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Cardiology Flashcards

1
Q

What is first line treatment for heart failure?

A

ACEi and beta-blocker - one at a time

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2
Q

Do ACEi and beta-blockers have any improvement on mortality when ejection fraction is preserved?

A

No

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3
Q

What is the second-line treatment of heart failure?

A

Aldosterone antagonist - e.g. spironolactone

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4
Q

Which vaccinations should pts with heart failure receive?

A

Annual flu + one-off pneumococcal

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5
Q

How should angina be managed when they have failed to respond to a beta-blocker?

A

Initiation of a calcium channel blocker

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6
Q

What types of CCB are amlodipine, nifedipine etc.?

A

Long-acting dihydropyridine

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7
Q

What types of CCB should not be used in conjunction with beta-blockers?

A

Diltiazem and verapamil are rate-limiting CCBs and should not be used in combination with a beta-blocker as they can result in life-threatening bradycardia and heart failure

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8
Q

What can be used when a dihydropyridine CCB is contraindicated or not tolerated?

A

Ivabradine - as long as HR>70, and on specialist advice

or Nicorandil

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9
Q

If an AF patient has a TIA or stroke, what is the anticoagulant of choice?

A

Warfarin or a direct thrombin or factor Xa inhibitor

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10
Q

In acute stroke, when should anticoagulation therapy begin?

A

2 weeks later (later, if very large infarction)

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11
Q

How does aortic regurgitation present?

A

Diastolic murmur loudest over the aortic valve and wide pulse pressure

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12
Q

How does aortic stenosis present?

A

Systolic murmur with narrow pulse pressure

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13
Q

How does mitral regurgitation present?

A

Systolic murmur loudest over the mitral valve

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14
Q

How does mitral stenosis present?

A

Diastolic murmur but it would be loudest over the mitral valve and would not have the characteristic wide pulse pressure

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15
Q

How does pulmonary regurgitation present?

A

Diastolic murmur but it would be the loudest over the 2nd intercostal space on the left and would not have the wide pulse pressure

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16
Q

What is De Musset’s sign?

A

Head bobbing associated with AR

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17
Q

What are the causes of AR?

A 
Valve issues:
Rheumatic fever
Infective endocarditis
Connective tissue diseases e.g. RA/SLE
Bicuspid aortic valve
Aortic root disease:
Aortic dissection
Spondylarthropathies (e.g. ank spond)
HTN
STS
Marfan's/Ehler-Danlos syndrome
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18
Q

What is the difference between Janeway lesions and Oslers nodes?

A

Oslers nodes = painful

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19
Q

What are the microbial causes of IE?

A

Staphylococcus aureus
Streptococcus viridans
Coagulase-negative Staphylococci such as Staphylococcus epidermidis
Streptococcus bovis

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20
Q

What is a PESI score?

A

Allows calculation of PE severity, and work out which patients may be managed in an outpatient basis

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21
Q

What types of antibiotics can cause torsades de pointes?

A

Macrolides - e.g. clarithromycin

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22
Q

What is torsades de pointes?

A

A form of polymorphic ventricular tachycardia associated with a long QT interval. It may deteriorate into ventricular fibrillation and hence lead to sudden death

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23
Q

What are the causes of long QT syndrome?

A

GENETIC - LQT1 / LQT2 (potassium channel mutation); LQT3 (sodium channel mutation); Jervell and Lange-Nielsen syndrome (associated with deafness); Romano-Ward syndrome

ELECTROLYTES - Hypocalcaemia; Hypomagnesaemia; Hypokalaemia

DRUGS - Antiarrhythmics (e.g. amiodarone, sotalol); Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin); Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)

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24
Q

When should fibrinolysis be offered in STEMI patients?

A

Fibrinolysis should be offered within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes

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25
Q

When can you abandon PE as a differential?

A

When a 2-level Well’s score =4 AND d-dimer = NEG

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26
Q

In whom is cardiac resynchronisation recommended?

