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Cardiology Flashcards

1
Q

What clinical feature is associated with mitral stenosis?

A

Malar flush

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2
Q

What murmur is associated with mitral stenosis?

A

Rumbling mid-diastolic murmur with opening snap

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3
Q

What murmur is associated with mitral regurgitation?

A

Pansystolic murmur radiating to the left axilla

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4
Q

What murmur is associated with aortic stenosis?

A

Ejection systolic murmur radiating to the carotids and apex

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5
Q

What murmur is associated with aortic regurgitation?

A

End diastolic murmur (Austin Flint murmur)

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6
Q

Name the pulse seen in aortic regurgitation.

A

Collapsing pulse

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7
Q

Describe how mitral stenosis is most commonly caused.

A
  • Group A beta-haemolytic streptococci e.g strep pyogenes cause rheumatic fever
  • Rheumatic fever can lead to rheumatic heart disease
  • This can result in mitral stenosis
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8
Q

How are valvular diseases diagnosed?

A

Echocardiogram

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9
Q

What is the most common cause of mitral regurgitation?

A

Mitral valve prolapse

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10
Q

What is the most common valvular disease in the UK?

A

Aortic stenosis

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11
Q

What is the most common cause of aortic stenosis?

A

Calcification due to ageing

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12
Q

What are the main clinical features of aortic stenosis?

A

Triad of:
- Exertional syncope
- Exertional angina
- Exertional dyspnoea

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13
Q

Name the pulse seen in aortic stenosis.

A

Carotid parvus et tardus (weak and slow-rising pulse)

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14
Q

What is cardiomyopathy?

A

Diseases of the heart muscle which make it harder for the heart to pump blood to the rest of the body

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15
Q

Name the 4 main types of cardiomyopathies.

A
  • Dilated cardiomyopathy (DCM)
  • Hypertrophic cardiomyopathy (HCM)
  • Restrictive cardiomyopathy (RCM)
  • Arrhythmogenic right ventricular cardiomyopathy (ARVC)
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16
Q

In what way can cardiomyopathies be inherited?

A

Autosomal dominant pattern

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17
Q

What is the most common cardiomyopathy?

A

Dilated cardiomyopathy

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18
Q

Which cardiomyopathy is associated with sudden death in young people?

A

Hypertrophic cardiomyopathy

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19
Q

What happens in DCM?

A

Heart chamber has become stretched and weakened so can’t effectively pump blood out of the heart

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20
Q

Describe what happens in HCM.

A

Abnormal thickening of the heart muscle:
- Systole is normal
- Diastole is reduced as the heart can’t relax properly due to thickening

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21
Q

Describe what happens in RCM.

A

Heart muscle becomes more stiff due to amyloidosis (abnormal amyloid deposits on the heart)
- Systole is normal
- Diastole is reduced as heart can’t relax properly due to stiffness

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22
Q

What happens in ARVC?

A

Right ventricular muscle is replaced by fat and fibrous tissue

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23
Q

What is infective endocarditis?

A

An infection caused by bacteria entering the bloodstream and reaching the heart

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24
Q

Name 6 clinical features of infective endocarditis.

A
  • Fever
  • New murmur
  • Splinter haemorrhages
  • Osler nodes
  • Janeway lesions
  • Roth spots
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25
Q

What is the 1st line investigation for infective endocarditis?

A

Blood cultures - 3 sets from 3 different sites before antibiotics

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26
Q

What is the gold standard investigation for infective endocarditis?

A

Echocardiogram - valvular vegetation

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27
Q

Which heart valve is first to be affected in infective endocarditis?

A

Tricuspid valve

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28
Q

What is the most common causative organism of infective endocarditis?

A

Staphylococcus aureus

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29
Q

What is the most common causative organism of infective endocarditis in IVDUs?

A

Staphylococcus aureus

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30
Q

What is the most common causative organism of infective endocarditis in non-IVDUs?

A

Streptococcus viridans

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31
Q

What is the most common causative organism of infective endocarditis following oral surgery?

A

Streptococcus viridans

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32
Q

What is the most common causative organism of infective endocarditis in those with prosthetic heart valves?

