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cardio + resp > cardio > Flashcards

cardio Flashcards

1
Q

which leads correspond to anterior ischaemia

A

V1-V4

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2
Q

which leads correspond to inferior ischaemia

A

II, III + aVF

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3
Q

which leads correspond to lateral ischaemia

A

1, V5, V6

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4
Q

blockage in what artery causes lateral ischaemia?

A

left circumflex

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5
Q

blockage in what artery causes inferior ischaemia?

A

right coronary artery

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6
Q

investigations aortic aneurysm

A

ultrasound first line
CT angiogram for more detail

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7
Q

who gets elective repair for abdominal aneursym

A

if symptomatic
if growing >1cm a year
diameter over >5.5cm

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8
Q

normal diameter abdominal aorta

A

<3cm

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9
Q

BNP levels + indication for an ECHO

A

> 2000 - 2 week referral
400-2000 - 6 week referral

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10
Q

NYHA heart failure classification

A

I - no limitation in physical activity
II - comfort at rest, limitation of normal physical activity
III - comfort at rest, limitation of minimal physical activity
IV - not comfortable at rest

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11
Q

what percentage defines preserved ejection fraction

A

> 40%

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12
Q

first line management heart failure

A

first line = ACE inhibitor + beta-blocker

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13
Q

causes heart failure with preserved ejection fraction

A
  • hypertrophic obstructive cardiomyopathy
  • restrictive cardiomyopathy
  • cardiac tamponade
  • constrictive pericarditis
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14
Q

ECG findings first degree heart block

A

fixed prolonged PR (>200ms)

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15
Q

ECG findings mobitz I heart block

A
  • prolonged PR interval until dropped beat
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16
Q

ECG findings mobitz 2 heart block

A

fixed prolonged PR interval
P:QRS not 1:1

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17
Q

management mobitz type II

A

permanent pace maker

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18
Q

features mitral stenosis

A

mid diastolic murmur (louder on expiration)
dyspnoea + haemoptysis
loud S1
malar flush (CO2 retention)
AF due to increased atrial pressure

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19
Q

what is s4 heart sound?

A

heard just before s1
indicates stiff or hypertrophic ventricle - turbulent flow from atria contracting against non-compliant ventricle

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20
Q

what is s3 heart sound?

A

heard after s2
indicates rapid ventricular filling
can indicate heart failure
low pitched

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20
Q

what is s3 heart sound?

A

heard after s2
indicates rapid ventricular filling
can indicate heart failure
low pitched

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21
Q

which murmur is quieter when squatting

A

HOCM

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22
Q

which murmurs get louder with valsalva manouvre?

A

HOCM + mitral regurg

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23
Q

microorganism associated with infective endocarditis due to poor dental hygeine

A

strep viridans

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24
Q

organism associated with infective endocarditis <2 months after prosthetic valve surgery

A

coag -ve staph e.g. staph epidermis

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25
Q

signs on examination infective endocarditis

A

janeway lesion - non-painful red spots on palms and soles of feet
osler nodes - painful red nodules on pads of fingers and toes
roth spots - exudative haemorrhagic retinal lesions
splinter haemorrhages

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26
Q

first line investigation infective endocarditis

A

transthoracic echo

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27
Q

what is long QT syndrome

A

delayed repolarisation of ventricles

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28
Q

what can long QT syndrome lead to

A

ventricular tachycardia/torsades de pointes
collapse/sudden death

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29
Q

normal corrected QT interval?

A

<440 ms in males
<460 ms in females

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30
Q

what are LQT1 + LQT2 caused by?

