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AA Y4 Finals cards NE > Cardio > Flashcards

Cardio Flashcards

1
Q

what cells make up a fatty streak in atherosclerosis?

A

fat saturated macrophages (foam cells)

macrophages try to phagocytize the oxidised LDL to reduce inflammation, but become laden with it –> they form foam cells

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2
Q

what is the main cause of angina?

A

atheroma (plaque)

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3
Q

what is the 1st line assessment for stable angina?

A

coronary angiography

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4
Q

what is 1st line medical treatment for angina?

A

1st line: BB or CCB

if neither of these work on their own, try combining them

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5
Q

what class of drug is nicorandril?

what is its mechanism of action?

A

potassium channel activator

activates K+ channels to widen and relax blood vessels

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6
Q

what 2 classes of drug may be given 1st line for symptom prophylaxis in angina?

A

CCB

BB

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7
Q

how may an acute coronary syndrome present in the elderly or diabetics?

A

painless

referred to as a silent MI

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8
Q

name 6 symptoms associated with ACS?

A
  • sweating
  • pallor
  • N&V
  • arrhythmias
  • SOB
  • anxiety
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9
Q

what is a thrombus in an artery mostly made up of?

how does this affect management?

A

platelets

mainstay of treatment is therefore anti-platelets

eg- aspirin, clopidogrel and ticagrelor

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10
Q

in the absence of ST elevation, how do troponin levels help guide diagnosis?

A

high troponin levels = NSTEMI

normal troponin levels = unstable angina

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11
Q

describe how the ST segment, T waves and Q waves present in a NSTEMI?

A
  • ST depression
  • T wave inversion
  • presence of Q waves (a late sign of a deep infarct)
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12
Q

where are troponins release from?

A

ischemic muscle

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13
Q

how should patients presenting within 12 hours of STEMI symptoms be treated?

A

1st line: primary PCI if available within 2 hours of presentation

2nd line: thrombolysis if PCI not available in 1st 2 hours

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14
Q

name 3 types of fibrinolytic medication used in thrombolysis?

A
  • alteplase
  • streptokinase
  • tenecteplase
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15
Q

how is acute STEMI or NSTEMI managed?

A

MONA T

Morphine
Oxygen (only if sats are <95%)
Nitrates
Aspirin

Ticagrelor 180mg stat dose

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16
Q

what is the diagnosis if a patient presents with pleuritic chest pain, low grade fever and pericardial rub 2-3 weeks following MI?

A

dressler’s syndrome

a localised immune response that causes pericarditis

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17
Q

which leads have ST elevation in an anterior MI?

A

V1-4

LAD artery affected

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18
Q

ST elevation in which leads would suggest infarction in the left circumflex artery?

A

I, aVL, V5&6

affecting the lateral aspect

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19
Q

ST elevation in leads I, aVL, V1-6 would suggest which area of the heart is affected?

A

anterolateral

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20
Q

what are the only class of drug known to reduce mortality in ACS?

A

BBs

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21
Q

what are the 6A’s in medical management of STEMI and NSTEMI?

A
  • Aspirin 75mg daily
  • Another anti platelet
  • Atorvastatin
  • ACEi
  • Atenolol
  • Aldosterone antagonist (for those with clinical HF)
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22
Q

how do timeframes differ for PCI treatment in NSTEMI from STEMI?

A

generally not as urgent… timeframe is more dependant on patient’s risk

it may not be carried out at all if patient risk low enough

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23
Q

q

A

q

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24
Q

what is the immediate management of unstable angina?

A

dual anti platelet therapy

  • aspirin PLUS P2Y12 inhibitor (clopidogrel, ticagrelor, prasugrel)
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25
Q

what scoring system is used to assess prognosis for PCI in NSTEMI and unstable angina?

A

GRACE scoring tool

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26
Q

what does a QRISK score calculate?

A

calculates the risk that a patient will have a stroke or MI within the next 10 years

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27
Q

what should all patients with CKD or T1DM for more than 10 years be offered?

A

atorvastatin

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28
Q

what do NICE recommend checking within 3 months of starting a statin and again at 12 months?

A

LFTs

statins can cause a transient and mild increase in ALT and AST

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29
Q

how should SVTs be treated? (1st, 2nd and 3rd line)

A

1st line: vasovagal manoeuvres (valsava or carotid sinus massage)

2nd line: adenosine

3rd line: DC cardioversion

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30
Q

how should Atrial Flutter be managed?

A

B Blocker

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31
Q

how should atrial fibrillation be managed?

A

rate control with BB or CCB (diltiazem)

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32
Q

how should VT or any tachycardia in an unstable patient be managed?

