Cardiology Flashcards
1
Q
SOB, experiencing weakness and tiredness
A
Pulmonary hypertension
2
Q
high pitched decrescendo murmur
A
Pulmonary regurgitation and therefore pulmonary hypertension
3
Q
treatment for pulmonary hypertension
A
oxygen therapy, diuretics and bosentan
4
Q
secondary to pulmonary hypertension and causes oedema
A
right heart failure
5
Q
Bosentan is an endothelin receptor antagonist. Endothelin is a
A
vasoconstrictor
6
Q
SOB, jugular veins distend even when he inspires
A
Constrcitive pericarditis
7
Q
budd chairi syndrome
A
blood clots in the hepatic vein or inferior vena cava
-flattened neck veins
8
Q
supraventricular tachycardias are
A
narrow complex tachycardias QRS <120ms
9
Q
long term hypertensions and painful burning sensation in both legs
A
coarctation of the aorta
10
Q
patients present with hypertension in the upper extremities and hypotension in lower extremities
A
coarctation of the aorta
11
Q
CXR-notching of ribs
A
coarctation of the aorta
12
Q
renal artery stenosis
A
bruit on auscultation of abdomen and creatinine would be elevated
13
Q
machine like murmur
A
patent ducts arteriosus
14
Q
widely split s2
A
atrial septal defect
15
Q
artery supplies the inferior aspect of the heart
A
posterior interventricular branch - branch off right coronary artery
16
Q
what does alcohol and caffeine do to blood pressure
A
elevates it
17
Q
what may cause an abnormally low bp
A
too large cuff
18
Q
gold treatment for STEMI
A
aspirirn, ticagrelor, LMWH, followed by pci
19
Q
most likely to be involved in a bundle branch block during an MI
A
Left anterior descending artery
20
Q
ecg findings of atrial fib
A
absent p waves and irregular qrs complexes
21
Q
long pr interval indicates
A
heart block
22
Q
bifid p waves
A
left atrial hypertrophy
23
Q
2 episodes of penumothorax, ectopia lentis, high arched palate, positive wrist and thumb sign
A
dilated aortic root
24
Q
marfan syndrome is associated with
A
mitral valve prolapse and aortic aneurysms
25
coarctation of the aorta is associated with
turners syndrome
26
wide spread st eleveation which are saddle shaped due to the concave upwards shape
pericarditis
27
pacemaker where both atria and ventricles are sensed
DDD
28
pacemaker for chronic atrial fibrilation
VVI
29
when are AAI pacemakers used
when there is sinus node dysfunction and intact av conduction
30
amiodarone impacts
thyroid and lung functions
31
anterior papillary muscle attaches to the --- and --- cusps of the tricuspid valve
septal papillary muscle attaches to the --- and ---
posteriour papillary muscle -posterior and septal cups
anterior and posterior
anterior and septal
32
formation of the atrial septum
the septum secundum grows down to the right of the septum primum
33
is not a complication of an uncomplicated atrial septal defect
cyanosis
34
foramen ovale describes a passage through the
septum secundum
35
first month post MI patients cannot have sex but can
drink up to 14 units /alchol per week
36
normal cardiac axis
-30 to 90
37
dyspnoea, ascites, peripheral oedema
right sided heart failure
38
high pitched holosystolic murmur at the left sternal edge radiating to the right sternal edge
39
acutely unwell patients treatment that are SOB
sit her up and administer high flow 02
40
treatment of ventricular tachycardia with any of the follwing- MI, syncope, shock heart failure
Synchronised electric cardioversion
41
treatment of tachycardia and has no adverse effects
amiodarone
42
turners syndrome is associated with
coarctation of the aorta
43
- palpable diastolic thrill over apex
- opening snap
- rumbling low diastolic murmur
mitral stenosis
44
pansystolic murmue heard over the left apex and radiating to the axilla
mitral regurg
45
echo- dilated left ventricle with poor wall motion
myocarditis
46
collapsing pulse and early diastolic murmur , corrigans signs
aortic regurg
47
pulsatile hepatomegaly
severe tricuspid regurg
48
tapping apex, malar flush
mitral stenosis
49
how does squatting affect murmurs
increases afterload and preload
50
Pateints with HCM may have
ejection systolic murmur decreased by squatting
51
jerky pulse, double apex beat
HCM
52
asymetrical hypertrophy of both ventricles
HCM
53
triad for pericardial effusion
hypotension , distended neck veins and muffled heart sounds
54
af treatment
rate control- beta blocker or calcium channel blocker
rhythm control - anticoagulant- apixaban
55
iv drug user, pan systolic murmur 4th left intercostal space( left sternal margin at the 5th costal cartillage)
