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Cardiology Flashcards

1
Q

What are the ECG features of hyperkaemia? (3)

A

Tall tented T waves, widening of QRS, small P waves

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2
Q

Management of Fast AF

A

Hypotension/ acutely unwell= DC cardio version
If stable= Rate or Rhythm control However if >48 hours then has to be RATE control.

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3
Q

What are the 2 first line drugs in treating heart failure with reduced ejection fraction?

A

Ace inhibitor and B blocker.

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4
Q

What drug is 2nd line in treating heart failure with reduced ejection fraction if still symptomatic?

A

Mineraolcorticoid receptor antagonist eg Sprinolactone

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5
Q

What drugs need to be avoided in people with heart failure?

A

Avoid calcium channel blockers eg vermapril

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6
Q

What are the components of CHA2DS2-VASc

A

Congestive HF
HTN
Age >75 (2)
Age 65-74
DM
Previous stroke/ TIA (2)
Vascular disease
Sex - female

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7
Q

What scores would indicate anticoagulation in men/ females using CHADSVASC?

A

Males scoring 1 = CONSIDER anticoagulation
Males and Females scoring >2 = anticoagulation

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8
Q

What is the management of stable angina?

A

Aspirin 75mg OD, and Statin if QRisk>10%
GTN PRN
1st line Beta blocker OR Calcium channel blocker
2nd line BB and CCB

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9
Q

What drugs are provided for secondary prevention post STEMI?

A

Dual antiplatlets, Statin, AceI, Beta blocker.

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10
Q

What is an example of a ‘Thiazide- like’ diuretic?

A

Example = indapamide

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11
Q

What score on the wells score = PE likely?

A

Wells score>4 = PE likely and a CTPA is organised.

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12
Q

What is the management if wells score is less than 4? (PE unlikely)

A

Organise D-dimer.
If d-dimer is pos-> CTPA
If d-dimer is neg-> Stop anticoagulation and consider alternative

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13
Q

What drug is used in non shockable rhythms?

A

Adrenaline 1mg ASAP for non shockable rhythms

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14
Q

What are the non shockable rhythms?

A

PEA/ Asystole

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15
Q

What are the ECG features with WPW?

A

Shortened PR interval, wide WRS with a delta wave

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16
Q

What is the 4th line management of hypertension

A

If potassium <4.5 = add Spirnolactone
If pottasium >4.5= Alpha or beta blocker

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17
Q

What is the management of VT ?

A

VT
Medical mx= Amiodarone/ Lidocaine
If unstable = synchronised DC cardiovascular shock

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18
Q

What drug is contraindicated in VT?

A

Veramapril

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19
Q

What is the cardiac deformity associated with Turners? and what murmur?

A

Bicuspid aortic valvue - ejection systolic

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20
Q

What time limit should PCI be delivered in? (for STEMI)

A

120 minutes

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21
Q

If PCI CANNOT be given within 120 minutes, what should be given? (for STEMI)

A

Fibrinolysis

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22
Q

What drugs need to be given on discharge post an MI?

A

Dual antiplatelet therapy (aspirin plus a second Antiplatelet agent)
ACE inhibitor
Beta-blocker
Statin

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23
Q

What is the first line management of patients with T2DM and new diagnosis of hypertension?

A

ACEi or ARB (regardless of age)

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24
Q

What sort of tachycardia is SVT?

A

Narrow complex tachycardia

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25
Q

How to manage SVT?

A

If unstable- DC cardioversion
If stable- vagal manoevures followed by adenosine

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26
Q

What is the first line treatment of DVT?

A

DOAC (apxiban or rivroxaban)

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27
Q

Treatment of unprovoked vs provoked DVT?

A

Provoked- 3 months of DOAC
Unprovoked- 6 months

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28
Q

What is the secondary prevention of a stroke?

A

Need to be commenced on clopidogrel monotherapy +/- statin

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29
Q

What is the ALS management of bradycardia?

A

Atropine IV AND if resistant to atropine then external pacing

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30
Q

What Q risk score should statins be considered?

A

10% or over- statins should be considered

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31
Q

Post an MI what drugs are required for 2ndary prevention?

