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Medicine Finals: HARD STUFF ONLY > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is seen on ECG in HOCM?

A

Deep/Amplified Q waves
Inverted T waves
LVH

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2
Q

What is seen on echo in HOCM?

A

MR SAM ASH
Mitral regurg
Systolic anterior moton
Asymmetric hypertrophy

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3
Q

Which drugs should be avoided in HOCM?

A

ACEi
Nifedipine
Nitrates

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4
Q

What are signs of HOCM?

A

Ejection systolic murmur loudest at LLSE
Jerky pulse
Displaced apex beat
Apical thrill

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5
Q

What are causes of dilated cardiomyopathy?

A

Idiopathic (most common)
Coxsackie B
Alcohol, cocaine
Peripartum

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6
Q

What are signs of dilated cardiomyopathy?

A

Features of HF
Systolic murmur
S3 sound
Displaced apex beat

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7
Q

What is Brugada syndrome?

A

Genetic condition caused by sodium channelopathies

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8
Q

What is the diagnostic criteria for Brugada syndrome?

A

VF or polymorphic VT (Torsades des pointes)
Family history of sudden cardiac death <50
Syncope
Nocturnal agonal breathing

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9
Q

What are risk factors for sudden cardiac death in Brugada Syndrome?

A 
Fever 
Excess alcohol
Dehydration
Hypokalaemia
Hypomagnasaemia
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10
Q

What are the diagnostic criteria for IE?

A

Need 2 major or 1 major + 3 minor or 5 minor

Major criteria=
Positive blood cultures
Evidence of endocardial involvement

Minor criteria=
IVDU or other predispositon
Fever
Vascular phenomena
Immunological phenomena
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11
Q

What are the diagnostic criteria for rheumatic fever?

A

Need evidence of recent strep + 2 major or 1 major + 2 minor

Evidence of recent strep = positive throat swab or increased strep antibodies

Major criteria = JONES
Joints - Arthritis
Pericarditis/Valvulitis
Nodules (subcutaneous)
Erythema marginatum
Sydenham's chorea
Minor criteria
Raised CRP/ESR
Fever
Arthralgia
Prolonged PR interval
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12
Q

How is rheumatic fever treated?

A

Pen V

NSAIDs

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13
Q

What to do after fibrinolysis in STEMI?

A

Repeat ECG in 60-90 mins

If ST elevation not resolved – urgent PCI

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14
Q

How to manage a patient who has received a PCI but is still experiencing pain or haemodynamic instability?

A

Urgent CABG

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15
Q

What further drugs can you consider adding in heart failure? (After ACEi, BB and Spironolactone)

A

Hydralazine + nitrate (especially in black/Caribbean)

Digoxin

Ivabradine (if in sinus rhythm >75bpm and left ventricular fraction <35%)

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16
Q

What is the criteria for starting Ivabradine in HF?

A

if in sinus rhythm >75bpm and left ventricular fraction <35%

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17
Q

What are contraindications to adenosine?

A

Asthma/COPD
Heart failure
Heart block
Severe hypotension

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18
Q

What are the 4 stages of hypertension?

A

Stage 1 = >140/80
Stage 2 =>160/100
Stage 3=Systolic >180 or diastolic >110

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19
Q

When to offer drug treatment for Stage 1 HTN?

A

If the patient is LESS THAN 80 plus has one of the following:
Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10 year cardiovascular risk of 10% or over

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20
Q

How should you mange acute heart failure not responding to treatment?

A

CPAP

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21
Q

How can raised ICP show on an ECG?

A

Long QT

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22
Q

When do beta blockers need to be stopped in heart failure?

A

Heart rate less than 50 BPM
2nd or 3rd degree AV block
Shock

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23
Q

What is the major contraindication to Verapamil?

A

Ventricular tachycardia

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24
Q

What should you consider in someone with a stroke/TIA/PE and a fever?

A

Infective endocarditis

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25
Q

P450 Inhibitors

A

SICKFACES.COM

Sodium valproate
Isoniazid
Clarithromycin
Ketoconazole
Fluconazole
Acute alcohol/Amiodarone/Allopurinol
C
Erythromycin
SSRIs
Ciprofloxacin
Omeprazole
Metronidazole
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26
Q

P450 inducers

A

CRAPGPS

Carbamazepine
Rifampicin
Alcohol - chronic
Phenytoin
G
Phenoarbital
St John's Wort
Smoking
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27
Q

What is the post-MI management?

A

75mg aspirin
75mg clop/tic/pras
80mg statin
ACEi + BB (Consider diltiazem/Verapamil)

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28
Q

Restrictive cardiomyopathy

A

x

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29
Q

How does left ventricular free wall rupture present? How is it managed?

A

1-2 weeks post MI
Raised JVP
Muffled heart sounds
Pulsus paradoxus

(similar to cardiac tamponade)

Management = urgent pericardiocentesis

30
Q

What does persistent ST elevation after an MI indicate?

A

Left ventricular aneurysm

31
Q

What is the most common cause of death following an MI?

A

Ventricular fibrillation –> Cardiac arrest

32
Q

What drug should be given during CPR if a PE is suspected?

A

Alteplase

33
Q

Which antihypertensive should be avoided in DM?

A

Thiazide-like - can worsen glycemic control

34
Q

How to manage heart block with an INFERIOR MI?

A

This is common - treat conservatively if haemodynamically stable

35
Q

How to manage heart block with an ANTERIOR MI?

A

Transcutaneous pacing

36
Q

Which MI most commonly causes heart block?

A

Inferior MI (RCA)

37
Q

What is the other most common cause of raised BNP as well as HF?