A

Patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms

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27
Q

In whom is an ICD recommended?

A

Patients with previous sustained ventricular tachycardia, ejection fraction <35% and symptoms no worse than class III of of the New York Heart Association functional classification

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28
Q

What are the possible ECG features of WPW?

A

Short PR interval
Wide QRS complexes with a slurred upstroke - ‘delta wave’
Left axis deviation if right-sided accessory pathway, right axis deviation if left-sided accessory pathway*

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29
Q

What are the associations with WPW?

A 
HOCM
Mitral valve prolapse
Ebstein's anomaly
Thyrotoxicosis
Secundum ASD
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30
Q

How is WPW managed?

A

Definitive treatment - radiofrequency ablation of the accessory pathway
Medical therapy - sotalol, amiodarone, flecainide

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31
Q

What is the anti-HTN of choice in T2DM?

A

Patients with a background of type 2 diabetes that receive a diagnosis of hypertension should be started on an ACE inhibitor (or angiotensin receptor blocker) regardless of age

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32
Q

What is amiodarone used in the Mx of?

A

Regular broad complex tachycardias without adverse features

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33
Q

What is adenosine used in the Mx of?

A

Treatment of supraventricular tachycardia (SVT). SVT would be a regular, narrow complexed tachycardia

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34
Q

What degree of renal impairment would make you consider stopping an ACEi initiated for HTN?

A

> 30% rise in creatinine

>25% reduction in eGFR

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35
Q

Which angina med can cause anal ulcers?

A

Nicorandil

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36
Q

What is the first line Mx of SVT?

A

Carotid sinus massage or Valsalva manoeuvre

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37
Q

What medication can be given to treat an SVT?

A

Adenosine - 6mg–>12mg–>12mg

Adenosine is contraindicated in asthma, verapamil is the preferable option then

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38
Q

What are the features of Buerger’s disease/

A

Extremity ischaemia - intermittent claudication and ischaemic ulcers
Superficial thrombophlebitis
Raynaud’s phenomenon

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39
Q

How does the CHA2DS2VS score determine anticoagulation strategy?

A 
0 = no anticoagulation
1 = Males, consider treatment. Females = no treatment
2 = Females, consider treatment
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40
Q

What are the ECG features of hypokalaemia?

A
  1. U waves
  2. Small or absent T waves (occasionally inversion)
  3. Prolong PR interval
  4. ST depression
  5. Long QT
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41
Q

What is Mobitz type I heart block?

A

Progressive prolongation of the PR interval until a dropped beat occurs

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42
Q

What is Mobitz type II heart block?

A

PR interval is constant but the P wave is often not followed by a QRS complex

43
Q

What are the features of cardiac tamponade?

A
  1. Hypotension
  2. Raised JVP
  3. Muffled heart sounds
44
Q

What may be found on an ECG in LVH?

A

The ECG shows large R waves in the left-sided leads (V5, V6) and deep S-waves in the right-sided leads (V1, V2). There is also ST elevation in leads V2-3. These findings are consistent with left ventricular hypertrophy. Furthermore, there is also T-wave inversion present in leads V5 and V6, known as the left ventricular ‘strain’ pattern.

45
Q

What type of replacement valve is used in younger people?

A

Mechanical

46
Q

What is the target INR with mechanical aortic valves?

A

3.0

47
Q

What is the target INR with mechanical mitral valves?

A

3.5

48
Q

How is bradycardia with signs of shock managed?

A
  1. Atropine, up to maximum of 3mg
  2. Transcutaneous pacing
  3. Isoprenaline/adrenaline infusion titrated to response
49
Q

What are the adverse effects of loop diuretics?

A 
Hypotension
Hyponatraemia
Hypokalaemia, hypomagnesaemia
Hypochloraemic alkalosis
Ototoxicity
Hypocalcaemia
Renal impairment (from dehydration + direct toxic effect)
Hyperglycaemia (less common than with thiazides)
Gout
50
Q

What is the recommended treatment for regular broad complex tachycardia?

