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Cardio Flashcards

1
Q

Give 3 clinical features of stable angina.

A

Exacerbated by exercise
Relieved by rest or GTN
Chest pain that radiates

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2
Q

What modifiable risk factors make up the QRISK?

A

Smoking, diabetes, cholesterol, blood pressure, BMI

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3
Q

What is QRISK?

A

A score that predicts the risk of cardiovascular disease

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4
Q

What non-modifiable risk factors make up the QRISK?

A

Age
Gender
Ethnicity
Diagnosis of AF, RA, SLE

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5
Q

Give 3 examples of ACE inhibitors.

A

Ramipril, enalapril, lisinopril

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6
Q

Give 4 side effects of ACE inhibitors.

A

Dry cough, headache, fatigue, hyperkalaemia

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7
Q

What is seen on ECG in the few hours after MI?

A

ST elevation, tall T waves

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8
Q

What is seen on ECG in the few days after MI?

A

T wave inversion, pathological Q waves

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9
Q

What are the 3 cardinal symptoms of heart failure?

A

Peripheral oedema, shortness of breath, fatigue

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10
Q

What signs are visible on X-ray in a patient with heart failure?

A

Mnemonic ABCDE

A - alveolar oedema 
B - kerley B lines
C - cardiomegaly 
D - dilated prominent upper lobe vessels 
E - pleural Effusion
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11
Q

What are the four features of tetralogy of fallot?

A

Overriding aorta
Right ventricular outflow tract obstruction
Right ventricular hypertrophy
Ventricular septal defect

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12
Q

In what condition would you see saddle shaped ST elevation?

A

Pericarditis

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13
Q

What is the first line hypertension treatment in Afro-carribbean patients?

A

Calcium channel blockers - amlodipine

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14
Q

What ECG findings are seen in patients with AF?

A

Irregularly irregular QRS complexes
F waves
No P waves

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15
Q

Give 3 clinical features of aortic dissection.

A

Sudden tearing chest pain (may radiate to the back)
Unequal arm pulses and BP
Acute limb ischaemia

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16
Q

What are the four stages of limb ischaemia?

A

Stage 1 - asymptomatic
Stage 2 - intermittent claudication
Stage 3 - rest pain/nocturnal pain
Stage 4 - necrosis/gangrene

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17
Q

Give 4 secondary causes of hypertension.

A

Phaeochromocytoma
CKD
Polycystic kidney disease
Cushing’s

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18
Q

Give 4 categories of ‘shock’

A

Cardiogenic
Septic
Anaphylactic
Haemorrhagic

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19
Q

Give 3 complications of an aneurysm.

A

Rupture
Pressing on other structures
Thrombosis

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20
Q

What causes a pansystolic murmur?

A

Mitral regurgitation

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21
Q

What are the inferior ECG leads?

A

II, III, aVF

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22
Q

What artery do the inferior ECG leads correspond to?

A

Right coronary artery

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23
Q

What are the anteroseptal ECG leads?

A

V1-V4

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24
Q

What artery do the anteroseptal ECG leads correspond to?

A

Left anterior descending

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25
Q

What are the lateral ECG leads?

A

I, aVL, V5-V6

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26
Q

What artery do the lateral ECG leads correspond to?

A

Left circumflex

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27
Q

What are the anterolateral ECG leads?

A

I, aVL, V4-V6

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28
Q

What arteries do the anterolateral ECG leads correspond to?

A

Left anterior descending or left circumflex

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29
Q

What is seen on an ECG in hypokalaemia?

A

Small T waves, ST depression, U waves, PR prolongation

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30
Q

How long is a normal PR interval?

A

120-200ms

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31
Q

How long is the PR interval in first degree heart block?

A

> 200ms

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32
Q

What is the first line treatment for hypertension in all patients with T2 DM?

A

ACE inhibitor (regardless of age or race)

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33
Q

What is the first line medication for rate control in AF?

A

Beta blocker (or CCB - beta blocker contraindicated in asthma)

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34
Q

Describe mobitz type 1 heart block.

A

Progressive PR prolongation, followed by a dropped QRS complex

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35
Q

What is the first line investigation for peripheral arterial disease?

A

ABPI (ankle brachial pressure index) and doppler ultrasound

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36
Q

What is the definition of intermittent claudication?

A

Ischaemic pain/cramping on exertion

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37
Q

Give 5 risk factors for an atypical MI presentation.

A 
Female
Non-white
Prior stroke
Heart failure
Diabetes
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38
Q

Give 3 symptoms of an atypical MI presentation.

