cardio Flashcards
treatment for acute MI?
MONA: morphine, O2 (if sats are <94%), nitrates, aspirin
pharmacology of spironolactone?
inhibition of aldosterone receptor at K+/Na+ channel in the distal tubules
list some risk factors for hypertension
High caffeine consumption, Sedentary lifestyle, Smoking, Type A personality, alcohol, family history, increasing age
presentations of mitral regurgitation?
SOB, fatigue, pan-systolic high-pitched “whistling” murmur at apex, may radiate to left axilla
presentations of aortic stenosis?
syncope, angina, ejection systolic murmur
presentations of aortic regurgitation?
syncope, angina, early diastolic / austin flint murmur
presentations of mitral stenosis?
SOB, fatigue, low pitched, “rumbling” mid-diastolic murmur
MI ECG changes?
ST elevation, T wave inversion, abnormal Q wave
what underlying heart condition can predispose you to strokes?
atrial fibrillation
what framework determines heart attack risk in those with hypertension?
QRISK2 score
describe the correct order for the electrical conduction of the heart?
SA node -> atria -> AV node -> bundle of His -> Purkinje fibres -> L and R bundle branches -> ventricles
explain the pathophysiology of aortic stenosis
coarctation (narrowing) of the aortic valve typically either due to calcification or bicuspid valve
XR for mitral stenosis?
enlarged left and right atriums
List some clinical signs you might find on examination or on a chest X-ray in heart failure
ABCDE:
- Alveolar oedema
- kerley B lines
- Cardiomegaly
- Dilation of the upper lobe vessels
- pleural Effusion
What marker might you find in blood that could be indicative of heart failure?
BNP
List 3 investigations that you would want to do for initial investigations of infective endocarditis
blood cultures, echocardiogram, ECG, FBC (anaemia), urinalysis
Define atherosclerosis
build up of lipids, macrophages and smooth muscle cells in the intima of arteries
Other than chest pain, name 4 other symptoms or signs you may find on the history or examination in a STEMI
sweating, hypotension, N/V, dizziness, SOB, anxiety, palpitations, pallor
Name the 4 cardiac defects involved in Tetralogy of Fallot.
ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta
what does 1st degree HB show?
prolonged PR interval
what does 2nd degree type I (Mobitz I or Wenckebach) show?
progressive prolongation of the PR interval followed by a dropped QRS complex
what does 2nd degree type II (Mobitz II) show?
intermittent non-conducted P waves without progressive PR prolongation
what does 3rd degree HB show?
absence of AV conduction; no association between P waves and QRS complexes
define thrombosis
formation of a blood clot inside a blood vessel which obstructs flow
define embolism
blocked vessel caused by a foreign body e.g. blood clot or air bubble
define infarction
death of cells due to a reduced or absent blood supply
define ischaemia
restriction in blood supply to tissues causing a shortage of oxygen that is needed for cell function
give 4 functions of the RAAS system
- increased sympathetic activity and arteriolar vasoconstriction therefore increases HR/BP
- increased tubular reabsorption of Na and Cl and K+ excretion
- increased aldosterone secretion resulting in Na reabsorption in DCT
- ADH secretion leading to H2O reabsorption
- overall: salt and water retention and an increase in BP
what is the difference between essential and secondary hypertension?
Essential hypertension occurs independent of any identifiable cause, secondary hypertension occurs as a result of an identifiable cause
state 4 causes of secondary hypertension
renal artery stenosis, chronic renal disease, primary hyperaldosteronism, stress
which part of the heart is likely to be affected if there is ST elevation in leads V3 and V4?
anterior
abnormalities in leads II, III, and aVF - Which coronary artery is most likely to be implicated?
right coronary
what is the treatment given post MI?
ACEi, dual antiplatelet therapy e.g. clopidogrel and aspirin/BBlocker, statin
what is given as acute management for supraventricular tachycardia?
valsalvar manoeuvre - nose and mouth is held during forceful expiration to stimulate the vagus nerve to return the heart into sinus rhythm
Which tool assesses starting anticoagulation in patients with stroke risk due to atrial fibrillation?
CHA2DS2-VASc
first line test for heart failure?
BNP
What is the most appropriate diagnostic investigation for aortic stenosis?
echocardiogram
define unstable angina
incomplete coronary artery occlusion usually by a thrombus, e.g. atherosclerotic plaque has ruptured which causes a clot to form and occlude the artery.
4 signs if infective endocarditis?
janeway lesions, roth spots, splinter haemorrhages, osler nodes
define cardiac tamponade
Accumulation of a large amount of fluid in the pericardial cavity that compresses the heart and reduces cardiac function
would you see ascites in left sided heart failure?
no
Which ECG abnormality is most associated with Wolff-parkinson-white syndrome?
delta wave
what is the ductus arteriosus?
a vessel that connects the pulmonary arteries to the aorta in the fetus allowing oxygenated maternal blood to bypass the lungs
state some signs of Dressler’s syndrome
- central chest pain worse on breathing in or lying flat, relieved by leaning forward
- fever
- friction rub heard on auscultation
what is Dressler’s syndrome
- also known as postmyocardial infarction syndrome
- a form of secondary pericarditis with or without pericardial effusion that occurs as a result of injury to the heart or pericardium.
where do roth spots typically occur?
eye
state some signs of right sided HF
raised JVP, pitting oedema, ascites
first line investigation for stable angina?
