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Year 3 - Medical Block Workbooks > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

How much elevation in leads for STEMI?

A

1mm limb, 2mm chest

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2
Q

When do Tnl levels begin to rise and for how long?

A

3-4 hours for up to two weeks

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3
Q

What hs/Tnl level for likely myocardial necrosis?

A

34 for men, 16 for women

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4
Q

When is hs-Tnl taken?

A

Admission and 1 hour

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5
Q

What may be seen in a posterior MI?

A

ST depression in leads v1-4

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6
Q

What four conditions can mimic STEMI on ECG?

A
  1. Early repolarisation (V1-2 in younger, athletic patients)
  2. Pericarditis (widespread, concave ST changes)
  3. Bruguda syndrome (Genetic electrical arhythmia)
  4. Takotsubo cardiomyopathy (stress reaction ‘broken heart’)
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7
Q

Which antiplatelet therapy is indicated in STEMI?

A

Aspirin (300 mg loading dose, 75mg od)
Prasugrel (60 mg loading, 10 mg od 12/12)
[PPCI, u75, >60kg, no prior TIA]

Clopidogrel (600mg loading, 75 mg daily)
Ticagrelor (180mg loading, 90mg bd)
[First choice NSTEMI]

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8
Q

NSTEMI medical management?

A
  1. Morphine
  2. Aspirin
  3. LMWH (Enoxaparin, 48 hours)
  4. Ticagralor if GRACE Score risk >3: (180mg loading, 90mg bd)
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9
Q

What investigations should be offered for patients with CAD likelihoods of:

61-90%
30-60%
10-29%?

A

61-90% - Invasive coronary angiography
30-60% - Stress MRI, echo, myoview
10-29% - CT Calcium scoring

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10
Q

What is the drug treatment for Stable Angina?

A
  1. Asprin 75mg OD ( or clopidogrel 75mg)
  2. GTN
  3. Beta-blockers AND non-dihydropyridines (diltiazem/verapamil)
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11
Q

What sinus node-blocking agent and dose may be used where beta-blockade is contra-indicated? (and HR above 70)

A

Ivabradine (5-7.5 mg)

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12
Q

What are four signs of secondary causes of HTN?

A
  1. Cushing’s
  2. Enlarged kidneys
  3. Renal bruits
  4. Radio-femoral delay (coarction)
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13
Q

What 5 investigations should be undergone in HTN?

A

Kidney

  1. Urine: Protein, albumin:creatinine ratio, haematuria
  2. Blood: Glucose, electrolytes, creatinine, eGFR, cholesterol total and ratio

Eyes
3. Retina screen

Heart

  1. ECG
  2. Echo if suggestion of LVH or valve disease
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14
Q

Which patients should be prescribed CCB over an ACEi?

A

55+ or African or Carribean origin

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15
Q

What four drugs should be started in a Hypertensive Emergency?

A
  1. Sodium nitroprusside
  2. Labetalol
  3. GTN
  4. Esmolol (0.5-1mg over 1 minute)
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16
Q

What combination of classes is advised in Hypertensive urgency? (And which specific drugs)

A
  1. ACEi

2. Calcium antagonist (nifedipine 20mg BD for three days and amlodipine 10 mg OD)

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17
Q

What is the investigation and managment plan for the triad of Headache, sweating, and tachycardia?

A

Phaeochromocytoma:

  1. 24 hr urine collection (metanephrines and catecholamines)
  2. Abdo CT/MRI
  3. Phenoxybenzamine 10 mg OD/BD, increasing (Alpha and beta blockade)
  4. Resection
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18
Q

What are four Ix for Cushing’s?

A
  1. Plasma glucose
  2. 24hr urine cortisol (3x normal)
  3. Low-dose dexamethasone suppresion test.
  4. Adrenal CT
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19
Q

Primary Aldosteronism?

  1. Suspicion
  2. Confirmation
A
  1. Low/normal potassium and high/normal sodium
  2. Resistant hypertension
  3. Aldosterone:Renin ratio
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20
Q

Which patients are likely to have HFNEF?

