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Gen Med and Surg - C.U > Cardiovascular > Flashcards

Cardiovascular Flashcards

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1
Q

What is a cause of an pulsus paradoxus? (abnormally large drop in BP on inspiration)

A

cardiac tamponade

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2
Q

Clinical features of an unruptured AAA

A

Can be asymptomatic
Back pain
Pulsating mass on abdo exam

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3
Q

Clinical features of a ruptured AAA

A 
Abdominal pain radiating to the back 
Sweating 
SOB
Shocked 
Dilated abdomen
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4
Q

Best imaging for a AAA

A

US

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5
Q

At what size can a AAA be monitored every 6m

A

< 5.5cm

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6
Q

What is used to monitor a AAA

A

Exam and US

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7
Q

When is surgery considered in a AAA

A

> 5.5cm or rapidly expanding

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8
Q

Two options for surgical intervention in AAA

A

Open / endoluminal approach

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9
Q

Acute approach to ruptured AAA

A

ABCDE
oxygen
contact vascular team

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10
Q

Prophylactic AB in AAA

A

Cefuroxime and Metronidazole

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11
Q

Type A dissecting aortic aneurysm

A

Includes the ascending aorta, starts proximal to the left SA branch

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12
Q

Type B dissecting AA

A

starts distal to the left SA brach

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13
Q

Aortic dissection risk factors

A
B
C

A

Age
Baby / BP
Connective tissue disorders

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14
Q

If dissection progresses proximally it can cause…

A

MI - affects the coronary arteries

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15
Q

If dissections progresses distally it can cause…

A

renal hypoperfusion

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16
Q

Typical description of pain in dissecting AA

A

tearing back pain between scapulae

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17
Q

Clinical features of a dissecting AA

A 
Back pain - tearing, scapula 
Loss of peripheral pulses 
May mimic an MI 
May be radio - radio delay 
Neuro symptoms if spinal arteries involved 
Shock if rupture
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18
Q

Bedside test for dissecting AA

A

ECG

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19
Q

Imaging (3) for dissecting AA

A

US
CT/MR
TO Echo

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20
Q

Management of a type A dissecting AA

A

Surgical

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21
Q

Management of type B dissecting AA

A

Medical - anti hypertensive and monitor

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22
Q

Potential complications in dissecting AA (4)

A

MI
Acute renal failure due to ischeamia
Neurological damage - hemiplegia
Lower limb ischaemia

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23
Q 
Primary causes of myocardial disease 
H
A
R
D
A

