CVS conditions - general

Question 1

What is the pathology of heart failure?

Answer 1

Heart can’t pump at the required rate

Question 2

What are the causes of heart failure?

Answer 2

Ischaemia
Hypertension
Valvular disease
Pulmonary embolism
Myocarditis
Endocarditis

Question 3

What are the signs of left sided heart failure?

Answer 3

Dyspnoea
Orthopnoea
Fatigue
Lung crepitations
Pleural effusion

Question 4

What are the signs of right sided heart failure?

Answer 4

Peripheral oedema
Abdominal distension
Increased JVP
Hepatomegaly

Question 5

What investigations would be done if heart failure was suspected?

Answer 5

ECG
ECHO - diagnostic
Blood - BNP, FBC, U&Es, LFT, TFT
CXR

Question 6

How is heart failure managed?

Answer 6

Reduce risk factors 
GTN spray - symptomatic
ACEi - ramipril 
B-blocker - bisoprolol
Loop diuretic - furosemide
K sparing diuretic - spironolactone

Question 7

What is involved in acute coronary syndrome?

Answer 7

Unstable angina
STEMI
NSTEMI

Question 8

What is the pathology of acute coronary syndrome?

Answer 8

Thrombus from atherosclerosic plaque blocking a coronary artery

Question 9

What is the cause of acute coronary syndrome?

Answer 9

Atherosclerosis

Question 10

What are the symptoms of acute coronary syndrome?

Answer 10

Central crushing chest pain
Potential radiation to neck/left arm
Sweating
Dyspnoea
Palpitations

Question 11

What investigations would be done if acute coronary syndrome was suspected?

Answer 11

ECG - if ST elevation then STEMI, if ST depression/T wave inversion then NSTEMI/unstable angina
Troponin - increased in STEMI and NSTEMI

Question 12

How is acute coronary syndrome treated?

Answer 12

Angina - reduce risk factors, GTN spray, B-blocker
STEMI - percutaneous coronary intervention (PCI if within 2hrs), thrombolysis (if after 2 hours)
NSTEMI - batman, b-blocker, aspirin, tricagrelor, morphine, anticoagulant, nitrates

Question 13

What are the complications of acute coronary syndrome?

Answer 13

Death
Rupture of heart septum
Oedema - heart failure
Arrhythmia
Aneurysm

Question 14

What are the causes of hypertension?

Answer 14

Can be essential, secondary or malignant
Risk factors - obesity, smoking, alcohol, high salt diet, DM
Secondary causes - cushing’s, acromegaly, chronic renal failure

Question 15

What is classified as essential hypertension?

Answer 15

140/90

Question 16

What are the signs of hypertension?

Answer 16

Normally asymptomatic

Question 17

What are the symptoms of malignant hypertension?

Answer 17

Severe hypertension
Headaches
Bilateral retinal haemorrhages and exudates
Papilloedema

Question 18

How is hypertension investigated?

Answer 18

Ambulatory blood pressure monitoring (ABPM)

Question 19

How is hypertension treated?

Answer 19

Confirm - ABPM
Address risk factors
<55 step 1 – ACEi/ARB (ramipril / candesartan)
>55 African step 1 – CCB (amlodipine)
Both step 2 – ACEi/ARB + CCB
Step 3 – ACEi/ARB + CCB + thiazide diuretic (indapamide)
Step 4 – resistant hypertension, refer to specialist

Question 20

What are the complications of hypertension?

Answer 20

IHD
Stroke
Haemorrhage
Heart failure

Question 21

What is the pathology of atrial fibrillation?

Answer 21

Disorganised atrial activity resulting in ventricular irregularities

Question 22

What are the causes of atrial fibrillation?

Answer 22

AF affects Mrs SMITH
Sepsis
Mitral valve pathology
IHD
Thyrotoxicosis
Hypertension

Question 23

What are the symptoms of atrial fibrillation?

Answer 23

Can be asymptomatic
Palpitations
SOB
Dizziness
Heart failure
Irregularly irregular pulse
Tachycardia

Question 24

How is atrial fibrillation investigated?

Answer 24

ECG - absent P waves, narrow QRS complexes, irregularly irregular ventricular rhythm
Bloods - FBC, U&Es, TFT, LFT
Cardiac enzymes

Question 25

How is atrial fibrillation treated?

Answer 25

Rate control - B-blocker (bisoprolol), Ca blocker (amlodipine) If symptoms <48hrs cardioversion Anticoagulant - warfarin

Question 26

What score is used to assess the risk of embolic stroke and the need for coagulation?

Answer 26

CHA2DAS2-VASc

Question 27

What are the causes of ventricular tachycardia?

Answer 27

IHD MI Cardiomyopathy Drug toxicity

Question 28

What are the symptoms of ventricular tachycardia?

Answer 28

Palpitations Chest pain Syncope

Question 29

How is ventricular tachycardia investigated?

Answer 29

ECG - broad complexes

Question 30

How is ventricular tachycardia treated?

Answer 30

Amiodarone

Question 31

What system is used to classify heat failure?

Answer 31

New York classification of heart failure

Question 32

New York classification of heart failure

Answer 32

1 – heart disease present but no breathless from normal activities 2 – comfortable at rest, dyspnoea during normal activities 3 – less than ordinary activities causes dyspnoea 4 – dyspnoea at rest

Question 33

What are some side effects of ACEi?

Answer 33

Cough

Question 34

Who can't have b-blockers?

Answer 34

Asthmatic - risk of bronchospasm

Question 35

What would be seen on an x-ray if the person had heart failure?

Answer 35

``` ABCDE: Alveolar oedema Kerley B lines – interstitial oedema Cardiomegaly Dilated prominent upper lobe vessels Pleural effusion ```

Question 36

What are other causes of ST elevation?

Answer 36

``` Coronary vasospasm Pericarditis Left bundle branch block Left ventricular hypertrophy Ventricular aneurysm ```

Question 37

What is stable angina?

Answer 37

Symptomatic reversible myocardial ischaemia – narrowing of coronary artery

Question 38

What causes stable angina?

Answer 38

Atheroma

Question 39

What are the signs of stable angina?

Answer 39

``` Constricting heavy pain to chest radiation to left arm and jaw – brought on by exertion Relieved by 5 mins rest with GTN spray 3 – typical angina 2 – atypical angina 0/1 – not angina ```

Question 40

What investigations would be done if stable angina was suspected?

Answer 40

ECG – normal CT coronary angiography Bloods – FBC, U&Es, TFTs, lipids, HbA1c Consider ECHO and CXR

Question 41

How is stable angina treated?

Answer 41

Address exacerbating factors Secondary prevention – reduce risk factors, aspirin Symptomatic – GTN spray B-blocker or CCB If medical fails – PCI, angioplasty, CABG