GeriQBank · Topic
Hypertension, heart failure, arrhythmias, ischaemic heart disease and thromboembolism.
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Textbook coverage note: Neither Pathy's (6th ed.) nor Essentials of Clinical Geriatrics (7th ed.) contains a dedicated cardiomyopathy chapter. They refer to cardiomyopathy only in passing — as a cause of sudden cardiac death and…
Definition: structural and functional myocardial disease in the absence of coronary, hypertensive, valvular or congenital disease sufficient to explain it. Five phenotypes (2023 ESC): dilated, hypertrophic, restrictive, arrhythmogenic…
Definition: left ventricular or biventricular dilatation with systolic dysfunction not explained by abnormal loading conditions or coronary artery disease. Epidemiology: Pathy's notes that idiopathic dilated cardiomyopathy is relatively…
Bare-metal stents (BMS) are plain metal scaffolds. They abolish elastic recoil but do nothing to prevent neointimal hyperplasia, so restenosis rates are high. Drug-eluting stents (DES) have a metal platform coated with a polymer…
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Isolated systolic hypertension (ISH) = systolic BP ≥140 mmHg with diastolic BP <90 mmHg. Widened pulse pressure is the hallmark. It is the dominant pattern of hypertension in old age. NHANES III showed that fewer than 20% of…
Deep vein thrombosis (DVT) is thrombus formation within the deep venous system, most often of the lower limb; proximal (popliteal and above) DVT carries the greatest risk of pulmonary embolism and of post-thrombotic syndrome. Venous…
STEMI is an acute coronary syndrome caused by complete thrombotic occlusion of a coronary artery following plaque rupture or erosion — a Type 1 myocardial infarction. Diagnosis rests on three things: clinical presentation, ST-segment…
Compliance with healthy lifestyle recommendations reduced mortality and the prevalence of chronic disease in a cohort of people aged 65–98 years — the benefits of prevention apply regardless of age or number of risk factors. Standard…
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Definition and place in the ACS spectrum. Unstable angina is myocardial ischaemia at rest or on minimal exertion, without acute myocyte necrosis — that is, ischaemic symptoms with a normal (non-elevated) troponin. It sits between stable…
Rationale. Atherosclerotic cardiovascular disease is the leading cause of death and disability in adults aged 75 and above, and age is the strongest single predictor of cardiovascular risk. Because absolute risk rises steeply with age,…
Lacunar Infarcts Definition and pathology Lacunes are small infarcts resulting from occlusion of the small perforating arterioles supplying the basal ganglia, external and internal capsule, thalamus and pons. On brain imaging they are…
Hypertension in older people is defined by the same thresholds as in the young, but the pattern differs: systolic BP rises with age while diastolic BP plateaus or falls after about 60 years. Prevalence rises steeply with age. In India,…
Heart failure (HF) is a clinical syndrome of symptoms and signs caused by a structural or functional cardiac abnormality resulting in reduced cardiac output or raised filling pressures. Prevalence rises with age — HF is present in…
Why it is difficult in the elderly: atypical presentation, multiple comorbidities that mimic HF (COPD, obesity, anaemia, venous stasis, renal disease), and cognitive impairment limiting history-taking. Essentials stresses that HF is…
Definition: persistent symptoms of heart failure at rest or on minimal exertion (NYHA class IV) with recurrent congestion or low output, despite maximal tolerated guideline-directed therapy — corresponds to ACC/AHA Stage D, advanced…
Definition: impaired ventricular relaxation and/or increased chamber stiffness causing raised filling pressures at normal or near-normal ejection fraction. When symptomatic it manifests as heart failure with preserved ejection fraction…
Atrial fibrillation (AF) is uncoordinated atrial electrical activation with loss of effective atrial mechanical function — the commonest sustained arrhythmia in older people. Prevalence rises from <0.5% at age 40–50 to 5–15% at age 80.…
