Core conditions CVD Flashcards
(99 cards)
1
Q
Common presenting CV conditions?
A
ACS - MI/ Unstable angina Stable Angina 1" HTN AF LVHF/RVHF/CHF Valvular HD Postural hypotension DVT Infective Endocarditis
2
Q
A 65 y/o man walks into the GP with chest pain/sweating/nausea/SOB.
What are the diffrentials?
A
MI*
Angina*
Aortic dissection
PE
Pneumothorax
Oesephgeal reflex*
Peptic ulcer
MSK: costocondiritis*
Neuro: shingles
Anxiety*
3
Q
What tests could you do to confirm if someone is having an MI?
A
Troponin (see in NSTEMMI)
ECG - ST elevation
4
Q
Treatment of MI?
ROAM GB
A
ROAM GB: Reassurance 02 ASPIRIN Morphine
GTN
B-blocker
(PCI)
5
Q
What might a patient later suffer from after an MI?
A
DARTH VADER: Death/ Depression Arrhythmias Ruptured myocardium Thrombus --> STROKE Heart failure
Ventricular aneurysm Angina Dressler's syndrome Emboli Recurrence
6
Q
A 70 y/o Diabetic man presents to A&E feeling SOB with chest pain on exertion and nausea. They feel better when they rest.
What is it likely to be?
A
Stable Angina
7
Q
Angina = chest pain from heart ischaemia.
State 3 common causes.
A
ATHEROMA/CHD
Vasospasm
Aortic stenosis
8
Q
Diffrentials of Angina?
A
Same as MI
9
Q
Angina can be diagnosed by exclusion using an ECG. What would you give to relieve the man’s symptoms?
A
GTN spray
B-blockers/Ca2+ blocker
+ 2” prevention measures (Statins, Aspirin, ACE-In)
10
Q
Complications of Angina?
A
MI
11
Q
Define AF
A
AF = disordered electrical activity in the atria
1.5% of population
12
Q
AF is associated with IHD*/HTN/Valvular HD/ Hyperthyroid/Congenital HD/Obesity.
T/F?
A
T
13
Q
What lifestyle risk factor can lead to AF?
A
Alcohol
CV risk factors
14
Q
State 4 symptoms that someone with AF may present with.
A
PALPITATIONS
SOB
Faint
Chest pain
15
Q
What is the classic sign of AF?
A
Irregularly irregular pulse
often very fast pulse
16
Q
Name 5 diffrentials of AF that the man could have.
A
Atrial tachycardia Ectopic beats Wolf-Parkinson-White syndrome Anxiety Sinus Tachycardia
17
Q
What investigative finding is diagnostic of AF?
A
ECG - No P waves
18
Q
______ and _______ is a potential complication of AF.
Whats the treatment for AF?
A
STROKE, Heart Failure
ABCD: Anti-coagulant B-blocker CCB (Rate-limitng) Digoxin
19
Q
Essential hypertension is present in > 30% of adults.
T/F?
A
T
Cause unknown
20
Q
If you are ________ or have a _______ of HTN, you are more likely to get it.
A
Afro-Carribean
FH
21
Q
List 7 diffrentials of essential HTN
A
WPW Syndrome
MI
Stroke
Hyperthyroid
Sleep apnoea
Anxiety
White coat HTN
22
Q
How would you diagnose Essential HTN?
A
Sustained BP > 140/90 in home and clinic
23
Q
State the 2 drugs most commonly prescribed for HTN.
A
ACE-In
Ca2+ blocker (>55ys/Afro-C)
24
Q
What lifestyle changes would you encourage for someone with Essential HTN
A
Reduce Salt/Alcohol
25
Those with HTN are advised to have their _________ function checed annually
Kidney
26
What is the clinical definition of a sudden drop in blood pressure when someone stands up too quickly?
POSTURAL HYPOTENSION
27
Postural hypotension is common in the ________
Elderly
28
Which type of drug has a side effect of postural hypotension?
Diuretic
29
Risk factors for postural hypotension?
Elderly
Diuretics
Heart failure
Aortic stenosis
Diabetes
Parkinsons
Pernicious anaemia
Pregnancy
30
What would a patient say that made you think "postural hypotension"
```
Light-headed/dizzy when stand
Blurred vision
Weakness
Headache
Nausea
Palpitations
```
31
The diffrentials of postural hypotension could be hypoglycaemia, vertigo, vasovagal syncope and psychogenic syncope.
What changes in the BP would make it diagnostic of PO?
Drop in BP when stand:
> 20mmHg systolic/
>10mmHg dialstolic
32
DVTs affect ~1 in 1000 per year. List some risk factors
```
Immobilisation
Recent surgey
Cancer
Obesity
Pregnancy
Dehydration
Factor V Leiden
Previous DVT
```
33
A 40 y/o come to the GP complaining of a red, hot, swollen leg.
