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revision year 1 > cardio corrections > Flashcards

cardio corrections Flashcards

1
Q

what is the most common arrhythmia following a heart attack?

A

ventricular fibrillation

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2
Q

outline the treatment for stable angina?

A 
GTN reliver spray
Lifestyle:
stop smoking
aspirin 75mg daily and atorvastatin
Therapy:
beta blocker or Ca channel blocker
if contraindicated:
isosorbibe mononitrate
ivabradine
nicorandil
if still symptoms:
swap to bb or Ca blocker
or BB and dihydrapyramidine( Ca B)
Then PCI if in 1 vessel and < 65yo
or CABG if multi, diabetic and >65yo
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3
Q

when is PCI contraindicated in stable angina?

A

kidney disease

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4
Q

what are the 3 things that makeup unstable angina?

A

new onset exertional angina within 1 month
angina at rest
angina of increasing frequency

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5
Q

what murmer may be heard during UA?

A

mitral regurg

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6
Q

what test distinguishes between NSTEMI and UA?

A

troponins

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7
Q

what anticoagulant is administered until discharge in ACS?

A

fondaparinux

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8
Q

what is different in the pathology of UA/ NSTEMI?

A

UA is ischaemic only

NSTEMI infarction also

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9
Q

what is the GOLD std for angina diagnosis?

A

CT coronary angiography

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10
Q

what is decubitis angina caused by?

A

lying flat

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11
Q

what is variant/primentzal angina caused by?

A

cornonary artery spasm

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12
Q

what extra heart sound might you hear occasionally in angina?

A

4th heart sound

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13
Q

what type pof infarction is it in a NSTEMI?

A

subendocardial

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14
Q

what type of infarction is it in a STEMI?

A

transmural

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15
Q

pathological changes in a STEMI 0-12hrs

A

cardiac myocytes undergo necrosis and gives oedema

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16
Q

ECG changes STEMI 0-12hrs

A

ST elevation

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17
Q

pathological changes in a STEMI 12-24hrs

A

continuing coagulative necrosis and neutrophil infiltration

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18
Q

Ecg changes stemi 12-24hrs

A

inverted T wave, st elevation and pathological q wave

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19
Q

pathological changes in a STEMI 1st week

A

neutrophil necrosis

collagen deposits via fibroblasts

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20
Q

ECG changes STEMI after 1st week

A

pathological q waves

t wave inversion

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21
Q

pathological changes in a STEMI weeks to months

A

loss of function due to increase collagen deposits leading to scar tissue

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22
Q

ECG changes in a STEMI

A

pathological q wave

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23
Q

ECG changes possibly seen on a STEMI?

A 
ST elvelation
t waves inverted
pathological Q waves
new LBBB
VF, AF or AV block
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24
Q

ECG changes on a NSTEMI?

A

ST depression

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25
Q

would you order a CXR for ECG?

A

possibly to check for signs of HF but not immeditaely

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26
Q

what coronorary artery causes a lateral MI?

A

LCX/RCA

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27
Q

what coronorary artery causes a Inferioir MI?

A

RCA

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28
Q

what coronorary artery causes a anterior MI?

A

LAD

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29
Q

what coronorary artery causes a septal MI?

A

LAD

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30
Q

if theres reciprocal ST depressions in which leads it is a posterolateral STEMI? what artery is it casued by?

A

V1-3 RCA/LCX

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31
Q

outline the investigations for intermittant claudication/ critical limb ischaemia

A 
measure of Ankle brchial pressure index
duplex ultrasound scanning
invasive:
magnetic resonance angiography
CT angiography
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32
Q

what is the ABPI value range for claudication

A

0.4-0.85

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33
Q

name the risk factors of secondary HT?

A 
conn's syndrome
cushings
phaechromocytoma
pregnancy-pre ecclampsia
drugs 
congenital coarcation of the aorta
renal disease
parathyroid
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34
Q

what is GOLD std for diagnosing HT?

A

ABPM

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35
Q

what is mild HT?

A

140/90 ABPM 135/85

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36
Q

what is moderate HT?

A

160/100 ABPM 155/95

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37
Q

What is severe HT?

