cardiovascular risk factors plus other stuff

Question 1

infarction risk factors

Answer 1

obesity, smoking, cholesterol

Question 2

atherosclerosis risk factors

Answer 2

poorly managed diabetes, smoking, HTN, hyperlipidaemia, FH, obesity (inflammatory cytokines), inflammatory conditions (cap weakened -> plaque ruptures)

Question 3

acute coronary syndromes risk factors

Answer 3

coronary thrombosis, anaemia, bradycardia, tachycardia, diabetes, smoking

Question 4

myocardial infarction risk factors

Answer 4

lack of exercise, smoking, diet high in fat

Question 5

heart failure risk factors

Answer 5

valve disease, HTN, MI, CAD, connective tissue disease, infection, pericardial disease, cardiomyopathy, arrhythmias

myocardial dysfunction due to IHD, alcohol, valvular disease, endocardial disease

oestrogen protects against IHD

Question 6

hypertension risk factors

Answer 6

family history, environment, hyperaldosteronism (as more salt is retained –> higher bp)

Question 7

atrial fibrillation risk factors

Answer 7

IHD, HTN, PE, hyperthyroidism

Question 8

atrial flutter risk factors

Answer 8

idiopathic, IHD, atrial dilation

Question 9

1st and 2nd degree heart block risk factors

Answer 9

family history, athletes, sick sinus syndrome, IHD, acute myocarditis, drugs (e.g. digoxin)

Question 10

3rd degree heart block risk factors

Answer 10

IHD, idiopathic (fibrosis), congenital, aortic valve calcification, surgery, trauma, digoxin, infiltration(abscesses, granulomas, tumours, parasites)

Question 11

sinus tachycardia risk factors

Answer 11

pain, infection, exercise, system vasodilation

accessory pathway causes arrhythmias

Question 12

supra ventricular tachycardia risk factors

Answer 12

genetic

Question 13

ventricular tachycardia risk factors

Answer 13

CHD, aortic stenosis, MI electrolyte imbalance

Question 14

ventricular ectopic beat risk factors

Answer 14

genetic, lifestyle (caffeine intake, potassium deficiency)

Question 15

prolonged QT syndrome risk factors

Answer 15

inherited, low potassium/calcium, family history, pre-existing CVD

Question 16

Wolff-Parkinson-White syndrome risk factors

Answer 16

Ebstein anomaly (genetic)

Question 17

atherosclerotic aortic aneurysm risk factors

Answer 17

age, family history, inherited collagen defects

Question 18

dissecting aortic aneurysm risk factors

Answer 18

systemic hypertension, Marfan’s syndrome (disorder of fibrillar expression)

Question 19

berry aneurysm risk factors

Answer 19

HTN, smoking

Question 20

capillary micro aneurysm (Charcot-Bouchard) risk factors

Answer 20

HTN, diabetes

Question 21

infective mycotic aneurysm risk factors

Answer 21

bacterial or fungal infections of arterial walls

Question 22

syphilitic aneurysm risk factors

Answer 22

tertiary syphilis

Question 23

claudication risk factors

Answer 23

peripheral vascular disease

Question 24

critical limb ischaemia risk factors

Answer 24

smoking, diabetes mellitus

Question 25

pericarditis risk factors

Answer 25

idiopathic, pacemaker implant, post-MI, Dressler's, post-surgery

Question 26

aortic stenosis risk factors

Answer 26

congenital, degenerative calcification, rheumatic heart disease

Question 27

mitral regurgitation risk factors

Answer 27

post MI, ischaemic heart disease, degenerative calcification, myxomatous degeneration, rheumatic heart disease, pure volume overload

Question 28

cardiomyopathy risk factors

Answer 28

inherited

Question 29

pathology of infarction

Answer 29

ischaemic necrosis of tissue --> inflammation

Question 30

signs of infarction

Answer 30

peripheral necrosis | gangrene

Question 31

complications of infarction

Answer 31

reperfusion in surgery

Question 32

treatment of infarction

Answer 32

lifestyle modifications beta blockers statins

Question 33

what is gangrene?

