Vascular Flashcards
(166 cards)
1
Q
What does PT measure?
A
Integrity of the extrinsic system of the clotting cascade
2
Q
How do you calculate INF?
A
Patient’s PT/Normal PT
3
Q
What does PTT measure?
A
Integrity of the intrinsic system of clotting cascade
4
Q
What is lymphodema?
A
Defective lymph system
Lymph can’t be drained back easily
Legs become enourmous
5
Q
What enzyme does Asprin inhibit?
A
COX-1
6
Q
What effector substance does asprin blocking its target enzyme reduce?
A
TXA2 (Thromboxane)
7
Q
Give 3 P2Y12 receptor antagonists
A
Clopidogrel
Prasugrel
Tricagrelor/cangrelor
8
Q
Give four major side effects of asprin
A
Blood disorders
GI heamhorrage
GI irritation
Increased bleeding time
9
Q
Give 5 contraindications of asprin
A
Bleeding disorders Heamophillia Active or previous peptic ulcer <16 yro Severe Cardiac failiure
10
Q
Give 4 indications of asprin
A
Secondary prevention (after an event) of stroke
Secondary prevention of MI
Angina
Peripheral vascular disease
11
Q
Give the names of two DOACS
A
Rivaroxaban
Dabigatran
12
Q
What two drugs should be used for atherothrombtic prophylaxis after ACI?
A
Rivaroxaban
Asprin/clopiogrel
13
Q
Give a use of DOACs or Warfarin (anticoagulants) (4 possible answers)
A
AF
Prevention of stroke or systemic embolism
Treatment and prevention of PE and DVT
Prophylaxis of venous thromboembolic events after elective surgery (hip or knee replacement)
14
Q
What does aortic dissection look like on CT?
A
Line in the middle of the aorta. Spanning it.
15
Q
What is the gold standard diagnostic technique for chest pain?
A
Invasive coronary angiography
16
Q
What is the current NICE definition Of hypertension?
A
> 140/90 if <80yro
>150/90 if >80yro
17
Q
Give 2 ACE inhibitors (4 possible)
A
Ramipril
Enalapril
Lisinopril
Trandilapril
18
Q
Give 2 Sx of ACE inhibitors
A
Dry cough
Rental impairment
19
Q
Give two contraindications of ACE inhibitors
A
Bilateral renovascular disease
Pregnancy
20
Q
Give 1 angiotensin 2 receptor blocker (3 possible)
A
Losartan
Irbesartan
Candesartan
21
Q
Give two contraindications of angiotensin 2 receptor blockers
A
Bilateral renovascular disease
Pregnancy
22
Q
Give 2 beta blockers (3 available)
A
Atenolol
Metoprolol
Nebivolol
23
Q
Give 4 Sx of beta blockers
A
Tiredness
Lethargy
Exercise intolerance
Cold hands
24
Q
Give 4 pros/indications of use of beta blockers to control hypertension
A
Good if anxiety related
Coexcitent heart failiure
Coexistant angina
Previous MI
25
Give 2 calcium channel blockers
Amlodipine
Nifedipine
Verapamil
26
Give three indications/pros of calcium channel blockers for hypertension
Elderly
Coexistent angina
Coexistent raynauds
27
Give 4 side effects of Calcium channel blockers
Ankle swelling
Constipation
Headache
Flushing
28
Give 2 diuretics (4 available)
Thiazide (bendroflumeththiazide)
Spironolactone (K sparing)
Furosemide (Koop)
Amiloride (k sparing)
29
Give 4 side effects of diuretics
Frequent urination
Incontinence
Impotence
Metabolic problems (gout, hyperglycaemia)
30
Give two contraindications of beta blockers
Bronchial narrowing diseases (asthma, bronchitis, emphysema)
| Arterial circulation problems
31
When would you use a PCSK-9 modulator?