A

Amiodarone

51
Q

Which drug is contraindicated in VT?

A

Verapamil - can precipitate a cardiac arrest in this instance

52
Q

Which group of drugs are contraindicated in renovascular disease?

A

ACEi

53
Q

Which anti-anginal drug can patients develop tolerance to?

A

Nitrates - e.g. isosorbide mononitrate

54
Q

What is the most specific ECG sign of pericarditis?

A

PR depression

55
Q

Which drug is strongly indicated when heart failure and AF co-exist?

A

Digoxin

56
Q

What is Dressler’s syndrome?

A

2-6 weeks following a MI. The underlying pathophysiology is thought to be an autoimmune reaction against antigenic proteins formed as the myocardium recovers. It is characterised by a combination of fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs

57
Q

What are the signs of a left ventricular anyeursm?

A

Persistent ST elevation + left ventricular failure

58
Q

What is a ventricular septal defect?

A

Usually occurs in the first week and is seen in around 1-2% of patients.
Features: acute heart failure associated with a pan-systolic murmur.
An echocardiogram is diagnostic.

59
Q

How does acute mitral regurgitation occur and present?

A

More common with infero-posterior infarction and may be due to ischaemia or rupture of the papillary muscle.
Acute hypotension and pulmonary oedema may occur.
An early-to-mid systolic murmur is typically heard.
Patients are treated with vasodilator therapy but often require emergency surgical repair.

60
Q

How does left ventricular free wall rupture present?

A

Occurs around 1-2 weeks afterwards.
Patients present with acute heart failure secondary to cardiac tamponade (raised JVP, pulsus paradoxus, diminished heart sounds).
Urgent pericardiocentesis and thoracotomy are required.

61
Q

What are normal ECG variants in athletes?

A
  1. Sinus bradycardia
  2. 1st degree atrioventricular block
  3. Wenckebach phenomenon (2nd degree atrioventricular block Mobitz type 1)
  4. Junctional escape rhythm
62
Q

What are the signs of HOCM?

A

Midsystolic murmur heard best at the left lower sternal border.
It was louder with the Valsalva manoeuvre.
An echocardiogram (ECHO) reported mitral regurgitation, systolic anterior motion of the anterior mitral valve leaflet, asymmetric hypertrophy and left ventricular outflow tract obstruction.

63
Q

which congenital heart defect can cause biventricular hypertrophy?

A

Ventricular septal defect

64
Q

How should tachycardia with adverse features be managed?

A

Synchronised DC shock (up to 3) –> followed by amiodarone 300mg + further shock –> then 900mg over 24 hours

65
Q

Which drug can shorten the QT interval?

A

Digoxin

66
Q

How is a <3cm AAA managed?

A

Discharge

67
Q

How is a 3-4.4cm AAA managed?

A

Yearly screening

68
Q

How is a 4.5-5.4cm AAA managed?

A

3/12 screening

69
Q

How is a 5.5cm AAA managed?

A

Referral for repair

70
Q

When may a patient drive again after successful angioplasty, with no further need for treatment?

A

1 week

71
Q

What is the most common defect in Marfan’s syndrome?

A

Aortic root dilatation –> lead to aortic regurgitation

72
Q

What are the features of Tetralogy of Fallot?

A
  1. Pulmonary Stenosis
  2. Right Ventricular Hypertrophy
  3. Overriding Aorta
  4. Ventricular Septal Defect
73
Q

How does apixaban work?

A

Direct factor Xa inhibitor

74
Q

What does CREST stand for?

A 
C - calcinosis
R - Raynaud syndrome
E - esophageal dysmotility
S - sclerodactyly
T - telangectasia
75
Q

What valve score should lead you to consider open valve repair?

