Cardio Flashcards
1
Q
‘global speckled’ pattern on ECHO
A
Cardiac amyloidosis
2
Q
Psuedoinfarction pattern on ECG appears as
A
Low-voltage complexes with poor R wave progression
3
Q
Pseudoinfarction pattern on ECG associated with
A
Cardiac amyloidosis
4
Q
Normal PR interval
A
120 - 200 ms
5
Q
Anteroseptal - ECG changes
A
V1 - V4
6
Q
Inferior - ECG changes
A
II, III, aVF
7
Q
Anterolateral - ECG changes
A
V4-V6, I, aVL
8
Q
Lateral - ECG changes
A
I, aVL +/- V5-V6
9
Q
Posterior - ECG changes
A
Tall R waves V1-V2
10
Q
Coronary artery affected: Anteroseptal changes
A
Left anterior descending
11
Q
Coronary artery affected: Inferior changes
A
Right coronary
12
Q
Coronary artery affected: Anterolateral changes
A
Left anterior descending,
or,
Left circumflex
13
Q
Coronary artery affected: Lateral changes
A
Left circumflex
14
Q
Coronary artery affected: Posterior changes
A
Usually left circumflex, also right coronary
15
Q
Long QT1
A
Adrenergic surge due to physical activity
16
Q
Long QT2
A
Adrenergic surge due to intense emotion
17
Q
Long QT3
A
Death during sleep
18
Q
Kussmaul’s sign looks like
A
JVP rises during inspiration
19
Q
Kussmails sign associated with
A
Constrictive pericarditis
20
Q
Definition of pulmonary arterial hypertension
A
Resting mean pulmonary artery pressure is >= 25 mmHg
21
Q
Wellen’s syndrome - appearance on ECG
A
Deeply inverted/biphasic T waves in V2 - V3
22
Q
Wellen’s syndrome - suggests
A
Critical LAD stenosis
23
Q
Aortic stenosis - Criteria for aortic valve surgery
A
Symptomatic
Valvular gradient > 40 mmHg and features of LV systolic dysfunction
24
Q
Dabigatran MOA
A
Inhibits thrombin
25
Dabigatran reversal agent
Idarucizumab
26
Blood pressure target - patient with hypertension without other comorbidity
< 140/90 mmHg
27
Blood pressure target - patient with diabetes and end organ damage
< 130/80 mmHg
28
Normal QRS duration
< 120 ms
29
INR > 8.0 with No bleeding
Oral Vitamin K 1-5 mg
Repeat dose vitamin K if INR still too high after 24hr
Restart warfarin when INR < 5
30
ECG findings associated with ostium primum
RBBB + LAD, prolonged PR
31
ECG findings associated with ostium secundum
RBBB + RAD
32
Heart failure - 1st-line management for all patients
ACEi + beta-blocker
(start one, then add other)
33
Heart failure - 2nd-line
Aldosterone antagonist
(spironolactine/eplerenone)
34
Heart failure - 3rd-line options
Ivabradine
Sacubitril-valsartan
Digoxin
Hydralazine with nitrate
Cardiac resynchroniziiton therpy
35
Heart failure management -- criteria for ivabridine
Sinus rhythm >75 bpm +
LVEF <35%
36
Heart failure management - criteria for sacubitril-valsartan
LVEF <35%
37
Heart failure management - indication for digoxin
Coexistant AF
38
Heart failure management - indication for hydralazine with nitrate
Afro-Caribbean patient
39
Heart failure management - indication for cardiac resynchronization therapy
Widened QRS complex >130ms
40
Infective endocarditis- empiric treatment for prosthetic valve
Vancomycin + rifampicin + low-dose gentamicin
41
Infective endocarditis- empiric treatment for native valve
Amoxicillin + consider low-dose gentamicin
42
Infective endocarditis- empiric treatment for native valve (Penicillin allergy)
Vancomycin + low-dose gentamicin
43
Mitral regurgitatiion with new AF - management?