Statin intolerent patients
| Treatment resistant hyper cholesterolaemia
32
Give two monoclonal antibody drugs that are PCSK-9 modulators/antagonists
Alirocumab
| Erolocumab
33
What three drugs are used in the primary prevention of CHD/atherothrombotic events ?
Atorvastatin (statin)
Amlodipine (ca channel blocker)
Ramipril (ACE inhibitor)
34
What two drugs are added on in secondary prevention of CHD/athertrombotic events?
```
Asprin
Clopidogrel (ADP receptor antagonist)
```
35
What is a PCSK-9 antagonist
PCSK-9 downregulates LDL receptors, preventing uptake of LDL from circulation. Monoclonal antibodies to PCSK-9 prevent this, increasing LDL uptake therefore lowering circulating LDL
36
What vasodilator is used in functional imaging of the heart?
Adenosine
37
What inotrophic agent is used in functional imaging of the heart?
Dobtamine
38
What are the 3 NICE symptoms of angina (2=atypical, 3=typical)
Central chest discomfort lasting equal to or less than 15 mins
Provoked by physical or emotional stress
Relived by rest or Nitrates
39
What two ECG changes show subendocardial ischeamia in angina?
ST depression
| T wave inversion
40
Generally, inherited cardiomyopathies involving cytoskeletal proteins result in what type of cardiomyopathy?
Dilated
41
Generally, inherited cardiomyopathies involving sarcomeric proteins result in what type of cardiomyopathy?
Hypertrophic
42
Generally, inherited cardiomyopathies involving desmosomal (conduction) proteins result in what type of cardiomyopathy?
Arrhythmogenic right ventricular cardiomyopathy
43
What are the three first line drugs in CHF treatment according to NICE
```
ACE inhibitor (ramipril)
Beta blocker (carbedilol or bisoprolol)
Diuretic
```
44
Give one Angiotensin 2 receptor blocker (ARB)
Losartan
45
What is the main Sx of ACE inhibitors
Dry cough
46
What is the indication for using an angiotensin 2 receptor blocker (ARB)?
ACE-I induced cough
47
Give four Sx of ACE-I
Dry cough
Hypotension
Renal failure
Hyperkalaemia
48
Give four contraindications of ACE-I?
Renal failure
Bilateral renal stenosis
Pregnancy
Angiiedema (face swelling condition)
49
Give a mineralocorticoid receptor antagonist?
Spironolactone
50
Give 3 Sx of MRAs (mineralocorticoid receptor antagonists)
Hyperkalaemia
Gyneacomastia
Renal dysfunction
51
What is the most common side effect of statins?
Myalgia
52
Give two signs of familial hypercholesterolaemia
Achilles’ tendon xanthelasma
| Corneal arcus
53
What is the pathology of familial hypercholesterolaemia?
Defective LDL receptors
54
what is the mechanism of action of dabigatran?
Direct thrombin inhibitor
55
What is the action of rivaroxaban
Factor X inhibitor
56
Give 4 CXR findings of heart failiure
alveoloar odema
cardiomegaly (cardiothoracic ratio >50%)
Upper zone vessel enlargement
Pleural effusio n
57
In what situation would you use angiotensin 2 receptor blocker (eg candesartan) for HNT?
Is ACe inhibitor not tolerateed due to dry cough
58
what is typicla ecg pattern in atrial flutter
sawtooth
59
what iis a typical rate of atrial contraction in atrial flutter?
300/min
60
ECG findings for pericarditis?
Global ST concave elevation and PR depression
61
What is the biggest indicated for coronary heart disease in older people?
Pulse pressure (as low diastolic = reduced coronary perfusion)
62
What is the home ambulatory montioring cut off for hnt (in under and over 80s) - offer if htn found in clinic
```
<80 = 135/85
>80 = 145/85
```
63
Give two pros of ACE inhibitors/ATreceptor blockers
v effective and well tolerated in young people
| v beneficial in diabetics
64
In what patients is ACEi the 1st line for HTN?