A

amiodarone infusion

synchronised DC shock

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33
Q

how should a known SVT with BBB be treated?

A

same as a SVT:

  • vasovagal manœuvres
  • adenosine
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34
Q

which type of tachycardia is caused by the electrical signal re-entering the atria from the ventricles?

A

SVT

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35
Q

which drug works by slowing cardiac conduction primarily through the AV node?

A

adenosine

it interrupts the AV node/accessory pathway during SVT and resets sinus rhythm

given as a rapid bolus to ensure it reaches the heart with enough impact

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36
Q

what is the long term treatment for SVTs?

A
  • B Blockers, CCBs, amiodarone

- radiofrequency ablation

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37
Q

what is the maximum dose of atropine allowed for symptomatic bradycardia?

A

3mg

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38
Q

what is 1st line tx in a patient with haemodynamic compromise due to bradycardia?

A

atropine 500mg IV

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39
Q

pregancy is a contraindication to which 2 cardio drug class?

A

statins

ACEi

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40
Q

which antibiotic interacts significantly with statins and is an important interaction to know about?

A

macrolides

statins should be stopped until patients complete the course of macrolides

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41
Q

what is beck’s triad?

what is it indicative of?

A
  • falling BP
  • rising JVP
  • muffled heart sounds

indicative of cardiac tamponade

kussmaul’s sign is in constrictive pericarditis

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42
Q

what is missing on the JVP in cardiac tamponade?

A

absent Y wave

due to limited RV filling

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43
Q

how was the NICE guidance on PE management updated in 2020?

A

now, when waiting for a CTPA, interim anticoagulation should be a DOAC (rivaroxaban or apixiban)

previously, the interim anticoagulation was LMWH

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44
Q

how do initial imaging techniques differ depending on if PE is likely or not?

A

wells score >4 (PE likely) = CTPA

wells score <4 (PE unlikely) = D Dimer test

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45
Q

if there is renal impairment in a patient with suspected PE, how is imaging modality affected?

A

cannot do CTPA due to the dye being nephrotoxic

instead, do V/Q scanning

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46
Q

what is step 1 treatment for hypertension in <55y/o’s or diabetics?

A

ACEi or ARB

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47
Q

what is step 1 treatment for hypertension in >55y/o’s or black people?

A

calcium channel blockers

ACEi have a reduced efficacy in black people so aren’t used

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48
Q

what is step 2 HT treatment?

A
  1. if already taking ACEi, then add a CCB

2. if already taking a CCB, then add an ACEi (unless you’re black - add a ARB)

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49
Q

what 3 things make up Cushing’s triad?

what is this a sign of?

A
  • hypertension
  • bradycardic
  • tachypnoeic

a sign of brain herniation

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50
Q

what would you hear on auscultation in a PE?

A

chest is clear

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51
Q

what medication can be used to treat orthostatic hypotension?

A

fludrocortisone

it increases renal sodium reabsorption and increases plasma volume

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52
Q

in tachyarrhythmia management, what BP would indicate immediate DC cardio version?

A

BP <90mmHg systolic

the patient is showing signs of shock and is haemodynamically unstable

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53
Q

in 4th line HT management, when are alpha or beta blockers preferred over spironolactone?

A

depends on K+ levels:

<4.5 = spironolactone

> 4.5 = a or b blockers

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54
Q

which artery is affected if there is ST elevation in II, III, aVF?

A

right coronary artery

inferior MI

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55
Q

which is more important to treat in atrial fibrillation; rate or rhythm control?

A

rate control

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56
Q

how is the rate controlled in atrial fibrillation 1st line?

A

beta blocker
or
calcium channel blocker

if one alone doesn’t work, combine them

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57
Q

what is the most common finding on EGC in a PE?

A

sinus tachycardia

textbooks quote S1Q3T3 but this is rarely seen

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58
Q

what is the most common clinical sign in a PE?

A

tachypnoea (96%)

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59
Q

what does a posterior MI typically present with on ECG?

A

tall R waves on V1&2

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60
Q

if angina is not controlled with a beta blocker, what should be added?

A

a calcium channel blocker

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61
Q

how is acute pericarditis managed?

A

NSAIDs + colchine

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62
Q

what is the investigation of choice in a patient with a suspected PE and CKD?

A

V/Q scan

CTPA can exacerbate renal impairment

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63
Q

what can flash pulmonary oedema occur secondary to?

A

MI

MI causes mitral valve régurgitation due to rupture of the tendinous cords

regurg causes back flow of blood into the pulmonary veins

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64
Q

what is the most common cause of death following an MI?

