Flashcards in CARDIOVASCULAR Deck (81)
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1
What is the different stages of hypertension
Stage 1: 140/90mmHg
Under 80 and 135/85mmHg
with
risk factors:
diabetic/renal disease/CVD/end organ damage
Stage 2: 160/100mmHg
SEVERE
Stage3: 180/110mmHg
Stage 4:
Persistent
2
What increases the risk of hypertension
Smoking
Diabetes
Hyperlipidaemia
Previous MI or stroke
Family history
Increased age - decreases arteriole compliance
Alcohol
High sodium diet (<6mg)
Obesity (activates SNS)
Low birth weight
3
What is the aetiology of hypertension
Primary - idiopathic
Secondary
Drug induced: oral contraceptive, NSAIDS, Steriods
Endocrine disorder: cushions, chronns
Co-arctation of aorta
Sleep apnoea
Renal disease: renal artery stenosis
4
What is the investigations for hypertension
ABPM - Ambulatory Blood pressure Monitoring
HBPM - Home Blood pressure Monitoring
For end organ damage:
ECG + ECHO
Renal ultrasound
asses GFR
5
What is the treatment plan for hypertension
TARGET BP
< 135/80mmHg
Over 80 years
<145/85mmHg
STAGE 1:
-CBB if over 55 or pregnant
or
-ACEI/ARB if under 55
STAGE 2:
-add thiazide diuretic with either CBB or ACEI
STAGE 3
- CBB+ACEI +Thiazide
STAGE 4:
- Further diuretic therapy
low K+ levels
- low does spironolactone
- further diuretic therapy
High K+ levels
-higher dose thiazide
PREGNANT
Before:
- CBB: nifiedipine
- beta blocker: atenelol
- Centrally acting agent: methydopa
During:
- add thiazide diuretic
-CBB: amlodipine
6
What is the symptoms of angina
pain or discomfort radiating from your retrosternal chest into your neck and jaw and down your left arm
Tight band pressure and heaviness on the chest
Stable - aggravates with exercise
Unstable - happens are rest
7
What is the investigations for stable angina
Bloods:
FBC
Lipid profile
Electrolytes
Liver/thyroid test
CXR
ECG
QRS- LVH
ST segment depression
Evidence of myocardial ischaemia
Exercise tolerance test/ETT
Myocardial perfusion imaging
Computed tomography (CT) coronary angiography
Cardiac catheterisation/coronary angiography
8
What is the medical treatment for stable angina
FIRST LINE TREATMENT:
Short acting nitrates - GTN
Beta blockers - bisoprolol/atenolol
SECOND LINE TREATMENT:
IK channel blockers (Ranolazin/Ivabradine)
Long-acting nitrates
K channel blockers (Nicorandil)
Fatty acid oxidation inhibitor -Trimetazidine
Angioplasty:
PCI- stenting or CABG
General measures to stop disease progression:
Statins
ACE inhibitors
Aspirin (or clopidogrel if allergic)
9
What is acute coronary syndrome
Spontaneous plaque rupture & local thrombosis, with
degrees of occlusion resulting in unstable angina, NSTEMI, STEMI, and sudden cardiac death
Potentially leading to myocardial necrosis
10
What is the risk factors of stable angina and ACS
Smoking
Lifestyle- exercise & diet
Diabetes mellitus
Hypertension
Hyperlipidaemia
11
What is the investigations for ACS
ECG
- ST elevation or depression?
-is Irregular/ Ventricular fibrillation /multiple wavelets?
