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Things I don't know, but need to know, for fourth year > Cardiology > Flashcards

Cardiology Flashcards

1
Q

When are statins used in primary prevention and at what dose?

A

Atorvastatin 20mg is used if Q-Risk score is over >10

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2
Q

When are statins used in secondary prevention and at what dose?

A

Atorvastatin 80mg is used in known cause of IHD Peripheral vascular disease etc

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3
Q

What is first line in Chronic Heart Failure?

A

ACEi/ARB + beta blocker

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4
Q

What is second line in chronic HF with a reduced ejection fraction?

A

Spirinolactone

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5
Q

What drug is used in Chronic Heart Failure 3rd line if there is a LVF of <35

A

Ivabridine

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6
Q

What is used third line in Chronic Heart Failure if there is concurrent AF?

A

Digoxin

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7
Q

What are strongly recommended in Chronic HF if they are Afro Caribbean ?

A

Hydralazine + Nitrates

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8
Q

What vaccinations are given to patients with HF

A

Yearly influenza

Pneumococcus every five years

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9
Q

What is the management of an NSTEMI if PCI isn’t indicated?

A

Aspirin + Ticagrelor or Clopidogrel

Fondaparinux

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10
Q

When is Ticragrelor used in NSTEMI?

A

If low bleed risk.

If not on anticoagulation

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11
Q

When is Clopidogrel used in NSTEMI?

A

If patient is at a high risk of bleeding

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12
Q

If a patient has a STEMI and is indicated for PCI what is the medical management?

A

Aspririn + Prasugrel + Fibroparinux

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13
Q

In STEMI when is Clopidogrel used in favour of Prasugrel?

A

In a high bleed risk patient

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14
Q

In a STEMI managed with fibrinolysis what should be given alongside it?

A

Antithrombin

Ticagrelor afterward

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15
Q

Post Fibrinolysis what investigation should be undertaken?

A

ECG after 60-90 minutes

If positive changes still consider PCI

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16
Q

What is the dosing of Adenosine used in SVT

A

6mg bolus -> 12mg bolus -> 18mg bolus

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17
Q

If you suspect a MI due to Cocaine use how do you manage this?

A

IV BDZ

Nitrates for the pain

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18
Q

What is the first line imaging in an aortic dissection?

A

CT angiography

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19
Q

If a patient with a query aortic dissection is acutely unstable what is the imaging of choice?

A

Trans Oesophageal Echocardiogram

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20
Q

What are some indications for urgent valvular repair in infective endocarditis?

A 
Pregnant
Congestive Heart Failure
Overwhelming sepsis despite Abx
Recurrent Emboli 
Abscess or Fistulae
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21
Q

Do you treat a >80 patient with stage one hypertension?

135-150 mmHg

A

No

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22
Q

How long after a stroke is anticoagulation prescribed and what is used first line? In the context of AF + Stroke

A

Wait 2 weeks. DOACs are used

Contraindicated in haemorrhagic or signs of bleeds

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23
Q

. A patient is found to be in AF. On subsequent investigation he is found to have valvular disease. What medication is first line?

Also applies in context of stroke.

A

Warfarin

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24
Q

Is LBBB always pathological?

A

Yes

MI Hypetension Aortic Sternosis, Cardiomyopathy, Digoxin toxicity

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25
Q

If someone has had persistent AF for over 48 hours what is their management?

A

Three weeks anticoagulation using DOAC before Electrocardioversion

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26
Q

New 1st degree heart block on the background of an Acute MI what artery is likely to have been affected?

A

Right Coronary Artery -

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27
Q

What is the criteria for surgical management of Aortic Stenosis?

A

Symptomatic

Gradient >40mmHg

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28
Q

What is the first line investigation in Acute Pericarditis - ECG is done routine.

A

Transoesophageal Echo

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29
Q

A new hypertensive presents with a Urinary Albumin : Creatine ratio of >30mg. What is their management?

A

ACEi - indicated in CKD with >30mg UAC

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30
Q

Post Electrical Cardioversion how long should someone at low risk for Stroke or TIA be on anticoagulation for?

A

4 weeks post cardio version

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31
Q

Post Electrical Cardioversion how long should someone at high risk for Stroke or TIA be on anticoagulation for?

A

Life long

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32
Q

What is used first line in Bradychardia + Shock

A

Atropine 500mcg

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33
Q

If Atropine alone isn’t increasing the heart rate what can be used?

A

Up to 3mg of Atropine can be used
Transcutaneous pacing
Adrenaline Infusion

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34
Q

What are some indications someone presenting with bradycardia may require further specialist input and transvenous pacing?

