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Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Stable Angina

A

*Constant stenosis
*Ischaemia with no necrosis
*Effort dependent and predictable symptoms
*No biomarker rise, may have reversible ECG changes

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2
Q

Unstable Angina

A

*Dynamic stenosis
*Ischaemia with no necrosis
*Unpredictable or worsening symptoms
*No biomarker rise, may have reversible ECG changes

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3
Q

NSTEMI

A

*Obstruction to flow
*Cardiomyocyte necrosis
*Prolonged symptoms
*Occurs at any time
*May have irreversible ECG changes
*Biomarker rise

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4
Q

STEMI

A

*Obstruction to flow
*Cardiomyocyte necrosis
*Prolonged symptoms, occurs at any time
*ST elevation in the distribution of affected coronary artery
*Biomarker rise

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5
Q

What are the non modifiable risk factors for coronary artery disease?

A

*Age
*Sex: increased risk in men
*Genetic predisposition
*Existing coronary artery disease

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6
Q

What are the modifiable risk factors for coronary artery disease?

A

*Smoking
*Hypertension
*Diabetes mellitus
*Dyslipidaemia

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7
Q

What are the investigations for CAD?

A

*ECG to look for ST elevation
*Cardiac markers e.g. troponin

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8
Q

Where would you see ECG changes in an anterior STEMI and what artery is most likely affected?

A

*V1-V4
*Left anterior descending

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9
Q

Where would you see ECG changes in an inferior STEMI and what artery is most likely affected?

A
  • II, III, aVF
    *Right coronary artery
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10
Q

Where would you see ECG changes in a lateral STEMI and what artery is most likely affected?

A

*I, V5, V6
*Left circumflex

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11
Q

What is the management of a STEMI?

A

*Morphine
*Oxygen if SATS<94%
*Nitrates
*Aspirin + prasugrel (if having PCI)
*Percutaneous coronary intervention if within 120 minutes of presentation to hospital and within 12 hours of symptom onset; if not possible then fibrinolysis

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12
Q

What is the management of a NSTEMI?

A

*Morphine
*Oxygen if SATS<94%
*Nitrates
•Aspirin
•Use GRACE stratification tool, if high risk then coronary angiography
• Antithrombin therapy with fondaparinux sodium should also be offered, unless the patient is undergoing immediate coronary angiography

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13
Q

What is the secondary prevention of CAD?

A

*Aspirin
*Clopidogrel
*Beta blocker
*ACEi
*Statin

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14
Q

What can be used to predict the prognosis post MI?

A

*KIllip class

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15
Q

What are the potential complications post MI?

A

*Cardiac arrest
*Cardiogenic shock
*Chronic heart failure
*Tachy or Brady arrhythmia
*Pericarditits
*Dressler’s syndrome
*Left ventricular aneurysm
*Left ventricular wall rupture
*Ventricular septal defect
*Acute mitral regurgitation

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16
Q

Grade 1 Hypertension

A

*Clinic: ≥140/≥90
*ABPM: ≥135/≥85

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17
Q

Grade 2 hypertension

A

*Clinic: ≥160/≥100
*ABPM: ≥150/≥95

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18
Q

Grade 3 hypertension

A

*Clinic: ≥180/≥110

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19
Q

What are the complications of hypertension?

A

*Atherosclerosis: increased risk of MI, stroke and peripheral vascular disease
*Renal damge
*Cardiac: increased after load increases LV work leading to LV hypertrophy and then heart failure
*Arrhythmia: increased AF risk
*Retinal damage: retinal haemorrhage and papilloedema leading to visual disturbance

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20
Q

What investigations should be carried out in those diagnosed with hypertension?

A

*Blood tests: renal function, electrolytes, lipids, HbA1c
*Urine dipstick: microscopic haematuria or proteinuria
*ECG: any LVH evidence
*Consider an echocardiogram

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21
Q

What is the treatment pathway for hypertension in someone under the age of 55?

