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1 Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what should be paid close attention for in diabetes with non specific symptoms and no chest pain present?

A

silent MI

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2
Q

if angina is not controlled with a beta blocker what should be added?

A

CCB

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3
Q

how does myocarditis present in a young patient?

A

ST elevation
acute pulmonary oedema
flu like symptoms

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4
Q

what is the NSTEMI management in unstable patients?

A

immediate coronary angiography

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5
Q

what should be investigated for in a patient with new BP >180/120 and no worrying signs

A

urgent investigation for end-organ damage

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6
Q

what can pericarditis arrise secondary to?

A

malignancy

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7
Q

what should be added to a patient with poorly controlled hypertension already on a CCB?

A

add ACEi or ARB or thiazide-like diuretic

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8
Q

what can happen after infarction of a right coronary and why?

A

can cause arrhythmias due to supply of the AV node

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9
Q

what are the most common ECG findings in arrhythmogenic right ventricular dysplasia? (ARVD)

A

epsilon wave

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10
Q

what is an epsilon wave?

A

small positive deflection at the end of QRS complex

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11
Q

what cardiology disease may patients with poor dental hygiene present with?

A

endocarditis secondary to streptococci infection

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12
Q

how do diuretics help heart failure?

A

only improve symptoms

no effect on mortality

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13
Q

what disease may thiazides cause?

A

gout

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14
Q

what diseases is Mitral regurgitation associated with?

A

collagen disorders such as Marfan’s syndrome and Ehlers-Danlos syndrome

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15
Q

what is S3 (gallop rhythm) a sign of?

A

LVF

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16
Q

what should be done in a suspected PE with wells score <4 and D-dimer is negative

A

stop anticoagulation

consider alternative diagnosis

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17
Q

what is the gold standard treatment for patient with STEMI

A

primary percutaneous coronary intervention

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18
Q

in heart failure with a reduced EF and maintained symptoms what should be offered after a ACEi and Beta blocker

A

mineralocorticoid receptor antagonist

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19
Q

what is aortic regurgitation associated with?

A

Marfan’s syndrome

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20
Q

what electrolyte imbalance may thiazide diuretics cause?

A

hypokalaemia

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21
Q

what is the investigation for suspected aortic dissection?

A

CT angiography

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22
Q

what should be done in new onset AF <48hrs after presentation?

A

electrical cardioversion

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23
Q

how long is the treatment for unprovoked PE?

A

6 months

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24
Q

what is the investigation for suspected PE with wells score >4

A

D-dimer

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25
Q

what is the conservative management for an NSTEMI antiplatelet choice?

A

aspririn plus either
ticagrelor (not high bleeding risk)
clopidogrel (high bleeding risk)

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26
Q

what may orthostatic hypertension be exacerbated by?

A

venous pooling during exercise
post prandial
post prolonged bed rest (deconditioning)

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27
Q

what disease is associated with sudden cardiac disease in young athletes?

A

hypertrophic obstructive cardiomyopathy

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28
Q

how long are provoked PE treated for?

A

3 months

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29
Q

what can cause long QT syndrome?

A

hypokalaemia

antidepressants (SSRI and tricyclics)

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30
Q

what is stable angina?

A

chest pain on exertion that is relieved by rest

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31
Q

what is the management for stable angina?

A

beta blockers
GTN spray
risk factor modification

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32
Q

what is the cause of stable angina?

A

mismatch in oxygen supply and demand to myocardium

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33
Q

what test should be run in non-ST elevation chest pain?

A

troponin

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34
Q

what is the cause of Non-ST elevation on ECG with high troponins?

A

NSTEMI

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35
Q

what is the cause of non-ST elevation on ECG with normal troponins?

A

Unstable angina pectoris

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36
Q

what are the ECG findings in an NSTEMI?

A

dynamic T wave inversion

ST depression

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37
Q

what can T wave inversion with sudden chest pain be suggestive of?

A

myocardial ischaemia

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38
Q

what is the immediate and long term management of ACS?

A 
MONA BASH
morphine 
oxygen 
nitrates- GTN spray
antiplatelet- dual- aspirin and clopidogrel or ticagrelor

Beta blockers (bisoprolol)
ACEi (ramipril)
Statin (atorvastatin)
heparin

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39
Q

what is the management of a STEMI <12 hrs from symptoms

A

percutaneous coronary intervention if possible within 2 hours or thrombolysis if not within 2 hours

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40
Q

what is the management STEMI >12 hrs symptoms?

A

angiography followed by PCI if necessary

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41
Q

what is the management of NSTEMI?

A
  1. immediate ACS protocol
  2. fondaparinux
  3. risk stratify high or low
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42
Q

what is the treatment for high risk stratified NSTEMI?

