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cardio Flashcards

1
Q

what is the treatment of acute coronary syndrome?

A

M - morphine

O - oxygen

N - nitrates e.g glycerol trinitrate

A - aspirin (high dose)

+T - ticagrelor (rapid acting antiplatelt)

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2
Q

what is the gold standard treatment of STEMI?

A

PCI w/in 90 mins

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3
Q

what is the management of NSTEMI?

A

beta blockade
ACE inhibitor
atorvastatin

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4
Q

how is unstable angina differentiated from NSTEMI?

A

unstable angina will have normal troponin levels

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5
Q

what is the definition of abdominal aortic aneurysm?

A

dilation of the abdo aorta w/ a diameter of >3cm

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6
Q

what is the normal diameter of the abdominal aorta?

A

<2cm

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7
Q

what should be done if an abdominal aortic aneurysm is found to be >5.5cm?

A

the pt should be seen by a vascular specialist w/in 2 wks

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8
Q

how often is surveillance carried out for AAAs 3cm - 4.4cm?

A

annually

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9
Q

how often is surveillance carried out for AAAs 4.5cm - 5.4cm?

A

every 3 months

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10
Q

what is a false / pseudo aneurysm?

A

when the inner 2 layers (intima and media) rupture and there is dilation of the blood vessel and the blood is only contained w/in the outer layer (adventitia)

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11
Q

what is a true aortic aneurysm?

A

when all 3 layers of the aorta are intact but dilated

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12
Q

what is aortic dissection?

A

when a tear in the inner layer (tunica intima) allows blood to flow between the intima and the media creating a false lumen

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13
Q

where is the most common place for a tear to occur in aortic dissection?

A

the ascending aorta

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14
Q

what is the key thing to measure if aortic dissection is suspected?

A

blood pressure in both arms

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15
Q

what is type A aortic dissection?

A

involving the ascending aorta

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16
Q

what is type B aortic dissection?

A

involving the descending aorta

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17
Q

how are type A aortic dissections managed?

A

urgen surgical management

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18
Q

how are type B aortic dissections managed?

A

medically managed

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19
Q

what causes the first heart sound?

A

closing of the mitral and tricuspid valves

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20
Q

what causes the second heart sound?

A

closing of the pulmonary and aortic valves

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21
Q

what does a third heart sound indicate in young people?

A

nothing it is normal

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22
Q

what does a third heart sound indicate in older people?

A

heart failure

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23
Q

what is the most common valvular heart disease?

A

aortic stenosis

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24
Q

describe aortic stenosis murmur

A

an ejection systolic high pitched murmur

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25
Q

where does aortic stenosis radiate to?

A

the carotids

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26
Q

describe aortic regurgitation

A

early diastolic soft murmur

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27
Q

where is aortic regurgitation heard?

A

at the apex

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28
Q

describe mitral stenosis?

A

mid diastolic low pitched rumbling murmur

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29
Q

describe mitral regurgitation

A

pan systolic high pitched whistling murmur

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30
Q

where does mitral regurgitation radiate to?

A

the axilla

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31
Q

what are the shockable arrhythmias?

A

ventricular tachycardia
ventricular fibrilaiton

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32
Q

how can superventricualr tachycardia be differentiated from sinus tachycardia?

A

superventricular tachycardia has an abrupt onset and no variaibilty

sinus tachycardia has a more gradual onset and more variability in rate

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33
Q

how can atrial fibrillation be identified on ECG?

A

absent P waves

irregularly irregular rhythm

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34
Q

what does a saw tooth appearance on ECG indicate?

A

atrial flutter

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35
Q

what is the rate usually in atrial flutter?

A

around 300 beats per minute

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36
Q

what is atrial flutter caused by?

A

a re-entrant rhythm

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37
Q

what is torsades de pointes?

A

a polymorphic ventricular tachycardia

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38
Q

what is the acute management of torsades de pointes?

A

treat the underlying cause

magnesium infusion (even if they have a normal magnesium)

defibrillation if ventricular tachycardia occurs

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39
Q

what are ventricular atopics?

