Cardio Flashcards
1
Q
Raised JVP, PR depression and ST elevation suggests..
A
pericarditis
2
Q
a pansystolic murmur is affecting the ____ or _____ valves?
if the lungs are clear where must the problem be?
A
mitral or tricuspid
clear lungs - must be tricuspid
3
Q
the left coronary artery divides into which two arteries?
A
left anterior descending
circumflex
4
Q
what area of the heart does the circumflex artery supply?
A
lateral
left atrium
posterior left ventricle
5
Q
what parts of the heart does the left anterior descending artery supply?
A
anterior
anterior left ventricle
anterior septum
6
Q
what parts of the heart does the right coronary artery supply?
A
posterior
right atrium and ventricle
inferior left ventricle
posterior septum
7
Q
symptoms of a heart attack?
A
central crushing chest pain radiating to jaw/arms palpitations sweating nausea anxiety / feeling of impending doom
8
Q
ST elevation or _______ is classsified as a STEMI
A
new left bundle branch block
9
Q
ECG changes seen in an NSTEMI?
A
ST depression
Deep T wave inversion
pathological Q wave
10
Q
troponin is a non specific marker. give 2 situations other than MI when it might be raised:
A
Chronic renal failure Sepsis Myocarditis Aortic dissection Pulmonary embolism
11
Q
2 acute treatment for STEMI?
A
primary PCI if within 2 hrs
thrombolysis if after 2hrs
12
Q
how does alteplase work?
A
it is a fibrinolytic
13
Q
treatment of an NSTEMI?
A
B – Beta-blockers unless contraindicated
A – Aspirin 300mg stat dose
T – Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative if higher bleeding risk)
M – Morphine titrated to control pain
A – Anticoagulant: Fondaparinux (unless high bleeding risk)
N – Nitrates (e.g. GTN) to relieve coronary artery spasm
14
Q
what score is used in NSTEMI to assess whether you need to do PCI?
A
GRACE
if more than 5% / medium risk, do it
15
Q
presentation of dresslers syndrome?
A
2-3 weeks after MI
pericarditis
pericardial rub
pleuritic chest pain
ECG shows global ST elevation and T wave inversion
16
Q
treatment for dresslers sydndrome?
A
aspirin
prednisolone
pericardiocentesis
17
Q
what ECG change in 1st degree heart block?
A
PR interval is longer than 0.2 seconds
18
Q
If the QRS waves do not always follow P but the PR interval is constant what is this?
A
2nd degree heart block
19
Q
define 3rd degree heart block?
A
P waves unrelated to QRS
20
Q
what causes Prinzmetals angina and how does it present?
A
coronary artery spasm
presents w sudden cardiac pain at rest
21
Q
treatment/management of prinzmetals angina?
A
avoid triggers eg smoking, cocaine, hypomagnesium calcium channel blockers (amlodipine) long acting nitrates (ivabradine) GTN avoid beta blockers and aspirin
22
Q
angina is a mismatch of oxygen demand and supply. give 4 situations when demand is increased?
A
exercise stress cold hyperthyroid hypertrophy hyper or hypo volaemia tachycardia eating anaemia
23
Q
gold standard investigation for angina?
A
CT coronary angiography
24
Q
side effect of GTN?
A
headache
25
1st line prophylactic treatment for angina?
atenolol / propanolol
| verapamil
26
what is 'dual antiplatelet therapy'?
aspirin
| P2Y12 inhibitor eg ticagrelor, clopidogrel
27
what are the two categories of heart failure?
- reduced ejection fraction (systolic failure) - problem with muscle contraction
- without reduced ejection fraction (diastolic failure) - problem with filling, poor compliance
28
5 aetiology of heart failure?
```
ischaemic heart disease
hypertension
alcohol
cardiomyopathy
valve disease
endocarditis
pericarditis
respiratory disease
drugs that cause arrythmias
```
29
what happens in the 'transition to failure' when heart failure is developing?
poor CO = low bp
vasopressin -- renin -- vasoconstriction -- hypertension
sodium and fluid retention, because of vasopressin/renin
endothelin released from damaged vessels
= aldsosterone
= sympathetic activation
= apoptosis of myocytes
left sided failure -- fluid backs up -- right sided failur
30
clinical presentation of heart failure?
```
breathless esp when lying
tired
oedema esp legs
cold peripheries
hepatomegaly
ascites
```
tachycardia
displaced apex beat
raised JVP
murmur
31
3 investigations you might do in ?heart failure?
