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Cardiology Flashcards

1
Q

If the person’s blood pressure is between 140/90 mmHg and 180/120 mmHg what is the method of diagnosis?

A

ambulatory blood pressure monitoring (ABPM) Or HBPM.

  1. 2 measurements taken per hour between 8am-10pm. Average of 14 readings.
  2. 7 day reading, 2 taken every hour (1 min apart) with the first day reading discarded, and the average taken.
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2
Q

Refer to same-day specialist if the reading is

a) 140/90
b) 160/100
c) 180/120

A

c) 180/120

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2
Q

What do you use to assess stroke risk in AF?

A

CHA2DS2VASC score
if scored more than 2 - offer anticoagulation
if its is 1 - then consider.
(considers, CHF, Hypertension, Diabetes, Vascular and Stroke (CVS)

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3
Q

What score do you use to assess bleeding risk?

A

Orbit Score / Has-bled

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4
Q

Sweating, jaw and arm ache, crushing central or dull chest pain. What treatment would you do if the presented within 2 hours of symptom onset?

A

PCI

if more than 2 hours - Fibrinolysis

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5
Q

What is Rheumatic fever?

A

Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly, and can effect the heart, joints, brain and skin.

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6
Q

What do you expect to see in blood results for rheumatic fever?

A

Group A streptococcus antibodies
Raised CPR/ESR
Positive throat swabs
ECG - Prolonged PR Interval

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7
Q

Whats the difference between pericarditis and cardiac tamponade?

A

Pericarditis - Inflammation of the sac surrounding the heart. Symptoms SHARP, constant STERNAL pain, slightly relieved when sitting forward. worse when coughing or on inspiration, or lying on left side.
Hear pericardial friction rub heard during expiration.
cardiac tamponade - compression of the heart due to cardiac effusion - fluid/blood filling up in the sac. (Beck’s Triad) - Hypotension, muffled sounds and raised JVP.

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8
Q

What test do you do for acute pericarditis?

A

TOE ECHO

ECG - Wide spread saddle-shaped ST elevation and PR depression.

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9
Q

What do you do to investigate and diagnose Infective Endocarditis

A 
Blood cultures
Echo 
U & E's - check renal function
Diagnosis - Duke Criteria 
(Prolonged fever of Unknown Origin), vascular phenomena (stroke, limb ischemia, physical findings of septic emboli) Persistently positive blood cultures (2 or more).
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10
Q

How do you test for orthostatic hypotension, and what are the key findings?

A

Standing/lying BP for 3 mins
a drop in 20 mmhg Systolic
and 10 mmhg Diastolic

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11
Q

What side HF has the following symptoms: Confusion, orthopnoea, restless, cyanosis & Crackles, and how is it measured?

A

Left side - Lung

BNP (Brain neurotic Peptide)

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12
Q

BNP is released in response to heart damage or heart stretch?
What side HF causes the following symptoms: Weight gain, oedema, ascites, hepato/splenomegaly)

A

Heart stretch.

Right sided HF.

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13
Q

What do is the investigation for arterial occlusion?

A

ABPI <0.5 is critical (refer to vascular MDT)

0.6-0.9 intermittent claudication (exercise management, angio or bypass)

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14
Q

What organism causes infective endocarditis?

A

Staphylococcus Aureus

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15
Q

What organism causes infective endocarditis?

A

Staphylococcus Aureus

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16
Q

What is the most common complication of hypertrophic obstructive cardiomyopathy?

A

Sudden death due to ventricular arrhythmia

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16
Q

What is the most common complication of hypertrophic obstructive cardiomyopathy?

A

Sudden death due to ventricular arrhythmia

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17
Q

How do you confirm the diagnosis of ACS?

A

resting 12-lead ECG and a blood sample taken for high-sensitivity troponin I or T measurement

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17
Q

What is the gold standard treatment of ST elevation MI?

A

PCI

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18
Q

What investigations are used to assess peripheral vascular disease?

A

Doppler US
Angiogram
ABPI

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19
Q

What should you not rely on when considering ACS as a diagnosis?

A
  1. Response to GTN

2. No ECG changes

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20
Q

How would you diagnose suspected ACS 72 hours after with no complications?

A

ECG -
Pathological P waves
T waves flattened or T waves inversion
Left branch bundle block (WiLLiaM) in leads V1 and V6

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21
Q

Troponin I and T allows you to differentiate between what two conditions?

