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**Bank > Cardio > Flashcards

Cardio Flashcards

1
Q

‘global speckled’ pattern on ECHO

A

Cardiac amyloidosis

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2
Q

Psuedoinfarction pattern on ECG appears as

A

Low-voltage complexes with poor R wave progression

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3
Q

Pseudoinfarction pattern on ECG associated with

A

Cardiac amyloidosis

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4
Q

Normal PR interval

A

120 - 200 ms

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5
Q

Anteroseptal - ECG changes

A

V1 - V4

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6
Q

Inferior - ECG changes

A

II, III, aVF

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7
Q

Anterolateral - ECG changes

A

V4-V6, I, aVL

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8
Q

Lateral - ECG changes

A

I, aVL +/- V5-V6

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9
Q

Posterior - ECG changes

A

Tall R waves V1-V2

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10
Q

Coronary artery affected: Anteroseptal changes

A

Left anterior descending

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11
Q

Coronary artery affected: Inferior changes

A

Right coronary

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12
Q

Coronary artery affected: Anterolateral changes

A

Left anterior descending,
or,
Left circumflex

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13
Q

Coronary artery affected: Lateral changes

A

Left circumflex

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14
Q

Coronary artery affected: Posterior changes

A

Usually left circumflex, also right coronary

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15
Q

Long QT1

A

Adrenergic surge due to physical activity

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16
Q

Long QT2

A

Adrenergic surge due to intense emotion

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17
Q

Long QT3

A

Death during sleep

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18
Q

Kussmaul’s sign looks like

A

JVP rises during inspiration

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19
Q

Kussmails sign associated with

A

Constrictive pericarditis

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20
Q

Definition of pulmonary arterial hypertension

A

Resting mean pulmonary artery pressure is >= 25 mmHg

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21
Q

Wellen’s syndrome - appearance on ECG

A

Deeply inverted/biphasic T waves in V2 - V3

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22
Q

Wellen’s syndrome - suggests

A

Critical LAD stenosis

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23
Q

Aortic stenosis - Criteria for aortic valve surgery

A

Symptomatic

Valvular gradient > 40 mmHg and features of LV systolic dysfunction

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24
Q

Dabigatran MOA

A

Inhibits thrombin

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25
Q

Dabigatran reversal agent

A

Idarucizumab

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26
Q

Blood pressure target - patient with hypertension without other comorbidity

A

< 140/90 mmHg

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27
Q

Blood pressure target - patient with diabetes and end organ damage

A

< 130/80 mmHg

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28
Q

Normal QRS duration

A

< 120 ms

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29
Q

INR > 8.0 with No bleeding

A

Oral Vitamin K 1-5 mg

Repeat dose vitamin K if INR still too high after 24hr

Restart warfarin when INR < 5

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30
Q

ECG findings associated with ostium primum

A

RBBB + LAD, prolonged PR

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31
Q

ECG findings associated with ostium secundum

A

RBBB + RAD

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32
Q

Heart failure - 1st-line management for all patients

A

ACEi + beta-blocker
(start one, then add other)

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33
Q

Heart failure - 2nd-line

A

Aldosterone antagonist
(spironolactine/eplerenone)

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34
Q

Heart failure - 3rd-line options

A

Ivabradine

Sacubitril-valsartan

Digoxin

Hydralazine with nitrate

Cardiac resynchroniziiton therpy

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35
Q

Heart failure management – criteria for ivabridine

A

Sinus rhythm >75 bpm +
LVEF <35%

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36
Q

Heart failure management - criteria for sacubitril-valsartan

A

LVEF <35%

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37
Q

Heart failure management - indication for digoxin

A

Coexistant AF

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38
Q

Heart failure management - indication for hydralazine with nitrate

A

Afro-Caribbean patient

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39
Q

Heart failure management - indication for cardiac resynchronization therapy

A

Widened QRS complex >130ms

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40
Q

Infective endocarditis- empiric treatment for prosthetic valve

A

Vancomycin + rifampicin + low-dose gentamicin

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41
Q

Infective endocarditis- empiric treatment for native valve

A

Amoxicillin + consider low-dose gentamicin

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42
Q

Infective endocarditis- empiric treatment for native valve (Penicillin allergy)

A

Vancomycin + low-dose gentamicin

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43
Q

Mitral regurgitatiion with new AF - management?

