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cardio Flashcards

1
Q

ASD

A

ESM louder on inspiration

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2
Q

MS

A

mid-late diastolic

loud S1, opening snap

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3
Q

soft S1

A

MR

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4
Q

loud S1

A

MS

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5
Q

soft S2

A

AS

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6
Q

when is S3 normal

A

<30 years

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7
Q

S3

A 
LV failure (e.g. dilated cardiomyopathy)
constrictive pericarditis (called a pericardial knock)
mitral regurgitation
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8
Q

when is S4 normal

A

<40 years

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9
Q

S4

A

aortic stenosis, HOCM, hypertension

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10
Q

HF (chronic) mx

A 
BASHeD
Beta blocker + ACEi
Spironolactone
(Get specialist input)
Hydralazine + Nitrates 
e
Digoxin
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11
Q

STEMI PCI within 120 mins

A

Aspirin 300mg
PCI
Prasugrel
Unfractionated heparin + bailout glycoprotein IIb/IIIa inhibitor

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12
Q

STEMI PCI not possible within 120 mins

A 
Aspirin 300mg
Fibrinolysis
Antithrombin
Ticagrelor post-prodecure
ECG 60-90 mins post-procedure
Persistent MI - PCI
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13
Q

NSTEMI/unstable angina low risk mortality (<=3%)

A

Aspirin 300mg + Fondaparinux if no immediate PCI planned

Ticagrelor

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14
Q

NSTEMI/unstable angina high risk mortality (>3%)

A

Aspirin 300mg (+Fondaparinux if no immediate PCI)
PCI immediately if unstable, otherwise within 72h
Prasugrel or Ticagrelor
Unfractionated heparin

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15
Q

SVT ECG

A

narrow complex tachycardia (QRS<120ms)

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16
Q

SVT mx

A

vagal manoeuvres

adenosine (CI in asthma, use CCB)

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17
Q 
P450 inducers (SCARS)
what do they do to INR?
A 
Smoking
Chronic alcohol use
Anti-epileptics (phenytoin and carbamazepine)
Rifampicin 
St Johns Wort
decrease INR
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18
Q 
P450 inhibitors (ASS-ZOLES)
what do they do to INR?
A 
ABX (Ciprofloxacin, Macrolides, Isoniazid)
SSRIs
Sodium valproate
-Zoles (Omeprazole, Ketoconazole)
increase INR
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19
Q

ejection systolic murmur

A

AS + HOCM - louder on expiration

PS + ASD - louder on inspiration

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20
Q

pansystolic murmur

A

MR/TR (TR louder on inspiration)

VSD (‘harsh’)

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21
Q

late systolic murmur

A

mitral valve prolapse

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22
Q

early diastolic murmur

A

AR

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23
Q

mid-late diastolic

A

MS

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24
Q

hypercalcaemia ECG

A

shortened QT interval

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25
Q

hyperkalaemia ECG

A

tall tented T waves
flattened P waves
broad QRS
QT prolongation

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26
Q

hypokalaemia ECG

A

U waves
prolonged PR
ST depression

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27
Q

loud S2

A

systemic or pulmonary hypertension

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28
Q

PS

A

ESM

louder on inspiration

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29
Q

complete heart block

A

P waves and QRS complexes are not related

P wave may be in the QRS complex

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30
Q

first degree heart block

A

PR interval >0.2s

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31
Q

second degree heart block - type 1 (Mobitz I, Wenkebach)

A

progressive prolongation of PR until dropped beat

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32
Q

second degree heart block - type 2 (Mobitz II, Wenkebach)

A

intermittent non-conducted P waves without progressive prolongation of the PR interval
when P waves conduct the PR is constant

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33
Q

target INRs:

  • normal
  • VTE etc
  • if VTE despite warfarin
A

normal = 0.8-1.2
VTE = 2-3
VTE despite warfarin = 3-4

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34
Q

what is Eisenmenger’s syndrome

A

reversal of a L->R shunt associated with VSD, ASD and PDA

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35
Q

pharmacological options for treatment of postural hypotension

A

fludrocortisone

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36
Q

ECG changes that indicate need for PCI or thrombolysis (3)

