Chapter 2- Cardiovascular

Question 1

What is heart failure?

Answer 1

A complex syndrome that can occur from any structural or functional cardiac disorder that impairs the ability of the heart to fill with and eject blood and therefore function efficiently as a pump to support physiological circulation

Question 2

Name two types of heart failure

Answer 2

1) systolic heart failure (reduced ejection fraction ventricles can’t pump it fully)
2) diastolic heart failure (preserved ejection fraction heart can’t fill with blood properly

-biventricular –> both sides

Question 3

What ejection fraction signifies systolic heart failure?

Answer 3

<40%

Question 4

Why is the ejection fraction in diastolic heart failure normal?

Answer 4

Because although you have a low stroke volume you also have a reduced ‘preload’ (low total volume entering ventricle)

Question 5

With left sided heart failure blood gets backed up to where?

Answer 5

The lungs

Question 6

With right sided heart failure blood gets backed up to where?

Answer 6

The body

Question 7

What’s JVP and what’s it often a sign of?

Answer 7

Jugular venous pressure (often in right sided heart failure)

Question 8

Why can patients with heart failure get enlarged livers and spleens and what can this lead to?

Answer 8

Fluid leaks out into interstitial space and they enlarge, can lead to e.g liver cirrhosis

Question 9

True or false: very little fluid can build up in the peritoneal space

Answer 9

False a LOT of fluid can = ascites

Question 10

What is pitting oedema?

Answer 10

E.g fluid build up in legs when you press it it leaves a ‘pit’ and takes a while to come back

Question 11

How many classes are on the New York heart association classification?

Answer 11

Four

Question 12

Tnt (troponin) above what levels indicates a probable MI?

Answer 12

> 30 ng/L

Question 13

What is troponin?

Answer 13

Specific cardiac structural proteins- if there is myocyte injury troponin will be released

Question 14

Name two cardioselective beta blockers used in heart failure

Answer 14

Bisoprolol

Carvedilol

Question 15

Name a new combination treatment used in heart failure

Answer 15

Sacubitril/valsartan

Question 16

What type of drug is sacubitril?

Answer 16

Neprilysin inhibitor

Question 17

How does sacubitril work?

Answer 17

Reduces the breakdown of natriuretic proteins, increasing salt and water excretion via kidneys

Question 18

What is an ICD?

Answer 18

Intra cardiac defirbrillator: implanted device to terminate or shock patients who develop life threatening heart rhythms, often combined with CRT device

Question 19

What is a CRT device?

Answer 19

Cardiac resynchronisation therapy: special pace maker device to improve efficiency of existing pump function

Question 20

Acute coronary syndrome can be split into three clinical presentations- what are these?

Answer 20

STEMI
NSTEMI
unstable angina (UA)

Question 21

Name three things that can damage the endothelium of artery walls

Answer 21

Low density lipoprotein
Smoking
High blood pressure

Question 22

What’s a foam cell

Answer 22

Dead macrophages containing excess low density lipoproteins

Question 23

Name two cardiac troponins and when should they be measured?

Answer 23

TnT and Tnl : levels taken on arrival, at 6 hours and 12hours if required (levels peak within 12 hours)

Question 24

How long does it take troponin levels to fall after their initial rise?

Answer 24

They fall slowly for up to 2 weeks

Question 25

Name two cardiac markers used in ACS

Answer 25

Cardiac troponins | Creatinine kinase

Question 26

Describe how creatinine kinase rises and fall post infarction?

Answer 26

Rises 6 hours post infarction and falls >36 hours

Question 27

Why is creatinine kinase levels not as good as troponin levels?

Answer 27

Creatinine kinase is not cardioselective - also found in skeletal muscle so may be higher in e.g athletes

Question 28

What does the GRACE score calculate?

Answer 28

% risk of mortality from ACS

Question 29

What GRACE score signifies high risk?

Answer 29

>3%

Question 30

What GRACE score signifies intermediate risk?

Answer 30

1.5-3%

Question 31

What GRACE score signifies low risk?

Answer 31

<1.5%

Question 32

The GRACE score tells you the % risk of death at 4 different intervals, what are these

Answer 32

1) in hospital 2) 6months 3) 1 year 4) 3 years

Question 33

During an acute NSTEMI the anticoagulant fondaparinux is used--> when would you use IV UFH instead?

Answer 33

When GFR <20ml/min

Question 34

When would you use tirofiban in acute treatment of NSTEMI?

Answer 34

If GRACE >6% or significant ECG changes --> NICE says it prevents thrombus extension

Question 35

List the medication expected for Intermediate risk NSTEMI

Answer 35

``` Aspirin 300mg Clopidogrel 600mg (or ticagrelor) Fondaparinux (or UFH) IV nitrates Morphine & metoclopramide Beta blocker ACEi Statin ```

Question 36

Name one extra medication use for high risk NSTEMI not used in intermediate risk NSTEMI

Answer 36

Tirofiban

Question 37

What heart rate do you aim for post NSTEMI?

Answer 37

50-60bpm

Question 38

When using aldosterone antagonists such as spironolactone or eplerenone what should you be cautious of

Answer 38

Hyperkalaemia

Question 39

If patients have evidence of heart failure post MI (ejection fraction <40%) what should they be started on within 3-14 days of the event?

Answer 39

Aldosterone antagonist such as eplereone (if already on spironolactone then remain on this)

Question 40

What is PCI

Answer 40

Percutaneous coronary intervention--> balloon stent to prevent stenosis

Question 41

When should thrombolysis be used?

Answer 41

When can't get to angioplasty for STEMI

Question 42

What is tirofiban?

Answer 42

Glycoprotein 2B/3A inhibitors --> reversible inhibition of platelets whilst bound