A

Nausea, vomiting, dizziness

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39
Q

What is the first line management of supra ventricular tachycardia?

A

Valsalva manoeuvre and carotid sinus massage

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40
Q

What is the next line management of supra ventricular tachycardia?

A

Cardioversion with atropine

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41
Q

What is the valsalva manoeuvre?

A

Where the patient blows against resistance e.g into a syringe

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42
Q

What features are seen on ECG in hyperkalaemia?

A

Tall tented T waves
P wave flattening
Wide QRS

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43
Q

What features are seen on ECG in hypokalaemia?

A

T wave inversion
ST depression
Prominent U wave

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44
Q

What organism is IE caused by dental surgery likely to be?

A

Viridans streptococci

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45
Q

What is the most common causative organism of IE overall?

A

Staphylococcus aureus

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46
Q

What is the gold standard investigation for aortic dissection?

A

CT angiography

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47
Q

What kind of arrhythmia does long QT syndrome predispose a patient to?

A

Ventricular tachycardia, specifically torasade-de-pointes

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48
Q

Give 5 causes of RBBB.

A 
Right ventricular hypertrophy
PE
MI
Atrial septal defect
Cardiomyopathy
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49
Q

What is the most common congenital heart defect in Down’s syndrome?

A

Ventricular septal defect

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50
Q

What organism causes rheumatic fever?

A

Streptococcus pyogenes

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51
Q

What lancefield group does streptococcus pyogenes belong to?

A

Group A

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52
Q

What is the first line diuretic in heart failure?

A

Furosemide

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53
Q

What are the first line medications for optimisation of heart function in heart failure?

A

Bisoprolol/ramipril

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54
Q

What is seen on ECG in third degree heart block?

A

No association between P waves and QRS complexes

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55
Q

What is the emergency treatment of third degree heart block?

A

Fit with pacemaker

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56
Q

What is the mechanism of action of apixaban?

A

Direct oral anticoagulant - inhibits factor Xa

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57
Q

What pattern is seen on ECG in atrial flutter?

A

Sawtooth pattern

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58
Q

Give 2 risk behavioural risk factors for atrial flutter.

A

Alcohol and cocaine

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59
Q

What is the first line treatment of ongoing atrial flutter?

A

Catheter ablation

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60
Q

Give 6 clinical signs of heart failure.

A 
Shortness of breath
Peripheral oedema
Bibasal crepitations 
Orthopnea
Nocturnal dyspnoea
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61
Q

Give 5 chest X-ray findings in a patient with heart failure.

A

Mnemonic ABCDE

A - alveolar oedema
B - kerley B line 
C - cardiomegaly 
D - dilated prominent upper lobe vessels 
E - pleural effusion
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62
Q

What blood test can be done to confirm a diagnosis of heart failure?

A

BNP

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63
Q

What is the pharmaceutical management of heart failure?

A

Mnemonic ABAL

A - ACE inhibitor
B - beta blocker
A - aldosterone antagonist
L - loop diuretic

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64
Q

What is the difference between essential and secondary hypertension?

A

Essential - no identifiable cause

Secondary - has an identifiable cause

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65
Q

Give 4 pieces of lifestyle advice for someone with hypertension.

A

Stop smoking
Reduce salt/alcohol consumption
Eat a healthy balanced diet
Exercise more regularly

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66
Q

What is the most common cause of secondary hypertension?

A

Conn’s syndrome

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67
Q

What is the scoring system used for risk of cardiovascular disease?

A

QRISK

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68
Q

What medication is prescribed for a QRISK score of more than 10%?

A

Statins

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69
Q

Give a side effect of statins.

A

Myalgia

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70
Q

What is the gold standard investigation for pulmonary embolism?

A

CT pulmonary angiography

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71
Q

What is the first line management of pulmonary embolism?

A

Low molecular weight heparin such as dalteparin

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72
Q

What is the long term treatment of PE?

A

Warfarin or direct oral anticoagulant sch as apixaban o r rivaroxaban

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73
Q

What is the first line investigation for IE?

A

Blood culture

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74
Q

What is the gold standard investigation in IE?

A

Echocardiogram

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75
Q

What is characteristic of Prinzmetal’s angina?

A

Pain usually occurs in the morning, and at rest

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76
Q

How is prinzmetal’s angina differentiated from stable/unstable angina?

A

Prinzmetal’s - ST elevation

Stable/unstable angina - ST depression

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77
Q

What improves the pain in pericarditis?

A

Leaning forwards

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78
Q

What is the presentation of rheumatic heart disease?

