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Y6 PASSMED > Cardio > Flashcards

Cardio Flashcards

1
Q

treatment for stable angina not controlled by beta blocker and GTN spray?

A

calcium channel blocker

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2
Q

ECG changes pericarditis?

A

-global wide spread changes
-Saddle shaped ST elevation
-PR depression most specific change

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3
Q

Condition that predisposes to pericarditis?

A

-auto-immune inflammatory conditions such as SLE, scleroderma and RA

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4
Q
A
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4
Q

Mitral stenosis - leaflets still have molbilty?

A

Loud opening snap - this indicates pateint would be suitable for balloon miitral valvuloplasty

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4
Q
A
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5
Q

What is the murmur heard in mitral stenosis?

A

-Mid-late diastolic murmur (heard expiration)
-Loud S1

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6
Q

Symptom of mitral stenosis?

A

haemoptyosis - increased pressures

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7
Q

Poorly controlled hypertension and already taking max dose of ACE inhibitor?

A

Calcium channel blocker or a thiazdie like diuretic

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7
Q

When is a thiazide like diuretic contraindicated?

A

Gout

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8
Q

What electrolyte imbalance do loop diuretics such as furosemide cause?

A

Hypokalaemia

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9
Q

What electrolyte imbalance does spironolactone cuse?

A

Hyperkalaemia

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10
Q

When are loop diuretics used?

A

-Heart failure
-Resistant hypertension, particularly with renal impairment

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11
Q

ECG findings PE?

A

-Sinus tachyvcardia
-Most specific chance is S1Q3T3 but this is rare
-RBBB and right axis deviation is also associated with PE

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12
Q

First line investigation for chronic heart failure?

A

NT-proBNP

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13
Q

WHat is BNP?

A

B-type natriuretic peptide - is a hormone produced by left vebtricular myocardium in response to strain

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14
Q

Levels of BNP and NTproBNP

A
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15
Q

If levels of NTproBNP are “high” what is the next step?

A

Specialist assessment within 2 weeks - transthoracic echocardiogrpahy

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16
Q

If levels of BNP are “raised’ what are the next step?

A

Arrange specialist assessment within 6 weeks

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17
Q
A
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18
Q

Warfarin PT and APTT

A

-PT is prolonged as main factor that is impacted is VII which is in the extrinsic pathway

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19
Q

Indication for warfarin?

A

-Mechanical heart valves
-Second line DOAC

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20
Q

If dose of warfarin was higher than therapeutic then could APTT increase?

A

yes

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21
Q

How is amiodarone given?

A

Central veins - can cause thrombophebitis

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22
Q

When is amiodarone used?

A

-Class III antiarrhythmic agent
-Blocks potassium channels which inhibit repolarisation

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23
Q

What ECG changes are seen in posterior MI?

A

ST depression not elevation

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24
Q

Acute presentation of AF hemodynamically unstable?

A

Electrically cardioverted

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25
Q

AF in stable patients?

A

-If <48 hours rate or rhythm control
->48 hours or uncertain rate control

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26
Q

Causes of dilated cardiomyopathy?

A

-Alcohol
-Coxsackie B virus
-Wet beri beri
-Doxorubicin

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27
Q

Causes of restrictive cardiomyopathy?

A

-AMyloidosis
-Post radiothepray
-Loefflers’ endocaridits

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28
Q

Clinical features of aortic stenosis?

A

-Chest pain dyspneoa
-Syncope/presyncope (feeling dizzy when exerted)
-Ejection systolic murmur us seen in aortic stenosis
-Radiates to carotids
-Valsalva manoeuvre decreases this

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29
Q

What is the Valsalve manoeurve?

A

You exhale forcefully with a closed mouth and nose, creating pressure in the chest. This maneuver increases pressure in the chest cavity

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30
Q

Features of severe aortic stenosis

A

-narrow pulse pressure
-slow rising pulse
-Left ventricular hypertrophy

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31
Q

management of aortic stenosis?

A

AVR is symptomatic otherwise cut off aortic valve gradient of 40

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32
Q

Cardiac arrest on monitor?

