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Passmed wrong > CARDIO > Flashcards

CARDIO Flashcards

1
Q

pharmacological options for treatment of orthostatic hypotension

A

Fludrocortisone and midodrine

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2
Q

If patients treated with PCI for MI are experiencing pain or haemodynamic instability post PCI

A

urgent coronary artery bypass graft (CABG) is recommended

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3
Q

causes of raised troponin

A

Cardio: MI, Aortic dissection, HF, inflammation,

Resp: PE, ARDS

Infectious: SEPSIS

GI: severe GI bleed

Nervous: stroke

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4
Q

Adenosine half life

A

8-10 seconds

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5
Q

causes of orthostatic hypotension

A

primary autonomic failure: Parkinson’s disease, Lewy body dementia

secondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uraemia

drug-induced: diuretics, alcohol, vasodilators

volume depletion: haemorrhage, diarrhoea

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6
Q

postural hypotension that does not cause an increase in HR VS exaggerated increase in HR

A

no increase in HR: autonomic dysfunction e.g. DM,

exaggerated increase in HR: anaemia, hypovolemia

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7
Q

mixed aortic valve disease

A

Bisferiens pulse -

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8
Q

Takayasu’s arteritis symptoms

A

absent peripheral pulses
uneven blood pressure and pulses between arms
claudication
AR murmur

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9
Q

Takayasu’s arteritis Ix

A

MR angiogram or CT angiogram

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10
Q

Takayasu’s arteritis associated with

A

renal artery stenosis

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11
Q

‘non-shockable’ rhythms:

A

asystole
pulseless-electrical activity

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12
Q

‘shockable’ rhythms:

A

ventricular fibrillation
pulseless ventricular tachycardia

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13
Q

acute HF management

A

IV loop diuretics
Nitrates (GTN) if concomitant myocardial ischaemia, severe hypertension or regurgitant aortic or mitral valve disease

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14
Q

‘Global’ T wave inversion

A

non-cardiac cause e.g. head injury

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15
Q

aortic dissection Ix stable vs unstable

A

stable- CT angiography
unstable- TOE

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16
Q

Acute heart failure with hypotension

A
  • inotropes be considered for patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock
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17
Q

elevated JVP, persistent hypotension and tachycardia despite fluid resuscitation in a patient with chest wall trauma

A

cardiac tamponade

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18
Q

how should adenosine be given in SVT

A

rapid bolus

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19
Q

loop diuretics electrolyte abnormalities

A

hyponatraemia
hypokalaemia, hypomagnesaemia
hypocalcaemia

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20
Q

thiazide diuretics electrolyte abnormalities

A

hypokalaemia
hyponatraemia
hypercalcaemia

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21
Q

blood pressure target for type 2 diabetics:

A

< 140/90 mmHg

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22
Q

In AF, if a CHA2DS2-VASc score suggests no need for anticoagulation

A

do an echo to exclude valvular heart disease

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23
Q

S3 causes

A

heard in left ventricular failure (e.g. dilated cardiomyopathy),
constrictive pericarditis (called a pericardial knock)
mitral regurgitation

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24
Q

Use rhythm control to treat AF if

A

there is coexistent heart failure, first onset AF or an obvious reversible cause

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25
Q

Moderate-severe aortic stenosis is a contraindication to

A

ACE-i

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26
Q

irregular broad complex tachycardia in a stable patient

A

Atrial fibrillation with bundle branch block

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27
Q

raised JVP that doesn’t fall with inspiration

A

Kussmauls sign

constrictive pericarditis

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28
Q

HF drug which reduced glycemic awareness

A

beta blocker

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29
Q

intervention of choice for severe mitral stenosis

A

Percutaneous mitral commissurotomy

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30
Q

digoxin ECG features

A

down-sloping ST depression (‘reverse tick’, ‘scooped out’)
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia

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31
Q

Concurrent use of clopidogrel and what drug can make clopidogrel less effective

A

PPI

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32
Q

polycystic kidney disease associated with what valvular abnormality

A

mitral valve prolapse

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33
Q

3rd line HF therapy:
ivabradine

A

sinus rhythm > 75/min and a left ventricular fraction < 35%

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34
Q

3rd line HF therapy:
sacubitril-valsartan

A

left ventricular fraction < 35%
is considered in heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs
should be initiated following ACEi or ARB wash-out period