tricuspid regurg most likely due to infective endocarditis
56
5th intercostal space mid clavicualr line
mitral valve
57
2nd intercostal space right sternal angle
aortic valve
58
slow rising pulse and ejection systolic murmur
aortic stenosis
59
alcohol excess can cause dilated cardiomyopathy, left ventricular dilation often results in mitral regurg which produces a
panasystolic murmur radiating to axilla
60
intra cardiac tumour causing transient left sided weakness
atrial myxoma
charactersitc murmur is atrial plop
61
splinter haemorrhages and pulses below finger nail suggests
aortic regurg due to infective endocarditis
62
how can the you acentuate murmur of aortic regurg
sitting the patient forward and asking them to hold their breath on expiration
63
treatment for broad complex tachycardia and low bp
DC cardioversion
64
irregularly irregular pulse
atrial fibrilation
65
--- may cause atrial fib
hypERthyroidism
66
absolute contraindicatio to thrombolysis
brain neoplasm, acute pancreitis, oesophageal varices, recent surgery, recent stroke
67
valve at second left intercostal space
pulmonary
68
unstable angina is a type of
acute coronary syndrome
69
St elevation in inferioru leads, what artery
Right coronary artery
70
St elevation in v1-4
LAD
71
young people with syncope and palpitations,slurred upstroke and wide qrs
wolf parkinson white syndrome
72
small t waves
st depression
prominent u waves
hypokalaemia
73
tall tented t waves, widened qrs
hyperkalaemia
74
shortening of Qt interval- nausea, constipationn , confusion, bone pain
hypercalcaemia
75
prolongation of Qt interval and no effect on t wave
hypocalcaemia
76
ST elevation and unlikely to affect t waves -drowsiness, vomitting, nausea
hyponatremia
77
yellow plaques near eyelid -xanthelasma
high cholesterol
78
increase bilirubin is seen in
liver disease, haemolytic anaemias
79
low sodium diet contains
less than 2g
80
in atrial fib there is absent
a waves
81
endocarditis can cause tricuspid regurg that causes
right sided heart failure
82
systolic cv waves
tricuspid regurg
83
multiple pulmonary emboli w severe leg oedema
heart failure and cor pulmoanle secondary to pulmonary emboli leading to pulmonary hypertension
84
when is there jvp elevation
pulmonary hypertension
85
raised JVP, large A waves
pulmonary hypertension
86
anterior MI, hypotensive and bradycardic
complete heart block
87
canon a wave
complete heart block
88
pansystolic murmur, loudest at left sternal angle and does not radiate to axilla
Ventricular septal defect
89
investigation for renal artery stenosis
MRI
90
harsh pan-systolic murmur, loudest at lower left sternal edge and inaudible at apex and apex is not displaced and does not intensify on inspiration
Ventricular septal defect
91
soft, late systolic murmur at apex radiating to axilla
mitral valve prolapse
92
crescendo-descendo murmur
aortic stenosis
93
PDA is a connection between the
aorta and pulmonary artery
94
slow rising and weak pulse
bicuspid aortic valve
95
history of collapse indicates
stenosis
96
pan systolic murmur heard best at the apex . apex beat displaced laterally
mitral valve regurg
97
collapsing pulse
aortic valve regurg
98
will cause a pan systolic at the apex if there is a co existing mitral regurg, but would otherwise present with mid-systolic click
mitral valve prolapse
99
what should be given right away to limit valve destruction
antibiotics
100
elevated jvp, large v waves, pan-systolic murmur at left sternal edge
-pulsatile hepatomegaly, left parasternal heave
tricupsid regurrg
101
example of indication for permanent pacemaker
complete heart block
102
triphasic systolic and diastolic rub
acute pericarditis
103
fever, improved sitting forward, diffuse mild st elevation,
acute pericardidits
104
soft blowing diastolic decrescendo murmur
aortic regurg
105
opening snap
mitral stenosis
106
high pitched pan systolic radiating to axilla
mitral regurg
107
continous systolic-diastolic murmur , radiating to back
coarctation of the aorta
108
muffled hearts sounds and pulsus paradoxus
cardiac tamponade
109
prominent u waves
hypokalaemia
110
digoxin toxicity on ECG
reversed tick st segment depression
111
increasing PR interval followed by a dropped ventricular complex
Mobitz type I second degree heart block
112
what drugs cause QT prolongation
phenothiazines, macrolides, quinolones, all type III anti-arrythmic drugs
113
What else causes Qt prolongation
Hypokalaemia and bradycardia
114
