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finals > Cardio > Flashcards

Cardio Flashcards

1
Q

posterior MI ECG findings

which vessel

A

lead v1-3

Op of STEMI:

horizontal ST depression
Tall Broad R waves
upright T waves

dominent R wave in v2

Basically if st depression in leads V1-V4 = do 2 extra leads V&V9 bc something going on posterior

LCX or RCA

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2
Q

? PE investigation CKD or pregnant

A

V&Q scan

instead of CTPA

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3
Q

malignant hypertention

A

BP> 180/120

end organ damage

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4
Q

hypokal ECG

A

prolonged PR ( 1st degree Hb)
Prominent U waves

flateneed t wave and st depression

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5
Q

HOCM hart sound

A

s4

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6
Q

when to stop anticoag consider alternative diagnosis with PE

A

2-level PE Wells score </= 4

-ve d-dimer

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7
Q

NSTEMI scoring scale and Mx

A

GRACE SCORE

<3% = conservative management

> 3% = PCI in 72hrs

haem unstable = PCI now

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8
Q

Conservative management NSTEMI

A

aspirin fondaparinux ticagrelor

clopidgrel if high bleedinig risk (ie on anti coags)

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9
Q

pulmonary embolism abg

A

resp alkalosis

bc hypervent = low co2

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10
Q

criteria for infective endocarditis

A

duke criteria

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11
Q

risk of bleeding af and on anticoags

A

ORBIT score

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12
Q

PE with haemodynaic instability

A

thrombolysis

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13
Q

mitral stenosis

mc cause
path
sx
tx

A

rheumatic fever

(blood backflow in left atrium) heart failure sx and af bc atrial stretch
malar flush
haemoptysis

tx af w mitral stenosis = anticiag

ASx = monitor w echo every 6-12 mths
sx = baloon valvotomy or perc mitral commissurotomy

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14
Q

mitral stenosis sounds

A

mid diastolic rumble (best in exp)
at apex
loud s1
opening snap

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15
Q

pt w PE that can be managed as outpatients

A

PESI score

(pe severity index)

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16
Q

aortic regrug causes and presentation

A

infection - infective endocarditis, rheuamtic fever
infarction
aortic dissection
spondoarthrop
RA, SLE , marfans and ehler danlos

acute = cardiogenic shock
chronic = CHF and chest pain maybe

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17
Q

aortic regurg signs

A

early diastolic rumble (increase by handgrip)
collapsing pulse
wide pulse pressure

quincke
de mussets

severe = mid diastolic austin flint murmur

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18
Q

quinckes sign

A

nailbed pulsation in aortic regrug

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19
Q

de mussets sigm

A

head bobbing in aortic regurg

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20
Q

what is austin flint murmur

A

severe aortic regurg

due to partuial closure of anterior mitral valve cusps bc regurg stream

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21
Q

aortic stenosis sx

A

chestpain dysponea syncope (exertional dizziness)

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22
Q

aortic stenosis causes and tx

A

calcification

ie old pt w athersclerosis
process sped up if bicuspid valve = ypunger pt
williams syndrome (supravalv aotic sten)
post rheumatic disease
HOCM

Asx = monitor
Sx = valve replacement

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23
Q

aortic stenosis murmur

what if severe

A

ejection systolic
radiates to carotids
decreased by valsalva manouvre
crescendo descrescendo

severe =
soft absent s2
s4 sound
slow rising pulse
narrow pulse pressure

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24
Q

causes mitral regurg

A

Post MI/ ACS ( bc papillary muscles/chordea tendinae affected)
mitral valve proplapse
infective endo
rheumatic fever
congenital

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25
Q

mitral regurg sx

A

often stays asx unless gets too bad = present w failure of Left vent, arythmia, or pul htn

ie fatigue SOB oedema

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26
Q

mitral regrug murmir

what if severe

A

pansystolic mumur
hollow high pitched blowing sound
apex and radiates to axilla

widely split S2 if severe

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27
Q

medical mx acute mitral regurg

A

nirates duiretics inotropes intraaortic balloon pump

if in heart failure maybe ace inhibitors n bb m spirinolactone

severe = replacement

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28
Q

making murmurs worse/better

A

murmur louder bc more blood in the heart
therefore

valsalva = dec venous return = improve

leg lift and squatting = increased venous return therefore worsens murm

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29
Q

hocm genes and path

A

autosomal dominant

diastolic dyfxn
left v hypertrophy -> decreased compliance -> decreased cardiac output

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30
Q

hcm presentation

murmur

A

extertional sob
young
syncope post exercise
sudden death bc vent arythmia

ejection systolic murmur
(made worse by vals and better by squatting)

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31
Q

hocm echo MR SAM ASH

A

MR SAM ASH

mitrak regurg
systolic antieror motion (of ant mitral valve leaflet)
assymetic hypertophy

