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Zero to Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q
  1. What would a scar down the centre of the chest suggest?
  2. What operations might a midline sternotomy suggest?
  3. What other scar would you look for to help establish the cause?
A
  1. A midline sternotomy
  2. Coronary Artery Bypass Graft (CABG)
    Aortic Valve Replacement
    Mitral Valve Replacement
  3. Saphenous vein harvesting scar on the inner calf (CABG)
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2
Q

65-year-old man with chest pain on exertion that always settles with rest

  1. Diagnosis
  2. Gold standard Ix
  3. Medication for immediate symptom relief
  4. Medication for long-term symptom relief? (2)
  5. Medication for secondary prevention? (4)
  6. Procedural/surgical options?(2)
A
  1. Stable angina
  2. CT Coronary Angiogram
  3. GTN spray
  4. Beta blocker (e.g. bisoprolol)
    Calcium channel blocker (e.g. amlodipine)
  5. Aspirin 75mg OD
    Atorvastatin 80mg OD
    ACE Inhibitor (e.g. Ramipril)
    Beta blocker (e.g. bisoprolol)
  6. Percutaneous Coronary Intervention (PCI)
    Coronary Artery Bypass Graft (CABG)
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3
Q
  1. Criteria for a STEMI
  2. Artery and ECG leads affected in:
    a. Anterolateral
    b. Anterior
    c. Lateral
    d. Inferior
  3. Protein tested for cardiac muscle damage?
  4. STEMI treatment options? (2)
  5. Initial NSTEMI treatment? (6)
  6. Complications (6)
A
  1. ST elevation or new LBBB
  2. a. Anterolateral –> LCA –> I, aVL, V3-V6
    b. Anterior –> LAD –> V1-V4
    c. Lateral –> Circumflex –> I, aVL, V5-V6
    d. Inferior –> RCA –> II, III, aVF
  3. Troponin
  4. Primary PCI
    Thrombolysis
  5. ‘BATMAN’
    Beta blockers
    Aspirin
    Ticagrelor
    Morphine
    Anticoagulant (fondaparinux)
    Nitrates (GTN)
  6. ‘DREAD’
    Death
    Rupture
    Edema
    Arrhythmia
    Aneurysm
    Dressler’s Syndrome
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4
Q

87-year-old lady on the medical ward presenting with acute shortness of breath and low oxygen sats. She had 3 litres of IV fluids in the last 24 hours.

  1. Diagnosis
  2. Possible triggers (4)
  3. Finding on auscultation
  4. CXR changes? (5)
  5. Acute management? (4)
A
  1. Acute Left Ventricular Failure and Pulmonary Oedema
  2. Iatrogenic (e.g. IV fluids), Sepsis, MI, Arrhythmias
  3. Bilateral basal crackles
  4. Upper lobe diversion
    Pleural effusions
    Cardiomegaly
    Fluid in fissures
    Kerley lines
  5. Treat cause (stop IV)
    Sit up
    Oxygen
    Diuretics
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5
Q

86 year old man with breathlessness, cough and swollen ankles. He sleeps with 4 pillows and sometimes wakes up gasping for breath/

  1. Diagnosis
  2. Name for waking short of breath?
  3. Causes? (4)
  4. First-line GP Investigation?
  5. Cut-off for urgent referral?
  6. First-line medical treatment? (4)
A
  1. Heart failure
  2. Paroxysmal Nocturnal Dyspnoea
  3. Ischaemic heart disease
    Valvular heart disease
    Hypertension
    Arrhythmias
  4. BNP blood test
  5. BNP >2000
  6. ‘ABAL’
    • ACE Inhibitor
    • Beta blockers
    • Aldosterone agonist
    • Loop Diuretic
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6
Q

