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MSRA 2023 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Janesway Lesion

A

signs in infective endocarditis

  • microemboli see on skins of palms and soles PAINLESS
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2
Q

Osler nodes

A

signs in infective endocarditis

  • immunological reaction seen on tips of fingers and toes PAINFUL
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3
Q

stages of HTN

A

stage 1: clinic BP 140/90 or ABPM >135/85. <80yr QRISK >10%

stage 2: >160/100 or ABPM > 150/95

stage 3: SBP >180 or DBP 120

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4
Q

HTN mx steps <55 years old OR DM

A

step 1: ACEi/ AT2R ATG
step 2: A+C/ A+D (D- thiazide like diuretics- indapamide/ metolazone)
step 3: A+C+D
step 4: if K <= 4.5- add spironolatone; if K >4.5 add BB or alpha ATG

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5
Q

HTN mx steps >= 55year with no DM2 OR Black-African or Black-Carribean

A

step 1: Calcium
step 2: C+A or C+D
step 3: A+C+D
step 4: if K <= 4.5- add spironolatone; if K >4.5 add BB or alpha ATG

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6
Q

ECG changes anteroseptal MI

A

V1-V4

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7
Q

ECG changes anterolateral MI

A

V1-6, aVL

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8
Q

ECG changes Lateral MI

A

I, aVL +/- V5-6

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9
Q

ECG changes posterior MI

A

V1-3, reciprocal changes of STEMI seen horizontal ST dep, tall broad R waves, upright T waves, dominant R waves. Post infarction confirmed by STEMI and Q waves in posterior leads V7-V9

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10
Q

ECG leads circumflex artery

A

Lead I, V5-6 (lateral)

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11
Q

ECG leads Right coronary

A

II, III, aVF (INFERIOR)

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12
Q

ECG leads left anterior descending

A

V1- V4 ( ANTERIOR)

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13
Q

HF management line

A

1st line: BB + ACEi
2nd line: aldosterone ATG (spiro/eplerenone) +SGLT-2 inhibitor
3rd line: specialist: ivabradine, entresto, digoxin, hydralazine + nitrate, cardiac resyndronisation

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14
Q

CHA2DS2 VASc Score

A

CHF
HTN
Age >= 75
Diabetes
Stroke/TIA or Thromboemboslism
Vascular disease
Age 65-74
Sex Female

if >1 then anticoag long term

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15
Q

When to start tx for HTN

A

140//90 or ABPM 135/85
or <80yrs QRISK >10%

=> START Tx

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16
Q

target BP for HTN mx

A

<80yrs 140/90 or ABPM 135/85
>80yrs: 150/90 or 145/85

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17
Q

Normal QT interval make and female

A

Male 430msec
Female 50msec

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18
Q

Mx of angina stable

A
  1. Aspirin + statin
  2. GTN spray
  3. Beta blocker or ca2+ blocker
    Ca ch blocker: verapamil or diltiazem-> rate limiting
    Use amlodipine or mr mifedipine if using bb (dihydropyridine )
  4. Long acting nitrate/ivabradine/nicorandil/ranolatine if pt monotx cannot tolerate addition of ca ch blocker/ beta blocker

Don’t use bb and verapamil or diltiazem together as it increases risk of heart block

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19
Q

When to expect dressier sy

A

> 2 weeks

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20
Q

When to expect pericarditis post MI

A

48hrs

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21
Q

When to expect acute mitral regurg post mi- inferolat mi or rupture of papillary muscle post mi

