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CARDIOVASCULAR SYSTEM Flashcards

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1
Q

How many surgical patients get DVT?

a) 1-2%
b) 20-50%
c) 60-70%
d) 80-90%

A

b) 20-50%

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2
Q

name 3 symptoms presents on the calf of a DVT patient

A

tenderness
warmth
swelling
pitting oedema

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3
Q

give one systemic symptom which may be present for DVT

A

mild fever

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4
Q

What is Homan’s sign for DVT?

a) pain on knee flexion
b) pain on dorsiflexion
c) pain on knee extension
d) pain on plantarflexion

A

b) pain on dorsiflexion

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5
Q

why shouldn’t Homan’s sign be performed?

A

may dislodge clot

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6
Q

if pain is referred to the iliofemoral region, what does this mean in reference to motility of the clot?

A

more likely to dislodge

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7
Q

in complete occlusion due to DVT, what sign of peripheral hypoxia might you see in the leg?

A

cyanosis

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8
Q

what is post-phlebitis syndrome?

A

ulceration after complete occlusion following a DVT

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9
Q

give 2 iatrogenic risk factors for DVT

A

HRT

COCP

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10
Q

give two lifestyle risk factors for DVT

A

immobility

obesity

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11
Q

give 3 physiological risk factors for DVT

A

malignancy
pregnancy
thrombophilia
past DVT

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12
Q

what is a thrombus in contrast to a clot?

A

solid mass in circulation from living blood constituents in life (not dried, dead etc)

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13
Q

what are red thrombi made of?

a) red cell & fibrin
b) red cell & cholesterol
c) white cell & fibrin
d) white cell & cholesterol

A

a) red cell & fibrin

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14
Q

What is Well’s score used to calculate?

A

DVT risk

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15
Q

what would a Well’s score of 3 or more indicate?

A

high risk DVT

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16
Q 
What are these criteria used to calculate?
active cancer
previous DVT
recent immobilisation
swollen superficial veins
calf swelling >3cm
entire leg swelling
localised swelling
A

Well’s Score

DVT

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17
Q

what specific blood test would you use in the case of suspected DVT?

A

D-Dimer

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18
Q

what specific radiological test would you do in a suspected DVT?

A

compression ultrasound

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19
Q

give 2 differential diagnoses for DVT

A

ruptured baker’s cyst

cellulitis

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20
Q

what is the first drug you would give in treatment of DVT?

A

LMWH e.g. enoxaparin

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21
Q

when would INR indicate it would be safe to stop LMWH?

