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Medicine Year 5 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

suffix for ACEi, ARB and Calcium channel blockers

A

ACEi: pril
ARB: sartan
Ca channel blockers: pine

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2
Q

threshold for clinic and ABPM

A

clinic 140/90
ABPM 135/85

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3
Q

threshold for stage 1 and 2 HTN

A

stage 1: above 135/85
stage 2: above 150/95

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4
Q

blood pressure 180/120 or above

A

assess target organ damage
if +ve then ADMIT

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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

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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

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7
Q

give an example of a thiazide like diuretic

A

indapamide

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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

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9
Q

which CCB is licensed in heart failure

A

amlodipine

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10
Q

QRISK above 10%

A

statin

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11
Q

MOA of statins

A

inhibit HMG-CoA reductase

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12
Q

when should you take statins

A

in the evening

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13
Q

monitoring for statin

A

LFT @ baseline, 3m and 12m

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14
Q

interaction between statin and ‘-mycin’ ABx

A

rhabdomyolysis

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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

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16
Q

which drug causes the following side effects:
cough, increased K, angioedema

A

ACEi

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17
Q

which condition contraindicates the use of ACEi

A

hypertrophic obstructive cardiomyopathy

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18
Q

what can ACEi and ARB cause if unknown renal impairment

A

bilateral renal artery stenosis

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19
Q

which drug causes the following side effects:
reduced hypoglycaemic awareness, ED and insomnia

A

beta blockers

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20
Q

which drug causes the following side effects:
ototoxicity, reduced Ca and K

A

loop diuretics

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21
Q

which drug causes the following side effects:
GI ulcers

A

Nicorandil

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22
Q

which drug causes the following side effects:
visual disturbance and green luminescence

A

ivabradie

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23
Q

which drug causes the following side effects:
thrombophlebitis and grey skin

A

amiodarone

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24
Q

where the the likely place inhaled foreign bodies are found

A

RIGHT bronchus
inferior lobe

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25
Q

heavy central chest pain radiating to the neck/arm causing nausea and sweating with CVD RF

A

cardiac pain
- might not be present if elderly/diabetic

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26
Q

right coronary infarct can lead to what

A

AV block

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27
Q

WHAT ARE THE ECG CHANGES

A

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

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28
Q

how do you confirm a posterior MI

A

ST elevation and Q waves in leads V7-V9

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29
Q

new LBBB

A

ALWAYS PATHOLOGICAL
urgent PCI

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30
Q

biochemical marker for NSTEMI

A

raised troponin

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31
Q

how can you check for reinfarction

A

check creatinine kinase - elevated for 3-4 days compared to troponin which remains elevated for 10 days

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32
Q

imaging for stable chest pain with suspected coronary artery disease

A

contrast CT coronary angiogram

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33
Q

what does CABG stand for

A

coronary artery bypass graft

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34
Q

stenosis in LAD causing no pain, normal cardiac enzymes, no ST elevation but deep T wave inversion

A

WELLEN’S SYNDROME

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35
Q

what medication is needed for secondary prevention

A

2 antiplatelets: aspirin and clopidogrel/ticagrelor
ACEi
BB
Statin

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36
Q

when would you stop the second antiplatelet post MI

A

after 12m

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37
Q

broad complex tachycardia post MI

A

VF - arrest

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38
Q

reduced ejection fraction post MI

A

cardiogenic shock
poor prognosis

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39
Q

pain in first 48 hours post MI

A

pericarditis

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40
Q

fever, pleuritic pain, pericardial effusion, increased ESR 2-6w post MI

A

Dresslers

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41
Q

pathophysiology and treatment of dresslers

A

autoimmune reaction to new pericardium
NSAIDs

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42
Q

ST elevation and LV failure causing thrombus post MI

A

LV aneurysm

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43
Q

pathophysiology and treatment of LV aneurysm

A

ischaemic weakens myocardium
anticoagulation

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44
Q

increased JVP, pulsus paradoxus and reduced heart sounds 1-2w post MI

A

LV free wall rupture

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45
Q

pathophysiology and treatment of LV free wall rupture

A

acute heart failure secondary to tamponadee
pericardiocentesis/thoractomy

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46
Q

heart failure and pansystolic murmur 1w post MI

A

ventricular septal defect

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47
Q

infero-posterior MI / papillary muscle rupture presenting with hypotension and pulmonary oedema post MI

