Cardiology Flashcards
1
Q
suffix for ACEi, ARB and Calcium channel blockers
A
ACEi: pril
ARB: sartan
Ca channel blockers: pine
2
Q
threshold for clinic and ABPM
A
clinic 140/90
ABPM 135/85
3
Q
threshold for stage 1 and 2 HTN
A
stage 1: above 135/85
stage 2: above 150/95
4
Q
blood pressure 180/120 or above
A
assess target organ damage
if +ve then ADMIT
5
Q
flowchart for HTN with T2DM or under 55
A
ACEi or ARB (ACEi 1st in DM)
+ CCB or thiazide-like
+ CCB + thiazide-like
6
Q
flowchart for HTN without T2DM age 55 over or black
A
CCB
+ ACEi or ARB or thiazide-like
+ ACEi or ARB + thiazide-like
7
Q
give an example of a thiazide like diuretic
A
indapamide
8
Q
stage 4 of flowchart
potassium above/below 4.5
A
potassium below 4.5 = spironolactone
potassium above 4.5 = alpha blocker or beta blocker
9
Q
which CCB is licensed in heart failure
A
amlodipine
10
Q
QRISK above 10%
A
statin
11
Q
MOA of statins
A
inhibit HMG-CoA reductase
12
Q
when should you take statins
A
in the evening
13
Q
monitoring for statin
A
LFT @ baseline, 3m and 12m
14
Q
interaction between statin and ‘-mycin’ ABx
A
rhabdomyolysis
15
Q
which drug causes the following side effects:
high calcium, low sodium, low urea
increases risk of gout and ED
reduces glucose tolerance
A
thiazides
16
Q
which drug causes the following side effects:
cough, increased K, angioedema
A
ACEi
17
Q
which condition contraindicates the use of ACEi
A
hypertrophic obstructive cardiomyopathy
18
Q
what can ACEi and ARB cause if unknown renal impairment
A
bilateral renal artery stenosis
19
Q
which drug causes the following side effects:
reduced hypoglycaemic awareness, ED and insomnia
A
beta blockers
20
Q
which drug causes the following side effects:
ototoxicity, reduced Ca and K
A
loop diuretics
21
Q
which drug causes the following side effects:
GI ulcers
A
Nicorandil
22
Q
which drug causes the following side effects:
visual disturbance and green luminescence
A
ivabradie
23
Q
which drug causes the following side effects:
thrombophlebitis and grey skin
A
amiodarone
24
Q
where the the likely place inhaled foreign bodies are found
A
RIGHT bronchus
inferior lobe
25
heavy central chest pain radiating to the neck/arm causing nausea and sweating with CVD RF
cardiac pain
- might not be present if elderly/diabetic
26
right coronary infarct can lead to what
AV block
27
WHAT ARE THE ECG CHANGES
Anteroseptal: V1-V4: LAD
Inferior: II, III, aVF: Right coronary
Anterolateral: V4-6, I, aVL: LAD/ left circumflex
Lateral: I, aVL +/- V5-6: Left circumflex
Posterior: V1-V3, tall R and T waves, ST depression: Left circumflex/ right coronary
28
how do you confirm a posterior MI
ST elevation and Q waves in leads V7-V9
29
new LBBB
ALWAYS PATHOLOGICAL
urgent PCI
30
biochemical marker for NSTEMI
raised troponin
31
how can you check for reinfarction
check creatinine kinase - elevated for 3-4 days compared to troponin which remains elevated for 10 days
32
imaging for stable chest pain with suspected coronary artery disease
contrast CT coronary angiogram
33
what does CABG stand for
coronary artery bypass graft
34
stenosis in LAD causing no pain, normal cardiac enzymes, no ST elevation but deep T wave inversion
WELLEN'S SYNDROME
35
what medication is needed for secondary prevention
2 antiplatelets: aspirin and clopidogrel/ticagrelor
ACEi
BB
Statin
36
when would you stop the second antiplatelet post MI
after 12m
37
broad complex tachycardia post MI
VF - arrest
38
reduced ejection fraction post MI
cardiogenic shock
poor prognosis
39
pain in first 48 hours post MI
pericarditis
40
fever, pleuritic pain, pericardial effusion, increased ESR 2-6w post MI
Dresslers
41
pathophysiology and treatment of dresslers