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32
Q

mitral valve prolapse causes features

A

usually idiopathuc ie congenital

midsystolic click (occurs later if pt standing)
late systolic murmur (longer if pt standing)

basically similar murmur to mitral regurg but improves with blood in the heart

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33
Q

angina tx

A

bb or ccb first line

if only ccb used = verpamil or diltazem

if on monotherapy still sx and cannot tolerate either bb or ccb = long acting nitreate. nicorandil, ivabradine

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34
Q

hyperaldoesteronism presentation

A

hypertension
hypokalaemia

metabolic alkalosis

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35
Q

hyperaldost 1stline investigtiion how to differentiate btween 1 and 2ndry

A

aldoesterone renin ratio

high = primary (in adrenals bc aldosterone being produced indepedant of renin)

low ratio = secondary (inc aldos bc renin raised ie problem in axis )

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36
Q

primary hyperaldosterone ix

A

1st aldosterone renin ratio (high ald = primary)

2nd high resolution ct abdo
(to see uni lat or bilat cause)
if normal/inconc = AVS

3rd adrenal venous sampling (AVS)
if aldos inc in both veins = bilateral cause

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37
Q

causes of primary hyperaldos

A

unilat adrenal adenoma

bilateral adrenal hyperplasia

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38
Q

Post MI complication pericarditis

A

2-3 days bc post transmural MI

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39
Q

Post Mi complications Dressler’s syndrome

A

2-6weeks post MI

autoimmune reactuion to proteins as myocardium recovers

fever pleuritic pain pericardial effusion
raised ESR

Tx - nsaids

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40
Q

after 5 days complications of post MI

A

RUPTURE ie

free wall = sx cardiac tamponade

VSD septal rupture = hf sx (pansystolic murm)

papllary muscle damage = mitral regurg and hf sx (early to mid systolic murm)

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41
Q

poorly controlled htn already on acei, ccb, and thiazide

A

if k<4.5 = add spironolactone

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42
Q

ccb SE gums

A

gingival hyperplasia = gum bleed

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43
Q

x ray findings heart failure

A

ABCDE

Alveolar oedema (bats wings)
Kerly B lines (intersitioal oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
effusion (pleural)

44
Q

ruptured AAA bloods

A

crossmatch blood 6 units

45
Q

acute pericarditis 1st tx

A

nsaids and colchicine

46
Q

fibronolysis given for ACS then what

A

repeat ecg after 60-90 mins if still st elevation = transfer for urgent PCI

47
Q

ccb se

A

headache flushing ankle oedema

48
Q

meseneteric ischaemia triad

A

cvd
hight lacate
sofy but tender abdo

49
Q

unstable pe

A

thrombolysis ie alteplase

50
Q

mesenteric ischaemia 1st ix

A

vbg - lactate
CT

51
Q

nifedipine SE

A

reflex tachycardia
palpitations dizziness

52
Q

bradycardia atropine CI

A

adrenaline infusion

53
Q

mechanical valve target INR

A

aortic = 3

mitral = 3.5

54
Q

AAA screening

A

all men aged 65 offered single abdo USS

55
Q

infective endocarditis indications for surgery

A

severe valv incompetence
aortic abscess
infxn reistant to abx or fungal infections
cardiac failure refractory to standard medical therapy
recurrent emboli after abx therpay

56
Q

isolated hemisensory loss stroke

A

lacunar infarct

57
Q

lacunar infarct

A

unilateral weakness and or senrsory face arm and leg or all 3

pure sensory stroke
ataxic hemiparesis

dysarthria/clumsy hand syndrome

58
Q

mx primary hyperaldoesterone

A

adrenal adenoma = laproscoopic adrenalenctomy

bilat adrenocortical hyperplasia = spironolactone

59
Q

what does opening snap mean in mitral stenosis

A

leaflets still have some mobilty

60
Q

new LBBB on ecg

A

wide QRS in precordial leads
normal shape but negative QRS in V1
mostly positive w slow upstroke R wave peak in lateral leads

61
Q

anticoag post catheter ablation for AF

A

so still need anticoag base on chadvasc score

0 = 2mths anticoag
1+ = long term anticoag

62
Q

risk factors for asystole in bradycardia

ie needs transvenous pacing

A

complete heart block w broad qrs complexes
recent asystole
mobitz type II av block
ventricular pause> 3 seconds

63
Q

CCB constipation which one most likely

A

verapamil

64
Q

acute limb ischaemie intial mx

A

abc
IV opiods
IV UFH
vascular review

65
Q

acute limb ischaemia def mx

A

intra arterial thrombolysis
surgical embolectomy
angioplasty
bypass surg
amputation is irrevesible