A

Unstable Angina and Myocardial Infarction

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22
Q

What other conditions can cause an increase in serum troponin?

A

Anything which damages the heart muscle: arrythymias, Pericarditis, PE, myocarditis.

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23
Q

How long after an MI can you detect serum troponin? and how long does it stay it stay in the body?

A

3-6 hours

2 weeks

24
Q

What condition causes spasms of the coronary arteries? and how is it relieved?

A

Prinzemetal’s
Does not relieve on rest, but does so with medication
Do not have angina during exercise.

25
Q

How to diagnose stable or atypical angina?

A

Refer them to a specialist chest pain service to confirm, or exclude the diagnosis of stable angina.

26
Q

What condition causes constricting chest pain? and is triggered by emotional stress?

A

Stable Angina - Relieved on rest within minutes or with GTN spray.
Unstable Angina requires immediate hospital admission as it forms part of the ACS.

27
Q

What is

A
28
Q

What are the three types of Natriuretic Peptides?

A

ANP - Atria of the heart
BNP - Ventricles of the heart - Used in Heart Failure
C type P - Vascular endothelium

29
Q

What are they two types of MI? Type 1 and Type 2?

A
  1. Athero-thrombosis in the artery supply

2. Mismatch between the o2 supply and demand.

30
Q

When does troponin PEAK in NSTEMI and STEMI?

A

12-16 hours (greater for figure in STEMI)

31
Q

Abnormal Lipids are treated under what conditions?

A
  1. Familial hypercholestremia
  2. Secondary prevention once you have established CVD
  3. primary prevention in T1D, T2D and CKD
  4. Q Risk is high
32
Q

What are abnormal Lipid levels? and when do you refer to specialist?

A 
TC > 9 mmol/l
non-HDL >7.5 mmol/l
FH
TG > 5 with no secondary cause
Note: Urgent referral - if Triglycerides are > 20 (not this can be effected by excess EToH and poorly controlled glycaemia)
33
Q

What drugs / conditions can effect BNP results?

A

Beta blockers
Diuretics
Chronic Kidney disease

34
Q

What conditions require an echocardiogram?

A

Heart failure
valvular disease
Cardiomyopathy
Aneurysms

35
Q

What is a Tilt Table Test? and how is it performed?

A

To determine where a change in position causes a sudden drop in heart rate or blood pressure.
Supine 5 mins
passive tilt 60-70 degrees for 20 mins
take 400mcg of GTN spray
passive tilt for a further 15 mins.
Drop in HR or BP corresponding with symptoms indicates a positive reading.

35
Q

What is a Tilt Table Test? and how is it performed?

A

To determine where a change in position causes a sudden drop in heart rate or blood pressure.
Supine 5 mins
passive tilt 60-70 degrees for 20 mins
take 400mcg of GTN spray
passive tilt for a further 15 mins.
Drop in HR or BP corresponding with symptoms indicates a positive reading.

36
Q

When do yo do an exercise tolerance test?

A 
Vaso-vagal or reflex syncope 
orthostatic intolerance 
autonomic dysfunction 
risk stratification
(Not to be performed if you've had any recent cardiac inflammation or infection, ongoing ACS, MI in past two days, decompensated HF, or symptomatic aortic stenosis)
37
Q

Difference between a stress test also know as exercise tolerance test vs a stress echo vs an echocardiogram

A
  1. Stress/exercise tolerance test -Use electrocardiography to measure electrical activity of the hearts response to exercise before, during and after. The BP and HR, it also measured. Used for chest pain, during exercise, and arrythmias or risk stratification after and MI.
  2. Stress Echo - measures the heart response to activity under stress via exercise or pharmacological (dobutamine). HR and ultrasound images are taken before exercise and taken again post exercise. Good to evaluate the gross structure of the heart and see how well it is pumping.
  3. Echocardiogram are ultrasound pictures of a static heart at rest.
38
Q

What is a transoesophageal echocardiogram?

A

Use an ultrasound probe via the mouth and down the oesphageous. It takes pictures of the hearts valves and chambers.

39
Q

What is an electrophysiology?