A

Refer for mitral valve replacement

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44
Q

Features of cholesterol embolism

A
  • Eosinophilia
  • Purpura
  • Renal failure
  • Livedo reticularis
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45
Q

Causes of LBBB

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
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46
Q

Epsilon wave looks like

A

Small positive deflection at end of QRS complex

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47
Q

Infective endocarditis - treatment for prosthetic valve, caused by staphylococci

A

Flucloxacillin + rifampicin + low-dose gentamicin

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48
Q

Prolonged QTc in men

A

> 440ms

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49
Q

Infective endocarditis - treatment for native valve, caused by staphylococci (PEN ALLERGIC)

A

Vancomycin + rifampicin

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50
Q

Acceptable increase in creatinine when starting AECi

A

Up to 30% increase

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51
Q

Infective endocarditis - treatment for prosthetic valve, caused by MRSA

A

Vancomycin + rifampicin + low-dose gentamicin

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52
Q

Secundum atrial septal defects occur where

A

Middle of atrial septum

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53
Q

Infective endocarditis - treatment if caused by fully-sensitive streptococci eg viridans (PEN ALLERGIC)

A

Vancomycin + low-dose gentamicin

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54
Q

Infective endocarditis - treatment if caused by less-sensitive streptococci (PEN ALLERGIC)

A

Vancomycin + low-dose gentamicin

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55
Q

Infective endocarditis - treatment if caused by less-sensitive streptococci

A

Benzylpenicillin + low-dose gentamicin

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56
Q

Causes of LBBB

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
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57
Q

Culture-negative causes of infective endocarditis

A

Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics

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58
Q

Which pre-excitation disorder shows ECG with a short PR interval, and normal QRS complex

A

Lown-Ganong-Levine syndrome

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59
Q

ECG findings in Wolff-Parkinson-White syndrome

A

Short PR interval, wide QRS complex with slurred upstroke (delta wave)

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60
Q

PMH contraindications to adenosine use in SVT

A

Asthma

Taking dipyridamole

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61
Q

ECG findings in dextrocardia

A

Inverted P wave in lead I
RAD
Loss of R wave progression

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62
Q

Patient with WPW in AF - which medication for cardioversion

A

Flecainide

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63
Q

Unifying diagnosis: Constrictive pericarditis + nephrotic syndrome + mononeuritis multiplex

A

Amyloidosis

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64
Q

Digoxin contraindication

A

Cardiac amyloidosis (digoxin binds to amyloid > toxicity)

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65
Q

1st line management of acute idiopathic/viral pericarditis

A

NSAID + colchicine

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66
Q

HACEK agents

A

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

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67
Q

Culture-negative causes of infective endocarditis

A

Coxiella burnetii
Bartonella
Brucella
HACEK
Prior antibiotics

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68
Q

ECG findings in dextrocardia

A

Small complexes in chest leads vs the limb leads
Inverted complexes in I and aVL

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69
Q

ECG findings in Second-degree AV block type 1 (Mobitz I, Wenckebach)

A

Progressive prolongation of PR interval until a dropped beat occurs

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70
Q

ECG findings in Second-degree AV block type 2 (Mobitz II)

A

P waves are often not followed by a QRS complex.

Where a QRS complex does follow, the PR interval is NORMAL

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71
Q

CHA2DS2-VASc

A

CCF - 1

HTN - 1

Age:
=>75 - 2
65-74 - 1

DM - 1

Stroke/TIA - 2

IHD/PAD - 1

Female - 1

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72
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K < 4.5 mmol/l

A

Add low-dose spironolactone

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73
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K > 4.5 mmol/l

A

Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)

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74
Q

Beta-blockers in systemic sclerosis

A

May worsen Raynauds

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75
Q

Hypertension - 3rd line management, already taking ACEi + CCB

A

Thiazide-like diuretic (Indapamide)

