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Phase 3A > Cardio > Flashcards

Cardio Flashcards

1
Q

What medication do you need to give to individuals who have a prosthetic heart valve?

A

Lifelong anticoagulation with Warfarin

Target range = 2.5 - 3.5

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2
Q

What makes the S1 sound?

A

Tricuspid and mitral valve closure

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3
Q

What would you hear in aortic stenosis?

A

ejection systolic, high pitched murmur, crescendo decrescendo pattern
(will radiate to carotids)
- Narrow pulse pressure (pulse pressure = difference between systolic and diastolic blood pressure - narrow means low)

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4
Q

What is the most common cause of aortic stenosis?

A
  • Age related calcification (> 65)

- Bicuspid aortic valve (< 65)

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5
Q

What would you hear in aortic regurgitation?

A

early diastolic, soft murmur

Collapsing pulse - carotids - blood flows right back into the heart

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6
Q

What would you hear in mitral stenosis?

A

mid-diastolic, low pitched rumbling, loud S1

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7
Q

What would you hear in mitral regurgitation?

A

pan systolic, high pitched whistling murmur

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8
Q

What is the most common cause of aortic regurgitation?

A

Age related weakness

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9
Q

What is the most common cause of mitral stenosis?

A

IE

RHD

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10
Q

What is the most common cause of mitral regurgitation?

A

Age related weakness
IE
RHD
Connective tissue disorders

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11
Q

What is the most common cause of infective endocarditis?

A

Staphyloccocus

used to be strep

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12
Q

What is the difference between valvular and non-valvular AF?

A

Valvular = mitral stenosis - assume that this has caused the AF

Non-valvular = No valve pathology / other valve pathologies

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13
Q

What would you see on the ECG of somebody with AF?

A
  • Absent p waves
  • Narrow QRS tachycardia
  • Irregularly irregular ventricular beats (disorganised electrical activity in atria prevents regular conduction to the ventricles)
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14
Q

What are the ECG changes that you would see in someone with pericarditis?

A
  • Saddle shaped ST elevation and PR depression across ALL LEADS
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15
Q

What is the treatment of pericarditis

A
  • NSAIDs

- Colchicine

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16
Q

List 4 causes of AF

A

‘SMITH’

  • sepsis
  • mitral pathology
  • ischaemic heart disease
  • thyrotoxicosis
  • hypertension
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17
Q

What scoring system is used to predict the risk of stroke of patients in AF?

A

CHADSVasc

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18
Q

Can you list the components of the CHADS2VASc scoring?

A
  • CHF
  • Hypertension
  • Age >75
  • Diabetes
  • Stroke / TIA
  • Vascular disease
  • Age 65 - 74
  • Sex (female)
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19
Q

What is the difficulty when giving anticoagulation to those with AF?

A

Anticoagulation = bleeding risk (HASBLED score).
However, bleeding is much easier to control, reversible, less long term concequences than having a stroke.
Useful to compare someones CHADS2VASc score to their HASBLED - often the risk of stroke outweighs that of bleeding.

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20
Q

What is the INR?

A

International Normalised Ratio
Prothrombin time of patient / prothrombin time of a normal healthy adult
Only used when a pt is on Warfarin

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21
Q

What is the action of Warfarin?

A

Vitamin K antagonist

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22
Q

When someone is in cardiac arrest, what are the two shockable rhythms?

A
  • VT

- VF

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23
Q

When someone is in cardiac arrest, what are the two non-shockable rhythms?

A
  • PEA

- asystole

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24
Q

What is WPW syndrome?

A
  • Bundle of Kent = extra electrical pathway connecting the atrium and ventricles
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25
Q

What is a type 1 heart block?

A
  • PR interval > 0.2

- Slowed conduction of impulse from atria - AV node - ventricles

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26
Q

What is a type 2, mobitz type 1 heart block?

A
  • Increasing interval between p and QRS complex, and then dropped beat. Cycle starts again.
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27
Q

What is a type 2, mobitz type 2 heart block?

A
  • 3 p waves to every 1 QRS complex

- Risk of asystole, needs to be treated

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28
Q

What is a type 3 heart block?