A

VF

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65
Q

what is the cut off for cardioversion in AF? why is this cut off required?

A

symptoms (palpitations, sweating) must have occurred for <48 hours

if cardioversion occurs >48hours, risk of stroke is increased

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66
Q

what is the management for NSTEMI?

A

-aspirin and fondaparinux

unless there is a high bleeding risk

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67
Q

compare what the immediate management for an NSTEMI would be, depending on of the patient was due to have immediate angiography?

A

patient was to have angiography: aspirin + DOAC

patient not to have angiography: aspirin + DOAC + fibrinolytic

DOAC = ticagrelor, prasugrel

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68
Q

if a patient with NSTEMI is having angiography, why is unfractionated heparin preferred to fondaparineux?

A

unfractionated heparin is easier to reverse

reverse using protamine sulphate

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69
Q

if a patient with STEMI is eligible for PCI, which 2 medications should they be given prior to it?

A

aspirin + prasugrel

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70
Q

if a patient with a STEMI presents but is not eligible for PCI, which medications should they be given along with fibrinolysis?

A

immediately: aspirin

during fibrinolysis: give an antithrombin drug

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71
Q

what can a new LBBB be indicative of?

A

STEMI

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72
Q

compare ACEi and thiazide diuretics in terms of how they affect potassium levels?

A

ACEi: hyperkalemia

thiazides: hypokalaemia

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73
Q

compare which tachycardias adenosine and amiodarone are used?

A

adenosine: used to terminate narrow complex tachycardias
amiodarone: terminates wide complex tachycardia

both can only be used if patient is haemodynamically stable

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74
Q

what is the most common valve affected by infective endocarditis?

A

mitral valve

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75
Q

infective endocarditis caused by strep viridian’s is usually associated with what?

A

poor dental hygiene or following a dental procedure

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76
Q

what is the most common cause of infective endocarditis in someone with previous prosthetic valve surgery?

A

staph epidermidis

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77
Q

which vaccine should be offered annually for all patients with heart failure?

A

influenza vaccine

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78
Q

what is the 1st line treatment for HF in patients with stable, impaired LV function?

A

ANRI + BB

ANRI = sacubitril/valsartan

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79
Q

what is 2nd line treatment of HF?

A

aldosterone antagonist

spironolactone and eplerenone

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80
Q

compare the doses of atorvastatin required in primary and secondary cardiac prevention?

A

primary prevention: 20mg

secondary prevention: 80mg

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81
Q

what is given for longterm anticoagulation in patients with mechanical heart valves?

A

warfarin

They require a constant level of anticoagulation to stop any clots on the mechanical HV… this can only be achieved by warfarin

DOACs are taken once a day so the level of anticoagulation peaks and troughs

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82
Q

which class of antibiotic can cause torsades de pointes?

A

macrolides (clarithromycin)

macrolides also cause prolonged QT interval

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83
Q

following ACS, what should all patients be offered?

A
  • dual anti platelet therapy (aspirin+ticagrelor)
  • statin
  • beta blocker
  • ACEi
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84
Q

compare the amount and route of administration of adrenaline in PEA and anaphylaxis?

A

pulseless electrical activity: 1mg Intravenous

anaphylaxis: 500mcg Intramuscular

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85
Q

what is the recommended treatment for all patients with acute heart failure?

A

IV loop diuretics

furosemide or bumetanide

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86
Q

what is the 1st line investigation for suspected PE?

A

CTPA

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87
Q

what is the most common cause of mitral stenosis?

A

rheumatic fever

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88
Q

which aortic murmur is associated with malar flush?

A

mitral stenosis

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89
Q

what is the most appropriate blood test monitoring for statins?

A

LFTs at baseline, 3 months and 12 months

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90
Q

what is the 1st line investigation for heart failure?

A

BNP (NT-proBP)

irrespective of if they’ve had a previous MI or not

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91
Q

what class of drug is candesartan?

A

ARB

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92
Q

explain the effect of diuretics on mortality in heart failure?

A

diuretics have no effect on mortality in heart failure

they improve symptoms tho

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93
Q

what ECG finding is most likely to be seen in cardiac tamponade?

A

electrical alternans

normal QRS complexes that alternate in height due to heart swinging back and forward in fluid filled pericardium

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94
Q

what is the most common cause of irregular broad complex tachycardia?

A

atrial fibrillation with bundle branch block

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95
Q

what is the only calcium channel blocker licensed for use in heart failure?

A

amlodipine

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96
Q

which antihypertensive can exacerbate gout?