A

defect in alpha subunit of potassium rectifier channels

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31
Q

drug causes prolonged QT interval

A

amiodarone, sotalol (anti-arrhythmics)
TCAs, SSRIs
methadone
antihistamine (non-sedating) e.g. terfenadine
erythromycin
haloperidol
ondansetron

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32
Q

non-drug or congenital causes long QT

A

electrolytes - hypokalaemia, hypocalcaemia, hypomagnesaemia
MI
hypothermia
SAH

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33
Q

pathophysiology rheumatic fever

A

occurs 2-4 week post group A strep (typically strep. pyogenes) infection
type 2 hypersensitivity, cross-reactive immune response + molecular mimicry
antibodies cross react with myosin + smooth muscles of arteries

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34
Q

presentation rheumatic fever

A

2-4 weeks after strep throat e.g. tonsilitis
fever
joint pain
rash
SOB
carditis
skin - subcutaneous nodules + erythema marginatum
neuro - chorea (muscle movement)

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35
Q

major JONES criteria for rheumatic fever

A

j - joint arthritis
o - organ inflammation e.g. carditis
n- nodules
e - erythema marginatum rash
s - sydenham chorea

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36
Q

minor jones criteria

A

fever
ECG changes
raised inflam markers
arthralgia with no arthritis

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37
Q

how to diagnose rheumatic fever

A

2 major OR
1 major + 2 minor

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38
Q

management rheumatic fever

A

IV benzyl penicillin STAT followed by 10 day course phenoxymethylpenicillin

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39
Q

classification of stages of hypertension

A
  1. single reading >140/90 + average/ambulatory readings 135/85
  2. single reading > 160/100 + average readings/ambulatory 150/95
  3. single reading systolic > 180 or diastolic > 110
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40
Q

indications to start pharmacological treatment for hypertension

A
  • stage 1 <80 years old AND target organ damage, CVD , renal disease, diabetes or a QRISK >10%
  • anyone with stage 2 or up
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41
Q

haemochromatosis pathophyiology

A

mutations in HFE gene on chromosome 6
autosomal recessive

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42
Q

presentation haemochromatosis

A

fatigue, erectile dysfunction, arthralgia
bronzed skin
diabetes mellitus
liver disease symptoms
cognitive symptoms

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43
Q

blood tests haemochromatosis

A

deranged LFTs
raised transferrin
raised ferritin

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44
Q

complications haemochromatosis

A

liver cirrhosis + hepatocellular carcinoma
T1DM
endocrine + sexual problems
chondrocalcinosis/pseudogout

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45
Q

important blood tests in PE

A
  • ABG
  • U&Es to assess renal function before CTPA
  • clotting function
  • D dimer to rule out
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46
Q

ECG changes pericarditis

A

PR depression
wide spread saddle shaped ST elevation

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47
Q

management pericarditis

A

1st line - NSAIDs + colchicine
2nd line - corticosteroids

48
Q

what well’s score indicates likelihood for DVT

A

> 2

49
Q

what wells score indicates PE likely?

A

> 4

50
Q

target INR for warfarin when treating DVTs

A

2-3
if VTE recurrent while on warfarin, increase to 3-4

51
Q

if conduction through AV node is normal - where is pacemaker placed

A

right atrium

52
Q

if conduction through AV node is abnormal - where is pacemaker placed

A

right ventricle

53
Q

which part of the waveform on an ECG is a shock synchronised with

A

R wave - ventricular contraction

54
Q

why do we use SYNCHRONISED cardioversion

A

to avoid delivering a shock on the t wave - can lead to ventricular fibrillation

55
Q

aortic regurg features

A

early diastolic murmur
wide pulse pressure
bobbing head
nailbed pulsation

56
Q

beta-blockers side effects

A

bronchospasm
sleep disturbances
erectile dysfunction
cold peripheries
fatigue

57
Q

features of ventricular free wall rupture post MI

A

rapid tamponade + cardiac arrest within seconds
poor prognosis

58
Q

features ventricular septal defect post MI

A

occurs within first week after infarction
SOB
CP
heart failure
pan-systolic murmur along sternal border

59
Q

features + management dressler’s syndrome

A

fever + pleuritic chest pain 2-3 weeks or a month after MI
manage with NSAID e.g. high dose aspirin or ibuprofen

