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Cardio Flashcards

1
Q

3 causes of aortic stenosis?

A

Calcification (degeneration)
Rheumatic fever
Congenitally bicuspid

—> narrow pulse pressure, slow rising pulse and ejection systolic

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2
Q

Give 5 causes of aortic regurgitation

A 
Rheumatic fever
Endocarditis
Marfans
HT
Syphillus 
Seronegative arthritis

—> wide pulse pressure, collapsing pulse, early diastolic murmur

ASES
ARED

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3
Q

List some physical signs of aortic regurgitation

A 
Visible carotids pulse - Corrigans sign
Nailbed pulsation - Quincke’s sign
Pistol shot femoral - Traube’s sign 
Head bobbing in time to pulse - de Musset
Austin Flint murmur
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4
Q

Remember the main problem in mitral stenosis is that the valve is not open enough so a high pressure is needed to push blood through —> high atrial pressure and pulmonary HT

List some causes

A

Rheumatic heart disease
Congenital
SLE

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5
Q

Features of mitral stenosis

A

Rumbling mid diastolic murmur (apex and exacerbated by exercise/ valsalva)
Malar flush
Raised JVP
Tapping apex
ECG = tall p waves in V1 and 11, RAD, RVH and AF

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6
Q

What are the 2 major complications of mitral stenosis?

A

1) Pulmonary hypertension

2) AF

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7
Q

Common cause of mitral regurgitation?

A

Rheumatic heart disease
Ischaemic heart disease
Post mI
Cardiomyopathy

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8
Q

Murmur in mitral regurgitation?

A

Pansystolic murmur which radiates to the axilla

MSMD
MRPS

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9
Q

What abnormalities may you see on CXR of mitral regurgitation?

A

LA enlargement —>big heart with double heart contour

Possibly pulmonary oedema

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10
Q

What is a valve prolapse?

A

The valve leaflets balloon upwards during contraction —> may be asymptomatic or cause palpitations, syncop etc

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11
Q

Mitral valve prolapse is associated with….

A

Rheumatic heart disease
IHD
Marfans
Ehlers-Danlos

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12
Q

Pulmonary stenosis causes an outflow obstruction. How is this graded?

A

Based on the transvalvular gradient

<50mmHg = mild
50-80mmHg = moderate
>80mmHg = severe
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13
Q

Which condition is pulmonary stenosis associated with?

A

Carcinoid syndrome

Caused by serotonin releasing carcinoid tumour of the bowel or lung

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14
Q

What type of murmur is associated with pulmonary stenosis?

A

Ejection systolic - best heard at left upper sternal edge

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15
Q

What are the 3 different types of ASD?

A

Little holes are present in the following places due to failure of septal development

Ostium primum - near AV valve
Ostium secondum - mid septum
Sinus venosus - near SVC

Ostium secondum is by far the most common cause

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16
Q

Ostium secondum is the most common type of ASD - which form is most common in patients with DS?

A

Ostium primum

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17
Q

ASD usually presents in adulthood with…

A 
Left parasternal heave
Fixed splitting of 2nd heart sound
Mid systolic murmur at left sternal edge
Cyanosis
Clubbing

There is a risk of a clot forming, passing through the defect and causing a stroke

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18
Q

Most VSD are in the membranous portion of the septum

A

Associated with fetal alcohol syndorme, DS and tetralogy do Falot

Most will close spontaneously in childhood

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19
Q

Murmur in VSD

A

Pansystolic murmur

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20
Q

What is Eisenmengers syndrome?

A

Normal VSD - oxygenated blood is pumped from LV to RV = little consequence

BUT this causes RVH as it is dealing with more blood —> increased muscle mass —> eventually pressure in RV is higher so shunt switches and now DEOXYGENTED blood is pumped from RV to LV = bad —> Cyanosis etc

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21
Q

ECG in pericarditis

A

Widespread ST elevation - typically described as concave in shape

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22
Q

Commonest cause of myocarditis

A

Coxsackie virus

Often a pansystolic murmur due to MR

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23
Q

What is Duke’s criteria for diagnosing endocarditis

A

Diagnosed if 2 major or 1 major + 3 minor or 5 minor

Major criteria

  • positive blood culture for typical organism
  • new/ changing murmur

Minor criteria

  • fever
  • previous heart disease/ IVDU
  • Janeway lesion
  • Splinter haemorrhage
  • Oslers nodes
  • Roth spots (small retinal haemorrhages)
  • ## Clubbing
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24
Q

What is the most common cause of sudden death in young, active adults?