Excessive qt interval prolongation predisposes to
torsades de pointes or polymorphic ventricular tachycardia
115
QRS axis of 150 degrees is what on ECG
Right axis deviation
| (-30 to 90)
116
delta wave
wolf parkinosn white syndrome
117
Patient with heart failure and reduced ejection fraction should be commenced on
beta blocker
118
frist line therapy for stable angina
calcium channel blocker or beta blocker, alongside nitrates
119
drug for patients with persistent symptoms despite first line treatment for heart failure
Digoxin
120
most appropriate treatment for high choelstrol
STart atorvastatatin, - not dietary advice
121
advised to stop what class of drugs in chronic heart disease and heart failure
calcium channel blocker eg diltiazem
122
first line investigation in primary care for heart failure
Serum brain natriuretic peptide and echo 6 weeks later except if had history of MI then should have echo right away
123
most likely cause of a Q wave MI
Complete occlusive thrombus
124
coronary artery stenosis is a cause of
stable angina
125
pulmonary oedema, lowe limb pitting oedema, elevated JVP
heart failure
126
mainfestations of heart failure due to diastolic dysfunction
LV hypertrophy, lack of cardiomegaly, LV dilation and S4 heart sound
127
diastolic dysfunction because of LV hypertrophy causes
impaired LV relaxation, end-diastolic pressure increases, end-diastolic volume remains normal (as systolic is still intact)
128
loud S1
mitral stenosis
129
when might the opening snap be absent and S1 soft in mitral stenosis
if mitral valve is calcified or there is severe stenosis
130
Mitral regurg and VSD cause what type of murmur
pan-systolic
131
early diastolic murmur
aortic regurg
132
what are these classical symptoms of - incrasing fatigue, wheezy , pitting ankle oedema
pulmonary heart disease, right ventricular failure, cor pulmonale
133
pulmonary fibrosis can lead to
cor pulmoanle
134
drugs known to cause pulmonary fibrosis
methotrexate, nitrofurantoin
135
gradual-onset central chest pain, worse on inspiration adn lying flat, relieved by leaning forward. PR depression and concave ST segment elevation in most leads
acute pericarditis
136
initial treatment for acute pericarditis if stable
ibuprofen
137
winging of scapula due to damage of
long thoracic nerve
138
pericarditis is a
post viral complication
139
diffuse chest pain improves leaning forward, friction rub, St snegement elevation on most leads
pericarditis
140
infective endocarditis iv drug users causative organism
staph aureus
141
pulse of aortic regurg
collapsing due to wide pulse pressure
142
pulse that can be found in cardiac tamponade
pulsus paradoxus
143
pulsus paradoxus can be heard in
cardiac tamponade, severe asthma, constrictive pericarditis
144
pulse of heart failure
pulsus alternans- pulse with regular rythm but with alternating beats that are weakk then strong
145
aortic stenosis pulse
slow rising
146
pulse in takayasu arteritis
absent
147
what is the mechanism for 3 heart sounds and latter two heart sounds become further apart on inspiration
Increased return to the right heart during inspiration, which prolongs closure of the pulmonary valve- normal not pathological
148
right to left shunting causes
cyanosis
149
stiff left ventricle causes
third heart sound called S4 but this sound does not vary with inspiration
150
atrial septal defect causes splitting of
S2
151
pericarditis or pericardial effusion can have
pulsus paradoxus
152
pericardial rub is used in the diagnosis of
pericarditis
153
bp over -- requires drug therapy
160/100
154
heart rate of 180, regularly spaced narrow QRS compexes, no visible P waves. preceding Qrs complexes
paraoxysmal supraventricular tachycardia
155
most common cause of PSVT
Atrioventricular nodal re-entrant tachycardia
156
irregulary spaced qrs complexes
atrial fibrilation
157
best jugular vein for measure of central venous pressure
right internal
158
frist line treatment for wolf parkinson white syndrome if stable
vagal maoeuvres such as carotid sinus massage or Valsalva manoeuvre, if this fails then adenosine
159
treatment for ventricular tachucardia secondary to MI
DC cardioversion with synchronised shock
160
treatment for supraventricular tachycardia that have not responded to vagal manoeivres
adenosine
161
pregnancy is a risk factor for developing
supraventricular tachycardia
162
has atrial fib and develops palpitations
rhythm control- flecainide
163
hyperkalaemia - tall tented T waves - treatment?