A

angiography within 48-72 hours

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43
Q

what is the treatment for low risk stratified NSTEMI?

A

medical management

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44
Q

what are the signs of right heart failure backlog in veins?

A

peripheral oedema

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45
Q

what are the signs of left heart failure

A

pulmonary oedema - breathlessness, cant lie flat, wake at night breathless

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46
Q

what are the causes of heart failure?

A

valvular disease
cardiomyopathy
hypertenion
IHD

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47
Q

what are the bedside tests for heart failure?

A

ECG

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48
Q

what are the bloods for heart falure?

A

ABG
troponin
BNP

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49
Q

what is BNP released in response to?

A

ventricular stretch

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50
Q

what imaging can be done for heart failure?

A

CXR- pulmonary oedema

echo

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51
Q

what is the immediate management for heart failure?

A

sit the patient up

high flow oxygen (15L/min via non-rebreathe mask)

52
Q

what is the medical management for heart failure?

A

IV furosemide (loop diuretic)
GTN or isosorbide mononitrate
morphine

53
Q

what is the long term management for HF?

A

beta blocker (bisoprolol)
ACEi( ramipril)
risk factor modificaiton

54
Q

what are the signs of pulmonary oedema on CXR?

A 
alveolar shadowing
kerly B lines
cardiomegaly
upper lobe diversion 
PE
55
Q

what are the causes of AF?

A 
idiopathic
pneumonia
IHD
valvular disease
hyperthyroidism
alcohol 
PE
56
Q

what is the ECG signs of AF?

A

irregularly irregular narrow complex tachycardia with no p-waves

57
Q

what is the management of hemodynamically unstable AF?

A

DC cardioversion

58
Q

what can be used for rate control in AF?

A

beta blocker (bisoprolol)

59
Q

what is used for rhythm control in AF

A

when clear reversible cause <48hrs –> DC or chemical cardioversion
>48hrs –> anticoagulated 3-4 weeks first

60
Q

what drugs can be used for chemical cardioversion?

A

amiodarone

flecainide

61
Q

what score can be used to calculate stroke risk after AF?

A

CHADS-Vasc

62
Q

what score is used for risk of bleeding if anticoagulated?

A

HAS-BLED

63
Q

what is used to minimise stroke risk after AF

A

DOAC (apixaban)

after calculating CHADS-Vasc vs HAS-BLED

64
Q

what is virchow’s triad?

A

factors contributing to abnormal clot formation
Stasis
hypercoagulability
vessel wall injury

65
Q

what may cause stasis?

A

activation of clotting factors from

AF or venous clots (PE/DVT))

66
Q

what pathway do anticoagulants act on

A

Stasis

inactivation of clotting factors

67
Q

what does vessel wall injury result in?

A

platelet activation resulting in a clot formation

68
Q

what may vessel wall injury cause?

A

arterial thrombosis (MI, stroke)

69
Q

what do anti-platelets work on?

A

inhibit platelet activation after vessel wall injury

70
Q

what is SVT?

A

regular narrow complex tachycardia with no P-waves and supraventricular origin

71
Q

what electrical abnormalities can cause SVT?

A

AVNRT

AVRT

72
Q

what causes AVNRT

A

nodal circuit formed within AV node that randomly fires off causing ventricular depolarisation

73
Q

what causes AVRT

A

accessory pathway between atria and ventricles

74
Q

what ECG abnormality may be present after the termination of the SVT?

A

delta wave (slurred upstroke of QRS complex)

75
Q

what disease may have the presence of an accessory pathway that pre-disposes to SVT?

A

WPW syndrome

76
Q

what is the management for haemodynamically unstable SVT?

A

DC cardioversion

77
Q

what is the management for haemodynamically stable SVT?

A
  1. vagal manoeuvres
  2. if unsuccessful- Adenosine 6mg
  3. If unsuccessful- adenosine 12mg
  4. if unsuccessful - adenosine 12mg again
  5. if unsuccessful again Beta blockers, IV digoxin, IV amiodarone, synchronised DC cardioversion
78
Q

what drug used in SVT is contraindicated in asthma? and what should be used instead?

A

adenosine - use verapamil

79
Q

what type of murmur is aortic stenosis?

A

ejection systolic

80
Q

what type of murmur is mitral stenosis

A

mid diastolic

81
Q

what type of murmur is aortic regurgitation?

A

early diastolic

82
Q

what type of murmur is mitral regurgitation?

A

pan systolic

83
Q

what are the right sided murmurs?

A

tricuspid and pulmonary

84
Q

when are right sided murmurs heard loudest?

A

inspiration

as blood goes IN the right side

85
Q

what are the left sided murmurs

A

mitral and aortic

86
Q

when are left sided murmurs heard loudest?

