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MSRA my cards > Cardio cards stems > Flashcards

Cardio cards stems Flashcards

1
Q

Duke’s criteria? (BE TIMER)
Most common murmur?

A

BE (major) TIMER(minor)
Blood culture x2 12 hrs apart
Echo
Temp 38+
Immunological signs (roth spots, osler’s)
Embolic diease (conjuctivial,
RF
DX: 2 major or 1 major+3minor or 3
Aortic regurg/ new murmur. early diastolic decrescendo murmur

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2
Q

Dressler’s syndrome?

A

2 -3 weeks post MI/ trauma. pericarditis (ST elevation and PR depression)- friction rub, low fever, pleuritic chest pain worse lying down, TX NAIDS/steroids.

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3
Q

Post MI complications?
structural ?
RF?

A

Arrhythmias (VT, VF, total AV block)
ISchaemia (CK-MB, recurrent chest pain)
LV dysfunction, heart failure - killip’s classifcation
Free wall rupture (bleeding into pericardium, tamponade)
Ventricle septal rupture (harsh pansystolic murmur left sternal edge, hypotension, shock, pulmonary oedema, do TOE)
Acute Mitral regurg (post infero-posterio MI, papillary muscle rupture/ necrosis)
Left ventricular outflow obstruction
dressler’s (2 to 4 weeks after)
DVT/PE (systemic)

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4
Q

RF for ventricle septal rupture/ free wall rupture post MI?

A

RF: female, non smoker, HTN, anterior infarction, first MI, 2-7 days after

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5
Q

HTN with t2DM first line drug?
after triple therapy?

A

ACEi/ ARB
already on ARB/ACIe and CCB and thiazide diuretic, give spironolactone if K <4.5 or alpha blocker/ BB if K5.5+

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6
Q

Hyperkalaemia ECG

A

Tall T waves, small p waves, wide QRS

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7
Q

Hypokalaemia ECg

A

small/ inverted T waves, U waves, long PR, depressed ST.

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8
Q

systolic murmur at apex of heart radiating to left axilla.

If person complains of dysopnoaa at rest?

A

MR, most common worldwide. LV blood backflows to LA
ACute MR (post MI/ rupture of chordae tendonae) presents as reduced CO, shock, dysopnoae at rest.

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9
Q

HF classification/ BNP values/ EF values?

TX summary?

A

BNP 2000 - 2ww, 400-2000 6ww. , <200 - not confirmed
EF - preserved 50+, <40 severe, 41-49 mild to mod.

TX: acei (ARB candesartan i not toelrate) (UEs at baseline and 1-2 weeks), BB, then spironolactone (U-Es at 7 days)
Others: ivabradine, SGLT2i, digoxin, hydralazine, nitrate, valsartan/ sacubritil

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10
Q

post MI drugs TX?

A

dual antiplatelet (aspirin lifelong, pasugrel P2Y12 i 12 months)
ACE i (lifelong, reduced cardiac vascular resistance and afterload, lower preload.
BB 12 months 9lfielong (LV EF reduced)

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11
Q

DVT/ PE TX summary?
Risks/ complications of DVT

A

wells<2 do dimer. 2+ do USS.
TX: LMWH 5/7 and then dabigatran (crcl 30+)/edoxaban
Crcl 15-50 - apixaban/riveroxaban
<15- LMWH/ UFH (Risk HIT)
warfarin - preferred if 120kg+/liver dysfunction/ egfr <30.
Risk: post thrombotic syndrome (chronic venous hypertension pain swelling, lipodermatosclerosis within 2 yrs)

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12
Q

Flash pulmonary oedema?

A

Post MI/MR

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13
Q

Cx of Heart block?
2nd degree HB?

A

flecanaide, BB, digoxin,
High K, Mg, Addisons,
SLE, scleroderma, RF, sarcoid, endocarditis

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14
Q

Post cardiac cauterization complication?

A

femoral pseudoaneurysm: pulsatile mass, bruit, compromised distal pulses

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15
Q

CI to exercise stress testing?

A

MI in last 2 days, severe AS, uncontrolled angina/ arrhythmias, HF, acute PE/ pericarditis, acute dissection

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16
Q

Aortic dissection pain and areas association?
neck and jaw?
anterior chest pain?
intracapsular region?

A

jawand neck: aortic arch
anterior chest: aortic arch or aortic root
intracapsular: descending aorta,

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17
Q

DVT TX
DOAC not recommended in?
When would you use fondaparinux?

If rapid reversal needed/ high risk of bleeding?

A

APLS, pregnancy, breastfeeding, liver impairment, prosthetic heart valves, <40kg/120kg+ (use LMWH/UHF)
riveroxaban has icnreased risk of GI bleed compared to warfarin
fondap - reserved for people with known HIT
high bleeding risk - IV UFH (short half life and reversed with protamine)

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18
Q

61 YO female collapses after 1st MI with distended neck veins

A

Left ventricular free wall rupture (cardiac tamponade - low bp, JVP distended, muffled HS)

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19
Q

High K drug causes?

