Core: Cardiology Flashcards
(105 cards)
1
Q
Patient - Funny sensation in the chest, feeling a little breathless, sudden onset, feeling feint. Returns to normal.
A
Arrhythmia
2
Q
Arrhythmia Aetiology
A
- Cardiac - post MIM IHD, mitral valve disease, cardiomyopathy, pericarditis, myocarditis and aberrant conduction.
- Non-cardiac - Caffeine, smoking, alcohol, sepsis, drugs (BB, digoxin, L-dopa, tricyclics), metabolic (hyper/hypokalaemia, calcium, magnesium), disease (thyroid)
3
Q
Arrhythmia Pathology
A
- Odd conduction through the nodes or other areas which create an impulse which is conducted.
eg; HB is a block at the AV node preventing conduction through to the ventricles.
4
Q
Arrhythmia Presentation
A
- Palpitations
- Chest pain
- Syncope
- Hypotension
- Pulmonary oedema
- Asymptomatic
5
Q
Arrhythmia Ix
A
1) ECG
2) Bloods - electrolytes
3) Sepsis 6
6
Q
Arrhythmia Rx
A
Bradycardia only - Tachy covered later on.
1) Identify and remove any causes. Correct electrolyte abnormalities
2) Adenosine can cardiovert even in brady
3) Pacing or an ICD can help prevent arrest and keep the heart beating at a sufficient rate.
7
Q
Patient - BP >120/80
A
HTN
8
Q
HTN aetiology
A
- Often UK
- Isolated systolic HTN can be due to atherosclerotic changes in vessels
- Essential HTN is often UK and most common cause.
- Secondary HTN - due to renal disease such as glomerulonephritis or atherosclerosis in the renal artery activating RAAS. Endocrine disorders; cushings, CAH, pheochromocytoma, hyperparathryroidism. Pregnancy, OCP, steroids.
9
Q
HTN - RAAS
A
Renin - angiotensinogen to angiotensin 1 - ACE (lungs) - Angiotensin 2 (peripheral action and sympathetic NS activation) - Aldosterone (salt and water retention) - HTN
10
Q
HTN Presentation
A
- Often nil
- Malignant HTN >200/130 = headaches, visual issues due to retinal haemorrhage and exudates.
11
Q
HTN Ix
A
1) BP
2) Ambulatory BP
3) Home BP
4) Cholesterol and Glucose for CV disease risk
5) End organ damage - U&E, ECG (LVH), urinalysis for protein.
12
Q
HTN Rx
A
Target = 140/90 <55 and white = 1) ACEI 2) ACEI + CCB or ACEI + thiazide 3) ACEI + CCB + thiazide >55 or black 1) CCB or thiazide 2) ACEI + CCB OR ACEI + thiazide 3) All three - Diabetics - ACEI at any age.
Malignant = atenolol Pregnancy = labetolol or methyldopa
13
Q
Patient - Central chest pain on exertion only and remises when not exerting.
A
Stable angina
14
Q
Angina Aetiology
A
- Atherosclerotic plaque in coronary artery system.
- Downstream hypoxia when supply and demand for O2 increases.
- Worsens as plaque increases to obscure more of the lumen.
RF = Age, Male, FHx, HTN, High lipids, Smoking, DM.
Other = Prinzmetals angina - coronary artery vasospasm w/o provocation.
15
Q
Angina Pathology
A
- Increased Myocardial demand for oxygen on exertion.
- Decreased supply due to narrowed lumen.
- Resolves when demand reduces again.
16
Q
Angina Presentation
A
- Central chest pain
- Tight, gripping, heavy
- Can radiate to chest, arm, jaw etc.
- Provoked by; exertion, meals, cold and stress.
- exacerbated by anaemia, hypotension etc.
Canadian CV society 1 = angina w/ strenuous activity 2 = angina on normal activity (stairs) 3 = angina w/ low levels of activity 4 = Angina at rest (unstable - see ACS)
17
Q
Angina Ix
A
1) ECG to rule out MI (often can have transient ST depression and T wave inversion)
2) Clinical
3) Coronary angiography to visualise vessels and blockage.
4) Trop at 6 hours post worst pain to rule out NSTEMI.
18
Q
Angina Rx
A
1) Reassure, good prognosis
2) Manage co-morbidities; HTN, DM, cholesterol
3) GTN spray for Sx relief.