A

180/110

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38
Q

What do you need to check Blood tests for in HT?

A

renin, aldosterone and Ca2+ levels
cholesterol
glucose

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39
Q

what does increased aldosterone in blood indicate?

A

Conn’s syndrome

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40
Q

what does hypercalcaemia in the blood indicate?

A

parathyroid issues

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41
Q

what do you check urinalysis for in HT?

A

protein and kidney function

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42
Q

what may be shown on fundoscopy in sever HT?

A

flame haemorrhage
cotton wool spots
hard exudates
papilloedema

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43
Q

what is the recommended sodium allowance a day?

A

5-6g

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44
Q

what is the recommended amount of exercise a week?

A

150min a week 75min of vigourous exercise

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45
Q

what is first line HT tx for less than 55yrs

A

ACE or ARB

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46
Q

what is first line tretment for HT and diabetic?

A

ACEi

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47
Q

what is step 1 HT for >55yr or black?

A

Ca2+ blockers

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48
Q

step 2 HT tx

A

ca2+ blockers + ARB/ACEi

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49
Q

step 3 HT tx?

A

ca2+ blockers +ARB/ACEi + thiazide diuretic

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50
Q

SE ACEi

A

cough dry

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51
Q

SE ca2+ blockers

A

peripheral oedema

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52
Q

SE thiazide diurectics

A

gout risk increase

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53
Q

what is the criteria that classifies endocarditis?

A

dukes criteria

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54
Q

what is dukes criteria?

A 
3 major/ 1 major +3 min/ 5 minor
major:
2 seperate blood cultures
endocardial involvement
minor:
Fever
IV/ heart condtion
Immune manifestations
Vascuklar manifestations
Eschocardiagram
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55
Q

what are the main causative agents of endocarditis gm +ve

A

staph aureus
strept viridians
enetrococcus
staph epidermis

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56
Q

what are the main causeative organism ofnendocarditis gm -ve

A 
HACER
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
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57
Q

what are the vegetations seen in endocarditis

A

septic emboli (broken off parts)

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58
Q

what is the Pneumonic for examination of endocarditis?

A 
FROM JANE
Fever
Roths spots
Oslars nodes
Murmer - tricusp
Janeway lesions
Anaemia
Nails - splinter haemorrhages
Emboli
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59
Q

are oslers nodes painful?

A

yes

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60
Q

are janeway lesions painful?

A

no

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61
Q

do janeway lesions blanch?

A

yes

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62
Q

if someone has glomelular nephritis what is it a sign of?

A

endocarditis

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63
Q

what is the 1st line investigation for endocarditis?

A

transthoracic echo

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64
Q

what is the pneumonic for the treatment of endocarditis?

A 
BBUCE
Blood culters 3 sep
Bloods- anaemia, incr WCC, decr platelets
Urinalysis- prtein
CXR- left sided pul oedema, emboli on RS
Echo
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65
Q

common cause endocarditis IV drug users?

A

staph aureus

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66
Q

common tx endocarditis IV drug users?

A

flucoxacillin

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67
Q

common tx endocarditis prosthetic valve?

A

ventamycin, gentamicin, riframycin

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68
Q

common tx endocarditis native valve?

A

amoxicilllin and gentamycin

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69
Q

common tx endocarditis viridians?

A

benzyl penicillin and gentamycin

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70
Q

common tx endocarditis enterococcus?

A

amoxicillin and gentamicin

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71
Q

what does kussmaul’s sign indicate and what is it?

A

paradoxical increased JVP on inspiration

constrictive pericarditis

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72
Q

saddle shaped ECG is?

A

pericarditis

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73
Q

what does a rub on auscultation indicate?

A

pericarditis

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74
Q

what virus causes pericarditis and myocarditis?

A

coxsackie

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75
Q

what causes the ST elevation in STEMI?

A

infarction, transmural in the ventricles, current cant get through so is travelling away from electrode

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76
Q

why do pathological Q waves emerge in STEMI?

A

emerge as it takes longer for ventricular depolarisation to happen makes it deep

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77
Q

why does a LBBB emerge in a STEMI?

