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18 Cards in this Set
- Front
- Back
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What may indicate pheochromocytoma as the cause for a persons hypertension?
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paroxysmal and or severe >180/110mmHg
Refractory to treatment Symptoms of catecholamine excess - sweating, HA, palpitations, sweating, panic attacks, pallor HT triggered by beta blockers, MAOI, micturition or changes in abdominal pressure incidental adrenal mass, MEN (multiple endocrine neoplasia) 2A or 2B, Recklinghausen's neurofibromatosis, von Hippel-Landau disease Ix - 24 hour metanephrine and normetanephrine urine - if positive - MRI or CT Rx- send to specialised HT center |
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What are the main cardiac symptoms to inquire about?
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dysnoea (orthopnoea/PND/Classify)
Palpitations Fatigue Syncope Peripheral oedema Claudication |
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What is a clinically significant AAA?
When is it likely to rupture? |
>3cm
rupture is more likely when>5cm |
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Causes of Ejection systolic murmur?
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Aortic stenosis
pulmonary stenosis Hypertrophic obstructive cardiomyopathy (HOCM) Late systolic mumur - mitral or tricuspid prolapse or papillary muscle dysfunction |
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Causes of pansysystolic mumur?
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Mitral regurgitation
TR VSD |
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Cause of Diastolic murmurs?
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EARLY
Aortic/pulmonary regurgitation MID Mitral stenosis / tricuspid stenosis |
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What are the major risk factors associated with atherosclerotic heart disease?
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early CAD/PVD in family member
high cholesterol = TG/LDL HT Smoking Diabetes Obesity |
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What are the major causes of heart failure?
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HT
IHD F. Hx alcohol diabetes thyroid disease anaemia |
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The relative risk of dying from a heart attack decreases by how much in the first year after stopping smoking?
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50%
reduces to almost "never" smoker values by 5-10yrs |
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What is the recommended alcohol intake?
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no more than 2 drink/daywith 2 alcohol free days - long term risk
no more than 4 drinks on 1 occasion - acute risk |
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Weight reduction with regard to cardiovascular risk factors - has what effect?
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Improves lipid profile
reduces blood pressure decreases insulin resistance increases exercise tolerance |
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what is primary prevention with regard to cardiovascular disease?
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preventing getting the disease - this would include angina and AMI
therefore - management of cholesterol/HT/weight/exercise/quit smoking - manage risk factors |
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What is secondary prevention with regard to CVD?
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Management of patients with CVD - ie angina or AMI
Aspirin, ACE, BB |
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What factors indicate someone presenting with chest pain requires immediate action?
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CV risk factors
Visceral pain (not localised, difficult to describe, ache, heavy/tight) Autonomic features - SOB, sweaty BP, HR abnormalities |
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What immediate action is required in a patient presenting with chest pain - suspected to be ACS?
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ECG
Blood - troponin (repeat at 8 hrs), CK-MB, FBC, EUC,BSL Vitals IV access ASPIRIN GTN (if SBP>90mmHg), morphine - for pain Oxygen if O2% < 90% |
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Ongoing management following STEMI / STEACS?
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aspirin + clopidogrel or prasugrel
ACE inhibitor beta-blocker statin |
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What is the management of a Patient with a STEMI / STEACS?
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Aspirin
Oxygen is O2% < 90% Morphine -pain (reduce SNS and cardiac demand) GTN (SBP>90mmHg) beta blockers - limit infarcton size - careful in hypotension/heart failure statins (high dose) - stabilise plaque clopidogrel/heparin glycaemic control PCI with stent placement if availible within 90 min or Thrombolysis (best within 3 hrs)- then transfer! CABG HAEMODYNAMIC SHOCK Emergency revascularisation or if it fails emergent CABG +/- dobutamine infusion or intra-aortic balloon pump 5% of AMI that survive the 1st hr will go into shock |
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Absolute contraindications to thrombolysis?
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any prior intracranial haemorrhage, known malignant intracranial lesion or structural cerebral vascular lesion (e.g., arteriovenous malformations), ischaemic stroke within previous 3 months, suspected aortic dissection, active bleeding or bleeding diathesis, and significant closed head or facial trauma within previous 3 months.
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