calcium chloride or calcium gluconate
164
causes of mitral stenosis
rheumatic fever, maligant causes, SLE, left atrial myxoma
165
what can mitral stenosis result in
left atrial hypertrophy, hoarseness, dysphagia and collapse of the left main bronchus
166
- malaise, weakness, low grade fever,
- roth spots(retinal heamorrhages, with pale centres), Oslers nodes( painful red raised lesions on the hands and feet), Janeways lesions( raised papules on hands and feet)
Subacute bacterial endocarditis
167
SBE is caused by
strep viridans, an oral commensal
168
SLE may cause
janeways lesions but not all 3
169
dilated cardiomyopathy is characterised by
dilation of all 4 heart chambers , increased end-diastolic volume, decreased contractility, depressed ejection fraction
170
alcoholic, enlarged globular heart, reduced ejection fraction
dilated cardiomyopathy
171
VVI pacemaker used in
atrial flutter and AF
172
DDD pacemakers used in
second degree heart block
173
treatment if got too low sodium
restrict fluid intake
174
drug used in acute coronary syndrome without st segment elevation
fondaparinux
175
fast rythm with wide complexes
ventricular tachycardia
176
broad complexes are -- in origin
ventricular
177
after cardioversion, x can be given
amiodarone
178
one kidney larger than the other
renal artery stenosis
179
what drug class can lead to kidney failure
ace inhibitor
180
patient presents with hypertension associaetd with too much sodium and not enough potassium. Hypertension resistant to treatment
conn syndrome
181
history of neurofibromatosis, hypertension and conplains of sweating, palpitations and intermittent headaches
PHAEOCHROMOCYTOMA
182
WHERE TO DETECT TRICUSPID VALVE AND RIGHT VENTRICLE
4TH INTERCOSTAL SPACE , LEFT PARASTERNAL AREA
183
FIRT LINE TREATMENT FOR SYMPTOMATIC, MITRAL STENOSIS IF VALVE IS MOBILE AND NOT CALCIFIED
BALLOON VALVULOPLASTY
184
IS SEVERE MITRAL STENOSIS --- WOULD BE FIRST LINE
MITRAL VALVE REPLACEMENT
185
FIRST LINE OPTIONS FOR HEART FAILURE
ACEI, BETA BLOCKERS, ALDOSTERONE ANTAGONISTS(SPIRONOLACTONE)
186
Hypertension and patient not liked ccb so give
thiazide diuretic - indapamide - increases bone mineral density
187
what valve is located between the left ventricle and ascending aorta
aortic
188
aortic valve composed of
right, left, posterior cusps
189
anterior and posterior cusps
mitral valve
190
antrior, posterior and septal cusps
tricuspid valve
191
right, left and anterior cusps
pulmonary valve
192
recently pregnant presents with, SOB, pitting ankle oedema, rigth axis deviation
primary pulmonary hypertension
193
signs of primary pulmonary hypertension
ecg shows right ventricular strain(right axis deviation, incomplete right bundle branch block), raised pulmonary artery systolic pressure
194
when microscopic changes of acute MI first become visible
12-24 hrs after infarct
195
perihilar shadowing/ bat wings
oedema
196
patchy shadowing in lower zones
pneumonia
197
blunting of costophrenic angles
pleural effusions
198
when is cardiothoracic ration normal
0.5 or less
199
if cardiothoracid ratito greater than 0.5 hints towards
heart failure
200
widening of the carina would suggest
enlargement of the left atrium
201
chest pain described as heavy but cardio,resp examiation normal and ecg normal, what etst would you order
12hr Troponin T assay
202
purple striae on abdomen, moon face, hypertensive
cushing syndrome - excess cortisol
203
hypertensive, large hands and feet, prominent jaw and brow
acromegaly -excess of growth hormone
204
contraceptivec pill, systolic murmur , weak foot pulses , unequal upper limb pulses
coarctation of the aorta
205
hyperthyroidism (thyrotoxicosis)- increases basal metabolic rate causing weight loss, diahorrea and atrial fibrilation
206
