CARDIO Flashcards
1
Q
What does QRISK score evaluate
A
Predicts risk of CVD in upcoming 10 years
2
Q
What % occlusion is required for angina symptoms
A
70-80%
3
Q
1st and GS investigations for angina
A
ECG and CT angiography
4
Q
1st line pharmacological treatment for Angina
A
Calcium Channel blocker or Beta Blocker
5
Q
Percutaneous Coronary Intervention (PCI) vs Coronary Artery Bypass (CABG)
A
Balloon stent (PCI) is less invasive but risk of stenosis
Bypas graft better prognosis but more invasive
6
Q
ECG changes after MI
A
Hyper Acute T wave
Pathologically deep Q waves
LBBB
7
Q
Type 1 vs Type 2 MI
A
T1:- IHD
T2:- Increase demand or spasm
8
Q
NSTEMI vs STEMI ecg changes
A
NSTEMI;- ST depression, T wave inversion, no Q waves
STEMI:- ST elevation, pathological Q waves after time
9
Q
Treatment for MI
A
M:- morphine
O:- oxygen (if sats<94%)
N:- nitrogen
A:- Asprin 300mg
C:- Clopidrogrel 75mg
10
Q
When should you do thrombolysis before PCI with STEMI
A
If been more than 12hr
11
Q
Long term prevention of ACS
A
Beta-blocker, aspirin (initial loading dose of 300mg- 75mg), clopigdognel 75mg 12 months, atorvostatin, ACEi
12
Q
Acute complications of MI
(<2 weeks)
A
Mitral incompetence, LV free wall rupture, Cardiogenic shock
13
Q
Complication after 2 weeks for MI
A
Dressler syndrome (autoimmune pericarditis)
LV anyeurysm (heart becomes saggy)
14
Q
Male or Female higher risk for HF
A
Male
15
Q
NY Heart Association classes of Heart Failure
A
1:- No limit of physical activity
2:- Slight limit of phsical activity
3:- Marked limit on moderate/ gentle activity
4:- Symptoms at rest
16
Q
What do you expect to see on CXR on someone with heart failure
A
ABCDE:-
Alveolar Bat wing oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Pleural Efuusion
17
Q
Pharmacological treatment for hf
A
ABAL:-
ACEi
Beta Blocker
Aldosterone antagonist (Spironolactone)
Loop Diuretic (Furosemide)
18
Q
Size requirement to be an abdominal aortic anyreusm
A
50% increase/ >3cm
19
Q
Are AAA’s typically infrarenl or suprarenal
A
Infrarenal
20
Q
Which layers affected in tru AAA
A
All 3 arterial layers
21
Q
At what size does rupture risk massivley increase
A
> 5.5cm
22
Q
Where does pain radiate to in AAA
A
Epigastric to flank
23
Q
Most common sites for aortic dissection
A
1:- Sinotublar junction
2:- Just distal to left subclavian artery
24
Q
What is the standard Classification of AD
A
A= Proximal to LSC artery 66%
B= Distal to LSC artery 33%
25
What does CXR show in AD
Widened mediastinum >8cm
26
Pharmacological treatment for AD
Special Beta Blocker, esmolol and labetolol
27
Htn treatment 1st line
<55 or T2DM:- ACEi (if CI ARB)
>55 or black African (CCB)
28
2nd+ line treatment htn
ACEi + CCB
ACEi + CCB + Thiazide like diuretic
29
Virchows trad component
Venous Stasis
Hypercoagulability
Endothelial Injury
30
Wells DVT score
<1 on dimer not raised means no DVT
>1 Duplex ultrasound Diagnostic
31
What is peripheral vascular disease
Essentially IHD of lower limb vessels
32
Six Ps of Acute limb ischemia
Pulslessness
Pallor
Pain
Perishingly cold
Paralysis
Parathesia
33
What is ABPI
Ankle-brachial pressure index, used in diagnossis of PVD <0.9
34
What does a ABPI of <0.5 mean
Chronic limb ischemia
35
Treatment for intermittent claudication PVD
Risk factor management
36
Treatment for Chronic limb ischemia
PCI/ bypass
37
Treatment for Acute limb-threatening ischemia
Revascularisation within 4-6 hours
38
Complications of PVD
Amputation, permanent limb weakness, Rhabdomydysis (CA2+ and K+ released into blood)
39
Most common cause of pericarditis
1:- Viral
2:- Autoimmune (SLE, Sjordens)
40
Symptoms/ signs of pericarditis
Sharp chest pain
Worse lying down or on inspiration
Pain radiates to left shoulder( trapiziues ridge) due to irritation of phrenic nerve
Pericardial friction rub on auscaliation
Raised ESR in autimmune
Raised WCC in infective
41
ECG showings of pericarditis
Saddle ST elevation
Pr depression
42
Treatment for idiopathic or viral pericarditis
NSAIDS(2 weeks) + Colchicine (3 weeks)
43
Treatment for IE with Staph Aureas
Vancomycin + rifampicin
44
Treatment for IE with Strep Viridans
Benzylpenicillin + Gentamicin
45
Best way to hear right-sided vs left-sided heart murmers
RILE
Right side on Inspiraton
Left on expiration
46
Causes of mitral stenosis
Rheumatic heart disease, valve calcification, IE
47
Symptoms of mitral stenosis, including murmur sound
Malar cheek flush, Low pitched mid-diastolic murmur (loudest at apex) loud s1 Snap due to thinkend valve cups.