Definition: Sick sinus syndrome (sinus node dysfunction) is a constellation of electrocardiographic abnormalities — sinus bradycardia, chronotropic incompetence (inadequate sinus response to exercise), sinoatrial exit block, and sinus…
Purpose: a permanent pacemaker delivers electrical stimuli to maintain an adequate heart rate and, where possible, atrioventricular synchrony, in symptomatic bradyarrhythmia. Nomenclature (NBG code): position 1 = chamber paced, 2 =…
Infective endocarditis (IE) is microbial infection of the endocardial surface of the heart, typically involving native or prosthetic valves or intracardiac devices, with vegetation as the characteristic lesion. Nearly 50% of all cases…
Mechanism: statins inhibit HMG-CoA reductase, reducing hepatic cholesterol synthesis and upregulating LDL receptors. Beyond LDL lowering they have pleiotropic effects — plaque stabilisation, reduced inflammation and improved endothelial…
Mechanism: calcium channel antagonists block L-type voltage-gated calcium channels, reducing calcium entry into vascular smooth muscle (vasodilatation) and into cardiac myocytes and nodal tissue (negative inotropy and negative…
Both the risk of thrombosis and the risk of haemorrhage increase with age. Older patients therefore stand to gain the most from anticoagulation and to lose the most from it — the central tension of geriatric prescribing. Guidelines are…
Venous thromboembolism (VTE) = deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Almost 60% of all VTE events occur in people over 65. Incidence rises exponentially with age — from <1 per 1000 person-years below 50 years to…
Thrombolysis in Stroke Fifteen–Twenty High-Yield Points Principle The introduction of intravenous alteplase (rt-PA) transformed acute stroke care. Its benefit is tempered by the risk of precipitating intracranial haemorrhage and by…
Note: In-stent restenosis is discussed only briefly in Pathy’s (in the context of DES superiority over BMS). The detailed mechanisms and management below are therefore drawn from current peer-reviewed cardiology literature and…
High-sensitivity cardiac troponin (hs-cTn) I and T is the gold standard biomarker of myocardial injury and the cornerstone of ACS diagnosis. Myocardial injury is defined by a troponin value above the 99th percentile upper reference…
Atrial fibrillation (AF) is the commonest sustained arrhythmia in older people and is a major cause of cardioembolic stroke, heart failure, and death. Stroke in AF arises mainly from thrombus in the left atrial appendage (LAA) — hence…
CHA2DS2-VASc is a clinical risk-stratification score that estimates the annual risk of ischaemic stroke and systemic embolism in patients with non-valvular atrial fibrillation. It was developed to refine the earlier CHADS2 score, which…
Secondary hypertension is high blood pressure due to an identifiable and often correctable underlying cause. It is uncommon in older adults overall, but should be actively considered in treatment-resistant hypertension and in those with…
Complete (third-degree) heart block is a total failure of conduction between the atria and the ventricles, resulting in regular atrial activity with an independent ventricular escape rhythm — atrioventricular dissociation. The escape…
Heart failure (HF) is a clinical syndrome in which structural or functional cardiac abnormality causes reduced cardiac output and/or elevated intracardiac pressures, producing typical symptoms and signs. Prevalence rises steeply with…
This is HFrEF with stage 3b chronic kidney disease — the classic cardiorenal situation in geriatric practice. CKD is present in nearly one-third of heart failure patients; renal function declines with age and creatinine clearance is…
Statins are HMG-CoA reductase inhibitors — they block the rate-limiting step of hepatic cholesterol synthesis, upregulate LDL receptors, and lower LDL-C by 20–55%. Pleiotropic effects matter as much as lipid lowering: statins stabilise…
Note: Pathy’s covers ezetimibe’s place in lipid management and the key trial evidence, but not its detailed pharmacokinetics. The pharmacology below is supplemented from standard pharmacological and regulatory sources. Ezetimibe is a…
