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CVS Flashcards

1
Q

What are the shockable rhythms?

A

VF

pulseless VT

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2
Q

In ALS, when can (1mg) adrenaline be administered?

A

After chest compression have started ( 30:2)

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3
Q

What ESM is heard louder on expiration?

A

1) aortic stenosis

2) hypertrophic obstructive cardiomyopathy

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4
Q

What ESM is heard louder on inspiration?

A

1) pulmonary stenosis

2) atrial septal defect

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5
Q

What ECG abnormality is associated with hypercalcaemia?

A

Shortened QT interval

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6
Q

When a patient in cardiac arrest has organised electrical activity but there is still no pulse and there are no signs of life, what do you do?

A

1) continuing CPR at a rate of 30:2

2) IV adrenaline

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7
Q

What is stage 3 HTN defined as?

A

BP above 180/120

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8
Q

1st steps in stage 2 HTN

A

Assess target organ damage if <80yo. Give meds if >80yo

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9
Q

How to manage stage 3 HTN?

A

Specialist referral if <40yo

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10
Q

In stage 2 HTN (and above) which investigations would you carry out?

A

ECG, Fundoscopy, Urinalysis, BP, bloods

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11
Q

Which ECG changes would you see in hyperkalaemia?

A

Tall Tented T waves

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12
Q

Side effects of ARB

A

hyperkalaemia, hypotension, renal failure

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13
Q

What is orthostatic hypotension?

A

decrease in BP by > 20 systolic, 10 diastolic

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14
Q

how do you check for postural hypotension?

A

lying/standing BP for 3 mins

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15
Q

What might you see in an ECG in someone who has postural hypotension?

A

prolonged QT, bundle branch block

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16
Q

How do patients with HF present (specify left and right)?

A

Left : lung (confused, restless, orthopnoea, cyanosis, crackles)

Right : rest of the body (ascites, oedema, hepato/splenomegaly, weight gain)

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17
Q

What is BNP?

A

Measured in heart failure. Released in response to the heart stretching.

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18
Q

a specific sx of phlebitis

A

hardening of surrounding tissue due to lack of perfusion caused by inflammation

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19
Q

Sx of varicose veins

A

pains, itching, throbbing

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20
Q

what are the 6Ps and when do you look for them

A

arterial occlusion

Pallor
Paraesthesia
Pain
Poikilothermia (temperature)
Pulselessness
Paralysis
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21
Q

investigations for arterial occlusion

A

ABPI <0.5 is critical (refer to vascular MDT)
ABPI 0.6-0.9 is intermittent claudication (exercise management, angio or bypass)

Ultrasound of blood flow in peripheries

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22
Q

When would a patient with aortic aneurysm require surgery?

A

Aneurysm >5.5 / symptomatic / rupture

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23
Q

Which valvular disease is associated with rheumatic fever?

A

mitral stenosis

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24
Q

which criteria is used to rheumatic fever? Define the criteria.

A

Jones:

2 major criteria
1 major with 2 minor criteria

Evidence of recent streptococcal infection
raised or rising streptococci antibodies,
positive throat swab
positive rapid group A streptococcal antigen test

Major criteria
erythema marginatum
Sydenham’s chorea: this is often a late feature
polyarthritis
carditis and valvulitis (eg, pancarditis)
subcutaneous nodules