48
Causes of mitral regurgitation
Myxomatous mitral valve
49
Risk factor for mitral regurgitation
Female, old, low BMI, prior MI
50
Symptoms of aortic stenosis include murmur sound
SAD:- Syncope, Angina, Dyspnoea
Ejection systolic crescendo decrescendo, radiating to carotids.
Prominent S4
Narrow pulse pressure + slow rising pulse
51
Symptoms of mitral regurgitation including murmur sound
Exertion dyspnoea
Pan systolic blowing murmer radiating to axilla
52
Causes of aortic stenosis
Ageing calcification, congenital bicuspid valve (normally tricuspid)
53
Causes of aortic stenosis
Congenital bicuspid valve, RHD,
54
Symptoms of aortic regurgitation include murmur sound
Early diastolic blowing murmur @ right sternal border second intercostal space.
Austin flat murmur in severe
Collapsing orrigan pulse
55
What makes atrial fibrillation unstable
Syncope, shock, chest pain, heart failure
56
Treatment for unstable atrial fibrillation and AF
DC synchronised cardioversion
57
Pharmacological Treatment for stable atrial fibrillation and AF
Beta blocker or CCB + oral anticoagulant
58
Surgical treatment for stable atrial fibrillatio And AF
Radiofrequency ablation
59
What does the CHA2D2-VASc score predict
Stroke risk IF 1< oral anticoagulant needed
60
What does HASBLED score predict
Risk of major bleeds in patients with af on anticoagulant
61
What electrolyte imbalances can cause long QT syndrome?
Hypocalcemia and hypokalemia
62
What is Torsades De Pointes
A ventricular tachycardia in patients with long QT syndrome. QRS complex 'twists' around the baseline
63
Main Cause of RBBB
Pulmonary embolism
64
Main cause of LBBB
Ischemic heart diseases
65
In hypertrophic cardiomyopathy, what is the inheritance pattern and what does the mutation affect
Autosomal dominant mutation of sarcomere proteins
66
Is diastolic or systolic function more affected in hypertrophic cardiomyopathy
Dyostolic filling, reduced cardiac output
67
What is the most common cardiomyopathy
Dilated cardiomyopathy
68
Gold Standard investigation for caridomyopahty
Echocardiogram
69
Treatment for hypertrophic cardiomyopathy
Beta-blocker, calcium channel blocker, amiodarone
70
What is the inheritance pattern for dilated cardiomyopathy
Autosomal Dominant. (Cytoskeleton gene mutation)
71
Other than inheritance, what is another cause for dilated cardiomyopathy
IHD, Alcohol
72
Treatment for dilated cardiomyopathy
Treat underlying causes
73
List 3 causes for restrictive cardiomyopathy
Granulomatous disease (sarcoidosis, amyloidosis) idiopathic, past MI (fibrotic)
74
Is the pulse pressure in restrictive CO narrow or wide
Narrow, 105/95
75
Treatment for RCO
Not really any other than possible transplant, typically die within 1 year
76
What is cardiogenic shock
Heart pump failure leading to hypoperfusion of tissues and organs
77
What is hypovolemic shock
Venous return failure reduces preload and thus hypoperfusion
78
What is distributive shock
An issue with arterial supply to tissues leading to hypoperfusion
79
Symptoms of hypovolemic shock
Headache
Chest pain
Dizzinies
Nausea
Shallow breathing
Blue lips/ fingernails
Abdominal swelling
80
What is neurogenic shock
When blood is unevenly distributed throughout body due to CNS injury
81
What is the treatment for neurogenic shock
Imobilse patient to prevent further injury, IV fluids and medications to increase blood pressure
82
Symptoms of cardiogenic shock
Chest pain, Shoulder pain, SOB, Pain along jawline, Lightheadedness, Nausea
83
Treatment for neurogenic shcok
ABCDE+ IV Atropine
84
What are the key organs at risk from shock
Kidney, Lung, Heart, Brain
85
What is rheumatic fever usually caused by
Post strep pyogenes infection (Group A B haemolytic strep) Pharyngitis. Almost exclusively developing countries
86
What % of cases of Rheumatic Fever affect the heart
50%
87
Explain the pathophysiology of rheumatic fever affecting the heart
M protein from s. pyogenes reacts with valve tissue of the heart, antibodies vs this crosslink results inauto antibody mediated destruction/ inflmation. Mainly affects mitral valve
88
Clinical features of Rheumatic fever
New murmur (mitral stenosis), Sydenham's chorea, arthritis, erythema nodosum, pyrexia
89
GS investigation for RF
Echo
90
What is the Jones criteria
For RF, Recent pyogenes infection + 2 major or 1 major 2 minor symptoms.