Hypertrophic obstructive
Arrhythmogenic RV
Restrictive
Dilated

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24
Q

Secondary causes of myocardial disease

A

systemic
ischaemic
hypertension
inflammatory

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25
what may dilation cardiomyopathy mask?
hypertrophy
26
3 common causes of dilated CM
Hypertension Alcohol Chemotherapy
27
What is found on biopsy in dilated cardiomyopathy?
haphazard architecture enlarged myocytes t cell infiltration fibrosis
28
Signs of myocardial disease Peripheral Heart Lung Abdo
Peripheral - cyanosis - oedema Heart - tachycardia - raised JVP - S3 Lungs - tachypnoea - basal creps - pleural effusions Abdo - ascites and hepatomegaly
29
Blood tests in dilated cardiomyopathy
``` UandEs LFTs TFTs Iron studies Infection screen Autoimmune screen Genetic screening ```
30
Possible ECG tests for DCM
Normal ECG 24 hr ECG Exercise testing
31
Imaging in DCM
Echo CXR Cardiac MR
32
Complications of ventricular dilation
Tachyarrhythmias LV thrombus w/ embolism causing stroke Valve dysfunction
33
How does hypertrophic cardiomyopathy causes reduced CO?
Stiff ventricular walls lead to reduced diastolic filling
34
main cause of hypertrophic cardiomyopathy?
genetic
35
where is abnormal tissues focused in hypertrophic cardiomyopathy? and what does this lead to
septal | leading to left ventricular outflow obstructin
36
ECG results in hypertrophic cardiomyopathy?
may be normal may be ST depression and T wave inversion
37
Imaging in hypertrophic cardiomyopathy?
ECHO Cardiac MRI
38
Patient education in hypertrophic cardiomyopathy?
Controlled exercise to prevent sudden death
39
Medical treatment in hypertrophic cardiomyopathy? How does each drug work
Beta blockers - improve diastolic filling and reduce myocardial demand Calcium channel blockers - negatively inotropic, reduce HR during activity Disopyramide - sodium channel blocker, antiarryhthmic
40
Other management of hypertrophic cardiomyopathy? (4)
ablate the septum pacemaker implantable defib myomectomy
41
How does restrictive cardiomyopathy cause poor CO
Poor diastolic filling, unable to increase due to a FIXED stroke volume
42
Causes of restrictive cardiomyopathy
``` idiopathic systemic sclerosis infiltration e.g. from amyloid familial fibrosis due to infection ```
43
restrictive cardiomyopathy is difficult to distinguish clinically from?
constrictive pericarditis
44
clinical features of restrictive cardiomyopathy
Peripheral - SOB - Fatigue - oedema Heart - palpable apex - Loud S3 / S4 - Raised JVP Lung - pulmonary oedema if severe Abdo - hepatomegaly
45
P wave changes in restrictive cardiomyopathy
P mitrale and P pulmonale
46
Imaging + other tests in restrictive cardiomyopathy
Echo | Cardiac catheterisation
47
Most common viral cause of myocarditis
Coxsackie virus B
48
Causes of myocarditis
Infective - bacterial / viral etc Immune reactions - post viral, rheumatic fever Transplant rejection
49
Clinical features of myocarditis
spans from asymptomatic to heart failure Can be - fever, SOB, chest pain, palpitations, tachycardia
50
Main blood tests in myocarditis
Serology for infectious agents
51
ECG sign in hypercalcaemia
Shortened QT interval
52
Imaging if suspect heart valve disease
CXR | Echo - TTE / TOE
53
Complications of replacement valves
Infective endocarditis PE / DVT Haemolysis / anaemia
54
Arrhythmia resulting from mitral stenosis
AF (increase in left atrial pressure)
55
Two main causes of mitral stenosis
Rheumatic fever and senile calcification
56
Symptoms of right heart failure
Dyspnoea Reduced exercise tolerance Cough Haemoptysis Palpitation
57
Signs on examination of mitral stenosis
Clubbing - heart failure Raised JVP ? anaemia due to haemolysis Early diastolic murmur
58
ECG signs of mitral stenosis
AF Right heart failure - right axis deviation P mitrale (if in sinus rhythm)
59
Signs of hf on CXR
ABCDE ``` Aveolar oedema Kerly B lines - interstitial oedema Cardiomegaly Dilated upper lobe vessels Pulmonary effusions ```
60
