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Finals Revision > Cardio > Flashcards

Cardio Flashcards

1
Q

How do you manage haemodynamically unstable AF (hypotension or HF present)?

A

DC cardioversion

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2
Q

How do you manage stable AF presenting in the 1st 48 hours?

A

Rate control (bisoprolol or metoprolol // verapamil or diltiazem) OR Rhythm control (DC cardioversion, start heparin beforehand)

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3
Q

How do you manage stable AF presenting after the 1st 48 hours?

A

Rate control (bisoprolol or metoprolol // verapamil or diltiazem) OR Elective DC Cardioversion (must be anticoagulated for at least 3 weeks)

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4
Q

If medical treatment fails and catheter ablation is required, do you still need to anticoagualte?

A

Yes if they were already being anticoagulated! Stroke risk does not change

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5
Q

What is the cause of congenital long QTc syndrome? When is QTc considered long?

A

Loss of functioning K+ channels
From the start of the QRS to the end of T, >12 in women, >11 in men

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6
Q

Which drug is always contraindicated in VT?

A

Verapamil

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7
Q

Name the ECG findings in hypokalaemia?

A

Small, absent or inverted T waves
Prolonged PR interval
ST depression
Long QTC
U waves

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8
Q

What is the normal QRS and PR interval?

A

QRS = 70-120ms (<3 small squares)
PR Interval = 120-200ms (3-5 small squares)

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9
Q

Is there an alternative to anticoagulating for 3 weeks before cardioversion?

A

Yes, Transoesophageal echo to exclude clots

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10
Q

Which connective tissue/inflammatory conditions are associated with aortic regurgitation?

A

Marfan’s Syndrome, Ehler-Danlos syndrome, RA, SLE and ankylosing spondylitis

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11
Q

Name 3 antibiotics which increase the INR?

A

Ciprofloxacin, clarithromycin and erythromycin

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12
Q

What is a gallop rhythm (S3 heart sound) a sign of?

A

Early LV heart failure

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13
Q

Which patients presenting >48 hours after AF begins will we offer elective DC cardioversion to?

A

<65s who are symptomatic or for whom this is the first presentation of AF
>65s or those with a history of IHD should be treated with rate control

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14
Q

How long should you anticoagulate after VTE or DVT when the patient has been pregnant within the last 3 months?

A

3/12. Pregnancy within the last 3 months is considered a provoking factor

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15
Q

Which drugs are contraindicated in aortic stenosis?

A

Nitrates

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16
Q

What is the most common cause of aortic stenosis?

A

<65s = bicuspid aortic valve
>65s = calcification of the aorta

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17
Q

What is the target INR in those with repeated PEs?

A

3.5

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18
Q

When should you replace the aortic valve in aortic stenosis?

A

If the stenosis is symptomatic or if the pressure gradient is >40mmHg

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19
Q

A patient presents with new onset AF. They are deemed to need urgent DC cardioversion. Which features may be present?

A

Haemodynamic instability (syncope, acute Pulmonary oedema, MI or ischaemic Chest pain, systolic BP <90, shock)
Heart failure (pulmonary oedema or raised JVP)

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20
Q

Above what value is hyperkalaemia always considered bad enough for urgent treatment?

A

> 6.5

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21
Q

How do we interperate Ferritin?

A

Low ferritin often indicated iron deficiency anaemia, high ferritin can be seen in inflammation, malignancy and liver disease

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22
Q

What is Brugada Syndrome?

A

An AD cause of sudden cardiac death.
ECG changes seen when giving flecainide = ST segment elevation in V1-V3 then negative T waves and a partial RBBB

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23
Q

How do we manage Brugada Syndrome?

A

Implantable Cardioverter Defibrillator

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24
Q

True or false, a large PE can cause a LBBB on ECG?

A

False! It can cause a RBBB

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25
Q

Mx of Chronic HF?

A

1st line = ACEi and Beta blocker
2nd line = spironolactone
If there is reduced EF a SGLT-2 inhibitor can be used to reduce hospital admissions (providing there is not severe renal failure)

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26
Q

What is Hypertrophic Obstructive Cardiomyopathy?

A

AD cause of sudden cardiac death (the most common in young people)
ECG = Left ventricular hypertrophy (tall R waves in I, aVL and V4-V6, increased S wave depth in III, aVR and V1-V3 and Left axis deviation)

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27
Q

What symptoms are seen in Hypertrophic Obstructive Cardiomyopathy?

