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Specialty Blocks > 5. Cardiothoracics > Flashcards

5. Cardiothoracics Flashcards

1
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

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2
Q

What type of hypersensitivity reaction causes rheumatic heart disease?

A

Type II (molecular mimicry) after group A strep (pyogenes) infection.

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3
Q

Give 3 examples of type II hypersensitivity reactions.

A

HDN
Goodpasture’s disease / anti-GBM (alpha-3 chain of type IV collagen on BM, only present in alveoli and glomeruli)
AIHA (cell surface antigen on rbcs)
Rheumatic heart disease

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4
Q

Which antibody mediates type II hypersensitivity, and what is the time frame?

A

IgG or IgM mediated cytotoxic reaction
Hours to days

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5
Q

Marfan syndrome is an AD condition. Which type of collagen is affected in this condition?

A

Type I collagen (mutation in FBN1 gene)
Type I collagen is found in bone, skin and tendons.

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6
Q

What is the most common form of cardiomyopathy?

A

Dilated CMO (90%)

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7
Q

How long can you not drive for post MI?

A

1 month

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8
Q

List 4 drug classes included in secondary prevention post-MI.

A

ACEi (/ARB if not tolerated)
DAPT (aspiring + P2Y12i e.g. clopidogrel *based on bleeding risk)
BB (/diltiazem / verapamil if not tolerated )
Statin

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9
Q

What are the symptoms and time of onset of Dressler’s Syndrome, and how is it treated?

A

Pleuritic chest pain
Fever
Raised ESR
Pericardial / Pleural effusion

Usually 2-6 weeks post MI

Treat with NSAIDs e.g. Aspirin. Steroids if severe.

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10
Q

Which coronary artery supplies the SAN and the AVN?

A

Right coronary artery

Complete occlusion of this may cause heart block and precipitate the need for temporary pacing.

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11
Q

State some complications of MI using the DARTH VADER mnemonic.

A

Death
Arrhythmias; tachy eg. VT, brady e.g. AV block in inf. STEMI
Rupture
Tamponade
Heart failure chronic
Valve disease
Aneurysm of LV
Dressler’s syndrome + immediate pericarditis
Embolism
Regurgitation mitral, recurrence

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12
Q

What is the time frame for delivering PCI in the acute setting?

A

Symptom onset <12 hours
Can be delivered within 120 mins

Consider if presenting >12 hours but ongoing myocardial ischaemia / cardiogenic shock

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13
Q

Give 5 conditions that can also cause a raised troponin.

A

Triple A rupture
PE
Hypertensive crisis / pre-eclampsia
Chemotherapy
IE COPD

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14
Q

Give 2 cardiac and 3 non-cardiac differentials for ACS.

A

Aortic dissection
Acute pericarditis

Acute pancreatitis
Cholecystitis
MSK chest pain
GORD

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15
Q

What are the top 3 modifiable risk factors for coronary artery disease?

A

Smoking
Hypertension
Hypercholesterolaemia

(Diabetes, obesity)

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16
Q

List 3 patient groups who may present with atypical symptoms of ACS, and list some atypical features.

A

Women
Elderly
Diabetics

Vomiting
Acute confusion
Epigastric pain
Hyperglycaemia
Hypotension
Pulmonary oedema

17
Q

Management of NSTEMI / unstable angina is complicated and depends on patient factors and a risk assessment. Which risk assessment tool is commonly used, and what factors are included in it?

A

GRACE score; estimates 6 month mortality

Age
Heart rate
BP
ECG findings
Cardiac (Killip class) and renal function (serum creatinine)
Cardiac arrest on presentation
Troponin

18
Q

A patient comes in and you diagnose an NSTEMI. They are clinically stable. You calculate their GRACE score and it comes out as 4% mortality. What interventions should be considered for them?

A

Angiography within 72 hours with PCI if necessary (their GRACE score is >3%).

If the patient was unstable e.g. hypotensive, immediate coronary angiography would be indicated.

