Cardio Flashcards
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 (IE)?
Staphylococcus aureus (Staph).
What is the treatment for prosthetic valve infection caused by Staph?
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 in infective endocarditis?
Streptococcus gallolyticus (Strep bovis).
What is the characteristic of pansystolic murmur in Ebstein’s anomaly?
Worsens on inspiration.
What is the antithrombotic treatment for bioprosthetic valve surgery?
Aspirin.
What is the antithrombotic treatment for mechanical valve surgery?
Aspirin and warfarin.
What are the histological features of 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 mechanism of action of Dipyridamole?
It is a non-specific phosphodiesterase inhibitor that decreases cellular uptake of adenosine.
What is the recommended diagnostic tool for DVT in pregnancy?
Compression duplex Doppler.
When does an LV aneurysm typically occur?
2 weeks after STEMI and LV 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 electrolyte imbalances are associated with Bendroflumethiazide?
Hyponatraemia and hypokalaemia.
What is the effect of Spironolactone on potassium levels?
It causes hyperkalaemia.
What is the interaction of Adenosine with Dipyridamole and Aminophylline?
Dipyridamole increases the effect, while Aminophylline reduces it.
What is the effect of Omeprazole on 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 the indication for Sacubitril-Valsartan?
Heart failure with LVEF <35% who are still symptomatic.
When should Amlodipine be avoided?
If the patient has peripheral oedema.
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 WPW life-threatening?
No, it is not life-threatening and does not warrant a defibrillator.
What is the management for recurrent DVT while on anticoagulation?
Mechanical aortic: 3.5.
What is the surgical indication for ascending aortic issues?
Proximal to brachiocephalic vessels.
What is the protocol 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 is the protein 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 are the ECG changes associated with hypokalaemia?
U waves, ST depression, T wave inversion.
What conditions can cause LBBB?
MI, HTN, AS, Cardiomyopathy, Fibrosis, Hyperkalaemia.
What causes hypokalaemia in thiazides?
Increased sodium reaching the collecting ducts reduces sodium reabsorption.
What happens to HR, SV, and BP 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 of ASD murmur?
Ejection systolic murmur louder on inspiration, similar to AS.
What condition is indicated by absent limb pulse?
Takayasu’s arteritis causing occlusion of the aorta.
What artery supplies the AV node?
Right coronary artery.
What is the recommended energy for defibrillation?
200 J.
What is the protocol for 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 in 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 is the potassium threshold for Spironolactone?
Below 4.5.
What should be done if PE is likely?
Do not perform D-Dimer; just do CTPA.
Is the risk of falls in old age a reason to stop anticoagulation?
No.
What differentiates tamponade from pericarditis in symptoms?
Tamponade has no Y descent on JVP.
How long does Troponin remain raised after MI?
10 days.
What is the alternative to Troponin for checking reinfarction?
CK-MB.
What side effect can Nicorandil cause?
Ulceration anywhere in the gastric tract.
What risk is associated with Phenelzine?
Hypertensive crisis.
What inflammatory response can occur in cholesterol emboli?
Eosinophilia.
What is Ebstein’s anomaly?
A malformed right heart and tricuspid valve.
What are the physical examination findings suggestive of aortic stenosis?
Late-peaking systolic murmur best heard 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/indomethacin.
What is the 23 rule for stopping exercise tolerance testing (ETT)?
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 does S4 coincide with on an ECG?
The P wave.
What is the BNP threshold for heart failure diagnosis?
100.
What is the characteristic of an Atrial Septal Defect (ASD) murmur?
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 secundum.
What is the axis deviation associated with secundum ASD?
Right axis deviation.
What is the axis deviation associated with primum ASD?
Left axis deviation (PRIME = LAD).
Where is an Atrial Myxoma typically located?
Left atrium.
What should women with pulmonary hypertension avoid?
Becoming pregnant.
What supplies the AV node?
Right coronary artery.
How long should anticoagulation continue after cardioversion?
Four weeks.
What is the initial blind therapy for infective endocarditis?
Amoxicillin and Gentamicin.
What is the ECG change associated with hypokalaemia?
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 cardiac ischemia?
Downsloping ST depression.
When should Ramipril be stopped in CKD?
When potassium is over 6.
What should be done if a patient is still symptomatic on BB 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 prosthetic valve infection within 2 months?
Staphylococcus epidermidis.
What is the characteristic of LV Aneurysm post-MI?
ST elevation, no pain post-MI.
When is Digoxin indicated for AF?
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 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 is a side effect of Erythromycin?
