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4th Year General Medicine > Diseases of the Cardiovascular System > Flashcards

Diseases of the Cardiovascular System Flashcards

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

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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

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3
Q

What type of chest pain is provoked by exertion and relieved by rest?

A

Angina pain

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4
Q

What type of chest pain is a tearing pain that radiates to the back?

A

Aortic dissection

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5
Q

What type of chest pain is sharp, worse with movement and relieved sitting forward?

A

Pericarditis

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6
Q

What is the definition of paroxysmal nocturnal dyspnoea?

A

Awake from sleep gasping for breath

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7
Q

What is the definition of orthopnoea?

A

Breathless lying flat

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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
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9
Q

What is the key diagnostic test(s) for hypertension?

A

ABPM/HBPM

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10
Q

What is the BP target for diabetics?

A

130/85

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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

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12
Q

What is the first line hypertension drug treatment for:

  • People >55
  • People of afrocarribean origin
A

Ca2+ channel blockers

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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

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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

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15
Q

Which anti-hypertensive drugs should be avoided in pregnancy?

A

ACEi or ARB

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16
Q

What is a side effect of Ca2+ channel blockers

A

Ankle swelling

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17
Q

What condition can be triggered by thiazide diuretics?

A

Goat

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18
Q

Name some ACEIs

A

Ramipril & lisinopril

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19
Q

Name some ARBs

A

Losartan, candesartan & valsartan

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20
Q

What is the classic respiratory side effect of ACEIs?

A

Dry cough

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21
Q

Name some calcium channel blockers

A

Verapamil, diltiazem & amlodipine

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22
Q

Name the most commonly used thiazide diuretic

A

Bendroflumethiazide

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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

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24
Q

What drug relives angina pain?

A

Glyceryl trinitrate (GTN)

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25
Q

What is the difference between unstable angina and an NSTEMI?

A

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

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26
Q

What drug treatments should be given alongside GTN in angina?

A

Symptom control = Beta-blocker or calcium-channel blocker

Secondary prevention = aspirin, statin, anti-hypertensive (ACI etc…)

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27
Q

How long after an ACS will troponins vs CK enzymes be elevated?

A

Troponins = 4hrs

CK enzyme = 24hrs until peak

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28
Q

What is the immediate treatment for an MI?

A 
M - Morphine
O -Oxygen if hypoxic 
N - nitrates (GTN)
A - Aspirin 300mg 
C - clopidogrel/ticagralor
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29
Q

What investigations are needed for unstable angina/NSTEMI?

A
  • Urgent angiography in high-risk - prevent progression into STEMI
  • Exercise ECG - +ve result directs invasive therapy
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30
Q

What is the difference in management between low risk and high risk unstable angina/NSTEMI patients?

A

Low-risk = aspirin, clopidogrel and nitrates

High risk = revascularisation with PCI/thrombolysis/CABG

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31
Q

What are the criteria for diagnosing an MI on ECG?

A

Must have ≥1mm STE in 2 adjacent limb leads or ≥2mm STE in 2 contiguous precordial leads to diagnose STEMI

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32
Q

Which ECG leads show an inferior MI

A

II, III and aVF

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33
Q

Which ECG leads show an anterior MI

A

V1-4

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34
Q

Which ECG leads show a lateral MI

A

I, aVL, V5-6

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35
Q

Which ECG leads show an anterolateral MI

A

I, aVL, V1-6

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36
Q

Which ECG leads show an anteroseptal MI

A

V1-4

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37
Q

What drugs should never be used in heart failure?

A

Calcium channel blockers

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38
Q

What type of heart failure will cause congestion of peripheral tissues/oedema and ascites/impaired liver function/anorexia/GI distress/weight loss

A

RHF

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39
Q

What type of heart failure will cause decreased cardiac output/impaired gas exchange/pulmonary oedema/orthopnea/PND/cough with frothy sputum

A

LHF

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40
Q

What additional heart sound is associated with HF?

A

3rd heart sound

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41
Q

What marker is a good marker of stress on the heart an can be used in investigating HF?