A
  1. ST elevation >2mm in 2 more more consecutive anterior leads
  2. ST elevation >1mm in >2 consecutive inferior leads
  3. new LBBB
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37
Q

medical mx of stable angina

A

beta-blocker or CCB first line
if beta-blocker used first and not controlled, add CCB (long-acting dihydropyridine such as - Amlodipine, Nifedipine)
CCB monotherapy - Verapamil or Diltiazem

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38
Q

adverse effects of ACE inhibitors

A

cough
hyperkalaemia
angioedema

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39
Q

ECG findings for acute pericarditis

A

saddle shaped ST elevation

PR depression

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40
Q

ECG changes caused by thiazides

A

thiazides can cause hypokalaemia leading to:

  • prolonged PR
  • U waves
  • flattened T waves
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41
Q

mx of AF with CHA2DS2-VASc score of 0

A

no anticoagulation treatment

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42
Q

BP targets

A

<80 years - clinic BP 140/90, home BP 135/85

>80 years - clinic BP 150/90, hope BP 145/85

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43
Q

features of AR

A

early diastolic murmur
collapsing pulse
wide pulse pressure
head bobbing

44
Q

adverse effects of nitrates

A

hypotension
tachycardia
headaches
flushing

45
Q

most important risk factor for aortic dissection

A

hypertension

46
Q

mx of torsades de pointes

A

magnesium sulphate

47
Q

CHA2DS2-VASc scoring

A 
Congestive HF - 1
HTN - 1
Age >=75 - 2 OR Age 65-74 - 1
Diabetes - 1
Prior stroke/TIA - 2
VAascular disease - 1
Sex (F) - 1
48
Q

features of VSD post-MI

A

occurs in first week
acute HF
pansystolic murmur

49
Q

what may cause statin-induced myopathy if prescribed alongside a statin

A

Erythromycin or Clarithromycin

50
Q

how to differentiate between NSTEMI and unstable angina

A

NSTEMI - elevated troponin

unstable angina - normal tropnonin

51
Q

features of acute MR post-MI

A

due to ischaemia or rupture of papillary muscles
acute hypotension and pulmonary oedema (SoB)
early-to-mid systolic murmur
can be seen in acute phase (i.e. before PCI or any mx has been started)

52
Q

hypothermia ECG findings

A 
Jesus Quist It's Bloody Freezing
J waves
QT prolongation
Irregular rhythm
Bradycardia
First degree heart block
53
Q

ix for cardiac tamponade

54
Q

appearance of LBBB on ECG

A

widened QRS complexes and a notched morphology of the QRS complexes in the lateral leads

55
Q

ECG features of Digoxin toxicity

A

down sloping ST depression
inverted T waves
short QT interval

56
Q

notching of inferior borders of ribs

A

Coarctation of the aorta

57
Q

dose of amiodarone used in ALS

A

300mg given after 3rd shock

58
Q

most common cause of death in MI

59
Q

PE CXR findings

60
Q

AR murmur and inferior MI

A

proximal aortic dissection

61
Q

moa fondaparinux

A

activates antithrombin III

62
Q

major bleed on warfarin mx

A

stop warfarin
IV vit K 5mg
prothrombin complex concentrate

63
Q

HF meds that improve survival

A

ACEi, beta blockers and spironolactone

64
Q

in synchronised DC cardioversion, which part of the QRS is used for synchronisation

65
Q

drugs to avoid in HOCM

A

ACEi
Nitrates
Inotropes

66
Q

valvulopathy seen in Marfan’s and Ehlors-Danlos

67
Q

Dressler’s syndrome vs LV aneurysm post-MI

A

Dressler’s - similar features to pericarditis (pleuritic pain, fever + raised ESR)
LV aneurysm - persistent ST elevation and LV failure

68
Q

rate control for AF

A

beta-blockers - Bisoprolol
CCB - Diltiazem
digoxin (not first-line)

69
Q

rhythm control for AF

A

echo first to check for thrombi
DC cardioversion if <48h of symptom or 3 week anticoagulation
pharmacological cardioversion with amiodarone or flecainide

