ 40% = HFpEF
105
High-output heart failure and causes?
Normal heart can't meet metabolic demands
→ anaemia, pregnancy, thyrotoxicosis
106
Management of acute heart failure?
Non-hypotensive = IV loop diuretic
Hypotensive = inotropic agents (e.g. dobutamine), vasopressors (e.g. adrenaline)
107
Management of chronic heart failure?
1st line = ACEi + beta-blocker
2nd line = add aldosterone antagonist
3rd line = add SGLT2 inhibitor or ivabradine or digoxin or salcubitril-valsartan or hydralazine + nitrate
108
Drugs which reduce mortality in chronic heart failure?
ACEi/ARB
Beta-blocker
Aldosterone antagonist
109
Vaccination recommendations for heart failure?
One-off pneumococcal + annual influenza
110
Main investigation for hypertension?
Ambulatory BP monitoring (ABPM) or
home BP monitoring (HBPM)
111
Additional investigations for hypertension and why?
ECG = LVH
U&Es = renal disease
Urinalysis = renal disease
HbA1c = co-existing diabetes
Lipid profile = co-existing hyperlipidaemia
Fundoscopy = diabetic retinopathy
112
Classification of hypertension?
Stage 1 = clinic ≥ 140/90 and ABPM/HBPM ≥135/85
Stage 2 = clinic ≥ 160/100 and ABPM/HBPM ≥ 150/95
Stage 3 = clinic systolic ≥ 180 OR diastolic ≥ 120
113
Drug options for hypertension?
1st line = A (< 55 or T2DM) OR C (> 55 or Afro-Caribbean)
2nd line = A+C or A+D (< 55 or T2DM) OR C+A OR C+D (> 55 or Afro-Caribbean)
3rd line = A+C+D
4th line = spironolactone (K < 4.5) OR alpha-blocker e.g. doxasozin or beta-blocker e.g. atenolol (K > 4.5)
114
Blood pressure targets for < 80 years vs > 80 years?
< 80 = 140/90
> 80 = 150/90
115
ACEi/ARB examples, side effects and cautions?
ACEi = ramipril, lisinopril
ARB = losartan, candesartan
Side effects = hyperkalaemia, cough (ACEi), angioedema (ACEi)
Cautions = pregnancy, renovascular disease
116
ACEi/ARB renal advice?
Generally renoprotective
Contraindicated in bilateral renal artery stenosis
Monitor U&Es regularly
117
Beta-blocker examples, side effects and cautions?
Cardioselective (β1) = atenolol, bisoprolol, metoprolol
Non-cardioselective (β1/β2) = propanolol, carvedilol, labetalol
Side effects = bronchospasm, hyperkalaemia, cold extremities, erectile dysfunction, sleep issues, fatigue
Cautions = asthma, uncontrolled HF, verapamil use
118
Calcium channel blocker examples and side effects?
Dihydropyridines = amlodipine, nifedipine
Non-dihydropyridines = verapamil, diltiazem
Side effects = peripheral oedema, flushing, headache
119
Thiazide diuretic examples, mechanism of action and side effects?
Thiazide = bendroflumethiazide
Thiazide-like = indapamide
Mechanism of action = blocks NaCl reabsorption in the DCT
Side effects = hyponatraemia/hypokalaemia, hypercalcaemia, impaired glucose tolerance, gout, erectile dysfunction
120
Loop diuretic examples, mechanism of action and side effects?
Examples = furosemide, bumetanide
Mechanism of action = blocks Na reabsorption in the thick ascending LoH
Side effects = hyponatraemia/hypokalaemia/hypocalcaemia, hypercalciuria, ototoxicity
121
Potassium sparing diuretic examples and side effects?
Aldosterone antagonists = spironolactone, eplerenone
ENaC inhibitors = amiloride
Side effects = hyperkalaemia, endocrine dysfunction (aldosterone antagonist)
122
Criteria and management of orthostatic hypotension?
Drop of ≥ 20mmHg systolic +/- ≥ 10mmHg diastolic within 3 mins of standing
Management = midodrine or fludrocortisone
123
Score used to investigate patients with low suspicion of a PE and interpretation?
Pulmonary embolism rule-out criteria (PERC)
All must be absent for negative result
124
Score used to investigate patients with suspected PE and values?
Wells score
> 4 points = PE likely
≤ 4 points = PE unlikely
125
Investigations for a likely PE (Wells > 4)?