A

BNP ( B-Natriuretic peptide)

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42
Q

What 3 classes of drugs are given in heart failure?

A
  • ACEi/ARBs
  • Beta-blockers
  • Diuretics
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43
Q

How do you treat acute HF?

A
  • ABCDE
  • Prop patient upright
  • IV furosemide
  • Opiates (carefully)
  • IV nitrates
  • Stop fluids
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44
Q

What drugs can be given in later stage HF?

A

Spironolactone & digoxin

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45
Q

In ventricular arrhythmias the QRS complex is…

A

Wide (>3 small boxes)

46
Q

In supraventricular arrhythmias the QRS complex is…

A

Narrow (< 3 small boxes)

47
Q

What is 1st degree heart block?

A

Prolongation of PR interval (>0.22s)

48
Q

What is Mobitz type 1 heart block?

A

Progressive PR interval prolongation, followed by dropped QRS

49
Q

What is Mobitz type 2 heart block?

A

Occasional dropped QRS but no progressive PR interval prolongation

50
Q

What is type 3 heart block?

A

Dissociation between P-wave and QRS (lonely P-waves)

51
Q

Bundle branch block has what type of QRS complex?

A

Broad (>3 small boxes)

52
Q

Which QRS complexes look “M shaped” in RBBB?

A

V1-3

53
Q

What is the cheat way to tell RBBB and LBBB apart?

A

If aVR is more up than down it’s right, if it’s more down than up then it’s left

54
Q

In LBBB, which leads show an “M shape” and which show a “W” shape?

A 
V1 = W
V6 = M
55
Q

What is the treatment for acute supraventricular tachycardias?

A

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
Q

What are the 2 main types of anticoagulants used for AF and when do you use them?

A

Warfarin - for patients with a metal valve

NOAC (edoxaban) - for patients without a metal valve

57
Q

What determines whether to try drugs for rate control or for rhythm control in AF?

A

Rate control = minor/asymptomatic, older patients, longer duration, abnormal cardiac structure

Rhythm control = symptomatic, younger patients, paroxysmal, recent onset, normal cardiac structure

58
Q

What 2 classes of drugs are the 1st line rate control treatment for AF?

A

Beta-blockers (bisoprolol) or calcium channel blockers (verapamil/diltiazem)

59
Q

When should you not prescribe calcium channel blockers in AF?

A

If there is left ventricular dysfunction

60
Q

What drug should be prescribed for rate control in AF in sedentary patients?

A

Digoxin

61
Q

What drugs are used for rhythm control in AF?

A
  • Sotalol
  • Flecainide (not in IHD or poor LV)
  • Propafenone
  • Amiodarone
62
Q

What drug combination is used in AF and congestive heart failure?

A

Digoxin and beta blockers

63
Q

What does the CHA2DS2-VASc score for AF measure?

A

Stroke risk

Patient need for anti-coagulation treatment

64
Q

What does the HAS-BLED score for AF measure?

A

1 year risk for major bleeding

65
Q

When can cardioversion be considered in AF?

A

If the patient is unwell or drugs are ineffective in new AF (<48hrs)

66
Q

What does a small increase in troponin with AF indicate

A

Type 2 MI - due to stress on the chest

67
Q

How fast is atrial flutter usually?

A

250-350 bpm

68
Q

What is the treatment of atrial flutter?

A
  • Ablation
  • Cardioversion
  • Anticoagulation
69
Q

What immediate treatment is given to patients with ventricular tachycardia and haemodynamic compromise (eg hypotension, pulmonary oedema, signs of reduced cardiac output)

A

Direct current cardioversion

70
Q

What immediate treatment is given to patients with ventricular tachycardia who are maintaining their BP and cardiac output?

A

Amiodarone

71
Q

When are systolic murmurs heard?

A

Between S1 and S2

72
Q

When are diastolic murmurs heard?

A

Between S2 and S1

73
Q

What type of murmur is aortic stenosis?

A

Ejection systolic radiating to the carotids

74
Q

What type of murmur is aortic regurgitation?

