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PHASE 2 > Cardiovascular > Flashcards

Cardiovascular Flashcards

(61 cards)

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1
Q

Give 7 risk factors for atherogenesis

A
  1. Age
  2. Smoking
  3. Diabetes
  4. High cholesterol (LDLs)`
  5. Family history
  6. Obesity
  7. Hypertension
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2
Q

How does atherogenesis begin

A

Endothelial damage due to irritants. Attracts monocytes and build up of cholesterol

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3
Q

What are the 4 stages of atherogenesis/atherosclerosis

A
  1. Fatty streaks
  2. Intermediate lesions
  3. Fibrous plaques
  4. Plaque rupture
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4
Q

Describe the first part of atherogenesis

A

Fatty streaks are lipid laden, full of T cells and macrophages

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5
Q

What are 3 stages of the second stage of atherogenesis

A

Foam cells, smooth muscle proliferation to the intima, and platelet adhesion

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6
Q

What covers the edge of a plaque

A

Fibrous cap of collagen, elastin and calcium secreted by smooth muscle cells (stimulated by presence of foam cells)

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7
Q

What causes plaque rupture in atherogenesis

A

Increased inflammation -> rupture and heal over and over, occluding more of the lumen each time -> ischaemia due to reduced blood flow -> angina

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8
Q

What causes MI (at the most basic level)

A

Imbalance between myocardial oxygen demand and supply

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9
Q

What is the most common cause of MI and give 2 other causes

A

Coronary artery atheroma

Hypertension and vasculitis

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10
Q

Give non-modifiable risks for myocardial ischaemia (3)

A
  • Family history
  • Age
  • Gender
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11
Q

Give modifiable risks for myocardial ischaemia (7)

A
  • Obesity
  • Hypertension
  • High cholesterol diet
  • Diabetes
  • Smoking
  • Alcohol
  • High saturated fats diet
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12
Q

How is cardiovascular risk estimated and what is the threshold for primary prevention

A

QRISK3

>10% risk over the next 10 years indicates primary prevention

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13
Q

Def: angina

A

Crushing chest pain due to myocardial ischaemia

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14
Q

What is the criteria for diagnosing angina

A
  • Central crushing chest pain radiating to jaw/right arm
  • Worse on exercise
  • Relieved by rest or GTN spray

Must be more than 1 symptom

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15
Q

Levine’s sign

A

Putting clenched fist over chest to cope with pain

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16
Q

Give 5 variants of angina

A
  1. Unstable
  2. Nocturnal
  3. Decubitis
  4. Cardiac syndrome
  5. Variant angina
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17
Q

4 investigations for suspected angina

A
  1. CT coronary angiogram
  2. Resting ECG
  3. Exercise ECG
  4. Stress echocardiography
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18
Q

2 principles of angina management

A
  1. Modifiable risk factor management

2. Symptom control

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19
Q

Pharmacological steps for treatment of angina

A

Control of risk factors: aspirin + clopidogrel + statin
Symptomatic:
- First line - GTN spray and beta blocker/ calcium channel blocker
- Second line - add beta blocker/ calcium channel blocker
- Third line - isosorbide mononitrate/nicorandil

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20
Q

2 interventional measures for uncontrolled angina

A

Percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG)

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21
Q

Common mechanism to all acute coronary syndromes

A

Rupture of atherosclerotic plaque

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22
Q

Difference between unstable angina, NSTEMI and STEMI

A

STEMI: ST elevation and raised cardiac markers
NSTEMI: no ST elevation (could be depression) and cardiac markers
Unstable angina: neither change

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23
Q

Clinical features of ACS

A

Central crushing chest pain at rest radiating to arm/jaw, sweating, cold, clammy, not relieved with GTN spray

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24
Q

Immediate management of suspected ACS (8)

