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3rd Year > Cardiovascular conditions > Flashcards

Cardiovascular conditions Flashcards

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1
Q

What are the non modifiable risk factors for atherosclerosis?

A

Age
Gender (male)
family history of premature coronary heart disease
premature menopause

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2
Q

What are the modifiable risk factors for atherosclerosis?

A 
Smoking
Diabetes mellitus
Hypertension
Obesity
physical inactivity
Raised LDL and reduced HDL
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3
Q

What non-atherosclerotic causes of ACS are there in younger patients?

A

Coronary emboli: infected cardiac valve

Coronary occlusion secondary to vasculitis, coronary artery spasm, cocaine use, congenital coronary anomalies, coronary trauma

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4
Q

How do NSTE-ACS present?

A

Prolonged anginal pain at rest (>20 mins)
New onset angina with limitation of daily activities
Destabalisation of previously stable angina
Post MI infarction angina

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5
Q

Which patients may not present with chest pain in ACS?

A

Elderly patients and patients with diabetes

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6
Q

What are the symptoms of ACS?

A

Chest pain lasting longer than 15 minutes
Chest pain with nausea, vomiting, sweating and/or breathlessness
New onset chest pain or abrupt deterioration in stable angina

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7
Q

Can the response to GTN be used in diagnosing ACS?

A

No

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8
Q

What are the gastrointestinal differential diagnosis for ACS symtoms?

A 
Oesophageal spasm
Oesophagitis
GORD
Acute gastritis
Cholecystitis
Acute pancreatitis
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9
Q

What are the cardiovascular differential diagnosis for ACS symptoms?

A

Acute pericarditis
Myocarditis
Aortic stenosis
Aortic dissection

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10
Q

What are the respiratory differential diagnosis for ACS symptoms?

A

Pneumonia
Pneumothorax
Pulmonary embolism

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11
Q

When are troponins tested for?

A

6 and 12 hours after the onset of pain

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12
Q

What investigations should we do for ACS?

A 
12 lead ECG
Cardiac enzymes
FBC
Blood glucose
Echocardiography
Chest Xray
Coronary angiography
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13
Q

What is the GRACE risk score?

A

Global registry of acute cardiac events risk score. It is recommended by NICE

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14
Q

What is the immediate management for suspected ACS

A 
Romance:
Reassurance
Oxygen
Morphine
Aspirin
Nitrates
Clopidogrel
ECG
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15
Q

After stabilisation what secondary risk reduction measures should be implemented?

A 
Stopping smoking
Continued aspirin therapy
Statins
ACE inhibitors
Beta-blockers
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16
Q

What is the difference between Stable and Unstable angina?

A

Stable angina is when the pain is precipitated by predictable factors - usually exercise

Unstable angina: angina occurs at any time and should be considered and managed as a form of acute coronary syndrome

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17
Q

How can we differentiate angina from acute pericarditis?

A

Acute pericarditis tends to be more constant pain which is aggravated by inspiration, lying flat, swallowing and movement

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18
Q

Anginal pain is?

A

Constricting discomfort in the front of the chest, neck, shoulders, jaw or arms
Precipitated by physical exertion
Relieved by rest or GTN in about 5 minutes

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19
Q

When should urgent hospital assessment and admission be arranged for people with angina symptoms?

A

If the symptoms suggest possible ACS:

Pain at rest
Pain on minimal exertion
Angina that is progressing rapidly despite increasing medical treatment

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20
Q

How many doses of GTM should a person experiencing an angina attack take before calling 999

A
  1. one every 5 minutes for 15 minutes.

If the pain is intensifying or the person is unwell 999 should be called earlier.

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21
Q

What are the first line pharmacological treatments for angina?

A

Beta-blocker/calcium channel blocker.

If the symptoms are not adequately controlled consider switching to the other option, or using a combination of the two.

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22
Q

Should aspirin be started in patients with angina?

A

Yes. Clopidogrel is an alternative for those who cannot take aspirin.

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23
Q

When is coronary revascularisation required?

A

In high risk patients and those who have failure to be controlled by medical therapy

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24
Q

How many patients with angina with suffer an MI within a year of diagnosis?