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35
Q

3rd line HF therapy:
Digoxin

A

coexistent atrial fibrillation

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36
Q

3rd line HF therapy:
hydralazine in combination with nitrate

A

Afro-Caribbean

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37
Q

3rd line HF therapy:
cardiac resynchronisation therapy

A

indications include a widened QRS (e.g. left bundle branch block) complex on ECG

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38
Q

For a person < 80, with stage 1 hypertension ( 135/90 - 149/99) only treat medically if:

A

diabetic,
renal disease,
QRISK2 >10%,
established coronary vascular disease
end organ damage

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39
Q

contraindications to thrombolysis

A

active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension

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40
Q

causes of raised BNP other than HF

A

age over 70 years,
left ventricular hypertrophy, ischaemia,
tachycardia,
right ventricular overload, hypoxaemia (ie pulmonary embolism),
renal dysfunction (eGFR less than 60 ml/minute/1.73 m2),
sepsis,
chronic obstructive pulmonary disease,
diabetes,
or cirrhosis of the liver

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41
Q

arrhythmogenic right ventricular dysplasia ECG

A

T-wave inversion in leads V1-3 and a terminal notch in the QRS complex (epsilon wave)

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42
Q

Torsade de pointes Tx

A

IV magnesium sulphate

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43
Q

trifasicular block

A

RBBB +left anterior or posterior hemiblock + complete heart block

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44
Q

young patient with exertion dyspnoea

A

HOCM
(AS if older)

45
Q

statin mechanism of action

A

Statins inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis

46
Q

Wolff Parkinson white ECG

A

short PR interval (<120ms),
wide QRS complex (>120ms),
upsloping delta wave

47
Q

ostium secundum atrial septal defect

A

passage of an embolus from the right-sided circulation to the left causing a stroke

48
Q

ejection systolic murmurs

A

aortic stenosis (expiration)
pulmonary stenosis (inspiration)

49
Q

infective endocarditis acute Ix

A

3x blood cultures first
TTE >TOE

50
Q

pulsus paradoxus

A

BP falls during inspiration

cardiac tamponade

51
Q

NSTEMI management: unstable patients

A

immediate coronary angiography

52
Q

young people with new onset chest pain with a recent history of viral illness

A

myocarditis

53
Q

statin + clarithromycin/erythromycin

A

rhabdomyolysis- elevated CK

54
Q

Acute heart failure: Ix in new-onset heart failure, cardiogenic shock, suspected valvular or post-MI problems

A

echocardiography

55
Q

Prosthetic heart valves - antithrombotic therapy:

A

bioprosthetic: aspirin
mechanical: warfarin + aspirin

56
Q

Eisenmenger’s syndrome ECG

A

RVH

57
Q

Electrical alternans is suggestive of

A

cardiac tamponade

58
Q

Infective endocarditis - indications for surgery:

A

severe valvular incompetence
aortic abscess (often indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

59
Q

ACS poor prognostic factors

A

age
development (or history) of heart failure
peripheral vascular disease
reduced systolic blood pressure
Killip class*
initial serum creatinine concentration
elevated initial cardiac markers
cardiac arrest on admission
ST segment deviation

60
Q

IV adenosine needs to be infused via

A

a large-calibre vein or central route

61
Q

Symptomatic aortic stenosis:

A

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

62
Q

first line investigation for stable chest pain

A

Contrast-enhanced CT coronary angiogram

63
Q

verapamil and beta blocker

A

risk of complete heart block

64
Q

Fondaparinux Mechanism of action

A

Activates antithrombin III.

65
Q

Beck’s triad

A

muffled heart sounds, hypotension and raised jugular venous pressure

66
Q

hypokalaemia ECG

A

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

67
Q

mitral stenosis features

A

dyspnoea
malar flush
haemoptysis
AF

68
Q

deeply inverted T-waves in leads V2-V3

A

wellen syndrome
critical stenosis of LAD

69
Q

left ventricular aneurysm

A

typically occurs 2 weeks after MI symptoms mimicking heart failure (presenting with shortness of breath, cough, and crackles on auscultation) alongside persistent ST elevation (as the ECGs are not changing).

