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FINALS: Passmed > Cardiology > Flashcards

Cardiology Flashcards

1
Q

An ECG shows tall R-waves in leads V1 and V2

A

Posterior MI

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2
Q

Aspirin, statins, bisoprolol - which of these are anti-anginals?

A

only bisoprolol

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3
Q

Widespread saddle-shaped ST-elevation in all leads - which Post-MI complication is this? How long after an MI would this present?

A

Dressler’s syndrome, 48h

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4
Q

If you see ST Elevation in Leads I and II, what is it unlikely/likely to be?

A

Unlikely: MI, it won’t cause elevations in I and II

Likely: pericarditis!

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5
Q

Other than MI, what else can cause rise in troponin? What else will be increased?

A

Sepsis (myocardial ischaemia from a supply-demand-mismatch secondary to another primary condition)

Lactate

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6
Q

ACS management: ________ should be used with caution if the patient is hypotensive

A

nitrates

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7
Q

“Suddenly, the patient develops worsening breathlessness. Upon cardiac auscultation, a new pan-systolic murmur is heard” - which post-MI complication is this?

A

flash pulmonary oedema secondary to new MR

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8
Q

NSTEMI conservative Mx

A

Aspirin + Ticagrelor + Fondaparinux

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9
Q

Which anti-anginal medication do patients commonly develop tolerance to?

A

Standard release isosorbide mononitrate

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10
Q

A patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound.

A

left ventricular aneurysm

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11
Q

What do S3 and S4 heart sounds indicate?

A

The presence of an S3 heart sound suggests the left ventricle is larger than normal (as S3 represents the sloshing of blood into a large ventricle during diastole). The presents of an S4 heart sound suggest that the left ventricle is stiffer than normal (as S4 represents the forceful atrial push of blood against a hard ventricular wall)

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12
Q

A _______________________ will cause persistent ST elevation in V1-6 on an ECG, after PCI

A

left ventricular aneurysm

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13
Q

A patient develops acute heart failure 10 days following a myocardial infarction. On examination he has a raised JVP, pulsus paradoxus and diminished heart sounds.

A

left ventricular free wall rupture

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14
Q

Angina management: if a patient has an inadequate response to verapamil then adding a ____________ is a suitable next step

A

long-acting nitrate

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15
Q

Notching of the inferior border of the ribs is present in around 70% of adults with ___________________________

A

coarctation of the aorta

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16
Q

Warfarin and INR, what will you do in:
1. Major bleeding (e.g. variceal haemorrhage, intracranial haemorrhage)

  1. INR > 8.0, Minor bleeding
  2. INR > 8.0, No bleeding
  3. INR 5.0-8.0, Minor bleeding
  4. INR 5.0-8.0, No bleeding
A
  1. INR > 8, major bleeding: stop warfarin, IV vitamin K, prothrombin complex concentrate/FFP
  2. INR > 8.0, Minor bleeding: stop warfarin, IV vitamin K, restart warfarin when INR < 5
  3. INR > 8.0, No bleeding: stop warfarin, oral vitamin K, restart when INR < 5
  4. INR 5.0-8.0, Minor bleeding: stop warfarin, IV vitamin K
  5. INR 5.0-8.0, No bleeding: withhold 1 or 2 doses of warfarin
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17
Q

WELLs criteria + what do the different scores mean

A

DVT signs: 3 pts
alternate Dx less likely than PE: 3
HR > 100: 1.5
immobilisation/surgery: 1.5
previous DVT/PE: 1.5
Haemoptysis: 1
Malignancy: 1

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18
Q

which valvular defect is associated with narrow pulse pressure

A

AS

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19
Q

Symptomatic bradycardia where atropine fails - next step?

A

transcutaneous pacing

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20
Q

patient with AAA presents with new diastolic murmur - what does this indicate? what is the tx?

A

aortic regurgitation = ascending aorta involved

type A - ascending aorta - control BP (IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)

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21
Q

most common causative agent in IE

A

staph aureus
if < 2 months post-valve surgery: staph epidermis

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22
Q

Acute heart failure not responding to treatment - consider ____

A

CPAP

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23
Q

Massive PE + _____________- thrombolyse

A

hypotension

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24
Q

what is kussmaul’s signt?

