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Internal Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Red flags for chest pain?

A

> acute onset
exertional pain
substernal /left sided pain
quality = crushing, pressure
new murmur
associated SOB
radiation to left arm, jaw or back
distant heart sounds
chest wall crepitus
hypotension
difference >20mmHg in systolic be between arms
pulses paradoxus
hypoxia

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2
Q

What are the life threatening causes of chest pain to rule out?

A

1) MI (STEMI vs nstemi vs unstable angina)
2) PE
3) aortic dissection
4) tension pneumothorax
5) cardiac tamponade
6) oesophageal rupture

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3
Q

Differential in a pain with chest pain

A

Cardiac causes
>MI
>pericarditis
>angina
>pulmonary embolism
>pulmonary hypertension
>aortic dissection

Non cardiac causes
>peptic ulcer disease
>spontaneous pneumothorax
>gastro-oesophageal reflux
>herpes zoster
>musculoskeletal disorder
>anxiety

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4
Q

What causes an S3 sound?

A

The rapid filling and deceleration of blood in the ventricle during diastole when the ventricle reaches its diastolic limit (best heard in mitral region)

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5
Q

In what conditions will you hear a pathological S3?

A

Chronic mitral regurgitation
Aortic regurgitation
Dilated cardiomyopathy
Heart failure
Thyrotoxicosis

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6
Q

When is an S3 heart sound normal?

A

Young (less than 40)
Pregnancy
Athletes

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7
Q

What scoring system is used to determine likelihood of PE?

A

Wells score

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8
Q

What are secondary causes of hypertension?

A

ROPE

Renal disease
Obesity
Pregnancy induced
Endocrine (hyperthyroid, hyperaldosteronism)

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9
Q

Complications of hypertension

A

Ischaemic heart disease
Hypertensive retinopathy
Hypertensive nephropathy
Stroke (CVI)
Heart failure

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10
Q

Target organ damage caused by hypertension

A

1) Heart
>cardiomyopathy
>MI
>arrhythmias
>left ventricular hypertrophy
>aortic valve insufficiency

2) Aorta
>aortic dissection
>artherosclerosis
>aneurysm

3) Peripheral arteries
>artherosclerosis

4) Renal
>CKD

5) Brain
>stroke
>dementia

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11
Q

Side effect of ACE-I

A

Dry cough

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12
Q

Side effect of ARB

A

Angioedema

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13
Q

Presentation of hypertension

A

Usually silent
Non specific signs
>chest palpitations
>headaches in the early morning
>dizziness
>fatigue
>epistaxis

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14
Q

Risk factors for hypertension

A

Non-modifiable
>positive family history
>advanced age
>ethnicity

Modifiable
>obesity
>diabetes
>smoking
>excessive alcohol intake
>poor diet (high in salt)
>physical inactivity
>psychological stress

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15
Q

Difference between hypertensive urgency or hypertensive emergency

A

Both = BP >180/110
But urgency: no signs of end organ damage
Emergency: signs of end organ damage

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16
Q

Red flags in a hypertensive crisis

A

Dyspnoea
Chest pain
Altered mental status
Focal neurological deficit

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17
Q

Define heart failure

A

When the heart is unable to pump enough blood to meet the metabolic demands of the body due to pathological changes in the myocardium

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18
Q

What are the stages of heart failure according to the American heart association?

A

A = at risk
B = abnormal heart structure but no signs/symptoms (previous MI, elevated BNP, asymptomatic valvular disease, LVH)
C = abnormal structure and symptomatic HF
D = end stage (need of heart transplant)

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19
Q

What is the functional classification of HF according to the New York Heart Association?

A

I: No limit to physical activity. No sx HF
II: slight limitation to moderate/prolonged physical activity (sx after climbing 2 flights of stairs) Comfortable at rest
III: Marked limitations during physical activity including activities of daily living. ONLY comfortable at rest
IV: Confined to bed. Symptoms at rest

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20
Q

Define syncope

A

A sudden loss of consciousness due to decreased cerebral perfusion

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21
Q

Define presyncope

A

A lightheadedness where the patient things he or she will fall down

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22
Q

Most important to rule out in pt with acute chest pain:

A

> pulmonary emboli
MI
pericardial effusion
haemo/pneumothorax
aortic dissection
ruptures oesophagus

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23
Q

Causes of sinus bradycardia

A

Hypothermia
Hypothyroidism
Drugs

24
Q

Causes of sinus tachycardia

A

Pregnancy
Exercise
Increased sympathetic activity
Other = anaemia, fever, drugs

25
Q

Differential diagnosis for prolonged QT interval

A

Electrolyte imbalances
>hypokalaemia
>hypocalcaemia
>hypomagnesaemia
Hypothermia
Drugs (anti-arhythmic)
Congenital
Cardiomyopathy
CAD
CNS Injury

26
Q

ECG changes in Hyperkalaemia

A

Initially peaked, tall, symmetrical T waves then
>ST segment depression
>prolonged QT interval
>widened QRS
>flattened P wave
>prolonged PR

27
Q

Wolf Parkinson white syndrome ECG features

A

TRIAD
1) shortened PR interval <0,12secs
2) broad QRS complex >0,12secs
3) delta wave or slurred upstroke of QRS complex

28
Q

Phases of an acute MI on ECG

A

1) tall upright/inverted T-waves
2) ST elevation (leads facing infarcted wall = upright, opposite leads = ST depression)
3) 8-12hrs after MI = new pathological Q wave

29
Q

Cardiovascular causes of syncope

A

> tachyarrythmias (VT, a-flutter, a-fib)
bradyarrythmias (2nd or 3rd degree heart block, sinus bradycardia)
primary pulmonary hypertension
left ventricle outflow lesion (stenosis, hypertrophic cardiomyopathy)
left ventricle inflow obstruction (mitral stenosis)

30
Q

What causes a 4th heart sound?