A

> 9

76
Q

What are the Major Criteria of the Jones Criteria for Rheumatic Fever?

A
  1. Arthritis
  2. Carditis
  3. Chorea
  4. Subcutaneous nodules
  5. Erythema marginatum
77
Q

Which methods may be used for aortic valve replacement in those unsuitable for traditional surgery?

A

Balloon valvuloplasty or TAVI

78
Q

Which patients with MR are not recommended for surgery?

A

LVEF <30%

79
Q

What type of drug is indapamide?

A

Thiazide-like diuretic

80
Q

How quickly should metformin be titrated?

A

No quicker than weekly

81
Q

Which vessel is implicated in an anteroseptal MI, and what ECG changes would you expect to see?

A

Left anterior descending - V1-V4

82
Q

Which vessel is implicated in an inferior MI, and what ECG changes would you expect to see?

A

Right coronary - II, III, aVF

83
Q

Which vessel is implicated in an anterolateral MI, and what ECG changes would you expect to see?

A

Left anterior descending or left circumflex - V4-V6, I, aVL

84
Q

Which vessel is implicated in a lateral MI, and what ECG changes would you expect to see?

A

Left circumflex - I, aVL, +/- V5-V6

85
Q

Which vessel is implicated in an posterior MI, and what ECG changes would you expect to see?

A

Usually left circumflex, also right coronary - tall R-waves V1-V2

86
Q

What type of MI causes changes to V1-V4?

A

Anteroseptal MI

87
Q

What type of MI causes changes to II, II, aVF?

A

Inferior MI

88
Q

What type of MI causes changes to V4-V6, I and aVL?

A

Anterolateral MI

89
Q

What type of MI causes changes to I, aVL +/- V5-V6?

A

Lateral MI

90
Q

What type of MI causes tall R waves in V1-V2?

A

Posterior MI

91
Q

After trying an ACEI, Ca2+-blocker and a thiazide-like diuretic, if K+ is =4.5, which anti-HTN should be given?

A

Spironolactone

92
Q

After trying an ACEI, Ca2+-blocker and a thiazide-like diuretic, if K+ is >4.5 which anti-HTN should be given?

A

Alpha or beta-blocker

93
Q

Which type drug should not be prescribed with verapamil because of a potential for profound bradycardia?

A

Beta-blockers

94
Q

Which type of anti-hypertensives are contraindicated in heart failure?

A

Calcium channel blockers

95
Q

How do you distinguish between myocarditis and pericarditis?

A

Myocarditis = raised troponin

96
Q

What factors can falsely increase BNP?

A
  1. Left ventricular hypertrophy
  2. Ischaemia
  3. Tachycardia
  4. Right ventricular overload
  5. Hypoxaemia (including pulmonary embolism)
  6. GFR < 60 ml/min
  7. Sepsis
  8. COPD
  9. Diabetes
  10. Age > 70
  11. Liver cirrhosis
97
Q

What factors can falsely decrease BNP?

A
  1. Obesity
  2. Diuretics
  3. ACE inhibitors
  4. Beta-blockers
  5. Angiotensin 2 receptor blockers
  6. Aldosterone antagonists
98
Q

What drug is given to manage Raynaud’s?

A

Nifedipine

99
Q

What are the 6 P’s of acute ischaemic limb?

A 
Pale
Painful
Pulseless
Paralysed
Paraesthesia
Perishingly cold
100
Q

Which drug is most commonly used in malignant hypertension?

A

IV sodium nitroprusside

101
Q

What is the first line treatment for stable angina?

A

Beta-blocker or calcium channel blocker (e.g. verapamil)

102
Q

What are the causes of LBBB?

A

Cardiomyopathy
Idiopathic fibrosis
HTN
Ischaemic heart disease

103
Q

What are the causes of RBBB?

A

Cor pulmonale

Cardiomyopathy

104
Q

What should patients receive after PCI?

A

Prasugrel + aspirin

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