A

-Three shocks
-Amiodarone given

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33
Q

Triad of symptoms of PE?

A

Pleuritic chest pain, dyspnoea and haemoptysis

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34
Q

If PE is suspected what should be used?

A

2-level PE wells score

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35
Q

If wells score >4?

A

Immediate CTPA if delay anticoagulation until scan (DOAC)

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36
Q

What electrolyte imbalance do loop diuretics such as furosemide cause?

A

Hyponatremia

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37
Q

Viral pericarditis management?

A

NSAIDS and colchine - this is given until symptoms resolve and normla inflammatory markers (1-2 weeks ) then dose is tapered

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38
Q

What infection commonly causes pericarditis?

A

Coxsackie (viral)

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39
Q

Management of pericarditis bacterial infection such as high fever?

A

Manage as inpatients with antibicotics

40
Q

Pulmonary embolism and renal impairemnt?

A

V/Q scan is investigation of choice

41
Q

Nitrates and hypotension?

A

Contraindicated if <90mmHg

42
Q

Symptoms of aortic dissection with aortic regurgitation symptoms where is false lumen seen on CT ?

A

-Ascending aorta

43
Q

What are symptoms and signs of aortic reguritation?

A

diastolic murmur 2ICS, right sternal border

44
Q

Heart sound if aortic dissection in descending aorta?

A

Normla heart sounds

45
Q

Stanford classification of aortic dissection?

A

Type A- ascending aorta 2/3 acses
Type B - descending aorta

46
Q

Type A management?

A

Surgical management

47
Q

Type B management?

A

-Conservative and bed rest
-Reduce BP with IV labetalol

48
Q

When should thrombolysis be considered for patients with massive PE?

A

If haemodynamically ustable - low BP

49
Q

Over 80 with blood pressue <150/90?

A

Lifetsyle advise

50
Q

Shockable rhythm but cardiac arrest not witnessed?

A

1 shock

51
Q

What classes of antibiotics can cause torades de pintes?

A

Macrolides - clarithromycin, erythromycin and ciprofloaxacin

52
Q

Most common cause of mitral stenosis?

A

rheumatic fever

53
Q

What can 24-hour holter monitor be used to find?

A

sinus pulses, abnormal bradycardia, supraventricular tachycardia or non-sustained

54
Q

Losing consciousness occuring at rest and on exertion?

A

Abnormal arrhytmias

55
Q

AF findings

A

-irregularly irregular pulse with absent P waves

56
Q

young patient with AF, no TIA or risk factors?

A

arrange transthoracic echo to exclude valvular disease

57
Q

Acute pulmonary oedmea?

A

IV loop diuretic such as furosemide

58
Q

How does loop diuretic help with pulmonary edema caused by heart failure ?

A

Decreased ventricular filling pressures therefore improving symptoms

59
Q

What antiplatelet do you give to patients with NSTEMI (managed with PCI)?

A

-If no oral anticoagulant prasugrel or ticagrelor
-If oral anticoagulant clopidogrel
-This is taken along with aspirin

60
Q

side effect of GTN spray?

A

Hypotension, tachycardia and headache

61
Q

What kind of haemorrhage can cause torsdeas de pointes?

A

Subarachnoid haemorrhage

62
Q

Hypothermia and rapid re warming?

A

Rapid rewarming can lead to peripheral vasodilation and shock

63
Q

Regular broad complex tachycardia no adverse features?

A

IV amiodarone

64
Q

Renovascular disease what antihypertensive to avoid?

A

ACE inhibitors are contraindicated - calcium channel blocker perfered

65
Q

Medication used for AF

A

-Beta blockers atenolol or bisoprolol
-Calcium channel blockers such as ditiazem or verapamil however not in heart failure
-Digoxin - if sendentary and persistent AF

66
Q

Severe hypertension no symptoms (>180/120)

A

Urgent referral for end organ damage - same day ophthalmology assessment

66
Q

NSTEMI management

A

Grace score - angio and PCI
-If grace score>3 then PCI and angio
-if < 3

67
Q

Dose of asprin in NSTEMI

A

300mg

68
Q

what drug is not prescirbed with verapamil?

