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Finals > Cardio > Flashcards

Cardio Flashcards

1
Q

what is beck’s triad?

A
  • muffled/absent heart sounds
  • low systolic BP
  • distended neck veins

associated with cardiac tamponade

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2
Q

Which ECG leads represent the inferior aspect of the heart?

A

II, III and AVF

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3
Q

Which ECG leads represent the lateral aspect of the heart?

A

I, AVL, V5 and V6

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4
Q

Which ECG leads represent the anterior / septal aspect of the heart?

A

V1-V4 (V1-2 septal, V3-4 anterior)

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5
Q

Which ECG leads represent the anterolateral aspect of the heart?

A

I, avL, V3-6

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6
Q

The inferior part of the heart is supplied by?

A

right coronary artery

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7
Q

The lateral part of the heart is supplied by?

A

left circumflex

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8
Q

The septal/anterior part of the heart is supplied by?

A

left anterior descending / bundle branches

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9
Q

ECG finding for hypercalcaemia?

A

short QT interval

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10
Q

Hypertension <55Y or type 2 diabetic first line management?

A

ACE inhibitor e.g. ramipril
or
ARB (when ACE not tolerated) e.g. candesartan

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11
Q

Hypertension >/=55Y or black african / african Caribbean first line management?

A

Calcium channel blocker e.g. amlodipine

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12
Q

Second line for hypertension?

A

Add ACE/ARB or Calcium channel blocker depending on what patient is already taking
OR
thiazide-like diuretic e.g. indapamide

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13
Q

Third line for hypertension?

A

Dependant on patient already taking - add ACE/calcium channel blocker/thiazide diuretic - whatever patient is not yet taking.

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14
Q

Management of resistant hypertension if K+ <4.5mmol/l?

A

spironolactone

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15
Q

Management of resistant hypertension if K+ >4.5mmol/l?

A

alpha or beta blocker e.g. Bisoprolol

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16
Q

Which conditions must be met before you would cardiovert someone with AF?

A

patient must be anticoagulated
or
have symptoms <48h

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17
Q

First line drug for rate control of AF?

A

beta-blocker
or
rate -limiting calcium channel blocker e.g diltiazem

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18
Q

Which antibiotic would you avoid in long QT syndrome?

A

erythromycin

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19
Q

HOCM inheritence type?

A

autosomal dominant

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20
Q

Hypokalaemia ECG findings?

A

U waves
small/absent T waves
prolonged PR
ST depression
Long QT

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21
Q

angina (stable) management?

A
  1. Aspirin + statin + lifestyle modification
  2. sublingual GTN
  3. beta-blocker or calcium channel blocker (rate limiting such as verapamil/diltiazem)
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22
Q

1st line management of Heart failure with reduced ejection fraction?

A
  1. loop diuretics for symptomatic relief e.g. furosemide
  2. ACE inhibitor + beta-blocker (e.g. bisoprolol, carvedilol, and nebivolol)

NOTE: ARB can be used if ACE not tolerated.

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23
Q

2nd line management of heart failure with reduced ejection fraction?

A
  1. aldosterone antagonist (e.g. spironolactone and eplerenone)
  2. consider SGLT2 inhibitor (e.g. Dapagliflozin and empagliflozin)
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24
Q

ACE inhibitors + aldosterone antagonists - which adverse effect is important to consider?

A

hyperkalaemia (monitor K+)

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25
Q

Investigations for heart failure?

A

NT-proBNP
ECG
Echo

Consider CXR, Bloods, urinalysis, peak flow or spirometry

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26
Q

NT-proBNP cut offs and indications?

A

<400 ng/l - HF not confirmed, consider other causes

400-2000ng/l - refer to specialist services within 6 weeks

> 2000ng/l - refer urgently to be seen within 2 weeks

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27
Q

Which drug may be started if a patient has HF + AF?

A

Digoxin

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28
Q

which 3rd line option would you consider for patients with HF who are symptomatic on ACE/ARB?

A

sacubitril-valsartan

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29
Q

3rd line drug for HF for patients who are Afro-Caribbean?

