Cardio Flashcards
Positional, worse on expiration, PR depression is most specific but also get saddle shaped ST elevation
Pericarditis
Treatment for Angina
All patients get aspirin and statin.
Recent onset AF treatment
Flecainide
AF treatment is also has LV failure
Digoxin
1st line treatment for heart failure
ACE-I and BB
2nd line treatment for heart failure
Spironolactone
Causes of long QT syndrome
Erythromycin, risperidone, Low Ca, K or Mge
Treatment of long QT syndrome
Magnesium sulphate
Indications for thrombolysis in PE
Massive PE and hypotension
How long to anticoagulate for provoked PE
3 months
How long to anticoagulate for unprovoked PE
6 months
Causes of monomorphic VT
MI
Causes of polymorphic VT
Long QT
How long off driving for ablation
2 days
How long off driving for angioplasty or pacemaker insertion
1 week
How long off driving for ACS, CABG etc
4 weeks
Treatment of severe mitral stenosis
Percutaneous mitral commissurotomy
What is S1
Closure of mitral and tricuspid valves
When is S1 soft
Long PR or mitral regurgitation
When is S1loud
Mitral stenosis
When is S1 variable intensity
Complete heart block
What is S2
Closure of aortic and pulmonary valves
When is S2 soft
Aortic stenosis
When is S2 split
inspiration
When is S2 loud
Hypertension
When is S2 reversed and split
LBBB
When is S2 fixed spit
ASD
What is S3
Diastolic filling of the ventricle
When is S3 normal
Women under 50, men under 30
What are abnormal causes of S3
LV failure, constrictive pericarditis and mitral regurg
What is S4
Atrial contraction against a stiff ventricle. Coincides with p wave.
When can S4 be heard
Aortic stenosis, HOCM and hypertension
What is the cut off for aortic stenosis surgery
Symptomatic or gradient of 40mmHg
When should you stop exercise tolerance test
If theres hypotension
Name two rate limiting CCBs that should not be used in hypertension
Verapamil and diltiazem
What is the leading cause of death in IE
Staphylococcus
IE and bad dentition
Strep sanguinis
IE and prosthetic valve
Staph- vanc gent rif
IE and replacement valve within last 2 months
Strep epidermidis
IE and colorectal cancer
Strep gallolyticus
Pansystolic murmur worse on inspiration
Tricuspid regurgitation
Antithrombotic therapy post bioprosthetic valve surgery
Aspirin
Antithrombotic therapy post mechanical valve surgery
Aspirin and warfarin
What are Verapamil and Diltiazem used for?
They are rate limiting CCBs and not used in hypertension.
What is the leading cause of death in infective endocarditis?
Staphylococcus aureus (Staph).
What is the treatment for prosthetic valve endocarditis?
Vancomycin, Gentamicin, and Rifampicin.
What organism is associated with valve replacement within the last 2 months?
Staphylococcus epidermidis.
What organism is associated with colorectal cancer?
Streptococcus gallolyticus (Strep bovis).
What heart sound is associated with Ebstein’s anomaly?
Pansystolic murmur worst on inspiration due to tricuspid regurgitation.
What is the antithrombotic treatment for bioprosthetic valve surgery?
Aspirin.
What is the antithrombotic treatment for mechanical valve surgery?
Aspirin and Warfarin.
What characterizes Hypertrophic Obstructive Cardiomyopathy (HOCM)?
Myofibrillary hypertrophy, myocyte disarray, and fibrosis.
What indicates a positive response to vasodilator testing in pulmonary hypertension?
Nifedipine.
What is the action of Dipyridamole?
It is a non-specific phosphodiesterase inhibitor that decreases cellular uptake of adenosine.
How is DVT diagnosed in pregnancy?
Compression duplex Doppler.
What is a common complication 2 weeks after STEMI?
Left ventricular aneurysm and heart failure.
What is Dressler’s syndrome?
Post-infarct pericarditis.
What are the signs of Digoxin toxicity?
Downsloping ST depression, flat T waves, short QT interval, and arrhythmias.
What side effects are associated with Bendroflumethiazide?
Hyponatremia and hypokalemia.
What is the effect of Spironolactone?
Hyperkalemia.
What is the interaction of Adenosine with Dipyridamole and Aminophylline?
