Disease summary Flashcards
(161 cards)
1
Q
What diseases can cause secondary hypertension?
A
Cushing’s syndrome
Conn’s syndrome
Phaeochromocytoma
Renal disease
2
Q
What investigations are used to diagnose hypertension?
A
ABPM/HBPM Urine test (protein, blood)
3
Q
First line treatment for hypertension in Caucasian under the age of 55?
A
ACE inhibitor (ramipril)
4
Q
First line hypertension treatment in possibly pregnant women
A
Beta blocker (e.g. propranolol)
5
Q
First line hypertensive treatment in caucasians over the age of 55 or black people
A
Calcium channel blocker
6
Q
Second line treatment of hypertension
A
ACE inhibitor + Calcium channel blocker
OR
ACE inhibitor + diuretic
7
Q
Side effect of calcium channel blockers
A
ankle oedema
8
Q
Side effect of thiazide diuretics
A
gout
9
Q
Risk factors for coronary heat disease
A
Rage Smoking Alcohol Obesity Hypertension Diabetes Hyperlipidaemia Family History
10
Q
How to estimate someones risk of a cardiovascular event
A
ASSIGN score
11
Q
Investigations for angina
A
If > 90% risk of cardio event just treat
If >61% risk of cardio event - catheter angiography
If > 30% risk should have functional testing
If > 10% risk should have CT angiography
12
Q
First line management of stable angina
A
GTN spray
13
Q
Second line treatment of angina
A
Beta blocker or Calcium channel blocker (if not adequately controlled both)
14
Q
Next step angina treament if no adequately controlled on BB and CCB
A
Long acting nitrate OR Ivabradine OR Nicorandil OR Rranolazine
15
Q
3 Types of acute coronary syndrome
A
Unstable angina
NSTEMI
STEMI
16
Q
First line investigations for acute coronary syndrome
A
ECG
Cardiac Troponins, CK enzyme
17
Q
Does unstable angina give elevated troponin?
A
not typically
18
Q
ECG changes in NSTEMI
A
ST depression
T wave inversion
19
Q
Managment of low risk unstable angina or NSTEMI
A
aspirin
clopidogrel
nitrates
20
Q
Management of NSTEMI
A
MONA+C
21
Q
Where is the MI if there is ST elevation in II, III and avF?
A
Inferior MI
22
Q
What artery is typically involved in inferior MI’s?
A
right coronary artery
23
Q
Where is the MI if there is ST elevation in V1-V4?
A
Anterior MI
24
Q
What artery is typically involved in anterior MI’s?
A
LAD
25
Where is the MI if there is ST elevation in I, aVL and V5-V6?
Lateral MI
26
Where is the MI if there is ST elevation in I, aVL and V1-V6?
Anterolateral MI
27
Where is the MI if there is ST elevation in V1-V4?
anteroseptal
28
What is the immediate treatment of a STEMI?
MONA+C
29
If able to be seen within 90 minutes what is the best choice of treatment for STEMI?
PCI (angioplasty)
30
If not able to be seen within 90 minutes what is the best treatment for STEMI?
Thrombolysis
31
What drugs are used in thrombolysis after an MI?
streptokinase + aspirin
32
When is thrombolysis contraindicated?
```
trauma
haemorrhage
Stroke
Recent surgery
Severe hypertension
Ulcers
```
33
Why does heart failure happen?
Heart fails to function as a pump to support the circulation, usually due to low cardiac coutput. Because of low CO the body tinks fluid is low so it retains fluid
34
Colour of sputum in pulmonary oedema?
Pink frothy sputum
35
Treatment of heart failure
Diuertics for fluid
ACE inhibitors
Beta blocker (START LOW GO SLOW)
36
What drugs are involved in late stage heart failure?
Spironolactone
| Digoxin
37
When are ACE inhibitors and ARBs contraindicated in heart failure?
renal artery stenosis
| pregnancy
38
What is it important to monitor when prescribing diuretics?
K+ concentration (watch for hypokaelemia)
39
Which diuretic is K+ sparing?
spironolactone
40
Investigation for arrhythmia's
ECG
41
What is the mechanism of action of class I anti-arrhthmic drugs?
