Diseases of the Cardiovascular System Flashcards
(111 cards)
1
Q
How much of a drop in blood pressure is classified as postural hypotension?
A
Drop in systolic BP > 20 mmHg upon standing from sitting
2
Q
What are the 4 main systems most affected by hypertension?
A
Cardiovascular - coronary artery disease/MI
Cerebrovascular - stroke
Ophthalmic - retinopathy
Renal - uraemia/proteinuria/haematuria
3
Q
What type of chest pain is provoked by exertion and relieved by rest?
A
Angina pain
4
Q
What type of chest pain is a tearing pain that radiates to the back?
A
Aortic dissection
5
Q
What type of chest pain is sharp, worse with movement and relieved sitting forward?
A
Pericarditis
6
Q
What is the definition of paroxysmal nocturnal dyspnoea?
A
Awake from sleep gasping for breath
7
Q
What is the definition of orthopnoea?
A
Breathless lying flat
8
Q
What kind of changes are seen in hypertensive retinopathy
A
- Attenuated blood vessels-copper or silver wiring
- cotton wool spots
- hard exudates
- retinal haemorrhage (flame haemorrhages)
- optic disc oedema
9
Q
What is the key diagnostic test(s) for hypertension?
A
ABPM/HBPM
10
Q
What is the BP target for diabetics?
A
130/85
11
Q
What is the first line hypertension drug treatment for:
- People <55
- People of non-afrocarribean origin
- Type 2 diabetics?
A
ACEi or ARB
12
Q
What is the first line hypertension drug treatment for:
- People >55
- People of afrocarribean origin
A
Ca2+ channel blockers
13
Q
What is the second line hypertension drug treatment plan for:
- People <55
- People of non-afrocarribean origin
- Type 2 diabetics?
A
ACEi or ARB
+
CCB or thiazide-like diuretic
14
Q
What is the second line hypertension drug treatment plan for:
- People >55
- People of afrocarribean origin
A
CCB
+
ACEi or ARB or thiazide-like diuretic
15
Q
Which anti-hypertensive drugs should be avoided in pregnancy?
A
ACEi or ARB
16
Q
What is a side effect of Ca2+ channel blockers
A
Ankle swelling
17
Q
What condition can be triggered by thiazide diuretics?
A
Goat
18
Q
Name some ACEIs
A
Ramipril & lisinopril
19
Q
Name some ARBs
A
Losartan, candesartan & valsartan
20
Q
What is the classic respiratory side effect of ACEIs?
A
Dry cough
21
Q
Name some calcium channel blockers
A
Verapamil, diltiazem & amlodipine
22
Q
Name the most commonly used thiazide diuretic
A
Bendroflumethiazide
23
Q
What scoring system is used to estimate risk of CV events over 10 years and what score classifies a patient as high risk?
A
Assign score - a score of 20 is high risk
24
Q
What drug relives angina pain?
A
Glyceryl trinitrate (GTN)
25
What is the difference between unstable angina and an NSTEMI?
NSTEMI involves ischaemia severe enough to cause myocardial damage, releasing detectable markers. Unstable angina typically does not produce elevated troponin and ischaemic ECG changes such as ST depression and T wave inversion
26
What drug treatments should be given alongside GTN in angina?
Symptom control = Beta-blocker or calcium-channel blocker
Secondary prevention = aspirin, statin, anti-hypertensive (ACI etc...)
27
How long after an ACS will troponins vs CK enzymes be elevated?
Troponins = 4hrs
| CK enzyme = 24hrs until peak
28
What is the immediate treatment for an MI?
```
M - Morphine
O -Oxygen if hypoxic
N - nitrates (GTN)
A - Aspirin 300mg
C - clopidogrel/ticagralor
```
29
What investigations are needed for unstable angina/NSTEMI?
- Urgent angiography in high-risk - prevent progression into STEMI
- Exercise ECG - +ve result directs invasive therapy
30
What is the difference in management between low risk and high risk unstable angina/NSTEMI patients?
Low-risk = aspirin, clopidogrel and nitrates
High risk = revascularisation with PCI/thrombolysis/CABG
31
What are the criteria for diagnosing an MI on ECG?