4) Low-dose aspirin 75-150mg daily
5) BB can reduce Sx (atenolol 50-100mg daily or CCB)
19
Q
Patient - central crushing chest pain radiating to L arm and jaw, Pain is present at rest. Normal ECG, slightly raised trop.
A
Unstable Angina
20
Q
Patient - Central crushing chest pain, radiating to L arm and jaw, present at rest. ST elevation, raised trop.
A
STEMI
21
Q
Patient - Central crushing chest pain, radiating to L arm and Jaw. Present at rest. No ST elevation, persistent ST depression and high trop.
A
NSTEMI
22
Q
ACS Aetiology
A
Unstable angina = Angina at rest. No occluding thrombus.
STEMI = Occluding thrombus w/ necrosis of the downstream myocardium w/ ST elevation on ECG
NSTEMI = occluding thrombus w/ necrosis of the downstream myocardium w/o ST elevation ?ST depression
23
Q
ACS pathology
A
- Rupture or erosion of a atherosclerotic plaque in a coronary artery.
- Platelet aggregation and adhesions can localised thrombus which can break off causing distant thromboembolism
- Lack of oxygen and blood to downstream myocardium = death and ischaemia.
24
Q
ACS Presentation
A
- New onset chest pain
- Pain at rest
- Worsening and development of angina
- N&V
- sweaty
- Pallor
- feeling of impending doom.
- Can be silent in women, DM and elderly.
25
ACS complications
- arrhythmia
- dressler's syndrome (pericarditis)
- HF
- Mitral regurgitation
26
ACS IX
1) ECG - ST elevation (or depression)
2) Troponin (at presentation and 6 hours after worst pain)
3) Echo for irregular heart wall contraction
4) CK, myoglobin etc.
27
ACS Rx
1) Oxygen
2) Aspirin 300mg + clopidogrel
3) Morphine/GTN for pain (IV nitrates if needed)
4) Oral BB metoprolol
4) Primary PCI is Rx of choice.
5) Thrombolysis if not available
28
Patient - SOB w/ fluttery sensations in the chest. Presenting w/ TIA.
AF
29
AF/Flutter Aetiology
- Alcohol
- Rheumatic fever
- Thyrotoxicosis
- HTN
- HF
- Infection
30
AF/Flutter pathology
- Continuous rapid 300-600bpm activation of the atria.
- Due to aberrant re-entry waves.
- The heart cannot beat this fast due to the AV node slowing down conduction.
- However it beats faster and irregularly due to increased frequency of impulses.
- Flutter is an organised (regular) atrial rhythm w/ a beat rate of 250-350bom
- Due to re-entry around the tricuspid annulus.
31
AF/Flutter Presentation
- Often nil
- Palpitations
- SOB
- Chest pain
- Syncope
o/e - irregularly irregular pulse which persists in exercise.
```
Paroxysmal = stops in 7 day
Persistent = required cardioversion
Permanent = doesn't respond to cardioversion
```
32
AF/Flutter Ix
1) ECG - absent P waves (fibrillation oscillation on the rhythm strip) QRS is fast and irregular. Flutter is a regular saw tooth pattern.
2) TFT if unexplained.
3) COAG
33
AF/Flutter Rx
Acute
1) Rate control
2) Cardioversion - DC shock or medically w/ flecanide or amiodarone (use if any existing heart disease)
Chronic
1) Rate control - BB, CCB, Digoxin
2) Rhythm control w/ amiodarone + anticoagulation
34
Types of shock
1. Hypovolaemic
2. Distributive
3. Cardiogenic
4. Obstructive
5. Dissociative
35
Define shock
- Acute circulatory failure w/ inadequate or inappropriately distributed tissue perfusion resulting in generalised hypoxia or an inability of cells to use oxygen.
36
Hypovolaemic shock
1. Causes
2. Presentation
1. D&V, haemorrhage, burns, 3rd spacing (peritonitis), volvulus and intussusception.
2. Low BP
- Cold, pale
- Long CRT
- Tachy. narrow MAP, weak pulse.
37
Distributive shock
1. Causes
2. Presentation
1. Sepsis, anaphylaxis, SIRS, Toxic shock
2. Pyrexia
- rigors
- Angioedema.
