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* year 3 core conditions (detailed) > cardiovascular > Flashcards

Flashcards in cardiovascular Deck (32):
1

MI/ACS:
- most common cause?
- non-modifiable risk factors? 3
- modifiable risk factors? 8

rupture/erosion of the fibrous cap of atheromatous plaque in coronary artery -> platelet-rich clot + vasoconstriction produced by platelet release of serotonin + thromboxane

nb can rarely be dt vasospasms or vasculitis

- older age
- male
- FH (1st degree relative had IHD <50)

- hyperlipidaemia
- hypertension
- metabolic conditions (diabetes)
- poor diet
- lack of exercise
- stress/depression
- smoking
- cocaine use

2

MI/ACS:
- symptoms? 8
- what is a silent MI?
- who is most likely to get a silent MI? 2

- acute central chest pain (>20 mins)
- pain in L arm, jaw or back

- anxiety (impending doom)
- fatigue
- nausea

- sweatiness
- palpatations
- SOB

MI presents without chest pain
- elderly
- diabetics

3

MI/ACS:
- signs? 3

nb history often more important!

- pale/grey
- sweaty (can't fake!)
- high pulse

nb may be signs of heart failure (^JVP, , 3rd heart sound, basal crepitus)

nb may also hear pericardial rub

4

MI/ACS:
- bloods? 5
- other investigations? 1

- troponin
nb creatinine Kinase -MB rarely used now

- FBC
- U+Es
- glucose
- lipids

- ECG (ST elevation or new LBBB)

nb in 20% of ACS, ECG is normal initially!

can do CXR to exclude differentials but don't delay treatment to do!

5

MI/ACS:
- initial pharm treatment? 7 (acronym)
- treatment for STEMI? 2

BROMANCE
- beta-blockers
- reassurance
- oxygen
- morphine (IV)
- aspirin
- nitrates (GTN)
- clopidogrel
- antiEmetics (eg metoclopramide)

(nb sometimes give a NOAC as well for VTE prophylaxis)

nb don't give B blockers if:
- bradycardiac
- hypotensive
- heart failure
- asthmatic

- fibrinolytics (rTPA)
- PCI surgery


6

MI/ACS
- long-term pharm treatments? 5
- long-term non-pharm treatments? 4

- aspirin
- clopidogrel
- statin
- B blocker (norm metoprolol)
- ACE inhibitor

- more exercise
- control diabetes (if relevant)
- better diet
- stop smoking

7

differential diagnosies for MI/ACS:
- cardiovascular? 5
- resp? 2
- GI? 3
- other? 1

- angina
- pericarditis
- myocarditis
- aortic dissection
- PE

- pneumonia
- pneumothorax

- oesophageal spasm
- GORD
- acute pancreatitis

- MSK pain

8

Angina pectoris:
- three types?
- pathophysiology?

- stable angina
- unstable angina
- prinzmetal (variant) angina

normally atheroma -> reduced O2 supply to heart muscle -> pain
(other rarer causes)

variant angina spasms in coronary artery

9

Angina pectoris:
- modifiable risk factors? 4
- unmodifiable risk factors? 6

- high fat diet
- smoking
- lack of exercise
- psychological stress

- age
- male
- FH (IHD <50yrs)
- diabetes
- hypertension
- elevated CRP

10

Angina pectoris:
- three features of stable angina (according to NICE)?
- triggers for stable angina, bar physical exertion? 3
- associated symptoms? 4

- constricting discomfort in:
--- front of chest
--- neck
--- shoulders
--- jaw
--- arms

- precipitated by physical exertion

- relieved by rest or GTN within about 5 mins

- emotion
- cold weather
- heavy meals

- dyspnoea
- nausea
- sweating
- light-headedness

11

Angina pectoris:
- symptoms that make diagnosis of stable angina unlikely? 5

- continuous or very prolonged pain
- pain unrelated to exertion/other triggers
- pain brought on by breathing
- pain associated with dizziness
- pain associated with palpitations, tingling or difficulty swallowing

12

Angina pectoris:
- ECG changes? 3

- pathological Q waves (in particular)
- LBBB
- ST- segment + T-wave abnormalities (eg ST-segment depression, T-wave flattening or inversion)

a normal ECG does not confirm or exclude angine!