A

Staphylococcus epidermidis

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33
Q

How is infective endocarditis treated?

A

Antibiotics

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34
Q

What criteria is used for infective endocarditis?

A

Modified Dukes criteria

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35
Q

What is pericarditis?

A

Inflammation of the pericardium which surrounds the heart

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36
Q

What is the most common cause of pericarditis?

A

Unknown - idiopathic

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37
Q

Name 4 causes of pericarditis.

A
  • Viruses e.g enterovirus
  • Bacteria e.g TB
  • Autoimmune e.g RA, SLE, SjS
  • Metastases from primary cancer e.g lung, breast
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38
Q

Describe the presentation of pericarditis (3).

A
  • Fever
  • Chest pain
  • Pericardial rub
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39
Q

Describe the chest pain associated with pericarditis (5).

A
  • Acute onset
  • Pleuritic - sharp chest pain when breathing deeply
  • Relief sitting forward
  • Worse lying down
  • Constant, not related to exertion
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40
Q

What is a pericardial rub?

A

A squeaky/scratchy sound best heard with the diaphragm of the stethoscope over the left sternal border at the end of expiration

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41
Q

How is pericarditis diagnosed?

A

ECG:
- PR depression
- Saddle-shaped ST elevation

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42
Q

How is pericarditis treated?

A

NSAIDs and colchicine (prevents recurrence)

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43
Q

What is a pericardial effusion?

A

Fluid within the pericardial cavity exceeds the physiological amount of 50 ml

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44
Q

What are the 2 types of pericardial effusion? How are they caused?

A
  • Transudative effusion - increased venous pressure results in reduced drainage of serous fluid
  • Exudative effusion - inflammatory processes affecting the pericardium
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45
Q

Name 2 causes of a transudative pericardial effusion.

A
  • Congestive heart failure
  • Pulmonary hypertension
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46
Q

Name 5 causes of an exudative pericardial effusion.

A
  • Infection e.g TB, HIV
  • Autoimmune e.g RA, SLE
  • Injury to pericardium e.g after MI or open heart surgery
  • Cancer
  • Medications e.g methotrexate
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47
Q

Describe the presentation of pericardial effusion (4).

A
  • Chest pain
  • A feeling of fullness in the chest
  • Dyspnoea
  • Orthopnoea
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48
Q

What may happen if a pericardial effusion compresses the phrenic nerve?

A

Hiccups

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49
Q

What may happen if a pericardial effusion compresses the oesophagus?

A

Dysphagia

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50
Q

What may happen if a pericardial effusion compresses the recurrent laryngeal nerve?

A

Hoarse voice

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51
Q

What is the 1st line investigation for a pericardial effusion? What does it show?

A

ECG:
- Tachycardia
- Low voltage QRS complexes
- Electrical alternans

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52
Q

What is the gold standard investigation for a pericardial effusion?

A

Echocardiogram - echo free zone around the heart:
- Assess size of effusion
- Assess haemodynamic effect of effusion

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53
Q

How is a pericardial effusion treated?

A
  • Treat underlying cause
  • Drainage of the fluid e.g needle pericardiocentesis or surgical drainage
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54
Q

What can be done if a pericardial effusion keeps recurring?

A

Pericardial window - a portion of the pericardium is removed to allow fluid to drain from the pericardial cavity into the pleural or peritoneal cavity

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55
Q

What happens in a cardiac tamponade?

A
  • Build-up of fluid around the heart which puts pressure on the heart
  • The fibrous pericardium is not-stretchy so heart is compressed and is unable to fill with blood properly
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56
Q

Describe the presentation of a cardiac tamponade.

A

Beck’s triad:
- Falling blood pressure
- Rising jugular venous pressure
- Muffled heart sounds

57
Q

Describe what can happen to blood pressure in a cardiac tamponade.

A

Pulsus paradoxus - systolic blood pressure drops by > 10 mmHg on inspiration

58
Q

How is cardiac tamponade treated?

A

Pericardiocentesis

59
Q

What is the main cause of peripheral vascular disease?

A

Atherosclerosis

60
Q

Describe the presentation of acute limb ischaemia.