A

increase in JVP on inspiration

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25
Q

The main ECG abnormality seen with hypercalcaemia is _________

A

shortening of the QT interval

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26
Q

A.fib that has been present for more than 48h - what is the tx?

A

the patient should be put on anticoagulants (such as apixaban) for at least 3 weeks and then referred for electrical cardioversion

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27
Q

amiodarone vs flecainide - what is the difference

A

both are medical cardioversion options for Afib (2nd line to electrical)

flecainide is used if there’s no structural heart disease

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28
Q

When to use the following

IV amiodarone:

IV: adenosine:

IV MgSO4:

A

IV amiodarone: broad complex tachy

IV: adenosine: narrow complex tachy (after trying vagal manoeuvres)

IV MgSO4: TDP

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29
Q

__________ Should be offered annually for all patients with heart failure

A

influenza vaccine

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30
Q

___________ Should be introduced first-line in patients with stable impaired left ventricular function

A

ACEI + BB

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31
Q

______________ Has only been demonstrated to improve mortality in patients with NYHA class III or IV heart failure who are already taking an ACE inhibitor

A

spironolactone

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32
Q

Concurrent use of ________and omeprazole/esomeprazole can make it less effective

A

clopidogrel

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33
Q

____________ is the preferred anticoagulant for patients with mechanical valves

A

warfarin

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34
Q

ALS, notable points

A
  1. is rhythm shockable (Vfib/Ttachy) or non-shockable (asystole/pulseless electrical activity)
  2. chest cimpressions to ventilation 30:2, do while defibrillator is charging
  3. single shock (or up to 3 successive shocks if happens in hospital) followed by 2 min of cpr
  4. Give adrenaline 1mg after third shock (contnue every 3-5 min)
  5. amiodarone 300mg after 3 shocks (give 150mg after 5 shocks)

lidocaine is an option is amiodrone is unavailable

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35
Q

IV amiodarone used for which type of tachycardias? Whats the other option?

A

broad
adenosine for narrow
IB beta-blockers if a fib
CCB for narrow-complex if adenosine not tolerated (like in asmatics)

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36
Q

_________presents with ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness. Troponin raised.

A

myocaditis

reduced contractile strength of heart–> can present as new-onset HF

37
Q

Poorly controlled hypertension, already taking an ACE inhibitor, calcium channel blocker and a standard-dose thiazide diuretic. K+ > 4.5mmol/l - add a

A

an alpha- or beta-blocker

if K+ < 4.5, add spironolactone instead

38
Q

____________________is used first-line to prevent angina attacks

A

A beta-blocker or a calcium channel blocker

39
Q

A man presents with central, pleuritic chest pain and fever 4 weeks following a myocardial infarction. The ESR is elevated -

A

Dressler’s syndrome

Dressler’s syndrome (postmyocardial pericarditis) is secondary pericarditis that may occur with or without pericardial effusion. The pathophysiology is thought to be due to the detection of antibodies from damaged myocardial tissue, which causes an immune response. The patient in the vignette has chest pain, fever, a raised ESR, and ECG findings of widespread concave ST-elevation and PR depression with reciprocal ST depression and PR elevation in aVR, which is consistent with pericarditis.

40
Q

cardiac tamponade - triad?

A
  • raised JVP
  • reduced blood pressure
  • muffled HS
41
Q

Pt has suspected NSTEMI within 6 days of another one - what marker will you check?

A

creatine kinase myocardial band (CKMB)

trops are elevated for up to 10 days, CKMB only for 3-4

42
Q

Iron defiency anaemia vs. anaemia of chronic disease:

A

TIBC is high in IDA, and low/normal in anaemia of chronic disease

43
Q

Infective endocarditis in intravenous drug users most commonly affects _______

A

the tricuspid valve

44
Q

what is C/I in broad complex tachycardia?

A

verapamil, can precipitate arrest

45
Q

A 14-year-old boy presents to the Emergency Department as he is unable to control his facial muscles and arm movements. For the last 5 weeks, following a throat infection, he has been experiencing ongoing fever, worsening shortness of breath and joint pains, mainly in his legs which have not been effectively managed. What is the most likely cause of the patient’s recent symptoms?