What are the diffrentials?
DVT*
Skin:
Cellutitis*/Superficial thrombophlebitis/Cirrhosis
Trauma: sprain*/fracture
CV: Heart failure*, Acute Limb ischaemia
MSK: Baker's cyst rupture*
Nephrotic syndrome*
34
Whats the 1st thing you would do if you suspect a DVT?
Other investigations?
Wells Score
Doppler
D-Dimer
35
The treatment for DVT is an anticoagulant. Give an example of one.
LMW heparin
36
State the main complication of DVT.
PE
37
LVHF is called by DYSFUNCTION or TOO MUCH PRESSURE.
What are the causes of LVHF?
MI
HTN
Valvular HD
(Also risk factors)
38
How would a person with LVHF present?
Cyanosed
SOB
Pulmonary oedema: Orthopnoea, PND
Blood in sputum
39
Diffrentials of LVHF can be anything Respiratory. What investigations would you do to exclude LVHF?
CXR - Cardiomegaly, pleural effusion, Kerley B lines, dilated hilum
ECHO - ejection fraction < 40%
BNP - if no previous MI
ECG - exclude
40
You order a CXR when you suspect LVHF from the signs. What signs did notice?
```
Signs:
High RR
High pulse
Low SATS
Dull to percuss
Bi-basal inspiratory crackles at
```
41
What medication would you give to relieve LVHF?
BAD:
B-Blocker
Ace-In
Diuretic
42
Complications of LVHF include (ROAD) Renal azotemia, Oedema, Arrythmias, Depression and ______
RVHF!
43
Which condition is common in elderly and described as bacteria and debris colonising on the heart valve?
INFECTIVE ENDOCARDITIS (IE)
44
State 5 risk factors of IE.
Dental work (Strep Viridans)
IVDU (Staph)
Defective valves
Congential heart defects
BOWEL CANCER (Strep Bovis)
45
What pneumonic is used to remember the sign/symptoms of IE?
FROM JANE
Fever
Roth spots
Oslers nodes
Murmur
Janeway lesion
Anaemia
Nail haemorrhages
Emoboli
46
The diffrential for IE are SLE, Cardiac tumours, Polymyalgia rheumatica.
How would you diagnose IE?
Blood culture
| ECHO - vegetations
47
Treatment of IE?
IV antibiotics
48
Complications of IE?
```
Septic embolic:
Stroke
Glomerulonephritis
AKI
MI
Congestive HF
```
49
Unstable angina is AKA ________ ________?`
Crescendo angina
50
How would you define unstable angina?
= angina of increasing freq OR with minimal exertion/at rest
51
Unstable angina is a medical emergency. T/F?
| How does it present?
T
Same signs, symptoms, diffrentials as MI.
52
You investigate unstable angina the same way you would investigate an MI.
ECG and Troponin. What ECG findings may you see?
Normal ECG!
ST depression
Inverted T wave
53
You are trying to avoid the unstable angina progressing to a MI. State the treatment you would give.
GTN spray
Analgesia
02
Other CV meds: Aspirin, B-blocker..
54
A 65 y/o lady walks into the GP and wants to know what RVHF can be caused by what...?
LVHF
Cor pulmonale
Pulmonary stenosis
MI
55
You explain that RVHF symptoms are less specific than for LVHF. What might a patient complain of?
CAW HEAD:
Constipation
Anorexia (nausea)
Weight loss
Hepatomegaly
Edema (bipedal, pulmonary)
Ascites
Distended neck vein
Urinary frequency
56
Think of signs of RVHF after doing a CV exam. What are they?
Cold peripheries
High RR
Raised JVP
RV heave
Pleural/pericardial effusion
Hepatomegaly/Splenomegaly
Peripheral oedema
57
Diffrentials for RVHF could be respiratory or renal. Name a few
Respiratory failure, CAP, COPD, ARDS
AKI, Nephrotic syndrome
58
The investigations for RVHF are different to the LVHF. T/F?
F
The same!
59
Treatment for RVHF?
B-A-D
60
The complications of RVHF are _____ and _____
Arrhythmias
| CCF
61
What is the term for the condition where the heart is not abe to meet the body's demands?
Congestive Cardiac Failure (CCF)
62
State the criteria used to diagnose CCF.
Framingham Criteria
| 2 major/1 major + 2 minor
63
Diffrentials for CCF are the same as for RVHF. T/F?
T
64
What 2 investigations could you do to confirm CCF?
ECHO - chamber dilation, hypertrophy
| CXR - cardiomegaly
65
Treatment for CCF differs to that for LVHF and RVHF. How so?