A
  1. Elderly
  2. Overweight
  3. HTN
  4. AF
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21
Q

What are the CXR features of Heart failure?

A

A. Alveolar Oedema
B. Kerley B Lines
C. Cardiomegaly
D. ‘Deer antlers’ perihilar-shadowing

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22
Q

What five drugs are used in the medical management of HF?

A
  1. Diuretics (Furosemide 40mg-500mg, Bumetanide, Dendroflumethiazide 2-5mg OD, Metolazone 2.5-5mg, Spironolactone 25mg OD)
  2. ACEi
  3. ARB (Valsartan/candesartan)
  4. ARNI [neprilysin inhibitor] (Sabcutril w/ valsartan)
  5. Beta blockers [low and go slow]
    Carvedilol (Two weeks 3.125 mg BD - 6.25 mg BD - 12.5 mg BD - 25 mg BD)
    Bisoprolol (1 week 1.25 mg OD, 2.5 mg OD, 3.75 mg OD, 5mg OD 4 weeks, 7.5 mg OD, 10mg OD)
23
Q

What does ‘Start low and go slow’ mean for Beta blockade?

A

Carvedilol (Two weeks 3.125 mg BD - 6.25 mg BD - 12.5 mg BD - 25 mg BD)
Bisoprolol (1 week 1.25 mg OD, 2.5 mg OD, 3.75 mg OD, 5mg OD 4 weeks, 7.5 mg OD, 10mg OD)

24
Q

When is a CRT pacemaker indicated and how does it work?

A

Cardiac resynchronisation pacemakers

  1. Left Bundle Branch Block
  2. The broad QRS results in septum-lateral wall delay
25
Q

When is an ICD indicated?

A

Secondary (or primary) prevention of sudden cardiac arrest

26
Q

What are two irreversible sequalae of Valvular disease?

A

Ventricular dysfunction

Pulmonary hypertension

27
Q

What are three classical symptoms of aortic stenosis?

A
  1. Angina
  2. Heart failure
  3. Syncope
28
Q

What are the most common causes and symptoms of Aortic Regurgitation?

A

Symptom:

  1. Exertional dyspnoea
  2. Reduced exercise tolerance

Causes:

  1. Idiopathic dilatation
  2. Congenital valve abnormalities (bicuspid)
  3. Calcific degeneration
  4. Rheumatic disease
  5. Endocarditis
  6. Marfan’s
29
Q

What are two signs of Aortic regurgitation?

A

De Musset’s (head bob)

Collapsing pulse

30
Q

Severe AR + LV dilation

- Medical Mx

A

ACEi (afterload reduction)

31
Q

What are the commonest causative organisms of IE, detailing after prosthesis?

A
  1. Strep viridans (50%)
  2. Staph a (20%) (IVDUs - 50%)
  3. Enterococal - 10%
  4. Fungi (high mortality) - 2-10% (candida/aspergillus; immunosupressed/IVDU/surgery/IV)
  5. HACEK - Not on culture

Prosthesis:

  1. First year - coag neg staph (epidermis)
  2. ‘Later’ - viridans, aureus, coag neg.
32
Q

Blood cultures for IE?

A

At least 3 (preferably 6)
Different sites
Several hours

33
Q

IE ABx ?

A

Strep:
Benzylpenicillin +gentamicin
(vanc if allergic)

Enterococci:
Amoxicillin + gent
(vanc if allergic)

Staph:
Flucloxacillin + gent
(benzylpenicillin or vanc if sensitive/allergic)

34
Q

Three degrees of AV block?

A

First degree:

PR > 0.2 seconds
(check digoxin toxicity/rate limiters)

Second:

Wenckebach (Mobitz I)
Progressive PR lengthening and drop

(Mobitz II)
Constant PR and drops
Permanent pacing arranged

Third degree:
No relationshipp between P and QRS

35
Q

What management is indicated in complete AV block?