A

premature ventricular beats caused by random electrical discharges outside the atria

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40
Q

what do patients with ventricular atopics tend to present w/?

A

random extra or missed beats

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41
Q

what causes first degree heart block?

A

delayed conduction through the atrioventricular node but every atrial impulse leads to ventricular contraction

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42
Q

how does first degree heart block present on an ECG?

A

PR interval longer than 0.2 seconds (5 small boxes / one big box)

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43
Q

what is second degree heart block?

A

when some atrial impulses do not make it through the atrioventricular node to the ventricles

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44
Q

how does second degree heart block present on ECG?

A

some P waves are not followed by QRS complexes

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45
Q

what are the 2 types of second degree heart block?

A

mobitz type 1
mobitz type 2

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46
Q

what is mobitz type 1 (second degree heart block)?

A

conduction through the AV node takes progressively longer until it fails

longer longer longer drop

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47
Q

how does mobitz type 1 present on ECG?

A

increasing PR interval until the P wave is not followed by a QRS complex then the PR interval returns to normal and the cycle repeats itself

longer longrer longer drop

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48
Q

what its mobitz type 2?

A

when there is intermittent failure of conduction through the AV node w/ an absence of QRS complexes following P waves

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49
Q

what is third degree heart block?

A

complete heart block

there is no relationship between P waves and the QRS complexes

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50
Q

what is the major risk w/ third degree heart block?

A

asystole

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51
Q

what is the first line treatment for those at risk of asystole?

A

IV atropine

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52
Q

what causes arterial ulcers?

A

insufficient blood supply to the skin due to peripheral artery disease

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53
Q

what causes venous ulcers?

A

pooling of blood and waste products in the skin secondary to venous insufficiency

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54
Q

where do arterial ulcers tend to occur?

A

distally, affecting the toes or the dorsum of the foot

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55
Q

how do arterial ulcers present?

A

punched out appearance

deep

pale in colour due to poor blood supply

less likely to bleed

painful

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56
Q

where do venous leg ulcers tend to occur?

A

between the top of the foot and the calf muscle

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57
Q

how do venous leg ulcers present?

A

larger and more superficial than arterial ulcers

irregular sloping border

more likely to bleed

less painful than arterial ulcers

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58
Q

how can you differentiate venous ulcers from arterial ulcers?

A

ABPI

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59
Q

how are venous ulcers treated?

A

compression therapy after arterial disease has been ruled out w/ ABPI

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60
Q

what are the reversible causes of cardiac arrest?

A

H - hypoxia
H - hypo / hyperkalaemia
H - hypo / hyperthermia
H - hypovolaemia

T - tension pneumothorax
T - tamponade
T - thrombosis
T - toxins

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61
Q

what is cardiac tamponade?

A

it results from blood / fluid in the pericardial space and this limits the filling of the ventricles, reducing stroke volume and cardiac output

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62
Q

what is acute heart failure?

A

rapid onset or worsening of the signs / symptoms of heart failure

may present as new onset heart failure or acute decompensation of chronic heart failure

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63
Q

when can acute heart failure be ruled out?

A

if BNP < 100 ng / l

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64
Q

what is the mainstay management of acute heart failure when there is evidence of congestion (wet patients)?

A

loop diuretics (furosemide)

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65
Q

what is chronic heart failure?

A

reduced cardiac output due to impaired cardiac contractility

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66
Q

what is the most common cause of chronic heart failure?

A

hypertension

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67
Q

what should all pts w/ chronic heart failure and a reduced ejection fraction be started on?

A

an ace inhibitor

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68
Q

how do DVTs present?

A

almost always unilaterally

leg swelling

tendernes

colour change

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69
Q

when measuring the diameter of the calves when DVT is suspected what difference is classed as significant?

A

> 3cm

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70
Q

what investigation is used to diagnose DVT?

A

doppler ultrasound

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71
Q

what should be done if there is -ve Doppler ultrasound but +ve d dimer and wells score suggests DVT is likely?

A

repeat the doppler ultrasound 6-8wks later

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72
Q

how is a pulmonary embolism diagnosed?

