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Y3 Clinical Case Revision > Cardiology > Flashcards

Cardiology Flashcards

1
Q

bradycardia examples

A

sinus bradycardia
sick sinus (tachy-brady)
sinus arrest vasovagal

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2
Q

sinus bradycardia causes

A

athletes

drug toxicity - beta blockers, calcium channel blockers, digoxin

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3
Q

asymptomatic sinus bradycardia management

A

NIL

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4
Q

symptomatic sinus bradycardia management

A

permanent pacemaker

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5
Q

sinus bradycardia origin

A

SAN / atria

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6
Q

first degree heart block ECG features

A

elongated PR interval

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7
Q

1D HB management

A

check for drug toxicity (digoxin)
NIL management if asymptomatic
if symptomatic - prov cardiac monitoring

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8
Q

Type I second degree heart block ECG features

A

longer, longer, longer, drop!

PR gradually elongating, then dropped QRS complex

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9
Q

2D HB Type I causes

A

high vagal tone ie. young, fit, healthy

post inferior MI

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10
Q

2D HB Type I management

A

NIL

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11
Q

Type II second degree heart block ECG features

A

sudden failure of P wave to be conducted to ventricles

ie. randomly dropped QRS

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12
Q

Type II 2D HB management

A

permanent pacing

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13
Q

third degree heart block ECG features

A

no relationship between p waves and QRS complexes

can have broad complex escape (beneath AVN) or narrow complex escape (above AVN)

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14
Q

third degree heart block causes

A

digoxin toxicity
post inferior STEMI
sev hyperkalaemia

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15
Q

third degree heart block management

A

atropine IV
isoprenaline
calcium chloride IV (hyperkalaemia)
permanent pacing

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16
Q

what is the most common cardiac arrhythmia encounter in clinical practice

A

AF

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17
Q

AF presentation

A

not typically presenting with symptoms
BUT - will present as a complication of another condition eg.
haemodynamic instability (due tachy / brady)
ACS
CCF
cardioembolic stroke

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18
Q

complications of AF

A

cardioembolic stroke
cardiac instability
death

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19
Q

AF diagnosis

A

manual pulse checks
ECG
(SOB, palpitations, syncope/dizziness, CP, stroke, TIA)
? paroxysmal - cardiac monitoring (24 hour cardiac monitor)

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20
Q

AF classifications

A

paroxysmal > persistent > permanent

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21
Q

Echocardiogram indications

A

structural heart disease
consideration of rhythm control strategy (eg. cardioversion)
baseline needed for LT treatment

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22
Q

AF management

A
  1. anticoagulation (stroke / systemic embolism prophylaxis) eg. apixaban
  2. Rate control
  3. Rhythm control
  4. CHAD2S2 VASC Score / HAS-BLED Score
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23
Q

DOACS MOA

A 
apixaban = inhibit factor Xa
dabigatran = inhibit direct thrombin inhibitor
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24
Q

DOACs excretion

A

kidney

monitor renal function yearly

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25
Q

DOAC benefit

A

less need for regular monitoring (INR)
lower rates of bleeding (vs warfarin)
better reduction in strokes

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26
Q

Rhythm control options

A

Haemodynamically unstable = electrical cardioversion
Haemodynamically stable =
+ SHD = IV amiodarone
+ no SHD = IV flecainide

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27
Q

Rate control options

A

beta blocker

digoxin

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28
Q

supraventricular tachycardia pathophysiology

A

AVNRT (AVN reentry tachy)

AVRT (atria-ventricular reentry tachy)

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29
Q

first line treatment SVT

A

vagal manoeuvres

  • breath holding
  • Valsalva manoeuvre
  • carotid massage
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30
Q

vagal manoeuvre MOA

A

slow AVN conduction > interruption of reentrant circuit

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31
Q

carotid massage risks

A

stroke / emboli

  • always ascultate for bruits
  • mostly used in younger patients
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32
Q

second line / 1st line drug treatment SVT

A

IV adenosine OR IV verapamil / diltiazem
adenosine = rapid IV bolus 6 mg stat + long saline flush in antecubital fossa
(if unsuccessful 12 mg stat, 12mg stat)

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33
Q

adenosine SEs

A

chest discomfort
transient hypotension
flushing

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34
Q

adenosine contraindications

A

reversible airways disease

significant bradycardia / tachycardias

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35
Q

adenosine MOA

A

reduces HR and conduction velocity @ AVN

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36
Q

atropine MOA

A

reduces vagal tone > ^ AVN conduction

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37
Q

synchronised cardioversion indication for SVT

A 
SVT 
\+ hypotension
\+ pulmonary oedema
\+ chest pain and ischaemia
\+ unstable 
Nb. under GA / sedation
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38
Q

verapamil contraindications

A

pts on BXs

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39
Q

flecainide MOA

A

Na channel blocker

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40
Q

flecainide contraindications

A

MI - past or present

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41
Q

2nd line drug treatment for SVT

A

flecainide
amiodarone
sotalol

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42
Q

HTN Target low-mod risk

A

<140 mmHg systolic

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43
Q

HTN target DM / stroke / TIA / IHD / CKD

A

< 130/80

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44
Q

HTN target >80 years old

A

140-150 systolic

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45
Q

HTN diastolic target

A

<90

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46
Q

HTN + DM diastolic target

A

<85

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47
Q

HTN first line tx <55 y/o

A

ACEi / ARB

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48
Q

HTN first line >55 y/o OR black (of any age)