A

acute mitral regurgitation

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48
Q

sudden SOB and chest pain associated with PMHx of marfans or asthma

A

pneumothorax

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49
Q

name one reversible cause of PEA

A

tension pneumothorax

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50
Q

pain worse on moving/coughing

A

MSK pain

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51
Q

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

A

pericarditis

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52
Q

investigations in pericarditis

A

ECG: saddle shaped ST elevation and PR depression
ECHO

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53
Q

management of viral/idiopathic pericarditis

A

NSAID/colchine

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54
Q

what is kussmals sign

A

Increased JVP on inspiration if constrictive pericarditis

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55
Q

DVLA rules for cardiac conditions (1w, 4w, indefinately)

A

stop for 1w: angioplasty, pacemaker
stop for 4w: CABG, ACS
stop indefinitely: AAA above 6.5cm

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56
Q

tearing pain radiating to the back with an unequal/weak/absent blood pressure

A

aortic dissection

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57
Q

investigations for aortic dissection

A

CT TAP
CXR: wide mediastinum
ECG: proximal changes

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58
Q

2 classification systems for aortic dissection

A

Stanford:
A (ascending, anterior pain and conservative management)
B (descending, posterior pain and surgical management)

DeBakey: I, II, III

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59
Q

medication for control of blood pressure before surgery for aortic dissection

A

labetalol

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60
Q

sudden SOB and chest pain with calf swelling associated with COCP or malignancy

A

pulmonary embolism

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61
Q

Investigations for PE

A

CTPA or V/Q scan if pregnant/renal impairment
CXR is normal

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62
Q

ABG in PE

A

respiratory acidosis

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63
Q

management for PE

A

1st: DOAC (rivaroxiban/apixiban)
2nd: LMWH/Warfarin

haemodynamically unstable = thrombolysis with alteplase

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64
Q

MOA of alteplase

A

plasmin –> plasminogen

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65
Q

how long must CPR continue for if you use a thrombolytic agent in ALS

A

60-90mins

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66
Q

medical management of angina

A

ALL pts: aspirin, statin, GTN
1st: BB or CCB
- CCB monotherapy (verapamil/diltazem)
- CCB & BB (amlodipine/nifedipine)
2nd: ivobradine, nicorandil

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67
Q

dosing of GTN

A

asymmetric dosing

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68
Q

BB and verapamil interaction

A

complete heart block

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69
Q

ST elevation and pulmonary oedema after the flu

A

myocarditis

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70
Q

acute presentation of AF with haemodynamic instability

A

cardiovert

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71
Q

when can you anticoagulate AF immediately

A

if sx less than 48hrs

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72
Q

2 medications to medically cardiovert AF

A

amiodarone/flecanide

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73
Q

what do you line electrical cardioversion to

A

R wave

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74
Q

3 lines of medication for rate control in AF

A

1st: BB
2nd: CCB (verapamil)
3rd Digoxin

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75
Q

2 medications for rhythm control in AF

A

BB, Amiodarone

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76
Q

when would you perform catheter ablation in AF

A

if no response to medication
anticoagulate for 4 w prior

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77
Q

2 scoring systems to determine the risk v benefit of anticoagulation in AF

A

CHADSV and ORBIT scoring systems

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78
Q

suffix for DOACs

A

‘-ban’

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79
Q

what is the CHADVSC score

A

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
Q

what is the ORBIT score

A

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
Q

what did the ORBIT score replace

82
Q

anticoagulation in AF + stroke

A

start anticoagulation after 2w

83
Q

what component would require immediate anticoagulation

A

valvular disease (perform ECHO)

84
Q

where does the long saphenous vein pass
what is it used for

A

anterior to the medial malleolus
venous cutdown

85
Q

MOA of fondaparinux

A

activates antithrombin III

86
Q

ejection systolic murmur radiating to the carotids with a loud S2

A

AORTIC STENOSIS

87
Q

when do you replace valves

A

if patient is symptomatic or serious dysfunction

88
Q

what medication is contraindicated in aortic stenosis

89
Q

ejection systolic murmur with no radiation

A

aortic sclerosis

90
Q

early diastolic murmur with a collapsing pulse and increased pulse pressure

A

aortic regurgitation

91
Q

what is corrigans/quincke’s sign

A

capillary pulsations when the nailbed is pressed
found in aortic regurgitation

92
Q

investigation for murmurs

93
Q

mid to late diastolic murmur with loud S1 and opening snap

A

mitral stenosis

94
Q

most common cause of mitral stenosis

A

rheumatic fever

95
Q

why do patients with mitral stenosis often present with SOB, haemoptysis and a malar flush

A

increased pulmonary pressure

96
Q

condition associated with mitral stenosis

97
Q

pansystolic murmur radiating from the apex to the axilla with a quiet S1 / split S2

A

mitral regurgitation

98
Q

presentation and management of acute mitral regurgitation

A

flash pulmonary oedema (e.g. post MI)
nitrates, diuretics and inotropes to increase CO