19
Q

Give 7 side effects of amiodarone:

A

Deranged thyroid function tests
Deranged LFTs
N&V
Interstitial lung disease
Bradycardia
Jaundice
Sleep disorders

20
Q

Where are beta-adrenoceptors located?

A

Heart and bronchi

General rule; B1 = heart, B2 = lung.
Also in brain.

21
Q

At what age are men invited for triple A screening US?

A

65

22
Q

What type of ulcer is relieved of pain on elevation?

A

Venous

23
Q

A patient presents with lower back pain, abdominal pain and anaemia; what is it important to exclude before continuing with investigations?

A

Triple A, via US

24
Q

Give 2 conditions where morphine is contraindicated.

A

Head injury
Acute respiratory depression

25
Q

Give 5 common side effects of morphine.

A

Respiratory depression
N&V
Confusion
Constipation
Hypotension

26
Q

Describe the MOA of aspirin and give 5 common side effects.

A

Inactivates COX enzyme, resulting in reduced production of TXA2, which reduces platelet aggregation.
Also reduces PG12 production which decreases nociceptive sensitisation.

Bleeding
Peptic ulceration
Angioedema
Bronchospasm
Reye’s syndrome (children)

27
Q

Describe the MOA of amiodarone.

A

Blocks K+ channels and efflux of potassium, prolonging the repolarisation phase of the cardiac cycle, restoring regular sinus rhythm and slowing AVN conduction.

28
Q

Describe the MOA of statins and give 3 common side effects.

A

Inhibits HMG-CoA reductase which results in increased LDL receptor expression on hepatocytes, which increase cholesterol uptake and lowers plasma cholesterol.

Diarrhoea
Myalgia (could lead to rhabdo but this is dose related, so titrate up)
Thrombocytopaenia

29
Q

Give 3 examples of rate controlling drugs used in AF.

A

Beta blocker e.g. bisoprolol

Rate limiting CCB e.g. verapamil

Digoxin

30
Q

Give 4 contraindications to digoxin.

A

Heart block
VT/VF
Pregnancy
SVTs involving accessory pathways e.g. WPW

31
Q

Give the 3 actions of digoxin on the cardiac cycle, and which ion channel it inhibits.

A
  1. Lengthens cardiac action potential
  2. Increases contractility
  3. Stimulates PNS via vagus nerve to reduce AVN conduction, reducing heart rate.

Na/K channel inhibitor

32
Q

Give 4 symptoms of toxicity / side effects of digoxin.

A

Confusion
N&V
Hyperkalaemia
Visual disturbance

The therapeutic index of digoxin is narrow and the toxicity symptoms are quite vague, which means it needs monitoring.

33
Q

State some contraindications for DOACs (6).

A

Pregnancy
Previous ICH
Active / recent bleeding
Coagulopathy e.g. severe liver disease
Falls risk e.g. elderly, alcohol abuse
Peptic ulcer

34
Q

Which clotting factors are vitamin K dependent?

A

II, VII, IX, X

Warfarin is a vitamin K antagonist.

35
Q

What rhymes are there for remembering P450 inducers and inhibitors?

A

CRAP GPS induce P450. (INR decreases).

Inhibition of P450 gives SICK FACES . COM. (INR increases).

36
Q

Give 4 signs of haemodynamic compromise that warrant medication in bradycardia:

A

Shock (hypotension <90mmHg, clammy, pallor, sweating, cold, confusion, impaired consciousness)
Syncope
Myocardial ischaemia
Heart failure

37
Q

Which patient groups should not receive prasugrel as part of their DAPT post MI?

A

Age >75
Weight <60kg
Hx of stroke or TIA

Appears to only benefit in invasively managed patients e.g. stenting.

38
Q

What is the MOA of clopidogrel, prasugrel and ticagrelor?

A

P2Y12 ADP-receptor inhibitors, inhibiting the activation of platelets.

39
Q
A

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