a) 2-3
b) 1-2
c) 4-5
d) 9-10

A

a) 2-3

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22
Q

name an anti-coagulant you might also give in the case of DVT

A

warfarin

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23
Q

name a factor Xa inhibitor that you might also give in the case of DVT

A

fondaparinux

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24
Q

give a complication of DVT

A

pulmonary embolism

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25
how common is acute coronary syndrome? a) 1/1000 b) 5/1000 c) 50/1000 d) 100/1000
b) 5/1000
26
name 2 rare causes of ACS
emboli coronary spasm coronary artery vasculitis
27
what differentiates between chest pain of unstable angina and of an MI?
unstable angina = 20mins
28
give two places that ACS chest pain radiate to?
left arm neck jaw
29
Give 4 symptoms of ACS
sweating tachycardia nausea breathlessness
30
name 2 signs you might hear when listening to the heart on chest examination in ACS
4th heart sound pan systolic murmur pericardial friction rub
31
name a sign you might see when observing the neck of a patient with ACS
raised JVP
32
name a sign you might hear when listening to the lungs of someone with ACS
crepitation due to pulmonary oedema
33
how would you distinguish a silent MI from other ACSs?
no pain
34
which of these is NOT at risk of getting a silent MI? a) old b) diabetic c) immobile
c) immobile
35
what is the difference between the tissue damage in a STEMI and a NSTEMI?
``` STEMI = infarction NSTEMI = ischaemia (reversible) ```
36
what are the three main causes of the arterial narrowing that can cause ACS?
rupture thrombosis inflammation
37
what is the end result of cells that are affected to artery narrowing of cells in ACS?
iscahemia infarction necrosis
38
what is the sinus rhythm in an inferior MI and why does this occur?
sinus bradycardia | vagal stimulation
39
what is a transmural MI?
necrosis through the thickness of the pericardium
40
name 7 risk factors for ACS
``` age male obesity smoking hypertension diabetes cholesterol sedentary lifestyle family history stress LVHF cocaine ```
41
why are ACS attacks more common in the morning?
blood pressure lower at night. | when it rises in the morning can dislodge a clot
42
what would high troponin and ACS symptoms indicate?
MI
43
what would normal troponin but ACS symptoms indicate?
unstable angina
44
what do the cardiac enzymes CK and CK-MB indicate in ACS?
myocyte death
45
when would you expect lactate dehydrogenase to rise after an MI? a) minutes b) hours c) days d) weeks
c) days
46
name 2 things you might see in a chest x-ray of someone with ACS
cardiomegaly pulmonary oedema widened mediastinum
47
give 4 differential diagnoses for ACS
``` pericarditis angina pulmonary embolism aortic dissection myocarditis pneumothorax GORD ```
48
what is the mortality for MIs within 2 hours of onset? a) 5% b) 25% c) 50% d) 75%
c) 50%
49
what is the 4-way treatment plan for acute STEMIs?
aspirin 300mg nitrate GTN spray clopidogrel 300mg oxygen
50
what surgical treatment would you recommend for an acute STEMI?
PCI angioplasty
51
what three drugs would you give in the case of an NSTEMI?
beta blockers LMWH nitrates
52
fill in the blanks for ACS rehabilitation advice: | no __ for 1 month, no __ __ for 2 months
sex | air travel
53
what 4 drug groups would you give long term following an MI?
anti-coagulant statin ACE inhibitors beta blockers
54
name 3 acute serious cardiac complications of ACS
cardiac arrest heart block cardiac tamponade
55
name 2 causes of sudden death following MI
ventricular fibrillation | asystole
56
name 2 peripheral complications of MI
DVT | PE
57
which of these is a cardiac enzyme that will rise within hours of an MI? a) ALT b) AST c) ALP d) AZT
b) AST
58
what is Dressler's syndrome?
immune mediated pericarditis
59
what immune mediated, post-MI condition do these symptoms indicate? post MI: fever, pericardial effusion, anaemia, cardiomegaly a) Dressler's b) Robert's c) Mallory-Weiss d) SLE
Dressler's symdrome
60
how is dressler's syndrome treated? a) self limiting, NSAIDs & steroids b) self limiting, antibiotics & DVT prophylaxis c) emergency, anti-coagulants & statins d) emergency, antibiotics and DVT prophylaxis
a) self limiting, NSAIDs & steroids
61
what is the prevalence of angina pectoris in the UK? a) 2% b) 10% c) 40% d) 60%
a) 2%
62
what causes the pain of angina pectoris?
insufficient oxygen supply to meet heart's demand
63
