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Year 3 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is a type I MI?

A

= MI due to a primary coronary artery event such as plaque rupture and/or dissection

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2
Q

What is a type II MI?

A

= MI due to oxygen supply/demand mismatch

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3
Q

What is a type III MI?

A

= sudden unexpected cardiac death, presumed secondary to MI

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4
Q

What is a type IV MI?

A

= MI associated with PCI or stent complications

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5
Q

What is a type V MI?

A

= MI associated with cardiac surgery

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6
Q

Which type of MI will show ECG changes in the following territories: II, III, aVF?

A

= inferior MI

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7
Q

Which type of MI will show ECG changes in the following territories: I, V5, V6, aVL?

A

= lateral MI

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8
Q

Which type of MI will show ECG changes in the following territories: V1-V4?

A

= anterior MI

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9
Q

ECG changes indicative of an MI in I, V5, V6, aVL would indicate an occlusion in which artery?

A

= left circumflex

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10
Q

ECG changes indicative of an MI in V1-V4 would indicate an occlusion in which artery?

A

= left anterior descending (LAD)

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11
Q

ECG changes you might expect to see in a STEMI (2)

A
  • ST-elevation, or
  • new LBBB
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12
Q

ECG changes you might expect to see in a NSTEMI (2)

A
  • ST-segment depression, and/or
  • T-wave inversion
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13
Q

What do pathological Q waves after an MI suggest?

A

= there has been full thickness (transmural) infarction

(usually appear 6 hours or more after symptoms start)

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14
Q

Patients with which co-morbidity are at particular risk of silent MIs?

A

= diabetes

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15
Q

+++ troponin, ST elevation or new LBBB on ECG, is suggestive of which type of ACS?

A

= STEMI

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16
Q

+++ troponin, ST depression or T-wave inversion on ECG , is suggestive of which type of ACS?

A

= NSTEMI

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17
Q

-ve troponin, no ECG changes, is suggestive of which type of ACS?

A

= unstable angina

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18
Q

What are the options for a patient presenting with STEMI within 2 hours of presenting,
and AFTER 2 hours?

A

Within 2 hours of presenting: percutaneous coronary intervention (PCI)
After 2 hours: thrombolysis

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19
Q

Which 2 medications should be given to a patient in preparation for a PCI?

A

= aspirin + Prasugrel (anti-platelets)

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20
Q

NSTEMI management

(mnemonic: BATMAN)

A

B - base decision of angiography + PCI on GRACE score
A - Aspirin, 300 mg stat dose
T - Ticagrelor, 180 mg stat dose (Clopidogrel if high bleeding risk, or Prasugrel if having angiography)
M - Morphine, titrated to control pain
A - antithrombin therapy with Fondaparinux (unless high bleeding risk or immediate angiography)
N - nitrate (GTN)

(give oxygen ONLY if their saturations drop)

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21
Q

In NSTEMI management, if patient has a high bleeding risk what can be given instead of Ticagrelor?

A

= Clopidogrel

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22
Q

In NSTEMI management, if patient is having an angiography what can be given instead of Ticagrelor?

A

= Prasugrel

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23
Q

What is the ‘GRACE Score’?

A

= Used to decide whether a patient with NSTEMI should undergo an angiography + PCI

Gives a 6-month probability of death after having an NSTEMI

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24
Q

GRACE score: what score is classed as ‘low risk’? And what does this mean?

A

= 3% or less

Pt not considered for early angiography + PCI

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25
Q

GRACE score: what score is classed as ‘medium to high risk’? And what does this mean?

A

= > 3%

Pt should be considered for early angiography + PCI

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26
Q

ECG changes indicative of an MI in II, III, aVF would indicate an occlusion in which artery?