A

Hydralazine in combination with nitrate

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30
Q

HF + widened QRS (e.g. LBBB) - what treatment would you consider?

A

cardiac resynchronisation therapy

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31
Q

3rd line HF - sinus rhythm >75bpm + left ventricular fraction <35% - which drug?

A

ivabradine

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32
Q

Most common cause of endocarditis?

A

staph aureus

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33
Q

most common cause of endocarditis if <2m post valve surgery?

A

staph epidermis

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34
Q

Endocarditis with poor dental hygiene/following a dental procedure?

A

staph viridans

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35
Q

AF pharmacological cardioversion drug options?

A

flecanide
amiodarone (indicated if structural heart disease)

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36
Q

Hyperkalcaemia ECG findings?

A

Tall-tented T waves
small P waves
widened QRS leading to a sinusoidal pattern and asystole

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37
Q

Hyperkalcaemia management?

A
  1. 10ml of 10% calcium gluconate (or chloride) over 10 mins
  2. Intravenous insulin (10U soluble insulin) in 25g glucose
  3. Nebulised salbutamol
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38
Q

investigations for aortic dissection?

A

CT angio - diagnostic

ECG
echo
CXR
Bloods - raised troponin + D-dimer

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39
Q

investigations for stable angina?

A
  1. CT coronary angiography - 1st line
  2. myocardial perfusion
  3. stress echo
  4. MRI
  5. coronary angiogram
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40
Q

management of SVT?

A
  1. vagal manoeuvre
  2. adenosine (6mg -> 12mg -> 18mg)
  3. electrical cardioversion
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41
Q

when is adenosine contraindicated + what would you use instead?

A

asthmatics - use verapamil instead

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42
Q

which drug should not be used in VT?

A

Verapamil - may cause severe hypotension, cardiac arrest and v fib

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43
Q

Differences in presentation in right sided HF vs left-sided HF?

A

right - raised JVP, peripheral oedema, hepatosplenomegaly and ascites.

left - SOB on exertion, paroxysmal nocturnal dyspnoea and orthopnoea.

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44
Q

ECG axis - lead I up, lead II up?

A

normal

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45
Q

ECG axis - lead I up, lead II down?

A

left axis deviation

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46
Q

ECG axis - lead I down, lead II up?

A

right axis deviation

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47
Q

Persistent ST elevation following recent MI, no chest pain = ?

A

left ventricular aneurysm

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48
Q

XRAY findings in heart failure?

A

Alveolar oedema (bat’s wings)
Kerley B lines (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)

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49
Q

ECG sign of cardiac tamponade?

A

electrical alternans

50
Q

Management of cardiac tamponade?

A

urgent pericardiocentesis

51
Q

How do you diagnose orthostatic hypotension?

A

when there is a drop in SBP of at least 20 mmHg and/or a drop in DBP of at least 10 mmHg after 3 minutes of standing

52
Q

Management of orthostatic hypotension?

A

midodrine or fludrocortisone

53
Q

secondary causes of hypertension (ROPE)?

A

renal - if non responsive to treatment then consider renal artery stenosis

Obesity

Pregnancy

Endocrine - consider hyperaldosteronism

54
Q

Investigations for diagnosis of hypertension?

A

two measured BP >140/90 + ambulatory BP monitoring or home blood pressure monitoring.

55
Q

What classification is used for heart failure and what are the stages?

A

New york heart association classification

class 1 - no limitations

class 2 - mild symptoms
slight limitation of physical activity

class 3 - moderate symptoms
marked limitation of physical activity - asymptomatic at rest

class 4 - severe symptoms
unable to carry out any physical activity without discomfort - symptomatic at rest

56
Q

Management of STEMI?

A
  1. aspirin 300mg
  2. establish if PCI available with 120mins

if YES then PCI (Prasugrel if not already on anti-coagulant or clopidogrel if on anticoagulant)

if NO then thrombolysis / fibrinolysis with alteplase + ticagleror

57
Q

Management of NSTEMI?