<55 and non black
| anyone w T2DM
65
In which patients is Ca blockers first line for HTN?
>55 or
Black
and without T2DM
66
What is 1st degree heart block?
P-R interval >0.22 second
67
What is mobitz 1 block?
Progressive PR elongation then a skipped QRS
68
What is Mobitz 2 block?
Randomly skipped QRS w/o progressivly enlongating PR
69
What is advacnced block 2:1 or 3:1 and how does it differ from Mobitz 2?
Only every 2nd or 3rd P wave conducts to the ventricles
| Never has 2 adjacent QRS) (Mobitz 2 over 50% of Ps conduct, 2:1, 3:1 50% or less of the P waves conduct
70
What is 3rd degree block
P completely dissociated from QRS (QRS relies on escape rhythm)
71
What is the management for 3rd degree block?
Pacemaker
72
What is an iatrogenic cause of L bundle branch block?
Pacemaker (leads sit at apex of R ventricle and may overstimulate R side = relative L weakness)
73
What is ventricular tachycardia
Life threatening! V short diastole therefore ventricles can't fill. CO is v low
74
Give two MI complications that may occur 5-14 days after
tamponarde due to ventricular wall rupture
| Mural Thrombus
75
Give a MI complcation likely <24 hrs after
Ventricular arrthymia
76
Give a MI complication that occurs weeks after
Dressler syndrome (autoimmune)
77
Give three clues (signs and Hx) of dressler syndrome
Pleuritis pain
Fever (same signs as pericarditis)
Hx of heart injury eg. MI
78
What stimulates angiogenesis?
hypoxia
79
What stimulate arteriogenesis
fluid sheer stress
80
Give 4 proangiogenic fators
VEGF
FGFs
Angiopoetins (mayalso be antiangiogenic)
PDGF
81
Give 2 managements for lymphodema
compression stockings
| Abx if recurring cellulitis
82
Give three causes of primary lymphodema
Turners
Prader willi
Milroys disease
83
What is chylous ascities?
Pelvic megalymphatics dont draw up lymph well
| fluid leaks out in pelvis and abdomen
84
What is the mechanism of heparin?
activates antithrombin 3
inhibits factors 10 (and 9 )
prevents thrombin activation
85
Give one example of a heparin
fondaparinux
86
Give 2 fibrinolytics (tissue plaminogen activators)
streptokinase
| alteplaste
87
What is the thrombin time test?
Time it takes for a clot to form in an excess of thrombin (tests fibrin system?)
88
What is D dimer?
Fibrin degradation product
89
give three indication of D dimer test
```
Supected :
PE
DVT
DIC
(elevated = positive result)
```
90
What is a normal INR target for pt on warfarin?
2-3
91
How do you carry out a PT test?
Add TF to pt plasma
Heat to 37 degree and add calcium chloride
See how long it takes to make a fibrin clot (11-15 seconds is normal)
92
What is a normal range for PT?
11-15 seconds
93
Give two causes of elevated TT
Fibrinogen deficiency/dysfunction
| too much heperin or direct thrombin inhibitors (heperin stops the activation of thrombiin)
94
Give two functions of thromboxane (which asprin blocks)
```
Platelet agonist (hence aspirin is antiplatelet)
Vasoconstriction
```
95
What is the most powerful ADP receptor antagonist?
