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Finals round 2 lol > cardio > Flashcards

cardio Flashcards

1
Q

What condition may cause a double pulse

A

HOCM
mixed aortic valve disease

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2
Q

Management of stable CVD with AF

A

stop platelets and start anticoagulant

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3
Q

Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a standard-dose thiazide diuretic. K+ > 4.5mmol/l

A

add alpha or beta blocker

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4
Q

What is the MOA of alteplase

A

activates plasminogen to form plasmin, which degrades fibrin

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5
Q

What medications inhibit the conversion of fibrinogen to fibrin

A

heparin/direct thrombin inhibitors

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6
Q

ECG + artery: anteroseptal

A

V1-V4 + LAD

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7
Q

ECG + artery: inferior

A

II, III, aVF + right coronary

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8
Q

ECG + artery: Lateral

A

I, aVL, V5-6 + left circumflex

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9
Q

Why do you get pulmonary oedema in MI

A
  • rupture of papillary muscle
  • acute mitral regurgitation causing backflow leading to pulmonary hypertnesion
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10
Q

persistant myocardial ischamia following fibrinolysis

A

PCI

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11
Q

stable angina

A
  1. aspirin/statin
  2. GTN spray
  3. CCB/BB
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12
Q

ECG change in WPW

A

shortened PR interval (early depolarisation)

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13
Q

What medication should be avoided with HOCM

A

ace-inhibitors

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14
Q

When should statins be stopped

A

if serum transaminase concs rise to persist 3x upper limit

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15
Q

what is seen on chest x-ray wit aortic dissection

A

widened mediastinum

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16
Q

j waves

A

hypothermia

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17
Q

complete heart block following inferior MI

A

atropine (if anterior, pacing)

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18
Q

what cardiac abnormalities are associated with carcinoid syndrome

A

pulmonary stenosis and tricuspid insufficiency

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19
Q

most common cause of endocariditis

A
  • staph aureus
  • staph epidermis if < 2 months valve replace
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20
Q

cardiac tamponade following MI

A

left ventricular free wall rupture

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21
Q

persistent ST elevation following MI

A

left ventricular aneurysm

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22
Q

causes of torsades de pointes

A

hypothermia, hypocalcamia, hpokalamia, hypomagnesemia

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23
Q

What investigation should be done post fibinolysis

A

ECG

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24
Q

What is a contraindication to adenosine

A

asthma

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25
Q

DVLA advice post MI

A

cannot drive for 4 weeks

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26
Q

hypokalaemia ecg

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

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27
Q

AF pharmacological cardioversion meds

A

amiodarone
flecainide (if no structural heart disease)

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28
Q

what NSAID is contraindicated in al CVD

A

diclofenac

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29
Q

A patient develops acute heart failure 5 days after a myocardial infarction. A new pan-systolic murmur is noted on examination

A

ventricular septal defect

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30
Q

normal QRS

A

0.08-0.10

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31
Q

chronic heart failure vaccine

A

annual influenza
one off pneumococcal

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32
Q

what antibiotic can cause torsades de pointes

A

macrolides

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33
Q

Long Qt causes

A

Electrolytes:
Hypocalcaemia
Hypomagnesaemia
Hypokalaemia

  1. Drugs:
    Antiarrhythmics (e.g. amiodarone, sotalol)
    Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)
    Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)
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34
Q

third heart sound

A

caused by diastolic filling of the ventricle
considered normal if < 30 years old (may persist in women up to 50 years old)
heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

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35
Q

raised vs low BNP causes

A

Raised
- myocardial ischaemia or valvular disease
-reduced excretion in patients with chronic kidney disease.

reduce BNP
- ACE inhibitors, angiotensin-2 receptor blockers and diuretics.

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36
Q

what murmur may be present with HOCM

A

ejection systolic murmur, louder on performing Valsalva and quieter on squatting

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37
Q

how to differentiate ascending vs descending aortic dissection

A

new murmur = aortic regurg = ascending
ascending: chest pain whilst descending is back pain and distal to subclavian vein

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38
Q

what diabetes drug should be stopped in MI

A

metformin: risk of lactic acidosis

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39
Q

what should be done before using flecinide

A

echo: look for structural heart disease

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40
Q

If a patient has been in AF for more than 48 hours…

A
  • anticoagulation for at least 3 weeks prior
  • perform a transoesophageal echo (TOE) to exclude a left atrial appendage (LAA) thrombus
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41
Q

A patient with AF + an acute stroke (not haemorrhagic) should have anticoagulation therapy….