A
  • No relationship between p and QRS complexes

- Risk of asystole, needs to be treated

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29
Q

What features can be seen on the ECG of someone with a PE?

A
  • Sinus tachycardia
  • S1Q3T3
  • RBBB
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30
Q

What features can be seen on the ECG of someone with a PE?

A
  • Sinus tachycardia - seen the most often
  • RBBB
  • S1Q3T3 (indicates R heart strain) - most diagnostic
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31
Q

What is the most common cause of pericarditis?

A

Coxsackie B

Other causes:

  • Tb
  • Trauma
  • Post MI / Dresslers syndrome
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32
Q

List some causes of long QT syndrome

A
  • Electrolyte disturbances (all LOW) - alcholics, malnutrition, D&V
  • Medications - antipsychotics, antidepressants
  • CNS lesions - stroke, etc
  • Congenital
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33
Q

What beta blocker can actually exaccerbate long QT syndrome?

A

Solatol

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34
Q

What are the 4H’s and 4T’s (reversible causes) of cardiac arrest?

A

4 H’s:

  • Hypoxia
  • Hypothermia
  • Hypovolaemia
  • ^ Potassium, low everything else!

4 T’s:

  • Tamponade
  • Thrombosis
  • Tension Pneumothorax
  • Toxins
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35
Q

What is the name given to the triad of features that suggest cardiac tamponade?

Can you list the features?

A

Beck’s triad

  • Hypotension
  • Raised JVP
  • Muffled heart sounds
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36
Q

What is the management of cardiac tamponade?

A

Urgent pericardiocentesis

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37
Q

What is the name of the criteria used for a definitive diagnosis of IE?

A

Duke criteria

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38
Q

What is Qrisk score used for?

A

Estimate the 10 year risk of cardiovascular disease

> 10% = statin

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39
Q

What is the most common cause of secondary hypertension?

A

Hyperaldosteroneism - treated with spironolactone

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40
Q

What is atrial flutter?

A
  • SVT
  • Rapid atrial depolarisation
  • Sawtooth pattern on ECG (due to atria rapidly contracting and the ventricles going at normal rte)
41
Q

How could you distinguish a posterior MI on an ECG?

A
  • ST depression (reciprocal - opposite to the site of the infarction)
42
Q

What is a pathological Q wave?

A
  • Seen days / weeks following MI

- Q wave descends much lower than usual

43
Q

List 4 risk factors for a PE

A
  • COCP / HRT
  • Recent surgery / immobilisation
  • FHx of clotting disorders
  • Recent long haul travel
  • Active malignancy
44
Q

List 4 risk factors for a PE

A
  • COCP / HRT
  • Recent surgery / immobilisation
  • FHx of clotting disorders
  • Recent long haul travel
  • Previous VTE
  • Current malignancy
45
Q

What scoring system is used to predict whether someone has had a PE, and what is the cut off score?

A

Wells

> 4 = PE likely

46
Q

How long do you treat someone with anticoagulation after they have had a DVT?

A
  • 3 months for provoked DVT (i.e. a cause identified)

- 6 months for unprovoked DVT

47
Q

What is the first line treatment for hypertension in a 46 year old male?

A

> 55, afro carribean, diabetic - calcium channel blocker

< 55, diabetic = ace inhibitor

  • diabetics ALWAYS on ACE inhibitor no matter what (renoprotective effect)
48
Q

What is the treatment of a STEMI?

A
  • < 120 minutes = PCI (ideally 90 mins)
  • aspirin
  • ticagrelor
  • UFH / LMWH - before PCI

*if no access to PCI, need thrombolysis (tPA)

49
Q

What is the management if torsades de pointes?

A
  • Stop causative drugs
  • Correct electrolyte abnormalities
  • IV magnesium sulphate
50
Q

How is torsades de pointes caused?

A

Prolonged QT syndrome

51
Q

List some of the symptoms of pericarditis

A
  • Central chest pain, eases leaning forward, made worse by lying down / breathing in
  • Pericardial rub
52
Q

What is teh GRACE score used for?

A

Folloiwng diagnosis of NSTEMI, patients risk of a repeat should be calculated.