Na+ channel blockers (prolong repolarisation) (phase O)
42
Example of class I anti-arrhythmic drugs?
lignocaine
Flecainide
Disopyramide
Propafenone
43
What is the mechanim of action of class II anti-arrhythmic drugs?
Beta adrenoceptor blockers (Phase 4)
44
Example of class II anti-arrhythmic drug?
Atenolol
| Propranolol
45
Mechanism of action fo class III anti-arrhythmic drug?
K+ channel blockers (Phase 3) Prolong repolarisation
46
Example of class III anti-arrhythmic drug
Amiodarone
| Sotalol
47
Mechanism of action of class IV anti-arrhythmic drug?
Calcium channel blockers (Phase 2)
48
Example of class IV anti-arrhythmic drug?
Verapamil
| Diltiazem
49
Which classes of anti-arrhythmic drugs control rate?
II and IV
50
Whcih classes of anti-arrhythmic drugs control rhythm?
I and III
51
Causes of sinus bradycardia
```
Ischaemia/infarction of the SA node
Fibrosis of atrium
Hypothermia
Hypothyroidism
Drug therapy
```
52
What drugs can cause sinus bradycardia?
Beta blockers and verapamil (VERAPAKILL)
53
What does Ist degree heart block look like on an ECG?
Prolonged PR interval
| Husband comes home late but always at same time
54
What does Mobitz type I look like on an ECG?
Progressive PR elongation then dropped QRS
| Husband comes home later and later then doesn't come home at all
55
What does Mobitz type II look like on an ECG?
Dropped QRS but no progressive PR elongation
| Husband sometimes comes home but sometimes he doesn't
56
What does complete heart block look like on an ECG?
Dissociation between P waves and QRS complexes
| Husband and wife now on different schedules an need counselling (pacing)
57
Characteristics of RBBB on ECG
Deep S waves - I and V6
| Tall R wave - V1
58
Characteristics of LBBB on ECG
Deep S wave - V1
Tall R waves - I and V6
abnormal Q waves
59
Treatment of heart block
IV atropinwe
| Temporary or permanent pacing
60
Appearance of AF on ECG
no p waves
61
Treatment of acute AF
cardioversion +/- warfarin
62
How is rhythm controlled in AF?
DC cardioversion
| Class I or II anti-arrhythmics
63
How is rate controlled in AF?
Claa II or IV anti-arrhthymics
64
ECG feature of Atrial Flutter
Sawtooth baseline
65
Treatment of atrial flutter
Electrical cardioversion
| Radiofrequency ablation
66
Appearance of VT on ECG
Broad QRS complexes
67
Treatment for pulseless VT
Defibrillation
68
Treatment of VT with well maintained BP and CO
Amiodarone + claa I drug (lignocaine)
69
Treatment of VT if haemodynamically compromised
DC cardioversion
70
What should be prescribed in VT if the patient is hyperkalemia
Calcium chloride
71
Appearance of VF on ECG
shapeless, unorganised QRS complexes
72
Treatment of VF
BEC + defibrillation
| Magnesium Chloride
73
Management for future VF
ICD's
74
Which sided murmurs are louder on inspiration?
right sided
75
Cuases of mitral regurgitation
Rheumatic disease
Degenerative disease
Endocarditis
Chordae rupture
76
Pansystolic murmur
displaced apex
radiates to the axilla
Ankle swelling
Mitral regurgitation
77
Treatment of Mitral regurgitation for those not elligible for surgery
Diuretics and ACE inhibitors
78
Causes of aortic stenosis
Congenital bicuspid valve
Degeneration/calcification with age
rheumatic disease
Hypertrophic obstructive cardiomyopathy
79
Ejection systolic radites to the carotids
slow rising pulse
heaving apex
aortic stenosis
80
treatment of aortic stenosis
balloon valvotomy
| TAVI (transcatheter valve implantation)
81
Causes of mitral stenosis
Rheumatic fever
| congenital
82
Mid diastolic rumbling murmur
| tapping apex
Mitral Stenosis
83
Treatment of Mitral Stenosis
Balloon valvotomy
| Diuretics, Beta blocker, digoxin
84
Causes of aortic regurgitation
Marfan's syndrome
UC
Connective tissue disorders (SLE)
85
Early diastolic murmur
collapsing pulse
displaced apex
Aortic regurgitation
86
Treatment of aortic regurgitation if not elligble for aurgery
Diuretics
| ACE inhibitors
87
What are the typical causing organisms of infective endocarditis
Stph aureua
Staph viridans
Staph epidermidis
88
What are the atypical causing organism of infective endocarditis?