autoimmune reaction to new pericardium
NSAIDs
42
ST elevation and LV failure causing thrombus post MI
LV aneurysm
43
pathophysiology and treatment of LV aneurysm
ischaemic weakens myocardium
anticoagulation
44
increased JVP, pulsus paradoxus and reduced heart sounds 1-2w post MI
LV free wall rupture
45
pathophysiology and treatment of LV free wall rupture
acute heart failure secondary to tamponadee
pericardiocentesis/thoractomy
46
heart failure and pansystolic murmur 1w post MI
ventricular septal defect
47
infero-posterior MI / papillary muscle rupture presenting with hypotension and pulmonary oedema post MI
acute mitral regurgitation
48
sudden SOB and chest pain associated with PMHx of marfans or asthma
pneumothorax
49
name one reversible cause of PEA
tension pneumothorax
50
pain worse on moving/coughing
MSK pain
51
sharp pleuritic pain relieved by sitting forward associated with a pericardial rub, high RR and HR
may have Hx of coksackie virus, TB, dresslers or SLE
pericarditis
52
investigations in pericarditis
ECG: saddle shaped ST elevation and PR depression
ECHO
53
management of viral/idiopathic pericarditis
NSAID/colchine
54
what is kussmals sign
Increased JVP on inspiration if constrictive pericarditis
55
DVLA rules for cardiac conditions (1w, 4w, indefinately)
stop for 1w: angioplasty, pacemaker
stop for 4w: CABG, ACS
stop indefinitely: AAA above 6.5cm
56
tearing pain radiating to the back with an unequal/weak/absent blood pressure
aortic dissection
57
investigations for aortic dissection
CT TAP
CXR: wide mediastinum
ECG: proximal changes
58
2 classification systems for aortic dissection
Stanford:
A (ascending, anterior pain and conservative management)
B (descending, posterior pain and surgical management)
DeBakey: I, II, III
59
medication for control of blood pressure before surgery for aortic dissection
labetalol
60
sudden SOB and chest pain with calf swelling associated with COCP or malignancy
pulmonary embolism
61
Investigations for PE
CTPA or V/Q scan if pregnant/renal impairment
CXR is normal
62
ABG in PE
respiratory acidosis
63
management for PE
1st: DOAC (rivaroxiban/apixiban)
2nd: LMWH/Warfarin
haemodynamically unstable = thrombolysis with alteplase
64
MOA of alteplase
plasmin --> plasminogen
65
how long must CPR continue for if you use a thrombolytic agent in ALS
60-90mins
66
medical management of angina
ALL pts: aspirin, statin, GTN
1st: BB or CCB
- CCB monotherapy (verapamil/diltazem)
- CCB & BB (amlodipine/nifedipine)
2nd: ivobradine, nicorandil
67
dosing of GTN
asymmetric dosing
68
BB and verapamil interaction
complete heart block
69
ST elevation and pulmonary oedema after the flu
myocarditis
70
acute presentation of AF with haemodynamic instability
cardiovert
71
when can you anticoagulate AF immediately
if sx less than 48hrs
72
2 medications to medically cardiovert AF
amiodarone/flecanide
73
what do you line electrical cardioversion to
R wave
74
3 lines of medication for rate control in AF
1st: BB
2nd: CCB (verapamil)
3rd Digoxin
75
2 medications for rhythm control in AF
BB, Amiodarone
76
when would you perform catheter ablation in AF
if no response to medication
anticoagulate for 4 w prior
77
2 scoring systems to determine the risk v benefit of anticoagulation in AF
CHADSV and ORBIT scoring systems
78
suffix for DOACs
'-ban'
79
what is the CHADVSC score
Congestive heart failure (1)
Hyeprtension (1)
Age above 75 (2) above 65 (1)
Diabetes (1)
Stroke (2)
female Sex (1)
Vascular disease (1)
0 = nothing 1 = treat if male 2 = treat if female
80
what is the ORBIT score
Hb below 130/120
Age above 74
PMHx stroke/GI bleed
eGFR under 60
Antiplatelet treatment
low (0-2) med (3) high (4-7)
81
what did the ORBIT score replace
