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Alice's finals cards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which scoring system can be used to calculate the risk that a patient will have a stroke or MI in the next 10 years?

A

Q risk 3

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2
Q

What should all patients with CKD or DMT1 for over 10 years be offered?

A

Atorvastatin 20mg

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3
Q

What is the monitoring for statins? Why?

A

LFTs should be checked within 3 months of starting a statin. This is because statins cause a transient and mild rise in ALT and AST

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4
Q

What should be given as secondary prevention of CVD?

A

A- Aspirin and a second antiplatelet (clopidogrel)
A-Atorvastatin (80mg)
A-Atenolol (or bisoprolol)
A-ACE inhibitor (ramipril)

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5
Q

What are the common side effects of statins?

A

Myopathy (check CK)

Type 2 diabetes

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6
Q

What causes angina?

A

Ischaemia during times of high demand because there is a narrowing of coronary arteries

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7
Q

What is the difference between stable and unstable angina?

A

Stable is when symptoms are relieved by rest or GTN. Unstable is when symptoms come on randomly at rest

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8
Q

What is the gold standard investigation for angina?

A

CT angiography

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9
Q

What is the management of angina?

A

GTN spray (advise take one dose, repeat after 5 mins, if still pain then call 999)

Beta blocker or CCB (bisoprolol or amlodipine both 5mg daily)

4 As for CVD (aspirin, atorvastatin, ACE-i and atenolol)

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10
Q

What should be offered to people with proximal or extensive disease causing angina?

A

PCI

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11
Q

What does the right coronary artery supply?

A

Right atrium
Right ventricle
Inferior aspect of the left ventricle and
Posterior septal area

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12
Q

What does the circumflex artery supply?

A

Left atrium

Posterior aspect of the left ventricle

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13
Q

What does the left anterior descending artery supply?

A

Anterior aspect of the left ventricle

Anterior aspect of the septum

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14
Q

What are the 3 types of acute coronary syndrome?

A

Unstable angina
ST elevation myocardial infarction
Non-ST elevation myocardial infarction

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15
Q

What confirms a diagnosis of STEMI?

A

ST elevation or new left bundle branch block

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16
Q

What investigations should be done in ACS where there is no ST elevation on ECG?

A

Troponin.

If raised/ there are other ECG changes then the diagnosis is NSTEMI

If troponin is normal and there are no ECG changes then the diagnosis is unstable angina

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17
Q

What are alternative causes of raised troponin?

A 
Chronic renal failure
Sepsis
Myocarditis
Aortic dissection
PE
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18
Q

What investigations should be done for ACS?

A 
Physical exam
Bloods (FBC,LFT,U&E, lipid, thyroid, HbA1C, troponin)
ECG
CXR
Echo
CT angio
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19
Q

What is the management of acute STEMI?

A

Primary PCI if <2 hours of presentation
Thrombolysis >2hours

BATMAN
B-beta blockers
A- Aspirin 300mg STAT
T- ticagrelor 180mg or clopidogrel 300mg if there is a high bleeding rosk
M-Morphine
A- Anticoagulant: Fondaparinux
N- Nitrates: GTN to relieve vasospasm
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20
Q

What is a GRACE score?

A

It assess for PCI in NSTEMI by calculating the 6 month risk of death or repeat MI

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21
Q

What are the complications of MI?

A

DREAD

D- death
R- rupture
E- Edema
A- Arrhythmia/ aneurysm
D- Dressler's syndrome
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22
Q

What is Dressler’s syndrome?

A

Occurs 2-3 weeks after MI. Caused by a localised immune response and causes pericarditis.

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23
Q

How does dressler’s syndrome present?

A

Pleuritic chest pain
Pericardial rub
Global ST elevation and T wave inversion

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24
Q

What are the common triggers for left ventricular failure?