A

Subcutaneous nodules, arthritis, chorea

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79
Q

What is pulsus paradoxus?

A

A significant drop in blood pressure on inspiration (more than 10mmHg)

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80
Q

What is pulsus paradoxus a sign of?

A

Cardiac tamponade

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81
Q

Define cardiac tamponade.

A

Accumulation of a large amount of fluid in the pericardial sac, which compresses the heart and reduces cardiac function

82
Q

Define pericardial effusion.

A

Accumulation of fluid in the pericardial sac, which does not reduce cardiac function

83
Q

What is Kussmaul’s sign?

A

Increase in JVP on inspiration

84
Q

What are the four features of tetralogy of fallot?

A

Overriding aorta
Right ventricular hypertrophy
Ventricular septal defect
Pulmonary artery stenosis

85
Q

Why does right ventriular hypertrophy occur in tetralogy of fallot?

A

As a response to pulmonary artery stenosis to try and maintain cardiac output

86
Q

Which type of heart failure is ascites a symptom of?

A

Right sided heart failure

87
Q

Give 4 features of left sided heart failure.

A

Dyspnoea
Orthopnoea
Raised JVP
Reduced ejection fraction

88
Q

What blood test is used to confirm a diagnosis of heart failure?

A

BNP - brain natriuretic peptide

89
Q

Where is BNP released from?

A

Ventricles in the brain in response to stretching of the heart

90
Q

What is decubitis angina?

A

Angina that occurs at night on the patient lying down

91
Q

Give 4 causes of hypovolaemic shock.

A

Severe burns
Ruptured aortic aneurysm
Vomiting
Trauma causing bleeding

92
Q

What does the HAS-BLED score calculate?

A

The risk of a patient with AF having a major bleed within one year

93
Q

What does the ABCD2 score calculate?

A

The risk of having a stroke in patients who have had a TIA

94
Q

Which ECG abnormality is most associated with Wolff-Parkinson White syndrome?

A

Delta wave

95
Q

What happens to the PR interval in Wolff Parkinson White syndrome?

A

PR interval decreases

96
Q

What type of murmur is mitral stenosis?

A

Mid diastolic rumbling murmur

97
Q

In what murmur would you see a slow rising pulse?

A

Aortic stenosis

98
Q

What type of murmur is aortic stenosis?

A

Ejection systolic murmur

99
Q

How long after an MI does Dressler’s syndrome develop?

A

2-10 weeks

100
Q

What is Dressler’s syndrome?

A

An autoimmune type of pericarditis seen after MI

101
Q

What is secondary prevention?

A

Methods to detect and address existing disease prior to the appearance of symptoms

102
Q

What is the first line investigation for patients with stable angina?

A

CT angiography

103
Q

What is the first line treatment for angina?

A

Beta blocker - bisoprolol (or cardioselective CCB - verapamil)

104
Q

What is the second line treatment for angina?

A

Add a non-cardio-selective calcium channel blocker (such as nifedipine) to the beta blocker

105
Q

What is the first line pharmacological management of heart failure?

A

ACE inhibitor and beta blocker

106
Q

What is the second line management of heart failure?

A

Add an aldosterone antagonist to ACE inhibitor and beta blocker

107
Q

Give 4 secondary causes of hypertension.

A

Cushing’s syndrome
ADPKD
Coarctation of the aorta
Conn’s syndrome

108
Q

What is the first line treatment of hypertension in diabetes patients?

A

ACE inhibitor

109
Q

What is the second line treatment of hypertension in diabetes patients?

A

Thiazide-like diuretic

110
Q

What is the most common cause of aortic stenosis?

A

Senile calcification of the valve

111
Q

What anticoagulants are used to prevent stroke in patients with AF?

A

DOACs or warfarin

112
Q

Which anticoagulants are preferred in patients with a prosthetic valve?

113
Q

What is the appropriate initial treatment for pain in pericarditis?

A

Ibuprofen and colchicine

114
Q

`What is decubitus angina?

A

Angina that is worse when lying down

115
Q

What is seen on ECG in Dressler’s syndrome

A

PR depression, ST elevation

116
Q

What is uraemic pericarditis?

A

Pericarditis due to high urea

117
Q

What kind of murmurs are pansystolic?

A

Mitral and tricuspid regurgitation

118
Q

When is mitral regurgitation louder?

A

On expiration

119
Q

When is triscuspid regurgitation louder?

A

On inspiration

120
Q

If the lungs are clear with a pansystolic murmur, what does this indicate?