A
  1. aspirin 300mg
  2. offer antithrombin (Fondaparinux) unless bleeding risk or immediate PCI.
  3. assess GRACE 6-month mortality risk
    LOW risk (<3%) - ticagrelor + aspirin OR clopidogrel + aspirin if bleeding risk
    HIGH risk - PCI (+ prasugrel/ticagrelor or clopidogrel)
58
Q

What screening is available for AAA?

A

Single USS at age 65y

59
Q

What are the screening result principles for AAA?

A
  • Small AAA (3-4.4cm) – offered yearly repeat ultrasound
  • Medium AAA (4.5-5.4cm) – offered repeat ultrasound every 3 months
  • Large AAA (>5.5cm) – surgery generally recommended.
60
Q

What are the indications for repair of AAA?

A

Size >5.5cm or rapid expansion (increase in diameter >5mm over a 6 month period or >10mm over one year)

61
Q

Surgical repair options for AAA?

A

Open repair OR Endovascular Aneurysm repair (EVAR).

62
Q

Intracranial haemorrhage on warfarin management?

A

Give IV vitamin K 5mg + prothrombin complex concentrate

63
Q

Torsades de pointes management?

A

IV magnesium sulphate

64
Q

What is an aortic dissection?

A

a tear in the tunica intima of the aorta creates a false lumen whereby blood can flow between the inner and outer layers of the walls of the aorta.

65
Q

Risk factors for aortic dissection?

A

Hypertension
Connective tissue disease e.g. Marfan’s syndrome
Valvular heart disease
Cocaine/amphetamine use

66
Q

Difference between aortic dissection type A and B?

A

A - involves ascending aorta, arch of aorta
B - involves descending aorta

67
Q

‘tearing’ chest pain which radiates to the back = ?

A

aortic dissection

68
Q

Investigations for aortic dissection?

A

CT angiogram - Diagnostic

ECG - pericardial effusion and aortic valve involvement.
echo - pericardial effusion and aortic valve involvement.
CXR - widened mediastinum
bloods - troponin and d-dimer may be raised

69
Q

Management of aortic dissection?

A

Resus
cardiac monitoring
strict blood pressure control (IV metoprolol)

Type A - surgical e.g. aortic graft
Type B - conservative, if evidence of organ failure then repair

70
Q

QRISK score >10% = ?

A

statin e.g. atorvastatin

71
Q

tachyarrhythmia, a systolic BP < 90 mmHg → ?

A

DC cardioversion

72
Q

Which drug improves survival in chronic congestive heart failure?

A

ACE inhibitors

73
Q

Anterolateral MI - which artery?

A

left coronary

74
Q

Management for the different types of heart block?

A

type 1 - no treatment
type 2 mobitz I - no treatment
type 2 mobitz 2 - pacemaker
complete - pacemaker

75
Q

Management of haemodynamically unstable patient with fast AF?

A

immediate DC cardioversion

76
Q

Scoring system to decide if patient with AF needs anti-coagulation?

A

CHADS2VASc score:

C: 1 point for congestive cardiac failure.
H: 1 point for hypertension.
A2: 2 points if the patient is aged 75 or over.
D: 1 point if the patient has diabetes mellitus.
S2: 2 points if the patient has previously had a stroke or transient ischaemic attack (TIA).
V: 1 point if the patient has known vascular disease.
A: 1 point if the patient is aged 65-74.
Sc: 1 point if the patient is female.

77
Q

How do you interpret the CHADS2VASc score?

A

Males who score 1 or more or females who score 2 or more should be anticoagulated.

78
Q

rSR’ pattern in V1-3 (‘M’ shaped QRS complex) = ?

A

Right bundle branch block

79
Q

What would you see on ECG for right bundle branch block?

A
  • broad QRS > 120 ms
  • rSR’ pattern in V1-3 (‘M’ shaped QRS complex)
  • wide, slurred S wave in the lateral leads (aVL, V5-6)
80
Q

How do you differentiate between RBBB and LBBB?

A
  • LBBB there is a ‘W’ in V1 and a ‘M’ in V6
  • RBBB there is a ‘M’ in V1 and a ‘W’ in V6
81
Q

Causes of RBBB?

