Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the pathophysiology of stable angina?

A

During times of high demand e.g. exercise there is insufficient supply of blood to meet the demand due to narrowing of coronary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 typical symptoms of angina?

A
  1. Precipitated by physical exertion
  2. Constricting pain in chest, neck, shoulder, jaws or arms
  3. Relieved by rest or GTN spray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the gold standard investigation for stable angina?

A

Invasive coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What medical management should be given for short and long term symptomatic relief of stable angina?

A

GTN spray/sublingual tablet, beta blocker or CCB (diltiazem/verapamil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When are angina patients considered for procedural or surgical interventions and what are they?

A

If still getting angina pain on two anti-anginals –> interventions

PCI = 1st line
CABG = used in those with more severe/extensive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What secondary prevention is required in those with angina?

A

Aspirin 75mg OD
Atorvastatin 80mg OD
ACE inhibitors (if co-morbidities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can you differentiate between STEMI, NSTEMI and unstable angina?

A

STEMI - ECG changes of ST elevation/new LBBB
NSTEMI = raised troponin with either normal ECG or ST depression/T wave inversion
Unstable angina = normal troponin with either normal ECG or ST depression/T wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which coronary artery supplies which area of the heart?

A

Left coronary artery - anterolateral (I, aVL, V3-V6 )

LAD - anterior (V1-V4)

Circumflex - lateral (I, aVL, V5, V6)

Right coronary - inferior (II, III, aVF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the initial management for all types of ACS?

A

ECG
Aspirin 300mg
IV morphine if required
Antiemetics if required
GTN spray (as long as BP is ok)
Oxygen - if saturations are low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is PCI used in management of STEMI?

A

If presenting within 12 hours of onset and PCI is available within 2 hours of presenting - if not they use thrombolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If patient is having primary PCI what should they be given in addition to aspirin for dual anti-platelet therapy?

A

Prasugrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If patient is having thrombolysis what should they be given in addition to aspirin for dual anti-platelet therapy?

A

Ticagrelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What scoring system is used to determine management in NSTEMI/unstable angina and what results are significant?

A

GRACE score
3% or less is considered low risk
Above 3% is medium to high risk –> PCI within 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What secondary prevention is done in those with ACS?

A

Aspirin 75mg OD for life
Another antiplatelet for 12 months
Atorvastatin 80mg OD for life
Bisoprolol titrated as high as possible
ACE inhibitors titrated as high as possible
PRN GTN spray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Dressler’s syndrome?

A

Occurs 2-3 weeks after acute MI, localised immune response that results in inflammation of the pericardium
ECG will show global ST elevation
Management is with NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the triggers for acute LV heart failure?

A

Iatrogenic (aggressive IV fluids), MI, arrhythmias, sepsis, hypertensive emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What symptoms/signs are common in acute LV failure?

A

Acute shortness of breath exacerbated by lying flat and improves on sitting up

Bilateral basal crackles on auscultation of lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What investigations would you do in someone with acute LV failure?

A

ECG, bloods (including BNP), ABG, CXR, echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a normal ejection fraction?

A

> 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is BNP blood test measuring?

A

BNP is released from the heart ventricles when cardiac muscle is stretched beyond normal i.e. heart is overloaded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What CXR findings are in keeping with heart failure?

A

Cardiomegaly
Upper lobe diversion
Bilateral pleural effusions
Fluid in interlobar fissures
Fluid in septal lines (Kerley B lines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the management of someone in acute LV failure?

A

Sit the patient upright
Oxygen
IV furosemide
May require Inotropes/Vasopressors - initiated by specialist, may require ICU admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is heart failure with preserved ejection fracture a result of?

A

Dysfunction of diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the common causes for heart failure?

A

IHD, valvular heart disease, hypertension, arrhythmias, cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What symptoms are associated with heart failure?

