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Zero to finals > Cardio 2 > Flashcards

Cardio 2 Flashcards

1
Q

which valves close to cause S1

A

mitral and tricuspid

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2
Q

which valves close to cause s2

A

aortic and pulmonary

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3
Q

when is the 4th heart sound heart

A

just before s1

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4
Q

what causes the 4th heart sound

A

hypertrophic ventricle

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5
Q

the 2 special manoeuvres in cardio exam assess for what valve abnormality

A

left hand side= mitral stenosis
leaning forward= aortic regurg

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6
Q

how to grade murmurs

A

grade 2= quiet
grade 3= easy to hear

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7
Q

how to present a murmur

A

the patient has a

  1. harsh/soft/blowing
  2. grade x
  3. systolic/diastolic
    murmur

it is heard loudest in the
4.aortic/pulmonary/mitral/tricuspid area
5. does/doesnt radiate to xyz

this suggests a diagnosis of

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8
Q

stenosis/regurg affects which chamber in relation to the valve

A

the chamber before

stenosis causes hypertrophy
regurg causes dilatation

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9
Q

aortic stenosis murmur

A

ejection systolic, crescendo decrescendo

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10
Q

how does aortic stenosis affect pulse

A

slow rising
narrow pulse pressure

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11
Q

aortic regurg murmur

A

early diastolic

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12
Q

how does aortic regurg affect the pulse

A

collapsing pulse- think if it as the blood flowing back because of regurg
wide pulse pressure

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13
Q

mitral stenosis murmur

A

early diastolic

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14
Q

signs of mitral stenosis

A

malar flush- due to back pressure into pulmonary system

AF- left atrium struggling to push can disrupt electrical activity

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15
Q

marfans syndrome common murmur

A

aortic regurg

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16
Q

mitral regurg murmur

A

pan systolic

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17
Q

causes of murmurs

A

infective endocarditis
rheumatic heart disease
ischaemic heart disease
connective tissue disorder eg marfans, ehlers danlos

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18
Q

tricuspid regurg murmur

A

pansystolic

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19
Q

signs of tricuspid regurg

A

raised JVP
pulsatile liver
peripheral oedema
ascites

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20
Q

pulmonary stenosis murmur

A

ejection systolic

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21
Q

signs of pulmonary stenosis

A

raised JVP
oedema
ascites

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22
Q

causes of pulmonary stenosis

A

congential: ToF and noonan syndrome

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23
Q

what valve pathology most commonly requires replacement

A

aortic stenosis

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24
Q

what scar indicates valve replacement

A

midline sternotomy

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25
Q

INR traget AF

A

2-3

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26
Q

INR target mechanical valve

A

2.5-3.5

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27
Q

complications of valve replacement

A

thrombus formation
infective endocarditis
haemolysis

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28
Q

what valve replacements need warfarin

A

only metallic

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29
Q

what surgeries can be done for valve replacement

A

TAVI- bioprosthetic replacement
open surgery- bioprosthetic or metallic replacement

30
Q

most common causative organism for infective endocarditis

A

staphylococcus aureus

31
Q

what do janeway lesions and oslers nodes look like

A

janeway lesions= flat red macules on palms and soles of feet

oslers nodes= red/purple nodules on pads of fingers/toes

32
Q

how should blood cultures be taken in infective endocarditis

A

3 times
different sites
6 hrs apart

33
Q

what is better out of TOE and trans thoracic echo

A

TOE- more sensitive and specific

34
Q

how long does abx therapy in infective endocarditis last

A

4 weeks= native valves
6 weeks= prosthetic valves

35
Q

criteria for infective endocarditis

A

dukes

36
Q

major criteria dukes

A
  1. positive culture
  2. imaging findings eg on echo
37
Q

HOCM inheritance

A

autosomal dominant

38
Q

how is blood flow disrupted in HOCM

A

left ventricular outflow tract obstruction

39
Q

what pathologies cause irregularly irregular heart rate

A

AF
ventricular ectopics

40
Q

how to differentiate between causes of irregularly irregualr heart rate

A

if ventricular ectopics they will disappear once heart rate is over a certain threshold

41
Q

what valve abnormality causes valvular AF

A

mitral stenosis

42
Q

first line rate control in AF

A

beta blocker

43
Q

flecanide vs amiodarone for rhythmn control in AF

A

amiodarone for structural heart disease

44
Q

how long should a patient be anticoagulated for before delayed cardioversion in AF

A

3 weeks

45
Q

what drug is used for pill in pocket management of AF

A

flecanide

46
Q

what investigation do you need to do for everyone on anticoagulation who has a fall

A

CT head

47
Q

reversal agent for apixaban/rivaroxaban

A

adenexat alpha

48
Q

reversal agent for dabigatran

A

idarucizumab

49
Q

moa warfarin

A

vitamin K antagonist
prolongs PT

50
Q

what enzyme metabolises warfarin and where is it found

A

cytochrome p450 in liver

51
Q

reversal agent for warfarin

A

vitamin K

52
Q

what score is used to assess bleeding risk in those with AF

A

ORBIT

53
Q

what is left atrial appendage occlusion

A

used when someone with AG cant be anticoagulated due to bleeding risk

the left atrial appendage is where clots are most likely to form so it is occluded

54
Q

SVT pathophysiology

A

there is a reentry circuit from ventricles to atria so the electrical signal goes back to atria, travels to AVN and causes a loop

55
Q

narrow QRS complex length

A

<0.12 secs
<3 small squares

56
Q

SVT mx

A
  1. vagal manoeuvres
  2. adenosine
  3. verapamil or beta blocker
  4. synchronised DC cardioversion
57
Q

what part of the nervous system do vagal manoeuvres affect

A

parasympathetic

58
Q

what should you not give in wolff parkinson white

A

beta blocker or adenosine (blocks the AV node and encourages use of the accessory pathway)

59
Q

avoid adenosine in

A

asthma
COPD
heart failure
heart block
wolff parkinson white

60
Q

adenosine dosage

A

6mg
then 12mg
then 18mg

61
Q

4 main narrow complex tachycardias

A

SVT
sinus tachycardia
AF
atrial flutter

62
Q

atrial flutter mx

A

same as AF- anticoagulation based on chadsvasc

radiofrequency ablation of re-entrant circuit

63
Q

QT interval prolonged when

A

> 440 milliseconds in men
460 milliseconds in women

64
Q

normal PR interval

A

0.2 secs
5 small squares

65
Q

first degree heart block on ECG

A

prolonges PR interval

66
Q

second degree heart block on ECG

A

mobitz type 1= increasing PR interval until one p wave is not followed by a QRS complex

mobitz type 2= regularly dropped QRS complex

67
Q

3rd degree heart block on ECG

A

no association between p waves and QRS complexes

68
Q

mx for unstable patients at risk of asystole

A
  1. atropine
  2. inotropes
  3. transcutaneous pacing
  4. transvenous pacing
  5. permanent pacemaker when possible
69
Q

when is a single chamber pacemaker placed in right atrium vs right ventricle

A

right atrium if issue with SA node

right ventricle if issue with AV node

70
Q

risk of what is an indication for implantable cardiac defibrillators

A

going into v tach or v fib

71
Q

how do you identify pacemaker on ECG

A

a single sharp vertical line before p waves/ qrs complexes

Zero to finals (11 decks)

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