A
  • Pain
  • Paralysis
  • Pallor
  • Parasthesia
  • Pulselessness
  • Perishingly cold
61
Q

What is the 1st line investigation for peripheral vascular disease?

A

Ankle-brachial index (ABI)

62
Q

What is the gold standard investigation for peripheral vascular disease?

A

CT angiography

63
Q

How is peripheral vascular disease treated (4)?

A
  • Viable limb - revascularisation
  • Non-viable limb - amputation
  • Anti-platelets to prevent clots e.g aspirin, clopidogrel
  • Exercise therapy
64
Q

How do anticoagulants work?

A

Prevent the formation of blood clots by interfering with clotting factors in the coagulation cascade
- Treatment of a venous thrombosis

65
Q

How do antiplatelets work?

A

Prevent the formation of blood clots by preventing platelets from clumping together
- Treatment of an arterial thrombosis

66
Q

Give 3 examples of anticoagulants.

A
  • Warfarin
  • Heparin e.g dalteparin, enoxaparin, tinzaparin
  • DOACs e.g apixaban, rivaroxaban
67
Q

How does warfarin work?

A

Vitamin K antagonist - prevents the formation of vitamin K dependent clotting factors (2, 7, 9 and 10)

68
Q

How does heparin work?

A

Inhibits factor 10a indirectly via antithrombin 3 and thrombin

69
Q

How do DOACs work?

A

Inhibits factor 10a directly

70
Q

Give 4 examples of antiplatelets. How do they work?

A
  • Aspirin - COX inhibitor
  • Clopidogrel - P2Y12 receptor antagonist
  • Tricagrelor - P2Y12 receptor antagonist
  • Prasugrel - P2Y12 receptor antagonist
71
Q

Describe the difference between the composition an arterial vs venous thrombosis.

A

Arterial - platelet rich (white)
Venous - fibrin rich (red)

72
Q

What are risk factors for a DVT (8)?

A
  • Prolonged immobility
  • Long haul flights
  • Recent trauma/surgery
  • Oral contraceptive pill (oestrogen)
  • Hormone replacement therapy
  • Pregnancy
  • Obesity
  • Smoking
73
Q

What score can be used to assess DVT or PE risk?

A

Wells score

74
Q

Describe the presentation of a DVT.

A

1 leg is:
- Red
- Hot
- Swollen
- Painful

75
Q

What can be done 1st for a suspected DVT/PE?

A

Quantitive D-dimer

76
Q

Is D-dimer sensitive or specific?

A

Sensitive - can be used to rule out a DVT/PE but can’t be used to confirm a diagnosis

77
Q

What is the gold standard investigation for a DVT?

A

Venous ultrasound with Doppler:
- Reduced blood flow where DVT is
- Unable to compress vein using ultrasound transducer

78
Q

How is a DVT/PE treated (3)?

A
  • Anticoagulation:
    –> 1st line - DOAC
    –> 2nd line - LMWH for 5 days, then dabigatran
  • Compression stockings
  • Physical activity
79
Q

How long should treatment last for a provoked vs unprovoked DVT?

A

Provoked - 3 months
Unprovoked - 6 months

80
Q

What is a possible consequence of a DVT?

A

PE

81
Q

Describe the presentation of a PE (6).

A
  • Chest pain - unilateral
  • Dyspnoea
  • Dizziness
  • Syncope
  • Cough
  • Haemoptysis
82
Q

How is a PE diagnosed?

A

CTPA

83
Q

Describe the ECG changes seen in PE.

A

S1 Q3 T3

84
Q

What are non-modifiable risk factors for cardiovascular disease (4)?

A
  • Age over 60
  • Black
  • Male
  • Family history
85
Q

What are modifiable risk factors for cardiovascular disease (7)?

A
  • Hypertension
  • Hypercholesterolaemia
  • Diabetes
  • Unhealthy diet
  • Overweight
  • Physical inactivity
  • Smoking
86
Q

What is an aneurysm?

A

An abnormal bulge in a vessel

87
Q

What are 2 types of aneurysms?

A
  • True - dilation involves all layers of the arterial wall
  • False (pseudoaneurysms) - collection of blood in the adventitia
88
Q

Where are aneurysms most commonly found (2)?