A

thiazides

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97
Q

what is the main ECG abnormality seen in hypercalcaemia?

A

shortened QT interval

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98
Q

describe the possible effects of thiazide diuretics on calcium, potassium and sodium?

A

hypo kalaemia and natraemia

hypercalcaemia

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99
Q

what should a patient with AF who had a stroke or new TIA be started on?

A

DOAC

if they have a mechanical heart valve, then warfarin

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100
Q

n

A

n

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101
Q

what medication should be given to patents with symptoms of HF post MI?

A

diuretic- spironolactone for 2 weeks

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102
Q

what is the general management for all tachycardias if the patient is haemodynamically unstable?

A

1st line: DC cardioversion

2nd line: amiodarone

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103
Q

what medications most commonly cause torsades de pointes?

A

TCAs
erythromycin (marcolides)
antipsychotics

cause a prolonged QT interval

104
Q

how is torsades de pointes managed?

A

IV magnesium sulphate

calcium gluconate is given for hyperkalaemia

105
Q

what does the ABG in an acute PE normally show?

A

respiratory alkalosis

PE causes hyperventilation

106
Q

why is a new LBBB significant? what treatment is it an indication for?

A

new LBBB is due to a STEMI until proven otherwise.

new LBBB is therefore an indication for PCI

107
Q

why is a new LBBB significant? what treatment is it an indication for?

A

new LBBB is often due to a STEMI.

new LBBB is therefore an indication for PCI

108
Q

while waiting for PCI or thrombolysis, how should STEMI be managed?

A

aspirin

clopidogrel

unfractionated heparin

109
Q

describe the doses of amiodarone given in cases of VF/pulseless VT?

A

initially, amiodarone 300mg should be given once 3 shocks have been given

after that, 150mg amiodarone should be given once 5 shocks have been delivered

110
Q

which beta blocker is known to cause long QT syndrome?

A

sotalol

111
Q

how should patients with T2D be treated for hypertension?

A

all diabetics should have HT treated with ACEi, regardless of age

112
Q

why are thiazide-like diuretics preferred to thiazide-type diuretics in 3rd line HT tx?

A

they have a better side effect profile

eg: lower incidence of hypokalaemia and hyponatremia compared to thiazide type diuretics

113
Q

what class of drug is indapamide?

A

thiazide-like diuretic

it is used 3rd line for hypertension management

thiazide like diuretics is a different class from bendroflumethiazide

114
Q

which murmur is early diastolic, high pitched and blowing in character?

A

aortic regurgitation

115
Q

which class of drug can cause hypercalcameia and hypocalcuria?

A

thiazides

116
Q

which cardiac condition can Kussmaul’s sign be a feature of?

what is kussmaul’s sign?

A

a feature of constrictive pericarditis

Kussmaul’s sign= the JVP increasing with inspiration

117
Q

what is the definition of a bifascicular block on ECG?

A

a combination of RBBB with left axis deviation

118
Q

how do thiazide diuretics cause gout?

A

they reduce uric acid excretion from the kidneys

119
Q

what will aspirated fluid in gout show?

A

negatively bifringent needle shaped crystals

120
Q

what will aspirated fluid in pseudogout show?

A

positively bifringent rhomboid shaped crystals

crystals are calcium pyrophosphate

121
Q

in SVT treatment, adenosine is contraindicated in asthmatics. What should be given as an alternative?

A

verapamil

122
Q

what class of drug is a) amiodarone and b) diltiazem?

A

a) amiodarone= anti arrhythmic
b) diltiazem = CCB

note- dont confuse amlodipine (CCB) with amiodarone!!

123
Q

name one of the adverse signs seen in AF that indicates the need for urgent synchronised DC cardioversion?

A

heart failure

124
Q

prior to PCI, compare treatment options for someone who isn’t on an anticoagulant with someone who is on anticoagulant?

A

isn’t on anti coagulant: aspirin and prasugrel

is on anticoagulant: aspirin and clopidogrel

125
Q

how should adenosine be given in SVT tx?

A

as a rapid IV bolus

126
Q

what finding on investigation would suggest a patient is falling into cariogenic shock during MI?

A

low blood pressure

127
Q

which drug used to treat angina can cause skin, mucosal and eye ulceration?

A

nicorandil

a K+ channel activator

128
Q

compare the character of mitral and aortic regurgitation?

A

mitral regurgitation: pansystolic

aortic regurgitation: early diastolic, high pitched and blowing

129
Q

what are tall R waves on V1 and V2 most indicative of?

A

posterior myocardial infarction

130
Q

what drop in blood pressure is required for orthostatic hypotension to be diagnosed?

