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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
GRACE score: what score is classed as 'medium to high risk'? And what does this mean?
= > 3% Pt should be considered for early angiography + PCI
26
ECG changes indicative of an MI in II, III, aVF would indicate an occlusion in which artery?
= right coronary artery
26
6A's - secondary prevention in ACS
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
27
What is Dressler's syndrome?
= post-MI pericarditis
28
What is atheroma?
= fatty deposits in the artery walls
29
What is sclerosis?
= hardening or stiffening of blood vessel walls
30
Are males or females more at risk of CVD?
= males
31
NICE recommends how long of moderate exercise a week? or how long of vigorous exercise?
= 150 minutes moderate = 75 minutes vigorous
32
What is QRISK3 score?
= estimates % risk that a patient will have a stroke or MI in the next 10 years
33
What is the QRISK3 score used for?
= deciding whether the patient should be offered a statin for primary prevention of CVD
34
QRISK3 score: what score indicates a patient should be offered a statin?
= >10%
35
Patient's with which 2 co-morbidities are offered Atorvastatin 20mg for CVD primary prevention?
- CKD (eGFR <60) - T1DM (for >10 years, or >40 years old)
36
How do statins reduce cholesterol?
= reduce cholesterol production in liver by inhibiting HMG CoA reductase
37
CVD secondary prevention (4A's)
Anti-platelet (Aspirin, Clopidogrel, Ticagrelor) Atorvastatin 80mg Atenolol (or alternative beta blocker) ACEi (commonly Ramipril)
38
What is left ventricular failure?
= when left ventricle is unable to move blood efficiently on the left side into the systemic circulation
39
How does left ventricular failure lead to pulmonary oedema?
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
40
What ejection fraction is considered 'normal'?
= > 50%
41
What is B-type Natriuretic Peptide (BNP)
= hormone released from heart ventricles when myocardium is stretched beyond a normal range Indicates heart is overloaded beyond it's normal capacity
42
Management of left ventricular failure? (mnemonic: 'sodium')
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
How does sitting up help patients who have pulmonary oedema?
= 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
What is orthopnoea?
= breathlessness when lying flat
45
What is required for a diagnosis of congestive HF according to the Framingham Criteria? (minors + majors)
= 1 or 2 major, AND 2 minor criteria
46
How is heart failure diagnosed?
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
What does Grade I mean in relation to New York Heart Association (NYHA) Classification of HF?
= no limitation in function
48
What does Grade II mean in relation to New York Heart Association (NYHA) Classification of HF?
= slight limitation/ moderate exertion causes symptoms, no symptoms at rest
49
What does Grade III mean in relation to New York Heart Association (NYHA) Classification of HF?
= marked limitation, mild exertion causes symptoms, no symptoms at rest
50
What does Grade IV mean in relation to New York Heart Association (NYHA) Classification of HF?
= severe limitation, any exertion causes symptoms. May also have symptoms at rest (not always)
51
Management of HF
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
What is the definition of hypertension? (clinic and ABPM/ HBPM values)
clinic: > 140/90 ABPM/ HBPM: > 135/85
53
Essential/ primary vs. secondary hypertension
Essential/ primary = high BP developed on it's own, doesn't have a secondary cause Secondary = has an underlying cause
54
Most common cause of secondary hypertension?
= renal disease
55
Causes of secondary hypertension (mnemonic 'ROPED')
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
How is hypertension diagnosed?
= 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
Stage 1 hypertension (clinic + ABPM/ HBPM)
Clinic: >140/90 ABPM/ HBPM: >135/85
58
Stage 2 hypertension (clinic + ABPM/ HBPM)
Clinic: >160/100 ABPM/ HBPM: >150/95
59
Stage 3 hypertension (clinic)
Clinic: 180/120
60
Clinic: ABPM/ HBPM
61
Which patients should be offered an ACEi or ARB as the first step in trying to manage their hypertension?
- those < 55 years old OR, - T2DM
62
Which patients should be offered a calcium channel-blocker as the first step in trying to manage their hypertension?