what causes the insufficient oxygen to the heart in angina pectoris?
atherosclerosis & narrowing of vessels
64
name 2 other causes of angina pectoris
anaemia thyrotoxicosis hyperlipidaemia
65
what environmental factors can precipitate angina pectoris?
exercise cold heavy meals
66
name 3 risk factors for angina pectoris
smoking exercise hypertension diabetes
67
what is classical angina?
exercise provoked | disappears w rest
68
what is decubitus angina?
when lying
69
what is nocturnal angina?
wakes patient | vivid dreams
70
what is prinzmetal's angina
at rest | without trigger
71
what ECG abnormality would you see in prinzmetal's angina?
ST elevation during pain
72
in which gender is Prinzmetal's angina more common?
female
73
what is cardiac syndrome X?
abnormal stress response to exercise with no artery abnormality
74
which gender is cardiac syndrome more common in?
female
75
what cardiac imaging might you do in suspected angina?
echocardiography | CT coronary angiography
76
name 4 drugs given to treat angina
aspirin 75mg beta blockers calcium channel blockers GTN spray
77
name 2 surgical interventions that you might consider if angina is severe or doesn't respond to drugs
PCI | CABG
78
which of these facts is wrong about prevalence of AF? a) 5% in over 65s b) 10% in over 70s c) 15% in stroke patients d) 20% of hyperthyroid patients
d) 20% of hyperthyroid patients
79
which of these doesn't cause AF? a) heart failure b) MI c) hypertension d) hypothyroidism e) mitral valve disease
d) hypothyroidism
80
which of these doesn't cause AF? a) PE b) pneumonia c) pneumothorax d) alcohol e) surgery f) sepsis
c) pneumothorax
81
what is the characteristic pulse pattern of someone with AF?
irregularly irregular
82
give 3 possible symptoms of AF
palpitations chest pain dyspnoea syncope
83
name 3 risk factors for AF
rheumatic heart disease alcohol intoxication hypertension thyrotoxicosis
84
what electrolyte imbalances can predispose to atrial fibrillation?
hypokalaemia | hypermagnaemia
85
what is the normal heart rate for someone with AF a) 40-60bpm b) 60-80bpm c) 120-180bpm d) 180-200bpm
c) 120-180bpm
86
what electrical fault results in AF?
AVN intermittently responds causing irregular ventricular contraction
87
which of these isn't a result of AF? a) stasis of blood in heart chambers b) neovascularisation c) cardiac output drops
b) neovascularisation
88
how long does acute AF last?
less than 48 hours
89
what is paroxysmal AF?
recurrent sudden episodes
90
what is the difference between persistent and permanent AF?
``` persistant = rhythm treatable permanent = rhythm non-treatable ```
91
what ECG sign shows AF?
absent P waves
92
name 3 possible drugs given to control ventricular rate in acute AF
diltiazem verapamil digoxin amoidarone
93
why would you give warfarin in chronic AF?
reduce risk of stroke (anticoagulation)
94
name 2 drugs used for first line treatment in chronic AF
beta blocker | calcium channel blocker
95
name a complication of AF
stroke
96
in what race is hypertension most common?
black africans
97
in what gender is hypertension most common?
men
98
what is the percentage of hypertension in the general population? a) 5-10% b) 20-30% c) 50-60% d) 75-85%
b) 20-30%
99
what is the main cause of essential hypertension?
no underlying cause
100
what is another element in the cause of essential hypertension?
genetics
101
what happens to blood pressure in hypertension?
elevated
102
name 2 non-circulatory symptoms of hypertension
headaches sweating shortness of breath
103
what would radio-femoral delay in hypertension indicate?
aortic coarctation
104
what would renal bruit in hypertension indicate?
renovascular disease
105
name 4 lifestyle risk factors for hypertension
obesity alcohol salt intake stress
106
name 3 endocrine diseases which may predispose to hypertension
``` conn's cushion's acromegaly pheochromocytoma diabetes ```
107
name 2 physiological risk factors for hypertension
pregnancy | diabetes
108
which of these describes hypertension a) increase in peripheral vascular resistance b) increase in coronary vascular resistance c) increase in coronary vascular lumen width d) increase in peripheral vascular lumen width
a) increase in peripheral vascular resistance
109
how is hypertension graded?
1-3 | 3 is most severe
110
what aldosterone disorder can cause hypertension?
primary aldosteronism
111
what condition would hypokalaemia in hypertension indicate?
Conn's
112
what heart changes might be seen in an ECG for hypertension