hasbled
82
anticoagulation in AF + stroke
start anticoagulation after 2w
83
what component would require immediate anticoagulation
valvular disease (perform ECHO)
84
where does the long saphenous vein pass
what is it used for
anterior to the medial malleolus
venous cutdown
85
MOA of fondaparinux
activates antithrombin III
86
ejection systolic murmur radiating to the carotids with a loud S2
AORTIC STENOSIS
87
when do you replace valves
if patient is symptomatic or serious dysfunction
88
what medication is contraindicated in aortic stenosis
nitrates
89
ejection systolic murmur with no radiation
aortic sclerosis
90
early diastolic murmur with a collapsing pulse and increased pulse pressure
aortic regurgitation
91
what is corrigans/quincke's sign
capillary pulsations when the nailbed is pressed
found in aortic regurgitation
92
investigation for murmurs
ECHO
93
mid to late diastolic murmur with loud S1 and opening snap
mitral stenosis
94
most common cause of mitral stenosis
rheumatic fever
95
why do patients with mitral stenosis often present with SOB, haemoptysis and a malar flush
increased pulmonary pressure
96
condition associated with mitral stenosis
AF
97
pansystolic murmur radiating from the apex to the axilla with a quiet S1 / split S2
mitral regurgitation
98
presentation and management of acute mitral regurgitation
flash pulmonary oedema (e.g. post MI)
nitrates, diuretics and inotropes to increase CO
99
Female and high BMI associated with which murmur
mitral regurgitation
100
pansystolic murmur from the left sternal edge radiating to the 4th IC space
tricuspid regurgitation
101
most common cause of tricuspid regurgitation
IVDU
102
ejection systolic murmur on inspiration (2)
pulmonary stenosis
atrial septal defect
103
loud S2
pulmonary HTN
104
most common organism in infective endocarditis
staph aureus (gram positive)
staph epidermidis if post valve surgery
105
murmur in infective endocarditis
aortic regurg (tricuspid if IVDU)
106
what are the modified duke criteria for infective endocarditis
pathological: +ve histology/microbiology
major: +ve cultures/serology
minor: IVDU, fever above 38, signs
1 path / 2 major / 1 major 3 minor / 5 minor
107
prophylaxis for infective endocarditis
none
108
immune reaction to strep pyrogen causing erythema marginatum, syndenham's chorea, carditis or valvulitis
rheumatic fever
109
ECG in rheumatic fever
increased PR interval
110
management of rheumatic fever
oral Pen V and NSAIDs
111
3 causes of a third heart sound
normal under 30y
left sided heart failure
dilated cardiomyopathy
112
murmur in coarctation of the aorta
mid-systolic with an apical click
113
4 associations with coarctation of the aorta
male
turners (radio-femoral delay)
neurofibromatosis
berry aneurysm
114
notching of the inferior border of the rib and bicuspid aortic valve in what condition
coarctation of the aorta
115
presentation of coarctation of the aorta in children and adults
children: heart failure
adults: HTN/syncrope
116
murmur in ventricular septal defect
pansystolic
117
presentation and management of VSD
FTT and heart failure in child with a chromosomal disorder
monitor and repair
118
murmur in atrial septal defect
pansystolic on inspiration
119
pedunculated mass on ECHO
atrial myxoma
120
what condition can cause a mitral valve prolapse
polycystic kidney disease
121
untreated PDA can lead to what
congestive heart failure
122
levine scale for murmurs
1. very faint
2. sligjt
3. moderate, no thrill
4. loud, palpable thrill
5. very loud thrill, stethoscope edge
6. extremely loud, no stethoscope needed
123
SOB, cough , orthopnoea, PND, wheeze, weight loss and bibasal crackles
L sided heart failure
124