- those > 55 years old, OR - Black African or Caribbean
63
Drug: -pril
= ACEi
64
Drug: -dipine
= calcium channel blocker
65
Drug: -sartan
= angiotensin II receptor blocker (ARB)
66
Hypertension Management: Step 4 depends on serum potassium. If potassium levels
= potassium-sparing diuretic, such as spironolactone
67
Hypertension Management: Step 4 depends on serum potassium. If potassium levels > 4.5 mmol/L, what should be considered?
= alpha-blocker (e.g., Doxazosin), or a beta-blocker (e.g., Atenolol)
68
Drug: -olol
= beta-blocker
69
Hypertension: Treatment targets for patients < 80
Clinic BP <140/90 ABPM/ HBPM <135/85
70
Hypertension: Treatment targets for patients > 80
Clinic BP <150/90 ABPM/HBPM <145/85
71
What is the most common causative organism in infective endocarditis?
= Staphylococcus aureus
72
Investigations for infective endocarditis (2)
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
What imaging is used in the diagnosis of infective endocarditis
Transoesophageal echocardiography (TOE)
74
What is the modified duke criteria used for?
= can be used to diagnose infective endocarditis
75
What is required for a diagnosis of infective endocarditis using 'modified duke criteria'? (minor + major)
Either, - 1 major + 3 minor, OR - 5 minor criteria
76
Management of infective endocarditis
= IV broad-spectrum antibiotics (e.g., Amoxicillin + optional Gentamicin) - antibiotic may be more specific following identification of causative organism
77
How long should antibiotics be continues in the treatment of infective endocarditis in those with native values vs. prosthetic?
Native valves: 4 weeks Prosthetic valves: 6 weeks
78
Definition of anginal pain according to NICE? (3)
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
Difference between 'stable' and 'unstable' angina
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
1st-line investigation for patients in whom stable angina cannot be excluded by clinical assessment alone
= CT coronary angiography
81
Stable angina: What is given for immediate symptomatic relief
= sublingual glyceryl trinitrate (GTN)
82
Key side-effects of GTN? (2)
- dizziness - headaches
83
Stable angina: What is given for long-term symptomatic relief (2)
Either OR, a combination of both: - beta-blocker (e.g., Bisoprolol) - calcium-channel blocker (e.g., Diltiazem or Verapamil)
84
When should calcium-channel blockers be avoided in long-term symptomatic relief for stable angina?
= if patients has HF with reduced EF
85
Stable angina: What is given for secondary prevention of CVD? (4 A's)
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
Stable angina: surgical intervention options (2)
- Percutaneous coronary intervention (PCI) - Coronary artery bypass graft (CABG)
87
Pericardial friction rub on auscultation is a key finding in which condition?
= pericarditis
88
How it pericarditis treated? (2)
- NSAIDs e.g., Aspirin or Ibuprofen - Colchicine (reduce risk of reoccurrence)
89
ECG changes seen in pericarditis (2)
- saddle-shaped ST-elevation - PR depression
90
Mainstay diagnosis for valvular heart disease
= echocardiogram (ECHO)
91
Most common cause of mitral regurgitation?
= mitral valve prolapse
92
Which valve is AF most associated with in regards to valvular heart disease?
= mitral
93
On examination patient presents with a pan-systolic murmur, best heard in mitral region, with radiation to left axilla. What is the diagnosis?
= mitral regurgitation
94
Most common cause of aortic stenosis?
= calcification of valve
95
What causes an ejection-systolic murmur, loudest in aortic region, patients have a low-rising pulse with narrow pulse pressure?
= aortic stenosis
96
Which murmurs are systolic? (4)
- pulmonary stenosis - aortic stenosis - mitral regurgitation/ prolapse - tricuspid regurgitation/ prolapse
97
Which murmurs are diastolic? (4)
- pulmonary regurgitation/ prolapse - aortic regurgitation/ prolapse - mitral stenosis - tricuspid stenosis
98
Do mechanical, or tissue valves last longer?
= mechanical
99
Are mechanical, or tissue valves preferred in younger patients?
= mechanical

Year 3 (10 decks)

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