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cardio Flashcards

1
Q

pathological q waves sign of

A

previous/ resolving MI. indefinite, hours to days

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2
Q

causes of ventricular tachycardia

A

hypokalaemia, hypo magnesaemia, (hyperkalaemia can too)

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3
Q

torsades de pointe

A

polymorphic VT precipitated by prolonged QT

treat with iv mag sulf

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4
Q

verapimil + betablocker

A

contraindicated due to bradycardia

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5
Q

management of stable angina

A

-betablocker
-dihydropyridine calcium channel blocker
- both
if not tolerated use:
A long-acting nitrate
Ivabradine
Nicorandil
Ranolazine

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6
Q

ivabradine side effects

A

visual disturbances including phosphenes and green luminescence
metabolised by oxidation through cytochrome P450 3A4 (CYP3A4) only. Therefore drugs that induce (e.g rifampicin) or inhibit (e.g erythromycin, itraconazole) CYP3A4, will decrease or increase the plasma concentration

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7
Q

INR:

  • following VTE/ AF
  • recurrent VTE
  • when to give vitamin k
A
  • 2.5
  • 3.5
  • 5-8 + bleed or 8+ or major bleed
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8
Q

management and doses of anaphylaxis

don’t discharge before observation for 6h due to biphasic reaction. can repeat adrenaline every 5 mins

A

Adrenaline Hydrocortisone Chlorphenamine

< 6 months 150 micrograms (0.15ml 1 in 1,000) 25 mg 250 micrograms/kg

6 months - 6 years 150 micrograms (0.15ml 1 in 1,000) 50 mg 2.5 mg

6-12 years 300 micrograms (0.3ml 1 in 1,000) 100 mg 5 mg

Adult and child > 12 years 500 micrograms (0.5ml 1 in 1,000) 200 mg 10 mg

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9
Q

ECG features of hypokalaemia

A 
U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT
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10
Q

eisenmengers syndrome definition

A

the reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension. This occurs when an uncorrected left-to-right leads to remodeling of the pulmonary microvasculature, eventually causing obstruction to pulmonary blood and pulmonary hypertension.

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11
Q

treatment of toursade de pointe

A

iv mag sulf

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12
Q

initial management of VF

A

1 shock then 2mins CPR

witnessed VF, up to 3 shocks

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13
Q

aortic coract associated with

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

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14
Q

causes of raised BNP

A

heart failure is the most obvious cause of raised BNP levels any cause of left ventricular dysfunction such as myocardial ischaemia or valvular disease may raise levels. Raised levels may also be seen due to reduced excretion in patients with chronic kidney disease.

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15
Q

loop diuretics side effects

A 
hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
ototoxicity
hypocalcaemia
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout
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16
Q

VT management

A

Drug therapy
amiodarone 300mcg: ideally administered through a central line
lidocaine: use with caution in severe left ventricular impairment
procainamide

Verapamil should NOT be used in VT

If drug therapy fails
electrophysiological study (EPS)
implant able cardioverter-defibrillator (ICD) - this is particularly indicated in patients with significantly impaired LV function
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17
Q

nitrates contraindicated in

A

aortic stenosis- profound hypotension

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18
Q

thiazide diuretics adverse effects

A 
Common adverse effects
dehydration
postural hypotension
hyponatraemia, hypokalaemia, hypercalcaemia*
gout
impaired glucose tolerance
impotence
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19
Q

dipyridamole MoA

A

Dipyridamole is an antiplatelet mainly used in combination with aspirin after an ischaemic stroke or transient ischaemic attack.

Mechanism of action
inhibits phosphodiesterase, elevating platelet cAMP levels which in turn reduce intracellular calcium levels
other actions include reducing cellular uptake of adenosine and inhibition of thromboxane synthase

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20
Q

IE dukes major criteria

A

Pathological criteria

Positive histology or microbiology of pathological material obtained at autopsy or cardiac surgery (valve tissue, vegetations, embolic fragments or intracardiac abscess content)

Major criteria

Positive blood cultures
two positive blood cultures showing typical organisms consistent with infective endocarditis, such as Streptococcus viridans and the HACEK group, or
persistent bacteraemia from two blood cultures taken > 12 hours apart or three or more positive blood cultures where the pathogen is less specific such as Staph aureus and Staph epidermidis, or
positive serology for Coxiella burnetii, Bartonella species or Chlamydia psittaci, or
positive molecular assays for specific gene targets

