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exam > 5 Cardiology > Flashcards

5 Cardiology Flashcards

1
Q

What condition causes ST elevation in ALL leads?

A

Endocarditis

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2
Q

Characteristic and lead of LBBB and RBBB

A 
LBBB = M shape in V6
RBBB = RSR' in V1
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3
Q

Normal axis of the heart

A

-30 > +90

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4
Q

Guideline recommendation classes (123)

A

1 = strong evidence/ agreement, use recommended
2 = conflicting/ mixed evidence
a - evidence in favour, should be considered
b- evidence less in favour, may be considered
3 = evidence against, not recommended

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5
Q

Levels of evidence (ABC)

A 
A = multiple RCT/ meta-analyses
B = single RCT/ large NR (non randomised) studies
C = small NR/ expert opinions/ retrospective/ registries
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6
Q

Hard vs soft endpoints of a clinical trial

A 
Hard = definitive e.g. death, MI
Soft = spectrum e.g. QoL
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7
Q

NYHA heart failure classification (1-4)

A

1) no symptoms or limitation - ordinary activity
2) mild symptoms and limitation - ordinary activity
3) marked limitation and symptoms - less than ordinary activity, only comfortable at rest
4) Severe limitations - symptoms at rest

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8
Q

Investigations for heart failure:

Initial (5)
2nd line (5)
A 
Initial:
>ECG
>CXR
>Echo
>Bloods - FBC (Hb, MCV), chemistry (LFT, U+E, urate, urea, creatinine)
>Natriuretic peptides
2nd line:
>Ambulatory ECG
>Exercise tolerancetest
>Coronary angiogram
>Genetic test
>Myocardial biopsy
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9
Q

Treatments of HF

A

1) ACE/ARB + BB
2) add MRA (+ ACE/ARB + BB)
3) swap ACE/ARB for sacubatril/valsartan (Neprolysin-inhibtor/ARB)
4) ICD + ivabradine
5) digoxin/ hydralazine-isosorbide dinitrate
6) LVAD/ transplant

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10
Q 
Endings of names of:
ACEi
ARBs
B-Blockers
Potassium sparing diuretic
A

ACEi = pril
ARBs = artan
B-Blockers = lol
Potassium sparing diuretic = one

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11
Q

Effects of entresto - sacubatril/valsartan

A

Valsartan = ARB - blocks angiotensin 2 binding receptor

Sacubitril = Neprilysin inhibitor - prevents breakdown of natriuretic peptides by neprilysin

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12
Q

Devices used in heart failure (2) and when are they used

A

ICD (implantable cardioverter defibrillator) - shocks heart if arrhythmia starts
CRT (cardiac resynchronisation technique) - electrodes in both sides of heart to resynchronise them

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13
Q

Function in heart failure of:
Ivabradine
Hydralazine-isosorbide dinitrate

A

Ivabradine: inhibits sinus node, reducing sinus rate

Hydralazine-isosorbide dinitrate: vasodilation

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14
Q

Risks of LVAD

A

Infection (line)

Clotting - needs blood thinners

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15
Q

CXR signs of heart failure (stage 1-3)

A

Stage 1 (redistribution):
>cardiomegaly
>dilation upper lobe vessels

Stage 2 (interstitial oedema):
>kerley B lines
>peribronchial cuffing
>hazy vessel contour
>sub pleural pulmonary oedema 
>thickened interlobular fissures
Stage 3 (alveolar oedema):
>alveolar oedema (bat wings)
>pleural effusion
>air bronchogram
>consolidation
>cotton will appearance
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16
Q

3 non-surgical procedures for valve repair

A

TAVI (transcatheter aortic valve replacement) - balloon with stent and new valve - aortic stenosis

Mitraclip - clips leaky valves together - mitral regurg

Valvuloplasty - Balloon opening stenosis in thickened mitral valve

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17
Q

Symptoms of mitral stenosis/regurg

A

Both:
Volume overload > dilated LA > AF > pul hypertension > dilated R heart

> Chest pain
Palpitations
SOB
RH failure symptoms

Stenosis only - haemoptysis

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18
Q

Symptoms of aortic stenosis/regurg

A

Both:
>SOB
>Decreased exercise tolerance

A Stenosis
>Syncope
>Presyncope

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19
Q

Causes of mitral stenosis/regurg

A

M Stenosis:
>Rheumatic
>Congenital

M Regurg: 
>Infective endocarditis
>Systemic CTD
>Rupture
>Damage to papillary muscles/ chord tendinae
>Prolapse
20
Q

Causes of aortic stenosis/regurg

A

A Stenosis:
>Calcification/ thickening
>Congential
>Rheumatic

A Regurg:
>Systemic CTD
>Infective endocarditis
>Degeneration
>Root annulus dilation
>Rheumatic 
>Bicuspid aortic valve
21
Q

Most common organism causing endocarditis:
NVE
PVE
IVDU

A

NVE - strep (viridans)
PVE - CoNS (coagulase negative staph)
IVDU - staph (aureus

22
Q

3 stages of presentations of acute infective endocarditis

A

1 - early:
>fever and new murmur
>malaise/ fatigue

2 - embolic:
>small - splinters, petichiae, haematuria
>large - stroke/ CVA, renal infarction
>septic emboli to lungs

3 - late:
>immunological - osler’s, clubbing, nephritis, splenomegaly, vasculitic skin and eye lesion
>tissue damage - valve abscess/ destruction

23
Q

Main points to think of infective endocarditis

A

Fever + NEW murmur = IE UPO
Any staph aureus bacteremia
IVDU/ prosthetic valve + +ve blood culture

24
Q

Criteria for diagnosis of infective endocarditis

A

Duke criteria = 5 min/ 2 maj/ 1maj+2min

Major:
>positive echo or new murmur/regurg
>typical organisms in at least 2/3 culture samples