A
  1. Atropine (600 micrograms to 3mg)
    - unstable (anticholinergic)
  2. Urgent pacing (within 24 hours)
  3. CaCL2 (10mlx 10%, 3-5 minutes)
    - Hyperkalaemia
  4. Isoprenaline (5micrograms/min)
    - Adrenaline analogue
    - Beta agonist
36
Q

AF stages and management?

A
  1. Silent: no treatment
  2. Paroxysmal:

CHADVaSc + HAS-BLED + anticoagulation
Rate control (betablocker, digoxin [non-dihydropyridine in >40% EF]
Ablation

3.Persistent:

Cardioversion

4.Permanent:

Ablation

37
Q

What are three vagal manoeuvres?

A
  1. Breath-holding
  2. Valsalva (modified)
  3. Carotid massage on one side (young patients)
38
Q

Short term medical management of SVT?

A

Flecainide (best but CI’d in MI history)

Adenosine (90% effective in AVNRT or AVRT)

CCB (Verapamil contraindicated in Beta Blocker patients)

39
Q

Which drugs should NOT be used in WPW or AVRT?

A

WPW Contraindications

  1. Verapamil
  2. Digoxin
  3. Amiodarone
40
Q

What is the medical management of stable VT?

A

Stable VT

  1. Beta blockade
  2. Amiodarone (300mg loading, 900mg over 24hrs)
  3. Lidocaine (50-100mg over 3-5 mins)
41
Q

AF Signs and Sx

A
  1. Palpitations
  2. Dizziness
  3. SoB and Fatigue
42
Q

AF Mx

A
  1. CHA2DVASc and HASBLED
  2. Rate control (BB /CCB)
  3. Rhythm control (BB)
  4. Catheter ablation
43
Q

AF

First prescription Follow-up

A

AF Follow-up

  1. 1 Week of Tx
  2. Ventricular rate: 60-80 (90-115 during exercise)
  3. INR 2-3 (Warfarin)
44
Q

HFPeF

-	Risk factors
A

HFPeF RFs

  1. Age
  2. Obesity
  3. Diabetes
  4. HTN
45
Q

HFReF Foundation Drugs

A

HFReF Foundation Drugs

  1. BB
  2. ACEi
  3. Spironolactone
  4. SGLT
46
Q

IHD Mx

A

IHD Mx

Conservative
1. Lifestyle

Medical

  1. BP
  2. Lipids (Statin -> PCSK9)
  3. HbA1c
  4. Anti-platelet
  5. GTN Spray
47
Q

Bi-fascicular block

- ECG

A

Bi-fascicular block

RBBB with:

  1. Left anterior fascicular block
    • Left axis deviation
  2. Left posterior fascicular block
    • Right axis deviation
    • Less common (R+L circumflex supply)
48
Q

Tri-fascicular Block

- ECG

A

Tri-fascicular Block

  1. RBBB
  2. Left axis deviation
  3. Third degree block
49
Q

Unstable WPW

- Management

A

Unstable WPW

  1. DC Cardiovert
50
Q

WPW Management

- Narrow tachy

A

Narrow Tachy WPW

  1. Valsalva
  2. Adenosine or AV blocking
    - 2º Verapamil/diltiazem
    - 2º Metoprolol
    - 3º Amiodarone/flecainide
  3. Rapid Pacing
  4. DC cardiovert
51
Q

WPW Management

- Wide complex

A

Wide tachy WPW

  1. IV Adenosine
    Or Anti-arrhythmics
    - 2º Procainamide
    - 2º Amiodarone/flecainide
52
Q

WPW Management

- Stable w/ AF or A Flutter

A

WPW and AF or A Flutter

  1. Antiarrhythmics
    - Procainamide
    - Flecainide
  2. Rapid pacing
  3. DC Cardiovert
53
Q

WPW Management

- Stable w/ Atrial Tachycardia

A

Atrial Tachy WPW

1 Anti-arrhythmic

  • Procainamide/ibutilide
  • Amiodarone/flecainide

Year 3 - Medical Block Workbooks (7 decks)

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