Low molecular weight heparins (LMWHs) are produced by chemical or enzymatic depolymerisation of unfractionated heparin (UFH), giving fragments of mean molecular weight 4,000–6,000 daltons (versus 15,000 for UFH). Like UFH, LMWH acts by…
Direct oral anticoagulants (DOACs) comprise a direct thrombin (factor IIa) inhibitor — dabigatran — and direct factor Xa inhibitors — apixaban, rivaroxaban, and edoxaban. They act directly on their target enzyme, unlike warfarin (which…
Major lower limb arthroplasty is among the highest-risk settings for venous thromboembolism, because it combines all three elements of Virchow’s triad — venous stasis from immobilisation, endothelial injury from surgical trauma, and a…
When heart muscle cells die, their proteins leak into the blood. Each marker appears, peaks and clears at its own pace, depending on its size, where it sits in the cell and how it is cleared. Myocardial infarction is now diagnosed by a…
No university frequency data yet
Definition and classification. Heart failure is a clinical syndrome in which the heart is unable to deliver an output adequate for the metabolic needs of the tissues, or can do so only at raised filling pressures. Classify by ejection…
Definition. Refractory (advanced or stage D) heart failure is persistent severe symptoms at rest or on minimal exertion (NYHA class III–IV) despite optimal guideline-directed medical and device therapy, with objective severe cardiac…
Rationale and mechanism. Chronic heart failure activates the sympathetic nervous system, which is initially compensatory but ultimately causes myocyte toxicity and apoptosis, adverse remodelling, arrhythmia, down-regulation of β…
Definition and mechanism. Diastolic dysfunction is retarded left ventricular filling with a higher left ventricular diastolic pressure, present both at rest and during exercise in older persons. It arises from impaired active relaxation…
discharge Recognise the syndrome in the first line: heart failure with hypotension is cardiogenic shock until proved otherwise — this is the "cold and wet" haemodynamic profile, not simple acute pulmonary oedema. Marks are earned by…
Definition. Cardiorenal syndrome (CRS) is a group of disorders of the heart and kidneys in which acute or chronic dysfunction of one organ induces acute or chronic dysfunction of the other. It is bidirectional, and its recognition…
Primary use — immediate triage. The 12-lead ECG must be obtained and interpreted within 10 minutes of first medical contact. Its principal function is to separate ST-elevation myocardial infarction, which requires immediate reperfusion,…
Frame the answer as structured secondary prevention. This man has established ASCVD with four modifiable risk factors and fresh stents — every point should name a target and an action. Antiplatelet therapy — the most urgent point.…
Stent types. A bare-metal stent (BMS) is a bare metallic scaffold that prevents acute recoil but has a high restenosis rate of 20–30%. A drug-eluting stent (DES) has three components — a metal platform, an antiproliferative drug and a…
Definition and burden. Atherosclerotic cardiovascular disease is the leading cause of death and disability in adults aged 75 and older. Atherosclerosis is a slow-developing chronic inflammatory disease that begins as early as the first…
Definition and the importance of the problem. Hypertension is defined as a systolic blood pressure of 140 mmHg or greater and/or a diastolic blood pressure of 90 mmHg or greater. It is the major risk factor for stroke, heart failure and…
Important framing point to state at the start of the answer: JNC 8 (2014) did not create a staging system. It was a treatment-threshold and target guideline; the stages that are conventionally quoted belong to JNC 7 (2003). Stating this…
Definitions and terminology. Accelerated hypertension is a severe elevation of blood pressure (usually diastolic > 120–130 mmHg) with grade III retinopathy — flame haemorrhages, cotton-wool spots and hard exudates. Malignant…
Definition and cut-off. Isolated systolic hypertension (ISH) is defined as a systolic pressure of 140 mmHg or greater WITH a diastolic pressure of less than 90 mmHg. It is the commonest form of hypertension in older adults, accounting…
