Cardiovascular

Question 1

Who is Acute Coronary Syndrome most likely to effect and when?

Answer 1

Men, Early morning hours

Question 2

What causes Acute Coronary Syndrome?

Answer 2

Coronary arteries become blocked/narrowed due to plaque = irreversible necrosis of heart muscle due to ischaemia

Question 3

What can lead to blockage of the Coronary Arteries?

Answer 3

LDLs, Saturated fats, Trans fats

Question 4

What 3 conditions come under the umbrella term of Acute Coronary Syndrome?

Answer 4

Unstable Angina, NSTEMI, STEMI

Question 5

What is the difference between a NSTEMI and a STEMI?

Answer 5

NSTEMI = no changes on ECG but blood markers indicate damage

STEMI = ECG changes due to large area of heart muscle being affected

Question 6

Acute Coronary Syndrome Risk Factors

Answer 6

High BP/Cholesterol, Diabetes, Obesity, Smoking, Age, Family Hx, Stress, Illicit drug use

Question 7

Acute Coronary Syndrome Presentation

Answer 7

Tight chest, Pain radiating to back/jaw, Sweating, Nausea, Anxiety

Question 8

Acute Coronary Syndrome Signs

Answer 8

Tachycardia or Arrhythmia, Hypertension initially and then Hypotension, Increased RR, Fever, Pallor

Question 9

Acute Coronary Syndrome Investigations

Answer 9

ECG, Bloods (troponins), Angiogram, Echo

Question 10

Acute Coronary Syndrome Treatment

Answer 10

Aspirin, Thrombolytics, Antiplatelets, GTN, Beta-blockers, ACE inhibitors, Statins, Analgesics, Surgery (CABG)

Question 11

Angina Risk Factors

Answer 11

Smoking, Hypertension, Diabetes, Obesity, Hyperlipidaemia

Question 12

Angina Presentation

Answer 12

Chest discomfort, Precipitated by exertion, Relieved by rest or GTN

Question 13

What is Levine sign?

Answer 13

Clenched fist to describe pain - Angina

Question 14

Angina Investigations

Answer 14

Exercise/Stress test, ECG, Angiography

Question 15

Angina Treatment

Answer 15

Statins, Antiplatelets/Aspirin, Beta-blockers, CCBs, Ace inhibitors, Surgery if sever

Question 16

What percentage of stoke patients have Atrial Fibrillation?

Answer 16

15%

Question 17

What causes Atrial Fibrillation?

Answer 17

Electrical impulses from different places in the atria = Quivering

Question 18

What conditions can lead to Atrial Fibrillation?

Answer 18

Heart failure, Ischaemia, Hypertension, Mitral valve disease

PE, Pneumonia, Hyperthyroidism, Alcohol, Sepsis

Question 19

Atrial Fibrillation Presentation

Answer 19

Palpitations, Fatigue, SOB, Dizziness

Irregularly Irregular pulse

Question 20

Atrial Fibrillation Investigations

Answer 20

ECG (no p waves), Bloods, Echocardiogram

Question 21

Atrial Fibrillation Treatment

Answer 21

Digoxin/Amiodarone, Beta-blockers, Anticoagulants

Cardioversion if uncompensated

Question 22

Who is most likely to have Hypertension?

Answer 22

Black people (4x more common)

Question 23

What blood pressure values constitute Hypertension?

Answer 23

> 140 systolic

> 90 diastolic

Question 24

Hypertension Risk Factors

Answer 24

Family Hx, >65, Obesity, Alcohol, Diabetes, Smoking, Salt in diet, CVD

Question 25

Hypertension Presentation

Answer 25

Headache, Fatigue, Vision problems, Haematuria

Question 26

Hypertension Medical Treatment

Answer 26

ACE inhibitors/ARBs Calcium channel blockers Diuretics (Beta-blockers, Alpha blockers - if resistant)

Question 27

What are the 3 factors of Virchow's Triad which contribute to DVT?

Answer 27

Venous stasis, Hypercoagulability, Endothelial damage

Question 28

What is the most commonly affected site for DVT?

Answer 28

Calf

Question 29

DVT Risk Factors

Answer 29

Standing up for long periods of time, Surgery, Cancer, Obesity, Smoking, Birth control, Pregnancy

Question 30

DVT Presentation

Answer 30

Pain, Swelling, Redness, Warmth

Question 31

How many cases of DVT have no symptoms?

Answer 31

50%

Question 32

What is Homans sign?