A
  • ECG and bloods - cardiac markers, creatinine, electrolyte, glucose
  • GTN/morphine, aspirin and clopidogrel, fondaparinux, tirobifan/abciximab, oxygen
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25
If NSTEMI or unstable angina what is the immediate management
Assess risk factors using TIMI. Low risk = ECG stress test Medium/high risk = PCI (percutaneous coronary intervention)
26
Drugs used in prolonged management of a patient with ACS
Aspirin + clopidogrel (1 year only), GTN for 24-48 hrs, statins + ACE inhibitors, GPIIb/IIIA inhibitor (abciximab/tirobifan) in high risk
27
What is the TIMI score
Thrombosis in MI score. Assesses the risk of a subsequent MI from ACS
28
Clinical features of a STEMI
Central crushing chest pain that may radiate to the arm/jaw at rest for hours. Associated with sweating, clamminess, vomiting, greyness
29
ECG changes over time in STEMI
Minutes: ST elevation Hours: T wave inversion and broad and deep Q waves Days: ST returns to normal Weeks: T wave returns, Q waves remain
30
Give likely cardiac markers elevated in STEMI
Troponin (most sensitive) Myocardial bound creatinine kinase also used but not as good
31
After immediate management of ACS, confirmed STEMI. What are the next steps
``` Immediate PCI (optimal) or thrombolysis If HR > 100 give IV metoprolol and titrate to match HR ```
32
What does heart failure result from
Heart failing to pump blood and maintain CO
33
3 most common causes of heart failure
- Ischaemic heart disease - Dilated cardiomyopathy - Hypertension
34
5 rarer causes of heart failure
- Valvular heart disease - Congenital heart disease - Pericardial heart disease - Hyperdynamic circulation (pregnancy, hyperthyroidism, obesity) - Other cardiomyopathies
35
Sympathetic nervous system contribution to heart failure
Increases HR and myocardial contractility. Contracts veins leading to increased preload (starling mechanism) and causes arterial constriction leading to increased afterload
36
RAAS contribution to heart failure
1. Cardiac output fall and sympathetic tone leads to RAAS activation 2. Increases fluid and salt retention 3. Preload increased causing oedema 4. Angiotensin II potent vasoconstrictor, increasing afterload
37
Ventricular dilatation contribution to heart failrue
Myocardial failure -> decrease in stroke volume so increased afterload. Increased volume stretches myocardium for stronger contraction. Stretching becomes detrimental. Bigger ventricles also need more O2
38
4 clinical syndromes of heart failure
1. Left ventricular systolic dysfunction 2. Right ventricular systolic dysfunction 3. Congestive heart failure 4. Heart failure with preserved ejection fraction
39
6 symptoms of left heart failure
1. Exertional dysponoea 2. Fatigue 3. Orthopnoea 4. Paroxymal nocturnal 5. Cyanosis 6. Pulmonary oedema
40
4 symptoms of right heart failure
1. Peripheral oedema 2. Dyspnoea 3. Fatigue 4. Increased weight (potential cor pulmonale so lung problems) cor pulmonale = abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.
41
8 signs of heart failure
1. Ascites 2. Hepatomegaly 3. Ankle oedema 4. Lung crackles 5. Cardiomegaly 6. Increased JVP (jugular venous pressure) 7. 3rd and 4th heart sounds 8. Tachycardia
42
How is heart failure classified
Class I: no symptoms and no limitations of normal activities Class II: mild symptoms and slight limitation in ordinary activity (e.g. shortness of breath when climbing stairs) Class III: Marked limitation in normal activities. Comfortable only at rest Class IV: Severe limitations. Dyspnoea at rest
43
Algorithm for investigating suspected heart failure
1. Bloods (FBC for anaemia, LFTs for hepatomegaly, glucose for diabetes, U+Es, thyroid tests) 2. Measure BNP (b type natriuretic peptide) >100 then do an echo
44
5 non-pharmacological management steps
1. Stop smoking 2. Lower salt intake 3. Moderate exercise + lose weight 4. No alcohol 5. Vaccine for pneumococcus and flu
45
3 drugs given in heart failure
1. Loop diuretics 2. ACE inhibitors/ ARBs (angiotensin receptor blockers) 3. Beta blockers
46
2 drugs given in heart failure following initial 3 drugs
1. Spironolactone (treats fluid build up) | 2. Digoxin (increases force of heart contraction)
47
Def: hypertension
Blood pressure > 140/90 | must be measured on 2 separate occasions
48
6 contributing factors to hypertension
1. Obesity 2. High salt intake 3. Alcohol 4. Diabetes 5. Genetics 6. Low birthweight
49
Initial investigations for someone with high BP
24 hour ambulatory BP monitoring
50
4 further investigations for high BP
1. Urine dipstick 2. U+Es 3. Blood glucose 4. Serum lipids
51
What is target blood pressure in: 1. Normal people 2. >80s 3. Diabetics
1. 140/90 2. 150/90 3. 130/80
52
7 examples of end organ damage
1. Retinopathy (most important to check) 2. Renal failure 3. Stroke/TIA 4. MI/angina 5. LV hypertrophy 6. Peripheral vascular disease 7. Heart failure
53
5 non-pharmacological treatments for hypertension
1. Stop smoking 2. Reduce salt intake 3. Reduce saturated fats 4. Increase exercise 5. Increase fruit and veg
54
Outline drug treatment pathway for hypertension
``` Step - Under 55: ACE inhibitors or ARB Over 55: calcium channel blocker Step 2 - Combine ACE-i/ARB and calcium blocker Step 3 - Thiazide diuretic Step 4 - alpha/beta blocker, spironolactone Pregnancy use methydopa ```
55
5 symptoms of arrhythmias
1. Palpitations 2. Dyspnoea 3. Syncope 4. Dizziness 5. Asymptomatic
56
How can arrhythmias get diagnosed
ECG, 24 ambulatory ECG, loop recorder
57
3 causes of heart block
- Coronary artery disease - Cardiomyopathies - Fibrosis of conducting pathways (particularly in older people)
58
Describe the 3 degrees of AV block and ECG changes
1st degree: >0.2s PR interval no Rx needed | 2nd degree: Mobitz 1 - progressively longer PR
59
How are the 3 degrees of AV block
1st degree - no Rx needed 2nd degree - mobitz 1 just monitor, mobitz 2 and 2:1 give pacemaker 3rd degree - pacemaker
60
Describe RBBB (right bundle branch block) and 3 causes
Right bundle branch no longer conducts. ????????
61
Describe LBBB (left bundle branch block) and 3 causes
Left bundle branch no longer conducts ???????

PHASE 2 (6 decks)

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