A

ACEi, BB, ARB, trimethoprim, heparin, digoxin

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20
Q

elderly women, Crushing retrosternal chest painr adiating to jaw, intermittent for 3 yrs. normal cardio ix

A

Oesophageal spasm - corckscrew appearance on barium swallow.

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21
Q

How to hear pericardial friction rub?

A

Sat forward, left sternal border on expriation.
https://youtu.be/-DB_8zyg9W8

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22
Q

ACS contraindication to thrombolytic?

A

haemorrhage, trauma, dental extraction, pericarditis, dissection, acute panc, coma, oesophageal varices, vaginal bleeding heavy, endocarditis bacterial, severe HTN, CVA recent

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23
Q

ST depression, V5, v6 inverted T waves?

A

digoxin toxicity

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24
Q

RAD, RBB, RV strain?

A

RV strain - ST depression, T wave inversion on leads 1, 2, AVF, V1, V2
in PE. S1Q3T3 is rarer

25
Q

Hypocalcaemia spot causes?
ECG features?

A

Acute panc, panc surgery, alkalosis (hyperventilation), rhabdomylisis, scepticaemia, osteolytic mets, Parathyroid gland surgery, bisphosponates, calcitonin, phenytoin, foscarnet, phosphate substitution
prolonged St and QT interval

26
Q

Cardiac tamponade features?
Normal pericardial space- 20-50ml fluid

A

Beck’s triad - hypotension, distended JVP, muffled hs,
pulsus paradoxus
kussmal sign,
ewart/pin’s sign - bronchial sounds below angle of left scapula
CXR: bottle shaped heart.
RF: surggery, mets, end stage renal disease, trauma, TB

27
Q

ALS: stable narrow complex, regular tachycardia?

A

likely SVT - trial vagal manouvers, then 6mg iv bolus adenosine, then 12mg, then 12mg, escalate

28
Q

Stable patient, Broad complex, regular tachy?

A

IV amiodarone 300mg

29
Q

Points when counselling on Af anticoagulation?
Do you offer anti-coagulation to <65YO with no other RF?

A

anticoagulation reduced risk by 2/3. Risk of stroke is x5 higher with AF and risk of severity is higher.
No dont offer if only score is for sex

30
Q

Driving advice for Mi/ CABG/pacemaker/ angio?

A

no driving for 1 week after angio, pacemaker, successful angio
no driving for 4 weeks after STEMI/ NSTEMI/ CABG
Return to work within 2 months
no sex for 1 month

31
Q

Cheyne stokes breathing?

A

progressively deeper and shallower in brainstem stroke/ raised ICP

32
Q

30YO male south eastern patient with collapse? ECG shows?

A

Brugada sign - ST elevation 2mm+ in V1-3 and T wave negative

33
Q

pansystolic murmur post MI?

A

Mitral regurg (damage to papillary muscle)

34
Q

Features of mitral stenosis?

A

rumbling mis-diastolic murmur loud on expiration with patient on left side., malar flush, AF, fatiuge, SOB, palpatations

35
Q

Causes of IE?

A

Staph A
Staph A (coagulase negative)

Streptococci (viridans, subacute)
Group D streptococcus (acutre and subacute)
strept intermedius
A, C, G - acute, high mortality
GBS - pregnancy, elderly
HACEK
fungi
enterococci

36
Q

ECG: J waves, long PR, long QRS, long QT, AF

A

Hypothermia

37
Q

24 YO footballer, LAD, sinus brady, LVH, SOB, chest pain, dizziness after training, systolic murmur on left sternal edge

A

Hypertrophic cardiomyopahty
AUtosomal D,exercsie testing to see severity,

Digoxin contraindicated in aF, anticoagulate, counsel, amiodarone for arrhythmias,
outflow obstruction - BB/verapamil. prophylactic abx bc raised risk of IE/

38
Q

pulseless paradoxus seen in?

A

12+ raise in BP on inspiration (abnormal)
PE, constrictive pericarditis, rapid and laboured breathing, RV infarction with shock, restrictive cardiomyopathy, severe obstructive pulmonary disease,

39
Q

Lone AF?

A

AF in <60 with no evidence of cardiac conditon

40
Q

Advice to give when someone has 1st degree HB?

A

reassure, caution when using BB/ diltiazem, digoxin, declare on driving/ health insurance. small risk of aF developing.

41
Q

Angina TX?

If using CCB with BB/ ivabradine?

A

1) BB or CCB (DHP, rate limiting verapamil/ diltiazem) if CI
2) Beta blocker + CCB (non-DHP - amlodipine/felodipine/nifedipine)
3) Add nitrate, ivabradine, nicorandil (ulceration risk) or ranolazine

Amlodipine can be used if HF
Verpamil and BB = very bad

42
Q

Post Mi complications timing of conditions?