A

drop of 20mmHg systolic or 10mmHg diastolic after 3 mins of standing

131
Q

what is the strongest risk factor for developing infective endocarditis?

A

a previous episode of endocarditis

132
Q

what can beta blockers combined with verapamil potentially cause?

A

profound bradycardia and systole

133
Q

what can beta blockers combined with verapamil (CCB) potentially cause?

A

profound bradycardia and asystole

134
Q

what is persistent ST elevation after a previous MI very suggestive of?

A

LV aneurysm

135
Q

what is the only licensed agent for long term anticoagulation following mechanical valve replacement?

A

warfarin

136
Q

if someone with AF has a stroke/TIA, what anticoagulant should be given?

compare this with the anticoagulant given prophylactically to someone who has had a TIA but does not have AF?

A

TIA/stroke in px w/ AF: warfarin/direct thrombin or factor Xa

TIA/stroke in px without AF: clopidogrel

137
Q

which class of antihypertensive cause hyperkalemia?

A

ACEi

138
Q

what is the 1st line treatment for all patients with chronic heart failure?

A

ACEi + BB

139
Q

which murmur is louder during inspiration?

A

tricuspid regurgitation

systolic murmur loudest on inspiration

140
Q

name the 3 medications used to treat heart failure?

A

1st: ACEi
2nd: BB
3rd: spironolactone

141
Q

what 2 findings on ECG suggest long term ischemia or previous MI?

A
  • ST depression

- T wave inversion

142
Q

compare the initial treatment of irregular and regular SVTs?

A

regular: vagal manœuvrés, adenosine

irregular (atrial fibrillation): beta blockers and anticoagulation

143
Q

if atrial fibrillation has an onset <48hours, what can be considered?

A

electrical or chemical cardioversion

144
Q

how is polymorphic VT (torsades des pointes) managed initially?

A

IV magnesium sulphate

145
Q

in which tachycardia is the rate normally easily divisible (ie- 100, 150, 300)?

A

SVTs

146
Q

which cardiac condition is synonymous with a delta wave?

what is a delta wave?

A

wolf parkinson white syndrome

delta wave= slurred upstroke of R wave

147
Q

describe what is seen on ECG in wolf parkinson white syndrome

A 
short PR interval 
delta wave 
broad QRS complex
LAD - if a right sided pathway 
RAD - if a left sided pathway
148
Q

what drugs should be avoided in wolf parkinson white syndrome?

A

drugs that affect AV node: BB, digoxin, verapamil

149
Q

how is atrial fibrillation in a patient with heart failure managed initially?

A

digoxin is given for rate control, rather than BB or CCB

150
Q

what 2 drugs can be given for chemical cardioversion in atrial fibrillation?

A

1st line: amiodarone

2nd line: flecanide

chemical cardioversion can be done if the onset of AF < 48 hours

151
Q

in which cases should flecinide be avoided?

A

in patients with IHD

152
Q

if chemical cardioversion doesn’t work, what can be tried?

A

DC cardioversion

153
Q

what is the drug of choice to anticoagulate patents with atrial fibrillation?

A

heparin

154
Q

why must anticoagulants aways be given to patients with AF prior to cardioversion?

A

in case the clots are pushed along and lodge somewhere

155
Q

rate control is 1st line management for chronic AF over rhythm control. when would rhythm control be considered more important?

A
  • symptomatic
  • CCF present
  • younger patient
  • presenting for 1st time with AF
  • a reversible cause
156
Q

what does the CHADVASC score measure?

A

the risk of stroke

157
Q

if a patient has a CHADVASC score of >2, what is the management?

A

commence anti-coagulents

158
Q

what anti-cogaulents should be offered to patients with a CHADVASC score >2?

A

Warfarin or DOAC

it is up to the patient

159
Q

compare the treatment of atrial flutter with atrial fibrillation?

A

acute: same as atrial fibrillation (BB or CCB)

long term: rate control in both with BBs

160
Q

a low volume of which 2 electrolytes can precipitate VT?

A

low potassium and magnesium can precipitate VT

161
Q

what are the most common post MI arrhythmia that indicates myocardial instability?

A

ventricular ectopics

162
Q

what its the most common cause of death following MI?

A

ventricular fibrillation

163
Q

which type of ventricular arrhythmia does long QT most commonly cause?

A

torsades des pointes

a polymorphic VT which can progress into VF and therefore death

164
Q

what medication is given to treat torsades des pointes?

A

IV magnesium sulphate

165
Q

name 4 risk factors for asystole in bradyarrhythmia?