A

The atria contracting against the high pressures of the ventricles at the end of diastole

31
Q

What are the pathological causes of S4 if palpable?

A

Ventricular hypertrophy
Ischaemic cardiomyopathy
Acute MI

32
Q

Causes of left axis deviation on ECG

A

Wolf Parkinson white syndrome
Deep Q wave inferior infarct
Left anterior hemi-block
Primula ASD

33
Q

Causes of right axis deviation on ECG

A

Wolf Parkinson white syndrome
Left posterior hemi-block
Antero-lateral infarct
Right ventricular hypertrophy

34
Q

Differential for tall R wave in V1

A

Right ventricular hypertrophy
Right bundle branch block
Wolf Parkinson white syndrome
True posterior infarct
Duchesses muscular dystrophy

35
Q

Define a Q wave

A

A negative deflection not preceded by a positive deflection

36
Q

Causes of ST depression

A

Non-STEMI MI
Myocardial ischaemia
Digoxin
Ventricular hypertrophy with systolic overload
Posterior infarct (in septal leads)
Reciprocal changes of an infarct in opposite wall

37
Q

Causes of ST elevation

A

Acute MI
Pericarditis
Ventricular aneurysm
Prinzmetal angina (ischaemia caused by coronary spasm)

38
Q

Causes of flattened T waves

A

Ischaemia
Pericarditis
Myocarditis
Hypercalcaemia

39
Q

Causes of peaked T waves

A

Acute MI
Hyperkalaemia

40
Q

Causes of T wave inversion

A

Bundle branch block
MI
Myocardial myopathy
Ventricular hypertrophy
Wolf Parkinson white syndrome
Ventricular rhythms
Normal in septal leads of black patients

41
Q

Causes of prolonged QT interval

A

Congenital
Hypomagnesaemia
Hypocalcaemia
Hypokalaemia
Drugs (TCA, anti-arrhythmics)
Ischaemia/infarction

42
Q

Cause of shortened QT interval

A

Hypercalcaemia

43
Q

Phases of acute MI on ECG

A

1) tall upright/inverted T waves
2) STEMI (elevated in leads facing wall, depressed in opposite)
3) new pathological Q wave

44
Q

Causes of atrial fibrillation

A

Rheumatic heart disease
Ischaemic heart disease
Cardiomyopathy
Hypertensive heart disease
Thyrotoxicosis

Other
>alcohol
>PE
>pericardial disease
>digoxin toxicity
>chest infection, pain, surgery (triggers)

45
Q

Precipitating causes of HF (acute or acute-on-chronic)

A

MI
PE
Intercurrent illness
Decreased meds/pt not taken meds
IV fluid overload
Increased demand (anaemia, pregnancy, thyrotoxicosis)
Arrthymia

46
Q

Clinical features of infective endocarditis

A

FROM JANE

Fever
Roths spots (retinal haemorrhages) - yellow centre with red ring
Oslers nodes (painful immune complexes)
Murmur

Janeway lesions (non-tender macular microabscesses from septic emboli)
Anaemia
Nail bed haemorrhages
Emboli

Other:
Acute Renal injury
Neurological manifestations
Signs of PE
Arthritis
Splenomegaly

47
Q

Common pathogens causing infective endocarditis

A

Staph aureus
Strep Viridans
Staph epidermidis
Enterococci
Fungal
Coxiella bernetti (can be culture neg) - gram neg doesn’t grow

48
Q

Criteria used for infective endocarditis

A

Dukes Criteria

Major
1) Positive blood culture for typical organisms
>2 positive blood cultures from 2 different sites at least 24 hours apart
>persistently positive 12 hours apart
>1 positive culture for coxiella burnetti
2) vegetation’s seen on echo

Minor
>fever >38
>predisposing factor
>immunological phenomenon (splinter haem or janeway lesions)
>positive blood culture that doesn’t meet major criteria
>vascular abnormalities

2 major OR 1 major + 3 minor OR 5 minor

49
Q

What does a PE look like on chest X-ray?

A

Wedge shaped infarct (Hampton Hump), Westermark sign, Fleisher sign

50
Q

Signs of digoxin toxicity

A

CNS = headache, seizures, confusion
GIT = nausea and vomiting, anorexia
CVS = ECG changes (AV block, tachyarrhythmias)
Eyes = halos, altered colour perception
Other = gynaecomastia, rash

ECG = paroxysmal atrial tachycardia + AV block
First for second degree (Mobitz 1) AV block

51
Q

How to tell if it’s a functional murmur

A

Usually systolic (hyper dynamic circulation)
Usually <3 grade
Midsystolic/continuous
Position dependent

52
Q

AV firing rate of pacemaker cellls

A

40-60 per minute

53
Q

Firing rate of purkinje fibre pacemaker cells

A

20-40 per minute

54
Q

What is the normal ejection fraction?

A

60-65%

55
Q

What does an increased troponin level indicate?

A

Myocardial necrosis (NOT ischaemia)

56
Q

What can mimic acute coronary syndrome?

A

Cardiac
>left valvular disease
>hypertrophic CMO
>uncontrolled HPT
>pericarditis
>aortic dissection

Lung
>PE
>pneumonia

GORD
Arthritis

57
Q

What does BNP stand for?

A

Brain natriuretic peptide

Internal Medicine (9 decks)

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