A

dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
ACE inhibitor
beta-blocker
statin

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32
Q

If patient has reduced ejection fraction post an MI which drug should be considered?

A

Aldosterone anatagonist eg. eplerenone

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33
Q

What is the management of bradycardia with shock?

A

Atropine is 1st line
Followed by either further dose of Atropine OR trasncutaneous pacing

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34
Q

Inheritance of HOCM?

A

Autosomal dominant

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35
Q

Death from HOCM is as a result of..?

A

Ventricular arrythmias

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36
Q

What are the age categories to get you points in CHADSVASC2?

A

Age 65-74= 1 point
>75= 2 points

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37
Q

Management of HTN in diabetic regardless of age?

A

ACEi/ ARB

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38
Q

How does left ventricular free wall rupture present ? ( post MI)

A

2 weeks post MI- presentation in acute heart failure

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39
Q

What is the management for a patient who presents with AF present >48 hours?

A

Rate control
Start on anticoagulation
Bring back for DC cardioversion in 3 weeks
Continue anticoagulation for 4 weeks

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40
Q

What are the drugs for secondary prevention after MI?

A

AceI, BB, statin, and DAPT (aspirin and clopidogrel)

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41
Q

Management of torsades de points?

A

IV Magnesium sulphate

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42
Q

Acute mitral regurgitation - what is the presentation post MI?

A

Occur hours- day post MI. New mumur (systolic). Acute hypotension and pulmonary oedema.

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43
Q

What electrolytes caused prolonged QT?

A

Hypokaemia, hypocalcaemia, hypomagnesium

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44
Q

What are some of the third line drug management options for heart failure?

A

Ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy

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45
Q

What is first and second line management of stable angina?

A

Beta blocker or calcium channel blocker
2nd line- use both together!

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46
Q

Which drugs can cause QT prolongation ?

A

SSRIs/ Tricyclic antidepressants

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47
Q

What are the rules around driving after a successful coronary angio?

A

1 week with no driving and no need to tell DVLA

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48
Q

What drugs need to be avoided in HOCM?

A

ACE inhibitors avoid in HOCM

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49
Q

Drugs for symptom control in Angina? (3)

A

GTN spray
BB
Calcium channel blocker

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50
Q

What are the causes of an ejection systolic murmur?

A

Aortic stenosis, pulmonary stenosis, aortic sclerosis.

51
Q

What causes a pan systolic murmur?

A

Mitral valve regurgitation
Tricuspid regurgitation
VSD

52
Q

What are the measurements and management of AAA?

A

4.5cm and above- refer to secondary care.
5.5 and above- urgent 2ww

53
Q

What are the 2 main causes of a broad complex tachycardia?

A

VT
(AF with bundle branch)

54
Q

How does an atrial myoxema present?

A

pan systolic murmur, dizziness, syncope. more commonly Left sided.

55
Q

What are the causes of a right bundle branch block?

A

Normal variant, cor pulmonale, or PE

56
Q

What ECG changes are seen with hypokalemia?

A

Flattened T waves and U waves.

57
Q

What ECG changes with hypocalacemia/ hypercalacemia?

A

Hypo- Prolongation of QT
Hyper- Shortened QT

58
Q

What are the lateral leads on an ECG?

A

1, AVL, V5 and V6

59
Q

What type of murmur does aortic regurgitation have?

A

Soft S1, early diastolic murmur.

60
Q

Following a STEMI if not suitable for PCI, what is the medical management?

A

Ticagrelor with Aspirin (if bleeding risk is low)

61
Q

What anti platelets are given prior to PCI?

A

Prasugrel and Aspirin

62
Q

What are the signs of Digoxin toxicity?

A

N+V, bradycardia, green/ yellow vision. AV node block

63
Q

What are the non shockable rhythms? and how are they managed?

A

PEA/ Systole
Non shockable- CPR and adrenaline every 3-5 mins

64
Q

Management of paryoxsmal SVT?

A
  1. Carotid sinus manoeuvres
  2. Adenosine
65
Q

What is Dressler’s syndrome?

A

2-6 weeks post MI
Fever, Pain, Pericarditis.+/- effusion

66
Q

Torsades de pointes is associated with which condition and what is the mx?

A

A/w long QT syndrome and management is with magnesium.

