cardio corrections Flashcards
1
Q
what is the most common arrhythmia following a heart attack?
A
ventricular fibrillation
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
3
Q
when is PCI contraindicated in stable angina?
A
kidney disease
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
5
Q
what murmer may be heard during UA?
A
mitral regurg
6
Q
what test distinguishes between NSTEMI and UA?
A
troponins
7
Q
what anticoagulant is administered until discharge in ACS?
A
fondaparinux
8
Q
what is different in the pathology of UA/ NSTEMI?
A
UA is ischaemic only
NSTEMI infarction also
9
Q
what is the GOLD std for angina diagnosis?
A
CT coronary angiography
10
Q
what is decubitis angina caused by?
A
lying flat
11
Q
what is variant/primentzal angina caused by?
A
cornonary artery spasm
12
Q
what extra heart sound might you hear occasionally in angina?
A
4th heart sound
13
Q
what type pof infarction is it in a NSTEMI?
A
subendocardial
14
Q
what type of infarction is it in a STEMI?
A
transmural
15
Q
pathological changes in a STEMI 0-12hrs
A
cardiac myocytes undergo necrosis and gives oedema
16
Q
ECG changes STEMI 0-12hrs
A
ST elevation
17
Q
pathological changes in a STEMI 12-24hrs
A
continuing coagulative necrosis and neutrophil infiltration
18
Q
Ecg changes stemi 12-24hrs
A
inverted T wave, st elevation and pathological q wave
19
Q
pathological changes in a STEMI 1st week
A
neutrophil necrosis
collagen deposits via fibroblasts
20
Q
ECG changes STEMI after 1st week
A
pathological q waves
t wave inversion
21
Q
pathological changes in a STEMI weeks to months
A
loss of function due to increase collagen deposits leading to scar tissue
22
Q
ECG changes in a STEMI
A
pathological q wave
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
24
Q
ECG changes on a NSTEMI?
A
ST depression
25
would you order a CXR for ECG?
possibly to check for signs of HF but not immeditaely
26
what coronorary artery causes a lateral MI?
LCX/RCA
27
what coronorary artery causes a Inferioir MI?
RCA
28
what coronorary artery causes a anterior MI?
LAD
29
what coronorary artery causes a septal MI?
LAD
30
if theres reciprocal ST depressions in which leads it is a posterolateral STEMI? what artery is it casued by?
V1-3 RCA/LCX
31
outline the investigations for intermittant claudication/ critical limb ischaemia
```
measure of Ankle brchial pressure index
duplex ultrasound scanning
invasive:
magnetic resonance angiography
CT angiography
```
32
what is the ABPI value range for claudication
0.4-0.85
33
name the risk factors of secondary HT?
```
conn's syndrome
cushings
phaechromocytoma
pregnancy-pre ecclampsia
drugs
congenital coarcation of the aorta
renal disease
parathyroid
```
34
what is GOLD std for diagnosing HT?
ABPM
35
what is mild HT?
140/90 ABPM 135/85
36
what is moderate HT?
160/100 ABPM 155/95
37
What is severe HT?
180/110
38
What do you need to check Blood tests for in HT?
renin, aldosterone and Ca2+ levels
cholesterol
glucose
39
what does increased aldosterone in blood indicate?
Conn's syndrome
40
what does hypercalcaemia in the blood indicate?
parathyroid issues
41
what do you check urinalysis for in HT?
protein and kidney function
42
what may be shown on fundoscopy in sever HT?
flame haemorrhage
cotton wool spots
hard exudates
papilloedema
43
what is the recommended sodium allowance a day?
5-6g
44
what is the recommended amount of exercise a week?
150min a week 75min of vigourous exercise
45
what is first line HT tx for less than 55yrs
ACE or ARB
46
what is first line tretment for HT and diabetic?
ACEi
47
what is step 1 HT for >55yr or black?
Ca2+ blockers
48
step 2 HT tx
ca2+ blockers + ARB/ACEi
49
step 3 HT tx?
ca2+ blockers +ARB/ACEi + thiazide diuretic
50
SE ACEi
cough dry
51
SE ca2+ blockers
peripheral oedema
52
SE thiazide diurectics
gout risk increase
53
what is the criteria that classifies endocarditis?
dukes criteria
54
what is dukes criteria?