increased JVP, ankle oedema, haepatomegaly and weight loss
R sided heart failure
125
marker for heart failure
NT pro BNP
126
what condition is BNP also raised in
CKD
127
3 lines of management for heart failure
1st: ACEi (or ARB) + BB
2nd: Aldosterone antagonist (spironolactone)
3rd: Ivabradine/valsartan/digoxin/hydralazine
128
vaccination in heart failure
annual flu
once pneumococcal
129
when do you stop the BB in acute heart failure
HR below 50
3rd degree heart block or shock
130
NYHA heart failure classification
1: no limitation of physical activity
2: normal at rest but normal activity --> SOB
3: normal at rest but less than ordinary activity --> SOB
4: sx at rest
131
explain the 4 types of heart block
1st degree: PR interval more than 2 seconds
2nd degree:
- mobitz I (wenkebach): progressive prolongation until dropped beat
- mobitz II: regular PR intervals but random missing QRS
3rd degree: no association between P and QRS
132
which heart block needs a pacemaker
mobitz 2
133
what is beck's triad for cardiac tamponade
low blood pressure
raised JVP
muffled heart sounds
134
ECG in cardiac tamponade
electrical alterans
135
treatment of cardiac tamponade in neoplastic disease
balloon pericardiotomy
136
management of haemodynamically unstable and tachycardia
cardiovert
137
management of irregular broad complex tachycardia (name)
polymorphic ventricular tachycardia (torsades de pointes)
MAGNESIUM 2mg
138
macrolides, hypothermia and subarachnoid are causes of what
torsades de pointes
139
management of regular broad complex tachycardia
VT: amiodarone
previous SVT: treat as regular narrow complex
140
management of regular narrow complex tachycardia
1. vagal manoeuvres
2. adenosine (6 - 12 - 18mg)
3. verapamil/BB
141
management of irregular narrow complex tachycardia
probable AF
control rate with BB and anticoagulate if less than 48hrs
142
end stage management of tachycardia if everything ineffective
synchronised DC shock
sedation/anaesthesia if conscious
143
management of bradycardia
Atropine 500mg IV
(repeat to 3mg, then isoprenaline/adrenaline)
144
witnessed arrest on monitor
3 shocks then CPR
145
medication for acute pulmonary oedema
IV furosemide
146
shocks in hypothermia
3 shocks then wait until pt warmed to 30 degrees
147
ECG in hypothermia
QT prolongation and J waves
148
when would you try transcutaneous/transvenous pacing in bradycardia
if risk of asystole (heart block, ventricular pause, recent asystole)
149
exertional SOB, angina, syncope and arrhythmias with ejection systolic/pansystolic murmur, S4, double apex, A waves and jerky pulse
hypertrophic obstructive cardiomyopathy
150
inheritance of hypertrophic obstructive cardiomyopathy
autosomal diminant
151
ECG: LV hypertrophy, T wave inversion, deep Q waves, AF, WPW
hypertrophic obstructive cardiomyopathy
152
which valve is affected in hypertrophic obstructive cardiomyopathy
mitral
153
treatment of WPW
accessory pathway ablation
154
demographic of dilated cardiomyopathy
alcoholics
155
difference between the ECHO in hypertrophic obstructive cardiomyopathy compared to dilated cardiomyopathy
dilated has no regional wall abnormalities unlike hypertrophic obstructive
156
absent radial pulse in a young asian female
takyasu's
157
investigation and management of takyasus
MRA/CTA
steroids
158
non-ischaemic ST elevations triggered by stress presenting with chest pain, heart failure, SOB, dizziness and syncope
Takotsubu
159
management of Takotsubu
supportive
160
intermittent claudication, ischaemic ulcers, raynauds and thrombophlebitis in a young male smoker
Buerger's
thromboangitis obliterans
161
3 criteria for autonomic neuropathy
postural hypotension
loss of respiratory arrhythmia
