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)
2
Q
what is the gold standard treatment of STEMI?
A
PCI w/in 90 mins
3
Q
what is the management of NSTEMI?
A
beta blockade
ACE inhibitor
atorvastatin
4
Q
how is unstable angina differentiated from NSTEMI?
A
unstable angina will have normal troponin levels
5
Q
what is the definition of abdominal aortic aneurysm?
A
dilation of the abdo aorta w/ a diameter of >3cm
6
Q
what is the normal diameter of the abdominal aorta?
A
<2cm
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
8
Q
how often is surveillance carried out for AAAs 3cm - 4.4cm?
A
annually
9
Q
how often is surveillance carried out for AAAs 4.5cm - 5.4cm?
A
every 3 months
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)
11
Q
what is a true aortic aneurysm?
A
when all 3 layers of the aorta are intact but dilated
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
13
Q
where is the most common place for a tear to occur in aortic dissection?
A
the ascending aorta
14
Q
what is the key thing to measure if aortic dissection is suspected?
A
blood pressure in both arms
15
Q
what is type A aortic dissection?
A
involving the ascending aorta
16
Q
what is type B aortic dissection?
A
involving the descending aorta
17
Q
how are type A aortic dissections managed?
A
urgen surgical management
18
Q
how are type B aortic dissections managed?
A
medically managed
19
Q
what causes the first heart sound?
A
closing of the mitral and tricuspid valves
20
Q
what causes the second heart sound?
A
closing of the pulmonary and aortic valves
21
Q
what does a third heart sound indicate in young people?
A
nothing it is normal
22
Q
what does a third heart sound indicate in older people?
A
heart failure
23
Q
what is the most common valvular heart disease?
A
aortic stenosis
24
Q
describe aortic stenosis murmur
A
an ejection systolic high pitched murmur
25
where does aortic stenosis radiate to?
the carotids
26
describe aortic regurgitation
early diastolic soft murmur
27
where is aortic regurgitation heard?
at the apex
28
describe mitral stenosis?
mid diastolic low pitched rumbling murmur
29
describe mitral regurgitation
pan systolic high pitched whistling murmur
30
where does mitral regurgitation radiate to?
the axilla
31
what are the shockable arrhythmias?
ventricular tachycardia
ventricular fibrilaiton
32
how can superventricualr tachycardia be differentiated from sinus tachycardia?
superventricular tachycardia has an abrupt onset and no variaibilty
sinus tachycardia has a more gradual onset and more variability in rate
33
how can atrial fibrillation be identified on ECG?
absent P waves
irregularly irregular rhythm
34
what does a saw tooth appearance on ECG indicate?
atrial flutter
35
what is the rate usually in atrial flutter?
around 300 beats per minute
36
what is atrial flutter caused by?
a re-entrant rhythm
37
what is torsades de pointes?
a polymorphic ventricular tachycardia
38
what is the acute management of torsades de pointes?
treat the underlying cause
magnesium infusion (even if they have a normal magnesium)
defibrillation if ventricular tachycardia occurs
39
what are ventricular atopics?
premature ventricular beats caused by random electrical discharges outside the atria
40
what do patients with ventricular atopics tend to present w/?
random extra or missed beats
41
what causes first degree heart block?
delayed conduction through the atrioventricular node but every atrial impulse leads to ventricular contraction
42
how does first degree heart block present on an ECG?
PR interval longer than 0.2 seconds (5 small boxes / one big box)
43
what is second degree heart block?
when some atrial impulses do not make it through the atrioventricular node to the ventricles
44
how does second degree heart block present on ECG?
some P waves are not followed by QRS complexes
45
what are the 2 types of second degree heart block?
mobitz type 1
mobitz type 2
46
what is mobitz type 1 (second degree heart block)?
conduction through the AV node takes progressively longer until it fails
longer longer longer drop
47
how does mobitz type 1 present on ECG?
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
48
what its mobitz type 2?
when there is intermittent failure of conduction through the AV node w/ an absence of QRS complexes following P waves
49
what is third degree heart block?
complete heart block
there is no relationship between P waves and the QRS complexes
50
what is the major risk w/ third degree heart block?
asystole
51
what is the first line treatment for those at risk of asystole?