A

HOCM
It can cause ischaemia
—> fatal arrhythmias

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25
Myocyte disarray?
Seen in HOCM
26
HOCM is usually inherited but is also associated with....
Fredericks Ataxia
27
Which drug is CI in HOCM?
Digoxin | It increases the force of contraction which can worsen the problem
28
What is HOCM?
- LV is thickened, heavy and hypercontractile - Heart cannot fill or pump as well —> reduced stroke volume and diastolic heart failure - Ejection systolic murmur (like AS) - Bifid pulse - Risk of dangerously fast arrhythmias
29
Atrial myxoma causes a tumour ‘plop’ (loud third heart sound. It requires surgical resection. What are the main complications?
Peripheral or pulmonary emboli
30
Remember that the SA node is usually from the RCA and the AV node is almost always from the RCA
The RBB is from the septal branch of the LAD The LBB is from the LAD
31
What does right and left heart dominance mean?
Dominance is defined by whether the posterior descending artery is from the RCA or LCA Most hearts are right dominant
32
ST elevation in V1/2
Septal (LAD)
33
ST changes in V3/4
Anterior (LAD)
34
ST changes in V5/6
Apical (mixed e.g. LAD, RCA etc )
35
ST changes in 1 and aVL
Lateral (left circumflex)
36
ST changes in II, III, aVF
Inferior | RCA
37
How do you activate the major haemorrhage protocol?
1) Call 2222 and state major haemorrhage 2) Call the blood bank and give patient details, location and whether o negative has been used 3) Send emergency blood samples - FBC, coagulation screen, fibrinogen, UE, ca and crossmatch 4) the transfusion lab will give you 4 adult red cells, 4 adult FFP and 1 platelets 5) Unless trauma, transfuse red cells and platelets in a 2:1 ratio
38
ST depression and prominent R/T waves are characteristic of....
Posterior MI Consider doing additional ECG leads (V7-V9)
39
Stokes Adams attack
Sudden collapse lasting several seconds Can be multiple Complete heart block seem on ECG Bradycardia during attack
40
Compare a mechanical and tissue replacement valve
Mechanical = lasts 30+ years but requires lifelong anti-coagulation Main risk is stroke and endocarditis Prosthetic = lasts 8-10 years but anti-coagulation only for 3 months. Main risk is calcification
41
All patients with heart failure should be on a beta blocker and ACEI (or ARB). What is the next line treatment?
Add spironolactone or eplenerone (better if gynaecomastia)
42
Heart failure patient with ongoing symptoms despite beta blocker, ACEI and spironolactone?
STOP ACE and start sacubitril or valsartin
43
Management options in a heart failure patient taking Beta blocker, spironolactone and sacubitril / valsartan?
Ivabradine (if sinus rhythm >75bpm) | Digoxin
44
Initial DRUG management for a suspected MI?
Aspirin 300mg loading dose | Ticagrelor 180mg
45
What is the time cut off for PCI vs thrombolysis therapy for MI?
120 MINUTES of ECG diagnosis
46
What drug treatment is given to patients with NSTEMI ?
Usual aspirin and ticagrelor Fondaparinux OR LMWH Fondaparinux is an activated factor X inhibitor
47
For people with NSTEMI treated with fondaparinux what is the next step?
Calculate the GRACE score If medium to high risk of death in the next 6 months (>5%) or recurrent symptoms then do early in hospital coronary angiography
48
What is the grace score?
Tool to estimate the 6 month mortality risk in patient with ACS. It considers numerous factor including: - age - BP/ HR - creating - Killip rating - tropinon etc Risk >5% = medium risk —> in hospital cardio angiography
49
After thrombolysis/ PCI, which drugs should all patient with ACS be on?
Aspiring + ticagrelor ( 6 month) Beta blocker ACEI Statin
50
Don’t forget that polycythameia e.g increased haematocrit concentration is a known complication of COPD
Don’t forget that polycythameia e.g increased haematocrit concentration is a known complication of COPD
51
Young person with R abdo pain and R tenderness on PR?
Appendicitis
52
Why do PPI increase the risk of hip #
They reduce the absorption of magnesium and phosphate which is good for bone health
53
Which drug is CI in patients on verapamil?
Beta blocker | Due to the risk of asystole + bradycardia
54
Management of a patient with Mobitz 11 heart block who has fainted a few times?
Pacemaker (1st degree = PR prolongation Mobitz 1 = PR prolongation then fail to conduct Mobitz 11 = PR normal but random fail to conduct
55
What are 4 common side effects of nitrates?
Hypotension Headache Reflex tachycardia Flushing
56
What is the investigation of choice to detect liver fibrosis in patient with Hep C?
Transient elastography | also called fibroscan
57
Acetazolamide is used in the prevention of high altitude cerebral oedema
Descent and dexamnethasone are used in the management
58
List some causes of NAFLD?
- OBESITY - metabolic things like Wilson’s - TPN - loss of lots of weight e.g. gastric bypass
59
Management of aortic stenosis
A valve replacement is only required if symptomatic OR echo shows valve gradient of >40mmHg Otherwise just observe review regularly
60
Most likely diagnosis in a patient who keeps collapsing every time he shaves his neck?