A

Beta blockers risk of complete heart block

69
Q

How does acute mitral regurgitation occur after MI?

A

There can be rupture of papillary muscle due to MI this causes rupture of papillary muscle leading to acute mitral regugitation

70
Q

What are the symptoms of of acute mitral regurgitation?

A

-early-to-miud systolic murmur
-hypotension and pulmonary oedema

71
Q

How is acute mitral regurgitation treated after MI?

A

Vasodilators but often surgical repair is required

72
Q

What is the most common MI that causes rupture of the papillary muscle and therefore acute mitral regugritaion?

A

infero-posterior infarction

73
Q

why is BNP used?

A

helpful test to rule out heart failure

74
Q

When else may there be increased BNP?

A

In patients with chronic kidney disease

75
Q

Mechanical valve anticoagulation?

A

Warfarin with INR range 2.5-3

76
Q

Mechanical valve INR target with warfarin?

A

Aortic: 3
Mitral : 3.5

77
Q

What drug is bendroflumethiazie?

A

Thiazide diuretics - inhibit sodium reabsorption
-Potassium loosing

78
Q

common adverse effects of thiazide diuretics - bendroflumethiazie?

A

-hyponatremia
-hypokalameia
-hypercalciemia and hypocalcuria

79
Q

Narrow QRS complex tachycardia? (SVT)

A

-Sinus tachycardia
-Atrial fibrillation
-Atrial flutter
-SVT

80
Q

ECG of sinus tachycardia?

A

-Narrow complex tachycardia
-P waves, QRS complex and T waves normal pattern

81
Q

Atrial fibrillation ECG?

A

-P waves absent
-Narrow QRS complex tachycardia
-Irregularly irregular ventricular rhythm

82
Q

Atrial flutter ECG

A

-Narrow QRS complex tachycardia - normal regular intervals
-Atrial rate is around 300bpm - saw tooth pattern
-Often two atrial contractions for everyone ventricular contraction
Ventricular rate 150bpm

83
Q

SVT ECG?

A

-Narrow complex tachycardia
-Immediately followed by T wave
-P waves are present but buried in P waves
-Regular rhythm

84
Q

How to distinguish between SVT and sinus tachycardia?

A

-SVT more abrupt and regular pattern
-Sinus tachycardia gradual onset and more variabilty in rate

85
Q

Beta blockers and diabetes?

A

Can reduce hypoglycaemic awarness

86
Q

Ventricular septal defect after MI?

A

-Features of acute heart failure with pan-systolic murmur
-Occurs within the first week
-Surgical repair

87
Q

PCI not available within 2 hours with STMEI?

A

Thrombolysis inject fibrinolytic agent

88
Q

DVLA Post MI advice

A

Dont drive for 4 weeks

89
Q

How are proximal aortic dissection managed?

A

Aortic root replacment

90
Q

Aortic regurguation murmur

A

Early diastolic murmur

91
Q

Mamnagement of PE score?

A

PESI - pulmomnaruy embolsim

92
Q

abosolute contrindication for thrombolysis?

A

known intracranial neoiplasm

93
Q

Electrolyte imbalances and ECG

A

Hypercalcaemia -short QT interval
Hyperkalemia - large T waves
Hypokalemia - small T waves

94
Q

Neurological complaints in aortic dissection?

A

Horners syndrome (ptosis, miosis and anihidrosis) due to compression of sympathetic trunk by expanding aortic dissection

95
Q

NSTEMI Grace score >3% how soon to get coronary angio?

A

within 72 hours

96
Q

What medication should be avoided in patient with HOCM?

A

ACE inhibitors

97
Q

Stable angina not controlled with beta blocker what should be added?

A

Longer acting dihydropyridine caclium channel blocker

98
Q

Becks triad for cardiac tamponade?

A

hypotension, distended neck veins, and muffled/difficult-to-auscultate heart sounds

99
Q

What is cardiac tamponade?

A

accumulation of pericardial fluid under pressure

100
Q
A

Y6 PASSMED (8 decks)

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