```
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
```
55
what are the main causative agents of endocarditis gm +ve
staph aureus
strept viridians
enetrococcus
staph epidermis
56
what are the main causeative organism ofnendocarditis gm -ve
```
HACER
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
```
57
what are the vegetations seen in endocarditis
septic emboli (broken off parts)
58
what is the Pneumonic for examination of endocarditis?
```
FROM JANE
Fever
Roths spots
Oslars nodes
Murmer - tricusp
Janeway lesions
Anaemia
Nails - splinter haemorrhages
Emboli
```
59
are oslers nodes painful?
yes
60
are janeway lesions painful?
no
61
do janeway lesions blanch?
yes
62
if someone has glomelular nephritis what is it a sign of?
endocarditis
63
what is the 1st line investigation for endocarditis?
transthoracic echo
64
what is the pneumonic for the treatment of endocarditis?
```
BBUCE
Blood culters 3 sep
Bloods- anaemia, incr WCC, decr platelets
Urinalysis- prtein
CXR- left sided pul oedema, emboli on RS
Echo
```
65
common cause endocarditis IV drug users?
staph aureus
66
common tx endocarditis IV drug users?
flucoxacillin
67
common tx endocarditis prosthetic valve?
ventamycin, gentamicin, riframycin
68
common tx endocarditis native valve?
amoxicilllin and gentamycin
69
common tx endocarditis viridians?
benzyl penicillin and gentamycin
70
common tx endocarditis enterococcus?
amoxicillin and gentamicin
71
what does kussmaul's sign indicate and what is it?
paradoxical increased JVP on inspiration
| constrictive pericarditis
72
saddle shaped ECG is?
pericarditis
73
what does a rub on auscultation indicate?
pericarditis
74
what virus causes pericarditis and myocarditis?
coxsackie
75
what causes the ST elevation in STEMI?
infarction, transmural in the ventricles, current cant get through so is travelling away from electrode
76
why do pathological Q waves emerge in STEMI?
emerge as it takes longer for ventricular depolarisation to happen makes it deep
77
why does a LBBB emerge in a STEMI?
as impulse cant travel due to infarction
78
STEMI is what in aVL, I, V5+V6?
lateral
79
STEMI is what in aVF, II, III?
inferior
80
STEMI in V1+2?
septal
81
STEMI in V2+3+4?
Anterior
82
outline initial STEMI treatment?
```
ECG
IV acess
FBC:
glucose
lipid
TROPONIN
```
83
Name medications given in STEMI?
aspirin 300mg
ticagrelor 180mg
IV morphine 5-10mg
and anti emetic : metoclopramide
84
what is the time frame in which PCI is allowed?
120min
85
name a drug used for thrombolysis?
streptokinase
86
what are contrindications for thrombolysis?
```
intercranial haemorrhage
ischaemic stroke
cerebral malignancy
major trauma
GI bleeding
aortic diesction
pregnancy
TIA< 6 months
active peptic ulcer
```
87
what is the pnemonic for further prevention of a stemi after discharge?
```
ABAS
ACEi/ ARB
BBlocker
Aspirin and clopidegril
Statins
do an echo first to check heart function
```
88
what is a contraindication for beta blockeers in MI and what can you give instead?
Ca2+ blockers and asthma
89
what drug might you also give in STEMI in hospital after MONAC?
fondaparinux
90
what is the treatment additions in NSTEMI compared to STEMI?
GTN IV
| B blocker or rate limiting Ca2+
91
Name some Ca2+ rate limiting blockers?
diazeltem/ verapamil
92
What change does aVR have in MI?
no change
| it is nondiagnostic lead
93
name the tests if someone has an arrhythmia?
```
FBC
ECG:
continuous may have to wear a monitor
ECHO
CXR
```
94
name the 3 supraventricular tachycardias
atrial flutter
atrial fibrillation
ectopic atrial tachycardia
95
what is the heart rate for atrial fibrillation?