CT coronary angiography
what is treatment for stable angina?
- GTN spray for acute attacks
- beta blocker e.g. bisoprolol OR cardioselective CCB e.g. verapamil for long term prevention
second line treatment for angina?
beta blocker + non-cardioselective CCB e.g. nifedipine
why can you not combine a beta blocker with a cardioselective CCB?
risk of asystole
what is the first line treatment in heart failure with reduced ejection fraction?
ACE-i and beta blocker
what is the second line treatment in heart failure with reduced ejection fraction?
addition of spironolactone to ACE-i and beta blocker
what is the first line treatment for hypertension in those with type 2 diabetes?
always an ACE-i
what is the first line medication given to those with a fib to prevent a stroke?
DOAC or warfarin
-> warfarin is better if any previous valve surgery
treatment of pericarditis?
NSAIDs + colchicine
what does TIMI stand for?
thrombosis in myocardial infarction
A common cause of MI is coronary artery disease, what causes this?
The coronary arteries get blocked by plaque build-up / deposits of cholesterol
What does the ST elevation indicate?
complete blockage of coronary artery
How does MI lead to contracted scar formation of the heart?
Death of heart muscle cells occur due to lack of oxygen, this leads to necrosis. This happens over about 2 weeks with a scar forming due to formation of granulation tissue
Name 2 risk factors for developing Mitral Valve Stenosis
- Rheumatic fever
- Untreated streptococcus infections
- increasing age
Name 1 class of drug used to manage Mitral Valve Stenosis and give 1 example
- Beta Blockers + example: e.g. bisoprolol/ propranolol etc.
- Diuretics + example: e.g. Furosemide (Salt + loop diuretic) / Bendroflumethiazide (thiazide diuretic) etc.
Name 2 surgical interventions that can be used to treat Mitral Valve Stenosis
- Percutaneous mitral balloon valvotomy
- Mitral valve replacement
What cardiac arrhythmia is often associated with Mitral Valve Stenosis?
a fib
Give 2 investigations the GP might request for HTN, and the relevant features of them that indicate it.
- Urinalysis: protein/albumin:creatinine ratio/haematuria
- Blood tests, serum creatinine/eGFR
- Fundoscopy/ophthalmoscopy, retinal haemorrhage/papilloedema
- ECG/Echocardiography: left ventricular hypertrophy
How might the size of a kidney change with hypertension?
reduced size
What class of drug is used to treat Infective Endocarditis and how long is this treatment given for?
antibiotics for 4-6 weeks
what does the CHADS VASc score stand for?
- Congestive Heart Failure
- Hypertension
- Age (75+=2)
- Diabetes
- Stroke/ TIA/ Thromboembolism
- Vascular disease
- Age (65-74)
- Sex category (female=1)
what are the 3 cardinal signs of HF?
SOB, fatigue, ankle oedema
first line management for acute coronary syndrome?
fibrinolysis with IV tenecteplase
which 2 structures are required to prevent the ventricles from contracting at very high rates in a fib?
annulus fibrosus and AVN
describe the management of AF
- Haemodynamically unstable – cardioversion with synchronised DC shock + anticoagulation.
- Haemodynamically stable – either: Rate control (Beta blockers / CCBs) + anticoagulation
OR Rhythm control (cardioversion) -> beta blockers + anticoagulation
gold standard investigation for heart failure?
echocardiogram
define atrial fib and how it is different to atrial flutter
irregularly irregular atrial rhythm at 300-600bpm, a flutter is fast but regular atrial rhythm
What are the two main things seen on an ECG for a patient with AF?
- no P wave
- irregularly irregular
- rapid QRS complex
suspects Wolff-Parkinson-White syndrome. If their suspicions are correct what should the ECG show?
Wide QRS, short PR, delta wave
What type of arrhythmia is Wolff-Parkinson-White syndrome?
atrioventricular re-entry tachycardia
What is the normal length of the PR interval on an ECG?
0.12-0.2s
what is the appropriate first line medication to treat a patient with heart failure?
BBlocker + ACEi
What is the correct method of action of clopidogrel?
P2Y12 inhibitor
What is the gold standard test used to diagnose unstable angina?
angiography
what is the first line treatment for unstable angina?
GTN spray and either B-blocker or CCB
which cardiac murmur presents with malar flush and what does it sound like?
mitral stenosis, diastolic murmur
give an example of a CCB
amlodipine
what is beck’s triad?
for cardiac tamponade symptoms:
- hypotension,
- distended jugular veins,
- muffled heart sounds
what is the name of the treatment to relieve pressure in cardiac tamponade
pericardiocentesis
give 3 diagnostic tests of cardiac tamponade
ECG, CXR, echocardiogram
state some signs/symptoms of cardiac tamponade
- decreased exercise tolerance
- progressive dyspnoea at rest.
- ankles oedema
- raised JVP
- pulsus paradoxus.
what is pulsus paradoxus?
bp decreases with inhalation