A

as impulse cant travel due to infarction

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78
Q

STEMI is what in aVL, I, V5+V6?

A

lateral

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79
Q

STEMI is what in aVF, II, III?

A

inferior

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80
Q

STEMI in V1+2?

A

septal

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81
Q

STEMI in V2+3+4?

A

Anterior

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82
Q

outline initial STEMI treatment?

A 
ECG
IV acess
FBC:
glucose
lipid
TROPONIN
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83
Q

Name medications given in STEMI?

A

aspirin 300mg
ticagrelor 180mg
IV morphine 5-10mg
and anti emetic : metoclopramide

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84
Q

what is the time frame in which PCI is allowed?

A

120min

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85
Q

name a drug used for thrombolysis?

A

streptokinase

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86
Q

what are contrindications for thrombolysis?

A 
intercranial haemorrhage
ischaemic stroke
cerebral malignancy
major trauma
GI bleeding
aortic diesction
pregnancy
TIA< 6 months
active peptic ulcer
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87
Q

what is the pnemonic for further prevention of a stemi after discharge?

A 
ABAS
ACEi/ ARB
BBlocker
Aspirin and clopidegril
Statins
do an echo first to check heart function
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88
Q

what is a contraindication for beta blockeers in MI and what can you give instead?

A

Ca2+ blockers and asthma

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89
Q

what drug might you also give in STEMI in hospital after MONAC?

A

fondaparinux

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90
Q

what is the treatment additions in NSTEMI compared to STEMI?

A

GTN IV

B blocker or rate limiting Ca2+

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91
Q

Name some Ca2+ rate limiting blockers?

A

diazeltem/ verapamil

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92
Q

What change does aVR have in MI?

A

no change

it is nondiagnostic lead

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93
Q

name the tests if someone has an arrhythmia?

A 
FBC
ECG:
continuous may have to wear a monitor
ECHO
CXR
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94
Q

name the 3 supraventricular tachycardias

A

atrial flutter
atrial fibrillation
ectopic atrial tachycardia

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95
Q

what is the heart rate for atrial fibrillation?

A

150-300bpm

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96
Q

ECG changes atrial fibrillation?

A

no p waves
fine iscillations
irregualrly ireegular pulse

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97
Q

if the ECg has a HR of 150-300 and no p waves plus fine baseline oscillations what is it?

A

atrial fibrillation

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98
Q

what is the serious complication of AF?

A

stroke

99
Q

if cardiovaersion isnt avaible within 24-48hr of symptom onset what do ya do?

A

anticoagulation for 6-8weeks

100
Q

what is the score that determines if you need anticoagulation therapy in AF?

A

CHA2DS2VASC

101
Q

what area are the reentrant looks especially found in in atrial flutter?

A

tricuspid area

102
Q

if an ecg has p waves, sawtooth baseline and irregularly regular pulse- what is it?

A

atrial flutter

103
Q

what is the rate for atrial flutter?

A

300bpm

104
Q

what are the non invasive treatments for varicose veins?

A

compressive stockings

105
Q

Name the 4T’s and 4H’s which cause reversible cardiac arrest

A

Hypoxia
Hypovolaemia
Hyperkalemia/hypokalemia/hypoglycemia/hypocalcemia (+ other metabolic disturbances)
Hypothermia

Tension pneumothorax
Tamponade
Toxins
Thrombosis

106
Q

what murmer is responsible for malar flush?

A

mitral stenosis

107
Q

if you hear a tapping apex beat what murmer is it?

A

mitral stenosis

108
Q

what murmer is best heard on the left hand side?

A

mitral stenosis

109
Q

which murmer is mid diastolic and rumbling?

A

mitral stenosis

110
Q

which murmer has a loud S1?

A

mitral stenosis

111
Q

AF is a complication of which murmers?

A

mitral murmers

112
Q

which murmers have a low pitch?

A

diastolic

113
Q

which murmers have a high pitch?

A

systolic

114
Q

Marfans is a syndrome that is aetiological of which murmers?

A

mitral and aortic regurg

115
Q

which murmer is pansystolic and whistling?