A

= right coronary artery

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26
Q

6A’s - secondary prevention in ACS

A

A – Aspirin, 75mg once daily indefinitely
A – another antiplatelet for 12 months (Ticagrelor or Clopidogrel)
A – Atorvastatin, 80mg once daily
A – ACEi (e.g., Ramipril) titrated as high as tolerated
A – Atenolol (or another beta-blocker, usually Bisoprolol) “”
A - Aldosterone antagonist (diuretic) – for those with clinical heart failure

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27
Q

What is Dressler’s syndrome?

A

= post-MI pericarditis

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28
Q

What is atheroma?

A

= fatty deposits in the artery walls

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29
Q

What is sclerosis?

A

= hardening or stiffening of blood vessel walls

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30
Q

Are males or females more at risk of CVD?

A

= males

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31
Q

NICE recommends how long of moderate exercise a week? or

how long of vigorous exercise?

A

= 150 minutes moderate

= 75 minutes vigorous

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32
Q

What is QRISK3 score?

A

= estimates % risk that a patient will have a stroke or MI in the next 10 years

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33
Q

What is the QRISK3 score used for?

A

= deciding whether the patient should be offered a statin for primary prevention of CVD

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34
Q

QRISK3 score: what score indicates a patient should be offered a statin?

A

= >10%

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35
Q

Patient’s with which 2 co-morbidities are offered Atorvastatin 20mg for CVD primary prevention?

A
  • CKD (eGFR <60)
  • T1DM (for >10 years, or >40 years old)
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36
Q

How do statins reduce cholesterol?

A

= reduce cholesterol production in liver by inhibiting HMG CoA reductase

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37
Q

CVD secondary prevention (4A’s)

A

Anti-platelet (Aspirin, Clopidogrel, Ticagrelor)
Atorvastatin 80mg
Atenolol (or alternative beta blocker)
ACEi (commonly Ramipril)

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38
Q

What is left ventricular failure?

A

= when left ventricle is unable to move blood efficiently on the left side into the systemic circulation

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39
Q

How does left ventricular failure lead to pulmonary oedema?

A

When blood can’t flow efficiently through left side of heart, there is a backlog of blood waiting in the left atrium, pulmonary veins + lungs

Increased volume + pressure of blood >fluid leaks > cannot reabsorb excess fluid surrounding tissues > resulting in pulmonary oedema

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40
Q

What ejection fraction is considered ‘normal’?

A

= > 50%

41
Q

What is B-type Natriuretic Peptide (BNP)

A

= hormone released from heart ventricles when myocardium is stretched beyond a normal range

Indicates heart is overloaded beyond it’s normal capacity

42
Q

Management of left ventricular failure?

(mnemonic: ‘sodium’)

A

S - sit up
O - oxygen
D - diuretics
I - IV fluids need to be STOPPED
U - underlying causes need to be identified + treated
M - monitor fluid balance

43
Q

How does sitting up help patients who have pulmonary oedema?

A

= when lying flat, fluid in lungs spreads to larger area. Upright fluid travels to the lung bases, leaving the middle + upper areas clear for better gas exchange

44
Q

What is orthopnoea?

A

= breathlessness when lying flat

45
Q

What is required for a diagnosis of congestive HF according to the Framingham Criteria?

(minors + majors)

A

= 1 or 2 major, AND 2 minor criteria

46
Q

How is heart failure diagnosed?

A

NT-proBNP measured:
- > 2000 - urgent 2 week referral for echocardiogram
- 400-2000 - referral for echocardiogram within 6 weeks
- < 400 - HF not suspected, consider other causes

Also do ECG, CXR, bloods, urinalysis + pulmonary function tests (to look for other causes)

47
Q

What does Grade I mean in relation to New York Heart Association (NYHA) Classification of HF?

A

= no limitation in function

48
Q

What does Grade II mean in relation to New York Heart Association (NYHA) Classification of HF?

A

= slight limitation/ moderate exertion causes symptoms, no symptoms at rest

49
Q

What does Grade III mean in relation to New York Heart Association (NYHA) Classification of HF?

A

= marked limitation, mild exertion causes symptoms, no symptoms at rest

50
Q

What does Grade IV mean in relation to New York Heart Association (NYHA) Classification of HF?