A
  • Abdominal aorta - below where renal arteries branch off, just before the aortic bifurcation
  • Thoracic aorta
89
Q

Describe the presentation of an abdominal aortic aneurysm (4).

A
  • Often asymptomatic until rupture - pulsatile abdominal mass
  • Abdominal pain
  • Hypotension
  • Tachycardia
90
Q

How are abdominal aortic aneurysms diagnosed?

A

Aortic ultrasound

91
Q

How are abdominal aortic aneurysms treated (3)?

A
  • Small aneurysms - monitored
  • Large/expanding aneurysms - surgical repair
  • Risk factor modification
92
Q

Name 3 complications of abdominal aortic aneurysms.

A
  • Rupture
  • Thrombosis
  • Exert pressure on adjacent structures
93
Q

What are the causes of aortic dissection? What is the most common cause (5)?

A
  • Chronic hypertension
  • Aneurysms
  • Atherosclerosis
  • Inflammation
  • Trauma - shearing stresses
94
Q

Where are the 2 most common sites for an aortic dissection to occur?

A
  • Just distal to the aortic valve in the ascending aorta
  • Just distal to left subclavian artery in the descending aorta
95
Q

Describe the presentation of an aortic dissection (5).

A
  • Sudden onset of tearing chest pain
  • Pain radiates to back and left arm (mimics MI)
  • Shock
  • Weak lower limb pulses
  • Acute lower limb ischaemia
96
Q

What is the 1st line investigation for an aortic dissection?

A

ECG - rule out MI

97
Q

What is the gold standard investigation for an aortic dissection?

A

CT scan - tennis ball sign

98
Q

Name the 2 types of classification for aortic dissection.

A
  • DeBakey classification
  • Stamford classification
99
Q

Explain the DeBakey classification.

A
  • Type 1 - originates in the ascending aorta and propagates to at least the aortic arch
  • Type 2 - confined to the ascending aorta
  • Type 3 - originates distal to the left subclavian artery in the descending aorta
100
Q

Explain the Stamford classification.

A
  • Group A - involves ascending aorta (DeBakey type 1 and 2)
  • Group B - does not involve the ascending aorta (DeBakey type 3)
101
Q

What is meant by sinus bradycardia?

A

A normal sinus rhythm that is below 60 bpm

102
Q

What is meant by sinus tachycardia?

A

A normal sinus rhythm that is above 100 bpm

103
Q

What are arrhythmias?

A

Abnormalities in the cardiac rhythm

104
Q

Name an arrhythmia which can cause bradycardia.

A

Heart block

105
Q

Name 2 types of arrhythmias which can can cause tachycardia. Explain.

A
  • Supraventricular tachycardias (SVT) - narrow complex (QRS < 120 ms)
  • Ventricular tachycardias (VT) - broad complex (QRS > 120 ms)
106
Q

Give 4 examples of supraventricular tachycardias.

A
  • Atrial fibrillation
  • Atrial flutter
  • AVNRT
  • AVRT (WPW)
107
Q

What is a sinus rhythm?

A

Normal rhythm of the heart - all 3 waveforms present:
- P wave
- QRS complex
- T wave

108
Q

What is the most common type of arrhythmia?

A

Atrial fibrillation

109
Q

What is atrial fibrillation?

A

An irregularly irregular atrial rhythm:
- This is due to disorganised electrical activity that overrides the normal, organised activity from SAN

110
Q

Give 4 possible complications of atrial fibrillation.

A
  • Irregularly irregular ventricular contractions
  • Tachycardia
  • Heart failure - due to poor filling of the ventricles during diastole
  • Stroke - due to blood pooling in the atria so increased risk of blood clots forming
111
Q

Describe the presentation of atrial fibrillation and atrial flutter (3).

A
  • Palpitations
  • Shortness of breath
  • Syncope
112
Q

How can atrial fibrillation be diagnosed?

A

ECG:
- Fibrillatory waves
- Absent P waves
- Narrow QRS complexes
- Irregularly irregular ventricular rhythm

113
Q

What are the causes of atrial fibrillation?