13

Angina pectoris:
- non-pharm management? 3
- pharm management? 4

- stop smoking
- loose weight
- more exercise

- GTN spray (contraindicated w Viagra)
(- consider long-acting nitrate)

- Beta-blocker (or Ca channel blocker)
- Aspirin
- Statin (if high chol)

nb can give K+ channel activator (eg nicorandil) if unresponsive

nb get diabetes and HTN under control too

nb consider surgery if bad

14

Angina pectoris differentials:
- CVS? 7
- Resp? 3
- GI? 4
- MSK? 4
- psych? 1

CVS
- MI
- unstable angina
- prinzmetal angina
- dissecting thoracic aneurysm
- pericarditis
- acute HF
- arrhythmias

Resp
- PE
- pneumothorax
- pneumonia

GI
- peptic ulcer
- ruptured oesophagus (boerhaves*)
- GORD
- pancreatitis

MSK
- costochondritis
- rib fracture
- arthritis
- pulled muscle

Psych
- anxiety/panic attack

15

AF
- commonest causes? 4
- other causes?
- what percentage are idiopathic ('lone AF')?

common:
- IHD (+/ MI or heart failure)
- HTN
- valvar heart disease
- hyperthyroidism

other:
- congenital heart disease
- caffeine/alcohol/stimulants
- sick sinus syndrome
- wolf-parkinson white
- acute infection (e.g. pneumonia)
- PE
- low K or Mg

10% are idiopathic

16

AF:
- risk factors? 3

- excessive alcohol + caffeine intake
- obesity
- age

17

AF:
- symptoms? 4
- signs? 1

- palpitations
- chest pain/dyscomfort
- dyspnoea
- faintness

nb often asymptomatic

- irregularly irregular pulse

nb if caused by valve disease then will hear a murmur (nb often mitral valve disease)

18

AF:
- bloods? 3
- other test needed? 1
- findings on other test? 2

- U&E
- troponin
- thyroid function test

- ECG

- absent P waves
- irregular QRS complexes

nb consider echo to look for structural abnormalities

19

AF:
- three TYPES of treatment?
- outline above treatment and which patients each would be suitable for

1) treat underlying cause
- suitable for:
--- acute precipitating event (alcohol toxicity, infection, hyperthyroidism)

2) Rhythm control
- suitable for:
--- younger patients (<65)
--- highly symptomatic
--- concurrent CCF
--- recent onset AF (<48hrs)
- how:
--- echo (TOE) to check for thrombus, treat with lmwh or warfarin prior to cardioversion (4 wks if thrombus found or >48hrs after start of AF)
--- pharmacological or electrical cardioversion

Rate control:
- suitable for:
--- older patients (>65)
--- previous cardio version failure
- how:
--- Warfarin (or dabigitran)
--- Beta blocker (or rate-limiting Ca channel blocker)
(--- if fails, add amiodarone or digoxin)

20

AF:
- differential diagnoses? 6

- atrial flutter* (sawtooth pattern)

- atrial extra systoles
- ventricular ectopic beats

- sinus tachycardia
- supra ventricular tachycardia
- wolf-parkinson white

21

Essential HTN:
- systolic/diastolic definition of high BP?
- % prevalence in 45-54 yo?
- % prevalence in over 75s?
- % that is actually secondary to another condition (e.g. conn's syndrome)

over 140/90mmHg

- 30% of 45-54 yo
- 70% of over 75s

5% is secondary

22

Essential HTN:
- non-modifiable risk factors? 3
- modifiable risk factors? 4

- afrocarribean ethnicity
- increased age

- FH
- diabetes


- obesity
- high salt intake

- high alcohol intake
- smoking

23

Essential HTN:
- bedside tests/investigations? 3
- blood tests? 3

- BP (incl 24-hr BP monitor)
- fundoscopy (hypertensive retinopathy)
- urine dipstick (protein)

nb can also do an ECG (looking for LVH or myocardial ischaemia) or possibly even an echo

nb on cardio exam may find LV heave or artery bruits

- blood cholesterol
- fasting glucose
- U&E (see kidney damage)

24

Essential HTN:
- non-pharm management? 6
- pharm control for all? 1
- 1st line drug for <55 yo?
- 1st line drug for >55 yo + black ethnicity of any age?

