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Cardiology Flashcards

1
Q

Which areas does the RCA supply?

A

RV, RA

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2
Q

Which areas does the L circumflex supply?

A

LA, LV

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3
Q

Which areas does the L marginal supply?

A

LV

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4
Q

Which areas does the LAD supply?

A

LV, RV, IV septum

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5
Q

Which leads show lateral (Circumflex)

A

1, V5, V6

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6
Q

Which leads show inferior (RCA)

A

2, 3, aVF

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7
Q

Which leads show anterior (LAD)

A

V1-V4

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8
Q

Complications of MI

A

cardiac arrest
cardiogenic shock
HF
tachy/brady arrhythmias
pericarditis
Dresslers syndrome
LV aneurysm, LV free wall rupture
ventricular septal defect
acute mitral regurg

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9
Q

MI secondary prevention

A

lifestyle
DAPT
ACE I
B Blocker
Statin

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10
Q

What should be offered to Pts following MI showing signs of Heart failure

A

aldosterone antagonist
eplerenone

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11
Q

Thrombolytic agent examples

A

alteplase
tenecteplase
streptokinase

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12
Q

Anti anginal meds

A

1) Beta blocker / CCB
2) ISMN
3) ivabradine/nicorandil/ranolazine

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13
Q

Which CCB should be used as anti-anginal

A

If monotherapy use verapamil/diltiazem (rate controlling)
If with BB, amlodipine/nifedipine

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14
Q

Acute pericarditis causes

A

infection: viral, TB
Conditions: Uraemia, connective tissue disorder (SLE, RA), hypothyroid, trauma, malignancy (breast, lung)
Secondary: Post MI, radiotherapy

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15
Q

What would a trop rise in pericarditis indicate

A

myopericarditis
- 30%

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16
Q

ECG changes in pericarditis

A

widespread
saddle ST elevation, PR depression

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17
Q

Mangement of pericarditis

A

treat cause
NSAIDS + colchicine (taper once asymptomatic)

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18
Q

Complications of acute pericarditis

A

Pericardial effusion -> cardiac tamponade
Constrictive pericarditis

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19
Q

Pathophysiology of constrictive pericarditis

A

Persistent inflammation causes fibrosis of serous pericardium which becomes stiff. Heart cannot expand/relax as well, decreased stroke volume, increased HR

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20
Q

Signs of constrictive pericarditis

A

Right heart failure - Increased JVP, ascites, oedema
Loud S3
Kussmals sign (increased JVP with inspiration, due to impaired RVF)

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21
Q

Management of constrictive pericarditis

A

pericardiectomy

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22
Q

Signs of large pericardial effusion

A

Decreased heart sounds
SOB, low BP (due to decreased cardiac OP)

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23
Q

Pathophysiology of cardiac tamponade

A

Increased fluid in pericardial space, heart cannot expand/relax fully, chambers dont fill, decreased cardiac OP, hypotension, increased HR

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24
Q

Causes of acute cardiac tamponade

A

Trauma
Post MI (ventricular wall rupture)
Heart surgery (weakened muscle rupture)
Aortic dissection