A

CKD

38
Q

What medications should all patients diagnosed with CVD e.g. Angina/PAD be offered as primary prevention?

A

A statin and an anti-platelet (Clopidogrel)

39
Q

What classes as postural hypotension?

A

A drop in systolic BP of 20mmHg or more (with or without symptoms)

A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without symptoms)

A drop in diastolic BP of 10mmHg with symptoms (although clinically much less significant than a drop in systolic BP).

40
Q

What causes mitral regurgitation after an MI?

A

Ruptured papillary muscle

Presents with acute hypotension + pulmonary oedema

41
Q

What are side effects of adenosine?

A

Bronchospasm
Flushing
Chest pain

42
Q

When do you start sacubitril-valsartan in heart failure?

A

x

43
Q

What is the first line investigation for angina?

A

Contrast enhanced coronary CT angiography

44
Q

How does Coarctation of the aorta present in adults?

A

Hypertension
Notching of the inferior border of the ribs “Rib notching”
Radio-femoral delay

45
Q

What counts as major bleeding in wafarin guidelines?

A

Bleeding which causes tachycardia/hypotension

Bleeding into critical site

46
Q

Someone diagnosed with AF whilst in for a stroke. When to start anticoagulation?

A

After 2 weeks of antiplatelet therapy

47
Q

What kind of murmur does a tricuspid regurg cause?

A

Pansystolic murmur

Loudest on INSPIRATION (RILE)

48
Q

What are the differentials of a pansystolic murmur?

A

Mitral regurgitation —> soft S1

Tricuspid regurgitation —> pulsatile hepatomegaly

49
Q

What are the differentials of an ejection systolic murmur? What can differentiate them?

A

Aortic stenosis —> narrow pulse pressure, slow rising pulse, loudest in RUSE
Pulmonary stenosis —> loudest in LUSE
ASD —> widely split S2

50
Q

How to manage a large PE which is causing hypotension?

A

Alteplase

51
Q

What are ECG changes in hypokalaemia?

A

U waves
Flattened T waves
Prolonged PR
Prolonged QT

52
Q

How does myocarditis present and what is is seen on ECG? How is it managed?

A

Myocarditis = inflammation of the myocardium

Usually young patient with chest pain and acute pulmonary oedema - doesn’t change with position like pericarditis does

Associated with signs of infection

ECG = tachycardia, ST elevation, T wave inversion

Management = supportive

53
Q

How long after an MI do you need to stop driving?

A

Cannot drive for 4 weeks

54
Q

How does Warfarin affect clotting results?

A

Prolonged APTT

55
Q

New presentation of severe hypertension. (systolic >180, diastolic >110) - what investigations?

A
  • Look for signs of retina haemorrhage or papilloedema
  • Or life threatening symptoms - chest pain, confusion, heart failure, AKI
  • Referral if pheachromocytoma is suspected
  • If none of above - bloods, urine creatinine, ECG (to look for end organ damage)
56
Q

How can you differentiate tricuspid regurg and mitral regurg?

A

Both pansytolic murmur
Mitral= loudest on expiration
Tricuspid = loudest on inspiration

57
Q

What are side effects of adenosine?

A

Chest tightness
Flushing
Feeling of impending doom

58
Q

How long to continue post-MI drugs for?

A

Continue all long term except stop second anti-platelet (not aspirin) after 12 months

59
Q

How long does troponin stay raised after an MI?

A

10 days

If another MI within 10 days suspected - check creatinine kinase MB (CK-MB)

60
Q

If someone with AF has a cha2ds2vasc score of 0 (or 1 in women), what do you need to make sure before not anticoagulating them?

A

Conduct an echo

If they have a valvular heart disease they need to be put on an anticoagulant

61
Q

Which drugs may you need to consider stopping in CHF?

A 
Calcium channel blockers - can depress cardiac function and exacerbate symptoms
Tricyclic antidepressants
NSAIDs - risk of decompensation
Corticosteroids
QT prolonging medication
62
Q

What are signs of acute heart failure?

A 
Cyanosis
Tachycardia 
Tachypnoea 
Raised JVP
Displaced apex beat
Bibasal crackles
Wheeze
S3 heart sound
63
Q

What other features are seen in mitral regurgitation? (as well as pan systolic murmur)

A

Soft S1
Widely split S2
S3 sound

64
Q

How is pericarditis diagnosed?

A

Transthoracic echo

65
Q

Which leads is it normal for the T wave to be inverted?

A

Lead V1 and avR
Can also be normal in lead I, avL and V6
Can also be normal in lead III

66
Q

How is Wolff-Parkinson White Syndrome seen on an ECG?

A 
Short PR interval
Broad QRS
Delta wave 
Left or right axis deviation 
Pseudo-Q waves
67
Q

How can Digoxin use affect an ECG?

A 
U waves
Short QT interval
Downward sloping ST depression (scooped out appearance)
T wave flattening
Arrhythmias - AV block
68
Q

How does digoxin toxicity present?

A

Generally unwell, N+V, anorexia
Confusion
Yellow green vision
Arrhythmias - AV block, bradycardia
Gynaecomastia

69
Q

What can precipitate digoxin toxicity?

A

Classicially HYPOKALAEMIA

Also renal failure and other electrolyte disturbances - hypomagnasaemia, hypercalcaemia, hypernatraemia
Drugs=Amiodarone,Verapamil,Diltiazem,Ciclosporin
Drugs which cause hypokalaemia e.g. thiazides and loop

70
Q

How does aortic dissection present?

A

Chest pain radiating to back
Pulse deficit – weak/absent pulses
Variation in systolic BP between the two arms
Aortic regurg

Medicine Finals: HARD STUFF ONLY (23 decks)

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