- Rash
38
Cardiogenic Shock
1. Causes
2. Presentation
1. HF, valve disease, MI, arrhythmia, cardiomyopathy.
2. Signs of HF
- Increased vascular resistance.
39
Obstructive Shock
1. Causes
2. Presentation
1. Outflow obstruction; PE, cardiac tamponade, tension pneumothorax.
2. Elevated JVP
- Signs of PE
40
Dissociative shock
| 1. Causes
1. CO, haemolytic anaemia, cyanide poisoning.
41
Shock Management
1. ABCDE
2. Raise legs to autotransfuse.
3. Fluid challenge (up to 2L)
4. Bloods - search for underlying cause.
42
Patient - Palpitation and dizziness. Pulse very fast but regular.
SVT
43
SVT aetiology
- Re-entry mechanisms bypassing the AV node hence fast.
- Induced by premature atrial or ventricular ectopic.
- Triggers = hyperthyroidism, caffeine, alcohol, drugs.
44
SVT Pathology
1) Sinus tachycardia - physiological response to stress; fever, anxiety, pain, stimulants.
2) AV nodal re-entry tachycardia - common. Often in young and healthy pts. Onset triggered by an atrial ectopic.
3) AV re-entrant tachycardia - More common in males. 2 or more conducting pathways, bypass the AV node.
- Re-entry circle forms.
45
SVT Presentation
- Palpitations
- Dizziness
- SOB
- Syncope
- Chest pain
- Fatigue
- Sweating
- Nausea
46
SVT Ix
1) ECG
2) Cardiac enzymes
3) Electrolyte imbalances
4) FBC
5) TFT
47
SCT Rx
1) ABCDE
2) Vagal manoeuvres.
3) IV adenosine - rapid through a large cannula + flush.
4) Verapamil 5mg IV over 2 mins
5) BB if not responsive to other drugs
6) DC cardioversion.
7) Catheter ablation of pathways
48
VSD
- Most common
- Louder the murmur indicates a smaller defect.
- Blood can move from L to R ventricle.
- Large defect has an Eisenmenger capacity.
49
ASD
- Common
- L to R shunt
- Cardiac overload and dilated R atrium.
- SOBOE and R atrial arrhythmia potential.
50
PDA
- Persisting communication between the proximal L pulmonary artery and the descending aorta.
- Continuous L to R shunt
- Normally closes in response to oxygen
- Indometacin (prostaglandin inhibitor) can be given neontally to close.
- Continuous machinery murmur.
51
Coarctation of the Aorta
- Narrow aorta just distally to the insertion of the ductus arteriosus.
- Associated w/ Turner's syndrome and bicuspid valve.
- Severe obstruction of systemic blood flow w/ renal hypoperfusion.
- Radio-femoral delay.
- IV NSAIDS in babies to close a patent PDA
52
TOF
1. A large VSD
2. Over-riding aorta
3. RV outflow tract obstruction (pulmonary stenosis)
4. RVH
- Cyanosis due to increased R heart pressure and R to L shunt.
53
Pericarditis Aetiology
- Infection - Viral (coxsackie, echovirus, mumps, herpes, HIV). Bacterial (Staph, Strep, pneumococcus, meningococcus) Fungal (candida)
- Uraemic pericarditis
- Autoimmune; RA/SLE
- Drugs; hydralazine, isoniazid, doxorubicin.
54
Pericarditis Pathology
- Fibrous material is deposited into the pericardial space and effusion develops.
55
Pericarditis Presentation
- Often viral, often short lived and painful.
- Sharp central pain relieved on leaning forward. Worse when lying down.
- Pain can refer to neck or shoulders.
- o/e - pericardial rub on auscultation occurring in 3 phases; atrial systole, ventricular systole and ventricular diastole.
- Post MI = in the first few days, more common in anterior MI & STEMI.
- Late onset = Dressler's syn.
Autoimmune response 2-10 weeks post MI.
56
Pericarditis Ix
1) ECG - widespread saddle-shaped ST elevation and PR depression.
2) CXR for cardiomegaly
3) ECHO for effusions
4) Cardiac enzymes to rule out MI
57
Pericarditis Rx
1) Rx cause if applicable (infection)
2) Bed rest + NSAID
3) Colchicine for recurrent cases.
58
Heart failure Aetiology
- IHD
- Cardiomyopathy
- HTN
- Valve disease
- Alcohol
- Arrhythmia
59
HF Pathology
- The heart fails
- Peripheral perfusion decreases
- Compensation to maintain CO and perfusion
- As HF progresses these changes are overwhelmed.
