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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
Q

Absolute indication for DOAC in AFib

A

AFib with valvular disease

26
Q

Stable AFib mx

A

<48hrs: if rate/rhythmn + heparinised electrical DC

If > 48 hours/ uncertain: rate and anticoagulation for minimum of 3 weeks

27
Q

When to consider amiodarone inAFib

A

Esp if patient in HF

28
Q

Scores used in AFib

A

CHA1DSC2 VASC RISK FACTOR
HASBLED

ORBIT

29
Q

HASBLED SCORE

A

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
Q

ORBIT SCORE

A

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
Q

Which criteria used for infective endocarditis

A

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
Q

Which valve most affected by IE

A

Mitral valve

Tricuspid in iv drug users

33
Q

Most common pathogen for IE, prosthetic valve

A

Staph aureus
Used to be strep Viridans

Prosthetic: coagulate negative strep epidermidis

34
Q

Stages of HTN

A

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
Q

When to expect rupture of papillary muscle due to MI

A

Severe complication of MI 3-5 days post

HoTN, pulmonary oedema
Early-mid systolic murmur

36
Q

PCI timing in MI

A

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
Q

DOAC & anti-latest post MI

A

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
Q

Secondary prevention after ACS

A

Statin, beta blocker, ACEi

39
Q

Pericarditis Ix esp ECG Findings

A

ECG: global widespread ST changes elevation (saddle shaped) with PR Depression

TTE: check pericardial effusion

Labs: high trip, high inflammatory markers, high ESR

40
Q

Mx pericarditis

A

NSAIDS + Colchicine 1st line for idiopathic/ viral cause
+/- corticosteroid

41
Q

Cardiac tamponade sx, whiat happens to SBP & ECG

A

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
Q

Scores used in PE

A

Wells criteria- likely PE calculation
PESI- PE severity index

ORBIT score for bleeding risk

43
Q

PE Ix esp ECg

A

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
Q

Duration of DOAC IN PE

A

Unprovoked use for 6months and review using ORBIT
Provoked for 3months

45
Q

Diastolic murmur

A

Aortic and pulmonary regurgitation
Mitral and tricuspid stenosis

46
Q

Which gives continuous murmur

A

Patent ductus arterosus

47
Q

When to consider surgical mx for aortic valve stenosis

A

When valve gradient >40mmHg and features of LV systolic dysfunction

48
Q

Biological vs prosthetic valve replacement

A

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
Q

Aortic dissection classification

A

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
Q

Aortic dissection Ix

A

CXR: widened mediastinum
CT-Angio: stable pt , able to mx surgically
TOE: unstable pt risky to take to CT scanner

51
Q

Mx Aortic dissection

A

Type A: surgical mx, control SBP 100-120mmHg

52
Q

Inheritance of hypertrophic obstructive cardiomyopathy

A

AD
Most common cause of sudden cardiac death in young pts

53
Q

Mx of hypertrophic obstructive cardiomyopathy

A

ABCDE

amiodarone, beatable/ verapamil, cardioverter Defib
Dual chamber pacemaker, endocarditis prophylaxis

54
Q

Definition of postural hypotension

A

Standing BP falls
SBP>20mmHg
DBP: >10mmHg

Or SBP<90mmHg

MSRA 2023 (22 decks)

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