Cardiology Flashcards
1
Q
HOCM: what is it?
A
AD disorder causing diastolic dysfunction
2
Q
HOCM: features
A
Exertional dyspnoea, angina, syncope, sudden death
3
Q
HOCM: JVP
A
large a waves
4
Q
HOCM: murmur
A
ejection systolic murmur
5
Q
HOCM: associations
A
Friedreich’s ataxia, WPW
6
Q
HOCM: echo
A
MR SAM ASH
Mitral regurgitation
Systolic anterior motion of anterior MV leaflet
Asymmetrical hypertrophy
7
Q
HOCM: ECG
A
LVH, non-specific ST segment and T wave changes, deep Q waves
8
Q
HOCM: Mx
A
ABCDE
Amiodarone, beta blockers, cardioverter defib, dual chamber pacemaker, endocarditis prophylaxis
9
Q
HOCM: avoid
A
Nitrate, ACE-i, inotropes
10
Q
Ebstein’s anomaly: what?
A
Low insertion of tricuspid valve resulting in large atrium and small ventricle
11
Q
Ebstein’s anomaly: associations
A
Patent foramen ovale or ASD
WPW
12
Q
Ebstein’s anomaly: features
A
Cyanosis, a wave, HSM, TR and RBBB
13
Q
LAD: causes
A
Left anterior hemi block LBBB Inferior MI WPW Hyperkalaemia Congenital (ASD, tricuspid atresia)
14
Q
RAD: causes
A
RVH Left posterior hemiblock Lateral MI Cor pulmonale PE ASD Normal in infants
15
Q
S1 represents…
A
Closure of mitral and tricuspid valves
16
Q
S2 represents…
A
Closure of aortic and pulmonary valves
17
Q
S3 represents…
A
Diastolic filling of ventricle
18
Q
S4 associations…
A
AS, HOCM, HTN
19
Q
S4: ECG
A
p waves
20
Q
S3: causes
A
LVF, constrictive pericarditis and MR
21
Q
Loud S1 causes
A
MS, left to right shunts, short PR, hyperdynamic states
22
Q
Quiet S1 causes
A
MR
23
Q
Loud S2
A
Hypertension, hyperdynamic states, ASD
24
Q
Soft S2
A
AS
25
Fixed split S2
ASD
26
Widely split S2
Deep inspiration, RBBB, pulmonary stenosis, severe MR
27
Pulmonary HTN: positive vasodilator testing
Oral CCB
28
Pulmonary HTN: negative vasodilator testing
Prostacyclin analogues - treprostinil, iloprost
Endothelin receptor antagonists - bosentan
Sildenafil
29
PR prolongation
```
MID RASH
Myotonic dystrophia
IHD/idiopathic
Digoxin
Rheumatic fever
Aortic abscess
Sarcoidosis
Hypo K/Ca
```
30
DVLA: angioplasty
1 week off driving
31
DVLA: CABG
4 weeks off driving
32
DVLA: pacemaker insertion
1 week off driving
33
DVLA: ICD: ventricular arrhythmia
6 months no driving
34
DVLA: ICD: prophylactic
1 month off driving
35
DVLA: ICD
Permanent bar for group 2
36
Malignant HTN: Mx
IV sodium nitroprusside / labetolol
37
Aortic dissection: causes
```
MEN TSH
Marfans
Ehler Danlos
Noonan's
Trauma / Turners
Syphilis
HTN
```
38
Aortic dissection: Type A
Ascending aorta
39
Aortic dissection: type B
Descending aorta
40
Central acting antihypertensives (3)
Methyldopa
Moxonidine
Clonidine
41
TR; signs
Pan-systolic murmur
Giant v waves
Pulsatile hepatomegaly
L parasternal heave
42
TR; causes
```
RV infarction
Pulmonary HTN
Rheumatic HD
IE
Ebstein's
Carcinoid's
```
43
Warfarin; major bleeding
Stop warfarin
IV vitamine K 5mg
PT complex
44
Warfarin; INR >8 and minor bleeding