Refer for mitral valve replacement
44
Features of cholesterol embolism
- Eosinophilia
- Purpura
- Renal failure
- Livedo reticularis
45
Causes of LBBB
- IHD
- HTN
- Aortic stenosis
- Cardiomyopathy
46
Epsilon wave looks like
Small positive deflection at end of QRS complex
47
Infective endocarditis - treatment for prosthetic valve, caused by staphylococci
Flucloxacillin + rifampicin + low-dose gentamicin
48
Prolonged QTc in men
>440ms
49
Infective endocarditis - treatment for native valve, caused by staphylococci (PEN ALLERGIC)
Vancomycin + rifampicin
50
Acceptable increase in creatinine when starting AECi
Up to 30% increase
51
Infective endocarditis - treatment for prosthetic valve, caused by MRSA
Vancomycin + rifampicin + low-dose gentamicin
52
Secundum atrial septal defects occur where
Middle of atrial septum
53
Infective endocarditis - treatment if caused by fully-sensitive streptococci eg viridans (PEN ALLERGIC)
Vancomycin + low-dose gentamicin
54
Infective endocarditis - treatment if caused by less-sensitive streptococci (PEN ALLERGIC)
Vancomycin + low-dose gentamicin
55
Infective endocarditis - treatment if caused by less-sensitive streptococci
Benzylpenicillin + low-dose gentamicin
56
Causes of LBBB
- IHD
- HTN
- Aortic stenosis
- Cardiomyopathy
57
Culture-negative causes of infective endocarditis
Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics
58
Which pre-excitation disorder shows ECG with a short PR interval, and normal QRS complex
Lown-Ganong-Levine syndrome
59
ECG findings in Wolff-Parkinson-White syndrome
Short PR interval, wide QRS complex with slurred upstroke (delta wave)
60
PMH contraindications to adenosine use in SVT
Asthma
Taking dipyridamole
61
ECG findings in dextrocardia
Inverted P wave in lead I
RAD
Loss of R wave progression
62
Patient with WPW in AF - which medication for cardioversion
Flecainide
63
Unifying diagnosis: Constrictive pericarditis + nephrotic syndrome + mononeuritis multiplex
Amyloidosis
64
Digoxin contraindication
Cardiac amyloidosis (digoxin binds to amyloid > toxicity)
65
1st line management of acute idiopathic/viral pericarditis
NSAID + colchicine
66
HACEK agents
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
67
Culture-negative causes of infective endocarditis
Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics
68
ECG findings in dextrocardia
Small complexes in chest leads vs the limb leads
Inverted complexes in I and aVL
69
ECG findings in Second-degree AV block type 1 (Mobitz I, Wenckebach)
Progressive prolongation of PR interval until a dropped beat occurs
70
ECG findings in Second-degree AV block type 2 (Mobitz II)
P waves are often not followed by a QRS complex.
Where a QRS complex does follow, the PR interval is NORMAL
71
CHA2DS2-VASc
CCF - 1
HTN - 1
Age:
=>75 - 2
65-74 - 1
DM - 1
Stroke/TIA - 2
IHD/PAD - 1
Female - 1
72
Hypertension - 4th line medical management
(already taking A + C + D)
- K < 4.5 mmol/l
Add low-dose spironolactone
73
Hypertension - 4th line medical management
(already taking A + C + D)
- K > 4.5 mmol/l
Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)
74
Beta-blockers in systemic sclerosis
May worsen Raynauds
75
Hypertension - 3rd line management, already taking ACEi + CCB
Thiazide-like diuretic (Indapamide)
76
Hypertension - 1st line management <55 years old and not AFC
ACEi/ARB
77
Hypertension - 1st line management any age, with T2DM, not AFC
ACEi/ARB
78
Hypertension - 1st line management >55 years old not T2DM
Calcium channel blocker (amlodipine)
79
Hypertension - 1st line management any age, AFC, not T2DM
Calcium channel blocker (amlodipine)
80
Hypertension - 2nd line management - already taking ACEi/ARB
Add:
CCB (amlodipine)
or
TLD (indapamide)
81
Hypertension - 2nd line management - already taking CCB
Add:
ACEi or ARB (ARB if AFC)
or
TLD (indapamide)
82
Hypertension - 3rd line management, already taking ACEi + TLD
Add CCB
83
Patient with AF, already on dual anti-platelet
Still needs formal anticoagulation (Warfarin/DOAC)
84
Which anti-coagulant for AF, in patient with CKD?