A
  • ventricular pause > 3s
  • recent asystole
  • mobitz type II HB
  • complete heart block
166
Q

what constitutes unstable/ haemodynamic compromise in bradyarrythmia?

A
  • shock symtoms (hypotensive, cold, clammy, sweaty)
  • syncope
  • MI
  • heart failure
167
Q

what is the 1st line immediate treatment for bradyarrhythmia in a patient who is haemodynamically compromised?

A

1st line: atropine IV, repeat up to 3mg at 2-3min intervals

168
Q

in Bradyarrhymias, if IV atropine is not successful, what procedure can be tried 2nd line?

A

transcutaneous pacing

isoprenaline and adrenaline are also given

169
Q

what 3 things are seen in Cushing’s triad?

what is it a sign of?

A
  • widened pulse pressure
  • bradycardia
  • irregular respirations

it is a response to acute changes in pressure of ICF

170
Q

what condition presents with alternating periods of bradycardia +/- arrest and asystole with periods of SVT?

A

sick sinus syndrome

a tachy-brady syndrome

171
Q

which types of heart block can be classed as a normal variant?

A

types 1 and 2 only

172
Q

which type of Mobitz has progressive lengthening of the PR interval, which eventually results in a dropped QRS complex?

A

mobitz type 1

173
Q

compare QRS complexes in Mobitz type 1 & 2

A

mobtiz type 1: gradual lengthening of the PR interval resulting in dropped beat

Mobitz type 2: fixed length of PR interval with a fixed number of missed QRS complexes

174
Q

compare the management of Mobitz type 1 and 2?

A

type 1: no management unless associated with collapse and haemodynamic compromise

type 2: ventricular pacemaker

175
Q

which 2 forms of heart block require ventricular pacemakers ?

A

Mobitz type 2

third degree heart block

176
Q

describe the relationship between heart rate and QT interval?

A

as HR decreases, QT interval increases

177
Q

which BB is most likely to cause long QT?

A

sotalol

178
Q

which SSRI is most likely to cause long QT?

A

citalopram

can go on to cause torsades des pointes

179
Q

at what stage should medication be started in HT?

A

for all stage 2 and above

160/100mmHg or 150/95 ambulatory

180
Q

why should patients with T1DM be started on an ACEi 1st line, irrespective of age, in HT?

A

due to its Reno-protective effects

181
Q

why would a BB blocker be started in a patient <55 with HT rather than an ACEi?

A

if they are planning on becoming pregnant

have a clear sign of sympathetic drive (sweating or palpitations)

182
Q

compare how hypertensive emergencies (>200/120mmHg) are managed, depending on the LV function?

A

LV function intact: labetalol

LV failure: furosemide and hydralazine

183
Q

name 4 symptoms of hypertensive emergencies?

A
  • CVS: chest pain, orthopnoea
  • kidneys: rapidly worsening function
  • eyes: papilloedema + retinal haemorrhages
  • CNS: confusion, focal neurological signs
184
Q

what does congestive heart failure mean?

A

HF that leads to congestion and buildup of fluids, especially in the lungs

185
Q

name the 3 overarching causes of left sided HF?

A
  1. CVS: CAD, HT, valve disease
  2. volume overload: CKD, nephrotic syndrome
  3. high output states: anaemia, sepsis, liver failure
186
Q

name 3 signs associated with left sided HF?

A
  1. S3
  2. bibasal crepitations - due to fluid in the lungs
  3. displaced apex beat
187
Q

what are the 2 main causes of right heart failure?

A
  1. secondary to left HF

2. secondary to lungs disease complicated by pulmonary hypertension

188
Q

name 3 symptoms of right HF?

A
  1. peripheral oedema
  2. ascites
  3. facial engorgement
189
Q

name 3 signs of right HF?

A
  1. raised JVP
  2. hepatomegaly
  3. chest vein dilation
  4. ascites
190
Q

compare the state of the ventricles in HF with REF and PEF?

A

REF (reduced ejection fraction): failure of ventricles to properly contract results in lowered EF

PEF: thought to be associated with atrial dysfunction- results in reduced ventricular filling and reduced CO, but ventricles thought to be intact

191
Q

what is the main difference between class 3 and 4 HF, based on the New York classification?

A

class 3: marked limitation on physical activity but comfortable at rest

class 4: symptoms present at rest

192
Q

in cases of suspected HF, what investigation is 1st line?

A

BNP- it is raised

B type natriuretic peptide

193
Q

what is BNP produced by and why is it produced?

A

produced by the left ventricular myocardium in response to strain

194
Q

if levels of BNP are found to be raised, then what additional investigation must be done? what is the timeframe?