A

CTPA

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73
Q

what is the initial treatment for DVT?

A

anticoagulation w/ apixaban or rivaroxaban

74
Q

what is the most common causative organism for infective endocarditis?

A

staph aures

75
Q

what are the key examination findings in infective endocarditis?

A

splinter haemorrhages
osler nodes
roth spots

76
Q

what is the key investigation for infective endocarditis?

A

blood cultures before starting antibiotics

77
Q

how should blood cultures be done for infective endocarditis?

A

three blood culture samples taken 6 hrs apart and from dif sites

78
Q

what is the management of infective endocarditis?

A

broad spectrum ABs (amoxicillin or gent)

79
Q

how long should antibiotics be given for in infective endocarditis?

A

4 wks for native heart valves
6 wks for prosthetic heart valves

80
Q

what is the first line treatment for pericarditis?

A

NSAIDs and colchicine for 3 months as an adjunct

81
Q

what is myocarditis?

A

inflammation of the myocardium (the muscle layer of the heart)

82
Q

what is the pt demographic at highest risk of myocarditis?

A

middled aged men (20-40 y/o)

83
Q

what is the most common cause of myocarditis when a cause can be identified?

A

viral infection

84
Q

what is the gold standard investigation for myocarditis?

A

end-myocardial biopsy (EMB)

85
Q

what histological findings on EMB confirms a diagnosis of myocarditis?

A

inflammatory infiltrate w/ necrosis

86
Q

a regular narrow complex tachycardia w/ absence of P waves is suggestive of what?

A

supraventricualr tachycardia

87
Q

what is the management of supraventricualr tachycardia?

A

vasovagal manoeuvres

IV adenosine (rapid bolus of 6mg, if unsuccessful give 12mg, if unsuccessful give further 18mg)

electrical cardio version

88
Q

what valve is used for aortic valve replacement in young pts (under 65)?

A

mechanical heart valve

89
Q

what is the likely diagnosis when there is persistent ST elevation following recent MI and there is no chest pain?

A

left ventricular aneurysm

90
Q

how does left ventricular aneurysm present?

A

persistent ST elevation and evidence of left ventricular failure (signs of heart failure)

91
Q

what is dresslers syndrome?

A

recurrent pericarditis following a myocardial infarction

92
Q

how does dresslers syndrome present?

A

fever
anaemia
raised ESR
pleural effusions

93
Q

when does dresslers syndrome present?

A

usually 6-8wks following MI

94
Q

how is dresslers syndrome treated?

A

NSAIDs

95
Q

when does left ventricular free wall rupture occur?

A

1-2 wks after an MI

96
Q

how do pts w/ left ventricular free wall rupture present?

A

w/ acute heart failure secondary to cardiac tamponade

97
Q

what is the management of left ventricular free wall rupture?

A

urgent pericardiocentesis and thoracotomy

98
Q

acute mitral regurgitation most commonly occurs following which type of MI?

A

infero-posterio infarction

99
Q

how does acute mitral regurgitation present?

A

acute hypotension
pulmonary oedema
early to mid systolic murmur

100
Q

what murmur is heard in pulmonary stenosis?

A

ejection systolic louder on inspiration

101
Q

what are the 3 hallmark signs of cardiac tamponade?

A

hypotension
elevated JVP
diminished heart sounds

102
Q

what is the definitive diagnostic test for cardiac tamponade?

A

echocardiogram

103
Q

what is the management of cardiac tamponade?

A

urgent pericardiocentesis

104
Q

which valve is most commonly affected in infective endocarditis?

A

the mitral valve

105
Q

which valve is most commonly affected in infective endocarditis in PWIDs?

A

the tricuspid valve

106
Q

what are the ECG findings of hypokalaemia?

A

U waves
small or absent T waves
long QT interval
prolonged PR interval

107
Q

which vessel is responsible for changes in lead 1?

A

circumflex artery

108
Q

which vessel is responsible for changes in leads 2,3 and aVF?

A

right coronary artery

109
Q

which vessel is responsible for changes in V1, V2, V3 and V4?