A

2 weeks after to prevent hemorrhagic transformation

42
Q

PAD investigation

A
  1. handheld arterial Doppler examination
  2. ABPI
43
Q

ACS initial management

A
  1. Morphine
  2. oxygen (if <94%)
  3. nitrates (unless hypotensive)
  4. Aspirin 300mg
44
Q

STEMI management

A
  1. MONA
  2. PCI with aspirin + prasugrel/clopidogrel prior and unfractionated heparin with bailout glycoprotein IIb/IIIa inhibitor (GPI) during (if <12 hours and can be delivered in <120 mins)
  3. Fibrinolysis with fondaparinux
45
Q

What encompasses the GRACE score

A

age
heart rate, blood pressure
cardiac (Killip class) and renal function (serum creatinine)
cardiac arrest on presentation
ECG findings
troponin levels

46
Q

Which patients with NSTEMI/unstable angina should have coronary angiography (with follow-on PCI if necessary)?

A

immediate: patient who are clinically unstable (e.g. hypotensive)
within 72 hours: patients with a GRACE score > 3% i.e. those at intermediate, high or highest risk

47
Q

what pain relief instead of morphine is used in ACS

A

paracetamol: NSAIDs may precipitate bleeding after antiplatelet drugs are given

48
Q

drug therapy for medically managed STEMI

A

Aspirin + ticagrelor

49
Q

Right heart failure vs Left heart failure signs

A

Right (body)
- Raised JVP
- Hepatomegaly
- Anorexia
- Peripheral oedema

Left (Lungs)
- Dyspnoea
- fine bibasal crackles
- orthopnoea

50
Q

what arrhythmia is associated with HOCM

A

WPW
PR <120ms and wide QRS

51
Q

Complete heart block following a MI?

A

right coronary artery as it supplies the AVN node

52
Q

hypokalaemia ECG

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

53
Q

when should statins be taken

A

last thing in the evening

54
Q

prosthetic valves antithrombotic therapy

A

bioprosthetic: aspirin
mechanical: warfarin + aspirin

55
Q

posterior infarct ECG

A

ST elevation and Q waves in posterior leads (V7-9)
ST depression
Tall, broad R-waves
Upright T-waves

56
Q

VF/pulseless VT treatment

A

not witnessed: 1 shock + 2 mins CPR
witnessed: up to 3 shocks

57
Q

Heart sounds

A

S1: mitral + tricuspid closing
S2: aortic and pulmonary closing
S3: rapid filling of ventricles (normal in young patients)
S4: stiff/hypertrophic ventricle

58
Q

Valve areas

A

Pulmonary: 2nd intercostal space left sternal border
Aortic: 2nd intercostal right sternal border
Tricuspid: 5th intercostal space left sternal border
Mitral: 5th intercostal space mid clavicular line (apex)

59
Q

What maneuver helps hear mitral stenosis better?

A

make patient lay on their left side

60
Q

what maneuver helps hear aortic regurg better

A

lean forward and exhale

61
Q

mitral stenosis murmur features

A
  1. dyspnoea
    ↑ left atrial pressure → pulmonary venous
  2. haemoptysis
  3. mid-late rumbling diastolic murmur (best heard in expiration)
  4. loud S1
  5. low volume pulse
  6. malar flush
  7. atrial fibrillation
    secondary to ↑ left atrial pressure → left atrial enlargement
62
Q

mitral regurg features

A

pansystolic murmur heard best at apex and radiates to axilla
reduced ejection fraction heart failure (S3)

63
Q

aortic stenosis features

A
  1. high pitched ejection systolic murmur (crescendo decrescendo)
  2. narrow pulse pressure
  3. slow rising pulse
  4. left ventricular hypertrophy or failure
  5. radiates to carotids
64
Q

aortic regurg features

A
  1. early diastolic murmur
  2. collapsing pulse
  3. wide pulse pressure
  4. Quincke’s sign (nailbed pulsation)
  5. De Musset’s sign (head bobbing)
    mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams
65
Q

symptomatic aortic stenosis treatment

A

surgical AVR for low/medium operative risk patients
transcatheter AVR for high operative risk patients