150-300bpm
96
ECG changes atrial fibrillation?
no p waves
fine iscillations
irregualrly ireegular pulse
97
if the ECg has a HR of 150-300 and no p waves plus fine baseline oscillations what is it?
atrial fibrillation
98
what is the serious complication of AF?
stroke
99
if cardiovaersion isnt avaible within 24-48hr of symptom onset what do ya do?
anticoagulation for 6-8weeks
100
what is the score that determines if you need anticoagulation therapy in AF?
CHA2DS2VASC
101
what area are the reentrant looks especially found in in atrial flutter?
tricuspid area
102
if an ecg has p waves, sawtooth baseline and irregularly regular pulse- what is it?
atrial flutter
103
what is the rate for atrial flutter?
300bpm
104
what are the non invasive treatments for varicose veins?
compressive stockings
105
Name the 4T's and 4H's which cause reversible cardiac arrest
Hypoxia
Hypovolaemia
Hyperkalemia/hypokalemia/hypoglycemia/hypocalcemia (+ other metabolic disturbances)
Hypothermia
Tension pneumothorax
Tamponade
Toxins
Thrombosis
106
what murmer is responsible for malar flush?
mitral stenosis
107
if you hear a tapping apex beat what murmer is it?
mitral stenosis
108
what murmer is best heard on the left hand side?
mitral stenosis
109
which murmer is mid diastolic and rumbling?
mitral stenosis
110
which murmer has a loud S1?
mitral stenosis
111
AF is a complication of which murmers?
mitral murmers
112
which murmers have a low pitch?
diastolic
113
which murmers have a high pitch?
systolic
114
Marfans is a syndrome that is aetiological of which murmers?
mitral and aortic regurg
115
which murmer is pansystolic and whistling?
mitral regurg
116
which murmer radiates to the left axilla?
mitral regurg
117
in which murmer can you hear the 3rd HS?
mitral regurg
118
which murmer has a collapsing pulse?
aortic regurg
119
which murmer is early diastolic and soft?
aortic regurg
120
where is aortic regurg heard best?
apex
121
which murmer is best heard leaning forward and holding an exhaled breath?
aortic regurg
122
what murmer is a slow rising pulse?
aortic stenosis
123
which murmer radiates to the carotids?
aortic stenosis
124
which murmer is ejection systolic
aortic stenosis
125
which is high pitched and crescendo descresenddo?
aortic stenosis
126
is S3 heart sounds normal in young patients?
yes
127
what causes S3?
chordae tendinae pinging back like a guitar string
128
first line investigation for murmer?
echo
129
what treatment is preferred before valve replacement in murmers?
balloon valvescotomy
130
what murmer is a LOUD pansystolic murmer throughout the chest caused by HF and hepatomeagly?
tricuspid regurg
131
what is the commonest cause of HF?
atherosclerosis
132
what is systolic HF due to?
reduced contractility and so heart cant pump enough lowering SV
133
is ejection fraction increased/decreased/the same in systolic HF?
decreased
134
is ejection fraction increased/decreased/the same in diastolic HF?
same
135
what is diastolic HF due to?
preload issues
136
what is the ejection fraction of systolic BP?
35-40%
137
what is the primary care test for HF?
positive BNP
138
What is the diagnostic test for HF and ejection fraction?
echocardiogram
139
which HF causes fluid retention in the lungs and what is its common cause?
LS HF- IHD
140
which HF causes peripheral oedema?
RS HF
141
what are the main causes of RS HF?
VSD/ASD and cor pulmonae
142
what heart failure may hepatosplenomeagly be seen in?
RS heart failure
143
what is the classification called for HF?
NYHA new york HF
144
outline the treatemnt for HF with decreased EF?
Loop diurectic - frusemide
ACE/ARB/BB - reduce mortality
Aldosterone antagonist -spirolactone 2 nd line if symptoms still
consider antiplatlets/statins for prevention
145
what drug is given for an exacerbation of HF?
digoxin
146
when in ivabradine given in HF?
for symptom relief if on BB
147
when is hyrdalazine and nitrates given for HF
afrocarribean
148
outline treat ment for HF with maintined EF?
loop diurectic and the antiplatlets and statin
149
when do the DVLA need to be notified in HF?
bus/lorry driver who has symptoms
150
give some surgical interventions in HF?
