CSIM vascular Flashcards
(107 cards)
1
Q
what are foam cells and when are they seen?
A
fat laden macrophages that are associated with atheroscelosis
2
Q
what is it on a plaque that prevents thrombosis?
A
fibrin cap
3
Q
stroke an TIA can be due to atherosclerosis in which artery?
A
carotids
4
Q
symptoms of PAD?
A
most are asymptomatic
symptoms:
- atypical exertional leg pain
- only 10-20% have intermittent claudication
- only a minority progress to rest pain / ulcers
5
Q
investigations into claudication?
A
APBI
Duplex ultrasound
angiography
6
Q
3 ways to do angiography?
A
catheter
MRA
CTA
7
Q
where is claudication most common?
A
calf
buttock
thigh
8
Q
what ABPI is diagnostic of PAD?
A
0.9
9
Q
what does an ABPI of 1.35 tell you?
A
calcification in the blood vessels
ABPI> 1.30 means the vessel is non-compressable this can be due to: - old age - chronic renal insufficency - diabetes
10
Q
what is ABPI and what is a normal value?
A
ankle brachial pressure index:
ratio of systolic BP in the ankle compared to the arm
the BP in the arm should be higher:
normal range = 0.91 - 1.30
11
Q
features of critical limb ischaemia?
A
pain @ rest
gangrene
necrosis
doppler pressure < 50mmHg at ANKLE
12
Q
when is critical ischaemia pain worst?
A
at night due to draining blood from feet
13
Q
how long does IHD pain normally last?
A
a few minutes
if > 5 then think MI
if fleeting then unlikely to be angina
14
Q
angina precipitaing factors?
A
EEEE
exertion - most important
eating - blood drawn to GI system
emotion
extreme weather- very hot or cold
15
Q
how is aortic dissection pain different to angina?
A
tearing pain with sudden onset
16
Q
how is chostrochondritis pain different from angina
A
hurts to press on it
17
Q
what blood test can be done to diagnose MI?
A
troponin T / I
18
Q
what is troponin
A
protein released exclusively by cardiac muscle and rise significantly in cardiac muscle damage
19
Q
what is metaclopramide?
A
anti - emetic often given with emetogenic drugs e.g. given with morphine
20
Q
in suspected MI when should troponin be taken?
A
on admission and after 3 hours
21
Q
how is troponin used to diagnose MI?
A
a rise of AT LEAST 10ng/l AND a 20% rise
22
Q
what is junctional rhythm?
A
when the AV node takes over form the SA node
the rate of the AVN is ~40bpm so get bradycardia too
23
Q
ECG: II, III and AVF ST elevation suggest what?
A
inferior ischaemia
AV-F -> points to Foot
24
Q
what is fundaparinux
A
the smallest LMWH
25
after a stent is put in following MI what drug therapy should they be on?
B-blockers
Statins
DUEL ANTI-PLATELET: aspirin and clopidigel for 1 year - to prevent stent thrombosis
26
why do we use anti platelets in the prevention of stroke / MI?
the acute formation of a clot is due to the activation of platelets on the rupture of a plaque
27
danger of statins
teratogenic
contraindicated in pregnancy and breastfeeding
28
effect of other NSAIDS on anti-platelet therapy?
decrease action of aspirin
| possibly compete for a receptor?
29
complications of hypertension
```
MI
stoke
hypertensive nephrosclerosis
dissecting aortic aneurysm
peripheral vascular disease
accellerated (malignant) hypertensioin
```
30
what are the causes of HF
due to LV systolic dysfunction:
- cardiomyopathy
- hypertension
- IHD
other cause:
- anaemia
- hyperthyroidism
- arrhythmia
- valve disease
- diastolic dysfunction
31
causes of cardiomyopathy
familial
alcohol
viral
32
clinical definition of MI?
evidence of myocardial necrosis (raised troponin)
AND AT LEAST ONE OF
- Symptoms of ischaemia
- ECG changes indicating ischaemia
- ECG evidence of necrosis: new pathological Q waves
- Imaging - new loss of myocardium, or new RWMA
33
there are two types of MI he said we need to know, what are they?
type 1 - occlusion of coronary artery due to atherosclerosis (the normal type)
type 2 - imbalance in O2 supply/demand -> ischaemia without definite CAD
34
what is the most common presentation to A&E?
chest pain
35
first line ix in chest pain?