> 3% - treatment with PCI < 72 hours

53
Q

Name 2 antiplatelets

A
  • Aspirin

- ADP receptor antagonists - clopidogerol

54
Q

Name 2 anticoagulants

A
  • Warfarin
  • DOAC’s
  • LWMH
55
Q

List 6 modifiable RFx of CV disease

A
  • Smoking
  • Diabetes
  • Sedentary lifestyle
  • Hyperlipidaemia
  • cocaine use
56
Q

List the 5 signs of CHF on CXR

A
  • Alveolar oedema
  • Kerly B lines
  • Cardiomegaly
  • Dilated upper lobe vessels
  • Effusions (pleural)
57
Q

What blood markers are suggestive of ACS?

A
  • Troponin T & I - ^3-12 hours (measure at 6 and 12 hours)
  • CK-MB - most specific (heart specific version of CK)
  • Myoglobin
58
Q

How long is intercourse best avoided for after MI?

59
Q

What scoring system is used to assess 6 month mortality from adverse cardiovascular events?

What scores are significant?

A

GRACE Score

Low: 3%
Intermediate: 3-6%
High: > 6%

Intermediate risk - should have coronary angiography with PCI < 72 hours if no contraindications (such as active bleeding).

60
Q

What ECG changes are seen in unstable angina / N-STEMI?

A

Unstable angina - no ECG changes.

N-STEMI - may be no ECG changes, ST depression and T wave inversion.

61
Q

How do you tell the difference between STEMI, N-STEMI and unstable angina?

A

Unstable angina - No ECG or trop changes.

N-STEMI - No ECG changes / ST depression and T wave inversion, trop elevation

STEMI - ECG changes and trop elevation

62
Q

What investigations would you do for a patient presenting with unstable angina?

63
Q

What is Prinzmetal’s angina?

A
  • Coronary artery spasm

- Usually seen in younger patients - no structural heart abnormalities

64
Q

What would you see on the ECG of someone with Prinzmetal’s angina?

A
  • Global ST elevation

- Relieved by rest

65
Q

What is the treatment of Prinzmetal’s angina?

A
  • Calcium channel blockers

- Long acting nitrates

66
Q

What things can aggrevate Prinzmetals angina?

A
  • Aspirin

- B-blockers

67
Q

What is an aneurysm?

A
  • Permenant, irreversible
  • > 50% increase in normal diameter of blood vessel - buldge
  • True = involve the whole wall
  • False = opening in the wall, blood pools in outer layer
68
Q

At what point do you have to treat an AAA?

A
  • > 5.5cm.

- Symptomatic.

69
Q

What are the three main causes of aneurysms?

A
  • Most - no identifiable cause
  • RFx: FHx, atherosclerosis, smoking, male gender, age, hypertension
  • specific cause = trauma, infection, connective tissue disorders
70
Q

At what age do all men get screened for AAA?

A
  • 65 years
  • US scan
  • If negative, rules out AAA for life.
71
Q

Where do most AAA occur?

A

BELOW the renal arteries

72
Q

What is the triad of symptoms seen in cardiac tamponade?

*Extra point for the name of the triad

A
  • BECKS triad!
  1. Hypotension
  2. Raised JVP
  3. Muffled heart sounds
73
Q

Name some causes of cardiac tamponade

A

Acute

  • Trauma
  • Aortic dissection
  • MI
  • Iatrogenic
Chronic
(Caused as the pericardium becomes inflamed, cannot absorb the pericardial fluid as effectively therefore it builds up)"
- Cancer 
- Build up of uraemia 
- Hypothyroid!
74
Q

What is the gold standard test used to diagnose cardiac tamponade?

75
Q

What ECG appearance would you expect to see in an individual with cardiac tamponade?

A

ELECTRIC ALTERNANS

(QRS peak high then half height then high then half height - alternates - thought to be a result of the ventricles wobbling in the pericardial sac)

76
Q

What is cor pulmonale?

A

Pulmonary hypertension (due to lung disorder) causes right sided heart failure (back pressure of blood) - leading to right sided heart failure

Origional problem causing the right sided heart failure has to be a problem with the lungs

77
Q

What is pulmonary arterial hypertension?