Stop warfarin
IV vitamin K 1-3mg
Restart when INR <5
45
Warfarin; INR >8 and no bleeding
Stop warfarin
PO vitamin K 1-5mg
Restart when INR <5
46
Warfarin; INR 5-8, minor bleeding
Stop warfarin
IV vitamin K 1-3 mg
Restart when INR <5
47
Warfarin; INR 5-8, no bleeding
Withhold 1-2 doses
48
ECG: V1-4
Anteroseptal MI
49
ECG: Anteroseptal MI
LAD
50
ECG: II, III, aVF
Inferior MI
51
ECG: Inferior MI
Right coronary
52
ECG: V4-6, I, aVL
Anterolateral MI
53
ECG: Anterolateral MI
LAD or left circumflex
54
ECG: I, aVL, V5-6
Lateral MI
55
ECG: Lateral MI
Left circumflex
56
ECG: Tall R wave V1-2
Posterior MI
57
ECG: Posterior MI
Left circumflex
58
Ejection systolic murmur, louder on expiration
AS, HOCM
59
Ejection systolic murmur, louder on inspiration
PS, ASD
60
Ejection systolic murmur
ToF
61
Pansystolic murmur
MR, TR
| VSD (harsh)
62
Late systolic murmur
Mitral prolapse
| Coarctation
63
Early diastolic murmur
AR
| Graham-Steel murmur (PR)
64
Mid-late diastolic murmur
MS
| Austin-Flint murmur (AR)
65
Continuous machine like murmur
PDA
66
Takaysau's arteritis: features
```
Features of vasculitis
Unequal BP
Carotid bruit
Intermittent claudication
AR
```
67
IE: poor prognostic factors
Staph
Prosthetic valve
Culture negative
Low complement levels
68
Decreased BNP
```
Obesity
Diuretics
ACEi
BB
ARBs
Aldosterone antagonists
```
69
JVP: a wave
atrial contraction
70
JVP: x descent
ventricular systole
71
JVP: c wave
closure of tricuspid valve
72
JVP: v wave
passive filling of atria
73
JVP: y descent
opening of tricuspid valve
74
JVP: large a wave
TS, PS, pulmonary HTN
75
JVP: absent a wave
AF
76
JVP: cannon a waves
complete heart block, VT
77
JVP: giant v waves
TR
78
CHADSVASC
```
CHA2 DSV2 ASC
CHF (1)
HTN (1)
Age >75 (2)
Diabetes (1)
Vascular - stroke/TIA (2)
Age 65-74 (1)
Sex (female) (1)
```
79
AR: features
Early Diastolic murmur
Collapsing pulse
WIde pulse pressure
80
AS: features
chest pain
dyspnoea
syncope
ESM
81
AS: severe features
```
Narrow pulse pressure
Slow rising pulse
Delayed ESM
Soft S2
S4
LVH
```
82
AS: Mx asymptomatic
observe
83
AS: Mx symptomatic
valve replacement
84
AS: valvular gradient
>40mmHg and with LVH then surgery
85
Arrythmogenic right ventricular cardiomyopathy: pathophysiology
AD
| RV is replaced by fatty and fibrofatty tissue
86
Arrythmogenic right ventricular cardiomyopathy: ECG
Abnormalities in V1-3
| Typically T wave inversion
87
Features suggestive of VT rather than SVT
```
AV dissociation
Capture beats
Positive QRS in chest leads
LAD
IHD
Lack of response to adenosine or valsalva
QRS >160ms
```
88
Brugada Sx: gene
Mutation in SCN5A gene
| Encode myocardial sodium ion channel
89
Angina: Mx
1) BB or CBB
2) BB AND CBB
3) Long acting nitrate, ivabradine, nicorandil or ranlazine
90
Type A dissection: Mx
Surgical management
| Target SBP 100-120
91
Typa B dissection: Mx
Conservative
Bed rest
BP control
92
BNP: effects
Vasodilator