A

mitral regurg

116
Q

which murmer radiates to the left axilla?

A

mitral regurg

117
Q

in which murmer can you hear the 3rd HS?

A

mitral regurg

118
Q

which murmer has a collapsing pulse?

A

aortic regurg

119
Q

which murmer is early diastolic and soft?

A

aortic regurg

120
Q

where is aortic regurg heard best?

A

apex

121
Q

which murmer is best heard leaning forward and holding an exhaled breath?

A

aortic regurg

122
Q

what murmer is a slow rising pulse?

A

aortic stenosis

123
Q

which murmer radiates to the carotids?

A

aortic stenosis

124
Q

which murmer is ejection systolic

A

aortic stenosis

125
Q

which is high pitched and crescendo descresenddo?

A

aortic stenosis

126
Q

is S3 heart sounds normal in young patients?

A

yes

127
Q

what causes S3?

A

chordae tendinae pinging back like a guitar string

128
Q

first line investigation for murmer?

A

echo

129
Q

what treatment is preferred before valve replacement in murmers?

A

balloon valvescotomy

130
Q

what murmer is a LOUD pansystolic murmer throughout the chest caused by HF and hepatomeagly?

A

tricuspid regurg

131
Q

what is the commonest cause of HF?

A

atherosclerosis

132
Q

what is systolic HF due to?

A

reduced contractility and so heart cant pump enough lowering SV

133
Q

is ejection fraction increased/decreased/the same in systolic HF?

A

decreased

134
Q

is ejection fraction increased/decreased/the same in diastolic HF?

A

same

135
Q

what is diastolic HF due to?

A

preload issues

136
Q

what is the ejection fraction of systolic BP?

A

35-40%

137
Q

what is the primary care test for HF?

A

positive BNP

138
Q

What is the diagnostic test for HF and ejection fraction?

A

echocardiogram

139
Q

which HF causes fluid retention in the lungs and what is its common cause?

A

LS HF- IHD

140
Q

which HF causes peripheral oedema?

A

RS HF

141
Q

what are the main causes of RS HF?

A

VSD/ASD and cor pulmonae

142
Q

what heart failure may hepatosplenomeagly be seen in?

A

RS heart failure

143
Q

what is the classification called for HF?

A

NYHA new york HF

144
Q

outline the treatemnt for HF with decreased EF?

A

Loop diurectic - frusemide
ACE/ARB/BB - reduce mortality
Aldosterone antagonist -spirolactone 2 nd line if symptoms still
consider antiplatlets/statins for prevention

145
Q

what drug is given for an exacerbation of HF?

A

digoxin

146
Q

when in ivabradine given in HF?

A

for symptom relief if on BB

147
Q

when is hyrdalazine and nitrates given for HF

A

afrocarribean

148
Q

outline treat ment for HF with maintined EF?

A

loop diurectic and the antiplatlets and statin

149
Q

when do the DVLA need to be notified in HF?

A

bus/lorry driver who has symptoms

150
Q

give some surgical interventions in HF?

A

ICD implantable cardioverter defib
Heart transplant
cardiac resynchronisation therapy

151
Q

how is an AAA monitored?

A

duplex US

152
Q

who is AAA monitored in?

A

> 65yr men

153
Q

at what size of AAA is someone provided with treatment?

A

> 5.5cm or growing greater than 1cm a year

154
Q

what is the treatment for AAA?

A

EVAR stenting

155
Q

what is the presentation for emergency AAA?

A

expansile abdo mass

abdo pain radiating to da back

156
Q

presentation for thoracic aortic dissection?

A

sudden tearing chest pain, radiating to the back

157
Q

what syndrome is associated with thoracic aortic dissection?

A

marfan’s

158
Q

what is the differnce between type a and b aortic dissection?

A

in a the dissection extends from the ascending aorta to descending
in B the dissection remains in the ascending aorta

159
Q

radial radial delay indicates what?

A

coarction of aorta or thoracic aortic disection

160
Q

rib notching indicates what on CXR?

A

thoracic aortic dissection or coarction of the aorta

161
Q

what do tall tented t waves indicate?