left ventricular hypertrophy
113
why is it important for the blood pressure not to be reduced too fast in treatment of hypertension?
baroreceptors in brain adapt to high pressure so reduction speedily may cause cerebral ischaemia
114
what would be first line treatment for essential hypertension?
ace inhibitor | or angiotensin 2 receptor antagonist
115
what would be first line treatment for someone over 55 or afro-carribean with hypertension?
thiazide diuretic and calcium channel blocker
116
what defines cardiac failure?
heart not able to pump blood at rate required for normal metabolism
117
disease of what arteries can cause cardiac failure?
coronary arteries
118
what is the prevalence of under 85s and over 85s for heart failure in the UK? a) 7/1000, 90/1000 b) 50/1000, 150/1000 c) 100/1000, 200/1000 d) 1/1000, 5/1000
a) 7/1000, 90/1000
119
where would you get oedema in left ventricular failure in contrast with right ventricular failure
``` left = pulmonary oedema right = ankle/sacral ```
120
what sided heart failure would be characterised by orthopnoea and paroxysmal nocturnal dyspnoea?
left
121
in which sided heart failure would you find a displaced apex beat?
left
122
in which sided heart failure might you find ascites?
right
123
in which sided heart failure might you find a right ventricular parasternal heave?
right
124
what is the name of the classification system for heart failure?
new york heart association
125
name 5 things you might see on a chest X-ray for heart failure
``` Alevolar oedema (bats wing) Interstitial oedema (kerley B lines) Cardiomegaly Upper lobe Deviation Pleural effusions ```
126
what might an echocardiogram show for heart failure?
chamber distension
127
what is forward heart failure in relation to the kidneys?
ventricle can't maintain normal renal circulation
128
Which system causes sodium and water retention in forward heart failure?
renin-angiotensin system
129
what occurs to the atria in backwards heart failure?
ventricles can't prevent atria from overfilling
130
what occurs to the pulmonary system in backwards heart failure
back pressure on system
131
when is the onset of acute heart failure?
sudden within minutes of MI or valvular collapse
132
what 2 things cause onset of chronic heart failure
mitral stenosis which leads to RHF | chronic ischaemia
133
which sided heart failure is most common?
left
134
how would you define the circulating volume in congestive cardiac failure?
hypervolaemic
135
what occurs to the lungs with congestive cardiac failure
pulmonary oedema
136
what is cor pulmonale and what causes it?
right sided heart failure due to COPD
137
what two words would you use to describe greater circulating fluid before and after entering the heart?
preload | afterload
138
what happens to the ventricles during heart failure
dilation
139
what 2 things happen to myocytes during heart failure?
hypertrophy & remodelling
140
name 2 diuretics you could give in treatment for heart failure
furosemide bendroflumethiazide bumetanide
141
name an ace inhibitor you could give in treatment of heart failure
ramipril
142
name an angiotensin 2 receptor antagonist you could give in treatment of heart failure
losartan
143
when would you use angiotensin two receptor antagonists in heart failure?
intolerance to ace inhibitors
144
why are ace inhibitors used in the treatment of heart failure?
Relax blood vessels and lower blood pressure. This improves blood flow. Your heart is then able to pump more blood to the rest of your body without working harder.
145
why are beta blockers used in heart failure?
to improve cardiac function
146
when would you give a cardiac glycoside in heart failure? give an example
if AF present | digoxin
147
why are vasodilators and nitrates used to treat heart failure?
to reduce preload and afterload
148
intolerance to what 2 drugs would justify giving vasodilators and nitrates?
ace inhibitors | angiotensin 2 receptor antagonists
149
when would you consider anticoagulation/antiplatelets in a heart failure patient?
risk of stroke
150
what is mortality at 5 years for heart failure? a) 5% b) 25% c) 50% d) 75%
c) 50%
151
risk of what other cardiac condition is increase by four times following heart failure?
stroke
152
what two red flags would make you worry about infective endocarditis?
fever | new murmur
153
what 4 hand and nail signs might you expect to see in infective endocarditis?
clubbing laneway lesions osler's nodes splinter haemorrhages