Dipyridamole increases the effect; Aminophylline reduces the effect.
How does Omeprazole affect Clopidogrel?
It reduces its efficacy.
What is the purpose of asymmetric ISMN regimes?
To prevent nitrate tolerance.
What is the management of complete heart block in inferior MI?
Conservative treatment.
What is the management of complete heart block in anterior MI?
Pacing.
What is Sacubitril-Valsartan used for?
Heart failure with LVEF <35% who are still symptomatic.
When should Amlodipine be avoided?
If the patient has peripheral edema.
What is the effect of Furosemide on prognosis?
It has no effect.
What is the CHADSVASC score for recent TIA?
2 points.
What is the antithrombotic treatment for prosthetic valves?
Bioprosthetic: Aspirin; Mechanical: Warfarin and Aspirin.
What should be given to high-risk patients for pre-eclampsia?
Low-dose aspirin.
Is Wolff-Parkinson-White syndrome life-threatening?
No, it does not warrant a defibrillator.
What is the management for recurrent DVT while on anticoagulation?
Mechanical aortic: 3.5.
What is the surgical approach for ascending aortic issues?
Surgery proximal to the brachiocephalic vessels.
What should be done if ALT is raised but not more than 3x in statin therapy?
Continue and retest.
What mutation is associated with Brugada syndrome?
Mutation encoding myocardial sodium ion channel.
What protein is associated with HOCM?
Beta myosin heavy chain protein.
What does Troponin bind to?
Tropomyosin, associated with thin filaments.
What is the treatment for Torsades de Pointes?
2g magnesium if no signs of shock.
What ECG changes are associated with hypokalemia?
U waves, ST depression, T wave inversion.
What conditions can cause Left Bundle Branch Block (LBBB)?
MI, hypertension, aortic stenosis, cardiomyopathy, fibrosis, hyperkalemia.
How does thiazide diuretics cause hypokalemia?
Increased sodium reaching the collecting ducts reduces sodium reabsorption.
What happens to heart rate and stroke volume during exercise?
HR and SV increase, but BP remains the same.
What is the biggest risk factor for PCI stent thrombosis?
Withdrawal of antiplatelets.
What is the characteristic murmur of Atrial Septal Defect (ASD)?
Ejection systolic murmur louder on inspiration, similar to aortic stenosis.
What does absent limb pulse indicate?
Takayasu’s arteritis causing occlusion of the aorta.
What supplies the AV node?
Right coronary artery.
What is the energy setting for defibrillation?
200 J.
What should be done after witnessed cardiac arrest on monitor?
Deliver three successive shocks before CPR.
What is preferable to FFP in treatment?
Prothrombin complex.
What skin manifestation is associated with cholesterol emboli?
Livedo reticularis - net-like rash.
What are the signs of Aortic Regurgitation?
Early diastolic murmur, Corrigan’s sign, and Quincke’s sign.
What does the C wave on JVP indicate?
Closure of the tricuspid valve.
What is preferred over Bendroflumethiazide in hypertension?
Indapamide.
What is the only CCB licensed for use in heart failure?
Amlodipine.
What is the target BP in aortic dissection?
100-120 mmHg.
What medications reduce mortality in heart failure?
Ramipril and beta-blockers.
What potassium level indicates the need for Spironolactone?
Below 4.5.
What should be done if pulmonary embolism is likely?
Do not perform D-Dimer, just do CTPA.
Is the risk of falls in old age sufficient to stop anticoagulation?
No.
How can you differentiate tamponade from pericarditis?
Tamponade has no Y descent on JVP.
What remains raised for 10 days after MI?
Troponin.
What should be checked if reinfarction is suspected within 4-10 days?
CK-MB.
What side effect can Nicorandil cause?
Ulceration anywhere in the gastric tract.
What is the risk associated with Phenelzine?
Hypertensive crisis.
What inflammatory response can occur with cholesterol emboli?
Eosinophilia.
What is Ebstein’s anomaly?
A malformed right heart and tricuspid valve.
What are the physical exam findings suggestive of aortic stenosis?
Late-peaking systolic murmur at the right upper sternal border with radiation to the carotids.
What is the first line treatment when not responsive to vasodilator testing?
Ambrisentan and Tadalafil.
What does a soft second heart sound indicate?