Rivaroxaban
(Reduced dose if GFR 15-50)
85
Dabigatran in renal impairment
Not safe, high risk of bleeding
86
Cardiac monitor shows 'short runs of polymorphic VT'
Torsades de pointes
87
Management of Torsades de pointes
IV Magnesium sulphate
88
Causes of long QT (therefore increase risk of Torsades de pointes)
Amiodarone, sotalol
Erythromycin/clarithromycin
Low Ca, K, Mg
TCA/antipsychotics
Chloroquine
Fluconazole
89
Management of monomorphic VT - no adverse signs
Amiodarone/
Lidocaine/
Procainamide
90
Management of monomorphic VT - with adverse signs
DC cardioversion
91
ECG findings in Brugada syndrome
Coved ST elevation in >1 of V1-V3 followed by negative T wave
92
Diagnostic tool for Brugada
Flecainide challenge
93
Management of Brugada syndrome
ICD
94
Long-term management of WPW
Radiofrequency ablation
95
Medical management of SVT in WPW
Sotalol, adenosine, flecainide, amiodarone
96
CI to use of sotalol/adenosine in for SVT in WPW
Possible underlying AF
97
Which type of atrial septal defect is most common
Ostium secundum defect
98
ST elevation without reciprocal depression, shortly after myocardial infarction, suggests
Left ventricle aneurysm
99
Feature that suggests vascular claudication (over neurogenic claudication)
No relief from leaning forward/sitting down.
Only relieved with rest
100
ABPI > 1.2
Calcified stiff arteries
May be PAD or normal in old age
101
ABPI 1.0 - 1.2
Normal
102
ABPI 0.9 - 1.0
Acceptable
103
ABPI < 0.9
Likely PAD
104
ABPI < 0.5
Severe PAD - urgent referral
105
ABPI required for compression bandaging
>= 0.8
106
ECG features of trifascicular block
RBB + LAD/RAD + prolonged PR
107
Management of sick sinus syndrome with bradarrhythmia
Pacemaker (AAIR)
108
Inherited long QT and sensorineural hearing loss seen in
Jervell & Lange-Nielson syndrome
109
Congenital syndrome with long QT (no hearing loss)
Romano-Ward syndrome
110
CHA2DS2-VASc
CCF - 1
HTN - 1
Age:
=>75 - 2
65-74 - 1
DM - 1
Stroke/TIA - 2
IHD/PAD - 1
Female - 1
111
CHADS-VaSc 1 (male)
Consider anticoagulation with DOAC (Rivaroxaban)
112
CHADS-VaSc 1 (female)
No anticoagulation
(Need ECHO to exclude valvular heart disease)
113
CHADS-VaSc 2
Offer anticoagulation with DOAC
114
Normal PR interval
120 - 200 ms
115
Anteroseptal - ECG changes
V1 - V4
116
Inferior - ECG changes
II, III, aVF
117
Anterolateral - ECG
V4-V6, I, aVL
118
Lateral - ECG changes
I, aVL +/- V5-V6
119
Posterior - ECG changes
Tall R waves V1-V2
120
Coronary artery affected: Anteroseptal changes
Left anterior descending
121
Coronary artery affected: Inferior changes
Right coronary
122
Coronary artery affected: Anterolateral changes
Left anterior descending,
or,
Left circumflex
123
Coronary artery affected: Lateral changes
Left circumflex
124
Coronary artery affected: Posterior changes
Usually left circumflex, also right coronary
125
Definition of pulmonary arterial hypertension
Resting mean pulmonary artery pressure is >= 25 mmHg
126
Normal QRS duration
< 120 ms
127
INR > 8.0 with No bleeding
Oral Vitamin K 1-5 mg
Repeat dose vitamin K if INR still too high after 24hr
Restart warfarin when INR < 5
128
Heart failure - 1st-line management for all patients
ACEi + beta-blocker
(start one, then add other)
129
Heart failure - 2nd-line
Aldosterone antagonist
(spironolactone/eplerenone)
130
Heart failure - 3rd-line options
Ivabradine
Sacubitril-valsartan
Digoxin
Hydralazine with nitrate
Cardiac resynchroniziiton therpy
131
Heart failure management -- criteria for ivabridine
Sinus rhythm >75 bpm +
LVEF <35%
132
Criteria for using sacubitril-valsartan (Entresto) for heart failure
LVEF <35%
133
Heart failure management - indication for digoxin
Coexistant AF
134
Heart failure management - indication for hydralazine with nitrate
Afro-Caribbean patient
135
Heart failure management - indication for cardiac resynchronization therapy
Widened QRS complex >130ms
136
Widened QRS complex >130ms
- IHD
- HTN
- Aortic stenosis
- Cardiomyopathy
137
Prolonged QTc in men
>440ms
138
Causes of LBBB
- IHD
- HTN
- Aortic stenosis
- Cardiomyopathy
139
Hypertension - 4th line medical management
(already taking A + C + D)
- K < 4.5 mmol/l
Add low-dose spironolactone
140
Hypertension - 4th line medical management
(already taking A + C + D)
- K > 4.5 mmol/l
Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)
141
Angina - all patients should be on
(in absence of contraindications)
Aspirin
Statin
Sublingual GTN prn
142
Angina - 1st line treatment
Beta-blocker + Calcium channel blocker
143
Medications which may exacerbate heart failure
Thiazolidinediones (pioglitazone)
Verapamil
NSAIDs
Glucocorticoids
Class I antiarrhythmics (flecainide)
144
Severe hypertension requiring same-day specialist assessment/admission.