A

Sydenham’s chorea is a late complication of rheumatic fever

46
Q

how does rheumatic fever come about?

A

it is an immunological reaction to a recent (2-4 weeks ago) strep pyogenes infection

47
Q

what is the Dx criteria for RF?

A

evidence of recent strep infection + 2 major/1 major and 2 mino criteria

48
Q

What are the major criteria for RF?

A
  • erythema marginatum ( bright pink or red circular lesions which have sharply-defined borders and faint central clearing.)
  • Sydenham’s chorea: this is often a late feature
  • polyarthritis
  • carditis and valvulitis (eg, pancarditis) [new regurgitant murmur]
  • subcutaneous nodules
49
Q

Diastolic murmur + AF → ?

A

mitral stenosis

The relation with atrial fibrillation lies in the fact that mitral stenosis causes an increase in left atrial pressure, leading to an increase in the size of the left atrium, which in turn leads to atrial fibrillation.

50
Q

Cardiovascular disease: atorvastatin ____mg for primary prevention, ____mg for secondary prevention

A

20mg
80mg

51
Q

If new BP >= 180/120 mmHg + no worrying signs then the first step is

A

urgent investigations for end-organ damage

52
Q

ECG change in moitral stenosis

A

P mitrale

53
Q

most likely cardiac sequala for hyperthyroidism?

A

high output cardiac failure and atrial fibrillation

54
Q

acute and chronic changes in ECG after MI

A

Immediate changes
seen on an ECG following a STEMI are hyperacute T waves and then
ST elevation (or new-onset left-bundle branch block). T-wave inversion
and pathological Q waves develop over the next few days.

55
Q

Tx pathway for tachycardias

A
56
Q

complication of right coronay infarct?

A

1st degree AB block as it supplies AV node

57
Q

damage to which vessel (in MI) will cause:
1. AV block
2. left ventricle wall thrombus
3. RBBB
4. ventricular free wall rupture

A
  1. AV block: RCA
  2. left ventricle wall thrombus: LAD
  3. RBBB: LAD
  4. ventricular free wall rupture: LAD
58
Q

___________ becomes louder during inspiration, unlike mitral regurgitation

A

Tricuspid regurgitation

59
Q

ALS

A
  1. is rhythm shockable?
    - shockable rhythms: ventricular fibrillation, pulseless VT
    - non-shockable rhythms: PEA, asystole
  2. Delivering shocks
    - in non-hospital setting: 1 shock + 2 min of CPR [30:2]
    - in hospital setting: 3 shocks + CPR
  3. Drugs
    - adrenaline 1mg ASAP for non-shockable rhythms
    - adrenaline 1mg after 3 shocks for Vtachy/Vfib
    - repeat 1mg adrenaline every 3-5 min
  • give 300mg amiodarone to Pts with VF/Vtachy after 3 shocks
  • give a further 150mg dose after 5 shocks
  • lidocaine is alternative for amiodarone
60
Q

___________presents with ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness

A

Myocarditis

61
Q

____________ is the first line investigation for stable chest pain of suspected coronary artery disease aetiology

A

Contrast-enhanced CT coronary angiogram

62
Q

bizarre, wide, inverted T-waves can be seen in ____________

A

Stokes-Adams attacks

63
Q

A 74-year-old man presents to the emergency department with episodes of haemoptysis, dyspnoea, and palpitations over the past month. On examination, he has an irregularly irregular heartbeat and a mid-diastolic murmur.

Given the likely diagnosis, what would indicate that the leaflets still have some mobility?

A

This is a two-part question. The first step is getting the diagnosis resulting in the patient’s symptoms. He has presented with haemoptysis, dyspnoea, an irregularly irregular pulse - likely secondary to atrial fibrillation, and a mid-diastolic murmur. These symptoms are all suggestive of mitral stenosis.

In mitral stenosis, an opening snap indicates the leaflets still have some mobility

64
Q

Persistent ST elevation following recent MI, no chest pain -

A

left ventricular aneurysm

65
Q

Following an ACS, all patients should be offered:

A

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

66
Q

Acute heart failure with hypotension -

A

inotropes be considered for patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock

67
Q

Patient factors favouring rhythm control include:

A

Age <65 years
First presentation of AF
Symptomatic.