67
Q

What are the ECG features of WPW?

A

short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’

68
Q

What criteria is used to diagnose rheumatic fever?

A

Jones criteria

69
Q

Thalssemia can result in what type of heart failure?

A

High output cardiac failure

70
Q

What are the ejection systolic murmurs?

A

Aortic stenosis
Pulmonary stenosis

71
Q

What are the pansystolic murmurs?

A

Tricuspid regurgitation
Mitral regurgitation

72
Q

What is an early diastolic mumur?

A

Aortic regurgitation

73
Q

What is mid-late diastolic murmur?

A

Mitral stenosis

74
Q

What are the causes of restrictive cardiomyopathy? (3)

A

Amyloidosis, Post radiotherapy/

75
Q

AAA rules and driving..

A

6cm- inform DVLA
6.5cm and over- cannot drive

5.5cm if lorry driver/ bus driver

76
Q

Narrow complex tachycardia- what are the management principles?

A

If unstable- SHOCK
Stable
Regular- Vagal manoeuvres/ ADENOSINE 6mg Iv bolus
Irregular - AF

77
Q

How to tell the difference between transposition of great arteries/ tetrology of fallot?

A

Tetrology of fallot- more common. presents 1-2 months.

Transposition of great arteries- at birth and less common!

78
Q

What are the two cardiac malformations in Turners?

A

Coarctation of aorta AND
Biscuspid aortic valve

79
Q

What is the management of aortic stenosis in children and which 2 conditions is it associated with?

A

A/w Williams and Turners
Management in children is with balloon valvuloplasty

80
Q

What are the features of aortic regurgitation ? And when is it loudest?

A

Early diastolic pressure
LOUDEST IN EXPIRATION!
Wide pulse pressure
Collapsing pulse
Pulsating nail beds
Head bobbing

81
Q

Aortic stenosis vs aortic sclerosis?

A

Sclerosis is an ejection systolic but it won’t radiate to the cartoids!

82
Q

When is Troponin the most sensitive?

A

12 hours. Most accurate.

83
Q

What ECG sign is characteristic of Hypothermia?

A

J Waves

84
Q

When should stage 1 hypertension be referred?

A

Stage 1 hypertension without evidence of end organ damage + UNDER 40 should be referred to secondary care!

85
Q

What is stage 1 hypertension?

A

Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg

86
Q

What is stage 2 hypertension?

A

Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg

87
Q

What is stage 3 hypertension?

A

Clinic readings >180/120

88
Q

Becks triad for cardiac tamponade?

A

Hypotension
Muffled heart sounds
Elevated JVP

89
Q

What is first line statin for primary prevention?

A

Atorvostatin 20mg

90
Q

What is the first line statin for secondary prevention?

A

Atorvostatin 80mg

91
Q

What are the rules for diabetics and statins?

A

If over 40, T1DM do not need risk assessment but should be on statins!

92
Q

Nicotinic Acid- what is it used for and what are the side effects?

A

Lowers cholesterol
Side effect: severe flushing

93
Q

What are the features of CCF on CXR?

A

Kerly B lines
Bilateral pleural effusions
Pulmonary oedema
Upper lobe diversion

94
Q

What are the 4 New York classifications of heart failure?

A
  1. No symptoms and no limitations
  2. Mild symptoms and comfortable at rest
    3.Moderate symptoms and limitations of physical activity
  3. Severe- symptoms at rest.
95
Q

When can the Q risk score NOT be used?

A

T1DM
Renal disease with egfr less than 60
Familial hypercholestaemia

96
Q

If statins are not having desired affect on lipid levels- what is next step?

A

Increase dose of statin
(NICE do not recommend Fibrates/ Nicotonic acid/ Bile acid sequestratants routinely)

97
Q

Rheumatic Fever- what organism? What treatment?

A

Strep pyogenes (Group A strep)
Mx: IM Ben Pen + PO Penicillin

98
Q

Pulsus paradoxus is seen in which conditions?

A

Severe Asthma, Cardiac tamponade

99
Q

What is sinus arrhythmia and how does it present?

A

Normal finding in fit individuals
Pulse increases during inspiration and decreases with expiration.

100
Q

What are the numbers to remember for AAA?