A

Exertional dyspnoea and syncope.
Ejection systolic murmur which is increased by the Valsalva manoeuvre and decreased by squatting
+/- a pansystolic murmur of mitral regurg

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28
Q

Which part of an ECG shows the anteroseptal territory of the heart? What supplies it?

A

V1-V4
LAD

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29
Q

Which part of an ECG shows the inferior territory of the heart? What supplies it?

A

II, III, aVF
R coronary

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30
Q

Which part of an ECG shows the anterolateral territory of the heart? What supplies it?

A

V1-V6, I and aVL
LAD

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31
Q

Which part of an ECG shows the lateral territory of the heart? What supplies it?

A

I, aVL +/- V5 and V6
Left cirucmflex

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32
Q

Where are ECG changes seen in a posterior MI? What additional changes are seen and what supplies the posterior territories?

A

V1-V3
Plus horizontal ST depression, tall broad R waves, upright T waves and dominant R waves in V2
Left circumflex and right coronary

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33
Q

Name 2 causes of and the symptoms of aortic regurg?

A

Rheumatic fever and Endocarditis
Early diastolic murmur, collapsing pulse, wide pulse pressure, nail bed pulsation, head bobbing and heart failure symptoms

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34
Q

Sx of cardiac tamponade?

A

Low BP, Raised JVP (with absent Y descent) and muffled heart sounds
Also pulsus paradoxus (a large drop in BP during inspiration)

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35
Q

Ix and Mx of cardiac tamponade?

A

Ix = Echo
Mx = urgent pericardiocentesis

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36
Q

What is Cor Pulmonale?

A

Right heart enlargement due to pulmonary pathology (of the lungs or vessels)

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37
Q

Mx of Angina?

A

1st line = Beta blocker OR Verapamil/Diltiazem
2nd line = Beta blocker AND Amlodipine/MR Nifedipine
3rd line = Long Acting Nitrate/Ivabradine/Nicorandil/Ranolazine

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38
Q

Which of the 3rd line angina drugs is contraindicated by sildenafil usage?

A

Long Acting Nitrates

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39
Q

How do we manage poorly controlled hypertension (when A/C/D drugs have already been given)?

A

If K+ >4.5 = Alpha or Beta blockers
If K+ <4.5 = spironolactone

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40
Q

What is the first line Ix for stable angina?

A

Contrast enhanced CT angiography

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41
Q

When must you admit a HTN for specialist assesment?

A

If there is a new BP >180/120 with any of new onset confusion, chest pain, symptoms of HF or AKI

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42
Q

Which NSTEMI patients get a coronary angiography (and PCI if indicated) within 72 hours?

A

Those who have a GRACE score >3%

43
Q

How do you treat STEMI if PCI can be done in <120 mins?

A

Do PCI
Give Prasugrel.
During PCI give unfractionated heparin with glycoprotein IIb/IIIa inhibitor

44
Q

How do we treat STEMI if PCI can not be done in <120 mins?

A

Fibrinolysis e.g. alteplase or tenecteplase.
Give Aspirin, Ticagrelor and Fondaparinux/LMWH
Repeat ECG 60-90 mins after Fibrinolysis, if MI persists consider for PCI

45
Q

When should you use GTN with caution in ACS?

A

If the patient has a low BP

46
Q

What is the most common cause of mitral stenosis? What are the symptoms?

A

Caused by rheumatic fever
Sx = mitral facies, AF, haemoptysis, pulmonary hypertension and a rumbling mid-late diastolic murmur best heard in expiration

47
Q

What are some ECG changes which can be considered normal variants in athletes?

A

1st degree heart block, 2nd degree (Mobitz type I), sinus bradycardia and junctional rhythm

48
Q

What is the only CCB that can be used (e.g. to treat HTN) in HF patients?

A

Amlodipine

49
Q

What is the commonest risk factor for aortic dissection?

A

Hypertension

50
Q

Sx of Acute Pericarditis?

A

Pleuritic chest pain worse on lying back and relieved by sitting forward, no productive cough, dyspnoea and flu like Sx. Pericardial rub may be seen

51
Q

Ix and Mx of Acute Pericarditis?

A

ECG = saddle shaped ST elevation and PR depression.
Troponin is mildly raised
Also do a transthoracic echo
Mx = NSAIDs and Colchicine

52
Q

Which diuretic is best used to manage HTN and which is best used to manage HF?