70
Q

right heart failure triad

A

raised JVP, hepatomegaly and ankle oedema

71
Q

SAH ECG

A

torsade de pointe

72
Q

widened QRS complexes and a notched morphology of the QRS complexes in the lateral leads suggests

A

a left bundle branch block

73
Q

bifasicular block

A

right bundle branch block and left axis deviation

74
Q

inferior myocardial infarction and AR murmur

A

ascending aorta dissection

75
Q

definitive treatment of Wolff-Parkinson White syndrome

A

radiofrequency ablation of the accessory pathway

76
Q

Rupture of the papillary muscle due to a myocardial infarction

A

→ acute mitral regurgitation → widespread systolic murmur, hypotension, pulmonary oedema

77
Q

left ventricular aneurysm post MI

A

persistent ST elevation and left ventricular failure.

78
Q

left ventricular free wall rupture

A

acute heart failure secondary to cardiac tamponade

79
Q

atrial septal defect murmur

A

ejection systolic murmur louder on inspiration

80
Q

asymptomatic mitral stenosis Tx

A

monitored with regular echocardiograms

81
Q

Subclavian steal syndrome presentation

A

posterior circulation symptoms, such as dizziness and vertigo, during exertion of an arm

82
Q

left ventricular hypertrophy ECG

A

sum of S wave depth in V1 and R wave in V5 or V6 exceeds 40mm

left atrial enlargement
left axis deviation
ST elevation in V1-V3
prominent U waves

83
Q

causes of LVH

A

HTN
aortic stenosis/regurgitation
mitral regurgitation
coarctation of aorta
hypertrophic cardiomyopathy

84
Q
A

large saddle embolus in pulmonary trunk

85
Q

new LBBB

A

new STEMI

86
Q

alternative to atropine in management of bradycardia

A

adrenaline/isoprenaline infusion

87
Q

following a TIA AF management

A

anticoagulation started immediately once imaging excluded haemorrhage
lifelong apixaban

88
Q

younger patient- which type of heart valve

A

prosthetic- last longer

89
Q

stable angina treatment

A

1st line= beta blocker or calcium channel blocker (verapamil or dilitazem) one or both

if used in combination- a longer-acting dihydropyridine calcium channel blocker can be used (amlodipine or nifedipine)

2nd line= isosorbide mononitrate, ivabradine, nicorandil, ranolazine

90
Q

mechanical valves target INR

A

aortic: 3.0
mitral: 3.5

91
Q

AF target INR

A

2.5

92
Q

severe anaemia can cause

A

high output cardiac failure

93
Q

QT interval

A

start of Q and end of T wave
normal= less than 430 ms in males and 450 ms in females.

94
Q

posterior MI

A

reciprocal changes in leads V1-V3:
ST depression
Tall, broad R-waves
Upright T-waves

95
Q

Patients on warfarin undergoing emergency surgery -

A

give four-factor prothrombin complex concentrate

96
Q

If fibrinolysis is given for an ACS,

A

an ECG should be repeated after 60-90 minutes and transfer for urgent PCI if ST elevation not resolved

97
Q

P Mitrale represents

A

left atrial hypertrophy/strain e.g. in mitral stenosis

98
Q

severe hypertension and bilateral retinal hemorrhages and exudates

A

malignant hypertension

99
Q

NSTEMI management: patients with a GRACE score > 3%

A

should have coronary angiography within 72 hours of admission

100
Q

Aortic stenosis management:

A

AVR if symptomatic, otherwise cut-off is gradient of 40 mmHg

101
Q

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

A

two weeks after the event

102
Q

Brugada syndrome ECG findings

A

convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave
partial right bundle branch block

the ECG changes may be more apparent following the administration of flecainide or ajmaline

103
Q

Brugada syndorme Tx

A

implantable cardioverter-defibrillator

104
Q

Heart failure patients on maximum triple therapy with widened QRS complex –>

A

cardiac resynchronisation therapy

105
Q

Beta-blockers should only be stopped in acute heart failure if

A

the patient has heart rate < 50/min,
second or third degree AV block,
or shock

106
Q

If new BP >= 180/120 mmHg + no worrying signs then the first step is

A

urgent investigations for end-organ damage
e.g. urine dipstick for haematuria
fundoscopy
urinary ACR
ECG

107
Q

most common cause of Infective endocarditis prosthetic valve

A

<2 months post valve surgery= staph epidermis
>2 months = staph aureus

108
Q

broad complex QRS=

A

> 0.12 seconds

109
Q

hypercalcaemia on ECG

A

shortened QT interval

Passmed wrong (21 decks)

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