A

Step 1: ACEi or ARB
Step 2: ACEi or ARB plus CCB (amlodipine) or thiazide like diuretic (indapamide)
Step 3: ACEi or ARB plus CCB plus Thiazide like diuretic
Step 4: discuss adherence, confirm resistant hypertension, consider expert advice or adding low dose spironolactone if K+≤4.5 or an alpha or beta blocker if K+>4

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22
Q

What is the treatment pathway for hypertension in someone over the age of 55?

A

Step 1: CCB
Step 2: CCB (amlodipine) plus ACEi or ARB or thiazide like diuretic (indapamide)
Step 3: ACEi or ARB plus CCB plus Thiazide like diuretic
Step 4: discuss adherence, confirm resistant hypertension, consider expert advice or adding low dose spironolactone if K+≤4.5 or an alpha or beta blocker if K+>4

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23
Q

What is the treatment pathway for hypertension in someone with type 2 diabetes?

A

Step 1: ACEi or ARB
Step 2: ACEi or ARB plus CCB (amlodipine) or thiazide like diuretic (indapamide)
Step 3: ACEi or ARB plus CCB plus Thiazide like diuretic
Step 4: discuss adherence, confirm resistant hypertension, consider expert advice or adding low dose spironolactone if K+≤4.5 or an alpha or beta blocker if K+>4

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24
Q

What is the treatment pathway for hypertension in someone of black African or African-caribbean family origin?

A

Step 1: CCB
Step 2: CCB (amlodipine) plus ARB or thiazide like diuretic (indapamide)
Step 3: ARB plus CCB plus Thiazide like diuretic
Step 4: discuss adherence, confirm resistant hypertension, consider expert advice or adding low dose spironolactone if K+≤4.5 or an alpha or beta blocker if K+>4

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25
Q

What are the symptoms of AF?

A

*Palpitations
*Dyspnoea
*Chest pain
*Irregualrly irregular pulse

26
Q

Rate control of AF

A

*Beta blocker or rate limiting calcium channel blocker (diltiazem)
*If one drug alone doesn’t control the rate, add a second of beta blocker or diltiazem or digoxin

27
Q

When would you offer rhythm control of AF

A

*Offered if reversible cause or if onset <48 hours, if heart failure or if remain symptomatic despite rate control

28
Q

Rhythm control of AF

A

*Cardioversion pharmacologically via flecanide or amiodarone
*Electrically using a defibrillator

29
Q

What is used to calculate stroke risk in AF?

A

*CHA2DS2-VASc

30
Q

Explain the interpretation of the CHA2DS2-VASc score

A

*0: no anticoagulation
*1: consider anticoagulation
*>1: offer anticoagulation
*Offer a choice between warfarin and a DOAC

31
Q

What are the causes of an irregularly irregular pulse?

A

*AF
*Ventricular ectopics

32
Q

Explain the CHA2DS2-VASc scoring system

A

*Congestive heart failure
*Hypertension
*Age: 65-74: 1, ≥75: 2
*Diabetes mellitus
*Prior Stroke or TIA or thromboembolism
*Vascular disease (PAD, IHD)
*Sex (female)
*S

33
Q

Describe supraventricular tachycardia on an ECG

A

*Fast, narrow complex tachycardia
*QRS<0.12s

34
Q

What are the three main types of SVT?

A

*Atrioventricualr nodal re-entrant tachycardia
*Atrioventricualr re-entrant tachycardia: Wolff-PArkinson White syndrome
*Atrial tachycardia

35
Q

Explain the management of supraventricular tachycardia

A
  • Continuous ECG monitoring
    *Valsalva manoeuvre: blow hard against resistance
    *Carotid sinus massage
    *Adenosine: initially 6mg then 12
    *Verapamil
    *DC cardio version if treatment fails
36
Q

Explain the management of ventricular tachycardia

A

*If adverse signs then immediate cardioversion is indicated
*Amiodarone ideally via a central line or lidocaine
*If drug therapy fails then electrophysiological study, implantable cardioverter defibrillator

37
Q

What are the causes of a prolonged QT interval?

A

*Congenital: Jervell-lange-neilsen syndrome, romano-ward syndrome
*Medications: amiodarone, tricyclic antidepressants, macrolides, sotalol, citalopram

38
Q

What is the management of sinus bradycardia?