60
Q

what kind of arrhythmia is a right coronary artery infarct likely to cause

A

complete heart block - supplies AV node

61
Q

ABPI results and what they indicate

A

0.6-0.9 = mild peripheral arterial disease
0.3-0.6 = moderate to severe
<0.3 = severe

62
Q

what is a TIA

A

sudden onset of a focal neurologic symptom and/or sign lasting typically less than an hour

63
Q

LACI presents with:

A

1 of
- unilateral hemiparesis/hemisensory loss of face + arm, arm + leg or all three
- pure sensory stroke
- ataxic hemiparesis

64
Q

how does wallenbergs syndrome/lateral medullary syndrome present

A

posterior inferior cerebellar artery infarct
- ipsilateral horners
- ipsilateral loss of facial pain and temp
- contralateral loss of limb/torso pain and temp

65
Q

how does lateral pontine syndrome present

A

anterior inferior cerebellar artery infarct
- ipsilateral horners
- ipsilateral facial loss pain and temp
- contralateral torso/leg loss pain and temp
- facial paralysis + deafness

66
Q

which vaccinations are offered to patients with heart failure

A

annual influenza
one off pneumococcal

67
Q

ECG finding LVH

A

S wave in V1 + R wave in V6 >35mm

68
Q

2 level wells score + points

A

clinical signs + symptoms DVT - 3 points
most likely diagnosis - 3 points
HR > 100 - 1.5 points
immobilisation or surgery - 1.5 points
previous DVT/PE - 1.5 points
haemoptysis - 1 point
malignancy - 1 point

69
Q

ECG criteria STEMI

A

≥ 2 contiguous leads of:
2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men < 40 years, or ≥ 2.0 mm ST elevation in leads V2-3 in men > 40 years
1.5 mm ST elevation in V2-3 in women
1 mm ST elevation in other leads
new LBBB

70
Q

STEMI criteria ECG

A

> 2 anatomically contiguous leads

71
Q

pathophysiology AF

A

abnormal electrical activity between pulmonary veins and left atria
intermittently conducted through AV node - irregularly irregular ventricular rate

72
Q

rate control first line in AF unless:

A
  • reversible cause
  • new onset (<48 hours)
  • haemodynamically unstable
  • heart failure
  • still symptomatic despite rate control

beta blocker (not sotalol) or calcium channel blocker (e.g. verapamil or diltiazem)

73
Q

when is immediate cardioversion used in AF

A
  • AF < 48 hours
  • life-threatening haemodynamic instability
74
Q

non-acute management atrial flutter

A

radiofrequency ablation of tricuspid valve

75
Q

management SVT, patient stable, regular rhythm

A

first line - vagal manoeuvres
if this fails - adenosine 12mg, then another 12mg

76
Q

what does LAD mean in wolff parkinson white?

A

right sided accessory pathway
type B - most common

77
Q

normal PR interval

A

120-200ms

78
Q

normal QRS interval

A

80-120ms

79
Q

definition broad QRS

A

> 120ms

80
Q

definitive management WPW

A

radiofrequency ablation accessory pathway

81
Q

management Vfib

A

ABCDE
CPR
shockable rhythm - unsynchronised
- 1mg adrenaline + 300mg amiodarone after 3rd shock, adrenaline administered every 3-5 mins after alternate shocks

82
Q

management pulseless VT

A

ABCDE
CPR
shockable - unsynchronised
1mg adrenaline + 300mg amiodarone after 3rd shock
adrenaline administered every 3-5 mins after alternate shocks

83
Q

management VT with pulse + adverse features

A

synchronised DC cardioversion
amiodarone

84
Q

management VT with pulse + no adverse features

A

amiodarone 300mg IV over 20-60 mins
900mg over 24 hours

85
Q

cause of torsades de pointes

A

prolonged QT interval

86
Q

management torsades de pointes if patient haemodynamically stable

A

IV magnesium sulphate (2g over 10 mins)

