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Med Finals - Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Define atherosclerosis

A

Combination of atheroma’s - fatty deposits - and sclerosis - hardening or stiffening - affecting medium to large arteries, caused by chronic inflammation leading to deposition of lipids and formation of plaques.

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2
Q

Risk factors for atherosclerosis

A

Age
FH
Male
Smoking
Alcohol
High sugar and fat diet low fruit and veg
Low exercise
Obesity
Poor sleep stress
Diabetes
HTN
CKD
Rheumatoid
Atypical antipsychotics

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3
Q

Complications of atherosclerosis

A

Angina
MI
TIA
Stroke
Peripheral vascular disease
Mesenteric ischaemia

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4
Q

Prevention of CVD

A

Diet, exercise and weight improvement
Stop smoking
Stop drinking
Tightly treat co-morbidities

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5
Q

Score the determine risk of stroke or MI in next 10 years

A

QRISK3 - if >10% risk, offer statin

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6
Q

Secondary prevention of CVD

A

AAAA
Aspirin
Atorvastatin
Atenolol
ACE inhibitor

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7
Q

Define stable angina

A

Narrowing of the coronary arteries such that during time of high demand, exercise, insufficient blood supply to the hear causing chest pain. Stable when symptoms are relieved by rest or GTN.

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8
Q

Investigations in stable angina

A

CT coronary angiogram - gold standard diagnostic
Physical examination
ECG
Bloods - FBC, UE, LFT, Lipid, Thyroid, HbA1c

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9
Q

Management of stable angina

A

RAMP
Refer to cardiology
Advise about diagnosis management and when to phone ambulance
Medical treatment
Procedural or surgical interventions

GTN - every 5 mins
Beta blockers, CCBs are first line
Long acting nitrites, ivabradine, nicorandil, ranolazine
2dry prevention - AAAA
Surgery - PCI, stents, balloon dilation, CABG

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10
Q

Define acute coronary syndrome

A

Term used to describe a range of conditions associated with sudden reduced blood flow to the hear.

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11
Q

Main types of ACS

A

Unstable angina
STEMI
NSTEMI

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12
Q

What is supplied by the Right Coronary artery

A

Inferior aspect
Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior aspect of septal area

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13
Q

What is supplied by the circumflex artery

A

Lateral aspect
Left atrium
Posterior aspect of the left ventricle

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14
Q

What is supplied by the Left anterior descending

A

Anterior aspect
Anterior aspect of the left ventricle
Anterior aspect of the septum

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15
Q

How to differentiated types of ACS

A

Chest pain = ECG
ST elevation - STEMI
No elevation = troponin
Raised trops +- other ECG changes - NSTEMI
Trops normal - unstable angina (or msk pain)

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16
Q

History of ACS

A

Central crushing chest pain
Nausea and vomiting
Sweating and clamminess
Feeling of impending doom
Shortness of breath
Palpitations
Pain radiates to jaw/arm
Symptoms continue at rest
Diabetic often have silent MIs - no pain

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17
Q

ECG changes in STEMI

A

ST segment elevation
New left bundle branch block

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18
Q

ECG changes in NSTEMI

A

ST depression
Deep T wave inversion
Pathological Q waves

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19
Q

Alternative causes for raised troponins

A

Chronic renal failure
Sepsis
Myocarditis
Aortic dissection
Pulmonary embolism

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20
Q

Investigations in ACS

A

Physical exam
ECG
Bloods - FBC, UE, LFT, Lipid, Thyroid, HbA1C
CXR
Echo - post event
CT coronary angiogram

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21
Q

Immediate management of ACS

A

MONA
Morphine
Oxygen (if low sats)
Aspirin 300mg
Nitrates - GTN

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22
Q

Management of STEMI

A

Primary PCI - if available within 2 hours
Thrombolysis - in PCI not available

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23
Q

Management of NSTEMI

A

BATMAN
Betablockers
Aspirin 300mg
Ticagrelor 180mg stat
Morphine
Anticoagulation - fodaparinux
Nitrates GTN

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24
Q

Complications of MI

A

Heart failure DREAD
Death
Rupture of heart septum or papillary muscles
Edema - heart failure
Arrhythmia + Aneurysm
Dressler’s Syndrome

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25
Q

Define Dressler’s syndrome

A

Also called post MI syndrome. Usually occurs 2-3 weeks post MI. Caused by local immune response and causes pericarditis. Pleuritic chest pain, low grade fever, pericardial rub , effusion./

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26
Q

Secondary prevention post MI

A

6 As
Aspirin - 75g OD
Another antiplatelet
Atorvastatin
ACE inhibitor
Atenolol
Aldosterone - if heart failue

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27
Q

Define left ventricular failure

A

The left ventricle is unable to adequately move blood throught the left side of the heart. Causes back pressure into the pulmonary system and they leak fluid causing pulmonary oedema.