A

= severe limitation, any exertion causes symptoms. May also have symptoms at rest (not always)

51
Q

Management of HF

A

Offer diuretic (e.g., Furosemide)

If HF with reduced EF:
Offer ACEi + beta-blocker
+ Mineralocorticoid/ aldosterone receptor antagonist (MRA) if symptoms continue (e.g., Spironolactone or Eplerenone)

Can use SGLT-2 as an add-on therapy if EF < 40%

If HF with preserved EF: manage co-morbidities. Offer personalised exercise-based cardiac rehab programme if unstable

52
Q

What is the definition of hypertension?
(clinic and ABPM/ HBPM values)

A

clinic: > 140/90
ABPM/ HBPM: > 135/85

53
Q

Essential/ primary vs. secondary hypertension

A

Essential/ primary = high BP developed on it’s own, doesn’t have a secondary cause

Secondary = has an underlying cause

54
Q

Most common cause of secondary hypertension?

A

= renal disease

55
Q

Causes of secondary hypertension

(mnemonic ‘ROPED’)

A

R – renal disease – most common cause
O – obesity
P – pregnancy-induced hypertension or pre-eclampsia
E – endocrine – e.g., hyperaldosteronism (Conn’s syndrome)
D – drugs (e.g., alcohol, steroids, NSAIDs, oestrogen + liquorice

56
Q

How is hypertension diagnosed?

A

= those with a clinic BP 140/90-180/120 mmHg should have a 24-hour ambulatory BP or home readings to confirm diagnosis

(to account for white coat syndrome)

57
Q

Stage 1 hypertension

(clinic + ABPM/ HBPM)

A

Clinic: >140/90
ABPM/ HBPM: >135/85

58
Q

Stage 2 hypertension

(clinic + ABPM/ HBPM)

A

Clinic: >160/100
ABPM/ HBPM: >150/95

59
Q

Stage 3 hypertension

(clinic)

A

Clinic: 180/120

60
Q
A

Clinic:
ABPM/ HBPM

61
Q

Which patients should be offered an ACEi or ARB as the first step in trying to manage their hypertension?

A
  • those < 55 years old OR,
  • T2DM
62
Q

Which patients should be offered a calcium channel-blocker as the first step in trying to manage their hypertension?

A
  • those > 55 years old, OR
  • Black African or Caribbean
63
Q

Drug: -pril

A

= ACEi

64
Q

Drug: -dipine

A

= calcium channel blocker

65
Q

Drug: -sartan

A

= angiotensin II receptor blocker (ARB)

66
Q

Hypertension Management: Step 4 depends on serum potassium. If potassium levels </= 4.5 mmol/L, what should be considered?

A

= potassium-sparing diuretic, such as spironolactone

67
Q

Hypertension Management: Step 4 depends on serum potassium. If potassium levels > 4.5 mmol/L, what should be considered?

A

= alpha-blocker (e.g., Doxazosin), or a beta-blocker (e.g., Atenolol)

68
Q

Drug: -olol

A

= beta-blocker

69
Q

Hypertension: Treatment targets for patients < 80

A

Clinic BP <140/90
ABPM/ HBPM <135/85

70
Q

Hypertension: Treatment targets for patients > 80

A

Clinic BP <150/90
ABPM/HBPM <145/85

71
Q

What is the most common causative organism in infective endocarditis?

A

= Staphylococcus aureus

72
Q

Investigations for infective endocarditis (2)

A

Blood cultures - 3 recommended, usually separated by at least 6 hours, and taken from different regions. Gap between repeats may be shorter if antibiotics are required more urgently

Echocardiography (transoesophageal more sensitive + specific) - TOE

73
Q

What imaging is used in the diagnosis of infective endocarditis

A

Transoesophageal echocardiography (TOE)

74
Q

What is the modified duke criteria used for?