BP >=180/120 and any of:
- Retinal haemorrhage /papilloedema
- New confusion
- Chest pain
- Signs of heart failure
- AKI
145
Most appropriate first-line anti-anginal for stable angina in a patient with heart failure.
Bisoprolol (beta-blocker)
146
If calcium channel blocker is used as monotherapy in stable angina - which one should be used?
Rate-limiting CCB (verapamil, diltiazem)
147
If calcium channel blocker is used in combo with beta-blocker in stable angina - which one should be used?
Long-acting dihydropyridine CCB (modified-release nifedipine).
148
Verapamil should never be prescribed with
Beta-blockers (risk of complete heart block)
149
Stage 1 HTN - clinic reading
>=140/90 mmHg
150
Stage 1 hypertension - criteria (ABPM/HBPM)
Average >= 135/85 mmHg
151
Stage 2 hypertension - criteria (clinic reading)
>=160/100 mmHg
152
Stage 2 hypertension - criteria (ABPM/HBPM)
Average >= 150/95 mmHg
153
Severe hypertension - criteria
Systolic BP >= 180 mmHg
or
Diastolic BP >= 120 mmHg
154
Clopidogrel effectiveness may be reduced by concurrent use of:
Omeprazole/esomeprazole
(lansoprazole ok)
155
At what eGFR should thiazide diuretics be avoided in CKD?
eGFR <30 ml/min (CKD stage 4)
156
Hypertension - 1st line management <55 years old and not AFC
ACEi/ARB
157
Hypertension - 1st line management any age, with T2DM, not AFC
ACEi/ARB
158
Hypertension - 1st line management >55 years old not T2DM
Calcium channel blocker (amlodipine)
159
Hypertension - 1st line management any age, AFC, not T2DM
Calcium channel blocker (amlodipine)
160
Hypertension - 2nd line management - already taking ACEi/ARB
Add:
CCB (amlodipine)
or
TLD (indapamide)
161
Hypertension - 2nd line management - already taking CCB
Add:
ACEi or ARB (ARB if AFC)
or
TLD (indapamide)
162
Hypertension - 3rd line management, already taking ACEi + TLD
Add CCB
163
Hypertension - 3rd line management, already taking ACEi + CCB
Thiazide-like diuretic (Indapamide)
164
Myocardial infarction secondary prevention - all patients should be offered
- Dual antiplatelet therapy
- ACEi
- Beta-blocker
- Statin
165
Myocardial infarction secondary prevention - with signs of heart failure + reduced LVEF
Aldosterone antagonist (eplerenone)
166
Timing of initiation aldosterone antagonist post-MI
Within 3-14 days of MI
After ACEi initiated
167
Dual antiplatelet therapy following medically-managed ACS
Aspirin life-long
+
Ticagrelor for 12 months
168
Dual antiplatelet therapy following PCI
Aspirin life-long
+
Ticagrelor or prasugrel for 12 months
169
Anti-thrombotic therapy for bio-prosthetic heart valve
Aspirin
170
Anti-thrombotic therapy for mechanical prosthetic heart valve
Warfarin + aspirin
171
DVLA advice post ACS (successful angioplasty)
1 week off driving
172
DVLA advice post ACS
(not successfully treated by angioplasty)
4 weeks of driving
173
DVLA advice post elective angioplasty
1 week off driving
174
DVLA advice post CABG
4 weeks off driving
175
DVLA advice post pacemaker insertion
1 week off driving
176
1st-line agents for long-term rate-control in AF
standard beta-blocker
or
rate-limiting calcium channel blocker (diltiazem)
177
Indication to use digoxin as rate-limiting agent in AF
Sedentary
Beta-blocker/CCB not appropriate
Co-existent heart failure
178
Caution/CI for ACEi
Pregnancy/breastfeeding
Renovascular disease
Aortic stenosis
Hereditory angioedema
Potassium >= 5.0
179
Amiodarone - baseline tests prior to starting
TFT, LFT, U&E, CXR
180
Amiodarone - monitoring
TFT, LFT 6-monthly
181
Drugs which cause QT prolongation
Amiodarone