paplitations after holidy and ecg shows atrial fib, most likely cause
alcohol excess
207
post Mi, high cholestrol and family history give
high dose atorvastatin
208
3 p's for vasovagal syncope
posture - she was standing
provoking factors- was inn a warm crowded environment
prodromal symptoms- complained of dizziness before collapse
209
what ecg finding isi common in young athletes
prolonged PR interval
210
pain worse lying down and is releiveed by leaning forward, radiates to left shoulder =
LOW BP, QUIET HEART SOUNDS, RAISED JVP=
PERICARDITIS
CARDIAC TAMPONADE
so cardiac tamponade secodnary to pericarditis
treatment - urgent pericardiocentesis
211
LMWH IS AN IMPORTANT STEP IN MANAGING
PULMONARY EMBOLUS
212
loud first heart sound, plopping sound in early diastole, clubbed , cxr- intra cardiac calcification within the left atrium
left atrial myxoma
213
mid-diastolic murmur, low volume pulse, clinically in a fib
mitral stenosis
214
displaced apex beat and pansystolic murmur
mitral regurg
215
patent come in with papitations and diagnosed with AF - no other medical conditions, give
IV flecainide
216
most common risk factor for af
alcohol
217
what artery supplies the left atrium of the heart
circumflex artery
218
Lad artery supplies
interventricular septum and both ventricle s
219
left ventricle is supplied by
left marginal artery
220
--supplies both ventricles and interventricualr septum
posterior interventricular branch
221
gols standard investigation for suspicion of cardiac chest pain
CT
222
new onset acute atrial fibrilation if deny carioversion and are unstable
flecainide (sodium channel blocker)
223
treatment for ventricular tachycardia secodnary to digoxin toxicity
Digibind
224
-syncopal attacks, palpitations after night out, biphasic T waves, saddle shaped St segments
Brugada syndrome
225
brugada syndrome is associated with -- arrythmias
ventricular
226
long term mamangemet for syncopal episodes
implantable cardiac defibrillator
227
type 2 diabetes and cardiovascular disease
atorvastatin
228
primary prevention of cardiovascualr disease
atorvastatin
229
management if suspect unstable angina
HOSPIRAL FOR URGENT ELECTIVE ANGIOGRAM - as they are at high risk of MI
230
Treatment of second degree heart block accompanied by acute MI, complete heart block, or symptomatic Mobitz II block what is indicated
Temporary pacing and primary PCI
231
rheumatic fever symptoms
inflamed, painful joints, very fast heart beat follwing sore throat
232
pyrexia, night sweats, changes to fingernails
infective endocarditis
233
these are significant signs of:
-low volume pulse
narrow pulse pressure
slow rising carotid pulse
undisplaced apex beat
soft or absent A2
ejection systolic murmur +4th heart sound
pulmonary oedema
aortic stenosis
234
for hypertension, if already taking aspirin, statin, aceI, calcium channel blocker, whats next
thiazide like diuretic eg indapamide
235
if got hypertension potentially diabetes(pees alot) and under 55 you should give
AceI- has renal protective effect for diabetes
236
treatmet for pregnancy induced hypertension
Labetalol, alternatives- methyldopa, nifedipine
237
treatment of joint hypertension and angina first line for over 55
CCB
238
uniform left ventricular hypertrophy is hallmark of
untreated hypertension
239
chest pain worse lying down and widespread st elevation
pericarditis
240
would you preferably place electrode of ecg on boney prominence
yes
241
avF should be put on left
foot
242
right arm electrode
red and aVR
243
history chronic resp infections, diastolic murmur, opening snap loudest at the 5th right intercostal in mid clav line
kartagener syndrome
244
abnormal cilia in kartageners syndrome can lead to infertility
245
best diagnsotic test for aortic stenosis
echocardiogram and doppler