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76
Q

Hypertension - 1st line management <55 years old and not AFC

A

ACEi/ARB

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77
Q

Hypertension - 1st line management any age, with T2DM, not AFC

A

ACEi/ARB

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78
Q

Hypertension - 1st line management >55 years old not T2DM

A

Calcium channel blocker (amlodipine)

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79
Q

Hypertension - 1st line management any age, AFC, not T2DM

A

Calcium channel blocker (amlodipine)

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80
Q

Hypertension - 2nd line management - already taking ACEi/ARB

A

Add:
CCB (amlodipine)
or
TLD (indapamide)

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81
Q

Hypertension - 2nd line management - already taking CCB

A

Add:
ACEi or ARB (ARB if AFC)
or
TLD (indapamide)

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82
Q

Hypertension - 3rd line management, already taking ACEi + TLD

A

Add CCB

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83
Q

Patient with AF, already on dual anti-platelet

A

Still needs formal anticoagulation (Warfarin/DOAC)

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84
Q

Which anti-coagulant for AF, in patient with CKD?

A

Rivaroxaban
(Reduced dose if GFR 15-50)

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85
Q

Dabigatran in renal impairment

A

Not safe, high risk of bleeding

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86
Q

Cardiac monitor shows ‘short runs of polymorphic VT’

A

Torsades de pointes

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87
Q

Management of Torsades de pointes

A

IV Magnesium sulphate

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88
Q

Causes of long QT (therefore increase risk of Torsades de pointes)

A

Amiodarone, sotalol
Erythromycin/clarithromycin
Low Ca, K, Mg
TCA/antipsychotics
Chloroquine
Fluconazole

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89
Q

Management of monomorphic VT - no adverse signs

A

Amiodarone/
Lidocaine/
Procainamide

90
Q

Management of monomorphic VT - with adverse signs

A

DC cardioversion

91
Q

ECG findings in Brugada syndrome

A

Coved ST elevation in >1 of V1-V3 followed by negative T wave

92
Q

Diagnostic tool for Brugada

A

Flecainide challenge

93
Q

Management of Brugada syndrome

94
Q

Long-term management of WPW

A

Radiofrequency ablation

95
Q

Medical management of SVT in WPW

A

Sotalol, adenosine, flecainide, amiodarone

96
Q

CI to use of sotalol/adenosine in for SVT in WPW

A

Possible underlying AF

97
Q

Which type of atrial septal defect is most common

A

Ostium secundum defect

98
Q

ST elevation without reciprocal depression, shortly after myocardial infarction, suggests

A

Left ventricle aneurysm

99
Q

Feature that suggests vascular claudication (over neurogenic claudication)

A

No relief from leaning forward/sitting down.
Only relieved with rest

100
Q

ABPI > 1.2

A

Calcified stiff arteries
May be PAD or normal in old age

101
Q

ABPI 1.0 - 1.2

102
Q

ABPI 0.9 - 1.0

A

Acceptable

103
Q

ABPI < 0.9

A

Likely PAD

104
Q

ABPI < 0.5

A

Severe PAD - urgent referral

105
Q

ABPI required for compression bandaging

106
Q

ECG features of trifascicular block

A

RBB + LAD/RAD + prolonged PR

107
Q

Management of sick sinus syndrome with bradarrhythmia

A

Pacemaker (AAIR)

108
Q

Inherited long QT and sensorineural hearing loss seen in

A

Jervell & Lange-Nielson syndrome

109
Q

Congenital syndrome with long QT (no hearing loss)

A

Romano-Ward syndrome

110
Q

CHA2DS2-VASc

A

CCF - 1

HTN - 1

Age:
=>75 - 2
65-74 - 1

DM - 1

Stroke/TIA - 2

IHD/PAD - 1

Female - 1

111
Q

CHADS-VaSc 1 (male)

A

Consider anticoagulation with DOAC (Rivaroxaban)

112
Q

CHADS-VaSc 1 (female)

A

No anticoagulation
(Need ECHO to exclude valvular heart disease)