A

Early diastolic

75
Q

What type of murmur is mitral stenosis

A

Mid-diastolic rumbling

76
Q

What type of murmur is mitral regurgitation?

A

Pansystolic

77
Q

What infecting organism in infective endocarditis is most common in PWIDs?

A

Staph aureus

78
Q

What infecting organism in infective endocarditis is most common in people with poor dental hygiene?

A

Strep. viridans

79
Q

What infecting organism in infective endocarditis is most common in people with prosthetic heart valves?

A

Staph. epidermidis

80
Q

How should the carotid arteries be auscultated?

A

With the patient holding their breath

81
Q

How should aortic regurgitation be auscultated?

A

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
Q

How should mitral regurgitation be auscultated

A

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
Q

How should mitral stenosis be auscultated

A

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
Q

What antibiotic treatment is given for subacute endocarditis with a natural valve?

A

Amoxicillin + gentamicin

85
Q

What antibiotic treatment is given for acute (sepsis) endocarditis with a natural valve?

A

Flucloxacillin

86
Q

What antibiotic treatment is given for endocarditis with a prosthetic valve valve?

A

Gentamicin + vancomycin

87
Q

What are the investigations for intermittent claudication?

A
  • Ankle Brachial Pressure Index (ABPI)
  • Duplex ultrasound v
  • Magnetic resonance/CT/catheter angiography
88
Q

What is the treatment for intermittent claudication?

A
  • 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
Q

What are the 5 Ps of acute limb ischemia?

A

Pain, pallor, paraesthesia (tingling), paralysis & perishing cold

90
Q

How do you treat acute limb ischemia?

A
  • Heparin (if improving) or warfarin (if severe)

- Surgery

91
Q

What is the best imaging test for DVT?

A

Doppler ultrasound

92
Q

What scoring system is used for DVTs?

A

Wells score

93
Q

What is first line treatment for DVT?

A

Apixaban or rivaroxaban

94
Q

What is thrombophlebitis?

A

Local superficial inflammation with secondary superficial thrombosis, often associated with varicose veins

95
Q

What direction does the blood shunt in a ventricular septal defect

A

Left-to-right, (↑pulmonary pressure)

96
Q

What direction does the blood shunt in an atrial septal defect

A

Left-to-right, (↑pulmonary pressure)

97
Q

What type of murmur is heard in ventricular septal defects?

A

Loud pansystolic

98
Q

What type of murmur is heard in atrial septal defects?

A

Pulmonary mid-systolic

99
Q

What kind of parasternal heave can be felt in atrial septal defects?

A

Right ventricular

100
Q

Where is the connection in patent ductus arteriosus

A

Between pulmonary artery and descending aorta

101
Q

80% of people with coarctation of the aorta also have _____ aortic valves

A

Bicuspid

102
Q

Which cardiomyopathy is the most common cause of sudden cardiac death in young people?

A

Hypertrophic cardiomyopathy

103
Q

How is hypertrophic cardiomyopathy inherited?

A

Autosomal dominant

104
Q

What is hypertrophic cardiomyopathy?

A

Hypertrophy of the myocardium in the absence of other disease

105
Q

What is dilated cardiomyopathy?

A

Dilation of ventricles with systolic dysfunction, with preserved wall thickness

106
Q

What is Arrhythmogenic right ventricular cardiomyopathy

A

Fatty/fibro-fatty replacement of myocytes leading to partial or complete RV dilation

107
Q

What is restrictive cardiomyopathy?

A

Decreased volume of both ventricles with bi-atrial enlargement; normal wall thickness; impaired filling

108
Q

How long should a patient avoid athletics after myocarditis

A

6 months

109
Q

What is the classic pain felt in pericarditis?

A

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
Q

What is the most common cause of pericarditis in the developed world?

A

Viruses (eg coxsackievirus, herpesvirus etc)

111
Q

What is the classic finding on an ECG indicating pericarditis?

A

Saddle-shaped ST-segment elevations

4th Year General Medicine (6 decks)

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