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2a mid tier > Cardio > Flashcards

Cardio Flashcards

1
Q

What is atrial fibrillation?

A

Irregular atrial rhythms of 300-600 bpm

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2
Q

What is the aetiology of atrial fibrillation?

A
  • idiopathic
  • any condition that causes raised atrial pressure, increased atrial muscle mass, atrial fibrosis or inflammation of the atria
  • hypertension
  • heart failure
  • coronary artery disease
  • valvular heart disease
  • cardiac surgery
  • cardiomyopathy
  • rheumatic heart disease
    acute excess alcohol intoxication
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3
Q

What is the pathophysiology of atrial fibrillation?

A
  • continuous rapid activation of the atria prevents proper emptying into the ventricles
  • this causes a drop of cardiac output by 10-20%
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4
Q

What are the risk factors of atrial fibrillation?

A
  • > 60y
  • diabetes
  • hypertension
  • coronary artery disease
  • prior MI
  • structural heart disease
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5
Q

What is the clinical presentation of atrial fibrillation?

A
  • very variable
  • may be asymptomatic
  • palpitations
  • dyspnoea and/or chest pain
  • fatigue
  • apical pulse rate greater than radial pulse rate
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6
Q

What are the differential diagnoses of atrial fibrillation?

A
  • atrial flutter

- supra ventricular tachyarrythmias

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7
Q

How is atrial fibrillation diagnosed?

A

ECG: absent P waves, irregular and rapid QRS complex

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8
Q

How is atrial fibrillation managed?

A

Acute management:

  • provoking cause should be treated
  • cardioversion (sovversione to sinus rhythm by a direct-current shock) and LMWH
  • ventricular rate control with CCB, BB, digoxin, amiodarone

Long term and stable patient management:

  • rate control → AV node slowing agents and oral anticoagulation
  • rhythm control for younger, symptomatic, physically active patients
  • cardioversion
  • anticoagulants
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9
Q

What is an atrial flutter?

A

Organised atrial rhythms with an atrial rate of 250-350bpm

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10
Q

What is the aetiology of an atrial flutter?

A
  • 30% idiopathic
  • coronary heart disease
  • obesity
  • hypertension
  • heart failure
  • COPD
  • pericarditis
  • acute excess alcohol intoxication
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11
Q

What is the main risk factor for an atrial flutter?

A

Atrial fibrillation

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12
Q

What is the clinical presentation of an atrial flutter?

A
  • palpitations
  • breathlessness
  • dizziness
  • syncope
  • fatigue
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13
Q

What are the differential diagnoses of an atrial flutter?

A
  • atrial fibrillation

- supra ventricular tachycardias

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14
Q

How is an atrial flutter diagnosed?

A

ECG: sawtooth-like atrial flutter between QRS complexes

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15
Q

How is an atrial flutter managed?

A
  • electrical cardioversion after anticoagulant e.g. LMWH
  • catheter ablation (thin tube inserted into a coronary vessel to stop abnormal conduction)
  • IV amiodarone to restore sinus rhythm
  • bisoprolol to suppress further arrhythmias
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16
Q

What is the aetiology of 1st degree AV block?

A
  • hypokalaemia
  • myocarditis
  • inferior MI
  • AV node blocking drugs e.g. BB or CCB
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17
Q

What is the pathophysiology of 1st degree AV block?

A
  • prolongation of the PR interval to >0.22s

- delay between atrial depolarisation and conduction to the ventricles

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18
Q

What are the symptoms of 1st degree AV block?

A

Asymptomatic

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19
Q

How is 1st degree AV block managed?

A

No treatment as asymptomatic

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20
Q

What is the aetiology of Mobitz I 2nd degree AV block?

A
  • AV node-blocking drugs

- inferior MI

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21
Q

What is the pathophysiology of Mobitz I 2nd degree AV block?

A

Conduction becomes progressively slower until there is no conduction for a beat

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22
Q

What is the clinical presentation of Mobitz I 2nd degree AV block?