Aortic pathology.
Why should Verapamil be avoided in AF with heart failure?
Due to negative ionotropic effects.
What is given if a baby still has PDA on echo one week after birth?
Ibuprofen or Indomethacin.
What is the 23 rule for stopping exercise tolerance testing?
3 mm ST depression, 2 mm ST elevation, SBP > 230 mmHg, SBP falling > 20 mmHg, HR falling > 20%.
What is the treatment for magnesium sulfate-induced respiratory depression?
Calcium gluconate.
What coincides with the P wave on an ECG?
S4 heart sound.
What is the BNP threshold for heart failure diagnosis?
100.
What is the characteristic murmur of Atrial Septal Defect (ASD)?
Ejection systolic murmur louder on inspiration.
What should be done regarding statins in pregnancy?
Stop statins.
Can COPD cause raised BNP levels?
Yes.
What does prolonged PR interval indicate?
Aortic root abscess.
What is Strep Sanguinus also known as?
Strep Mitis in dental infections.
What is the most common type of ASD in adults?
Ostium secondum.
What is the axis deviation for Ostium secondum ASD?
Right axis deviation.
What is the axis deviation for Ostium primum ASD?
Left axis deviation (PRIME = LAD).
Where is Atrial Myxoma typically found?
Left atrium.
What should women with pulmonary hypertension avoid?
Becoming pregnant.
How long should anticoagulation continue after cardioversion?
Four weeks.
What is the initial treatment for infective endocarditis?
Blind therapy with Amoxicillin and Gentamicin.
What ECG change is associated with hypokalemia?
U waves.
What is the treatment for pericarditis?
Colchicine and NSAIDs.
What is the effect of smoking on pre-eclampsia?
It is protective.
What ECG change is associated with Digoxin?
Downsloping ST depression.
What should be done if potassium is over 6 in CKD while on Ramipril?
Stop Ramipril.
What should be done if a patient is still symptomatic on beta-blockers and ACE-I?
Stop ACE-I and start Sacubitril-Valsartan.
What is sick sinus syndrome characterized by?
Bradycardia.
What is the risk of asystole associated with bradycardia?
AB23: Asystole, Broad complex complete heart block, type ‘2’ AV Block (Mobitz), >3 seconds ventricular pause.
What organism is associated with infective endocarditis if within 2 months of valve surgery?
Staphylococcus epidermidis.
What is the presentation of LV aneurysm post-MI?
ST elevation with no pain.
When is Digoxin indicated for atrial fibrillation?
If the patient is sedentary and has heart failure.
What is the most common cyanotic congenital heart disease at birth?
Transposition of the great arteries (TGA).
What is the most common overall cyanotic congenital heart disease?
Tetralogy of Fallot.
What is the most common acyanotic congenital heart disease?
Ventricular septal defect (VSD).
What causes farmer’s lung?
Saccharopolyspora rectivirgula.
What channel is affected in cystic fibrosis?
Chloride channel.
What side effect does Erythromycin cause?
Prolonged QT interval.
Why are thiazides preferred over Amlodipine?
They do not cause ankle swelling.
What is the first-line treatment for magnesium-induced respiratory depression?
Calcium gluconate.
What is the treatment for heart failure?
Beta-blockers and CCBs.
What is the urgent treatment for infective endocarditis causing heart failure?
Urgent surgery.
Where do thiazides act in the nephron?
Proximal distal convoluted tubule.
What is the mechanism of Hydralazine?
Increases cGMP leading to smooth muscle relaxation, more in arterioles than veins.
How long should Warfarin continue after successful cardioversion?
4 weeks.
What is the role of Amlodipine in dual therapy?
It is not rate-limiting.
What is the treatment for Prinzmetal’s angina?
Felodipine.
How long should a patient avoid driving after elective cardiac angioplasty?
4 weeks.
What does hypothermia do to ECG intervals?
It prolongs all intervals.
What is associated with young patients and RBBB?
Brugada syndrome, associated with SCN5A gene.
What is the mechanism of hypokalemia due to thiazides?
Increased delivery of sodium to the distal convoluted tubule.
What are the causes of restrictive cardiomyopathy?
Amyloid (most common), hemochromatosis, Löffler’s syndrome, sarcoidosis, scleroderma.
