Cardiovascular Disease

Question 1

Chest pain

Answer 1

Angina/MI
GTN spray
Makes veins dilate

Question 2

Tachycardia

Answer 2

Palpitations/breathlessness

Question 3

Heart failure

Answer 3

Breathlessness

Question 4

Bradycardia

Answer 4

Dizziness/fatigue/N

Question 5

Endocarditis

Answer 5

Usually treated outside of surgery

Question 6

Questions to ask

Answer 6

Tolerant of Tx?
Will Tx complicate the condition? - very rarely - bleeding risk
Tell anyone about cardiac symptoms

Question 7

Myocardial issue

Answer 7

Heart failure

Question 8

Valve malfunction

Answer 8

Heart failure/endocarditis if infected

Question 9

Conduction malfunction

- consequences

Answer 9

Arrhythmia (tachycardia, bradycardia, sudden death)

Question 10

Coronary blood supply failure

Answer 10

Angina, myocardial infarction

Question 11

Heart failure caused by

Common causes

Answer 11

Any conditions affecting efficiency of pump –> reduced cardiac output
Previous MI, hypertension, genetic causes, drugs and idiopathic

Question 12

Assessment of pump fx

Answer 12

Transthoracic echocardiography (ultrasound) 
Allows for viewing of valves and ventricles and pick up on heart failure

Question 13

Symptoms of heart failure

Answer 13

Breathlessness after little exercise
Swelling
Dizziness, tiredness and weight loss

Question 14

Heart failure mechanism

Answer 14

Reduced cardiac output increases fluid pressure in lungs (L heart failure)
Venous returns to heart via VC its reduced (R heart failure)
Fluid retention and vasoconstriction results

Question 15

Clinical signs of heart failure

Answer 15

Low BP
High pulse
Crepitations in lungs 
Raised jugular venous pressure
Pitting ankle oedema

Question 16

Valves can become

and causes of it

Answer 16

Regurgitant or stenosed
Same symptoms as heart failure  
Degeneration (ie it just happens)
Rheumatic fever
Congenitally abnormal valve
Endocarditis
Papillary muscle rupture after MI

Question 17

Vascular stenosis

Answer 17

Valve becomes thicker and stiffer and doesn’t open sufficiently

Question 18

Infective endocarditis
Most likely in?
Range of possible organisms

Answer 18

Systemic infection (night sweats, fever, rigors, weight loss)
Infection lumps moving through blood stream –> VEGETATIONS –> embolic complications
Valves eaten away - regurgitation and heart failure
Artificial valves, abnormal valves, elderly, IV drug abusers and previous endocarditis
Streptococcal or staphlococcal

Question 19

Infective endocarditis causes

Answer 19

Cerebral abscesses
Digital emboli
Retinal emboli
Aortic and mitral vegetation

Question 20

Arrhythmia

Answer 20

Rhythm examined by ECG <60 >100

Question 21

P waves

Answer 21

Atria depolarise

Question 22

QRS

Answer 22

Ventricles depolarising

Further apart = slower heart rate

Question 23

T

Answer 23

Ventricles repolarising

Question 24

Coronary artery disease
Two types
Left coronary artery divides into 2
Driven by?

Answer 24

Angina
Myocardial infarction
Lifestyle and genetic factors
Plaque build up in major arteries

Question 25

Risk factors for CAD

Answer 25

``` Smoking High cholesterol Hypertension Diabetes Obesity Poor diet Lack of physical activity Other conditions Family history Genetics Male sex Age ```

Question 26

Angina Cause Feeling

Answer 26

CAD becomes obstructive Plaques are stable Chest pressure/heaviness/pain/indigestion sometimes radiating to arm, neck and back Almost always precipitated by stress/exertion when more blood supply is needed

Question 27

Unstable angina

Answer 27

Increased frequency, duration or onset at rest | Sign of risk of impending heart attack

Question 28

MI

Answer 28

Atherosclerotic plaque in a CA ruptures --> thrombus formation Inflammatory cells in plaque which weaken it? Permanent death of some myocardium

Question 29

When does MI occur?

Answer 29

Any time, rest, on exertion whilst asleep Chest discomfort similar to angina Rarely lasts more than 10 mins MI can be fatal or lead to lifelong heart failure

Question 30

How to identify CAD?

Answer 30

Exercise ECG - easy but inaccurate by inducing ischaemia Myocardial perfusion scan Angiography either CT or invasion angio by injecting X ray dye

Question 31

CAD treatment

Answer 31

``` Lifestyle modifications Statins Anti platelet lowers MI risk other risk factors All improve prognosis not angina problems ```

Question 32

Cad treatment if causing angina

Answer 32

``` Previous Medicine to reduce attacks NItrates/long acting tablets Beta blockers/Ca channel blockers Stenting or CA bypass if medication ineffective ```

Question 33

Investigations

Answer 33

ECG and serum troponin measurement Death of cardiomyocytes results in raised troponin ST elevation/non ST elevation - peak in ST segment

Question 34

Management of STEMI/NON STEMI

Answer 34

``` Anti platelet therapy Anticoag for 24-72hr Both should have angiography and stenting if poss STEMI immed. NSTEMI within 72 hrs MONA previously but no longer useful Secondary prevention Cardiac rehab ```

Question 35

Investigation of HF

Answer 35

TT echocardiography to detect ventricular impairment Newer test for elevated serum B-type Natriuretic peptide (BNP) Cardiac MR

Question 36

Treatment of Heart failure

Answer 36

Treatment is predominantly medical (drugs) ACE inhibitors, Betablockers, Aldosterone Antagonists (Spironolactone or Eplerenone), Diuretics, Ivabradine. Correction of other causes (anaemia, thyroid dysfunction) Management of complications (arrhythmia) Some Heart Failure patients benefit from Cardiac Resynchronisation Therapy (CRT – special form of pacemaker)

Question 37

Investigation of valve disease

Answer 37

Transoesophageal echocardiography gives better images

Question 38

Treatment of valves disease Metal valves Aortic stenosis

Answer 38

``` Form of heart failure Symptomatic --> valve surgery Metallic prosthesis or biological Metallic requires lifelong warfarin TAVI (transcatheter aortic valve implantation) ```

Question 39

Arrhythmia investigation

Answer 39

Diagnosis made by ECG at time of symptoms Other investigations look for causes Treatment varies according to specific type of arrhythmia

Question 40

Treatment of bradyarrhythmia

Answer 40

Pacemaker insertion

Question 41

Subcutaneous devices

Answer 41

Dual chamber pacemaker Treats bradyarrhythmia Implantable cardioverter/defibrillator Ventricular tachycardia or VF Can pace bradycardia Cardiac resynchronisation therapy Treats heart failure and bradycardia

Question 42

When /when not to defer treatment

Answer 42

``` Increasing pain at rest Increasing breathlessness and/or oedema Recent MI (within last 6 weeks( Frequent attacks of disabling tachycardia Stable awaiting surgery Stable angina Stable heart failure ```

Question 43

Adrenaline?

Answer 43

Vasoconstriction? | More likely to get angina, high BP,