IV atropine
52
what causes arterial ulcers?
insufficient blood supply to the skin due to peripheral artery disease
53
what causes venous ulcers?
pooling of blood and waste products in the skin secondary to venous insufficiency
54
where do arterial ulcers tend to occur?
distally, affecting the toes or the dorsum of the foot
55
how do arterial ulcers present?
punched out appearance
deep
pale in colour due to poor blood supply
less likely to bleed
painful
56
where do venous leg ulcers tend to occur?
between the top of the foot and the calf muscle
57
how do venous leg ulcers present?
larger and more superficial than arterial ulcers
irregular sloping border
more likely to bleed
less painful than arterial ulcers
58
how can you differentiate venous ulcers from arterial ulcers?
ABPI
59
how are venous ulcers treated?
compression therapy after arterial disease has been ruled out w/ ABPI
60
what are the reversible causes of cardiac arrest?
H - hypoxia
H - hypo / hyperkalaemia
H - hypo / hyperthermia
H - hypovolaemia
T - tension pneumothorax
T - tamponade
T - thrombosis
T - toxins
61
what is cardiac tamponade?
it results from blood / fluid in the pericardial space and this limits the filling of the ventricles, reducing stroke volume and cardiac output
62
what is acute heart failure?
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
63
when can acute heart failure be ruled out?
if BNP < 100 ng / l
64
what is the mainstay management of acute heart failure when there is evidence of congestion (wet patients)?
loop diuretics (furosemide)
65
what is chronic heart failure?
reduced cardiac output due to impaired cardiac contractility
66
what is the most common cause of chronic heart failure?
hypertension
67
what should all pts w/ chronic heart failure and a reduced ejection fraction be started on?
an ace inhibitor
68
how do DVTs present?
almost always unilaterally
leg swelling
tendernes
colour change
69
when measuring the diameter of the calves when DVT is suspected what difference is classed as significant?
>3cm
70
what investigation is used to diagnose DVT?
doppler ultrasound
71
what should be done if there is -ve Doppler ultrasound but +ve d dimer and wells score suggests DVT is likely?
repeat the doppler ultrasound 6-8wks later
72
how is a pulmonary embolism diagnosed?
CTPA
73
what is the initial treatment for DVT?
anticoagulation w/ apixaban or rivaroxaban
74
what is the most common causative organism for infective endocarditis?
staph aures
75
what are the key examination findings in infective endocarditis?
splinter haemorrhages
osler nodes
roth spots
76
what is the key investigation for infective endocarditis?
blood cultures before starting antibiotics
77
how should blood cultures be done for infective endocarditis?
three blood culture samples taken 6 hrs apart and from dif sites
78
what is the management of infective endocarditis?
broad spectrum ABs (amoxicillin or gent)
79
how long should antibiotics be given for in infective endocarditis?
4 wks for native heart valves
6 wks for prosthetic heart valves
80
what is the first line treatment for pericarditis?
NSAIDs and colchicine for 3 months as an adjunct
81
what is myocarditis?
inflammation of the myocardium (the muscle layer of the heart)
82
what is the pt demographic at highest risk of myocarditis?
middled aged men (20-40 y/o)
83
what is the most common cause of myocarditis when a cause can be identified?
viral infection
84
what is the gold standard investigation for myocarditis?
end-myocardial biopsy (EMB)
85
what histological findings on EMB confirms a diagnosis of myocarditis?
inflammatory infiltrate w/ necrosis
86
a regular narrow complex tachycardia w/ absence of P waves is suggestive of what?
supraventricualr tachycardia
87
what is the management of supraventricualr tachycardia?
vasovagal manoeuvres
IV adenosine (rapid bolus of 6mg, if unsuccessful give 12mg, if unsuccessful give further 18mg)
electrical cardio version
88
what valve is used for aortic valve replacement in young pts (under 65)?
mechanical heart valve
89
what is the likely diagnosis when there is persistent ST elevation following recent MI and there is no chest pain?
left ventricular aneurysm
90
how does left ventricular aneurysm present?
persistent ST elevation and evidence of left ventricular failure (signs of heart failure)
91
what is dresslers syndrome?
recurrent pericarditis following a myocardial infarction
92
how does dresslers syndrome present?
fever
anaemia
raised ESR
pleural effusions
93
when does dresslers syndrome present?
usually 6-8wks following MI
94
how is dresslers syndrome treated?