99
Q

Female and high BMI associated with which murmur

A

mitral regurgitation

100
Q

pansystolic murmur from the left sternal edge radiating to the 4th IC space

A

tricuspid regurgitation

101
Q

most common cause of tricuspid regurgitation

102
Q

ejection systolic murmur on inspiration (2)

A

pulmonary stenosis
atrial septal defect

103
Q

loud S2

A

pulmonary HTN

104
Q

most common organism in infective endocarditis

A

staph aureus (gram positive)
staph epidermidis if post valve surgery

105
Q

murmur in infective endocarditis

A

aortic regurg (tricuspid if IVDU)

106
Q

what are the modified duke criteria for infective endocarditis

A

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
Q

prophylaxis for infective endocarditis

108
Q

immune reaction to strep pyrogen causing erythema marginatum, syndenham’s chorea, carditis or valvulitis

A

rheumatic fever

109
Q

ECG in rheumatic fever

A

increased PR interval

110
Q

management of rheumatic fever

A

oral Pen V and NSAIDs

111
Q

3 causes of a third heart sound

A

normal under 30y
left sided heart failure
dilated cardiomyopathy

112
Q

murmur in coarctation of the aorta

A

mid-systolic with an apical click

113
Q

4 associations with coarctation of the aorta

A

male
turners (radio-femoral delay)
neurofibromatosis
berry aneurysm

114
Q

notching of the inferior border of the rib and bicuspid aortic valve in what condition

A

coarctation of the aorta

115
Q

presentation of coarctation of the aorta in children and adults

A

children: heart failure
adults: HTN/syncrope

116
Q

murmur in ventricular septal defect

A

pansystolic

117
Q

presentation and management of VSD

A

FTT and heart failure in child with a chromosomal disorder
monitor and repair

118
Q

murmur in atrial septal defect

A

pansystolic on inspiration

119
Q

pedunculated mass on ECHO

A

atrial myxoma

120
Q

what condition can cause a mitral valve prolapse

A

polycystic kidney disease

121
Q

untreated PDA can lead to what

A

congestive heart failure

122
Q

levine scale for murmurs

A
  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
Q

SOB, cough , orthopnoea, PND, wheeze, weight loss and bibasal crackles

A

L sided heart failure

124
Q

increased JVP, ankle oedema, haepatomegaly and weight loss

A

R sided heart failure

125
Q

marker for heart failure

A

NT pro BNP

126
Q

what condition is BNP also raised in

127
Q

3 lines of management for heart failure

A

1st: ACEi (or ARB) + BB
2nd: Aldosterone antagonist (spironolactone)
3rd: Ivabradine/valsartan/digoxin/hydralazine

128
Q

vaccination in heart failure

A

annual flu
once pneumococcal

129
Q

when do you stop the BB in acute heart failure

A

HR below 50
3rd degree heart block or shock

130
Q

NYHA heart failure classification

A

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
Q

explain the 4 types of heart block

A

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
Q

which heart block needs a pacemaker

133
Q

what is beck’s triad for cardiac tamponade

A

low blood pressure
raised JVP
muffled heart sounds

134
Q

ECG in cardiac tamponade

A

electrical alterans

135
Q

treatment of cardiac tamponade in neoplastic disease

A

balloon pericardiotomy

136
Q

management of haemodynamically unstable and tachycardia

A

cardiovert

137
Q

management of irregular broad complex tachycardia (name)

A

polymorphic ventricular tachycardia (torsades de pointes)
MAGNESIUM 2mg

138
Q

macrolides, hypothermia and subarachnoid are causes of what

A

torsades de pointes

139
Q

management of regular broad complex tachycardia

A

VT: amiodarone
previous SVT: treat as regular narrow complex

140
Q

management of regular narrow complex tachycardia

A
  1. vagal manoeuvres
  2. adenosine (6 - 12 - 18mg)
  3. verapamil/BB
141
Q

management of irregular narrow complex tachycardia

A

probable AF
control rate with BB and anticoagulate if less than 48hrs

142
Q

end stage management of tachycardia if everything ineffective

A

synchronised DC shock
sedation/anaesthesia if conscious

143
Q

management of bradycardia

A

Atropine 500mg IV
(repeat to 3mg, then isoprenaline/adrenaline)

144
Q

witnessed arrest on monitor

A

3 shocks then CPR

145
Q

medication for acute pulmonary oedema

A

IV furosemide

146
Q

shocks in hypothermia

A

3 shocks then wait until pt warmed to 30 degrees

147
Q

ECG in hypothermia

A

QT prolongation and J waves

148
Q

when would you try transcutaneous/transvenous pacing in bradycardia

A

if risk of asystole (heart block, ventricular pause, recent asystole)