154
what organ may be enlarged in septic infective endocarditis?
spleen
155
which of these is not a results of immune-complex deposition in infective endocarditis? a) haematuria b) non-viral hepatitis c) glomerulonephritis
b) non-viral hepatitis
156
name 2 lifestyle risk factors for infective endocarditis
IVDU | poor dental hygiene
157
name 2 physiological risk factors for infective endocarditis
new arrhythmias | congestive heart failure
158
name an iatrogenic risk factor for infective endocarditis
prosthetic material in heart
159
what is the most common causative organism for infective endocarditis?
Staph A
160
name 2 other causative organisms for infective endocarditis
Coagulase negative Staph A | Streptoccous= Most common Strep Viridans
161
what is Duke's criteria?
diagnosis of infective endocarditis
162
which of these is not a feature of Duke's criteria a) positive blood culture b) fever c) positive echo d) new murmur e) heart diameter f) predisposing factors
e) heart diameter
163
what is mortality rate for infective endocarditis without treatment?
100%
164
what 2 antibiotics would you give for infective endocarditis
penicillin & gentamicin
165
what 2 antibiotics would you give for MRSA infective endocarditis?
vancomycin & gentamicin
166
name 2 complications of infective endocarditis
sepsis infective emboli abscess
167
what hearing distortions are common with postural hypotension?
tinnitus
168
what kind of syncope is present with postural hypotension?
vasovagal
169
what occur to the blood pressure that is abnormal in postural hypotension?
suddenly falls on standing
170
what condition is defined by a fall in the systolic by 20mmHg and diastolic by 10mmHg?
postural hypotension
171
where does blood pool upon a change in body position in postural hypotension?
lower extremities
172
how does pooling of blood in postural hypotension affect venous return? how does this affect cardiac output?
compromises venous return | decreases cardiac output and arterial pressure
173
which group does postural hypotension NOT commonly affect? a) elderly b) those with low blood pressure c) young children
c) young children
174
what are the causes of postural hypotension? | 4A's, 2D's, 2P's
``` anorexia addison's atherosclerosis antidepressants diabetes ehler's Danklos Parkinson's phaechromocytoma ```
175
what change to diet is encouraged in postural hypotension?
high salt
176
what drug would you give in the case of anaemic postural hypotension?
erythropoietin
177
name a common heart irregularity in a young person
supra ventricular tachycardia (SVT)
178
name 3 symptoms associated with SVT
rapid regular heart beat chest pain improves with rest
179
how would you treat SVT?
beta blocker | ca-ch blocker
180
What is congested heart failure?
It is both right and left heart failure. Blood returning to the heart get trapped in the IVC and SVC causing oedema.
181
What affect does congested heart failure have on the kidney?
Causes them to retain water and sodium which causes further oedema.
182
What are the condition that cause restrictive blood flow and therefore CHF?
Cardiac temponade | Constrictive pericarditis
183
What conditions cause inadequate heart rate and therefore CHF?
Beta blockers Post MI heart block
184
What is the New York heart Classification of heart failure?
Class I (no symptoms) – you don't have any symptoms during normal physical activity Cass II (mild) – you're comfortable at rest, but normal physical activity triggers symptoms Class III(moderate) – you're comfortable at rest, but minor physical x triggers symptoms Class IV (severe) – you're unable to carry out any physical activity without discomfort and you may have symptoms even when resting ( symptomatically severe HF)
185
What conditions causes increase pre-load in low output heart failure?
Mitral regurgitation and fluid overload
186
What conditions causes increase after-load in low output heart failure?
Aortic stenosis and hypertension
187
What are the two main causes of HF?
CAD and hypertension
188
What is high output HF?
It is when the heart has a normal cardiac output however the demand of the body is greater than normal and therefore cannot meat the bodies demand
189
What conditions cause high output HF?
Hyperthyriodism Paget disease Heart disease with anaemia or pregnancy
190
What are the two types of LHF?
Systolic and diastolic heart failure
191
What is systolic LHF?