A
  • light-headedness
  • dizziness
  • syncope
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23
Q

How is Mobitz I 2nd degree AV block diagnosed?

A

ECG: progressive PR prolongation until a beat is ‘dropped’

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24
Q

How is Mobitz I 2nd degree AV block managed?

A

No intervention unless poorly tolerated

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25
Q

What is the aetiology of Mobitz II 2nd degree AV block?

A
  • anterior MI
  • mitral valve surgery
  • SLE
  • Lyme disease
  • rheumatic disease
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26
Q

What is the pathophysiology of Mobitz II 2nd degree AV block?

A

Failure of conduction through the His-Purkyne fibres

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27
Q

What is the clinical presentation of Mobitz II 2nd degree AV block?

A
  • SOB
  • postural hypotension
  • chest pain
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28
Q

How is Mobitz II 2nd degree heart AV diagnosed?

A

ECG: PR interval is constant and QRS interval is intermittently dropped

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29
Q

How is Mobitz II 2nd degree heart AV managed?

A

Pacemaker inserted due to high risk of sudden complete AV block

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30
Q

What is the aetiology of 3rd degree (complete) AV block?

A
  • structural heart disease
  • ischaemic heart disease
  • hypertension
  • endocarditis
  • lyme disease
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31
Q

What is the pathophysiology of 3rd degree (complete) AV block?

A
  • all atrial activity fails to conduct to the ventricles

- ventricle contractions are maintained by a spontaneous escape rhythm which originates from below the block

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32
Q

What is the clinical presentation of 3rd degree (complete) AV block?

A
  • faintness
  • breathlessness
  • extreme fatigue, sometimes with confusion
  • chest pain
  • bradycardia
  • palpitations
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33
Q

How is 3rd degree (complete) AV block diagnosed?

A

ECG: presence of complete AV-dissociation (atrial rate > ventricular rate i.e. more P waves than QRS complexes with no relationship between them)

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34
Q

What is the management of 3rd degree (complete) AV block?

A
  • depends on aetiology
  • only option is permanent pacemaker
  • IV amiodarone
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35
Q

What is the aetiology of a RBBB?

A
  • PE
  • IHD
  • atrial/ ventricular defect
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36
Q

What is the pathophysiology of a RBBB?

A

Right bundle of His doesn’t conduct, so impulses spread from left to right, causing late activation of the right ventricle

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37
Q

What is the clinical presentation of bundle branch blocks?

A

Usually asymptomatic

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38
Q

How is a RBBB diagnosed?

A

ECG: MarroW (QRS looks like an M in lead V1 and a W in leads V5/6)

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39
Q

How are bundle branch blocks managed?

A
  • pacemaker

- cardiac resynchronisation

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40
Q

What is the aetiology of a LBBB?

A
  • IHD

- aortic valve disease

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41
Q

What is the pathophysiology of a LBBB?

A
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42
Q

How is a LBBB diagnosed?

A

ECG: WilliaM (QRS looks like a W in leads V1/2 and an M is leads V4-6)

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43
Q

What is the aetiology of sinus tachycardia?

A
  • anaemia
  • anxiety
  • exercise
  • pain
  • heart failure
  • pulmonary embolism
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44
Q

What is sinus tachycardia?

A

HR >100bpm

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45
Q

What is the clinical presentation of sinus tachycardia?

A
  • abnormally strong or forceful heartbeats
  • irregular heartbeats
  • difficulty breathing
  • dizziness and fainting
  • chest pain
  • anxiety
  • changes in BP
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46
Q

How is sinus tachycardia diagnosed?

A
  • ECG: *****
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47
Q

How is sinus tachycardia managed?

A
  • treat underlying cause

- use beta blockers if necessary (e.g. bisoprolol)

48
Q

What is the aetiology of supraventricular tachycardia?

A
  • can be triggered by tiredness, caffeine, alcohol or drugs

- often no obvious trigger

49
Q

What is the pathophysiology of supraventricular tachycardia?

A
  • arise from the atria or the AV junction

- **

50
Q

What is the clinical presentation of supraventricular tachycardia?

