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Internal Medicine > Cardio > Flashcards

Cardio Flashcards

1
Q

Atherosclerosis is

A

Athermatous plaques forming in artery walls

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2
Q

Atherosclerosis plaques result in (3)

A

Stiffening
Stenosis
Plaque rupture

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3
Q

Stiffening in atherosclerosis leads to

A

HTN

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4
Q

Stenosis in atherosclerosis leads to

A

Angina

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5
Q

Plaque Rupture in atherosclerosis leads to

A

MI etc

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6
Q

Start a statin first check

A

LFTs

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7
Q

Statin ADRs

A

Myopathy, rhabdomyolysis

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8
Q

After a MI, offer patients

A

Dual antiplatelets
Aspirin 75 mg
Clopidogrel or Ticagrelor
Generally for 12 months

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9
Q

Angina is stable when

A

Symptoms come on with exertion only, and always relieved by rest or GTN

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10
Q

Angina is unstable when

A

Symptoms appear randomly whilst at rest
- type of acute coronary syndrome and require immediate management

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11
Q

Patients with angina should have which investigations (6)

A

Physical examination (cardio, BP, BMI), ECG, blood tests

Cardiac stress testing
CT coronary angiography
Invasive coronary angiography (gold standard)

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12
Q

GTN ADRs

A

dizziness and headaches

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13
Q

long-term symptomatic relief of stable angina medications (2)

A

B-blocker (bisoprolol)
CCB - diltiazem or verapamil - avoid in HF

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14
Q

MI prevention thrombus med

A

Aspirin

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15
Q

Surgical interventions for angina

A

Percutaneous coronary intervention, Coronary artery bypass graft.

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16
Q

Three types of acute coronary syndrome

A

Unstable angina
STEMI
NSTEMI

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17
Q

ACS Investigations

A

Troponin, baseline bloods
ECG
CXR
Echocardiogram - once stable - to assess functional damage to the heart.

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18
Q

Troponin specific?

A

Troponin is a non-specific marker, meaning that a raised troponin does not automatically imply acute coronary syndrome. The alternative causes of a raised troponin include:

Chronic kidney disease
Sepsis
Myocarditis
Aortic dissection
Pulmonary embolism

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19
Q

STEMI management

A

PCI (within 2 hrs)
Thrombolysis

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20
Q

Complications of MI

A

Death
Rupture
oEdema (Heart failure)
Arrhythmia
Dressler’s syndrome

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21
Q

Dressler’s syndrome

A

2-3 weeks after acute MI, localised immune response resulting in inflammation of pericardium - pericarditis.

Pleuritic chest pain, low grade fever, pericardial rub on auscultation.

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22
Q

Dressler’s syndrome complications

A

Pericardial effusion and rarely pericardial tamponade

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23
Q

Dressler’s syndrome management

A

NSAIDs, steroids, pericardiocentesis if needed.

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24
Q

Pericarditis

A

idiopathic, infective - viral mostly.
Also autoimmune (RA, SLE), injury, uraemia, cancer

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24
Q

Pericarditis complication

A

Pericardial effusion & pericardial tamponade

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25
Q

Pericarditis symptoms

A

Chest pain, low-grade fever

Chest pain is sharp, worse with inspiration (pleuritic), worse on lying down, better on sitting forward.

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26
Q

Pericarditis examination

A

Pericardial friction rub alongside heart sounds

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27
Q

Pericarditis investigations

A

Blood tests, ECG (saddle shaped ST elevation), PR depression

Echo can diagnose pericardial effusion

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28
Q

Management of pericarditis

A

NSAIDs
Colchicine taken longer term e.g. 3 months to reduce risk of recurrence.
Steroids second line
Pericardiocentesis if needed

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29
Q

Pacemakers incompatible with

A

MRI scans, diathermy

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30
Q

Indications for a pacemaker

A

symptomatic bradycardia, some types of heart block, , AV node ablation for atrial fibrillation, severe heart failure

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31
Q

ECG changes pacemaker

A

Sharp vertical line on all leads before P wave and/or before QRS

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32
Q

Acute left venticular failure symptoms

A

Pulmonary oedema

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33
Q

Triggers of acute left ventricular failure

A

Iatrogenic - e.g. agressive IV fluids
MI
Arrhythmias
Sepsis
Hypertensive emergency

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34
Q

Right sided HF findings

A

Raised JVP
Peripheral oedema

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35
Q

Assessment of patients with acute left ventricular failure

A

ECG - ischaemia & arrhythmias
Bloods - anaemia, infection, kidneys, BNP, troponin
Arterial blood gas
Chest X-ray
Echo

