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Medicine (Y4) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Give causes of secondary hypertension.

A

CHAPS - Cushing’s, Hyperaldosteronism, Aortic Coarctation, Pheochromocytoma, Stenosis of renal artery

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2
Q

Give red flags in hypertension.

A
  • Young patient (< 40)
  • Severe hypertension (>180/120)
  • Evidence of organ damage - papilloedema, heart failure, encephalopathy
  • Features of secondary cause eg. cushinoid features, palpitations, renal bruits
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3
Q

What is the gold-standard test for diagnosing hypertension?

A

Ambulatory Blood Pressure Monitoring (ABPM)

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4
Q

What blood pressure cut-off is suggestive of hypertension?

A

> 140/90 in clinic or > 135/85 in ABPM

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5
Q

Which patients with new hypertension would warrant an emergency referrak?

A

> 180/120 or evidence of organ damage (particularly papilloedema)

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6
Q

Which investigations should be performed in a newly diagnosed hypertensive patient?

A

Urinalysis
ECG
Fundoscopy
Blood tests - Us&Es, cholesterol and HbA1C

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7
Q

Mrs R is 45 years old and newly diagnosed with hypertension. What is the first-line anti-hypertensive agent for her?

A

ACEI or ARB

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8
Q

Mrs R is 45 years old and newly diagnosed with hypertension. She completes a trial of Lisinopril but her BP is still 145/95. Which medications could be trialed next?

A

ACEI/ARB and CBB or Thiazide diuretic

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9
Q

Mrs R is 45 years old and newly diagnosed with hypertension. She completes a trial of Lisinopril but her BP is still 145/95. Her GP adds Amlodipine but her BP remains high. Which medications could the GP try now?

A

ACEI/ARB + CCB + Thiazide diuretic

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10
Q

What is the first-line anti-hypertensive agent in patients with T2DM?

A

ACEI/ARB

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11
Q

Mr D is a 60-year-old male who has been newly diagnosed with hypertension. What would be the first-line anti-hypertensive?

A

CCB

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12
Q

Mr D is a 60-year-old male who has been newly diagnosed with hypertension. His GP commences Amlodipine but his BP remains high at 150/100. What would be the next step?

A

CCB + ACEI/ARB or thiazide diuretics

Add ACEI/ARB or a thiazide diuretic

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13
Q

Mr D is a 60-year-old male who has been newly diagnosed with hypertension. His GP commences Amlodipine but his BP remains high at 150/100. After addition of Lisinopril, his BP is still high. What would be the next step?

A

Add a thiazide diuretic

ACEI + CCB + thiazide diuretic

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14
Q

What is the first-line anti-hypertensive agent in patients of African-Caribbean heritage?

A

CCB

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15
Q

Which medications may be considered in resistant hypertension?

A

Spironolactone, beta-blockers or alpha-blockers

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16
Q

What are the first-line medications for stable HF with reduced ejection fraction?

A

ACEI + Beta-blocker

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17
Q

Beta-blockers should not be prescribed with which medications?

A

non-dihydropyridine calcium blockers such as verapamil or diltiazem

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18
Q

Spironolactone causes which electrolyte imbalance?

A

Hyperkalaemia

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19
Q

Inverted T waves may be a sign of…

A

Myocardial ischaemia

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20
Q

Which coronary artery is most likely to be affected in a lateral STEMI?

A

LAD or Left cirumflex

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21
Q

Which coronary artery is most likely to be affected in an inferior STEMI?

A

RCA

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22
Q

What is the treatment for haemodynamically unstable fast AF?

A

DC Cardioversion or IV Amiodarone

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23
Q

What CHADS-VASC score suggests that anti-coagulation is indicated?

A

2 or more

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24
Q

Aortic regurg and ST elevation inferior leads suggests…

A

Proximal aortic dissection

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25
Q

Which electrolyte abnormality is associated with thiazide diuretics?

A

Hypokalaemia

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26
Q

How long after an MI does Dressler syndrome tend to present?

A

2-3 weeks

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27
Q

Give causes of diastolic murmurs.

A

ARMS - Aortic Regurg & Mitral stenosis

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28
Q

Slow-rising pulse suggests…

A

Aortic stenosis

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29
Q

What is the normal cardiac axis?

A

-30 to 90 degrees

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30
Q

Give 3 causes of systolic murmurs.

A

Aortic Stenosis
Mitral Regurg
Tricuspid Regurg

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31
Q

‘Ejection systolic murmur radiating to carotids’ suggests…

A

Aortic stenosis

32
Q

‘Pan-systolic murmur radiating to left axilla’ suggests…

A

Mitral Regurg

33
Q

Which murmur may appear after MI if there is papillary muscle ischaemia?