Causes of mitral regurg
Post MI Infective endocarditis Rheumatic fever
61
General symptoms of heart failure
SAD - syncope, angina and dyspnoea - SOB - Palpitations - Chest pain - Syncope / presyncope - Swelling / weight gain - orthopnea - paraoxysmal nocturanl dyspnoea - nocturia - cough with pink frothy sputum - abdo pain / swelling
62
Mitral regurg on clinical exam
pansystolic murmur | radiates into the axilla
63
Management in heart valve problems
Medical - AF control - anticoag in valve replacement Surgical - valve repair - valve replacement
64
3 causes of aortic stenosis
Age related Bicuspid valve e.g. turners syndrome Rheumatic fever
65
Pulse in aortic stenosis
narrow pulse pressure | slow rising
66
Which type of arrhythmia is common in AS
AV block - calcification in this area
67
Which type of medication should be avoided in AS?
Drugs that reduce after load e.g. nitrates and ACE inhibt
68
Causes of AR?
Infective endocarditis Rheumatic fever Connective tissue diseases
69
Pulse in AR
Collapsing and wide pulse pressure
70
Medications to be use in regurgitation conditions
vasodilators to reduce afterload
71
HF definition in terms of ejection fraction
<40%
72
``` New York heart association classification of HF 1 2 3 4 ```
1 no symptoms 2 symptoms on moderate exertion (climbing a flight of stairs) 3 mild effort (100m on flat ground) 4 symptoms at rest
73
How does reduced renal perfusion in heart failure contribute to further decompensation
Activates RAAS and sympathetic system - fluid retention - vasoconstriction - fluid overload - increased muscle stretch - the cycle continues
74
Causes of left ventricular failure 1) Low output 2) Increased demand
- IHD - valve disease - HTN - cardiomyopathy - pregnancy - anaemia
75
Signs of heart failure
``` Clubbing Peripheral cyanosis Tachycardia Tachypnoea Displaced apex 3rd heart sound basal creps oedema - sacral and pedal ```
76
Bed side tests in heart failure
``` FBC U&Es (kidney function) LFTs BNP TFTs Bone and clotting profile Fasting glucose and lipids Urine dip ``` ECG CXR
77
Imaging in heart failure
ECHO = gold standard
78
Acute management of heart failure
ABCDE - sit up - ECG - Full set of bloods - ABG - look for hypoxia - CXR
79
Acute medical management fo HF if BP >100
IV furosemide IV GT IV opiates
80
Acute medical management fo HF if BP <100
Consider CPAP - aid venodilation and reduce preload | Consider ICU
81
Important education in CHF
``` Regular vaccinations fluid input and output Exercise important good diet stop smoking ```
82
3 key drugs in heart failure
Diuretic ACE inhib Beta blocker
83
Device therapy for heart failure
Implantable defib Cardiac biventricular pacemakers
84
Which drugs are contraindicated in HF?
Calcium channel blockers and NSAIDs - precipitate decompensation
85
Anteroseptal ST elevation MI ECG changes Coronary artery
V1-4 LAD
86
Inferior ST elevation MI ECG changes Coronary artery
II, III and aVF Right coronary
87
Anterolateral ST elevation MI ECG changes Coronary artery
I, aVL and V1-4 LAD / circumflex
88
Lateral ST elevation MI ECG changes Coronary artery
I, aVL +/- V5-6 Left circumflex
89
Posterior ST elevation MI ECG changes Coronary artery
Tall R waves V1-2 Left circumflex / right coronry
90
Which valve is most commonly affected in infective endocarditis
Infective endocarditis in intravenous drug users most commonly affects the tricuspid valve
91
Dose of statin Primary prevention Secondary ""
20mg 80mg
92
AF rate control therapies (2)
Digoxin Beta blockers Diltiazem
93
AF anti-arrhythmics
amiodarone | flecanide
94
Anticoagulation in AF
Heparin / Warfarin / NOAC
95
Main complication of AF
Systemic embolisation
96
Atrial flutter usually accompanied by with arrhythmia?
AV block
97
Two treatment strategies for atrial flutter
Rate control - antiarrythmics and anticoagulants curative - DV cardioversion / ablation
98
WPW definition
atrial re-entry tachy + accessory pathway linking atrium and ventricle
99
ECG signs of WPW
Short PR, delta wave and wide QRS
100