91
What is the treatment for RF
ABx, IV Benzylpenicillin
Haloperidol for Syndenhams chorea
92
What are the 4 defects in Tetralogy of Fallot
Pulmonary stenosis. Ventricular septal defect, Overriding Aorta, Right Ventricular Hypertrophy
93
How does the hear with tetralogy of fallot look like on CXR
Boot shaped
94
Treatment for Tetralogy of Fallot
Full surgical repair within 2y of life
95
What is Coarctation of Aorta
Aorta narrows just distal to ductus arteriosis
96
Is upper or lower bodily more perfused in Coarction of Aorta
Upper body due to blood diverted through aortic arch branches
97
What are the signs of coarctation of the aorta
Scapular bruits, upper body hypertension
98
What is the treatment for coarctation of the aorta
Surgical repair or stenting
99
What is another type of angina that's not stable or unstable
Prinzmetals
Coronary vasospasm seen in cocaine users
100
What ECG change is seen in Prinzmetals angina
ST elevation
101
1st line investigation for stable angina
ECG
102
GS investigation for stable angina
CT angiography
103
What is the GRACE score
Predicts mortality from MI in next 6months-3 years in patients with ACS
104
What chemokines are present in the formation of atherosclerotic plaque when endothelial injury
IL1, IL6, IFN-gama
105
Why are diabetics major culprits of silent MIs
Cause diabetic neuropathy; don't feel pain
106
What organisms usually cause cellulitis
Staph aureus
Strep pyogenes
107
What is becks traid
In cardiac tamponade; Hypotnesion, raised JVP, muffled s1+s2 heart
108
What is pulsus paradoxus
Fall in systolic BP of more than 10mmg on inspiration. Good indicator of cardiac tamponade
109
What does ECG show in pericardial effusion
Electrical alternans; varying QRS amplitudes due to the heart bouncing back + forth in pericardial fluid
110
What is the treatment for cardiac tamponade
Urgent pericardiocentesis
111
What are 3 types of atrial fibrillation
Paroxysmal (episodic)
Persistent (longer than 7 days)
Permanent
112
ECG seen in atrial fibrillation
Iregullay irregular pulse with narrow QRS
No p waves
113
What score on HASBLED requires regular reviews
3 or more`
114
What score on CHA2DS2-VASc score requires oral anticoagulant
2 or more
115
What ECG changes seen in wolf-parkinson white syndrome
Slurred delta waves
Short PR interval
Wide QRS
116
1st line treatment for wolf parkinson white syndrome
Valsava manoeuvre
117
2nd line treatment for Wolf Parkinson white syndrome
IV adenosine (6mg first then 12mg if unsuccessful)
118
SE of adenosine
Sens of impending doom need to warn patient
119
Last treatment for wolf parkinson white syndrome
Radiofrequency ablation
120
What can cause long QT syndrome
Romano ward syndrome
Jerrell-large syndrome
Hypokalmeia+ hypocalcemia
Drugs
121
What inheritance pattern is Romano Ward syndrome
Autosomal dominant
122
What inheritance pattern is Jerrell-large syndrome
Autosomal recessive
123
What is 1st line treatment for ventricular fibrillation
Electrical defibrillation (non synchronised)
124
What drugs can lead to primary+ secondary heart block
Beta-blocker, CCB, digoxin
125
In which location can an MI cause secondary heart block
Inferior MI
126
What can cause Mobitz type 2 other than drugs and Inferior MI
Rheumatic fever
127
What is treatment for 3rd-degree heart block
IV atropine + permanent pacemaker
128
What happens to S2 heart sound in RBBB and LBBB
RBBB; wide physiological splitting
LBBB; Reversed s2 splitting
129
What is Eisenmenger syndrome
In atrial or ventricular septal defect when Pul Hypertension causes blood to be shunted from Right to left instead of left to right so deoxygenated blood gets pumped around the body
130
What murmur heard in the ventricular septal defect
Harsh pan systolic murmur
131
What septal defect is associated with downs
Atrioventricular
132
How would you describe murmur in patent ductus arteriosus
Machine like murmur
133
What pharmacological treatment can help close a patent ductus arteriosus
Prostaglandin inhibitor