A

Iatrogenic
Sepsis
Myocardial infarction
Arrythmias

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25
How does acute LVF present?
``` rapid onset breathlessness Type 1 respiratory failure SOB Feeling unwell Increased RR and HR Reduced O2 sats 3rd heart sound Hypotension Bilateral basal crackles ```
26
How can a diagnosis of acute LVF be confirmed?
BNP or echo
27
What is a normal ejection fraction for ventricles?
above 50%
28
What does cardiomegaly look like on CXR?
The cardiothoracic ratio is >0.5
29
What does acute LVF look like on CXR?
Cardiomegaly Bilateral pleural effusions Fluid in interlobar fissures Fluid in septal lines (kerley lines)
30
What is the management of acute LVF?
Pour SOD Pour away fluids S-sit up O-Oxygen D- diuretics
31
What are the 2 types of chronic heart failure?
Systolic and diastolic
32
What are the key features of heart failure?
``` Breathlessness worsened by exertion Cough Orthopnoea Paroxysmal nocturnal dyspnoea Peripheral oedema ```
33
How is chronic heart failure diagnosed?
Clinical presentation BNP Echo ECG
34
How should chronic heart failure first be managed?
Refer to cardiology Lifestyle changes Flu and pneumococcal vaccines ``` ABAL: ACE-i Beta-blocker Aldosterone antagonist: spironolactone Loop diuretic (furosemide) ```
35
What is cor pulmonale?
Right sided heart failure caused by respiratory disease
36
What is the most common cause of cor pulmonale?
COPD
37
What is the presentation of cor pulmonale?
Usually asymptomatic SOB Peripheral oedema Syncope
38
What is the management of cor pulmonale?
Treating symptoms and the underlying cause | Long term O2 therapy
39
What are the readings which suggest a diagnosis of hypertension?
>140/90 in clinic or | >135/85 ambulatory
40
What are the causes of secondary hypertension?
``` ROPE: Renal disease Obesity Pregnancy/ pre-eclampsia Endocrine (Conn's syndrome) ```
41
What are the 3 stages of hypertension?
1= 140/90 2-160/100 3=180/120
42
Which tests should be done to assess for end organ damage in all new patients with a diagnosis of HTN?
``` Urine albumin: creatinine ratio Urine dipstick for blood HbA1c, renal function and lipids Fundus examination ECG ```
43
What are the potential antihypertensives which can be used?
``` A- ACE-i (ramipril) B- Beta-blocker (bisprolol) C- CCB (amlodipine) D- Diuretic (thiazide like, indapamide) ARB candasartan ```
44
What is the medical management of HTN?
1= A if <55 and white, C if >55 or black 2= A+C, if black ARB+C 3= A+C+D 4=A+C+D+ spironolactone, B, alpha blocker (doxazosin)
45
What can be used when thiazide like diuretics cause hypokalaemia in management of HTN and why?
Potassium sparing diuretics like spironolactone because it causes sodium excretion and potassium reabsorption by blocking aldosterone
46
What causes the first heart sound?
Closing of the AV valves
47
What causes the second heart sound?
Closing of the semilunar valves
48
What causes a third heart sound?
Rapid ventricular filling causing the chordae tendineae to twang like a guitar string
49
What kind of hypertrophy does mitral stenosis cause?
Left atrial hypertrophy
50
What kind of hypertrophy does aortic stenosis cause?
Left ventricular hypertrophy
51
What causes hypertrophy and what causes dilatation?
``` Stenosis= Hypertrophy Regurgitation= dilatation ```
52
What are the common causes of mitral stenosis?
Rheumatic heart disease | Infective endocarditis
53
What is heard when there is mitral stenosis
A low, rumbling mid-diastolic murmur
54
What are the associations of mitral stenosis?
Malar flush | Atrial fibrilation
55
What type of murmur is heart in mitral regurgitation?
Pan-systolic, high pitched whistling
56
What are the causes of mitral regurgitation
Ehlers Danlos syndrome or Marfan syndrome
57
What does aortic stenosis sound like?
Ejection systolic, high pitched murmur which has a crescendo-decrescendo character
58
What does aortic regurgitation sound like?
Early diastolic, soft murmur
59
What is aortic regurgitation associated with?
Corrigan's pulse (collapsing pulse)
60
What are the major complications of mechanical heart valves?
Thrombus Infective endocarditis Haemolysis
61
What are the presenting features of atrial fibrilation?
Palpitations SOB Syncope
62
What are the 2 differentials for an irregularly irregular pulse?
AF | Ventricular ectopics
63
What is seen on an ECG of AF?
Absent P waves Narrow QRS complex tachycardia Irregularly irregular ventricular rhythm
64
What are the most common causes of AF?
SMITH ``` Sepsis Mitral valve pathology Ischaemic heart disease Thyrotoxicosis Hypertension ```
65
What are the contraindications for rate control in AF?
There is a reversible cause of AF AF is of new onset in the last 48 hours AF is causing heart failure
66
What are the options for rate control in AF?
Beta blocker CCB Digoxin
67