There is a reduced ejection fraction and the cardiac output of the left heart cannot meat the demand of the body. Abnormal left ventricular contraction EF = <40%
192
What is diastolic LHF?
It is when the left side of the heart has a thickened heart muscle and cannot relax properly and therefore fill up normally. Increased filling pressure EF= >50%
193
What causes systolic LHF?
``` MI CAD Hypertension Aortic stenosis Mitral regurgitation IHD Arrhythmia ```
194
What causes diastolic LHF?
``` Cardiac tamponade Constrictive pericarditis Pericarditis disease Hypertension Aortic stenosis that leads to hypertrophy Hypertension can lead to hypertrophy CAD ```
195
What are signs and symptoms of RHF?
``` Increase JVP Hepato congestion leading to ascites Peripheral oedema ( ankle and sacral) Right ventricle parasternal heaves Pitting oedema Fatigue ```
196
In which side heart failure would cause Haemoptysis and coughing up sputum that is frothy and pink?
Left
197
What are the symptoms of LHF?
``` Haemoptysis Coughing up pink and frothy sputum Fatigue PND Orthoponea ```
198
What are the signs of LHF?
``` S3 gallop Tachycardia Tachypnoea Pleural effusion Pleural oedema Displaced apex beat ```
199
What is the main cause of RHF?
Main cause of RHF is caused by LHF which causes increase in pressure in the lungs and then back to the right hand side of the heart increasing the work load
200
What lung diseases causes RHF?
PE, Pulmonary hypertension and emphysema
201
What type of stenosis causes RHF?
Mitral stenosis causes hypertrophy of atria and also increase in preload
202
What type of regurgitation causes RHF?
Tricuspid regurgitation as it causes volume overload and dilation of the right ventricle.
203
What birth defect leads to RHF?
Left to right shunt
204
What type of stenosis is there in Fallots Tetralogy?
Pulmonary stenosis
205
What is Ebstein’s anomaly?
Abnormality in tricuspid valves
206
What is Rheumatic heart disease?
Valvular disease due to rheumatic fever
207
What causes Rheumatic fever?
Untreated throat infection caused by Group A Streptoccocus
208
What is the cause of mitral stenosis?
Mainly due to Rheumatic heart disease | Can be due to calfication
209
Who is mitral stenosis commonly seen in?
Pregnancy
210
What are the symptoms of mitral stenosis?
``` Chest pain Fatigue Dyspnoea palpitations Haemoptysis ```
211
Signs of mitral stenosis
Mid late diastolic murmur Radiates to axillia Malar flush
212
What are the complications of Mitral stenosis?
``` AF Pulmonary Hypertension HF Left atrial dilation Thromboembolism ```
213
How do you diagnose mitral stenosis?
``` CXR = L atrial enlargement Echo = L atrial enlargement, thick+calcified mitral valve ```
214
What is the most common valvular disease in western world?
Aortic stenosis
215
What is the cause of aortic stenosis?
Calcification by age but made worse by dm and hypertension
216
Symptoms of aortic stenosis?
HF, angina and syncope
217
What are the signs of aortic stenosis?
Ejection systolic murmur that radiates from aortic area to carotid Slow rising pulse Narrow BP Left ventricular heaves
218
What are the complications of aortic stenosis?
Left ventricular hypertrophy and dilation HF Thromboembolism
219
How is aortic stenosis diagnosed?
Cardiac chamber catheterisation --> definitive ECG Echo--> thickened valves and LV hypertrophy Cxray--> cardiomegaly
220
What is the most common valvular disease?
Mitral regurgitation
221
What are the causes of mitral valve regurgitation?
Infective endocarditis Mitral valve prolapse Connective tissue disorder (marfans) Rheumatic fever
222
What type of murmur in mitral regurgitation?
Pan systolic murmur
223
Where does mitral regurgitation radiate to?
Axilia
224
What is mitral regurgitation complications?
Heart failure Pulmonary oedema LV hypertrophy AF
225
What is the main diagnosis of mitral regurgitation?
Echo which shows prolapsed valve
226
What is treatment for mital regurgitation?
* Vasodilators to reduce afterload * Treat HTN * Treat AF * Intra-aortic balloon pump if acute until surgery * Valve repair or replacement
227
What is the cause of aortic regurgitation?
* Idiopathic aortic root dilatation * Dilatation due to ageing, infection, HTN or inflammatory disease * Congenital bicuspid valve * Infective endocarditis * Aortic dissection * Trauma
228
What sort of murmur is aortic regurgitation?
Early dialstolic murmur
229
What is the characteristic of BP in aortic regurgitation?
Wide BP

Y3 CORE CONDITIONS (15 decks)

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