52-year-old man with a clinic BP of 154/94

  1. Diagnosis
  2. To confirm diagnosis?
  3. Secondary causes? (4)
  4. Additional Ix with a new diagnosis? (4)
  5. First-line in this patient?
  6. When would the first-line be different? What would is be?
  7. Treatment target in under 80s
A
  1. Hypertension
  2. Home or ambulatory readings
  3. ROPE
    Renal disease
    Obesity
    Pregnancy
    Endocrine
  4. Urine dipstick and albumin-creatinine ratio
    Bloods (HBA1c, U&E, Lipids)
    Fundoscopy
    ECG
  5. ACE Inhibitor
  6. Aged over 55 or black –> Calcium channel blocker
  7. <140/<90
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7
Q

What valve pathology would cause:

  1. Left atrial hypertrophy
  2. Left ventricular dilation
  3. Malar flush
  4. Slow rising pulse
  5. Corrigan’s pulse
  6. Mid-diastolic, low-pitched ‘rumbling’ murmur
  7. Pan-systolic, high-pitched ‘whistling’ murmur
  8. Early-diastolic, soft murmur
  9. Atrial fibrillation
A
  1. Mitral stenosis
  2. Aortic regurgitation
  3. Mitral stenosis
  4. Aortic stenosis
  5. Aortic regurgitation
  6. Mitral stenosis
  7. Mitral regurgitation
  8. Aortic regurgitation
  9. Mitral stenosis
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8
Q

75 year old with exertional syncope and a murmur

  1. Diagnosis
  2. Describe the murmur
  3. Radiation of the murmur
  4. Pulse pressure?
  5. Causes? (2)
  6. Surgical treatment option for severe disease in patients high risk for open valve replacement?
A
  1. Aortic stenosis
  2. Ejection-systolic, high-pitched, crescendo-decrescendo murmur –> loudest at the aortic area
  3. Neck or carotids
  4. Narrow
  5. Idiopathic age-related calcification
    Rheumatic heart disease
  6. Transcatheter aortic valve implantation
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9
Q
  1. What lifelong medication would you need with a mechanical valve?
  2. Complications of mechanical valves? (3)
  3. Heart sounds with mechanical valves?
A
  1. Warfarin with INR 2.5-3.5
  2. Thrombus formation
    Infective endocarditis
    Haemolysis
  3. ‘Click’ replaces S1->Mitral S2->Aortic
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10
Q

Atrial Fibrillation

  1. Pulse rhythm?
  2. Most common causes? (5)
  3. First-line for rate control?
  4. Options for pharmacological cardioversion?(2)
  5. Scoring system for risk of a stroke? Bleeding?
  6. Options for anticoagulation? (2)
A
  1. Irregularly irregular
  2. Mitral valve pathology
    Ischaemic heart disease
    Sepsis
    Thyrotoxicosis
    Hypertension
  3. Beta blocker
  4. Amiodarone
    Flecanide
  5. CHA2DS2VASc
    HAS-BLED
  6. Warfarin
    DOAC (e.g. apixaban, dabigatran, rivaroxaban)
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11
Q

Supraventricular tachycardia

  1. Initial non-pharmacological management?(2)
  2. Main drug used in treatment?
  3. Contraindications to this drug? (4)
  4. Immediate side-effect?
  5. Doses? (3)
  6. Treatment if the above fails?
  7. Procedural treatment of recurrent episodes?
A
  1. Valsalva manoeuvre
    Carotids sinus massage
  2. Adenosine
  3. Asthma/COPD, HF, Heart block, sever hypertension
  4. Feeling of dying/doom
  5. Initially 6mg, then 12mg, then 12mg
  6. Direct Current Cardioversion
  7. Radiofrequency ablation
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12
Q
  1. Types of pacemakers?
  2. Indications? (5)
  3. Consideration after death?
A
  1. Single-chamber
    Dual-chamber
    Biventricular (triple-chamber)
    Implantable cardioverter defibrillators
  2. Symptomatic bradycardias
    Mobitz Type 2 AV block
    3rd Degree Heart Block
    Severe HF
    Hypertrophic obstructive cardiomyopathy (ICD)
  3. Must be removed before cremation
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Zero to Finals (2 decks)

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