78
Q

How can you tell the difference between an acute lung disorder - RHF or a chronic lung disorder - RHF?

A

Acute: R ventricle will balloon outwards due to the pressure

Chronic: R ventricular hypertrophy due to chronic back pressure from the lungs –> as the R ventricle hypertrophies, it needs more oxygen to work - weaker contractions - contributes to failure

79
Q

Would left sided heart failure causing pulmonary hypertension - leading to RSHF, be classed as cor pulmonale?

A

NO - original problem is with the heart and NOT the lungs

80
Q

What ECG changes would you expect in someone with cor pulmonale?

A
  • P pulmonale (high p wave - atrial enlargement)
  • Right axis deviation
  • Right ventricular hypertrophy
81
Q

What are the risk factors for IE?

A
  • IV drug use
  • Prosthetic valves
  • RHD
82
Q

What is the most common cause of IE?

A
  • Viridans Streptococci

Others

  • Staph Aureus
  • Staph epidermidis (prosthetic valve - human introduced)
  • Gut bacteria - can migrate across barrier in disease states and reach the heart
  • HACEK organisms
83
Q

What are the signs of IE?

A
  • Septic emboli - splinter haemorrhages / Janeway lesions

- Antigen-antibody complexes - Osler’s nodes / Roth spots (eyes), glomerulonephritis and acute renal failure

84
Q

What are the symptoms of IE?

A
  • Fever
  • New heart murmur
  • Valvular disorders

FEVER AND NEW MURMUR I.E UNLESS PROVEN OTHERWISE.

85
Q

What criteria is used to diagnosis I.E?

A

DUKE CRITERIA - Major

  • Multiple positive blood cultures
  • Positive ECHO (TOE) / new valve regurgitation
86
Q

What Ix would you do to look for I.E?

A
  • TOE
  • Blood cultures - x 3 from different sites
  • Blood tests
  • Urinalysis - microscopic haematuria - glomerulonephritis

*Note - don’t want to treat too early with ABx, won’t to wait to culture so you can fight the exact bacteria - there are lots that cause it!

87
Q

Is ABx prophylaxis recommended with I.E?

A

Not any more! As not effective

88
Q

W

A
  • Following episode of rheumatic fever - caused by Group A B-haemolytic strep
  • Therefore, be careful in those with recent throat infection
89
Q

What is the cause of rheumatic heart disease?

A
  • Following rheumatic fever - caused by Group A B-haemolytic strep pyogenes (molecular mimicry - antibodies similar to those on the vessel walls, damage them)
90
Q

What is the treatment for RHD?

A
  • IV Benzylpenicillin
  • Pain relief: NSAID / aspirin

Acute attacks last around 3 months - need to wait until CRP reduced for 2 weeks straight

91
Q

How does rheumatic heart disease present?

A
  • CLASSIC presentation = young child, developing country, throat infection, 2-3 weeks after have a rash, carditis, arthritis.

Other signs:

  • Chorea
  • Rash with clear centre

*Think similar to rheumatoid arthritis

92
Q

What is the difference between scarlet fever and rheumatic fever?

A
  • Scarlet fever = illness due to Group A beta haem strep pyogenes
  • Rheumatic fever = systemic, inflammatory response, delayed, to antibodies produced by Group A beta haemolytic strep - like an autoimmune
93
Q

What is the main cause of pericarditis (developed countries)?

A

Viruses

- Coxsackie B

94
Q

What is Dressler syndrome?

A
  • 1 week - 2 months post-MI - cardiac inflammation due to cell necrosis - pericarditis
95
Q

What ECG changes would you see in pericarditis?

A
  • Saddle shaped ST elevation globally
96
Q

What is the treatment of pericarditis?

A
  • Analgesia

- NSAIDs + Colchicine

97
Q

What Ix would you do for pericarditis?

A
  • ECG - saddle shaped ST elevation
  • ECHO - cardiac tamponade (acute complication)
  • Bloods - WCC, CRP
98
Q

After insertion of a stent, what medical therapy is needed?

A

Dual anti-platelet therapy - to ensure no clots around the stent

Phase 3A (17 decks)

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