A
  • normal variant - more common with increasing age
  • right ventricular hypertrophy
  • chronically increased right ventricular pressure - e.g. cor pulmonale
  • PE
  • MI
  • atrial septal defect (ostium secundum)
  • cardiomyopathy or myocarditis
82
Q

Complete heart block following MI - which artery?

A

Right coronary artery lesion (supplied AV node in 90% of people)

83
Q

Familial hypercholesterolaemia inheritence type?

A

Autosomal dominant

84
Q

Which drugs for patient’s after MI (no AF)?

A

Aspirin 75mg
clopidogrel or ticagrelor

85
Q

Surgical management of unstable angina?

A

PCI
CABG

86
Q

NSTEMI ECG findings?

A

ST segment depression
T wave inversion

87
Q

STEMI ECG findings?

A

ST elevation
new LBBB

88
Q

What is troponin?

A

A protein found in cardiac muscle and skeletal muscle - a rise is consistent with myocardial ischaemia.

89
Q

What is cardiac tamponade?

A

The pericardial effusion large enough to raise the intra-pericardial pressure - This increased pressure squeezes the heart and affects its ability to function. It reduces heart filling during diastole, decreasing cardiac output during systole.

90
Q

Investigations for pericarditis?

A
  • raised inflammatory markers (WBC, CRP and ESR)
  • ECG - saddle-shaped ST-elevation, PR depression
91
Q

Management of pericarditis?

A

NSAIDs + Colchicine (3 month course to reduce risk of recurrence)

Steroids - 2nd line, in recurrent cases + associated with inflammatory conditions

92
Q

What is acute left ventricular failure?

A

when acute events result in the left ventricle being unable to move blood efficiently through the left side of the heart and into the circulation. This results in a backlog of blood and causes an increase in volume and pressure which results in pulmonary oedema.

93
Q

What can trigger acute left ventricular failure?

A

usually a result of Decompensated chronic heart failure

  • Iatrogenic (e.g., aggressive IV fluids in a frail elderly patient with impaired left ventricular function)
  • Myocardial infarction
  • Arrhythmias
  • Sepsis
  • Hypertensive emergency (acute, severe increase in blood pressure)
94
Q

Presentation of acute left ventricular failure?

A
  • Acute SOB - worse on lying flat / improves with sitting up
  • type 1 resp failure
  • cough with frothy white/pink sputum
  • reduced oxygen sats
  • 3rd heart sound
  • bilateral basal crackles
95
Q

How do you assess acute left ventricular failure?

A

ABCDE
ECG - ischaemia and arrhythmias
Bloods - anaemia, infection, kidney function, BNP, and consider troponin if suspecting myocardial infarction
Arterial blood gas (ABG)
Chest x-ray
Echocardiogram

96
Q

Management of acute left ventricular failure?

A

S - sit up
O - oxygen
D - diuretics
I - IV fluids should be stopped
U - underlying causes need to be identified and treated
M - monitor fluid balance

97
Q

Signs and symptoms of aortic stenosis?

A
  • ejection systolic, high pitched murmur (crescendo-decresendo character), radiates to carotids
  • thrill in aortic area
  • slow rising pulse
  • narrow pulse pressure
  • exertional syncope
98
Q

Causes of aortic stenosis?

A

Idiopathic age-related calcification (by far the most common cause)
Bicuspid aortic valve
Rheumatic heart disease

99
Q

Signs and symptoms of aortic regurgitation?

A
  • early diastolic, soft murmur
  • thrill in aortic area
  • collapsing pulse
  • wide pulse pressure
  • heart failure and pulmonary oedema
100
Q

Causes of aortic regurgitation?

A

Idiopathic age-related weakness
Bicuspid aortic valve
Connective tissue disorders, such as Ehlers-Danlos syndrome and Marfan syndrome

101
Q

Signs and symptoms of mitral stenosis?

A
  • mid-diastolic, low pitched ‘rumbling’ murmur
  • loud S1
  • opening snap after S2
  • tapping apex beat
  • malar flush - due to rise in CO2
  • AF
102
Q

Causes of mitral stenosis?