A

left anterior descending

110
Q

which vessel is responsible for changes in V5 and V6?

A

circumflex artery

111
Q

what is the management of pts w/ bradycardia and signs of shock?

A

IV atropine 500mg repeated up to a max of 5 times

112
Q

is left bundle branch block ever normal?

A

no

it is always abnormal and is usually assoc w/ underlying ischaemic or structural heart disease

113
Q

which murmur is mid - late diastolic, radiates to the apex and louder on expiration?

A

mitral stenosis

114
Q

which arrhythmia is assoc w/ mitral stenosis?

A

AF

115
Q

what is the first step in the management of hypertension in a pt <55y/o or w/ T2DM?

A

ACE inhibitor e.g. ramipril

OR

angiotensin receptor blocker e.g. losartan

116
Q

what is the second step in the management of hypertension in a pt <55y/o or w/ T2DM?

A

ACEi / ARB + calcium channel blocker e.g. amlodipine

OR

ACEi / ARB + thiazide like diuretic e.g. indapamide

117
Q

what is the third step in the management of hypertension for all pts?

A

ACEi / ARB + calcium channel blocker + thiazide like diuretic

118
Q

what is the first step in the management of hypertension in a pt >55y/o or afro carribean?

A

calcium channel blocker e.g. amlodipine

119
Q

what is the second line management of hypertension in a pt >55y/o or afro carribean?

A

calcium channel blocker + ACEi or ARB

OR

calcium channel blocker + thiazide like diuretic

120
Q

what is the next step in the management of symptomatic bradycardia if atropine fails?

A

external pacing

121
Q

what is the first line pharmacological intervention for sustained torsades de pointes?

A

IV magnesium sulphate

122
Q

if a pt w/ AF has a stroke or a TIA what should the anticoagulant of choice be?

A

warfarin or a direct thrombin or factor Xa inhibitor

123
Q

what is the management of PE when there is hypotension?

A

thrombolysis

124
Q

what is the most common ECG finding in pts w/ PE?

A

sinus tachycardia

125
Q

what is the management of an uncomplicated dissection of the descending aorta?

A

medical management - beta blockade and analgesia

126
Q

what is Stanford A dissection?

A

ascending aortic dissection

127
Q

what is Stanford B dissection?

A

descending aortic dissection

128
Q

what is the management of Stanford A dissection or Stanford B dissection where there is evidence of end organ ischaemia?

A

endovascular repair or open intervention

129
Q

what are the ECG findings of ostisum secumdum?

A

right bundle branch block w/ right axis deviation

130
Q

what is the significance of a PR interval >200ms in an athlete?

A

no significance

first degree heart block is a normal variation in athletes

131
Q

what is the most common CXR finding in PE?

A

normal CXR

132
Q

which drug can make clopidogrel less effective?

A

PPIs

133
Q

what is the management of pulseless electrical activity?

A

1mg IV adrenaline

134
Q

is pulseless electrical activity shockable?

A

no

135
Q

what is the investigation of a PE in a pt w/ renal failure?

A

V/Q scan

136
Q

what is the management of major bleeding when a pt is on warfarin?

A

stop warfarin

IV vit K

prothrombin complex concentrate (f not available give FFP)

137
Q

what is the management of a pt on warfarin and the INR is >8 and there is minor bleeding?

A

stop warfarin

IV vit K

restart warfarin when INR <5

138
Q

what is the management of a pt on warfarin and the INR is >8 but there is no bleeding?

A

stop warfarin

give oral vit K

restart warfarin when INR <5

139
Q

what is the management of a pt on warfarin and the INR is between 5-8 and there is minor bleeding?

A

stop warfarin

give IV vit K

restart warfarin when INR <5

140
Q

what is the management of a pt on warfarin and the INR is between 5-8 but there is no active bleeding?

A

w/hold 1/2 doses of warfarin

reduce subsequent maintenance dose

141
Q

what is the management of a witnessed cardiac arrest while on a monitor?

A

deliver 3 successive shocks

142
Q

how does a posterior MI present on ECG?