Diuretic and natriuretic
Suppress sympathetic tone and RAAS
93
First cardiac enzyme to rise
Myglobin
94
Cardiac enzyme for re-infarctions
CK-MB
95
Hypokalaemia: ECG
```
U waves
Small T waves
Prolonged PR
ST depression
Long QT
```
96
NYHA Class 1
No Symptoms
| No limitation
97
NYHA Class 2
Mild symptoms
| Slight limitation of physical activity
98
NYHA Class 3
Moderate symptoms
| Marked limitation of physicial activity
99
NYHA Class 4
Severe symptoms
| Unable to carry out any physical activity
100
IE: Staph aureus
Most common cause
101
IE: Staph epidermis
Indwelling lines
| Post 2 months valve replacement
102
IE: Strep viridans / sanguinis
Poor dentition
103
IE: Strep bovis
CRC
104
IE: Strep galloyticus
CRC
105
IE: Blind therapy
Native valve: amoxicillin/vanc +/- gent
| Prosthetic valve: vanc, rifampicin + gent
106
Long QT: drugs
```
Amiodarone, sotalol
TCA, SSRIs
Methadone
Chloroquine
Erythromycin
Haloperidol
Ondansetron
```
107
MS: features
Mid late diastolic murmur
Loud S1
Low volume pulse
Malar flush
108
Direct thrombin inhibitors
Bivalirudin
| Dabigatran
109
Treprostinil, iloprost MoA
Prostacyclin analogues
110
Bosentan, abrisentan
Endothelin receptor antagonists
111
Ticragelor SE
Dyspnoea
112
Right ventricular MI avoid..
Nitrates as reduces preload
113
COX inhibitors e.g.
Aspirin
114
P2Y12 Receptor blockers
Clopidogrel
115
GPIIb IIIa Inhibitors
Abciximab, tirofiban
116
Phosphodiesterase inhibitors
Dipyridamole
117
Drugs to maintain rhythm in AF
Sotalol, amiodarone and flecanide
118
AF: Factors favouring rate control
65+
| History of IHD
119
AF: factors favouring rhythm control
```
Younger than 65
Symptomatic
First presentation
Lone AF
Congestive HF
```
120
Atrial myxoma: location
Left atrium
| Attached to fossa ovalis
121
Features suggestive of VT rather than SVT
```
AV dissocation
Fusion / capture beats
Positive QRS in chest leads
Marked LAD
History of IHD
Lack of response to adenosine or valsala
QRS >160
```
122
Acyanotic congenital heart disease
```
VSD
ASD
PDA
Coarctation of aorta
Aortic valve stenosis
```
123
Cyanotic heart disease
ToF
TGA
Tricuspid atresia
124
HOCM: poor prognosis
```
Syncope
FH sudden death
Young age
Non sustained VT
Abnormal BP changes on exercise
```
125
VSD: complications
```
AR
IE
Eisenmenger's
RH failure
Pulmonary HTN
```
126
Atrial Myxoma: location
Left atrium
| Attached to fossa ovalis
127
Atrial Myxoma: features
Dyspnoea, fatigue, weight loss, pyrexia unknown origin, clubbing
Emboli
AF
Mid-diastolic murmur
128
Cholesterol Embolus: features
Eosinophilia
Purpura
Renal failure
Livedo reticularis
129
PDA: Mx
Indomethacin or ibuprofen
130
Pulsus paradoxus
Severe asthma, cardiac tamponade
131
Slow rising pulse
AS
132
Collapsing pulse
AR, PDA, hyperkinetic states
133
Pulsus alternans
Severe LVF
134
Syndrome X: what?
Angina like pain on exertion
ST depression of exercise stress test
Normal coronary angiogram