Prasugrel
96
Give two Sx of clopidogrel
GI irritation
| Bleeding disorder
97
Give three contraindications of ADP receptor antagonists
```
Active bleeding
Hx of:
- stroke
-mi
- intracranial heamhorrage
```
98
Give three classes of antiplatelets
Asprin
ADP receptor antagonist
GP 2b3a antagonist
99
Give three GP 2b3a antagonists
Eptifibatide
tirofiban
Abciximab
100
What clotting factors does warfarin inhibit
10/9/7/2 (1972)
101
give two warfarin antidotes
Vit k
| Plasma
102
Give three pros and one con of using DOACS over Warfarin
Doesnt need frequent INR monitoring
lower heamhorrage chance
faster to kick in and wear off
No antidote (vit k/plasma for warfarin)
103
What is the first line investigation for chest pain
Coronary CT angiography
104
Give the indications for Coronary CT angiography
2 or more of
- central chest pain <15mins
- provoked by exercise or stress
- Relieved by rest or nitrates
105
What stage of cardiac cycle is CT angiography taken
diastole
106
how do you prep patient for Coronary CT angiography
HR must be under <65 bpm to elongate diastole sufficienty
| Give oral beta blockade or IV bisoprolol
107
What does white mean on a coronary ct angiogram?
calcification
108
What is the gold standard method for chest pain evaluation
Invasive coronary angiography
109
What is the biggest CVD risk factor
HTN
110
What is the definition of metabolic syndrome
3 or more of
- hyperglycaemia
- hyperension
- dyslipidaemia
- central obesity
111
What does QRISK measure
Chance of developing any CVD event in the next 10 years
112
What is the most up to date CVD risk assessment model
QRISK 3
113
What three blood levels are directly measured in a lipid screen
TAG
Total Cholestrol
HDL Cholestrol
114
How is LDL cholestrol assessed?
Total cholestrol - HDL cholestrol - TAG/2.2
| all are directly measured levels
115
How is non-HDL assessed?
Total Cholestrol - HDL cholestrol
| both are directly measured
116
What course of action should be taken if TAG>20 is found? (2 is normal)
Check to see if caused by alcohol or uncontrolled diabetes
| Refer to lipid clinic
117
What course of action if you find TAG 11-20 (2 is normal)
Repeat in 7 days
| Consider lipid clinic referal
118
What blood parameter is best indicator of atherogenic load?
Non HDL cholestrol
119
What blood test can be used instead of the calculationn to estimate non HDL cholestrol?
Apo B
120
What blood level can estimate HDL cholestrol level
Apo A1
121
Give a familial hyperlipaemia risk marker
Lipoprotein a
122
What is the function of Apo B
LDL mediator
123
Give three things that can go wrong to cause familial hypercholestroaemia
LDL receptor mutation
Apo B100 mutation
PCSK-9 Overactivity
124
Give three presentations of Familal Hypecholestrolaemia
High Total cholestrol and high LDL
Tendon Xanthomata
CHD around age 55
125
What cholestrol levels are suggestive of familial hypercholestrolaemia
TC >9 (<4.5)
| LDL >4.5 (<2.6)
126
What is the mode of inheritence of familal hypercholestrolaemia?
autosomal dominant
127
Give three signs of recesive famial hypercholestroaemia
TC >16 (<4.5)
Big Xanthomata
CHD age 20
128
Give three mangagement options of recessive fammilial hypercholestrolamia
Drug therapy
Apheresis (lipid dialysis)
Liver transplant
129
What does elevated Lipoprotein a mean?
Accelerator of coronary heart disease (poor prognostic indicator)
130
Give the two mechanisms by which Statins lower LDL
Reduce synthesis by blocking HMG CoA reductase
| Increased uptake by causing liver to upregulate LDL uptake receptors
131
Give one Sx of atorvastatin
Muscle ache (may progress to Rhabdomyelisis)
132
When would you use a PCSK-9 modulator (alirocumab, erolocumab)
Statin intolerant
| Treatment resistant hypercholestrolaemia
133
What drug class is used to lower TAG?
Fibrates
134
Give 4 signs of lipoprotein llipase deficieny
TAG >20 (2)
Milky, yellow, orange blood (blood lipidaemia - can see VLDL on layer in blood sample)
Yellowing of arteries in eyes (lipidaemia retinalis)
Eruptive xanthomata (blebs on skin)
135
When should you refer a pt with lipoprotein lipase deficiency?
TAG >20
Acute abdo pain
pregnancy (big risk in pregnancy!)