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25
Signs of cardiac tamponade
Becks triad 1) Raised JVP 2) Hypotension 3) Reduced HS + tachycardia and SOBE
26
ECG findings in cardiac tamponade
electrical alterans Tachy, low QRS
27
Explain pulses paradoxus
During normal inspiration, negative pressure causes systemic venous return into RV which expands into pericardial space. In cardiac tamponade RV is unable to expand into pericardial space so pushes into IV septum reducing the LV diastolic volume therefore reducing SV, and systolic BP Decrease in systolic BP by 10 mmHg = pulses paradoxus
28
what are the layers of artery
1) tunica adventitia 2) tunica media 3) tunica intima
29
What is aortic dissection
tear in tunica intima of aorta
30
What is aortic dissection associated wtih
HTN trauma Connective tissue disorders Aneursyms Bicusipd aortic valve
31
How does aortic dissection present
Chest/back pain (severe, tearing) Weak/absent lower pulses >20mmHg diffence between arm sytolic BP (compression L subclavian)
32
What are the classification systems used for aortic dissection
Stanford and DeBakey
33
What is Standford classification
Used for aortic dissection Type A: Ascending aorta (2/3) Type B: Descending aorta
34
What is DeBakey classification
Used for aortic dissection Type 1: Ascending aorta to aortic arch Type 2: only ascending aorta Type 3: descending aorta to distal
35
Investigations for aortic dissection
CXR: wide mediastinum TOE CT angio: false lumen
36
Management of aortic dissection
Type A: surgery Type B: conservative B blockers, BP control
37
Complications of aortic dissection
Backward tear: aortic regurg, MI Forward tear: unequal BP, stroke, renal failure
38
Rhythm control in AF
onset <48h heparinise DCCV amiodarone No anticoag needed if in AD <48h onset >48h 3/52 anticoag -> DCCV anti coag needed at least 4/52 Meds: BB, Amiodarone (in HF), flecanide
39
Rate controlling medications in AF
BB, CCB, digoxin
40
Symptoms of LV failure
Pulmonary oedema - dyspnoea - orthopnoea - paroxysmal noctural dyspnoea - bibasal fine crackles
41
Symptoms of RV failure
Peripheral oedema Weight gain Increased JVP Hepatomegaly Cardiac cachexia
42
Which classification system is used for HF
NYHA
43
Which tests are used to diagnose HF?
NT-proBNP BNP ECHO
44
1st line management HF
ACE inhibitor and Beta Blocker (dont affect mortality in p EF)
45
2nd line management HF
aldosterone antagonist (monitor K+) e.g spiro, eplerenone SGLT-2 inhibitors e.g. dapagliflozin
46
3rd line management HF
ivabradine (HR >70 EF <35%) sacubitril- valsartan (after ACE I/ARB Washout) Digoxin Hydralazine and nitrate (African-caribbean)
47
Meds to be avoided in HF
Verapamil NSAIDS/glucocorticoids (retention) Class I anti-arrhythmics
48
causes of atrial stenosis
- degen calcification - bicuspid aortic valve - rheumatic fever - HOCM
49
pathophysiology and symptoms of AS
stenosed AV causes reduced blood flow and cardiac output -SOB - dizzy/syncope - angina normally on exertion
50
signs of AS
ESM slow rising pulse soft/ascent s2
51
sign of severe AS
S4
52
management of AS
if symptomatic - valve replacement (surgical AVR or TAVI)
53
causes of aortic regurg
-root dilatation (bicuspid valve, HTN) - valvular damage (infective endocarditis, rheumatic fever)
54
signs of aortic regurg
-early diastolic murmur - increased pulse pressure (systolic - diastolic) -> collapsing pulse, nail bed pulsing, head bobbing
55
signs of severe aortic regurg
mid diastolic murmur - Austin Flint
56
What is Quinckes sign?
Nailbed pulsing, sign of increased pulse pressure such as in aortic regurg
57
What is De Mussets sign?
head bobbing, sign of increased pulse pressure such as in aortic regurg
58
When would you consider surgery in aortic regurg?
if severe or causing LV dysfunction
59
Pathophysiology of coarctation of aorta in infants
RV -> PA -> PDA -> Aorta (lower pressure due to narrowing) Deoxygenated blood to lower extremities cyanosis lower limbs
60
Pathophysiology of coarctation of aorta in adults