Answer 32

Pain on dorsiflexion of foot (DVT)

Question 33

What score is used in the diagnosis of DVT?

Answer 33

Wells score

Question 34

DVT Investigations

Answer 34

USS, D-Dimer, Venography

Question 35

DVT Treatment

Answer 35

Anti-coagulation, Compression stockings

Question 36

Who is most likely to have Left-Sided Heart Failure?

Answer 36

Men, 50-70yrs, African-American

Question 37

What are the two classes of Left-Sided Heart Failure?

Answer 37

Systolic failure = cannot contract forcefully enough Diastolic failure = stiff/thick ventricle, can't fill properly

Question 38

Causes of Left-Sided Heart Failure

Answer 38

Coronary Artery Disease, Hypertension, Arrhythmia, Valvular damage

Question 39

Left-Sided Heart Failure Risk Factors

Answer 39

Cardiomyopathy, Cocaine use, Diabetes, Alcohol, Obesity, Smoking

Question 40

Left-Sided Heart Failure Presentation

Answer 40

Respiratory symptoms (SOB, Crackles, Oedema, Orthopnea), Fatigue, Dizziness

Question 41

Left-Sided Heart Failure Signs

Answer 41

Laterally displaced apex beat, Possible murmurs, Tachycardia

Question 42

Left-Sided Heart Failure Investigations

Answer 42

Chest X-ray, Echo, ECG, Bloods, ABG, Sats

Question 43

Left-Sided Heart Failure Treatment

Answer 43

Sodium restriction, Diuretics, Vasodilators, Inotropic agents (digoxin), Anticoagulants, Surgery (PCI)

Question 44

What is Congestive Heart Failure?

Answer 44

Left and Right Sided Heart Failure at the same time

Question 45

What extra symptoms are present with Congestive Heart Failure as well as those in Left-Sided Heart Failure?

Answer 45

Swelling in legs/ankles, Weight gain, Nausea

Question 46

Causes of Valvular disease?

Answer 46

Aging, Congenital, Rheumatic disease, Pregnancy

Question 47

Valvular Disease Presentation

Answer 47

Heart failure, Palpitations, Chest pain, Oedema

Question 48

Which Valvular Disease presents with a diastolic murmur and left ventricle enlargement?

Answer 48

Aortic Regurgitation

Question 49

Which Valvular Disease presents with a holosytolic murmur secondary to right ventricle dilation?

Answer 49

Tricuspid Regurgitation

Question 50

Which Valvular Disease presents with a holosystolic murmur and left atrial/ventricle dilation?

Answer 50

Mitral Regurgitation

Question 51

Which Valvular Disease presents with a harsh systolic murmur and an Enlarged left ventricle?

Answer 51

Aortic Stenosis

Question 52

Which Valvular Disease presents with left atrial enlargement and a diastolic rumble?

Answer 52

Mitral stenosis

Question 53

What is Right-Sided Heart Failure often caused by?

Answer 53

Cor Pulmonale

Question 54

Right-Sided Heart Presentation

Answer 54

Swelling, Ascites, Nocturia, Pitting oedema

Question 55

Right-Sided Heart Treatment

Answer 55

ACE/ARBs, Beta-blockers, Diuretics

Question 56

Where does Infective Endocarditis effect?

Answer 56

Inner surface of heart - Particularly the valves

Question 57

Infective Endocarditis Presentation

Answer 57

Fever, Fatigue, Murmur, Heart failure, Low RBCs

Question 58

Most common bacterial cause of Infective Endocarditis?

Answer 58

Staph aureus | followed by Viridans strep and negative staph

Question 59

What criteria is used for Infective Endocarditis?

Answer 59

DUKE Criteria

Question 60

Infective Endocarditis Investigations

Answer 60

Blood culture, USS

Question 61

Infective Endocarditis Treatment

Answer 61

IV antibiotics (usually start with vancomycin/ceftriaxone IV infusion), Surgery may be required

Question 62

Postural Hypotension Definition

Answer 62

Fall in systolic blood pressure of at least 20 or diastolic of at least 10 when assuming a standing position

Question 63

Postural Hypotension Causes

Answer 63

Medications (alpha blockers), Autonomic neuropathy, Age-related vessel stiffness

Question 64

Postural Hypotension Presentation

Answer 64

Lightheadedness, Weakness, Blurred vision, Palpitations, Nausea, Syncope

Question 65

Postural Hypotension Treatment

Answer 65

Increase salt and water intake, Compression stockings, Fludrocortisone