NSAIDs
95
when does left ventricular free wall rupture occur?
1-2 wks after an MI
96
how do pts w/ left ventricular free wall rupture present?
w/ acute heart failure secondary to cardiac tamponade
97
what is the management of left ventricular free wall rupture?
urgent pericardiocentesis and thoracotomy
98
acute mitral regurgitation most commonly occurs following which type of MI?
infero-posterio infarction
99
how does acute mitral regurgitation present?
acute hypotension
pulmonary oedema
early to mid systolic murmur
100
what murmur is heard in pulmonary stenosis?
ejection systolic louder on inspiration
101
what are the 3 hallmark signs of cardiac tamponade?
hypotension
elevated JVP
diminished heart sounds
102
what is the definitive diagnostic test for cardiac tamponade?
echocardiogram
103
what is the management of cardiac tamponade?
urgent pericardiocentesis
104
which valve is most commonly affected in infective endocarditis?
the mitral valve
105
which valve is most commonly affected in infective endocarditis in PWIDs?
the tricuspid valve
106
what are the ECG findings of hypokalaemia?
U waves
small or absent T waves
long QT interval
prolonged PR interval
107
which vessel is responsible for changes in lead 1?
circumflex artery
108
which vessel is responsible for changes in leads 2,3 and aVF?
right coronary artery
109
which vessel is responsible for changes in V1, V2, V3 and V4?
left anterior descending
110
which vessel is responsible for changes in V5 and V6?
circumflex artery
111
what is the management of pts w/ bradycardia and signs of shock?
IV atropine 500mg repeated up to a max of 5 times
112
is left bundle branch block ever normal?
no
it is always abnormal and is usually assoc w/ underlying ischaemic or structural heart disease
113
which murmur is mid - late diastolic, radiates to the apex and louder on expiration?
mitral stenosis
114
which arrhythmia is assoc w/ mitral stenosis?
AF
115
what is the first step in the management of hypertension in a pt <55y/o or w/ T2DM?
ACE inhibitor e.g. ramipril
OR
angiotensin receptor blocker e.g. losartan
116
what is the second step in the management of hypertension in a pt <55y/o or w/ T2DM?
ACEi / ARB + calcium channel blocker e.g. amlodipine
OR
ACEi / ARB + thiazide like diuretic e.g. indapamide
117
what is the third step in the management of hypertension for all pts?
ACEi / ARB + calcium channel blocker + thiazide like diuretic
118
what is the first step in the management of hypertension in a pt >55y/o or afro carribean?
calcium channel blocker e.g. amlodipine
119
what is the second line management of hypertension in a pt >55y/o or afro carribean?
calcium channel blocker + ACEi or ARB
OR
calcium channel blocker + thiazide like diuretic
120
what is the next step in the management of symptomatic bradycardia if atropine fails?
external pacing
121
what is the first line pharmacological intervention for sustained torsades de pointes?
IV magnesium sulphate
122
if a pt w/ AF has a stroke or a TIA what should the anticoagulant of choice be?
warfarin or a direct thrombin or factor Xa inhibitor
123
what is the management of PE when there is hypotension?
thrombolysis
124
what is the most common ECG finding in pts w/ PE?
sinus tachycardia
125
what is the management of an uncomplicated dissection of the descending aorta?
medical management - beta blockade and analgesia
126
what is Stanford A dissection?
ascending aortic dissection
127
what is Stanford B dissection?
descending aortic dissection
128
what is the management of Stanford A dissection or Stanford B dissection where there is evidence of end organ ischaemia?
endovascular repair or open intervention
129
what are the ECG findings of ostisum secumdum?
right bundle branch block w/ right axis deviation
130
what is the significance of a PR interval >200ms in an athlete?
no significance
first degree heart block is a normal variation in athletes
131
what is the most common CXR finding in PE?
normal CXR
132
which drug can make clopidogrel less effective?
PPIs
133
what is the management of pulseless electrical activity?
1mg IV adrenaline
134
is pulseless electrical activity shockable?
no
135
what is the investigation of a PE in a pt w/ renal failure?