136
What drugs do you give for familal hypercholestrolaemia?
Aggresive atorvastatin
| Ezetimib (blocks gut cholestrol absoption)
137
What is ezetimib
blocks cholestrol absorbtion from gut (only works in people who have a relatively high proportion of their cholestrol absorbbed not produced)
138
Give the three first line drugs in 1 prevention of CVD events
Atorvastatin
Amlodipine (>55 / black)
Ramipril (<55 and not black or T2DM)
139
What two drugs are added to the 1 prevention drugs of CHD if an event happpens (now for 2 prevention)
Asprin
Clopidogrel
(dual antiplatelet)
140
When does the pain occur in ACS or critical limb ischeamia
at rest
141
Give three three classic symptoms of angina
<15 min pain
Brought on by physical or emotional stress
Relived by rest or nitrates
142
What is it called if Pt has 2 of the three classic angina symptoms and what is the course of action
Atypical angina
| CT coronary angiogram
143
What is it called if Pt has all 3 of the classic angina symptoms and what is the course of action?
Typical angina
| CT coronary angiogram
144
What is it called if Pt only has 1 of the classic angina symptoms and what do you do
non anginal chest pain
Blood test to rule out aneamia induced angina
Resting ECG. If this shows pathological Q waves or ST changes progress to Coronary CT angiogram as usual
145
IF claudication pain occurs in the hip of buttock which artery is occluded?
iliac
146
If upper 2/3 of calf in pain during claudication, what artery is affected?
superfiscal femoral
147
If lower 1/3 of calf in pain in claudication, which artery?
popliteal
148
What is the indication for functional coronary testing?
In typical or atypical anginal pain, if the CT coronary angiogram has shown lesions that are inconclusive as to how much they affect blood flow
149
Give 4 functional imaging tests that are indicated if CT coronary angiogram is inconclusive in determining if lesions causes occlusion
Stress echocardiogram
SPECT / PET
Stress perfusion CMR (MRI used to assess blood flow)
1st pass contrast enhanced MRI
150
What is the action of dobutamine in functional testing
ionotrophic agent therefore increased myocardial O2 demand
151
Give 2 side effects of dobutamine
sustained VT
| severe hypertensive reaction
152
What is the action of adenosine in functional testing?
Vasodilator (see which coronaries have vasodilating capabilities reduced)
153
What ECG change shows subendocardial ischaemia?
ST depression
154
What does pathological Q wave mean (really deep Q)
Previous infarction (therefore, coronary artery disease is likely)
155
What tracer is used in SPECT functional imaging for angina
O15
156
What are the three first line drugs for angina
```
GTN (for immediate releif)
beta blocker (bisoprolol)
Ca blocker (amlodipine or verapamil)
```
157
Give 4 drugs that may be given on top of the first line in severe cases of angina
long acting nitrate
Ivabradine (blocks funny current)
Nicorandil (Katp channel activator, vasodilates)
Ranolazine (reduces cardiac stiffness)
158
What is the indication for angioplasty in angina?
V treatment resistant
| V drug intolerant
159
Give 2 problems that may occur with angioplasty
Stent thrombosis
| Stent restenosis
160
What is the indication for CABG?
Severely stenosed coronary artery that cant be all stented
161
What is the indication for TAVI?
Severe aortic stenosis
| TAVI = Transcatheter aortic valve implant
162
What is the key feature of systolic heart failiure
Reduced ejection fraction
| neurohumeral antagonism helps this better than they help diastolic HF
163
What is the key feature of diastolic heart failiure
Ejection fraction not reduced
164
Give the three first line drug classes used to treat HF
ACEi
Beta blocker
Diuretic
165
Which beta blocker is safest to used in asthmatic w heart failiure as is most B1 selective
Bisoprolol
166
If heart failiure first lines dont work and LVejection fraction is <35% what two drugs do you give
Sacubatril (preserves ANP)
| Valsartan (an ARB)
