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MRCP > Cardiology > Flashcards

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
Q

Signs of cardiac tamponade

A

Becks triad
1) Raised JVP
2) Hypotension
3) Reduced HS

+ tachycardia and SOBE

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26
Q

ECG findings in cardiac tamponade

A

electrical alterans
Tachy, low QRS

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27
Q

Explain pulses paradoxus

A

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

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28
Q

what are the layers of artery

A

1) tunica adventitia
2) tunica media
3) tunica intima

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29
Q

What is aortic dissection

A

tear in tunica intima of aorta

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30
Q

What is aortic dissection associated wtih

A

HTN
trauma
Connective tissue disorders
Aneursyms
Bicusipd aortic valve

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31
Q

How does aortic dissection present

A

Chest/back pain (severe, tearing)
Weak/absent lower pulses
>20mmHg diffence between arm sytolic BP (compression L subclavian)

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32
Q

What are the classification systems used for aortic dissection

A

Stanford and DeBakey

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33
Q

What is Standford classification

A

Used for aortic dissection
Type A: Ascending aorta (2/3)
Type B: Descending aorta

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34
Q

What is DeBakey classification

A

Used for aortic dissection
Type 1: Ascending aorta to aortic arch
Type 2: only ascending aorta
Type 3: descending aorta to distal

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35
Q

Investigations for aortic dissection

A

CXR: wide mediastinum
TOE
CT angio: false lumen

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36
Q

Management of aortic dissection

A

Type A: surgery
Type B: conservative B blockers, BP control

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37
Q

Complications of aortic dissection

A

Backward tear: aortic regurg, MI
Forward tear: unequal BP, stroke, renal failure

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38
Q

Rhythm control in AF

A

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

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39
Q

Rate controlling medications in AF

A

BB, CCB, digoxin

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40
Q

Symptoms of LV failure

A

Pulmonary oedema
- dyspnoea
- orthopnoea
- paroxysmal noctural dyspnoea
- bibasal fine crackles

41
Q

Symptoms of RV failure

A

Peripheral oedema
Weight gain
Increased JVP
Hepatomegaly
Cardiac cachexia

42
Q

Which classification system is used for HF

A

NYHA

43
Q

Which tests are used to diagnose HF?

A

NT-proBNP
BNP
ECHO

44
Q

1st line management HF

A

ACE inhibitor and Beta Blocker
(dont affect mortality in p EF)

45
Q

2nd line management HF

A

aldosterone antagonist (monitor K+)
e.g spiro, eplerenone
SGLT-2 inhibitors
e.g. dapagliflozin

46
Q

3rd line management HF

A

ivabradine (HR >70 EF <35%)
sacubitril- valsartan (after ACE I/ARB Washout)
Digoxin
Hydralazine and nitrate (African-caribbean)

47
Q

Meds to be avoided in HF

A

Verapamil
NSAIDS/glucocorticoids (retention)
Class I anti-arrhythmics

48
Q

causes of atrial stenosis

A
  • degen calcification
  • bicuspid aortic valve
  • rheumatic fever
  • HOCM
49
Q

pathophysiology and symptoms of AS

A

stenosed AV causes reduced blood flow and cardiac output
-SOB
- dizzy/syncope
- angina
normally on exertion

50
Q

signs of AS

A

ESM
slow rising pulse
soft/ascent s2

51
Q

sign of severe AS

A

S4

52
Q

management of AS

A

if symptomatic - valve replacement (surgical AVR or TAVI)

53
Q

causes of aortic regurg

A

-root dilatation (bicuspid valve, HTN)
- valvular damage (infective endocarditis, rheumatic fever)

54
Q

signs of aortic regurg

A

-early diastolic murmur
- increased pulse pressure (systolic - diastolic)
-> collapsing pulse, nail bed pulsing, head bobbing

55
Q

signs of severe aortic regurg

A

mid diastolic murmur - Austin Flint

56
Q

What is Quinckes sign?

A

Nailbed pulsing, sign of increased pulse pressure such as in aortic regurg

57
Q

What is De Mussets sign?

A

head bobbing, sign of increased pulse pressure such as in aortic regurg

58
Q

When would you consider surgery in aortic regurg?