Coxiella brunetti
Brucella
Garm negatives
Fungi
89
Symptoms of infective endocarditis
```
Breathless
fever
new/changing heart murmur
sepsis
clubbing,
splinter haemorrhages
roth spots, janeways lesions, oslers nodes
```
90
Investigations for infective endocarditis
3 sets of blood cultures
CRP
FBC
Echocardiography
91
Main 2 antibiotics in treatment of infective endocarditis
vancomycin, gentamicin
92
What stagin sstem is used to asses intermittent claudication?
Fonataine staging system
93
Investigations for intermittent claudication
ABPI
| Duplex ultrasound
94
Treatment of intermittent claudication
Antiplatelets (aspirin)
| Surgery if high risk
95
The 5 P's of acute lower limb ischaemia
```
Pain
Pallor
Paraesthisia (tingling)
Paralysis
Perishing cold
```
96
Treatment of acute lower limb ischaemia
Heparin if improving
Warfarin if severe
Surgery
97
Symptoms of AAA
```
Severe pain -- back
Pulsatile/expansile abdominal mass
Hypotension
Tachycardia
Anaemia
Discoloured peripheries
```
98
Treatment of AAA
Endovascular stenting
| Open surgery
99
Investigations of DVT
D-dimers (rule out not rule in)
| Doppler ultrasound
100
Treatment of DVT
Anticoagulation
| Stockings
101
What causes varicose veins?
Back pressure due to an incompetent valve causing blood to pool in superficial vein
102
Treatment for varicose veins
Compression stockings
| Surgery
103
What is thrombophebitis?
Local superficial inflammation with secondary thrombosis
104
Treatment of thrombophlebitis
Analgesics
Elevation of limb
Fondaparinux
105
Symptoms & signs of congential heart disease
Central cyanosis due to right-to-left shunt in the heart
Pulmonary hypertension from large left-to-right shunt in the heart
clubbing
106
What is the mostr common congenital cardiac malformation?
Ventricular septal defect
107
Features of VSD
Increased pulmonary pressure
Loud pansystolic murmur
Heart failure syptoms
108
Features of atrial septal defect
increase pulmonary pressure
exercise intolerance
atrial arrthymias from atrial dilation
RV heave, pulmonary mid-systolic murmur
109
Signs of patent ductus arterosus
Machine gun murmur
| Bounding pulse
110
Signs of coarctation of the aorta
Headaches
nosebleeds
Diminished, absent lower limb pulses
Rib-notching on CXR
111
Features of tetralogy of fallot
cyanosis in first month
112
Features of transposition of the reat vessels
Cyanosis in the first day
113
How to recognise stroke
Face
Arm
Speech
Time
114
Treatment of stroke
Thrombolysis
| ABCDE
115
What are the 3 types of cardiomyopathy?
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Arrhthymogenic Right Ventricular Cardiomyopathy
Restrictive Cardiomyopathy
116
What is HCM a mutation of?
Genes encoding sarcomeric proteins - particular myosin light chains
117
Symptoms of HCM
Jerky pulse
4th heart sound
Chest pain
Syncope
118
Investigation for HCM
ECG
119
Treatment of HCM
Amiodarone in low risk patients
| Betablockers or verapamil
120
What is DCM?
Mutation in the genes encoding cytoskeletal/mmyocyte proteins - cuase contractile/conduction diseases
121
Investigations for DCM
CXR cardiac enlargement
Echocardioraphy
ECG
122
Treatment of DCM
Management of heart failure
Cardiac resync therapy
ICD in high risk
123
What is ARVC a mutation of?
genes encoding desmosomal proteins (e.g. ryanodine receptor)
124
Treatment of ARVC
Beta blockers
| Amiodarone, sotalol ( for symptomatic arrhythmias)
125
What change occurs in the size of chambers in restrictive cardiomyopathy?