NT - pro - BNP will be raised
Echo - ejection fraction
ECG shows AF
CXR shows pulmonary congestion
32
what are the 4 severity classes for heart failure?
1 - asymptomatic
2- slight limitation to exercise
3 - severe limitation to exercise
4 - symptoms at rest
33
what does the ejection fraction need to be to be HFREJ?
40% or less
34
what is the 1st, 2nd and 3rd line treatment for heart failure with reduced EF?
1st line = ace inhib (or arb) + beta blocker
eg ramipril + bisoprolol
2nd line = swab arb/acei for hydralazine or add spironolactone
3rd line = consider valsartan sacubitril / digoxin / amiodarone
35
what does ivabradine do?
acts at the SAN to decrease heart rate
| sometimes used for heart failure
36
for heart failure with preserved ejection fraction what is first line?
diuretic
37
5 risk factors for hypertension?
```
CKD
male
age
family history
increased sympathetic nervous system activity
smoking
salt
obesity
alcohol
sedentary lifestyle
```
38
4 causes of secondary hypertension?
Pregnancy
Endocrine (hyperaldosteronsim, cushigs)
Renal impairment
Medication - steroids, antipsychotics, contraceptives
39
at what BP is hypertension diagnosed?
140/90
40
what is stage 2 and stage 3 hypertension?
```
1 = 140/90
2 = 160/100
3 = 180/120
```
41
what BP do you aim for when you have treated it?
140/90 for under 80
130/90 if high risk eg CKD, DM
150/90 if 80 +
42
first line antihypertensive for caucasian under 65?
ACEi eg -pril
43
first line antihypertensive for 65+ or afro-carribean?
calcium channel blocker eg amlodipine
44
what is malignant hypertension?
180/120 +
risk of immediate end organ damage
emergency
45
what two substances build up as a result of anaerobic metabolism, causing pain?
lactic acid
| potassium
46
apart from pain, give 3 presentations of intermittent claudication?
thin shiny skin
ulceration
temperature difference
hair loss
47
most common cause of pericarditis?
```
viral
coxsackie
HHV8
EBV
CMV
```
48
IVDU commonly get infective endocarditis from which bacteria?
staph epidermidis
49
rheumatic fever is caused by what bacteria/illnesses?
group A strep
strep throat
scarlet fever
50
staph aureus pericarditis usually affects who?
immunocompromised
51
3 non infective causes of pericarditis?
```
dresslers
sjoren/RA
uraemia
hypothyroid
aortic dissection
chronic heart failure
amyloidosis
```
52
what is tamponade?
a pericardial effusion that is large enough to affect the beating of the heart
53
what is constrictive pericarditis?
develops from chronic pericardial effusion -- fibrosis -- heart hasnt got room to beat
54
what is the pain like in pericarditis?
```
severe, sharp (not crushing)
pleuritic
worse when lying
best when sitting forward
rapid onset
left of chest -- upper epigastric//shoulder
```
55
apart from pain 3 symptoms of pericarditis?
```
breathlessness
cough
hiccups
fever
tachycardia
```
56
in pericarditis what can you hear with the stethoscope?
pericardial rub
| on left of sternum with the bell
57
what 3 things comprise Becks triad and what does it indicate?
hypotension
quiet heart sounds
distended jugular veins
cardiac tamponade
58
to be diagnosed with pericarditis you need 2 of what 4 features?
Chest pain
ECG changes
Pericardial rub
Pericardial effusion
59
On the ECG what do you see in pericarditis?
ST elevation, saddle shaped
PR depression
high J point
symmetrical but strange T wave
60
in pericarditis what will you see on the echo?
pulsus paradoxus
| effusion
61
treatment for pericarditis?
```
colchicine
IV abx
rest
may need to raise heart rate
pericardiocentesis
```
62
which valve disease is most common?
aortic stenosis
63
two things that can cause all valve diseases?
infective endocarditis
| rheumatic fever
64
wide pulse is most commonly associated with which valve disease?
aortic regurg
high at first bc LV very full and need high pressure to expell all blood
low at end bc all the blood has fallen down back into LV
65
aortic regurg and mitral stenosis both produce diastolic murmurs but what is the difference in the murmur?
aortic regurg - 'blowing' murmur at Erb's point when pt is leaning forward
Mitral stenosis - low pitched murmur at the apex when pt is on their side
They are different because in aortic regug the blood is moving backwards whereas in mitral stenosis the blood is moving forward but slowly
66
in which valve disease are you most likely to see mitral facies & what are they?
pink-purple patches on the cheeks
mitral stenosis
because this causes the worst pulmonary hypertension
67
how do you treat mitral stenosis?
beta blockers/digoxin/amiodarone to slow the heart
diuretics
balloon valvectomy or replacement
68
3 risk factors for infective endocarditis?
