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Finals SAQs > Cardio > Flashcards

Cardio Flashcards

1
Q

What neurohormonal systems may be activated in heart failure?

A

Renin, Aldosterone, Angiotensin System

Catecholamines of the Sympathetic Nervous System

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2
Q

What changes are seen on X-ray in heart failure?

A

Kerley B lines

Dilated prominent upper lobe vessels

Cardiomegaly

Bilateral Pleural Effusions

Bat wing perihilar shadowing: alveolar oedema

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3
Q

What are the symptoms of left heart failure?

A

Exertional dyspnoea

Orthopnoea

Paroxysmal nocturnal dyspnoea

Breathelessness

Nocturnal cough productive of pink frothy sputum

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4
Q

How can blood pressure affect the administration of drugs?

A

Low BP delays absorption of oral and IM prescribed drugs

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5
Q

What are the complications to thrombolysis?

A

Any previous haemorrhagic stroke

Head trauma/ brain surgery within last 6 months

Known intracranial neoplasm

Recent major surgery

Active bleeding or known bleeding disorder

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6
Q

What is the mechanism of action of aspirin?

A

Surpresses production of prostaglandins and thromboxanes due to its reversible inactivation of cyclooxygenase

This inhibits platelet aggregation

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7
Q

What is the mechanism of action of statins?

A

Inhibit HMG-CoA, reducing liver synthesis of cholesterol. Also has protective endothelial effects

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8
Q

What is the mechanism of action of B-blockers?

A

Via B1-receptor they reduce force of contraction and speed of conduction in the heart.

This relieves myocardial ischaemia by reducing cardiac work and oxygen demand, and increasing myocardial perfusion

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9
Q

What is congestive heart failure?

A

Combination of both left and right heart failure

Will have symptoms of both

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10
Q

Why are loop diuretics best in heart failure?

A

Loop diuretics also have a direct effect on blood vessels, causing dilatation of capacitance veins. In acute heart failure, this reduces preload and improves contractile function of the “overstretched” heart muscle

This is probably this main benefit of loop diuretics in acute heart failure, as illistrated by the fact that the clinical response is usually evident before

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11
Q

What drugs are contraindicated in aortic stensosis?

A

Nitrates

Calcium channel blockers

ACEi
ARBs

Dipyridamole

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12
Q

Give causes of a systolic murmur

A

Aortic stenosis

Pulmonary stenosis

Mitral regurgitation

Tricuspid regurgitation

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13
Q

Give 4 non-modifiable risk factors of an MI

A

Age
Gender
Family history
Ethnicity

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14
Q

What 4 conditions predispose an individual to coronary heart disease?

A

Diabetes mellitus
Hypertension
Hyperlipidaemia
Obesity

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15
Q

Give 4 lifestyle factors which put patients at risk of CHD

A

Smoking
Obesity
Physical Inactivity
Cocaine use

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16
Q

What should be covered in 6 week consultation post MI?

A

Review symptoms: any dyspnoea, angina, palpitations

Consider coronary angiography: establish extent of residual coronary disease

17
Q

What are the differentials for a systolic murmur in a post MI patient?

A

Post MI:

  • Mitral regurgitation (papillary muscle dysfunction, acute left ventricular dilation)
  • Ventricular septal defect (rupture of the interventricular septum)

General:

  • Mitral regurgitation
  • Ventricular septal defect
  • Aortic stenosis
  • Hypertrophic cardiomyopathy
  • Tricuspid regurgitation
  • Pulmonary stenosis
18
Q

What are the investigations for renal artery stenosis?

A

Renal USS
CT/MRI angiography
Renal angiography

19
Q

What is the management of renal artery stenosis?

A

Comprehensive antihypertensive regimen (stop ACEi for something else)

Transluminal angioplasty +/- stent placement

Revascularisation surgery

20
Q

What are the side effects of B-blockers?

A 
fatigue
cold extremities
headahce
GI disturbance
Sleep disturbance and nightmares
Impotence
21
Q

Side effects of thiazide diuretics?

A

Hyponatraemia
Hypokalaemia
Impotence
Gout

22
Q

What are the side effects of CCBs?

A

Ankle swelling
Flushing
Headache
Palpitations

Verapamil

  • Constipation
  • Bradycardia
  • Heart block
  • Cardiac failure
23
Q

What are the side effects of ACEi?

A

Hypotension
Dry cough
hyperkalaemia

Rarely
-angioedema and other anaphylactoid reactions

24
Q

What are the causes of secondary hypertension?

A

Polycystic kidney disease

Cushing’s syndrome

Conn’s syndrome

Phaeochromocytoma

Hyperparathyroidism

Coarctation of the Aorta

Renal artery stenosis

25
Q

ECG features of aortic stenosis

A

p-mitrale
LVH with strain
left axis deviation

Finals SAQs (8 decks)

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