66
Q

MC cause infective endocarditis

A

Staph aureus

staph epidermidis if <2mths post valve surgery

67
Q

symptomatic aortic stenosis tx

A

surgical AVR for low/med risk op pts

transcatheter AV for high risk

68
Q

driving post MI

A

4 weeks
dont tell dvla

69
Q

useful cardiac enzyme to look for reinfarction

A

ck-mb

returns to normal after 2-3 days

70
Q

complications after coronary anggiography

A

bleeding
infection
allergy to contrast
mi
stroke

71
Q

angina triggers

A

cold weather
amotionie anger/excitement
vivid dreams
lying down

72
Q

blood tests and why for pt w angina

A

fbc - anaemia
tft - thyrotox
blood glucose - d
u&e if considering acei

73
Q

how does aspirin work

A

Cox inhib
prevents thromboxine production
inhibits platelets aggregation

74
Q

what is an aneurysm

A

abnormal dilation of vessal wall >150% of orgininal diameter due to weakness in vessel wall

75
Q

true aneurysm

A

dilatation of vessel involving all 3 layers of vessel

76
Q

false aneurysm,

A

collection of blood in a dilatation only secured by adventitia (outermost layer) due to damage to other two layers

77
Q

aneurysm screening <3cm

A

no further action

78
Q

AAA screening dilation found

A

3-4.4cm = rescan every 12 mths

4.5-5.4 = rescan every 3mths

79
Q

AAA screening found aneur >5.5cm

A

refer 2 weks for vascular surgery for repair

either EVAR (Eelective endovasc repair)
or open surgery if unsuitable

80
Q

causes AAA and RF

A

marfans/ehlers
atheromatous degeneration

smoking
fhx
dm
htn
male
inc age
hyperlipidemia

81
Q

reasons why EVAR for aaa may be prefered over open surg

A

comorbidties = open surgery too much risk
morphology of AAA = evar suitable
position of renal arteries

82
Q

-ve of EVAR for aaa repaire

A

long term follow up needed
not suitable for every aneurysm
high reintervention rate (endo leak)

83
Q

ruptured aaa ix if stable

A

abdo ct with contrast

84
Q

Trash foot

A

cholesterol embolism
atheromatous debris shed during vasc surgery, lodges in distal vessel = local ischaemia

mottled skin and darekened segments on toes

85
Q

4 layers of vessel

A

endothelium/intima
tunica media
tunica externa
serosa/adventitia

86
Q

capture beat

A

normal qrs complex inbetween broad VT complexes

87
Q

VT or VF shockable ?

A

VF yes

VT yes if no palpable pulse

88
Q

VT mx

A

oxygen
adrenaline
amiodarone
lidocaine

89
Q

vt vs vf

A

vt more regular and uniform than vf

90
Q

severity of HF

A

NYHA

91
Q

acute left heart failure path and sx

A

LV cant pump blood out to SVS, back log= pulmonary oedema= acute SOB, reduce sats, worse lying down. T1RF.

unwell, cough pink frothy sputum, wheeze cough

raised RR, tachyC, 3rd HS, bibasal crackles, hypotension. RSHF?

92
Q

right heart failure sx

A

peripheral oedema, facial engorgement and distension o f the abdomen.
raised jvp
hepatomegaly

93
Q

how does furesimide work

A

competitively inhibits na/k/cl cotransporter in thick ascending loop of henle

removes osmotic water gradient for water to reabsorb

94
Q

reverse tick pattern on ecg

A

down sloping st depression
t wave inversion/flat
short qt

bc DIGOXIN

95
Q

ACEi side effects

A

cough
first drop hypotension
angioedeema
hyperkalemia
renal impairement

96
Q

hypertensive retinopathy classification

A

Keith-Wagener

97
Q

signs of hypertensive retinopathy

A

silver wiring
AV nipping
flame haemorrhages
cotton wool exudates
flame and blot haemorhages (may collect around mac = macular star)
papilloedema

98
Q

complications of essential hypertension

A

HF
IHD
CKD
Stroke
PVD
hypertensive retinopathy

99
Q

causes of AF

A

pneumonia
MI
PE
HF
hyperthyroid
alocohol excess
endocarditis

100
Q

af ecg

A

ireggular qrs
absent p wave

101
Q

AF cardioversion

A

medcal = amiodarine flecanide

electrical DC cardioversion

ablation

102
Q

complications of AF

A

stroke
tia
HF
systemic emboli
falls

103
Q

why check urine sample in infective endocarditis

A

microscopic haematuria
bc

immune complex glomerulonephritis
septic emboli
renal cortical necrosis

104
Q

infective endocarditis eyes

A

roth spots on retina

white centered haemorrhages

105
Q

infecttive endo ix

A

3 blood cultures 3 seperate times 3 sep places

echo
cxr
ecg
urine dip

106
Q

infective endo RF

A

prev episode
IDVU
prosthestic valves
rheumatic valve disease
congen heart defects ie PDA VSD
recent piercings

107
Q
A

finals (28 decks)

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