A

Rheumatic heart disease
Infective endocarditis

103
Q

Signs and symptoms of mitral regurgitation?

A
  • can cause congestive HF
  • pan-systolic, high pitched ‘whistling’ murmur
  • murmur radiates to left axilla
  • 3rd heart sound
  • thrill in mitral area
  • signs of HF and pulmonary oedema
  • AF
104
Q

Causes of mitral regurgitation?

A

Idiopathic weakening of the valve with age
Ischaemic heart disease
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome

105
Q

Signs and symptoms of tricuspid regurgitation?

A
  • pan-systolic murmur
  • split 2nd heart sound
  • thrill in tricuspid area
  • raised JVPA
  • pulsatile liver
  • peripheral oedema
  • ascites
106
Q

Causes of tricuspid regurgitation?

A
  • Pressure due to left-sided heart failure or pulmonary hypertension (“functional”)
    -Infective endocarditis
    -Rheumatic heart disease
    -Carcinoid syndrome
    -Ebstein’s anomaly
    -Connective tissue disorders, such as Marfan syndrome
107
Q

Signs and symptoms of pulmonary stenosis?

A
  • ejection systolic murmur loudest in pulmonary area in expiration
  • widely split 2nd heart sound
  • thrill
  • raised JVP
  • peripheral oedema
  • ascites
108
Q

Causes of pulmonary stenosis?

A

Usually congenital -
- Noonan syndrome
- Tetralogy of Fallot

109
Q

What does tetralogy of fallot consist of?

A

Ventricular septal defect (VSD)
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

110
Q

Most common cause of endocarditis?

A

Staphylococcus aureus

111
Q

Signs and symptoms of infective endocarditis?

A
  • fever
  • fatigue
  • night sweats
  • muscle aches
  • anorexia
  • new/changing heart murmur
  • hand signs - splinter haemorrhages, Janeway lesions, osler’s nodes
  • petechiae
  • roth spots (haemorrhages on retina)
112
Q

Investigations for infective endocarditis?

A
  • blood cultures (before antibiotics) - 3 samples, usually separated by 6 hours and taken from different sites.
  • Echo - TOE is more sensitive/specific than transthoratic but transthoratic is 1st line.
113
Q

Which criteria is used to diagnose infective endocarditis?

A

Modified Duke criteria

A diagnoses requires either:
- 1 major + 3 minor
- 5 minor

Major - +ve blood cultures, specific imaging findings
Minor - predisposition, fever >38, vascular phenomena, immunological phenomena, microbiological phenomena

114
Q

Management of infective endocarditis?

A

Admission

IV broad-spectrum antibiotics (usually amoxicillin + gentamicin) - then change antibiotics depending on causative bacteria

Surgical repair

115
Q

Indications for surgical repair in infective endocarditis?

A
  • severe valvular incompetence
  • aortic abscess (often indicated by a lengthening PR interval)
  • infections resistant to antibiotics/fungal infections
  • cardiac failure refractory to standard medical treatment
  • recurrent emboli after antibiotic therapy
116
Q

what are the components of the CHA2DS2-VASc score?

A

1 point for:
Congestive heart failure
Hypertension (controlled or uncontrolled)
Age of 65-74 years
Diabetes
Vascular disease
Female sex

2 points for:
An age of 75 years or over
Prior stroke or thromboembolism.

117
Q

ST depression in leads V1,V2,V3 and tall R waves in V1 and V2 = ?

A

Posterior myocardial infarction

118
Q

Critical vs acute limb ischaemia?

A

Critical limb ischaemia - pain at rest for greater than 2 weeks, often at night, not helped by analgesia

acute - ‘6 P’s’ (pale, pulseless, pain, paralysis, paraesthesia, perishingly cold)

119
Q

widespread systolic murmur + hypotension + pulmonary oedema post STEMI - likely diagnosis?

A

acute mitral regurgitation due to papillary muscle rupture

120
Q

Which drugs should patients with peripheral arterial disease be taking?

A

Statin + anti-platelet (e.g. clopidogrel)

Finals (18 decks)

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