When can rhythm control be offered in AF?
New, reversible cause of AF New onset < 48 hours Causing heart failure Symptomatic
68
What are the 2 types of cardioversion for AF?
Immediate and delayed. If someone has delayed cardioversion they must be anticoagulated for a minimum of 3 weeks prior
69
What are the 2 choices of pharmacological cardioversion?
Flecanide | Amiodarone
70
What is the management of paroxysmal AF?
If no structural heart defect then "pill in the pocket" approach can be appropriate If there is a defect, manage as normal
71
What is the mechanism of action of warfarin?
Vitamin K antagonist. Prolongs the prothrombin time
72
What is the target INR for someone on warfarin?
2-3
73
How do you reverse apixaban and rivaroxaban?
Andexanet alfa
74
Why are DOACs better than warfarin?
No monitoring required | No major interaction problems
75
What should the CHADSVASC score be to offer coagulation?
>1
76
Which scoring system assesses the risk of a bleed?
HASBLED
77
What are the 2 shockable rhythms?
VT | VF
78
What are the 2 non-shockable rhythms
Asystole | Pulseless activity
79
How are supraventricular tachycardias managed?
Vagal maoeuvres and adenosine
80
What causes atrial flutter?
Re-entrant rhythm
81
What is seen on an ECG of atrial flutter?
atrial contraction 300bpm, ventricular contraction 150 bpm and sawtooth appearance
82
What is the management of atrial flutter?
Rate and rhythm control Radiofrequency ablation Anticoagulation
83
What happens in supraventricular tachycardia?
Electrical signal re-enters the atria from the ventricles causing a self perpetuating loop
84
What are the ECG changes seen in Wolf-Parkinson White?
Short PR Wide QRS Delta wave (slurred upstroke of the QRS)
85
What is toursades de pointes?
Polymorphic ventricular tachycardia
86
What is wenkebach's phenomenon
Present in mobitz type 1 where atrial impulses become gradually weaker until they dont pass through the AV node. There is then no QRS complex and the pattern repeats
87
What is type 1 heart block
Delayed conduction through the AV. There is a QRS after every P but the PR interval is greater than 0.2s (1 big square)
88
What is mobitz type 2 block?
Failure or interruption of AV conduction. 3:1 block, 3 p waves to every 1 QRS
89
What is 3rd degree heart block?
Complete heart block, there is no relationship between P and QRS
90
How are heart blocks managed?
Pacing or atropine
91
What is eisenmenger syndrome?
When pulmonary pressure increases so much that a left to right shunt is reversed so that it is a right to left shunt
92
What is the presentation of atrial septal defects?
Dyspnoea Stroke Atrial fibrillation or atrial flutter
93
What can be heard on auscultation in atrial septal defect?
Mid-systolic, crescendo-decrescendo murmur which is loudest at the left sternal border with a fixed split second heart sound
94
What is the management of atrial septal defects?
Percutaneous transvenous catheter closure or open heart surgery. Can be managed by anticoagulants if asymptomatic
95
How do VSDs present?
pansystolic murmur | Present late in adulthood
96
What are the 3 differentials for pansystolic murmur?
VSD Mitral regurgitation Tricuspid regurgitation
97
What is the management of VSD?
Transvenous catheter closure Open heart surgery
98
What is coarctation of the aorta?
When there is narrowing of the aortic arch
99
Which condition is coarctation of the aorta particularly associated with?
Turner's syndrome
100
How does coarctation of the aorta present?
Systolic murmur | Left ventricular heave
101
How is coarctation of the aorta managed?
Stenting | Open surgical repair
102
What can cause a pericardial effusion?
``` Transudates (low protein) Exudates (high protein) Blood pus Gas ```
103
What is cardiac tamponade?
A pericardical effusion is large enough to raise the pericardial pressure. This squeezes the heart and impacts its ability to function
104
What might cause a transudative pericardial effusion?
Congestive heart failure | Pulmonary HTN
105
What might cause an exudative pericardial effusion?
``` Infection Autoimmune Injury MI Cancer Medications ``` (basically anything inflammatory)
106
What is the presentation of pericardial effusion?
``` Chest pain SOB Feeling of fullness in the chest Orthopnoea Pulsus paradoxus Quiet heart sounds ``` Compression of phrenic nerve may cause hiccups, reccurrent laryngeal may cause hoarseness of voice, oesophagus may cause difficulty swallowing
107
How is pericardial effusion diagnosed?
Echo | Fluid analysis
108
What is the management of pericardial effusion?
Treating the underlying cause Drainage of effusion (needle pericardiocentesis or surgical drainage) Inflammatory causes (pericarditis) can be treated with aspirin, NSAIDs, colchicine and steroids

Alice's finals cards (21 decks)

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