A

if BNP raised, an ECHO must be done within 6 weeks

195
Q

what condition are Kerley B lines and alveolar oedema (bat wings) synonyms with?

A

left ventricular failure (heart failure)

196
Q

compare the CXR seen in R and L sided HF?

A

RHF: CXR normal

LHF: Kerley B lines, alveolar oedema (bats wings), cardiomegaly, pleural effusion, dilated prominent upper lobe vessels

197
Q

what is the non pharmacological treatment of HF?

A
  • fluid restriction
  • low salt diet
  • weight loss
  • exercise
198
Q

what are the 3 main drug treatments that all patients with heart failure should be on?

A
  1. beta blockers
  2. ACEi
  3. loop diuretics - provides symptomatic relief in acute setting
199
Q

which drug class used in HF prolongs life as it prevents cardiac remodelling?

A

ACEi

200
Q

which class of drug in HF reduces mortality but must be started at low dose as it can initially worsen heart failure?

A

beta blockers

201
Q

which beta blocker is used in HF

A

bisoprolol

202
Q

if angina is not controlled by a beta blocker, what should be added?

A

a calcium channel blocker

eg- nifedipine

203
Q

compare which CCBs should be used in angina, depending on if it is monotherapy or dual therapy?

A

mono therapy: use verapamil or diltiazem

dual therapy: use long acting one - eg: nifedipine

204
Q

what biomarker is useful for detecting re-infarction in a patient 4-10 days following initial insult?

A

CK-MB

it is more specific for muscle ischemia than CK and remains elevated for only 3-4 days

in comparison, troponin remains elevated for 10 days

205
Q

what is the 1st cardiac enzyme to rise in MI?

A

myoglobin

206
Q

why is tricuspid regurgitation loudest on inspiration?

A

blood flow into the right atrium and ventricle is increased during inspiration

this exacerbates any tricuspid regurgitation and enhances the murmur

207
Q

which anti-hypertensive medication is preferred in a patient with gout?

A

CCBs

thiazide-like diuretics are contraindicated

208
Q

which murmur is associated with a collapsing pulse, laterally shifted apex beat, and their head bobs in time with their pulse?

A

aortic regurgitation

head bobbing in aortic regurgitation is known as De Musset’s sign

209
Q

name 2 DOACs that are used in VTE management?

A

apixaban and rivaroxiban

210
Q

which class of anti-hypertensives should be avoided in diabetics?

A

thiazides

they can worsen glucose tolerance

211
Q

what is kussmaul’s sign and in what condition is it seen?

A

kussmaul’s sign = raised JVP with inspiration

seen in constrictive pericarditis

212
Q

compare the management of INR > 8 in patents with no bleeding, minor bleeding and major bleeding?

A

in all cases, stop warfarin.

no bleeding: + give oral vit K

minor bleeding: + give IV vit K

major bleeding: + prothrombin complex concentrate

213
Q

what type of diastolic murmur often causes AF?

A

mitral stenosis

mid diastolic murmur loudest over the apex

214
Q

which medication is contraindicated in patients with VF?

A

verapamil

215
Q

which murmur is Marfan’s syndrome most commonly associated with?

A

aortic regurgitation

an early diastolic murmur

216
Q

rate control is always the 1st line strategy for AF, except in which cases?

A

if there is co-existent heart failure or a reversible cause (ie-pneumonia)

in this case, rhythm control is 1st line

217
Q

what is the definition of acute heart failure?

A

acute HF is the worsening of heart failure in an already diagnosed patient

218
Q

what causes acute heart failure?

A

coronary syndrome
hypertensive crises
acute arrhythmia
valvular disease

219
Q

name 5 causes of mitral regurgitation?

A
  1. LV dilation
  2. rupture of the chordae tendineae
  3. papillae muscle rupture due to ischemia
  4. rheumatic fever
  5. collagen disease (marfan’s and Ehlers-danlos)
220
Q

which heart murmur is most likely to cause orthopnoea and paroxysmal nocturnal dyspnea?

A

aortic regurgitation

221
Q

when and in what position is aortic regurgitation heard best?

A

when patient is sitting forward and expiring

an early diastolic murmur should be heard

222
Q

name 4 additional signs of aortic regurgitation?

A
  • head bobbing with each heartbeat
  • displaced apex
  • pulsations in capillary nailbeds
  • wide pulse pressure (bounding pulse)
223
Q

at what point is surgery indicated for aortic regurgitation?

A

-when LV dilation and heart failure progresses

224
Q

what are the 2 most common causes of mitral stenosis?