```
abnormal valves
prosthetic valve
IVDU
recent surgery esp heart
rheumatic fever
septal defect
```
69
presentation of infective endocarditis?
```
new murmur
embolic
fever
sepsis
arrythmia
heart failure
```
petechiae
splinter haemorrhage
oslers nodes
janeway lesions
roth spots on fundoscopy
70
what classifying system is used for the likelihood of infective endocarditis?
Dukes
| need 2 major + 1 minor or 1 major + 3 minor
71
2 things that are in the major Dukes category for infective endocarditis?
pathogen isolated on blood culture
evidence on echo
new valve leak
72
what are 3 examples of minor Dukes criteria?
```
IVDU
prosthetic valve
fever
embolic event
immune response
equivocal blood culture
```
73
2 types of echo, which is better?
transthoracic is safer
| transoesophageal is more invasive but cleaer
74
management of infective endocarditis?
IV abx for 6 weeks
75
what scoring system is used to calculate the risk of developing stroke from AF and what does the score mean about treatment?
```
CHAD2
Congestive heart failure
Hypertension
Age over 75
Diabetes
S2 - prev stroke or TIA - worth 2 points
```
score of 0 -- aspirin
score of 1 -- warfarin or aspirin
score of 2+ -- warfarin
76
if there is primary resistant hypertension, loin pain and haematuria what do you need to be considering?
polycystic kidney disease
77
what is Kussmauls sign?
increased jugular distention on inspiration
| constrictive pericarditis
78
aetiology of hypertrophic cardiomyopathy?
- primary (primary hypertrophic obstructive cardiomyopathy) - autosominal dominant inheritance eg of a faulty sarcomere gene
- secondary: in response to hypertension or valve defects
79
what do you see on ECG in hypertrophic cardiomyopathy?
large voltages
inverted T wave
arrythmia
may lead to ventricular tachycardia/VF
80
treatment for hypertrophic cardiomyopathy? 3
beta blocker or calcium channel blocker to decrease heart rate
amiodarone to stop arrythmia
anticoagulants to stop clotting especially if there is some AF
81
what is the presentation of dilated cardiomyopathy?
```
thin overstretched walls are rubbish at contraction so is similar to heart failure
arrythmia
fatigue
dyspnoea
tachycardia
```
82
what is Naxos disease?
A type of arrythmogenic cardiomyopathy caused by mutation in the genes that make the desmosome
83
presentation of arrythmogenic cardiomyopathy?
arrythmia
palpitation
syncope
heart failure like when sevvere
84
what is the ECG like in arrythmogenic cardiomyopathy?
epsilon waves
inverted T
wide QRS in V1-V3
85
give 2 types of shock caused by decreased cardiac output and what might cause them?
hypovolaemic - eg haemorrhage, burns, diarrhoea, vomiting
cardiogenic - eg MI, myocarditis
Obstructive - eg tamponade, tension pneumothorax
86
give 2 types of shock caused by decreased systemic vascular resistance?
septic
anaphylactic
neurogenic (eg spinal cord lesion that means the body loses its ability to control BP)
87
physiological changes in compensated vs decompensated shock?
compensated : increased heart rate, peripheral vasoconstriction and increased resp to maintain BP
decompensated: BP is not maintained and/or the body continues to lose blood and cannot maintain sufficient volume
88
5 presentations of shock (caused by decreased CO)?
```
hypoxia
tachycardia -- bradycardia as it becomes decompensated
Kussmaul breathing / increased resp
cold pale peripheries
decreased cap refill
hypotension
confusion
weak pulse
```
89
signs of anaphylactic/septic shock?
```
warm
flushed
pyrexia / rigors
vomitting
cyanosis
pulmonary oedema
wheeze (esp anaphylactic)
```
90
treatment of shock?
```
A - maintain airway eg intubate
B - give oxygen
C - raised legs, give fluid/blood
maintain heart rate
manage cause - abx / adrenaline / hydrocortisone
```
91
the 4 features of tetralogy of fallot?