A

Complete Heart Block
Recent Asystole
Mobitz Type II
Ventricular tase of >3 seconds

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35
Q

Management of a DVT if CKD eGFR >15

A

DOAC

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36
Q

Management of a DVT if eGFR <15

A

Unfractionated or LMWH Heparin

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37
Q

When is a carotid endarterectomy undertaken in an asymptomatic patient?

A

If >70% of the vessel is occluded.

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38
Q

When is a endarterectomy undertaken in a symptomatic patient?

A

If >50% of the carotid artery is occluded

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39
Q

What medication is used in all Acute Heart Failure?

A

IV Furosemide and O2 if indicated

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40
Q

What medication for chronic HF can be continued into an acute episode?

A

Beta Blocker - unless <50bpm or signs of shock

ACEi

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41
Q

In cardiogenic shock with a systolic of <85 mmHg what is the treatment?

A

Ionotropes - Dobutamine
Vasopressors - Norepeniphrine - if signs of end organ damage
Mechanical Circulatory aids

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42
Q

If there are signs of respiratory failure what is indicated in Acute Heart Failure?

A

CPAP

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43
Q

When are nitrates used in Acute Heart Failure?

A

Sever hypertension
Mitral or aortic valve issues
Signs of myocardial ischaemia

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44
Q

When is synchronised DC cardio version and sedation used?

A

In SVT

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45
Q

When is unsynchronised DC used?

A

VT or VF

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46
Q

In someone with stable Toursade De Pointes what is the management?

A

IV magnesium sulphate
2g over 1 hour
Stop offending agent at correct electrolyte imbalance

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47
Q

In someone with unstable Toursades De Pointes what is the management?

A

Unsynchronised CardioVersion and IV amiodarone

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48
Q

What is the first stage of NSTEMI management

A

Aspirin + Fondaparinux + Calculate GRACE mortality score

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49
Q

In an NSTEMI if someone has a low GRACE mortality score what is next?

A

Ticagrelor

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50
Q

In an NSTEMI with a high GRACE score what is next ?

A

PCI if unstable

Stable - wait 72 hours for PCI give Prasugrel or Ticagrelor

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51
Q

Management of Heart Failure with preserved ejection fraction and fluid overload

A

ACEi
Loop diuretics
Lifestyle

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52
Q

Causes of high output cardiac failure

A 
Pregnacy
Pagets
Anaemia
AV malformation
thyrotoxicosis
Thymoma
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53
Q

Inferior ST elevation on ECG + New onset Aortic Regurgitation

A

Proximal Aortic dissection

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54
Q

What is a high GRACE score indicating PCI for NSTEMI?

A

> 3%

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55
Q

What is 1st line in secondary prevention of an MI?

A

ACEi
Beta Blockers
Statin
Dual Antiplatelet therapy

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56
Q

If someone post MI presents with a reduced LVF or ejection fraction what can be added ?

A

Eplerinone - aldosterone antagonist

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57
Q

If someone has had an ACS alone what dual antiplatelet therapy is recommended?

A

Ticagrelor + Aspirin

Stop Ticagrelor after 12 month

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58
Q

If someone underwent PCI for an ACS what dual antiplatelet is used?

A

Prasugrel/ Ticagrelor + Aspirin

Stop P/T after 12 months

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59
Q

When is the duration of dual antiplatelet therapy altered?

A

If at an increased CDV risk or increased haemorrhage risk

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60
Q

How long post MI - general advice

A

Sexual activities start after 4 weeks

Sildenafil after 6 months

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61
Q

Pericarditis vs Dresslers syndrome - MI

A

Pericarditis occurs days after MI

Dresslers - Autoimmune antibody mediated pericarditis like syndrome

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62
Q

Young male smoker with hyper cellular occlusions of lower limbs
Tortuous Corkscrew collaterals on angiography

A

Buergers Disease

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63
Q

Secondary prevention of Peripheral Vascular Disease

A

Clopidogrel + Atorvastatin

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64
Q

List congenital cyanotic cardiac abnormalities

A

Tetralogy of Fallow
Transposition of the great vessels
Tricuspid atresia

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65
Q

What is the commonest cause of cardiac cyanotic disease.

A

Tetralogy of fallot presents 1-2 month

Transposition of the great vessels is most common in first few days as it presents earlier

66
Q

Presentation of Tetralogy of Fallot

A

Ejection systolic murmur
Tet Spells
Boot shaped heart on X-ray

67
Q

Tetralogy of Fallot

A

Ventricular Septal defect
Pulmonary Stenosis - dictates severity of the disease
Left Ventricular Hypertrophy
Overriding aorta

68
Q

Treatment of congenital cardiac cyanotic diseases.