Decreased volume in ventricle
| Atrial enlargement
126
What is restrictive cardiomyopathy associated with?
Amyloidosis
Sarcoidosis
Endocardial fibrosis
127
What is myocarditis?
Acute inflammation of the myocardium. Heart becomes flabby with focal haemorrhages and inflammatory infiltrate
128
Causes of myocarditis
Infection
Coxsackie virus
Drugs causing hypersensitivity reactions
Radiation
129
Investigations for myocarditis
CK and troponin elevated
ECG
CXR
130
Treatment of myocarditis
ACE inhibitors
Beta blockers
Spironolactone
Digoxin
131
What effects does atropine have on the heart?
speeds of heart rate
| revers bradycardia after an MI
132
Side effects of atropine
Arrhthymias
Hallucinations
Confusion
133
Whta is the mechanism of action of digoxin?
Blocks Na/K ATPase pump
Increased vaal activity
slows down SA node discharge
increases force contraction and CO
134
What conditions is digoxin used to treat?
Heart failure
| AF
135
Side effects of digoxin?
Heart block
Dysrhthmias
Myocarditis
136
Mechanism of action of nitrates
Produce NO
No caused Ca+ efflux producing hyperpolarization and relaxation
Arteriolar dilation
Increased coronary blood flow
137
Side effects of ACE inhibitors
Renal dysfunction
Angioneurotic oedema
Fetal abormalities
138
Exampes of calcium channel blockers
Amlodipine
Verapamil
Diltiazem
139
How do calcium channel blockers affect HR?
Decrease HR
140
Side effects of calcium channel blockers
nkle oedema
| Bradycardia (VERPAKILL)
141
Side effects of alpha blockers
postural hypotension
142
Example of potassium channel openers
Minoxidil
| Nicorandil
143
Effect of potassium channel openers
relaxes vascular smooth muscle
144
Side effects of potassium channel openers
Slt and water retention
| Tachycardia
145
Side effects of diuretics
```
Hypokaelmia
Arrhthymias
Fatigue
Hyperglycaemia
Gout (increased uric acid deposits)
```
146
Mechanism of action of statins
Blocks HMG CoA reductase which inhibits cholesterol formation
147
side effects of statins
Use in caution with hyperthyroidism and liver failure
Myalgia
Myopathy
Myositis
148
Examples of fibrates
Bezafibrate
| Gemifibrozil
149
Mechanism of action of fibrates
Enhances transcription of LPL whcih hydrolyses triglycerides to fatty acids & glycerol
150
What are fibrates used in>
High triglyceride levels
151
Side effects of fibrates
myositis
152
What do bile caid binding resins do?
cause excretion of bile salts resulting in more cholesterol to be converted to bile salts
Bile resins bind to bile in the intstine s it is not absorbed in the duodenum
Liver metabolises cholesterol to compensate for it lost
153
Example of bile acid binding resin
colestryamine
colestipol
aolsevelam
154
What is ezetimibe used in?
Decrease in LDL
155
Side effects of ezetimibe
Diarrhoea
Abdmoinal pain
Headache
Contraindicated in breasting feeding
156
Whatis the mechanism of action of warfarin?
Block clotting factors 2, 7, 8 & 10
| Acts as vitamin K antagonists whcih prevents production of mature coagulation factors.
157
Mechanism of action of Heparin?
Binds to anti-thrombin II, increasing its affintiy for serine proteases to greatly increase their rate of inactivation
158
Mechanism of action of rivaroxaban?
Directly inhibits Factor Xa
Factor Xa - acitvates thrombin IIa
Thrombin IIa - fibrin
Fibrin - blood clot
159
Mechanism of action of anti-platelets?
Blocks COX inhibitng formation of TXA2 which causes crosslinking of platelets
Blocks ADP from binding to P2Y12 receptor and formation of fibrin
160
Examples of fibrinolytic drugs
Streptokinase
| Tissue plasminogen
161
Mechanism of action of fibrinolytic drugs
Fibrinolytic cascade opposes coagulation cascad
| Activate formation of plasmin from plasminogen whcih lysis fibrin into fibrin fragment causing lysis of theclot
