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General Medicine > Cardio > Flashcards

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
Q

Myocyte disarray?

A

Seen in HOCM

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26
Q

HOCM is usually inherited but is also associated with….

A

Fredericks Ataxia

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27
Q

Which drug is CI in HOCM?

A

Digoxin

It increases the force of contraction which can worsen the problem

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28
Q

What is HOCM?

A
  • 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
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29
Q

Atrial myxoma causes a tumour ‘plop’ (loud third heart sound. It requires surgical resection. What are the main complications?

A

Peripheral or pulmonary emboli

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30
Q

Remember that the SA node is usually from the RCA and the AV node is almost always from the RCA

A

The RBB is from the septal branch of the LAD

The LBB is from the LAD

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31
Q

What does right and left heart dominance mean?

A

Dominance is defined by whether the posterior descending artery is from the RCA or LCA

Most hearts are right dominant

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32
Q

ST elevation in V1/2

A

Septal (LAD)

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33
Q

ST changes in V3/4

A

Anterior (LAD)

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34
Q

ST changes in V5/6

A

Apical (mixed e.g. LAD, RCA etc )

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35
Q

ST changes in 1 and aVL

A

Lateral (left circumflex)

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36
Q

ST changes in II, III, aVF

A

Inferior

RCA

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37
Q

How do you activate the major haemorrhage protocol?

A

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

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38
Q

ST depression and prominent R/T waves are characteristic of….

A

Posterior MI

Consider doing additional ECG leads (V7-V9)

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39
Q

Stokes Adams attack

A

Sudden collapse lasting several seconds
Can be multiple
Complete heart block seem on ECG
Bradycardia during attack

40
Q

Compare a mechanical and tissue replacement valve

A

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
Q

All patients with heart failure should be on a beta blocker and ACEI (or ARB). What is the next line treatment?

A

Add spironolactone or eplenerone (better if gynaecomastia)

42
Q

Heart failure patient with ongoing symptoms despite beta blocker, ACEI and spironolactone?

A

STOP ACE and start sacubitril or valsartin

43
Q

Management options in a heart failure patient taking Beta blocker, spironolactone and sacubitril / valsartan?

A

Ivabradine (if sinus rhythm >75bpm)

Digoxin

44
Q

Initial DRUG management for a suspected MI?

A

Aspirin 300mg loading dose

Ticagrelor 180mg

45
Q

What is the time cut off for PCI vs thrombolysis therapy for MI?

A

120 MINUTES of ECG diagnosis

46
Q

What drug treatment is given to patients with NSTEMI ?

A

Usual aspirin and ticagrelor
Fondaparinux OR LMWH

Fondaparinux is an activated factor X inhibitor

47
Q

For people with NSTEMI treated with fondaparinux what is the next step?

A

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
Q

What is the grace score?

A

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
Q

After thrombolysis/ PCI, which drugs should all patient with ACS be on?

A

Aspiring + ticagrelor ( 6 month)
Beta blocker
ACEI
Statin

50
Q

Don’t forget that polycythameia e.g increased haematocrit concentration is a known complication of COPD

A

Don’t forget that polycythameia e.g increased haematocrit concentration is a known complication of COPD

51
Q

Young person with R abdo pain and R tenderness on PR?

A

Appendicitis

52
Q

Why do PPI increase the risk of hip #

A

They reduce the absorption of magnesium and phosphate which is good for bone health

53
Q

Which drug is CI in patients on verapamil?

A

Beta blocker

Due to the risk of asystole + bradycardia

54
Q

Management of a patient with Mobitz 11 heart block who has fainted a few times?

A

Pacemaker

(1st degree = PR prolongation
Mobitz 1 = PR prolongation then fail to conduct
Mobitz 11 = PR normal but random fail to conduct

55
Q

What are 4 common side effects of nitrates?

A

Hypotension
Headache
Reflex tachycardia
Flushing

56
Q

What is the investigation of choice to detect liver fibrosis in patient with Hep C?

A

Transient elastography

also called fibroscan

57
Q

Acetazolamide is used in the prevention of high altitude cerebral oedema

A

Descent and dexamnethasone are used in the management

58
Q

List some causes of NAFLD?

A
  • OBESITY
  • metabolic things like Wilson’s
  • TPN
  • loss of lots of weight e.g. gastric bypass
59
Q

Management of aortic stenosis

A

A valve replacement is only required if symptomatic OR echo shows valve gradient of >40mmHg

Otherwise just observe review regularly

60
Q

Most likely diagnosis in a patient who keeps collapsing every time he shaves his neck?

A

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
Q

What is the main indication for NIV in patients with acute exacerbation of COPD?