A

Prostaglandin E1 -> surgery

69
Q

Patent Ductus Arteriosus

A

Left subclavicular thrill, continuous machinery murmur, collapsing pulse, heaving apex beat, wide pulse pressure

70
Q

What is gold standard in the assessment of a diagnosed ACS?

A

CT coronary angiogram is first line over exercise ECG now

71
Q

List some indication for stopping Beta Blockers in HF

A

HR <50

or 2/3 degree heart block

72
Q

What grading system is used in chronic HF?

A

NYHA 1 = No symptoms
NYHA 2 = Mild symptoms during exercise causing some limitation. None at rest
NYHA 3 = Moderate symptoms causing marked decrease in exercise tolerance. Comfortable at rest
NYHA 4 = Severe symptoms uncomfortable at rest.

73
Q

Describe the two types of aortic dissection.

A

Group A = 2/3rds and occur in the ascending aorta

Group B = Descending aorta

74
Q

How does the type of aortic dissection affect the management?

A

Group A - BP reduced to 100-120 then surgery

Group B - conservative with tight BP control and bed rest.

75
Q

AAA - 3 - 4.4cm on USS

A

Repeat scan in 12 months

76
Q

AAA 4.5 - 5.4cm on USS

A

Repeat in 3 months

77
Q

AAA >5.5cm on USS

A

Refer to vascular surgery

78
Q

If an aneurysm has grown by over 1cm in a year what is the management?

A

Referral to vascular

79
Q

In a newly diagnosed LBBB what investigation should be undertaken?

A

High sensitivity troponin

As likely to represent a new LBBB

80
Q

If someone has a CHADVAS score of 0 (M) or 1 (F) - meaning they require no anticoagulation. What investigation should they undergo?

A

Echocardiogram to rule out valvular disease as this is an absolute indication for anticoagulation.

81
Q

Causes of dilated cardiomyopathy

A 
Alcohol
Wet Berri Berri syndrome 
Pregnancy 
Idiopathic 
Doxorubicin
82
Q

What is a normal PR interval?

A

120-200ms

83
Q

At what PR interval could you diagnose First degree Hear Block ?

A

> 200ms

84
Q 
Sharp stabbing chest pain
ST elevation
Acute pulmonary oedema 
Younger patient
Recent URTI
A

Myocarditis

85
Q

Resolved chest pain

Deeply inverted T waves in V2-3

A

Wellens syndrome

Critical stenosis of LAD

86
Q

Modified DUKEs - major and minor criteria

A

Major - 2 +ve blood cultures, +ve serology, +ve echocardiogram, New valvular regurgitation
Minor ->38, vascular phenomena, glomerulonephritis, oslers nodes, Roth spots

87
Q

List the common causes of aortic stenosis and what type of stenosis occurs in Williams ad HOCM.

A

> 65 - calcification
<65 - Bicuspid
Williams - supravalvular stenosis
HOCM - Subvalvular stenosis

88
Q

In chronic Heart failure what can be used if ACEi/ARB cant be tolerated?

A

Sacubitin Valsartan

89
Q

DVT WELLS score >2

A

DVT likely
USS in 4 hours - +ve = DOAC
- -ve = D-dimer
If USS > 4 hours - DOAC + D- Dimer
- scan -ve but D-dimer +ve = stop DOAC and USS in a week

90
Q

DVT WELLS score <1 or 1

A

D-Dimer within 4 hours - if +ve = USS then same as WELLS >2
- if -ve = alternate diagnosis
If D-Dimer will take over 4 hours - DOAC

91
Q

List BP targets for clinic and ambulatory.

A

Under 80 - Clinic = <140/90. Ambulatory = 135/85

Over 80 - Clinic = 150/90. Ambulatory = 145/85

92
Q

How do you investigate someone for arrhythmias?

A

ECG + Bloods - FBC TFT
Holter monitor
External Loop Recorder

93
Q

CHADVAS score

A 
Congestive Heart Failure = 1
Hypertension = 1
Age <65 = 0  65-75 = 1 >75=2
Diabetes = 1
Stroke, TIA or VTE = 2
Gender  Male = 0 Female =1
Vascular disease history = 1

Anticoagulation in AF

94
Q

A third heart sound in someone under 30

A

can be physiological

95
Q

What can be a cause of a third heart sound?