Answer 33

infarction of mixed tissues in bulk

Question 34

pathology of atherosclerosis

Answer 34

damage of endothelial cells (smoking, HTN, diabetes, lipids) | thrombus forms around tear and heals to leave fibrous tissue --> cumulative build up --> atheroma

Question 35

stages of atherosclerosis

Answer 35

``` initial lesion fatty streak intermediate lesion atheroma lesion fibroatheroma complicated lesion ```

Question 36

why are statins used to treat atherosclerosis?

Answer 36

cause foam cells to die | inhibit HMG CoS reductase during cholesterol synthesis

Question 37

treatment of atherosclerosis

Answer 37

``` statins diet surgery (percutaneous coronary intervention) aspirin clopidogrel ```

Question 38

action of clopidogrel

Answer 38

inhibits P2Y12 ADP receptor on platelets

Question 39

action of aspirin

Answer 39

irreversible inhibitor of platelet cyclo-oxygenase --> stops production of thromboxane

Question 40

causes of acute coronary syndromes

Answer 40

``` rupture of plaque coronary vasospasm cocaine (causes coronary spasm) dissection of coronary artery dissection of aorta descending into coronaries ```

Question 41

signs of acute coronary syndrome

Answer 41

chest pain radiating to jaw and left arm

Question 42

what is poor R wave progression a sign of?

Answer 42

myocardial ischaemia

Question 43

treatment of acute coronary syndrome

Answer 43

antihypertensives quit smoking anti-coagulants

Question 44

diagnosis of acute coronary syndrome

Answer 44

angiogram (give fondaparinux to pts waiting for angiogram) | ECG

Question 45

pathology of myocardial infarction

Answer 45

necrosis of heart muscle due to impaired blood flow necrosis is followed by inflammatory infiltration and fibrous repair enzymes are released from necrotic muscle and leucocytosis are diagnostic markers

Question 46

what does troponin indicate?

Answer 46

cardiac muscle injury

Question 47

what does an NSTEMI look like on an ECG?

Answer 47

small R wave and no Q wave

Question 48

signs of myocardial infarction

Answer 48

tight chest pain pain in jaw pain in left arm tiredness

Question 49

complications of myocardial infarction

Answer 49

``` arrhythmias cardiac failure mitral incompetence myocardial rupture leading to haemopericardium mural thrombus leading to embolism cardiac embolism ```

Question 50

treatment of myocardial infarction

Answer 50

``` lifestyle modification beta blockers statins revascularisation ACEi anticoagulants antipaltelets ```

Question 51

initial management of MI

Answer 51

``` MONA Morphine Oxygen Nitrates (dilates arteries --> reduces bp) Aspirin - 300mg oral ```

Question 52

definition of heart failure

Answer 52

an inability of the heart to deliver blood at a rate commensurate with the requirements of metabolising tissues, despite normal or increased cardiac filling pressures

Question 53

pathology of heart failure

Answer 53

ventricles unable to contract and relax normally

Question 54

neurohormonal changes in heart failure

Answer 54

sympathetic - increased afterload RAAS - increased afterload/preload vasopressin - increased afterload and preload

Question 55

signs of right sided heart failure

Answer 55

``` raised JVP hepatomegaly ascites pitting oedema nausea epistaxis anorexia ```

Question 56

signs of left sided heart failure

Answer 56

``` cardiomegaly weight loss tachycardia murmur exertional dyspnoea orthopnoea paroxysmal nocturnal dyspnoea fatigue pink frothy nocturnal cough ```

Question 57

heart failure signs (non-specific to which side)

Answer 57

``` breathlessness leg swelling increased weight fluid retention fatigue cold peripheries ```

Question 58

complications of heart failure

Answer 58

``` renal dysfunction rhythm disturbances systemic thrombo-embolism DVT PE LBBB bradycardia hepatic dysfunction neurological ```

Question 59

treatment of heart failure

Answer 59

``` diuretics ACEi ARB BB spironolactone digoxin vasodilators (hydralazine and isosorbide dinitrate) ```

Question 60

diagnosis of heart failure

Answer 60

``` CXR bloods B-type natriuretic peptide (elevated) ECG trans thoracic echocardiogram displaced apex beat 3rd heart sound abnormally high noradrenaline, arginine, and renin ```