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Revision Qs > Cardiology 1 > Flashcards

Cardiology 1 Flashcards

1
Q

What are the common presenting symptoms of aortic stenosis?

A

Syncope
CP
SOB, orthopnoea, PND, palps, fatigue

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2
Q

Clinical signs of aortic stenosis?

A

Narrow pulse pressure, slow rising pulse
Heaving LV apex
Soft or absent HS2 plus ejection systolic murmur

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3
Q

Complications of aortic stenosis?

A

LVF
Endocarditis
Damage to AV node -> heart blocks/arrhythmias

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4
Q

Surgical options for aortic stenosis?

A

Transcatheter Aortic Valve Implantation TAVI

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5
Q

5 causes of aortic regurgitation?

A 
Aortic dissection
Congenitally bicuspid
Infection 
Degenerative 
Inflammatory
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6
Q

Clinical signs of aortic regurgitation?

A

End diastolic murmur (Austin Flint), 3HS if lean forward
Apex beat moves due to LVH
Wide pulse pressure, bounding pulse effects in various places

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7
Q

What is the most common cause of congenital tricuspid regurgitation?

A

Ebsteins anomaly

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8
Q

Clinical signs of tricuspid regurgitation?

A

Signs of RVF incl Rosenbach pulsatile liver
Parasternal heaves/thrills
Pansystolic murmur at LSF louder on inspiration

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9
Q

Common causes of mitral regurgitation?

A

Usuals
Papillary muscle rupture - MI, IE
Ring dilatation secondary to LVF

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10
Q

Clinical signs of mitral regurgitation?

A

Signs of LVF
Apical thrill
Pansystolic murmur radiating to axilla

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11
Q

What arrhythmia is related to mitral stenosis and how?

A

Mitral stenosis causes increased LA pressure and can cause AF

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12
Q

3 main causes of aortic stenosis?

A

Congenitally bicuspid
Degenerative
Infective (rheumatic - though normally mitral)

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13
Q

3 types of ACS?

A

Unstable angina
STEMI
NSTEMI

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13
Q

What is the difference between stable and unstable angina?

A

Stable is atheromatous plaque formation in coronary arteries leading to chest pain, SOB, tachy, palps etc. on exertion
Unstable is rupture of plaque causing resting symptoms

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13
Q

What combo of investigations/clinical picture is suggestive of unstable angina?

A

Symptoms occurring at rest

Normal ECG and cardiac markers

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14
Q

First line management and advice of stable angina?

A

Short acting nitrate PRN (GTN spray)

Advise of SEs, tell to use twice 5 mins apart and if not better after 10 call ambulance

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15
Q

Apart from GTN spray, first line drugs for stable angina?

A

Beta blockers or calcium channel blockers

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16
Q

Management of angina after first line?

A

Long acting nitrate (isosorbide)
Nicorandil
Add either to B blocker or Ca channel blocker

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17
Q

Secondary prevention drugs in ischaemic heart disease?

A

Aspirin
Statins
ACEi

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18
Q

2 operations for revascularisation in IHD?

A

CABG

PCI

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19
Q

Drug of choice for symptom management in CCF?

A

Diuretics (furosemide)

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20
Q

3 drugs to slow disease process in CCF?

A

ACEi
B blockers
Digoxin

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21
Q

2 most common causes of heart failure?

A

Hypertension

IHD

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22
Q

Normal PR interval?

A

120-200ms

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23
Q

What is first degree heart block?

A

A long PR interval >200ms

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24
Q

What is Mobitz type I second degree heart block?

A

Wenkebach - progressive PR elongation until dropped QRS

E.g. 4:3 Mobitz I

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25
Q

What is Mobitz type II second degree heart block?

A

Intermittent non-conduction of P->QRS complexes with no change in PR interval

26
Q

What helps to differentiate type I from type II second degree heart block?

A

Progressive PR elongation in I

No change in II

27
Q

What does type I second degree heart block suggest malfunction of?

A

AV node

28
Q

What does type II second degree heart block suggest malfunction of?