A

= can be used to diagnose infective endocarditis

75
Q

What is required for a diagnosis of infective endocarditis using ‘modified duke criteria’?

(minor + major)

A

Either,
- 1 major + 3 minor, OR
- 5 minor criteria

76
Q

Management of infective endocarditis

A

= IV broad-spectrum antibiotics (e.g., Amoxicillin + optional Gentamicin) - antibiotic may be more specific following identification of causative organism

77
Q

How long should antibiotics be continues in the treatment of infective endocarditis in those with native values vs. prosthetic?

A

Native valves: 4 weeks
Prosthetic valves: 6 weeks

78
Q

Definition of anginal pain according to NICE? (3)

A
  1. constricting discomfort in front of chest, or in neck, shoulder, jaws, or arms
  2. precipitated by physical exertion
  3. relieved by rest or GTN in about 5 minutes
79
Q

Difference between ‘stable’ and ‘unstable’ angina

A

Stable angina = when symptoms only come on exertion and are always relieved by rest or glyceryl trinitrate (GTN)

Unstable angina = when symptoms appear randomly whilst at rests. Unstable angina is a type of ACS and requires immediate treatment

80
Q

1st-line investigation for patients in whom stable angina cannot be excluded by clinical assessment alone

A

= CT coronary angiography

81
Q

Stable angina: What is given for immediate symptomatic relief

A

= sublingual glyceryl trinitrate (GTN)

82
Q

Key side-effects of GTN? (2)

A
  • dizziness
  • headaches
83
Q

Stable angina: What is given for long-term symptomatic relief (2)

A

Either OR, a combination of both:
- beta-blocker (e.g., Bisoprolol)
- calcium-channel blocker (e.g., Diltiazem or Verapamil)

84
Q

When should calcium-channel blockers be avoided in long-term symptomatic relief for stable angina?

A

= if patients has HF with reduced EF

85
Q

Stable angina: What is given for secondary prevention of CVD? (4 A’s)

A

A – Aspirin 75mg once daily
A – Atorvastatin 80mg once daily
A – ACE-I (if DM, hypertension, CKF or HF also present)
A – Already on beta-blocker for symptomatic relief

86
Q

Stable angina: surgical intervention options (2)

A
  • Percutaneous coronary intervention (PCI)
  • Coronary artery bypass graft (CABG)
87
Q

Pericardial friction rub on auscultation is a key finding in which condition?

A

= pericarditis

88
Q

How it pericarditis treated? (2)

A
  • NSAIDs e.g., Aspirin or Ibuprofen
  • Colchicine (reduce risk of reoccurrence)
89
Q

ECG changes seen in pericarditis (2)

A
  • saddle-shaped ST-elevation
  • PR depression
90
Q

Mainstay diagnosis for valvular heart disease

A

= echocardiogram (ECHO)

91
Q

Most common cause of mitral regurgitation?

A

= mitral valve prolapse

92
Q

Which valve is AF most associated with in regards to valvular heart disease?

A

= mitral

93
Q

On examination patient presents with a pan-systolic murmur, best heard in mitral region, with radiation to left axilla.

What is the diagnosis?

A

= mitral regurgitation

94
Q

Most common cause of aortic stenosis?

A

= calcification of valve

95
Q

What causes an ejection-systolic murmur, loudest in aortic region, patients have a low-rising pulse with narrow pulse pressure?

A

= aortic stenosis

96
Q

Which murmurs are systolic? (4)

A
  • pulmonary stenosis
  • aortic stenosis
  • mitral regurgitation/ prolapse
  • tricuspid regurgitation/ prolapse
97
Q

Which murmurs are diastolic? (4)

A
  • pulmonary regurgitation/ prolapse
  • aortic regurgitation/ prolapse
  • mitral stenosis
  • tricuspid stenosis
98
Q

Do mechanical, or tissue valves last longer?

A

= mechanical

99
Q

Are mechanical, or tissue valves preferred in younger patients?

A

= mechanical

Year 3 (10 decks)

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