A

Clear lungs with a pansystolic murmur indicates right sided heart failure, and a tricuspid regurgitation

121
Q

What is the most important first line step in treating sepsis?

122
Q

What makes up sepsis 6?

A 
O2
Blood culture
IV antibiotics
Fluid challenge
Measure lactate
Measure urine output
123
Q

What is Buerger’s test?

A

Tests for sufficient arterial supply to the leg

124
Q

What is seen on ECG in hypercalcaemia?

A

Tall T waves, short QT interval,

125
Q

What organism most likely causes IE in IVDU?

A

Staph aureus

126
Q

What organism mostly likely causes IE in patients with prosthetic valves?

A

Staph epidermis

127
Q

What is the most likely tissue outcome of MI?

A

Organisation

128
Q

What is Beck’s triad?

A

Muffled heart sound, raised JVP, hypotension

129
Q

What condition is Beck’s triad seen in?

A

Cardiac tamponade (or pericardial effusion)

130
Q

What is a coronary artery steal?

A

Rerouting of blood to other arteries when one is narrowed

131
Q

What changes are seen in atherosclerosis?

A 
T lymphocytes
Lipid deposits
Thinning of tunica media 
Macrophages
Lumen narrowing
132
Q

What does aortic stenosis sound like?

A

Early diastolic murmur

Collapsing pulse

133
Q

What would be seen on chest X-ray in mitral stenosis?

A

Dilated left and right ventricles

134
Q

What would be heard in mitral stenosis?

A

Pansystolic murmur

Soft S1 sound

135
Q

Define atherosclerosis.

A

An accumulation of lipids, macrophages and smooth muscle cells in the tunica intima of medium and large arteries.

136
Q

Other than chest pain, give 4 symptoms of an MI.

A

Nausea/vomiting
Pallor
Sweating
Palpitations

137
Q

Define embolism.

A

A blocked vessel caused by a foreign body.

138
Q

Define thrombosis.

A

Formation of a blood clot inside a blood vessel, which obstructs flow.

139
Q

Define infarction.

A

The death of cells due to reduced or absent blood supply

140
Q

Define ischaemia.

A

Restriction in blood flow causing a reduction in oxygen needed for the cells function

141
Q

Give 4 effects of activation of the RAAS system.

A

Arteriolar vasoconstriction
Increased aldosterone
ADH secretion
Increase in blood pressure

142
Q

Give 5 causes of secondary hypertension.

A 
Conn's syndrome 
Chronic kidney disease
Phaeochromocytoma
Pre-eclampsia
Hypothyroidism
143
Q

What murmur is a collapsing pulse seen in?

A

Aortic regurgitation

144
Q

What murmur is a slow rising pulse seen in?

A

Aortic stenosis

145
Q

What is recommended to help with exercise in patients with intermittent claudication?

A

Smoking cessation and an exercise programme

146
Q

What is the most appropriate investigation for suspected aortic stenosis?

A

Echocardiogram

147
Q

What is the most common myocardial dysfunction that leads to heart failure?

A

Ischaemic heart disease

148
Q

What does a high INR put a patient at risk of?

A

Bleeding problems

149
Q

What is the gold standard investigation of unstable angina?

A

CT coronary angiography

150
Q

What drugs are used for secondary prevention of acute coronary syndrome?

A

Dual antiplatelet - aspirin and clopidogrel
Beta blocker or calcium channel blocker
ACE inhibitor
Statin

151
Q

What score is used to predict the risk of stroke after a TIA?

152
Q

What are the components of the ABDC2 score?

A

A - age > 60 - 1 point
B - blood pressure >140/90 - 1 point
C - clinical features - speech disturbance 1 point, unilateral weakness 2 points
D - duration - <1 hour 1 point, >1 hour 2 points
D - Diabetes - 1 point

153
Q

What is the classification of ABCD2 scores?

A

0-3 - low risk
4-5 - moderate risk
6-7 - high risk

154
Q

What is the first line treatment of ischaemic stroke?

A

If within 4.5 hours - thrombolysis (with alteplase)

155
Q

What is the protocol for taking blood cultures in suspected IE?

A

Take 3 blood cultures, from 3 different places, at 3 different times

156
Q

Give 4 complications of infective endocarditis.

A

Sepsis
Pulmonary embolism
Stroke
Heart failure

157
Q

What signs are seen on X-ray in aortic stenosis?

A

Calcification of aortic valve
Cardiomegaly
Pulmonary oedema
Dilated ascending aorta

158
Q

What are the symptoms of septic infection?