Treatment options for WPW Invasive Medical
DC cardioversion / ablation rate control - beta blocker / calcium channel blocker
101
Common causes of VT
Ischaemia Drugs metabolics problems long QT syndrome
102
VT presentation on ECG
broach complex tachy
103
VT treatment medical invasive
Amiodarone / lidocaine DC cardioversion
104
VT recurring, treat with
Implantable cardiac defib
105
VT main complication?
VF
106
Presentation of VF
syncope or cardiac arrest
107
Treatment of VF
Cardiac defib
108
Definition of first degree block?
PR longer than 5 small squares
109
Definition of mobitz type 1
PR interval lengthens then drops
110
Definition of mobitz type 2
1:3 or 1:2 p to QRS ratios (no link to PR interval)
111
Definition of third degree block?
no association between Ps and QRSs
112
Medical treatment for AV block
atropine
113
Gold standard for symptomatic 2nd or 3rd degree heart block
Cardiac pacing
114
Cardiac risk factors (8)
``` HTN Hyperlipidaemia IHD Diabetes FH Smoking Cocaine - young people? ```
115
What is seen in aortic dissection on CXR
widened mediastinum
116
Aortic dissection suspected - two types of imaging
CXR | CT
117
Imaging in PE
CTPA
118
ACS immediate management
``` Morphine Oxygen (if sats below 94%) Nitrates Aspirin Clopidogrel Antiemetic ```
119
PCI vs Fibrinolyitc therapy for ST elevation
Can you initiate treatment within 120 mins
120
How to recognise bifasciular block
- RBBB / LBBB | - And left/ right axis deviation
121
How to recognise trifesicular block
- RBBB / LBBB - And left/ right axis deviation - Above + AV node block
122
What can trifesicular block lead to?
heart block
123
In IVDU which side of the heart is usually affected by endocarditis?
RHS
124
Causes of the introduction of bacteria into the blood
IVDU Surgery Lines being put in etc Liver / renal failure
125
2 commonest bacteria causing infective endocarditis
Strep virians | Staphylococcus
126
2 non infective causes of endocarditis
SLE | Marantic
127
In which patient presentation should you have a high index of suspicion for IE
New murmur and fever
128
Valves affected by IE in order of how common
Aortic > Mitral > Tricuspid
129
Clinical features of IE
``` Fever Rigors Sweats High temp Malaise Fatigue Anorexia Splenomegaly ```
130
Findings on peripheral exam in IE
``` Clubbing Splinter haemorrhages Oslers nodes Janeway lesions Roth spots ```
131
Bloods in IE
CRP FBC LFTs UandEs BLOOD CULTURES - 3 SITES, 1-2hrs apart, must be +ve in two
132
Bedside tests in IE
ECG Urine dip and culture Swab wounds / cavaties
133
Imaging in IE
TOE | CXR
134
Major in dukes criteria
2 seperate +ve blood cultures +ve echo - vegetation / abscess New valve regurg
135
Minor in dukes criteria
``` Risk factor for IE Fever <38 Vascular phenomena e.g. embolic stroke Immunological phenomena e.g. +ve blood culture not meeting major criteria +ve echo no meeting major criteria ```
136
Dukes criteria diangosis
2 major 1 major, 3 minor all 5 minor
137
what must be confirmed before starting treatment of IE?
3 +ve blood cultures
138
Importance of the presence in mechanical valve in IE?
More aggressive medical treatment and lower threshold for surgery
139
Monitoring in IE
``` Vital signs bloods blood cultures = repeat consider PIC line ECG ECHOs ```
140
Commonest cause of death in IE
Septic thromboemboli and infarcts
141
first line for AF in most - >
rate control
142
drug to be given alongside cardioversion
amiodarone
143
acute temporary causes of AF
include alcohol abuse, hyperadrenergic states or sympathomimetic drug intoxication, cardiac or non-cardiac surgery, electrocution, myocarditis, PE, chronic pulmonary disease, and hyperthyroidism
144
AF patients with hemodynamic compromize require with new onset AF of <48hrs ...
Immediate DC cardioversion
145
AF patients with a wide complex AF suggestive of WPW syndrome require...
Immediate DC cardioversion
146
AF patients with evidence of conducting system disease
Pacemakers insertion before DC cardioversion
147
Pt with LV dysfunction, choice of rate control drug =
diltiazem and digoxin