- weight loss
- exercise
- low fat diet
- reduce salt intake
- reduce alcohol intake
- stop smoking

- statin (also diabetes control if relevant)

<55 yo
- ACE inhibitor (or ARB if hate cough)

>55 yo or black
- Ca channel blocker (or thiazide diuretic)

25

DVT:
- Risk factors? 10

- increased age
- obesity

- past DVT

- pregnancy
- synthetic oestrogen

- trauma
- surgery (esp pelvic or orthopaedic)

- immobility

- cancer
- thrombophilia

26

DVT:
- symptoms + signs
- scoring system used?
- blood test?
- imaging?

- red
- painful
- swollen
- hot

must be UNILATERAL

- WELLS

- D-dimer (very sensitive, not specific)
(- nb could do specific bloods if suspect thrombophilia)

- ultrasound of leg

27

DVT:
- treatment?
- prevention? 3

- high dose LMWH
- or high dose LMWH with warfarin then take LMWH off

(nb warfarin is pro-thrombotic for first 48hrs)

- low dose LMWH
- TED stockings
- stay mobile

28

DVT:
- infectious differential diagnoses? 3
- other DD? 4

- cellulitis
- superficial thrombophlebitis
- insect bite

- ruptured baker's cyst
- sprain/rupture achilles tendon
- physical trauma (imvl haematoma)

- peripheral (stasis) oedema (or lymphedema)

nb other rarer causes (e.g. compartment syndrome)

29

Common causes of heart failure:
- Right-sided? 4
- Left-sided? 4

Right-sided
- LVF
- pulmonary stenosis
- Right ventricular MI
- lung disease (cor pulmonate)

Left-sided
- Left-ventricular MI
- hypertension
- aortic stenosis
- mitral or aortic regurg

nb CCF = right AND left failure

nb rare causes include steroids, come chemo, cocaine and other stuff

30

Signs + symptoms of heart failure:
- Right-sided? 6
- Lef-sided? 10

Right-sided

- peripheral oedema
- ascites
- nausea
- anorexia
- pulsation in neck + face (RHF -> tricuspid regurg)
- murmur (+/or 3rd 'gallop' heart sound)

Left-sided

- fatigue
- wheeze (cardiac 'asthma')
- SOB
- poor exercise tolerance
- displaced apex beat
- cold peripheries

- nocturnal cough (+/- pink frothy sputum)
- orthopnoea
- paroxysmal nocturnal dyspnoea (PND)
- nocturia




nb think logically about the back-up of fluid when each side of the heart has failed

31

Heart failure:
- blood tests?
- other investigations? (and what they show)

- BNP
- FBC
- U&E
(- LFT, may cause hepatic-congestion)

- ECG (indicate cause)

- CXR (ABCDE)
--- Alveolar oedema (bat wing shadow)
- Kerley B lines (interstitial oedema)
--- Cardiomegaly (heart width >50%)
--- Dilated prominent upper lobe vessels
--- pleural Effusion (blunting of angles)

- Echocardiogram
--- valvular defects, previous MI, ejection fraction, hypertrophy etc

32

Heart failure differential diagnoses:
- conditions causing dyspnoea? 5
- conditions causing peripheral oedema? 6

dyspnoea DD:

- COPD
- asthma
- PE
- lung cancer
- anxiety

peripheral oedema DD:

- prolonged inactivity
- venous insufficiency

- nephrotic syndrome
- hypoalbuminaemia

- some drugs (some Ca channel blockers, NSAIDs)

- obesity