A

hyperkalaemia

162
Q

blurred yellowing vision headache is a side effect of what?

A

digoxin toxicity

163
Q

bounding pulse is indicative of what?

A

acute CO2 retention

164
Q

strawberry milkshake coloured blodd is indicative of what?

A

hyperlipidaemia

165
Q

what coronary artery supllies the SA node?

A

RCA

166
Q

name the 4 types of cardiomyopathies?

A

HCOM
Dilated
restrictive
arrhythmogenic RV

167
Q

what type of cardiomyopathy is thickened LV/

A

HCOM

168
Q

sudden cardiac death in a young person or athlete is what?

A

HCOM

169
Q

what are the mutations that cause HCOM?

A

alpha tropomyosin, beta myosin and troponin T

170
Q

what causes SCD in HCOM?

A

increased EDV as ventricles to thick to let enough out, causes heart failure

171
Q

treatment of HCOM?

A

avoid competative sport

B blockers and CCB

172
Q

what ix woould you do for HCOM?

A

ECG +ECHO and excercise test

173
Q

what type of cardiomyopathy is dilated ventricle?

A

dilated

174
Q

what type of cardiomyopathy is stiff ventricles?

A

restrictive

175
Q

what CM is due to replacement of cardiac muscle with fibro fatty deposits?

A

arrhythmic RV

176
Q

what can cause dilated CM?

A

alcohol, chemo, pregnancy and cardiac infection

177
Q

what HS is present in DCM?

A

3rd HS

178
Q

What murmers are heard in DCM and why?

A

mitral and tricuspid regurg- dilated muscle means that valves are stretched and as a result cant close fully, leading to HF and back flow of blood

179
Q

what are the symptoms of DCM?

A

HF mixed L and R

180
Q

what is the treatment of DCM?

A

beta blockers/ CCB

ICD - implantable cardiac defib

181
Q

pneumonic for aetiology of RCM?

A 
MEGA CHRIST
Mets
Endocarditis
Glycogen
Amphyloidis
Carcinoid
Haemochromatosis
Radiation
Idiopathic
Sarcoidosis
Transplant
182
Q

what happens to preload and EDV in pathophysiology of RCM?

A

decreases due to stiff ventricles cant contract properly

183
Q

ix for RCM?

A

ECG, ECHO and cardiac catherisation

184
Q

how do you treat RCM?

A

treat cause

185
Q

what is the mutation in ARVCM? and if its not in desmosome

A

AD in desmosomeand AR if not in desmosome

186
Q

what does ECG show in ARVCM?

A

RV tachycardia, hr >1000, QRS greater than 120ms, r axis deviation and LBBB

187
Q

What is the ductus arteriosus a connection between?

A

pulmonary artery and descending aorta

188
Q

what is the function of the ductus arteriosus?

A

present during foetal development to bypass lungs so blood can be oxygenated at placenta

189
Q

what happens to ductus arteriosus when born?

A

should close

190
Q

what is the most common defect when born?

A

VSD

191
Q

how is a heart defect detected?

A

newborn screening

192
Q

what are the signs of a congenital defect?

A

cyanosis

collapse and HF

193
Q

why do babies get cyanosed due to heart?

A

if hole continues to bypass lumps and mix oxygenated and deoxygenated blood to enter circulation

194
Q

what disease are all patients with congenital heart disease particularly at risk from?

A

infective endocarditis

195
Q

what are tetralogy of fallot, tranus arteriosus and transposition of the great vessels an example of?

A

cyanotic congenital heart disease

196
Q

what are ASD, VSD, AVSD, aortic and pulmonary stenosis egs of?

A

acyanotic HD

197
Q

how does a patoient with congenital HD get O2 sufficiently?

A

patent ductus arteriosus

198
Q

what is needed to keep patent ductus arteriosis open until the defect can be repaired?

A

a prostaglandin e2 transfusion

199
Q

what is it if its a machine like murmer?

A

patent ductus arteriosus

200
Q

how do yopu manage a patent ductus arteriosis?

A

NSAIDs eg indomethacin

201
Q

what syndrome is associated with coarction of the aorta?