Sotalol
TCAs
SSRIs (especially citalopram)
Chloroquine
Erythromycin
Haloperidol
Ondansetron
182
Target clinic BP if patient <80y
140/90 mmHg
183
Target clinic BP if patient >=80y
150/90 mmHg
184
Target ABPM/HBPM if patient <80y
135/85 mmHg
185
Target ABPM/HBPM if patient >=80y
145/85 mmHg
186
Target clinic BP: Type 1 diabetes without albuminuria/metabolic syndrome
135/85 mmHg
187
Target clinic BP: Type 1 diabetes with albuminuria or metabolic syndrome
130/80 mmHg
188
Target BP in CKD with Diabetes
<130/80 mmHg
189
Target BP in CKD (not diabetic, ACR <70)
<140/90 mmHg
190
Target BP in CKD (not diabetic, but ACR >70)
<130/80 mmHg
191
Target clinic BP in T2DM (no CKD)
Same as gen pop:
Under 80y <140/90
Over 80y <150/90
192
Target INR for aortic mechanical valve
3.0
193
Target INR for mitral mechanical valve
3.5
194
Blood test monitoring for statins
LFTs at baseline, 3 months + 12 months
195
Investigation for suspected IHD (non-acute) - 1st line
CT coronary angiography
196
Investigation for suspected IHD (non-acute) - 2nd line
Non-invasive functional imaging
(MR perfusion scan, stress echo)
197
Investigation for suspected IHD (non-acute) - 3rd line
Invasive coronary angiography
198
DVLA post ICD insertion for HOCM (no history of arrhythmia)
4 weeks off driving
199
Amlodipine maximum dose
10mg per day
200
A side effect of which cardiac medication is ulceration?
Nicorandil (vasodilator used in angina)
201
Statins in pregnancy
Contraindicated in pregnancy and pre-conception (congenital anomaly)
202
If suspect chronic heart failure
NT-pro-BNP
ECG
Tests for other causes/aggravators
203
Suspected CHF and NT-pro-BNP >2000
2 week referral for ECHO + cardiologist
204
Suspected CHF and NT-pro-BNP 400-2000
6-week referral for ECHO + cardiologist
205
Offer statin for primary prevention to:
=10% + lifestyle ineffective
=10% + T2DM
T1DM + age 40y+/diagnosed >10y/nephropathy/CVD RF
CKD
Familial hypercholesterolaemia
206
Offer statin (without risk assessment) to T1DM if: *
>40y
Diagnosed >10y ago
Nephropathy
CVD risk factors
207
Offer statin (without risk assessment) to
Certain T1DM pt*
CKD
Familial Hypercholesterolaemia
208
*Consider* offering statin (without risk assessment) to
>=85y
All with T1DM
| All T1DM
209
<85y QRISK >10% + no T2DM
Lifestyle modification first (if appropriate)
| Offer statin
210
<85y QRISK >10% + T2DM
Offer statin
211
Statin for primary prevention - followup
Repeat TC, HDL, non-HDL in 3m
| Looking for 40% reduction in non-HDL
212
Statin for primary prevention
atorvastatin 20mg
213
Statin for secondary prevention
atorvastatin 80mg
214
Who should receive a statin
- Known CVD (stroke/TIA, IHD, PAD)
- 10 year CV risk >= 10%
- T1DM diagnosed >10y, or, aged >40, or nephropathy
215
NSTEMI immediate management
- aspirin 300mg
- nitrates/morphine PRN
- oxygen only if hypoxic
- Fondaparinux (UFH if PCI within 24h/poor renal function)
- Ticagrelor for 12 months
-Tirofiban (gpIIb/IIIa receptor antagonist)
Coronary angiography within 96hr
216
Management of Torsades de pointes
IV magnesium sulphate
217
Acute pericarditis - management
Treat underlying cause
NSAID + colchicine
218
Antiplatelet therapy - after ACS (medically treated)
Aspirin lifelong +
Ticagrelor 12 months
219
Antiplatelet therapy - after ACS (PCI)
Aspirin lifelong +
Prasurgrel/ticagrelor 12 months
220
Antiplatelet therapy - after TIA
Clopidogrel lifelong
221
Antiplatelet therapy - after ischaemic stroke
Clopidogrel lifelong
222
Antiplatelet therapy - peripheral arterial disease
Clopidogrel lifelong