A

Diastolic filing of the ventricle

Dilated Cardiomyopathy
Mitral Regurgitation
Constrictive Pericarditis
Left Ventricular failure

96
Q

Fourth heart sound

A

Atrial contraction against a stiff ventricle

Aortic stenosis
HOCM
Hypertension

97
Q

Persistent ST elevation post MI with no chest pain. Usually V1-V4 + shortness of breath.

A

Ventricular Wall aneurysm - usually left

Requires anticoagulation

98
Q

What can heart failure trigger in terms of sodium?

A

Dilutional Hyponatraemia
Poor perfusion of the kidneys causes activation of the renin angiotensin system. Causes increased reabsorption of sodium and water. Water more so than sodium.

99
Q

Reciprocal ST depression V1-V3
Tall broad R waves
Upright T waves

A

Posterior STEMI

100
Q

What kind of Heart Failure does HOCM present with?

A

Preserved ejection fraction

101
Q

Intrapartum lithium use
Pan systolic ( tricuspid regurgitation)
Mid diastolic ( tricuspid stenosis)
Right atrial enlargement

A

Ebsteins anomaly

102
Q

Fatigue
Pallor
Breathlessness
Soft ejection systolic murmur - doesn’t radiate

A

Anaemia

Causes a aortic flow murmur

103
Q

What medication that can be used to terminate SVT is contraindicated in VT?

A

Verapamil - can cause cardiac arrest

104
Q

Signs and symptoms of a fat embolism

A

Tachypnoea Tachychardia Pyrexia
Petechial Rash , subconunctival and oral petechia
Confusion and agitation
Retinal Haemorrhage

105
Q

LBBB vs RBBB

A

WilliaM MarroW

V1. V6. V1. V6

Left Right

106
Q

Late diastolic, low pitch, dyspnoea, orthopnoea

A

Mitral stenosis

Loud S1, opening snap, low volume pulse, malar flush, haemoptysis

107
Q

If someone has asymptomatic mitral stenosis how is this managed?

A

Regular Echocardiogram

108
Q

Acute Chest Pain management if presenting after

A

<12 hours ago or current with abnormal ECG - Ambulance Referral
12-72 hours ago - same day referral
>72 hours ago - ECG + troponin the decide

109
Q

Cardioversion is synced too were on the ECG?

A

R wave

110
Q

What is considered long QT?

A

> 430 in men

>450 in women

111
Q

Causes of a prolonged QT

A

Medication - Amiodarone TCA SSRI Citalopram Erythromycin Haloperidol Ondansetron
Electrolytes - Hypokalaemia Hypomagnesia
Conditions - Acute MI, Hypothermia, SAH

112
Q

Management of congenital Long Qt

A

Avoid QT prolonging drugs
Beta blockers
Implanted Cardioverter defibrillator

113
Q

BP target if over 80?

A

<150/90

114
Q

Signs linked to aortic regurgitation

A 
Quinckes signs - pulsing fingernail bed
De Mussets sign - head bobbing
Early diastolic - louder on fist clenching 
Collapsing pulse
Wide pulse pressure
115
Q

Cardiac tamponade

A

Electrical alternans on ECG

Pulses paradoxus - inspiration causes a BP drop

116
Q

Restrictive pericarditis

A

Kussmauls sign - Increased JVP on inspiration

117
Q

Anterior MI plus complete heart block - management

A

External pacing

118
Q

Posterior MI with new heart block - management

A

Atropine 500mcg

119
Q

Triple AAA screening

A

one scan at 65

if positive then you enter screening programme

120
Q

Describe and explain what pulmonary artery occlusive pressure is.

A 
Represents preload
8-12 is normal
<5 = hypovolaemia
<5 + oedema = ARDS
>18 = fluid overload
121
Q

ST elevation
Chest Pain
No changes on Coronary Angiogram
Recent stress

A

Takotsubo Cardiomyopathy

Treatment is supportive

122
Q

Risk factors for coarctation of the aorta

A

Turners
Bicuspid aortic valve
NF
Berry aneurysm

123
Q

A new onset pan systolic murmur + low grade fever. What are you thinking?

A

Infective endocarditis

124
Q

Infective endocarditis - organisms

A

Staph Aureus = #
Staph Epidermidis = within two months of valve replacement
Step Viridans = Poor dental hygiene + dental procedures
Strep Bovis = linked to colonic cancer
HACEK = Rarer culture negative causes

125
Q

Valves affected in infective endocarditis

A

Mitral valve is the commonest

IVDU = Tricuspid valve

126
Q

New BP >180/120 +

HF AKI End organ damage

A

Urgent same day referral to a specialist

127
Q

BP target in type 1 diabetes mellitus

A

135/85

130/80 if albuminuria

128
Q

If your patient is afro-carribean with hypertension not controlled by a Ca channel blocker. What medication can be used?