A
  • sudden fast heart beat for several minutes to sometimes hours
  • sometimes also chest pain, weakness, breathlessness, nausea, fatigue
51
Q

How is supraventricular tachycardia managed?

A

Acute: stimulate vagus nerve to slow HR (= vagotonic manoeuvres)

Maintenance: BB or verapamil

52
Q

What is ventricular tachycardia?

A

HR>100bpm with at least 3 irregular beats in a row

53
Q

What is the pathophysiology of ventricular tachycardia?

A
  • rapid ventricular beating so there is inadequate filling of the ventricles
  • this results in decreased cardiac output therefore decreased circulation of oxygenated blood
54
Q

What are the symptoms of ventricular tachycardia?

A
  • breathlessness
  • chest pain
  • palpitations
  • lightheadedness/ dizziness
55
Q

How is ventricular tachycardia managed?

A
  • IV amiodarone or IV lidocaine
  • Oral amiodarone
  • Treat symptoms with a BB
56
Q

What is the pathophysiology of ventricular ectopic tachycardia?

A
  • premature ventricular contraction

- if the ectopic are frequent then LV dysfunction may develop

57
Q

What are the risk factors of ventricular ectopic tachycardia?

A 
Previous MI 
(VET is the most common type of post-MI arrhythmia)
58
Q

What is the clinical presentation of ventricular ectopic tachycardia?

A
  • usually asymptomatic
  • may be uncomfortable (especially if frequent)
  • irregular pulse
  • can feel faint or dizzy
  • may complain of extra beats, missed beats or heavy beats
59
Q

How is ventricular ectopic tachycardia diagnosed?

A

ECG: wide QRS complex (>0.12s)

60
Q

How is ventricular ectopic tachycardia managed?

A
  • reassure patients

- BB if symptomatic

61
Q

What is the aetiology of prolonged QT syndrome?

A

Congenital: Jervell-Lange-Nielsen syndrome, Romano-Ward syndrome

Acquired: hypokalaemia, hypercalcaemia, some drugs (antibiotics, antihistamines, antidepressants, diuretics), bradycardia, acute MI, diabetes

62
Q

What is the clinical presentation of prolonged QT syndrome?

A
  • syncope

- palpitations

63
Q

How is prolonged QT syndrome diagnosed?

A

ECG: QT >0.45 or 0.47s

64
Q

How is prolonged QT syndrome managed?

A
  • treat underlying cause
  • IV isoprenaline for acquired
  • BB to control heartbeat
  • pacemaker if severe
65
Q

What is the aetiology of Wolff-Parkinson-White syndrome?

A

Congenital accessory conduction pathway between atria and ventricles

66
Q

What is the pathophysiology of Wolff-Parkinson-White syndrome?

A
  • type of AV re-entrant tachycardia

- atrial activation occurs after ventricular activation

67
Q

What is the clinical presentation of Wolff-Parkinson-White syndrome?

A
  • pounding/fluttering heartbeat
  • lightheaded or dizzy
  • SOB
  • chest pain
  • feeling anxious
  • fainting
68
Q

How is Wolff-Parkinson-White syndrome diagnosed?

A

ECG: short PR, wide QRS

69
Q

How is Wolff-Parkinson-White syndrome managed?

A

For mild symptoms or very infrequent: regular check ups but no intervention

First line symptomatic: catheter ablation, anti-arrhythmic drugs

70
Q

What is the aetiology of an abdominal aortic aneurysm?

A

Atherosclerotic disease

71
Q

What is the pathophysiology of an abdominal aortic aneurysm?

A

Degradation of collagen and elastin in the media and adventitious as well as smooth muscle cell loss results in tapering of the medial wall

72
Q

What are the risk factors of an abdominal aortic aneurysm?

A
  • cigarette smoking
  • family history
  • increasing age
  • male sex
  • COPD
  • hyperlipidaemia
  • hypertension
73
Q

What is the clinical presentation of an unruptured abdominal aortic aneurysm?