A

HTN = thiazide like diuretics
HF = K+ sparring diuretics

53
Q

How can we differentiate between cardiac tamponade and constrictive pericarditis?

A

In cardiac tamponade there is pulsus paradoxus (a large drop in BP on inspiration)
In constrictive pericarditis there is Kussmaul’s sign (a rise in JVP on inspiration)

54
Q

Describe Myocarditis?

A

New onset chest pain, dyspnoea and arrhythmias seen in previously well young people following a recent illness

55
Q

Ix and Mx of Myocarditis?

A

Ix = raised inflammatory markers, cardiac enzymes and BNP are seen. ECG may show tachycardia, arrhythmias and ST elevation/T wave inversion
Mx = treat cause

56
Q

True or false, you can not get lung crackles/fever in PE?

A

False, you can! If you are suspicious that PE is the most likely diagnosis (e.g. breathlessness, pleuritic chest pain and tachycardia) still suspect in the presence of lung crackles/fever!

57
Q

How do you detect a re-infarction after MI?

A

Use CK-MB if it occurs in the first 4-10 days as troponin T can stay high for 10 days after insult

58
Q

How can sepsis affect troponin?

A

It can cause an increase in troponin due to hypoxia of the tissues (as there is a supply and demand mismatch)

59
Q

How does fondaparinux work?

A

It activates antithrombin III

60
Q

How does a Left Ventricular Aneurysm present?

A

Occurs 2 weeks after MI, it mimics heart failure alongside persistent ST elevation

61
Q

What is Dressler’s syndrome?

A

Pericarditis occurring post MI

62
Q

Should you worry about a new LBBB?

A

YES!! It is always pathological and is suggestive of a STEMI

63
Q

Describe the stages of HTN?

A

Stage 1: Clinic reading >=140/90 or ABPM >= 135/85
Stage 2: Clinic reading >= 160/100 or ABPM >= 150/95
Severe: Systolic >=180 or Diastolic >=120

64
Q

If you get a complete heart block following an MI where can you localise the lesion to

A

Right coronary artery lesion

65
Q

What should you do with an AF patient who has a CHA2Ds2-VASc score indicating there is no need for anti-coagulation?

A

Do an ECHO to exclude valvular heart disease

66
Q

Which valve abnormality is associated with Marfan’s and Ehler’s Danlos?

A

Mitral valve regurgitation

67
Q

Name some causes of postural hypotension?

A

DM and PD can cause it secondary to autonomic dysfunction
Hypovolaemia, drug and alcohol can also cause it

68
Q

What should you do if a CTPA is negative?

A

If CTPA OR D-dimer is negative and Wells score =<4 stop anticoagulation treatment
If CTPA is negative and Well’s Score >4 consider a proximal leg vein USS if you suspect DVT

69
Q

When is CTPA contraindicated? What should you do instead

A

If there is renal impairment or allergy to the contrast media.
Here do a V/Q (Ventilation-Perfusion) scan

70
Q

What should you do in IE with congestive HF?

A

Urgent valve replacement (will most likely be the tricuspid valve)

71
Q

What is the first line Mx of IE if the causative organism is unknown?

A

Amoxicillin

72
Q

True or false, thiazide like diuretics can cause erectile dysfuncion?

A

True!

73
Q

Sx of Rheumatic fever?

A

CASES
Carditis, Arthritis, Subcutaneous nodules, Erythema Marginatum, Sydenham’s Chorea

74
Q

How often should you measure LFTs with statins?

A

Pre-treatment, at 3 months and at 12 months

75
Q

How do you treat raised INR?

A

If >8 give vitamin K, if active bleed give IV if no active bleed give orally
If 5-8 give IV vitamin K if there is a bleed, if no bleed just withhold the next few warfarin doses

76
Q

When should you stop Beta blockers in acute HF?

A

If the HR <50, if there is 2nd or 3rd degree heart block or if the patient is shocked

77
Q

What should you consider if there is evidence that a peripheral clot (e.g. from a leg DVT) has travelled to the brain? What may you see on examiantion?

A

Suspect a septal defect (most likely ASD)
OE: Ejection systolic murmur and a fixed splitting of S2

78
Q

How do we manage warfarin in patients requiring emergency surgery?