A

ARB is preferred over an ACEi

129
Q

Definitive management of wolf Parkinson white syndrome

A

Ablation of accessory pathway
Right axis deviation = left sided pathway
Left axis deviation = right sided pathway

130
Q

Brown pigment
Champagne bottle legs (lipidermatosclerosis)
Eczema

A

Chronic venous insufficiency

131
Q

QT

A

Start of Q wave to the end of the T wave

132
Q

PR interval

A

Start of P wave to the start of the QRS

133
Q

Atrial Septa Defect

A

Pulmonary Ejection systolic murmur

Fixed split 2nd heart sound

134
Q

Ejection systolic murmur louder on inspiration

A

Atrial Septal Defect

135
Q

Diastolic murmur 2nd intercostal space right sternal border

A

Aortic Regurgitation

136
Q

Murmurs and Breathing

A

rIght sided - louder on Inspiration

lEft sided - louder on Expiration

137
Q

What medication is contraindicated in HOCM

A

ACEi as reduce preload

138
Q

If cardiac tamponade has developed secondary to neoplasm what is the managment?

A

Percutaneous Balloon Pericardiotomy

139
Q

ECG changes indicating PCI

A

> 2mm in 2 congruent anterior leads - V1-V6
1mm in 2 congruent inferior leads - II, III, avF, avL
LBBB

140
Q

Angina management - CABG > PCI

A

CABG is preferred over PCI for management of angina if
>65
Diabetes
Complex 3 vessel disease

141
Q

Hypokalaemia

A 
U waves 
Absent or small T waves
Prolonged PR
Prolonged Qt 
ST depression
142
Q

Varicose Veins Management

A

Majority conservatively managed - Leg elevation, weight loss, regular exercise, graduated compression stockings
Refer if - pain discomfort or significant swelling, bleeding, past or present ulceration, chronic venous insufficiency.

143
Q

Varicose Veins management if referred.

A

Endothermal Ablation
Foam scleropathy
Surgical ligation or stripping

144
Q

Contraindication to compression stockings

A

ABPI <0.8

145
Q

When is aortic regurgitation surgically managed?

A

If symptomatic

or asymptomatic if LV systolic dysfunction

146
Q

Management of primary heart block

A

Non required if asymptomatic

Beta blockers, Ca channel blockers, AV node fibrosis - all cause primary heart block

147
Q

What marker is elevated in congestive heart failure?

A

BNP

148
Q

Someone is in AF for over 48 hours and they are over 65. How are they managed?

A

Rate control

Beta blocker or calcium channel blocker

149
Q

How do you differentiate drug induced postural hypotension from Parkinson or diabetic induced postural hypotension?

A

In drug induced postural hypotension it is accompanied by a reflex tachycardia as the autonomic system is still functioning. Diabetes and Parkinson’s result in autonomic dysfunction so there is no reflex tachycardia.

150
Q

What is eisenmengers syndrome?

A

An uncorrected VSD leads to right ventricular hypertrophy. This eventually causes a right to left shunt.

Cyanosis, Clubbing, RVF, haemoptysis, embolism

Heart and lung transplant is required.

151
Q

Which Mobitz type has a risk of progressing to 3rd degree heart block?

A

Mobitz II - PR interval is fixed and every nth P wave is dropped
- also carries risk of severe bradycardia and haemodynamic instability

152
Q

Where is aortic regurgitation best heard?

A

Left lower sternal edge 3rd ICS

153
Q

Management of superficial thrombophlebitis

A

USS to exclude DVT
Exclude arterial disease -> Compression stockings
NSAIDs - consider LMWH

154
Q

Left circumflex ECG territory

A

avL I +/- V5/V6

155
Q

Imaging in infective endocarditis

A

1st line = Transthorasic echo

Most sensitive = trans oesophageal echo

156
Q

PR interval prolongation + infective endocarditis

A

Aortic root abscess -> surgery

157
Q

Management of buergers disease

A

Stop smoking + nifedipine

158
Q

Broad QRS

A

> 120ms or 0.12 seconds

159
Q

Younger patient
Palpitations - heart stops then beats rapidly
Multiple episodes
No adverse affects

A

Supraventricular Premature Beat

160
Q

What investigation should be considered in a unprovoked DVT?

A

CT chest abdo and pelvis - to rule out malignancy

161
Q

Maintenance fluids in cardiac disease.

A

20-25ml/kg

162
Q

1st line superficial thrombophlebitis

A

NSAID

Things I don't know, but need to know, for fourth year (31 decks)

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