113
Q

CHADS-VaSc 2

A

Offer anticoagulation with DOAC

114
Q

Normal PR interval

A

120 - 200 ms

115
Q

Anteroseptal - ECG changes

116
Q

Inferior - ECG changes

A

II, III, aVF

117
Q

Anterolateral - ECG

A

V4-V6, I, aVL

118
Q

Lateral - ECG changes

A

I, aVL +/- V5-V6

119
Q

Posterior - ECG changes

A

Tall R waves V1-V2

120
Q

Coronary artery affected: Anteroseptal changes

A

Left anterior descending

121
Q

Coronary artery affected: Inferior changes

A

Right coronary

122
Q

Coronary artery affected: Anterolateral changes

A

Left anterior descending,
or,
Left circumflex

123
Q

Coronary artery affected: Lateral changes

A

Left circumflex

124
Q

Coronary artery affected: Posterior changes

A

Usually left circumflex, also right coronary

125
Q

Definition of pulmonary arterial hypertension

A

Resting mean pulmonary artery pressure is >= 25 mmHg

126
Q

Normal QRS duration

127
Q

INR > 8.0 with No bleeding

A

Oral Vitamin K 1-5 mg

Repeat dose vitamin K if INR still too high after 24hr

Restart warfarin when INR < 5

128
Q

Heart failure - 1st-line management for all patients

A

ACEi + beta-blocker
(start one, then add other)

129
Q

Heart failure - 2nd-line

A

Aldosterone antagonist
(spironolactone/eplerenone)

130
Q

Heart failure - 3rd-line options

A

Ivabradine

Sacubitril-valsartan

Digoxin

Hydralazine with nitrate

Cardiac resynchroniziiton therpy

131
Q

Heart failure management – criteria for ivabridine

A

Sinus rhythm >75 bpm +
LVEF <35%

132
Q

Criteria for using sacubitril-valsartan (Entresto) for heart failure

133
Q

Heart failure management - indication for digoxin

A

Coexistant AF

134
Q

Heart failure management - indication for hydralazine with nitrate

A

Afro-Caribbean patient

135
Q

Heart failure management - indication for cardiac resynchronization therapy

A

Widened QRS complex >130ms

136
Q

Widened QRS complex >130ms

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
137
Q

Prolonged QTc in men

138
Q

Causes of LBBB

A
  • IHD
  • HTN
  • Aortic stenosis
  • Cardiomyopathy
139
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K < 4.5 mmol/l

A

Add low-dose spironolactone

140
Q

Hypertension - 4th line medical management
(already taking A + C + D)
- K > 4.5 mmol/l

A

Add alpha-blocker (doxazosin) or beta-blocker (nebivolol, carvedilol)

141
Q

Angina - all patients should be on
(in absence of contraindications)

A

Aspirin
Statin
Sublingual GTN prn

142
Q

Angina - 1st line treatment

A

Beta-blocker + Calcium channel blocker

143
Q

Medications which may exacerbate heart failure

A

Thiazolidinediones (pioglitazone)

Verapamil

NSAIDs

Glucocorticoids

Class I antiarrhythmics (flecainide)

144
Q

Severe hypertension requiring same-day specialist assessment/admission.

A

BP >=180/120 and any of:

  • Retinal haemorrhage /papilloedema
  • New confusion
  • Chest pain
  • Signs of heart failure
  • AKI
145
Q

Most appropriate first-line anti-anginal for stable angina in a patient with heart failure.

A

Bisoprolol (beta-blocker)

146
Q

If calcium channel blocker is used as monotherapy in stable angina - which one should be used?

A

Rate-limiting CCB (verapamil, diltiazem)

147
Q

If calcium channel blocker is used in combo with beta-blocker in stable angina - which one should be used?

A

Long-acting dihydropyridine CCB (modified-release nifedipine).