68
Q

e- abnormalities that cause long qt

A

hypocalcaemia, hypokalaemia, hypomagnesaemia

69
Q

__________ should be considered for Afro-Caribbean patients with heart failure who are not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy

A

Hydrazine and nitrate

70
Q

to be given ivabradine as 3rd line for HF your HR must be

A

> 75

71
Q

If new BP >= 180/120 mmHg + __________________then admit for specialist assessment

A

new-onset confusion, chest pain, signs of heart failure, or acute kidney injury

72
Q

Atrial fibrillation with bundle branch block is the most likely cause of an irregular broad complex tachycardia in a stable patient

A
73
Q

MS - choice of Tx?

A

Percutaneous mitral commissurotomy is the intervention of choice for severe mitral stenosis

74
Q

Ibuprofen and diclofenac are both non-steroidal anti-inflammatory drugs that are avoided in those with ACS.

A

This is because they will be given an array of antiplatelet drugs, which can interact with NSAIDs to precipitate bleeding (e.g. aspirin, ticagrelor).

75
Q

summarise ALS

A

Shockable - VF/VT (+ pVT)
Non-shockable - asystole/PEA

Witnessed - 3 stacked shocks
Non-witnessed - 1 shock

Non-shockable - adren 1mg 1:10,000 immediately, repeat every 3-5 mins (i.e. every other cycle); amiodarone does NOT play a role in non-shockable

Shockable - 1mg adren 1:10,000 after 3rd shock (and every 3-5 mins thereafter); 300mg amiodarone after 3rd shock, 150mg after 5th shock

If ?PE, thrombolyse (and you’re committing to do CPR for a minimum of 60 minutes afterwards)

76
Q

bradycardia steps in Tx

A
  1. atropine 500mch IV
  2. atropine up to 3mg
  3. transcutaneous pacing
  4. isoprenaline/adrenaline
  5. transvenous pacing
77
Q

It is important to consider the 8 reversible causes of cardiac arrest before calling time of death. These can be remembered by the 4Hs and 4Ts:

A

Hypothermia
Hypoxia
Hypovolaemia
Hypokalaemia / hyperkalaemia / hypoglycaemia
Tension pneumothorax
Toxins
Tamponade
Thrombosis

78
Q

If intravenous access is difficult or impossible, consider

A

the intraosseous (IO) route during a cardiac arrest

79
Q

systolic murmur + hypotension post MI?

A

mitral regurgitation

80
Q

How to differentiate the different post-MI complications

A

most common: V.fib –> cardiac arrest

[pericarditis]
- within 48h: pericarditis
- in 2-6 weeks: dressler’s syndrome

Left ventricular aneurysm: persistent ST elevation [needs anticoagulation as thrombus can form within stroke]

Left ventricular free wall rupture: acute HF secondary to cardiac tamponade. Happens 2w after MI.

VSD: pan-systoolic murmur

MR: ischaemia/papillary muscle rupture. Acute hypotension + flash pulmonary oedema.

81
Q

which anti-hypertensive drug can worsen glucose tolerance?

A

Thiazides can worsen glucose tolerance

82
Q

Mitral stenosis patients who are asymptomatic - Mx?

A

are generally monitored and given medical therapy rather than having percutaneous/surgical intervention

83
Q

features of patent ductus arteriosis?

A
  • continuous machinery murmur
  • heaving apex beat
  • wide pulse pressure
  • left subclavicular thrill
84
Q

What is bisferiens pulse + what is associated with?

A

two strong systolic peaks separated by a midsystolic dip
aortic regurgitation and hypertrophic cardiomyopathy

85
Q

Patients with MI secondary to cocaine use should be given_______as part of acute (ACS) treatment

A

IV benzodiazepines + glyceryl trinitrate

86
Q

R waves in V4,V5 + deep S waves in V1,V2 + T-wave inversion in V5, V6 =

A

left ventricular hypertrophy

87
Q

which NSAID is contraindicated in cardiovascular disease

A

Diclofenac

88
Q
A

FINALS: Passmed (40 decks)

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