A

Breathlessness (worsened by exertion), cough (may be frothy white), orthopnoea, paroxysmal nocturanl dyspnoea, peripheral oedema, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the medical management for heart failure?

A

ACE-i/ARB
Beta blocker
Aldosterone antagonist (if reduced EF and not controlled on the two above)
Loop diuretics - given if symptoms of fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the causes of secondary hypertension?

A

Renal disease, obesity, pregnancy, endocrine disorder such as Conn’s, drugs such as alcohol, steroids, oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If a patient has a clinical BP of >140/90 but less than 180/120 what should you do?

A

24 hour ambulatory BP OR home readings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What investigations are performed to assess for end organ damage in hypertension?

A

Urine ACR and urine dipstick - assess for kidney damage

Bloods - HbA1c, renal function and lipids

Fundus examination for hypertensive retinopathy

ECG - for cardiac abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

If under 55 and Caucasian/T2DM what is the first step in managing HTN?

A

ACE-inhibitor e.g. ramipril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

If over 55 or black what is the first step in managing HTN?

A

Calcium channel blocker e.g. amlodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When is an ARB used over ACE inhibitor in HTN?

A

Black people and those who do not tolerate ACE-i due to dry cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the side effect commonly associated with CCB and what is an alternative?

A

Ankle oedema
Thiazide diuretic e.g. indapamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the second step in managing HTN?

A

ACE inhibitor plus CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the 3rd step in managing HTN?

A

ACE inhibitor plus CCB plus thiazide like diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the 4th step in managing HTN?

A

ACE inhibitor plus CCB plus thiazide like diuretic plus another based on K

if serum potassium <4.5mmol consider spironolactone
If serum potassium >4.5mmol consider alpha blocker such as doxazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are you aiming for when treating HTN (dependent on age)?

A

BP <140/90 in under 80s
BP <150/90 in over 80s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What should be done in a patient with clinic BP of >180/120

A

Same day referral to assess for retinal haemorrhage or papilloedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

In malignant hypertension with signs of end organ damage what should be done?

A

Start antihypertensive medication ASAP without waiting for results of home BP monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the ECG signs associated with AF?

A

Absent P waves, chaotic baseline, narrow complex tachy, irregularly irregular ventricular rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why are patients at AF at increased risk of stroke?

A

The unco-ordinated atrial activity means that blood can stagnate in the atria forming a blood clot –> block cerebral artery –> ischaemic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What symptoms can be assoicated with AF?

A

Palpitations, SOB, dizziness, syncope, reduced exercise intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What investigations are done in someone with paroxysmal AF?

A

24 hour ambulatory ECG or cardiac event recorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the principles behind managing AF with rate control?

A

Slowing the heart down to between 60 and 80bpm extends the time spent in diastole allowing the ventricles to fill with blood

45
Q

What are the options for rate control in AF?

A

Beta blockers = 1st line
CCB such as Diltiazem/verapamil = 2nd line
Digoxin = 3rd line

46
Q

When is rhythm control preferred to rate control in AF?

A

They have a reversible cause for their AF, new onset AF (within 48 hours), heart failure caused by AF or continuing symptoms despite effective rate control

47
Q

What are the options for rhythm control in AF?

A

Cardioversion - immediate if <48 hours of AF, delayed if not for 3 weeks to anticoagulate
Electrical cardioversion - done with synchronised DC cardioversion
Pharmacologically - flecanide or amiodarone

48
Q

What is the treatment for paroxysmal AF?

A

Pill in pocket approach with flecanide

49
Q

When is ablation used in AF?

A

When drug treatment for rate or rhythm control is not adequate or tolerated

50
Q

Where is the location of clots most commonly in AF?

A

Left atrial appendage

51
Q

What is the 1st line anticoagulation used in AF?

A

DOAC
Warfarin is only used if DOACs are contraindicated

52
Q

When should anticoagulation be considered in those with AF?

A

If score is 1 - consider anticoagulation in men
If score is 2 or more - offer anticoagulation

53
Q

What is the management for acute AF?