erectile dysfunction
162
dizziness and vertigo on arm extension due to stenosis
subclavian steal syndrome
163
investigation for subclavian steal
USS/angiography
164
investigation for syncrope
24 hour ECG then tilt table test
165
diagnostic criteria for orthostatic hypotension
drop in 20 systolic and 10 diastolic in 3 minutes
166
medical management of orthostatic hypotension
FLUDROCORTISONE
167
warfarin and surgery
elective: stop 5 days prior
emergency: prothrombin concentrate
168
warfarin bleeding
- major
- minor INR above 8
- none INR above 8
- minor INR 5-8
- minor INR 5-8
- major: stop, IV K 5mg, prothrombin concentrate, FFP
- minor INR above 8: IV K 1-3mg, restart when INR below 5
- none INR above 8: oral K 1-5mg, restart when INR below 5
- minor INR 5-8: IV K 1-3mg, restart INR below 5
- minor INR 5-8: withhold 2 doses and reduce subsequent
169
prothrombin time and APTT in warfarin treatment
increased prothrombin time
normal APTT
170
can you use warfarin whilst breastfeeding
yes
171
2 drugs which interact with warfarin
phenobarbital and fluconazole
172
foods to avoid whilst on warfarin
kale, spinach, broccoli (high in vitamin K)
173
side effect of warfarin
skin necrosis
174
reversal agent for dabigatran
idarucizumab
175
reversal agent for apixiban and rivoroxaban
andexanet alpha
176
reversal agent for heparin
protamine
177
reversal agent for warfarin
phyromenadione (vitamin K)
178
ECG: global T wave inversion
head injury
179
ECG: short PR and delta wave
WPW
180
ECG: large R waves, deep S wave, ST elevation, T wave inversion
LV hypertrophy
181
ECG: sinus tachy, RBBB, T wave inversion, ST depression, leads V1 V2
PE
182
ECG: ST depression, inverted T, short QT
digoxin toxicity
183
eisenmengers
reversal of L to R shunt
184
CAUSES OF PROLONGED QT
congenital
drugs: Amiodarone, Sotalol, Tricyclic, SSRI, methodone, chloroquine, eryth/azithromycin, haloperidol, ondansetrol
Other: low Ca, K and Mg
185
2 shockable rhythms
VF
Pulseless VTP
186
2 non-shockable rhythms
PEA
Asystol
187
2 non-shockable rhythms
PEA
Asystole
188
when do you give adrenaline and amiodarone in an arrest
SHOCKABLE RYTHM
adrenaline 1mg every 3-5 min
amiodarone 300mg after 3 shocks and 150mg after 5 shocks
NON-SHOCKABLE
adrenaline immediately
no amiodarone
189
what medication can you give in an arrest if amiodarone is unavailable
lidocaine
190
reversible causes of an arrest
Hypoxia
Hypovolemia
Hypo/hyperkalaemia
Hypo/hyperthermia
Toxins
Tamponade (cardiac)
Tension pneumothorax
Thrombosis (coronary or pumonary)
191
which artery is used for primary PCI
radial
192
management of a STEMI
Aspirin 300mg
PCI if possible within 120 mins and presented within 12 hours
otherwise Fibrinolysis - if ST elevation after 60-90 mins then still PCI
193
management of NSTEMI
Aspirin 300mg and fondaparinux if no immediate PCI planned
Calculate GRACE score
- below 3% give ticagrelor or fondaparinux and aspirin
- above 3% PCI within 72 hours
194
what medication should be given before PCI
prasugrel or ticagrelor
195
Explain the Well's score
clinical signs and symptoms - 3
alternative diagnosis less likely - 3
HR above 100 - 1.5
immobilisation for 3 days or surgery in past 4w - 1.5
PMHx DVT/PE - 1.5
Haemoptysis - 1
Malignancy - 1
above 4 - PE likely
196
management of a PE if the Well's score is above 4
Immediate CTPA with possible interim anticoagulation
CTPA +ve is diagnostic of PE
CTPA -ve then consider proximal leg USS
197
management of a PE if the Well's score is equal or below 4
D-Dimer with interim anticoagulation if results take more than 4hrs
D-Dimer +ve then immediate CTPA (+ possible USS if -ve)
D-Dimer -ve then consider alternative dx and stop anticoagulation