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36
Q

BNP sensitive but not specific - can also be

A

tachycardia, sepsis, PE, renal impairment, COPD

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37
Q

BNP represents myocardial

A

stretch

acts on smooth muscle in blood vessels to reduce systemic vascular resistance

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38
Q

LVEF normal value

A

if above 50%

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39
Q

CXR findings HF

A

Cardiomegaly, pleural effusion, kerley B lines, upper lobe diversion

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40
Q

Management Acute left ventricular failure

A

S - sit up
O - oxygen
D - diuretics
I - intravenous fluids STOP
U - underlying cause identified and treated
M - monitor fluid (urine output, Us&Es, body weight)

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41
Q

Management Acute left ventricular failure
- acronym

A

SODIUM

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42
Q

Causes chronic heart failure

A

Ischaemic heart disease, valvular heart disease - commonly aortic stenosis, hypertension, arrhythmias - commonly atrial fibrillation, cardiomyopathy

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43
Q

Chronic heart failure treatment - medications

A

ABAL
Ace Inhibitor
B blocker
Aldosterone antagonist (if A&B not adequate)
Loop diuretic

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44
Q

ACE inhibitors and aldosterone effect on K

A

Can cause hyperkalaemia

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45
Q

Secondary causes of hypertension acronym

A

ROPED

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46
Q

Secondary causes of hypertension

A

R - renal disease - e.g. renal artery stenosis
O - obesity
P - pregnancy
E - endocrine
D - drugs

Sleep apneoa

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47
Q

HTN increases the risk of

A

Ischaemic heart disease, cerebrovascular accident, vascular disease, retinopathy, nephropathy, vascular dementia, left ventricular hypertrophy, heart failure.

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48
Q

New HTN diagnosis investigations

A

Urine dipstick, bloods - HbA1c, renal function, lipids, fundus examination, ECG

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49
Q

HTN management

A

Lifestyle
Ace inhibitor (not if african), B blocker, CCB e.g. amlodipine, Diuretic (thiazide), ARB

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50
Q

HTN meds - monitor

A

K+ (Us & Es)
Spironolactone - K sparing
bendroflumethiazide - hypokalaemia

51
Q

Malignant hypertension

A

BP > 180/120
with retinal haemorrhages or papilloedema

bad - end organ damage - give labetalol, GTN

52
Q

Aortic stenosis affect on heart

A

Left ventricular hypertrophy

53
Q

Mitral stenosis affect on heart

A

Left atrial hypertrophy

54
Q

Mitral regurgitation affect on heart

A

Left atrial dilation

55
Q

Aortic regurg affect on heart

A

Left ventricular dilation

56
Q

causes of aortic stenosis

A

idiopathic calcification age related, bicuspid aortic valve, rheumatic heart disease

57
Q

Aortic regurg causes

A

Bicuspid valve, idiopathic age related, marfan syndrome, ehlers-danlos syndro,e

58
Q

Mitral Stenosis causes

A

Rheumatic heart disease, infective endocarditis

59
Q

Mitral Regurgitation causes

A

Idiopathic age, ischaemic heart disease, rheumatic hear disease, IE, marfan or ehlers danlos syndrome

60
Q

Pan systolic

A

Mitral regurg

61
Q

Tetralogy of fallot - may cause pulmonary stenosis

A

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

62
Q

Aortic valve click replaces

63
Q

Mitral valve click replaces

64
Q

Three major complications of mechanical heart valves:

A

-Thrombus formation
-Infective endocarditis
-Haemolysis causing anaemia

65
Q

TAVI

A

Transcatheter Aortic Valve implantation
- treatment for severe aortic stenosis, if patients don’t tolerate open surgery.

Bioprosthetic valve therefore do not typically require warfarin

66
Q

Infective endocarditis caused by

A

Staph Aureus most common, strep viridans, enterococcus faecalis

67
Q

Infective endocarditis risk factors

A

IV drug use, structural hearth pathology (valvular heart disease, congenital heart disease, hypertrophic cardiomyopathy, prosthetic valve, implantable cardiac devices e.g. pacemakers), CKD, immunocompromised, history of infective endocarditis

68
Q

Types of IE (3)

A

Acute, subacute, chronic

69
Q

IE area of heart affected

A

Endothelium, most commonly the heart valve

70
Q

IE symptoms

A

Fever, fatigue, night sweats, muscle aches, anorexia (loss of appetite)

71
Q

IE examination findings

A
  • New or changing murmur
  • splinter haemorrhages
  • petechiae
  • janeway lesions, osler’s nodes
  • finger clubbing
72
Q

IE investigations

A

Blood cultures
Echo - look for vegetations

73
Q

IE diagnosis criteria

A

Modified duke criteria

74
Q

IE management

A

Admission
IV broad spectrum ABx - e.g. amoxicillin and optional gentamicin

Becomes more specific once causative organism identified.