A
  • often asymptotic
  • pain in abdomen, back, loin or groin
  • pulsation abdominal swelling
74
Q

What is the clinical presentation of a ruptured abdominal aortic aneurysm?

A
  • intermittent/ continuous abdominal pain radiating to back, iliac fossa and groin
  • pulsation abdominal swelling
  • hypotension
  • tachycardia
  • collapse
  • profound anaemia
  • sudden death
75
Q

What are the differential diagnoses of an abdominal aortic aneurysm?

A
  • diverticulitis
  • uterine colic
  • irritable bowel syndrome
  • inflammatory bowel disease
  • appendicitis
76
Q

How is an abdominal aortic aneurysm diagnosed?

A

First line = abdominal ultrasound (aortic dilation of >1.5x expected diameter)

  • FBC
  • blood cultures
  • CT
  • MRI
77
Q

How is an abdominal aortic aneurysm managed?

A
  • ruptured/ symptomatic: urgent surgical repair and perioperative antibiotics
  • monitored if small
  • treat underlying cause
  • modify risk factors (smoking cessation, lowering blood lipid, vigorous BP control)
78
Q

What is the aetiology of an aortic dissection?

A

Intimate tear that extends into the media of the aortic wall

79
Q

What is the pathophysiology of an aortic dissection?

A
  • blood passes through the media, creating a false lumen

- flow though the false lumen can occlude flow through the aortic branches

80
Q

What are the risk factors of an aortic dissection?

A
  • hypertension
  • Marfan’s syndrome
  • Ehlers-Danlos syndrome
  • bicuspid aortic valve
81
Q

What is the clinical presentation of an aortic dissection?

A
  • acute severe “tearing” chest pain that radiates to the back and down the arms (mimics an MI)
  • hypertension
  • may develop aortic regurgitation, coronary ischaemia and cardiac tamponade
  • distal extension may cause acute kidney failure, cute lower limb ischaemia or visceral ischaemia
82
Q

What are the differential diagnoses of an aortic dissection?

A
  • acute coronary syndrome
  • pericarditis
  • aortic aneurysm
  • musculoskeletal pain
  • PE
  • mediastinal tumour
83
Q

How is an aortic dissection diagnosed?

A
  • urgent CT or MRI to confirm the diagnoses
  • CXR shows widened mediastinum
  • ECG shows ST depression
  • cardiac enzymes
84
Q

How is an aortic dissection managed?

A
  • opioid analgesia e.g. morphine
  • surgery to replace aortic arch
  • endovascular stent-graft repair
  • vasodilator
  • antihypertensives
  • long-term follow up with CT or MRI
85
Q

What is the aetiology of peripheral vascular disease?

A
  • common = atherosclerosis

- rare = arterial embolism, thrombosis, vasospasm

86
Q

What is the pathophysiology of peripheral vascular disease?

A

Haemodynamic compromise

87
Q

What are the risk factors for peripheral vascular disease?

A
  • smoking
  • diabetes
  • hypertension
  • elevated C reactive protein
88
Q

What is the clinical presentation of peripheral vascular disease?

A
  • intermittent claudication (pain caused by inadequate blood flow to limbs)
  • thigh or buttock pain when walking (relieved at rest)
  • leg pain at rest
  • gangrene
  • erectile dysfunction
89
Q

What are the differential diagnoses of peripheral vascular disease?

A
  • spinal stenosis
  • arthritis
  • venous claudification
90
Q

How is peripheral vascular disease diagnosed?

A
  • ankle-brachial index (ratio of BP at the ankle to the BP at the upper arm)
  • duplex ultrasound
91
Q

What is the management for peripheral vascular disease?

A
  • antiplatelet therapy
  • analgesia
  • anticoagulation
  • surgical revascularisation
92
Q

What is the pathophysiology of critical ischaemia?

A
  • blood supply is barely enough to allow basal metabolism

- no reserve available for decreased demand

93
Q

What is the clinical presentation of critical ischaemia?

A

Rest pain (typically nocturnal in the legs)

94
Q

How is critical ischaemia managed?