Urgent CTPA
DOAC if CTPA delayed
+ve CTPA = PE confirmed
-ve CTPA = consider doppler scan
126
Investigations for an unlikely PE (Wells ≤ 4)?
D-dimer
+ve D-dimer = urgent CTPA
-ve D-Dimer = consider alternative diagnosis
127
Indication for V/Q scan in PE and why?
Renal disease or pregnancy
No contrast required (renal), no increased risk of breast cancer (pregnancy)
128
Management of stable PE?
Provoked = 3 months of DOAC
Unprovoked or cancer = 6 months of DOAC
129
Management of unstable vs recurrent PE?
Unstable = thromboylsis e.g. alteplase
Recurrent = IVC filter
130
Score used to investigate patients with suspected DVT and values?
Wells score
≥ 2 = DVT likely
< 2 = DVT unlikely
131
Investigations for a likely DVT (Wells ≥ 2)?
Urgent leg USS
DOAC if USS delayed
USS +ve = DVT confirmed
USS -ve = consider D-dimer
132
Investigations for an unlikely DVT (Wells < 2)?
D-dimer
D-dimer +ve = urgent leg USS
D-dimer -ve = consider alternative diagnosis
133
Management of DVT?
Provoked = 3 months of DOAC
Unprovoked or cancer = 6 months of DOAC
134
Preferred anticoagulant in pregnancy and why?
LMWH e.g. dalteparin
→ does not cross the placenta
135
Advice for patients regarding flights and thrombosis?
Low risk = no measures needed
Moderate-high risk = compression stockings
136
Most common cardiomyopathy?
Dilated cardiomyopathy
137
Most common cause of death in young athletes?
Hypertrophic obstructive cardiomyopathy (HOCM)
138
Medical name for "broken heart" syndrome?
Takotsubo cardiomyopathy
139
ECG feature of Wolff-Parkinson White (WPW) syndrome and management?
Slurred QRS upstroke (delta wave)
Management = radiofrequency ablation
140
ECG feature of Brugada syndrome and management?
ST elevation in V1-V3 followed by inverted T wave
Management = ICD
141
Heart condition associated with DiGeorge vs Turner's syndrome?
DiGeorge = Tetralogy of Fallot
Turner's = coarctation of the aorta
142
Large cell vasculitis associated with occlusion of the aorta and absent limb pulses?
Takayasu's arteritis
143
Small and medium vessel vasculitis with strong link to smoking?
Buerger's disease (thromboangiitis obliterans)
144
Outline the screening programme for AAA?
One-off abdominal USS for men age 65
→ < 3cm = no action
→ 3-4.4cm = re-scan every 12 months
→ 4.5-5.4cm = re-scan every 3 months
→ ≥ 5.5cm = refer for intervention
145
High rupture risk features of AAA?
Symptomatic
≥ 5.5cm
Grown > 1cm/year
146
Management of AAA?
Endovascular repiar (EVAR)
Open aneurysm repair
147
Abnormal ABP values?
< 0.9 or > 1.2
148
Location of venous vs arterial ulcers and management?
Venous = above medial/lateral malleoli
→ compression bandaging
Arterial = toes, shins, pressure points
→ modify risk factors e.g. hypertension
149
Features of lower limb venous insufficiency?
Varicose veins
Venous ulcer
Stasis eczema
Lipodermatosclerosis
Haemosiderin deposition
Superficial thrombophlebitis
150
Management of superficial thrombophlebitis?
Compression stockings + NSAID
151
What does peripheral arterial disease (PAD) cover?
Intermittent claudication
Critical limb ischaemia
Acute limb-threatening ischaemia
152
Features and management of intermittent claudication?
Pain in leg muscles during exercise then resolves at rest
Management = exercise regime + statin + clopidogrel
153
Features and management of critical limb ischaemia?
Rest pain (hang legs out of bed)
Ulceration
Gangrene
Management = endovascular revascularisation (< 10cm) or open surgical revascularisation (> 10cm)
154
Features and management of acute limb-threatening ischaemia?
Pale, pulseless, painful, paralysed, paraesthesis, perishingly cold
Management = analgesia + urgent vascular review
155
Wet vs dry gangrene and management?
Wet = infectious e.g. necrotising fasciitis
→ IV antibiotics + debridement or amputation
Dry = non-infectious e.g. ischaemic
→ amputation