Minor criteria
raised ESR or CRP
pyrexia
arthralgia (not if arthritis a major criteria)
prolonged PR interval
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25
Tx of acute rheumatic fever
Penicillin V and NSAIDs (aspirin or naproxen)
26
Giant cell arteritis buzzwords and sx!
Sx = Headache, visual disturbance, polymyalgia rheumatica Ix = Temporal artery biopsy Tx = Oral prednisolone
27
which valve is associated with endocarditis
mitral
28
Which criteria is used in endocarditis
Infective endocarditis diagnosed if pathological criteria positive, or 2 major criteria, or 1 major and 3 minor criteria, or 5 minor criteria Pathological criteria: Positive histology or microbiology ``` Major criteria - Positive blood cultures - Evidence of endocardial involvement positive echocardiogram or new valvular regurgitation ``` Minor criteria - predisposing heart condition or intravenous drug use - fever > 38ºC - vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, Janeway lesions, petechiae or purpura - immunological phenomena: glomerulonephritis, Osler's nodes, Roth spots
29
Endocarditis which causes HF requires what treatment ?
emergency valve replacement surgery
30
ECG findings for pericarditis
widespread saddle-shaped ST elevation in all leads
31
What is Becks triad?
cardiac tamponade 1. hypotension 2. muffled heart sounds 3. raised JVP
32
which ECG finding is seen in cardiac tamponade
electric alternans
33
ECG findings in an NSTEMI
pathological P waves
34
what is Prinzemtal angina
sometimes relieved by medication but not by rest
35
What is the most common causative organism for infective endocarditis?
Staphylococcus aureus
36
What long-term medication should patient HF take?
ACEi = | BB = carvedilol and bisoprolol
37
What medication is contraindicated with atenolol?
Verapamil = risk of heart block
38
What is the most common complication of Hypertrophic obstructive cardiomyopathy?
Sudden death due to ventricular arrhythmia
39
What is the gold-standard Tx for ST-elevation MI?
PCI
40
What is hypertension?
a clinic reading persistently above >= 140/90 mmHg, or: a 24 hour blood pressure average reading >= 135/85 mmHg
41
What are the 2 main types of hypertension?
Primary/essential: no single disease is identified as the cause of HTN, usually due to physiological changes as we age Secondary: caused by a variety of endocrine, renal and other causes
42
List some of the causes of secondary hypertension
Renal: - glomerulonephritis - renal artery stenosis - chronic pyelonephritis Endocrine: - primary hyperaldosteronism - Cushings - congenital adrenal hyperplasia Other: - glucocorticoids - NSAIDs - COCP
43
Which symptoms may be seen in patients with severe hypertension?
- headaches - visual disturbances - seizures
44
How is end organ damage assessed?
Fundoscopy: check for retinopathy Urine dipstick: renal disease as a cause or consequence of HTN ECG: left ventricular hypertrophy or ischaemic heart disease
45
What tests do patients typically have following a diagnosis of hypertension?
- U&Es - HbA1c - Lipids - ECG - Urine dipstick
46
What is end organ damage?
End organ damage usually refers to damage occurring in major organs fed by the circulatory system (heart, kidneys, brain, eyes)
47
When is an ARB preferred over an ACEi?
patients of black African or African–Caribbean origin taking a CCB, if they require a second agent consider an ARB in preference to an ACEi
48
Criteria for stage 1, stage 2 and severe hypertension?
Stage 1) Clinic BP >= 140/90 mmHg and subsequent ABPM average BP >= 135/85 mmHg Stage 2) Clinic BP >= 160/100 mmHg and subsequent ABPM average BP >= 150/95 mmHg Severe) Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg
49
How does NICE recommend measuring BP when considering a diagnosis of Hypertension?
measure in both arms and if the difference is >20mmHg then repeat if this remains the case then measure from the arm with higher readings and listen to heart sounds as there may be a pathological cause such as supravalvular aortic stenosis
50
What should you do if BP >= 180/120mmHg?
specialist assessment - ?retinal haemorrhage or papilloedema - life-threatening sx - end organ damage assessment
51
Which symptoms are life threatening in severe HTN?
- new-onset confusion - chest pain - signs of heart failure - AKI
52
When would a patient with stage 1 HTN be offered drug tx?
if <80yo AND: - end organ damage - established CVD - renal disease - diabetic - QRISK >10%
53
Which algorithm can be used to estimate the risk of developing cardiovascular risk of the next 10 years and what is considered as high risk?
QRISK >= 20% is considered high risk
54
What is the clinic BP and ABPM for <80yo?
Clinic: 140/90 mmHg ABPM: 135/85 mmHg
55
What is the clinic BP and ABPM for >80yo?
Clinic: 150/90 mmHg ABPM: 145/85 mmHg
56
What is isolated systolic HTN?
systolic blood pressure 160 mmHg or more
57
Examples of drugs which can cause hypertension
- COCP - steroids - NSAIDs - SSNRI - recreational drugs
58
What is malignant/accelerated hypertension?
EMERGENCY | rapid increase in BP >= 180/120mmHg resulting in end organ damage
59
Define phlebitis and thrombophlebitis
Phlebitis means inflammation of a vein. Thrombophlebitis refers to a blood clot causing the inflammation.
60
Patients with clinical signs of superficial thrombophlebitis affecting the proximal long saphenous vein should have which investigation?
ultrasound scan to exclude concurrent DVT
61
What is a complication of arterial occlusion?
Gangrene
62
Sx of peripheral vascular disease
may be sx free - sx of intermittent claudication (cramping with exercise, relieved by rest) - ulcers - hair loss - skin changes (thinning, brittle, shiny)
63
Which investigations may be used in suspected PVD?
- Doppler US - Angiogram - Ankle-brachial index
64
Complications of PVD
- stroke - restricted mobility - reduced wound healing - amputation
65
What can cause cardiogenic shock?
Intrinsic: - MI - Arrhythmia Extrinsic: - PE - Pneumothorax
66
Why do symptoms occur in cadiogenic shock? | What are the symptoms?
Due to hypoperfusion or fluid overload - Chest pain - SOB - Palpitations - Syncope - Confusion - Sweating - Pale skin
67
What are the signs of cardiogenic shock?
- Tachycardia - Raised JVP - Cold peripheries - Hypotension - Peripheral oedema - Weak pulse
68
What are the signs of hypovolaemic shock?
- Tachycardia/tachypnoea - Reduced CRT - Cold peripheries - Hypotension - End organ dysfunction: - -> Oliguria/anuria - -> Confusion - -> irritability - -> Chest pain/ SOB
69
How does rheumatic fever develop?
Following an immunological reaction to recent (2-6 weeks ago) streptococcus pyogenes infection (strep throat)
70
What is the diagnostic criteria for rheumatic fever?
Jones: Evidence of recent streptococcal infection accompanied by: --> 2 major criteria --> 1 major with 2 minor criteria
71
What is the evidence of recent streptococcal infection in rheumatic fever?
1. raised or rising streptococci antibodies, 2. positive throat swab 3. positive rapid group A streptococcal antigen test
72
What is the major criteria in rheumatic fever?
1. erythema marginatum 2. Sydenham's chorea: this is often a late feature 3. polyarthritis 4. carditis and valvulitis (eg, pancarditis) 5. subcutaneous nodules
73
What is the minor criteria in rheumatic fever?
1. raised ESR or CRP 2. pyrexia 3. arthralgia (not if arthritis a major criteria) 4. prolonged PR interval
74
What is acute rheumatic fever?
Inflammation in the heart, joints, skin or CNS. | - can develop after strep throat
75
Ix for suspected aortic dissection
CT angiography TOE tends to be used to confirm the diagnosis if still unclear after CT angiography, or if the patient is unstable and is likely to deteriorate before getting to the CT scanner.

ICM Matrix (15 decks)

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