ECG- done before full history or examination
36
define typical angia?
1. crushing central chest pain
2. relieved by rest
3. relieved by GTN spray
2/3 is atypical angina
37
if there is reduced pain with GTN angina is confirmed T/F?
F
oesphageal spasm is relieved by GTN too
38
when is there ST elevation?
when there has been complete occlusion of the coronary artery
39
when should the troponin be done in relation to other management steps?
after ECG, history and examinatioin
40
what type of MI can AF lead to?
type 2
41
how long after infarct is high sensitivity troponin detectable?
~1hr
42
what troponin level will be seen in an ST elevation MI?
very high, can be in the thousands
43
raised troponin is diagnostic of MI T/F? why?
F
other things raise it:
- sepsis
- PE
- post operation
- AF
- renal disease
44
what ix can rule out MI?
troponin taken 6 hrs later if not raised
45
use of anti platelets in in ACS?
high dose aspirin ASAP
| clopidegril if not tolerated
46
what Ix is most useful for planning tx in ACS?
coronary angiogram, most people will have one
47
discharge planning following ACS?
AABCCDDEE
```
anti-platelets and ACE inhibitors
B blockers
Cholesterol and ciggs
diabetes and diet
exercise and education
```
48
diagnosis of acute coronary syndrome?
at least two of:
1. Chest pain (>20 mins and not relieved by rest or GTN)
2. ECG changes consistent with ischaemia or
necrosis (ST elevation or NEW LBBB)
3. Elevation of cardiac markers
49
if suspecting ACS but ecg is normal, what ix to do next?
troponin
| repete ECG in 30 mins
50
why does BP increase with age?
decreased elasticity of large arteries due to:
- increased calcium
- increased collagen
- decreased elastin
51
what % of hypertension is 'essential'?
80%
52
common renal causes of hypertension?
glomerulonephritis
diabetes
polycystic kidneys
53
endocrine causes of hypertension?
steroid excess
54
what does angiotensin II do?
vasoconstriction
| makes adrenal glands release aldosterone
55
what does aldosterone do?
makes kidney reabsorb Na+
56
what BP makes you suspect phaeochromocytoma?
fluctuating
| hypertension with postural hypOtentension
57
why do kidney US in hypertension
exclude polycystic disease
a shrunken kidney may suggsest renal artery stenosis
58
initial tests in those with hypertension?
test urine for presence of protein
take blood to measure glucose, electrolytes, creatinine
estimated glomerular filtration rate
cholesterol
examine fundi for hypertensive retinopathy
arrange a 12-lead ECG
59
ECG: what leads show the inferior heart border?
II, III and AVF
60
ECG: what leads show the lateral heart border?
I, V5 and V6
61
ECG: what leads show the anterior heart border?
V1 -> V4
62
ST elevation in I, V3, V4, V5, V6 indicates what?
anterior lateral STEMI
63
what hx is relevant in the assessment of dyslipidaemia?
symptoms of related conditions
- angina, claudication, dyspnoea
- thirst / polyuria
risk factors
- diet
- alcohol
- smoking
- exercise
family history
64
how does fat distribution effect risks associated with obesity?
central obesity is worse than peripheral
potentially because it drains straight to the liver
65
what stigmata of hyperlipidaemia?
XANTHOLASMA
Eyes – eyelids, cornea, retina
Achilles and digital extensor tendons
Knees and elbows
Palms and flexures
66
pathophys of hyperlipidaemia -> increased CV risk?
- LDLs infiltrate the tunica intima causing it to expand (this is a fatty streak)
- inflammation causes macrophage recruitment
- macrophages take up lipids making FOAM cells
- dying macrophage, mast cells and a fibrous, necrotic plaque make a complicated plaque
67
which are the major atherogenic lipoproteins?
LDLs
IDLs
LP(a)
chylomycron-remnants
these can all infiltrate the endothelium to get into the tunica intima
68
which lipoproteins are included in the total cholesterol blood test?
LDL
VLDL
IDL
HDL
69
what is the triglyceride level used for?
calculating the LDL level
not considered directly atherogenic but is a RISK MODIFIER
70
should you fast for a cholesterol test?
no
71
what is the best marker for the risk of CV disease?
ratio of apolipoprotein b to apolipoprotein a
apoB is 'BAD cholesterol'
apoA is 'GOOD cholesterol'
therefore the higher the ratio of b : a the higher the risk
72
investigations to exclude secondary hyperlipaemias?