Min:
>positive for other organisms 
>fever >38
>predisposition )IVDU/heart condition)
>vascular/ embolic phenomena
>immunological phenomena
25
Q

Investigations for infective endocarditis

A

Blood cultures
Echocardiogram
ECG

26
Q 
Antibiotics used in infective endocarditis
MSSA (IVDU)
MRSA 
CoNS (PVE)
Enterococci
Strep viridans (NVE)
A 
MSSA (IVDU) - flucloxicillin
MRSA - vancomycin
CoNS (PVE) - vancomycin and rifampicin
Enterococci - amoxycillin OR vancomycin
Strep viridans (NVE) - benzylpenicillin

ALL GENTAMYCIN

27
Q

Definition of unstable angina

A

Acute coronary event without rise in troponin (ECG change and clinical presentation like MI)

28
Q

5 types of MI

A 
Type 1 - 1y
Type 2 - 2y
Type 3 - sudden cardiac death
Type 4 - iatrogenic (stent)
Type 5 - iatrogenic (CABG surgery)
29
Q 
Arteries relating to MI:
Anterior (V1-4)
Posterior (anterior ST depression)
Inferior (II, III, aVF)
Superior (aVR)
High lateral (V5-6, I, aVL)
A 
Anterior (V1-4) - LAD
Posterior (anterior ST depression) - circumflex
Inferior (II, III, aVF) - RCA
Superior (aVR) - LCA
High lateral (V5-6, I, aVL) - circumflex
30
Q

Treatment of STEMI (Pre-PCI)

A

1) ABCD - defib and call ambulance/ rush to PCI centre
Give aspirin and UFH

2) clopidogrel, antiemetic and analgesic
3) swap clopidogrel for ticagrelor and activate PCI team

Give pre-hospital thrombolysis only if:
>wait over 90mins for PCI
>not in shock
>not contraindicated

31
Q

Treatment of STEMI (and NSTEMI) Post-PCI

A

Monitor in CCU for complications

Drugs:
>ACEi, BB, statin
>eplerenone - diabetic, LVSD, HF

Cardiac rehab
Echo
Consider ICD - LVSD >9 months

32
Q

What differentiates pericarditis from STEMI on ECG?

A

Concave ST elevation instead of convex
ST elevation doesn’t follow a pattern
No reciprocal ST depression
(PR depression)

33
Q

What do hyper acute T waves suggest?

A

Early sign of STEMI

34
Q

Symptoms and examination of ASD (secundum)

A

Symptoms:
>Palpitations
>Oedema
>SOB

Exam:
>Atrial arrythmia (dilation) --> Stroke
>Tricuspid regurgitation --> Pulmonary flow murmur
>Fixed, split, second heart sound
>Pulmonary hypertension
>RV failure
>Eisenmenger syndrome
35
Q

General symptoms of coarctation of aorta (if after ductal position/ juxta-ductal)

And treatment/ repair (2)

A

> Upper body hypertension - nosebleeds, berry aneurysms, headaches
Lower body hypotension - abdo angina, claudication, cyanosis, renal insufficiency
Radiofemoral delay
Continuous murmur - due to turbulent blood flow

Repair:

1) trans catheter balloon stent
2) surgical resection end-end anastomosis

36
Q

Treatment options and risks for repair of great artery transposition (2)

A

1) atrial switch - RV can’t cope with pressure long term - RV dilation/ failure, tricuspid regurg
2) arterial switch - coronary artery problems

37
Q

Characteristics of Tetralogy of Fallot

and imaging/ECG appearances (2)

A

1) overriding aorta
2) obstruction of pulmonary outflow
3) VSD
4) RV hypertrophy

CXR - boot shape
ECG - R hypertrophy and RBBB

38
Q

Treatments of of Tetralogy of Fallot (2)

A

Repair VSD and pulmonary flow with patches

Cut away excess muscle

39
Q

Causes of pressure change in Fontan circulation

A

PE - inc pul
Bleeding - dec systemic
Arrhythmia - dec systemic
Dehydration - dec systemic

40
Q

Investigations done in AF (4)

A

ECG
Echo
TFTs
LFTs

41
Q

Scoring system to identify annual stroke risk in AF patients

A

CHA2DS2-VASc score

42
Q

Anti-arrhythmic drugs used in AF

A

Class 1 = Na channel blockers
> flecainide
>propafenone

Class 2 = K channel blockers
>sotalol
>amiodarone

Multichannel blockers = dronedarone

43
Q

Hypertension grade classifications

A 
1 = > 140/ 90
2 = > 160/ 100
3= > 180/110
44
Q

Causes of 2y hypertension (5)

A

1) Drugs - coke, NSAIDs, steroids, herbals, OCP, cyclosporin, liquorice
2) Endocrine - hyperaldosterone, Cushings, thyroid, phaechromocytoma
3) Renal - stenosis, disease
4) Vascular - coarctation of aorta
5) Other - COPD

45
Q

ASA (american society anaesthetics) surgical risk score

A 
1 = healthy
2 = mild systemic disease
3 = severe systemic disease
4 = severe systemic disease, constant threat to life
5 = moribund, not likely to survive
6= brain dead organ donor
E/P = emergency / pregnant
46
Q

MET (metabolic equivalent of task) scoring and surgical risk

A 
1 = basal
3 = walking 100m
4 = walking up stairs/ gardening
7 = jog
10 = intense exercise
47
Q

Lee’s revised cardiac risk index for elective surgery (6)

A

% chance of a CV incident

1) high risk surgery
2) IHD
3) previous HF
4) cerebrovascular disease
5) insulin therapy
6) creatinine >177

exam (8 decks)

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