149
Q

exertional SOB, angina, syncope and arrhythmias with ejection systolic/pansystolic murmur, S4, double apex, A waves and jerky pulse

A

hypertrophic obstructive cardiomyopathy

150
Q

inheritance of hypertrophic obstructive cardiomyopathy

A

autosomal diminant

151
Q

ECG: LV hypertrophy, T wave inversion, deep Q waves, AF, WPW

A

hypertrophic obstructive cardiomyopathy

152
Q

which valve is affected in hypertrophic obstructive cardiomyopathy

153
Q

treatment of WPW

A

accessory pathway ablation

154
Q

demographic of dilated cardiomyopathy

A

alcoholics

155
Q

difference between the ECHO in hypertrophic obstructive cardiomyopathy compared to dilated cardiomyopathy

A

dilated has no regional wall abnormalities unlike hypertrophic obstructive

156
Q

absent radial pulse in a young asian female

A

takyasu’s

157
Q

investigation and management of takyasus

A

MRA/CTA
steroids

158
Q

non-ischaemic ST elevations triggered by stress presenting with chest pain, heart failure, SOB, dizziness and syncope

159
Q

management of Takotsubu

A

supportive

160
Q

intermittent claudication, ischaemic ulcers, raynauds and thrombophlebitis in a young male smoker

A

Buerger’s
thromboangitis obliterans

161
Q

3 criteria for autonomic neuropathy

A

postural hypotension
loss of respiratory arrhythmia
erectile dysfunction

162
Q

dizziness and vertigo on arm extension due to stenosis

A

subclavian steal syndrome

163
Q

investigation for subclavian steal

A

USS/angiography

164
Q

investigation for syncrope

A

24 hour ECG then tilt table test

165
Q

diagnostic criteria for orthostatic hypotension

A

drop in 20 systolic and 10 diastolic in 3 minutes

166
Q

medical management of orthostatic hypotension

A

FLUDROCORTISONE

167
Q

warfarin and surgery

A

elective: stop 5 days prior
emergency: prothrombin concentrate

168
Q

warfarin bleeding
- major
- minor INR above 8
- none INR above 8
- minor INR 5-8
- minor INR 5-8

A
  • 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
Q

prothrombin time and APTT in warfarin treatment

A

increased prothrombin time
normal APTT

170
Q

can you use warfarin whilst breastfeeding

171
Q

2 drugs which interact with warfarin

A

phenobarbital and fluconazole

172
Q

foods to avoid whilst on warfarin

A

kale, spinach, broccoli (high in vitamin K)

173
Q

side effect of warfarin

A

skin necrosis

174
Q

reversal agent for dabigatran

A

idarucizumab

175
Q

reversal agent for apixiban and rivoroxaban

A

andexanet alpha

176
Q

reversal agent for heparin

177
Q

reversal agent for warfarin

A

phyromenadione (vitamin K)

178
Q

ECG: global T wave inversion

A

head injury

179
Q

ECG: short PR and delta wave

180
Q

ECG: large R waves, deep S wave, ST elevation, T wave inversion

A

LV hypertrophy

181
Q

ECG: sinus tachy, RBBB, T wave inversion, ST depression, leads V1 V2

182
Q

ECG: ST depression, inverted T, short QT

A

digoxin toxicity

183
Q

eisenmengers

A

reversal of L to R shunt

184
Q

CAUSES OF PROLONGED QT

A

congenital
drugs: Amiodarone, Sotalol, Tricyclic, SSRI, methodone, chloroquine, eryth/azithromycin, haloperidol, ondansetrol
Other: low Ca, K and Mg

185
Q

2 shockable rhythms

A

VF
Pulseless VTP

186
Q

2 non-shockable rhythms

A

PEA
Asystol

187
Q

2 non-shockable rhythms

A

PEA
Asystole

188
Q

when do you give adrenaline and amiodarone in an arrest

A

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
Q

what medication can you give in an arrest if amiodarone is unavailable

190
Q

reversible causes of an arrest

A

Hypoxia
Hypovolemia
Hypo/hyperkalaemia
Hypo/hyperthermia

Toxins
Tamponade (cardiac)
Tension pneumothorax
Thrombosis (coronary or pumonary)

191
Q

which artery is used for primary PCI

192
Q

management of a STEMI

A

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
Q

management of NSTEMI

A

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
Q

what medication should be given before PCI

A

prasugrel or ticagrelor

195
Q

Explain the Well’s score

A

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
Q

management of a PE if the Well’s score is above 4

A

Immediate CTPA with possible interim anticoagulation

CTPA +ve is diagnostic of PE
CTPA -ve then consider proximal leg USS

197
Q

management of a PE if the Well’s score is equal or below 4

A

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

Medicine Year 5 (27 decks)

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