Evidence of endocardial involvement
positive echocardiogram (oscillating structures, abscess formation, new valvular regurgitation or dehiscence of prosthetic valves), or
new valvular regurgitation
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21
Q

ecg changes hypothermia

A 
bradycardia
'J' wave - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias
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22
Q

drugs to control rate in AF

A

beta-blockers
calcium channel blockers
digoxin (not considered first-line anymore as they are less effective at controlling the heart rate during exercise. However, they are the preferred choice if the patient has coexistent heart failure)

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23
Q

drugs to maintain sinus rhythm in AF

A

sotalol
amiodarone
flecainide
others (less commonly used in UK): disopyramide, dofetilide, procainamide, propafenone, quinidine

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24
Q

atorvastatin interacts with

A

macrolides- risk of rhabdomyolsis

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25
Q

when to stop statins

A

Treatment with statins should be discontinued if serum transaminase concentrations rise to and persist at 3 times the upper limit of the reference range.

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26
Q

takayasu features

A 
large vessel vasculitis
females
aorta/ renal artery stenosis
systemic features of a vasculitis e.g. malaise, headache
unequal blood pressure in the upper limbs
carotid bruit
intermittent claudication
aortic regurgitation (around 20%)
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27
Q

child pugh scale

A

liver cirrhosis

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28
Q

buergers disease features

A

small and medium vessel vasculitis that is strongly associated with smoking.

Features
extremity ischaemia: intermittent claudication, ischaemic ulcers etc
superficial thrombophlebitis
Raynaud’s phenomenon

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29
Q

anti coag vs antiplatelet in:

  • 2ry prevention of MI
  • 2ry prevention of MI with AF
  • post ACS/PCI
  • VTE
A
  • anitplatelet
  • anticoag monotherapy
  • 2 antiplatelets and 1 doac
  • if already on anti P go to anti C, if low HASBLED anti P
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30
Q

new onset AF less than 48 hours

more than 48 hourse

A

dc cardioversion

3 weeks of anticoagulation first

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31
Q

aortic regurge signs

A 
Corrigan's - exaggerated carotid pulse
Quinke's - nailbed pulsation
De Musset's - head nodding
Duroziez's - diastolic femoral murmur
Traube's - 'pistol shot' femorals
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32
Q

ECG changes for thrombolysis or percutaneous intervention:

A

ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR

ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR

New Left bundle branch block

33
Q

hocm management

A 
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*
34
Q

dilated cardiomyopathy causes

A 
Classic causes include
alcohol
Coxsackie B virus
wet beri beri
doxorubicin
35
Q

amiodarone side effects

A 
Bradycardia
Hyper/hypothyroidism
pulmonary fibrosis/pneumonitis
liver fibrosis/hepatitis
jaundice
taste disturbance
persistent slate grey skin discolouration
raised serum transaminases
nausea
constipation (particularly at the start of treatment)
36
Q

pulsus paradoxus

A

greater than normal drop 10mmhg in systolic bp

asthma, cardiac tamponade

37
Q

most common cause of drug induces angioedema

A

ace inhibitors

38
Q

management of PE

A

LMWH or heparin initially for 5 days

warfarin within 24h to 3 months

39
Q

tx of SVT

A

valsalva
adenosine 6mg 12mg 12mg
electrical cardioversion
ablation

40
Q

causes of long qt

A

congenital: Jervell-Lange-Nielsen syndrome, Romano-Ward syndrome
antiarrhythmics: amiodarone, sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants
antipsychotics
chloroquine
terfenadine
erythromycin
electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
myocarditis
hypothermia
subarachnoid haemorrhage

41
Q

systolic murmur under left clavicle and on back

A

aortic coarct

42
Q

haemodynamic instability and pain after PCI

A

urgent CABG

43
Q

3rd heart sound

A

caused by diastolic filling of the ventricle
considered normal if < 30 years old (may persist in women up to 50 years old)
heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

44
Q

4th heart sound

A

may be heard in aortic stenosis, HOCM, hypertension
caused by atrial contraction against a stiff ventricle
therefore coincides with the P wave on ECG
in HOCM a double apical impulse may be felt as a result of a palpable S4

45
Q

ix for chronic heart failure

A

BNP

aldosterone antagonists, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics can all falsely lower BNP levels, as can obesity.