A

Respiratory acidosis (raised CO2 and pH<7.35)

62
Q

Most likely diagnosis in a young adult with hyperpigmented spots on hands, feet and face, previous intussusception and multiple hartomas in the GI tract?

A

Peutz-Jegers syndrome

63
Q

Sulfonylureas are a recognised cause of cholestasis

A

Sulfonylureas are a recognised cause of cholestasis

64
Q

What do the H’s in ‘get smashed’ stand for?

A

Hypercalcaemia
Hyopthermia
Hyperlipidaemia

65
Q

1st line treatment for HT in a patient with T2DM?

A

ACEI

66
Q

Next treatment for a patient with pulmonary oedema and failed medical management?

A

CPAP

67
Q

Why does isoniazid cause a burning sensation in the feet?

A

It causes peripheral neuropathy due to vit B 6 deficiency

68
Q

ECG features of wolf-parkisons white?

A

Short PR interval (<120ms)
Wide QRS with slurred upstroke (delta wave)
RAD or LAD (depending on which side the accessory pathway is on)

69
Q

What is a +ve Kussmal’s sign? Why is it clinically useful?

A

Raised JVP that does not fall on inspiration

It is present in constrictive pericarditis and absent in cardiac tamponade

70
Q

Which vessel supplies the AV node?

A

RCA

71
Q

The LCA originates from the posterior aortic sinus. What vessels supplies the apex of the heart?

A

LAD

72
Q

Don’t forget that Paget’s can cause bowing of the tibia. What is this called?

A

Sabre tibia

73
Q

Why would amiodarone be a bad choice of treatment for a night lorry driver?

A

It often causes visual disturbances such as blue vision —> corneal deposits which can cause night glare

74
Q

Treatment choice for an isolated hypertriglycerideaemia?

A

Fibrate

75
Q

Statins improve survival after MI even if cholesterol is ‘normal’

A

Statins improve survival after MI even if cholesterol is ‘normal’

76
Q

5-0 proline suture is used for cuts on the face

A

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
Q

How do you manage PEA?

A
  • 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
Q

How do you manage VF/ pulseless VT?

A
  • 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
Q

How do you manage witnessed VF/ pulseless VT?

A
  • 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
Q

When assessing a patient who is peri-arrest what are adverse features?

A
  • 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
Q

How do you manage tachycardia peri-arrest with adverse features?

A
  • Synchronised DC shock (up to 3)
  • get expert help
  • amiodarone 300mg
82
Q

Management of peri-arrest broad complex, regular tachycardia?

A

Probably VT

—> amiodarone 300MG IV over 20-60 min then 900mg over 25

83
Q

Management of regular narrow complex tachycardia peri-arrest rhythm?

A

Probably SVT

  • vagal manouveres
  • adenosine 6mg IV bolus
  • then 12, then 12
  • no response = expert help
84
Q

Management of irregular, narrow complex tachycardia with no adverse features?

A

Probable AF
Control rate with beta-blocker of diltiazem

If in heart failure, consider digoxin

85
Q

Management of bradycardia with adverse features?

A

Atropine 500mcg IV
(repeat up to a maximum of 3mg)

If unsuccessful consider pacing, isoprenaline of adrenaline

86
Q

How do you determine if patients in bradycardia are at risk of asystole?

A
  • 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
Q

Drug management of ischameic stroke presenting within 4.5 hours

A

Assuming no CI:

Alteplase 0.9mg/kg up to max 90mg

88
Q

What food should you avoid while on warfarin?

A

Cranberry juice

89
Q

Mechanism of action of dabigitron?

A

Direct thrombin (11a) inhibitor

90
Q

Which new oral anti-coagulants act to inhibit activated factor X?

A

Rivaroxaban and apixiban

(10 RA)

(this is also where LMWH e.g. fondaparinux acts)

2D10RA

91
Q

Which new oral anticoagulants inhibit thrombin?

A

Dabigitran

92
Q

Which patients may benefit from a target INR of 3-4?

A

Those with recurrent DVT or PE in patients receiving anti-coagulation with an INR above 2

93
Q

Why should patient with heart failure be encouraged to reduce salt consumption but NOT use ‘low salt’ alternatives?

A

Lo-salt = high K = bad

94
Q

Avoid TCA in patients with HF

A

Avoid TCA in patients with HF

95
Q

What does St John’s Wart interfere with?

A

Everything but especially:

  • warfarin
  • epleronone
  • digoxin
  • SSRI
96
Q

ECG electrical alterans?

one high QRS followed by a low QRS

A

LARGE pericardial effusion

General Medicine (6 decks)

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