Continue treatment 4 weeks for with native heart valves
6 weeks for patients with prosthetic heart valves

May need surgery if HF, not responding

75
Q

Complications IE

A

Valve damage, HF, emboli, glomerulonephritis

76
Q

IE prophylaxis

A

in especially high risk patients give ABx before dental procedures

77
Q

HOCM stands for

A

Hypertrophic obstructive cardiomyopathy

78
Q

HOCM increases risk of

A

HF, MI, arrhythmias and sudden cardiac death

79
Q

HOCM genetics

A

Autosomal dominant

80
Q

HOCM Presentation

A

Mostly asymptomatic - may have SOB, fatigue, dizziness, syncope, chest pain, palpitations

Severe may present with HF
Family history of heart disease and sudden death

81
Q

HOCM examination findings

A

Ejection systolic murmur at lower left sternal border

82
Q

HOCM investigations

A

ECG - left ventricular hypertrophy
CXR - usually normal
Echo - for diagnosis
Genetic testing

83
Q

HOCM management

A

B-blockers
Surgical myectomy
Heart transplant

Avoid intense exercise, heavy lifting & dehydration

ACE inhibitors and Nitrates avoids

84
Q

LVOT

A

Left ventricular outflow tract obstruction - in HCOM

85
Q

AFib increased risk of

86
Q

Most common causes of AFib

A

SMITH
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension

87
Q

Most common causes of Afib acronym

88
Q

Irregularly irregular pulse differentials

A

AFib, ventricular ectopic

89
Q

Ventricular ectopics differ from afib how

A

Disappear when Heart rates gets above certain threshold

90
Q

Ectopics also called

A

Premature ventricular contractions

91
Q

AFib investigations

A

ECG
Echo for differentials

92
Q

Types of AF

A

Paroxysmal - less than 48 hrs
Persistent
Permanent

93
Q

AFib management principles (2)

A

Rate & rhythm control
Anticoagulation

94
Q

Rate control Afib meds

A

B-blocker, CCB

95
Q

Rhythm control Afib meds

A

Cardioversion - amiodarone, flecainide

Electrical cardioversion

B blocker

Ablation

96
Q

Anticoagulation Afib meds

A

DOACs first line - dabigatran, rivaroxaban

Warfarin if DOAc contraindicated e.g. valve?

97
Q

How to determine if need anticoagulation Afib?

A

CHA2DS2VASc

+ bleeding risk - hasbled

98
Q

Supraventricular tachycardia

A

Abnormal electrical signals from above the ventricles cause a fast heart rate
Electrical signal re-enter the atria from the ventricles - self-perpetuating electrical loop without an end point

99
Q

SVT narrow or broad

A

Narrow QRS

100
Q

Narrow complex tachycardia differentials (4)

A

SVT, Sinus tachycardia, Atrial fibrillation, atrial flutter

101
Q

Sinus tachycardia how tell

A

Normal PQRST pattern

102
Q

AFib how tell

A

Absent P waves, tachycardia, irregularly irregular ventricular rhythm

103
Q

Atrial flutter atrial rate

104
Q

Adenosine

A

Interrupts the AV node - reset sinus rhythm

105
Q

Paroxysmal SVT management

A

B blocker, CCB, amiodarone

Radiofrequency ablation

106
Q

Shockable rhythms

A

Ventricular tachycardia, ventricular fibrillation

107
Q

Non-shockable rhythms

A

Pulseless electrical activity, asystole

108
Q

Broad complex tachycardia length

A

QRS more than 120 ms

109
Q

Atrial flutter treatment

A

Anticoagulation based on CHADS-Vasc, radiofrequency ablation

110
Q

QT prolongation length

A

From start of QRS to end of T wave more than 440

111
Q

Torsades de points associated with

A

QT prolongation

Looks like ventricular tachycardia but qrs twisting around baseline

112
Q

QT prolongation meds

A

Antipsychotics, citalopram, flecainide, amiodarone

Hypokalaemia, hypomagnesaemia, hypocalcaemia

113
Q

Ventricular ectopics are

A

Premature ventricular beats caused by random electrical discharges outside the atria

ECG - isolated random abnormal QRS complexes on an otherwise normal ECG

114
Q

Heart block 1st degree

A

PR consistently longer
Usually benign

115
Q

PR interval should be

A

120-200 ms

116
Q

Heart block second degree type 1 wenckebach

A

PR longer and longer until drops qrs and restarts
Usually fine

117
Q

Heart block second degree type 2

A

PR interval normal, intermittent qrs failure
Bad

118
Q

Heart block third degree

A

Complete P waves and QRS no relationship
Risk of asystole

119
Q

Bradycardia causes

A

Athletes, meds e.g. B blockers, heart block, sick sinus syndrome

120
Q

Asystole risk in

A

2nd degree type 2 & 3rd degree heart block

Pacemaker

121
Q

Pacemaker indications

A

2nd degree type 2 & 3rd degree heart block, Bradycardia if symptomatic, severe heart failure

122
Q

ECG changes with pacemaker

A

Sharp vertical line on all leads

123
Q

Pericarditis ECG

A

Saddle shaped ST elevation

124
Q

STEMI Management

A

Aspirin, clopidogrel, heparin, nitrites, morphine and controlled oxygen.

PCI

Internal Medicine (6 decks)

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