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28
Q

Common causes of left ventricular failure

A

Iatrogenic - aggressive fluids in frailty
Sepsis
MI
Arrhythmia

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29
Q

History of left ventricular failure

A

Shortness of breath - worse on lying.
Cough p frothy white/pink sputum

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30
Q

Clinical signs of left ventricular failure

A

High RR
Low O2
Tachycardia
3rd heart sound
Bilateral basal crackles
Hypotension
Peripheral oedema

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31
Q

Investigations in left ventricular failure

A

ECG
ABG
CXR
Bloods - BNP
Echo

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32
Q

CXR findings in heart failure

A

ABCDE
Alveolar oedema - bat wings
Kerley B lines - interstitial oedema
Cardiomegaly
Dilated prominent upper lobe vessels/Upper lobe Diversion
Effusion

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33
Q

Management of left ventricular failure

A

Pour sod
Pour away IV fluids - fluid balance
Sit up
Oxygen
Diuretics

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34
Q

History of chronic heart failure

A

Breathlessness worse on exertion
Cough - white pink frothy sputum
Orthopnoea - SOB on lying
Paroxysmal nocturnal dyspnoea
Peripheral oedema

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35
Q

Management of Chronic heart failure

A

ABAL
ACE inhibitor
Beta Blocker
Aldosterone - when controled with A or B
Loop diuretics - furosemide for symtom management

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36
Q

Define Cor pulmonale

A

Is right sided hear failure caused by respiratory disease, increased pressure in the pulmonary arteries results in right ventricle being unable to pump effectively causing back pressure.

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37
Q

Common causes of Cor Pulmonale

A

COPD
Pulmonary embolism
Interstitial lung disease
Cystic fibrosis
Primary pulmonary hypertension

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38
Q

History of Cor Pulmonale

A

Shortness of breath - also caused by respiratory condition
Peripheral oedema
Syncope
Chest pain

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39
Q

Clinical signs of Cor Pulmonale

A

Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
Third heart sound
Murmur - pan-systolic in tricuspid regurg
Hepatomegaly - due to back pressure

40
Q

Management of Cor Pulmonale

A

Treat underlying cause
Manage symptoms

41
Q

Define hypertension

A

High blood pressure - 140/90 in clinic or 135/85 at home/ambulatory

42
Q

Common causes of hypertension

A

ROPE
Renal disease - artery stenosis
Obesity
Pregnancy - pre-eclampsia
Endocrine - Conns (Hyperaldosteronism)

43
Q

Complications of hypertension

A

Ischaemic heart disease
Cerebrovascular accident - stroke, haemorrhage
Hypertensive retinopathy
Hypertensive nephropathy
Heart failure

44
Q

Stages of hyper tension

A

Stage 1 - >140/90 (135/85)
Stage 2 - >160/100 (150/96)
Stage 3 - >180/120

45
Q

Management of hypertension

A

ABCD
ACE inhibitor
ARB
Beta blocker
Calcium channel blocker
Diuretics

ACEi first line then CCB
>55 CCB first or black
ACEi always in diabetics

46
Q

Define heart murmur

A

Extra or unusual sounds heard when ascultating the heart. Caused by turbulent blood flow through the heart, or opening or closing of valves

47
Q

What causes S1 Sound

A

Closing of the atrioventricular valves - tricuspid and mitral
Heard at the start of systolic contraction

48
Q

What causes S2 sound

A

The closing of the semilunar valves - aortic and pulmonary
Heard once systolic contraction is complete

49
Q

What causes S3 sound

A

Heard rapidly after S2 caused by rapid ventricular filling - chordae tendineae pull to full length - can be normal in ages 15-40
Indicates heart failure in older people.

50
Q

What causes S4 sound

A

Heard directly before S1
Caused by turbulent flow from an atria contracting against a non-compliant ventricle.
Suggests a stiff or hypertrophic ventricle

51
Q

What vale condition cause hypertrophy

A

Stenosis - mitral and aortic
Heart works hard to push against stiff valve

52
Q

What valve conditions cause dilation

A

Regurgitation

53
Q

What murmur is heard in mitral stenosis

A

A low rumbling mid-diastolic murmur
Caused by low blood flow through stenosed valve during atrial contraction

54
Q

What heart murmur is heard in mitral regurgitation

A

Pan-systolic high pitched murmur
Caused by blood leaking back into the atria during ventricular contraction

55
Q

What is associated with mitral stenosis

A

Malar flush - back pressure into pulmonary system causing rise in CO2 and vasodilation
AF - left atria struggling to push through stenotic valve

56
Q

What does a mitralregurgitation murmur radiate to

A

Left axila -

57
Q

Cause of mitral regurgitation

A

Idiopathic -
ischaemic heart disease
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders - ehlers danlos/marfans

58
Q

What murmur is heard in aortic stenosis

A

Ejection systolic high pitched murmur
Crescendo-decrescendo character
Caused by turbulent blood flor across the valve during ventricular contraction