70
Q

when should rate control be favoured

A

> 65 years

hx of ischaemic heart disease

71
Q

when should rhythm control be favoured

A

<65 years
symptomatic
first presentation
congestive HF

72
Q

analgesia CI in any form of CVD

A

Diclofenac

73
Q

preferred NOAC for patients with renal impairment

74
Q

when is amiodarone used for pharmacological cardioversion

A

if there is evidence of structural heart disease

75
Q

which imaging should be carried out when investigating a PE

A

CTPA or V/Q scan

CXR

76
Q

mx of bradycardia with shock

A

IV atropine 500 micrograms (repeated up to 3mg)

77
Q

what is used for anticoagulation in AF

78
Q

which arrest rhythm is seen in tension pneumothorax

79
Q

adverse effects of beta blockers

A 
cold peripheries
fatigue
sleep disturbances
erectile dysfunction
bronchospasm
reduced hypoglycaemic awareness
80
Q

how to interpret CHADS-VaSc in terms of annual stroke risk

A

% adjusted annual stroke risk must be multiplied by the number of years a person has left (based on average life expectancy)
e.g. 63 y/o w CHADS-Vasc of 3%, this means 3% risk per year, they have ~20 years left so their lifetime risk of a stroke is 60% (3x20)

81
Q

best diuretic for HTN if accompanying peripheral oedema

A

furosemide

82
Q

which cardiomyopathy are alcoholics most at risk of

A

dilated cardiomyopathy

therefore they will have reduced LV ejection fracture and dilated LV on echo

83
Q

moa of alteplase

A

activates plasminogen to form plasmin

altePLASe - activates PLASminogen

84
Q

differentiating between torsades de pointes and VT

A

while torsades is a type of VT, it has variable QRS height (polymorphic)

85
Q

causes of postural hypotension

A

hypovolaemia
autonomic dysfunction: diabetes, Parkinson’s
drugs: diuretics, antihypertensives, L-dopa
alcohol

86
Q

ECG features of WPW

A

short PR

wide QRS complexes with slurred upstroke - delta wave

87
Q

minor bleed on warfarin mx

A

stop warfarin
give IV vitamin K 1-3 mg
restart warfarin when INR <5

88
Q

mx of regular broad complex tachycardia

A

IV amiodarone

89
Q

mx of regular narrow complex tachycardia

A

vagal manoeuvres

IV adenosine

90
Q

what must be ruled out in chest pain + focal neurology

A

aortic dissection

91
Q

medication for symptomatic relief in aortic stenosis

A

furosemide

92
Q

mx of AF post-stroke

A

anticoagulation is needed - warfarin or DOAC (Dabigatran) should be given 2 weeks after stroke

93
Q

mx of patients on warfarin undergoing emergency surgery

A

stop warfarin

give four-factor prothrombin complex concentrate (aka dried prothrombin complex or Beriplex)

94
Q

first-line HTN med if Afro-Caribbean

A

CCB - Amlodipine

95
Q

ix for suspected aortic dissection

A

CT aortogram

96
Q

mx of aortic dissection

A 
ascending aorta (type A) - IV labetalol and surgery
descending aorta (type B) - IV labetalol
97
Q

cardiac pathology in acromegaly

A

cardiomyopathy

98
Q

mx of diabetes in STEMI

A

stop oral agents
dose-adjusted IV insulin infusion
regular monitoring of blood glucose

99
Q

HF (acute) mx

A 
LMNOP
Loop diuretics
Morphine
Nitrates
Oxygen - CPAP
Position - sit patient up
100
Q

meds to give patients with mechanical heart valves

A

aspirin and warfarin

101
Q

mx of superficial thrombophlebitis

A

NSAIDs, e.g. Naproxen

102
Q

bumetanide

A

loop diuretic

103
Q

medication CI in ventricular tachycardia

104
Q

ix for AF if CHADSVASc 0

105
Q

why should metformin be stopped prior to coronary angiography

A

due to use of contrast agent in angiography which can cause renal failure, this may increase the risk of lactic acidosis with metformin

finals (25 decks)

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