A

congenital

rheumatic heart disease

225
Q

describe mitral stenosis and where it is heard best?

A

rumbling mid diastolic murmur, heard best on expiration with patient lying on their side

226
Q

which murmur has a malar rash, opening snap on S1 (loud S1), tapping apex beat and AF listed as possible symptoms?

A

mitral stenosis

227
Q

describe how blood cultures are taken in cases of endocarditis?

A

3 blood samples are taken from 3 different sites

228
Q

following blood cultures, name the 1st and 2nd line investigations for endocarditis?

A

1st line: trans-thoracic echo

2nd line: trans-oesophageal echo

229
Q

in cases of endocarditis, when is a trans-oesophageal echo done?

A

only after vegetations or non-diagnostic images are seen on trans-thoracic echo

also done if patient has prosthetic valve

230
Q

what criteria is used to scale endocarditis?

A

duke’s criteria

231
Q

which antibiotic is given in cases of strep viridian’s endocarditis?

A

benzylpenicillin

232
Q

what antibiotic is given in cases of prosthetic valve disease, due to staph epidermidis?

A

fluclox + rifampicin + low dose gentamicin

233
Q

what is the reason there is an S4 in HOCM?

A

reduced compliance

234
Q

what murmur can be seen on ECHO in HOCM?

A

mitral regurgitation

235
Q

in which condition is a jerky pulse seen?

A

HOCM

236
Q

how are the symptoms managed in HOCM?

A

chest pain: BB/ verapamil

arrhythmia: amiodarone/ anti-coagulation

237
Q

what is the most common cardiomyopathy?

A

dilated cardiomyopathy

238
Q

name 4 known causes of dilated cardiomyopathy?

A
  • alcohol
  • viral infections
  • autoimmune disease
  • genetics
239
Q

how is dilated cardiomyopathy investigated?

A
  • plasma BNP

- CXR - heart looks like a balloon

240
Q

how are the symptoms of dilated cardiomyopathy managed?

A

depends on the symptoms;

HF: ACEi, BBs, diuretics

palpitations: digoxin, anticoagulation

241
Q

name 3 causes of restrictive cardiomyopathy?

A
  • ideopathic
  • amyloidosis
  • sarcoidosis
242
Q

how does restrictive cardiomyopathy typically present?

A

with heart failure

predominately RHF

243
Q

describe the classic presentation of myocarditis?

A

young patient with history of recent viral illness

presenting with acute SOB, chest pain, fever and palpitations

244
Q

name 2 signs seen in myocarditis?

A

tachycardia, S4 gallop

245
Q

what are the 2 main viral causes of myocarditis?

A

coxsackie B virus

HIV

246
Q

what are the 2 main bacterial causes of myocarditis?

A

TB

mycoplasma

247
Q

name 3 drugs that can cause myocarditis?

A

cyclophosphamide, penicillin, spironolactone

248
Q

how is myocarditis managed?

A

supportive care

antibiotics if bacterial

remove precipitating drug

249
Q

describe the classic presentation of pericarditis

A

chest pain that is relieved by sitting forward, and worse when lying flat

exacerbated by inspiration

250
Q

if fibrinolysis is given for ACS, how long after should an ECG be repeated?

A

60-90 mins after fibrinolysis

if ST elevation persists, transfer for urgent PCI

251
Q

compare when adrenaline is given if the pulse is shockable or non shockable?

A

shockable: give adrenaline agter 3rd shock

non-shockable: adrenaline should be given ASAP

252
Q

which coronary artery supplies the AV node?

therefore, which type of STEMI can result in a heart block?

A

right coronary artery supplies the AV node

therefore, an inferior STEMI (II, III, aVF,) can result in a heart block

253
Q

in NSTEMI, a GRACE score greater than what indicates PCI?

A

GRACE score > 3% is indicative for PCI

they should receive PCI within 72 hours of admission

254
Q

compare when aortic stenosis and pulmonary stenosis are loudest?

A

both loudest during systole

aortic stenosis: loudest during expiration

pulmonary stenosis: loudest during inspiration

the blood flow to the lungs is highest during inspiration, hence this is when PS is loudest

255
Q

compare the 1st line imaging techniques for aortic dissection depending on if the patient is haemodynamically stable or not?

A

haemodynamically stable: CT angio of chest, abdomen and pelvis

haemodynamically unstable: transoesophageal echo

256
Q

what bleeding test is prolonged in warfarin therapy?

A

prothrombin time is prolonged

INR is the patients prothrombin time divided by the normal, standardised prothrombin time

AA Y4 Finals cards NE (40 decks)

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