V/Q scan
136
what is the management of major bleeding when a pt is on warfarin?
stop warfarin
IV vit K
prothrombin complex concentrate (f not available give FFP)
137
what is the management of a pt on warfarin and the INR is >8 and there is minor bleeding?
stop warfarin
IV vit K
restart warfarin when INR <5
138
what is the management of a pt on warfarin and the INR is >8 but there is no bleeding?
stop warfarin
give oral vit K
restart warfarin when INR <5
139
what is the management of a pt on warfarin and the INR is between 5-8 and there is minor bleeding?
stop warfarin
give IV vit K
restart warfarin when INR <5
140
what is the management of a pt on warfarin and the INR is between 5-8 but there is no active bleeding?
w/hold 1/2 doses of warfarin
reduce subsequent maintenance dose
141
what is the management of a witnessed cardiac arrest while on a monitor?
deliver 3 successive shocks
142
how does a posterior MI present on ECG?
ST depression
143
which electrolyte abnormality can lead to long QT syndrome?
hypokalaemia
144
what should be given to pts on warfarin and undergoing emergency surgery?
4 factor prothrombin complex concentrate
145
which murmur is assoc w/ a collapsing pulse?
aortic regurgitation
146
what is the most common cause of secondary hypertension?
primary hyperaldosteronism
147
in a PE what is an indication for thrombolysis?
hypotension
148
what is the most characteristic ECG finding in arrhythmogenic right ventricular dysplasia (ARVD)?
epsilon wave = a small positive deflection at the end of each QRS
149
is there a right circumflex artery?
no
150
what is the investigation of choice for suspected aortic aneurysm?
CT aortic angiogram
151
what is the treatment of type A aortic aneurysms?
surgery
152
what is the treatment of type B aortic aneurysms?
beta blockers
153
what is the most common ecg change seen in PE?
sinus tachycardia
154
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?
left ventricular free wall rupture
155
what is the investigation of choice for aortic dissection?
CT aortic angiogram
156
what is the management when there is massive PE and hypotension?
thrombolyse w/ alteplase
157
hypertrophic obstructive cardiomyopathy is assoc w/ what examination finding?
S4 heart sound
158
what is the first line treatment for broad complex tachycardias w/out adverse features?
amiodarone
159
when in heart failure should beat blockers be stopped?
if the heart rate is <50 bpm
if there is second or third AV block
if the pt is in shock
160
infective endocarditis in IVDUs most commonly affects which valve?
tricuspid
161
what should be done after fibrinolysis is given for ACS?
ECG after 60-90 mins
162
what is the investigation of choice for suspected aortic dissection?
CT angio chest abdo pelvis
163
what is the treatment for symptomatic bradycardia?
atropine
164
what is the most common cause of mitral stenosis?
rheumatic fever
165
what is the main ECG change seen w/ hypercalcaemia?
shortening of the QT interval
166
what is the most specific ECG finding in acute pericarditis?
PR depression
167
what is the first line management for hypertension in diabetic pts regardless of age?
ACEi / ARB
168
what is the likely diagnosis when there is persistent ST elevation following recent MI and there is no chest pain?
left ventricular aneurysm
169
what is the management of a normal stroke?
aspirin first for 2wks
the life long clopidogrel
170
where is most commonly affected in infective endocarditis in IVDUs?
tricuspid valve
171
what is the likely diagnosis when the pt presents w/ rash, arthritis, murmur and history of a recent sore throat?
rheumatic fever
172
173
what is the management of a normal TIA?
aspirin first for 2 wks
then life long clopidogrel
174
what is the management of a stroke caused by AF?
aspirin first for 2 wks
then life long clopidogrel
175
what is the management of a TIA caused by AF?
immediate DOAC
176
what is the management of supraventricualr tachycardias?
try vagal manoeuvres then adenosine (6, then 12 then 18)
177
what is the management of ventricular tachycarida?
initiate rhythm control w/ amiodaron
178
what does narrow complex tachycardia indicate?
supraventricualr tachycardia
179
what does broad complex tachycardia indicate?
ventricular tachycardia
180
what is the management of a pt w/ AF who has pneumonia and why?
rhythm control because the AF is due to a reversible cause
181
which 2 drugs are used for cardioversion in AF?
amiodarone and flecainide
182