A

If haemodynamically compromised DC cardioversion (regardless of length of symptoms)

If symptoms <48 hours can try cardioversion

If symptoms >48 hours or unclear rate control and consider cardioversion in 3 weeks (after anticoagulation)

54
Q

Why does SVT occur?

A

Due to abnormal electrical signals from above the ventricles - electrical signal re-enters the atria from the ventricles where it then travels through AV node causing another ventricular contraction

55
Q

What does an ECG look like in SVT?

A

No p waves
Tachycardia
QRS <120ms (3 small squares)

56
Q

What is Wolff-Parkinson-White syndrome?

A

There is an additional pathway that allows electrical activity to pass between the atria and ventricles bypassing the AV node

57
Q

What are the ECG features of WPW syndrome?

A

Short PR interval
Wide QRS complex
Delta wave - slurred upstroke in the QRS complex

58
Q

What is the definitive management of WPW?

A

Radiofrequency ablation of accessory pathway

59
Q

What is the stepwise approach to managing SVT?

A
  1. Vagal manoeuvres - valsalva manoeuvre, carotid sinus massage
  2. Adenosine - 6mg –> 12mg –> 18mg
  3. Verapamil or beta blocker
  4. Synchronised DC cardioversion
60
Q

If a patient is in SVT and is unstable what is the 1st line management?

A

Synchronised DC cardioversion (under sedation)

61
Q

If a patient with WPW is unstable what is the management?

A

Procainamide or electrical cardioversion

62
Q

What causes atrial flutter

A

Re-entrant rhythm in either atrium, electrical signal goes round and round in self-perpetuating loop

63
Q

What is the average atrial rate in atrial flutter?

A

300bpm (not every atrial beat goes into ventricles due to long refractory period in AV node)

64
Q

What does the ECG of someone in atrial flutter look like?

A

Repeated P waves - sawtooth appearance on ECG

65
Q

What is the treatment for atrial flutter?

A

Rate and/or rhythm control
Requires anticoagulation based on CHADSVASC

66
Q

What are the shockable cardiac arrest rhythms?

A

VF and VT

67
Q

What are the non-shockable cardiac arrest rhythms?

A

Pulseless electrical activity and asytole

68
Q

What is the management of someone in VT?

A

If unstable immediate electrical cardioversion is needed

If stable amiodarone IV is 1st line, lidocaine and procainamide are alternatives

69
Q

Which bradycardias carry a risk of asystole?

A

Mobitz type II, complete heart block, ventricular pauses >3 seconds

70
Q

What is the acute management of unstable bradycardic patients?

A

IV atropine
Inotropes
Temporary cardiac pacing

71
Q

What is first degree heart block and what are the signs on ECG?

A

Delayed conduction through the AV node

PR interval greater than 0.2 seconds (5 small squares)

72
Q

What is Mobitz type I/Wenkebach phenomenon and what are the ECG findings?

A

Conduction through the AV node takes progressively longer until it finally fails after which the process restarts

Increasing PR interval until a P wave is not followed by QRS complex

73
Q

What is Mobitz type II and what are the ECG findings?

A

Intermittent failure of conduction through the AV node

PR interval remains normal
P waves with an absence of QRS complexes at certain intervals e.g. 2:1

74
Q

What is third degree heart block?

A

There is no relationship between P waves and QRS complexes

Bradycardia

75
Q

What are the ECG features of LBBB?

A

QRS >120ms
Broad negative QRS complex in V1 (W)
Broad positive QRS complex in V6 (M)

76
Q

What are the ECG findings in RBBB?

A

QRS >120ms
Broad positive biphasic QRS complex in V1
Deep S waves in I, aVL and V5-V6

77
Q

What classifies as prolonged QT?

A

QTc >440ms in men or >460ms in women

78
Q

What can prolonged QT progress to if it develops?

