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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

What is Deep vein thrombosis and its aetiology

Venous thromboembolism
in the legs

Venous thrombus due to disruption of virchos triad
- more due to stasis + hypercoagubility