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CVD Flashcards

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1
Q

What are the risk factors for hypertension?

A 
Obesity
Alcohol
Smoking
High sodium intake
Age >65
Medications (OCP, NSAIDs)
Co-morbidities (renal disease, diabetes)
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2
Q

What is defined as hypertension?

A

Clinical reading >140/90 mmHg

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3
Q

Why would you treat hypertension?

A

Could lead to organ damage:
blood vessels (atherosclerosis, aneurysm)
cardiac (LVH, increased afterload, IHD)
brain (ischemic, hemorrhagic stroke, vascular stroke, dementia)
kidneys (glomerulosclerosis, renal artery stenosis or aneurysm)
eyes (retinopathy)
sleep apnoea
sexual dysfunction

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4
Q

What is the treatment algorithm for CVD?

A

< 55 years old or diabetic, then ACE inhibitors

> 55 years old or afro-carribean, then calcium channel blockers

After first step, ACE + CCB
Then ACE + CCB + thiazide diuretic
Then, add spironolactone or increase thiazide

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5
Q

What groups should you specifically consider when treating hypertension?

A
  1. Patients over 80 years (only treat stage 2 hypertension)
  2. Patients with diabetes (in type 1, only treat if BP >135/85. In type 2, treat if > 140/80)
  3. Patients under 40 years of age (secondary investigation)
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6
Q

What are the side effects of ACE-inhibitors?

A

Dry cough, angioedema, hyperkalaemia

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7
Q

What are the side effects of CCB?

A

Ankle oedema, flushing, headache

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8
Q

What are the side effects of thiazide diuretic?

A

Hyponatraemia, hypokalaemia

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9
Q

What are the underlying causes of hypertension?

A

Primary hyperaldosteronism
Structural renal disease
Endocrinological disorders

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10
Q

What happens to the blood pressure in pregnancy?

A

Falls in first trimester, continues to fall until 20-24 weeks. Then increases by term

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11
Q

How is hypertension in pregnancy defined?

A

Systolic > 140 mmHg or diastolic > 90 mmHg

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12
Q

What are risk factors for pregnancy hypertension?

A

Hypertension during previous pregnancies
Chronic kidney disease
Autoimmune disorders
Type I or II diabetes

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13
Q

What is malignant hypertension?

A

High BP with symptoms and signs indicative of acute impairment of one or more organ system (BP often > 180mmHg)

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14
Q

How would you treat malignant hypertension?

A

IV sodium nitroprusside

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15
Q

What are causes of malignant hypertension?

A

Discontinuation of medication, drug use, head trauma, eclampsia

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16
Q

What are symptoms of malignant hypertension?

A

Chest pain, headache, dyspnoea, anxiety, palpitations

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17
Q

What is a silent MI related to?

A

Diabetes, sometimes presents with epigastric pain

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18
Q

What are the symptoms, troponin and ECG for angina?

A

Precipitated by activity, minimal symptoms at rest or after GTN

Normal T

Normal ECG

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19
Q

What are the symptoms, troponin and ECG for unstable angina?

A

Symptoms occur at rest and often persist more than 10 minutes

Normal T

Normal or abnormal ECG

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20
Q

What are the symptoms, troponin and ECG for NSTEMI?

A

Long-lasting symptoms, even at rest

Raised T

ST depression and T wave flattening/inversion

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21
Q

What are the symptoms, troponin and ECG for STEMI?

A

Long-lasting symptoms, even at rest

Raised T

ST segment elevation and hyperacute T waves

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22
Q

If there is an abnormality in the anterior or septal leads, where would the occlusion be?

A

Left anterior descending artery

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23
Q

If there is an abnormality in the lateral leads, where would the occlusion be?

A

Left circumflex artery

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24
Q

If there is an abnormality in the inferior leads, where would the occlusion be?