Must have ≥1mm STE in 2 adjacent limb leads or ≥2mm STE in 2 contiguous precordial leads to diagnose STEMI
32
Which ECG leads show an inferior MI
II, III and aVF
33
Which ECG leads show an anterior MI
V1-4
34
Which ECG leads show a lateral MI
I, aVL, V5-6
35
Which ECG leads show an anterolateral MI
I, aVL, V1-6
36
Which ECG leads show an anteroseptal MI
V1-4
37
What drugs should never be used in heart failure?
Calcium channel blockers
38
What type of heart failure will cause congestion of peripheral tissues/oedema and ascites/impaired liver function/anorexia/GI distress/weight loss
RHF
39
What type of heart failure will cause decreased cardiac output/impaired gas exchange/pulmonary oedema/orthopnea/PND/cough with frothy sputum
LHF
40
What additional heart sound is associated with HF?
3rd heart sound
41
What marker is a good marker of stress on the heart an can be used in investigating HF?
BNP ( B-Natriuretic peptide)
42
What 3 classes of drugs are given in heart failure?
- ACEi/ARBs
- Beta-blockers
- Diuretics
43
How do you treat acute HF?
- ABCDE
- Prop patient upright
- IV furosemide
- Opiates (carefully)
- IV nitrates
- Stop fluids
44
What drugs can be given in later stage HF?
Spironolactone & digoxin
45
In ventricular arrhythmias the QRS complex is...
Wide (>3 small boxes)
46
In supraventricular arrhythmias the QRS complex is...
Narrow (< 3 small boxes)
47
What is 1st degree heart block?
Prolongation of PR interval (>0.22s)
48
What is Mobitz type 1 heart block?
Progressive PR interval prolongation, followed by dropped QRS
49
What is Mobitz type 2 heart block?
Occasional dropped QRS but no progressive PR interval prolongation
50
What is type 3 heart block?
Dissociation between P-wave and QRS (lonely P-waves)
51
Bundle branch block has what type of QRS complex?
Broad (>3 small boxes)
52
Which QRS complexes look "M shaped" in RBBB?
V1-3
53
What is the cheat way to tell RBBB and LBBB apart?
If aVR is more up than down it's right, if it's more down than up then it's left
54
In LBBB, which leads show an "M shape" and which show a "W" shape?
```
V1 = W
V6 = M
```
55
What is the treatment for acute supraventricular tachycardias?
1st line - vagal manoeuvres/carotid massage/submerging face in ice cold water
2nd line - IV adenosine
3rd line - IV verapamil
4th line - direct current cardioversion
56
What are the 2 main types of anticoagulants used for AF and when do you use them?
Warfarin - for patients with a metal valve
NOAC (edoxaban) - for patients without a metal valve
57
What determines whether to try drugs for rate control or for rhythm control in AF?
Rate control = minor/asymptomatic, older patients, longer duration, abnormal cardiac structure
Rhythm control = symptomatic, younger patients, paroxysmal, recent onset, normal cardiac structure
58
What 2 classes of drugs are the 1st line rate control treatment for AF?
Beta-blockers (bisoprolol) or calcium channel blockers (verapamil/diltiazem)
59
When should you not prescribe calcium channel blockers in AF?
If there is left ventricular dysfunction
60
What drug should be prescribed for rate control in AF in sedentary patients?
Digoxin
61
What drugs are used for rhythm control in AF?
- Sotalol
- Flecainide (not in IHD or poor LV)
- Propafenone
- Amiodarone
62
What drug combination is used in AF and congestive heart failure?
Digoxin and beta blockers
63
What does the CHA2DS2-VASc score for AF measure?
Stroke risk
| Patient need for anti-coagulation treatment
64
What does the HAS-BLED score for AF measure?
1 year risk for major bleeding
65
When can cardioversion be considered in AF?
If the patient is unwell or drugs are ineffective in new AF (<48hrs)
66
What does a small increase in troponin with AF indicate
Type 2 MI - due to stress on the chest
67
How fast is atrial flutter usually?
250-350 bpm
68
What is the treatment of atrial flutter?
- Ablation
- Cardioversion
- Anticoagulation
69
What immediate treatment is given to patients with ventricular tachycardia and haemodynamic compromise (eg hypotension, pulmonary oedema, signs of reduced cardiac output)
Direct current cardioversion
70
What immediate treatment is given to patients with ventricular tachycardia who are maintaining their BP and cardiac output?
Amiodarone
71
When are systolic murmurs heard?
Between S1 and S2
72
When are diastolic murmurs heard?
Between S2 and S1
73
What type of murmur is aortic stenosis?