- RAAS etc
60
New York heart association classification
```
1 = no limitation
2 = mild limitation SOBOE
3 = Marked limitation only comfortable at rest
4 = symptoms at rest
```
61
HF Presentation
- Can be acute, chronic or acute on chronic.
- LV systolic dysfunction is common due to IHD but can also occur w/ valve disease and HTN.
- RV dysfunction with chronic LVSD and due to pulmonary HTN, infarct or ARVC
- Diastolic - w/ preserved ejection fraction due to stiff ventricles.
- SOBOE
- Orthopnoea
- PND
- Fatigue
- Oedema
o/e = cardiomegaly, elevated JVP, tachy, hypotensive, oedema, lung crackles.
62
HF CXR changes
```
A - alveolar oedema (bat wings)
B - Kerley B lines
C -Cardiomegaly
D - Dilated prominent upper lobe vessels
E - Pleural effusion.
```
63
HF Ix
1) ECG
2) BNP
3) CXR
4) ECHO
5) Bloods
64
HF Rx
1) General lifestyle advice - smoking, diet, weight loss.
2) ACEI + BB - Ramipril + bisoprolol first line.
3) Second line - + aldosterone agtagonsit, ARD or hydralazine + nitrate.
4) Digoxin/ ivabradine.
5) Diuretics for fluid overload.
65
PVD Aetiology
- Atherosclerosis in vessels.
- Affects the aorto-iliac or infrainguinal arteries.
- Closely linked to stroke and MI.
RF's = smoking, DM, High cholesterol and HTN
66
PVD Presentation
- Pain
- Pallor
- Parasthesia
- Paralysis
- Perishingly cold brrrrrr
- Loss of hair
- Skin marbling
- Loss of peripheral pulses
67
Fontaine classification for chronic limb ischemia
Stage 1 = Asymptomatic
Stage 2 = intermittent claudication (discomfort on exertion in the calf which is relieved by rest, this can also be see in the hip/thigh or present as ED)
Stage 3 = Rest pain/nocturnal pain severe unremitting pain stopping the patient from sleeping.
Stage 4 = necrosis/gangrene.
68
PVD Ix
1) ABPI - 0.5-0.9 (intermittent claudication) <0.5 (critical limb ischaemia)
2) CT angiography
3) MRI w/ contrast.
69
PVD Rx
1) Risk factor management (smoking etc)
2) Drugs to promote vasodilation (nitrates)
3) Surgery - percutaneous transluminal angioplasty or bypass.
Acute = Heparin + thrombolysis or embolism removal.
70
Mitral stenosis
1. Causes
2. Presentation
3. Ix
4. Rx
1. Rheumatic heart disease secondary to GAS infection.
- Inflammation --> reduction in valve opening
- Over years this thickens and calcifies.
- Orifice often <1cm in MS (normal = 4-6cm)
- To maintain CO LA hypertrophies and dilates. Back pressure into the lungs and eventual RHS heart failure.
2. No Sx until valve = <2cm
- SOB due to lung involvement
- RHS HF
- Large L atrium (AF)
- Malar flush
- Mid diastolic murmur.
3. CXR
- ECG
- TOE
4. Conservative measures
- Trans-septal balloon valvotomy
- Open valvotomy
- Valve replacement
71
Mitral Regurgitation
1. Causes
2. Presentation
3. Ix
4. Rx
1. Occurs due to abnormalities in valve anatomy. (leaflets, muscles)
- IHD, Degeneration, IE, SLE, marfan's, Ehlers danlos.
- Regurge into the LA produces LA dilatation.
- Increased back pressure into the lungs.
2. Palpitations
- SOB and orthopnoea
- Fatigue and lethargy
- RHS HF
- Pan-systolic murmur
3. CXR
- ECG
- TOE
4. Conservative management
- IE prophylaxis
- Surgical replacement if required
72
Aortic Stenosis
1. Causes
2. Presentation
3. Ix
4. Rx
1. Calcification, Bicupsid valve.
- Obstruction to LV outflow.
- LVH and eventual LV ischaemia and pulmonary HTN etc.