ICD implantable cardioverter defib
Heart transplant
cardiac resynchronisation therapy
151
how is an AAA monitored?
duplex US
152
who is AAA monitored in?
>65yr men
153
at what size of AAA is someone provided with treatment?
>5.5cm or growing greater than 1cm a year
154
what is the treatment for AAA?
EVAR stenting
155
what is the presentation for emergency AAA?
expansile abdo mass
| abdo pain radiating to da back
156
presentation for thoracic aortic dissection?
sudden tearing chest pain, radiating to the back
157
what syndrome is associated with thoracic aortic dissection?
marfan's
158
what is the differnce between type a and b aortic dissection?
in a the dissection extends from the ascending aorta to descending
in B the dissection remains in the ascending aorta
159
radial radial delay indicates what?
coarction of aorta or thoracic aortic disection
160
rib notching indicates what on CXR?
thoracic aortic dissection or coarction of the aorta
161
what do tall tented t waves indicate?
hyperkalaemia
162
blurred yellowing vision headache is a side effect of what?
digoxin toxicity
163
bounding pulse is indicative of what?
acute CO2 retention
164
strawberry milkshake coloured blodd is indicative of what?
hyperlipidaemia
165
what coronary artery supllies the SA node?
RCA
166
name the 4 types of cardiomyopathies?
HCOM
Dilated
restrictive
arrhythmogenic RV
167
what type of cardiomyopathy is thickened LV/
HCOM
168
sudden cardiac death in a young person or athlete is what?
HCOM
169
what are the mutations that cause HCOM?
alpha tropomyosin, beta myosin and troponin T
170
what causes SCD in HCOM?
increased EDV as ventricles to thick to let enough out, causes heart failure
171
treatment of HCOM?
avoid competative sport
| B blockers and CCB
172
what ix woould you do for HCOM?
ECG +ECHO and excercise test
173
what type of cardiomyopathy is dilated ventricle?
dilated
174
what type of cardiomyopathy is stiff ventricles?
restrictive
175
what CM is due to replacement of cardiac muscle with fibro fatty deposits?
arrhythmic RV
176
what can cause dilated CM?
alcohol, chemo, pregnancy and cardiac infection
177
what HS is present in DCM?
3rd HS
178
What murmers are heard in DCM and why?
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
what are the symptoms of DCM?
HF mixed L and R
180
what is the treatment of DCM?
beta blockers/ CCB
| ICD - implantable cardiac defib
181
pneumonic for aetiology of RCM?
```
MEGA CHRIST
Mets
Endocarditis
Glycogen
Amphyloidis
Carcinoid
Haemochromatosis
Radiation
Idiopathic
Sarcoidosis
Transplant
```
182
what happens to preload and EDV in pathophysiology of RCM?
decreases due to stiff ventricles cant contract properly
183
ix for RCM?
ECG, ECHO and cardiac catherisation
184
how do you treat RCM?
treat cause
185
what is the mutation in ARVCM? and if its not in desmosome
AD in desmosomeand AR if not in desmosome
186
what does ECG show in ARVCM?
RV tachycardia, hr >1000, QRS greater than 120ms, r axis deviation and LBBB
187
What is the ductus arteriosus a connection between?
pulmonary artery and descending aorta
188
what is the function of the ductus arteriosus?
present during foetal development to bypass lungs so blood can be oxygenated at placenta
189
what happens to ductus arteriosus when born?
should close
190
what is the most common defect when born?