increased pressure before coartation - increased pressure on aortic branches, increased BP to uper limbs and head (Berry aneursyms) - increased risk of aortic dissection Increased pressure after coarctation - decreased pressure lower limbs, leg claudication, decreased renal perfusion
61
Signs of coarctation of aorta
radio-femoral delay mid-systolic murmur
62
Management of coarctation of aorta
balloon dilatation or surgical removal of coarctation
63
Causes of Mitral stenosis
rheumatic fever
64
symptoms of mitral stenosis
SOB haemoptysis (Due to pulmonary venous HTN)
65
signs of mitral stenosis
mid-late diastolic murmur loud S1 AF (LA enlargement)
66
Management of mitral stenosis
If AF - anti-coagulate with warfarin if symptomatic - balloon valvotomy or valve replacement
67
Causes of Mitral regurg
mitral valve prolapse (associated with connective tissue disoders) papillary muscle damage following MI heart failure (dilated LV) rheumatic fever
68
symptoms of mitral regurg
LV heart failure
69
Signs of mitral regurg
pansystolic murmur quiet S1 (incomplete closing) severe - split S2
70
causes of tricuspid regurg
- dilation of RA/RV (pulmonary hypertension, L->R shunt) - rheumatic heart disease - papillary muscle damage post MI
71
signs of tricuspid regurg
pansystolic murmur louder on inspiration
72
symptoms of tricuspid regurg
RS HF
73
What is VSD associated with?
FAS Downs Edwards post MI
74
pathophysiology of VSD
L->R shunt (pansystolic murmur) increased volume R heart -> pulm HTN Increased pressure so becomes R->L shunt which leads to cyanosis
75
post natal VSD symptoms
FTT heart failure
76
two origins of ASD
ostium secondum (more common) and ostium primum
77
pathophysiology ASD
L->R shunt Split S2 because PV takes longer to close than AV systolic murmur emboli to brain
78
pathophysiology of Tetralogy of fallot
1) RVOT stenosis 2) RV hypertrophy (boot shaped) 3) VSD (increased RV pressure due to RVOTO) 4) overiding aorta
79
TOF symptoms
cyanosis, clubbing, FTT, TET spellss, ESM
80
Management of TOF
surgery to RVOTO and VSD
81
what is PDA associated with
Maternal Rubella in 1st trimester
82
PDA murmur
pansystolic, machine like
83
pathophysiology of PDA
blood travels from aorta to pulmonary artery via PDA, causes pulmonary hypertension which then causes shunt to switch
84
Management of PDA
indomethacin (inhibits prostaglandin E2 synthesis) Surgery: may need to give prostaglandin to keep open prior to surgery
85
What Is Eisenmenger syndrome
When L->R shunt becomes R->L shunt e.g PDA, VSD
86
What is 1st degree heart block
PR interval >0.2s (4 small squares)
87
What is 2nd degree heart block
Mobitz 1 - increasing PR interval with dropped beat Mobitz 2 - Constant increased PR but often no QRS
88
What is complete heart block
No relation between PR and QRS
89
Symptoms of CHB
syncope, SOB, dizziness, CP
90
Indications for temp pacemaker
-symptomatic/haemodynamically unstable bradycardia not responding to atropine -post anterior MI type 2 or CHB -trifascicular HB before surgery
91
Cardiology life threatening signs
shock, MI, HF, syncope
92
Management of bradycardia with life threatening signs
atropine 500mcg IV (up to 3mg) isoprenaline 5mcg/min adrenaline 2-10mcg/min pacing
93
What features would increase risk of asystole in bradycardia
recent asystole type 2 AV block CHB with broad QRS Ventricular pause >3 seconds
94
Treatment of tachycardia with life threatening signs
synchronised DC shock up to 3 times amiodarone 300mcg IV repeat DC shocks
95
treatment of non life threatening tachycardia broad QRS
regular: amiodarone 300mg IV Iregular: AF with BBB or polymorphic - Mg 2mg
96
treatment of non life threatening tachycardia narrow QRS
regular: vagal manoeuvers, adenosine 6mg ->12mg -> 18mg verapamil/BB -> DC shock Irregular: AF, BB, Dig/amiodarone if HF
97
prevention of SVT
BB, radio-frequency ablation
98
Causes of ventricular tachy
Amiodarone, tricyclics Low ca, K, Mg MI, myocarditis
99
Treatment of ventricular tachy
if life threatening -> DC shocks Amiodarone ICD

MRCP (19 decks)

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