A

1 in 10

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25
What is the most common cause of death in the UK?
Coronary heart disease. It is responsible for he deaths of 1 in 5 men and 1 in 6 women.
26
Which ethnic groups are at higher risk (40-60% higher) of CHD-related mortality
South Asians
27
What features can be seen on an ECG during/after an MI?
Features may initially be normal but abnormalities include new ST segment elevation; initially peaked T waves and then T-wave inversion; new Q waves; new conduction defects.
28
Does a normal resting 12-lead ECG exclude an ACS
No
29
What is the characteristic pulse in Atrial Fibrillation
irregularly irregular
30
Loss of active ventricular filling is associated with what?
Stagnation of blood in the atria, leading to thrombus formation and risk of embolism Reduction in cardiac output
31
What type of AF is it if it lasts longer than seven days and is not self terminating
Persistent
32
What is paroxysmal AF?
Spontaneously terminates within seven days and most often within 48 hours
33
AF with an onset within the last 48 hours is called?
Acute AF
34
Define permanent AF?
Long standing AF (over a year) that is not successfully terminated by cardioversion
35
What is the prevalence of AF?
1%
36
What is the prevalence of AF in people over 85?
18%
37
Aetiology of AF?
``` Hypertension CAD Valvular heart disease Cardiac surgery Myocarditis Atrial septal defect Atrial myxoma Dilated and hypertrophic cardiomyopathy Hyperthyroidism Acute infections Excess alcohol intake ```
38
What are the respiratory caused of AF?
``` lung cancer COPD Pleural effusion PE Pulmonary hypertension ```
39
Investigations for people with AF?
ECG Blood tests (TFTs, FBC, U&Es, LFTs, coagulation screen) CXR
40
How is AF managed?
control of arrythmia and thromboprophylaxis to prevent strokes
41
When would AF indicate for urgent hospital referral?
Rapid pulse (>150bpm) and/or low blood pressure
42
What is the first line management strategy for people with AF?
Rate control: Beta Blocker/rate limiting calcium channel blocker Consider digoxin monotherapy for sedentary people with non-paroxysmal AF
43
If rate control is unsuccessful or symptoms are still present after rate control what is the next management plan?
Rhythm control: Cardioversion
44
What is amiodarone used for?
The treatment of arrhythmia's. It should only be initiated under hospital and specialist treatment
45
How much does AF increase risk of stroke?
x6
46
What are the risk factors for DVT?
``` Previous history of DVT Major surgery or cancer Immobilization Thrombophillia Prolonged travel Obesity Age >60 Pregnancy ```
47
How many cases of PE have symptoms of DVT beforehand?
1 Third of cases
48
Clinical features of DVT?
``` Limb pain and tenderness Swelling of calf and thigh (usually unilateral) Increase in skin temp. Distension of superficial veins Skin discolouration ```
49
What is the most common differential diagnosis for DVT?
Cellulitis. Secondary cellulitis may develop with primary DVT. Primary cellulitis may be followed by a secondary DVT.
50
What investigations are recommended in suspected DVT?
A proximal leg vein ultrasound carried out within 4 hours or a D-dimer test and interim 24 hour dose of parenteral anticoagulant nutil proximal leg vein ultrasound is available
51
What scoring system is used to assess DVT risk?
Wells diagnostic algorithm A score of 2 or more means the risk of DVT is likely
52
D-dimers are raised in patients with?
Venous thromboembolism Malignancy Pregnancy
53
What is pharmacological the management for DVT?
Taking into account comoribidities and contraindications offer a choice of low molecular weight heparin or fondaparinux Offer warfarin for 3 months
54
What other managements are available for DVT?
Compression stockings | Vena caval filters
55
If there is is no obvious cause for DVT (eg immobilisation or operation) what other causes should be suspected?
>45 cancer
56
What is the definition of heart failure?
Cardiac output is inadequate for the bodys requirements
57
What is the prevalence Heart failure?
1-3%
58
What is the difference between systolic and Diastolic failure?
Systolic is the inability of the ventricle to contract normally resulting in reduced cardiac output Diastolic is the inability of the ventricle to relax and fill normally causing increased filling pressures
59
What are the symptoms of left sided ventricular failure?
``` Dyspnoea poor excercose tolerance fatigue orthopnoea paroxysmal nocturnal dyspnoea nocturnal cough (pink frothy sputum) Wheeze nocturia cold peripheries weight loss muscle wasting ```
60
What are the symptoms of right sided ventricular failure?
``` Peripheral oedema ascites nausea anorexia facial engorgement pulsation in neck and face epistaxis ```
61
What is acute heart failure?
New onset acute or decompensation of chronic heart failure characterised by pulmonary/peripheral oedema with or without signs of peripheral hypoperfusion
62
What is low output heart failure and what is it caused by?
cardiac output is decreased and fails to increase normally with exertion. Caused by pump failure, excessive preload, chronic excessive afterload
63
What is high output failure?
This is rare, output is normal or increased in the face of very high demands. failure occurs when output fails to meet these high needs
64
What causes high output failure?
``` Anaemia Pregnancy Hyperthyroidism Pagets disease Arteriovenous malformation Beriberi ```
65
What criteria is used for diagnosing Heart failure?
Framingham criteria (2 major criteria or 1 major criteria and 2 minor criteria)
66
What does NICE suggest should be abnormal for a Heart failure diagnosis to be made?
Abnormal ECG | B-type natriuretic peptide
67
What signs of heart failure are present on a heart failure patient CXR?
``` Alveolar Oedema (Bat wings) Kerly B lines (intersitial oedema) Cardiomegaly Dilated prominent upper lobe vessels Pleural effusion ```
68
What is the prognosis of Heart failure?
5 yr mortality is roughly 75%
69
What chronic heart failure management should be undertaken? (not medication)
Stop smoking, eat less salt, optimize weight and nutrition Treat the cause of heart failure Treat exacerbating factors (anaemia, thyroid disease, infection) Avoid exacerbating factors eg, NSAIDS (fluid retention) On admission weigh daily (assess fluid loss)
70
What medication should be used for chronic heart failure management?
``` Loop Diuretics (ferusemide, butmetanide) ACE-i (LVF dysfunction) Beta Blockers (start low and go slow) Spironalactone (potassium-sparing diuretic ) Digoxin Vasodilators (hydralazine) ```
71
What is BNP?
B-type natriurtic peptide
72
What is BNP used for?
As BNP reflects myocyte stretch it is used to diagnose heart failure. >100 ng/l BNP is diagnostic of heart .
73
If >55 years old and in black black patients what is the first choice of treatment for hypertension?
Calcium channel blocker (amlodipine)
74
If
ACE-i (Ramipril)

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