A

*If stable then observe
*If unstable or chance of asystole, then atropine 500mcg IV up to 6 doses, then other inotropes e.g. noradrenaline or transcutaneous cardiac pacing

39
Q

First degree heart block

A

PR interval >0.2 seconds

40
Q

Mobitz type I heart block

A

Progressive prolongation of the PR interval until a dropped beat occurs

41
Q

Mobitz type II heart block

A

*PR interval is constant but the P wave is often moot followed by QRS (usually a set ratio)

42
Q

Third degree heart block

A

No association between P waves and QRS complex

43
Q

What is the management of heart block?

A

*If stable, observe
*Mobitz type II +
- Atropine 500mcg then other inotropes then temporary transvenous cardiac pacing/ permanent implantable pacemaker

44
Q

Presentation of Heart Failure

A

*Breathlessness - worse on exertion
*Cough: white/pink frothy sputum
*Orthopnoea: how many pillows?
*Paroxysmal nocturnal dyspnoea
*Peripheral oedema

45
Q

What are the signs of heart failure on examination?

A

*Bibasal crackles
*Signs of right sided heart failure: JVP, ankle oedema, hepatomegaly
*Displaced apex beat

46
Q

Investigations for heart failure

A

*NT-proBNP
*ECG
* Echocardiogram
*Consider chest x ray

47
Q

What is the medical management of heart failure?

A

*ACEi/ARNI
*Beta blocker
*MRA- spironolactone
*SGLT2i - Empagliflozin or dapagliflozin
*Loop diuretic

48
Q

What is the management of acute heart failure?

A

*Nitrates for vaso and venodilation
*Furosemide
*CPAP for preload reduction
*Inotropes: dobutamine/dopamine
*Ultrafiltration

49
Q

What is the most common cause of infective endocarditis?

A

Staphylococcus aureus

50
Q

What is the second most common cause of infective endocarditis?

A

Streptococcus viridans

51
Q

In patients following prosthetic valve surgery, what is the most common cause of infective endocarditis?

A

Staphylococcus epidermidis

52
Q

What is used to diagnose infective endocarditis?

A

Duke criteria

53
Q

When is infective endocarditis diagnosed using Dukes?

A

*Pathalogical criteria are positive
* 2 major
*1 major and 3 minor
*5 minor

54
Q

In Duke’s criteria, what are the major criteria

A

1) 2 positive blood culturesshowing typical organsims
2) Persistent bacteraemia from blood cultures taken >12 hours apart (3 if the pathogen is less specific)
3) Positive echocardiogram
4) New valvular regurgitation

55
Q

In Duke’s criteria, what are the minor criteria

A

1) Predisposing heart condition or IV drug use
2) Microbiological evidence that doesn’t meet the major criteria
3) Fever >38 degrees
4) Vascular phenomena: major emboli, splenomegaly, clubbing, splinter haemorrhages, janeway lesions, petechiae or purpura
5) Immunological phenomena: glomerulonephritis, osler’s nodes, roth spots

56
Q

What is the initial blind therapy for infective endocarditis?

A

*Native valve: amoxicillin
*Pen allergy/MRSA/severe sepsis: vancomycin and low dose gentamicin
*Prosthetic valve: vancomycin + rifampicin +low dose gent

57
Q

What is the therapy for staphylococci infective endocarditis?

A

*Native valve: flucloxacillin
*Prosthetic valve: flucloxacillin, rifampicin, low dose gentamicin
*Penicillin allergy: Vancomycin +rifampicin

58
Q

What is the therapy for streptococci infective endocarditis?

A

*Benzylpenicillin
*If penicillin allergy: Vancomycin +low dose gent

59
Q

What are the indications for surgery for infective endocarditis?

A

*Recurrent emboli after antibiotic therapy
*Aortic aneurysm
*Infection resistant to antibiotics/fungal infections
*Severe valvular incompetence
*Cardiac failure refractory to standard medical treatment

60
Q

What is postural hypotension?

A

A fall of systolic BP >20mmHg on standing

61
Q

What is the treatment of postural hypotension?

A

mineralcorticoid: fludrocortisone 0.1-0.2mg once daily

Finals (37 decks)

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