A

Mitral regurg

34
Q

‘Holosystolic murmur on right side’ suggests…

A

Tricuspid regurg

35
Q

‘Early diastolic murmur best heard on expiration sitting forward’ suggests…

A

Aortic regurg

36
Q

‘Rumbling mid-diastolic murmur (best heard with patient lying on side)’ suggests…

A

Mitral stenosis

37
Q

Tapping apex beat, malar flush suggests…

A

Mitral stenosis

38
Q

What grade of murmur have you heard in the OSCE?

A

Grade 3 (if no thrill)

39
Q

What are the first-line agents for angina prophylaxis?

A

Beta-blocker and CCB

40
Q

What are the second-line agents for angina prophylaxis?

A

isosorbide mononitrate, nicorandil, ivabradine

41
Q

What is important to remember about isosorbide mononitrate dosing?

A

Asymmetric dosing to avoid nitrate tolerance

42
Q

Which medications are recommended in angina to reduce CV risk?

A

Statin and Aspirin

43
Q

Which ECG change is seen in hypercalcaemia?

A

Shortened QT interval

44
Q

What are the treatments for bradycardia?

A
  1. Atropine 2. Cardiac pacing wire
45
Q

What are the 1st and 2nd line treatments for SVT?

A
  1. Vagal manoevres

2. Adenosine

46
Q

What is the treatment for stable acute AF?

A

Cardioversion with Flecainide

47
Q

What is the treatment for acute atrial flutter?

A

Amiodarone or electrical cardioversion

48
Q

What is the treatment for VF?

49
Q

What is the treatment for VT with a pulse?

A

Amiodarone

50
Q

What is the treatment for torsades de pointes?

A

Magnesium Sulphate… DC Shock if required

51
Q

Which types of heart block are usually treated with a pacemaker?

A

2nd degree, Mobitz 2 and 3rd degree heart block

52
Q

What monitoring is required for Digoxin?

A

None required except in suspected toxicity

53
Q

Which gene is faulty in familial hypercholesterolaemia?

A

LDL receptor

54
Q

Which murmur is associated with rheumatic fever?

A

Mitral stenosis

55
Q

How should new-onset AF be treated?

A

Cardioversion with Flecainide or Amiodarone if structural heart disease

56
Q

What 10-year CV risk score indicates a statin should be considered?

57
Q

What is the investigation of choice for stable angina?

A

CT coronary angiogram

58
Q

JVP rising on inspiration suggests…

A

Constrictive pericarditis

59
Q

Which ECG changes are suggestive of ischaemia?

A 
ST elevation
ST depression
T wave inversion
Patholoical Q waves
New LBBB
60
Q

Which artery is likely affected in ACS with new LBBB?

A

Proximal LAD or left main stem

61
Q

Which artery is usually affected in anterior MI?

62
Q

What is the initial management for all ACS?

A

Morphine
Oxygen if hypoxic
Nitrates
Aspirin & Ticagrelor

63
Q

What is the gold-standard treatment for STEMI?

64
Q

For how long can treatment for STEMI de delayed to allow for PCI?

65
Q

How is treatment for NSTEMI and unstable angina determined?

A

GRACE score

66
Q

What GRACE score indicated low 6-month mortality?

67
Q

What management should be offered to patients with NTSEMI/unstable angina if their GRACE score is low?

A

Offer conservative management

Can offer coronary angiography (with follow-on PCI if required) if multiple episodes

68
Q

What management should be offered to patients with NTSEMI/unstable angina if their GRACE score is intermediate or high?

A

Offer coronary angiography (+/- PCI) within 96 hours of admission

69
Q

What is meant by Type 1 MI?

A

‘typical’ MI due to atherosclerosis

70
Q

What is meant by Type 2 MI?

A

ischaemia due to insufficient oxygen supply eg. anaemia, hypovolaemia, coronary artery vasospasm

71
Q

How do you calculate rate from an ECG?

A

Regular: 300/number of large boxes between QRS
Irregular: No. of QRS in 30 squares x 10

72
Q

Which leads help to determine the axis on an ECG?

73
Q

When is thrombolysis indicated in MI?

A

If pt presents within 12 hours of onset but PCI not possible within 120 mins

74
Q

What are the main side effects of Amiodarone?

A

Thyroid dysfunction
Pulmonary fibrosis
Hypokalaemia
Liver cirrhosis

75
Q

Harsh mid-systolic murmur suggests…

A

Pulmonary stenosis

76
Q

New widened T waves could suggest…

A

Hyperacute changes of MI

77
Q

Which anti-hypertensive class is first-line in Afro-Carribean’s?

Medicine (Y4) (13 decks)

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