A

CCB

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49
Q

HTN second step management

A

ACEi / ARB + CCB

50
Q

HTN third step management

A

ACEi / ARB
CCB
Thiazide diuretic

51
Q

Resistant hypertension definition

A

HTN sustained after three medical interventions

52
Q

Resistant HTN management

A 
ACEi / ARB
CCB
Thiazide diuretic
Additional diuretic OR BB
Seek expert advice
53
Q

Complications of Hypertensive emergencies

A 
encephalopathy 
LV failure
aortic dissection
unstable angina
renal failure
54
Q

HTN emergencies management

A

sodium nitroprusside
labetaolol
GTN 1-10mg/hr
esmolol

55
Q

Hypertensive urgency features

A

sev HTN > damage over a period of days
diastolic >130
retinal damages

56
Q

phaeochromocytoma triad of symptoms

A

episodic headache
sweating
tachycardia
sustained / paroxysmal HTN

57
Q

phaeochromocytoma diagnosis

A

urinaary / plasma metanephrines and catecholamines

CT / MRI (adrenal tumors)

58
Q

phaeochromocytoma management

A

(FIRST) alpha + beta blockers

eg. phenoxybenzamine

59
Q

Primary aldosteronism signs

A

HTN
low serum potassium
high / normal sodium

60
Q

HF causes

A 
IHD
HTN
Valvular HD (Rheumatic fever)
AF
Chronic lung disease
Cardiomyopathy
Chemo
HIV
61
Q

assessment of LV function

A

echocardiogram

cardiac MRI

62
Q

medication for HF

A 
diuretics (furosemide)
ACEi
ARBs (candesartan)
Angiotensin receptor-neprilysin inhibitor - ANRI (saubitril)
Beta blockers
63
Q

Complex device therapy for HF options

A

CRT (cardiac resynchronisation pacemaker)

implantable cardiac defibrillators (ICD)

64
Q

CXR findings of HF

A 
ABCDE
Alveolar oedema
(Kerley) B lines
Cardiomegaly
Dilated upper lobes
pleural Effusions
65
Q

why do HF patients develop peripheral oedema?

A

^ capillary hydrostatic pressure
v plasma oncotic pressure
> ^ fluid from IV > IT space

66
Q

regular narrow complex tachycardias treatment

A

vagal manouveres

adenosine

67
Q

adenosine contraindications

A

asthma

verapamil indicated instead

68
Q

irregular narrow complex tachycardia management

A

MOST LIKELY Dx = AF
anticoagulation: apixaban
<48 hrs px: rhythm control ie. flecainide
>48 hrs px: rate control ie. bisoprolol

69
Q

most likely pathogen in infective endocarditis (no existing cardiac pathology)

A

staphylococcus aureus

70
Q

most likely pathogen in infective endocarditis with existing cardiac pathology

A

streptococcus viridans

71
Q

secondary prevention and symptom control of stable angina

A

GTN spray
bisoprolol 5mg
aspirin 75 mg
atorvostatin 80mg

72
Q

rheumatic fever presentation

A 
recent streptococcal infection 
generalised rash 
fever
arthritis 
pancarditis / murmur (MS)
SC nodules
73
Q

rheumatic fever management

A

eradication of group A beta haemolytic streptococcal infection =
STAT IV benzylpenicillin
10/7 phenoxymethylpenicillin

74
Q

contraindications of digoxin

A

WPW (> VF)

75
Q

WPW management

A

radiofrequency pathway ablation
amiodarone / sotalol (to prevent SVTs)
rare: open heart ablation

76
Q

MS heart sounds

A

mid-diastolic rumbling + ‘opening’ snap
malar flush
AF

77
Q

most common cause of MS

A

rheumatic valve disease

78
Q

most common cause of AS

A

age related calcification

79
Q

acute ischaemic stroke management

A

<4.5 hours presentation = alteplase (60mg IV)

80
Q

aortic stenosis presentation

A

triad = angina, HF, syncope

+ v exercise tolerance / dyspnoea on exertion

81
Q

aortic stenosis causes

A

age related
CKD
previous rheumatic fever

82
Q

aortic stenosis auscultation

A

ejection systolic murmur
radiating to the carotid arteries
crescendo-decrescendo
best heard in aortic area = 2nd IC space on the RHS

83
Q

aortic stenosis investigations

A

echocardiogram

assesses severity of stenosis + competency of rest of heart

84
Q

aortic stenosis management

A

TAVI (transcatheter aortic valvular implantation)

via femoral artery

85
Q

aortic stenosis indications for surgery

A

symptomatic
symptomatic / abnormal upon exercise test
left ventricular systolic dysfunction
abnormal at time of other surgery (CABG)