```
renal profile - exclude renal failure
liver profile - exclude cholestasis
TFTS - exclude hypOthyroidism
glucose / HbA1c - exclude diabetes
dipstick - exclude nephrotic syndrome
```
73
familial hyperlipidaemia: how is it passed on and how does it effect lipid profile?
autosomal dominant
reduce clearance of LDLs -> doubled LDLs from childhood
low fasting triglycerides
74
diagnosis of familial hyperlipidaemia?
genetic testing is necessary as there is an overlap in the LDL profile
75
who do we test for familial combined hyperlipidaemia?
moderate to severe mixed hyperlipidaemia
AND
personal / family history of CVD or hyperlipidaemia
dont test children for this as it's not useful
76
how does remnant hyperlipidaemia lead to deranged lipid profile? and what is that profile?
reduced clearance of remnant
high total cholesterol
high triglycerides
77
what does palmar xantholasma suggest?
pathognomic of remnant hyperlidipaemia
78
what is isolated hypertriglyceridaemia closely related to?
diatebes
79
pancreatitis is a complication of which metabolic problem?
severe hypertriglyceridaemia
80
what does a raised CK tell you?
there has been muscle break down
NOT specific to cardiac muscle
81
what is the best marker for cardiac muscle death?
Trop I
82
what drug class is amlodipine
CCB
83
what drug class is verapamil?
CCB
84
what is the first line tx for AF?
B blockers
85
what is CHAD vasc used for?
calculating risk of stroke in AF patients
86
what is HAS BLED used for?
calculating 1 yr risk of bleeding in AF patients
87
what is amaurosis fugax?
transient (and painless) loss of vision- TIA of the retinal artery
from the greek for 'fleeting darkness'
88
what is the first line Ix if carotid bruit is heard?
duplex US
89
what counts as 'sudden' death?
occurs within 1 hour of onset of symptoms
90
what is the most common cause of syncope in HCM patients?
vasovagal syndrome- this is just very common in general
91
most common cause of sudden death in the UK
coronary artery disease
| by far
92
what are the signs that are useful in predicting cardiac syncope?
Any sign of heart failure
Left ventricular dysfunction (best predictor)
Carotid sinus hypersensitivity (elderly)- rub the carotid bulb and see if they pass out
ECG abnormalities
93
what investigations would you in suspected cardiac syncope?
```
ECG
Echo
Heart monitors
Genetic testing
MRI of heart for anyone with ?structural heart disease- better than echo
```
94
what re the red flags in cardiac syncope?
Any pre-existing cardiac history
| Any malignant sounding family history
95
what does a slurring of the Q wave indicate?
WPW syndrome
96
a very short PQ interval indicates what?
WPW syndrome
97
how do channelopathies cause cardiac arrest?
cells are firing and resetting at different times which leads to polymorphic VT or VF
98
what happens in arrthymogenic right ventricular cardiomyopathy? what ECG does this give?
clusters of fat and fibrous tissue get depositied in between cells (due to weakened connecting proteins between the cells) in response to stretch damage which occurs mostly in the RV and worsens with exercise
monomorphic VT / VF
99
what is dilated cardiomyopathy and what are the two ways it can happen?
SAGGY HEART: the chamber dilates and scars form either due:
to an idiopathic/'poisoning' process
Or due to the actual scar of the infarct plus super-added damage due to the neuro-hormonal response in chronic heart failure
100
what is commotio cordis?
blow over the heart -> VF
101
what kind of ECG does long QT syndrome give?
polymorphic VT
102
where is there slow conduction in a post infarct heart?
around the scar
| there is NO conduction where the scar is
103
Most LQTS involve problems with what channels?
potassium
104
what is first line imaging for PAD in whom revascularisation is being considered?
duplex ultrasound
105
effect of NSIADs on platelets?
enhance effect of low dose aspirin
106
how do NSAIDs increase risk of MI?
worsen HF due to effect on prostaglandins - > sodium retention
107
an absolute risk reduction of 4% means you have to treat how many people to avoid one event?
25 - this is considered an okay number