Ejection systolic radiating to the carotids
74
What type of murmur is aortic regurgitation?
Early diastolic
75
What type of murmur is mitral stenosis
Mid-diastolic rumbling
76
What type of murmur is mitral regurgitation?
Pansystolic
77
What infecting organism in infective endocarditis is most common in PWIDs?
Staph aureus
78
What infecting organism in infective endocarditis is most common in people with poor dental hygiene?
Strep. viridans
79
What infecting organism in infective endocarditis is most common in people with prosthetic heart valves?
Staph. epidermidis
80
How should the carotid arteries be auscultated?
With the patient holding their breath
81
How should aortic regurgitation be auscultated?
Sit the patient forwards and auscultate over the aortic area (2nd intercostal space at the right sternal edge) with the diaphragm of the stethoscope during expiration
82
How should mitral regurgitation be auscultated
Roll the patient onto their left side and listen over the mitral area (5th intercostal space in the midclavicular line) with the diaphragm of the stethoscope during expiration
83
How should mitral stenosis be auscultated
Roll the patient onto their left side and listen over the mitral area (5th intercostal space in the midclavicular line) with the bell of the stethoscope during expiration
84
What antibiotic treatment is given for subacute endocarditis with a natural valve?
Amoxicillin + gentamicin
85
What antibiotic treatment is given for acute (sepsis) endocarditis with a natural valve?
Flucloxacillin
86
What antibiotic treatment is given for endocarditis with a prosthetic valve valve?
Gentamicin + vancomycin
87
What are the investigations for intermittent claudication?
- Ankle Brachial Pressure Index (ABPI)
- Duplex ultrasound v
- Magnetic resonance/CT/catheter angiography
88
What is the treatment for intermittent claudication?
- Lifestyle advice (smoking/exercise)
- Supervised exercise program/unsupervised (walk till it hurts then take a break -exercise approximately 30 minutes three to five times per week)
- Antiplatelets (aspirin/naftidrofuryl oxalate)
- Surgery (angioplast + stent/bypass/amputation) as last resort
89
What are the 5 Ps of acute limb ischemia?
Pain, pallor, paraesthesia (tingling), paralysis & perishing cold
90
How do you treat acute limb ischemia?
- Heparin (if improving) or warfarin (if severe)
| - Surgery
91
What is the best imaging test for DVT?
Doppler ultrasound
92
What scoring system is used for DVTs?
Wells score
93
What is first line treatment for DVT?
Apixaban or rivaroxaban
94
What is thrombophlebitis?
Local superficial inflammation with secondary superficial thrombosis, often associated with varicose veins
95
What direction does the blood shunt in a ventricular septal defect
Left-to-right, (↑pulmonary pressure)
96
What direction does the blood shunt in an atrial septal defect
Left-to-right, (↑pulmonary pressure)
97
What type of murmur is heard in ventricular septal defects?
Loud pansystolic
98
What type of murmur is heard in atrial septal defects?
Pulmonary mid-systolic
99
What kind of parasternal heave can be felt in atrial septal defects?
Right ventricular
100
Where is the connection in patent ductus arteriosus
Between pulmonary artery and descending aorta
101
80% of people with coarctation of the aorta also have _____ aortic valves
Bicuspid
102
Which cardiomyopathy is the most common cause of sudden cardiac death in young people?
Hypertrophic cardiomyopathy
103
How is hypertrophic cardiomyopathy inherited?
Autosomal dominant
104
What is hypertrophic cardiomyopathy?
Hypertrophy of the myocardium in the absence of other disease
105
What is dilated cardiomyopathy?
Dilation of ventricles with systolic dysfunction, with preserved wall thickness
106
What is Arrhythmogenic right ventricular cardiomyopathy
Fatty/fibro-fatty replacement of myocytes leading to partial or complete RV dilation
107
What is restrictive cardiomyopathy?
Decreased volume of both ventricles with bi-atrial enlargement; normal wall thickness; impaired filling
108
How long should a patient avoid athletics after myocarditis
6 months
109
What is the classic pain felt in pericarditis?
Chest pain radiating to the trapezius ridge (the bottom portion of scapula on the back) - relieved by sitting up or bending forward, and worsened by lying down
110
What is the most common cause of pericarditis in the developed world?
Viruses (eg coxsackievirus, herpesvirus etc)
111
What is the classic finding on an ECG indicating pericarditis?
Saddle-shaped ST-segment elevations