46
Q

st elevation without blockage on angiogram

A

takotsubo

47
Q

mx angina

A

aspirin and statin
gtn spray
beta blocker or ccblocker (verapamil/diltiazem) 1st line
long acting nitrate 3rd line ivabradine, nicorandil or ranolazine

48
Q

fondaparinux moa

A

activates antithrombin III

49
Q

pulmonaryy artery pressure, cardiac output and vascular resistance in
hypovolaemia
cardiogenic shock
septic shock

A

low, low, high (decreased preload)
high low, high (hence venodilators for pulmonary oedema)
low, high, low (hence vasoconstrictors)

50
Q

wellens sign

A

deep inverted t waves (critical stenosis of LAD)§

51
Q

marker for second MI in quick succession

A

CK MB (remains elevated for 3-4 days) trop for 10 days

52
Q

indications for emergency valve replacement

A

Severe congestive cardiac failure
Overwhelming sepsis despite antibiotic therapy (+/- perivalvular abscess, fistulae, perforation)
Recurrent embolic episodes despite antibiotic therapy
Pregnancy

53
Q

MOA statin

A

HMG coa reductase inhibitor in hepatic synthesis

54
Q

ix in PE and renal failure

A

v/q perfusion scan

55
Q

bisferiens pulse

A

HOCM (happens in subaortic stenosis)

56
Q

drug which only improve mortality in NYHA 3

A

spironolactone

57
Q

pedunculated mass on echo leading to emboli and AF

A

atrial myxoma

58
Q

when to stop warfarin before surgery

A

5 days

59
Q

high grace score- what other drug

A

abciximab glp3a/2b inhib

60
Q

when not to treat htn

A

over 80 and low qrisk

61
Q

non cardiac pain but ECG changes - imaging?

A

coronary ct angio

62
Q

mx of aortic dissection

A

Type A
surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention

Type B*
conservative management
bed rest
reduce blood pressure IV labetalol to prevent progression

63
Q

An inferior myocardial infarction and AR murmur should raise suspicion of

A

ascending aorta dissection rather than an inferior myocardial infarction alone
Other features may include pericardial effusion, carotid dissection and absent subclavian pulse.

64
Q

eisenmengers

A

reversal of left-to-right shunt associated with ventricular septal defects, atrial septal defect and a patent ductus arteriosus.

65
Q

severe mitral stenosis

A

p mitrale bifid p wave

66
Q

carotid sinus hypersensitivity

A

ventricular pause of 4 secs, fall in SBP of 10mmhg

67
Q

erythema marginatum

A

rheumatic fever, sydenha

68
Q

hocm fx

A

often asymptomatic
exertional dyspnoea
angina
syncope
typically following exercise
due to subaortic hypertrophy of the ventricular septum, resulting in functional aortic stenosis
sudden death (most commonly due to ventricular arrhythmias), arrhythmias, heart failure
jerky pulse, large ‘a’ waves, double apex beat
ejection systolic murmur
increases with Valsalva manoeuvre and decreases on squatting
hypertrophic cardiomyopathy may impair mitral valve closure, thus causing regurgitation

69
Q

statin monitoring

A

LFTs at 0,3 and 12 months

70
Q

when to operate on aortic stenosis

A

aortic valve gradient > 40 mmHg or there is evidence of significant left ventricular dysfunction then surgery is sometimes considered in selected asymptomatic patients

71
Q

kussmauls’s sign

A

JVP increase with inspiration, feature of contrictive pericarditis

72
Q

mx of long qt

A

avo;id drug
betablocker
icd

73
Q

when to treat HTN

A 
stage 1 135/85 and <80
organ damage
cvd
renal disease
diabetes
qrisk 10%

or <60
or all stage 2

74
Q

cor pulmonale

A

right heart failure

75
Q

power of defib in VF

A

150 J

76
Q

bi/trifascicular block

A

Bifascicular block
combination of RBBB with left anterior or posterior hemiblock
e.g. RBBB with left axis deviation

Trifascicular block
features of bifascicular block as above + 1st-degree heart block

77
Q

mx proximal aortic dissection

A

Proximal aortic dissections are generally managed with surgical aortic root replacement.

78
Q

cha2ds2vasc

A 
C	Congestive heart failure	1
H	Hypertension (or treated hypertension)	1
A2	Age >= 75 years	2
Age 65-74 years	1
D	Diabetes	1
S2	Prior Stroke or TIA	2
V	Vascular disease (including ischaemic heart disease and peripheral arterial disease)	1
S	Sex (female)	1

revision (24 decks)

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