59
Q

Where might an aortic stenosis murmur radiate to

A

Carotids

60
Q

Other examination findings in aortic stenosis

A

Slow rising pulse
Narrow pulse pressure
Exertional syncope

61
Q

Causes of aortic stenosis

A

Idiopathic
Rheumatic

62
Q

What murmur is heard in aortic regurgitation

A

Early diastolic soft murmur
Caused by immediate back flow of blood through competent valve

63
Q

What other clinicals signs of aortic regurgitation might be found

A

Collapsing pulse
Austin flint murmur - early diastolic rumbling murmur heard at the apex

64
Q

Define atrial fibrilation

A

Contraction of the atria is uncoordinated, rapid and irregular due to disorganised electrical activity that overrides the normal activity of the sinoatrial node

65
Q

Define atrial fibrillation

A

Contraction of the atria is uncoordinated, rapid and irregular due to disorganised electrical activity that overrides the normal activity of the sinoatrial node

66
Q

History of atrial fibrillation

A

Asymptomatic
Palpitations
Shortness of breath
Syncope
Stroke,

67
Q

What are the two differentials of irregularly irregular pulses

A

AF
Ventricular ectopic

68
Q

Signs of AF on ECG

A

Absent P waves
Narrow QRS
Irregularly irregular ventricular rhythm

69
Q

Common causes of AF

A

SMITH
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension

70
Q

Main principles of managing AF

A

Rate or Rhythm control
Anticoagulation

71
Q

Why use rate control in AF

A

Atria are very inefficient
If atria contracting fast, they are even less efficient
Despite reducing rate you increase cardiac output by increasing atrial filling

72
Q

When should you not use rate control to manage AF

A

First line unless:
Reversible cause
New onset
Causing heart failure
Remain symptomatic despite rate controll

73
Q

Options for rate control in AF

A

Beta blocker - first line - atenolol 50mg
CCB - diltiazem - not in heart failure
Digoxin - sedentary people

74
Q

What is the aim of rhythm control

A

Returning to sinus rhythm
Single cardioversion or long term medical rhythm control

75
Q

When to use immediate cardioversion

A

AF present for <48 hours or severely haemodynamically unstable

76
Q

When to use delayed cardioversion

A

If AF present for >48 hours and they are stable

77
Q

How long should you be anticoagulated before delayed cardio version

A

At least 3 weeks - also rate control whilst waiting.

78
Q

Options for cardioversion in AF

A

Pharmacological - flecanide, amiodarone
Electrical cardioversion
Long term - beta blockers, dronedarone, amiodarone

79
Q

Scoring system to assess risk of stroke in AF

A

CHADSVASc (Orbit score for bleeding)

80
Q

Define arrhythmia

A

Abnormal heart rhythms, they result from interruption to the normal electrical signals that coordinate the contraction of the heart

81
Q

What are the shockable rhythms

A

Ventricular tachycardia
Ventricular fibrillation

82
Q

What are the non-shockable rhythms

A

Pulseless electrical activity
Asystole

83
Q

Management of Narrow complex tachycardia in stable patients

A

Atrial fibrilation - rate control with beta blocker or diltiazem
Atrial flutter - rate control with beta blocker
Supraventricular tachy cardia - treat with vagal manoeuvres and adenosine

84
Q

Management of broard complex tachycardias in stable patients

A

Amiodarone

85
Q

Define atrial flutter

A

Caused by a re-entrant rhythm in the atrium which stimulates the atria to contract rapidly

86
Q

Management of atrial flutter

A

Rate/rhythm control - betablockers or cardioversion
Treat cause
Radiofrequency ablation of the re-entrant rhythm
Anticoagulation - CHADSVASC

87
Q

Define supraventricular tachycardia

A

Cause by electrical signal re-entering the atria from the ventricles, causing a narrow complex tachycardia.

88
Q

Define wolff-parkinson white syndrome

A

Extra electrical pathway that connects the atria and ventricles.

89
Q

ECG changes in wolff-parkinson white syndrome

A

Delts wave - slurred upstroke on QRS
Short PR
Wide QRS

90
Q

Define first degree heart block

A

Delayed atrioventricular conduction through the AV node
PR interval >0.2 (1 big square)

91
Q

Define second degree heart block

A

Failure of atrial impulse to pass the AV node

92
Q

Main types of second degree heart block

A

Mobitz Type 1 - Wenckebach’s phenomenon
Mobitz type 2

93
Q

Define second degree heart block Mobitz type 1

A

Gradual lengthening of the PR interval until there is failure in conduction

94
Q

Define second degree heart block Mobitz type 2

A

Intermittent failure to conduct atrial impulses
Usually in set ratio - 2:1, 3:1

95
Q

Define third degree heart block

A

Complete heart block - no observable relationship between P waves and QRS complexes
Big risk of asystole

96
Q

Management of hear block

A

Unstable mobitz type 2 or 3 - atropine

Med Finals - Medicine (10 decks)

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