148
Q

Verapamil should never be prescribed with

A

Beta-blockers (risk of complete heart block)

149
Q

Stage 1 HTN - clinic reading

A

> =140/90 mmHg

150
Q

Stage 1 hypertension - criteria (ABPM/HBPM)

A

Average >= 135/85 mmHg

151
Q

Stage 2 hypertension - criteria (clinic reading)

A

> =160/100 mmHg

152
Q

Stage 2 hypertension - criteria (ABPM/HBPM)

A

Average >= 150/95 mmHg

153
Q

Severe hypertension - criteria

A

Systolic BP >= 180 mmHg
or
Diastolic BP >= 120 mmHg

154
Q

Clopidogrel effectiveness may be reduced by concurrent use of:

A

Omeprazole/esomeprazole
(lansoprazole ok)

155
Q

At what eGFR should thiazide diuretics be avoided in CKD?

A

eGFR <30 ml/min (CKD stage 4)

156
Q

Hypertension - 1st line management <55 years old and not AFC

157
Q

Hypertension - 1st line management any age, with T2DM, not AFC

158
Q

Hypertension - 1st line management >55 years old not T2DM

A

Calcium channel blocker (amlodipine)

159
Q

Hypertension - 1st line management any age, AFC, not T2DM

A

Calcium channel blocker (amlodipine)

160
Q

Hypertension - 2nd line management - already taking ACEi/ARB

A

Add:
CCB (amlodipine)
or
TLD (indapamide)

161
Q

Hypertension - 2nd line management - already taking CCB

A

Add:
ACEi or ARB (ARB if AFC)
or
TLD (indapamide)

162
Q

Hypertension - 3rd line management, already taking ACEi + TLD

163
Q

Hypertension - 3rd line management, already taking ACEi + CCB

A

Thiazide-like diuretic (Indapamide)

164
Q

Myocardial infarction secondary prevention - all patients should be offered

A
  • Dual antiplatelet therapy
  • ACEi
  • Beta-blocker
  • Statin
165
Q

Myocardial infarction secondary prevention - with signs of heart failure + reduced LVEF

A

Aldosterone antagonist (eplerenone)

166
Q

Timing of initiation aldosterone antagonist post-MI

A

Within 3-14 days of MI
After ACEi initiated

167
Q

Dual antiplatelet therapy following medically-managed ACS

A

Aspirin life-long
+
Ticagrelor for 12 months

168
Q

Dual antiplatelet therapy following PCI

A

Aspirin life-long
+
Ticagrelor or prasugrel for 12 months

169
Q

Anti-thrombotic therapy for bio-prosthetic heart valve

170
Q

Anti-thrombotic therapy for mechanical prosthetic heart valve

A

Warfarin + aspirin

171
Q

DVLA advice post ACS (successful angioplasty)

A

1 week off driving

172
Q

DVLA advice post ACS
(not successfully treated by angioplasty)

A

4 weeks of driving

173
Q

DVLA advice post elective angioplasty

A

1 week off driving

174
Q

DVLA advice post CABG

A

4 weeks off driving

175
Q

DVLA advice post pacemaker insertion

A

1 week off driving

176
Q

1st-line agents for long-term rate-control in AF

A

standard beta-blocker
or
rate-limiting calcium channel blocker (diltiazem)

177
Q

Indication to use digoxin as rate-limiting agent in AF

A

Sedentary
Beta-blocker/CCB not appropriate
Co-existent heart failure

178
Q

Caution/CI for ACEi

A

Pregnancy/breastfeeding
Renovascular disease
Aortic stenosis
Hereditory angioedema
Potassium >= 5.0

179
Q

Amiodarone - baseline tests prior to starting

A

TFT, LFT, U&E, CXR

180
Q

Amiodarone - monitoring

A

TFT, LFT 6-monthly

181
Q

Drugs which cause QT prolongation

A

Amiodarone
Sotalol
TCAs
SSRIs (especially citalopram)
Chloroquine
Erythromycin
Haloperidol
Ondansetron