A

Expiration

as blood EXits the left side of the heart

87
Q

what are the causes of murmus?

A 
infective endocarditis
senile calcification (especially aortic valve)
rheumatic heart disease
cardiomyopathy
physiological (high turbulent flow)
ischaemic heart disease
88
Q

what side heart murmurs are more common and why?

A

left- higher pressure system

89
Q

what are right sided heart murmurs commonly caused by?

A

IV drug users by S. aureus infection

90
Q

what is acute limb ischaemia?

A

sudden decrease in limb perfusion that threatens the viability of the limb

91
Q

what is a major risk factor for acute limb ischaemia?

A

AF

92
Q

what is the presentation of acute limb ischaemia?

A 
6P's 
pale
pulseless
painful
perishingly cold
paralysis
paraestheia
93
Q

what is the management for acute limb ischemia?

A

IV heparin immediately
refer vascular surgery
options: embolectomy, bypass, amputation

94
Q

what is peripheral vascular disease?

A

limb ischaemia resulting from atherosclerosis in the lower limb vasculature

95
Q

what is the presentation of mild peripheral vascular disease?

A

intermittent claudication

96
Q

what is intermittent claudication

A

cramping leg pain after walking
relieved by rest
peripheral parallel of stable angina

97
Q

what are the signs of a severe form of PVD?

A

ulcers (tissue loss)
gangrene
limb pain at rest
night pain

98
Q

what are the investigations for PVD?

A

ABPI (ankle brachial pressure index)
duplex USS
CT/MRI angiography
dealt with by vascular surgeons

99
Q

what should be given before angiography?

A

IV unfractionated heparin

100
Q

what are stents infused with for anti-proliferative agent?

A

tacrolimus

101
Q

what are the consequences of tacrolimus for anti-proliferation in stents?

A

decreased endothelialisation requiring Dual antiplatelet therapy for 1 year, after which can continue on one antiplatelet

102
Q

what can cause a raised BNP?

A

heart failure
left ventricular dysfunction (MI or valvular disease)
chronic kidney disease

103
Q

what factors reduce BNP levels

A

ACEi
ARB
diuretics

104
Q

when should antihypertensive treatment initially be offered

A

<80YO stage 1 hypertension with organ damage, established CVD, diabetes, renal disease and >10% QRISK
stage 2 hypertension always

105
Q

what is the diagnosis of stage 1 hypertension?

A

BP >140/90 clinically

ABPM >135/85

106
Q

what is diagnosis of stage 2 hypertension

A

BP >160/100 clinically

ABPM >150/95

107
Q

what is diagnosis severe hypertension

A

clinical systolic >180 or diastolic >110

108
Q

what is the first line treatment for hypertension?

A

<55 or diabetic ACEi or ARB

>55 of black african/acro-caribbean = CCB

109
Q

what are the ECG findings suggestive of cardiac tamponade?

A

electrical alternans (varying heights of QFS complex)

110
Q

what is used to counteract warfarin

A

vitamin K

111
Q

what should be done in a patient with INR > 5 <8 with minor bleeding

A

withold warfarin until INR <5

give vitamin K

112
Q

what should be done in a patient >8 no bleeding

A

stop warfarin
give vitamin K
restart when INR <5

113
Q

what should be done in patient with 5

A

withold couple doses warfarin

no vit K

114
Q

if angina is not being controlled with a beta blocker what should be added?

A

CCB (amlodipine)

115
Q

what are the signs of VSD?

A

symptoms of heart failure
pansystolic murmum at lower left sternal edge (blood rushing across septum from left to right ventricle)
louder P2

116
Q

what is the most common cause of mitral stenosis?

A

rheumatic fever

117
Q

what is used to treat torsades de pointes?

A

IV magnesium sulfate

118
Q

what are a side effect of thiazide diuretics?

A

hypercalcaemia and hypocalciuria

119
Q

what is the likely diagnosis in a patient with persistent ST elevation 4 weeks post MI with bibasal crackles and S3 and S4 heard

A

left ventricular aneurysm

120
Q

what should be given to paitents with >10% CVD risk?

A

statins

121
Q

for black african or african-caribbean origin taking a CCB for hypertension what is the preferred second agent if required?

A

ARB over ACEi

122
Q

what is used to treat symptomatic bradycardia first line?

A

atropine

123
Q

what is used to treat symptomatic bradycardia if atropine fails?

A

external pacing

124
Q

what is the likely diagnosis of a young male smoker with symptoms similar to limb ischaemia?

A

Buerger’s disease

125
Q

what drug may be associated with visual disturbances including phosphenes and green luminsecence?

A

ivabradine

126
Q

what do statins commonly have interaction with?

A

clarithromycin/erythromycin

1 Medicine (10 decks)

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