87
Q

management acute bradycardia

A

atropine 500mcg IV

88
Q

mechanism atropine

A

blocks vagal activity on AV node

89
Q

what is takotsubo cardiomyopathy

A

broken heart syndrome
stress induced cardiomyopathy
‘octopus trap’

90
Q

management PAD stenosis <10cm

A

endovascular revascularisation surgery (angioplasty)

91
Q

management stable angina

A
  • aspirin + statin
  • GTN + beta-blocker or rate-limiting calcium channel blocker (verapamil or diltiazem) first line
  • beta blocker + long-acting dihydropyridine CCB (e.g. amlodipine)
  • if persistent, re-vascularisation
92
Q

indications for CABG > PCI in angina

A

> 65
diabetic
3 vessel disease

93
Q

management type A aortic dissection

A

surgical management
blood pressure controlled before

94
Q

management type B aortic dissection

A

conservative
bed rest
reduce blood pressure with IV labetalol

95
Q

which medication should be added to CCB if hypertension not controlled in a black man

A

ARB
preferential to an ACEi

96
Q

second line therapy heart failure

A

aldosterone antagonist e.g. spironolactone, eplerenone
SGLT-2 inhibitors

97
Q

side effect loop diuretics

A

hypotension
hyponatraemia
hypokalaemia

98
Q

DVLA hypertension rules

A

can’t drive lorries/van if consistently stage 3

99
Q

DVLA rules after angioplasty

A

1 week off

100
Q

DVLA rules after CABG

A

4 weeks off

101
Q

DVLA rules after ACS

A

4 weeks off
1 week if successful angioplasty

102
Q

DVLA rules pacemaker insertion

A

1 week off

103
Q

DVLA rules aortic aneursym

A

notify DVLA if >6cm
>6.5cm - can’t drive

104
Q

what do u waves signify

A

hypokalaemia
- deflection after t wave in same direction

105
Q

ECG findings digoxin toxicity

A

down-sloping ST depression ‘reverse tick’
inverted t wave
short QT interval

106
Q

features coarctation of aorta

A

narrowing around ductus arteriosus
associated with Turners syndrome
reduction of blood pressure distal to narrowing and increase pressure in areas proximal to narrowing
causes hypertension in adults

107
Q

gold standard diagnostic test asthma

A

FeNO + spirometry with bronchodilator reversibility
FeNO measures inflammation with eosinophils

108
Q

gold standard diagnostic test asthma

A

FeNO + spirometry with bronchodilator reversibility
FeNO measures inflammation with eosinophils

109
Q

which patients with NSTEMI/unstable angina should have coronary angiography? (and PCI if needed)

A

immediate - clinically unstable e.g. hypotensive
within 72 hours - patients with GRACE score >3%

110
Q

second line management AF rate control

A

digoxin
diltiazem (non-hydropyridine CCB) (verapamil cannot be used in combination with beta blocker)

111
Q

useful biomarker to check for reinfarction

A

CK-MB (creatine kinase)

112
Q

step 4 treatment hypertension (i.e. already taking A + C + D)

A

if potassium < 4.5 - spironolactone
if potassium > 4.5 - alpha or beta-blocker

113
Q

investigations mesothelioma

A

CXR - shows effusion or pleural thickening
pleural CT next step
thoracoscopy
if nodularity seen on CT - pleural biopsy

114
Q

stages of COPD according to FEV1

A

stage 1 - > 80%
stage 2 - 50-79%
stage 3 - 30-49%
stage 4 - < 30%

115
Q

how much fluid should be given in initial resuscitation

A

500ml
250ml if cardiac disease or elderly

116
Q

maximum fluid given until patient considered fluid non-responsive

A

2L

117
Q

indications surgery IE

A
  • severe valvular incompetence
  • aortic abscess (prolonged PR)
  • infections resistant to abx
  • cardiac failure refractory to normal management
  • recurrent emboli
118
Q

rate control AF if beta-blocker contraindicated

A

rate-limiting CCB e.g. verapamil, diltiazem

cardio + resp (8 decks)

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