A

3-4.5cm= repeat scan in 12 months
4.5-5.5= repeat in 3 months
>5.5cm= vascular surgeon

Driving- tell DVLA at 6cm, and stop driving at 6.5cm
Coach 5.5cm STOP DRIVING

101
Q

Digoxin toxicity does what to an ECG?

A

(Yellow vision)
ST depression with inverted T waves V5/ V6

102
Q

Hypocalcaemia - clinical features and ECG features?

A

Prolonged QT
(trousseau/ chokekeu signs) INCREASED reflexes

103
Q

What valvular pathology may occur post MI

A

Mitral regurgitation

104
Q

Lone AF
Paroxysmal AF
Persistant AF
Permanent AF

A

Lone AF- isolated episode and no trigger
Paroxysmal AF - less than 7 days and SELF TERMINATE
Persistent AF - OVER 7 days and doesn’t self terminate
Permanent AF- continuous and resistant

105
Q

Management of NSTEMI/ Unstable Angina

A

Grace score less than 3%
- Ticagrelor with aspirin if low bleeding risk
- Clopidogrel with aspirin if high bleeding risk

Grace score >3%
- Angiography +/- PCI + Prasugrel
- Ticagrelor with aspirin

106
Q

HTN guidelines for afro-carbribean?

A

C is first line
C+ A or D

ARB is first line rather than ACE inhibitors in afrocaribeean populations

107
Q

Secondary prevention for NSTEMI

A

DAPT follows whatever is started in acute phase
EG:
Low risk grace score less than 3%
- Ticagrelor and aspirin (low risk bleeding)
- Clopidogrel and aspirin (high risk bleeding)

High risk grace score (PCI)
-Prasugrel and Aspirin

108
Q

Driving rules after ACS, Angio, CABG, Heart transplant

A

ACS (STEMI/NSTEMI) 1 month
Successful angio including PCI for STEMI- 1 week
CABG - I month
Heart transplant- 6 weeks

109
Q

After ACS how long before return to work, return to sexual intercourse and reminder of the driving rules?

A

Driving rules- stop driving for 1 month. unless successful angio in which case no driving for 1 week

No sex for 1 month
Return to work after 2 months

110
Q

How does Left ventricular free wall rupture present?

A

5 days after MI, elevated JVP. Cardiac tamponade - diminished heart sounds.

111
Q

Pan systolic murmur following MI?
Early to mid systolic murmur following MI?

A

Ventricular septal defect
Mitral regurgitation (early to mid systolic)

112
Q

What is the dose for Adenosine for SVT?

A

SVT
Narrow complex tachycardia (REGULAR)
1st: Vagal manoeuvres
2nd line: 6mg IV Adenosine
12mg Adenosine
18mg Adenosine

113
Q

What are some examples of rate controlling drugs for AF?

A

Beta Blockers
Calcium channel Blocker
Digoxin

114
Q

Verapamil is an example of what type of drug?

A

Calcium channel blocker for rate control in AF

115
Q

Management of PAD.

A

Clopidogrel 75mg OD
If Q risk >10% then STATIN!

116
Q

Features of constrictive pericarditis

A

Presents with raised JVP/ heart failure
Calcification of pericardium ‘pericardial calcification’

117
Q

2,3, AVF is which ECG territory and which artery?

A

Inferior
RAD
AVF for F= failure = inferior aspect of the heart

118
Q

V1-V4

A

Anterioseptal
LAD

v1-v4 are the main leads therefore ladddy!

119
Q

V1-6, I, aVL

A

AVL is LATERAL. (Anteriolateral)
Left circumflex/ Proximal left anterior descending

L for lateral

120
Q

V1-V3

A

Posterior
left circumflex, also right coronary

121
Q

What is the energy used for shockable rhythms?

A

150-200j on first shock, and then 150-360j on subsequent shocks

122
Q

What drugs improve survival in HF?

A

ACEi and BB!!!

123
Q

What drugs to avoid in HF?

A

Calcium channel blockers!
and (pioglitazone - fluid retention)

124
Q

How might pulsus paradoxus be described in a question?

A

Absent or faint pulse in inspiration
Seen in cardiac tamponade and severe asthma.

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