66
Q

what murmur is associated with ADPKD

A

Mitral valve prolapse

67
Q

loud s2 sound

A

pulmonary hypertension

68
Q

in mitral stenosis, what implies that the valve leaflets are still mobile

A

loud opening snap

69
Q

heart failure x ray

A

A: Alveolar oedema
B: Kerley B lines
C: Cardiomegaly
D: dilated upper lobe vessels
E: pleural effusion

70
Q

how to differentiate cardiac tamponade and constrictive pericarditis

A

CP has a positive kussmaul sign (JVP that doesnt fall with inspiration)

71
Q

patient with severe HF and hypotension

A

inotropes such as dobutamine

72
Q

hypertension stages

A

Stage 1
Clinic: 140/90
Home: 135/85

Stage 2
clinic: 160/100
home: 150/90

73
Q

management of aortic dissection

A

type a: surgery (aortic root replacement) and iv labetalol
type b: iv labetalol

74
Q

investigation for aortic dissection

A

Stable: CT angiography of the chest, abdomen and pelvis
Unstable: TOE

75
Q

IE antibiotic duration

A

4 weeks native valve
6 weeks prosthetic valve

76
Q

infective endocarditis indications for surgery

A

severe valvular incompetence
aortic abscess
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

77
Q

Dukes criteria

A

Major criteria
- Persistently positive blood cultures (typical bacteria on multiple cultures)
- Specific imaging findings (e.g., a vegetation seen on the echocardiogram)

Minor criteria are:
- Predisposition (e.g., IV drug use or heart valve pathology)
- Fever above 38°C
- Vascular phenomena (e.g., splenic infarction, intracranial haemorrhage and Janeway lesions)
- Immunological phenomena (e.g., Osler’s nodes, Roth spots and glomerulonephritis)
- Microbiological phenomena (e.g., positive cultures not qualifying as a major criterion)

78
Q

what can cocaine trigger

A

coronary artery vasospasm

79
Q

what CCB is used as monotherapy in stable angina

A

diltiazam or verapamil

80
Q

virchows triad

A

stasis, endothelial injury and hypercoagubility

81
Q

rare complication of ace inhibitors

A

angioedema

82
Q

when do you DC cardiovert with AF

A

HISS –> DC cardioversion
(HF, Myocardial infarction, Shock, Syncope)

83
Q

which hypertensive is avoided in high hba1c

A

thiazide like diuretics

84
Q

what arrhythmia can tension pneumothorax cause?

A

PEA

85
Q

WPW ecg and treatment

A

W - delta Wave
P - short PR interval
W - Wide QRS complexes

Accessory pathway ablation

86
Q

reversible causes of arrest

A

4 Ts
thrombus
tamponade
tension pneumothorax
toxins

87
Q

what medication is stopped with macrolides

A

statins (pregnancy also a contraindication)

88
Q

ecg findings in cardiac tamponade

A

electrical alterens

89
Q

what drug is contraindicated in aortic stenosis

A

ramipril

90
Q

causes of torsades de pointes

A

tricyclic antidepressants
antipsychotics
chloroquine
terfenadine
erythromycin
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
myocarditis
hypothermia
subarachnoid haemorrhage

91
Q

what MI can cause RBBB

A

anterior

92
Q

What is the most common cause of death in patients following a myocardial infarction?

A

v fib

93
Q

PAD medication

A

statin 80mg and clopidogrel 75mg

94
Q

TIA/stroke + AF

A

TIA due to AF: DOAC immediately and continue for life

TIA not due to AF: Aspirin 300mg immediately for 2 weeks and then clopidogrel lifelong

Stroke due to AF: Aspirin 300mg for 2 weeks and then DOAC lifelong

Stroke not due to AF: Aspirin 300mg for 2 weeks and then clopidogrel lifelong

95
Q

normal QRS

A

3-5 little squares

96
Q

all patients with tia should have a…

A

carotid doppler

97
Q

normal PR interval

A

3-5 little squares (0.12-.0.20)

98
Q

ALS adrenaline dose

A

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM
cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

99
Q

first line imaging for stable angina

A

ct coronary angiography

100
Q

what should be measured 3 months after starting statin

A

A lipid profile and liver function tests should be performed 3 months after starting a statin

101
Q

what can make clopidogrel less effective

A

omeprazole

Finals round 2 lol (24 decks)

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