A

turners

202
Q

what is coarction of the aorta?

A

narrowing of the aorta usually in the proximal thoracic aorta

203
Q

if someone shows rib notching on CXR, has weak femoral pulses and a radial femoral delay what is it?

A

coarction of the aorta

204
Q

what is a complication of coarction of the aorta?

A

HT secondary cause

205
Q

what are the features of tetraology of fallot?

A

RV hypertrophy, VS defect, overriding aorta, pulmonary stenosis

206
Q

what is ewarts sign and what is it a sign of?

A

cardiac tampoinade and the sign is effusion at base of lung causing dullness below scapula

207
Q

what does pulsus paradoxus indicate?

A

cardiac tamponade

208
Q

causes of cardiacc tamponade?

A

pericarditis
iatrogenic
trauma
malignancy

209
Q

what shows a large pear shaped heart on CXR?

A

cardiac tamponade

210
Q

what does an ECG show cradiac tamponade? why

A

compressed QRS complexes as heart is compressed via blood and cant pump as much

211
Q

what is the treatment of cardiac tamponade?

A

PERICARDIOCENTESIS

212
Q

what is a complication of pericardiocentesis?

A

pneumothorax

213
Q

what is an ejection systolic murmer decreased by squatting indicative of?

A

HCOM

214
Q

what murmer is most likely to be associated with RS HF?

A

Tricuspid regurg

215
Q

what does a delta wave in V1 suggest?

A

WPW syndrome

216
Q

what type of haemolysis is strep viridians?

A

alpha haemolysis

217
Q

what is the mechanism for clopidegril?

A

works through P2Y12 receptor by disulphide bond

218
Q

what type of drug is warfarin and how does it work

A

vit k antagonist, binds to vita k reductase inhibiting production of clotting factors in blood

219
Q

what clotting factors does warfarin ihibit?

A

2,7,9,10

220
Q

mechanism of action of heparin?

A

binds to AT3inhibits thromin by forming a complex between antithrombin III (AT3) and thrombin and inactivates it also inactivating factor Xa

221
Q

what spinal level is herpes zoster virus SHINGLES at?

A

T4/5

222
Q

what is the longest vein in the body?

A

great saphenous

223
Q

what vein is on the right side of the thoracic vertebra?

A

azygous

224
Q

what coronary artery runs in the interventricular groove?

A

LAD

225
Q

vagus nerve is ____ to the phrenic nerve

A

medial

226
Q

what does the coronary groove hold?

A

RCA

227
Q

what valve sits deep to the coronory groove?

A

tricuspid

228
Q

what artery sits in the posterioir interventricular artery?

A

RCA

229
Q

what differentiates the superior mediastenum and inferior mediasteinum?

A

tranverse thoracic plane is the line between the sternal angle and the t4/5 intervertebral disc

230
Q

what 2 coronary arteries branch from the ascending aorta?

A

left and right coronary

231
Q

what arteries branch from the descending aorta?

A

bilateral posterior intercostal arteries

232
Q

what is located at the left sternoclavicular joint?

A

left venous angle

233
Q

names the 3 nerves of the superior mediasteinum from lateral to medial?

A

phrenic vagus and reccurent laryngeal

234
Q

pulsitile hepatomeagly is what murmer?

A

tricuspid regurg

235
Q

what vein is the best for measuring CVP central venous pressure?

A

right internal jugular

236
Q

where is mitral stenosis commonly heard?

A

apex

237
Q

what murmers are heart at the lower left sternal border?

A

aortic and tricuspid regurg
VSD
opening snap of mitral stenosis

238
Q

what murmers are heart at the upper left sternal border?

A

pulmonary valve murmers

239
Q

what murmurs are heart at the upper right sternal border?

A

aortic stenosis

HOCM

240
Q

what murmur is heard at left axilla?

A

radiation of mitral regurg

241
Q

what murmer is best heard below the left clavicle?

A

patent ductus arteriosus

242
Q

what hormone is released on stretching of the ventricle?

A

BNP

243
Q

murmer in endocarditis?

A

tricupid regurg

revision year 1 (7 decks)

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