2. Chest pain from myocardial ischaemia
- SOB
- Syncope due to decreased cerebral perfusion
- Poor exercise tolerance
- Ejection systolic murmur (crescendo - decrescendo)
3. CXR
- ECG
- TOE
4. Aortic valve replacement in those who have Sx
- Monitor in those who are yet to develop Sx.
73
Aortic Regurgitation
1. Causes
2. Presentation
3. Ix
4. Rx
1. Marfan's (dilatation of the aortic root)
- AR is refluxed blood from the aorta back to the LV in diastole.
- Increased preload and decreases systemic CO.
- LVH to maintain CO
2. Late developing Sx
- Angina
- Head bobbing w/ pulse (demusset's) and pistol shot femoral.
3. CXR
- ECG
- TOE
4. Rx if underlying cause is obvious
- Vasodilators and inotropes
- Surgery if severe.
74
Aortic dissection Aetiology
- Often starts as a tear in the intima, blood enters and dissects to the layers.
- Intramural haematoma is a precursor to AD and is often secondary to vasa vasorum failure and aortic wall infarction.
- Associated w/ HTN, trauma, Connective tissue disease.
75
Types of Aortic dissection
A = Involving the arch and aortic valve - proximal to the L subclavian artery origin.
B = Involves the descending thoracic aorta distal to the L subclavian.
76
AD presentation
- Sudden onset severe and central chest pain.
- Pain often radiates to the back
- Can mimic MI
- Tearing and ripping pain
- Patient is often shocked
- Aortic regurgitation is present
- Coronary ischemia
- Cardiac tamponade.
77
AD Ix
1) Urgent CT or TOE
78
AD Rx
1) Correct HTN or reduce BP (BB and GTN)
2) Type A = surgery asap w/ arch replacement
3) Type B = medically manage until stable
4) Stent.
79
Aortic Aneurysm Aetiology
AAA = Atherosclerosis, infection (E.coli, salmonella), trauma, Genetics (Marfan's)
- Often seen below the renal arteries
- Incidence increase w/ age
TAA = Often secondary to Marfan's or HTN
- Can be seen in ascending, arch or descending.
- Permanent dilatation of an artier to twice it's normal diameter
- True aneurysm = the walls of the vessel form the walls of the aneurysm
- Pseudo aneurysm = the surrounding tissues form the wall.
80
Aortic Aneurysm presentation
- Most are asymptomatic until rupture.
- AAA can be a pulsatile abdominal mass.
- Screening for all men >65yo
- Often detected on routine Ix; CT KUB, USS, AXR.
Ruptured AAA =
- Severe pain (epigastric, radiation to the back)
- Developing shock
- Pressure on other areas via haemoperitoneum.
TAA =
- Often incidentally seen on CXR
- Rapid expansion can cause chest pain radiating to the back.
- Rupture causes shock.
- Pressure of adjacent thoracic structure - stridor, haemoptysis, hoarse voice.)
81
Aortic aneurysm Ix
1) NHS screening for men >65yo
2) Incidental findings
3) Confirmation via CT/MRI if required.
82
Aortic aneurysm Rx
1) Operate if;
- >5.5cm mass
- expanding >1cm/yr
- Symptomatic
2) Medical Rx = control HTN, stop smoking, statins, regular USS.
TAA
1) >6cm diameter - surgical repair or stent.
83
Cardiac tamponade Aetiology
- Collection of fluid in the pericardial sac
- Often accompanying acute pericarditis
- Causes obstructive shock.
- Cancer, Aortic dissection, trauma
84
Cardiac tamponade Presentation
- Sx of pericarditis
o/e
- Muffled heart sounds
- Apex beat obscured
- Raised JVP
- Kussmauls sign (JVP increased w/ inspiration)
- Pulsus paradoxus
- Reduced CO
85
Cardiac tamponade Ix
1) ECG - low voltage QRS w/ sinus tachy. Electrical alternans (alternation of the QRS complex amplitude or axis between beats)
2) CXR - large globular or pear shaped heart w/ sharp outlines.
3) Echo - late diastolic collapse of the R atrium and early diastolic collapse of the R ventricle
4) Pericardiocentesis
86
Cardiac tamponade Rx
1) Rx cause
2) Pericardiocentesis
3) Drain in situ to prevent recurrence.