A

ST depression

143
Q

which electrolyte abnormality can lead to long QT syndrome?

A

hypokalaemia

144
Q

what should be given to pts on warfarin and undergoing emergency surgery?

A

4 factor prothrombin complex concentrate

145
Q

which murmur is assoc w/ a collapsing pulse?

A

aortic regurgitation

146
Q

what is the most common cause of secondary hypertension?

A

primary hyperaldosteronism

147
Q

in a PE what is an indication for thrombolysis?

A

hypotension

148
Q

what is the most characteristic ECG finding in arrhythmogenic right ventricular dysplasia (ARVD)?

A

epsilon wave = a small positive deflection at the end of each QRS

149
Q

is there a right circumflex artery?

A

no

150
Q

what is the investigation of choice for suspected aortic aneurysm?

A

CT aortic angiogram

151
Q

what is the treatment of type A aortic aneurysms?

A

surgery

152
Q

what is the treatment of type B aortic aneurysms?

A

beta blockers

153
Q

what is the most common ecg change seen in PE?

A

sinus tachycardia

154
Q

what is the likely diagnosis of a pt who develops acute heart failure 10 days post M and has a raised JVP, pulses paradoxus and diminished heart sounds?

A

left ventricular free wall rupture

155
Q

what is the investigation of choice for aortic dissection?

A

CT aortic angiogram

156
Q

what is the management when there is massive PE and hypotension?

A

thrombolyse w/ alteplase

157
Q

hypertrophic obstructive cardiomyopathy is assoc w/ what examination finding?

A

S4 heart sound

158
Q

what is the first line treatment for broad complex tachycardias w/out adverse features?

A

amiodarone

159
Q

when in heart failure should beat blockers be stopped?

A

if the heart rate is <50 bpm

if there is second or third AV block

if the pt is in shock

160
Q

infective endocarditis in IVDUs most commonly affects which valve?

A

tricuspid

161
Q

what should be done after fibrinolysis is given for ACS?

A

ECG after 60-90 mins

162
Q

what is the investigation of choice for suspected aortic dissection?

A

CT angio chest abdo pelvis

163
Q

what is the treatment for symptomatic bradycardia?

A

atropine

164
Q

what is the most common cause of mitral stenosis?

A

rheumatic fever

165
Q

what is the main ECG change seen w/ hypercalcaemia?

A

shortening of the QT interval

166
Q

what is the most specific ECG finding in acute pericarditis?

A

PR depression

167
Q

what is the first line management for hypertension in diabetic pts regardless of age?

A

ACEi / ARB

168
Q

what is the likely diagnosis when there is persistent ST elevation following recent MI and there is no chest pain?

A

left ventricular aneurysm

169
Q

what is the management of a normal stroke?

A

aspirin first for 2wks

the life long clopidogrel

170
Q

where is most commonly affected in infective endocarditis in IVDUs?

A

tricuspid valve

171
Q

what is the likely diagnosis when the pt presents w/ rash, arthritis, murmur and history of a recent sore throat?

A

rheumatic fever

172
Q
A
173
Q

what is the management of a normal TIA?

A

aspirin first for 2 wks

then life long clopidogrel

174
Q

what is the management of a stroke caused by AF?

A

aspirin first for 2 wks

then life long clopidogrel

175
Q

what is the management of a TIA caused by AF?

A

immediate DOAC

176
Q

what is the management of supraventricualr tachycardias?

A

try vagal manoeuvres then adenosine (6, then 12 then 18)

177
Q

what is the management of ventricular tachycarida?

A

initiate rhythm control w/ amiodaron

178
Q

what does narrow complex tachycardia indicate?

A

supraventricualr tachycardia

179
Q

what does broad complex tachycardia indicate?

A

ventricular tachycardia

180
Q

what is the management of a pt w/ AF who has pneumonia and why?

A

rhythm control because the AF is due to a reversible cause

181
Q

which 2 drugs are used for cardioversion in AF?

A

amiodarone and flecainide

182
Q
A

finals (25 decks)

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