A 
Night sweats
Fever
Rigors
Weight loss
Anaemia
159
Q

What is a normal ejection fraction?

160
Q

How is a clinical reading of hypertension confirmed?

A

Ambulatory blood pressure readings/home BP monitoring

161
Q

What is the definition of the white coat effect?

A

A discrepancy of more than 20/10 between clinical and ambulatory blood pressure readings

162
Q

What are the stages of hypertension?

A

Stage 1 - >140/90
Stage 2 - >160/100
Stage 3 - >180/20

163
Q

What is disseminated intravascular coagulation?

A

Where there is abnormal activation of coagulation

164
Q

What causes disseminated intravascular coagulation?

A

Massive haemorrhage, malignancy

165
Q

What is disseminated intravascular coagulation?

A

Small clots develop throughout the bloodstream. This uses up clotting factors and fibrinogen, leading to excessive bleeding

166
Q

What can trigger disseminated intravascular coagulation?

A

Trauma
Sepsis
Malignancies

167
Q

What blood results will be seen in DIC?

A

Low platelets
Prolonged clotting times e.g PT
Decreased fibrinogen
Elevated D-dimer

168
Q

What is the first line investigation for peripheral arterial disease?

A

Ankle brachial pressure index

169
Q

What is the first line treatment of chronic peripheral vascular disease?

170
Q

What is the first line treatment of acute limb ischaemia?

A

Immediate assessment for revascularisation surgery

171
Q

What is the gold standard investigation for peripheral arterial disease?

A

Contrast angiography

172
Q

What is the appearance of an arterial ulcer?

A 
Found at tips of toes/extremities
Punched out appearance
Absence of hair 
Shiny
Minimally exudative
173
Q

What is the appearance of a venous ulcer?

A 
Found in the gaiter area - below the knee and above the ankle 
Highly exudative 
Irregular/granular appearance
Hardening of skin 
Firm oedema
174
Q

Where is the aortic valve auscultated?

A

2nd intercostal space, left sternal edge

175
Q

What condition is Beck’s triad seen in?

A

Cardiac tamponade

176
Q

What is Beck’s triad?

A

Hypotension, distended jugular veins, muffled heart sounds

177
Q

What investigations are used in patients with cardiac tamponade?

A

ECG
CXR
Echocardiogram

178
Q

What is the first line management of cardiac tamponade?

A

Pericardiocentesis

179
Q

What is the first line of treatment for symptoms of unstable angina?

180
Q

What are the major criteria for IE?

A

Evidence of endocardial involvement e.g vegetations seen on echocardiogram

181
Q

What are the minor criteria for IE?

A

Fever > 38
Predisposing factor e.g IVDU
Vascular phenomena
Immunologic phenomena

182
Q

Give 4 complications of infective endocarditis.

A

Pulmonary embolism
Stroke
Sepsis
Valvular regurgitation

183
Q

When is aortic stenosis heard?

A

Early diastole

184
Q

What is the gold standard investigation for cardiac murmurs?

A

Echocardiogram

185
Q

What would be seen on CXR in mitral stenosis?

A

Enlarged left and right ventricles

186
Q

What does mitral stenosis sound like?

A

Mid-diastolic rumbling

187
Q

When is mitral regurgitation heard?

A

Throughout systole - pansystolic

188
Q

Give 4 risk factors for infective endocarditis.

A

Poor dental hygiene
IVDU
Immunosuppressed
Elderly

189
Q

What is the diagnostic criteria for infective endocarditis called?

A

Dukes criteria

190
Q

What is the appearance of atrial flutter on ECG?

A

Sawtooth pattern

191
Q

What is the first line management of atrial flutter?

A

Rate management - beta blocker

Heparin

192
Q

What are the ECG abnormalities in RBBB?

A

R wave in V1, S wave in V6

193
Q

What are the ECG abnormalities in LBBB?

A

S wave in V1, R wave in V6

194
Q

Give 3 side effects of beta blockers.

A

Erectile dysfunction
Cold peripheries
Bronchospasm

195
Q

What socioeconomic factors contribute to rates of heart disease?

A

Depression
Anxiety
Smoking
Social isolation

196
Q

What are the most common causes of pericarditis?

A

Viral and autoimmune

197
Q

What is heard on examination in pericarditis?

A

Friction rub

198
Q

When is oxygen indicated after an MI?

A

If oxygen saturation is below 94%

199
Q

What causes a pansystolic murmur?

A

Mitral regurgitation

200
Q

What causes a mid diastolic rumbling murmur?

A

Mitral stenosis

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