```
right ventricular hypertrophy
over riding aorta
small pulmonary outflow tract
ventricular septal defect
(PASH - pulmonary aorta septum hypertrophy)
```
92
in tetralogy of fallot can you expect cyanosis?
yes
deoxygenated blood can get into the systemic circulation
because right ventricular hypertrophy and poor pulmonary outflow = higher pressure on the right than the left = blood moves right to left
'fallots spells' = periods of cyanosis, especially when crying etc
93
what is the treatment and long term prognosis of tetralogy of fallot?
surgical repair of septa defect
incise pulmonary valve -- pulm outflow tract will grow as it is used, no need fo r such hypertrophy of RV anymore, so aorta can move back over
at risk of pulmonary valve regurgitation or arrythmia later in life but generally life normally
94
in a ventricular septal defect would you expect cyanosis?
only in a large hole
in a small hole the blood will generally move from left (high pressure) to right (low pressure), all this means is that oxygenated blood goes back to the lungs unncessarily
when the hole is large lots of oxygenated blood goes to the lungs, this results in pulmonary hypertension and raises the pressure backing up into the right ventricle, one RV pressure is as high as LV, the blood will flow the opposite way (Eisenmenger) = cyanosis and v bad
95
prognosis/complications of a small VSD?
buzzing murmur
| increased risk of valve defects or infective endocarditis but generally fine
96
what is the plexiform reaction?
thickening, fibrosis, hypertrophy of pulmonary vessels in response to pulmonary hypertension
97
treatment options for a large ventricular septal defect?
patch the hole
| band the pulmonary artery to decrease the blood flow to the lungs
98
symptoms & investigation findings (inc a murmur!) of an atrial septal defect?
short of breath on exertion (lungs are full of blood that they have already oxygenated)
pulmonary flow murmur
CXR shows enlarged atria and pulmonary arteries
99
do you get cyanosis in atrial septal defect?
no, blood flows from left (higher pressure) to right (lower pressure). it would be very unusual for Eisenmengers to develop because the atria have much lower pressure altogether than the ventricles
100
what is co-arctation of the aorta? how might it present?
narrowing of the aorta
hypotension and formation of collateral vessels in lower body
hypertension in right arm not in left
radio-femoral delay
activation of RAAS and sympathetic systems
101
how can coarctation of the aorta be repaired? do you always have to repair them?
with a stent or subclavian flap
| you need to repair else can cause vascular fragility
102
what do you see in pulmonary stenosis?
RV hypertrophy
decreased pulmonary blood flow
tricuspid regurgitation
103
When is JVP raised?
pericarditis
right sided heart failure (not left).
-- right sided heart failure = blood cannot get out of the right side into lungs = blood builds up around body. increased systemic blood in veins = raised JVP
104
would you expect right or left sided heart failure to present with dyspnoea?
left sided
as blood builds up in the left side of the heart
so the blood cannot move from the lungs into the left and instead builds up in the left
105
NT-pro-BNP is a marker of heart failure but what is it and where does it come from?
brain natriuretic peptide
| released from the ventricles when they are stretched
106
5 signs of left heart failure of an x ray?
```
Alveolar oedema
B Kerley B lines (intersitial oedema)
Cardiomegaly
Dilated upper lobe vessels
E pleural Effusion
```
107
SOB thats worse on exertion or lying + coughing pink frothy sputum + fine crackles on ascultation could be?
left sided heart failure
108
2 times when you would get ST depression and 2 times when you would get ST elevation?
ST depression: NSTEMI, unstable angina
ST elevation: STEMI, pericarditis, prinzmetal angina
109
what is the difference physiologically between a STEMI and an NSTEMI?
NSTEMI: the infarction does not go all the way across the myocardium
110
definition of atherosclerosis?
Accumulation of lipids, macrophages, and smooth muscle cells in the intima of large and medium
sized arteries.
111
what valve do you hear best at the left 2nd intercostal space?
pulmonary
112
what valve do you hear best at the left 4th intercostal space on the sternal edge?
tricuspid
113
what valve do you hear best at the left 5th intercostal space on the midclavicular line?
mitral
114
what drug is NOT a good choice for coronary artery spasm?
beta blockers
115
an early diastolic decrescendo murmur indicates what?
aortic regurg
116
side effect of GTN?
headache