148
Malignant hypertension defined as?
200 / 130
149
Which end organs can be damaged by high blood pressure?
Heart, kidney, eyes and brain
150
Most common cause of secondary hypertension
Renal disease
151
Definition of essential hypertension
140 / 90
152
RF for HTN
``` Metabolic syndrome Obesity High alcohol intake DM Black ancestry Age 60+ FH ```
153
Grade 1 HTN retinopathy
Slight arterionlar narrowing
154
Grade 2 HTN retinopathy
Definite narrowing
155
Grade 3 HTN retinopathy
Cotton wool spots and flame haemorrhages
156
Grade 4 HTN retinopathy
Papilloedema
157
Blood tests in HTN
Lipids U&Es Fasting glucose
158
Hypertensive emergency how fast should BP be reduced?
25% in 4hrs
159
BP aim in diabetic patients
< 130mmHg
160
1st line for HTN in under 55s
ACE inhibi
161
1st line for HTN in over 55s / AFC
Calcium channel blocker
162
2nd line in essential HTN
A + C
163
3rd line in essential HTN
A + C + D
164
lifestyle measures to combat HTN
Lose weight regular exercise eat well stop smoking
165
Mechanism of action of aspirin
Thromboxabe A2 inhibitor so inhibits platelets
166
Clopidogrel mechanism of action
inhibits platelet function by inhibiting ADP induced platelet aggregation
167
Ticagrelor MOA
inhibit platelet aggregation
168
MOA of statins
HMG- CoA reductase inhibitors
169
SE of beta blockers
``` Bradycardia Heart block Hypotension Fatigue Impotence ```
170
Two classes of angina
Stable - relieved by rest and brought on by prolonged physical activity Unstable - severe and persistent. not relieved by rest.
171
Causes of angina
Atherosclerosis Anaemia AS Tachyarrythmias
172
Modifable risk factors for angina
``` Obesity Diet - low fat Smoking Diabetes Sedentary lifestyle Stress excess alcohol ```
173
Non modifiable risk factors for angina
``` Family hx Increasing age Males Post menopausal Asian race ```
174
ECG findings in angina
ST depression
175
Investigations for angina in a non acute setting
``` ECG Exercise stress test Stress echo Myocardial perfusion scan Coronary angiography ```
176
Acute treatment of stable angina
Nitrates - sublingual GTN
177
Medical treatment of stable angina
Beta blockers - first line Calcium channel blockers Nitrate tablets
178
Invasive management of stable angina
PCI Bypass surgery
179
Medication post stent
Aspirin for life Clopi added for a length of time depending on the type of stent inserted
180
WHO definition of MI (two of) ....
Chest pain >15min, good clinical hx Dynamic ECG changes - ST elevation / depression, Q waves, T waves Rise in troponin
181
3 types of condition in ACS
STEMI NSTEMI Unstable angina
182
STEMI defining features
ST elevation >2mm in two congruent leads (V1-6) OR 1mm in limb leads OR new LBBB Troponin +ve
183
NSTEMI defining features
Troponin +ve | Without STEMI on ECG but may be ischaemic changes
184
Unstable angina defining features
Minimal ECG changes Troponin -ve High risk of MI in 30 days
185
Specific pathology of MI
Rupture of atherosclerotic plaque, causing ischaemia to the heart
186
Management of ACS
``` A - airway B - sats - low O2 - RR - listen to chest ``` ``` C - cap refil - HR - BP - ECG - Blood - FBC, U&E, Troponin D - glucose ``` E - drugs - aspirin, nitrates Aspririn 300mg Second anti platelet Consider - anti thrombotic therapy - PCI
187
Medication post MI
Beta blocker - immediately and titrate up ACEi - within 24hrs Statin - immediate Continue on an anti-platelet
188
Complications on an MI
Angina Arrhythmia Valve disease
189
MOA of amiodarone
blocks patassium channels
190
Amiodarone SE
- thyroid dysfunction - corneal deposits - pulmonary - fibrosis/pneumonitis - liver fibrosis/hepatitis - peripheral neuropathy, myopathy - photosensitivity - 'slate-grey' appearance - thrombophlebitis and injection site reactions - bradycardia
191
Causes of pericarditis
``` Infective - Virus, TB, Rheumatic fever Vascular - Post MI Metabolic - Uraemia (acute renal failure) Autoimmune - CTD, SLE Trauma - bleed post surgery ```
192
Signs of pericarditis on ECG
Widespread concave ST elevation
193