A

Hang leg over side of bed at night or walk around to restore blood flow

95
Q

What is the aetiology of pericarditis

A
  • 90% due to viral infection e.g. EBV
  • autoimmune disorders
  • bacterial infections
96
Q

What is the pathophysiology of pericarditis?

A
  • inflammation of the pericardial tissue

- pericardium is well-innervated to inflammation causes severe pain

97
Q

What are the risk factors for pericarditis?

A
  • male sex
  • age 20-50y
  • cardiac surgery
98
Q

What is the clinical presentation of pericarditis?

A
  • chest pain
  • fever
  • pericardial rub
  • myalgia (muscle pain)
99
Q

What are the differential diagnoses of pericarditis?

A
  • myocardial infarction or ischaemia
  • PE
  • pneumonia
  • pneumothorax
100
Q

How is pericarditis diagnosed?

A
  • ECG: ST segment elevation, PR depression
  • raised serum troponin
  • pericardial fluid/ blood cultures will be positive if infectious cause
  • raised ESR, CRP, urea and WCC
  • CXR: enlarged cardiac silhouette
101
Q

How is pericarditis managed?

A
  • pericardiocentesis (fluid is aspirated from the pericardium)
  • systemic antibiotics
  • NSAIDs
  • PPI
  • exercise restriction
102
Q

What is the aetiology of aortic stenosis?

A
  • calcification of tricuspid valves

- congenitally bicuspid aortic valve

103
Q

What is the pathophysiology of aortic stenosis?

A
  • valvular endocardium is damaged as a result of abnormal blood flow across the valve
  • endocardium injury initiates an inflammatory process
104
Q

What are the risk factors of aortic stenosis?

A
  • age >60y
  • congenitally bicuspid aortic valve
  • rheumatic heart disease
  • CKD
105
Q

What is the clinical presentation of aortic stenosis?

A
  • SOBOE
  • angina
  • syncope
  • ejection systolic murmur
  • diminished 2nd heart sound
106
Q

What are the differential diagnoses of aortic stenosis?

A
  • aortic sclerosis
  • ischaemic heart disease
  • hypertrophic cardiomyopathy
107
Q

How is aortic stenosis diagnosed?

A
  • trans thoracic echocardiogram including Doppler: elevated aortic reassure gradient
  • ECG: may have LV hypertrophic and absent Q waves, AV block, hemiblock or bundle branch block
108
Q

How is aortic stenosis managed?

A
  • balloon valvuloplasty
  • surgical aortic valve replacement
  • long term antibiotic prophylaxis
  • long term anticoagulation
109
Q

What is the aetiology of aortic regurgitation?

A
  • diastolic leakage of blood from the aorta into the LV

- primary disease of aortic valve leaflets

110
Q

What is the pathophysiology of acute aortic regurgitation?

A

End diastolic pressure in the LV rises

111
Q

What is the pathophysiology of chronic aortic regurgitation?

A

LV pressure and volume overload

112
Q

What are the risk factors of aortic regurgitation?

A
  • bicuspid aortic valve
  • rheumatic fever
  • endocarditis
  • Marfan’s syndrome
113
Q

What is the clinical presentation of aortic regurgitation?

A
  • diastolic murmur
  • SOBOE
  • fatigue
  • weakness
114
Q

What are the differential diagnoses of aortic regurgitation?

A
  • mitral regurgitation
  • mitral stenosis
  • aortic stenosis
  • pulmonary regurgitation
115
Q

How is aortic regurgitation diagnosed?

A
  • ECG: non-specific ST-T wave changes
  • CXR may show cardiomegaly
  • echocardiogram
  • Doppler scan
116
Q

How is acute aortic regurgitation managed?

A
  • inotropes
  • vasodilators
  • aortic valve repair/ replacement
117
Q

What is the management of chronic aortic regurgitation?

A
  • no need to intervene until ejection fracture <50%
  • aortic valve replacement
  • ACEi
  • vasodilators

2a mid tier (10 decks)

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