A

Torsades de pointes

79
Q

How do you manage torsades de pointes?

A

IV magnesium sulphate (even if they have normal magnesium)

80
Q

What is cardiac tamponade and what are the symptoms?

A

Fluid accumulates in the pericardial sac which is large enough to squeeze the heart and affect its ability to function

Hypotension, raised JVP, difficult to auscultate heart sounds

81
Q

What is the treatment for cardiac tamponade?

A

Pericardiocentesis

82
Q

What are the most common causes of pericarditis?

A

Viral infection and idiopathic

83
Q

What symptoms are associated with pericarditis?

A

Sharp central pleuritic chest pain that is worse on lying down better on sitting forward

Low grade fever

84
Q

What ECG changes are found in pericarditis?

A

Saddle shaped ST elevation (widespread), PR depression

85
Q

What is the treatment fir pericarditis?

A

NSAIDs and colchicine

86
Q

What is the most common valvular pathology?

A

Aortic stenosis

87
Q

What murmur is heard in aortic stenosis?

A

Ejection-systolic crescendo-decresendo murmur

88
Q

What other signs are associated with aortic stenosis?

A

Thrill in aortic area, slow rising pulse, narrow pulse pressure, exertional syncope

89
Q

What murmur is associated with aortic regurgitation?

A

Early diastolic soft murmur

90
Q

What other signs are associated with aortic regurgitation?

A

Collapsing pulse, wide pulse pressure, heart failure/pulmonary oedema

91
Q

What murmur is heard in mitral stenosis?

A

Mid-diastolic low pitched rumbling murmur

92
Q

What other signs are associated with mitral stenosis?

A

Tapping apex beat, malar flush, AF

93
Q

What murmur is associated with mitral regurgitation?

A

Pan systolic high pitched whistling murmur

94
Q

What other signs are associated with mitral regurgitation?

A

Murmur radiates to left axilla, 3rd heart sound, signs of heart failure and pulmonary oedema

95
Q

What murmur is associated with tricuspid regurgitation?

A

Pan systolic murmur loudest in tricuspid region

96
Q

What murmur is heard in pulmonary stenosis?

A

Ejection systolic murmur loudest in the pulmonary area with deep inspiration

97
Q

What is hypertrophic obstructive cardiomyopathy associated with?

A

Sudden onset cardiac death during exertion

98
Q

What is the management for HOCM?

A

Beta blockers, surgical myectomy, septal ablation, implantable cardioverted defibrillator

99
Q

What is the next step in management of acute heart failure that is not responding to IV diuretics?

A

CPAP

100
Q

When is warfarin used in preference to a DOAC?

A

If a mechnical heart valve is present - aim for INR 3-4

101
Q

By what mechanism can cocaine cause an MI?

A

Coronary artery spasm

102
Q

What is the recommended maintenance fluid for someone with cardiac disease?

A

20-25ml/kg/day

103
Q

When is a shock given in ALS?

A

In VF/pulseless VT - single shock followed by 2 minutes of CPR (repeat process)

104
Q

In ALS if IV access is unsuccessful what route should be used for administering drugs?

A

Intraosseous route (into bone)

105
Q

When is adrenaline given in ALS?

A

Given as soon as possible for non-shockable rhythms, if shockable rhythm give after third shock, repeat every 3-5 minutes

106
Q

When is amiodarone given in ALS?

A

Amiodarone 300mg given to patients with VF/VT after 3 shocks have been administered, further dose of 150mg after 5 shocks (lidocaine is an alternative)

107
Q

When are thrombolytic drugs given in ALS?

A

If pulmonary embolus is suspected, if given CPR should be continued for 60-90 minutes

108
Q

A patient presents with fatigue and persistent ST elevation on ECG 6 weeks after an MI - what is the diagnosis?

A

Left ventricular aneurysm

109
Q

What is likely to be elevated in a repeat MI?

A

Creatine kinase

Finals (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions