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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
P450 Inhibitors
SICKFACES.COM ``` Sodium valproate Isoniazid Clarithromycin Ketoconazole Fluconazole Acute alcohol/Amiodarone/Allopurinol C Erythromycin SSRIs Ciprofloxacin Omeprazole Metronidazole ```
26
P450 inducers
CRAPGPS ``` Carbamazepine Rifampicin Alcohol - chronic Phenytoin G Phenoarbital St John's Wort Smoking ```
27
What is the post-MI management?
75mg aspirin 75mg clop/tic/pras 80mg statin ACEi + BB (Consider diltiazem/Verapamil)
28
Restrictive cardiomyopathy
x
29
How does left ventricular free wall rupture present? How is it managed?
1-2 weeks post MI Raised JVP Muffled heart sounds Pulsus paradoxus (similar to cardiac tamponade) Management = urgent pericardiocentesis
30
What does persistent ST elevation after an MI indicate?
Left ventricular aneurysm
31
What is the most common cause of death following an MI?
Ventricular fibrillation --> Cardiac arrest
32
What drug should be given during CPR if a PE is suspected?
Alteplase
33
Which antihypertensive should be avoided in DM?
Thiazide-like - can worsen glycemic control
34
How to manage heart block with an INFERIOR MI?
This is common - treat conservatively if haemodynamically stable
35
How to manage heart block with an ANTERIOR MI?
Transcutaneous pacing
36
Which MI most commonly causes heart block?
Inferior MI (RCA)
37
What is the other most common cause of raised BNP as well as HF?
CKD
38
What medications should all patients diagnosed with CVD e.g. Angina/PAD be offered as primary prevention?
A statin and an anti-platelet (Clopidogrel)
39
What classes as postural hypotension?
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
What causes mitral regurgitation after an MI?
Ruptured papillary muscle | Presents with acute hypotension + pulmonary oedema
41
What are side effects of adenosine?
Bronchospasm Flushing Chest pain
42
When do you start sacubitril-valsartan in heart failure?
x
43
What is the first line investigation for angina?
Contrast enhanced coronary CT angiography
44
How does Coarctation of the aorta present in adults?
Hypertension Notching of the inferior border of the ribs "Rib notching" Radio-femoral delay
45
What counts as major bleeding in wafarin guidelines?
Bleeding which causes tachycardia/hypotension | Bleeding into critical site
46
Someone diagnosed with AF whilst in for a stroke. When to start anticoagulation?
After 2 weeks of antiplatelet therapy
47
What kind of murmur does a tricuspid regurg cause?
Pansystolic murmur | Loudest on INSPIRATION (RILE)
48
What are the differentials of a pansystolic murmur?
Mitral regurgitation —> soft S1 | Tricuspid regurgitation —> pulsatile hepatomegaly
49
What are the differentials of an ejection systolic murmur? What can differentiate them?
Aortic stenosis —> narrow pulse pressure, slow rising pulse, loudest in RUSE Pulmonary stenosis —> loudest in LUSE ASD —> widely split S2
50
How to manage a large PE which is causing hypotension?
Alteplase
51
What are ECG changes in hypokalaemia?
U waves Flattened T waves Prolonged PR Prolonged QT
52
How does myocarditis present and what is is seen on ECG? How is it managed?
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
How long after an MI do you need to stop driving?
Cannot drive for 4 weeks
54
How does Warfarin affect clotting results?
Prolonged APTT
55
New presentation of severe hypertension. (systolic >180, diastolic >110) - what investigations?
* 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
How can you differentiate tricuspid regurg and mitral regurg?
Both pansytolic murmur Mitral= loudest on expiration Tricuspid = loudest on inspiration
57
What are side effects of adenosine?
Chest tightness Flushing Feeling of impending doom
58
How long to continue post-MI drugs for?
Continue all long term except stop second anti-platelet (not aspirin) after 12 months
59
How long does troponin stay raised after an MI?
10 days | If another MI within 10 days suspected - check creatinine kinase MB (CK-MB)
60
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?
Conduct an echo | If they have a valvular heart disease they need to be put on an anticoagulant
61
Which drugs may you need to consider stopping in CHF?
``` Calcium channel blockers - can depress cardiac function and exacerbate symptoms Tricyclic antidepressants NSAIDs - risk of decompensation Corticosteroids QT prolonging medication ```
62
What are signs of acute heart failure?
``` Cyanosis Tachycardia Tachypnoea Raised JVP Displaced apex beat Bibasal crackles Wheeze S3 heart sound ```
63
What other features are seen in mitral regurgitation? (as well as pan systolic murmur)
Soft S1 Widely split S2 S3 sound
64
How is pericarditis diagnosed?
Transthoracic echo
65
Which leads is it normal for the T wave to be inverted?
Lead V1 and avR Can also be normal in lead I, avL and V6 Can also be normal in lead III
66
How is Wolff-Parkinson White Syndrome seen on an ECG?
``` Short PR interval Broad QRS Delta wave Left or right axis deviation Pseudo-Q waves ```
67
How can Digoxin use affect an ECG?
``` U waves Short QT interval Downward sloping ST depression (scooped out appearance) T wave flattening Arrhythmias - AV block ```
68
How does digoxin toxicity present?
Generally unwell, N+V, anorexia
Confusion Yellow green vision Arrhythmias - AV block, bradycardia Gynaecomastia
69
What can precipitate digoxin toxicity?
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
How does aortic dissection present?
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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