A

3-5 days

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22
Q

2nd degree type 1 heart block aka, mx, ecg findings

A

Wenckebach, Mobil’s type 1

PR elongations until QRS drop beat occurs

Mx: nil mx needed unless symptomatic, pre-syncopated or syncopated, HoTN

23
Q

2nd degree heart block type 2

A

Mobitz type 2

ECG: prolonged PR and drops QRS

Mx: pacemaker

24
Q

Classification of AFib

A

Paroxysmal AF: lasts less than 7 days

Persistent AF: 1/12

Longstanding: >12 months

25
Absolute indication for DOAC in AFib
AFib with valvular disease
26
Stable AFib mx
<48hrs: if rate/rhythmn + heparinised electrical DC If > 48 hours/ uncertain: rate and anticoagulation for minimum of 3 weeks
27
When to consider amiodarone inAFib
Esp if patient in HF
28
Scores used in AFib
CHA1DSC2 VASC RISK FACTOR HASBLED ORBIT
29
HASBLED SCORE
bleeding risk of DOAC in AFIB HTN Abnormal renal/liver function Stroke Bleeding hx Labile INR Elderly >65 Drugs/ alcohol 0-0-1 low risk 2 intermediate >3 high risk
30
ORBIT SCORE
Bleeding risk DoAC in AFib Older age >74 Reduced haemoglobin or anaemia Bleeding hx Insufficient kidney function Tx with anti-plt 0-2 low risk 3 intermediate >4 high risk
31
Which criteria used for infective endocarditis
Dukes criteria: 2 major or 1 major + 3 minor or 5 minor BE TIMER Blood culture positive >2 times 12 hours apart Echocardiogram evidence of IE Temp >38 Immunological phenomena: oslernode, Roth spots Microbiological evidence + BC not meeting criteria Embolic phenomenon- arterial embolism, septic embolism, conjunctival haemorrhage, painless skin lesion-Janeway Risk factors: congenital heart condition or iv drug use
32
Which valve most affected by IE
Mitral valve Tricuspid in iv drug users
33
Most common pathogen for IE, prosthetic valve
Staph aureus Used to be strep Viridans Prosthetic: coagulate negative strep epidermidis
34
Stages of HTN
Stage 1 : >140/90 or ABPM >135/85 Stage 2 : >160/100 or 150/95 Stage 3 or severe: SBP 180 OR DBP >120
35
When to expect rupture of papillary muscle due to MI
Severe complication of MI 3-5 days post HoTN, pulmonary oedema Early-mid systolic murmur
36
PCI timing in MI
PCI: STEMI sx within 12 hours and PCI can be offered within 120min- aspirin + clopidogrel If sx within 12 hours but primary PCI x offered within 120min then start fibrinolysis (fondaprinux) Repeat ECG with ST elevation not resolving needs rescue PCI
37
DOAC & anti-latest post MI
If post ACS/ PCI with Bg AFib DAPT and 1 DoAC for 1-6months then 1 anti platelet and 1 anticoagulant If stable CVD with indication for DoAC eg. AFib then anticoagulant monotx without anti platelet
38
Secondary prevention after ACS
Statin, beta blocker, ACEi
39
Pericarditis Ix esp ECG Findings
ECG: global widespread ST changes elevation (saddle shaped) with PR Depression TTE: check pericardial effusion Labs: high trip, high inflammatory markers, high ESR
40
Mx pericarditis
NSAIDS + Colchicine 1st line for idiopathic/ viral cause +/- corticosteroid
41
Cardiac tamponade sx, whiat happens to SBP & ECG
Becks triad: HoTN, elevated JVP, muffled heart sound Tachycardia Oculus’s paradoxes deacrease in SBP >10mmHg during inspiration ECG small QRS complexes Electric alternates - QRS complexes different height
42
Scores used in PE
Wells criteria- likely PE calculation PESI- PE severity index ORBIT score for bleeding risk
43
PE Ix esp ECg
CTPA> V/Q scan When to use VQ scan: alternative dx of PE, renal impairment. Mismatch V/Q: old PE, AV malformation/ vasculitis/ COPD D-dimer- use age adjusted d-dimer ECG S1Q3T3, RBBB, RT AXIS DEVIATION
44
Duration of DOAC IN PE
Unprovoked use for 6months and review using ORBIT Provoked for 3months
45
Diastolic murmur
Aortic and pulmonary regurgitation Mitral and tricuspid stenosis
46
Which gives continuous murmur
Patent ductus arterosus
47
When to consider surgical mx for aortic valve stenosis
When valve gradient >40mmHg and features of LV systolic dysfunction
48
Biological vs prosthetic valve replacement
Biological: for older patient >65 as risk of calcification over time. Long term anticoagulant not usually needed Mechanical increased risk of thrombosis- long term anticoagulant needed. Warfarin used in preference to DOAC
49
Aortic dissection classification
Stanford and DeBakey Stanford: A- asc aorta , 2/3 of cases B- describe aortal distal left subclavian 1/3 cases DeBakey Type I: asc aorta to at least aortic arch and possibly beyond dismally Type II: asc aorta only Type III: descending aorta
50
Aortic dissection Ix
CXR: widened mediastinum CT-Angio: stable pt , able to mx surgically TOE: unstable pt risky to take to CT scanner
51
Mx Aortic dissection
Type A: surgical mx, control SBP 100-120mmHg
52
Inheritance of hypertrophic obstructive cardiomyopathy
AD Most common cause of sudden cardiac death in young pts
53
Mx of hypertrophic obstructive cardiomyopathy
ABCDE amiodarone, beatable/ verapamil, cardioverter Defib Dual chamber pacemaker, endocarditis prophylaxis
54
Definition of postural hypotension
Standing BP falls SBP>20mmHg DBP: >10mmHg Or SBP<90mmHg

MSRA 2023 (22 decks)

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