A

Purkinje fibres/His bundle

29
Q

Which type of second degree heart block is Wenkebach?

A

Type I

30
Q

Which type of second degree heart block is worse and why?

A

Type II because it can progress to complete heart block

31
Q

What is third degree heart block?

A

Complete lack of atrial-> ventricular conduction, leading to separate atrial and ventricular rhythms

32
Q

What infectious disease can cause complete heart block?

A

Lyme disease

33
Q

Management of third degree heart block?

A

Needs dual chamber pacemaker

34
Q

What does a LAD artery blockage result in?

A

An anterior MI with ST elevation in V1-6

35
Q

What artery is responsible for an anterior MI?

A

LAD

36
Q

What artery is responsible for an inferior MI?

A

RCA

37
Q

Which artery is responsible for a lateral MI?

A

Left circumflex

38
Q

Progression of acute STEMI on ECG?

A

Ischaemia - ST depression, T wave elevation and inversion
Injury - ST elevation
Infarct and tissue necrosis - Q wave depth (pathological)

39
Q

What are pathological Q waves due to?

A

Scar tissue formation

40
Q

What normally constitutes sinus arrhythmia?

A

HR increasingly slightly on inspiration due to inhibition of vagal tone and increased sympathetic activity

41
Q

What is pulsus paradoxus?

A

BP fall of over 10mmHg on inspiration due to pressure equalisation in the heart chambers

42
Q

Major causes of pulsus paradoxus?

A

Cardiac tamponade, constrictive pericarditis
Massive PE, pneumothorax, COPD
Shock

43
Q

Normal paper speed of ECG trace?

A

25mm/sec

44
Q

How long is one big square in ECG trace?

A

0.2 seconds

45
Q

How to work out rate from rhythm strip?

A

300/no. of big squares between QRS

OR 6x no. of QRS in the rhythm strip in 10s

46
Q

Normal QRS interval on ECG?

A

Less than 200ms

47
Q

2 shockable heart rhythms?

A

Pulseless VT

VF

48
Q

What is the QRS hallmark of VT?

A

Broad complex tachycardia

49
Q

What might you suspect in an otherwise CV-healthy patient who presents with mild CP, SOB, fever following a viral illness?

A

Myocarditis

50
Q

Describe pericarditic chest pain?

A

Sharp pain at left precordium radiating through to back, better sitting forward

51
Q

Differentiating angina vs pericarditic pain?

A

Pericarditic is affected by posture (better sitting forward) not activity
Angina often activity-dependant and doesn’t radiate through to back

52
Q

What disease can cause a cardiac tamponade over a long period of time which can accumulate large volumes of fluid?

A

Hypothyroid (myxoedema)

53
Q

Becks triad of cardiac tamponade?

A

Hypotensive
Distended jugular veins
Distant heart sounds

54
Q

2 differentials for AF? (Irregularly irregular pulse)

A

Multifocal ventricular ectopics

SVT with variable AV block

55
Q

Is a fourth heart sound ever normal?

A

No

56
Q

Which murmur is listened for with the patient rolled onto their left in expiration?

A

Mitral stenosis

57
Q

Which murmur is listened for with patient leaning forward in expiration?

A

Aortic regurgitation

58
Q

What type of murmurs generally are best listened for with the patient in expiration?

A

Diastolic murmurs

59
Q

Which valve disease causes a malar flush?

A

Mitral stenosis

60
Q

Which valve disease is characterised by an opening snap followed by a low pitched mid diastolic murmur?

A

Mitral stenosis

61
Q

First line investigation of heart failure if previous MI?

A

Echo within 2 weeks

62
Q

First line investigation if heart failure suspected but no previous MI?

A

Measure serum BNP

63
Q

5 causes of a falsely elevated BNP?

A 
CKD
Liver cirrhosis
Chronic hypoxia (COPD)
Sepsis
Old age
64
Q

4 features of ToF?

A

Large VSD
Overriding aorta
Pulmonary stenosis
RVH

Revision Qs (28 decks)

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