86
Q

aortic regurgitation symptoms

A

can be asymptomatic for years

decreased exercise tolerance / dyspnoea on exertion

87
Q

aortic regurgitation causes

A

congenital abnormalities of the aorta (progressive aortic dilatation)
rheumatic disease
infective endocarditis
Marfan syndrome

88
Q

aortic regurgitation pathophysiology

A

progressive LV dilatation

HF

89
Q

aortic regurgitation signs

A

early diastolic murmur
collapsing pulse
best heard in aortic area

DeMusset’s sign (head bobbing)

90
Q

aortic regurgitation investigations

A

echocardiogram

assess severity + competency of rest of heart

91
Q

aortic regurgitation management

A

ACEi - reduces after load + v LV dilatation

92
Q

aortic regurgitation surgery indications

A

symptomatic
evidence of early LV systolic dysfunction
aortic root dilatation

93
Q

mitral regurgitation management

A

diuretics
IF functional / ischaemic MR = ACEi
IF LV systolic dysfunction = ACEi + BXs (v sev.)

94
Q

mitral regurgitation causes

A 
Marfan's 
familial association
rheumatic heart disease
IHD
infective endocarditis
collagen vascular disease 
LV dilatation
95
Q

mistral regurgitation auscultation

A

pan-systolic blowing murmur
radiates to auxilla
best heard over 5th ICD mid clavicular line

96
Q

mitral regurgitation investigations

A

echocardiogram

97
Q

mitral regurgitation surgery indications

A

symptomatic

mild-mod LV dysfunction

98
Q

mitral regurgitation surgery options

A

mitral valve replacement / repair

99
Q

common valvular pathology associated with AF

A

mitral regurgitation

O/E - decompensated HF, systolic murmur loudest at apex

100
Q

cause of torsades de points

A

drugs: ondansetron / clarithromycin / methadone - > QT prolongation => polymorphic VT

101
Q

leads for inferior changes

A

II III aVF

RCA

102
Q

leads for lateral changes

A 
I aVL (high lateral - circumflex a.)
V5 V6 (low lateral)
103
Q

leads for apex changes

A

V5 V6

distal LAD, RCA, circumflex a.

104
Q

leads for septal changes

A

V1 V2

prox LAD a.

105
Q

leads for anterior changes

A

V3 V4

LAD a.

106
Q

torsades de points management

A

IV magnesium sulfate = stable pt

urgent DC cardio version = unstable pt

107
Q

aortic regurgitation pulse characteristic

A

collapsing pulse

108
Q

aortic coarctation clinical features

A

radial-femoral delay
hypERtension
differences in BP of upper and lower extremities

109
Q

associated disease with streptococcus bovis IE

A

colorectal carcinoma
nb. s bovis is normal component of gut flora, therefore systemic presence may be sign of haematogenous spread due to gut wall breakdown

110
Q

hyperkalaemia management

A

10ml of 10% calcium gluconate
IV fast acting insulin (10 units)
Iv dextrose 50% 50 ml
5-10 ml nebulised salbutamol

Nb. calcium resonium is LT management

111
Q

hyperkalaemia management

A

10ml of 10% calcium gluconate
IV fast acting insulin (10 units)
Iv dextrose 50% 50 ml
5-10 ml nebulised salbutamol

Nb. calcium resonium is LT management

112
Q

NSTEMI ECG changes

A

ST depression
T wave inversion
Q waves (late)

113
Q

NSTEMI management

A 
BATMAN
BXs
aspirin
ticagrelor 
morphine
anticoagulants: LMWH (enoxaparin) 
nitrates

Can consider PCI if high risk of mortality, schedule in 4 days

114
Q

LT management for MI

A 
Aspirin
Atorvastatin
Anti-platelet (consider clopidogrel) for 12 months
ACEi
Atenalol 
Aldosterone antagonist 
Lifestyle changes
115
Q

Secondary complications of MI

A 
DREAD
Death
Rupture of the papillary muscles
Emoblism / oEdema
Arrhythmias / aneurysms
Dresler's syndrome (post-ACS pericarditis presents within 2-3 weeks)
116
Q

Dresler’s syndrome diagnosis and management

A

Echo + ECG changes + infection changes

NSAIDs + steroids +/- pericardiocentesis

117
Q

ECG changes in pericarditis

A

PR depression = most specific

saddle shaped syndrome

118
Q

cardiac tamponade symptoms

A

BECK’S TRIAD: hypotension, muffled heart sounds, raised JVP

119
Q

cardiac tamponade management

A

pericardiocentesis

IV fluids

120
Q

management of acute heart failure and WHY

A

sit up - reduces preload
high flow oxygen - corrects hypoxia
IV furosemide - combats fluid overload
IV GTN - vasodilation: reduces preload and after load

121
Q

chronic heart failure management

A

all HF = diuretic
HFpEF = lifestyle, treat underlying cause, cardiac rehabilitation programme
HFrEF = cardiac rehabilitation programme, ACEi + Bx
No improvement = swap ACEi for valsartan, add digoxin / nitrates / hydralazine (esp in black pts)
No improvement = CRT, ICD

Y3 Clinical Case Revision (17 decks)

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