Carotid sinus hypersensitivity Carotid sinus is hyperactive —> pressure trigers barcoreceptors and parasympathetic activity —> fall in BP and HR Diagnose with a carotid massage Diagnostic if ventricular pause for >3 seconds or SBP drop by >50mmHg
61
What is the main indication for NIV in patients with acute exacerbation of COPD?
Respiratory acidosis (raised CO2 and pH<7.35)
62
Most likely diagnosis in a young adult with hyperpigmented spots on hands, feet and face, previous intussusception and multiple hartomas in the GI tract?
Peutz-Jegers syndrome
63
Sulfonylureas are a recognised cause of cholestasis
Sulfonylureas are a recognised cause of cholestasis
64
What do the H’s in ‘get smashed’ stand for?
Hypercalcaemia Hyopthermia Hyperlipidaemia
65
1st line treatment for HT in a patient with T2DM?
ACEI
66
Next treatment for a patient with pulmonary oedema and failed medical management?
CPAP
67
Why does isoniazid cause a burning sensation in the feet?
It causes peripheral neuropathy due to vit B 6 deficiency
68
ECG features of wolf-parkisons white?
Short PR interval (<120ms) Wide QRS with slurred upstroke (delta wave) RAD or LAD (depending on which side the accessory pathway is on)
69
What is a +ve Kussmal’s sign? Why is it clinically useful?
Raised JVP that does not fall on inspiration It is present in constrictive pericarditis and absent in cardiac tamponade
70
Which vessel supplies the AV node?
RCA
71
The LCA originates from the posterior aortic sinus. What vessels supplies the apex of the heart?
LAD
72
Don’t forget that Paget’s can cause bowing of the tibia. What is this called?
Sabre tibia
73
Why would amiodarone be a bad choice of treatment for a night lorry driver?
It often causes visual disturbances such as blue vision —> corneal deposits which can cause night glare
74
Treatment choice for an isolated hypertriglycerideaemia?
Fibrate
75
Statins improve survival after MI even if cholesterol is ‘normal’
Statins improve survival after MI even if cholesterol is ‘normal’
76
5-0 proline suture is used for cuts on the face
6-0 is smaller and used for lesions round the eye 4-0 is larger and used for lesions around the neck, hands and fingers
77
How do you manage PEA?
- Start CPR 30:2 - 1mg adrenaline IV as soon as IV access achieved - re-check rhythm every 2 minutes - 1mg adrenaline every 3-5 minutes - continue until death/ reversible causes have been treated
78
How do you manage VF/ pulseless VT?
- CPR 30:2 - Deliver shock at least 150J - after 3 shocks give adrenaline 1mg IV and amiodarone 300mg IV - further 1mg adrenaline is given after every 2nd shock
79
How do you manage witnessed VF/ pulseless VT?
- confirm cardiac arrest and get help - give up to 3 consecutive shocks - after 3 shocks, continue with standard CPR if no return of spontaneous circulation
80
When assessing a patient who is peri-arrest what are adverse features?
- shock e.g. SBP <90, pallor, sweating, cold and clammy, confusion - syncope - ischaemic chest pain or Ischaemic changes on 12 lead - heart failure e.g. pulmonary oedema The mnemonic is Save My Sorry Heart (Syncope, myocardial Ischaemia, shock and heart failure)
81
How do you manage tachycardia peri-arrest with adverse features?
- Synchronised DC shock (up to 3) - get expert help - amiodarone 300mg
82
Management of peri-arrest broad complex, regular tachycardia?
Probably VT | —> amiodarone 300MG IV over 20-60 min then 900mg over 25
83
Management of regular narrow complex tachycardia peri-arrest rhythm?
Probably SVT - vagal manouveres - adenosine 6mg IV bolus - then 12, then 12 - no response = expert help
84
Management of irregular, narrow complex tachycardia with no adverse features?
Probable AF Control rate with beta-blocker of diltiazem If in heart failure, consider digoxin
85
Management of bradycardia with adverse features?
Atropine 500mcg IV (repeat up to a maximum of 3mg) If unsuccessful consider pacing, isoprenaline of adrenaline
86
How do you determine if patients in bradycardia are at risk of asystole?
- recent asystole - ventricular pauses >3s - Mobitz II/ complete heart block If at risk —> treat as per bradycardia with adverse features If not at risk —> continual monitoring and reassessment
87
Drug management of ischameic stroke presenting within 4.5 hours
Assuming no CI: | Alteplase 0.9mg/kg up to max 90mg
88
What food should you avoid while on warfarin?
Cranberry juice
89
Mechanism of action of dabigitron?
Direct thrombin (11a) inhibitor
90
Which new oral anti-coagulants act to inhibit activated factor X?
Rivaroxaban and apixiban (10 RA) (this is also where LMWH e.g. fondaparinux acts) 2D10RA
91
Which new oral anticoagulants inhibit thrombin?
Dabigitran
92
Which patients may benefit from a target INR of 3-4?
Those with recurrent DVT or PE in patients receiving anti-coagulation with an INR above 2
93
Why should patient with heart failure be encouraged to reduce salt consumption but NOT use ‘low salt’ alternatives?
Lo-salt = high K = bad
94
Avoid TCA in patients with HF
Avoid TCA in patients with HF
95
What does St John’s Wart interfere with?
Everything but especially: - warfarin - epleronone - digoxin - SSRI
96
ECG electrical alterans? | one high QRS followed by a low QRS
LARGE pericardial effusion

General Medicine (6 decks)

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