A

Time from infarction and their complications (Pathoma);
0-4hrs - Cardiogenic Shock, CHF, arrhythmia
4-24hrs - Arrhythmia
1-3 days - Pericarditis
4-7 days - Rupture of ventricular free wall, interventricular septum, or papillary muscle
Months - Dressler syndrome, aneurysm, mural thrombus

43
Q

67 YO man, home BP is 145/95, QRISK is 8%. MX?

what is BP is 150/100?

A

stage 1 HTN - treat if end organ damage/ QRISK 10%, known CVD, known DM otherwise can amange with lifestyle.
If stage 2 treat regardless of age. (150/95+ at home)

44
Q

PERC rule to rule out PE?

A

if all abscent can rule out:
age 50+, HR100+, unilateral swelling, on HRT/ COCP, o2<94, previous DVT/PEsurgery/ trauma in 4 weeks, haemoptysis

45
Q

75 difficulty breathing at night, occasional palpitations and tight chest pain. collapsing pulse and a laterally shifted apex beat. head bobs in time with his pulse

A

Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
Aortic regurgitation, early diastolic murmur increased when squeezing hand.
(backflow during ventricular diastole)

46
Q

Causes of AR?

A

RF (common, developing world)
Marfans/ SLE/EDS/ ank spond/ bicuspid Aortic valve
Acute: infective endocarditis/ aoritc dissection

47
Q

Ace I profile?
SE?

A

stop ang1 to ang 2. vasodilation, reduce BP, reduced kidney water and sodium retention, reduced aldosterone. dilate efferent arterioles in kidney (good for dM nephropathy)

SE: cough, K high, angiodema, CI-AS, pregnancy breastfeeding, renovasc disorder
Monitor:UEs before and after changing dose. Could reveal unknown B/L RAS. K rise to 5.5 or 30% is acceptable.

48
Q

SE and CI of nicorandil?

A

Adverse effects
headache
flushing
skin, mucosal and eye ulceration
gastrointestinal ulcers including anal ulceration
Contraindications
left ventricular failure

49
Q

HF MX summary?

A

1st line: ACEi/BB(Bisoprolol, Carvedilol)
2nd line Aldosterone antagonist(Spironolactone, Eplerenone)
3rd line: involve a specialist for
-Ivabradine(SR, HR>75+ EF<35%)
-Sacubitril-valsartan( EF <35%+ Symptoms despite ACEi/ARB)
-Digoxin( if coexistent AF)
- Hydralazine+Nitrate( in Afro-Caribbean)
-Cardiac resynchronization therapy( Widened QRS e.g. LBBB)
Role of SGLT2i in preservd EF

50
Q

Orthostatic hypotension - DX?
TX?

A

BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnostic

fludrocortisone, midodrine, compression, salt intake, head elevation

51
Q

When to give 20 mg atorvastatin to t1dM?

A

40+, DM for 10 yrs+
Have established nephropathy
Have other CVD risk factors (such as obesity and hypertension)

52
Q

Statin profile?

A

Myopathy, LFTs, CI- macroglides (clarithromycin) and pregnancy,LFTs at baseline, 3 months and 12 months - stop if 3x upper limit

53
Q

History of asthma, Marfan’s etc
Sudden dyspnoea and pleuritic chest pain

A

pneumothorax

54
Q

Central crushing pain with absent distal pulse?

If patient is too unstable for this imaging

unequal arm pulses?

A

Dissecting aorta
CXR - wide mediastinum
CT angio CAP
TOE - if unstable to get to CT scanner
Risk of backward tear - inferior MI/ AR
Risk of forward tear- unequal arm pulses, stroke, renal failure
Standford and debakey classification

55
Q

Syncope, chest pain, SOB, ES murmur that reduces with valsalva manouver?

A

AS. CX:
<65 - bicuspid, >65 - degenerative calcification, post rF, HOCM
chjildren - balloon
Surgical AVR - if 40mmHG +/ symptomatic
TAVR - for high risk (transcatheter AVR)

56
Q

CX of IE associated with colorectal cancer?

AF with indwelling lines?

A

Streptococcus bovis

staph epidermis

57
Q

TX of IE for native valve?

suspected MRSA/ penicillin allergy or sepsis?

NVE with severe sepsis/ RF forgram negative?

Prosthetic valve endocarditis?

A

Native valve endocarditis (NVE): amoxicillin + gentamicin
NVE with severe sepsis, penicillin allergy or suspected methicillin-resistent staphylococcus aureus (MRSA): vancomycin + gentamicin
NVE with severe sepsis and risk factors gram negative infection: vancomycin + meropenem
Prosthetic valve endocarditis: vancomycin, gentamicin + rifampacin

58
Q

What drug reduced efficacy of clopidogrel?

A

omeprazole

59
Q

PE causes resp acidosis or alkalosis?

A

alkalosis (hyperventilation)

MSRA my cards (15 decks)

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