VSD
191
how is a heart defect detected?
newborn screening
192
what are the signs of a congenital defect?
cyanosis
| collapse and HF
193
why do babies get cyanosed due to heart?
if hole continues to bypass lumps and mix oxygenated and deoxygenated blood to enter circulation
194
what disease are all patients with congenital heart disease particularly at risk from?
infective endocarditis
195
what are tetralogy of fallot, tranus arteriosus and transposition of the great vessels an example of?
cyanotic congenital heart disease
196
what are ASD, VSD, AVSD, aortic and pulmonary stenosis egs of?
acyanotic HD
197
how does a patoient with congenital HD get O2 sufficiently?
patent ductus arteriosus
198
what is needed to keep patent ductus arteriosis open until the defect can be repaired?
a prostaglandin e2 transfusion
199
what is it if its a machine like murmer?
patent ductus arteriosus
200
how do yopu manage a patent ductus arteriosis?
NSAIDs eg indomethacin
201
what syndrome is associated with coarction of the aorta?
turners
202
what is coarction of the aorta?
narrowing of the aorta usually in the proximal thoracic aorta
203
if someone shows rib notching on CXR, has weak femoral pulses and a radial femoral delay what is it?
coarction of the aorta
204
what is a complication of coarction of the aorta?
HT secondary cause
205
what are the features of tetraology of fallot?
RV hypertrophy, VS defect, overriding aorta, pulmonary stenosis
206
what is ewarts sign and what is it a sign of?
cardiac tampoinade and the sign is effusion at base of lung causing dullness below scapula
207
what does pulsus paradoxus indicate?
cardiac tamponade
208
causes of cardiacc tamponade?
pericarditis
iatrogenic
trauma
malignancy
209
what shows a large pear shaped heart on CXR?
cardiac tamponade
210
what does an ECG show cradiac tamponade? why
compressed QRS complexes as heart is compressed via blood and cant pump as much
211
what is the treatment of cardiac tamponade?
PERICARDIOCENTESIS
212
what is a complication of pericardiocentesis?
pneumothorax
213
what is an ejection systolic murmer decreased by squatting indicative of?
HCOM
214
what murmer is most likely to be associated with RS HF?
Tricuspid regurg
215
what does a delta wave in V1 suggest?
WPW syndrome
216
what type of haemolysis is strep viridians?
alpha haemolysis
217
what is the mechanism for clopidegril?
works through P2Y12 receptor by disulphide bond
218
what type of drug is warfarin and how does it work
vit k antagonist, binds to vita k reductase inhibiting production of clotting factors in blood
219
what clotting factors does warfarin ihibit?
2,7,9,10
220
mechanism of action of heparin?
binds to AT3inhibits thromin by forming a complex between antithrombin III (AT3) and thrombin and inactivates it also inactivating factor Xa
221
what spinal level is herpes zoster virus SHINGLES at?
T4/5
222
what is the longest vein in the body?
great saphenous
223
what vein is on the right side of the thoracic vertebra?
azygous
224
what coronary artery runs in the interventricular groove?
LAD
225
vagus nerve is ____ to the phrenic nerve
medial
226
what does the coronary groove hold?
RCA
227
what valve sits deep to the coronory groove?
tricuspid
228
what artery sits in the posterioir interventricular artery?
RCA
229
what differentiates the superior mediastenum and inferior mediasteinum?
tranverse thoracic plane is the line between the sternal angle and the t4/5 intervertebral disc
230
what 2 coronary arteries branch from the ascending aorta?
left and right coronary
231
what arteries branch from the descending aorta?
bilateral posterior intercostal arteries
232
what is located at the left sternoclavicular joint?
left venous angle
233
names the 3 nerves of the superior mediasteinum from lateral to medial?
phrenic vagus and reccurent laryngeal
234
pulsitile hepatomeagly is what murmer?
tricuspid regurg
235
what vein is the best for measuring CVP central venous pressure?
right internal jugular
236
where is mitral stenosis commonly heard?
apex
237
what murmers are heart at the lower left sternal border?
aortic and tricuspid regurg
VSD
opening snap of mitral stenosis
238
what murmers are heart at the upper left sternal border?
pulmonary valve murmers
239
what murmurs are heart at the upper right sternal border?
aortic stenosis
| HOCM
240
what murmur is heard at left axilla?
radiation of mitral regurg
241
what murmer is best heard below the left clavicle?
patent ductus arteriosus
242
what hormone is released on stretching of the ventricle?
BNP
243
murmer in endocarditis?
tricupid regurg