A

Right coronary artery

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25
What is the management of a STEMI or NSTEMI?
1. Cardiac chest pain 2. If SaO2 < 94%, give O2 3. Analgesia, anti-emetics, nitrates 4. Dual antiplatelet therapy -> aspirin 300mg + ticagrelor 5. Test for troponin and look at ECH If STEMI -> percutaneous coronary intervention If NSTEMI -> fondaparinux
26
What does the secondary prevention of acute coronary syndrome entail?
Lifestyle changes and drug therapy
27
What are common drugs given to acute coronary syndrome patients?
ACE inhibitors (ramapril) Dual antiplatelet (aspirin + ticagrelor) Beta-blocker (bisoprolol) Statin (atorvastatin)
28
What does ramapril do?
Decrease BP
29
What does aspirin/ticagrelor do?
Reduce clotting risk
30
What does bisoprolol do?
Reduce HR
31
What does atorvastatin do?
Reduce cholesterol
32
What are the short term complications of MI?
Within 24h: Arrhythmia, pulmonary oedema, cardiogenic shock 1-10 days: Ventricular septal defect, mitral regurgitation, free wall rupture, pericarditis
33
What are the longer-term complications of MI?
7-10 days: embolism Late: heart failure, arrhythmias, LV aneurysm, Dressler's syndrome
34
What are the three main symptoms of left ventricular failure?
Dyspnoea, poor exercise tolerance, fatigue
35
What are the two main symptoms of right ventricular failure?
Peripheral oedema, ascites
36
What are the two types of left ventricular failure?
Preserved EF | Reduced EF
37
What is the consequence of preserved ventricular failure?
Heart can't fill due to stiff and thick walls
38
What is the consequence of reduced ventricular failure?
Heart can't pump due to stretched and thin walls
39
What are the causes of heart failure?
1. Pressure overload (regurgitation) 2. Volume overload (hypertension, stenosis) 3. Contractile dysfunction
40
How does heart failure typically present?
``` Pulmonary oedema - will hear lung crackles Cardiomegaly - on CXR Exertional dyspnoea Paroxysma nocturnal dyspnoea Peripheral oedema Clubbing RaisedJ VP ```
41
What are CXR findings in heart failure?
Cardiomegaly Small pleural effusion Pulmonary oedema
42
What are lifestyle changes to manage heart failure?
Exercise-based rehabilitation programme Stop smoking Reduce alcohol Annual influenza jab and one-off pneumococcal jab
43
What is the pharmacological management of heart failure?
First line: ACE + beta-blocker Second line: angiotensin blockers, digoxin, diuretics
44
What does "lub" mark?
Start of ventricular systole Closure of AV valves Synchronised with radial pulse
45
What does "dub" mark?
Start of ventricular diastole | Closure of semilunar valves
46
What are the main causes of heart murmurs?
Regurgitation or stenosis
47
What are the 4 categories of murmurs?
1. Obstruction of outflow tracts 2. Regurgitation 3. Continuous murmur (shnuts) 4. Flow murmur (increased haemodynamic flow; no harm)
48
What are the two types of murmurs in S1?
1. Pan-systolic - during S1 (AV valve regurgitation) | 2. Ejection systolic - after S1 (aortic stenosis)
49
What are the two types of murmurs in S2?
1. Early diastolic - start of S2 (aortic regurgitation) | 2. Late diastolic - later on in diastole (AV valve stenosis)
50
What is Carvallo's sign?
Murmurs louder upon inspiration
51
When are ride sided murmurs louder?
Inspirations
52
When are left-sided murmurs louder?
Expiration
53
What is S3?
Early diastole; early ventricular filling bc of high volume (normal in athletes)
54
What is S4?
Occurs late in diastole; atrial contraction against stiff ventricle (may be heard in stenosis and hypertension)
55
What are symptoms of supraventricular tachycardias?
Palpitations, light-headed, chest pain, SoB
56
What types of supraventricular tachycardias exist?
1. AF (irregular) | 2. Atrial flutter (regular)
57
What are risk factors for supraventricular tachycardias?
Age Pre-existing CVD
58
What are symptoms of ventricular tachycardia?
Palpitations, light-headed, chest pain, SoB WITH regular rhythm
59
What is the result of ventricular tachycardias?
Haemodynamic compromise
60
What are symptoms of heart block?
Palpitations, light-headed, chest pain, SoB WITH regular rhythm Bradycardia
61
How would you recognise AFib on an ECG?
1. Lack of P waves 2. Narrow QRS complex 3. Small fibrillatory waves 4. Irregular
62
How would you recognise AFlut on an ECG?
1. Regular atrial activity 2. Flutter waves 3. Narrow QRS complex 4. Often present with AV block
63
How would you recognise ventricular tachycardia on an ECG?
1. Mono or polymorphic QRS 2. Indeterminate axis 3. Broad QRS complex 4. Rapid heart rate
64
How would you recognise ventricular fibrillation on an ECG?
1. Chaotic irregular deflections 2. Varying amplitude 3. No discernable P, QRS, T waves 4. Rate 150-500 bmp
65
How would you treat ventricular tachycardia?
Haemodynamically stable --> IV amiodarone (300 mg) Haemodynamically unstable --> DC cardiovesion Pulseless VT --> defibrillation
66
How would you treat ventricular fibrillations?
Defibrillation
67
How would you treat atrial flutter?
Haemodynamically compromised --> DC cardioversion Haemodynamically stable --> vagal maneuvers; cough, cold stimulus. Otherwise IV adenosine 6/12/12 mg
68
How would you treat atrial fibrillation?
Haemodynamically compromised --> DC cardioversion Haemodynamically stable: 1. New onset --> BBs + IV flecainide or amiodarone 2. Chronic onset --> anticoagulants
69
What are class 1 antiarrhythmics?
Sodium channel blockers
70
What are class 2 antiarrhythmics?
Beta-blockers
71
What are class 3 antiarrhythmics?
Potassium channel blockers
72
What are class 4 antiarrhythmics?
Calcium channel blockers

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