ECHO
-Overall contractility
- MR
-abnormality
-LV ejection: LV dysfunction
Troponin test
Blood test
CXR
12
What is the medical treatment for ACS
IMMEDIATE
Morphine (or diamorphine)
Oxygen
Nitroglycerine (GTN spray or tablet)
Aspirin 300 mg orally (crush/chew)
Fibrinolysis /thrombrolysis
Primary PCI
Defibrillation
LATER TREATMENT
Dual anti-platelet therapy Aspirin + ADP receptor (clopidogrel) for one year following ACS event
SECONDARY PREVENTION: REDUCE RISK
ADP receptor blocker: clopidogrel
antithromboytic therapy: Heparin + Fondaprinux
Intravenous nitrate
Statin
Beta blockers - no other contradictions
ACE inhibitors - LV dysfunction present
Coronary revascularisation treatment: CABG or PCI
13
Define aneurysm
Weakened blood vessel wall, which is pushed outwards due to blood pressure causing excessive localised swelling in the wall of an artery
True: involving all 3 layers
False: thin adventitial layer or by the surrounding soft tissue
Dissecting: An aneurysm in which the inner wall of an artery rips longitudinally, the blood forces the wall apart creating two lumen passages
14
What is the aetiology of THORASIC AORTIC DISSECTING ANEURYSM
Hypertension
Atherosclerosis
Trauma
Smoking
Marfan's syndrome
co-arctation
Bicuspid valve
Syphilis/mycotic infection
15
What is the signs and symptoms of an aortic aneurysm
SOB
Heart Failure: pulmonary oedema
Hypotension
Pulsatile mass, tender
Back pain
In the Ascending aorta
Dysphagia (difficult swallowing)
Hoarseness
Sharp chest pain radiating to back and between shoulder blades
Collapse
- due to rupture or dilation
ST elevation
soft early diastolic murmur - AR
Reduced or absent peripheral pulses
(BP mismatch between sides)
Hypotension/ hypertension
16
What is the treatment of aneurysm
TYPE A - ascending aorta : Surgery
Open
Endovascular
TYPE B descending aorta : BP control
(sodium nitroprusside plus beta blocker)
17
What is the investigations for aneurysm
Screening
Ultrasound
- easy, cant plan from
CT /MRA
- detailed anatomy,
- bad for contrast + radiation
ECHO
Test for fitness for surgery
Lung function
ECG
Bloods
18
What is the investigations for chronic/ acutelimb ischaemia
Exercise tolerance test
Ankel brachial pressur index
Bruegers test - thombosis
Ascultation of peripheral pulses
CT/MRA
-First line
- allows treatment planning
Duplex
Digital subtraction angiogram
- visualise blood vessels
19
What is the treatment of chronic/ acutelimb ischaemia
Anti-coagulation:
Antiplatelte therapy
Statin therapy
Analgesia
Embolectomy/ thromectomy
Thrombolysis
Angioplasty and stent
Surgical bypass
- new route for blood
Non-Salvageable
Amputation
Smoking cessation
Diabetic control
BP control
Exercise
20
What is the cause of chronic and acute limb ischaemia
Chronic
-Atheosclerotic, Vasculitis
Buergers disease - thrombosis
(linked to smoking)
Diabetes mellitus
Acute: thrombosis or embolus
21
What is the symptoms and staging of chronic limb ischemai
Ulceration, Pallor
Feet slow to regain colour - then dark red appears
(Decreases capillary refill time)
Hair loss
decreased peripheral pulses
Diabetes
STAGE 1: Asymptomatic
STAGE 2: Mid claudication (cramping) pain in limb
{IIA- walking >200m}
{IIB - walking <200m}
STAGE 3: Rest pain, mostly in the feet
STAGE 4: Necrosis, gangrene of the limb
22
What is the symptoms for acute limb ischaemia
Pain
Pallor
Perishingly cold
Paraesthesia
Paralysis
Pulseless
(compared in both legs)
23
Definition of varicose veins and aetiology
Dilated swollen superficial veins in the lower limbs
if the valves become weaked or damaged then blood can back up and pool in the veins; causing them to swell
long saphenous; 80-87%
short sapnhenous; 21-30%
24
Risk factors of varicose veins
Standing occupation
Pregnancy - twins
previous DVT
Previous major trauma
Family history - can be hereditary
Female
Lack of exercise
Obesity
25
Symptoms and signs of varicose veins
localised / generalised discomfort in the leg
nocturnal cramps
swelling
acute haemorrhage
pruritis (itching)
Superficial thrombophlebitis (inflammation of the wall of a vein associated with thrombosis)
Skin changes:
spider
discolouration
26
What is the investigations and treatment for vaircose veins
Duplex ultrasound
MANAGMENT
exercising, losing weight
elevation, loose clothing
compression hosiery (stockings)
Superficial venous Surgery:
Minimally invasive procedures involving thermal ablation:
Endovenous Laser removal
Radio frequency ablation
Injection - sclerotherapy
Compression
27
What is the definition of chronic venous insufficiency
and the aeitiology
a condition where veins cannot pump enough blood back to the heart
Venous hypertension
Varicose veins
Failure of muscle pumps
-Superficial /deep venous reflux
Venous obstruction
Neuromuscular
Obesity
Inactivity
28
What is the signs and symptoms of chronic venous insufficiency
Ankle oedema
Telangectasia - spider veins
Venous eczema
Haemosiderin pigmentation - orangey colour in the lower limbs
Hypopigmentation “atrophie blanche” - white patches
Lipodermatosclerosis - inflammation of subcutaneous fat in the legs
Venous ulceration
29
What is the investigations and management of chronic venous insufficency
Ambulatory venous pressure:
Fall in pressure from standing motionless to active movements
ABPI (Ankle Brachial Pressure Index)
Duplex ultrasound
compression therapy;
systemic / topical therapy; most ulcers colonised rather than infected
exercise; calf muscle pump
30