A

SMITH:
- Sepsis
- Mitral valve pathology
- Ischaemic heart disease
- Thyrotoxicosis
- Hypertension
- Others e.g idiopathic, heart surgery, heart failure, cardiomyopathy

114
Q

What are the 2 methods which can be used to treat atrial fibrillation?

A
  • Rate control - first line generally
  • Rhythm control
115
Q

When should rhythm control for atrial fibrillation be used instead (4)?

A
  • Cause of AF is reversible
  • New onset AF - less than 48 hours
  • AF is causing heart failure
  • Still symptomatic despite rate being controlled
116
Q

Describe the treatment for rate control in atrial fibrillation.

A
  • 1st line - beta blockers e.g atenolol
  • Calcium-channel blockers e.g diltiazem (not in heart failure)
  • Digoxin (only in sedentary people)
117
Q

How can rhythm control be achieved?

A

Cardioversion:
- Pharmacological cardioversion
- Electrical cardioversion

118
Q

What can be used for pharmacological cardioversion?

A
  • Flecanide
  • Amiodarone - for patients with structural heart diseases
119
Q

What is the CHA2DS2-VASc score used for?

A

To assess whether a patient with atrial fibrillation should be started on anticoagulation due to stroke and TIA risk

120
Q

Explain the CHA2DS2-VASc score.

A

C - congestive heart failure (1)
H - hypertension (1)
A - age > 75 (2)
D - diabetes (1)
S - stroke or TIA previously (2)
V - vascular disease (1)
A - age 65 - 74 (1)
S - sex female (1)

0 = no anticoagulation
1 = consider anticoagulation
> 1 = offer anticoagulation

121
Q

Name 2 scoring systems which can be used to assess risk of bleeding whilst on anticoagulation.

A
  • ORBIT tool (new)
  • HAS-BLED
122
Q

What is atrial flutter?

A

Fast and regular atrial rhythm, the AVN usually conducts every 2nd flutter so ventricular rate is usually half the atrial rate

123
Q

How is atrial flutter diagnosed?

A

ECG:
- Sawtooth waves

124
Q

How is atrial flutter treated?

A

1st line - electrical cardioversion
Other - catheter ablation

125
Q

What is heart block?

A

When electrical signals from the top chambers of the heart don’t conduct properly to the bottom chambers of the heart

126
Q

What are the 2 types of heart block?

A
  • Atrioventricular (AV) block
  • Bundle branch block
127
Q

What are the different types of AV block?

A
  • First degree
  • Second degree (I and II)
  • Third degree
128
Q

What are the different types of bundle branch block?

A
  • Right bundle branch block (RBBB)
  • Left bundle branch block (LBBB)
129
Q

What is a 1st degree heart block?

A

Simple prolongation of the PR interval to greater than 120 ms

130
Q

How is 1st degree heart block treated?

A

Usually no treatment needed

131
Q

What is a 2nd degree heart block?

A

Occurs when some P waves conduct and others do not, so there are more P waves than QRS complexes as some impulses fail to reach the ventricles

132
Q

What are the 2 types of 2nd degree heart block?

A
  • Mobitz I block (Wenckebach phenomenon)
  • Mobitz II block
133
Q

Describe a Mobitz I block.

A

PR intervals gradually elongate until a P wave fails to conduct, resulting in an absent QRS complex

134
Q

Describe a Mobitz II block.

A

PR intervals are constant but some P waves don’t conduct, resulting in an absent QRS complex

135
Q

How is a 2nd degree heart block usually treated?

A

Mobitz I - pacemaker unlikely
Mobitz II - pacemaker likely

136
Q

What is a 3rd degree heart block?

A

A complete heart block where all atrial activity fails to conduct to the ventricles, so P waves and QRS complexes are completely independent of each other

137
Q

How is a 3rd degree heart block treated?

A

Pacemaker

138
Q

Describe the ECG changes seen in a right bundle branch block.

A

maRRow:
- M - QRS looks like an M in V1
- w - QRS looks like a W in V6

139
Q

Describe the ECG changes seen in a left bundle branch block.

A

wiLLiam:
- W - QRS looks like a W in V1
- M - QRS looks like a M in V6

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