Definition and prevalence. Orthostatic (postural) hypotension is a sustained fall in systolic blood pressure of at least 20 mmHg, or in diastolic pressure of at least 10 mmHg, within 3 minutes of standing (or of head-up tilt to 60°).…
Epidemiology and aetiology. Acquired calcific degenerative aortic stenosis is the commonest valve disease in the elderly, with a prevalence of 2.8% in those aged 75 and over, and it is found at autopsy in about 4–6% of those over 65.…
Definition. Aortic sclerosis is focal thickening, fibrosis and calcification of the aortic valve leaflets WITHOUT significant obstruction to left ventricular outflow — by convention a peak transvalvular velocity below 2.5 m/s with…
Definition and classification. Mitral regurgitation (MR) is systolic backflow from the left ventricle into the left atrium through an incompetent mitral valve. Classify as PRIMARY (degenerative/organic) — a structural abnormality of the…
Definition and burden. Infective endocarditis (IE) is infection of the endocardium, usually of the heart valves. In people over 65 the incidence is about four times that of the general population and mortality is about twice that of…
Source note: Cardiomyopathy is not covered adequately as a standalone topic in the uploaded textbook (Pathy's refers to dilated and hypertrophic cardiomyopathy mainly as causes of sudden cardiac death; Essentials of Clinical Geriatrics…
Definition. Third-degree (complete) heart block is complete failure of conduction between atria and ventricles, producing regular atrial activity with an independent escape rhythm. The escape is usually ventricular — wide QRS at 30–40…
Definition. Sick sinus syndrome (sinus node dysfunction) is a spectrum of inappropriate sinus bradycardia, sinus arrest or pause, sinoatrial exit block, chronotropic incompetence, and tachycardia–bradycardia syndrome. Dysfunction may…
Definition and epidemiology. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, characterised by uncoordinated atrial activation with consequent loss of atrial mechanical function. It is now regarded as a…
Purpose. CHA DS -VASc estimates the annual risk of ischaemic stroke and systemic thromboembolism in non-2 2 valvular atrial fibrillation and decides who needs oral anticoagulation. HAS-BLED estimates major bleeding risk on…
Definition and classification. A tachyarrhythmia is a rhythm with a ventricular rate above 100 beats per minute. Classify first by QRS width — this is the practical bedside division: Narrow complex (QRS < 120 ms) — supraventricular…
Principle. Head-up tilt testing reproduces the haemodynamic stress of standing under controlled, monitored conditions. Passive upright tilt causes venous pooling of about 500–800 mL of blood in the lower limbs and splanchnic bed,…
Definition. Syncope is a transient loss of consciousness due to global cerebral hypoperfusion, characterised by rapid onset, short duration and spontaneous complete recovery. It is one cause of the wider syndrome of transient loss of…
Definition. A drop attack is a sudden, unexpected fall to the ground WITHOUT loss of consciousness and without warning (no prodrome), with preserved awareness throughout, occurring in the absence of dizziness or vertigo. The patient…
Definition and principle. The ankle brachial index (ABI) is the ratio of the highest systolic pressure at the ankle to the highest systolic pressure in either arm, measured with a sphygmomanometer and a hand-held Doppler probe. In…
Drugs and mechanism. Dabigatran is a direct thrombin (factor IIa) inhibitor. Rivaroxaban, apixaban and edoxaban are direct factor Xa inhibitors. Advantages over warfarin: predictable pharmacokinetics, no routine monitoring, rapid onset…
Risk factors (Virchow's triad). Stasis — immobility, hospitalisation, stroke with hemiplegia, long travel, heart failure. Endothelial injury — surgery, especially hip fracture and hip or knee arthroplasty, trauma, central venous…
Concept and definition. The polypill is a fixed-dose combination tablet containing several cardiovascular drugs, taken once daily, designed to deliver comprehensive cardiovascular risk reduction in a single pill. The concept was…