LAD:
Lifestyle modifications
Ace-In
Diuretics
(No B-blockers!)
66
70% of all Valvular Heart Disease (VHD) is due to ______/______ ______
Aortic/Mitral Stenosis
67
State the most common VHD.
Aortic stenosis
10% of >80yrs
68
Aortic stenosis has 2 principle causes...?
1. Age-related calcification
| 2. Congenital 2 cusps (accelerates cusps)
69
Aortic stenosis symptoms can be summarised using the mneumonic SATS.
What does it stand for?
S - Syncope
A - Angina
T - Tiredness
S - SOB (esp exertion)
70
You perform a CV exam of someone who has symptoms of Aortic stenosis. What would you find?
Slow-rising pulse
Narrow systolic-diastolic pressure differences
LV heave
Ejection systolic murmur
71
Diffrentials of Aortic stenosis can be made based on the murmurs. Name 2 diffrentials.
Aortic sclerosis
Aortic regurgitations
Subacute IE.
72
If you suspect a patient has Aortic stenosis. What investigations would you do to confirm this?
ECHO
ECG - large QRS wave
CXR - cardiomegaly, AS calcification
73
The standard treatment for Aortic stenosis is _____ _____ ________.
What if you are a child or unfit for surgery?
Aortic valve replacement (TAVI)
| Balloon Valvuloplasty
74
The main complication of Aortic stenosisis ____, which a patient can also present with.
State other complications.
ANGINA
Postural hypotension
CCF (LVH with no HTN)
Sudden death
75
Which VHD is less common: mitral stenosis or mitral regurgitation?
Mitral regurgitiation
76
Mitral stenosis occurs more commonly in males than females.T/F?
F
More common in females.
77
State 5 causes of Mitral stenosis
Age-related calcification
Congenital
Rheumatic fever
Infective Endocarditis
SLE, AF
78
How might a patient present with mitral stenosis? 4 P's
| think of anatomy
```
Progressive SOB
Pulmonary oedema (Orthopnoea, PND)
```
Palpitations (AF)
HaemoPtysis
79
Signs of mitral stenosis?
Malar flush on cheeks
AF
Raised JVP
Mid-diastolic murmur
80
The diffrentials of mitral stenosis may be...?
AF
Heart failure
SLE
81
Mitral stenosis is closely related to ____.
AF!
LA dilataton can lead to AF
AF can loose some "atrial kick" --> stensosis
82
You investigate to confirm a mitral stenosis diagnosis. What would you do?
CXR - enlarged LA
ECG - AF
ECHO
83
The main treatment for Mitral stensosis is Percutanous Mitral Commisurectomy (PMC).
What medication would you give to treat the patient's symptoms?
Diurectics (pulmonary oedema)
B-blockers/CCB (AF)
Anti-coagulant (AF)
84
State 4 complications of mitral stenosis.
Dilated LA
AF
Pulmonary HTN --> RVHF
Infective Endocarditis (risk factors)
85
Aortic regurgitation can present as SYNCOPE. What mneumonic is used to remember the causes of it?
```
CREAM:
C- Congenital
R - RF
E - Endocarditis
A - Aortic root dilation
M - Marfan's (RA, SLE, Syphilus)
```
86
What signs would you expect to see in Aortic regurgitation?
Collapsing pulse
| Diastolic murmur
87
Diffrentials of Aortic regurgitation?
IE?
88
You would investigate Aortic regurgitation using _____.
ECHO
89
If symptomatic, how would you treat Aortic regurgitation?
Surgery
90
When listening to heart sounds. When is systole and diastole in relation to the 1st and 2nd heart sounds?
Systole = between 1st and 2nd sound
Diastole = after 2nd sound
91
Mitral regurgitation is more common in females than males. T/F?
T
92
State causes of mitral regurgitation
```
Mitral Valve Prolapse (MVP)*
Papillary muscle insufficiency (CHD)
IE
SLE
Calcification
Fen-Phen
```
93
MVP is caused by myomatous degeneration from Conn Tissue disorder such as...?
Marfan's
| Enlos-Danlos
94
The symptoms of mitral regurgitation are often ______?
ASYMPTOMATIC
95
The signs of mitral regurgitation will be picked up in ausculation. What type of murmur would you hear?
Mid-systolic murmur
Holosystolic murmur
96
You do an ECHO, CXR AND ECG to look for evidence of mitral regurgitation. What would you find?
ECHO - floppy valve
CXR - enlarged LA/LV
ECG - broad P wave
97
Diffrentials of Mitral regurgitation?
?
98
If severe you would treat mitral regurgitation by _____?
Valve repair
99
Complications of mitral regurgitation?
AF --> Stroke
LV dysfunction
Pulmonary HTN --> RVHF