A

If the surgery can wait 6-8 hours give IV vitamin K, if they can not wait give 25-50 units/kg four factor prothrombin complex

79
Q

True or false, Turner’s syndrome is associated with coarctation of the aorta?

A

True!

80
Q

When do you hear the S3 and S4 heart sound?

A

S3 heart sound is heard in DCM (Dilated Cardiomyopathy)
S4 heart sound is heard in HOCM (Hypertrophic Obstructive Cardiomyopathy)

81
Q

What is Hypertrophic Obstructive Cardiomyopathy frequently associated with?

A

Fredreich’s ataxia and wolff-parkinson’s white syndrome

82
Q

When is ejection fraction considered reduced?

A

<40%

83
Q

What should you do with the Wells score?

A

=<4 arrange a D-dimer
>4 do an immediate CTPA

84
Q

Which antibiotics must you stop a statin to give?

A

Clarithromycin or Erythromycin

85
Q

How can you localise aortic dissection on clinical exam?

A

Associated with normal heart sounds = Type B (there is a false lumen in the descending aorta)
Associated with aortic regurg = Type A (there is a false lumen in the ascending aorta)

86
Q

Mx of Aortic dissection?

A

Type A (ascending) = IV labetalol and surgical repair
Type B (descending) = IV labetalol and supportive management

87
Q

Describe erythema marginitum?

A

A ring like rash found on the trunk, arms and legs associated with mitral stenosis due to Rheumatic fever

88
Q

Describe the Pulmonary stenosis Murmur?

A

A harsh mid-ejection systolic murmur which may be associated with carcinoid syndrome (Hedinger syndrome)

89
Q

Describe the Tricuspid Regurg murmur?

A

High pitched pan-systolic murmur

90
Q

When should you give oxygen in ACS?

A

When sats are <94%

91
Q

Mx of NSTEMI?

A

Give Aspirin and Ticagrelor
If PCI is planned (GRACE score >3%) give unfractionated heparin
If PCI is not planned give fundaparinux

92
Q

True or false, aortic dissection can cause a neurological defect?

A

TRUE!

93
Q

How do thiazide like diuretics affect calcium?

A

They cause hypercalcaemia and hypocalciuria

94
Q

Describe Takayasu’s arteritis?

A

Unequal upper limb BP, absent/weak peripheral pulses, limb claudication, aortic regurg (an early diastolic decrescendo murmur), carotid bruits and malaise/headaches seen in females.
Ix = MR or CT angiography
Mx = steroids

95
Q

When should you treat stage 1 HTN (BP >= 140/90 clinic or 135/85 ABPM)?

A

If the patient is under 80 and there is one of:
Organ damage, CVD, renal disease, DM and a QRISK >10%

96
Q

What is the treatment recommended to Afro-Caribbean patients who have HF which has nor responded to ACEis, Beta-blockers or K+ sparring diuretics)?

A

Hydralazine and a nitrate

97
Q

What is the 3rd line Mx of HF in non-Afro-Caribbean patients? (after ACEi, beta blockers and K+ sparring diuretics have failed)

A

Ivabradine, Sacubitril, Valsartan and Digoxin

98
Q

What is the 3rd line Mx of HF in patients with a widened QRS? (after ACEi, beta blockers and K+ sparring diuretics have failed)

A

Cardiac resynchronisation

99
Q

Mx Torsade’s de Points?

A

MgSO4

100
Q

Primary and Secondary prevention of CVD?

A

Primary = 20mg Atorvastatin
Secondary = 80mg Atorvastatin

101
Q

What should you do in acute HF if the patient is hypotensive and at risk of cardiogenic shock?

A

Speak to HDU ?inotropic support

102
Q

ALS Mx of Shockable Rhythms (VF or VT)?

A

Deliver 1 shock immediately, if witnessed on cardiac monitoring (e.g. on CCU) give up to 3 initial shocks
Deliver CPR for 2 mins before shocking again
After 3 shocks give 1mg adrenaline and 300mg amiodarone
Repeat 1mg adrenaline every 3-5 mins
After 5 shocks give 150mg amiodarone
If amiodarone is not available give lidocaine

103
Q

ALS Mx for Non-Shockable Rhythms (PEA and Asystole)?

A

1mg Adrenaline ASAP then continuous CPR
Repeat adrenaline 1mg every 3-5mins

Finals Revision (23 decks)

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