87
Pulsus paradoxus
1. Define
2. Causes
1. Drop in pulse volume on inspiration
| 2. Cardiac tamponade
88
Slow rising pulse
| 1. Causes
1. Aortic stenosis
89
Collapsing pulse
1. Define
2. Causes
1. Fast upstroke and fast downstroke.
2. Aortic regurg.
- PDA
90
Pulsus alternans
1. Define
2. Causes
1. Alternating strong and weak beats
| 2. Severe left ventricular failure.
91
Bisferiens pulse
1. Define
2. Causes
1. Double pulse w/ two systolic peaks
| 2. Mixed aortic valve disease.
92
Heart failure Rx
1. ACEI + BB
2. Spironolactone + ARB + nitrate
3. Cardiac resynchronisation or digoxin
4. Thiazide diuretics at any time for fluid overload.
5. One off pneumococcal vaccine and yearly influenza vaccine.
93
Third heart sound
1. Define
2. Causes
1. A heart sound other than the standard lub-dub.
- Caused by diastolic filling of the ventricle.
- Normal in kids and people under 30.
- Abnormal in adults.
2. Normal in kids and adults <30.
- Sign of left ventricular failure (dilated cardiomyopathy), constrictive pericarditis and mitral regurg.
94
Fourth heart sound
1. Define
2. Causes
1. Atrial contraction against a stiff ventricle
| 2. Aortic stenosis, HCOM, HTN.
95
High INR management - INR 5-8 with NO bleeding.
1. Stop warfarin for 1 or 2 doses
| 2. Reduce subsequent maintenance
96
Major bleeding on warfarin
1. Stop warfarin
2. Give IV vitamin K 5mg
3. Prothrombin complex concentrate or FFP
97
INR >8 + minor bleeding.
1. Stop warfarin
2. Give IV vitamin K 1-3mg
3. Repeat Vit K if still high after 24hrs
4. Restart warfarin when Vit K is <5.
98
INR Targets
DVT - 2.5 or if recurrent 3.5
| AF - 2.5
99
Peri-arrest arrhythmia management
1. ABCDE
- Haemodynamically compromised?
2. If shocked = SHOCK !!
3. Regular Broad complex tachycardia (VT) - Amiodarone.
4. Irregular Broad complex tachycardia - torsade de pointes - IV magnesium
5. Regular narrow complex (aflutter) - Vagal then adenosine then BB rate control.
6. Irregular narrow complex tachycardia (AF) - electrical or chemical cardioversion, BB.
100
Long QT syndrome
1. Causes
2. Presentation
3. Ix
4. Rx
1. Delayed repolarisation of the ventricles.
- Can lead to VT or torsade de pointes.
- Congenital
- Drugs; amiodarone, soltalol, tricyclics, SSRI's. erythromycin, haloperiodol.
- Electrolytes
- Myocarditis
- SAH
2. Long QT1 = exertional syncope, especially swimming
- Long QT2 = often associated w/ syncope following emotional stress, exercise and noises
- Long QT3 = events at night or rest
- Sudden cardiac death.
3. ECG
4. Avoid drugs which prolong further and other precipitants.
- ICD
101
STEMI management
Aspirin + Ticagrelor/clopidogrel + IV heparin + PCI
102
Dilated Cardiomyopathy
1. Causes
2. Presentation
3. Ix
4. Rx
1. Idiopathic
- Myocarditis
- IHD
- HTN
- alcohol
- Inherited
- Dilated heart leading to reduced ejection fraction.
- Sign of LHS HF
2. Sign of LHS HF
- SOB etc.
- S3
- Displaced apex beat.
3. ECG - LBBB
- echo
- CXR
- BNP
4. Diuretics for fluid overload.
- ACEI
- Digoxin
- BB
- Spironolactone
- Tx
103
MI ECG changes + Location and Vessel
1. Anteroseptal
2. Inferior
3. Anterolateral
4. Lateral
5. Posterior
1. V1-4 = LAD
2. 2,3,AVF = R coronary
3. V4-6, 1 and AVL = LAD or L Cx
4. 1, AVL +/- V5/6 = L Cx
5. Tall R waves in V1-2 = LCx or R coronary.
104
CHADVASC
1. Congestive HF = 1
2. HTN = 2
3. Age >75 = 2
4. DM = 1
5. Stroke/TIA = 2
6. Vascular disease = 1
7. Age 65-74 = 1
8. Female = 1
105
PE - thrombolysis
PE + Hypotension