A

if severe or causing LV dysfunction

59
Q

Pathophysiology of coarctation of aorta in infants

A

RV -> PA -> PDA -> Aorta (lower pressure due to narrowing)
Deoxygenated blood to lower extremities
cyanosis lower limbs

60
Q

Pathophysiology of coarctation of aorta in adults

A

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
Q

Signs of coarctation of aorta

A

radio-femoral delay
mid-systolic murmur

62
Q

Management of coarctation of aorta

A

balloon dilatation or surgical removal of coarctation

63
Q

Causes of Mitral stenosis

A

rheumatic fever

64
Q

symptoms of mitral stenosis

A

SOB
haemoptysis
(Due to pulmonary venous HTN)

65
Q

signs of mitral stenosis

A

mid-late diastolic murmur
loud S1
AF (LA enlargement)

66
Q

Management of mitral stenosis

A

If AF - anti-coagulate with warfarin
if symptomatic - balloon valvotomy or valve replacement

67
Q

Causes of Mitral regurg

A

mitral valve prolapse (associated with connective tissue disoders)
papillary muscle damage following MI
heart failure (dilated LV)
rheumatic fever

68
Q

symptoms of mitral regurg

A

LV heart failure

69
Q

Signs of mitral regurg

A

pansystolic murmur
quiet S1 (incomplete closing)
severe - split S2

70
Q

causes of tricuspid regurg

A
  • dilation of RA/RV (pulmonary hypertension, L->R shunt)
  • rheumatic heart disease
  • papillary muscle damage post MI
71
Q

signs of tricuspid regurg

A

pansystolic murmur
louder on inspiration

72
Q

symptoms of tricuspid regurg

A

RS HF

73
Q

What is VSD associated with?

A

FAS
Downs
Edwards
post MI

74
Q

pathophysiology of VSD

A

L->R shunt (pansystolic murmur)
increased volume R heart -> pulm HTN
Increased pressure so becomes R->L shunt which leads to cyanosis

75
Q

post natal VSD symptoms

A

FTT
heart failure

76
Q

two origins of ASD

A

ostium secondum (more common) and ostium primum

77
Q

pathophysiology ASD

A

L->R shunt
Split S2 because PV takes longer to close than AV
systolic murmur
emboli to brain

78
Q

pathophysiology of Tetralogy of fallot

A

1) RVOT stenosis
2) RV hypertrophy (boot shaped)
3) VSD (increased RV pressure due to RVOTO)
4) overiding aorta

79
Q

TOF symptoms

A

cyanosis, clubbing, FTT, TET spellss, ESM

80
Q

Management of TOF

A

surgery to RVOTO and VSD

81
Q

what is PDA associated with

A

Maternal Rubella in 1st trimester

82
Q

PDA murmur

A

pansystolic, machine like

83
Q

pathophysiology of PDA

A

blood travels from aorta to pulmonary artery via PDA, causes pulmonary hypertension which then causes shunt to switch

84
Q

Management of PDA

A

indomethacin (inhibits prostaglandin E2 synthesis)
Surgery: may need to give prostaglandin to keep open prior to surgery

85
Q

What Is Eisenmenger syndrome

A

When L->R shunt becomes R->L shunt
e.g PDA, VSD

86
Q

What is 1st degree heart block

A

PR interval >0.2s (4 small squares)

87
Q

What is 2nd degree heart block

A

Mobitz 1 - increasing PR interval with dropped beat
Mobitz 2 - Constant increased PR but often no QRS

88
Q

What is complete heart block

A

No relation between PR and QRS

89
Q

Symptoms of CHB

A

syncope, SOB, dizziness, CP

90
Q

Indications for temp pacemaker

A

-symptomatic/haemodynamically unstable bradycardia not responding to atropine
-post anterior MI type 2 or CHB
-trifascicular HB before surgery

91
Q

Cardiology life threatening signs

A

shock, MI, HF, syncope

92
Q

Management of bradycardia with life threatening signs

A

atropine 500mcg IV (up to 3mg)
isoprenaline 5mcg/min
adrenaline 2-10mcg/min
pacing

93
Q

What features would increase risk of asystole in bradycardia

A

recent asystole
type 2 AV block
CHB with broad QRS
Ventricular pause >3 seconds

94
Q

Treatment of tachycardia with life threatening signs

A

synchronised DC shock up to 3 times
amiodarone 300mcg IV
repeat DC shocks

95
Q

treatment of non life threatening tachycardia broad QRS

A

regular: amiodarone 300mg IV
Iregular: AF with BBB or polymorphic - Mg 2mg

96
Q

treatment of non life threatening tachycardia narrow QRS

A

regular: vagal manoeuvers, adenosine 6mg ->12mg -> 18mg
verapamil/BB -> DC shock

Irregular: AF, BB, Dig/amiodarone if HF

97
Q

prevention of SVT

A

BB, radio-frequency ablation

98
Q

Causes of ventricular tachy

A

Amiodarone, tricyclics
Low ca, K, Mg
MI, myocarditis

99
Q

Treatment of ventricular tachy

A

if life threatening -> DC shocks
Amiodarone
ICD

MRCP (19 decks)

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