A
  1. Thin wire electrodes passed through the groin/neck via a fluoroscopy. Stimulates the heart and monitors its response to electrical activity. Good in detecting abnormal rhythms.
    Indications: Dizziness, Syncope, Pre-syncope, SOB, Weakness, palpitations,
40
Q

What is Percutaneous Coronary Intervention.

A

A cut is made in the wrist or groin. a sheath (Long plastic tube is inserted into the artery. a thin wire is passed through this into the narrow part of the artery, and over this a balloon is inflated. Sometimes a stent can also be inserted at this point.
A dye is injected - hot flushing sensation when the contrast is injected.

41
Q

When would a vascular ultrasound be indicated?

A 
Carotid 
Arterial
Venous
AAA
Endovascular aortic repair
Fistuala/repair
42
Q

When would you intervene and refer for carotid stenosis?

  1. 30%
  2. 50%
  3. 65%
  4. 70%
A

2-week referral
At 70% occlusion.
symptomatic
Causes - Stroke, Cardiac, ENT issues

43
Q

What are the indications of Arterial USS?

A
  1. Claudication / PAD
  2. Necrosis/ischemia
  3. diabetic ulcers
44
Q

Indications for venous USS?

A

incompetent/varicose veins
DVT
Pre surgery mapping

45
Q

AAA at what size do you monitor and b. need to intervene?

  1. > 3.00cm
  2. > 3.5cm
  3. > 4.0cm
  4. > 5.5cm
A

3.0cm monitor
5.5 intervention
80% mortality if it ruptures

46
Q

What two medications must you take a day before arriving to a catheter lab for a stent? and during the day of the procedure?

A

Day before: Aspirin (300mg) & Clopidogrel (300 mg)
On the day: Aspirin 75mg & Clopidogrel 75mg
(Do not take metformin and diuretics on the day of the procedure)
warfarin to stop 5 days before the procedure, and for the INR to be tested 2 days before the procedure.

47
Q

What blood tests and timeline are indicated before an angiogram and a stent?

A

6 months before angiogram - Kidney function and FBC
2 months before stent - Kidney function and FBC.
(Cannot drive for 1 week after having a stent)

48
Q

What is the recovery time for Stent/angio?

A

Angio - 3 hours

stent - 6 hours

49
Q

What is an angiogram? and an angiogram with stent?

A

Takes X-ray pictures of the arteries of the heart using a contrast dye.
Unblock narrowed blood vessels using balloons and stents.
Complications: Local bruising, infection, allergic reaction to the dye, brief-angina type pain during angiography.

50
Q

Percutaneous coronary intervention is also know as?

A

Coronary Angioplasty
Stenting
PCI
Catheter

51
Q

what are the reversible causes of AF?

A
  • hyperthyroid
  • Diabetes mellitus
  • Hypokalaemia and hyponatreumia
  • Infection / Pericarditis
  • Alcohol intoxication / Drugs (thyroxine or bronchodilators / caffeine
  • PE
52
Q

What are cardiac causes of AF?

A

Heart failure
Coronary artery disease
Hypertension
myocarditis, pericarditis

53
Q

What is AF also known as?

  1. Supraventricular tachyarrythmia
  2. supraventricular tachycardia
A
  1. Supraventricular tachycardia
54
Q

Do you see p waves in AF?

A

NO

ventricles are also 160-180 beats per minute.

55
Q

What are the three types of AF?

A
  1. Paroxysmal lasting longer than 30 seconds but less than 7 days (often less than 48 hours) that are self-terminating and recurrent.
  2. persistant - occurs for 7 days or less, but requires cardioversion or pharmacological treatment
  3. permanent - returns after cardioversion, within 24 hours and is present for over a year
56
Q

what are the symptoms of AF?

A 
SOB,
Syncope
Dizziness 
Palpitations 
chest discomfort
57
Q

What are the risks of AF?

A

Stroke - chest with chad2vas2score

peripheral thromboembolism

58
Q

Investigation for AF?

A

1 - 24 ambulatory ECG if the symptoms recur within 24 hours

2. Holter monitor - if symptoms occur more than 24 hours apart.

59
Q

What two scoring systems do you use in AF?

A

Chad2VAS2score - for stroke risk (if over 2 offer anticoagulant, if over 1 for males consider anticoagulant. DOAC - riveroxiban, or warfarin.

ORBIT score - assess bleeding risk if started on anticoagulant.

fcm (13 decks)

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