Treatment of pericarditis
NSAIDs and treat the cause
194
What is pulsus paradoxus
drop in arterial pressure of greater then 10 when the patient is in inspiration (seen in cardiac tamponade)
195
Pericardial effusion vs cardiac tamponde
Pericardial effusion - fluid build up in the pericardium Cardiac tamponade - when the heart is unable to fill properly due to a pericardial effusion
196
Causes of pericarial effusion
``` Vascular - MI, aortic dissection Infection - TB Trauma - post surgery Autoimmune Malignancy Metabolic - renal failure ```
197
Beck's triad for tamponade
Distant heart sounds Distended jugular veins - increased JVP Decreased arterial pressure
198
Causes of acute limb ischaemia
Vascular - thrombosis from atheroma or embolus from the heart (e.g. AF) Trauma Graft occlusion post surgery
199
6 clinical features of an ischaemic limb
``` Pale Perishingly cold Pulseless Pain Paralysed Paraesthetic ```
200
Imaging in acute limb ischaemia
Arteriogram
201
Risk factors for atherosclerosis in LL
``` Atherosclerosis elsewhere DM Hyperlipideamia FH Smoking ```
202
Bedside test in chronic limb ischaemia
CV exam | ABPI
203
How is ABPI calculated?
largest of the popliteal systolic / brachial systolic >1 - normal Diabetic hardened veins may give a false +ve result
204
Blood tests in chronic limb ischaemia
``` FBC U&E LFTs blood glucose Clotting Platelets ```
205
Conservative treatment of chronic limb ischaemia
lose weight stop smoking good diet
206
medical treatment of chronic limb ischaemia
aspirin statin control diabetes
207
surgical options in chronic limb ishcaemia
angioplasty bypass graft amputation
208
Screening for AAA
Screening for an abdominal aortic aneurysm consists of a single abdominal ultrasound for males aged 65
209
In venous insufficiency Doppler US looks for? Duplex US looks for?
reflux anatomy / flow of the vein
210
Where do arterial ulcers occur?
Heels and toes
211
Arterial ulcer presentation
``` On heel and toes Foot is painful Cold Difficult to feel pulses ABPI low ```
212
Normal ABPI score
1.0 - 1.2
213
ABPI score > 1.2 may indicate?
may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
214
MOA of clopidogrel
Blocks platelet aggregation
215
Virchow's triad
Abnormal blood flow e.g. stasis Vessel wall abnormalities Hypercoagulable state
216
Causes of blood stasis
Dehydration Nephrotic syndrome Post operatively Immobility
217
Causes of vein wall abnormalities
trauma varicose veins phlebitis
218
Hypercoaguable state can be due to
``` Pregnancy COCP Obesity Maligancy Hereditary ```
219
Anticoagulation treatment post VTE
3-6 m if known trigger now eliminated If not - long term
220
Hereditary causes of thrombophilia
Factor V leiden Antiphosopholipid syndrome Protein C and S deficiency Antithrombin deficiency
221
Most common heritable form of thrombosis
Factor V leiden - autosomal dominant Results in overactivity of the clotting cascade
222
ECG changes for thrombolysis or percutaneous intervention ->
ECG changes for thrombolysis or percutaneous intervention: ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR New Left bundle branch block
223
Which group of medications are associated with long QT?
Antipsychotics
224
Which coronary artery supplies the AV node?
Right coronary artery
225
Acute management of PE
Normotensive - LMWH Hypotensive - Thromboylsis
226
Second line management of heart failure
second-line treatment is now either an aldosterone antagonist, angiotensin II receptor blocker or a hydralazine in combination with a nitrate
227
After second line management, if symptoms persist in hf what are the next options?
if symptoms persist cardiac resynchronisation therapy or digoxin* should be considered.
228
vaccinations in heart failure
yearly flu one of pneumococcal
229
NIV used in pulmonary oedema
CPAP
230
Types of cardiac implantable devices
Pacemaker Bi ventricular ICD Implantable cardiac loop recorder
231
Classic cause of digoxin toxicity
hypoK

Gen Med and Surg - C.U (16 decks)

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