182
Q

Target clinic BP if patient <80y

A

140/90 mmHg

183
Q

Target clinic BP if patient >=80y

A

150/90 mmHg

184
Q

Target ABPM/HBPM if patient <80y

A

135/85 mmHg

185
Q

Target ABPM/HBPM if patient >=80y

A

145/85 mmHg

186
Q

Target clinic BP: Type 1 diabetes without albuminuria/metabolic syndrome

A

135/85 mmHg

187
Q

Target clinic BP: Type 1 diabetes with albuminuria or metabolic syndrome

A

130/80 mmHg

188
Q

Target BP in CKD with Diabetes

A

<130/80 mmHg

189
Q

Target BP in CKD (not diabetic, ACR <70)

A

<140/90 mmHg

190
Q

Target BP in CKD (not diabetic, but ACR >70)

A

<130/80 mmHg

191
Q

Target clinic BP in T2DM (no CKD)

A

Same as gen pop:
Under 80y <140/90
Over 80y <150/90

192
Q

Target INR for aortic mechanical valve

193
Q

Target INR for mitral mechanical valve

194
Q

Blood test monitoring for statins

A

LFTs at baseline, 3 months + 12 months

195
Q

Investigation for suspected IHD (non-acute) - 1st line

A

CT coronary angiography

196
Q

Investigation for suspected IHD (non-acute) - 2nd line

A

Non-invasive functional imaging
(MR perfusion scan, stress echo)

197
Q

Investigation for suspected IHD (non-acute) - 3rd line

A

Invasive coronary angiography

198
Q

DVLA post ICD insertion for HOCM (no history of arrhythmia)

A

4 weeks off driving

199
Q

Amlodipine maximum dose

A

10mg per day

200
Q

A side effect of which cardiac medication is ulceration?

A

Nicorandil (vasodilator used in angina)

201
Q

Statins in pregnancy

A

Contraindicated in pregnancy and pre-conception (congenital anomaly)

202
Q

If suspect chronic heart failure

A

NT-pro-BNP
ECG
Tests for other causes/aggravators

203
Q

Suspected CHF and NT-pro-BNP >2000

A

2 week referral for ECHO + cardiologist

204
Q

Suspected CHF and NT-pro-BNP 400-2000

A

6-week referral for ECHO + cardiologist

205
Q

Offer statin for primary prevention to:

A

=10% + lifestyle ineffective
=10% + T2DM
T1DM + age 40y+/diagnosed >10y/nephropathy/CVD RF
CKD
Familial hypercholesterolaemia

206
Q

Offer statin (without risk assessment) to T1DM if: *

A

> 40y
Diagnosed >10y ago
Nephropathy
CVD risk factors

207
Q

Offer statin (without risk assessment) to

A

Certain T1DM pt*
CKD
Familial Hypercholesterolaemia

208
Q

Consider offering statin (without risk assessment) to

A

> =85y
All with T1DM

All T1DM

209
Q

<85y QRISK >10% + no T2DM

A

Lifestyle modification first (if appropriate)

Offer statin

210
Q

<85y QRISK >10% + T2DM

A

Offer statin

211
Q

Statin for primary prevention - followup

A

Repeat TC, HDL, non-HDL in 3m

Looking for 40% reduction in non-HDL

212
Q

Statin for primary prevention

A

atorvastatin 20mg

213
Q

Statin for secondary prevention

A

atorvastatin 80mg

214
Q

Who should receive a statin

A
  • Known CVD (stroke/TIA, IHD, PAD)
  • 10 year CV risk >= 10%
  • T1DM diagnosed >10y, or, aged >40, or nephropathy
215
Q

NSTEMI immediate management

A
  • 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
Q

Management of Torsades de pointes

A

IV magnesium sulphate

217
Q

Acute pericarditis - management

A

Treat underlying cause

NSAID + colchicine

218
Q

Antiplatelet therapy - after ACS (medically treated)

A

Aspirin lifelong +
Ticagrelor 12 months

219
Q

Antiplatelet therapy - after ACS (PCI)

A

Aspirin lifelong +
Prasurgrel/ticagrelor 12 months

220
Q

Antiplatelet therapy - after TIA

A

Clopidogrel lifelong

221
Q

Antiplatelet therapy - after ischaemic stroke

A

Clopidogrel lifelong

222
Q

Antiplatelet therapy - peripheral arterial disease

A

Clopidogrel lifelong

**Bank (74 decks)

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