Prolonged QT interval.
What is preferred over Amlodipine for hypertension?
Thiazides, as 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 CCB.
What is the urgent surgical indication for infective endocarditis?
Causing heart failure.
Where do thiazides act in the nephron?
Proximal distal convoluted tubule (DCT).
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.
What is the driving restriction after elective cardiac angioplasty?
Cannot drive for 4 weeks.
What is the effect of hypothermia on ECG intervals?
It prolongs all ECG intervals.
What is the association of Young patients with RBBB?
Brugada syndrome due to SCN5A gene mutation.
What is the mechanism of hypokalaemia due to thiazides?
Increased delivery of sodium to the distal part of the distal convoluted tubule.
What are the causes of restrictive cardiomyopathy?
Amyloid (most common), haemochromatosis, Loffler’s syndrome, sarcoidosis, scleroderma.
What is the initial treatment for all patients with angina?
Aspirin and statin
What medications can be used for angina?
Beta blocker or CCB
Which CCBs are used for monotherapy in angina?
Verapamil or Diltiazem as rate limiting
What CCBs should be used if combined with a beta blocker?
Amlodipine or Nifedipine as not rate limiting
What is the characteristic pain of pericarditis?
Positional, worst on expiration
What is the most specific ECG finding in pericarditis?
PR depression
Also get Saddle shaped ST elevation
What is the treatment for recent onset atrial fibrillation?
Flecainide
What is the treatment for atrial fibrillation in LV failure?
Digoxin
What is the first-line treatment for heart failure?
ACE-I and BB
What is the second-line treatment for heart failure?
Aldosterone Antagonist (Spiro)
What can be used to optimize heart failure treatment?
Dapagliflozin (SGLT 2 inhibitor)
What is a characteristic finding in heart failure?
Pulsus alternans
What medications can cause Long QT syndrome?
Erythromycin, Risperidone
What electrolyte imbalances can lead to Long QT?
Low Ca, K and Mg
What is the treatment for Long QT syndrome?
MgSO4
What should be done in case of massive PE with hypotension?
Thrombolyse
What is the duration of treatment for provoked PE?
3 months
What is the duration of treatment for unprovoked PE?
6 months
What is the cause of monomorphic VT?
MI
What is the cause of polymorphic VT?
Long QT
What is the recovery time for minor cardiac procedures?
1 week (ablation=2 days)
What is the recovery time for major cardiac procedures?
4 weeks
What is the treatment for severe mitral stenosis?
Percutaneous mitral commissurotomy
What is a poor prognostic factor in MI?
Reduced LVEF
What does S1 heart sound indicate?
Closure of Mitral and Tricuspid Valves
What can cause a soft S1 heart sound?
Long PR or mitral regurgitation
What can cause a loud S1 heart sound?
Mitral stenosis
What is a variable intensity S1 heart sound indicative of?
Complete Heart Block
What does S2 heart sound indicate?
Closure of aortic and pulmonary valves
What can cause a soft S2 heart sound?
Aortic stenosis
What is normal for S2 heart sound during inspiration?
Splitting
What can cause a loud S2 heart sound?
Hypertension
What is a reversed split S2 indicative of?
LBBB
What is a fixed split S2 indicative of?
ASD
What does S3 heart sound indicate?
Diastolic filling of the ventricle
When is S3 heart sound normal?
Normal in women under 50, men under 30
What conditions can cause S3 heart sound?
Left Ventricular Failure, Constrictive Pericarditis and Mitral Regurg
What does S4 heart sound indicate?
Atrial contraction against a stiff ventricle
What conditions can cause S4 heart sound?
Aortic stenosis, HOCM, hypertension
What coincides with S4 heart sound on ECG?
P wave
What are the actions of BNP?
• Vasodilator: can decrease cardiac afterload
• Diuretic and natriuretic
• Suppresses both sympathetic tone and the renin-angiotensin-aldosterone system
Anteroseptal ECG changes
V1-V4
Left anterior descending
Inferior ECG changes
II, III, aVF
Right coronary
Anterolateral ECG changes
V1-6, I, aVL
Proximal left anterior descending
Lateral ECG changes
I, aVL +/- V5-6
Left circumflex
Posterior ECG changes
Changes in V1-3
Usually left circumflex, also right coronary
Reciprocal changes of STEMI
Typically seen as horizontal ST depression, tall broad R waves, upright T waves, and dominant R wave in V2.
Confirmation of posterior infarction
ST elevation and Q waves in posterior leads (V7-9).
